Mechanical gain device for a medical device

Abstract

The invention relates to a mechanical gain device for a medical device. A medical device includes a force transmitting member, an elongate member housing a first tension element, a mechanical gain device, and a second tension element. The first tension element is configured to receive and transmit tension. The mechanical gain device is configured to receive and multiply the tension. The second tension element is configured to deliver the multiplied tension to the distal end of the medical device. The first tension element may include a different material than the second tension element. The mechanical gain device may be a pulley or a lever. The tension element may have first and second ends distal to the mechanical gain device, and a proximal portion coupled to the mechanical gain device.

Description

Technical Field

[0001] The present disclosure relates to mechanical advantage devices for medical devices. Background Art

[0002] Minimally invasive medical techniques are designed to reduce the amount of tissue damaged during medical procedures, thereby reducing patient recovery time, discomfort, and harmful side effects. Such minimally invasive techniques can be performed through natural orifices in the patient's anatomy or through one or more surgical incisions. Through these natural orifices or incisions, an operator can insert a minimally invasive medical device to reach the target tissue location. Minimally invasive medical devices include instruments such as therapeutic, diagnostic, biopsy, and surgical instruments. Medical instruments can be inserted into anatomical pathways and navigated toward an area of ​​interest within the patient's anatomy.

[0003] For flexible articulating devices (such as instruments and / or endoscopes) driven by robot-assisted manipulators, the articulation of the instruments and / or endoscopes can be performed via a tensioning element (such as a drive cable) wound around a rotating capstan. The capstan can be operably connected to an external device (such as a robotic manipulator) and receives force / torque from the manipulator to drive the instrument and / or endoscope. However, for applications with long path lengths in the body with tortuous anatomical structures (such as intracavitary applications exceeding 1 meter or longer, where the length of the instrument / endoscope and associated drive cables is long), the capstan friction of moving the tensioning cable through the tortuous path may hinder the actuation of the surgical instrument because the capstan friction increases exponentially according to the bending angle. Even a slight increase in the bending angle may multiply the force loss to the extent that the surgical instrument functions poorly or stops working completely, for example, the cumulative bending angle to reach the cecum may exceed 360 degrees. In short, the design of surgical instruments is hindered by the actuation challenges caused by capstan friction.

[0004] There is a need for an instrument that can operate despite high capstan friction to enable medical procedures to be performed. Summary of the invention

[0005] Consistent with some examples, a medical device may include a force transfer member, an elongated member accommodating a plurality of first tension elements, a plurality of mechanical advantage devices, and a plurality of second tension elements. The force transfer member may include one or more input ends. The force transfer member may be configured to receive a force or torque from an external device. The elongated member may be coupled to the force transfer member and may extend distally from the force transfer member. A plurality of first tension elements may be respectively coupled to one or more input ends of the force transfer member and configured to receive and transfer tension. A plurality of first tension elements may include a first material. A plurality of mechanical advantage devices may be configured to receive and multiply tension. Each mechanical advantage device may be coupled to one of the plurality of first tension elements and may be capable of rotating about a corresponding rotation axis. A plurality of second tension elements may be configured to transfer tension to a distal end of the medical device after multiplication of the tension. Each second tension element may be coupled to one of the plurality of mechanical advantage devices and may be operably coupled to the distal end of the medical device. A plurality of second tension elements may include a second material different from the first material.

[0006] In some examples, the elongated member can be flexible.

[0007] In some examples, the elongated member can be rigid.

[0008] In some examples, the first material may include one of a polymer and a metal, and the second material may include the other of a polymer and a metal.

[0009] In some examples, the metal may be at least one of tungsten and stainless steel.

[0010] In some examples, each first tension element can be coupled to one of the plurality of mechanical advantage devices a distance from the corresponding axis of rotation.

[0011] In some examples, the mechanical gain device may provide a mechanical transmission ratio of 2:1 for the output tension.

[0012] In some examples, at least one of the plurality of mechanical advantage devices may be arranged in a series with a secondary mechanical advantage device and may be coupled to the secondary mechanical advantage device via an intermediate drive element to transfer and iteratively multiply tension.

[0013] In some examples, the mechanical transmission ratio of the series connection may be at least 4:1.

[0014] In some examples, the distal end may be manually actuated when the medical device is disconnected from the external device.

[0015] In some examples, a guide housing may be provided around a plurality of mechanical advantage devices and coupled to the elongated member and the distal end of the medical device.

[0016] In some examples, the guide housing may include guide channels to guide movement of the plurality of mechanical advantage devices.

[0017] In some examples, a plurality of mechanical advantage devices may be configured to move axially within the guide channel.

[0018] In some examples, the plurality of mechanical advantage devices can translate within the guide channel parallel to the longitudinal axis of the medical device.

[0019] In some examples, each mechanical advantage device may include a pivot at each respective axis of rotation and rotate about the pivot.

[0020] In some examples, the guide housing may include a central open passage.

[0021] In some examples, the medical device may be a surgical instrument.

[0022] In some examples, the distal end can be an end effector actuated by the plurality of second tension elements.

[0023] In some examples, the medical device may be an endoscope.

[0024] In some examples, the distal end can be an articulated, curved section of the endoscope.

[0025] In some examples, the length of the elongated member may exceed one meter.

[0026] In some examples, multiple mechanical advantage devices may be arranged in antagonistic pairs.

[0027] In some examples, the medical device may include four antagonistic pairs to provide bidirectional motion along four axes.

[0028] Consistent with some examples, a medical device may include a force transfer member, an elongated member that accommodates a plurality of first tension members, a plurality of pulleys, and a plurality of second tension elements. The force transfer member may include one or more input ends, and the force transfer member may be configured to receive a force or torque from an external device. The elongated member may be coupled to the force transfer member and may extend distally from the force transfer member. A plurality of first tension elements may be respectively coupled to one or more input ends of the force transfer member and may be configured to receive and transfer tension. A plurality of pulleys may be configured to receive and multiply tension. Each pulley is capable of rotating about a corresponding axis of rotation and is coupled to one of the plurality of first tension elements. A plurality of second linear tension elements may be configured to transfer tension to a distal end of the medical device after multiplication of the tension. Each tension element may be coupled to one of the plurality of pulleys.

[0029] In some examples, one of the first plurality of tension elements can have a first end operably coupled to one or more input ends of the force transfer member, a length wrapped around a pulley, and a second end that is stationary.

[0030] In some examples, each second tensioning element can be coupled to one of the plurality of pulleys at a respective axis of rotation via a tube having a clevis interface, the tube being operably coupled to a distal end of the medical device.

[0031] In some examples, the plurality of pulleys may be configured to move axially.

[0032] In some examples, the plurality of pulleys can be configured to translate parallel to a longitudinal axis of the medical device.

[0033] Consistent with some examples, a medical device may include a force transfer member, an elongated member accommodating a plurality of first tension elements, a plurality of levers, and a plurality of second tension elements. The force transfer member may include one or more input ends, and the force transfer member may be configured to receive a force or torque from an external device. The elongated member may be coupled to the force transfer member and may extend distally from the force transfer member. A plurality of first tension elements may be respectively coupled to one or more input ends of the force transfer member and may be configured to receive and transfer tension. A plurality of levers may be configured to receive and multiply tension. Each lever is capable of rotating about a corresponding rotation axis and may be coupled to one of the plurality of first tension elements at a first distance from the corresponding rotation axis. A plurality of second tension elements may be configured to transfer tension to a distal end of the medical device after multiplication of the tension. Each second tension element may be coupled to one of the plurality of levers at a second distance from the corresponding rotation axis that is less than the first distance, and the second end may be operably coupled to the distal end of the medical device.

[0034] Consistent with some examples, a medical device may include a force transfer member, an elongated member, an end effector, a mechanical advantage device, and a tension element. The force transfer member may include one or more input ends, and the force transfer member may be configured to receive a force or torque from an external device. The elongated member may be coupled to the force transfer member and may extend distally from the force transfer member. The end effector may be operably coupled to the force transfer member. The mechanical advantage device may be positioned between the end effector and the force transfer member. The tension element may be coupled to the end effector to drive articulation of the end effector. The tension element may have a first end distal to the mechanical advantage device, a second end distal to the mechanical advantage device, and a proximal portion coupled to the mechanical advantage device.

[0035] It should be understood that the above general description and the following detailed description are exemplary and explanatory in nature, and are intended to provide an understanding of the present disclosure without limiting the scope of the present disclosure. In this regard, through the following detailed description, additional aspects, features and advantages of the present disclosure will be apparent to those skilled in the art. BRIEF DESCRIPTION OF THE DRAWINGS

[0036] Various aspects of the present disclosure may be best understood from the following detailed description when read in conjunction with the accompanying drawings. It should be emphasized that, in accordance with industry standard practice, various features are not drawn to scale. In fact, for clarity of discussion, the sizes of various features may be increased or decreased arbitrarily. In addition, the present disclosure may repeat reference numerals and / or letters in various examples. Such repetition is for the purpose of simplicity and clarity and does not in itself determine the relationship between the various embodiments and / or configurations discussed.

[0037] Figure 1 is a schematic diagram of a first robotic-assisted manipulator system according to the present disclosure.

[0038] Figure 2A An instrument system utilizing aspects of the present disclosure is shown.

[0039] Figure 2B Shows Figure 2A A distal portion of an instrument system having an expanded example of an instrument according to the present disclosure.

[0040] Figure 3 is a perspective view of a manipulator system according to the present disclosure.

[0041] Figure 4 is a schematic diagram of a manipulator system according to the present disclosure.

[0042] Figure 5 is a perspective view of a medical device according to an embodiment.

[0043] Figure 6 yes Figure 5 A perspective view of a distal portion of a medical device.

[0044] Figure 7 is a perspective view of a medical device including a mechanical advantage device according to the present disclosure, wherein the mechanical advantage device is a pulley.

[0045] Figure 8 yes Figure 7 A partial cross-sectional view of a medical device.

[0046] Fig. 9 yes Figure 7 and Figure 8 A perspective view of a proximal bulkhead of a medical device.

[0047] Fig.10 yes Figure 7 and Figure 8 A perspective view of the housing of a mechanical advantage device.

[0048] Fig.11 yes Figure 7 and Figure 8 A perspective view of a distal partition of a medical device.

[0049] Fig.12 yes Figure 7 and Figure 8 A perspective view of a tube of a medical device having a U-clip interface.

[0050] Fig.13 is a cross-sectional view of a medical device including a plurality of mechanical advantage devices in a compound series arrangement according to the present disclosure.

[0051] Fig.14 is a perspective view of a medical device including a plurality of mechanical advantage devices arranged in a linear series according to the present disclosure.

[0052] Fig.15 is a cross-sectional view of a medical device including a mechanical advantage device according to the present disclosure, wherein the mechanical advantage device is a lever.

[0053] Fig.16 is a schematic diagram of a method of assembling a medical device including a plurality of mechanical advantage devices according to the present disclosure.

[0054] Fig.17 is a schematic diagram of a method of actuating a medical device including a plurality of mechanical advantage devices according to the present disclosure.

[0055] Examples of the present disclosure and their advantages can be best understood by referring to the detailed description below. It should be understood that the same reference numerals are used to identify the same elements shown in one or more figures, wherein the illustrations therein are for illustrating examples of the present disclosure, rather than for limiting examples of the present disclosure. DETAILED DESCRIPTION

[0056] In the following detailed description of various aspects of the present invention, many specific details are set forth in order to provide a thorough understanding of the disclosed embodiments. However, it will be apparent to those skilled in the art that embodiments of the present disclosure may be practiced without these specific details. In other cases, well-known methods, procedures, components, and circuits are not described in detail to avoid unnecessarily obscuring aspects of embodiments of the present invention. Also, in order to avoid unnecessary descriptive repetitions, one or more components or actions described according to an illustrative embodiment may be used or omitted, as applicable to other illustrative embodiments. For the sake of brevity, multiple iterations of these combinations will not be described separately. For simplicity, in some cases, the same reference numerals are used throughout the accompanying drawings to refer to the same or similar parts.

[0057] A mechanical advantage device is provided that allows mechanical force to be multiplied before it is delivered to the distal end of a surgical instrument (where, for example, an end effector and / or an optional wrist mechanism may be attached). The multiplied mechanical force is sufficient to allow effective actuation of the surgical instrument despite, for example, capstan friction. Exemplary mechanical advantage devices (such as pulleys and levers) do not merely incidentally provide mechanical advantage, for example, when redirecting force to a different direction. Rather, the sole purpose of a mechanical advantage device is to multiply the mechanical force before it is used, for example, in an end effector or wrist mechanism. The mechanical advantage may have a 2:1 ratio. In some arrangements, multiple mechanical advantage devices may be arranged in series to further increase the mechanical advantage.

[0058] Turning to the accompanying drawings, Figure 1-Figure 6 Systems and medical devices that may be adapted for use with a mechanical advantage device are shown, and Figure 7-Figure 14 Embodiments and features of mechanical advantage devices are shown.

[0059] Figure 1 An embodiment of a robot-assisted manipulator system for use with the rotation-to-linear force articulated member described herein is shown. The manipulator system may be used, for example, for surgical, diagnostic, therapeutic, biopsy, or non-medical procedures and is generally indicated by the reference numeral 100. Figure 1As shown, the robot-assisted manipulator system 100 may include one or more manipulator assemblies 102 for operating one or more medical device systems 104 when performing various procedures on a patient P positioned on a table T in a medical environment 101. For example, the manipulator assembly 102 can drive the movement of a catheter or end effector, can apply treatment to a target tissue, and / or can manipulate a control member. The manipulator assembly 102 can be a teleoperated, non-teleoperated, or hybrid teleoperated and non-teleoperated assembly, with selected degrees of freedom of motion that can be motorized and / or teleoperated and selected degrees of freedom of motion that can be non-motorized and / or non-teleoperated. An operator input system 106, which can be inside or outside the medical environment 101, generally includes one or more control devices for controlling the manipulator assembly 102. The manipulator assembly 102 supports the medical device system 104 and can optionally include a plurality of actuators or motors that drive inputs on the medical device system 104 in response to commands from a control system 112. The actuator may optionally include a drive system that, when coupled to the medical device system 104, can advance the medical device system 104 into a natural or surgically created anatomical orifice. Other drive systems can move the distal end of the medical device in multiple degrees of freedom, which can include three linear motions (e.g., linear motion along the X, Y, Z Cartesian axes) and three rotational motions (e.g., rotation around the X, Y, Z Cartesian axes). The manipulator assembly 102 can support various other systems for flushing, treatment, or other purposes. Such systems can include fluid systems (e.g., including reservoirs, heating / cooling elements, pumps, and valves), generators, lasers, interrogators, and ablation components.

[0060] The robot-assisted manipulator system 100 also includes a display system 110 for displaying images or representations of the surgical site and the medical instrument system 104 generated by the imaging system 109, which may include an endoscopic imaging system. The display system 110 and the operator input system 106 may be oriented so that the operator O can control the medical instrument system 104 and the operator input system 106 with a telepresence perception. A graphical user interface can be displayed on the display system 110 and / or a display system of a separate planning workstation.

[0061] In some examples, the endoscopic imaging system components of imaging system 109 can be integrally or removably coupled to medical instrument system 104. However, in some examples, a separate endoscope attached to a separate manipulator assembly can be used with medical instrument system 104 to image a surgical site. Endoscopic imaging system 109 can be implemented as hardware, firmware, software, or a combination thereof that interacts with or is otherwise executed by one or more computer processors, which can include a processor of control system 112.

[0062] The robot-assisted manipulator system 100 may also include a sensor system 108. The sensor system 108 may include a position / location sensor system (e.g., an actuator encoder or an electromagnetic (EM) sensor system) and / or a shape sensor system (e.g., a fiber optic shape sensor) for determining the position, orientation, speed, velocity, posture, and / or shape of the medical device system 104. The sensor system 108 may also include temperature, pressure, force, or contact sensors, etc.

[0063] The robot-assisted manipulator system 100 may also include a control system 112. The control system 112 includes at least one memory 116 and at least one computer processor 114 for implementing control between the medical device system 104, the operator input system 106, the sensor system 108, and the display system 110. The control system 112 also includes programming instructions (e.g., a non-transitory machine-readable medium storing instructions) to implement procedures using the robot-assisted manipulator system, including navigation, steering, imaging, deployment or retraction of engagement features, application of treatment to target tissue (e.g., via application of energy), etc.

[0064] The control system 112 may also optionally include a virtual visualization system to provide navigation assistance to the operator O when controlling the medical device system 104 during an image-guided surgical procedure. Virtual navigation using the virtual visualization system can be based on reference to a preoperative or intraoperative data set of an acquired anatomical pathway. The virtual visualization system processes images of the surgical site imaged using imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermal imaging, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, nanotube X-ray imaging, etc. The control system 112 can use the preoperative images to locate the target tissue (using visual imaging techniques and / or by receiving user input) and create a preoperative plan, including an optimal first position for performing treatment. The preoperative plan can include, for example, a planned size of an expanded expandable device, a duration of treatment, a treatment temperature, and / or multiple deployment positions.

[0065] Figure 2A2 is a simplified diagram of a medical device system 200 according to some embodiments. In some embodiments, the medical device system 200 can be used for image-guided medical procedures. In some examples, the medical device system 200 can be used for non-teleoperated exploratory procedures, or for procedures involving traditional manually operated medical devices (such as endoscopes).

[0066] The medical device system 200 includes an elongated flexible device 202, such as a flexible catheter or endoscope, coupled to a drive unit 204. The elongated device 202 includes a flexible body 216 having a proximal end 217 and a distal end or tip portion 218. In some embodiments, the flexible body 216 has an outer diameter of approximately 14-20 mm. Other flexible body outer diameters may be larger or smaller.

[0067] The medical device system 200 optionally includes a tracking system 230 for determining the position, orientation, speed, velocity, posture, and / or shape of the distal end 218 and / or one or more segments 224 along the flexible body 216 using one or more sensors and / or imaging devices. The entire length of the flexible body 216 between the distal end 218 and the proximal end 217 can be effectively divided into the segments 224. The tracking system 230 can optionally be implemented as hardware, firmware, software, or a combination thereof that interacts with or is otherwise executed by one or more computer processors, which can include Figure 1 A processor of the control system 112 in the system.

[0068] Tracking system 230 may optionally track distal end 218 and / or one or more segments 224 using shape sensor 222. In some embodiments, tracking system 230 may optionally and / or additionally track distal end 218 using orientation sensor system 220 (e.g., an electromagnetic (EM) sensor system). In some examples, orientation sensor system 220 may be configured and positioned to measure six degrees of freedom (e.g., three orientation coordinates X, Y, Z and three orientation angles of pitch, yaw, and roll indicating a base point) or five degrees of freedom (e.g., three orientation coordinates X, Y, Z and two orientation angles of pitch and yaw indicating a base point).

[0069] The flexible body 216 includes one or more channels 221 sized and shaped to receive one or more medical devices 226. In some embodiments, the flexible body 216 includes two channels 221 for separate devices 226, however, a different number of channels 221 may be provided. Figure 2B2 is a simplified diagram of a flexible body 216 with an extended medical device 226 according to some embodiments. In some embodiments, the medical device 226 can be used for procedures such as surgery, biopsy, ablation, illumination, irrigation, or suction. The medical device 226 can be deployed through the channel 221 of the flexible body 216 and used at a target location within the anatomical structure. The medical device 226 can include, for example, an image capture device, a biopsy instrument, an ablation instrument, a catheter, a laser ablation fiber, and / or other surgical, diagnostic, or therapeutic tools. The medical tool can include an end effector with a single working member, such as a surgical scalpel, a blunt blade, an optical fiber, an electrode, etc. Other end effectors can include, for example, forceps, graspers, scissors, clip applicators, etc. Other end effectors can also include electrically activated end effectors, such as electrosurgical electrodes, transducers, sensors, etc. The medical device 226 can be advanced from the opening of the channel 221 to perform a procedure and then retracted into the channel when the procedure is completed. The medical device 226 can be removed from the proximal end 217 of the flexible body 216 or from another optional instrument port (not shown) along the flexible body 216. The medical device 226 can also be used with an image capture device (e.g., an endoscopic camera) within the flexible body 216. Alternatively, the medical device 226 itself can be an image capture device.

[0070] The medical device 226 may additionally house cables, linkages, or other actuation controls (not shown) extending between its proximal and distal ends to controllably bend the distal end of the medical device 226. The flexible body 216 may also house cables, linkages, or other steering controls (not shown) extending between the drive unit 204 and the distal end 218 to controllably bend the distal end 218, as shown, for example, by a dashed line depiction 219 of the distal end 218. In some examples, at least four cables are used to provide independent "up and down" steering to control the pitch motion of the distal end 218, and independent "left and right" steering to control the yaw motion of the distal end 218. In embodiments where the medical device system 200 is actuated by a robotic-assisted assembly, the drive unit 204 may include a drive input that is removably coupled to a drive element (e.g., an actuator) of a remotely operated assembly and receives power therefrom. In some embodiments, the medical device system 200 may include a gripping feature, a manual actuator, or other component for manually controlling the motion of the medical device system 200. Information from the tracking system 230 may be sent to the navigation system 232 where it is combined with information from the visualization system 231 and / or preoperatively acquired models to provide real-time position information to the physician or other operator.

[0071] Other configurations of teleoperated manipulator systems are also contemplated, such as systems configured for multi-port or single-port procedures. Surgical systems (such as da Vinci or Surgical systems, all of which are commercialized by Intuitive Surgical, Inc. of Sunnyvale, California).

[0072] Figure 3 An example embodiment of a manipulator system 300 that may be used as part of the manipulator system 100 is shown. The manipulator system 300 includes a base 320, a main column 340, and a main boom 360 connected to the main column 340. The manipulator system 300 also includes a plurality of manipulator arms 310, 311, 312, 313, each manipulator arm connected to the main boom 360. The manipulator arms 310, 311, 312, and 313 may be used as the manipulator assembly 102. The manipulator arms 310, 311, 312, 313 each include an instrument mounting portion 322 to which an instrument 330 may be mounted, the instrument 330 being shown attached to the manipulator arm 310. Although the manipulator system 300 depicts four manipulator arms, various embodiments may include more or fewer manipulator arms.

[0073] According to one embodiment, the instrument mounting portion 322 may include a drive assembly 323 and a cannula mount 324, wherein a transfer mechanism 334 of the instrument 330 is connected to the drive assembly 323. The cannula mount 324 is configured to hold a cannula 336 through which the shaft 332 of the instrument 330 can extend to the surgical site during a surgical procedure. The drive assembly 323 contains various drive and other mechanisms that are controlled to respond to input commands at the operator input system 106 and transfer force to the transfer mechanism 334 to actuate the instrument 330. Although Figure 3 The embodiment of shows the instrument 330 attached only to the manipulator arm 310 for ease of viewing, but the instrument may be attached to any and each manipulator arm 310 , 311 , 312 , 313 .

[0074] Figure 4 An example embodiment of a manipulator system 400 that may be used as part of the manipulator system 100 is shown. Figure 4 , a portion of a manipulator arm 440 of a manipulator system 400 is shown with two instruments 408, 410 in an installed position. Figure 4 The schematic diagram of only two instruments is depicted, but as is familiar to those skilled in the art, more than two instruments may be mounted in the mounting position of the manipulator system 400. Each instrument 408, 410 includes a shaft 420, 430 having a movable end effector or endoscope, camera or other sensing device at the distal end, and may or may not include a wrist mechanism (not shown) to control the movement of the distal end.

[0075] exist Figure 4 In the embodiment of the present invention, the distal end portions of instruments 408, 410 are received by a single port structure 480 to be introduced into the patient. As shown, the port structure includes a cannula and an instrument entry guide inserted into the cannula. A single instrument is inserted into the entry guide to reach the surgical site.

[0076] The transfer mechanisms 485, 490 are disposed at the proximal portion of each shaft 420, 430 and are connected to the drive assembly 470, 475 via the sterile adapters 450, 460, which includes various internal mechanisms (not shown) that are controlled by a controller (e.g., at a control cart of the surgical system) to respond to input commands at the surgeon-side console of the surgical system, thereby transferring force to the force transfer mechanisms 485, 480 to actuate the instruments 408, 410.

[0077] The manipulator system described herein is not limited to Figure 1 Figure 2 Figure 3 and Figure 4 Embodiments of the present invention and various other teleoperated, computer-assisted manipulator configurations may be used with the embodiments described herein. The diameter of the instrument shaft and end effector is typically selected based on the size of the cannula with which the instrument will be used and depending on the surgical procedure being performed.

[0078] Figure 5 and Figure 6 5 are various views of a medical device 500 according to one embodiment. In some embodiments, the medical device 500 or any component thereof is optionally part of an instrument of a surgical system for performing a surgical procedure, and the surgical system may include a manipulator unit, a series of kinematic linkages, a series of cannulas, etc. The medical device 500 (and any instrument described herein) may be used in any suitable surgical system, such as the manipulator system 100 or the manipulator system 200 shown and described above. The medical device 500 may be used as the medical devices 226, 330, 408, and 410 described above. Figure 5As shown, medical device 500 defines (or is included in) a distal boundary (or footprint) 502, which corresponds to the size of the cannula, or the size of the working channel of an elongated flexible device (such as a flexible catheter or endoscope), or other sizes determined by the surgical environment. The elongated flexible device can be used for long and circuitous anatomical pathways, such as the gastrointestinal tract. Surgical instruments for gastrointestinal procedures (such as endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR)) can be run through the long and flexible working channel of a standard or custom endoscope or otherwise along such an endoscope, which can reach a length of more than 1.6 meters. The distal boundary 502 can be a cylindrical shape with any suitable nominal diameter (e.g., 8mm, 5mm, or any size therebetween). Medical device 500 includes a force transfer mechanism 504, a shaft 506, an optional distal wrist assembly 508, a distal end effector 510, and a set of tension elements 512 (which may be, for example, cables, straps, etc.).

[0079] The medical device 500 may include a plurality of tension elements 512. For example, in some embodiments, the medical device 500 may include two tension elements 512, wherein each tension element 512 has two segments extending along the axis 506 of the instrument, thereby forming four proximal portions. Figure 6 , a corresponding tension element 512 can be routed through the wrist assembly 514 and wrapped around a corresponding pulley 516 or 517 of the tool member 518, 519. Each tension element 512 has two tension element segments along the axis 506, wherein the two proximal portions can (among other things) cause the corresponding tool member 518 or 519 to rotate about the axis A1 when moved in opposite directions. This arrangement can be referred to as a "four-cable" wrist, and changes in the pitch, yaw, or grip of the medical device 500 can be performed by manipulating the four proximal portions of the tension element 512 in a manner similar to that shown and described in U.S. Patent Publication No. 2020 / 0390430, which is incorporated herein by reference above. In other embodiments, the medical device 500 may include four separate tension elements 512, wherein two separate tension elements are connected to the pulley 516 of the tool member 518, and two separate tension elements are connected to the pulley 517 of the tool member 518, thereby creating four proximal tension element end portions. In some embodiments, the medical device 500 may include more than two or four tension elements 512 and more than four proximal tension element end portions. The tension elements 512 may be, for example, cables, straps, etc. that couple the force transfer mechanism 504 to the distal wrist assembly 508 and the end effector 510. In some embodiments, the tension elements 512 may be composed of a polymer.

[0080] The medical device 500 is configured such that movement of the one or more tension elements 512 produces rotation of the end effector 510 about the first rotation axis A1 (see Figure 6 , which serves as a yaw axis, the term yaw being arbitrary), rotation of the wrist assembly 508 about the second rotation axis A2 and / or optionally about the third rotation axis A3 (which serves as a pitch axis, the term pitch being arbitrary), a cutting rotation of the tool member of the end effector 510 about the first rotation axis A1, or any combination of these movements. Changing the pitch or yaw of the medical device 500 can be performed by manipulating the tension element 512 in a manner similar to that described with reference to the device 2400 described in co-pending International Patent Application Serial No. PCT / US2002 / 039942, entitled "Surgical Instrument Cable Control and Routing Structures," the disclosure of which is incorporated herein by reference in its entirety.

[0081] like Figure 5 As shown, the proximal force transfer mechanism 504 includes a set of drive components (e.g., capstans 522 and 524) that rotate or "wind" the proximal portion of any one of the tension elements 512 to produce the desired movement of the tension element. In some embodiments, the two proximal ends of the tension element 512 associated with opposite directions of a single degree of freedom are connected to two independent drive capstans 522 and 524. This arrangement is generally referred to as an antagonistic drive system, which allows independent control of the movement (e.g., pulling in or releasing) of each end of the tension element 512. The force transfer mechanism 504 produces movement of the tension element 512, which operates to produce the desired articulated movement (pitch, yaw, or grip) at the wrist assembly 508 and the end effector 510. Therefore, the force transfer mechanism 504 includes components for moving a first proximal portion of the tension element 512 in a first direction (e.g., a proximal direction) via a first capstan 522, and moving a second proximal portion of the tension element 512 in an opposite second direction (e.g., a distal direction) via a second capstan 524. The force transmission mechanism 504 can also move the two proximal portions of the tension element 512 in the same direction. In this way, the force transmission mechanism 504 can maintain the desired tension in the tension element 512.

[0082] In some embodiments, the force transfer mechanism 504 may include any of the components or parts described in International Patent Application Serial No. PCT / US2002 / 039942, entitled "Surgical Instrument Cable Control and Routing Structures," the disclosure of which is incorporated herein by reference in its entirety. However, in other embodiments, any of the medical devices described herein may have both ends of the tension element wound around a single capstan. This alternative arrangement is generally referred to as a self-antagonizing drive system, which uses a single drive motor to operate both ends of the tension element.

[0083] In addition, although the force transfer mechanism 504 is shown as including a winch, in other embodiments, the force transfer mechanism may include one or more linear actuators that produce translation (linear motion) of a portion of the cable. Such a force transfer mechanism may include, for example, a universal joint, a lever, or any other suitable mechanism to directly pull (or release) the end portion of any cable. For example, in some embodiments, the proximal force transfer mechanism 504 may include any proximal force transfer mechanism or component described in U.S. Patent Application Publication No. US2015 / 0047454 A1 (filed on August 15, 2014) entitled "Lever Actuated Gimbal Plate" or U.S. Patent No. US 6817974 B2 (filed on June 28, 2001) entitled "Surgical Tool Having Positively Positionable Tendon-Actuated Multi-Disk Wrist Joint", each of which is incorporated herein by reference in its entirety.

[0084] The shaft 506 can be any suitable elongated shaft that is coupled to the force transfer mechanism 504 and the optional wrist assembly 508 (when present) or the end effector 510. Specifically, the shaft 506 includes a proximal portion 526 that is coupled to the force transfer mechanism 504 and a distal portion 528 that is coupled to the optional wrist assembly 508 or the end effector 510. The shaft 506 defines a passageway or series of passageways through which the tension element 512 and other components (e.g., electrical wires, ground wires, etc.) can be routed from the force transfer mechanism 504 to the wrist assembly 508. In some embodiments, the shaft 506 can be a substantially rigid member, while in other embodiments, the shaft 506 can be a flexible member.

[0085] Figure 7 and Figure 8A medical device 600 is shown that includes a plurality of mechanical advantage devices 630. The medical device 600 may be, for example, a surgical instrument or an endoscope. The plurality of mechanical advantage devices 630 may be configured to fit within, for example, an endoscope having an outer diameter between 16 mm and 20 mm or an instrument having an outer diameter between 4 mm and 6 mm. Figure 5 and Figure 6 Features common to the apparatus 500 are indicated by the same reference numerals increased by one hundred. After the initial introduction, common features are not described in detail for subsequent arrangements. Unique features are identified by unique reference numerals.

[0086] and Figure 5 and Figure 6 Like the medical device 500 shown, the medical device 600 includes a force transfer member 604 that includes one or more input ends. The force transfer member 604 is configured to receive a force or torque from an external device. A slender member 606 is coupled to the force transfer member 604 and extends distally from the force transfer member 602. The slender member 606 can be flexible or can be rigid. The length of the slender member 606 can exceed one meter, for example, if the medical device is intended for use in the gastrointestinal tract. The slender member 606 accommodates a plurality of first tension elements 632, which are respectively coupled to one or more input ends of the force transfer member 604 and are configured to receive and transfer tension. As shown in FIG. Figure 7 As shown, first tension element 632 is comparable to tension element 512, except that first tension element 632 terminates prior to reaching distal end 638 of medical device 600. For example, first tension element 632 may terminate at Figure 7 The end effector 610 and the proximal end of the wrist mechanism are depicted.

[0087] Go to Figure 7 and Figure 8 Each of the plurality of mechanical advantage devices 630 is configured to receive and multiply tension when a corresponding first tension element 632 is actuated. Each mechanical advantage device 630 is coupled to one of the plurality of first tension elements 632 and is capable of being actuated by, for example, a pivot pin 634 (e.g., Figure 8 ) rotates around the corresponding rotation axis A. Specifically, Figure 7 and Figure 8 In the illustrated arrangement, the plurality of mechanical advantage devices 630 are movable pulleys, and the rotation axis A is located at the center of the movable pulley, i.e., where the pivot 634 is disposed. The pulleys are rotatable about their respective rotation axes A, and the pulleys are also axially movable relative to the elongated member 606, as described below.

[0088] As shown below Fig.15 As mentioned above, in other arrangements, the plurality of mechanical advantage devices 630 may be levers. Figure 7 and Figure 8 As shown, the plurality of second tension elements 636 are configured to transmit tension to the distal end 638 of the medical device (eg, to the distal end effector 610) after the tension is multiplied by the mechanical advantage device 630. Figure 8 As shown, each first tension member 632 is coupled to one of the plurality of mechanical advantage devices 630 and is spaced a distance D from the corresponding rotation axis A. Figure 7 and Figure 8 In the arrangement shown, each first tension element 632 is wound around a mechanical advantage device 630 which is a pulley. Figure 8 As best shown in , each first tension element 632 has a first end 637 proximal to the mechanical advantage device 630 , a second end 639 proximal to the mechanical advantage device 630 , and a distal portion 641 coupled to the mechanical advantage device 630 .

[0089] Each second tension member 636 is operably coupled to a distal end 638 of the medical device 600. As an example, Figure 7 As shown, the distal end 638 can include an end effector 610 and / or a wrist mechanism actuated by a plurality of second tension elements 636. As another example, the distal end can be an articulated bending section of an endoscope. The distal end 638 can optionally be manually actuated when the medical device 600 is disconnected from the external device. This is useful, for example, in the event of a power failure to the external device.

[0090] The benefit of having both a plurality of first tension elements 632 and a plurality of second tension elements 636 as compared to a single set of tension elements 512 is that different materials can be used to optimize their performance relative to their positions within the medical device 600. The plurality of first tension elements 632 can include a first material, and the plurality of second tension elements 636 can include a second material different from the first material. For example, the first material can include one of a polymer and a metal, and the second material can include the other of a polymer and a metal. The polymer can be, for example, at least one of ultra-high molecular weight polyethylene or nylon. The metal can be, for example, at least one of tungsten and stainless steel. Metals are generally stiffer than polymers, but may have disadvantages of winding around small bends, while polymers can have a lower coefficient of friction and be able to be wound at a smaller bend radius, but provide less stiffness. The design of the medical device 600 affects which material properties are most important, and thus the design of the medical device 600 can drive the material selection of the plurality of first tension elements 632 and the plurality of second tension elements 636. In some arrangements, if similar material properties are optimal throughout the medical device 600, the plurality of first tension elements 632 and the plurality of second tension elements 636 can include the same material.

[0091] Multiple mechanical advantage devices 630 may be arranged in antagonistic pairs. Figure 7 In the arrangement shown, pulleys 640a and 640b arranged parallel to each other can be an antagonistic pair. For example, movement of one pulley in the antagonistic pair (e.g., pulley 640a) in a first direction causes equidistant movement of the other paired pulley (e.g., pulley 640b) in an opposite direction. To achieve this, a second tension element 636 coupled to the first pulley 640a can be connected to a second tension element 636 coupled to the second pulley 640b via a rope, cable, or connecting structure of, for example, the end effector 610. Thus, the antagonistic pair of pulleys 640a and 640b can provide bidirectional movement along, for example, an axis of the end effector 610. If bidirectional movement along more axes is required, additional antagonistic pairs can be added. For example, the medical device 600 can include four antagonistic pairs of the mechanical advantage device 630 to provide bidirectional movement along four axes.

[0092] In order to provide the above functions, the medical device 600 further includes a proximal diaphragm 642, a guide housing 644, a distal diaphragm 646 and a tube 648, a plurality of first tension elements 632 are connected to and extend through the proximal diaphragm 642, a mechanical advantage device 630 is positioned in the guide housing 644, a distal diaphragm 644 is adjacent to the guide housing 644, and a tube 648 extends through the distal diaphragm 645 and is connected to a plurality of second tension elements 636. The proximal diaphragm 642, the guide housing 644, the distal diaphragm 646 and the tube 648 are respectively Figure 9-12 and described in more detail below.

[0093] like Fig. 9 As shown, the proximal partition 642 includes a plurality of connecting holes 650 and a plurality of proximal passages 652. Figure 8 As shown, the first end 637 of the first tension member 632 is fixed in or to the connection hole 650 by, for example, adhesive, friction fit or other connection means. Figure 8 As shown, length 656 (e.g., the length of portion 641) is wrapped around a mechanical advantage device 630 (here, a pulley) and then extends through proximal passage 652 to be operably coupled to force transfer member 604. Return to Fig. 9 , the proximal septum 642 includes a proximal open center 658, through which, for example, drive cables, electrical cables, or fluid channels may pass if used in a medical device as an instrument. If used in a medical device as an endoscope, the proximal open center 658 allows passage of, for example, a working channel, vision system electronics, shaping fibers, and fluid channels.

[0094] like Figure 7As shown, a guide housing 644 is provided around the plurality of mechanical advantage devices 630 and is coupled to the elongated member 606 (similar to Figure 5 The shaft 506 in the figure) and the distal end 638 of the medical device 600 (such as Figure 7 ). Fig.10 As shown, the guide housing 644 includes a guide channel 660 to guide the movement of the plurality of mechanical advantage devices 630. Each of the plurality of mechanical advantage devices 630 is provided within the guide channel 660. The guide channel 660 aligns the orientation of the respective mechanical advantage devices 630 and prevents the mechanical advantage devices 630 from becoming tangled with each other. In the arrangement shown, the cross-section of the guide channel 660 is complementary to the cross-section of the pulley, wherein additional space (e.g., a notch or groove) is provided for the pivot pin 634 of each pulley. The guide housing 644 includes a central open passage 662, through which, for example, drive cables, cables, or fluid channels can pass if used in a medical device as an instrument. If used in a medical device as an endoscope, the central passage 662 allows, for example, a working channel, a vision system electronic device, a shaping fiber, and a fluid channel to pass.

[0095] like Fig.11 As shown, the distal diaphragm 646 includes a plurality of distal passages 664 through which the plurality of first tension members 632 operate. One of the plurality of second tension members 636 is operated through Fig.12 The tube 648 shown in is coupled to each mechanical advantage device 630. The tube 648 includes a U-clip interface 666 to connect to the pivot pin 634 at a corresponding rotation axis A. The U-clip interface 666 allows the mechanical advantage device 630 connected thereto to rotate about the pivot pin 634 without hindrance. Distal to the U-clip interface 666, the tube 648 includes a central path 668 into which a corresponding second tension element 636 can be inserted and secured to the tube 648. Each tube 648 is inserted into one of a plurality of distal passages 664 through the distal partition 646 to be operably coupled to the distal end 638 of the medical device 600 via a corresponding second tension element 636. For example, if the distal end 638 is the end effector 610, the second end 639 of the second tension element 636 can be secured to a structure within the end effector 610 to facilitate movement of the end effector 610. As shown in FIG. Fig.11 As shown, the distal septum 646 also includes a distal open center 670, through which, for example, if used in a medical device as an instrument, a drive cable, a cable, or a fluid channel can pass. If used in a medical device as an endoscope, the distal open center 670 allows, for example, a working channel, vision system electronics, shaping fibers, and fluid channels to pass.

[0096] Back to Figure 8, movement of the first tension element 632 in a first direction away from the distal end 638 (e.g., in response to the force transfer member 604) causes the mechanical advantage device 630 to be displaced axially in the first direction away from the distal end 638. When the mechanical advantage device 630 is a pulley, because the second end 639 of the first tension element 632 is stationary, movement of the first end 637 causes the pulley to rotate about the axis A and displace proximally. The guide channel 660 of the guide housing 644 prevents the mechanical advantage device 630 from moving in any non-axial direction. The guide channel 660 ensures that the mechanical advantage device 660 translates parallel to the longitudinal axis of the medical device 600. The mechanical advantage device 630 thereby applies a force on the second tension element 636 via the tube 648, and thus applies a force on, for example, the end effector 610 to actuate the medical device 600.

[0097] Go to Fig.13 and Fig.14 , the medical device 600 may optionally have at least one of a plurality of mechanical advantage devices 630 arranged in series 672 with a secondary mechanical advantage device 674 and may be coupled to the secondary mechanical advantage device 674 via an intermediate drive element 676 to transmit and iteratively multiply tension. Fig.13 and Fig.14 In the arrangement shown, the secondary mechanical advantage device 674 is a pulley. Fig.13 In FIG. 6 , one of the plurality of mechanical advantage devices 630 and the secondary mechanical advantage device 674 are shown in the same cross-section. Fig.14 In the embodiment of the present invention, secondary mechanical advantage device 674 can be positioned proximal to mechanical advantage device 630 to minimize the outer diameter of medical device 600. Tandem 672 can have a mechanical transmission ratio of at least 4: 1. In addition, in the case where both mechanical advantage device 630 and secondary mechanical advantage device 674 include pulleys, the pulleys can have the same size as each other or can have different sizes than each other.

[0098] Fig.15 A medical device 600 is shown using a lever 678 as a plurality of mechanical advantage devices 630. For clarity, Fig.15Only a single exemplary lever 678 is shown, although multiple levers may be used in the device 600. Each lever 678 is capable of rotating about a respective rotation axis A and is coupled to one of the plurality of first tension elements 632 at a first distance D1 from the respective rotation axis A. Each lever 678 is also coupled to one of the plurality of second tension elements 636 at a second distance D2 from the respective rotation axis A. The second distance D2 is less than the first distance D1 so that the lever 678 provides a mechanical advantage. With this arrangement, the proximal diaphragm 642 need not have a connection hole 650. Instead, the pivot pin 634 can be secured to the guide housing 644. Additionally, the guide housing 644 may include a recess 686 for each lever 684 to rotate therein, rather than including a guide channel 660.

[0099] Fig.16 A method 800 of assembling a medical device 600 is shown. At box 802, the method 800 includes configuring a force transfer member 604 to receive a force or torque from an external device. At box 804, the method 800 includes coupling a plurality of first tension elements 632 to one or more input ends of the force transfer member 604. At box 806, the method 800 includes coupling a plurality of mechanical advantage devices 630 to the plurality of first tension elements 632. At box 808, the method 800 includes coupling a plurality of second tension elements 636 to the plurality of mechanical advantage devices 630. At box 810, the method includes coupling a plurality of second tension elements 636 to a distal end 638 of the medical device 600. The method 800 may also include housing the plurality of first tension elements 632 within a flexible, elongated member 606. Alternatively, the method 800 may also include housing the plurality of first tension elements 632 within a rigid, elongated member 606. Method 800 can include selecting a plurality of first tensile elements 632 comprising a first material and selecting a plurality of second tensile elements 636 comprising a second material different from the first material. In addition, any of the various features and structures described above can be included in method 800.

[0100] Fig.17 A method 900 of articulating a medical device 600 is shown. At box 902, the method 900 includes transferring a force or torque from an external device to a force transfer member 604. At box 904, the method 900 includes receiving a force or torque at a plurality of first tension elements 632 via an input end of the force transfer member 604. At box 906, the method 900 includes transferring tension to a plurality of mechanical advantage devices 630 via the plurality of first tension elements 632. At box 908, the method 900 includes multiplying the tension via the plurality of mechanical advantage devices 630. At box 910, the method 900 includes transferring the multiplied tension to a distal end 638 of the medical device 600 via a plurality of second tension elements 636 to actuate the medical device 600. The method 900 may also include any of the functions and features described above.

[0101] In the description, the specific details describing some examples have been set forth. In order to provide a thorough understanding of the examples, many specific details have been set forth. However, it is apparent to those skilled in the art that some examples may be practiced without some or all of these specific details. The specific examples disclosed herein are intended to illustrate rather than to limit. Those skilled in the art may realize other elements within the scope and spirit of the present disclosure although not specifically described here.

[0102] As long as feasible, the element described in detail with reference to an example, example, implementation or application can be optionally included in other examples, implementations or applications that are not specifically shown or described. For example, if an element is described in detail with reference to an example, and is not described with reference to a second example, the element can still be required to be included in the second example. Therefore, in order to avoid unnecessary repetition in the above description, one or more elements shown and described in association with an example, implementation or application can be incorporated into other examples, implementations or applications, unless otherwise specifically stated, unless one or more elements make the example or implementation inoperative, or unless two or more elements provide conflicting functions. Similarly, it should be understood that any specific element (including system components or method processes) is optional and is not considered as an essential feature of the present disclosure, unless otherwise clearly stated.

[0103] It is fully contemplated that any changes and further modifications to the described devices, apparatuses, methods, and any further applications of the principles of the present disclosure would normally occur to one skilled in the art to which the present disclosure relates. In particular, it is fully contemplated that features, components, and / or steps described with respect to one example may be combined with features, components, and / or steps described with respect to other examples of the present disclosure. Furthermore, the dimensions provided herein are for specific examples, and it is contemplated that different sizes, dimensions, and / or ratios may be utilized to implement the concepts of the present disclosure.

[0104] Although some examples are provided herein in the context of medical procedures, any reference to medical or surgical instruments and medical or surgical methods is non-limiting. For example, the instruments, systems, and methods described herein can be used for non-medical purposes, including industrial uses, general robotic uses, and sensing or manipulating non-tissue artifacts. Other example applications relate to cosmetic improvements, imaging of human or animal anatomical structures, collecting data from human or animal anatomical structures, and training medical or non-medical personnel. Additional example applications include procedures for tissues removed from human or animal anatomical structures (not returned to human or animal anatomical structures), and performing procedures on human or animal corpses. In addition, these technologies can also be used in surgical and non-surgical medical or diagnostic procedures.

[0105] The methods described herein are shown as a set of operations or processes. Not all of the processes shown may be performed in all examples of the method. In addition, one or more processes not explicitly shown or described may be included before, after, between, or as part of the example process. In some examples, one or more processes may be performed by a control system (e.g., control system 112), or may be implemented at least in part in the form of executable code stored on a non-transient, tangible, machine-readable medium, which, when run by one or more processors (e.g., a processor of control system 112), may cause one or more processors to perform one or more processes.

[0106] One or more elements in the examples of the present disclosure may be implemented in software to be executed on a processor of a computer system such as a control processing system. When implemented in software, the elements of the examples of the present disclosure are essentially code segments that perform necessary tasks. The program or code segment may be stored in a processor-readable storage medium or device, which may be downloaded via a computer data signal embodied in a carrier wave on a transmission medium or a communication link. The processor-readable storage device may include any medium capable of storing information, including optical media, semiconductor media, and magnetic media. Examples of processor-readable storage devices include electronic circuits; semiconductor devices, semiconductor storage devices, read-only memories (ROMs), flash memories, erasable programmable read-only memories (EPROMs); floppy disks, CD-ROMs, optical disks, hard disks, or other storage devices. The code segment may be downloaded via a computer network (such as the Internet, an intranet, etc.). Any of a variety of centralized or distributed data processing architectures may be employed. The programming instructions may be implemented as multiple separate programs or subroutines, or they may be integrated into multiple other aspects of the system described herein. In one example, the control system supports wireless communication protocols such as Bluetooth, IrDA, HomeRF, IEEE 802.11, DECT, and wireless telemetry.

[0107] Please note that the processes and displays presented may not be inherently related to any particular computer or other device. Various general purpose systems may be used with the programs taught herein, or it may prove convenient to build more specialized devices to perform the described operations. The structures required for various of these systems will appear as elements in the claims. In addition, the examples of the present disclosure are described without reference to any particular programming language. It should be understood that the teachings of the present disclosure may be implemented using various programming languages.

[0108] The disclosure describes various instruments, instrument parts and anatomical structures in three-dimensional space with respect to the state of various instruments, instrument parts and anatomical structures. As used herein, the term "position" refers to the position of an object or a part of an object in three-dimensional space (e.g., three translational degrees of freedom along Cartesian x, y and z coordinates). As used herein, the term "orientation" refers to the rotational placement of an object or a part of an object (three rotational degrees of freedom, such as roll, pitch and yaw). The "pitch" direction and the "yaw" direction are not necessarily limited to vertical and horizontal movement, respectively, but can be any direction orthogonal to each other. As used herein, the term "attitude" refers to the orientation of an object or a part of an object on at least one translational degree of freedom, and the orientation of the object or a part of an object on at least one rotational degree of freedom (up to six total degrees of freedom). As used herein, the term "shape" refers to a group of attitudes, orientations or orientations measured along the length of an object. As used herein, when used in conjunction with a reference numeral indication, the term "about" refers to the reference numeral indication plus or minus 10% of the reference numeral indication. For example, the language "about 50" covers a range of 45 to 55. Similarly, the language "about 5" covers a range of 4.5 to 5.5.

[0109] As used in this specification and the appended claims, the term "distal" refers to a direction toward a working site, and the term "proximal" refers to a direction away from a working site. Thus, for example, the end of a medical device closest to a target tissue would be the distal end of the medical device, and the end opposite the distal end would be the proximal end of the medical device.

[0110] In addition, the specific words selected to describe one or more embodiments and optional elements or features are not intended to limit the present invention. For example, spatial relative terms, such as "below", "below", "lower", "above", "upper", "near side", "distal side", etc., can be used to describe the relationship between an element or feature and another element or feature as shown in the figure. In addition to the position and orientation shown in the figure, these spatial relative terms are intended to cover the different positions (i.e., translation placement) and orientations (i.e., rotation placement) of the device in use or operation. For example, if the device in the figure is flipped, the element described as "below" or "below" other elements or features will be "above" or "on" other elements or features. Therefore, the word "below" can cover the position and orientation above and below. The device can be oriented in other ways (e.g., rotated 90 degrees or in other orientations), and the spatial relative descriptors used herein are interpreted accordingly. Similarly, the description of the movement along (translation) and around (rotation) various axes includes various spatial positions and orientations. The combination of the position and orientation of the body defines the posture of the body.

[0111] Similarly, geometric terms such as "parallel," "perpendicular," "circular," or "square" are not intended to require absolute mathematical precision unless the context indicates otherwise. Rather, these geometric terms allow for variations due to manufacturing or equivalent functions. For example, if an element is described as "circular" or "substantially circular," components that are not exactly circular (e.g., slightly rectangular or multi-sided polygonal) are still encompassed by this description.

[0112] In addition, unless the context indicates otherwise, the singular forms "a", "an", and "the" are intended to include the plural forms as well. The terms "comprises", "includes", "having", etc. specify the presence of stated features, steps, operations, elements, components, etc., but do not exclude the presence or addition of one or more other features, steps, operations, elements, components, or groups.

[0113] Unless otherwise specified, the terms equipment, medical device, medical instrument and their variations are used interchangeably.

[0114] Although certain illustrative examples of the present disclosure are described and shown in the drawings, it should be understood that these examples are intended to illustrate rather than limit the broad disclosure herein, and that the examples of the present disclosure should not be limited to the specific constructions and arrangements shown and described, since various other modifications may be conceived by those skilled in the art.

Claims

1. A medical device comprising: a force transfer member including one or more inputs, the force transfer member being configured to receive a force or torque from an external device; an elongated member coupled to the force transfer member and extending distally from the force transfer member, the elongated member housing a plurality of first tension elements, the plurality of first tension elements being respectively coupled to the one or more input ends of the force transfer member and configured to receive and transfer tension, the plurality of first tension elements comprising a first material; a plurality of mechanical advantage devices configured to receive and multiply the tension force, each mechanical advantage device being coupled to one of the plurality of first tension elements and rotatable about a respective rotational axis; A plurality of second tension elements configured to transmit the tension to the distal end of the medical device after multiplication of the tension, each second tension element being coupled to one of the plurality of mechanical advantage devices and operably coupled to the distal end of the medical device, the plurality of second tension elements comprising a second material different from the first material.

2. The medical device of claim 1, wherein the elongated member is flexible.

3. The medical device of claim 1, wherein the elongated member is rigid. 4 . The medical device of claim 1 , wherein the first material comprises one of a polymer and a metal, and the second material comprises the other of the polymer and the metal.

5. The medical device of claim 4, wherein the metal is at least one of tungsten and stainless steel.

6. The medical device of claim 1, wherein each first tension element is coupled to the one of the plurality of mechanical advantage devices a distance from the corresponding rotational axis.

7. The medical device of claim 1, wherein at least one of the plurality of mechanical advantage devices is arranged in series with a secondary mechanical advantage device and coupled to the secondary mechanical advantage device through an intermediate drive element to transmit and multiply the tension.

8. The medical device of claim 7, wherein the series connection has a mechanical transmission ratio of at least 4:

1.

9. The medical device of claim 1, wherein the distal end is manually actuatable when the medical device is decoupled from the external device.

10. The medical device of claim 1, further comprising a guide housing provided about the plurality of mechanical advantage devices and coupled to the elongated member and the distal end of the medical device.

11. The medical device of claim 10, wherein the guide housing comprises a guide channel to guide movement of the plurality of mechanical advantage devices.

12. The medical device of claim 11, wherein the plurality of mechanical advantage devices are configured to move axially within the guide channel.

13. The medical device of claim 12, wherein the plurality of mechanical advantage devices translate within the guide channel parallel to a longitudinal axis of the medical device.

14. The medical device of claim 10, wherein each mechanical advantage device includes a pivot at each respective axis of rotation and rotates about the pivot.

15. The medical device of claim 10, wherein the guide housing comprises a central open passageway.

16. The medical device of claim 1, wherein the medical device is a surgical instrument.

17. The medical device of claim 16, wherein the distal end is an end effector actuated by the plurality of second tension elements.

18. The medical device of claim 1, wherein the medical device is an endoscope.

19. The medical device of claim 18, wherein the distal end is an articulated curved section of the endoscope.

20. The medical device of claim 1, wherein the elongated member has a length of more than one meter.

21. The medical device of claim 1, wherein the plurality of mechanical advantage devices are arranged in antagonistic pairs.

22. The medical device of claim 21, wherein the medical device comprises four antagonistic pairs to provide bidirectional motion along four axes.

23. A medical device comprising: a force transfer member including one or more inputs, the force transfer member being configured to receive a force or torque from an external device; an elongated member coupled to and extending distally from the force transmitting member, the elongated member housing a plurality of first tension elements, the plurality of first tension elements being respectively coupled to the one or more input ends of the force transmitting member and configured to receive and transmit tension; a plurality of pulleys configured to receive and multiply the tension, each pulley being rotatable about a respective rotational axis and coupled to one of the plurality of first tension elements; A plurality of second tensioning elements are configured to transmit the tension to a distal end of the medical device after multiplication of the tension, each second tensioning element being coupled to one of the plurality of pulleys.

24. The medical device of claim 23, each second tensioning element being coupled to said one of said plurality of pulleys at said respective rotational axis by a tube having a clevis interface, said tube being operably coupled to a distal end of said medical device.

25. The medical device of claim 23, the one of the plurality of first tension elements coupled to each pulley having a first end operably coupled to the one or more input ends of the force transfer member, a length wrapped around the pulley, and a stationary second end.

26. The medical device of claim 23, wherein the plurality of pulleys are configured to move axially.

27. The medical device of claim 26, wherein the plurality of pulleys are configured to translate parallel to a longitudinal axis of the medical device.

28. The medical device of claim 23, wherein a mechanical transmission ratio of the tension provided by the second plurality of tension elements relative to the first plurality of tension elements is 2:

1.

29. A medical device comprising: a force transfer member including one or more inputs, the force transfer member being configured to receive a force or torque from an external device; an elongated member coupled to and extending distally from the force transmitting member, the elongated member housing a plurality of first tension elements, the plurality of first tension elements being respectively coupled to the one or more input ends of the force transmitting member and configured to receive and transmit tension; a plurality of levers configured to receive and multiply the tension force, each lever being rotatable about a respective rotational axis and coupled to one of the plurality of first tension elements at a first distance from the respective rotational axis; A plurality of second tension elements configured to transmit the tension to the distal end of the medical device after multiplication of the tension, each second tension element being coupled to one of the plurality of levers at a second distance from the corresponding rotation axis, the second distance being less than the first distance, and a second end being operably coupled to the distal end of the medical device.

30. A medical device comprising: a force transfer member including one or more inputs, the force transfer member being configured to receive a force or torque from an external device; an elongated member coupled to and extending distally from the force transmitting member; an end effector operably coupled to the force transfer member; a mechanical advantage device positioned between the end effector and the force transfer member; and A tension element is coupled to the end effector to drive articulation of the end effector, the tension element having a first end distal to the mechanical advantage device, a second end distal to the mechanical advantage device, and a proximal portion coupled to the mechanical advantage device.

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