Method and system for robotic single port laparoscopic access

Abstract

The laparoscopic tool has a semi-circular middle portion having a center point on a common axis and a coincident remote center of a robotic arm to which the tool is mounted, the semi-circular middle portion being located between a straight proximal section and a straight distal section. A straight proximal section of the laparoscopic tool is rotatably mounted on a stationary side mount on the surgical robotic arm. The robotic arm is separated from the surgical robot to allow manual positioning of the robotic arm to position the semi-circular intermediate portion through the percutaneous port and to position a center point of the semi-circular intermediate portion and a coincident remote center of the robotic arm to which the tool is mounted at a target virtual insertion point on the body of the patient. A visual aid is provided to assist in locating the center point.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This PCT application claims priority to U.S. Patent Application No. 18 / 172,290 filed on February 21, 2023 (Attorney Docket No. 41628-716.201), which claims the benefit of U.S. Provisional Application No. 63 / 335,548 filed on April 27, 2022 (Attorney Docket No. 41628-716.101), the entire contents of which are incorporated herein by reference. Background Art

[0003] 1. Field of the Invention The present invention relates generally to medical systems, tools and methods. More particularly, the present invention relates to systems and tools for robotic-assisted laparoscopic access, typically for the access of multiple robotically manipulated tools through a single incision in the umbilicus or other location.

[0004] In recent years, many open surgical procedures performed in the abdominal cavity have been replaced by minimally invasive procedures performed through several very small incisions using an endoscope (called a laparoscope) inserted through one incision. Other incisions are used to introduce surgical tools, and the abdominal cavity is inflated to create a space for the operation to be performed. Such procedures are often called "laparoscopy" and may be used for gallbladder removal, hernia repair, hysterectomy, appendectomy, fundoplication, and other procedures. Similar endoscopic, thoracoscopy, and other procedures may be performed in other body cavities, with or without inflation.

[0005] Although a significant improvement over open surgical procedures that may require an incision of several inches or more through the abdominal wall, such laparoscopic procedures still require incisions through the muscle or fascia at several separate sites. Each incision can increase the patient's risk of infection, bleeding from trocar site hernias, increased postoperative pain, compromised cosmesis, and other adverse events.

[0006] As an improvement to this type of laparoscopic surgery, "single port" laparoscopic surgery has been proposed, in which a single access port is inserted through the umbilicus (the patient's belly button). Access only through the umbilicus is advantageous because it provides excellent cosmetic and functional results. However, the introduction of the laparoscope and all other tools required for the surgery through a single port makes the operation more difficult to perform. In particular, using traditional laparoscopic tools, which are typically straight, it is difficult to access a single target area in the treatment tissue with two or more tools at the same time.

[0007] Further improvements in the field of single port laparoscopic surgery are described in U.S. Patent Publications 2012 / 0116362, 2016 / 0081752, and 2019 / 0307474, which are generally assigned together with the present application, and the entire disclosures of these patents are incorporated herein by reference. As generally described in these applications, a system for performing single port laparoscopic surgery includes a percutaneous seal and a plurality of tools. The tool includes a substantially rigid tubular sleeve having a C-shaped central region and an actuator core that is translatably and rotatably disposed in the sleeve. The C-shaped central region of the tubular sleeve, which is typically formed as a semicircle, physically passes through a single port, while the "center point" of the semicircle is aligned with the "virtual" insertion site of the tool on the patient's abdominal wall. Even if the tool physically passes through a single port position that deviates from the virtual insertion site, this virtual insertion site acts as a fulcrum for the tool when it is manipulated. Two, three or even more such tools may have a C-shaped central region physically passing through a single port, with their virtual remote centers located radially outward from the center defined by the single port.

[0008] Of particular interest to the present invention is that US2019 / 0307474 describes a method for rigidly attaching such laparoscopic tools (i.e., laparoscopic tools having a C-shaped center region) to a robotic arm. However, this rigid attachment limits the physician's ability to manually position the surgical arm and align the tool prior to commencing robotic surgery. Unlike conventional straight laparoscopic tools, laparoscopic tools having a C-shaped center region require that the center point of the C-shaped center region be aligned with the "virtual" remote center of the robotic surgical system, i.e., the site where the straight laparoscopic tool is inserted for operation by the robotic surgical system.

[0009] Therefore, it would be beneficial to provide improved methods, systems, and devices for robotic manipulation of laparoscopic tools having a C-shaped center region, such as those described in U.S. Patent Publications 2012 / 0116362, 2016 / 0081752, and 2019 / 0307474, which are commonly assigned with the present application. If the improved methods, systems, and devices allow a physician to manually position the C-shaped center region of a laparoscopic tool carried by a robotic arm through a single port, it would be particularly desirable to manually align the center point of a C-shaped segment located at the remote center of the attached robotic arm with the virtual insertion point, while the C-shaped segment passes through the actual insertion point and freely moves the center point to an alternative virtual insertion site without removing the laparoscopic tool from a single port or penetrating the patient's skin at any target virtual insertion site. Such improved methods, systems, and devices would preferably facilitate access of multiple tools to the abdomen and other surgical target sites through a single port at the patient's umbilicus or elsewhere, with minimal interference between adjacent tools during the procedure. The invention described below will meet at least some of these purposes.

[0010] 2. Description of background technology. U.S. Patent Publications 2019 / 0307474, 2012 / 0116362, and 2016 / 0081752 have been described above. Surgical robot systems of the type suitable for use with the laparoscopic tool of the present invention are described in US2009 / 0163931, US2014 / 0188130, US2011 / 0118709, US2013 / 0116712, US2016 / 0235496, US2007 / 0021738, and US2003 / 0045778. Other patents of interest include US2011 / 0071541, US2007 / 0049966, and US2006 / 0167440. Summary of the invention

[0011] In a first aspect of the invention, a laparoscopic tool is configured to be mounted on a surgical robot arm that includes a fixed side mount configured to be removably coupled to a straight laparoscopic cannula or other cannula and a driver interface. The laparoscopic tool includes a shaft having (a) a straight proximal segment; (b) a straight distal segment that is axially aligned with the straight proximal segment along a common axis; (c) a semicircular middle portion having a center point on the common axis and located between and connected to the straight proximal segment and the straight distal segment; and (d) a central channel that extends through the shaft. The flexible cable assembly is configured to pass through the central channel of the shaft and accommodate the semicircular middle portion when the flexible cable assembly is axially translated and rotated in the central channel of the shaft. A driven interface on the straight proximal end section of the shaft is configured to be removably connected to a driver interface on the robotic arm to manipulate the flexible cable assembly, and a distal end effector extends from the straight distal end section of the shaft and is drivably coupled to the distal end of the flexible cable assembly. A rotatable side mount is rotatably coupled to the straight proximal end section of the shaft, and the side mount is configured to be removably connected to a fixed side mount on the robotic arm and allows a common axis of the shaft to rotate about at least two axes orthogonal to the longitudinal axis of the surgical robotic arm.

[0012] In some cases, the side mount is coupled to the straight proximal section of the shaft via a pair of orthogonally oriented swivel joints.

[0013] In some cases, the laparoscopic tool also includes a telescoping section extending distally from the distal end effector end of the shaft to accommodate extension and retraction of the flexible cable assembly. Typically, but not necessarily, the segments of the telescoping section have alignment features that prevent relative rotation when extending and retracting the segments.

[0014] In some cases, the flexible cable assembly is configured to be rotatably and translationally attached to a driver interface in a surgical robotic arm, such that the driver interface enables the push / pull wires of the flexible cable assembly to be axially and rotationally repositioned relative to a common axis of the shaft to actuate the distal end effector. In such cases, the flexible cable assembly may also include a bidirectional torque tube coaxially located above the push / pull wires and configured to transmit torque and axial translation forces from the driver interface in the robotic arm to the distal end effector.

[0015] In a second aspect of the invention, a laparoscopic tool system for use with a surgical robot includes a laparoscopic tool and an alignment tool. The laparoscopic tool can be configured in any manner described and claimed herein, and the alignment tool is typically coupled to the shaft of the laparoscopic tool and is configured to visually "mark" the center point of the semicircular middle portion of the shaft and the location of the remote center of the robotic arm to which the tool is mounted, so as to facilitate manual positioning of the surgical robotic arm with the mounted tool to place the center point at the target virtual insertion point. The remote center corresponds to the "virtual" tool insertion site, that is, the site where the abdominal wall or other cavity wall penetration is performed to accommodate the location of the straight laparoscopic tool.

[0016] In conventional robotic surgery using straight laparoscopic cannulas and tools, the "remote center" (also called the "remote center of motion") is the point in space where the cannula and inserted tools pass through the abdominal wall and enter the patient's body. This entry point serves as a fixed fulcrum that limits lateral repositioning of the cannula after insertion. In addition, each robotic arm and tool has a separate remote center and abdominal penetration. As described in detail below, the tools of the present invention allow the remote center (i.e., virtual insertion point) to be moved without the need for additional penetrations and often without even removing the tool from the patient.

[0017] In some cases, the alignment tool is removably coupled to the shaft.

[0018] In some cases, the alignment tool is an elongated body having a proximal end coupled to the shaft and a distal marking tip located at a center point when the proximal end is coupled to the shaft.

[0019] In other cases, the alignment tool is configured to project a pair of visible light beams that intersect at a center point of the semicircular mid-section of the tool when the alignment tool is coupled to the shaft. In this way, the center point of the semicircular mid-section of the tool aligned with the remote center of the robotic arm to which the tool is mounted can be precisely positioned at the virtual insertion point on the patient's abdominal wall by manually positioning the robotic arm so that the light beams intersect precisely at the desired location of the virtual insertion point on the patient's abdomen or other skin area.

[0020] In both cases, the alignment of the center point of the semicircular middle part of the tool with the remote center of the robotic arm occurs when the tool is attached to the robotic arm. From this point on, even if the laparoscopic tool and the supporting robotic arm move in space, the center point of the semicircular middle part and the remote center of the robotic arm will remain coincident in space, i.e., remain in the same position in space.

[0021] In a third aspect of the invention, a method for performing robotic surgery using at least one laparoscopic tool having an axis and a remote center aligned with a target virtual insertion point on the abdomen of a patient includes providing (a) a surgical robotic system having at least one robotic arm including a fixed side mount and a drive interface; and (b) at least one laparoscopic tool having a semicircular middle portion having a center point on a common axis, the semicircular middle portion being located between and connected to a straight proximal segment and a straight distal segment. The straight proximal segment of the shaft is rotatably coupled to the fixed side mount on the robotic arm so that the common axis of the shaft can rotate about at least two axes orthogonal to the longitudinal axis of the surgical robotic arm. The semicircular middle portion of the shaft of the at least one laparoscopic tool is positioned to pass through a percutaneous passage, and the at least one robotic arm is separated from the surgical robot so that the at least one robotic arm can be manually positioned.

[0022] Manually positioning at least one robotic arm to position the center point of the semicircular middle portion of the shaft of at least one laparoscopic tool (which coincides with the remote center of the robotic arm) at the target "virtual" insertion point of the tool on the body surface. That is, even if the tool physically passes through a different location (such as through a "single port" located at the umbilicus or other location of the patient), the robotic arm can be controlled to manipulate the tool as if the tool is straight and passes through the "virtual" insertion point.

[0023] The laparoscopic tools of the present invention are typically attached to the robotic arm while the semicircular mid-section remains positioned through a single port or other percutaneous passage so that the common axis of the at least one laparoscopic tool self-rotates and aligns relative to the longitudinal axis of the surgical robotic arm. After the at least one robotic arm is engaged with the surgical robot, the robotic arm is manipulated to surgically interact the end effector on the at least one laparoscopic tool with tissue while the mid-section of the shaft remains positioned in the percutaneous passage and the center point remains at the remote center previously set on the patient's abdomen.

[0024] In some cases, manually positioning at least one robotic arm to position a center point of a semicircular mid-portion of a shaft of at least one laparoscopic tool and a coincident remote center of a robotic arm to which the tool is mounted with a virtual insertion point on the patient's abdomen includes providing a visual marker of the location of the center point on the patient's abdomen and aligning the visual marker with the location of the target virtual insertion point. For example, providing a visual marker of the location of the center point on the patient's abdomen can include coupling an elongated body having a distal marker tip located at the center point to the shaft. In another example, providing a visual marker of the location of the center point on the patient's abdomen can include projecting a pair of visible light beams that intersect at the center point on the patient's abdomen.

[0025] In some cases, rotatably coupling the straight proximal end section of the shaft to the fixed side mount on the robotic arm includes removably attaching a rotatable side mount rotatably coupled to the straight proximal end section of the shaft to the fixed side mount on the robotic arm. For example, the rotatable side mount can be rotatably coupled to rotate about at least two axes orthogonal to the longitudinal axis of the surgical robotic arm.

[0026] In some cases, the method as described above may further include providing a second laparoscopic tool having a semicircular middle portion having a center point on a common axis, the semicircular middle portion being located between and connected to the straight proximal segment and the straight distal segment. The straight proximal segment of the shaft of the second laparoscopic tool is rotatably coupled to a fixed side mount on a second robotic arm of the surgical robot so that the common axis of the shaft of the second laparoscopic tool can rotate about at least two axes orthogonal to the longitudinal axis of the second surgical robotic arm. The semicircular middle portion of the shaft of the second laparoscopic tool is positioned to pass through a percutaneous passage, and the second robotic arm is separated from the surgical robot so that the second robotic arm can be manually positioned. The second robotic arm is manually positioned to position the center point of the semicircular middle portion of the shaft of the second laparoscopic tool and the coincident remote center of the robotic arm to which the tool is mounted together with a second virtual insertion point on the abdomen of the patient, while the semicircular middle portion remains positioned to pass through the percutaneous passage so that the common axis of the second laparoscopic tool rotates and is aligned relative to the longitudinal axis of the second surgical robotic arm. The second robotic arm is then reengaged with the surgical robot so that the second robotic arm is again manipulated by the surgical robot. Once reengaged, the surgical robot is operated to manipulate the second robotic arm so that the end effector on the second laparoscopic tool surgically interacts with tissue while the middle portion of the shaft of the second laparoscopic tool remains located in the percutaneous passage and the center point and the remote center of the second robotic arm remain located at the second virtual insertion point on the abdomen of the patient.

[0027] Incorporation by reference

[0028] All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference. BRIEF DESCRIPTION OF THE DRAWINGS

[0029] The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the invention will be obtained by reference to the following detailed description of illustrative embodiments in which the principles of the invention are utilized and the accompanying drawings, in which:

[0030] Figure 1 A commercially available robotic surgical system is shown that can be used to manipulate the laparoscopic tools of the present invention.

[0031] Figure 2 A pair of laparoscopic tools intended for manual manipulation in surgical procedures are shown, wherein the tools are intended for single port access and are pivotally mounted in a support frame, with a repositioned view of one of the tools shown in phantom.

[0032] Figure 3 is a perspective view of a laparoscopic tool constructed in accordance with the principles of the present invention and configured to be manipulated by the arm of a surgical robot.

[0033] Figure 4A-4D Shows Figure 3 The internal components of the laparoscopic tool, Figure 4A and Figure 4B The telescopic distal extension is shown extended and retracted, respectively, and Figure 4C and Figure 4D Flexible cables and wires configured to actuate an end effector are shown.

[0034] Figure 5 is attached to Figure 3 A detailed view of a side connector of a proximal end segment of a shaft of a laparoscopic tool showing in phantom the rotation of the side connector about a first axis transverse to the shaft.

[0035] Figure 6 yes Figure 3 Detailed view of a side connector of a laparoscopic tool showing in phantom the rotation of the side connector about a second axis transverse to the shaft.

[0036] Figure 7 A first embodiment of an alignment tool attachable to the shaft of a laparoscopic tool of the present invention is shown, the alignment tool being configured to allow a user to align a center point of the tool with a utilized remote center of a robotic system.

[0037] Figure 8A second embodiment of an alignment tool attachable to the shaft of a laparoscopic tool of the present invention is shown, the alignment tool being configured to allow a user to align a center point of the tool with a utilized remote center of a robotic system.

[0038] Fig. 9 The laparoscopic tool of the present invention is shown adjacent to the arm of a surgical robotic system before the tool is mounted on the arm.

[0039] Fig.10 Shows Fig. 9 A laparoscopic tool and a surgical robotic arm, wherein the tool is mounted on the arm.

[0040] Fig. 10A A prior art straight laparoscopic tool is shown connected to a tool holder of a robotic surgical system, showing the location of the "Telecenter" feature of the robotic surgical system marked on the straight laparoscopic tool.

[0041] Fig. 10B The connection of the laparoscopic tool of the present invention to the tool holder of a robotic surgical system is shown, showing the location of the "remote center" feature of the robotic surgical system coinciding with the center point of the semicircular middle portion of the laparoscopic tool in free space.

[0042] Figures 11A-11E A method for performing robotic surgery using a laparoscopic tool having an axis aligned with a target remote center on the patient's abdomen in accordance with the principles of the present invention is shown. DETAILED DESCRIPTION

[0043] Reference now Figure 1 The laparoscopic tools and end effectors of the present invention are intended to be used with and manipulated by known and commercially available robotic systems, such as the da Vinci Surgical System available from Intuitive Surgical, Inc. of Sunnyvale, California. Surgical System. The exemplary robotic surgical system 10 includes a robotic station 12 including a plurality of robotic arms 14 (three of which are shown) and a controller module 16 where a surgeon can view the surgical procedure and control the surgical arms to manipulate tools to perform a desired laparoscopic or other procedure.

[0044] Reference now Figure 2, a prior art laparoscopic tool system 100 of the type described in US2016 / 0081752, previously incorporated herein by reference, includes a tool attachment frame 112 to which a first tool 114 and a second tool 120 are pivotally attached. The first tool has a middle portion 116 and the second tool has a middle portion 122, and both middle portions extend generally inwardly from an axis 128 of the tool. Both middle portions 116 and 122 are preferably circular and have a radius emanating from a virtual rotation point that is generally aligned with a pivot 152 of an assembly attached to the outer periphery of the tool attachment frame 112. Having the virtual rotation point of each tool located outside the periphery of the ring in a dual pivot position allows the generally circular middle portions 116 and 22 to pass through and move through the central opening 118 of the frame 112 without interfering with each other. While the intermediate portions 116 and 22 may alternatively have non-circular geometries (e.g., elliptical or polyhedral) that extend radially inwardly relative to the frame 112, the circular shape will keep the intermediate portion's pass-through point fixed within the frame's central opening 118 as long as the tool is constrained to move in an orthogonal plane by the pivot attachments, as will be explained in more detail below. While in some cases the arms of a surgical robot may be modified to manipulate these prior art tools, these tools are intended to be manually manipulated, and any attempt to directly interface the exterior with a robotic arm is suboptimal.

[0045] Reference now Figure 3 and Figure 4A-4D , a laparoscopic tool 200 constructed in accordance with the principles of the present invention includes a shaft 202 having a straight proximal section 204 and a straight distal section 206 separated by a semicircular middle section 208. The straight proximal section 204 and the straight distal section 206 are aligned along a common longitudinal axis, and the straight proximal section has a swivel connector 220 located proximal to the semicircular middle section 208 that allows the semicircular middle section and the straight distal section to rotate about the common longitudinal axis relative to the straight proximal section 204. This ability to rotate is critical to allowing the laparoscopic tool 200 to be repositioned to a different virtual insertion point (which will serve as a remote central location for the robotic system) without removal from the patient and while the tool remains attached to the robotic arm, as will be described in more detail below. Typically, the proximal section 204 includes a sleeve 244 that telescopically releases another portion of the proximal section to allow length adjustment.

[0046] The laparoscopic tool 200 also includes an end effector 214 (such as a forceps, cutter, electrosurgical element, etc.) at its distal end, and the distal segment 206 will typically have a telescopic structure to allow adjustment of its length. A rotatable side mount 240 is attached to the proximal segment 204 of the shaft 202 at a location proximal to the rotary connector, and the rotatable side mount is configured to be removably attached to a robotic arm of a surgical robot, which will be described in more detail below. In this way, all portions of the shaft 202 distal to the rotatable connector 220 will be free to rotate about the longitudinal axis of the shaft, and in particular, the semicircular middle portion 208 will be able to rotate to other positions, such as Figure 3 Shown by the dashed line.

[0047] Now specific reference FIG. 4A to FIG. 4B , the internal components of the laparoscopic tool 200 that allow for manipulation of the end effector 214 will be described. The shaft 202 has a hollow central channel that accommodates a flexible cable 210. The flexible cable 210 has a hollow lumen extending from its distal end to its proximal end that accommodates a pull and / or push wire 212 having an end effector 214 at its distal end. The flexible cable 210 has a proximal attachment member 222 at its proximal end, and the pull and / or push wire 212 has a proximal attachment member 224 at its proximal end. The distal section 206 of the shaft 202 is preferably connected as a telescopic structure having a plurality of sections 216, including a distal-most section 218 that carries the end effector 214. The telescopic distal section can be axially extended and retracted to accommodate full axial extension of the flexible cable 210 (e.g., Figure 4A ) and full axial retraction of the flexible cable (as Figure 4B 200). The flexible cable 210, due to its flexibility, provides a conformable center region 226 to accommodate bending of the cable as it passes through the preferably C-shaped middle portion 208 of the shaft. Similarly, the pull / push wire 212 will have a conformable region 228 to accommodate bending as the pull / push wire 212 is extended and retracted through the conformable region 226 of the flexible cable 210. The surgical robot manipulates the end effector 214 via these internal components using a drive head 286 mounted on a tool holder 282, which is connected to a robot arm interface 242 on the laparoscopic tool 200 when the tool is mounted on the tool holder of the surgical robot, as described below. Fig.10 shown.

[0048] The robotic arm interface 242 allows the drive head 286 of the robotic surgical system to mechanically drive the end effector 214 by manipulating the internal components of the laparoscopic tool 200. Axial translation of the cable and wire assembly (including the flexible cable 210 and the pull / push wire 212) relative to the shaft 202 can be achieved by selectively tensioning the proximal attachment member 222 at the proximal end of the flexible cable 210. Similarly, rotation of the cable and wire assembly about the longitudinal axis of the assembly can also be achieved by rotating the proximal attachment member 222 at the proximal end of the flexible cable 210. In addition, axial translation of the pull / push wire 212 relative to the flexible cable 210 for actuating the end effector can be achieved by manipulating the proximal attachment member 224 at the proximal end of the pull / push wire 212.

[0049] The proximal end section 204 of the laparoscopic tool 200 is secured to the tool holder 282 by attaching the robotic arm interface 242 to the drive head 286, as shown in FIG. Fig. 9 and Fig.10 As seen in FIG. 2 , the distal end section 206 of the laparoscopic tool is secured to the tool holder by attaching the rotatable side mount 240 to the tool attachment head 284 at the lower end of the tool holder, also as shown in FIG. Fig. 9 and Fig.10 . The specific connection between the robotic arm interface 242 and the drive head 286 will depend on the nature of the laparoscopic tool and does not form a part of the present invention. Typically, the specific connection pattern of the tool of the present invention will be arranged to match the connection pattern of a corresponding conventional laparoscopic tool of the same type, for example, all forceps and all cutters will be similarly connected, and the robotic control system will be independent of the use of conventional tools or the tools of the present invention. In contrast, the rotatable side mount 240 is designed to provide one or more axes of rotation to facilitate connection of the laparoscopic tool 200 to the tool holder 282.

[0050] Reference now Figure 5 and Figure 6 , the rotatable side mount 240 includes a base cylinder 248, a base plate 250, and an insertable connector 252. The base cylinder 248 is crimped or otherwise fixed to the outer surface of the proximal section 204 of the shaft 202 on the proximal side of the rotatable connector 220. The base plate 250 is pivotally attached to the base cylinder 248 at a pivot axis 254 so that it can be tilted relative to the shaft, such as Figure 5 The pluggable connector 252 is pivotally attached to the base plate 250 at the pivot axis 256 so that it can rotate relative to the axis, as shown in FIG. Figure 6Thus, the insertable connector 252 has two orthogonal pivot axes relative to the axis of the shaft 202, which allows the laparoscopic tool to be first connected to the tool holder 282 at its lower end and then be reoriented when the robotic arm interface 242 is connected to the drive head 286 at the upper end of the tool holder.

[0051] Reference now Figure 7 and Figure 8 The alignment tool is typically coupled to the shaft of the laparoscopic tool and is configured to visually "mark" the location of the center point CP of the semicircular middle portion of the shaft to facilitate manual positioning of the surgical robotic arm to place the center point / remote center at the target "virtual insertion point" on the patient's body. Figure 7 As shown, the alignment tool 260 can be a simple straight rod or probe having a tip 262 that is located at the center point CP when the connector hub 264 is removably attached to the proximal end section 204 of the shaft 202, as shown in dashed lines. Figure 8 As shown, the alignment tool 266 includes a rod with a pair of LEDs or other light sources 268 and 270 arranged to project light beams 268a and 268b that intersect at a point 272 located at the center point CP of the semicircular mid-portion of the shaft 202. Thus, the laparoscopic tool 200 can be aligned by manually moving the laparoscopic tool 200 and the tool holder 282 until the tip 62 of the alignment tool 260 or the intersection 272 of the alignment tool 266 is located at the target virtual insertion point, which will be referred to below. Figures 11A-11E Describe in more detail.

[0052] Fig. 9 The apparatus shown is used with a surgical robot system (such as a Figure 1 The laparoscopic tool 200 of the present invention is adjacent to a tool holder 282 carried by an arm 280 of a surgical robotic system (shown in FIG. 2 ). The laparoscopic tool 200 is mounted by inserting the pluggable connector 252 of the rotatable side mount 240 into an attachment cavity 288 on one side of the attachment head 284 of the tool holder 282. A mounting release lever 290 allows the tool 200 to be released from the tool holder 282 after the procedure has been completed. Typically, the rotatable side mount 240 of the laparoscopic tool 200 will be attached to the attachment head 284 of the tool holder 282 before the robotic interface 242 is attached to the drive head 286. In this way, the shaft 202 of the laparoscopic tool 200 remains free to rotate relative to the mounting axis defined by the rotatable side mount 240, as previously described with reference to FIG. Figure 5 and Figure 6 Once the attachment head 284 is attached to the tool holder 282, as Fig.10As shown, the laparoscopic tool 200 will be fixed relative to the tool holder 282, and the laparoscopic tool 200 and the tool holder 282 will be moved together as a unit by the surgical robotic arm 280. The attachment head 284 of the tool holder 282 will typically include a clutch release device (not shown) that allows the user to selectively disengage the surgical robotic arm 282 so that it can be manually positioned relative to the patient for initial setup, which will be referred to in detail. Figures 11A-11E Describe in more detail.

[0053] Fig. 10A The connection of a straight laparoscopic tool, such as a straight cannula SC, to an attachment head 284 of a tool holder of a robotic surgical system is shown showing the location of the "Remote Center RC" feature of the robotic surgical system marked on the straight laparoscopic tool. The location of the Remote Center RC is marked on the axis of the cannula SC so that the user can position the Remote Center at the actual abdominal wall penetration in conventional robotic laparoscopic surgery. The Remote Center is a feature of the particular surgical system employed and is the fulcrum or pivot point of the tool axis and is used by the robotic surgical system to plan all manipulations of the tool.

[0054] Fig. 10B The laparoscopic tool of the present invention is shown connected to the attachment head 284 of the tool holder of the robotic surgical system, which shows the location of the "remote center" feature of the robotic surgical system. Fig. 10B In contrast to the conventional straight tool shown in , the remote center RC will coincide with the center point CP of the semicircular middle part of the laparoscopic tool located in free space. Fig. 10B Further in contrast to the conventional straight tool shown in , the remote center RC of the laparoscopic tool of the present invention will be positioned at a virtual insertion site without the need for actual penetration. By sizing the laparoscopic tool of the present invention to position the center point CP of the semicircular mid-portion at the remote center of the particular robotic surgical system to be used, the robotic surgical system will be able to manipulate the tool like a straight tool, thus eliminating the need for modification to the robotic surgical system (although there may be situations where modification may be useful).

[0055] Now refer to Figures 11A-11E A method for positioning the laparoscopic tool of the present invention is described. Fig.11A and Fig. 11B As shown, a laparoscopic port or seal S (such as the port or seal S described in co-owned US2019 / 0380743 (the entire disclosure of which is incorporated herein by reference)) is placed in the patient's abdomen A through the umbilicus U. Fig. 11C As shown, the tool 200 is introduced into the inflated abdomen until the level when the semicircular middle section 208 reaches the port seal S. Fig.11DAs shown, after engaging the clutch, the user brings the robot arm 282 into proximity with the tool side mount 240, depresses the mounting lever 290 on the robot arm 282, engages the tool side mount 240, and locks the tool 200 to the robot arm by releasing the mounting lever 290. Keeping the clutch engaged and without shifting the position of the semicircular middle section 208 within the seal S, the user moves the robot arm 282 to align the robot interface 242 with the drive head 286 and locks it.

[0056] After the tool holder 282 is attached to the laparoscopic tool 200, the user actuates the clutch to disengage the tool holder 282 and align the center point CP of the semicircular middle portion 208 with the virtual insertion point before starting the procedure, as shown in FIG. Fig.11D Typically, although not necessarily, the user will employ an alignment tool, such as the one previously referenced Figure 7 and Figure 8 Once the tool 200 and the bracket 282 are aligned with the virtual insertion point (eg, Fig.11D AL in the alignment line AL), the user can release the clutch release lever, locking the tool and the bracket so that their movement will now be controlled by the robotic system (not manually controlled). The laparoscopic tool 200 is then ready for use, although depending on the requirements of the surgery to be performed, the surgery will typically require the introduction of one, two, three or even more laparoscopic tools through the seal.

[0057] At any time during the surgical procedure, the user may wish to reposition the center point CP of the semicircular middle portion 208 with a different target virtual insertion point, such as Fig.11E The user can perform this repositioning by simply detaching the arm 280 and tool holder 282 from the surgical robot using a clutch release (not shown) that is part of the surgical robot. The tool 200 and holder 282 can then be manually repositioned until the center point CP of the tool 200 is at a different virtual insertion point, such as Fig.11E This repositioning is accomplished without removing the tool 200 from the port seal S and without creating a penetration through the patient's abdomen at a new target virtual insertion point. Although this repositioning is limited by the radius of the semicircular middle portion 208, the first tool can be replaced with a second tool having a different semicircular middle portion radius, although in this case the tool needs to be removed.

[0058] During surgery, the robotic system will reposition the robotic arm and tool at multiple different angles relative to the penetration plane of the abdominal wall, with the pivot being at the level of the abdominal wall (remote center). Once set up, the distance from the proximal portion of the laparoscopic tool held by the robotic arm to the virtual insertion point of the tool will typically remain constant. The initial distance is selected so that the semicircle center point and the shared spatial remote center ( Figure 7 and Figure 8 ) is at the level of the virtual insertion point into the body cavity. From this point on, all movements of the robotic arm will maintain this distance so that the remote center remains at the same position of the virtual insertion point into the abdominal wall.

[0059] Preferred embodiments of the present invention are described herein, including the best mode known to the inventor for implementing the present invention. For those of ordinary skill in the art, after reading the above description, changes in those preferred embodiments may become apparent. The inventor hopes that skilled technicians will adopt such changes as appropriate, and the inventor wants to practice the present invention in a manner different from that specifically described herein. Therefore, the present invention includes all modifications and equivalents to the subject matter recorded in the claims attached hereto as permitted by applicable law. In addition, unless otherwise specified herein or otherwise clearly contradictory to the context, the present invention covers any combination of the above-mentioned elements in all possible variations thereof.

[0060] All references, including publications, patent applications, and patents, cited herein are hereby incorporated by reference to the same extent as if each reference were individually and specifically indicated to be incorporated by reference and were set forth in its entirety herein.

Claims

1. A laparoscopic tool, the laparoscopic tool being configured to be mounted on a tool holder of a surgical robotic system having a robotic arm with a remote center, the tool holder comprising a fixed side mount and a drive interface, the laparoscopic tool comprising: A shaft having: (a) a straight proximal segment; (b) a straight distal segment axially aligned with the straight proximal segment along a common axis; (c) a semicircular middle portion having a center point on the common axis and located between and connected to the straight proximal segment and the straight distal segment, wherein the center point is located to coincide with the remote center of the robotic arm when the laparoscopic tool is mounted on the tool holder; and (d) a central passage extending through the shaft; a flexible cable assembly configured to pass through the central passage of the shaft and to accommodate the semicircular mid-section as the flexible cable assembly translates axially and rotates within the central passage of the shaft; a driven interface on the straight proximal segment of the shaft, the driven interface being configured to be removably connected to the driver interface on the robotic arm to manipulate the flexible cable assembly; a distal effector extending from the straight distal segment of the shaft, the distal effector drivably coupled to a distal end of the flexible cable assembly; as well as a rotatable side mount rotatably coupled to the straight proximal segment of the shaft, the side mount being configured to be removably connected to the fixed side mount on the robotic arm and to allow the common axis of the shaft to rotate about at least two axes orthogonal to the longitudinal axis of the surgical robotic arm; Wherein the semicircular middle portion is attached to the straight proximal end section by a rotatable bearing, the rotatable bearing allowing the semicircular middle portion to rotate relative to the straight proximal end section about the common axis.

2. The laparoscopic tool of claim 1, wherein the side mount is coupled to the straight proximal section of the shaft by a pair of orthogonally oriented rotational joints.

3. The laparoscopic tool according to claim 1 or 2, further comprising a telescoping section extending distally from the distal effector end of the shaft to accommodate extension and retraction of the flexible cable assembly.

4. The laparoscopic tool of claim 3, wherein segments of the telescoping section have alignment features that prevent relative rotation when extending and retracting the segments.

5. A laparoscopic tool according to any one of claims 1 to 4, wherein the flexible cable assembly is configured to be rotatably and translationally attached to the drive interface on the surgical robot arm, so that the drive interface can enable the push / pull wires of the flexible cable assembly to be axially and rotationally repositioned relative to the common axis of the shaft to actuate the distal actuator.

6. A laparoscopic tool according to claim 5, wherein the flexible cable assembly further comprises a bidirectional torque tube coaxially located above the push / pull line and configured to transmit torque and axial translation forces from the drive interface in the robotic arm to the distal actuator.

7. A laparoscopic tool system for use with a surgical robot, the system comprising: The laparoscopic tool according to any one of claims 1 to 6; as well as an alignment tool configured to couple to the shaft in a fixed orientation and, when coupled to the shaft, mark the location of the center point of the semicircular middle portion of the shaft, wherein a user is able to visualize the marked location and manually position the surgical robotic arm to place the center point of the semicircle and a coincident remote center of the robotic arm to which the tool is mounted together with a virtual insertion point on the patient's abdomen.

8. The laparoscopic tool system of claim 7, wherein the alignment tool is removably coupled to the shaft.

9. The laparoscopic tool system of claim 7 or 8, wherein the alignment tool is an elongated body having a proximal end coupled to the shaft and a distal marking tip located at the center point when the proximal end is coupled to the shaft.

10. The laparoscopic tool system according to any one of claims 7 to 9, wherein the alignment tool is configured to project a pair of visible light beams that intersect at the center point when the alignment tool is coupled to the shaft.

11. A method for performing robotic surgery using at least one laparoscopic tool having an axis aligned with a virtual insertion point on the abdomen of a patient, the method comprising: A surgical robotic system is provided, the surgical robotic system comprising at least one robotic arm having a remote center and a tool holder carried by the robotic arm, the tool holder having a fixed side mount and a drive interface; providing at least one laparoscopic tool, the at least one laparoscopic tool comprising a shaft having a semicircular middle portion, the semicircular middle portion having a center point on a common axis, the semicircular middle portion being located between and connected to a straight proximal segment and a straight distal segment of the shaft, the center point coinciding with the location of the remote center of the robotic arm when the laparoscopic tool is mounted on the tool holder; coupling the straight proximal end section of the shaft to the fixed side mount on the robotic arm, wherein the center point of the semicircular mid-section is located at the distal center of the surgical robotic system; positioning the semicircular mid-portion of the shaft of the at least one laparoscopic tool through a percutaneous passage, wherein the percutaneous passage is offset from the remote center of the surgical robotic system by a distance equal to a radius of the semicircular mid-portion; detaching the at least one robotic arm from the surgical robot so that the at least one robotic arm can be manually positioned; manually positioning the at least one robotic arm to position the center point of the semicircular midsection of the shaft of the at least one laparoscopic tool at the virtual insertion point on the patient's abdomen while the semicircular midsection remains positioned through the percutaneous passage, wherein the semicircular midsection rotates about the common axis relative to the straight proximal section while the robotic arm is repositioned; reengaging the at least one robotic arm with the surgical robot so that the robotic arm is manipulated by the surgical robot; as well as The surgical robot is operated to manipulate at least one robotic arm so that an end effector on at least one laparoscopic tool surgically interacts with tissue while the mid-portion of the shaft remains located in the percutaneous channel and the center point and the coincident remote center of the robotic arm to which the tool is mounted remain located at the virtual insertion point on the patient's abdomen.

12. The method of claim 11, wherein manually positioning the at least one robotic arm to locate the center point of the semicircular mid-portion of the shaft of the at least one laparoscopic tool and a coincident remote center of the robotic arm to which the tool is mounted together with the virtual insertion point on the patient's abdomen comprises providing a visual marker of the location of the center point on the patient's abdomen.

13. The method of claim 12, wherein providing the visual marking of the location of the center point of the semicircular mid-portion of the tool on the patient's abdomen comprises coupling an elongated body having a distal marking tip located at the center point to the shaft.

14. The method of claim 12 or 13, wherein providing a visual marker of the location of the center point on the patient's abdomen comprises projecting a pair of visible light beams that intersect at the center point on the patient's abdomen.

15. The method of any one of claims 11 to 14, wherein rotatably coupling the straight proximal end section of the shaft to the fixed side mount on the robotic arm comprises removably attaching a rotatable side mount rotatably coupled to the straight proximal end section of the shaft to the fixed side mount on the robotic arm.

16. The method of claim 15, wherein the rotatable side mount is rotatably coupled to rotate about at least two axes orthogonal to a longitudinal axis of the surgical robotic arm.

17. The method of any one of claims 11 to 16, wherein the straight proximal section of the shaft is rotatably coupled to the fixed side mount on the robotic arm such that the common axis of the shaft of the laparoscopic tool is rotatable about at least two axes orthogonal to the longitudinal axis of the surgical robotic arm.

18. The method according to any one of claims 11 to 17, further comprising: providing a second laparoscopic tool having a semicircular midsection having a center point on a common axis coinciding with a distal center of the robotic arm to which the tool is mounted, the semicircular midsection being located between and connected to a straight proximal end section and a straight distal end section; rotatably coupling the straight proximal end segment of the shaft of the second laparoscopic tool to a fixed side mount on a second robotic arm of the surgical robot such that the common axis of the shaft of the second laparoscopic tool is rotatable about at least two axes orthogonal to the longitudinal axis of the second surgical robotic arm; positioning the semicircular mid-portion of the shaft of the second laparoscopic tool through the percutaneous passage; detaching the second robotic arm from the surgical robot so that the second robotic arm can be manually positioned; manually positioning the second robotic arm to locate the center point of the semicircular midsection of the shaft of the second laparoscopic tool and a coincident remote center of the robotic arm to which the tool is mounted together with a second remote center on the patient's abdomen while the semicircular midsection remains positioned through the percutaneous passage so that the common axis of the second laparoscopic tool self-rotates and is aligned relative to the longitudinal axis of the second surgical robotic arm; reengaging the second robotic arm with the surgical robot so that the second robotic arm is manipulated by the surgical robot; as well as The surgical robot is operated to manipulate the second robotic arm so that the end effector on the second laparoscopic tool surgically interacts with tissue while the middle portion of the shaft of the second laparoscopic tool remains located in the percutaneous channel and the center point remains located at the second remote center on the patient's abdomen.

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