Medical device with single input for driving multiple cables

Abstract

A medical instrument includes a shaft, a wrist, a mechanical structure, a first cable, and a second cable. The wrist is coupled to a distal end portion of the shaft. The mechanical structure is coupled to a proximal end portion of the shaft and includes a capstan assembly. The capstan assembly includes a first cable drum having a first radius and a second cable drum having a second, different radius. The first cable is routed along the shaft. A distal end portion of the first cable is coupled to the wrist, and a proximal end portion of the first cable is wound on the first cable drum. The second cable is routed along the shaft. A distal end portion of the second cable is coupled to the wrist, and a proximal end portion of the second cable is wound on the second cable drum.

Description

[0001] Related applications

[0002] This patent application claims priority and filing date benefit to U.S. Provisional Patent Application No. 63 / 019,529, filed May 4, 2020, entitled “Medical Instrument Having a Single Input for Driving Multiple Cables,” the entire contents of which are incorporated herein by reference. Technical Field

[0003] The aspects described herein relate to medical devices, and more specifically to medical devices used during minimally invasive surgery. More specifically, the embodiments described herein relate to devices including mechanisms (e.g., drive wheels) for driving multiple cables using a single rotational input. Background Technology

[0004] Known techniques for minimally invasive surgery (MIS) employ instruments that can be manually or remotely controlled via computer assistance to manipulate or otherwise reference the movement of tissue within the patient's body. Many known MIS instruments include therapeutic or diagnostic end effectors (e.g., forceps, cutting tools, cauterization tools, suture devices, needle drivers, or biopsy tools) mounted on an optional wrist mechanism at the distal end of an axis. During an MIS procedure, the end effector, wrist mechanism, and distal end of the axis are inserted into a small incision or natural orifice in the patient to position the end effector at the working site within the patient's body.

[0005] In known MIS devices, end effector movement within the patient body is typically accomplished in two ways. First, the device as a whole can move in one or more mechanical degrees of freedom (DOF) (e.g., along the x, y, and z Cartesian axes) to translate the end effector at the working site. Second, an optional wrist mechanism includes one or more mechanical degrees of freedom to allow the end effector to rotate relative to the body of the device (e.g., about the x, y, and z Cartesian axes, sometimes arbitrarily referred to as the pitch axis, yaw axis, and insertion axis). For example, known wrist mechanisms are typically capable of altering the pitch and yaw of the end effector relative to the device axes. The wrist may optionally provide a rolling DOF for the end effector, or the rolling DOF may optionally be achieved by rolling the device axis. The end effector may optionally have additional mechanical DOFs, such as gripping motion of a jaw element or blade motion. In some cases, the wrist mechanical DOF and the end effector mechanical DOF may be used in combination. For example, U.S. Patent No. 5,792,135 (filed May 16, 1997) discloses a mechanism that combines a wrist yaw DOF and an end effector grip DOF.

[0006] To achieve the desired movement of the wrist mechanism and end effector, known devices typically include a tension element (e.g., a cable) extending from the distal wrist mechanism and end effector along the device's axis to a proximal mechanical structure configured to move the tension element to operate the wrist mechanism and end effector. For computer-aided teleoperated systems, the mechanical structure is typically motor-driven and operatively coupled to a processing system to provide a user interface for clinical users (e.g., surgeons) to control the device. Known mechanical structures in teleoperated medical devices include one or more drive wheels, each coupled to a cable such that when the drive wheel is rotated by a motor, the cable moves to operate the wrist mechanism or end effector. Typically, each drive wheel is attached to two cables (or the ends of a single cable loop) so that as the drive wheel rotates, one side of the drive wheel releases the cable while the other side pulls in an equal length of cable. In this architecture, three degrees of freedom utilize a total of six cables extending from the wrist mechanism along the length of the device's axis to the mechanical structure of the device. For example, the wrist mechanism can be operatively coupled to three drive wheels for rotation about the pitch axis, yaw axis, or grip axis. However, efficient implementation of the wrist mechanism and mechanical structure presents a complex design problem, as careful cabling is required to maintain the stability of the wrist mechanism throughout its range of motion and minimize the interaction (or coupling effect) between one wrist rotation axis and another.

[0007] For some known devices, it is desirable for the wrist mechanism to be able to angularly displace more than 90 degrees about an axis (e.g., an arbitrarily designated pitch axis). The concept of the wrist mechanism bending backward more than 90 degrees is called "recurve" motion. To accomplish this recurve motion, some known wrist mechanisms include multiple links that are pivotally connected in series to rotate relative to each other about one or more axes between the links. For example, a wrist mechanism with two or more pairs of links (where each pair rotates about an axis (e.g., two or more parallel pitch axes)) can produce recurve motion when each pair of links rotates more than 45 degrees about its associated axis.

[0008] However, multiple links increase the complexity of operating the wrist mechanism mechanically. Specifically, such a wrist mechanism with additional moving elements requires additional cables in the wrist mechanism, shaft, and mechanical structure that move these cables. Additional cables are included to overcome the limitations of available space due to the mechanical structure and overall instrument size constraints required by the design architecture of MIS applications or existing computer-assisted remote surgical systems (e.g., limited available drive input devices). For example, the mechanical structure may only allow a limited number of drive wheels (or drive input devices for moving associated drive wheels) to move the cables. Therefore, within a particular mechanical structure and within the specific design constraints of the instruments used in computer-assisted remote surgical systems, it may not be possible to add additional cables to facilitate the desired performance of the wrist mechanism.

[0009] Therefore, there is a need for improved minimally invasive surgical instruments that incorporate improved mechanical structures to include additional cables for manipulating the wrist mechanism, reducing instrument costs and manufacturing costs by reducing the number of required parts. There is also a need for improved minimally invasive surgical instruments that can provide improved control over the movement of the wrist mechanism, particularly its recurve motion. Summary of the Invention

[0010] This summary describes certain aspects of the embodiments described herein to provide a basic understanding. This summary is not a broad overview of the subject matter of the invention and is not intended to identify key or essential elements or to define the scope of the subject matter. In some embodiments, a medical device includes an instrument shaft having distal and proximal portions, a wrist, a mechanical structure, a first cable, and a second cable. The wrist is coupled to the distal portion of the instrument shaft. The mechanical structure is coupled to the proximal portion of the instrument shaft and includes a drive wheel assembly. The drive wheel assembly includes a first cable reel having a first radius and a second cable reel having a second radius different from the first radius. The first cable includes a proximal and distal portions and is routed along the instrument shaft. The distal portion of the first cable is coupled to the wrist, and the proximal portion of the first cable is wound around the first cable reel. The second cable includes a proximal and distal portions and is routed along the instrument shaft. The distal portion of the second cable is coupled to the wrist, and the proximal portion of the second cable is wound around the second cable reel.

[0011] In some embodiments, the drive wheel assembly includes an input disk and defines a rotation axis. The input disk is configured to be driven by an actuator to rotate the drive wheel assembly about the rotation axis. The rotation of the drive wheel assembly about the rotation axis moves a first cable at a first speed proportional to a first radius and a second cable at a second speed proportional to a second radius. In some embodiments, the rotation of the drive wheel assembly about the rotation axis moves the first and second cables in the same direction to actuate the wrist. In other embodiments, the rotation of the drive wheel assembly about the rotation axis moves the first cable in a first direction and moves the second cable in a second direction opposite to the first direction.

[0012] In some embodiments, the medical device includes a third cable and a fourth cable. The third cable includes a proximal portion and a distal portion and is routed along the device axis. The distal portion of the third cable is coupled to the wrist, and the proximal portion of the third cable is wound on a first cable reel. The fourth cable includes a proximal portion and a distal portion and is routed along the device axis. The distal portion of the fourth cable is coupled to the wrist, and the proximal portion of the fourth cable is wound on a second cable reel. In some embodiments, the drive wheel assembly includes an input disc and defines a rotation axis. The input disc is configured to be driven by an actuator to rotate the drive wheel assembly about the rotation axis. Rotation of the drive wheel assembly about the rotation axis moves the first and second cables in a first direction to actuate the wrist. Rotation of the drive wheel assembly about the rotation axis moves the third and fourth cables in opposite second directions to actuate the wrist. In some embodiments, the drive wheel assembly includes a drive wheel shaft, and the input disc is coupled to rotate the drive wheel shaft. The first cable reel includes a first winding member and a second winding member. A first winding member is connected to the drive shaft via a first clamp, and the proximal portion of the first cable is wound around the first winding member in a first direction. A second winding member is connected to the drive shaft via a second clamp, and the proximal portion of the third cable is wound around the second winding member in a second direction.

[0013] In some embodiments, the wrist includes a first link and a second link, defining a first axis and a second axis. The first link is rotatable about the first axis relative to the instrument axis, and a distal portion of a first cable is coupled to the first link. The second link is rotatable about the second axis relative to the instrument axis, and a distal portion of a second cable passes through the first link and is coupled to the second link. In some embodiments, the first link is coupled to the second link via one or more intermediate links, and the first axis is parallel to the second axis.

[0014] In some embodiments, the medical device includes an instrument shaft having distal and proximal portions, a wrist, a mechanical structure, a first cable, and a second cable. The wrist is coupled to the distal portion of the instrument shaft. The mechanical structure is coupled to the proximal portion of the instrument shaft and includes a drive wheel assembly. The drive wheel assembly includes a first drive member and a second drive member. The first cable includes a proximal and distal portion and is routed along the instrument shaft. The distal portion of the first cable is coupled to the wrist, and the proximal portion of the first cable is operatively coupled to the first drive member, such that rotation of the drive wheel shaft moves the proximal portion of the first cable at a first speed. The second cable includes a proximal and distal portion and is routed along the instrument shaft. The distal portion of the second cable is coupled to the wrist, and the proximal portion of the second cable is operatively coupled to the second drive member, such that rotation of the drive wheel shaft moves the proximal portion of the second cable at a second speed different from the first speed. In some embodiments, the drive wheel shaft, the first drive member, and the second drive member are concentric. In other embodiments, one or both of the first and second drive members may not be concentric with the drive wheel shaft.

[0015] In some embodiments, the first drive member is a first cable reel coupled to the drive shaft, and the proximal portion of the first cable is wound around the first cable reel. In some embodiments, the second drive member is a second cable reel coupled to the drive shaft, and the proximal portion of the second cable is wound around the second cable reel. In some embodiments, the second drive member is a drive gear coupled to the drive shaft. The mechanical structure also includes a transmission member having a driven gear portion engaging with the drive gear. The proximal portion of the second cable is coupled to the transmission member. In some embodiments, the drive shaft defines a first axis of rotation, and the first cable reel and drive gear member are concentric with the first axis of rotation. The transmission member defines a second axis of rotation that is not concentric with the first axis of rotation. In some embodiments, the driven gear portion of the transmission member is a sector gear.

[0016] In some embodiments, the medical device includes a third cable and a fourth cable. The third cable includes a proximal portion and a distal portion and is routed along the device axis. The distal portion of the third cable is coupled to the wrist, and the proximal portion of the third cable is operatively coupled to a first drive member. The fourth cable includes a proximal portion and a distal portion and is routed along the device axis. The distal portion of the fourth cable is coupled to the wrist, and the proximal portion of the fourth cable is operatively coupled to a second drive member. In some embodiments, rotation of the drive wheel assembly about a rotation axis moves the first and second cables in a first direction to actuate the wrist. Rotation of the drive wheel assembly about a rotation axis causes the third and fourth cables to move in opposite second directions to actuate the wrist.

[0017] In some embodiments, the medical device includes an instrument shaft having a distal portion and a proximal portion, a wrist, a first cable, and a second cable. The wrist is coupled to the distal portion of the instrument shaft. The first cable includes a proximal portion and a distal portion and is routed along the instrument shaft. The distal portion of the first cable is coupled to the wrist. The second cable includes a proximal portion and a distal portion and is routed along the instrument shaft. The distal portion of the second cable is coupled to the wrist. The medical device also includes means for moving the proximal portions of the first and second cables to actuate the wrist based on a single input device, such that the proximal portion of the first cable moves at a first speed and the proximal portion of the second cable moves at a second speed different from the first speed.

[0018] In some embodiments, the means for movement includes a drive shaft, a first cable reel, and a second cable reel. The first and second cable reels are each coupled to the drive shaft. The proximal portion of the first cable is wound on the first cable reel, and the proximal portion of the second cable is wound on the second cable reel. In some embodiments, the first cable reel defines a first radius, and the second cable reel defines a second radius different from the first radius.

[0019] In some embodiments, the means for movement includes a drive shaft, a cable reel, a drive gear, and a transmission member. The cable reel is coupled to the drive shaft, and a proximal portion of a first cable is wound around the first cable reel. The drive gear is coupled to the drive shaft and engages with the transmission member. A proximal portion of a second cable is coupled to the transmission member.

[0020] In some embodiments, the medical device includes a distal first movable member, a distal second movable member, a first tension member, a second tension member, a proximal rotatable drive wheel, a first drive member coupled to the drive wheel, and a second drive member coupled to the drive wheel. The first drive member includes a first winding region, and the second drive member includes a second winding region. The first tension member extends from the first movable member to at least partially wind around the first drive member at the first winding region. The second tension member extends from the second movable member to at least partially wind around the second drive member at the second winding region. The first drive member has a first radius of rotation at the point where the first tension member winds and unwinds at the first winding region. The second drive member has a second radius of rotation at the point where the second tension member winds and unwinds at the second winding region. The second radius of rotation is different from the first radius of rotation.

[0021] In some embodiments, the medical device includes a third tension member, a fourth tension member, a third drive member coupled to a drive wheel, and a fourth drive member coupled to the drive wheel. The third drive member includes a third winding region, and the fourth drive member includes a fourth winding region. The third tension member extends from a first movable member to be at least partially wound around the third drive member at the third winding region. The fourth tension member extends from a second movable member to be at least partially wound around the fourth drive member at the fourth winding region. The third drive member has a first radius of rotation at the point where the third tension member is wound and unwound at the third winding region, and the fourth drive member has a second radius of rotation at the point where the fourth tension member is wound and unwound at the fourth winding region.

[0022] In some embodiments, the tension member is a cable. In some embodiments, the medical device includes a distal wrist and a distal end effector coupled to the wrist. A first movable member and a second movable member form at least a portion of the wrist (e.g., the first and second movable members are links of the wrist). The medical device defines a first longitudinal orientation, and the end effector defines a second longitudinal orientation. Rotation of the drive wheel moves the end effector from a first state where the second longitudinal orientation is aligned with the first longitudinal orientation to a second state where the second longitudinal orientation is bent backward relative to the first longitudinal orientation.

[0023] In some embodiments, the medical device includes a proximal means for moving a first tension member a first distance and a second tension member a second distance during rotation of a single drive wheel. The medical device includes a distal first movable means coupled to the first tension member. The medical device includes a distal second movable means coupled to the second tension member.

[0024] In some embodiments, a method of operating a medical device includes moving a distal first movable component and a distal second movable component by rotating a proximal single drive wheel to move a first tension member connected to the first movable component a first distance and to move a second tension member connected to the second movable component a second distance different from the first distance.

[0025] In some embodiments, a medical device includes an instrument shaft having distal and proximal portions, a wrist, a mechanical structure, a first tension member, a second tension member, a third tension member, and a fourth tension member. The wrist is coupled to the distal portion of the instrument shaft. The mechanical structure is coupled to the proximal portion of the instrument shaft and includes a drive wheel assembly. The drive wheel assembly includes a first drive member, a second drive member, a third drive member, and a fourth drive member. The first tension member includes a proximal and distal portions and is routed along the instrument shaft. The distal portion of the first tension member is coupled to the wrist, and the proximal portion of the first tension member is operatively coupled to the first drive member. The second tension member includes a proximal and distal portions and is routed along the instrument shaft. The distal portion of the second tension member is coupled to the wrist, and the proximal portion of the second tension member is operatively coupled to the second drive member. The third tension member includes a proximal and distal portions and is routed along the instrument shaft. The distal portion of the third tension member is coupled to the wrist, and the proximal portion of the third tension member is operatively coupled to the third drive member. The fourth tension member includes a proximal portion and a distal portion and is routed along the instrument axis. The distal portion of the fourth tension member is coupled to the wrist, and the proximal portion of the fourth tension member is operatively coupled to the fourth drive member.

[0026] Other medical devices, related components, medical device systems, and / or methods according to the embodiments will be apparent or will become apparent to those skilled in the art after reading the following drawings and detailed description. All such additional medical devices, related components, medical device systems, and / or methods included in this specification are intended to fall within the scope of this disclosure. Attached Figure Description

[0027] Figure 1 This is a floor plan of a minimally invasive remote-operated medical system for performing medical procedures such as surgery, according to an embodiment.

[0028] Figure 2 yes Figure 1 A perspective view of the optional auxiliary units of the minimally invasive remote surgical system shown.

[0029] Figure 3 yes Figure 1 A perspective view of the user console of the minimally invasive remote surgical system shown.

[0030] Figure 4 yes Figure 1 The front view of the manipulator unit of the minimally invasive remote surgical system shown includes multiple instruments.

[0031] Figure 5-6 This is a schematic diagram of a medical device according to an embodiment, showing a rear view. Figure 5 ) and front view ( Figure 6 ).

[0032] Figure 7 yes Figure 5 and Figure 6 Side view of the drive wheel assembly of the medical device shown.

[0033] Figure 8 This is a front view schematic diagram of a medical device according to an embodiment.

[0034] Figure 9 This is a side view of the drive wheel assembly of a medical device according to an embodiment.

[0035] Figure 10 This is a side view of the drive wheel assembly of a medical device including a cable reel and a drive gear according to an embodiment.

[0036] Figure 11 This is a front view of the drive wheel assembly of a medical device including a cable reel and a drive gear according to an embodiment.

[0037] Figure 12 This is a perspective view of a medical device according to an embodiment.

[0038] Figure 13 and Figure 14 From a distance perspective ( Figure 13 ) and proximal view ( Figure 14 What I saw Figure 12 An enlarged perspective view of the mechanical structure shown in region Z1.

[0039] Figure 15 yes Figure 13 and Figure 14 A near-perspective view of the mechanical structure shown, in which the first mounting bracket has been removed to show the internal components more clearly.

[0040] Figure 16 yes Figure 13 and Figure 14 A near-perspective view of the mechanical structure shown, in which the second mounting bracket has been removed to show the internal components more clearly.

[0041] Figure 17 yes Figure 13 and Figure 14 A near-side perspective view of the mechanical structure shown, with additional components removed to more clearly show the drive wheel assembly according to the embodiment.

[0042] Figure 18 and Figure 19 yes Figure 17 A perspective view of the drive wheel assembly shown.

[0043] Figure 20 yes Figure 13 and Figure 14The cross-sectional view of the mechanical structure shown is to illustrate Figure 17 The shown is the drive wheel assembly.

[0044] Figure 21 yes Figure 17 The diagram shows an exploded view of the drive wheel assembly.

[0045] Figure 22 yes Figure 17 A perspective view of the input disc and the first cable reel of the drive wheel assembly shown.

[0046] Figure 23 yes Figure 17 A perspective view of the fourth cable reel of the drive pulley assembly shown.

[0047] Figure 24 yes Figure 17 A perspective view of the second cable reel of the drive pulley assembly shown.

[0048] Figure 25 yes Figure 12 An enlarged perspective view of the wrist assembly and end effector shown in region Z2.

[0049] Figure 26 and Figure 27 yes Figure 25 The wrist component shown is in the first configuration ( Figure 26 ) and second configuration ( Figure 27 (Side view of )

[0050] Figure 28 yes Figure 25-27 The distal perspective view of the wrist assembly shown, with some links removed to clearly show the cable routing.

[0051] Figures 29-30 yes Figure 25-27 A perspective view of the first link of the wrist assembly shown.

[0052] Figures 31-32 yes Figure 25-27 A perspective view of the second link of the wrist assembly shown.

[0053] Figures 33-34 yes Figure 25-27 A perspective view of the fifth link of the wrist assembly shown. Detailed Implementation

[0054] The embodiments described herein can be advantageously used in a variety of grasping, cutting, and manipulation operations associated with minimally invasive surgery.

[0055] The medical device of this application is capable of movement in three or more degrees of freedom (e.g., about pitch, yaw, and grip axes) and can accommodate any suitable number of cables to accommodate the desired movement. Specifically, the medical device described herein includes a wrist mechanism capable of producing recurve motion and actuated by eight or more cables. The mechanical structure described herein for moving cables to operate the wrist mechanism includes a mechanism capable of moving multiple cables at different amounts or speeds via a single input device. For example, the embodiments described herein may include one or more drive wheel assemblies including a first drive member driving a first cable pair at a first speed and a second drive member driving a second cable pair at a second speed. By moving two cable pairs (i.e., four cables) with a single drive wheel assembly (rotated by a single rotational input), the space required within the mechanical structure is reduced (as is the number of drive input devices or drive wheels required to achieve the movement) and the architecture for connecting the device to current MIRS systems can be maintained. The embodiments described herein also limit the number of required parts, thereby reducing the overall cost and enabling further miniaturization of the medical device to facilitate MIS procedures. Furthermore, the medical device described herein provides improved control over cable movement used to operate wrist mechanisms.

[0056] As used herein, the term “about” when used in conjunction with a referenced numerical indication means the referenced numerical indication plus or minus up to 10% of that referenced numerical indication. For example, the language “about 50” covers a range of 45 to 55. Similarly, the language “about 5” covers a range of 4.5 to 5.5.

[0057] The term "flexible" in relation to parts (such as mechanical structures, components, or component assemblies) should be interpreted broadly. Essentially, the term refers to a part that can be repeatedly bent and return to its original shape without damage. Some flexible parts can also be elastic. For example, a part (e.g., a flexure) is said to be elastic if it has the ability to absorb energy during its elastic deformation and then release the stored energy upon unloading (i.e., returning to its original state). Many "rigid" objects have a slight inherent elastic "bending" due to material properties, but these objects are not considered "flexible" (as the term is used herein).

[0058] As used in this specification and the appended claims, the term "distal" refers to the direction toward the working part, while the term "proximal" refers to the direction away from the working part. Thus, for example, the end of the tool closest to the target tissue would be the distal end of the tool, while the end opposite the distal end (i.e., the end manipulated by the user or connected to the actuation shaft) would be the proximal end of the tool.

[0059] Furthermore, the specific terms chosen to describe one or more embodiments and optional elements or features are not intended to limit the invention. For example, spatially relative terms—such as “below,” “under,” “lower,” “above,” “upper,” “proximal,” “farthest,” and similar expressions—are used to describe the relationship between one element or feature and another element or feature illustrated in the figures. In addition to the positions and orientations shown in the figures, these spatially relative terms are intended to encompass different positions (i.e., spatial positions) and orientations (i.e., rotational placement in space) of the device in use or operation. For example, if the device in the figures were inverted, an element described as “below” or “under” other elements or features would become “above” or “on” other elements or features. Thus, the term “below” can encompass both above and below positions and orientations. The device may be oriented in other ways (e.g., rotated 90 degrees or in other orientations), and the spatially relative descriptors used herein may be interpreted accordingly. Similarly, descriptions of movement along different axes (translation) and around different axes (rotation) include the positions and orientations of various spatial devices. The combination of body position and orientation defines body posture.

[0060] Similarly, unless the context otherwise indicates otherwise, geometric terms (e.g., "parallel," "perpendicular," "circular," or "square") are not intended to require absolute mathematical precision. Instead, such geometric terms allow for variations or equivalent functions due to manufacturing processes. For example, if an element is described as "circular" or "generally circular," this description still covers parts that are not precisely circular (e.g., slightly elongated elliptical or a polygonal shape).

[0061] Additionally, unless the context otherwise indicates otherwise, the singular forms “a,” “an,” and “the / said” are also intended to include the plural forms. The terms “comprising,” “including,” “having,” and similar expressions specify the presence of the stated features, steps, operations, elements, components, etc., but do not exclude the presence or addition of one or more other features, steps, operations, elements, components, or groups.

[0062] Unless otherwise stated, the terms device, medical equipment, apparatus and variations thereof are used interchangeably.

[0063] The primary basis for this technology is the use of DA, a commercially available product from Intuitive Surgical, Inc., based in Sunnyvale, California. The embodiments of the surgical system describe various aspects of the present invention. An example of such a surgical system is da Vinci. Surgical system (IS4000 model), da Vinci Surgical system (IS4200 model) and da Vinci Surgical system (IS3000 model). However, a learned person will understand that the inventive aspects disclosed herein can be embodied and implemented in various ways, including computer-aided, non-computer-aided, and mixed combinations of manual and computer-aided embodiments and implementations. Regarding da The embodiments of the surgical systems (e.g., IS4000, IS3000, IS2000, IS1200) are presented as examples only and should not be considered as limiting the scope of the inventive aspects disclosed herein. Where applicable, inventive aspects can be embodied and implemented both in relatively small handheld manual operating devices and in relatively large systems with additional mechanical support.

[0064] Figure 1 This is a floor plan of a computer-aided remote operating system. The diagram shows a medical device, a minimally invasive robotic surgery (MIRS) system 1000 (also referred to herein as a minimally invasive remote surgical system), for performing minimally invasive diagnostic or surgical procedures on a patient P lying on an operating table 1010. The system may have any number of components, such as a user control unit 1100 for use by a surgeon or other skilled clinician S during the procedure. The MIRS system 1000 may further include a manipulator unit 1200 (generally referred to as a surgical robot) and an optional assistive device unit 1150. The manipulator unit 1200 may include an arm assembly 1300 and a tool assembly removably attached to the arm assembly. While the surgeon S views the surgical site and controls the movement of at least one removably attached instrument 1400 (also referred to herein as a "tool") via the control unit 1100, the manipulator unit 1200 can manipulate the instrument 1400 through a minimally invasive incision or natural orifice in the patient P's body. Images of the surgical site are obtained by an endoscope (not shown), such as a stereoscopic endoscope, which can be oriented by manipulating the endoscope using the manipulator unit 1200. The auxiliary equipment unit 1150 can be used to process the images of the surgical site for subsequent display to the surgeon S via the user control unit 1100. The number of instruments 1400 used at one time will typically depend on factors such as the diagnostic or surgical procedure and space constraints within the operating room. If it is necessary to change one or more of the instruments 1400 in use during the procedure, an assistant removes the instrument 1400 from the manipulator unit 1200 and replaces it with another instrument 1400 from the tray 1020 in the operating room. Although shown as being used with instrument 1400, any instrument described herein can be used with the MIRS 1000.

[0065] Figure 2This is a perspective view of the control unit 1100. The user control unit 1100 includes a left-eye display 1112 and a right-eye display 1114 for presenting the surgeon S with a coordinated stereoscopic view of the surgical site capable of depth perception. The user control unit 1100 further includes one or more input control devices 1116, which in turn enable the manipulator unit 1200 ( Figure 1 (As shown) the user control unit 1116 manipulates one or more tools. The input control device 1116 provides at least the same degrees of freedom as the instruments 1400 associated with it, to provide the surgeon S with a sense of remote presentation or integration (or direct connection) of the input control device 1116 with the instruments 1400. In this way, the user control unit 1100 provides the surgeon S with a strong sense of direct control over the instruments 1400. For this purpose, position, force, and tactile feedback sensors (not shown) can be used to transmit position, force, and tactile sensations from the instruments 1400 back to the surgeon's hand via the input control device 1116.

[0066] User control unit 1100 Figure 1 In some embodiments, the user control unit 1100 and the surgeon S are shown in the same room as the patient, allowing the surgeon S to directly monitor the procedure, be physically present if necessary, and speak directly with an assistant, rather than via telephone or other communication medium. However, in other embodiments, the user control unit 1100 and the surgeon S may be in different rooms, in completely different buildings, or at other remote locations for patients who are permitted to undergo remote surgical procedures.

[0067] Figure 3 This is a perspective view of the auxiliary equipment unit 1150. The auxiliary equipment unit 1150 may be coupled to an endoscope (not shown) and may include one or more processors to process captured images for subsequent display, such as via a user control unit 1100, or on another suitable display located locally and / or remotely. For example, in the case of using a stereoscopic endoscope, the auxiliary equipment unit 1150 may process the captured images to present a coordinated stereoscopic image of the surgical site to the surgeon S via a left-eye display 1112 and a right-eye display 1114. This coordination may include alignment between relative images and may include adjusting the stereoscopic working distance of the stereoscopic endoscope. As another example, image processing may include compensating for imaging errors, such as optical aberrations, of the image capture device using previously determined camera calibration parameters.

[0068] Figure 4A front perspective view of the manipulator unit 1200 is shown. The manipulator unit 1200 includes components (e.g., arms, linkage mechanisms, motors, sensors, and similar components) to provide manipulation of an instrument 1400 and an imaging device (not shown), such as a stereoscopic endoscope, for capturing images of the procedure site. Specifically, the instrument 1400 and the imaging device can be manipulated via a remote manipulation mechanism having a plurality of joints. Furthermore, the instrument 1400 and the imaging device are positioned and manipulated through an incision or natural orifice in the patient P such that the software and / or kinematic remote motion center is held at that incision or orifice. In this way, the incision size can be minimized.

[0069] Figure 5-7 This is a schematic diagram of a medical device 2400 according to an embodiment. The device 2400 includes a shaft 2410, a wrist 2500, an end effector 2460, a mechanical structure 2700, and a set of cables 2401. The shaft 2410 includes a proximal portion 2411 and a distal portion 2412, and can be any suitable elongated structure connecting the wrist 2500 to the mechanical structure 2700. In some embodiments, the shaft 2410 (and any shaft described herein) may define a lumen through which the cables 2401 and other components (e.g., wires) operating the wrist 2500 and end effector 2460 are routed. The end effector 2460 is connected to the distal portion 2412 of the shaft 2410 via the wrist 2500. The end effector 2460 (and any end effector described herein) can be any suitable mechanism for grasping, cutting, and manipulating tissue or other objects during MIS procedures. For example, in some embodiments, end effector 2460 (and any end effector described herein) may include tweezers, cutting tools, cauterization tools, staplers, or suture actuators. End effector 2460 may include one or more components (e.g., tool members) actuated by one or more of the cables 2401.

[0070] The wrist 2500 includes one or more links ( Figure 5-7(Not shown in the diagram), the one or more links serve as movable components connecting the end effector 2460 to the distal portion 2412 of the shaft 2410. The links of the wrist 2500 rotate relative to each other (and the shaft 2410) about one or more axes of rotation to produce desired degrees of freedom. For example, in some embodiments, the links of the wrist 2500 can rotate about a first axis of rotation serving as a pitch axis (the term pitch is arbitrary), as indicated by arrow AA. In some embodiments, the links of the wrist 2500 can rotate about a second axis of rotation (e.g., orthogonal to the first axis of rotation) serving as a yaw axis (the term yaw is arbitrary). In some embodiments, the wrist 2500 may include a set of links connected together by pin joints defining axes of rotation. In other embodiments, the links are connected together via mating disc surfaces of the type shown and described herein (see, for example, wrist 7500 described below). In still other embodiments, the links are connected together via mating spherical surfaces such that a pair of mating links can rotate about multiple different axes of rotation. In some embodiments, wrist 2500 (and any wrist described herein) may include one or more links connected together in a manner capable of producing a recurved motion about one or more axes of rotation.

[0071] Mechanical structure 2700 serves as a transmission device or drive assembly to move wrist 2500 and end effector 2460 to perform desired operations. Mechanical structure 2700 also interfaces with other parts of the surgical system (e.g., the aforementioned manipulator unit 1200 or arm assembly 1300). In some embodiments, mechanical structure 2700 (and any mechanical structures described herein) may include one or more drive motors to generate force or torque for moving components of medical device 2400. In other embodiments, mechanical structure 2700 (and any mechanical structures described herein) does not contain any motors. For example, as... Figure 7 As shown, mechanical structure 2700 (and any mechanical structure described herein) may be coupled to or driven by actuator 2330 (e.g., actuator of manipulator unit, not shown) which provides rotational input to mechanical structure 2700.

[0072] like Figure 5As shown, mechanical structure 2700 is coupled to the proximal portion 2411 of shaft 2410 and includes a set of drive pulley assemblies for moving cable 2401. Specifically, although mechanical structure 2700 is shown as including four drive pulley assemblies (i.e., first drive pulley assembly 2710, second drive pulley assembly 2720, third drive pulley assembly 2730, and fourth drive pulley assembly 2740), in other embodiments, mechanical structure 2700 (and any mechanical structure described herein) may include any suitable number of drive pulley assemblies. Furthermore, mechanical structure 2700 (and any mechanical structure described herein) may include any other suitable components (e.g., pulleys, gear-driven mechanisms, or transmission mechanisms) to generate the desired movement and routing of cable 2401 within mechanical structure 2700 and shaft 2410.

[0073] The first drive pulley assembly 2710 (also referred to as the drive pulley assembly) includes an input disc 2760, a first cable reel 2711, and a second cable reel 2712. The drive pulley assembly 2710 also defines a drive pulley axis A. c The drive wheel assembly 2710 is positioned around the drive wheel axis A. c Rotation. (e.g.) Figure 7 As shown, when the mechanical structure 2700 is connected within the surgical system, the input disk 2760 engages the actuator 2330. In use, the actuator 2330 can drive the input disk 2760 (i.e., generate a rotational input to the input disk 2760) to cause the drive wheel assembly 2710 to rotate around the drive wheel axis A. c Rotation, such as Figure 7 As indicated by the middle arrow BB, a first cable reel 2711 (which serves as a first drive member) is connected to the first cable 2420 in the set of cables 2401 and has a first radius R1. The first radius R1 is perpendicular to the drive wheel axis A. c This is, and therefore, the radius of rotation of the first cable reel 2711. The second cable reel 2712 (which serves as a second drive member) is connected to the second cable 2430 in the set of cables 2401 and has a second radius R2 different from the first radius R1. The second radius R2 is perpendicular to the drive wheel axis A. c This is, and therefore, the radius of rotation of the second cable reel 2712. Although the second radius R2 is shown as being greater than the first radius R1, in other embodiments, the second radius R2 may be smaller than the first radius R1.

[0074] The cable set 2401 may include any suitable number of cables routed within or connected to the wrist 2500 and end effector 2460 to generate desired motion upon cable movement. Specifically, the cable set 2401 includes at least a first cable 2420 and a second cable 2430. The first cable 2420 (which serves as a tension member) includes a proximal portion 2421 and a distal portion 2422. The first cable 2420 is routed along axis 2410, with the distal portion 2422 connected to the wrist 2500 and the proximal portion 2421 wound on a first cable reel 2711. The second cable 2430 (which serves as a tension member) includes a proximal portion 2431 and a distal portion 2432. The second cable 2430 is routed along the shaft 2410, with the distal portion 2432 connected to the wrist 2500 and the proximal portion 2431 wound around the second cable reel 2712. Although the first cable 2420 and the second cable 2430 are shown extending within the inner cavity of the shaft 2410, in other embodiments, either of the cables 2401 may be routed outside the shaft 2410. Furthermore, the first cable 2420 and the second cable 2430 may be connected to the wrist 2500 and their respective cable reels by any suitable mechanism (e.g., by securing the cables in a mating groove (or clamp), by winding the cables around a cable reel (or wrist) in a manner that prevents slippage, or by adhesive).

[0075] With the first cable 2420 and the second cable 2430 respectively connected to the drive wheel assembly 2710 and the wrist 2500, rotational movement of the first drive wheel 2710 can cause movement of the first cable 2420 and the second cable 2430, thereby operating the wrist 2500. Specifically, when the actuator 2330 engages the input disk 2760, the rotational input from the actuator 2330 causes the drive wheel assembly 2710 (including the first cable reel 2711 and the second cable reel 2712) to rotate around the drive wheel axis A. c Rotation, such as Figure 7 As indicated by the middle arrow BB, the rotation of the first cable reel 2711 causes the proximal portion 2421 of the first cable 2420 to move in the direction CC, as shown by the middle arrow BB. Figure 7 As shown. Similarly, the rotation of the second cable reel 2712 causes the proximal portion 2431 of the second cable 2430 to move in the direction DD, as... Figure 7As shown. Because the dimensions of the first radius R1 are different from the second radius R2, the rotation of the drive wheel assembly 2710 causes the proximal portion 2421 of the first cable 2420 to move a first distance and the proximal portion 2431 of the second cable 2430 to move a different second distance through a specific angular displacement. Similarly, the rotation of the drive wheel assembly 2710 at a specific angular velocity causes the proximal portion 2421 of the first cable 2420 to move at a first linear velocity and the proximal portion 2431 of the second cable 2430 to move at a different second linear velocity. The difference between the first distance and the second distance (and the difference between the first linear velocity and the second linear velocity) is related to the difference between the first radius R1 and the second radius R2. For example, if the ratio between the second radius R2 and the first radius R1 is 2:1, then the distance moved by the second cable 2430 and the linear velocity of the second cable 2430 will be twice that of the first cable 2420.

[0076] This arrangement advantageously allows a single drive wheel to produce varying amounts of cable movement or cable speed. Different characteristics of cable movement can improve the operation of the wrist 2500 and / or end effector 2460. For example, in some embodiments, the wrist 2500 may include a set of links defining multiple bending axes. When operating such a wrist, the first cable (e.g., a cable actuating the nearest link) will have a shorter cable path than the second cable (e.g., a cable actuating the farthest link). In this case, the movement (or speed) of the first cable should be less than that of the second cable. The drive wheel assembly 2710 (and other drive wheel assemblies described herein) can utilize a single input to produce the desired varying amounts of movement (or cable speed), thereby preserving space in the mechanism 2700 and allowing the mechanism 2700 to be driven by existing interfaces.

[0077] like Figure 7 As shown, the proximal portion 2421 of the first cable 2420 is wound around a first side (or along a first winding direction) of the first cable reel 2711, and the proximal portion 2431 of the second cable 2430 is wound around a first side (or along a first winding direction) of the second cable reel 2712. In this way, the drive pulley assembly 2710 is wound around the drive pulley axis A. c The rotation causes the first cable 2420 and the second cable 2430 to move in the same direction (e.g., simultaneously pulling in or simultaneously releasing the ends of each cable). However, in other embodiments, the proximal portion 2421 of the first cable 2420 can be wound around a first side (or along a first winding direction) of the first cable reel 2711, and the proximal portion 2431 of the second cable 2430 can be wound around the opposite second side (or along an opposite second winding direction) of the second cable reel 2712. In this way, the drive pulley assembly 2710 moves about the drive pulley axis A. cThe rotation causes the first cable 2420 to move in a first direction and the second cable 2430 to move in the opposite second direction. This results in the first cable 2420 being pulled in while the second cable 2430 is being released, and vice versa.

[0078] Although the medical device 2400 is shown and described as including a first cable 2420 wound on a first cable reel 2711 and a second cable 2430 wound on a second cable reel 2712, in other embodiments, the medical device 2400 may include additional cables wound on (and moved by) the first cable reel 2711 and the second cable reel 2712. For example, in some embodiments, the medical device 2400 (or any medical device described herein) may include a third cable (not shown) wound on the first cable reel and a fourth cable (not shown) wound on the second cable reel. In this arrangement, rotation may cause the first cable to be released at a first distance (or at a first speed) and the third cable to be pulled in at a first distance (or at a first speed). Rotation may also cause the second cable to be released at a second distance (or at a second speed) and the fourth cable to be pulled in at a second distance (or at a second speed). In this way, the drive wheel assembly 2700 can move four cables with a single rotational input.

[0079] Although both the first cable reel 2711 and the second cable reel 2712 are shown as cylindrical and have a first radius R1 and a second radius R2, respectively, in other embodiments, any cable reel or drive member described herein may have a non-circular cross-sectional shape. For example, in some embodiments, any cable reel or drive member described herein may have an elliptical shape, similar to a camshaft cam angle, to change the distance or speed of the cable being pulled in or released from the cable reel. In this way, even when the drive pulley assembly rotates at a constant angular velocity, the linear velocity of the cable can vary depending on the angular position of the drive pulley assembly. For example, Figure 8This is a front view schematic diagram of a medical device 3400 according to an embodiment. Like the device 2400 described above, device 3400 includes a shaft 3410, a wrist 3500, an end effector 3460, a mechanical structure 3700, and at least a first cable 3420 and a second cable 3430. The shaft 3410 includes a proximal portion 3411 and a distal portion 3412, and can be any suitable elongated structure connecting the wrist 3500 to the mechanical structure 3700. The end effector 3460 is connected to the distal portion 3412 of the shaft 3410 via the wrist 3500. The end effector 3460 (and any end effector described herein) can be any suitable mechanism for grasping, cutting, and manipulating tissue or other objects during MIS procedures. For example, in some embodiments, the end effector 3460 (and any end effector described herein) can include forceps, cutting tools, cauterization tools, staplers, or suture actuators. The end effector 3460 may include one or more components (e.g., tool members) actuated by one or more cables. The wrist 3500 may be structurally and functionally similar to the wrist 2400 and therefore will not be described in detail here. Specifically, as described above, the link of the wrist 3500 may rotate about a first rotational axis serving as the pitch axis (the term pitch is arbitrary), as indicated by arrow EE. In some embodiments, the link of the wrist 3500 may rotate about a second rotational axis serving as the yaw axis (the term yaw is arbitrary) (e.g., orthogonal to the first rotational axis).

[0080] Mechanical structure 3700 serves as a transmission device or drive assembly to move wrist 3500 and end effector 3460 to perform desired operations. Mechanical structure 3700 is also coupled to other parts of the surgical system (e.g., the aforementioned manipulator unit 1200 or arm assembly 1300). For example, like mechanical structure 2700, mechanical structure 3700 may be coupled to or driven by an actuator (e.g., an actuator of the manipulator unit, not shown) that provides rotational input to mechanical structure 3700. Mechanical structure 3700 is coupled to the proximal portion 3411 of shaft 3410 and includes one or more drive wheel assemblies for the cable within moving instrument 3410. Specifically, mechanical structure 3700 includes a first drive wheel assembly 3710 having an input disc (not shown), a first cable reel 3711, and a second cable reel 3712. The drive wheel assembly 3710 further defines a drive wheel axis about which the drive wheel assembly 3710 rotates. In use, an actuator (not shown) can generate a rotational input to rotate the drive wheel assembly 3710 about the drive wheel axis. A first cable reel 3711 (serving as a first drive member) is coupled to a first cable 3420, and a second cable reel 3712 (serving as a second drive member) is coupled to the first cable 3430.

[0081] As shown, the first cable reel 3711 has a non-circular cross-sectional shape characterized by a first dimension S1. The cross-sectional shape of the first cable reel 3711 can be an elliptical shape with a desired profile (e.g., a cam profile). The first dimension S1 can be the radius of the base circle of the elliptical shape. In other embodiments, the first dimension S1 can be the radius of curvature of a portion of the elliptical shape of the first cable reel 3711. Similar to the second cable reel 2711, the second cable reel 3712 has a circular cross-sectional shape characterized by a second dimension S2, which can be the radius of the second cable reel 3712. As shown, the second dimension S2 is larger than the first dimension S1. In other embodiments, the second dimension S2 can be smaller than the first dimension S1.

[0082] As shown in the figure, a first cable 3420 (which serves as a tension member) includes a proximal portion 3421 and a distal portion 3422. The first cable 3420 is routed along an axis 3410, with the distal portion 3422 connected to the wrist 3500 and the proximal portion 3421 connected to a first cable reel 3711. A second cable 3430 (which serves as a tension member) includes a proximal portion 3431 and a distal portion 3432. The second cable 3430 is routed along an axis 3410, with the distal portion 3432 connected to the wrist 3500 and the proximal portion 3431 connected to a second cable reel 3712. The first cable 3420 and the second cable 3430 can be connected to the wrist 3500 and their respective cable reels by any suitable mechanism (e.g., by securing the cable coil within a mating groove (or clamp), by winding the cable around a cable reel (or wrist) in a manner that prevents slippage, or by adhesive).

[0083] With the first cable 3420 and the second cable 3430 respectively connected to the drive wheel assembly 3710 and the wrist 3500, rotational movement of the first drive wheel 3710 can cause movement of the first cable 3420 and the second cable 3430, thereby operating the wrist 3500. Rotation of the first cable reel 3711 causes linear movement of the proximal portion 3421 of the first cable 3420. Similarly, rotation of the second cable reel 3712 causes linear movement of the proximal portion 3431 of the second cable 3430. Because the first dimension S1 is different from the second dimension S2, rotation of the drive wheel assembly 3710 causes the proximal portion 3421 of the first cable 3420 to move a first distance and causes the proximal portion 3431 of the second cable 3430 to move a different second distance through a specific angular displacement. Similarly, the rotation of the drive wheel assembly 3710 at a specific angular velocity causes the proximal portion 3421 of the first cable 3420 to move at a first linear velocity and the proximal portion 3431 of the second cable 3430 to move at a different second linear velocity. Furthermore, because the first cable reel 3711 has a non-circular shape, the linear velocity of the first cable 3420 released from or pulled into the first cable reel 3711 varies depending on the angular position of the drive wheel assembly 3710. Therefore, the non-circular shape of the first cable reel 3710 can provide additional levels of control over the movement of the wrist 3500.

[0084] Although the drive pulley assembly 3710 is shown and described as including a non-cylindrical first cable reel 3711 and a cylindrical second cable reel 3712, in other embodiments, the drive pulley assembly may include two (or more) non-cylindrical cable reels. In still other embodiments, the second cable reel 3712 may be non-cylindrical and the first cable reel 3711 may be cylindrical.

[0085] Although the first cable reel 2711 and the second cable reel 2712 are shown relative to the drive pulley axis A c Concentric, but in other embodiments, the drive wheel assembly may include a drive wheel axis A. c One or more cable reels or drive members that are not concentric. In other words, in some embodiments, the drive pulley assembly may include one or more cable reels or drive members having a centerline that is not concentric with the axis of rotation of the drive pulley assembly. For example, Figure 9 This is a schematic side view of a portion of a medical device according to an embodiment. Specifically, Figure 9 A drive pulley assembly 4710 is shown, connected to a first cable 4420 and a second cable 4430. The drive pulley assembly 4710 can be included in any mechanical structure or medical device described herein.

[0086] As shown in the figure, the drive pulley assembly 4710 includes an input disc 4760, a first cable reel 4711, and a second cable reel 4712. The drive pulley assembly 4710 also defines a drive pulley axis A. c The drive wheel assembly 4710 rotates about the drive wheel axis. Therefore, when the mechanical structure is coupled within the surgical system (not shown), the input disk 4760 engages the actuator (not shown). The actuator can generate a rotational input to the input disk 4760 to cause the drive wheel assembly 4710 to rotate about the drive wheel axis A. c Rotation, such as Figure 9 As indicated by arrow FF, a first cable reel 4711 (which serves as a first drive member) is coupled to a first cable 4420 and has a first radius (or dimension). The first cable reel 4711 defines a path relative to the drive pulley axis A. c The first concentric center line CL1. Therefore, when the drive wheel assembly 4710 is around the drive wheel axis A c During rotation, the first cable reel 4711 rotates about its centerline CL1. The second cable reel 4712 (which serves as a second drive member) is coupled to the second cable 4430 and has a second radius (or size) different from the first radius (or size). Although the second radius is shown as being larger than the first radius, in other embodiments, the second radius may be smaller than the first radius. The second cable reel 4712 defines a path relative to the drive pulley axis A. c The second center line CL2 is not concentric. Therefore, when the drive wheel assembly 4710 is about the drive wheel axis A... c During rotation, the second cable drum 4712 does not rotate around its centerline CL2. This arrangement can produce an eccentric motion of the second cable drum 4712.

[0087] With the first cable 4420 and the second cable 4430 respectively connected to the drive wheel assembly 4710 and the wrist (not shown, but similar to the wrist 2500), rotational movement of the drive wheel assembly 4710 can cause movement of the first cable 4420 and the second cable 4430, thereby operating the wrist. Specifically, the drive wheel assembly 4710 is positioned about the drive wheel axis A. c The rotation causes the first cable reel 4711 to rotate about the first center line CL1 and the second cable reel 4712 to rotate about an axis offset from the second center line CL2. The rotation of the first cable reel 4711 causes the proximal portion 4421 of the first cable 4420 to move in the direction GG, such as... Figure 9 As shown. Similarly, the rotation of the second cable reel 4712 causes the proximal portion 4431 of the second cable 4430 to move in the direction HH, as... Figure 9As shown. Because the dimensions (e.g., radius) of the first cable reel 4711 are different from the dimensions of the second cable reel 4712, the rotation of the drive pulley assembly 4710 causes the proximal portion 4421 of the first cable 4420 to move a first distance and causes the proximal portion 4431 of the second cable 4430 to move a different second distance by a specific angular displacement. Similarly, the rotation of the drive pulley assembly 4710 at a specific angular velocity causes the proximal portion 4421 of the first cable 4420 to move at a first linear velocity and the proximal portion 4431 of the second cable 4430 to move at a different second linear velocity. Additionally, because the second centerline CL2 is offset from the axis of rotation (i.e., the drive pulley axis A)... c Therefore, the linear movement of the second cable is greater than the movement if the second center line CL2 is concentric with the axis of rotation.

[0088] Although drive pulley assemblies 2710, 3710, and 4710 are shown and described as comprising two cable reels coupled to and driving two (or more) cables, in other embodiments, the drive pulley assembly may include any suitable drive member or mechanism for driving the two (or more) cables. For example, in some embodiments, the drive pulley assembly may include one or more cable reels (of the type described herein), one or more gears (indirectly coupled to the cables), or any combination of cable reels and gears. Other drive members may include sprockets, belt drive systems, or other mechanisms by which the drive pulley assembly can drive a group of cables. For example, Figure 10 This is a schematic side view of a portion of a mechanical structure 5700 according to an embodiment. The mechanical structure 5700 includes a drive wheel assembly 5710 and a transmission member 5742 that drive a first cable 5420 and a second cable 5430. The mechanical structure 5700 and any of its components (e.g., the drive wheel assembly 5710 and the transmission member 5742) can be included in any mechanical structure or medical device described herein.

[0089] As shown in the figure, the drive wheel assembly 5710 includes an input disk 5760, a first drive member 5711, and a second drive member 5712. The drive wheel assembly 5710 also defines a first axis A1 about which it rotates. Therefore, when the mechanical structure is coupled within a surgical system (not shown), the input disk 5760 engages an actuator (not shown). The actuator can generate a rotational input to the input disk 5760 to rotate the drive wheel assembly 5710 about the first axis A1, as... Figure 10 As indicated by arrow II in the diagram. The first drive member 5711 is a cable reel having a first size (e.g., radius) and is coupled to the proximal portion 5721 of the first cable 5420. The second drive member 5712 is a drive gear having a second radius (e.g., size) and is indirectly coupled to the proximal portion 5731 of the second cable 5430, as described below.

[0090] The conveying member 5742 includes a driven gear 5743 and a drum portion 5744. The conveying member 5742 also defines a second axis A2 about which it rotates. The drum portion 5744 of the conveying member 5742 has a second dimension (e.g., radius) and is coupled to the proximal portion 5731 of the second cable 5430. The driven gear 5743 engages with the drive gear 5712 of the drive wheel assembly 5710. Therefore, rotational movement of the drive wheel assembly 5710 causes movement of the first cable 5420 and the second cable 5430, thereby operating the wrist (not shown). Specifically, rotation of the drive wheel assembly 5710 about the first axis A1 causes the cable drum 5711 to rotate about the first axis A1, thereby moving the proximal portion 5421 of the first cable 5420 in direction JJ, such as... Figure 10 As shown. Rotation of the drive wheel assembly 5710 about the first axis A1 also causes the drive gear 5712 to rotate. The drive gear 5712 engages with the driven gear 5743, and thus the transmission member 5742 rotates about the second axis A2, as indicated by arrow KK. The rotation of the transmission member 5742 causes the drum portion 5744 to rotate about the second axis A2, thereby moving the proximal portion 5431 of the second cable 5430 in the direction LL.

[0091] Because the dimensions of the drive gear 5712 and the driven gear 5743 are different, the rotational speed of the transmission member 5742 will be different from the rotational speed of the drive wheel assembly 5710. Similarly, the gear ratio between the drive gear 5712 and the driven gear 5743 will result in a difference in the rotational speeds of the transmission member 5742 and the drive wheel assembly 5710. For example, if the gear ratio is 2:1 (i.e., the drive gear 5712 is twice the size of the driven gear 5743), the rotational speed of the transmission member 5742 will be twice that of the drive wheel assembly 5710. However, if the gear ratio is 1:1 (i.e., if the gears have the same dimensions), the rotational speed of the transmission member 5742 will be the same as that of the drive wheel assembly 5710. Furthermore, the speed (and distance) by which the first cable 5420 moves is a function of the dimensions (e.g., radius) of the first drive member 5711, and the speed (and distance) by which the second cable 5430 moves is a function of the dimensions of the drum portion 5744 of the transmission member 5742. Therefore, the speed and distance of the first cable 5420 are different from the speed and distance of the second cable 5430.

[0092] Although the proximal portion 5421 of the first cable 5420 is shown withdrawing from the first drive member 5711 in a first direction, and the proximal portion 5431 of the second cable 5430 is shown withdrawing from the reel portion 5744 in the opposite second direction, in other embodiments, the first cable 5420 and the second cable 5430 may withdraw in any suitable direction. For example, in other embodiments, the first cable 5420 and the second cable 5430 may withdraw in the same direction. In still other embodiments, the first cable 5420 and the second cable 5430 may withdraw in directions orthogonal to each other (i.e., 90 degrees apart).

[0093] Although the transmission member 5742 is shown as cylindrical or includes a cylindrical driven gear 5743, in other embodiments, any mechanical structure described herein may include any suitable transmission member such that the drive wheel assembly (or mechanical structure) can move multiple cables by different distances or move multiple cables at different speeds by a single rotational input. For example, in some embodiments, the transmission member may be a lever that pushes or pulls the cables and does not include a cable reel on which the cables are wound. In some embodiments, the transmission member may include a sector gear (i.e., a gear with teeth only along a portion of its circumference). For example, Figure 11 This is a schematic side view of a portion of a mechanical structure 6700 according to an embodiment. The mechanical structure 6700 includes a drive wheel assembly 6710 and a transmission member 6742 that drive a first cable 6420 and a second cable 6430 via a single input. The mechanical structure 6700 and any of its components (e.g., the drive wheel assembly 6710 and the transmission member 6742) can be included in any mechanical structure or medical device described herein.

[0094] The drive wheel assembly 6710 includes an input disc (not shown, but may be similar to the input disc 5760 described above), a first drive member 6711, and a second drive member 6712. The drive wheel assembly 6710 also defines a first axis A1 about which it rotates. Therefore, when the mechanical structure is coupled within a surgical system (not shown), the input disc engages an actuator (not shown). The actuator can generate a rotational input to the input disc 6760 to rotate the drive wheel assembly 6710 about the first axis A1. The first drive member 6711 is a cable reel having a first dimension (e.g., radius) coupled to the proximal portion 6721 of the first cable 6420. The second drive member 6712 is a drive gear having a second radius (or dimension), indirectly coupled to the proximal portion 6731 of the second cable 6430, as described below.

[0095] The transmission member 6742 is a lever, comprising a sector gear 6743 and a connecting portion 6744. The transmission member 6742 rotates about a second axis A2, which can be defined as a pin connection within a mechanical structure. The connecting portion 6744 of the transmission member 6742 is connected to the proximal portion 6731 of the second cable 6430. The sector gear 6743 engages with the drive gear 6712 of the drive wheel assembly 6710. Therefore, rotational movement of the drive wheel assembly 6710 causes movement of the first cable 6420 and the second cable 6430, thereby operating the wrist (not shown). Specifically, rotation of the drive wheel assembly 6710 about the first axis A1 causes the cable reel 6711 to rotate about the first axis A1, thereby moving the proximal portion 6421 of the first cable 6420 in the direction MM, such as... Figure 11 As shown. Rotation of the drive wheel assembly 6710 about the first axis A1 also causes the drive gear 6712 to rotate. The drive gear 6712 engages with the sector gear 6743, and thus the transmission member 6742 rotates about the second axis A2. The rotation of the transmission member 6742 causes the connecting portion 6744 to rotate about the second axis A2, thereby moving the proximal portion 6431 of the second cable 6430 in the direction NN.

[0096] Because the dimensions of the drive gear 6712 and the sector gear 6743 are different, the rotational speed of the transmission member 6742 will differ from the rotational speed of the drive wheel assembly 6710. Similarly, the gear ratio between the drive gear 6712 and the driven gear 6743 will result in a difference in the rotational speeds of the transmission member 6742 and the drive wheel assembly 6710. For example, if the gear ratio is 1:3 (i.e., the size of the drive gear 6712 is one-third the size of the sector gear 6743), the rotational speed of the drive wheel assembly 6710 will be three times that of the transmission member 6742. Furthermore, the speed (and distance) of the first cable 6420 is a function of the dimensions (e.g., radius) of the first drive member 6711, and the speed (and distance) of the second cable 6430 is a function of its dimensions (i.e., the distance between the lever arm and the connecting portion 6744 and the second axis A2). Therefore, the speed and distance of the first cable 6420 are different from those of the second cable 6430.

[0097] Figure 12-34These are various views of the instrument 7400 according to an embodiment. In some embodiments, the instrument 7400 or any component thereof may optionally be part of a surgical system for performing surgical procedures, and may include a manipulator unit, a series of kinematic linkages, a series of cannulas, or the like. The instrument 7400 (and any instruments described herein) can be used with any suitable surgical system, such as the MIRS system 1000 shown and described above. The instrument 7400 includes a mechanical structure 7700, a shaft 7410, a wrist assembly 7500, an end effector 7460, and a cable assembly. This cable assembly includes eight cables connecting the mechanical structure 7700 to the wrist assembly 7500. For clarity, only four of the eight cables are identified and described herein (see, for example,...). Figure 17 It shows the first cable 7420, the second cable 7430, the third cable 7440, and the fourth cable 7450. This set of cables also includes two cables connecting the mechanical structure 7700 to the end effector 7460 (see, for example...). Figure 26 and Figure 28 These are shown as fifth cable 7455 and sixth cable 7456. The device 7400 is configured such that movement of the first cable 7420, second cable 7430, third cable 7440, and fourth cable 7450 produces a linkage within the wrist assembly 7500 about a first pitch rotation axis A. P1 Second pitch rotation axis A P2 Rotation (i.e., pitch rotation) (see) Figure 25 (The term pitch is arbitrary), the link within the wrist assembly 7500 rotates about the first yaw axis A. Y1 Second yaw rotation axis A Y2 The rotation (i.e., yaw rotation) (see) Figure 26 and Figure 27 (The term yaw is arbitrary) or any combination of these movements. Movement of the fifth cable 7455 and the sixth cable 7456 produces actuation of the end effector 7460 (e.g., gripping, cutting rotation, or suture arm movement). Although the end effector 7460 is shown as a needle driver used as a suture mechanism, in other embodiments, the instrument 7400 may include any suitable end effector, such as a cutting tool, cauterization instrument, gripper, or the like.

[0098] The first cable 7420 includes a proximal portion 7421 and a distal portion 7422, the second cable 7430 includes a proximal portion 7431 and a distal portion 7432, the third cable 7440 includes a proximal portion 7441 and a distal portion 7442, and the fourth cable 7450 includes a proximal portion 7451 and a distal portion 7452. The proximal portions of the cables are connected to a mechanical structure 7700 (see, for example...). Figure 14-17The cable is connected to the wrist assembly 7500 (see example). Figure 25-28 The fifth cable 7455 and the sixth cable 7456 each also have a proximal portion (unidentified) connected within the mechanical structure and a distal portion (unidentified) connected to the end effector 7460. The cables can be formed of any suitable material. For example, in some embodiments, any cable described herein can be formed of tungsten strand wire. In other embodiments, any cable described herein can be formed of ultra-high molecular weight polyethylene (UHMWPE) fibers.

[0099] The shaft 7410 can be any suitable elongated shaft that couples the wrist assembly 7500 to the mechanical structure 7700. Specifically, the shaft 7410 includes a proximal end 7411 coupled to the mechanical structure 7700 and a distal end 7412 coupled to the wrist assembly 7500 (e.g., the first link 7510 of the wrist assembly 7500). The shaft 7410 defines a lumen (not shown) or multiple channels through which cables and other components (e.g., wires, ground wires, or the like) can be routed from the mechanical structure 7700 to the wrist assembly 7500.

[0100] The mechanical structure 7700 includes a chassis 7770 (which serves as a base), a first mounting bracket 7775, a second mounting bracket 7776, and a set of drive wheels rotatably mounted to the chassis. The chassis 7770, the first mounting bracket 7775, and the second mounting bracket 7776 provide structural support for mounting and aligning components (e.g., drive wheels) within the mechanical structure 7700. For example, the chassis 7770 defines an axle opening in which the proximal end 7411 of a shaft 7410 is mounted. Figure 20As shown, chassis 7770 further defines one or more openings 7771, within which the drive wheel is mounted and rotatably supported via bearing 7706. Second mounting bracket 7776 also includes one or more openings 7772 within which the drive wheel is mounted (and also rotatably supported via bearing 7706). The openings 7771 of chassis 7770 are axially aligned with the openings 7772 of second mounting bracket 7776. In addition to providing mounting support for internal components of mechanical structure 7700, chassis 7770 may also include external features (e.g., grooves, clips, etc.) that engage with a mating port of a drive device (not shown). The drive device may be, for example, a handheld system or a computer-aided remote operating system capable of receiving and manipulating instrument 7400 to perform various surgical procedures. The drive device may include one or more motors to drive the drive wheel of mechanical structure 7700. In other embodiments, the drive device may be a component capable of receiving and manipulating instrument 7400 to perform various surgical procedures. In some embodiments, the mechanical structure 7700 includes a cover (not shown) attached to the chassis 7770. The cover may partially or completely enclose components disposed within the mechanical structure 7700.

[0101] The mechanical structure 7700 includes a first drive wheel assembly 7710, a second drive wheel assembly 7720, a third drive wheel assembly 7730, and a rolling drive assembly 7740. As described herein, the first drive wheel assembly 7710 and the second drive wheel assembly 7720 are each configured to move four cables connected to the wrist assembly to operate the wrist assembly 2500 (e.g., to rotate various links of the wrist assembly about a pitch axis, a yaw axis, or a combination of pitch and yaw axes). Therefore, the wrist assembly 7500 may be referred to as an eight-cable wrist. Specifically, the first drive wheel assembly 7710 is configured to move the first cable 7420, the second cable 7430, the third cable 7440, and the fourth cable 7450, as described in detail herein. Since the structure and function of the second drive wheel assembly 7720 are similar to those of the first drive wheel assembly 7710, they will not be described separately. The third drive wheel assembly 7730 is configured to move the fifth cable 7455 and the sixth cable 7456 to operate the end effector 7460. The rolling drive assembly 7740 is configured to rotate the shaft 7410 about its centerline (which serves as the rolling axis; the term rolling is arbitrary).

[0102] The first drive wheel assembly 7710 includes a shaft 7715 defining the drive wheel axis A1, an input disc 7760, a first cable reel 7711, a second cable reel 7712, a third cable reel 7713, and a fourth cable reel 7714. For example... Figure 17As shown, when the drive pulley assembly 7710 rotates about the drive pulley axis A1, as indicated by arrow PP, the first cable reel 7711 acts as a first drive member to move the proximal portion 7421 of the first cable 7420. Figure 22 As shown, the input disk 7760 defines a first drive claw receiver 7761 and a second drive claw receiver 7762. The input disk 7760 also includes a set of protrusions 7763. When the instrument 7400 is coupled within the surgical system, an actuator (not shown) can engage the input disk 7760 to provide rotational input to the first drive wheel assembly 7710. Specifically, the actuator's drive claws can be fitted into the drive claw receivers 7761, 7762 to transmit torque from the actuator, thereby rotating the first drive wheel assembly 7710 about the rotation axis A1. The protrusions 7763 can be used to manually rotate the drive wheel assembly 7710.

[0103] like Figure 20 and Figure 21 As shown, the first cable reel 7711 is coupled to the input reel 7760 and fixedly coupled to the lower shaft member 7716 of the shaft 7715. In some embodiments, the first cable reel 7711 and the input reel 7760 may be integrally constructed. In other embodiments, the first cable reel 7711 and the input reel 7760 may be separately constructed and subsequently coupled to the lower shaft member 7716. (See reference...) Figure 18 and Figure 19 The first cable reel 7711 includes a first set of cable winding grooves 7751 terminated at the first connection opening 7755. The proximal portion 7421 of the first cable 7420 is wound around the first cable reel 7711 in the cable winding grooves 7751 and is connected to the first cable reel 7711 by a coil or connecting portion (not shown) fixed in the first connection opening 7755.

[0104] When the drive pulley assembly 7710 rotates about the drive pulley axis A1, the second cable reel 7712 acts as a second drive member to move the proximal portion 7431 of the second cable 7430. Figure 20 and Figure 21 As shown, the second cable reel 7712 is fixedly connected to the lower shaft member 7716 of the shaft 7715 by a second clamp 7702 (which is secured by two screws 7705). The second cable reel 7712 includes a shaft connection portion 7764 defining a retainer groove 7765. The shaft connection portion 7764 receives and is connected to the upper shaft member 7717. In this way, the second cable reel 7712 is connected to and secured together with both the lower shaft member 7716 and the upper shaft member 7717. In other embodiments, the shaft 7715 does not need to consist of two parts, but can be a single piece. The second cable reel 7712 is rotatably supported in a second mounting bracket 7776 by a bearing 7706, which is secured by a retainer 7707 (see [link to mounting bracket]). Figure 21 ). refer to Figure 18 and Figure 19 The second cable reel 7712 includes a second set of cable winding grooves 7752 terminated at a second connection opening (not shown, but may be similar to the first connection opening 7755). The proximal portion 7431 of the second cable 7430 is wound around the second cable reel 7712 within the cable winding grooves 7752 and is connected to the second cable reel 7712 by a coil or connection portion (not shown) fixed within the second connection opening.

[0105] like Figure 17 As shown, the proximal portion 7421 of the first cable 7420 is wound around a first side (or along a first winding direction) of the first cable reel 7711, and the proximal portion 7431 of the second cable 7430 is wound around the opposite second side (or along an opposite second winding direction) of the second cable reel 7712. In this way, rotation of the drive pulley assembly 7710 about the drive pulley axis A1 causes the first cable 7420 to move in a first direction and the second cable 7430 to move in the opposite second direction. This results in the first cable 7420 being pulled in while the second cable 7430 is being released, and vice versa. Furthermore, as Figure 20 As shown, the first cable reel 7711 and the second cable reel 7712 each have a first radius R1. Therefore, the rotation of the drive pulley assembly 7710 at a specific angular velocity causes the proximal portions 7421 of the first cable 7420 and 7430 of the second cable 7430 to move the same distance at the same linear velocity. This arrangement helps maintain the desired tension in the first cable 7420 and the second cable 7430, preventing slack derailment in the cables and preventing excessive tension in the cables from deforming or damaging other components. This is sometimes referred to as cable length conservation.

[0106] The second cable reel 7712 is connected to the shaft 7715 independently of the first cable reel 7711. This allows the angular position of the second cable reel 7712 on the shaft 7715 relative to the angular position of the first cable reel 7711 on the shaft 7715 during the assembly of the device 7400. Specifically, during assembly, the first cable 7420 can be routed from the wrist assembly 7500 and connected to the first cable reel 7711. The first cable reel 7711 and / or the lower shaft member 7716 can be rotated to adjust the tension in the first cable 7420 to a desired amount. With the first cable reel 7711 in a fixed position, the second cable 7430 can be routed from the wrist assembly 7500 and connected to the second cable reel 7712. The second cable reel 7712 can rotate relative to the first cable reel 7711 and the lower shaft member 7716 to adjust the tension in the second cable 7430 to a desired amount. The second cable reel 7712 can then be secured to the lower shaft member 7716 by the second clamp 7702 to maintain cable tension.

[0107] When the drive pulley assembly 7710 rotates about the drive pulley axis A1, the third cable reel 7713 acts as a third drive member to move the proximal portion 7441 of the third cable 7440. Figure 20 and Figure 21 As shown, the third cable reel 7713 is fixedly connected to the upper shaft member 7717 of the shaft 7715 via a third clamp 7703 (which is secured by two screws 7705). The third cable reel 7713 is connected to the shaft 7715 independently of the first cable reel 7711 and the second cable reel 7712. This allows the angular position of the third cable reel 7713 on the shaft 7715 to be adjusted relative to the angular positions of the first cable reel 7711 and the second cable reel 7712 in a similar manner to that described above during the assembly of the device 7400. (Reference) Figure 18 and Figure 19 The third cable reel 7713 includes a third set of cable winding grooves 7753 terminated at a third connection opening (not shown, but may be similar to the first connection opening 7755). The proximal portion 7441 of the third cable 7440 is wound around the third cable reel 7713 within the cable winding grooves 7753 and is connected to the third cable reel 7713 by a coil or connection portion (not shown) fixed within the second connection opening.

[0108] When the drive pulley assembly 7710 rotates about the drive pulley axis A1, the fourth cable reel 7714 acts as a fourth drive member to move the proximal portion 7451 of the fourth cable 7450. Figure 20 and Figure 21As shown, the fourth cable reel 7714 is fixedly connected to the upper shaft member 7717 of the shaft 7715 via a fourth clamp 7704 (which is secured by two screws 7705). The fourth cable reel 7714 is connected to the shaft 7715 independently of the first cable reel 7711, the second cable reel 7712, and the third cable reel 7713. This allows the angular position of the fourth cable reel 7714 on the shaft 7715 to be adjusted relative to the angular position of the third cable reel 7713 (and the other two first cables) in a similar manner to that described above during the assembly of the device 7400. Reference Figure 18 and Figure 19 The fourth cable reel 7714 includes a fourth set of cable winding grooves 7754 terminated at the fourth connection opening 7758. The proximal portion 7451 of the fourth cable 7450 is wound around the fourth cable reel 7714 within the cable winding grooves 7754 and is connected to the fourth cable reel 7714 by a coil or connection portion (not shown) fixed within the fourth connection opening 7758.

[0109] like Figure 15 and Figure 17 As shown, the proximal portion 7441 of the third cable 7440 is wound around the first side (or along the first winding direction) of the third cable reel 7713, and the proximal portion 7451 of the fourth cable 7450 is wound around the opposite second side (or along the opposite second winding direction) of the fourth cable reel 7714. In this way, rotation of the drive pulley assembly 7710 about the drive pulley axis A1 causes the third cable 7440 to move in the first direction and the fourth cable 7450 to move in the opposite second direction. This results in the third cable 7440 being pulled in while the fourth cable 7450 is being released, and vice versa. Furthermore, as Figure 20 As shown, the third cable reel 7713 and the fourth cable reel 7714 each have a second radius R2. Therefore, the rotation of the drive pulley assembly 7710 at a specific angular velocity causes the proximal portions 7441 of the third cable 7440 and 7451 of the fourth cable 7450 to move the same distance at the same linear velocity. This arrangement helps maintain the desired tension in the third cable 7440 and the fourth cable 7450 to prevent slack derailment and to prevent excessive tension in the cables from deforming or damaging other components.

[0110] Because the first radius R1 is smaller than the second radius R2, the rotation of the drive wheel assembly 7710 causes the first cable 7420 and the second cable 7730 to move a first distance through a specific angular displacement, and causes the third cable 7440 and the fourth cable 7450 to move a second distance greater than the first distance. Similarly, the rotation of the drive wheel assembly 7710 at a specific angular velocity causes the first cable 7420 and the second cable 7730 to move at a first linear velocity, and causes the third cable 7440 and the fourth cable 7450 to move at a second linear velocity greater than the first velocity. The difference between the first distance and the second distance (and the difference between the first linear velocity and the second linear velocity) is related to the difference between the first radius R1 and the second radius R2. For example, if the ratio between the second radius R2 and the first radius R1 is 2:1, then the distance moved by the third cable 7440 and the fourth cable 7450, as well as the linear velocity of the third cable 7440 and the fourth cable 7450, will be twice that of the first cable 7420 and the second cable 7430.

[0111] This arrangement advantageously allows the first drive wheel assembly 7710 to generate varying amounts of cable movement or cable speed with a single rotational input. The different characteristics of the cable movement improve the operation of the wrist 7500. Specifically, as described in more detail below, the first cable 7420 and the second cable 7430 terminate at the third link 7530 of the wrist assembly 7500 and control only the second link 7520 (about the first pitch axis A). P1 ) and the third link (around the first yaw axis A) Y1 The rotation of the fourth link 7540 (around the second pitch axis A) is controlled by the third cable 7440 and the fourth cable 7450. Conversely, the third cable 7440 and the fourth cable 7450 terminate at the fifth link 7550 of the wrist assembly 7500 and control the fourth link 7540 (around the second pitch axis A). P2 ) and the fifth link (around the second yaw axis A) Y2 The rotation of the wrist assembly 7500. Because the third cable 7440 and the fourth cable 7450 pass through all the linkage wiring of the wrist assembly 7500, the cable paths of the third cable 7440 and the fourth cable 7450 are longer than the cable paths of the first cable 7420 and the second cable 7430. Therefore, when the wrist assembly 7500 is in the first (or straight) configuration ( Figure 25 and Figure 26 Move to the second (or curved) configuration. Figure 27 When the third cable 7440 and the fourth cable 7450 move at a faster speed and over a longer distance than the first cable 7420 and the second cable 7430, the first drive wheel assembly 7710 can advantageously generate the desired movement of all four cables with a single rotational input, thereby preserving space in the mechanical structure 7700 and allowing the mechanical structure 7700 to be driven by an existing interface.

[0112] The ratio between the second radius R2 and the first radius R1 can be any suitable value (e.g., to accommodate differences in cable path length between cables). For example, in some embodiments, the ratio between the second radius R2 and the first radius R1 is between 1.5:1 and 2.5:1. In other embodiments, the ratio between the second radius R2 and the first radius R1 is between 1.5:1 and 2:1. In still other embodiments, the ratio between the second radius R2 and the first radius R1 is approximately 1.8:1. Furthermore, although the second radius R2 is shown as being larger than the first radius R1, in other embodiments, the second radius R2 may be smaller than the first radius R1. In still other embodiments, the second radius R2 may have the same dimensions as the first radius R1. In such embodiments, the cables will move at substantially the same speed, resulting in portions of the wrist rotating at different speeds (or amounts) relative to each other.

[0113] The near-end portion of the cable is routed through mechanical structure 7700 and enters shaft 7410 via two sets of pulleys. For example... Figure 15 As shown, the mechanical structure 7700 includes a first set of pulleys supported by a first mounting bracket 7775, which routes the proximal end portion 7421 of the first cable 7420 and the proximal end portion 7431 of the second cable 7430 into the shaft 7410. The first set of pulleys is shown more clearly in... Figure 16 and Figure 17 For clarity, Figure 16 and Figure 17 The mechanical structure with the first mounting bracket 7775 and the second mounting bracket 7776 removed is shown. Specifically, the first set of pulleys includes a first pulley 7791, a second pulley 7792, and a third pulley 7796. A first cable 7420 is routed from a first cable reel 7711 around the first pulley 7791 and into the shaft 7410. A second cable 7430 is routed from a second cable reel 7712 around the third pulley 7796 and the second pulley 7792 and into the shaft 7410. Similarly, the mechanical structure 7700 includes a second set of pulleys supported by the second mounting bracket 7776, which routes the proximal portions 7441 of the third cable 7440 and 7451 of the fourth cable 7450 into the shaft 7410. The first set of pulleys is shown more clearly in... Figure 15 and Figure 17 For clarity, Figure 15 and Figure 17The mechanical structure with the second mounting bracket 7776 removed is shown. Specifically, the second set of pulleys includes a fourth pulley 7781, a fifth pulley 7782, and a sixth pulley 7786. A third cable 7440 is routed from a third cable reel 7713 around the fourth pulley 7781 and into the shaft 7410. A fourth cable 7450 is routed from a fourth cable reel 7714 around the sixth pulley 7786 and the fifth pulley 7782 and into the shaft 7410. This routing ensures that the cables are routed to the desired location within the shaft 7410 (e.g., relative to the shaft centerline). Specifically, the first cable 7420, the second cable 7430, the third cable 7440, and the fourth cable 7450 can be positioned within the shaft, spaced apart from the shaft centerline, and at different radial or circumferential locations within the shaft 7410. This arrangement reduces the possibility of the cables becoming entangled (e.g., twisted) within the shaft 7410.

[0114] Wrist assembly 7500 and its components Figure 25-34 As shown in the diagram, the wrist assembly 7500 includes five links rotatably connected together, connecting the end effector 7460 to the distal portion 7412 of the shaft 7410. As described herein, the links of the wrist assembly 7500 rotate about multiple axes of rotation relative to each other (and the shaft 7410) to produce desired degrees of freedom. Specifically, the wrist assembly 7500 is configured to produce recurve motion (see [reference]). Figure 27 The wrist assembly 7500 includes a first link 7510, a second link 7520, a third link 7530, a fourth link 7540, and a fifth link 7550. Each of the links has a proximal portion and a distal portion. The proximal portion of the first link 7510 is coupled to a shaft 7410. Figure 25 As shown, the distal portion of the first link 7510 is rotatably connected to the proximal portion of the second link 7520, such that the second link 7520 and the first link 7510 can revolve around a first pitch axis A. P1 (The term pitch is arbitrary) rotation relative to each other. More specifically, such as Figure 29 and Figure 30 As shown, the first link 7510 includes two rolling surfaces 7513 and two sets of teeth 7514. The rolling surfaces 7513 correspond to the proximal rolling surfaces 7523 of the second link 7520 (see...). Figure 32The two sets of teeth 7514 engage with the corresponding sets of teeth 7524 of the second link 7520. Any set of teeth and rolling surfaces described herein may be similar to those shown and described in U.S. Patent Application Publication No. US 2017 / 0120457 A1 (filed February 20, 2015), entitled "Mechanical Wrist Joints with Enhanced Range of Motion, and Related Devices and Methods," the entire contents of which are incorporated herein by reference. Because the joint between the first link 7510 and the second link 7520 is not a pin joint, during rotation of the second link 7520, the first pitch axis A... P1 It will move relative to the first link 7510.

[0115] like Figure 26 As shown, the distal portion of the second link 7520 is rotatably connected to the proximal portion of the third link 7530, such that the third link 7530 and the second link 7520 can rotate about a distance orthogonal to the first pitch axis A. P1 First yaw axis A Y1 (The term yaw is arbitrary) rotation relative to each other. For example... Figure 31 As shown, the distal portion of the second link 7510 includes two distal rolling surfaces 7527 and two sets of teeth 7528. The distal rolling surfaces 7527 correspond to the proximal rolling surfaces 7533 of the third link 7530 (see...). Figure 28 The two sets of teeth 7528 engage with the corresponding sets of teeth (unidentified) of the third link 7530. Since the joint between the second link 7520 and the third link 7530 is not a pin joint, the first yaw axis A is [not specified] during rotation of the third link 7530. Y1 It will move relative to the second link 7520.

[0116] In a similar manner, the distal portion of the third link 7530 is rotatably connected to the proximal portion of the fourth link 7540, such that the fourth link 7540 and the third link 7530 can revolve around the second pitch axis A. P2 Relative to each other, they rotate. The structures of the third link 7530 and the fourth link 7540 are similar to the structure of the second link 7520 (e.g., Figure 31 and Figure 32 The links shown are basically similar, therefore the details of the third link 7530 and the fourth link 7540 will not be described separately in this article. (See references) Figure 28The third link 7510 includes two rolling surfaces 7537 and two sets of teeth 7538 (similar to the rolling surfaces 7527 and teeth 7528 of the second link 7520). The rolling surfaces 7537 engage with the corresponding proximal rolling surfaces of the fourth link 7540, and the two sets of teeth 7538 mesh with the corresponding sets of teeth of the fourth link 7540. Because the joint 7540 between the third link 7530 and the fourth link is not a pin joint, the second pitch axis A is maintained during rotation of the fourth link 7540. P2 This will move relative to the third link 7530. Similarly, the distal portion of the fourth link 7540 is rotatably connected to the proximal portion of the fifth link 7550, allowing the fifth link 7550 and the fourth link 7540 to move about the second yaw axis A. Y2 Rotating relative to each other. (Reference) Figure 34 The fifth link includes two rolling surfaces 7557 and two sets of teeth 7558 (which are similar to the rolling surfaces 7523 and teeth 7524 of the second link 7520).

[0117] As shown in the figure, the wrist assembly 7500 includes multiple pairs of links that rotate relative to each other about alternating normal axes. Specifically, the links of the wrist assembly 7500 rotate about a first pitch axis A. P1 First yaw axis A Y1 Second pitch axis A P2 Second yaw axis A Y2 Rotation. Therefore, the wrist assembly 7500 is referred to as having a "pitch-yaw-pitch-yaw" configuration. However, in other embodiments, the wrist assembly 7500 (or any wrist assembly described herein) may be configured to have a "pitch-yaw-yaw-pitch" configuration or a "yaw-pitch-pitch-yaw" configuration.

[0118] The cable passes through a series of cable openings that serve as guide holes, through the linkage wiring of the wrist assembly 7500, and connects to the linkage of the wrist assembly 7500. For example... Figure 30 As shown, the first link includes four internal cable openings 7515 and four external openings 7516. Similarly, the second link 7520 includes four internal cable openings 7525 and four external openings 7526. Four cables (i.e., four shorter cables) terminating in the third link 7530 are routed through the four internal cable openings 7515 and 7525. Specifically, as... Figure 28 As shown, the distal portion 7422 of the first cable 7420 and the distal portion 7432 of the second cable 7430 are routed through internal cable openings 7515 and 7525. Four cables (i.e., four longer cables) terminating at the fifth link 7550 are routed through four external cable openings 7516 and 7526. Specifically, as... Figure 28As shown, the distal portions 7442 of the third cable 7440 and 7452 of the fourth cable 7450 are routed through external cable openings 7516 and 7526. The fifth link 7550 includes only four external cable openings 7556 (through which the longer portions of the third cable 7440 and fourth cable 7450 are routed). The fifth link 7550 also includes four termination openings 7559 for securely connecting the ends of the four longer cables (including the third cable 7440 and fourth cable 7450) to the fifth link 7550.

[0119] refer to Figure 28 The distal portion 7422 of the first cable 7420 is connected to and terminated at the third link 7530. The first cable 7420 is routed through the wrist assembly 7500 via internal cable openings 7515 and 7525 and enters the shaft 7410. As described above, the proximal portion 7421 of the first cable 7420 is routed within the mechanical structure 7700 (e.g., via pulley 7791) and wound onto (and connected to) the first cable reel 7711. The distal portion 7432 of the second cable 7430 is connected to and terminated at the third link 7530. The second cable 7430 is routed through the wrist assembly 7500 via internal cable openings 7515 and 7525 and enters the shaft 7410. The proximal portion 7431 of the second cable 7430 is routed within the mechanical structure 7700 (e.g., via pulley 7792) and wound (and connected to) the second cable reel 7712. Therefore, the first cable 7420 and the second cable 7430 (and corresponding short cables connected to the first and second cable reels of the second drive pulley assembly 7720) cause the first link 7710, the second link 7720, and the third link 7730 to revolve around the first pitch axis A. P1 and the first yaw axis A Y1 The rotation of the first cable 7420. Although in some embodiments the distal end 7422 of the first cable 7420 is shown connected to the distal end of another cable (e.g., a cable whose proximal end is connected to the second drive wheel assembly 7720), the distal end 7422 of the first cable 7420 may have a separate termination portion (e.g., a coil). Similarly, although in some embodiments the distal end 7432 of the second cable 7430 is shown connected to the distal end of another cable (e.g., a cable whose proximal end is connected to the second drive wheel assembly 7720), the distal end 7432 of the second cable 7430 may have a separate termination portion (e.g., a coil). Furthermore, in some embodiments, the distal ends 7422 of the first cable 7420 and the distal ends 7432 of the second cable 7430 may be connected together (i.e., the first cable 7420 and the second cable 7430 may be two parts of a cable loop).

[0120] The distal portion 7442 of the third cable 7440 is connected to and terminated at the fifth link 7550. The third cable 7440 is routed through the wrist assembly 7500 via external cable openings 7516 and 7526 and enters the shaft 7410. The proximal portion 7441 of the third cable 7440 is routed within the mechanical structure 7700 (e.g., via pulley 7781) and wound onto (and connected to) the third cable reel 7711. The distal portion 7452 of the fourth cable 7450 is connected to and terminated at the fifth link 7550. The fourth cable 7450 is routed through the wrist assembly 7500 via external cable openings 7516 and 7526 and enters the shaft 7410. The proximal portion 7451 of the fourth cable 7450 is routed within the mechanical structure 7700 (e.g., via pulley 7782) and wound onto (and connected to) the fourth cable reel 7714. Therefore, the third cable 7440 and the fourth cable 7450 (along with the corresponding long cables of the third and fourth cable reels connected to the second drive wheel assembly 7720) cause all links to rotate about all four axes of the wrist assembly 7500. First pitch axis A P1 and the first yaw axis A Y1 Therefore, the cable paths of the third cable 7440 and the fourth cable 7450 are longer than those of the first cable 7420 and the second cable 7430. Therefore, when the wrist assembly 7500 is configured from the first (or straight) position... Figure 25 and Figure 26 Move to the second (or curved) configuration. Figure 27 When the third cable 7440 and the fourth cable 7450 are in operation, they will travel a longer distance at a faster speed than the first cable 7420 and the second cable 7430.

[0121] As described above, when the first cable 7420, second cable 7430, third cable 7440, and fourth cable 7450 are each connected to the wrist assembly 7500 and the first drive wheel assembly 7710, the rotational movement of the first drive wheel assembly 7710 about the first drive wheel axis A1 causes the first cable 7420 and second cable 7430 to move at a first speed (and traverse a first distance) and the third cable 7440 and fourth cable 7450 to move at a second speed (and traverse a second distance), thereby operating the wrist 2500. In this way, the wrist assembly 7500 can be configured in its first (or linear) position ( Figure 26 ), its second (or curved) configuration ( Figure 27The wrist assembly 7500 can move between a configuration involving rotation about any axis of the wrist assembly 7710 and a configuration involving rotation about any axis of the wrist assembly 7500. The arrangement of the first drive wheel assembly 7710 and the second drive wheel assembly 7720 advantageously allows a single drive wheel assembly to produce different amounts of cable movement or cable speed. Different cable motion characteristics can improve the operation of the wrist assembly 7500. The first drive wheel assembly 7710 (and other drive wheel assemblies described herein) can produce different amounts of desired movement (or cable speed) with a single input, thus preserving space in the mechanical structure 7700.

[0122] While various embodiments have been described above, it should be understood that they are presented by way of example only and not as limitations. Where the methods and / or diagrams above indicate specific events and / or flow patterns occurring in a specific order, the ordering of specific events and / or operations may be modified. Although embodiments have been specifically shown and described, it should be understood that various changes in form and detail may be made.

[0123] For example, any instrument (and components thereof) described herein may optionally be part of a surgical assembly for performing minimally invasive surgical procedures, and may include a manipulator unit, a series of kinematic linkages, a series of cannulas, or the like. Therefore, any instrument described herein can be used with any suitable surgical system, such as the MIRS system 1000 shown and described above. Furthermore, any instrument shown and described herein can be used to manipulate target tissue during a surgical procedure. Such target tissue can be cancer cells, tumor cells, lesions, vascular occlusion, thrombosis, stones, uterine fibroids, bone metastases, adenomyosis, or any other body tissue. The examples of target tissues presented are not exhaustive. Additionally, target structures may also include artificial materials (or non-tissues) within or associated with the body, such as stents, portions of artificial tubes, fasteners within the body, etc.

[0124] For example, any wrist or tool component can be made of any material, such as medical-grade stainless steel, nickel alloys, titanium alloys, etc. Furthermore, any link, tool component, tension member, or part described herein can be composed of multiple components subsequently connected together. For example, in some embodiments, a link can be constructed by connecting separately constructed components together. However, in other embodiments, any link, tool component, tension member, or part described herein can be constructed as a single unit.

[0125] Any cable described herein may be formed from any suitable material. For example, in some embodiments, any cable described herein may be formed from tungsten strands. In other embodiments, any cable described herein may be formed from ultra-high molecular weight polyethylene (UHMWPE) fibers. In some embodiments, any cable described herein may be composed of a single strand or fibers. In other embodiments, any cable described herein may be composed of multiple fibers braided or otherwise linked together to form a cable. In some embodiments, any cable described herein may include a coating or other surface treatment to enhance the cable's frictional properties. Such enhanced frictional properties may facilitate cable winding onto the drive pulley assembly or cable reel described herein.

[0126] Although the cables of the device 7400 (e.g., the first cable 7420) are shown and described as being coupled to their respective cable reels (e.g., the first cable reel 7711) by coiling within a connection opening (e.g., the first connection opening 7755), in other embodiments, any cable described herein may be coupled to the drive pulley by any suitable mechanism (e.g., by winding the cable onto the cable reel in a manner that prevents slippage or by means of adhesive).

[0127] Although medical devices are described herein as comprising one or more cables, in other embodiments, any medical device described herein may include any suitable tension member for manipulating a wrist or end effector. For example, any medical device described herein may include a tension band (instead of a cable or other than a cable) of the type shown and described in International Patent Application No. PCT / US2018 / 064721 entitled “Medical Tools Having Tension Bands” (filed December 10, 2018), the entire contents of which are incorporated herein by reference.

[0128] Although various embodiments have been described as combinations of specific features and / or components, other embodiments may have any combination of features and / or components from any of the embodiments discussed above. Various aspects have been described in the general context of medical devices, and more specifically surgical instruments, but the inventive step is not necessarily limited to use in medical devices.

Claims

1. A medical device comprising: The instrument axis includes a distal portion and a proximal portion; The wrist, which is connected to the distal portion of the instrument shaft; A mechanical structure, coupled to the proximal portion of the instrument shaft, includes a drive wheel assembly comprising a first cable reel defining a first radius and a second cable reel defining a second radius different from the first radius. The first and second cable reels are rotatable about a common drive wheel axis. The first cable reel includes a first centerline, and the second cable reel includes a second centerline that is not concentric with the first centerline. The first cable in the first cable pair includes a proximal portion and a distal portion. The first cable is routed along the axis of the instrument. The distal portion of the first cable is connected to a first link of the wrist. The proximal portion of the first cable is wound on the first cable reel in a first winding direction. as well as The second cable in the first cable pair includes a proximal portion and a distal portion. The second cable is routed along the axis of the instrument. The distal portion of the second cable is connected to a second link of the wrist. The proximal portion of the second cable is wound on a second cable reel in the same first winding direction as the proximal portion of the first cable. Wherein: Rotation of the drive wheel assembly about the common drive wheel axis causes the distal portion of the first cable to move along a first direction and a first distance, the first distance being partially defined by the first radius. The same rotation of the drive wheel assembly about the common drive wheel axis causes the distal portion of the second cable to move along the first direction and along a second distance, the second distance being partially defined by the second radius.

2. The medical device according to claim 1, wherein: The drive wheel assembly includes an input disk; The input disk is configured to be driven by an actuator to rotate the drive wheel assembly about the common drive wheel axis; and The rotation of the drive wheel assembly about the common drive wheel axis causes the first cable to move at a first speed proportional to the first radius and causes the second cable to move at a second speed proportional to the second radius.

3. The medical device according to claim 2, wherein: The movement of the distal portion of the first cable and the distal portion of the second cable actuates the wrist.

4. The medical device according to claim 1, further comprising: The second cable pair includes the third and fourth cables, wherein: The third cable includes a proximal portion and a distal portion and is routed along the axis of the instrument. The distal portion of the third cable is coupled to the wrist, and the proximal portion of the third cable is wound on the first cable reel in a second winding direction opposite to the first winding direction. The fourth cable includes a proximal portion and a distal portion and is routed along the axis of the instrument. The distal portion of the fourth cable is connected to the wrist, and the proximal portion of the fourth cable is wound on the second cable reel in the same second winding direction as the proximal portion of the third cable.

5. The medical device according to claim 4, wherein: The drive wheel assembly includes an input disk; The input disk is configured to be driven by an actuator to rotate the drive wheel assembly about the common drive wheel axis; The rotation of the drive wheel assembly about the common drive wheel axis causes the first cable and the third cable to move at a first speed proportional to the first radius; and The rotation of the drive wheel assembly about the common drive wheel axis causes the second cable and the fourth cable to move at a second speed proportional to the second radius.

6. The medical device according to claim 4, wherein: The drive wheel assembly includes an input disk; The input disk is configured to be driven by an actuator to rotate the drive wheel assembly about the common drive wheel axis; Rotation of the drive wheel assembly about the common drive wheel axis causes the first cable pair to move in a first direction to actuate the wrist; and Rotation of the drive wheel assembly about the common drive wheel axis causes the second cable pair to move in a second direction to actuate the wrist, the second direction being opposite to the first direction.

7. The medical device according to claim 1, wherein: The drive wheel assembly includes a drive wheel axle, a first clamp, a second clamp, and an input disk; The input disk is connected to the drive wheel shaft, such that rotation of the input disk causes rotation of the drive wheel shaft; The first cable reel includes a first winding member and a second winding member; The first winding member is connected to the drive wheel axle via the first clamp; The second winding member is connected to the drive wheel axle via the second clamp; and The proximal portion of the first cable is wound around the first winding member in a first direction.

8. The medical device according to claim 1, wherein: The wrist includes a first link and a second link; The first connecting rod is rotatable about a first axis relative to the instrument axis; The second link is rotatable about a second axis relative to the instrument axis; The distal portion of the first cable is connected to the first link; and The distal portion of the second cable passes through the first link wiring and is connected to the second link.

9. The medical device according to claim 8, wherein: The wrist includes one or more intermediate links; The first link is connected to the second link via one or more intermediate links; and The first axis is parallel to the second axis.

10. A medical device comprising: The instrument axis includes a distal portion and a proximal portion; A wrist, which is connected to the distal portion of the instrument axis, the wrist including a first link rotatable about a first axis relative to the instrument axis and a second link rotatable about a second axis relative to the instrument axis; A mechanical structure coupled to the proximal portion of the instrument shaft, the mechanical structure including a drive wheel assembly, the drive wheel assembly including a drive wheel shaft, a first drive member, a second drive member, and a transmission member, the first drive member and the second drive member being rotatable about a common drive wheel axis defined by the drive wheel shaft; A first cable includes a proximal portion and a distal portion, the distal portion of the first cable being coupled to the first link, and the proximal portion of the first cable being operably coupled to the first drive member, such that rotation of the drive wheel shaft moves the proximal portion of the first cable at a first speed. as well as A second cable includes a proximal portion and a distal portion, the distal portion of the second cable being coupled to a second link, and the proximal portion of the second cable being operably coupled to a second drive member, such that rotation of the drive wheel shaft moves the proximal portion of the second cable at a second speed different from the first speed, wherein: The first driving component is a first cable reel connected to the drive wheel shaft. The second driving component is a drive gear connected to the drive wheel shaft. The transmission component includes a driven gear portion that meshes with the drive gear, and The driven gear portion of the transmission component is a sector gear.

11. The medical device according to claim 10, wherein: The drive wheel assembly includes an input disk configured to be driven by an actuator to rotate the drive wheel shaft.

12. The medical device according to claim 10, wherein: The drive axle, the first drive component, and the second drive component are concentric.

13. The medical device according to claim 10, wherein: The proximal portion of the first cable is wound around the first cable reel; The proximal portion of the second cable is connected to the transmission member.

14. The medical device according to claim 13, wherein: The first cable reel and the drive gear are concentric with the common drive wheel axis; The conveying component includes a rotation axis; and The axis of rotation is not concentric with the axis of the common driving wheel.

15. The medical device according to any one of claims 10-14, wherein: The rotation of the drive shaft causes the first cable to move in a first direction and the second cable to move in the first direction, thereby actuating the wrist.

16. The medical device according to any one of claims 10-14, further comprising: A third cable including a proximal portion and a distal portion, the distal portion of the third cable being coupled to the wrist, and the proximal portion of the third cable being operatively coupled to the first drive member. as well as A fourth cable includes a proximal portion and a distal portion, the distal portion of the fourth cable being coupled to the wrist, and the proximal portion of the fourth cable being operatively coupled to the second drive member.

17. The medical device according to any one of claims 10-14, wherein: The distal portion of the second cable passes through the first link wiring and is connected to the second link.

18. The medical device according to claim 17, wherein: The medical device includes one or more intermediate links; The first link is connected to the second link via one or more intermediate links; and The first axis is parallel to the second axis.

19. A medical device comprising: The instrument axis includes a distal portion and a proximal portion; A wrist, which is connected to the distal portion of the instrument axis, the wrist including a first link rotatable about a first axis relative to the instrument axis and a second link rotatable about a second axis relative to the instrument axis; A first cable includes a proximal portion and a distal portion, the distal portion of the first cable being connected to the first link; The second cable includes a proximal portion and a distal portion, the distal portion of which is connected to the second link; as well as A means for moving the proximal portion of the first cable and the proximal portion of the second cable to actuate the wrist based on a single input. The device for movement includes a drive wheel axle, a first cable reel, and a second cable reel. The first cable reel and the second cable reel are rotatable about a common drive wheel axis defined by the drive wheel axle; The first cable reel includes a first center line. The second cable reel includes a second centerline that is not concentric with the first centerline. The proximal portion of the first cable moves at a first speed in response to the single input. The proximal portion of the second cable moves at a second speed in response to the single input, and The second speed is different from the first speed.

20. The medical device according to claim 19, wherein: The first cable reel is connected to the drive wheel axle; The proximal portion of the first cable is wound onto the first cable reel along a first winding direction; The second cable reel is connected to the drive pulley shaft; and The proximal portion of the second cable is wound onto the second cable reel in the same first winding direction.

21. The medical device according to claim 20, wherein: The first cable reel includes a first radius; and The second cable reel has a second radius that is different from the first radius.

22. The medical device according to claim 19, wherein: The device for movement includes a drive wheel axle, a cable reel, a drive gear, and a transmission component; The cable reel is connected to the drive wheel axle; The proximal portion of the first cable is wound around the cable reel; The drive gear is connected to the drive wheel axle; The drive gear engages with the transmission component; and The proximal portion of the second cable is connected to the transmission member.

23. A medical device comprising: The system comprises a distal first movable component, a distal second movable component, a proximal rotatable drive wheel, a first drive member connected to the drive wheel, and a second drive member connected to the drive wheel, wherein the first drive member and the second drive member are rotatable about a common drive wheel axis, and a pair of tension members including a first tension member and a second tension member, wherein: The first driving member includes a first winding region, and the second driving member includes a second winding region. The first tension member extends from the first movable member to be at least partially wound around the first drive member along a first winding direction at the first winding region. The second tension member extends from the second movable member to be at least partially wound around the second drive member at the second winding region along the same first winding direction. The first driving member has a first radius of rotation at a point where the first tension member winds and unwinds at the first winding region. The second driving member has a second radius of rotation at the point where the second tension member winds and unwinds in the second winding region; The second rotation radius is different from the first rotation radius. The rotation of the drive wheel about the common drive wheel axis causes the distal portion of the first tension member to move along a first direction and a first distance, which is partially defined by the first rotation radius. As the first driving component rotates with the drive wheel, the first radius of rotation remains constant. The same rotation of the driving wheel about the common driving wheel axis causes the distal portion of the second tension member to move along the first direction and along a second distance, the second distance being partially defined by the second rotation radius, and As the second drive member rotates with the drive wheel, the second radius of rotation is not constant.

24. The medical device according to claim 23, further comprising: The third tension member, the fourth tension member, the third drive member connected to the drive wheel, and the fourth drive member connected to the drive wheel, wherein: The third driving component includes a third winding region. The fourth driving component includes a fourth winding region. The third tension member extends from the first movable member to at least partially wrap around the third drive member at the third winding region. The fourth tension member extends from the second movable member to at least partially wrap around the fourth drive member at the fourth winding region, and The third driving member has the first rotation radius at the point where the third tension member is wound and unwound in the third winding region, and The fourth driving member has the second rotation radius at the point where the fourth tension member is wound and unwound in the fourth winding region.

25. The medical device according to claim 24, wherein: The third tension member is wound around the third driving member along a second winding direction opposite to the first winding direction; and The fourth tension member is wound around the fourth drive member in the same second winding direction.

26. The medical device according to any one of claims 23-25, further comprising: A rotatable drive disc connected to the drive wheel; and The drive disc is configured to receive motor drive input to rotate the drive wheel.

27. The medical device according to any one of claims 23-25, wherein: Define a longitudinal orientation for the medical device and define a longitudinal orientation for the second movable part; The second movable component is located distal to the first movable component; and The rotation of the drive wheel moves the second movable component from a first state in which the longitudinal orientation of the second movable component is aligned with the longitudinal orientation of the medical device to a second state in which the longitudinal orientation of the second movable component is reversed relative to the longitudinal orientation of the medical device.

28. The medical device according to any one of claims 23-25, further comprising: The distal wrist and the distal end effector connected to the wrist; The wrist includes the first movable component and the second movable component; Define a longitudinal orientation for the medical device, and define a longitudinal orientation for the end effector; and The rotation of the drive wheel moves the end effector from a first state in which the longitudinal orientation of the end effector is aligned with the longitudinal orientation of the medical device to a second state in which the longitudinal orientation of the end effector is reversed relative to the longitudinal orientation of the medical device.

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