Actuating combiner mechanism for surgical tools

Abstract

A surgical tool for a surgical robotic system, the surgical tool comprising: a surgical tool gripper having a jaw operable to perform a surgical procedure; a handle coupled to the surgical tool gripper and having a lever operable to actuate the jaw; and an actuation combiner mechanism coupled to the lever and operable to combine a first actuation force input from the lever input connection of the lever and a second actuation force input from the mechanical input connection of the mechanical actuator into the output connection to control operation of the jaw or the lever. Other aspects are described and claimed.

Description

Technical Field

[0001] The present disclosure relates generally to the field of robotic surgery, and more particularly to surgical tools, systems, and methods having an actuation combiner mechanism that allows for manual adjustment of sealing force and motorization. Background Art

[0002] Minimally invasive surgery (MIS) such as laparoscopic surgery relates to a technique intended to reduce tissue damage during surgical procedures. For example, laparoscopic surgery generally involves forming multiple small incisions in the patient's body (e.g., in the abdomen), and one or more tools (e.g., surgical staplers and / or energy devices) and at least one endoscopic camera are introduced into the patient's body through the incisions. The surgical procedure is then performed by using the introduced tool, wherein visualization assistance is provided by the camera. Generally speaking, MIS provides multiple beneficial effects, such as reducing patient scars, alleviating patient pain, shortening patient recovery periods, and reducing medical expenses associated with patient recovery. In some embodiments, MIS can be performed with a robotic system, which includes one or more robotic arms for manipulating surgical instruments based on commands from an operator. Summary of the invention

[0003] Aspects of the present disclosure include surgical instruments with an actuating assembly mechanism that allows manual adjustment of sealing force and realizes motorization. Representatively, the actuating assembly mechanism combines the actuation and force of two input connectors into an output connector that controls various aspects of the surgical instrument. In some aspects, an input connector in the input connector is coupled to a closing lever, and another input connector is coupled to a combiner / lever adjustment mechanism, a preload spring, or a motor for motorized input or actuation. In some aspects, having an independent input for an adjustment mechanism, a preload spring, or a motor allows the instrument to have improved, enhanced, and / or new functionality for both manual or motor actuation, while also allowing tactile feedback on the closing lever. Representative improved, enhanced, and / or new functionality may include, but is not limited to, improved sealing, tissue property identification, motor sealing, improved ergonomics, jaw control, overfilled jaw detection, auxiliary lever closure, user-adjustable sealing force, jaw gap, and force measurement. In some aspects, the combiner mechanism allows the force applied to the tissue to be varied, thereby allowing the same tool to perform different levels of force during sealing. In addition, the introduction of the motor allows force sensing, which can be used to perform better sealing by controlling the clamping force applied. Since the applied force level is defined by the motor, this allows fine-tuning of the applied clamping force, which can reduce sealing problems. For example, rapid motor-assisted movement can help prevent tissue from sticking to the jaws. In addition, motor-assisted movement can also allow better tissue gripping and manipulation. Further, the motorization of the jaws can be used to perform a modulated load that applies high and low forces over several cycles to soften hard tissue / fat tissue and remove excess fluid. This in turn allows better sealing and reduces the possibility of tissue sticking to the jaws by performing cycles before the seal is completed. Knowing the load profile allows the tool to clamp to the tissue with a lower force, and once the sealing procedure is triggered, the profile is run, which can be gradually increased to a higher force, and once it is completed, it returns to the initial force. This allows the user to close the jaws with the minimum effort required and perform a much higher clamping force when sealing. Motorization also allows for pre-measurements such as tissue properties, like stiffness, and performs data plots such as jaw gap versus jaw load, and other measurements that can help identify different types of tissue and monitor the sealing cycle.

[0004] The surgical tool can be any surgical tool having a surgical tool gripper for performing a surgical procedure or operation. Representatively, in one aspect, the surgical tool can be an energy tool, a harmonic tool, a stapler, or any other surgical tool or device with a handle, which has a lever latch mechanism for the surgeon to control and / or manipulate the surgical tool (e.g., using an energy tool to apply energy) or device. As used herein, "energy tool" or "energy device" is intended to refer to any surgical instrument that can be used to manipulate tissue by applying energy during a surgical procedure. For example, an energy tool or device can be any surgical instrument that can emit enough energy to cut, incise, cauterize, seal, coagulate, dehydrate, electrocauterize, and / or achieve tissue homeostasis when in contact with tissue. Energy tools or devices can apply energy in the form of high frequency, radio frequency, ultrasound, microwaves, etc. In some aspects, the energy tool may include a surgical tool gripper with jaws, which is inserted into the patient's body to perform a surgical procedure and is connected to a handle with a lever or trigger, which controls the opening or closing of the gripper and the jaws. For example, during operation, the surgeon may hold the handle and manipulate the lever or trigger to control the clamping of the gripper or jaws on the tissue, or apply energy from the gripper of the jaws. Representatively, in some aspects, the user may squeeze the lever toward the closed position to cause the gripper or jaws to close or clamp onto the tissue and / or emit energy. In other words, squeezing the lever toward the handle (or closed position) may cause the anvils forming the top and bottom of the jaws to become closer together, and thus the size of the jaw gap is reduced. The opposite operation (e.g., the movement of the lever or trigger away from the handle toward the open position) may cause the gripper or jaws to open, or be less closed, or reduce the application of energy. In other words, releasing the lever or otherwise moving it away from the handle toward the open position may cause the anvils forming the top and bottom of the jaws to separate further, and thus the size of the jaw gap is increased. In further aspects, the lever may latch (or otherwise be fixed) in the closed position and / or open position and remain latched until the user applies an opposite force to push the lever or trigger away from the handle. The lever or trigger can then remain in the latched position until a user applies a force that pulls the lever or trigger back toward the handle to the closed position or pushes the lever or trigger away from the handle to the open position. In some aspects, a combiner mechanism can be coupled to the lever or trigger to enhance or modify the operation of the lever or a component controlled by the lever, such as a jaw.

[0005] In one aspect, the present disclosure relates to a surgical tool for a surgical robotic system, the surgical tool comprising: a surgical tool gripper having a jaw operable to perform a surgical procedure; a handle coupled to the surgical tool gripper and having a lever operable to actuate the jaw; and an actuation combiner mechanism coupled to the lever and operable to combine a first actuation force input from a lever input connector of the lever with a second actuation force input from a mechanical input connector of a mechanical actuator into an output connector to control the operation of the jaw or the lever. In some aspects, the actuation combiner mechanism comprises a combiner wheel that rotates around a central pivot point and couples the lever input connector and the mechanical input connector to the output connector, and the output connector is coupled to a yoke that moves to open or close the jaw. In some aspects, the lever input connector is coupled to the combiner wheel at a first pivot point, the mechanical input connector is coupled to the combiner wheel at a second pivot point, and the output connector is coupled to the combiner wheel at a central point. In a further aspect, the first end of the lever input connector is coupled to the combiner wheel at a first pivot point, and the second end of the lever input connector is coupled to the lever, so that movement of the lever moves the lever input connector. In some aspects, the mechanical actuator is an adjustment lever, the first end of the mechanical input connector is coupled to the combiner wheel at a second pivot point, and the second end of the mechanical input connector is coupled to the adjustment lever, and movement of the adjustment lever adjusts the position of the combiner wheel to set the default open position of the lever. The mechanical actuator can be a preload spring, the first end of the mechanical input connector is coupled to the combiner wheel at a second pivot point, and the second end of the combiner input connector is coupled to the preload spring, and the second actuation force input of the mechanical input connector is generated by the force output by the preload spring. In some aspects, an adjustable nut is coupled to the preload spring to allow adjustment of the second actuation force input to move the combiner input connector. In some aspects, the combined actuation force output of the output connector is selected by modifying the ratio of the distances of the first pivot point and the second pivot point to the combiner wheel output center point. The combiner wheel may include a radially oriented slot, and the first pivot point is defined by a pin operable to slide within the radially oriented slot to modify the distance of the first pivot point to the combiner wheel output center point. The tool may also include a tactile feedback mechanism that provides a user with a tactile output corresponding to the operation of the jaws or lever.

[0006] In other aspects, a tool for a surgical robotic system is provided, the tool comprising: a surgical tool gripper having a jaw operable to perform a surgical procedure; a handle coupled to the surgical tool gripper and having a lever operable to actuate the jaw; and an actuation combiner mechanism coupled to the lever and operable to combine the actuation force output of the lever with the actuation force output of the preloaded spring to control the operation of the jaw or the lever. The actuation combiner mechanism may include a combiner wheel that rotates around a central pivot point and couples a lever input connector from the lever and a spring input connector from the preloaded spring to an output connector, the output connector being coupled to a yoke that is operable to control the opening or closing of the jaw. In some aspects, the movement of the lever to the closed position generates an actuation force output of the lever in a first direction that causes the yoke to move the jaw to the closed position. In some aspects, the movement of the lever to the open position generates an actuation force output of the lever in a second direction that causes the yoke to move the jaw to the open position. In a further aspect, a force adjustment member is coupled to the preload spring to increase or decrease the actuation force output of the preload spring. In some aspects, a position adjustment member is coupled to the preload spring and is operable to move the preload spring between a first position in which the lever is in a first default open position and a second position in which the lever is in a second default open position. The actuation combiner mechanism may include a combiner wheel coupled to a first connection of the lever at a first pivot point and to a second connection of the preload spring at a second pivot point, and wherein a position of the combiner wheel about the first pivot point is operable to be modified to increase or decrease the force output by the actuation combiner mechanism to control the operation of the jaws.

[0007] In a further aspect, a surgical tool for a surgical robotic system is provided, the surgical tool comprising: a surgical tool gripper having a jaw operable to perform a surgical procedure; a handle coupled to the surgical tool gripper and having a lever operable to actuate the jaw; and an actuating combiner mechanism comprising a combiner wheel, a lever input connector coupled to the combiner wheel at a first pivot point and coupled to the lever, an adjustment input connector coupled to the combiner wheel at a second pivot point and coupled to an adjustment lever operable to adjust a default open position of the lever, and an output connector coupled to a yoke that causes the jaw to open or close. In some aspects, the combiner wheel is operable to translate along a slot in response to movement of the adjustment lever to set a default open position of the lever. In some aspects, movement of the adjustment lever in a counterclockwise direction around the pivot point translates the combiner wheel in a first direction and sets a first default open position of the lever. In some aspects, movement of the adjustment lever in a clockwise direction about the pivot point translates the combiner wheel in a second direction and sets a second default open position of the lever that is less than the first default open position. The combiner wheel may include a circular gear member, and the adjustment input connection includes a linear gear member coupled to the circular gear member, such that movement of the adjustment lever causes movement of the combiner wheel and sets the default open position of the lever.

[0008] On the other hand, a surgical tool for a surgical robot system includes: a surgical tool gripper having a jaw operable to perform a surgical procedure; a handle coupled to the surgical tool gripper and having a lever operable to actuate the jaw; an actuation combiner mechanism coupled to the lever and operable to combine the actuation force output of the lever with the actuation force output of the motor into an output connector to control the jaw or lever; and one or more processors configured to analyze the characteristics associated with the actuation force output of the lever or motor to optimize the surgical procedure. In some aspects, the actuation combiner mechanism includes a combiner wheel that rotates around a central pivot point and couples a lever input connector from the lever and a motor input connector from the motor to an output connector that controls the operation of the jaw or lever. In some aspects, the tool also includes one or more sensors operable to measure the actuation force output by the motor, the size of the jaw gap, or the position of the lever. In some aspects, the processor is operable to determine the clamping force of the jaws on the tissue based on the actuation force output by the motor. In some aspects, the surgical procedure is a sealing operation, and the processor is further operable to modify the clamping force of the jaws on the tissue or the size of the jaw gap to optimize the sealing operation. In some aspects, based on the clamping force of the jaws or the jaw gap, the processor is operable to determine the characteristics of the surgical procedure, which include at least one of an overfilled jaw condition, a sealing parameter, or an abnormal sealing sequence. In some aspects, the sealing parameter includes the stiffness of the tissue. In a further aspect, the processor is operable to control the direction of the actuation force output of the motor based on the lever position. In a further aspect, the motor is further operable to output a micro-modulation frequency to the output connector. In some aspects, the micro-modulation frequency is operable to reduce the influence of friction on the operation of the jaws or lever.

[0009] The above summary does not include an exhaustive list of all aspects of the invention. It is contemplated that the present invention includes all systems and methods that can be implemented by all suitable combinations of the various aspects summarized above and those disclosed in the detailed description below and specifically pointed out in the claims filed with this patent application. Such combinations have specific advantages not specifically recited in the above summary. BRIEF DESCRIPTION OF THE DRAWINGS

[0010] Various aspects are illustrated by way of example and not limitation in the figures of the accompanying drawings, wherein like reference numerals indicate similar elements. It should be noted that reference to "one" or "an" aspect in the present disclosure is not necessarily the same aspect, and they refer to at least one.

[0011] Figure 1 is an overview schematic diagram of an operating room setup with a surgical robotic system.

[0012] Figure 2 is a side perspective view of one aspect of a surgical tool of a surgical robotic system.

[0013] Figure 3 is a cross-sectional side view of another aspect of a surgical tool of a surgical robotic system having a lever.

[0014] Figure 4 yes Figure 3 An enlarged cross-sectional side view of one aspect of a surgical tool.

[0015] Figure 5 yes Figure 3 An enlarged cross-sectional side view of one aspect of a surgical tool.

[0016] Figure 6 is a cross-sectional side view of another aspect of a surgical tool of a surgical robotic system having a lever.

[0017] Figure 7 is a cross-sectional side view of another aspect of a surgical tool of a surgical robotic system having a lever in a first default position.

[0018] Figure 8 is a cross-sectional side view of another aspect of a surgical tool of a surgical robotic system with a lever in a second default position.

[0019] Fig. 9 is a cross-sectional side view of another aspect of a surgical tool of a surgical robotic system.

[0020] Fig.10 yes Fig. 9 An enlarged cross-sectional side view of one aspect of a surgical tool.

[0021] Fig.11 yes Fig. 9 An enlarged cross-sectional side view of one aspect of a surgical tool.

[0022] Fig.12 yes Fig. 9 An enlarged cross-sectional side view of one aspect of a surgical tool.

[0023] Fig.13 yes Fig. 9 An enlarged cross-sectional side view of one aspect of a surgical tool.

[0024] Fig.14 yes Fig. 9 An enlarged cross-sectional side view of one aspect of a surgical tool.

[0025] Fig.15 yes Fig. 9An enlarged cross-sectional side view of one aspect of a surgical tool.

[0026] Fig.16 is a cross-sectional side view of another aspect of a surgical tool of a surgical robotic system.

[0027] Fig.17 A graph comparing jaw gap size and tissue stiffness of jaws of surgical tools is shown.

[0028] Fig.18 is a block diagram of a computer portion of a surgical robotic system including an energy tool according to aspects of the present disclosure. DETAILED DESCRIPTION

[0029] In various embodiments, description is made with reference to the accompanying drawings. However, certain embodiments may be implemented without one or more of these specific details, or may be implemented in combination with other known methods and configurations. In the following description, many specific details, such as specific configurations, sizes and processes, are listed to provide a comprehensive understanding of the embodiments. In other cases, well-known processes and manufacturing techniques are not particularly described in detail to avoid unnecessary fuzzy descriptions. "One embodiment", "embodiment" etc. mentioned throughout this specification means that the specific features, structures, configurations or characteristics described are included in at least one embodiment. Therefore, the phrases "one embodiment", "embodiment" etc. that appear everywhere in the entire specification do not necessarily refer to the same embodiment. In addition, in one or more embodiments, specific features, structures, configurations or characteristics can be combined in any suitable manner.

[0030] In addition, the terms used herein are only for the purpose of describing specific aspects and are not intended to limit the present invention. For ease of description, spatial relative terms such as "below", "lower than", "lower", "higher than", "upper" etc. may be used herein to describe the relationship between an element or feature and another element or feature as shown in the figure. It should be understood that spatial relative terms are intended to cover different orientations of the device in use or operation except the orientation depicted in the accompanying drawings. For example, if the device in the figure is flipped, the element described as "lower than" other elements or features or "below it" will be oriented to "higher than" other elements or features. Therefore, the exemplary term "lower than" can cover orientations above and below. The device can be oriented in other ways (e.g., rotated 90 degrees or in other orientations), and the spatial relative descriptors used herein are interpreted accordingly.

[0031] As used herein, unless the context clearly indicates otherwise, the singular forms "a", "an", and "the" are intended to include the plural forms as well. It should also be understood that the terms "include" and / or "comprise" specify the presence of stated features, steps, operations, elements, and / or components, but do not exclude the presence or addition of one or more other features, steps, operations, elements, components, and / or groups thereof.

[0032] As used herein, the terms "or" and "and / or" should be understood as inclusive or meaning any one or any combination. Thus, "A, B, or C" or "A, B, and / or C" means "any of the following: A; B; C; A and B; A and C; B and C; A, B, and C." An exception to this definition will only occur if a combination of elements, functions, steps, or actions are inherently mutually exclusive in some way.

[0033] In addition, relative terms used throughout the description may indicate relative positions or directions. For example, "distal" may indicate a first direction away from a reference point (e.g., away from a user). Similarly, "proximal" may indicate a position in a second direction opposite to the first direction (e.g., toward the user). However, such terms are provided to establish a relative frame of reference and are not intended to limit the use or orientation of any particular surgical robot component to the specific configurations described in the various embodiments below.

[0034] See also Figure 1 , which is a pictorial view of an example surgical robotic system 100 in a surgical setting. The surgical robotic system 100 includes a user console 102, a control tower 103, and one or more surgical robots 120 (including a robotic arm 104) at a surgical robotic platform 105 (e.g., an operating table, a bed, etc.). The system 100 may incorporate any number of devices, tools, or accessories for performing a surgical procedure on a patient 106. For example, the system 100 may include one or more surgical tools 107 for performing a surgical procedure. The surgical tool 107 may be an end effector attached to the distal end of the surgical arm 104 for performing a surgical procedure. In some aspects, the surgical tool 107 may include one or more of an energy tool, a harmonic tool, a stapler, or any other surgical tool or device.

[0035] Each surgical tool 107 can be manually manipulated, robotically manipulated, or both during a surgical procedure. For example, the surgical tool 107 can be a tool for accessing, viewing, or manipulating the internal anatomical structure of the patient 106. In one embodiment, the surgical tool 107 can be a grasper that can grasp the patient's tissue and / or an energy tool that can emit energy to cut, coagulate, dehydrate, and / or electrocauterize the grasped tissue. The surgical tool 107 can be manually controlled by a bedside operator 108; or it can be robotically controlled by actuating movement of the surgical robot arm 104 to which it is attached. The robotic arm 104 is shown as a table-mounted system, but in other configurations, the arm 104 can be mounted on a cart, ceiling, or sidewall, or in another suitable structural support.

[0036] Generally speaking, a remote operator 109 (such as a surgeon or other operator) can use the user console 102 to remotely manipulate the arm 104 and / or the attached surgical tool 107, e.g., teleoperation. Teleoperation can be entered or disengaged based on user actions. It should be understood that "entering" teleoperation mode is intended to refer to an operation in which, for example, a UID or foot switch that is blocked from controlling a surgical instrument is transitioned to a mode in which the surgical instrument can now be controlled (e.g., teleoperation mode). On the other hand, disengaging from teleoperation mode is intended to refer to an operation that occurs when the system is in teleoperation mode and then transitions to a mode in which the UID or foot switch may no longer control a surgical instrument (non-teleoperation mode). For example, teleoperation mode can be disengaged when the system determines that the detected movement is an unintentional action or movement of the user or the user enters any other action that suggests no longer engaging in teleoperation mode.

[0037] User console 102 may be located in the same operating room as the rest of system 100, such as Figure 1 As shown. However, in other environments, the user console 102 may be located in an adjacent or nearby room, or it may be located in a remote location, for example, in a different building, city, or country. The user console 102 may include a seat 110, one or more user interface devices such as foot controls 113 or a handheld user input device (UID) 114, and at least one user display 115 that is configured to display, for example, a view of a surgical site within a patient 106. In the example user console 102, a remote operator 109 sits in the seat 110 and views the user display 115 while manipulating the foot controls 113 and the handheld UID 114 to remotely control the arm 104 and the surgical tool 107 (which is mounted on the distal end of the arm 104).

[0038] In some variations, the bedside operator 108 can also operate the system 100 in an "in bed" mode, where the bedside operator 108 (user) is now located on one side of the patient 106 and manipulates the robotically driven tools (the end effector attached to the arm 104) simultaneously, e.g., holding the handheld UID 114 and the manual laparoscopic tools with one hand. For example, the bedside operator's left hand can manipulate the handheld UID to control the robotic components, while the bedside operator's right hand can manipulate the manual laparoscopic tools. Thus, in these variations, the bedside operator 108 can perform both robotic-assisted minimally invasive surgery and manual laparoscopic surgery on the patient 106.

[0039] During the example procedure (surgical operation), the patient 106 is prepared for surgery and covered with a sterile drape in a sterile manner to achieve anesthesia. When the arm of the robotic system 100 is in a stowed configuration or a withdrawn configuration, the initial entry to the surgical site (to facilitate access to the surgical site) can be performed manually. In order to form a port that can introduce surgical instruments into the patient 106, the cannula needle assembly can be at least partially inserted into the patient's body through an incision or entry point in the patient's body (e.g., in the abdominal wall). The cannula needle assembly may include a cannula or a cannula needle, an obturator, and / or a seal. In some variations, the cannula needle assembly may include an obturator, such as a needle with a sharp tip for penetrating the patient's skin. The obturator can be set in the lumen of the cannula when inserted into the patient 106, and then removed from the cannula so that the surgical instrument can be inserted through the lumen of the cannula. Once positioned within the body of the patient 106, the cannula may provide access to a body cavity or other site within the body of the patient 106, for example, so that one or more surgical instruments or tools (e.g., energy tools) may be inserted into the body cavity of the patient 106, as further described herein. It should be understood that the cannula as described herein may be part of a trocar and may optionally include an obturator or other components.

[0040] Once access is completed, initial positioning or preparation of the robotic system 100 (including its arms 104) can be performed. Then, the surgical procedure continues, wherein the remote operator 109 at the user console 102 uses the foot control 113 and the UID 114 to manipulate various end effectors and possible imaging systems to perform the surgical procedure. Manual assistance can also be provided at the operating bed or table by a bedside person (e.g., a bedside operator 108) wearing a sterile surgical suit, who can perform tasks on one or more of the robotic arms 104, such as retracting tissue, performing manual repositioning, and tool changes. Non-sterile personnel may also be present to assist the remote operator 109 at the user console 102. When the procedure or surgical procedure is completed, the system 100 and the user console 102 can be configured or set to a certain state to facilitate the completion of postoperative procedures, such as cleaning or disinfection and entering or printing health records via the user console 102.

[0041] In one embodiment, the remote operator 109 holds and moves the UID 114 to provide input commands to move the robot arm actuator 117 in the robot system 100. The UID 114 may be communicatively coupled to the rest of the robot system 100, for example, via the console computer system 116. Representatively, in some embodiments, the UID 114 may be a portable handheld user input device or controller that is not grounded relative to another component of the surgical robot system. For example, the UID 114 may be ungrounded when tethered to or untied from the user console. The term "ungrounded" is intended to refer to a specific implementation in which, for example, two UIDs are neither mechanically nor dynamically constrained relative to the user console. For example, a user may hold the UID 114 in his hand and move freely to any possible position and orientation within a space limited only by, for example, a tracking mechanism of the user console. The UID 114 may generate a spatial state signal corresponding to the movement of the UID 114, such as the position and orientation of the handheld housing of the UID, and the spatial state signal may be an input signal for controlling the movement of the robot arm actuator 117. The robotic system 100 can use control signals derived from the spatial state signals to control the proportional motion of the actuators 117. In one embodiment, the console processor of the console computer system 116 receives the spatial state signals and generates corresponding control signals. Based on these control signals (which control how the actuators 117 are powered to move the segments or connections of the arm 104), the movement of the corresponding surgical tool attached to the arm can simulate the movement of the UID 114. Similarly, the interaction between the remote operator 109 and the UID 114 can generate, for example, a clamp control signal that causes the jaws of the gripper of the surgical tool 107 to close and clamp the tissue of the patient 106.

[0042] The surgical robotic system 100 may include several UIDs 114, with respective control signals generated for each UID controlling the actuators and surgical tools (end effectors) of the respective arms 104. For example, the teleoperator 109 may move a first UID 114 to control the movement of an actuator 117 located in the left robotic arm, where the actuator responds by moving a link, gear, etc. in the arm 104. Similarly, movement of a second UID 114 by the teleoperator 109 controls the movement of another actuator 117, which in turn moves other links, gears, etc. of the robotic system 100. The robotic system 100 may include a right arm 104 secured to a bed or table on the right side of a patient, and a left arm 104 located on the left side of the patient. The actuators 117 may include one or more motors that are controlled so that they drive the rotation of the joints of the arm 104 to, for example, change the orientation of an endoscope or gripper of a surgical tool 107 attached to the arm relative to the patient. The movement of several actuators 117 in the same arm 104 can be controlled by a spatial state signal generated from a specific UID 114. The UID 114 can also control the movement of the corresponding surgical tool gripper. For example, each UID 114 can generate a corresponding clamping signal to control the movement of an actuator (e.g., a linear actuator) that opens or closes the jaws of the gripper at the distal end of the surgical tool 107 to clamp the tissue in the patient 106. In some aspects, the surgical tool gripper can be a surgical stapler or energy tool, and the UID 114 is used to control the opening or closing of the jaws of the surgical stapler or energy tool and the release of the nail and / or the application of energy through the tissue. When the user is finished controlling the surgical tool with the UID 114, the user can dock (i.e. store) the UID 114 with a docking station or UID holder located on the console 102.

[0043] In some aspects, communications between the platform 105 and the user console 102 may be through a control tower 103, which may convert user commands received from the user console 102 (and more specifically from the console computer system 116) into robotic control commands that are transmitted to the arm 104 on the robotic platform 105. The control tower 103 may also transmit status and feedback from the platform 105 back to the user console 102. The communication connection between the robotic platform 105, the user console 102, and the control tower 103 may be via wired and / or wireless links, using any suitable data communication protocol among a variety of data communication protocols. Any wired connection may optionally be built into the floor and / or walls or ceiling of the operating room. The robotic system 100 may provide video output to one or more displays, including displays within the operating room and remote displays accessible via the Internet or other network. The video output or feed may also be encrypted to ensure privacy, and all or part of the video output may be saved to a server or electronic health record system. It should be understood that Figure 1 The operating room scenes are illustrative and may not accurately represent certain medical practices.

[0044] Now go to Figure 2 , Figure 2 A perspective view of an exemplary surgical tool or instrument 200 for a surgical robotic system is shown. The tool 200 may include a proximal end 200A, which is held by a user outside the patient's body during a surgical procedure, and a distal end 200B, which is inserted into the patient's body during a surgical procedure. The tool 200 may include a handle portion 202, a shaft portion 204, and a surgical tool gripper or jaws 206 coupled to the shaft portion 204. The handle portion 202 may include various mechanisms, such as a lever or trigger 208 and an actuator button 210, which are suitable for manipulating the jaws 206 in the patient's body and controlling energy application. For example, the lever or trigger 208 is operable to transition between a closed position and an open position, the closed position causing the jaws 206 to clamp onto tissue and / or otherwise perform a surgical procedure (e.g., emitting energy from the jaws 206), in which the jaws 206 are open and / or the surgical procedure is terminated (e.g., no energy is emitted from the jaws 206). Representatively, in some aspects, moving the lever or trigger 208 toward the closed position (e.g., closer to the handle portion 202) will cause the top anvil 206A and the bottom anvil 206B of the jaws 206 to move closer together. In other words, this operation reduces the gap or distance between the top anvil 206A and the bottom anvil 206B, so that the jaws 206 are clamped to the tissue positioned therein, or the clamping force on the tissue is increased. Conversely, in some aspects, moving the lever or trigger 208 toward the open position (e.g., away from the handle portion 202) will cause the top anvil 206A and the bottom anvil 206B of the jaws 206 to move farther apart. In other words, this operation increases the gap or distance between the top anvil 206A and the bottom anvil 206B, so that the clamping force of the jaws 206 to the tissue positioned therein is reduced, or the tissue is otherwise released from the jaws 206. In some aspects, the closing or opening of the lever 208 also actuates the application of energy, while in other aspects, the application of energy can be controlled solely using the actuator button 210. For example, the lever 208 can be squeezed to close the jaws, or otherwise clamped to the tissue, and the actuator button 210 can be pressed to cause energy to be applied from the jaws. In this regard, releasing the actuator button 210 can terminate the application of energy. The shaft portion 204 can be an elongated portion that connects the handle portion 202 to the jaws 206. The shaft portion 204 can enclose circuits or other components extending from the handle portion 202 to the jaws 206 to control the jaws 206 and the application of energy. The shaft portion 204 can be used to insert and position the jaws 206 in the patient.

[0045] Now refer to Figures 3 to 17 Various representative surgical tools having a combiner mechanism disclosed herein are discussed in more detail. Representatively, Figure 3 A cross-sectional side view of the internal components of a surgical tool handle with a combiner mechanism is shown. As can be seen from this view, the handle 202 includes a lever 208 in a relatively open position. It should be understood that, although not fully shown, the handle 202 is coupled to the shaft portion 204 and the jaws 206 as described above to form a surgical tool 200. As can be seen from this view, the handle 202 includes a housing 302 that encapsulates or otherwise supports various components (e.g., mechanical components, electrical components, etc.) for operating surgical tools. The housing 302 can form a main body portion 302A and a base portion 302B of the handle 202. The main body portion 302A can be configured to accommodate most electrical and mechanical tool components and be coupled to the shaft portion 204. The base portion 302B can extend from the main body portion 302A and be configured to rest in the palm of the user, near the palm, or facing the palm when the user holds the handle 202.

[0046] The lever or trigger 208 is movably coupled to the housing 302 in front of the base portion 302B so that when the user grasps the handle 202, the user's fingers wrap around or otherwise contact the lever or trigger 208. The lever or trigger 208 can be coupled to the housing 302 at a pivot point 304, which allows the lever or trigger 208 to move relative to the base portion 302B. Representatively, the lever or trigger 208 can move, pivot, or rotate around the pivot point 304 (e.g., a pivot joint or pin), for example, in a clockwise or counterclockwise direction. For example, the lever 208 can move in a first direction as shown by arrow 330 to a first or closed position, in which the lever 208 contacts or is otherwise close to the base portion 302B. In some aspects, the first direction can be considered to be a clockwise direction around the pivot point 304, a direction toward the base portion 302B, or any other direction that moves the lever 208 toward the base portion 302B to a position that is considered to be a closed position. The lever or trigger 208 can also move, pivot, or rotate about the pivot point 304 (e.g., pivot joint or pin), for example, in a second direction as indicated by arrow 332. For example, the lever 208 can move in the second direction to a second or open position in which the lever 208 is spaced a distance from the base portion 302B. In some aspects, the second direction can be considered to be a counterclockwise direction, a direction away from the base portion 302B, or any other direction that moves the lever 208 away from the base portion 302B to a position that is considered to be an open position.

[0047] As from Figure 3 and from Figures 4 to 8As can be further seen from the enlarged view of the portion of the handle in FIG. 2 , the lever or trigger 208 is also coupled to an actuation combiner mechanism 306 that combines the actuation force input from the lever or trigger 208 with a second actuation force input for enhancing tool functionality and / or control. Representatively, the actuation combiner mechanism 306 includes a combiner wheel 308 that is rotatably coupled to the handle 202 at a central pivot point 316. The central pivot point 316 can be, for example, a pin or other mechanism that connects the combiner wheel 308 to the handle 202, and the combiner wheel 308 can rotate or pivot about the pin or other mechanism. The lever or trigger 208 can be coupled to the combiner wheel 308 at a pivot point 312 via an input connector 310. Representatively, the input connector 310 can have a first end and a second end, the first end being connected to the combiner wheel 308 at a pivot point 312, and the second end being connected to the lever or trigger 208 at a pivot point 314. In this regard, movement of the lever or trigger 208 in the direction of arrows 330, 332 will provide an actuation force input to the combiner wheel 308. This actuation force input from the lever or trigger 208 can in turn be transmitted by the combiner wheel 308 to the actuation combiner output connector 318. The actuation combiner output connector 318 can be connected to the combiner wheel 308 at one end (e.g., at the central pivot point 316). The actuation combiner connector 318 can be connected to the yoke assembly 320 at the other end. The yoke assembly 320 translates in the direction of arrow 322 to drive movement of the tool gripper or jaw 206 in response to the opening or closing of the lever or trigger 208.

[0048] Representatively, in some aspects, the yoke assembly 320 can be connected to a spring (e.g., see Figure 6 206) and circuitry or other components 324 extending from the handle portion 202 via the shaft portion 204 to the jaws 206 for controlling the jaws 206 (and the application of energy). For example, in one aspect, moving the lever 208 to a closed position (e.g., toward the base portion 302B) can generate an actuation input force to the actuation combiner mechanism 306 via the input connection 310. This force is in turn transmitted to the output connection 318, which causes the yoke assembly 320 to translate and cause the jaws (not shown) to close, reduce the size of the jaw gap, increase the clamping force on the tissue, etc., as previously described. Conversely, moving the lever 208 to an open position (e.g., away from the base portion 302B) can generate an actuation input force to the actuation combiner mechanism 306 via the input connection 310. This force is in turn transmitted to the output connector 318, which causes the yoke assembly 320 to translate in the opposite direction and cause the jaws (not shown) to open, increase the size of the jaw gap, reduce the clamping force, etc., as previously described.

[0049] It can also be seen from this view that the actuation combiner mechanism 306 is also connected to another input connection 326. The input connection 326 generates or produces a second actuation force input. The combiner mechanism 306 combines this second actuation force input of the input connection 326 with the actuation force input from the lever 208 to output a combined force via the output connection 318. Representatively, in some aspects, the combination ratio of the two inputs from the connections 310, 326 can be controlled by selecting or changing the ratio of the radial distances of the pivot points 312, 334 to the combiner wheel center pivot point 316. Representatively, as from Figure 4 As can be seen from the enlarged view of the combiner mechanism 306 in FIG, the pivot point 334 of the input connector 326 on the combiner wheel 308 has a radial distance (r1) from the center pivot point 316 of the combiner wheel 308. In addition, the pivot point 312 of the input connector 310 on the combiner wheel 308 has a radial distance (r2) from the center pivot point 316 of the combiner wheel 308. The ratio of these radial distances (r1) and (r2) can be selected or changed to achieve a desired combination ratio of the two inputs. Representatively, for the input connector 310, the combination ratio of the two inputs can be expressed as follows: r1 / (r1+r2). On the other hand, for the input connector 326, the combination ratio of the two inputs can be expressed as follows: r2 / (r1+r2). In this regard, if the radial distance (r1) of the connector 326 is selected to be greater than the radial distance (r2) of the connector 310, the force required to generate the output will be reduced. Subsequently, it may be necessary to apply less input force to the combiner wheel 308 through the connector 326 (e.g., a preload spring coupled to the connector 326 may be less compressed and generate less force on the connector 326). When the radial distance (r1) and the radial distance (r2) are the same, half of the actuation force input comes from the connector 326 and half of the actuation force input comes from the connector 310. In some aspects, the radial distance (r1) or (r2) can be changed by including a slot in the combiner wheel 308 that allows the pivot points 312, 334 (e.g., pivot point pins) to slide radially along the combiner wheel 308 to different positions closer to or farther from the central pivot point 316.

[0050] In some aspects, the input connector 326 is connected to an adjustment mechanism or lever 328 that generates an actuation force input that adjusts the position of the combiner wheel and can be used to set the default open position of the lever 208. For example, the adjustment lever 328 can be movably (e.g., rotatably) connected to the handle housing 302 (e.g., the body portion 302A) at a pivot point 338 so that it can pivot / rotate in a clockwise or counterclockwise direction, as shown by arrow 340. The input connector 326 can include one end coupled to the combiner wheel 308 at a pivot point 334 and another end connected to the adjustment lever 328 at a pivot point 336. In some aspects, the adjustment lever 328 can have an elongated shape (e.g., rectangular, teardrop-shaped, etc.), and the pivot point 336 of the input connector 326 can be located at one end, while the pivot point 338 of the lever 328 is located at the other end. It should be noted that any pivot points discussed herein (e.g., pivot points 304, 312, 314, 316, 334, 336, 338) may be formed, for example, by a pin, bolt, or other connecting member that is positioned through the connected components in a manner such that one or more of the components can move about the pin or bolt and relative to each other.

[0051] Rotation or pivoting of the adjustment lever 328 about the pivot point 338 in a counterclockwise direction (e.g., to the left) or clockwise direction (e.g., to the right) pushes or pulls the input connector 326 to the left or right, thereby generating an actuation force input from the input connector 326 to the combiner wheel 308. This pushing or pulling on the combiner wheel 308 can in turn cause the combiner wheel 308 to translate (e.g., move to the left or right) and / or rotate (e.g., clockwise or counterclockwise) between different positions. Movement of the combiner wheel 308 between these different positions can be used to change the default position of the input connectors 310, 326 and / or the default open position of the lever 208 coupled to the input connector 310. Representatively, as shown from Figure 5 , in which the combiner wheel 308 is omitted and shown in phantom so that the structure below the wheel 308 is more visible, the central pivot point 316 is formed by a pin that is translatable within a slot 502 coupled to the housing 302 as indicated by arrow 504. For example, the pin is translatable between a first position proximate an end 506 of the slot 502 and a second position proximate an end 508 of the slot.

[0052] The translation of the pin within the slot 502 may also cause the combiner wheel 308 attached to the pin to translate and / or rotate between different positions. The translation and / or rotation of the combiner wheel 308 in turn changes the default position of the input connectors 310, 326. For example, as shown in FIG. Figure 4It can be seen that when the pin forming the center pivot point 316 of the combiner wheel 308 is closer to the end 506 of the slot 502 (e.g., moved to the right), the combiner wheel 308 can move and / or rotate to the right, causing the pivot point 334 and the input connection member 326 to move to the left and the pivot point 312 and the input connection member 312 to move to the right and have a first default position. In this regard, the pivot point 334 can be considered to be on the left side of the center, while the pivot point 312 can be considered to be on the right side of the center, as shown by the diagonal line through the center point 316. Conversely, when the pin forming the center pivot point 316 of the combiner wheel 308 is closer to the end 508 of the slot 502 (e.g., moved to the left), the combiner wheel 308 can move and / or rotate to the left, causing the pivot point 334 and the input connection member 326 to move to the right and the pivot point 312 and the input connection member 310 to move to the left and have a second default position.

[0053] from Figure 6 An exemplary mechanism including a rack and pinion for driving the movement of the pivot point 316 can be seen. Representatively, as shown in FIG. Figure 6As can be seen, the adjustment lever 328 may include a circular gear member 638 (e.g., a pinion) attached to the adjustment lever 328 such that rotation of the adjustment lever 328 about the pivot point 338 drives rotation of the gear member 638. The input connection 326 may include a linear gear member 626 (e.g., a rack) that can translate in the direction of arrow 628 (e.g., left or right) and is positioned above and in contact with the circular gear member 638. The combiner wheel 308 may also include a circular gear member 608 that rotates about the central pivot point 316. The linear gear member 626 may also be positioned above and in contact with the circular gear member 608. In this regard, translation of the linear gear member 626 in the direction of arrow 628 may also drive or otherwise cause movement of the gear members 638 and 608. For example, movement of the adjustment lever 328 in a counterclockwise direction (as indicated by arrow 340) or to the left about the pivot point 338 will cause the circular gear member 638 to rotate in a counterclockwise direction. This rotation of the circular gear member 638 in a counterclockwise direction as indicated by arrow 340 will in turn cause the linear gear member 626 to translate to the left. This translation of the linear gear member 536 to the left will in turn cause the circular gear member 608 attached to the combiner wheel 308 to rotate in a counterclockwise direction about the pivot point 316 as indicated by arrow 650. Since the circular gear member 608 is attached to the combiner wheel 308, this will also cause the combiner wheel 308 to rotate and / or translate within the slot 502 between the ends 506, 508. On the other hand, movement of the adjustment lever 328 in a clockwise direction or to the right about the pivot point 338 will cause the circular gear member 638 to rotate in a clockwise direction. This rotation of the circular gear member 638 in a clockwise direction will in turn cause the linear gear member 626 to move to the right. This translation of the linear gear member 536 to the right, in turn, causes the circular gear member 608 attached to the combiner wheel 308 to rotate in a clockwise direction about the pivot point 316, as indicated by arrow 650. Since the circular gear member 608 is attached to the combiner wheel 308, this will also cause the combiner wheel 308 to rotate and / or translate within the slot 502 between the ends 506, 508.

[0054] Since two input connectors 310, 326 are attached to the combiner wheel 308, the movement (rotation and / or translation) of the combiner wheel 308 will then change the default position of the connectors 310, 326. For example, the default position of the connectors 310, 326 can be translated to different starting default positions in the directions shown in arrows 628, 642. In some aspects, changing the default position of the connectors 310, 326 can also set the default open and / or closed position of the lever 208. This aspect can help improve ergonomics, because the default position of the lever 208 can be set or otherwise changed according to the size of the user's hand. In the further aspect that the tool is motorized (for example, the mechanism 328 is replaced by a motor), these aspects can be used to allow low-force closure to be used as a default value, so as to have a soft clamping force. For example, it is conceivable that once low-force clamping is completed, the motor can set the tool to high force just before the sealing energy is delivered, thereby allowing the motor to perform final high-force clamping.

[0055] Referring now in more detail to the ergonomic advantages discussed earlier, Figure 7 and Figure 8 The default positions of large openings (e.g., larger hands) and small openings (e.g., smaller hands) are shown, respectively. Figure 7 As can be seen, moving the adjustment lever 328 to the left (e.g., counterclockwise about the pivot point 338) causes the center pivot point 316 of the combiner wheel to move in the direction of arrow 504 to a position proximate the right end 506 of the slot 502. Additionally, this can cause the combiner wheel to rotate in a counterclockwise direction (not shown) about the pivot point 338, thereby substantially extending the input connector 326 and pushing the input connector 310 attached to the lever 208 in the direction of arrow 702. In other words, the pivot point 334 of the input connector 326 moves to the left of the center pivot point 316, while the pivot point 312 of the input connector 310 moves to the right of the center pivot point 312. This arrangement, in turn, pushes the lever 208 away from the base portion 302B of the handle, resulting in a wider or larger default open position of the lever 208, as shown by the distance (D1). This wider or larger default open position (D1) may be more comfortable or otherwise desirable for users with relatively large hands. In some aspects, a user may appreciate that movement of the adjustment lever 328 to the left or placement of the lever 328 to the left of the center position will set the default position of the lever 208 to the wider or larger default open position (D1).

[0056] On the other hand, as Figure 8As can be seen, moving the adjustment lever 328 to the right (e.g., clockwise about the pivot point 338) causes the center pivot point 316 of the combiner wheel to move in the direction of arrow 504 to a position proximate the left end 508 of the slot 502. Additionally, this can cause the combiner wheel to rotate in a clockwise direction (not shown) about the pivot point 338, thereby substantially shortening the input connector 326 and pulling the input connector 310 attached to the lever 208 in the direction of arrow 802. In other words, the pivot point 334 of the input connector 326 and the pivot point 312 of the input connector 310 are substantially vertically aligned with each other and with respect to the center pivot point 312. This arrangement, in turn, pulls the lever 208 toward the base portion 302B of the handle, resulting in a narrower or smaller default open position of the lever 208, as shown by the distance (D2). In some aspects, the user may appreciate that movement of the adjustment lever 328 to a more upright position or placement of the lever 328 in a central position will set the default position of the lever 208 to the narrower or smaller default open position (D1). The narrower or smaller default open position (D2) may be more comfortable or otherwise desirable for users with relatively small hands.

[0057] It can be further understood from the foregoing description that the actuation of each connector coupled to the combiner wheel contributes to the movement of other connectors. In some respects, the slot 502 can therefore be understood as limiting the degree of movement of the actuation transmission between the connectors. Representatively, when the output connector center pivot point 316 is within the limitation of the slot 502, the actuation of any connector contributes to the other two connectors. For example, when the center pivot point 316 is on the right side limitation (e.g., end 506) of the slot 502, the pull actuation on the input connector 326 will generate an actuation transmission only to the input connector 310. In addition, for the fixed position of the adjustment lever 328, only the push actuation force on the input connector 310 will be transmitted to the input connector 326. In this regard, the pull movement on the input connector 326 using the adjustment lever 208 will close (or reduce) the default position of the lever 328.

[0058] Reference now Fig. 9 , Fig. 9A cross-sectional side view of another aspect of a surgical tool handle with a combiner mechanism is shown. The tool handle 202 includes the same features as the handle previously discussed. For example, the handle 202 includes a housing 302 defining a handle body portion 302A and a base portion 302B, a lever 208 connected to the base portion 302B, and a yoke 320 connected to a circuit or other component 324 and an axis 204 for controlling a gripper or jaws (not shown). In addition, the handle 202 includes a combiner mechanism 306 that couples the handle input connector 310 and the input connector 326 to the output connector 318, which outputs the actuation force input by the connectors 310, 326 to the yoke 320. However, in this aspect, the input connector 326 is connected to the preload spring assembly 902. Thus, in this aspect, the combiner mechanism 306 combines the actuation input force generated, produced, or caused by the lever 208 from the link 310 with the actuation input force generated, produced, or caused by the preload spring 902 from the link 326. Additionally, in some aspects, the preload spring 902 may be used to drive the movement of the yoke 320, and reference to the actuation input force generated, produced, or caused by the preload spring 902 may be omitted. Figure 6 The yoke spring 640 discussed previously is described. It should be understood that the spring is Figure 6 The position on the yoke 320 discussed in the above is moved to Fig. 9 The input connection 326 shown in the Figure 300 may allow for a smaller spring to be used, since the force on the input connection 326 is a ratio of the output actuation force. Additionally, this may allow for easier adjustment of the preload force, and the possibility of utilizing a lower powered and smaller sized motor for any such adjustment. It is also contemplated that the force generated, produced, or caused by the preload spring 902, or the position of the preload spring 902 within the housing 302, in combination with the input force from the lever 208, may be used to modify, enhance, or improve certain functions of the tool handle 202.

[0059] For example, Fig. 9 As further shown, the tool handle assembly may include a force sensor 904 coupled to the output connector 318 for measuring the force output to the yoke 320 and / or the jaws or gripper. The tool handle assembly may also include a position sensor 906 coupled to the yoke 320 for indirectly measuring the position of the jaws or gripper (e.g., Figure 2318. The force sensor 904 is configured to measure the force output by the lever 208 and the spring assembly 902. The force sensor 904 is configured to measure the force output by the lever 208 and the spring assembly 902. The force sensor 904 is configured to measure the force output by the lever 208 and the spring assembly 902. The force sensor 904 is configured to measure the force output by the lever 208 and the spring assembly 902.

[0060] Alternatively, it is contemplated that in some configurations, another sensor 910 may be used to measure the length of the compression spring to determine the level of spring compression, which may also be used to provide jaw force information. This force information may then be used to determine (e.g., analyzed by a processor associated with the tool) the sealing pressure of the jaws on the tissue positioned therein. In addition, using the position sensor 906 to measure the position of the yoke 320 allows the jaw position (e.g., the size of the jaw gap) to be determined. For example, movement of the yoke 320 in a first direction may open the jaws or gripper, while movement of the yoke 320 in an opposite second direction may close the jaws or gripper. Therefore, the different positions to which the yoke 320 moves in the first and second directions may correspond to the size of the jaw gap when in the open and / or closed position. The position sensor 906 may be positioned along the rod 908 and connected to the yoke 320 so that the position sensor 906 may detect movement of the yoke 320 to different positions. This information from the position sensor may then be used to determine the size of the jaw gap. Understanding the sealing pressure or clamping force of the jaws and / or the size of the jaw gap allows for enhanced jaw control and sealing. For example, when performing a sealing operation with energy application, the force on the jaws may vary depending on the energy delivery, and / or the energy delivery may increase / decrease depending on the jaw position and / or the clamping force. For example, the energy delivery may increase / decrease depending on whether the jaws are determined to be more open or more closed. Representatively, if the jaws are determined to be less closed based on the position of the yoke 320 determined by the position sensor 906, and therefore the tissue is less compressed, the energy delivery may be reduced. On the other hand, if the jaw gap is determined to be smaller, and therefore the tissue is less compressed, the energy delivery may be increased. In addition, the user may control how much clamping force is applied to the tissue using the jaws based on the position of the jaws in the energy cycle. For example, the user may apply a smaller force when initially clamping onto the tissue, and then apply a larger force as the energy cycle proceeds.

[0061] The input force may be modified, for example, by adjusting the force output of the preload spring assembly 902, as will now be described with reference to Fig.10 , Fig.11 and Fig.12discussed in more detail. Figures 10 to 12 An enlarged view of the preload spring assembly 902 is shown. Representatively, as shown in FIG. Fig.10 As can be seen, the preload spring assembly 902 includes a spring 1002 positioned within a spring housing 1004. The spring 1002 can be connected to the input connector 326 so that the force from the spring 1002 provides an actuation input force to the input connector 326. The spring housing 1004 can be attached to a handle, such as the handle housing 302 discussed previously. The spring housing 1004 can be any type of housing or other structure capable of accommodating the spring 1002 in a desired position within the housing 302. The spring assembly 902 can also include a force adjustment member 1006 and a housing adjustment member 1008 coupled to the housing 1004 and / or the spring 1002. The force adjustment member 1006 can be any type of mechanism that can adjust the force output by the spring 1002. For example, in some aspects, the spring 1002 can be a compression spring. The force adjustment member 1006 can adjust the force of the compression spring 1002 by applying a load that compresses (or shortens) the spring and increases the force output, or by removing the load so that the spring expands and therefore the force output decreases.

[0062] Representatively, in some aspects, the force adjustment member 1006 can be a nut that is coupled to complementary threads around the housing 1004 and can be rotated to move it in the direction of arrow 1010 to compress or expand the spring 1002. For example, as Fig.11 As shown, when the nut 1006 is rotated in one direction about the housing 1004, it translates toward the spring 1002 in the direction of arrow 1010 and compresses the spring 1002 (or makes it shorter), thereby increasing the force output of the spring 1002. Rotating the nut 1006 in the opposite direction will cause the nut 1006 to translate in the opposite direction (e.g., back to the original position). Fig.10326), thereby allowing the spring 1002 to expand, thereby reducing the force output of the spring 1002. In some aspects, since the input force from the spring 1002 contributes to the jaw position control (via the input connector 326 connected to the combiner wheel and yoke), adjusting the nut 1006 to modify the force can be used to achieve different jaw sealing pressures (or clamping forces). For example, in the case where it is desired to increase the jaw sealing pressure (or clamping force), the compression of the preload spring 1002 by the force adjustment member 1006 can be increased to increase the force output by the spring 1002 to the input connector 326. This in turn increases the combined force output by the combiner mechanism to the yoke to drive the clamping of the jaws on the tissue. On the other hand, in the case where it is desired to reduce the jaw sealing pressure (or clamping force), the compression of the preload spring 1002 by the force adjustment member 1006 can be reduced to reduce the force output by the spring 1002 to the input connector 326. This in turn reduces the combined force output by the combiner mechanism to the yoke to drive the clamping of the jaws on the tissue.

[0063] Referring now to housing adjustment member 1008, housing adjustment member 1008 can be coupled to the housing and can be any type of mechanism that can adjust the position of housing 1004. Typically, adjustment member 1008 can translate housing 1004 to different positions, as indicated by arrow 1012. Typically, in some aspects, housing adjustment member 1008 can be a nut that couples to complementary threads around housing 1004 and can be rotated to move the nut in the direction of arrow 1012 to move housing 1004 left or right. For example, as shown in FIG. Fig.12 As shown, when the nut 1008 is rotated in one direction about the housing 1004, it causes the spring housing 1004 to translate in the direction of arrow 1012. Rotating the nut 1008 in the opposite direction will cause the housing 1004 to translate in the opposite direction (e.g., back to the Fig.10 ). Moving the spring housing 1004 can be used to adjust the handle position and improve the ergonomics of the user. Representatively, similar to the previous reference Figure 7 As discussed, moving the adjustment lever 328, moving the spring housing 1004 can change the default position of the combiner wheel 308 and the input connections 326, 310, which in turn changes the default position of the lever connected to the input connection 310. For example, moving the spring housing 1004 in the direction of arrow 1012 (to the left) can cause the combiner wheel 308 to rotate counterclockwise about the center point 316. Movement of the combiner wheel 308 causes the pivot point 334 of the input connection 326 to move to the left of the combiner center pivot point 316, and causes the pivot point 312 to move to the right of the combiner center pivot point 316, as shown in FIG. Fig.12This essentially lengthens the input connector 326 and pushes the input connector 310 away from the combiner wheel 308, which in turn pushes the lever 208 connected to the connector 310 away from the handle base portion. This results in a wider or larger default open position of the lever 208, similar to the use of Figure 7 Adjustment lever 328 discussed in.

[0064] In addition, as previously referenced Figure 4 As discussed, the ratio of the radial distances (r1) and (r2) of the pivot points 334, 312 to the central pivot point 316 of the combiner wheel 308 may also affect the preload spring force required to generate the desired output. For example, if the radial distance (r1) of the connector 326 is selected to be greater than the radial distance (r2) of the connector 310, the force required to generate the output is reduced or smaller. Therefore, a smaller preload spring force may be required to generate the output. In this regard, the compression of the preload spring 1002 by the force adjustment member 1006 may be reduced, which in turn reduces the force output by the spring 1002. Alternatively, in the case where the ratio of the radial distances (r1) and (r2) is selected to require a greater force input from the preload spring 1002, the adjustment member 1006 may be adjusted along the housing to increase the compression of the preload spring 1002. It should also be understood that although an adjustable preload spring 1002 that can be adjusted to modify the force is described, a fixed spring that is not adjustable in force is also conceivable. Where a fixed preload spring is used, the radial distances ( r1 ) and ( r2 ) of the pivot points 334 , 312 on the combiner wheel 308 may be modified or varied to adjust or otherwise achieve a desired force output, rather than changing the compression of the preload spring.

[0065] Representatively, such as Figures 13 to 15 As shown, the pin forming pivot point 334 can be positioned within an adjustment slot 1302 that extends outwardly in a substantially radial direction from the center pivot point 316. In some aspects, the slot 1302 can have a slight bend or bend, or can be relatively straight. To set or change the radial distance (r1), the user can adjust the pin forming pivot point 334 within the slot 1302 in the direction of the arrow to any number of positions between the ends 1304, 1306. Adjustment of the pin forming pivot point 334 within the slot 1302 further adjusts the position of the input connector 326 relative to the wheel 308 and the input connector 310. For example, as shown in FIG. Fig.13 As shown, when the pin forming pivot point 334 is close to the radially outermost end 1304 of the slot 1302, the radial distance (r1) of the pivot point 334 is greater than the radial distance (r2) of the pivot point 312 (e.g., r1>r2). Fig.14As shown, when the pin-forming pivot point 334 moves towards the radially innermost end 1306 of the slot 1302, the radial distance (r1) of the pivot point 334 is substantially equal to the radial distance (r2) of the pivot point 312 (e.g., r1 = r2). Although not shown, it should be understood that if the pin-forming pivot point 334 is moved all the way to the end 1306 of the slot 1302, the radial distance (r1) of the pivot point 334 may be less than the radial distance (r2) of the pivot point 312 (e.g., r1 < r2). The pin-forming pivot point 334 can be manually adjusted by the user, for example, by a knob or other mechanism coupled to the pin and extending from a handle that can be manually manipulated by the user. In other aspects, the adjustment can be automatic, such as by a motor that drives the movement of the pin and can be electrically connected to a button or other mechanism that the user can press to actuated the movement of the pin. Although the combiner wheel 308 is shown in the foregoing configuration as having a circular shape, it is contemplated that in other aspects, the combiner wheel 308 can have an elongated shape as Fig.15 shown. For example, the combiner wheel 308 can have a teardrop shape, where the slot 1302 is formed near the narrowest end 1502 of the wheel 308 to accommodate the adjustment of the pin-forming pivot point 334, thereby achieving different radial distances (r1) as described above.

[0066] Now refer to Fig.16 , Fig.16A cross-sectional side view of a tool handle including a motor is shown. The tool handle 202 can be similar to the tool handles previously discussed, except that in this configuration, the tool handle 202 includes a motor 1602 coupled to an input connector 326. Representatively, the tool handle 202 includes a housing 302 that forms a body portion 302A and a base portion 302B that enclose the handle components, and the housing is coupled to a tool shaft 204 that extends from the handle to a tool gripper or jaw. A lever 208 for controlling the tool gripper or jaw is also coupled to the handle housing 302 near the body portion 302B. The lever 208 is also connected to a combiner wheel 308 of the combiner mechanism 306 via an input connector 310. The combiner wheel 308 connects the input connector 310 to the input connector 326, and combines the input forces from the two connectors 310, 326 to the output connector 318 of the yoke 320. However, in this configuration, the input connector 326 is connected to the motor 1602 instead of the preload spring. In this regard, the tool handle can be considered to be automatic rather than manual, and / or many of the previously discussed functions can be automatic. The motor 1602 can be any type of motor suitable for providing the desired force input, such as an N20 motor. In addition, the handle can also include a plurality of sensors 904, 906, 1604, 1606 to detect the position of the various handle components, force input / output, etc. as previously described. For example, the tool handle can include a force sensor 904 and / or a position sensor 906 as previously described. In addition, in some aspects, the tool handle can also include a sensor 1604 coupled to the motor 1602 to detect or determine the position of the jaws and / or a sensor 1606 coupled to the lever 208 to detect or determine, for example, the position of the lever 208. In some aspects, one or more of the sensors 1604, 1606 can be an encoder that detects the movement of the jaws and / or the lever and outputs a corresponding electrical signal that can be used to determine the position of the jaws and / or the lever. For example, an encoder 1604 coupled to the motor 1602 can indicate the position of the motor 1602, which can be used to determine how much the yoke 320 has moved, and in turn, how much the jaws are opening or have opened (e.g., the size of the jaw gap). In some aspects, the position sensor 906 coupled to the yoke 320 can be omitted where the motor 1602 includes an encoder 1604 to detect or determine the jaw position (e.g., the size of the jaw gap).

[0067] The motor 1602, in combination with the information measured by the sensors 904, 906, 1604 and / or 1606, can provide, generate or otherwise generate an actuation force input to the input connector 326, which is combined with the actuation force input of the input connector 310 through the combiner wheel 308 to provide enhanced functionality and / or additional functions to the tool 202. For example, the motor 1602 can be used to replace the preload spring to automate the tool handle while still providing many of the same enhanced and / or new functions discussed previously, such as improved sealing, tissue characteristic identification, motor sealing, improved ergonomics, jaw control, overfilled jaw detection, auxiliary lever closure, user-adjustable sealing force, jaw gap and force measurement. Representatively, the combination of jaw gap and force data as described above can be used to detect overfilled jaw conditions, determine appropriate sealing parameters, abnormal sealing sequences or other functions. Further, the motor control loop or energy delivery can be closed based on the jaw pressure or force data to optimize the sealing procedure.

[0068] For example, the motor 1602 can enhance the function of the lever 208 to provide fine jaw movement and improved jaw control. Representatively, as previously described, the sensor 1606 can be an encoder that can be used to indicate the movement or position of the lever 208, for example, the degree to which the lever 208 is closed or opened (e.g., the open position distance D1, D2 or any position / distance therebetween). In addition, the encoder 1604 coupled to the motor 1602 determines the movement of the motor 1602. The motor 1602 can therefore be controlled to increase or enhance the output of the lever 208, or to reduce the output of the lever 208. For example, in the case where the movement of the jaw is expected to be large, the motor 1602 can output a larger force in the same direction as the lever 208, which in turn causes the yoke 320 to move faster and for a given lever movement causes a greater movement of the jaw. On the other hand, in the case where a finer movement is expected, the force output of the motor 1602 can be in the opposite direction to the lever force output, which in turn causes the yoke 320 to move more slowly. In this regard, motor actuation may be used to supplement manual lever actuation to provide more controlled and / or refined jaw movement as desired.

[0069] In a further aspect, the motor 1602 can help provide motorized dynamic and / or variable jaw force and jaw gap control during tissue sealing. This functionality can be similar to that previously described with reference to Figure 8The jaw force control discussed in the preload spring configuration of the present invention is motorized (e.g., adjusted using a motor) rather than manual (e.g., adjusted by manually modifying the preload spring force). In particular, as previously described, when sealing, it may be desirable to control one or both forces on the jaws and / or energy delivery relative to each other. For example, a user may wish to deliver more or less energy depending on the size of the jaw opening. Representatively, if the jaws are determined to be less closed based on the position of the yoke 320 determined by the sensor 906 or 904, and therefore the compression of the tissue is less, the energy delivery can be reduced. On the other hand, if it is determined that the jaw gap is smaller, and therefore the compression of the tissue is less, the energy delivery can be increased. In addition, the user can use the motor 1602 to control how much clamping force is applied to the tissue using the jaws according to the position of the jaws in the energy cycle. For example, the user can reduce the motor output to produce a smaller force when initially clamped to the tissue, and then increase the motor output to produce a larger force as the energy cycle proceeds.

[0070] In addition, the motor 1602 can be used to provide micro-modulation or shaking during surgical procedures. Representatively, in some aspects, the movement of the yoke and / or the opening or closing of the jaws may be subject to friction, which may ultimately reduce performance. For example, if there is a friction force opposite to the force output for driving the jaws to move, the force applied to the jaws may actually be reduced. Introducing micro-modulation (e.g., micro-vibration) into the components used to drive these actions can help reduce friction, thereby resulting in an increased force output or driving force on the jaws. In some aspects, these micro-vibrations may be output by an actuator 1608, which is a part of the motor 1602 or otherwise associated with the motor, and the actuator is operable to generate micro-vibrations that can be output by the motor 1602. The micro-modulation generated by the motor 1602 is fed into the combiner mechanism 308, which in turn introduces the micro-modulation into the output connector 318 so that it is realized in the force output. In addition, micro-modulation information can be used to provide real-time tissue mechanical property information, such as information about tissue stiffness, tissue relaxation, etc. Furthermore, micro-modulation can be used to achieve more effective tissue compression and reduce the final gap while applying the same maximum force as in non-modulated compression.

[0071] Representatively, Fig.17A graph comparing jaw gap size and tissue stiffness is shown, which can be determined using micro-modulation force. For example, vertical lines 1702, 1706 indicate when the user starts sealing or applying energy, and vertical lines 1704 and 1708 indicate when the user ends sealing or terminates energy application. As can be seen from line 1710 of the figure above, which shows the change in jaw gap size over time, the jaw gap size decreases between the time when the user starts sealing and the time when the user ends sealing, and the jaw gap size can be determined using an encoder coupled to the motor as described above. In addition, it can be seen that there is a more significant reduction during the first sealing operation (e.g., between lines 1702 and 1704) compared to the second sealing operation (e.g., between lines 1706 and 1708). However, the clamping force is constant, so the reduced jaw gap size is the result of the change in tissue stiffness characteristics as energy is applied. Using this information related to the change in jaw gap size and micro-modulation force information, the change in stiffness can be shown as shown in line 1712 of the figure below. Representatively, stiffness can be measured as the ratio of the peak-to-peak micro-modulation force divided by the peak-to-peak change in the jaw gap size. This ratio can be measured in real time because the micro-modulation force is continuously monitored, resulting in real-time tissue stiffness or characteristic measurement. It can be understood from line 1712 of the graph that during the first sealing operation (e.g., the period between lines 1702 and 1704), stiffness has some changes. When the first sealing operation is completed, it can be seen from line 1712 that stiffness begins to rise. Once the second seal begins, as shown by vertical line 1706, during the second sealing operation (e.g., the period between lines 1706 and 1708), stiffness begins to decrease again. This information related to tissue stiffness and / or relaxation can be used to achieve more effective tissue compression and / or sealing operations. For example, real-time understanding of tissue properties (such as stiffness and / or relaxation) can help identify different types of tissues during the sealing operation and therefore identify when to apply more / less clamping force and / or energy, and monitor the sealing cycle.

[0072] Furthermore, it is conceivable that the previous reference Figures 13 to 15 Any of the mechanisms discussed may also be used in combination with a motor to change or modify the ratio of the radial distances (r1) and (r2) from the pivot points 334, 312 to the center pivot point 316 of the combiner wheel 308 to modify the force required to generate the desired output. For example, if the radial distance (r1) of the connector 326 is selected to be greater than the radial distance (r2) of the connector 310, the motor force required to generate the output is reduced or smaller. Therefore, a smaller motor output force may be required to generate the output. Alternatively, in the case where the ratio of the radial distances (r1) and (r2) is selected to require a higher force input, the force output by the motor 1602 may be increased.

[0073] In further aspects, it is contemplated that any of the previously discussed tool configurations (e.g., manual or motorized) may have a tactile feedback mechanism. Representatively, it is contemplated that in some aspects, the movement of the yoke may present a tactile output (e.g., force, vibration, or motion) to the lever 208, which may be felt by the user when using the tool 200. Representatively, in some aspects, when the lever 208 is moved (e.g., squeezed or released) by the user, it may cause the yoke to move, and the movement of the yoke may be felt by the user's hand as a vibration, resistance feedback, or other tactile signal on the lever 208. The tactile output may indicate to the user, for example, that the jaws are moving, closing, clamping, cutting, applying energy, etc. on the tissue, or that these operations are terminating. In this way, the tool allows the user to feel that they are working directly on the patient, even if they are away from the patient.

[0074] Fig.18 1 is a block diagram of a computer portion of a surgical robotic system that is operable to implement any one or more of the operations described above. An exemplary surgical robotic system 1800 may include a user console 102, a surgical robot 120, and a control tower 103. The surgical robotic system 1100 may include other or additional hardware components; therefore, the diagram is provided by way of example and not as a limitation of the system architecture.

[0075] As described above, the user console 102 may include a console computer 1811, one or more UIDs 1812, a console actuator 1813, a display 1814, a foot switch 1816, and a network interface 1818. In addition, the user console 102 may include multiple components, such as a UID tracker 1815, a display tracker 1817, and a console tracker 1819, for detecting various surgical conditions required for system operation (e.g., UID orientation, surgeon's orientation relative to the display, console chair orientation, etc.). It should also be understood that the user or surgeon sitting at the user console 102 can manually adjust the ergonomic settings of the user console 102, or the settings can be automatically adjusted according to a user profile or user preferences. Manual and automatic adjustments can be achieved by driving the console actuator 1813 based on user input or a configuration stored in the console computer 1811. The user can perform robot-assisted surgery by controlling the surgical robot 120 using one or more master UIDs 1812 and a foot switch 1816. The position and orientation of the UID 1812 is continuously tracked by the UID tracker 1815, and changes in state are recorded as user input by the console computer 1811 and dispatched to the control tower 103 via the network interface 1818. Real-time surgical video of the patient's anatomy, instruments, and related software applications can be presented to the user on a high-resolution 3D display 1814 (including an open display or an immersive display).

[0076] The user console 102 is communicatively coupled to the control tower 103. The user console also provides additional functionality for improving ergonomics. For example, the user console may be an open architecture system including an open display, but in some cases an immersive display may be provided. In addition, a height-adjustable surgeon's chair and a master UID tracked by an electromagnetic tracker or an optical tracker are included at the user console 102 for improved ergonomics.

[0077] The control tower 103 may be a mobile field care cart housing a touch screen display, a computer that controls the surgeon's robotically assisted manipulation of instruments, a safety system, a graphical user interface (GUI), a light source, and a video and graphics computer. Fig.18 As shown, the control tower 103 may include a central computer 1831 (including at least a visualization computer), a control computer and an auxiliary computer, various displays 1833 (including a team display and a nurse display), and a network interface 1838 that couples the control tower 103 to both the user console 102 and the surgical robot 120. The control tower 103 may provide additional features for user convenience, such as a nurse display touch screen, soft power and E-hold buttons, a user-facing USB for video and still images, and an electronic caster control interface. The auxiliary computer may also run real-time Linux, providing logging / monitoring and interaction with cloud-based web services.

[0078] The surgical robot 120 may include an operating table 1824 having a plurality of integrated robotic arms 1822 that may be positioned over a target patient anatomy. Energy tools 1823 may be attached to or detached from the distal ends of the arms 1822, enabling the surgeon to perform a variety of surgical procedures. The energy tools 1823 may be as previously described with reference to Figures 2 to 17Any one or more of the energy tools discussed. The surgical robot 120 may also include a control interface 1825 for manually or automatically controlling the arm 1822, the table 1824, and the tool 1823. The control interface may include items such as, but not limited to, remote controls, buttons, panels, and touch screens. Other accessories such as trocars (cannulas, sealing cartridges, and obturators) and drapes may also be required to perform surgery using the system. In some variations, the plurality of arms 1822 include four arms mounted on both sides of the operating table 1824, with two arms on each side. For a particular surgical procedure, the arm mounted on one side of the table can be positioned on the other side of the table by stretching and crossing under the table and the arm mounted on the other side, so that a total of three arms are positioned on the same side of the table 1824. The surgical tool may also include a table computer 1821 and a network interface 1828, which can place the surgical robot 120 in a position to communicate with the control tower 103.

[0079] For the purpose of explanation, the foregoing description uses specific nomenclature to provide a thorough understanding of the present invention. However, it will be apparent to those skilled in the art that specific details are not required to practice the present invention. The foregoing descriptions of specific aspects of the present invention have been provided for the purposes of illustration and description. They are not intended to be exhaustive or to limit the present invention to the specific forms disclosed; various modifications and changes may be made to the present disclosure in light of the above teachings. The embodiments are selected and described in order to best explain the principles of the present invention and its practical application, so that other persons skilled in the art can best utilize the present invention and various embodiments with various modifications suitable for the specific purposes contemplated.

Claims

1. A surgical tool for a surgical robot system, the surgical tool comprising: a surgical tool grasper having jaws operable to perform a surgical procedure; a handle coupled to the surgical tool gripper and having a lever operable to actuate the jaws; and An actuation combiner mechanism is coupled to the lever and is operable to combine a first actuation force input from a lever input connector of the lever with a second actuation force input from a mechanical input connector of a mechanical actuator into an output connector to control operation of the jaw or the lever.

2. The surgical tool according to claim 1, wherein: The actuation combiner mechanism includes a combiner wheel that rotates about a central pivot point and couples the lever input link and the mechanical input link to the output link, and the output link is coupled to a yoke that moves to open or close the jaws.

3. The surgical tool according to claim 2, wherein: The lever input link is coupled to the combiner wheel at a first pivot point, the mechanical input link is coupled to the combiner wheel at a second pivot point, and the output link is coupled to the combiner wheel at the center point.

4. The surgical tool according to claim 3, wherein: A first end of the lever input link is coupled to the combiner wheel at the first pivot point, and a second end of the lever input link is coupled to the lever such that movement of the lever moves the lever input link.

5. The surgical tool according to claim 3, wherein: The mechanical actuator is an adjustment lever, the first end of the mechanical input link is coupled to the combiner wheel at the second pivot point, and the second end of the mechanical input link is coupled to the adjustment lever, and movement of the adjustment lever adjusts the position of the combiner wheel to set the default open position of the lever.

6. The surgical tool according to claim 3, wherein: The mechanical actuator is a preload spring, the first end of the mechanical input link is coupled to the combiner wheel at the second pivot point, and the second end of the combiner input link is coupled to the preload spring, and the second actuation force input of the mechanical input link is generated by the force output by the preload spring.

7. The surgical tool according to claim 6, wherein: An adjustable nut is coupled to the preload spring to allow adjustment of the second actuation force input to move the combiner input connection.

8. The surgical tool according to claim 3, wherein: The combined actuation force output of the output links is selected by modifying the ratio of the distances of the first pivot point and the second pivot point to the combiner wheel output center point.

9. The surgical tool according to claim 8, wherein: The combiner wheel includes a radially oriented slot, and the first pivot point is defined by a pin operable to slide within the radially oriented slot to modify a distance of the first pivot point to the combiner wheel output center point.

10. The surgical tool of claim 1, further comprising a tactile feedback mechanism that provides a user with tactile output corresponding to operation of the jaw or the lever.

11. A surgical tool for a surgical robot system, the surgical tool comprising: a surgical tool grasper having jaws operable to perform a surgical procedure; a handle coupled to the surgical tool gripper and having a lever operable to actuate the jaws; and An actuation combiner mechanism is coupled to the lever and is operable to combine the actuation force output of the lever with the actuation force output of a preload spring to control operation of the jaws or the lever.

12. The surgical tool according to claim 11, wherein: The actuating combiner mechanism includes a combiner wheel that rotates about a central pivot point and couples a lever input connector from the lever and a spring input connector from the preload spring to an output connector that is coupled to a yoke that is operable to control the opening or closing of the jaws.

13. The surgical tool according to claim 11, wherein: Movement of the lever toward the closed position generates the actuation force output of the lever in a first direction, which causes the yoke to move the jaws to the closed position.

14. The surgical tool according to claim 13, wherein: Movement of the lever to the open position generates the actuation force output of the lever in a second direction, which causes the yoke to move the jaws to the open position.

15. The surgical tool according to claim 11, wherein: A force adjustment member is coupled to the preload spring to increase or decrease the actuation force output of the preload spring.

16. The surgical tool according to claim 11, wherein: A position adjustment member is coupled to the preload spring and is operable to move the preload spring between a first position in which the lever is in a first default open position and a second position in which the lever is in a second default open position.

17. The surgical tool according to claim 11, wherein: The actuating combiner mechanism includes a combiner wheel coupled to a first link of the lever at a first pivot point and to a second link of the preload spring at a second pivot point, and wherein a position of the combiner wheel about the first pivot point is operable to be modified to increase or decrease a force output by the actuating combiner mechanism to control operation of the jaws.

18. A surgical tool for a surgical robotic system, the surgical tool comprising: a surgical tool grasper having jaws operable to perform a surgical procedure; a handle coupled to the surgical tool gripper and having a lever operable to actuate the jaws; and An actuating combiner mechanism includes a combiner wheel, a lever input connector coupled to the combiner wheel and to the lever at a first pivot point, an adjustment input connector coupled to the combiner wheel at a second pivot point and to an adjustment lever operable to adjust a default open position of the lever, and an output connector coupled to a yoke that causes the jaws to open or close.

19. The surgical tool according to claim 18, wherein: The combiner wheel is operable to translate along a slot in response to movement of the adjustment lever to set the default open position of the lever.

20. The surgical tool according to claim 19, wherein: Movement of the adjustment lever in a counterclockwise direction about the pivot point translates the combiner wheel in a first direction and sets a first default open position of the lever.

21. The surgical tool according to claim 20, wherein: Movement of the adjustment lever in a clockwise direction about the pivot point translates the combiner wheel in a second direction and sets a second default open position of the lever that is less than the first default open position.

22. The surgical tool according to claim 18, wherein: The combiner wheel includes a circular gear member and the adjustment input connection includes a linear gear member coupled to the circular gear member such that movement of the adjustment lever causes movement of the combiner wheel and sets a default open position of the lever.

23. A surgical tool for a surgical robotic system, the surgical tool comprising: a surgical tool grasper having jaws operable to perform a surgical procedure; a handle coupled to the surgical tool gripper and having a lever operable to actuate the jaws; and An actuation combiner mechanism is coupled to the lever and is operable to combine the actuation force output of the lever with the actuation force output of the motor to control operation of the jaw or the lever.

24. The surgical tool according to claim 23, wherein: The actuation combiner mechanism includes a combiner wheel that rotates about a central pivot point and couples a lever input connection from the lever and a motor input connection from the motor to an output connection that controls operation of the jaws or the lever.

25. The surgical tool according to claim 24, wherein: The lever input connection is coupled to the combiner wheel at a first pivot point at a first radial distance from the central pivot point, and the motor input connection is coupled to the combiner wheel at a second pivot point at a second radial distance from the central pivot point.

26. The surgical tool according to claim 25, wherein: The combined actuation force output of the output connection is selected by modifying a ratio of the first radial distance and the second radial distance.

27. The surgical tool according to claim 25, wherein: The combiner wheel includes a radially oriented slot, and the first pivot point is defined by a pin operable to slide within the radially oriented slot to modify a distance of the first pivot point to the combiner wheel output center pivot point.

28. The surgical tool of claim 23, wherein: The motor also includes a sensor for determining the position of the jaws during operation.

29. The surgical tool according to claim 28, wherein: The sensor is an encoder that detects the position of the motor to indirectly determine the position of the jaws during operation.

30. The surgical tool of claim 23, wherein: The motor also includes an actuator operable to output a fine modulation frequency to an output connection of the actuation combiner mechanism.

31. The surgical tool of claim 23, further comprising a tactile feedback mechanism that provides a user with tactile output corresponding to operation of the jaw or the lever.

32. A motorized surgical tool for a surgical robotic system, the surgical tool comprising: a surgical tool grasper having jaws operable to perform a surgical procedure; a handle coupled to the surgical tool gripper and having a lever operable to actuate the jaws; and An actuating combiner mechanism includes a combiner wheel, a lever input connector coupled to the combiner wheel and to the lever at a first pivot point, a motor input connector coupled to the combiner wheel and to a motor at a second pivot point, and an output connector coupled to a yoke that causes the jaws to open or close.

33. The motorized surgical tool of claim 32, wherein: Movement of the lever toward the closed position generates an actuation force output of the lever in a first direction that causes the yoke to move the jaws to the closed position.

34. The motorized surgical tool of claim 33, wherein: Movement of the lever to the open position generates an actuation force output of the lever in a second direction, which causes the yoke to move the jaws to the open position.

35. The motorized surgical tool of claim 34, wherein: The combiner mechanism combines the actuation force output of the lever in the first direction or the second direction with the actuation force output of the motor to move the jaw.

36. The motorized surgical tool of claim 35, wherein: The combined actuation force output of the lever and motor is operable to be modified by modifying a ratio of a first radial distance from the first pivot point to a center of the combiner wheel to a second radial distance from the second pivot point to the center of the combiner wheel.

37. The motorized surgical tool of claim 35, wherein: The combiner wheel includes a radially oriented slot, and a pin defining the first pivot point is adjustable within the slot to modify the first radial distance.

38. The motorized surgical tool of claim 37, wherein: The radially oriented slots are curved.

39. The motorized surgical tool of claim 35, wherein: The combiner wheel comprises an elongated shape.

40. The motorized surgical tool of claim 32, wherein: The motor also includes an encoder that detects the position of the motor to indirectly determine the position of the jaws during operation.

41. The motorized surgical tool of claim 32, wherein: The motor also includes an actuator operable to output a fine-modulation frequency to the output connection.

42. The motorized surgical tool of claim 32 further comprising a tactile feedback mechanism that provides a tactile output to a user corresponding to operation of the jaws.

43. A surgical tool for a surgical robotic system, the surgical tool comprising: a surgical tool grasper having jaws operable to perform a surgical procedure; a handle coupled to the surgical tool gripper and having a lever operable to actuate the jaws; an actuation combiner mechanism coupled to the lever and operable to combine the actuation force output of the lever with the actuation force output of a motor into an output connection to control the jaw or the lever; and One or more processors configured to analyze characteristics associated with the actuation force output of the lever or the motor to optimize the surgical procedure.

44. The surgical tool according to claim 43, wherein: The actuation combiner mechanism includes a combiner wheel that rotates about a central pivot point and couples a lever input connection from the lever and a motor input connection from the motor to an output connection that controls operation of the jaws or the lever.

45. The surgical tool of claim 43, further comprising one or more sensors operable to measure an actuation force output by the motor, a size of a jaw gap, or a position of the lever.

46. ​​The surgical tool of claim 45, wherein: The processor is operable to determine a clamping force of the jaws on tissue based on the actuation force output by the motor.

47. The surgical tool according to claim 46, wherein: The surgical procedure is a sealing operation, and the processor is further operable to modify the clamping force of the jaws on the tissue or the size of the jaw gap to optimize the sealing operation.

48. The surgical tool of claim 46, wherein: Based on the clamping force of the jaws or the jaw gap, the processor is operable to determine a characteristic of the surgical procedure, the characteristic including at least one of an overfilled jaw condition, a sealing parameter, or an abnormal sealing sequence.

49. The surgical tool according to claim 48, wherein: The sealing parameters include the stiffness of the tissue.

50. The surgical tool of claim 43, wherein: The processor is operable to control a direction of the actuation force output of the motor based on the lever position.

51. The surgical tool of claim 43, wherein: The motor is further operable to output a finely modulated frequency to the output connection.

52. The surgical tool of claim 51, wherein: The fine modulation frequency can be operated to reduce the effect of friction on the operation of the jaws or the lever.

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