Medical device wrist

Abstract

A medical device includes a wrist link, a tool member, and a tension element. The wrist link includes discrete first link members and discrete second link members. The first link includes a first U-lug and the second link includes a second U-lug. The second link is coupled to the first link such that the second U-lug is positioned opposite the first U-lug and to define a tension element guide channel between the first link and the second link. The tool member is coupled to rotate about a tool member axis of rotation between the first U-shaped lug and the second U-shaped lug. The tension element is coupled to the tool member and extends from the tool member through the tension element guide channel. Tension on the tension element causes the tool member to rotate about the tool member axis of rotation.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application claims priority to U.S. Provisional Application Serial No. 63 / 319,971, filed on March 15, 2022, entitled “Medical Device Wrist,” which is incorporated herein by reference in its entirety. Background Art

[0003] Embodiments described herein relate to medical devices, and more particularly to endoscopic tools. More particularly, embodiments described herein relate to medical devices including a wrist mechanism having one or more links constructed from a plurality of discrete pieces.

[0004] Known minimally invasive surgery (MIS) techniques utilize instruments to manipulate tissues, which can be controlled manually or by computer-assisted remote operation. Many known MIS instruments include a treatment or diagnostic end effector (e.g., forceps, cutting tools, or cautery tools) mounted on a wrist mechanism at the distal end of a shaft. During the MIS procedure, the distal end of the end effector, wrist mechanism, and shaft are inserted into a small incision or natural orifice of the patient to position the end effector at a working site in the patient's body. The wrist mechanism can be used to change the orientation of the end effector relative to the shaft to perform the desired procedure at the working site. Known wrist mechanisms generally provide desired mechanical degrees of freedom (DOF) for the movement of the end effector. For example, known wrist mechanisms can change the pitch and yaw orientation of the end effector relative to the longitudinal axis of the shaft. The wrist can optionally provide the end effector with a rolling DOF relative to the shaft, or the rolling DOF of the end effector can be implemented by rolling the shaft, wrist, and end effector together as a unit. The end effector can optionally have additional mechanical DOFs, such as gripping or blade motion. In some cases, the mechanical DOF of the wrist and end effector can be combined to provide various end effector control DOFs. For example, U.S. Pat. No. 5,792,135 (filed May 16, 1997) discloses a mechanism in which the mechanical DOF of the wrist and end effector gripping is combined to provide the yaw control DOF of the end effector.

[0005] In order to achieve the desired movement of the distal wrist mechanism and the end effector, known instruments include a cable that extends through the instrument shaft and connects the wrist mechanism to a mechanical structure configured to move the cable to operate the wrist mechanism and the end effector. For a remotely operated system, the mechanical structure is generally motor-driven and operably connected to a computer processing system to provide a user interface for a clinical user (e.g., a surgeon) to control the entire instrument and its components and functions.

[0006] Patients benefit from the continuous efforts to improve the effectiveness of MIS methods and devices. For example, reducing the size and / or operating footprint of the shaft and wrist mechanism can allow for a smaller entry incision and reduced space requirements at the surgical site, thereby reducing the negative effects of surgery, such as pain, scarring, and undesirable healing time. But it can be challenging to produce small medical devices that implement the clinically required functions of minimally invasive procedures. Specifically, simply reducing the size of the known wrist mechanism by shrinking the components will not produce an effective solution because the required components and material properties will not scale under relatively small physical dimensions. For example, the effective implementation of the wrist mechanism will be complicated because the rope must be carefully laid through the wrist mechanism to maintain rope tension and minimize the interaction (coupling effect / coupling effect) of the movement around one rotation axis to the movement around another rotation axis throughout the range of motion of the wrist mechanism or end effector. As another example, pulleys and / or contoured surfaces / contoured surfaces are generally required to reduce rope friction, which allows operation without applying excessive force to the rope or other structures in the wrist mechanism. However, increased local forces resulting from smaller structures and rope bend radii (including smaller diameter ropes and other wrist and end effector components) can lead to undesirable elongation (e.g., stretching or creep) of the rope during storage and use, shortened rope life, etc.

[0007] In addition, the wrist mechanism generally provides specific degrees of freedom for the movement of the end effector. For example, for forceps or other grasping tools, the wrist may be able to change the pitch, yaw and grip orientation of the end effector relative to the instrument shaft. More degrees of freedom can be implemented by the wrist, but it is necessary to add additional actuating components (such as ropes) in the wrist and shaft, and these additional components will compete for the limited space that exists in view of the size restrictions required for MIS applications. The components required to actuate other degrees of freedom (such as end effector rolling or insertion / withdrawal through the main body movement) will also compete for space at or in the shaft of the device.

[0008] The conventional architecture of the wrist mechanism in the manipulator-driven medical device uses a rope pulled in and released by a capstan in the proximal mechanical structure, so that the part of the wrist mechanism connected to the capstan by the rope rotates. For example, the wrist mechanism can be operably connected to three capstans-each capstan is used to rotate around the pitch axis, the yaw axis and the grip axis. Each capstan can be controlled by using two ropes, which are attached to the capstan so that one side releases the rope and the other side pulls in the rope of equal length. Under this architecture, the three degrees of freedom require a total of six ropes extending from the wrist mechanism along the length of the instrument spindle rod tube to the proximal side back to the proximal mechanical structure of the instrument. The effective implementation of the wrist mechanism and the proximal mechanical structure may be complicated because the rope must be carefully laid through the tool member, the wrist mechanism and the proximal mechanical structure to maintain the stability of the wrist throughout the range of motion of the wrist mechanism and minimize the interaction (or coupling effect) of one rotation axis to another rotation axis.

[0009] In addition to the need to reduce the size and improve the performance of wrist devices, it is also desirable to develop low-cost instruments that are effectively disposable (i.e., intended to be used only once at an economical cost). With such instruments, each MIS procedure can be performed with a new, sterilized instrument, which eliminates the cumbersome and expensive cleaning and sterilization procedures for instrument reuse. However, many current instrument designs are expensive to produce, so these instruments are sterile reprocessed for use in multiple surgical procedures.

[0010] Furthermore, in order to achieve the desired performance, known wrist mechanisms include many complex parts, including pulleys, one or more U-shaped portions defining complex cable channels, and in some cases electronic components (for cautery instruments). Assembly of such known wrist mechanisms involves many complex operations, which can further increase the production cost of the wrist mechanism.

[0011] Therefore, there is a need for an improved wrist mechanism that can be assembled more easily and contain fewer parts while still providing the desired performance.

[0012] Furthermore, in the case of smaller instruments, achieving the desired output force (e.g., for rotating the end effector about the pitch axis or rotating the cutting blade about the grip axis) may be challenging due to reduced space. Thus, there is also a need for a wrist mechanism with improved cable channels to optimize the output force in multiple degrees of freedom. Summary of the invention

[0013] This summary introduces certain aspects of the embodiments described herein to provide a basic understanding. This summary is not an extensive overview of the inventive subject matter and is not intended to identify key or critical elements or to delineate the scope of the inventive subject matter.

[0014] In some embodiments, a medical device includes a wrist link, a tool member, and a tension element. The wrist link includes a discrete first link member and a discrete second link member. The first link member includes a first U-shaped ear, and the second link member includes a second U-shaped ear. The second link member is connected to the first link member to position the second U-shaped ear opposite to the first U-shaped ear and define a tension element guide channel between the first link member and the second link member. The tool member is connected to rotate between the first U-shaped ear and the second U-shaped ear around the tool member rotation axis. The tension element is connected to the tool member and extends from the tool member through the tension element guide channel. The tension on the tension element causes the tool member to rotate around the tool member rotation axis.

[0015] In some embodiments, the first link member is substantially identical to the second link member. In some embodiments, the configuration of the first link member is identical to the configuration of the second link member.

[0016] In some embodiments, the wrist link is a distal wrist link, and the medical device includes a proximal wrist link and a connector link. The connector link includes a distal end and a proximal end. The distal wrist link is coupled to the distal end of the connector link, and the proximal wrist link is coupled to the proximal end of the connector link. The distal wrist link rotates relative to the connector link about a distal connector link rotation axis. The connector link rotates relative to the proximal wrist link about a proximal connector link rotation axis. When the distal wrist link rotates relative to the proximal wrist link, the distal wrist link is in rolling contact with the proximal wrist link.

[0017] In some embodiments, the first link member includes a first connector link receiving portion, and the second link member includes a second connector link receiving portion. The second link member is coupled to the first link member to position the second connector link receiving portion opposite the first connector link receiving portion. The distal end of the connector link is rotatably fixed to the distal wrist link between the first connector link receiving portion and the second connector link receiving portion. In some embodiments, the first protrusion of the distal end of the connector link is within the first connector link receiving portion, and the second protrusion of the distal end of the connector link is within the second connector link receiving portion.

[0018] In some embodiments, a longitudinal axis is defined between a distal end and a proximal end of the connector link. The proximal wrist link includes a connector link receiver that receives insertion of the connector link proximal end in a first orientation of the connector link about the longitudinal axis of the connector link. The connector link receiver resists withdrawal of the connector link proximal end in a second orientation of the connector link about the longitudinal axis of the connector link.

[0019] In some embodiments, the proximal wrist link includes a discrete third link member and a discrete fourth link member. The third link member includes a third connector link receiving portion, and the fourth link member includes a fourth connector link receiving portion. The fourth link member is coupled to the third link member to position the fourth connector link receiving portion opposite the third connector link receiving portion. The proximal end of the connector link is rotatably fixed to the proximal wrist link between the third connector link receiving portion and the fourth connector link receiving portion.

[0020] In some embodiments, the second link member is coupled to the first link member by any of an adhesive joint, a weld joint, or a mechanical fastener.

[0021] In some embodiments, a medical device includes a first link member, a second link member discrete from the first link member, a tool member, and a connector link. The first link member includes a distal portion and a proximal portion, and the distal portion includes a first U-shaped ear, and the proximal portion includes a first connector. The second link member includes a distal portion and a proximal portion, and the distal portion includes a second U-shaped ear, and the proximal portion includes a second connector. The second link member is connected to the first link member to form a wrist link and to position the second U-shaped ear opposite to the first U-shaped ear and to position the second connector opposite to the first connector. The tool member is connected to rotate between the first U-shaped ear and the second U-shaped ear around the tool member rotation axis. The connector link is connected to rotate between the first connector and the second connector around the connector link rotation axis.

[0022] In some embodiments, the wrist link is a distal wrist link, and the connector link includes a distal end and a proximal end. The distal end of the connector link is rotatably coupled between the first connector and the second connector. The medical device also includes a proximal wrist link. The proximal end of the connector link is rotatably coupled to the proximal wrist link.

[0023] In some embodiments, a medical device includes a tensioning element. A second link member is coupled to a first link member to define a tensioning element guide channel between the first link member and the second link member. The tensioning element is coupled to a tool member and extends from the tool member through the tensioning element guide channel. When tension is applied to the tensioning element, it causes the tool member to rotate about a tool member rotation axis.

[0024] In some embodiments, the tool member rotation axis is perpendicular to the connector link rotation axis.

[0025] In some embodiments, a medical device includes a distal wrist link, a proximal wrist link, and a connector link. The distal wrist link includes a first tool support and a second tool support opposite to the first tool support, and is configured to be rotatably connected to a tool member. The distal wrist link includes a distal connector link receiving portion, and the proximal wrist link includes a proximal connector link receiving portion. The connector link includes a distal end and a proximal end, and a longitudinal axis is defined by the distal end and the proximal end of the connector link. The distal end of the connector link is connected in the distal connector link receiving portion, and the distal wrist link can rotate relative to the connector link around the distal connector link rotation axis. The proximal end of the connector link is connected in the proximal connector link receiving portion, and the proximal wrist link can rotate relative to the connector link around the proximal connector link rotation axis. At least one of the proximal connector link receiving portion or the distal connector link receiving portion is configured to receive the insertion of the connector link in a first orientation of the connector link around the longitudinal axis of the connector link. At least one of the proximal connector link receptacle or the distal connector link receptacle is configured to resist withdrawal of the connector link in a second orientation of the connector link about a longitudinal axis of the connector link.

[0026] In some embodiments, the distal wrist link is in rolling contact with the proximal wrist link as the distal wrist link rotates relative to the proximal wrist link.

[0027] In some embodiments, the proximal connector link receiving portion is configured to receive insertion of the connector link in a first orientation. The proximal connector link receiving portion or the distal connector link receiving portion is configured to resist withdrawal of the connector link in a second orientation. The end surface of the proximal wrist link defines an insertion opening leading to the proximal connector link receiving portion. The shape of the insertion opening taken in a plane perpendicular to the longitudinal axis defines an insertion primary axis aligned with the first orientation of the connector link about the longitudinal axis of the connector link.

[0028] In some embodiments, the distal wrist link includes a discrete first link member and a discrete second link member. The first link member includes a first tool support, and the second link member includes a second tool support. The second link member is coupled to the first link member to position the second tool support opposite the first tool support.

[0029] In some embodiments, the second link member is coupled to the first link member to define a tension member guide channel between the first link member and the second link member. The medical device includes a tension member coupled to the tool member and extending from the tool member through the tension member guide channel. The tension on the tension member causes the tool member to rotate about the tool member rotation axis.

[0030] In some embodiments, a method of assembling a medical device is disclosed herein. The medical device includes a first link member, a second link member, a tool member, a pin, and a tension element. The first link member includes a first U-shaped ear and a first guide channel. The second link member includes a second U-shaped ear and a second guide channel. The pin includes a first end portion, a second end portion, and a center portion. The tool member is rotatably connected around the center portion of the pin, and the tension element is connected to the tool member. The assembly method includes inserting the first end portion of the pin into the first U-shaped ear. Inserting the second end portion of the pin into the second U-shaped ear. Arranging a portion of the tension element into at least one of the first guide channel or the second guide channel. The method includes positioning the second link member on the first link member so that the second U-shaped ear is opposite to the first U-shaped ear, and connecting the second link member to the first link member to form a wrist link.

[0031] In some embodiments, a medical device includes a proximal wrist link, a distal wrist link, a tool member, and a tension element. The proximal wrist link includes a proximal portion and a distal portion and defines a proximal tension element guide channel. The distal wrist link includes a proximal portion and a distal portion and defines a distal tension element guide channel. The proximal portion of the distal wrist link is coupled to the distal portion of the proximal wrist link so that the distal wrist link rotates relative to the proximal wrist link about a wrist rotation axis. A longitudinal centerline is defined between the proximal portion of the proximal wrist link and the distal portion of the distal wrist link. A first distal wrist link plane is defined as being perpendicular to the longitudinal centerline and at a first position within the distal wrist link along the longitudinal centerline, and a second distal wrist link plane is defined as being perpendicular to the longitudinal centerline and at a second position within the distal wrist link along the longitudinal centerline. The tension element is coupled to the tool member and extends from the tool member through the distal tension element guide channel and through the proximal tension element guide channel. The tension on the tension element causes at least one distal wrist link to rotate about a wrist rotation axis or causes the tool member to rotate about a tool member rotation axis. A first central portion of the tension element is spaced a first X distance from the longitudinal centerline along a first dimension in a distal wrist link entry plane, and a first Y distance from the longitudinal centerline along a second dimension in a distal wrist link entry plane in the distal wrist link entry plane. A second central portion of the tension element is spaced a second X distance from the longitudinal centerline along the first dimension in a distal wrist link exit plane, and a second Y distance from the longitudinal centerline along the second dimension in the distal wrist link exit plane. The first X distance is greater than the second X distance, and the first Y distance is less than the second Y distance.

[0032] By reading the following drawings and detailed description, other medical devices, related components, medical device systems and / or methods according to the embodiments will be apparent or become apparent to those skilled in the art. All such additional medical devices, related components, medical device systems and / or methods contained in the description herein are within the scope of the present disclosure. BRIEF DESCRIPTION OF THE DRAWINGS

[0033] Figure 1 is a plan view of a minimally invasive teleoperated medical system for performing a medical procedure, such as surgery, according to one embodiment.

[0034] Figure 2 yes Figure 1 A perspective view of a user console for a minimally invasive teleoperated surgical system is shown.

[0035] Figure 3 yes Figure 1 A perspective view of an optional auxiliary unit of a minimally invasive teleoperated surgical system is shown.

[0036] Figure 4 yes Figure 1 A front view of a manipulator unit including a plurality of instruments of a minimally invasive teleoperated surgical system is shown.

[0037] Figure 5A is a schematic exploded view of a medical device according to one embodiment.

[0038] Figure 5B yes Figure 5A A perspective exploded view of a portion of the medical device is shown.

[0039] Figure 5C yes Figure 5A a rear side view of the medical device shown, and Figure 5D yes Figure 5A A top view of the medical device is shown.

[0040] Fig. 6A is a schematic exploded view of a medical device according to one embodiment.

[0041] Figure 6B yes Fig. 6A a rear side view of the medical device shown, and Figure 6C yes Fig. 6A A top view of the medical device is shown.

[0042] Fig. 7A is a schematic side view of a medical device according to one embodiment.

[0043] Figure 7B and 7C yes Fig. 7A The medical device shown in FIG. Figure 7B) and the second orientation ( Figure 7C ) when viewed from above.

[0044] Fig.7D yes Fig. 7A A perspective view of a connector link of the illustrated medical device.

[0045] Fig. 7E is along Figure 7B A cross-sectional view of a portion of the medical device taken along line EE in FIG. Figure 7F is along Figure 7B A cross-sectional view of a portion of the medical device taken along line FF in FIG.

[0046] Fig. 8A is a schematic top view of a medical device according to one embodiment, and Figure 8B yes Fig. 8A Schematic side view of the medical device shown.

[0047] Fig. 9 is a perspective view of a medical device according to one embodiment.

[0048] Fig.10 yes Fig. 9 A perspective view of a distal portion of a medical device.

[0049] Fig.11 yes Fig. 9 An exploded perspective view of selected components of a distal portion of a medical device.

[0050] Fig.12 yes Fig. 9 a top view of a distal portion of a medical device, and Fig.13 yes Fig. 9 Side view of a distal portion of a medical device.

[0051] Fig.14 yes Fig. 9 A perspective view of a proximal wrist link of a medical device, and Fig.15 yes Fig. 9 Front view of the proximal wrist link of the medical device (along the Fig.12 (taken from plane P1 shown).

[0052] Fig.16A yes Fig. 9 A perspective view of a proximal wrist link and a connector link of a medical device shown in a first configuration.

[0053] Fig. 16B yes Fig. 9 A top view of a proximal wrist link and a connector link of a medical device are shown in a first configuration.

[0054] Fig.17A yes Fig. 9A perspective view of a proximal wrist link and a connector link of a medical device shown in a second configuration.

[0055] Fig. 17B yes Fig. 9 A top view of a proximal wrist link and a connector link of a medical device are shown in an intermediate configuration between a first configuration and a second configuration.

[0056] Fig. 17C yes Fig. 9 A perspective view of a proximal wrist link and a connector link of a medical device shown in a second configuration.

[0057] Fig.18 yes Fig. 9 A top perspective view of a distal wrist link of a medical device, and Fig.19 yes Fig. 9 A bottom perspective view of a distal wrist link of a medical device.

[0058] Fig. 20 yes Fig. 9 A partially exploded perspective view of a medical device showing a cable passing through a distal wrist link and coupled to an end effector.

[0059] Fig.21 yes Fig. 9 A perspective view of a medical device with the links removed to show a cable routed through the distal wrist link and coupled to the end effector.

[0060] Fig. 22 yes Fig. 9 A front view of the distal wrist link of the medical device, which is Fig.21 The plane P2 shown is cut to show the position of the rope in the plane P2.

[0061] Fig.23 yes Fig. 9 A front view of the distal wrist link of the medical device, which is Fig.21 The plane P3 shown is cut to show the position of the rope in the plane P3.

[0062] Fig.24 is a perspective view of a distal portion of a medical device, wherein both the proximal link and the distal link are constructed from discrete link pieces.

[0063] Fig.25 yes Fig.24 An exploded perspective view of selected components of a distal portion of a medical device.

[0064] Fig.26 yes Fig.24 a top view of a distal portion of a medical device, and Fig. 27 yes Fig.24 Side view of a distal portion of a medical device.

[0065] Fig.28 yes Fig.24 A top perspective view of a proximal wrist link of a medical device, and Fig.29 yes Fig.24 A bottom perspective view of a proximal wrist link of a medical device.

[0066] Fig.30 yes Fig.24 A top perspective view of a distal wrist link of a medical device, and Fig.31 yes Fig.24 A bottom perspective view of a distal wrist link of a medical device.

[0067] Fig.32 yes Fig.24 A side view of a medical device in which portions of the link member are transparent to show a cable routed through the wrist assembly and coupled to the end effector.

[0068] Fig.33 yes Fig.24 A perspective view of a medical device with links removed to show cables routed through the wrist assembly and coupled to the end effector.

[0069] Fig.34 yes Fig.24 A top view of a medical device of claim 1 with the wrist assembly in a rotated orientation and the links removed to show a cable routed through the wrist assembly and coupled to an end effector.

[0070] Fig.35 yes Fig.24 Front view of the proximal wrist link of the medical device (along the Fig.34 (taken from plane P1 shown).

[0071] Fig.36 yes Fig.24 A front view of the distal wrist link of the medical device, which is Fig.33 The plane P2 shown is cut to show the position of the rope in the plane P2.

[0072] Fig.37 yes Fig.24 A front view of the distal wrist link of the medical device, which is Fig.33 The plane P3 shown is cut to show the position of the rope in the plane P3.

[0073] Fig.38 is a flow chart of a method of assembling a medical device according to one embodiment. DETAILED DESCRIPTION

[0074] The embodiments described herein can be beneficially used for a variety of grasping, cutting, and manipulation operations associated with minimally invasive surgery. In some embodiments, the end effector of the medical device can move with three mechanical DOFs (e.g., pitch, yaw, and roll (axle roll)) relative to the body of the instrument. The end effector itself can also have one or more mechanical DOFs, such as two jaws, each rotating relative to the U-shaped portion (2 DOFs), and a distal U-shaped portion, which rotates relative to the proximal U-shaped portion (one DOF).

[0075] The medical device of the present application can realize the motion of three degrees of freedom (for example, around the pitch axis, yaw axis and grip axis) using only four ropes, thereby reducing the total number of ropes required, reducing the space required in the shaft and wrist, reducing the overall cost, and enabling further miniaturization of the wrist and shaft assembly to facilitate MIS procedures. In addition, the medical device described herein may include a U-shaped portion or a wrist link, which is assembled by connecting two separate pieces together. This arrangement can achieve manufacturing improvements, such as by allowing the rope to be arranged in one or more rope channels before assembling the wrist. Such improvements can reduce costs, thereby promoting disposable devices. The medical device described herein can have a reduced number of unique parts, which can also reduce costs.

[0076] As described herein, in some embodiments, the medical device includes a first link member and a second link member that is discrete from the first link member. The first link member includes a first U-shaped ear and a first connector. The second link member includes a second U-shaped ear and a second connector. The two link members can be coupled together to form a wrist link having a second U-shaped ear opposite to the first U-shaped ear and a second connector opposite to the first connector. The tool member can be coupled to rotate between the two U-shaped ears, and the connector link can be coupled to the two connectors.

[0077] The medical device described herein may include one or more ropes (which act as tension elements) made of a polymer material and may pass through the wrist along one or more rope channels. The rope channel may be nonlinear and may be shaped so that the rope is spaced a first distance (along a first dimension) from the centerline of the wrist at a first position. The first distance may be selected to maximize the torque applied by the rope at that point. The rope may be spaced a second distance (along a second dimension) from the centerline at a second position. The second distance may be selected to maximize the torque applied by the rope at that point. The rope channel may be shaped so that the two distances remain within the overall footprint (or boundary) of the device. This arrangement may allow for the desired torque performance of the wrist while promoting miniaturization of the wrist.

[0078] As used herein, the term "about", when used in conjunction with a numerical indication, means the numerical indication plus or minus up to 10% of the numerical indication. For example, the expression "about 50" covers a range of 45 to 55. Similarly, the expression "about 5" covers a range of 4.5 to 5.5.

[0079] As used in this specification and the appended claims, the word "distal" refers to a direction toward a working site, and the word "proximal" refers to a direction away from a working site. Thus, for example, the end of a medical device closest to the target tissue would be the distal end of the medical device, and the end opposite the distal end (i.e., the end manipulated by a user or coupled to an actuation shaft) would be the proximal end of the medical device.

[0080] In addition, the specific words selected to describe one or more embodiments and optional elements or features are not intended to limit the present invention. For example, spatial relative terms, such as "lower", "below", "lower", "above", "upper", "near side", "distal side", etc., can be used to describe the relationship between an element or feature and another element or feature as shown in the figure. In addition to the position and orientation shown in the accompanying drawings, these spatial relative terms are also intended to cover the different positions (i.e., translation placement) and orientations (i.e., rotation placement) of the device when in use or operation. For example, if the device in the figure is flipped, the element described as "below" or "below" other elements or features will then be "above" or "on" other elements or features. Therefore, the term "below" can cover both the position and orientation of the upper and lower parts. The device can be oriented in other ways (e.g., rotated 90 degrees or other orientations), and the spatial relative descriptors used herein can be interpreted accordingly. Similarly, the description of motion along various axes (translation) and around various axes (rotation) includes various spatial positions and orientations. The position and orientation combination of the body defines the posture of the body.

[0081] Similarly, geometric terms, such as "parallel," "perpendicular," "circular," or "square," are not intended to require absolute mathematical precision unless the context indicates otherwise. Instead, these geometric terms allow for variations due to manufacturing or equivalent functions. For example, if an element is described as "circular" or "generally circular," such description still encompasses parts that are not exactly circular (e.g., slightly elliptical or polygonal parts).

[0082] In addition, unless the context indicates otherwise, the singular forms "a", "an", and "the" are intended to include the plural forms as well. The terms "include", "comprise", "have", etc. specify the presence of stated features, steps, operations, elements, components, etc., but do not exclude the presence or addition of one or more other features, steps, operations, elements, components, or groups.

[0083] Unless otherwise specified, the terms equipment, medical device, medical apparatus and their variations are used interchangeably.

[0084] Aspects of the present invention are primarily accomplished by using a da Examples of such surgical systems include the da Vinci Surgical system (model IS4000), da Vinci Surgical System (Model IS4200) and da Vinci Surgical System (Model IS3000). However, the skilled person will appreciate that the inventive aspects disclosed herein may be implemented and realized in a variety of ways, including computer-assisted, non-computer-assisted, and hybrid combinations of manual and computer-assisted embodiments and implementations. Implementations on surgical systems (e.g., Model IS4000, Model IS3000, Model IS2000, Model IS1200, Model SP1099) are shown only as examples and should not be considered to limit the scope of the inventive aspects disclosed herein. Where applicable, the inventive aspects may be implemented and realized in both relatively small, handheld, manually operated devices (not mechanically grounded in a world reference frame) and relatively larger systems (with additional mechanical support that is grounded in a world reference frame).

[0085] Figure 11 is a plan view example of a remotely operated surgical system 1000 ("telesurgical system") that operates at least in part with computer assistance. The telesurgical system 1000 and its components are considered medical devices. The telesurgical system 1000 is a minimally invasive robotic surgery (MIRS) system for performing minimally invasive diagnostic or surgical procedures on a patient P lying flat on an operating table 1010. The system can have any number of components, such as a user control unit 1100 for use by a surgeon or other skilled clinician S during the procedure. The MIRS system 1000 can also include a manipulator unit 1200 (commonly referred to as a surgical robot) and an optional auxiliary equipment unit 1150. The manipulator unit 1200 can include an arm assembly 1300 and a surgical instrument tool assembly detachably coupled to the arm assembly 1300. The manipulator unit 1200 can manipulate at least one detachably coupled instrument 1400 that passes through a minimally invasive incision or natural orifice of the body of the patient P, while the surgeon S views the surgical site and controls the movement of the instrument 1400 through the control unit 1100. An image of the surgical site is obtained through an endoscope (not shown), such as a stereo endoscope, which can be manipulated by the manipulator unit 1200 to orient the endoscope. An auxiliary equipment unit 1150 can be used to process the image of the surgical site for subsequent display to the surgeon S through the user control unit 1100. The number of instruments 1400 used at one time generally depends on factors such as the diagnostic or surgical procedure and the space limitations in the operating room. If it is necessary to replace one or more instruments 1400 used during the procedure, the assistant removes the instrument 1400 from the manipulator unit 1200 and replaces it with another instrument 1400 from the tray 1020 in the operating room. Although shown as being used with instrument 1400, any instrument described herein can be used with MIRS 1000.

[0086] Figure 2 11 is a perspective view of the control unit 1100. The user control unit 1100 includes a left-eye display 1112 and a right-eye display 1114 for presenting a coordinated stereoscopic view of the surgical site to the surgeon S that enables depth perception. The user control unit 1100 also includes one or more input control devices 1116, which in turn cause the manipulator unit 1200 ( Figure 1 The input control device 1116 provides at least the same degrees of freedom as the instrument 1400 to which it is associated, thereby providing the surgeon S with a remote display or the appearance that the input control device 1116 is integral with (or directly connected to) the instrument 1400. In this way, the user control unit 1100 provides the surgeon S with a strong sense of directly controlling the instrument 1400. Thus, position, force, strain or tactile feedback sensors (not shown) or any combination of such perceptions are transmitted from the instrument 1400 back to the surgeon's hand or hands through one or more input control devices 1116.

[0087] Figure 1 The user control unit 1100 is shown to be in the same room as the patient, allowing the surgeon S to directly monitor the procedure, be present in person if necessary, and speak directly to an assistant, rather than via a telephone or other communication medium. However, in other embodiments, the user control unit 1100 and the surgeon S may be in different rooms, completely different buildings, or other locations remote from the patient, thereby allowing remote surgical procedures to be performed.

[0088] Figure 3 is a perspective view of the auxiliary equipment unit 1150. The auxiliary equipment unit 1150 can be connected to an endoscope (not shown) and can include one or more processors to process captured images for subsequent display, such as display via the user control unit 1100, or display on other suitable displays located locally (e.g., on the unit 1150 itself, on a wall-mounted display) and / or remote display. For example, in the case of using a stereoscopic endoscope, the auxiliary equipment unit 1150 can process the captured images to present a coordinated stereoscopic image of the surgical site to the surgeon S via the left eye display 1112 and the right eye display 1114. Such coordination may include alignment between relative images, and may include adjusting the stereo working distance of the stereoscopic endoscope. As another example, image processing may include using previously determined camera calibration parameters to compensate for imaging errors of the image capture device, such as optical aberrations.

[0089] Figure 4 A front perspective view of the manipulator unit 1200 is shown. The manipulator unit 1200 includes components (e.g., arms, linkages, motors, sensors, etc.) for implementing manipulation of the instrument 1400 and an imaging device (not shown), such as a stereo endoscope, for taking images of the captured procedure site. Specifically, the instrument 1400 and the imaging device can be manipulated by a remote control mechanism having one or more mechanical joints. In addition, the instrument 1400 and the imaging device can be positioned and manipulated through an incision or natural orifice of a patient P in the following manner: the center of motion (remote from the manipulator and generally located at a certain position along the instrument shaft) is maintained at the incision or orifice by a motion mechanical constraint or a software constraint. In this way, the incision size can be minimized.

[0090] Figures 5A-5Dis a schematic illustration of a portion of a medical device 2400 according to an embodiment. In some embodiments, the medical device 2400 or any component thereof is optionally part of an instrument of a surgical system for performing a surgical procedure, and it may include a manipulator unit, a series of motion linkages, a series of cannulas, etc. The medical device 2400 (and any instrument described herein) may be used in any suitable surgical system, such as the MIRS system 1000 shown and described above. The medical device 2400 includes an axis 2410, a wrist assembly 2500 including at least one wrist link 2610, an end effector 2460, and a tension element 2420 (which may be a rope). Although only one tension element 2420 and one tool member 2462 are shown, one or more additional tension elements or one or more additional tool members may be included. The medical device 2400 is configured such that movement of the tension element 2420 produces movement of the wrist assembly 2500 (similar to the movement described below with respect to the medical device 3400), movement of the tool member 2462 (such as Figure 5C as shown), or movement of the wrist assembly 2500 and movement of the tool member 2462.

[0091] The wrist assembly 2500 includes at least one wrist link 2610, which includes a discrete first link member 2601 and a discrete second link member 2602 (see Figure 5B ). In other words, the first link member 2601 is separate from the second link member 2602. The first link member 2601 and the second link member 2602 are constructed as separate pieces and are then coupled together (as described herein) to form the wrist link 2610. By forming the wrist link 2610 from two discrete pieces, the assembly method of the device 2400 can be made more efficient than a device having a wrist link of an integral construction. For example, as described herein, the tension element 2420 can be arranged in the tension element channel before the second link member 2602 is coupled to the first link member 2601, thereby eliminating the need to pass the loose end of the tension element through the closed channel. The second link member 2602 can be coupled to the first link member 2601 by any suitable mechanism (e.g., an adhesive joint, a weld joint, or a mechanical fastener).

[0092] like Figure 5A and 5BAs shown, the first link member 2601 includes a first U-shaped ear 2651, which defines an opening 2652. The first link member 2601 also defines a channel 2615. The second link member 2602 includes a second U-shaped ear 2661, which defines an opening 2662. The second link member 2602 also defines a channel 2625. When the second link member 2602 is coupled to the first link member 2601, the channel 2615 of the first link member 2601 and the channel 2625 of the second link member 2602 form a tension element guide channel 2650. The tension element guide channel 2650 can have any suitable size, shape, or contour to provide a desired path for the passage of the tension element 2420. For example, the tension element guide channel 2650 can be shaped to reduce sharp bends, which can reduce friction losses when the tension element 2420 moves within the tension element guide channel 2450. As another example, in some embodiments, the tension element guide channel 2650 can be shaped to ensure that the tension element 2420 is routed to the end effector in a manner that creates a desired offset distance between the distal portion 2422 of the tension element 2420 and the tool member rotation axis A1. In this way, the magnitude of the torque applied to the tool member 2462 can be maximized (for a given amount of tension applied to the tension element). In some embodiments, the tension element guide channel 2650 can be shaped to create a desired offset distance between the tension element 2420 and the wrist rotation axis A2. For example, although Figure 5D The tension element 2420 is shown aligned with the wrist rotation axis A2 in the top view plane, but in other embodiments, the tension element guide channel 2650 can be curved to create an offset distance (which will create or increase the torque about the wrist rotation axis A2 that the tension element 2420 can apply to the wrist link 2610). Thus, the tension element guide channel 2650 can include any shape or feature described below with respect to the medical devices 6400 and 7400.

[0093] As shown, when the second link member 2602 is coupled to the first link member 2601, the second U-shaped ear 2661 is opposite to the first U-shaped ear 2651. Therefore, the openings 2652 and 2662 are aligned so that a pin (not shown) or other structure can be coupled between the first U-shaped ear 2651 and the second U-shaped ear 2661 to allow rotation of the tool member 2462 around the tool member rotation axis A1. In other words, when the second link member 2602 is coupled to the first link member 2601, the second U-shaped ear 2661 is aligned with the first U-shaped ear 2651 to define the tool member rotation axis A1.

[0094] In some embodiments, the first link member 2601 and the second link member 2602 can have the same configuration. In other words, in some embodiments, the first link member 2601 and the second link member 2602 can be substantially the same member. In this way, the number of unique parts included in the wrist assembly 2500 can be reduced, which further improves manufacturability (e.g., by reducing the number of parts and also reducing the potential errors associated with connecting inappropriate parts together). In addition, in some embodiments, the first link member 2601 or the second link member 2602 (or both) can be partially formed with a conductive material. In this way, the first link member 2601 or the second link member 2602 (or both) can be part of a circuit to deliver energy to the tool member 2462.

[0095] As shown, wrist link 2610 is coupled to shaft 2410. Shaft 2410 (and any shaft described herein) may include or be coupled to any suitable components, such as an inner shaft, an insulating portion, a spacer, and a seal, etc. Shaft 2410 may be formed, for example, with a conductive material (such as stainless steel). In some embodiments, shaft 2410 (and any shaft described herein) may be similar to the shaft (and shaft assembly) shown and described in co-pending U.S. Provisional Patent Application Serial No. 63 / 294,103, entitled "Surgical Instrument Including Electrical and Fluid Isolation Features", the disclosure of which is incorporated herein by reference in its entirety.

[0096] The wrist link 2610 is coupled to the shaft 2410 by any suitable mechanism, such as by welding, interference fit, adhesive, etc. In some embodiments, the wrist link 2610 can be coupled to the shaft 2410 by another wrist link or connector link (not shown, but which can be similar to the connector link 3580 shown and described below) such that the wrist link 2610 can rotate about the wrist rotation axis A2 (which serves as the pitch axis; the term pitch is arbitrary). In such an embodiment, movement of the first proximal portion 2421 and the second proximal portion 2423 of the tension element 2420 can produce movement of the wrist link 2610 about the wrist rotation axis A2. Reference is made below to Figure 9-23 An embodiment in which a wrist assembly includes a plurality of wrist links is shown and described.

[0097] The end effector 2460 includes at least one tool member 2462, which is connected to rotate around the tool member rotation axis A1 between the first U-shaped ear 2651 and the second U-shaped ear 2661. More specifically, the tool member 2462 includes a contact portion and a pulley portion 2467. The contact portion is configured to engage or manipulate the target tissue during the surgical procedure. For example, in some embodiments, the contact portion may include an engagement surface that acts as a grasper, a cutter, a tissue manipulator, etc. In other embodiments, the contact portion may be an energized portion of a tool member for a cautery or electrosurgical procedure. The pulley portion 2467 is rotatably connected to the first U-shaped ear 2651 and the second U-shaped ear 2661 by a pin (not shown) or other appropriate mechanism, which is connected within the openings 2652 and 2662 and aligned with the tool member rotation axis A1. The pulley portion 2467 includes a contact surface or other structure connected to the distal end 2422 of the tension element 2420. In this manner, when tension is applied to the tension element 2420, the tension element 2420 causes the tool member 2462 to rotate about the tool member rotation axis A1. In other words, the applied tension causes the first proximal portion 2421 (see Figure 5C BB in the figure) and / or the second proximal portion 2423 (see Figure 5C 2420) moves the tool member 2462 in the direction of arrow AA about the tool member rotation axis A1 (which serves as the yaw axis; the term yaw is arbitrary). In some embodiments, the movement of the first proximal portion 2421 and the second proximal portion 2423 of the tension element 2420 may also cause the wrist link 2610 to move about the wrist rotation axis A2. In some embodiments, the wrist rotation axis A2 is not parallel to the tool member rotation axis A1.

[0098] Although only one tool member 2462 is shown, in other embodiments, the medical device 2400 may include two or more moving tool members that cooperate to perform a grasping or shearing function. Thus, the tool member rotation axis A1 may also serve as a cutting axis when the tool members rotate counter-rotating to each other, as described in more detail below. Thus, in some embodiments, the medical device 2400 may provide at least three degrees of freedom (i.e., yaw motion around the tool member rotation axis A1, pitch rotation around the wrist rotation axis A2, and cutting motion around the tool member rotation axis A1).

[0099] In some embodiments, the end effector 2460 and wrist assembly 2500 are operably coupled to a mechanical structure (not shown, but which may be similar to the mechanical structure 6700 described below) that acts to accept one or more motor input forces or torques and mechanically transmit the accepted forces or torques (e.g., via the tension element 2420) to move one or more associated components of the end effector 2460 and wrist assembly 2500. For example, one or more electric motors in the manipulator unit 1200 (described above) provide input to the mechanical structure, which in turn transmits the input via the tension element 2420 to move the tool member 2462 or wrist link 2610, as described above. The tension element 2420 may be disposed along or through the shaft 2410 to couple a mechanical structure (not shown) at the proximal end of the shaft 2410 to the end effector 2460 at the distal end of the shaft 2410. More specifically, the tension element 2420 includes a first proximal portion 2421, a second proximal portion 2423, and a distal portion 2422. The first proximal portion 2421 and the second proximal portion 2423 extend along (or through) the shaft 2410 through the tension element guide channel 2650 and are connected to the mechanical structure. The distal portion 2422 is connected to the end effector 2460 (e.g., the pulley portion 2467 of the tool member 2462). In some embodiments, any tension element described herein (including tension elements 2420, 3420, 4420, 5420, 6420, 7420) can be a rope having a polymer braided structure. With the tension element 2420 connected to the mechanical structure (not shown) and the end effector 2460, actuation at the mechanical structure causes the first proximal portion 2421 of the rope 2420 to move in direction BB (e.g., proximally or distally depending on the direction of rotation), as shown in FIG. Figure 5C Similarly, actuation at the mechanical structure causes the second proximal portion 2423 of the cable 2420 to move in direction CC (eg, proximally or distally depending on the direction of rotation), as shown. Figure 5C shown.

[0100] As described above, in some embodiments, a medical device can include a wrist assembly having multiple links to facilitate movement (e.g., rotation) about multiple different rotational axes. In some embodiments, the wrist assembly can include a link composed of multiple discrete pieces that are coupled together to define multiple different connection points with different rotational axes. For example, Figures 6A-6C3400 is a schematic illustration of a portion of a medical device 3400 according to an embodiment. In some embodiments, the medical device 3400 or any component thereof is optionally part of an instrument of a surgical system for performing a surgical procedure, and it may include a manipulator unit, a series of motion linkages, a series of cannulas, etc. The medical device 3400 (and any instrument described herein) can be used in any suitable surgical system, such as the MIRS system 1000 shown and described above. The medical device 3400 includes a shaft 3410, a wrist assembly 3500 (which includes at least a wrist link 3610 and a connector link 3580), and an end effector 3460. Although only one tool member 3462 is shown, one or more additional tool members may be included. In addition, although the medical device is not shown to include any tension elements, one or more tension elements (similar to the tension element 2420) may be included. However, in other embodiments, the movement of the wrist or end effector may be caused by the movement of any suitable actuator (not shown, but may be, for example, a motor, a hydraulic actuator, or a tension member within the end effector). Thus, movement of the actuator causes movement of the wrist assembly 3500, the tool member 3462 (eg, Figure 6B ), or movement of the wrist assembly 3500 and movement of the tool assembly 3462.

[0101] The wrist assembly 3500 includes a wrist link 3610 and a connector link 3580 that is coupled to rotate relative to the wrist link 3610. The wrist link 3610 includes a discrete first link member 3601 and a discrete second link member 3602 (see Fig. 6A ). In other words, first link member 3601 and second link member 3602 are constructed as separate parts and are later coupled together (as described herein) to form wrist link 3610. Second link member 3602 may be coupled to first link member 3601 by any suitable mechanism (e.g., an adhesive joint, a weld joint, or a mechanical fastener). Fig. 6A and 6B As shown, the first link member 3601 includes a proximal portion 3603 and a distal portion 3604. The distal portion 3604 includes a first U-shaped ear 3651 defining an opening 3652. The proximal portion 3603 includes a first connector 3655. The second link member 3602 includes a proximal portion 3605 and a distal portion 3606. The distal portion 3606 of the second link member 3602 includes a second U-shaped ear 3661 defining an opening 3662. The proximal portion 3605 of the second link member 3601 includes a second connector 3665.

[0102] Connector 3655 and connector 3665 may be any connector suitable for rotatably coupling connector link 3580 to wrist link 3610 as described herein. For example, as shown, connector 3655 may include a receiving portion (or volume) within which protrusion 3583 of connector link 3580 is rotatably coupled, and connector 3665 may include a receiving portion (or volume) within which protrusion 3584 of connector link 3580 is rotatably coupled. However, in other embodiments, either (or both) connector 3655 or connector 3665 may include a protrusion that is coupled within a receiving portion or hole of the connector link.

[0103] As shown, when the second link member 3602 is coupled to the first link member 3601, the second U-shaped ear 3661 is opposite to the first U-shaped ear 3651. Therefore, the openings 3652 and 3662 are aligned so that the pin 3670 can be coupled between the first U-shaped ear 3651 and the second U-shaped ear 3661 to allow the tool member 3462 to rotate around the tool member rotation axis A1. In other words, when the second link member 3602 is coupled to the first link member 3601, the second U-shaped ear 3661 is aligned with the first U-shaped ear 3651 to define the tool member rotation axis A1. When the second link member 3602 is coupled to the first link member 3601, the second connector 3665 is opposite to the first connector 3655. Thus, the connectors 3665 and 3655 are aligned so that a portion of the connector link 3580 (e.g., the protrusion 3583 and the protrusion 3584) can be coupled between the first connector 3655 and the second connector 3665 to allow the connector link 3580 to rotate about the connector link rotation axis A2. In other words, when the second link member 3602 is coupled to the first link member 3601, the second connector 3665 is aligned with the first connector 3655 to define the connector link rotation axis A2. In some embodiments, the tool member rotation axis A1 is perpendicular to the connector link rotation axis A2.

[0104] In some embodiments, the medical device 3400 can include one or more tensile elements coupled to the mechanical structure, and movement of the tensile elements can produce desired movement of the wrist assembly 3500, the tool member 3462, or both. Thus, neither the first link member 3601 nor the second link member 3602 is shown as defining a channel that forms a tensile element guide channel, but in some embodiments, either the first link member 3601 or the second link member 3602 (or both) can define one or more channels (not shown). When the first link member 3601 is coupled to the second link member 3602, such channels can form one or more tensile element guide channels. Any tensile element guide channel can have any suitable size, shape, or profile to provide a desired path for the tensile element to pass therethrough, such as the shapes of the tensile element guide channels 6515 and 6615 described herein.

[0105] In some embodiments, the first link member 3601 and the second link member 3602 can have the same configuration. In other words, in some embodiments, the first link member 3601 and the second link member 3602 can be substantially the same member. In this way, the number of unique parts included in the wrist assembly 3500 can be reduced, which further improves manufacturability (e.g., by reducing the number of parts and also reducing potential errors associated with connecting inappropriate parts together). In addition, in some embodiments, the first link member 3601 or the second link member 3602 (or both) can be partially formed with a conductive material. In this way, the first link member 3601 or the second link member 3602 (or both) can be part of a circuit to deliver energy to the tool member 3462.

[0106] The connector link 3580 includes a proximal portion 3581 and a distal portion 3582. The distal portion 3582 includes a first protrusion 3585 and a second protrusion 3586. The first protrusion 3585 is coupled to the first connector 3655 of the wrist link 3610. The second protrusion 3586 is coupled to the second connector 3665 of the wrist link 3610. As shown, the proximal portion 3581 of the connector link 3580 is coupled to the shaft 3410. The shaft 3410 (and any shaft described herein) can include or be coupled to any suitable components, such as an inner shaft, an insulating portion, a spacer, and a seal, etc. The shaft 3410 can be similar to the shaft (and shaft assembly) shown and described in the co-pending U.S. Provisional Patent Application Serial No. 63 / 294,103 entitled "Surgical Instrument Including Electrical and Fluid Isolation Features", the disclosure of which is incorporated herein by reference in its entirety. The connector link 3580 is coupled to the shaft 3410 by any suitable mechanism, such as welding, interference fit, adhesive, etc.

[0107] In some embodiments, the connector link 3580 can be coupled to the shaft 3410 via another wrist link. For example, in some embodiments, the wrist link 3610 is a distal wrist link and the wrist assembly 3500 includes a proximal wrist link (not shown). In such an embodiment, the proximal wrist link can be coupled to the shaft 3410 and the connector link 3580 can be rotatably coupled between the distal wrist link 3610 and the proximal wrist link. In such an embodiment, the proximal end portion 3581 of the connector link 3580 can include a protrusion (similar to protrusions 3585 and 3586) or any other suitable connector that can be rotatably coupled to the proximal wrist link (or coupled within the proximal wrist link). The following references Figure 9-23 An embodiment is shown and described having a wrist assembly including a proximal wrist link, a distal wrist link, and a connector link coupled between the proximal wrist link and the distal wrist link.

[0108] The end effector 3460 includes at least one tool member 3462 that is coupled to rotate about a tool member rotation axis A1 between a first U-shaped ear 3651 and a second U-shaped ear 3661. More specifically, the tool member 3462 includes a contact portion and a pulley portion 3467. The contact portion is configured to engage or manipulate target tissue during a surgical procedure. For example, in some embodiments, the contact portion may include an engagement surface that acts as a grasper, a cutter, a tissue manipulator, etc. In other embodiments, the contact portion may be an energized portion of a tool member for a cautery or electrosurgical procedure. The pulley portion 3467 is rotatably coupled to the first U-shaped ear 3651 and the second U-shaped ear 3661 by a pin 3670 or other appropriate mechanism. The pulley portion 3467 includes a contact surface or other structure that can be coupled to an actuator or a tension element (not shown). In this manner, when actuated, the tool member 3462 can rotate about the tool member rotation axis A1 (which serves as the yaw axis; the term yaw is arbitrary) in the direction of arrow DD. In some embodiments, the medical device 3400 can be actuated to produce movement of the wrist link 3610 relative to the connector link 3580 about the connector link rotation axis A2 in the direction of arrow EE. In some embodiments, the connector link rotation axis A2 is not parallel to the connector link rotation axis A1.

[0109] Although only one tool member 3462 is shown, in other embodiments, the medical device 3400 may include two or more moving tool members that cooperate to perform a clamping or shearing function. Thus, the tool member rotation axis A1 may also serve as a cutting axis when the tool members rotate counter-rotating to each other, as described in more detail below. Thus, in some embodiments, the medical device 3400 may provide at least three degrees of freedom (i.e., yaw motion around the tool member rotation axis A1, pitch rotation around the wrist rotation axis A2, and cutting motion around the tool member rotation axis A1).

[0110] In some embodiments, the end effector 3460 and the wrist assembly 3500 are operably connected to a mechanical structure (not shown, but which can be similar to the mechanical structure 6700 described below) that is used to receive one or more motor input forces or torques and mechanically transmit the received forces or torques (e.g., via tension elements or other suitable mechanisms) to move one or more related components of the end effector 3460 and the wrist assembly 3500.

[0111] As described above, in some embodiments, the medical device may include a wrist assembly having a distal wrist link, a proximal wrist link, and a connector link rotatably connected between the distal wrist link and the proximal wrist link. In some embodiments, either or both of the distal wrist link or the proximal wrist link may be composed of two (or more) discrete link pieces (as described above with reference to wrist link 2610 and wrist link 3610). In some embodiments, either or both of the distal wrist link and the proximal wrist link may include one or more connectors, and the connector link may be rotatably connected to the connector. In addition, in such embodiments, the connector may be configured to accept the insertion of a part of the connector link in the first orientation, and resist the withdrawal (or removal) of the connector link in the second orientation. In other words, in some embodiments, the connector link may be rotated (or otherwise oriented) to lock the connector link into the connector of the wrist link. Such an arrangement can simplify the manufacturing process. As an example, Figures 7A-7F is a schematic diagram of a portion of a medical device 4400 according to one embodiment. In some embodiments, the medical device 4400 or any component therein is optionally part of an instrument of a surgical system for performing a surgical procedure, and it may include a manipulator unit, a series of motion linkages, a series of cannulas, etc. The medical device 4400 (and any instrument described herein) can be used in any suitable surgical system, such as the MIRS system 1000 shown and described above. The medical device 4400 includes a wrist assembly 4500 and an end effector 4460. Although only one tool member 4462 is shown, one or more additional tool members may be included. In addition, although the medical device is not shown to include any tension elements, it may include one or more tension elements (similar to tension element 2420). However, in other embodiments, movement of the wrist or end effector may be caused by movement of any suitable actuator (not shown, but may be, for example, a motor within the end effector, a hydraulic actuator, or movement of a tension member). Thus, movement of the actuator produces movement of the wrist assembly 4500 (see Figure 7C ), the movement of the tool member 4462 (see Fig. 7A ), or movement of both the wrist assembly 4500 and the tool member 4462.

[0112] The wrist assembly 4500 includes a proximal wrist link 4510, a distal wrist link 4610, and a connector link 4580. The connector link 4580 is rotatably coupled between the distal wrist link 4610 and the proximal wrist link 4510. Specifically, the distal wrist link 4610 is rotatable relative to the connector link 4580 about a distal connector link rotation axis A2, and the proximal wrist link 4510 is rotatable relative to the connector link 4580 about a proximal connector link rotation axis A3. This arrangement can produce a rotation of the distal wrist link 4610 relative to the proximal wrist link 4510 about a wrist rotation axis A4.

[0113] refer to Figure 7A-7B , the distal wrist link 4610 includes a proximal portion and a distal portion. The distal portion includes a first tool support 4651 (which may be a U-shaped ear) and a second tool support 4661 (which may be a U-shaped ear). The second tool support 4661 is opposite to the first tool support 4651, and they jointly define the tool member rotation axis A1. The proximal portion includes a distal connector link receiving portion 4655. The distal link connector receiving portion 4655 may be a volume within the distal wrist link (i.e., a volume defined by the sidewalls of the distal wrist link 4610), and the distal end 4582 of the connector link 4580 is rotatably coupled within the volume. The distal link connector receiving portion 4655 and the sidewall of the distal wrist link 4610 defining the distal link connector receiving portion 4655 can have any suitable shape, size or orientation to couple the connector link 4580 therein so that the distal wrist link 4610 can rotate about the distal connector link rotation axis A2 (arrow GG) relative to the connector link 4580. For example, in some embodiments, the distal link connector receiving portion 4655 can include opposing cylindrical portions that align (or define) the distal connector link rotation axis A2. The sidewalls surrounding the cylindrical portions can retain the distal end 4582 of the connector link 4580 in the distal link connector receiving portion 4655 while also allowing the distal link 4610 to rotate relative to the connector link 4580. In other words, the distal connector link receiving portion 4655 is configured to resist withdrawal of the connector link 4580 from the distal wrist link 4610. In some embodiments, the distal connector link rotation axis A2 is not parallel to the tool member rotation axis A1 .

[0114] The end effector 4460 includes at least one tool member 4462 that is coupled to rotate about a tool member rotation axis A1 between a first tool support 4651 and a second tool support 4661. More specifically, the tool member 4462 includes a contact portion and a pulley portion 4467. The contact portion is configured to engage or manipulate a target tissue during a surgical procedure. For example, in some embodiments, the contact portion may include an engagement surface that acts as a grasper, a cutter, a tissue manipulator, etc. In other embodiments, the contact portion may be an energized portion of a tool member for a cautery or electrosurgical procedure. The pulley portion 4467 is rotatably coupled to the first tool support 4651 and the second tool support 4661 by a pin 4670. The pulley portion 4467 includes a contact surface or other structure that can be coupled to an actuator or a tension element (not shown). In this way, when actuated, the tool member 4462 can rotate about the tool member rotation axis A1 in the direction of the arrow FF. Although only one tool member 4462 is shown, in other embodiments, the medical device 4400 may include two or more moving tool members that cooperate to perform a grasping or shearing function. Thus, the tool member rotation axis A1 may also serve as a cutting axis when the tool members rotate counter-rotating to each other as described herein.

[0115] See also Fig.7D , the connector link 4580 includes a proximal portion 4581 and a distal portion 4582 and defines a longitudinal axis AL extending between the proximal portion 4581 and the distal portion 4582. The distal portion 4582 includes a first protrusion 4585 and a second protrusion 4586 coupled within a distal link connector receptacle 4655 of the wrist link 4610. As described above, the distal link connector receptacle 4655 can retain the distal end 4582 of the connector link 4580 while also allowing the distal link 4610 to rotate relative to the connector link 4580. The proximal portion 4581 includes a first protrusion 4583 and a second protrusion 4584 coupled within a proximal link connector receptacle 4555 of the wrist link 4510, as described in more detail below.

[0116] The proximal wrist link 4510 includes a proximal portion and a distal portion. The proximal portion is coupled to a shaft, spacer, or other structure (not shown) for coupling the wrist assembly 4500 to a mechanical structure (e.g., similar to the mechanical structure 6700) to actuate the device. The distal portion includes a proximal connector link receptacle 4555. The proximal link connector receptacle 4555 may be a volume within the proximal wrist link (i.e., a volume defined by the sidewalls of the proximal wrist link 4510) within which the proximal end 4581 of the connector link 4580 is rotatably coupled. The proximal link connector receiving portion 4555 and the side wall of the proximal wrist link 4510 that defines the proximal link connector receiving portion 4555 can have any suitable shape, size, or orientation to couple the connector link 4580 therein so that the proximal wrist link 4510 can rotate relative to the connector link 4580 about the proximal connector link rotation axis A3 (arrow HH). For example, in some embodiments, the proximal link connector receiving portion 4555 can include opposing cylindrical portions that align with (or define) the proximal connector link rotation axis A3. The opposing cylindrical portions are located at Fig. 7E Shown as part 4557.

[0117] Either the proximal link connector receiving portion 4555 or the distal link connector receiving portion 4655 (or both) is configured to extend along the connector link 4580 around the longitudinal axis L of the connector link. A The connector link 4580 is inserted into the first orientation of the connector link 4580. Either the proximal link connector receiving portion 4555 or the distal link connector receiving portion 4655 (or both) is also configured to receive the connector link 4580 around the longitudinal axis L. A In other words, either (or both) of the proximal wrist link 4510 or the distal wrist link 4610 are constructed so that the end of the connector link 4580 can be inserted into the link connector receiving portion while also remaining captured (or locked) within the link connector receiving portion. In this way, the connector link 4580 can be connected to either wrist link (i.e., within the proximal link connector receiving portion 4555 or the distal link connector receiving portion 4655) in an effective manner. For example, as Fig. 7E As shown, in some embodiments, the end surface of the proximal wrist link 4510 defines an insertion opening 4556 leading to the proximal connector receiving portion 4555. The shape of the insertion opening 4556 corresponds to the shape of the proximal portion 4581 of the connector link 4580 to allow the proximal portion 4581 to pass therethrough during assembly. More specifically, the shape of the insertion opening 4556 (when perpendicular to the longitudinal axis L A When viewed in the plane of Fig. 7E As shown) defines the insertion main axis Ains . Insert the main axis A ins 4556. The line passing through the farthest point on the cross-sectional shape of the insertion opening 4556. In order to pass through the insertion opening 4556, the connector link 4580 must be rotated to a first orientation (eg, Fig. 7E In this manner, the proximal end portion 4581 of the connector link 4580 is aligned with the insertion opening 4556.

[0118] After the proximal end portion 4581 of the connector link 4580 moves through the insertion opening 4556 and into the proximal link connector receiving portion 4555, the connector link 4580 is rotated toward the second orientation, as indicated by arrow JJ. When the connector link is in the second orientation, the first protrusion 4583 and the second protrusion 4584 are retained within the proximal link connector receiving portion 4555 and aligned with the proximal connector link rotation axis A3. Although the proximal wrist link 4510 is shown as including an insertion opening 4556, in other embodiments, the distal wrist link 4610 may include a similar insertion opening.

[0119] In addition to being coupled together via the connector link 4580 , in some embodiments, the distal wrist link 4610 is in rolling contact with the proximal wrist link 4510 as the distal wrist link 4610 rotates relative to the proximal wrist link 4510 .

[0120] In some embodiments, either (or both) the distal wrist link 4610 or the proximal wrist link 4510 can be constructed from multiple discrete link pieces, similar to the above-described wrist links 2610 and 3610. In other embodiments, either (or both) the distal wrist link 4610 or the proximal wrist link 4510 can be integrally constructed (i.e., as a unitary structure).

[0121] In some embodiments, the medical device 4400 can include one or more tensile elements coupled to the mechanical structure, and movement of the tensile elements can produce desired movement of the wrist assembly 4500, the tool member 4462, or both. Thus, while neither the distal wrist link 4610 nor the proximal wrist link 4510 is shown as defining a channel forming a tensile element guide channel, in some embodiments, either the distal wrist link 4610 or the proximal wrist link 4510 (or both) can define one or more tensile element guide channels (not shown). Any tensile element guide channel can have any suitable size, shape, or profile to provide a desired path for the tensile element to pass therethrough, such as the shapes of the tensile element guide channels 6515, 6615 described herein.

[0122] As described above, any wrist assembly described herein may include any suitable tension element guide channel having a desired size, shape, or contour to provide a desired path for the tension element to pass therethrough. Fig. 8A and 8B 5400, according to one embodiment. In some embodiments, the medical device 5400, or any component thereof, is optionally part of an instrument of a surgical system for performing a surgical procedure, and may include a manipulator unit, a series of motion linkages, a series of cannulas, etc. The medical device 5400 (and any instrument described herein) can be used in any suitable surgical system, such as the MIRS system 1000 shown and described above. The medical device 5400 includes a wrist assembly 5500, an end effector 5460, and a tension element 5420. Although only one tool member 5462 is shown, one or more additional tool members may be included.

[0123] The wrist assembly 5500 includes a proximal wrist link 5510 and a distal wrist link 5610 rotatably coupled to the proximal wrist link about a wrist rotation axis A2. The wrist assembly 5500 defines a longitudinal centerline CL. Although the longitudinal centerline CL is shown as being linear, the longitudinal centerline CL may be curved when the wrist assembly is moved to a different orientation (i.e., when the second link 5610 is rotated relative to the first link 5510).

[0124] The proximal wrist link 5510 defines a first tensile element guide channel 5515, and the distal wrist link 5610 defines a second tensile element guide channel 5615. The tensile element guide channels 5515, 5615 are shaped and contoured to produce a desired path for the tensile element (e.g., through which the tensile element 5420 passes). Considerations affecting the shape of the first tensile element guide channel 5515 and the second tensile element guide channel 5615 (and any tensile element guide channels described herein) include reducing friction losses (from movement of the tensile element within the channel), keeping the tensile element within the distal boundaries of the wrist assembly 5500, minimizing the offset angle / fleet angle of the tensile element relative to its connection to the end effector 5460, and positioning the tensile element relative to the longitudinal centerline CL to maximize the torque that can be applied about one of the rotational axes of the wrist assembly 5500 or the end effector 5460. For example, the tension element guide channel 5515 can be shaped to reduce sharp bends, which can reduce friction losses when the tension element 5420 moves therein.

[0125] The end effector 5460 includes at least one tool member 5462 that is coupled to rotate about a tool member rotation axis A1 at a distal end portion of a distal wrist link 5610. More specifically, the tool member 5462 includes a contact portion and a pulley portion 5467. The contact portion is configured to engage or manipulate target tissue during a surgical procedure. The pulley portion 5467 is rotatably coupled to the distal wrist link 5610 and includes a contact surface or other structure that can be coupled to an actuator or tension element (not shown). In this way, when actuated, the tool member 5462 can rotate about the tool member rotation axis A1.

[0126] The shape of the guide channel can be described with reference to a plurality of different planes that are orthogonal to the longitudinal centerline CL of the wrist assembly 5500. This plane can be referred to as the XY plane and is defined by a first dimension (in Fig. 8A The second dimension (denoted as X dimension in Figure 8B The proximal portion 5421 of the tension element is disposed within the first tension element guide channel 5515, which is shaped and sized such that the first proximal end 5421 of the tension element 5420 is offset from the centerline CL by a first X distance X1 and a first Y distance Y1. Since the Y axis is parallel to the second rotation axis A2 (i.e., the pitch axis), it is desirable that the first distance X1 have a larger value to maximize the torque that the tension element can apply when rotating the second link 5610 about the second rotation axis A2. In addition, since the tension element must be disposed within the distal boundary, increasing the first distance X1 will result in a smaller value for the first distance Y1.

[0127] The tension element 5420 includes a first central portion 5426 and a second central portion 5427. The first central portion 5426 of the tension element 5420 is located between the first proximal portion 5421 and the distal portion 5422, and is the length of the tension element between the exit of the tension element guide channel 5515 of the first link 5510 and the entry point of the tension element guide channel 5615 of the second link 5610. Therefore, the first central portion 5426 of the tension element 5420 is located within the tension element guide channel 5615 on the second plane. The second central portion 5427 of the tension element 5420 is located between the first proximal portion 5421 and the distal portion 5422, and is the length of the tension element that leaves the tension element guide channel 5615 and is connected to the tool member. Therefore, the second central portion 5427 of the tension element 5420 is located within the tension element guide channel 5615 on the third plane. Fig. 8A and 8BAs shown, the tension member guide channel 5615 is curved in both the X and Y dimensions to produce the desired performance.

[0128] Specifically, the first tension element guide channel 5615 is shaped and dimensioned such that the first central portion 5426 of the tension element 5420 is offset from the centerline CL by a second X distance X2 and a second Y distance Y2. Since the Y axis is parallel to the second rotation axis A2 (i.e., the pitch axis), it is desirable that the second distance X2 has a larger value to maximize the torque that the tension element can apply when rotating the second link 5610 about the second rotation axis A2. In some embodiments, the second distance X2 is the same as the first distance X1. In other words, in some embodiments, the shape and position of the entrance portion (i.e., the portion at the second plane) of the tension element guide channel 5615 relative to the centerline CL are the same as the shape and position of the entrance portion (i.e., the portion at the first plane) of the tension element guide channel 5515 relative to the centerline CL.

[0129] As shown, the tension element guide channel 5615 is curved and is sized so that the second center portion 5427 of the tension element 5420 is offset from the center line by a third X distance X3 and a third Y distance Y3. Since the X-axis is parallel to the first rotation axis A1 (i.e., the yaw axis), it is desirable that the third distance Y3 has a larger value to maximize the torque that the tension element can apply when rotating the tool member 5462 about the first rotation axis A1. In addition, since the tension element must be arranged within the distal boundary, increasing the third distance Y3 will result in a smaller value for the third distance X3. Here, the third distance Y3 is greater than the second distance Y2, and the third distance X3 is less than the second distance X2. The smaller third distance X3 (which causes the tension element to be more inboard in the X dimension) also reduces the offset angle between the pulley portion 5467 and the second center portion 5427 of the rope.

[0130] Figure 9-23 6400, according to one embodiment. In some embodiments, the instrument 6400 or any component thereof is optionally part of a surgical system for performing a surgical procedure, and may include a manipulator unit, a series of motion linkages, a series of cannulas, etc. The instrument 6400 (and any instrument described herein) may be used in any suitable surgical system, such as the MIRS system 1000 shown and described above. Fig. 9As shown, the instrument 6400 defines (or is included in) the following features: a distal boundary (or footprint) 6599 that corresponds to the cannula size or other dimensions dictated by the surgical environment. The distal boundary 6599 can be cylindrical with any suitable nominal diameter (e.g., 8 mm, 5 mm, or any size therebetween). The instrument 6400 includes a proximal mechanical structure 6700, a shaft 6410 (e.g., see Fig. 9 and 10 ), distal wrist assembly 6500, distal end effector 6460 and a set of ropes (see Figure 20-23 , where one of the cables is identified as cable 6420). The cables act as tension elements that couple the proximal mechanical structure 6700 to the distal wrist assembly 6500 and the end effector 6460. In some embodiments, the cables can be composed of polymers as described above with respect to the cables 2420. The instrument 6400 is configured such that movement of one or more of the cables produces rotation of the end effector 6460 about the first rotation axis A1 (see Fig.10 , which serves as the yaw axis, the term yaw is arbitrary), rotation of the wrist assembly 6500 about the second rotation axis A2 (see Fig.10 , which serves as the pitch axis), cutting rotation of the tool member of the end effector 6460 about the first rotation axis A1, or any combination of these motions. The pitch or yaw of the instrument 6400 can be changed by manipulating the cable in a manner similar to the device 2400 described in reference to co-pending U.S. Provisional Patent Application Serial No. 63 / 233,904, entitled “Surgical Instrument Cable Control and Routing Structures,” the disclosure of which is incorporated herein by reference in its entirety.

[0131] The proximal mechanism 6700 generates movement of the various cables (including the cables 6420) to produce the desired movement (pitch, yaw, or grip) at the wrist assembly 6500 and the end effector 6460. Specifically, the proximal mechanism 6700 includes components and controls to move some cables in a proximal direction (i.e., pull in certain tension members) while allowing other cables to move distally (i.e., release or "let out"). In this way, the proximal mechanism 6700 can cause the desired movement while also maintaining the desired tension in the cables. Fig. 9 As shown, the proximal mechanical structure 6700 includes a set of capstans that rotate or "wind" the proximal portion of any rope to produce the desired rope movement. In some embodiments, the two proximal ends of the rope 6420 (see, for example, Fig. 20 and 21The first proximal portion 6421 and the second proximal portion 6423 shown in (which are associated with opposing directions of a single degree of freedom) are connected to two independent drive capstans 6710 and 6720. This arrangement (generally referred to as an antagonistic drive system) allows independent control of the movement of each end of the rope 6420 (e.g., pulling in or releasing). The mechanical structure 6700 generates the movement of the rope 6420, and the rope 6420 operates to produce the desired articulated movement (pitch, yaw, or grip) at the wrist assembly 6500 and the end effector 6460. Therefore, the mechanical structure 6700 includes components and controls to move the first proximal portion 6421 of the rope 6420 in a first direction (e.g., a proximal direction) through the first capstan 6710, and to move the second proximal portion 6423 of the rope 6420 in a second opposite direction (e.g., a distal direction) through the second capstan 6720. The mechanical structure 6700 can also move the two proximal portions of the rope 6420 in the same direction. In this way, the mechanical structure 6700 can maintain a desired tension within the rope.

[0132] See also Fig. 20 In use, the first capstan 6710 can be actuated to move the first proximal portion 6421 of the rope 6420 in a first direction along arrow BB. At the same time, the second capstan 6720 can be actuated to move the second proximal portion 6723 of the rope 6420 in a direction opposite to the first proximal portion 2423 along arrow CC. Therefore, the opposite movements of the first proximal portion 6421 and the second proximal portion 6423 cause the end effector 6460 to rotate about the rotation axis A1 (see Fig.10 ; for example, yaw motion) rotation (connected to the end effector 6460 via the cable 6420). In a similar manner, the rotation about the second axis A2 (see Fig.10 ; for example, pitch; orthogonal to the above-mentioned yaw axis A1) accurate pitch rotation. Specifically, the first capstan 6710 and the second capstan 6720 can each be actuated to move the first proximal portion 6421 and the second proximal portion 6423 of the cable 2420 together in the same direction (along arrows BB and CC, respectively). This causes the wrist assembly 6500 to rotate in the direction (e.g., pitch motion) around the second rotation axis A2 (via the cable 6420 passing through the wrist assembly 6500 and connected to the end effector 6460).

[0133] In some embodiments, the mechanical structure 6700 may include any of the components or parts described in U.S. Provisional Patent Application Serial No. 63 / 233,904, entitled "Surgical Instrument Cable Control and Routing Structures," the disclosure of which is incorporated herein by reference in its entirety. However, in other embodiments, any of the medical devices described herein may have both ends of the cable wound around a single capstan. Such alternative devices, generally referred to as self-antagonizing drive systems, utilize a single drive motor to operate both ends of the cable.

[0134] In addition, although the mechanical structure 6700 is shown as including a winch, in other embodiments, the mechanical structure may include one or more linear actuators that produce translation (linear motion) of a portion of the rope. Such a proximal mechanical structure may include, for example, a gimbal, a lever, or any other suitable mechanism to directly pull (or release) the end portion of any rope. For example, in some embodiments, the proximal mechanical structure 6700 may include any proximal mechanical structure or component described below: U.S. Patent Application Publication No. US2015 / 0047454Al (filed on August 15, 2014), entitled "LeverActuated Gimbal Plate", or U.S. Patent No. US 6,817,974 B2 (filed on June 28, 2001), entitled "Surgical Tool Having Positively Positionable Tendon-Actuated Multi-Diskrist Joint", both of which are incorporated herein by reference in their entirety.

[0135] The shaft 6410 can be any suitable elongated shaft coupled to the wrist assembly 6500 and to the mechanical structure 6700. Specifically, the shaft 6410 includes a proximal end 6411 coupled to the mechanical structure 6700 and a distal end 6412 coupled to the wrist assembly 6500 (e.g., a proximal link of the wrist assembly 6500). The instrument shaft 6410 defines a channel or a series of channels through which cables and other components (e.g., electrical wires, ground wires, etc.) can be routed from the proximal mechanical structure 6700 to the wrist assembly 6500. In some embodiments, the shaft 6410 can be at least partially formed of, for example, a conductive material such as stainless steel. In such embodiments, the shaft can include any of an inner insulating covering or an outer insulating covering. Thus, the shaft 6410 can be a shaft assembly including a plurality of different components. For example, as Fig. 9 and 10As shown, the shaft 6410 can include (or be coupled to) a spacer 6900 that provides the desired fluid seal, electrical isolation features, and any other desired features that couple the wrist assembly 6500 to the shaft 6410. In other words, although the wrist assembly 6500 (and other wrist assemblies or linkages described herein) are described as being coupled to the shaft 6410, it should be understood that any wrist assembly or linkage described herein can be coupled to the shaft via any suitable intermediate structure, such as a spacer 6900 and a cable guide, etc. In some embodiments, any medical device described herein can include any of a spacer, a seal, a cable guide, or other structure, as described in U.S. Provisional Patent Application Serial No. P06585-US-PRV, filed as of today, entitled “Surgical Instrument Including Electrical and Fluid Isolation Features,” the disclosure of which is incorporated herein by reference in its entirety.

[0136] refer to Fig.10 , the wrist assembly 6500 (also referred to as a joint assembly) includes a first link 6510 (which serves as a proximal wrist link), a second link 6610 (which serves as a distal wrist link), and a connector link 6580. As described in detail herein, the connector link 6580 is coupled between the first link 6510 and the second link 6610 to form an articulated wrist assembly 6500. The first link 6510 is coupled to the connector link 6580 by a pin-type joint, so that the first link 6510 can rotate relative to the connector link 6580 about a third rotation axis A3 (which serves as a proximal connector link rotation axis; see Fig.12 and 13 ) rotation. The second link 6610 is also coupled to the third link 6580 via a pin joint, such that the second link 6610 can rotate about a fourth rotation axis A4 (which serves as the distal connector link rotation axis; see Fig.12 and 13) rotates. In this way, during the rotation of the second link 6510 relative to the first link 6510, the connector link 6580 maintains the connection between the first link 6510 and the second link 6610. In addition, as described below, the distal portion 6512 of the first link 6510 includes a joint portion 6540, which is rotatably connected to the mating joint portion 6640 at the proximal portion 6611 of the second link 6610. In this way, the second link 6610 rotates relative to the first link 6510 about the second rotation axis A2 (which acts as a pitch axis, the term pitch is arbitrary). Since the joint between the first link 6510 and the second link 6610 is not a pin-type joint, the second rotation axis A2 will move relative to the first link 6510 during the rotation of the second link 6610.

[0137] The wrist assembly 6500 defines a longitudinal centerline CL (see Fig.12 , 13 , 15, 22 and 23). Although the longitudinal centerline CL is shown as linear, the longitudinal centerline CL can be curved when the wrist assembly moves to different orientations (i.e., when the second link 6610 rotates relative to the first link 6510). The distal boundary 6599 can be a cylindrical boundary centered along the longitudinal centerline CL.

[0138] The first link 6510 has a proximal portion 6511 and a distal portion 6512. The proximal portion 6511 includes a coupling protrusion that is coupled to the spacer 6900. The proximal portion 6511 can be coupled to the spacer 6900 by any suitable mechanism. For example, in some embodiments, the proximal portion 6511 can be cooperatively disposed within a portion of the spacer 6900 (e.g., by an interference fit). In some embodiments, the proximal portion 6511 can include one or more protrusions, recesses, openings, or connectors that couple the proximal portion 6511 to the spacer 6900. In some embodiments, some portions of the wrist assembly 6500 are made of a metal material and are used to deliver electrical energy to the tool members 6462 and 6482. For example, the first link 6510 and the second link 6610 can be formed of a metal material. Thus, as shown, the coupling protrusion of the proximal portion 6511 includes an interior region that forms an electrical connector 6573 that is configured to receive an electrical wire (not shown) to electrically couple the wire to the first link 6511. The electrical connector 6573 may be a push-in type connector that includes a sharp protrusion that is configured to strip a portion of the insulation from the wire to establish an electrical connection between the wire and the first link 6510.

[0139] The distal portion 6512 of the first link 6510 includes a joint portion 6540 that is rotatably coupled to a mating joint portion 6640 of the second link 6610. Specifically, the joint portion 6540 includes a first set of teeth 6541, a second set of teeth 6542, and a curved contact surface 6544. The first set of teeth 6541 is mutually meshed with the corresponding first set of teeth 6641 on the second link 6610, and the second set of teeth 6542 is mutually meshed with the corresponding second set of teeth 6642 on the second link 6610. When the second link 6610 rotates relative to the first link 6510 (i.e., pitches and rotates about the second rotation axis A2), the curved contact surface 6544 rolls in contact with the corresponding curved contact surface 6644 of the second link 6610. The mating joint portions 6540 and 6640 can be similar to those shown and described in U.S. patent application publication number US2017 / 0120457 Al (filed on February 20, 2015), entitled “Mechanical Wrist Joints with Enhanced Range of Motion, and Related Devices and Methods,” which is incorporated herein by reference in its entirety.

[0140] The first link 6510 includes a proximal connector link receiving portion 6555 that receives and holds the proximal end 6581 of the connector link. In other words, the side wall of the first link 6510 defines a volume within the first link 6510 that serves as the proximal connector link receiving portion 6555. Fig.14 and 16B As shown, the side wall portion 6557 of the first link 6510 defines an opposing cylindrical portion that receives the cylindrical protrusions 6583, 6584 of the proximal end 6581 of the connector link 6580. The opposing cylindrical portions align (or define) the proximal connector link rotation axis A3. In this way, the proximal end 6581 of the connector link 6580 is rotatably connected to the first link 6510 via the proximal connector link receiving portion 6555 around the third rotation axis A3.

[0141] like Figures 16A-17C As shown, the proximal link connector receiving portion 6555 is configured to receive the insertion of the connector link 6580 when the connector link is in a first orientation about the longitudinal axis LA of the connector link 6580 (see Fig.16A , 16B 17B). In other words, the proximal wrist link 6510 is structured so that the proximal end 6581 of the connector link 6580 can be inserted into the link connector receptacle 6555 while also remaining captured (or locked) therein.

[0142] For example, Fig.16A and 17A As shown, the end surface of the first link 6510 defines an insertion opening 6556 leading to the proximal connector link receiving portion 6555. The shape of the insertion opening 6556 corresponds to the shape of the proximal portion 6581 of the connector link 6580 to allow the proximal portion 6581 to pass therethrough during assembly. More specifically, the shape of the insertion opening 6556 (in a direction perpendicular to the longitudinal axis L A When viewed in the plane of Fig.15 As shown) defines the insertion main axis A ins . Insert the main axis A ins 6556. The line represents the farthest point on the cross-sectional shape through the insertion opening 6556. In order to pass through the insertion opening 6556, the connector link 6580 must be rotated to the first orientation ( Fig.16A , 16B 17B). In this way, the proximal end portion 6581 of the connector link 6580 is aligned with the insertion opening 6556. Then, the connector link 6580 is inserted through the insertion opening 6555, as shown in FIG. Fig. 17B As shown by the arrow MM.

[0143] After the proximal end portion 6581 of the connector link 6580 moves through the insertion opening 6556 and into the proximal link connector receiving portion 6555, the connector link 6580 is rotated toward the second orientation, such as Fig.17A and 17C When the connector link is in the second orientation, the first protrusion 6583 and the second protrusion 6584 are retained in the proximal link connector receiving portion 6555 and aligned with the third rotation axis A3. Therefore, the proximal link connector receiving portion 6555 is also configured to be rotated when the connector link 6580 is in the third rotation axis L A The second orientation of the connector link 6580 resists withdrawal. Although the first link 6510 is shown as including an insertion opening 6556, in other embodiments, any wrist link herein may include a similar insertion opening.

[0144] refer to Fig.14 and 15, the first link defines a first rope guide channel 6515 and a second rope guide channel 6525. Although the details of the rope guide channels are discussed below with reference to the first rope guide channel 6515 and the rope 6420, it should be understood that the disclosed structure and function are also applicable to the second rope guide channel 6525 and any rope guide channels and ropes described herein. The rope guide channels are shaped and contoured to produce a desired path for the rope (e.g., the rope 6420 passes therethrough). Considerations affecting the shape of the first rope guide channel 6515 and the second rope guide channel 6525 (and any rope guide channel described herein) include reducing friction losses (from rope movement within the channel), keeping the rope within the distal boundary 6599, minimizing the offset angle of the rope relative to its connection with the end effector 6460, and positioning the rope relative to the longitudinal centerline CL to maximize the torque that can be applied around one of the rotation axes of the wrist assembly 6500 or the end effector 6460. For example, the rope guide channel 6515 can be shaped to reduce sharp bends, which can reduce friction losses when the rope 6420 moves therein.

[0145] As shown, wrist assembly 6500 does not include (i.e., does not contain) any pulleys or rollers within rope guide channel 6515 and rope guide channel 6615. In other words, no portion of rope 6420 (including proximal portion 6421 within first link 6510, first center portion 6426, or second center portion 6427 within second link 6610) contacts a pulley or roller. Instead, the side walls of the first and second links defining rope guide channel 6515 and rope guide channel 6615 are shaped and contoured to provide the desired friction and bending characteristics for routing the rope therethrough. Therefore, wrist assembly 6500 may be referred to as a pulleyless wrist assembly. In addition, as Fig. 20 and 21 As shown, there is no central structure or guide surface within the wrist assembly that is located between the first proximal portion 6421 and the second proximal portion 6423 as the cable passes through the wrist assembly 6500.

[0146] Fig.15 It is shown that in plane P1 (such as Fig.12 6500). Plane P1 is perpendicular to the longitudinal centerline CL of wrist assembly 6500. Plane P1 is defined by the first dimension (in Fig.15 The second dimension (in Fig.15The Y axis is defined by the second rotation axis A2 (i.e., the pitch axis), the third rotation axis A3, and the fourth rotation axis A4. The X axis is parallel to the first rotation axis A1 (i.e., the yaw axis). As shown in the figure, the first link 6510 includes an inner guide surface 6516, an outer guide surface 6517, and two end guide surfaces 6518, each of which forms a portion of the boundary of the first guide channel 6515. The inner guide surface 6516 is closer to the longitudinal centerline CL than the outer guide surface 6517. The end guide surface 6518 is an opposing curved surface connecting the inner guide surface 6516 and the outer guide surface 6517 at the top and bottom of the guide channel. The first proximal portion 6421 of the rope is arranged in the first rope guide channel 6515 and contacts the end guide surface 6518 (the second proximal portion 6423 is arranged to contact the opposite end guide surface, but in Fig.15 not shown).

[0147] like Fig.15 As shown, the first rope guide channel 6515 is shaped and sized so that the first proximal end 6421 of the rope 6420 is offset from the Y axis by a first X distance X1, and is offset from the X axis by a first Y distance Y1. Since the Y axis is parallel to the second rotation axis A2 (i.e., the pitch axis), it is desirable that the first distance X1 has a larger value to maximize the torque that the rope can apply when rotating the second link 6610 around the second rotation axis A2. In addition, since the rope must be routed within the distal boundary 6599, increasing the first distance X1 will result in a smaller value for the first distance Y1. As described in more detail, the rope guide channel passing through the second link 6610 is configured to route the rope 6420 to reduce the X distance and maximize the Y distance (to increase the torque that the rope can apply when rotating the end effector 6460 around the first rotation axis A1 (yaw axis)).

[0148] The second link 6610 has a proximal portion 6611 and a distal portion 6612. The proximal portion 6611 is rotatably coupled to the distal portion 6512 of the first link 6510. As described herein, the second link 6610 rotates relative to the first link 6510 about the second rotation axis A2. As described in more detail below, the distal portion 6612 is coupled to the end effector 6460. Reference Fig.18 and 19, the second link 6610 includes a discrete first link member 6601 and a discrete second link member 6602. In other words, the first link member 6601 and the second link member 6602 are constructed as separate pieces and are subsequently coupled together to form the second link 6610. By forming the second link 6610 from two discrete pieces, the assembly method of the instrument 6400 can be more efficient than a device having a wrist link of an integral construction. For example, as described herein, a rope (e.g., rope 6420) can be arranged in the rope guide channel 6615 before the second link member 6602 is coupled to the first link member 6601, thereby eliminating the need to pass the loose end of the rope 6420 through the closed channel. The second link member 6602 can be coupled to the first link member 6601 by any suitable mechanism (e.g., an adhesive joint, a welded joint, or a mechanical fastener). In addition, although described separately herein, in some embodiments, the first link member 6601 and the second link member 6602 can have the same configuration. In other words, in some embodiments, the first link member 6601 and the second link member 6602 can be substantially the same member.

[0149] The first link member 6601 includes a proximal portion 6603 and a distal portion 6604. The distal portion 6604 includes a first U-shaped ear 6651 defining an opening 6652. The proximal portion 6603 includes an opening 6657, which together with a corresponding opening 6658 of the second link member 6602 forms a distal connector link receiving portion. The distal connector link receiving portion (including the opening 6657 and the opening 6658) receives and retains the distal end 6582 of the connector link 6580. In other words, the side wall of the first link member 6601 defines an opening 6657, which receives and retains the cylindrical protrusion 6685 of the distal end 6582 of the connector link 6580. The opening 6657 is aligned with the corresponding opening 6658 of the second link member 6602, and they together define the distal connector link rotation axis A4. The proximal portion 6603 also includes a first set of teeth 6641 and a curved contact surface 6544.

[0150] The first link member 6601 defines a first channel 6621 and a second channel 6622. The first channel 6621 is opposite to the corresponding first channel 6631 of the second link member 6602, and the second channel 6622 is opposite to the corresponding second channel 6632 of the second link member 6602. In this way, when the first link member 6601 is coupled to the second link member 6602, the first channel 6621 is aligned with the first channel 6631 to define the first rope guide channel 6615 (see Fig. 22 ). Similarly, the second channel 6622 is aligned with the second channel 6632 to define a second rope guide channel 6625.

[0151] The second link member 6602 includes a proximal portion 6605 and a distal portion 6606. The distal portion 6606 includes a first U-shaped ear 6661 that defines an opening 6662. The proximal portion 6605 includes an opening 6658 that forms a distal connector link receiving portion with a corresponding opening 6657 of the first link member 6601, as described above. The proximal portion 6605 also includes a first set of teeth 6642 and a curved contact surface 6544. The second link member 6602 defines a first channel 6631 and a second channel 6632, as described above.

[0152] like Fig.18 and 19 As shown, the first link member 6601 and the second link member each include a connecting pin 6653 and a connecting hole 6654. The connecting pin 6653 of the first link member 6601 is configured to be received in the connecting hole 6654 of the second link member 6602 (see Fig.18 ), and vice versa, in order to facilitate coupling the first link member 6601 to the second link member 6602. When the second link member 6602 is coupled to the first link member 6601 to form the second link 6610, the second U-shaped ear 6661 is opposite to the first U-shaped ear 6651. Therefore, the openings 6652 and 6662 are aligned so that the pin 6670 can be coupled between the first U-shaped ear 6651 and the second U-shaped ear 6661 to allow the end effector 6460 to rotate around the tool member rotation axis A1. In other words, when the second link member 6602 is coupled to the first link member 6601, the second U-shaped ear 6661 is aligned with the first U-shaped ear 6651 to define the tool member rotation axis A1. In addition, when the second link member 6602 is coupled to the first link member 6601, the opening 6657 is opposite to the opening 6658. Thus, the openings 6657 and 6658 are aligned so that the protrusions 6585 and 6586 can be coupled within the openings to allow the connector link 6580 to rotate about the fourth rotation axis A4. The tool member rotation axis A1 is perpendicular to the distal connector link rotation axis A4.

[0153] When the second link 6610 is assembled, the end effector 6460 is rotatably coupled to the second link 6610 about the first rotation axis A1. The end effector 6460 includes a first tool member 6462 and a second tool member 6482 coupled between the U-shaped ears 6651 and 6661. The first tool member 6462 includes a contact portion 6464 and a pulley portion 6467. The second tool member 6482 includes a contact portion 6484 and a pulley portion 6487. The pulley portion 6467 is rotatably coupled to the first U-shaped ear 6651, and the pulley portion 6487 is rotatably coupled to the second U-shaped ear 6661 by a pin 6670. The pulley portions each include a contact surface or other structure that can be coupled to a rope. In this way, when actuated, the tool members 6462, 6482 can rotate around the tool member rotation axis A1 (which serves as a yaw axis; the term yaw is arbitrary).

[0154] like Fig.11 As shown, the first washer 6671 is located between the first U-shaped ear 6651 and the first tool member 6462, and the second washer 6672 is located between the second U-shaped ear 6661 and the second tool member 6482. The first washer 6671 can be biased to push the first tool member 6462 away from the U-shaped ear 6651 and toward the second tool member 6482. The second washer 6672 can be biased to push the second tool member 6482 away from the U-shaped ear 6661 and toward the first tool member 6462. Thus, the washers can cause the tool members to be pushed inwardly toward each other to provide the desired interference between the tool member blades, as described in co-pending U.S. Provisional Patent Application Serial No. 63 / 234,662, entitled "Surgical Instrument Shears," the disclosure of which is incorporated herein by reference in its entirety.

[0155] like Figure 20-22 As shown, when the second link 6610 is assembled, the second link defines a first rope guide channel 6615 and a second rope guide channel 6625. The rope guide channels are shaped and contoured to produce a desired path for the rope (e.g., the path through which the rope 6420 passes). Considerations affecting the shape of the first rope guide channel 6615 and the second rope guide channel 6625 (and any rope guide channels described herein) include reducing friction losses (from rope movement within the channel), keeping the rope within the distal boundary 6599, minimizing the offset angle of the rope relative to its connection with the end effector 6460, and positioning the rope relative to the longitudinal centerline CL to maximize the torque that can be applied around one of the rotation axes of the wrist assembly 6500 or the end effector 6460.

[0156] As an example, Fig.18As shown, the second link member 6601 includes two protrusions 6629, which provide surfaces for the connection hole 6654 and the connection pin 6653. The protrusions 6629 also form the curved boundaries of each of the rope guide channels 6615, 6625. Fig.21 As shown, the protrusion 6629 forms a portion of the outer surface defining the guide channel and routes the rope on the inner side (i.e., toward the center line CL in the X dimension, as shown in FIG. Fig.23 In this way, the protrusion 6629 and the guide channel ensure that the second central portion 6627 of the rope leaves the second link 6610 in a manner that reduces the offset angle relative to the connection of the rope to the pulley portion 6487.

[0157] To further illustrate the rope guide channel in the second link 6610, Fig. 22 It is shown that in plane P2 (such as Fig.21 ), the plane P2 can be characterized as the entry plane (or the plane at the entry point of the rope entering the proximal portion 6611 of the second link 6610). Fig.23 It is shown that in plane P3 (such as Fig.21 6487), the plane P3 can be characterized as the exit plane (or the plane at the exit point where the cable leaves the distal portion 6612 of the second link 6610 and connects to the pulley portion 6487). Planes P2 and P3 are perpendicular to the longitudinal centerline CL of the wrist assembly 6600. Like the above-mentioned plane P1, planes P2 and P3 are each defined by a first dimension (in Fig. 22 and 23 The second dimension (in Fig. 22 and 23 The Y axis is defined by the second rotation axis A2 (i.e., the pitch axis), the third rotation axis A3, and the fourth rotation axis A4. The X axis is parallel to the first rotation axis A1 (i.e., the yaw axis). As shown in the figure, the second connecting rod 6610 includes an inner guide surface 6616, an outer guide surface 6617, and two end guide surfaces 6618, each of which forms a part of the boundary of the first guide channel 6615. The inner guide surface 6616 is closer to the longitudinal centerline CL than the outer guide surface 6617. The end guide surface 6618 is an opposite curved surface connecting the inner guide surface 6616 and the outer guide surface 6617 at the top and bottom of the guide channel.

[0158] The rope 6420 includes a first central portion 6426 and a second central portion 6427. The first central portion 6426 of the rope 6420 is between the first proximal portion 6421 and the distal portion 6422, and is the length of the rope between the exit of the rope guide channel 6515 of the first link 6510 and the entry point of the rope guide channel 6615 of the second link 6610. Therefore, the first central portion 6426 of the rope 6420 is located within the rope guide channel 6615 at the second plane P2. The second central portion 6427 of the rope 6420 is between the first proximal portion 6421 and the distal portion 6422, and is the length of the rope that exits the rope guide channel 6615 and is connected to the tool member. Therefore, the second central portion 6427 of the rope 6420 is located within the rope guide channel 6615 at the third plane P3. Fig.21 As shown, the rope guide channel 6615 is curved in both the X and Y dimensions to produce the desired performance.

[0159] Specifically, Fig. 22 As shown, the first rope guide channel 6615 is shaped and sized so that the first center portion 6426 of the rope 6420 is offset from the Y axis by a second X distance X2 and from the X axis by a second Y distance Y2. Since the Y axis is parallel to the second rotation axis A2 (i.e., the pitch axis), it is desirable that the second distance X2 has a larger value to maximize the torque that the rope can apply when the second link 6610 is rotated around the second rotation axis A2. In addition, since the rope must be arranged within the distal boundary 6699, increasing the second distance X2 will result in a smaller value for the second distance Y2. In some embodiments, the second distance X2 is the same as the first distance X1. In other words, in some embodiments, the shape and position of the entrance portion (i.e., the portion at the plane P2) of the rope guide channel 6615 relative to the centerline CL are the same as the shape and position of the entrance portion (i.e., the portion at the plane P1) of the rope guide channel 6515 relative to the centerline CL.

[0160] like Fig.23As shown, the rope guide channel 6615 is curved and is sized so that the second center portion 6427 of the rope 6420 is offset from the Y axis by a third X distance X3 and from the X axis by a third Y distance Y3. Since the X axis is parallel to the first rotation axis A1 (i.e., the yaw axis), it is desirable that the third distance Y3 has a larger value to maximize the torque that the rope can apply when rotating the tool member 6482 around the first rotation axis A1. In addition, since the rope must be arranged within the distal boundary 6699, increasing the third distance Y3 will result in a smaller value for the third distance X3. Here, the third distance Y3 is greater than the second distance Y2, and the third distance X3 is less than the second distance X2. The smaller third distance X3 (which causes the rope to be more inboard in the X dimension) also reduces the offset angle between the pulley portion 6487 and the second center portion 6427 of the rope.

[0161] In some embodiments, the wrist assembly can include multiple links (e.g., proximal links and distal links) formed from multiple discrete pieces. Figure 24-37 7400, according to one embodiment. In some embodiments, the instrument 7400 or any component thereof is optionally part of a surgical system for performing a surgical procedure, and it may include a manipulator unit, a series of motion linkages, a series of cannulas, etc. The instrument 7400 (and any instrument described herein) can be used in any suitable surgical system, such as the MIRS system 1000 shown and described above. The instrument 7400 includes a proximal mechanical structure, a shaft, and a spacer 7900 that may be similar or identical to the proximal mechanical structure 6700, shaft 6410, and spacer 6900 described above. The instrument 7400 includes a distal wrist assembly 7500, a distal end effector 7460, and a set of cables (see Figure 32-37 , one of the cables is labeled as cable 7420). The cables act as tension elements that couple the proximal mechanical structure to the distal wrist assembly 7500 and the end effector 7460. In some embodiments, the cables can be composed of polymers as described above with respect to the cables 2420. The instrument 7400 is configured so that movement of one or more cables produces rotation of the end effector 7460 about the first rotation axis A1 (see Fig.24 , which serves as the yaw axis, the term yaw is arbitrary), rotation of the wrist assembly 7500 about the second rotation axis A2 (see Fig.24 , which serves as the pitch axis), a cutting rotation of the tool member of the end effector 7460 about the first rotation axis A1, or any combination of these motions.

[0162] See also Fig.24, the wrist assembly 7500 (also referred to as a joint assembly) includes a first link 7510 (which serves as a proximal wrist link), a second link 7610 (which serves as a distal wrist link), and a connector link 7580. The connector link 7580 is connected between the first link 7510 and the second link 7610 to form an articulated wrist assembly 7500. The first link 7510 is connected to the connector link 7580 by a pin-type joint, so that the first link 7510 can rotate relative to the connector link 7580 around a third rotation axis A3 (which serves as a proximal connector link rotation axis; see Fig. 27 ) rotation. The second link 7610 is also connected to the third link 7515 by a pin joint, so that the second link 7610 can rotate about a fourth axis of rotation A4 (which serves as the distal connector link rotation axis; see Fig. 27 ) rotates. In this way, the connector link 7580 maintains the connection between the first link 7510 and the second link 7610 during the rotation of the second link 7610 relative to the first link 7510. In addition, as described below, the distal portion 7512 of the first link 7510 includes a joint portion 7540 that is rotatably connected to a mating joint portion 7640 at the proximal portion 7611 of the second link 7610. In this way, the second link 7610 rotates relative to the first link 7510 about the second rotation axis A2 (which serves as the pitch axis, the term pitch being arbitrary). The wrist assembly 7500 defines a longitudinal centerline CL (see Fig.26 , 27 ). Although the longitudinal centerline CL is shown as linear, it is not linear when the wrist assembly is moved to a different orientation (i.e., when the second link 7610 is rotated relative to the first link 7510; see Fig.34 ), the longitudinal center line CL can be curved.

[0163] The first link 7510 has a proximal portion 7511 and a distal portion 7512. The proximal portion 7511 includes a coupling protrusion that is coupled to the spacer 7900. In some embodiments, some portions of the wrist assembly 7500 are formed of a metal material and are used to deliver electrical energy to the tool members 7462 and 7482. For example, the first link 7510 and the second link 7610 can be formed of a metal material. Therefore, as shown, the coupling protrusion of the proximal portion 7511 includes an inner region that forms an electrical connector 7573 that is configured to receive an electrical wire (not shown) to electrically couple the wire to the first link 7511. The electrical connector 7573 can be a push-in type connector that includes a sharp protrusion that is configured to strip a portion of the insulation from the wire to establish an electrical connection between the (electrical) wire and the first link 7510.

[0164] The distal portion 7512 of the first link 7510 includes a joint portion 7540 that is rotatably coupled to a mating joint portion 7640 of the second link 7610. Specifically, the joint portion 7540 includes a first set of teeth 7541, a second set of teeth 7542, and a curved contact surface 7544. The first set of teeth 7541 is mutually meshed with the corresponding first set of teeth 7641 on the second link 7610, and the second set of teeth 7542 is mutually meshed with the corresponding second set of teeth 7642 on the second link 7610. When the second link 7610 rotates relative to the first link 7510 (i.e., pitches and rotates about the second rotation axis A2), the curved contact surface 7544 rolls in contact with the corresponding curved contact surface 7644 of the second link 7610.

[0165] refer to Fig.18 and 19 , the first link 7510 includes a discrete first link member 7501 and a discrete second link member 7502. In other words, the first link member 7501 and the second link member 7502 are constructed as separate pieces and are subsequently coupled together to form the first link 7510. The second link member 7502 can be coupled to the first link member 7501 by any suitable mechanism (e.g., an adhesive joint, a weld joint, or a mechanical fastener). In addition, although described separately herein, in some embodiments, the first link member 7501 and the second link member 7502 can have the same configuration. In other words, in some embodiments, the first link member 7501 and the second link member 7502 can be substantially the same piece.

[0166] The first link member 7501 includes a proximal portion 7503 and a distal portion 7504. The proximal portion 7503 includes an electrical connector 7573 and a portion of a coupling protrusion. The distal portion 7504 includes a first set of teeth 7541 and a curved contact surface 7544. The distal portion 7504 of the first link member 7501 also includes an opening 7557, which together with a corresponding opening 7558 of the second link member 7502 forms a proximal connector link receiving portion. The distal connector link receiving portion (including the opening 7557 and the opening 7558) receives and retains the proximal end 7581 of the connector link 7580. In other words, the side wall of the first link member 7501 defines an opening 7557, which receives and retains the cylindrical protrusion of the proximal end 7581 of the connector link 7580. The opening 7557 is aligned with a corresponding opening 7558 of the second link member 7502 and they collectively define a proximal connector link rotation axis A3.

[0167] The first link member 7501 defines a first channel 7521 and a second channel 7522. The first channel 7521 is opposite to the corresponding first channel 7531 of the second link member 7502, and the second channel 7522 is opposite to the corresponding second channel 7532 of the second link member 7502. In this way, when the first link member 7501 is coupled to the second link member 7502, the first channel 7521 is aligned with the first channel 7531 to define the first rope guide channel 7515 (see Figure 33-35 ). Similarly, the second channel 7522 is aligned with the second channel 7532 to define a second rope guide channel 7525. The rope guide channel is shaped and contoured to produce a desired path for the rope (e.g., the rope 7420 passes therethrough). Considerations affecting the shape of the first rope guide channel 7515 and the second rope guide channel 7525 (and any rope guide channels described herein) include reducing friction losses (from rope movement within the channel), keeping the rope within a distal boundary (e.g., similar to the distal boundary 6900 described above), minimizing the offset angle of the rope relative to its connection with the end effector 7460, and positioning the rope relative to the longitudinal centerline CL to maximize the torque that can be applied around one of the rotation axes of the wrist assembly 7500 or the end effector 7460. For example, the rope guide channel 7515 can be shaped to reduce sharp bends, which can reduce friction losses when the rope 7420 moves therein.

[0168] The second link member 7502 includes a proximal portion 7505 and a distal portion 7506. The proximal portion 7505 includes an electrical connector 7573 and a portion of a coupling protrusion. The distal portion 7506 includes a second set of teeth 7542 and a curved contact surface 7544. The distal portion 7506 also includes a connector link opening 7558, as described above. The second link member 7502 defines a first channel 7531 and a second channel 7532, as described above.

[0169] like Fig.28 and 29 As shown, the first link member 7501 and the second link member each include a connecting pin 7553 and a connecting hole 7554. The connecting pin 7553 of the first link member 7501 is configured to be received in the connecting hole 7554 of the second link member 7502 (see Fig.28 ), and vice versa, so as to facilitate coupling the first link member 7501 to the second link member 7502 to form a first (proximal) link 7510. The first link member 7501 and the second link member 7502 each include an opening 7571, a connecting pin 7570 (see Fig.25) can be inserted through the opening 7571 to facilitate coupling the first link member 7510 to the spacer 7900. When the second link member 7502 is coupled to the first link member 7501 to form the first link 7510, the opening 7557 is opposite to the opening 7558. Therefore, the openings 7557 and 7558 are aligned so that the protrusion of the proximal end 7581 of the connector link 7580 can be coupled therein to allow the connector link 7580 to rotate about the third rotation axis A3.

[0170] The second (distal) link 7610 has a proximal portion 7611 and a distal portion 7612. The proximal portion 7611 is rotatably coupled to the distal portion 7512 of the first link 7510. As described herein, the second link 7610 rotates relative to the first link 7510 about a second rotation axis A2. The distal portion 7612 is coupled to the end effector 7460. Fig.30 and 31 , the second link 7610 includes a discrete first link member 7601 and a discrete second link member 7602. In other words, the first link member 7601 and the second link member 7602 are constructed as separate pieces and are subsequently coupled together to form the second link 7610. The second link member 7602 can be coupled to the first link member 7601 by any suitable mechanism (e.g., an adhesive joint, a weld joint, or a mechanical fastener). In addition, although described separately herein, in some embodiments, the first link member 7601 and the second link member 7602 can have the same configuration. In other words, in some embodiments, the first link member 7601 and the second link member 7602 can be substantially the same piece.

[0171] The first link member 7601 includes a proximal portion 7603 and a distal portion 7604. The distal portion 7604 includes a first U-shaped ear 7651 defining an opening 7652. The proximal portion 7603 includes an opening 7657, which together with a corresponding opening 7658 of the second link member 7602 forms a distal connector link receiving portion. The distal connector link receiving portion (including the opening 7657 and the opening 7658) receives and retains the distal end 7582 of the connector link 7580. In other words, the side wall of the first link member 7601 defines an opening 7657, which receives and retains the cylindrical protrusion of the distal end 7582 of the connector link 7580. The opening 7657 is aligned with the corresponding opening 7658 of the second link member 7602, and they together define the distal connector link rotation axis A4. The proximal portion 7603 also includes a first set of teeth 7641 and a curved contact surface 7544.

[0172] The first link member 7601 defines a first channel 7621 and a second channel 7622. The first channel 7621 is opposite to the corresponding first channel 7631 of the second link member 7602, and the second channel 7622 is opposite to the corresponding second channel 7632 of the second link member 7602. In this way, when the first link member 7601 is coupled to the second link member 7602, the first channel 7621 is aligned with the first channel 7631 to define the first rope guide channel 7615 (see Fig.33 ). Similarly, the second channel 7622 is aligned with the second channel 7632 to define a second rope guide channel 7625.

[0173] The second link member 7602 includes a proximal portion 7605 and a distal portion 7606. The distal portion 7606 includes a first U-shaped ear 7661 defining an opening 7662. The proximal portion 7605 includes an opening 7658, which together with the corresponding opening 7657 of the first link member 7601 forms a distal connector link receiving portion, as described above. The proximal portion 7605 also includes a first set of teeth 7642 and a curved contact surface 7544. The second link member 7602 defines a first channel 7631 and a second channel 7632, as described above.

[0174] like Fig.30 and 31 As shown, the first link member 7601 and the second link member each include a connecting pin 7653 and a connecting hole 7654. The connecting pin 7653 of the first link member 7601 is configured to be received in the connecting hole 7654 of the second link member 7602, and vice versa, so as to facilitate coupling the first link member 7601 to the second link member 7602. When the second link member 7602 is coupled to the first link member 7601 to form the second link 7610, the second U-shaped ear 7661 is opposite to the first U-shaped ear 7651. Therefore, the openings 7652 and 7662 are aligned so that the pin 7670 can be coupled between the first U-shaped ear 7651 and the second U-shaped ear 7661 to allow the end effector 7460 to rotate around the tool member rotation axis A1. In other words, when the second link member 7602 is coupled to the first link member 7601, the second U-shaped ear 7661 is aligned with the first U-shaped ear 7651 to define the tool member rotation axis A1. In addition, when the second link member 7602 is coupled to the first link member 7601, the opening 7657 is opposite to the opening 7658. Therefore, the openings 7657 and 7658 are aligned so that the distal end portion 75822 of the connector link 7580 can be coupled within the opening to allow the connector link 7580 to rotate about the fourth rotation axis A4.

[0175] When assembling the second link 7610, the end effector 7460 is rotatably coupled to the second link 7610 about the first rotation axis A1. The end effector 7460 includes a first tool member 7462 and a second tool member 7482 coupled between the U-shaped ears 7651 and 7661. The first tool member 7462 includes a contact portion and a pulley portion 7467. The second tool member 7482 includes a contact portion and a pulley portion 7487. The pulley portion 7467 is rotatably coupled to the first U-shaped ear 7651 and the pulley portion 7487 is rotatably coupled to the second U-shaped ear 7661 by a pin 7670. The pulley portions each include a contact surface or other structure that can be coupled to a rope. In this way, when actuated, the tool members 7462, 7482 can rotate around the tool member rotation axis A1 (which serves as a yaw axis; the term yaw is arbitrary).

[0176] like Figure 20-22 As shown, when the second link 7610 is assembled, the second link defines a first rope guide channel 7615 and a second rope guide channel 7625. The rope guide channel is shaped and contoured to produce a desired path for the rope (e.g., rope 7420 to pass through it). Considerations affecting the shape of the first rope guide channel 7615 and the second rope guide channel 7625 (and any rope guide channel described herein) include reducing friction losses (from rope movement within the channel), keeping the rope within the distal boundary, minimizing the offset angle of the rope relative to its connection with the end effector 7460, and positioning the rope relative to the longitudinal centerline CL to maximize the torque that can be applied around one of the rotation axes of the wrist assembly 7500 or the end effector 7460.

[0177] To further illustrate the rope guide channels within the first and second links of the wrist assembly, Figure 32-34 Various views of the cable 7420 being routed through the wrist assembly 7500 are shown. Fig.35 It is shown that in plane P1 (such as Fig.34 100). The plane P1 is perpendicular to the longitudinal centerline CL of the wrist assembly 7500. The plane P1 is defined by the first dimension (in Fig.35 The second dimension (in Fig.35 The Y axis is parallel to the second rotation axis A2 (i.e., the pitch axis), the third rotation axis A3, and the fourth rotation axis A4. The X axis is parallel to the first rotation axis A1 (i.e., the yaw axis). Fig.15As shown, the first rope guide channel 7515 is shaped and sized so that the first proximal end 7421 of the rope 7420 is offset from the Y axis by a first X distance X1 and from the X axis by a first Y distance Y1. Since the Y axis is parallel to the second rotation axis A2 (i.e., the pitch axis), it is desirable that the first distance X1 has a larger value to maximize the torque that the rope can apply when the second link 7610 is rotated around the second rotation axis A2. In addition, since the rope must be routed within the distal boundary, increasing the first distance X1 will result in a smaller value for the first distance Y1. As described in more detail, the rope guide channel passing through the second link 7610 is configured to route the rope 7420 to reduce the X distance and maximize the Y distance (to increase the torque that the rope can apply when the end effector 7460 is rotated around the first rotation axis A1 (yaw axis)).

[0178] Fig.36 It is shown that in plane P2 (such as Fig.33 ), the plane P2 can be characterized as the entry plane (or the plane at the entry point where the rope enters the proximal portion 7611 of the second link 7610). Fig.37 It is shown that in plane P3 (such as Fig.33 7600). As shown in FIG. 76, the plane P3 can be characterized as an exit plane. Planes P2 and P3 are perpendicular to the longitudinal centerline CL of the wrist assembly 7600. Like the plane P1 described above, planes P2 and P3 are each defined by a first dimension (denoted as the X axis) and a second dimension (denoted as the Y axis). The rope 7420 includes a first central portion 7426 and a second central portion 7427. The first central portion 7426 of the rope 7420 is located between the first proximal portion 7421 and the distal portion 7422, and is the length of the rope between the exit of the rope guide channel 7515 of the first link 7510 and the entry point of the rope guide channel 7615 of the second link 7610. Therefore, the first central portion 7426 of the rope 7420 is located in the rope guide channel 7615 at the second plane P2. The second central portion 7427 of the cord 7420 is located between the first proximal portion 7421 and the distal portion 7422 and is the length of the cord that exits the cord guide channel 7615 and is coupled to the tool member. Thus, the second central portion 7427 of the cord 7420 is located within the cord guide channel 7615 at the third plane P3. Fig.32 and 33 As shown, the rope guide channel 7615 is curved in both the X and Y dimensions to produce the desired performance.

[0179] Specifically, Fig.36As shown, the first rope guide channel 7615 is shaped and sized so that the first central portion 7426 of the rope 7420 is offset from the Y axis by a second X distance X2 and from the X axis by a second Y distance Y2. Since the Y axis is parallel to the second rotation axis A2 (i.e., the pitch axis), it is desirable that the second distance X2 has a larger value to maximize the torque that the rope can apply when the second link 7610 is rotated around the second rotation axis A2. In addition, since the rope must be arranged within the distal boundary, increasing the second distance X2 will result in a smaller value for the second distance Y2. In some embodiments, the second distance X2 is the same as the first distance X1. In other words, in some embodiments, the shape and position of the entrance portion (i.e., the portion at the plane P2) of the rope guide channel 7615 relative to the centerline CL are the same as the shape and position of the entrance portion (i.e., the portion at the plane P1) of the rope guide channel 7515 relative to the centerline CL.

[0180] like Fig.37 As shown, the rope guide channel 7615 is curved and is sized so that the second center portion 7427 of the rope 7420 is offset from the Y axis by a third X distance X3 and from the X axis by a third Y distance Y3. Since the X axis is parallel to the first rotation axis A1 (i.e., the yaw axis), it is desirable that the third distance Y3 has a larger value to maximize the torque that the rope can apply when rotating the tool member 7482 around the first rotation axis A1. In addition, since the rope must be arranged within the distal boundary, increasing the third distance Y3 will result in a smaller value for the third distance X3. Here, the third distance Y3 is greater than the second distance Y2, and the third distance X3 is less than the second distance X2. The smaller third distance X3 (which causes the rope to be more inboard in the X dimension) also reduces the offset angle between the pulley portion 7487 and the second center portion 7427 of the rope.

[0181] Fig.38is a flow chart of a method for assembling a portion of a medical device according to one embodiment. The method can be performed with any device described herein having one or more wrist links consisting of two (or more) discrete link members. Specifically, the method can be used to assemble the medical device 6400 or medical device 7400 described herein. Such a medical device includes a first link member, a second link member, a tool member, a pin, and a tension element. The method includes inserting the first end portion of the pin into the first U-shaped ear of the first link member at 12. The first link member can be any first discrete link member described herein, such as, for example, the first link member 6601 or the first link member 7601. The pin is a portion of an end effector having at least one tool member (e.g., pin 6670 or 7670, which is connected to the end effector 6460 or 7460, respectively). The second end portion of the pin is inserted into the second U-shaped ear of the second link member at 14. The second link member is discrete from the first link member and can be any second separate link member described herein, such as, for example, second link member 6602 or second link member 7602 .

[0182] At 16, the method includes arranging a portion of a tension element into at least one of a first guide channel of a first link member or a second guide channel of a second link member. The tension element may be a rope, and the method of arranging a portion of the rope into an open (i.e., not fully enclosed) guide channel may make assembly more efficient. Then, at 18, the second link member is arranged on the first link member so that the second U-shaped ear is opposite the first U-shaped ear. Then, at 20, the second link member is coupled to the first link member to form a wrist link.

[0183] Although various embodiments have been described above, it should be understood that these embodiments are presented as examples only and are not intended to be limiting. While the above methods and / or schematics show that certain events and / or process patterns occur in a certain order, the order of certain events and / or operations may be modified. Although embodiments have been specifically shown and described, it should be understood that various changes in form and detail may be made.

[0184] For example, any instrument described herein (and components therein) is optionally part of a surgical assembly for performing a minimally invasive surgical procedure, and it may include a manipulator unit, a series of motion linkages, a series of sleeves, etc. Therefore, any instrument described herein may be used in any suitable surgical system, such as the MIRS system 1000 shown and described above. In addition, any instrument shown and described herein may be used to manipulate target tissue during a surgical procedure. Such target tissue may be cancer cells, tumor cells, injuries, vascular occlusions, thrombi, stones, uterine fibroids, bone metastases, adenomyosis, or any other body tissue. The target tissue examples shown are not exhaustive. In addition, the target structure may also include artificial substances (or non-tissues) in or associated with the body, such as, for example, a portion of a stent, an artificial tube, a fastener in the body, etc.

[0185] For example, any of the components of the surgical instruments described herein can be constructed from any material, such as medical grade stainless steel, nickel alloys, titanium alloys, etc. In addition, any of the connecting rods, tool members, tension members, or components described herein can be constructed from multiple pieces that are subsequently joined together. For example, in some embodiments, the connecting rod can be constructed by joining together separately constructed components. However, in other embodiments, any of the connecting rods, tool members, tension members, or components described herein can be constructed integrally.

[0186] In some embodiments, any tension element described herein (including tension elements 2420, 3420, 4420, 5420, 6420, 7420) can be a rope having a polymer braided structure. In some embodiments, the distal portion of any tension element described herein can include an oil coating. In some embodiments, the distal portion of any tension element described herein can include a hydrophobic material. In some embodiments, any tension element described herein (including tension elements 2420, 3420, 4420, 5420, 6420, 7420) can be made of a material having temperature characteristics suitable for a cautery instrument. For example, such materials include liquid crystal polymers (LCP), aramids, para-aramids, and polybenzobisoxazole fibers (PBO). Such materials can provide frictional properties that increase frictional coupling capabilities and improve retention capabilities, such as for coupling the tension element to a proximal mechanical structure (e.g., mechanical structure 6710) and / or a capstan within an end effector. This capability can also improve slip characteristics during operation of the medical device (e.g., helping to prevent rope slippage). Such materials may or may not require coatings or other surface treatments to increase frictional properties.

[0187] Although the instrument is generally shown with a tool member rotation axis (e.g., axis A1) perpendicular to the wrist assembly rotation axis (e.g., axis A2), in other embodiments, any instrument described herein may include a tool member rotation axis offset from the wrist assembly rotation axis by any suitable angle.

[0188] Although various embodiments have been described as having specific features and / or component combinations, other embodiments are possible having any combination of features and / or components of any of the embodiments described above. Aspects have been described in the general context of medical devices and more specifically surgical instruments, but inventive aspects are not necessarily limited to use in medical devices.

Claims

1. A medical device comprising: wrist link, tool member, and tension element; wherein the wrist link comprises a discrete first link member and a discrete second link member; wherein the first connecting rod member includes a first U-shaped ear; wherein the second connecting rod member includes a second U-shaped ear; wherein the second link member is coupled to the first link member to position the second U-shaped ear opposite the first U-shaped ear and to define a tension member guide channel between the first link member and the second link member; wherein the tool member is coupled for rotation about a tool member rotation axis between the first U-shaped ear and the second U-shaped ear; wherein the tension element is coupled to the tool member and extends from the tool member through the tension element guide channel; and wherein tension on the tension element causes the tool member to rotate about the tool member rotation axis. 2 . The medical device of claim 1 , wherein the configuration of the first link member is the same as the configuration of the second link member.

3. The medical device according to claim 1, wherein: The wrist link is a distal wrist link; The medical device includes a proximal wrist link; and The distal wrist link is coupled to the proximal wrist link and rotates relative to the proximal wrist link.

4. The medical device according to claim 1, wherein: The wrist link is a distal wrist link; The medical device includes a proximal wrist link and a connector link; The connector link includes a distal end and a proximal end; the distal wrist link being coupled to the distal end of the connector link; The proximal wrist link is coupled to the proximal end of the connector link; and The distal wrist link rotates relative to the connector link about a distal connector link rotation axis; the connector link rotating relative to the proximal wrist link about a proximal connector link rotation axis; The distal wrist link is in rolling contact with the proximal wrist link as the distal wrist link rotates relative to the proximal wrist link.

5. The medical device according to claim 4, wherein: The first link member includes a first connector link receiving portion; The second link member includes a second connector link receiving portion; the second link member being coupled to the first link member so that the second connector link receiving portion is positioned opposite the first connector link receiving portion; and The distal end of the connector link is rotatably secured to the distal wrist link between the first connector link receiver and the second connector link receiver.

6. The medical device according to claim 5, wherein: a first protrusion of the distal end of the connector link within the first connector link receiving portion; and The second protrusion of the distal end of the connector link is within the second connector link receiving portion.

7. The medical device according to claim 4, wherein: The first link member includes a first connector link protrusion; The second link member includes a second connector link protrusion; the second link member being coupled to the first link member such that the second connector link protrusion is positioned opposite the first connector link protrusion; and The distal end of the connector link is rotatably secured to the distal wrist link between the first connector link tab and the second connector link tab.

8. The medical device according to any one of claims 4 to 7, wherein: defining a longitudinal axis between the distal end of the connector link and the proximal end of the connector link; The proximal wrist link includes a connector link receiving portion; the connector link receiving portion being configured to receive insertion of the proximal end of the connector link in a first orientation of the connector link about a longitudinal axis of the connector link; and The connector link receptacle is configured to resist withdrawal of the proximal end of the connector link in a second orientation of the connector link about the longitudinal axis of the connector link.

9. The medical device according to any one of claims 4 to 7, wherein: The proximal wrist link includes a discrete third link member and a discrete fourth link member; The third link member includes a third connector link receiving portion; The fourth link member includes a fourth connector link receiving portion; the fourth link member being coupled to the third link member so that the fourth connector link receiving portion is positioned opposite the third connector link receiving portion; and The proximal end of the connector link is rotatably secured to the proximal wrist link between the third connector link receptacle and the fourth connector link receptacle.

10. The medical device according to any one of claims 1 to 7, wherein: The medical device includes a pin; the pin extends from the first U-shaped ear through the tool member to the second U-shaped ear such that the tool member rotates about the pin; and The pin is under tension.

11. The medical device of claim 10, wherein: The tool member is a first tool member; The tension element is a first tension element; The tension element guide channel is a first tension element guide channel; The medical device further includes a second tool member and a second tensioning element; the second tool member being coupled for rotation about the tool member rotation axis between the first U-shaped ear and the second U-shaped ear; the second tensile element being coupled to the second tool member and extending from the second tool member through the second tensile element guide channel; and The tension on the second tension element causes the second tool member to rotate about the tool member rotation axis.

12. The medical device of claim 11, wherein: The medical device includes a first gasket and a second gasket; the first washer being positioned between the first U-shaped ear and the first tool member; the second washer being positioned between the second U-shaped ear and the second tool member; the first washer urges the second tool member toward the first tool member; and The second washer pushes the first tool member toward the second tool member.

13. The medical device of any one of claims 1-7, wherein the second link member is coupled to the first link member by any of an adhesive joint, a weld joint, or a mechanical fastener.

14. A medical device comprising: a first link member, a second link member discrete from the first link member, a tool member, and a connector link; wherein the first link member includes a distal portion and a proximal portion, the distal portion of the first link member includes a first U-shaped ear, and the proximal portion of the first link member includes a first connector; wherein the second link member includes a distal portion and a proximal portion, the distal portion of the second link member includes a second U-shaped ear, and the proximal portion of the second link member includes a second connector; wherein the second link member is coupled to the first link member to form a wrist link and such that the second U-shaped ear is positioned opposite the first U-shaped ear and such that the second connector is positioned opposite the first connector; wherein the tool member is coupled for rotation between the first U-shaped ear and the second U-shaped ear about a tool member rotation axis; and Wherein the connector link is coupled for rotation between the first connector and the second connector about a connector link rotation axis.

15. The medical device of claim 14, wherein: The wrist link is a distal wrist link; The connector link includes a distal end and a proximal end; The distal end of the connector link is rotatably coupled between the first connector and the second connector; The medical device includes a proximal wrist link; and The proximal end of the connector link is rotatably coupled to the proximal wrist link.

16. The medical device of claim 15, wherein: The distal wrist link rotates relative to the proximal wrist link; and The distal wrist link is in rolling contact with the proximal wrist link as the distal wrist link rotates relative to the proximal wrist link.

17. The medical device of claim 15, wherein: defining a longitudinal axis between the distal end of the connector link and the proximal end of the connector link; The proximal wrist link includes a connector link receiving portion; the connector link receiving portion being configured to receive insertion of the proximal end of the connector link in a first orientation of the connector link about a longitudinal axis of the connector link; and The connector link receptacle is configured to resist withdrawal of the proximal end of the connector link in a second orientation of the connector link about the longitudinal axis of the connector link.

18. The medical device of claim 14, wherein: The first connector of the distal wrist link is a first connector link receiving portion; The second connector of the distal wrist link is a second connector link receiving portion; the distal end of the connector link being rotatably secured to the distal wrist link between the first connector link receiving portion and the second connector link receiving portion; The proximal wrist link includes a discrete third link member and a discrete fourth link member; The third link member includes a third connector link receiving portion; The fourth link member includes a fourth connector link receiving portion; the fourth link member being coupled to the third link member so that the fourth connector link receiving portion is positioned opposite the third connector link receiving portion; and The proximal end of the connector link is rotatably secured to the proximal wrist link between the third connector link receptacle and the fourth connector link receptacle.

19. The medical device according to any one of claims 14 to 18, wherein: The medical device includes a tensioning element; the second link member being coupled to the first link member to define a tension member guide channel between the first link member and the second link member; the tension element being coupled to the tool member and extending from the tool member through the tension element guide channel; and The tension on the tension element causes the tool member to rotate about the tool member rotation axis.

20. The medical device of any one of claims 14 to 18, wherein the tool member rotational axis is perpendicular to the connector link rotational axis.

21. A medical device comprising: a distal wrist link, a proximal wrist link, and a connector link; wherein the distal wrist link includes a first tool support and a second tool support opposite the first tool support and is configured to be rotatably coupled to a tool member; wherein the distal wrist link includes a distal connector link receiving portion; wherein the proximal wrist link includes a proximal connector link receiving portion; wherein the connector link includes a distal end and a proximal end, and a longitudinal axis is defined by the distal end and the proximal end of the connector link; wherein the distal end of the connector link is coupled within the distal connector link receptacle, and the distal wrist link is rotatable relative to the connector link about a distal connector link rotation axis; wherein the proximal end of the connector link is coupled within the proximal connector link receptacle, and the proximal wrist link is rotatable relative to the connector link about a proximal connector link rotation axis; and at least one of the proximal connector link receptacle or the distal connector link receptacle being configured to accept insertion of the connector link in a first orientation of the connector link about a longitudinal axis of the connector link; and At least one of the proximal connector link receptacle or the distal connector link receptacle is configured to resist withdrawal of the connector link in a second orientation of the connector link about the longitudinal axis of the connector link.

22. The medical device of claim 21, wherein: The distal wrist link is in rolling contact with the proximal wrist link as the distal wrist link rotates relative to the proximal wrist link.

23. The medical device of claim 21, wherein: the proximal connector link receiving portion being configured to receive insertion of the connector link in a first orientation of the connector link about the longitudinal axis of the connector link; the proximal connector link receptacle or the distal connector link receptacle being configured to resist withdrawal of the connector link in a second orientation of the connector link about the longitudinal axis of the connector link; The end surface of the proximal wrist link defines an insertion opening leading to the proximal connector link receiving portion; and The insertion opening has a shape taken in a plane perpendicular to the longitudinal axis defining a primary insertion axis that is aligned with a first orientation of the connector link about the longitudinal axis of the connector link.

24. The medical device of claim 21, wherein: the distal connector link receiving portion being configured to receive insertion of the connector link in a first orientation of the connector link about the longitudinal axis of the connector link; the distal connector link receptacle or the distal connector link receptacle being configured to resist withdrawal of the connector link in a second orientation of the connector link about the longitudinal axis of the connector link, An end surface of the distal wrist link defines an insertion opening leading to the distal connector link receiving portion; and The insertion opening has a shape taken in a plane perpendicular to the longitudinal axis defining a primary insertion axis that is aligned with a first orientation of the connector link about the longitudinal axis of the connector link.

25. The medical device of claim 21, wherein: The distal end of the connector link includes a first protrusion and a second protrusion; the distal connector link receptacle being surrounded by a sidewall of the distal wrist link such that the first protrusion and the second protrusion are each captured within the distal connector link receptacle; and the proximal connector link receiving portion being configured to receive insertion of the proximal end of the connector link in a first orientation of the connector link about the longitudinal axis of the connector link; and The proximal connector link receptacle is configured to resist withdrawal of the proximal end of the connector link in a second orientation of the connector link about the longitudinal axis of the connector link.

26. The medical device according to any one of claims 21 to 25, wherein: The distal wrist link includes a discrete first link member and a discrete second link member; The first link member includes a first tool support member; The second link member includes a second tool support member; and The second link member is coupled to the first link member so that the second tool support is positioned opposite the first tool support.

27. The medical device of claim 26, wherein: the second link member being coupled to the first link member to define a tension member guide channel between the first link member and the second link member; The medical device includes a tensioning element coupled to the tool member and extending from the tool member through the tensioning element guide channel; and The tension on the tension element causes the tool member to rotate about the tool member rotation axis.

28. The medical device according to any one of claims 21 to 25, wherein: The connector link defines a passage from the distal end to the proximal end of the connector link.

29. A method of assembling a medical device, wherein: The medical device includes a first link member, a second link member, a tool member, a pin, and a tension element; wherein the first connecting rod member includes a first U-shaped ear and a first guide channel; wherein the second connecting rod member includes a second U-shaped ear and a second guide channel; wherein the pin comprises a first end portion, a second end portion, and a central portion; wherein the tool member is rotatably coupled about a central portion of the pin; wherein the tension element is coupled to the tool member; and The method comprises: inserting the first end portion of the pin into the first U-shaped ear, inserting the second end portion of the pin into the second U-shaped ear, placing a portion of the tension element into at least one of the first guide channel or the second guide channel, positioning the second link member on the first link member so that the second U-shaped ear is opposite the first U-shaped ear, and The second link member is coupled to the first link member to form a wrist link.

30. The method of claim 29, wherein: the first link member including a distal portion and a proximal portion, the distal portion of the first link member including the first U-shaped ear, and the proximal portion of the first link member including a first connector link receiving portion; the second link member including a distal portion and a proximal portion, the distal portion of the second link member including the second U-shaped ear, and the proximal portion of the second link member including a second connector link receiving portion; The medical device includes a connector link, and the connector link includes a first protrusion and a second protrusion; and The method further includes coupling the second link member to the first link member after inserting the first protrusion into the first connector link receptacle and inserting the second protrusion into the second connector link receptacle.

31. The method of claim 30, wherein: the wrist link including a connector link rotation axis defined by the first connector link receiving portion and the second connector link receiving portion; and After coupling, the distal link rotates relative to the central link about the connector link rotation axis.

32. The method of claim 29, wherein: The tool member is a first tool member; The tension element is a first tension element; The disposing includes disposing the portion of the tension element into the first guide channel; The medical device further includes a second tool member rotatably coupled about a central portion of the pin and a second tensioning element, the second tool member being coupled to the second tool member; The method further comprises: A portion of the second tensile element is arranged into the first guide channel.

33. The method of claim 32, wherein: Inserting the first end portion of the pin into the first U-shaped ear includes disposing a first washer between the first U-shaped ear and the first tool member; Inserting the second end portion of the pin into the second U-shaped ear includes disposing a second washer between the second U-shaped ear and the second tool member; the first washer urges the second tool member toward the first tool member; and The second washer pushes the first tool member toward the second tool member.

34. The method according to any one of claims 29 to 33, wherein: Coupling the second link member to the first link member includes welding the second link segment to the first link segment.

35. A medical device comprising: a proximal wrist link, a distal wrist link, a tool member, and a tensioning element; wherein the proximal wrist link comprises a proximal portion and a distal portion, the proximal wrist link comprising a proximal tension element guide channel; wherein the distal wrist link includes a proximal portion and a distal portion, the proximal portion of the distal wrist link being coupled to the distal portion of the proximal wrist link such that the distal wrist link rotates relative to the proximal wrist link about a wrist rotation axis; wherein a longitudinal centerline is defined between said proximal portion of said proximal wrist link and said distal portion of said distal wrist link; wherein a first distal wrist link plane is defined perpendicular to the longitudinal centerline and at a first location within the distal wrist link along the longitudinal centerline; wherein a second distal wrist link plane is defined perpendicular to the longitudinal centerline and at a second location within the distal wrist link along the longitudinal centerline; wherein the distal wrist link includes a distal tension element guide channel; wherein the tool member is coupled for rotation relative to the distal wrist link about a tool member rotation axis; wherein the tensile element is coupled to the tool member and extends from the tool member through the distal tensile element guide channel and through the proximal tensile element guide channel; wherein the tension on the tension element causes at least one of: rotation of the distal wrist link about the wrist rotation axis, or rotation of the tool member about the tool member rotation axis; wherein a first central portion of the tensile element is spaced a first X distance from the longitudinal centerline along a first dimension within a distal wrist link entry plane and a first Y distance from the longitudinal centerline along a second dimension within a distal wrist link entry plane within the distal wrist link entry plane; and wherein a second central portion of the tensile element is spaced a second X distance from the longitudinal centerline along a first dimension in the distal wrist link exit plane and a second Y distance from the longitudinal centerline along a second dimension in the distal wrist link exit plane; wherein the first X distance is greater than the second X distance; and The first Y distance is smaller than the second Y distance.

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