Medical robot system

Abstract

A robotic surgical system configured to control movement and actuation of a single robotic arm and to control movement and actuation of a plurality of tools carried at a distal end of the robotic arm. A medical robotic system includes a robotic arm having a plurality of movable arm segments; an endoscopic viewing assembly removably coupled to the distal section of the robotic arm; a stabilization device detachably coupled to the distal section of the robotic arm; the stabilization device has an elongate tool shaft adapted to engage tissue to stabilize the cervix of a patient, and a cervical canal sealing assembly with a contact sensor configured to move coaxially with a middle portion of the elongate endoscope shaft.

Description

Related application information

[0001] This application is a continuation of U.S. patent application No. 17 / 804,428 filed on May 27, 2022, the contents of which are incorporated herein by reference. background

[0002] The present invention relates to a robotic surgery system configured to control the movement and actuation of a single robotic arm and the movement and actuation of a plurality of tools in gynecological surgery. Overview

[0003] The principles of the present disclosure relate to medical robotic systems. For example, some aspects of the technology described herein relate to a medical robotic system, the medical robotic system comprising: a robotic arm having a plurality of movable arm segments; an endoscopic viewing assembly removably coupled to a distal segment of the robotic arm, the endoscopic viewing assembly having an elongated endoscopic shaft extending about a longitudinal axis to a distal end carrying an image sensor; and a stabilization device removably coupled to the distal segment of the robotic arm, the stabilization device having an elongated tool shaft extending about the longitudinal axis, the elongated tool shaft being adapted to engage tissue to stabilize a patient's cervix.

[0004] Variations of the medical robotic system may also include a motor drive configured to manipulate various instruments on the medical robotic system. For example, the motor drive may rotate the elongated endoscope shaft relative to its longitudinal axis. The motor drive may also be configured to move the elongated endoscope shaft axially relative to its longitudinal axis.

[0005] Additionally, the motor drive is configured to rotate the elongated tool shaft relative to its longitudinal axis.The motor drive may also be configured to move the elongated tool shaft axially relative to its longitudinal axis.

[0006] In some aspects, the technology described herein relates to a medical robotic system, which also includes a treatment tool that is detachably connected to a distal segment of a robotic arm, the treatment tool having a treatment tool shaft extending around a longitudinal axis to a working end, wherein the treatment tool shaft is configured for introduction through a working channel of an endoscopic observation assembly.

[0007] The motor drive of the present robotic system can be configured to rotate the treatment tool shaft relative to its longitudinal axis and / or to move the treatment tool shaft axially relative to its longitudinal axis. Examples of such treatment tools include, but are not limited to, resection devices, ablation devices, coagulation devices, biopsy devices, and dissection devices.

[0008] In further variations, the treatment tool includes a resection device having a mobile cutting member, and wherein the system includes a resection motor drive for moving the mobile cutting member, the mobile cutting member moving at least rotationally or axially.

[0009] Variations of the medical robotic system include a cervical canal sealing assembly coupled to at least one of the robotic arm and the endoscopic viewing assembly. In further variations, the distal end of the cervical canal sealing assembly includes a cervical seal configured to move coaxially with a mid-portion of the elongated endoscopic shaft.

[0010] In addition, the present robotic system may include a motor drive adapted to move the cervical seal. A variation of the system includes a contact sensor carried by the cervical seal, the contact sensor adapted to sense contact with the patient's cervix and send a contact signal or a signal of no contact to a controller. In a further variation, the medical robotic system includes a controller configured to actuate the motor drive to move the cervical seal in response to a contact signal from the contact sensor. A variation of the system includes a contact sensor that is a pressure sensor, a capacitive sensor, an impedance sensor, and an optical sensor. Alternatively, the contact sensor may include a plurality of contact sensors, including a combination of those listed above.

[0011] In some aspects, the technology described herein relates to a method for treating tissue in a patient's uterine cavity, the method comprising: providing a medical robotic system having a robotic arm, the robotic arm having multiple movable arm segments, the movable arm segments having a distal arm segment, the distal arm segment carrying multiple motor drives, the multiple motor drives being used to move at least one device connected to the distal arm segment; removably connecting a resection device to the distal arm segment, the resection device having an elongated shaft extending about a longitudinal axis to a working end, the working end carrying a cutter configured to rotate and / or axially reciprocate; introducing the working end of the resection device into the patient's uterine cavity through the cervix; actuating the resection device to cause the cutter to rotate and / or reciprocate; and using a controller to operate at least one of the multiple motor drives to move the working end of the resection device in a predetermined pattern to resect tissue.

[0012] Method disclosed herein can also include controller operating motor driver to make working end move in axial mode, while actuating cutter to excise tissue.In addition, controller can operate motor driver to make working end move in rotation mode, while actuating cutter to excise tissue.

[0013] This disclosure is related to commonly assigned U.S. Patent Application No. 17 / 662,182, the entire contents of which are incorporated herein by reference. BRIEF DESCRIPTION OF THE DRAWINGS

[0014] Additional aspects of the present invention will become apparent from the following description of illustrative embodiments and the accompanying drawings, in which: Figure 1 is a schematic diagram of a surgical robotic system including a rolling frame having a tower portion, a surgical console and a user input interface, and a surgical robotic arm adapted to carry and robotically manipulate a plurality of tools in a procedure to treat intrauterine tissue.

[0015] Figure 2 yes Figure 1 A magnified view of the robotic arm with the single-use endoscopic viewing system and the single-use tissue removal device detached from the robotic arm.

[0016] Figure 3 is similar to Figure 2 A view of the endoscope with the viewing system and tissue removal device locked in place in the robotic arm.

[0017] Figure 4 yes Figures 1 to 3 A perspective view of a proximal housing and working end of a disposable endoscope of an endoscopic viewing system, wherein the endoscope is of a type having an expandable and collapsible working channel in its working end.

[0018] Figure 5 yes Figures 1 to 3 An endoscopic viewing system is shown in perspective views from different angles of the proximal housing and the working end of a disposable endoscope having an expandable and collapsible working channel.

[0019] Figure 6 yes Figure 4 A perspective view of the working end of an endoscope with the shaft of a tubular cutter device inserted through an expandable and collapsible working channel of the endoscope and also showing a preselected or programmed robotic cutting mode.

[0020] Figure 7 is a perspective view of a proximal portion of a cutting device including a drive component and a tubular cutter, with only the proximal housing of the tubular cutter shown.

[0021] Figure 8 yes Figure 7 A perspective view of a tubular cutter with an enlarged view of the working end showing the rotating inner sleeve and cutting window.

[0022] Fig. 9 It is as Figure 1 and Figure 3 A perspective view of the proximal portion of the assembled endoscopic viewing system and resection device when removably coupled to a robotic arm.

[0023] Fig.10 is a perspective view of the proximal portion of the robotic tissue stabilization assembly with the drive components adjacent to Fig. 9 Endoscopic observation system and resection device.

[0024] Fig.11 yes Fig.10 A perspective view of the hook component of the tissue stabilization assembly.

[0025] Fig.12 is a perspective view of a cervical seal slidably mounted on the shaft of an endoscope.

[0026] Fig.13 is a perspective view of a robotically operated cervical seal assembly slidably mounted on the shaft of an endoscope.

[0027] Fig.14 yes Fig.13 A perspective view of a proximal portion of a robotic cervical seal assembly showing the robotic cervical seal assembly and Fig.10 The tissue stabilization component, endoscopic observation system and resection device are assembled together.

[0028] Fig.15 is a perspective view of the distal working end of the endoscope, cervical seal, tubular cutter, and holding hook, indicating the dimensions of the robotic movement of some components.

[0029] Fig.16A is a schematic cross-sectional view of a patient's uterus illustrating steps in a method of using a robotic arm to move a gripper type into position to grasp the patient's cervix and move an endoscope toward the patient's cervix.

[0030] Fig. 16B is a schematic diagram of subsequent steps in the method, illustrating actuating the robotic arm to advance the endoscope working end through the endocervical canal into the uterine cavity, and moving the cervical seal toward the patient's cervix.

[0031] Fig. 16C Another subsequent step of the method is shown in which the robotic arm is actuated to advance the cutting device through the working channel of the endoscope into the uterine cavity, and the robotic arm is further actuated to angle the working end of the tubular cutter toward the target fibroid, and a cervical seal is also shown advanced to contact the cervix.

[0032] Fig.16D Another subsequent step of the method is shown, in which the robotic arm further moves the working end of the tubular cutter laterally to resect the uterine fibroid.

[0033] Fig.17is a perspective view of the working end of an endoscope and tubular cutter showing a preselected or programmed robotic cutting pattern. Detailed Description

[0034] Figure 1 A surgical robotic system 100 suitable for use in gynecological surgery or other surgery with similar access requirements is shown, which includes a rolling frame 104 with a vertical column or tower 105, the rolling frame 104 carrying a surgical robotic assembly, the surgical robotic assembly including a robotic arm 110, which is operated from a console 112 having a user input interface 115 and an image display 116. The user input interface 115 may include one or more joysticks, ball bearings, and other input mechanisms known in the art. The image display 116 may be a touch screen, and the image display 116 may also be used to guide the movement of the arm 110 and / or control other operating parameters of the system 100, as described below. The robotic arm 100 is capable of moving relative to multiple axes provided by multiple drives and actuators. In one variation, the robotic arm 110 of the system 100 may include as a core unit a commercially available multi-segment robotic arm manufactured by KUKA Robotics Corporation having an office at 51870 Shelby Parkway, Shelby Township, Michigan, 48315.

[0035] refer to Figure 1 and Figure 2 , the lower base platform 118 of the robotic arm 110 is driven by a motor to move vertically on a vertical track 125 within the tower 105 of the rolling frame 104. In one variation, the robotic arm 110 is configured to have seven movable arm segments 120A to 120G, wherein the base rotates the arm segment 120A relative to the base platform 118 ( Figure 2 ) rotation. The arm segments 120A to 120G are adapted as follows Figure 2 The sixth arm segment 120F rotates as indicated by arrows A to G. The distal end 126 of the sixth arm segment 120F is coupled to a seventh rotating segment 120G driven by a motor for rotation. As described below, additional motor drives and surgical tools are adapted to be detachably coupled to the rotating arm segment 120G. Figure 3 It will be appreciated that during a surgical procedure, the robotic arm 110 may move the distal end of the tool in all directions, angles, pitches, and yaws (eg, in the X, Y, and Z directions).

[0036] refer to Figure 2 and Figure 3It can be seen that the first and second cooperative tools are suitable for attachment to the rotating section 120G. The first tool is a disposable endoscope observation assembly 140, and the second tool is a disposable tissue removal device 145, and the second tool is configured to be inserted through the working channel WC in the endoscope observation assembly 140. Figure 2 , the endoscope assembly 140 and the resection device 145 are shown separated from the rotating section 120G of the robotic arm. Figure 3 In FIG. 1 , the endoscope assembly 140 and the resection device 145 are fully assembled with the robotic arm 110 .

[0037] Figure 4 and Figure 5 The endoscope 150 ( Figure 4 ) and endoscope drive component 152 ( Figure 5 ). Endoscope 150 has a proximal hub 154 coupled to an elongated shaft 155 extending about a longitudinal axis 158 to a working end 160 carrying an image sensor 162 and at least one LED, two LEDs 164a and 164b are shown in this variation ( Figure 4 ). The endoscope 150 has a working channel WC with a proximal seal 168, wherein the working channel extends through the elongated shaft 155 to the working end 160 of the endoscope. Figure 4 140, the working end 160 of the endoscope has an S-shape or curve in the rest or insertion shape, and the working end 160 of the endoscope has a small cross-section that allows for atraumatic introduction through the cervical canal of the patient. The working channel WC has a distal region 172 that is expandable in cross-section to receive the shaft of a component of the cutting device 145, such as Figure 6 or accepts the shaft of any similar tool having a straight rigid shaft. Figure 5 The working end 160 of the endoscope shaft 155 and other related endoscopes are described in more detail in commonly owned U.S. Patents 10,433,717 and 11,259,695 and commonly owned U.S. patent applications 15 / 975,626; 16 / 351,909; 16 / 562,069; 16 / 848,050; 17 / 447,380 and 17 / 490,643, which are incorporated herein by reference.

[0038] refer to Figure 4 and Figure 5, it can be seen that the hub 154 of the endoscope 150 has a proximal extension 174 and a swivel collar 175 that carries two Luer connectors 176a and 176b in its lower surface 177. The Luer connector 176a is adapted to be connected to a fluid inlet tube 178a from a tubing set of a fluid management system 180, which is located at the bottom of the fluid management system 180. Figure 1 The second Luer connector 176b is suitable for connecting the fluid management system 180 ( Figure 1 ) is connected to the outflow tube 178b. The inflow tube 178a is connected to the inflow channel 182 in the endoscope shaft 155, and the inflow channel 182 has an open terminal end 184 ( Figure 4 ). The working channel WC in the endoscope shaft 155 serves as a fluid outflow channel and communicates with the Luer connector 176b and the outflow tube 178b. The arrangement of components within the interior of the rotating collar 175 that allow flow into and out of the rotating collar 175 from the rotatable endoscope shaft 155 is described in more detail in commonly owned U.S. Patent 10,433,717, which is incorporated herein by reference.

[0039] The upper surface of the rotating collar 175 includes a connector 185 for connecting a cable 186 to the endoscope 150 to transmit signals from the image sensor 162 to the image processor and to transmit current to the LEDs 164a to 164b. The rotating collar 175 includes a protruding key 192 that projects into a receiving recess 194 in a housing 195 of the drive member 152, which is adapted to maintain the rotating collar 175 in an upright position when the endoscope shaft 155 is rotated during use (see FIG. Figure 5 The upright position of the collar 175 facilitates the movement of the inflow and outflow tubes 178a, 178b and the cable 186 as the endoscope shaft 155 is rotated. Figure 1 ) are maintained in an upright, non-rotated position.

[0040] Now go to Figure 5 , the endoscope drive member 152 can be adapted for single use or multiple use, and will typically be adapted for multiple use. In one variation, the drive member 152 is removably coupled to the arm segment 120G using a pin 196 that cooperates with a hole 198 in the housing 195 of the drive member 152 (see Figure 2 ).

[0041] Reference again Figure 5 , the endoscope drive component 152 carries a rotating receiver 200 that is adapted to receive the proximal extension 174 of the hub 154 of the endoscope 150. Figure 5The proximal extension 174 is shown having a keying surface 202 that cooperates with a keying surface 204 of a rotation receiver 200, which provides a rotational lock of the endoscope 150 and the drive component 152. The rotation receiver 200 is operably coupled to a motor drive 205 carried in the drive housing 195 by a suitable gear mechanism and when in Figure 5 and Figure 6 The rotating receiver 200 and the endoscope 150 are adapted to be rotated when locked in place in the direction of arrow R1 in FIG. The motor drive 205 may be a DC stepper motor or other motor type and is adapted to rotate the rotating receiver 200 and the locked endoscope 150 from 180° to 360°. The gear mechanism may be any form of conventional spur gear that converts the rotation of the motor shaft into the rotation of the receiver 200.

[0042] Now go to Figure 7 and Figure 8 , a resection device 145 is shown and includes a motor-driven tubular cutter 210 and a tool drive component 212. The drive component 212 can be adapted for single use or multiple use, and is typically adapted for multiple use. In one variation, the tool drive component 212 is removably coupled to the housing 195 of the endoscope drive component using a pin 214a that cooperates with a hole 214b in the endoscope drive housing 195 ( Figure 5 Tool drive component 212 carries first and second DC motors 215A, 215B for respectively (i) rotating and (ii) axially moving a movable receiver 220 in drive component 212 that receives an extension 222 of a proximal housing 224 of tubular cutter 210 .

[0043] like Figure 6 As shown, the shaft 225 of the tubular cutter 210 is adapted to pass through Figure 4 and Figure 5 The working channel WC of the endoscope shaft 155 is introduced. It should be understood that in addition to the tubular cutter, other treatment tools such as any type of ablation or coagulation device, RF device, biopsy device, ultrasound device, laser device, dissector, retractor or manipulator can be used, wherein the tubular cutter 210 is shown for illustration purposes.

[0044] refer to Figure 7 and Figure 8 , tubular cutter 210 has a proximal housing 224 coupled to an elongated shaft assembly 225 extending about an axis 228 to a working end 240 ( Figure 8 ).exist Figure 8, it can be seen that the shaft assembly 225 includes concentric inner sleeves 244 and outer sleeves 245, respectively, wherein the inner sleeve 244 has an inner cutting window 246, and the inner cutting window 246 rotates in the outer cutting window 248 of the outer sleeve 245 to cut tissue (see Figure 8 ). Proximal housing 224 of tubular cutter 210 carries motor drive 250 for rotating inner sleeve 244 and inner cutting window 246 at a suitable rotational speed in the range of 1,000 RPM to 10,000 RPM or more to cut tissue.

[0045] Reference now Figure 7 , tubular cutter 210 is shown partially inserted into tool drive component 212. Rotational receiver 220 of drive component 212 is adapted to receive an extension portion 222 of a proximal housing 224 of tubular cutter 210. Figure 7 Extension portion 222 of housing 224 is shown having keyed surface 252 that cooperates with keyed surface 254 of rotation receiver 220 to provide locking rotational engagement of proximal housing 224 and receiver 220. As can be appreciated, shaft 225 of tubular cutter 210 may be provided in conjunction with rotational receiver 220. Figures 1 to 3 When assembling other components, they are also introduced into the working channel WC of the endoscope 150 through the seal 168.

[0046] In one variation, Figure 7 The rotating receiver 220 in the embodiment is operably coupled to the first motor drive 215A by a gear mechanism that rotates the movable receiver 220, for example, using gear surfaces 262a and 262b. The first motor drive 215A is adapted to rotate the receiver 220 and the engaged cutter 210 from 180° to 360°. Figure 6 and Figure 7The tool drive component 212 also carries a second motor drive 215B, which is geared to move the receiver 220 axially in the housing 264 of the drive component 212. A suitable gear mechanism may consist of a worm gear 268a that engages a feature 268b in the surface of the receiver 220. Thus, when the tubular cutter 210 is locked in place, the second motor drive 215B is adapted to axially move the rotating receiver 220 (and engage the tubular cutter 210) back and forth in the drive housing 212 in the direction of arrow AX1. The motor drives 215A and 215B may likewise be DC stepper motors or other suitable motor types. As can be appreciated, second motor driver 215B is adapted to position working end 240 of tubular cutter 210 in a fully retracted position within working channel WC of endoscope 150 and working end 240 within a field of view (FOV) of endoscope image sensor 162 during surgery. Figure 3 The working end 240 extends beyond the endoscope 150 to a distance of 15 cm beyond the lens plane of the image sensor 162.

[0047] refer to Figure 7 and Figure 8 It can also be seen that tubular cutter 210 is configured for use with fluid management system 180. Fluid outflow tube 178b of fluid management system 180 is coupled to luer connector 268 on housing 224 of tubular cutter 210. As is known in the art, fluid flows out and excised tissue is aspirated through the lumen of inner sleeve 244 of tubular cutter 210. Figure 7 and Figure 8 2, it can also be seen that the proximal housing 224 of the tubular cutter 210 has a rotatable surface portion 275 that is free to rotate about the core portion 276. The arrangement of components within the proximal housing 224 that allow outflow from the tubular cutter 210 to communicate with the Luer connector 268 in the rotatable surface portion 275 is described in more detail in commonly owned U.S. Patent No. 10,433,717, which is incorporated herein by reference. The rotatable surface portion 275 also carries a connector 277 that is used to couple with a cable 278 to deliver current to the motor 250 in the tubular cutter 210. The upright position of the rotatable surface portion 275 facilitates the connection of the outflow tube 178b and the cable 278 ( Figure 1 ) are maintained in a stable, non-rotating position.

[0048] Now go to Fig. 9, it can be seen how the endoscopic viewing assembly 140 and the cutting device 145 can be assembled and coupled to the rotating robotic arm segment 120G. The first drive component 152 is lifted vertically to couple to the pin 196 in the arm segment 120G. Thereafter, the extension 174 of the proximal hub 154 of the endoscope is inserted into the receiver 200 of the endoscope drive component 152. Next, the tool drive component 212 and its pin 214a mate with the receiving hole 214b in the endoscope drive housing 195. Finally, the elongated shaft 225 of the tubular cutter 210 is introduced through the two drive components 152, 212 and the working channel WC of the endoscope 150. As an example, Figure 1 and Figure 3 The shaft 225 and working end 240 of the tubular cutter 210 are shown, both fully extending beyond the working end 160 of the endoscope 150. However, it should be understood that when the robotic arm 110 is used, the endoscope shaft 155 is initially introduced through the patient's cervical canal CC ( FIG. 16A to FIG. 16B ), wherein the working end 240 of the tubular cutter 210 is retracted into the working channel WC of the endoscope 150, as shown Fig.15 A to Fig.15 As shown in B.

[0049] Now go to Fig.10 and Fig.11 , shows a configuration with Figure 1 Another robotic component used in conjunction with the system 100 of the present invention includes a tissue stabilization assembly 400 adapted to engage and grasp the patient's cervix, as is known in the art. In any typical intrauterine procedure using a transcervical approach, the physician uses a gripper or forceps to grasp and stabilize the patient's cervix to facilitate passage of the endoscope shaft through the patient's cervical canal CC ( FIG. 16A to FIG. 16B ) is introduced. In this robotic variation, the method is similar, wherein the stabilizing component 400 is a robotic component. Fig.10 The proximal portion of the endoscopic viewing assembly 140 and the resection device 145 and the tissue stabilization assembly 400 are shown. Fig.11 As more fully shown in FIG. 4 , the tissue stabilization assembly 400 also has a drive component 405 that is motorized to drive a tool or hook component 410. The hook component 410 has an elongated shaft 415 extending about an axis 418 to a working end 420 having a first jaw 422a and a second jaw 422b ( Fig.11 ).Although Figure 10 to Figure 11 A conventional hook-shaped working end 420 is shown, but it will be appreciated that suction contact working ends and other forms of grippers may be used to engage and stabilize the patient's cervix. In the illustrated variation, the stabilizer drive member 405 is similar to that previously described. Figure 7The tool drive component 212 is provided as it also provides two motor drives for the rotation and axial movement of the receiver 425 in which the hook holding component is received.

[0050] As in Fig.10 As can be seen in the figure, the drive component 405 carries a first motor 428A and a second motor 428B, which are configured to move the receiver 425 rotationally and axially. The drive system can be the same as those described in the tool drive component 212. The proximal handle or housing 430 of the hook 410 also includes an extension 440 having a keying surface 442, which cooperates with a keying surface 444 in the receiver 425. The hook 410 also carries a motor driver 445, which has a suitable gear mechanism, such as a worm gear 446, for example. Fig.11 The outer sleeve 448 of the shaft assembly 415 is shown to be advanced and retracted to close and open the jaws 422a and 422b. The proximal housing 430 also carries a connector 452 for connecting a cable 454 to the housing 430 to deliver current to the motor 445. Fig.10 , it can be seen that the stabilizer drive component 405 has a bracket 455 for coupling the tissue stabilization assembly 400 to the robotic arm 110, for example using a multi-pin arrangement of the type previously described. Fig.10 In one variation shown, a middle portion of a bracket 455 of a stabilizer drive component 405 may include a flexible or resilient material 458 to allow for flexing between the stabilizer drive component 405 and other tools.

[0051] Fig.12 Another component of the present invention is shown, which includes a cervical seal 460. This cervical seal 460 includes a concentric sleeve 462 that slides on the shaft 155 of the endoscope 150. The cervical seal 460 carries a tapered distal seal member 464 that can be placed against the patient's cervix CC and optionally pushed into the cervical canal CC to prevent expansion fluid from passing through the cervical canal (see Fig. 16B ) escapes the uterine cavity. In this variation, the cervical seal 460 is installed on the endoscope shaft 155 during manufacture and is manually moved axially by a locking mechanism 465 at the proximal end of the sleeve 462.

[0052] Now go to Fig.13 and Fig.14 , shows a robotically controlled cervical seal 480, which also includes a sleeve 482 extending over the endoscope shaft 155, the sleeve 482 having a distal conical sealing member 484 that contacts the patient's cervix. In this variation, reference Fig.14, a seal drive component 485 is provided that is adapted to robotically and automatically move the sealing sleeve 482 back and forth to maintain a proper seal. Similar to the other drive components described above, the seal drive component 485 unit has a DC motor 486 that drives a worm gear 488 that engages a protruding feature 490 on the sleeve 482 to move the sleeve back and forth. In this variation, the drive component 485 has an open side slot 492 for receiving the sleeve 482 so that the drive can be installed on an already assembled endoscope 150 and its drive component 212. In one method of use, the cervical sealing sleeve 482 would be manually advanced to engage the cervix and then the drive component 485 would be positioned in the appropriate position to engage the sealing sleeve 482 for continuous adjustment during the resection procedure using the sensor system described below. The cervical sealing sleeve 482 may require an expanded range of motion and robotic adjustment is optimally suited for precise shorter axial movements once the sealing member 484 is close to the patient's cervix. In Figure 13 to Figure 14 , it can be seen that the seal drive component 485 has elongated mounting pins 495a and 495b, which are suitable for connecting the housing 195 of the endoscope drive component 212, such as Fig.14 In this variation, mounting pins 495a and 495b carry electrical contacts 496a and 496b for engaging cooperating electrical contacts in endoscope drive housing 195 to deliver electrical current to DC motor 486 in seal drive assembly 485.

[0053] In one variation, the cervical seal 480 may have one or more sensors 498, such as Fig.13 As shown, for sensing contact with the patient's cervix, the sensor 498 sends a signal to the controller 500 to operate the drive component 485 to move and maintain the sealing member 484 in proper engagement with the patient's cervix to prevent leakage of the expansion fluid. Such a sensor 498 can be any suitable sensor having a wired connection or wireless connection to one controller 540 or multiple controllers through electrical contacts 496a and 496b, such as a capacitive sensor, an impedance sensor, a pressure sensor, an optical sensor, etc.

[0054] Fig.14 Four robotically driven components are shown (endoscopic viewing assembly 140, resection device 145, tissue stabilization assembly 400, cervical seal 480), and the steps to assemble these three components can be understood. In use, as will be described below, the illustration of the receiver of the drive components may not be drawn to scale, and it can be understood that the extendable dimensions of the tools relative to each other can be substantial. Fig.15The working end of the device is shown, and it will be appreciated that the hook shaft 415 is initially configured to extend beyond the endoscope working end 160 by up to 10 cm to grip the patient's cervix ( Fig.16A Thereafter, the endoscope shaft 155 is introduced through the patient's cervical canal CC while the clamped gripper working end 420 remains stationary, such that the drive component 152 is configured to extend the endoscope working end 160 beyond the gripper working end 420 by up to 15 cm. Fig.15 The distance D1 in Fig. 16B ). In addition, the tool drive component 212 and the tubular cutter 210 are configured to extend the working end 240 of the tubular cutter Fig.15 The distance D2 in the image sensor 162 is beyond the working channel WC and the image sensor 162 ( Fig. 16C ) up to 10 cm from the end. In addition, the cervical sealing member 484 requires a wide range of axial adjustment on the endoscope shaft 155, using both manual and robotic adjustment as described above.

[0055] Return to reference Figure 1 , a fluid management system 180 is operably connected to the endoscope 150 and the tubular cutter 210 as is known in the art. The fluid management system 180 includes an inflow peristaltic pump 500A and an outflow peristaltic pump 500B. The inflow tube 176a has a proximal end coupled to a fluid source 510 (such as a saline bag), wherein the distal end of the inflow tube 178a is connected to a luer connector 176a in the lower surface of the endoscope handle 154. The inflow pump 500A is adapted to provide a fluid flow through the inflow tube 178a and the flow channel 182 in the endoscope shaft 155 to the outlet 184 in the working end 160 of the endoscope (see Figure 4 In one variation, the outflow tube 178b is coupled to the Luer connector 176b on the endoscope 150 ( Figure 4 ), and branch 515 of outflow tube 178b is coupled to Luer connector 268 ( Figure 5 A valve or diverter 516 may be provided in the outflow tube 178b to select the flow from the endoscope 150 or the tubular cutter 210 ( Figure 1 and Figure 3 ) outflow fluid path. Thus, when no cutting device occupies the working channel WC of the endoscope 150, the fluid management system 180 allows the endoscope 150 to be used alone, with inflow and outflow passing through the endoscope shaft 155. Figure 3When positioned in working channel WC as shown, the outflow will flow through the tubular cutter 210 and the connector 268 on the handle 224 thereof. Thus, the outflow pump 500B is adapted to flow fluid from the working space to the collection reservoir 525. A tissue trap (not shown) may be provided in the outflow tube 178b. Independent motor drives are provided to operate the first peristaltic pump 500A and the second peristaltic pump 500B and are controlled by a controller 540 or multiple controllers ( Figure 1 ) controls, these controllers are typically configured to maintain a set pressure in a working space such as the uterine cavity.

[0056] Now go to FIG. 16A to FIG. 16D , the method of the present invention using the robotic system 100 and various tools in robotic surgery is schematically illustrated for removing a uterine fibroid 544 in a patient's uterus 545. The uterine fibroid 544 is shown in the wall of the uterine cavity 550, but it should be understood that in other variations of the method, the target tissue can be polyps, adhesions, endometrium and other abnormal tissues as well as uterine fibroids or myomas. Fig.16A , it will be appreciated that the user has actuated various sections of the robotic arm 110 to align the endoscope shaft 155 and the gripper shaft 415 with the external os 552 of the patient's cervix 554 after advancement into the patient's vagina 556, which may be held open with a suitable speculum device (not shown). Fig.16A It is shown that under endoscopic vision, the endoscope 155 and the holding jaws 422a and 422b are robotically manipulated axially and rotationally as needed, and then closed to grasp the cervix 554, thereby stabilizing the cervix.

[0057] Fig. 16B A subsequent step of the method is shown in which the user operates the robotic arm 110 to advance the endoscope working end 160 with its reduced cross-section or insertion profile through the cervical canal CC into the uterine cavity 550. The fluid management system 180 is typically actuated to provide fluid inflow through the endoscope 150 to facilitate introduction of the working end 160 through the cervical canal CC. The S-shaped end of the endoscope working end 160 can be rotated to optimally position it relative to the holding jaws for introduction into the cervical canal CC. Fig. 16B Further shown is the step of manually advancing the sealing sleeve 482 and sealing member 484 toward the cervix 554 and endocervical canal CC.

[0058] Fig. 16C Sealing sleeve 482 and sealing member 484 are shown fully advanced, either manually or using drive member 485, to contact cervix 554 to prevent leakage of dilation fluid outwardly from cervical canal CC. Fig. 16BAlso shown is the user actuating tool drive component 212 to advance shaft 225 of tubular cutter 210 through working channel WC in endoscope shaft 155 and into uterine cavity 550, which causes the distal portion of working channel WC to expand as described above. Fig. 16C Also shown is robotic arm 110 being actuated to move distal end 160 of endoscope 150 and distal end 240 of tubular cutter 210 in direction or plane X to engage the surface of uterine fibroid 544 .

[0059] Fig.16D The user is also shown operating the robotic arm 110 to tilt the working end 240 and cutting window of the tubular cutter 210 into the uterine fibroid 544 to cut and remove tissue. It should be understood that this step of the method of cutting tissue can include axially moving the working end 240 of the cutter 210 and / or slightly rotating the working end forward and backward to cut the uterine fibroid 544. In addition, the user can rotate the axis 155 of the endoscope to reposition the image sensor 162 and LED, such as Figure 6 As shown, to obtain the best view of the surface of the uterine fibroid 544 being resected. As described above, during the resection procedure, the seal drive component 485 can be operated to adjust the seal 484 to maintain contact with the cervix and thereby prevent fluid leakage.

[0060] Although Fig.16D Steps of a method for resecting a uterine fibroid are shown, but it should be further understood that the operating parameters of the tubular cutter 210 and the robotic system 100 can be controlled or automated by a controller 540 or multiple controllers of the robotic system 100 during resection. In one variation, for example, the fluid management system 180 can be controlled by the user from the user input interface 115 during resection, which includes adjusting any operating parameters of the fluid management system. The operating parameters of the fluid management system include (i) adjusting the set pressure in the uterine cavity, (ii) temporarily increasing the fluid inflow as a flushing mechanism to clear the resected debris or blood from the field of view, (iii) increasing the fluid pressure to a selected level for a selected time interval as a tamponade, and (iv) adjusting the fluid insufficiency level and any warnings or system shutdowns associated with the fluid insufficiency. The user can also adjust the operating parameters of the endoscope 150 from the user input interface 115, which includes (i) adjusting the light from the LED, and (ii) capturing images or videos of the procedure.

[0061] The user may also adjust operating parameters of the tubular cutter 210 at the user input interface 115, including (i) adjusting the rotational speed of the inner cutting sleeve 144, and (ii) in some variations, adjusting the oscillation and / or translation of the inner cutting sleeve 144 within the outer sleeve 146 during use. As is known in the art, a tubular cutter may use a rotating cutting sleeve, a reciprocating cutting sleeve, or a rotating and axially translating cutting sleeve.

[0062] In another variation of the method of excising tissue, reference is made to Figure 6 and Fig.17 , the controller 540 or controllers of the robotic system 100 can automate the parameters of the resection interval in a preset "resection plan" in which the drive components of the resection device and the actuation of the motors of the robotic arm 110 move the working end 160 of the tubular cutter 210 in a preset movement while operating to effectively resect tissue. For example, in Figure 6 In the embodiment of the present invention, the user can select a resection plan "RP1" via the user input interface 115, in which the inner cutting sleeve 144 is operated at a selected RPM between 1,000 RPM and 10,000 RPM, while the drive component 212 axially moves the working end 160 back and forth at a selected rate of 0.1 cm / sec to 1.0 cm / sec and a selected reciprocating distance of 0.1 cm to 2 cm. Figure 6 The resection plan RP1 may be run for a preset number of seconds, such as from 5 to 30 seconds, or may be initiated and terminated by user input. Another preset resection plan (not shown) may operate the inner cutting sleeve 244 within the above RPM range while actuating the drive member 212 to move the inner cutting sleeve 244 within the above RPM range. o / second and 90 o / second, the working end 160 of the tubular cutter 210 is moved from 10 o Rotate to 180 o Another variant may consist of a preset resection plan "RP2", such as Fig.17 As shown, it combines reciprocating motion and rotation within the above parameters to remove tissue at any preselected time interval or by activation and termination by the user. Fig.17 Discrete, sequential axial and rotational movements are depicted, but zigzag movements are possible for simultaneous axial and rotational movements. The user can rotate the working end 160 of the endoscope 150 ( Figure 6 and Fig.17 ) to optimize the observation of tissue resection. In any of the above resection plans, the user will further operate the robot arm to move the robot in any direction X, Y, or Z ( Figure 3) to move the cutter working end 240 to optimally engage the target tissue.

[0063] exist Figure 1 , it can be seen that the console 112 with the user input interface 115 is connected to the controller 540 and the connector 582 at the base of the robotic arm 110 via a cable 580. The various tools and drive units 140 and 145 can also be connected to the connector 582 via cables (e.g., cables 186 and 278) to provide power transmission and electrical signals between all tools, the console 112 and one controller 540 or multiple controllers. Although cables are shown, it should be understood that the electrical signals can also be wireless.

[0064] In another variation, the reference is returned Figure 4 and Figure 5 , the extension 174 of the housing 154 of the endoscope 150 received by the receiver 200 can carry one or more load sensors 590 or force sensors around the circumference of the housing, the sensors being engaged with the receiver 200 to sense the forces applied to the working ends 160, 225 and the shaft 155 of the endoscope 150 and the shaft 225 of the tubular cutter 210 during the resection procedure ( Fig.16D ). Signals from force sensor 590 are received by controller 540, and a control algorithm may continuously monitor the forces and directions of the forces on shaft 155 and shaft 225 of the device. In one variation, excess forces (such as bending forces) on shafts 155 and 240225 may provide an audible or visual signal that the forces exceed a preset level, or the control algorithm may stop operation of the resection device or automatically initiate movement of the robotic arm in an appropriate direction to reduce the forces on shaft 155 of endoscope 150 and shafts 240225 of tubular cutter 240210. In another variation, any of the above preset resection plans (e.g., Figure 6 RP1; Fig.17 RP2) may include actuating the robotic arm 110 to move in X, Y, and Z directions (see Figure 3 ), wherein the force sensing algorithm also automatically controls and maintains the resection plan of the preselected pressure on the working end 240 as the working end 240 engages and resects tissue. It should be understood that such a force sensor 590 may be positioned in any tool housing or any cooperating drive unit where sensing the force on the grapple 410 may also be useful.

[0065] Generally, the robotic system 100 of the present invention comprises a surgical robotic arm 110 having a base and a plurality of arm segments that rotate or translate relative to a plurality of axes, wherein at least one distal segment of the robotic arm is adapted to be removably coupled to a disposable endoscopic viewing system 140, a resection device 145, and a tissue stabilization system 400, all of which can be operated with a robotic drive mechanism to move tools from a remote user input interface 115.

[0066] A method of the present invention for treating target tissue in a uterine cavity of a patient includes providing a robotic arm having a plurality of arm segments to provide movement of the robotic arm relative to a plurality of axes, wherein the distal arm segment carries a single-use endoscope having an elongated shaft having a working channel disposed therein, wherein the endoscope shaft has a first insertion profile having a non-expanded shape and a second expanded shape by introducing a shaft of a treatment tool through the working channel, and thereafter (i) operating the robotic arm to introduce the endoscope shaft with its first insertion profile into the uterine cavity through the cervical canal of the patient, (ii) operating the robotic arm to introduce the shaft of the treatment tool through the working channel, thereby expanding the working channel to its second expanded shape and moving the working end to its expanded working profile, and (iii) treating the target tissue in the uterine cavity with the working end of the treatment tool. Additionally, a robotic stabilizer carried by the robotic arm may be used to stabilize the patient's cervix prior to introducing the endoscope into the cervical canal of the patient.

[0067] Although specific embodiments of the present invention have been described in detail above, it should be understood that this description is only for illustrative purposes, and the above description of the present invention is not exhaustive. Specific features of the present invention are shown in some drawings and not shown in other drawings, and this is only for convenience, and any feature according to the present invention can be combined with another feature. Many variations and alternatives will be apparent to those of ordinary skill in the art. Such alternatives and variations are intended to be included within the scope of the claims.

[0068] Certain features presented in the dependent claims may be combined and fall within the scope of the invention. The invention also encompasses embodiments in which the dependent claims are alternatively written in a multiple dependent claim format referring to other independent claims.

[0069] It is important to note that, where possible, aspects of the various described embodiments or the embodiments themselves may be combined. All such combinations are intended to fall within the scope of the present disclosure. All references cited herein, including publications, patent applications, and patents, are hereby incorporated by reference to the same extent as if each reference individually and specifically indicated was incorporated by reference and is set forth herein in its entirety.

Claims

1. A medical robot system for intrauterine surgery, comprising: a robotic arm having a plurality of movable arm sections; an endoscopic viewing assembly removably coupled to the distal section of the robotic arm, the endoscopic viewing assembly having an elongated endoscopic shaft extending about a longitudinal axis to a distal end carrying an image sensor; and a stabilization device removably coupled to the distal section of the robotic arm, the stabilization device having an elongated tool shaft extending about a longitudinal axis, the elongated tool shaft adapted to engage tissue to stabilize a cervix of a patient; a treatment tool removably coupled to the distal section of the robotic arm, the treatment tool having a treatment tool shaft extending about a longitudinal axis to a working end, wherein the treatment tool shaft is configured for introduction through a working channel of the endoscopic viewing assembly; and A motor drive is configured to move the elongated tool shaft axially relative to its longitudinal axis, and wherein the motor drive is configured to: rotate the treatment tool shaft relative to its longitudinal axis and to move the treatment tool shaft axially relative to its longitudinal axis.

2. The medical robotic system of claim 1, further comprising an endoscope motor drive configured to rotate the elongated endoscope shaft relative to its longitudinal axis.

3. The medical robotic system of claim 1, further comprising an endoscope motor drive configured to move the elongated endoscope shaft axially relative to a longitudinal axis thereof.

4. The medical robot system according to claim 1, wherein: The endoscopic viewing assembly carries a working channel extending therethrough.

5. The medical robot system according to claim 1, wherein: The treatment tool includes at least one of a resection device, an ablation device, a coagulation device, a biopsy device, and a dissection device.

6. The medical robot system according to claim 1, wherein: The treatment tool comprises a cutting device having a movable cutting member, and the treatment tool further comprises a cutting motor drive for at least rotationally or axially moving the movable cutting member.

7. The medical robotic system of claim 1, further comprising an endocervical sealing assembly coupled to at least one of the robotic arm and the endoscopic viewing assembly.

8. The medical robotic system of claim 7, further comprising a contact sensor carried by the cervical canal sealing assembly, the contact sensor adapted to sense contact with the patient's cervix and send a contact signal or a no-contact signal to a controller.

9. The medical robot system according to claim 8, wherein: The controller is configured to actuate the motor driver to move the cervical canal sealing assembly in response to the contact signal from the contact sensor.

10. The medical robot system according to claim 8, wherein: The contact sensor is at least one of a pressure sensor, a capacitive sensor, an impedance sensor, and an optical sensor.

11. The medical robotic system of claim 1 , further comprising an endocervical sealing assembly coupled to at least one of the robotic arm and the endoscopic viewing assembly.

12. A medical robot system for intrauterine surgery, comprising: a robotic arm having a plurality of movable arm sections; an endoscopic viewing assembly removably coupled to the distal section of the robotic arm, the endoscopic viewing assembly having an elongated endoscopic shaft extending about a longitudinal axis to a distal end carrying an image sensor; and a stabilization device removably coupled to the distal section of the robotic arm, the stabilization device having an elongated tool shaft extending about a longitudinal axis, the elongated tool shaft adapted to engage tissue to stabilize a cervix of a patient; a cervical canal sealing assembly coupled to at least one of the robotic arm and the endoscopic viewing assembly, wherein a distal end of the cervical canal sealing assembly includes a cervical seal configured for coaxial movement with a mid-portion of the elongated endoscopic shaft; and A motor drive is provided, the motor drive being adapted to move the cervical seal.

13. The medical robotic system of claim 12, further comprising a contact sensor carried by the cervical seal, the contact sensor adapted to sense contact with the patient's cervix and send a contact signal or a signal of no contact of the contact sensor to a controller.

14. The medical robot system according to claim 13, wherein: The controller is configured to actuate the motor driver to move the cervical seal in response to the contact signal from the contact sensor.

15. The medical robot system according to claim 13, wherein: The contact sensor is at least one of a pressure sensor, a capacitive sensor, an impedance sensor, and an optical sensor.

16. A medical robotic system for intrauterine surgery, comprising: a robotic arm having a plurality of movable arm sections; an endoscopic viewing assembly removably coupled to the distal section of the robotic arm, the endoscopic viewing assembly having an elongated endoscopic shaft extending about a longitudinal axis to a distal end carrying an image sensor and a working channel extending through the endoscopic viewing assembly; and A stabilization device is removably coupled to the distal section of the robotic arm, the stabilization device having an elongated tool shaft extending about a longitudinal axis, the elongated tool shaft adapted to engage tissue to stabilize a patient's cervix.

17. The medical robotic system of claim 16, further comprising a motor drive configured to rotate the elongated endoscopic shaft relative to its longitudinal axis.

18. The medical robotic system of claim 16, further comprising a motor drive configured to move the elongated endoscopic shaft axially relative to a longitudinal axis thereof.

19. The medical robotic system of claim 16, further comprising a motor drive configured to rotate the elongated tool shaft relative to its longitudinal axis.

20. The medical robotic system of claim 16, further comprising a motor drive configured to move the elongated tool shaft axially relative to a longitudinal axis thereof.

21. The medical robotic system of claim 20, further comprising a treatment tool detachably coupled to the distal section of the robotic arm, the treatment tool having a treatment tool shaft extending about a longitudinal axis to a working end, wherein The treatment tool shaft is configured for introduction through the working channel of the endoscopic viewing assembly.

22. The medical robotic system according to claim 21, wherein: The motor drive is configured to rotate the treatment tool shaft relative to its longitudinal axis.

23. The medical robotic system according to claim 21, wherein: The motor drive is configured to move the treatment tool shaft axially relative to its longitudinal axis.

24. The medical robotic system according to claim 21, wherein: The treatment tool includes at least one of a resection device, an ablation device, a coagulation device, a biopsy device, and a dissection device.

25. The medical robotic system according to claim 24, wherein: The treatment tool comprises a cutting device having a mobile cutting member, and wherein the medical robotic system comprises a cutting motor drive for moving the mobile cutting member at least rotationally or axially.

26. The medical robotic system of claim 16, further comprising an endocervical sealing assembly coupled to at least one of the robotic arm and the endoscopic viewing assembly.

27. The medical robotic system according to claim 26, wherein: The distal end of the cervical canal sealing assembly includes a cervical seal configured to move coaxially with the intermediate portion of the elongated endoscopic shaft.

28. The medical robotic system of claim 27, further comprising a motor drive adapted to move the cervical seal.

29. The medical robotic system of claim 28, further comprising a contact sensor carried by the cervical seal, the contact sensor adapted to sense contact with the patient's cervix and send a contact signal or a lack of contact signal to a controller.

30. The medical robotic system according to claim 29, wherein: The controller is configured to actuate the motor driver to move the cervical seal in response to the contact signal from the contact sensor.

31. The medical robotic system according to claim 29, wherein: The contact sensor is at least one of a pressure sensor, a capacitive sensor, an impedance sensor, and an optical sensor.

32. A method of treating tissue in a uterine cavity of a patient, comprising: Providing a medical robotic system having a robotic arm with a plurality of movable arm segments having a distal arm segment, the plurality of movable arm segments carrying a plurality of motor drives for moving at least one device coupled to the distal arm segment; removably coupling a cutting device to the distal arm section, the cutting device having an elongated shaft extending about a longitudinal axis to a working end carrying a cutter configured for rotation and / or axial reciprocation; introducing the working end of the resection device into the uterine cavity of the patient through the cervix; actuating the cutting device to rotate and / or reciprocate the cutter; and At least one of the plurality of motor drivers is operated by a controller to move the working end of the cutting device in a predetermined pattern to cut tissue.

33. The method of claim 32, wherein: The controller operates the motor drive to move the working end in an axial mode while actuating the cutter to resect tissue.

34. The method of claim 32, wherein: The controller operates the motor drive to move the working end in a rotational mode while actuating the cutter to resect tissue.

35. The method of claim 32, wherein: The controller operates at least one motor drive to move the working end in a rotational and axial mode while actuating the cutter to resect tissue.

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