Medical instrument wrist with grip position measurement

Abstract

The invention relates to a medical instrument wrist with grip position measurement. A medical device includes a distal wrist link and first and second jaws each coupled to the distal wrist link. The shape fiber carrier is pivotally coupled to the distal wrist link and defines a shape fiber lumen. A medical device includes a shape fiber having a distal end fixedly coupled within a shape fiber lumen. The shape fiber carrier is indirectly coupled to the first jaw and the second jaw, and movement of the shape fiber carrier causes the shape fiber to generate a signal related to movement of at least one of the first jaw and the second jaw.

Description

Technical Field

[0001] The embodiments described herein relate to medical devices and, more particularly, to tools for minimally invasive surgery. More particularly, the embodiments described herein relate to medical devices that include a wrist mechanism and system for measuring the grasping position of the medical device. Background Art

[0002] Techniques for minimally invasive surgery (“MIS”) use instruments to manipulate tissue, which can be manually controlled or controlled via computer-assisted remote operation. Some MIS instruments include a treatment or diagnostic end effector (e.g., forceps, cutting tool, or cautery tool) mounted on a wrist mechanism at the distal end of the instrument shaft. During an MIS procedure, the distal end of the end effector, wrist mechanism, and shaft are inserted into a small incision or natural orifice in the patient to position the end effector at a work site within the patient. The wrist mechanism can be used to change the orientation of the end effector relative to the shaft to perform a desired procedure at the work site. The wrist mechanism generally provides specific mechanical degrees of freedom (“DOF”) for the movement of the end effector. For example, the wrist mechanism can change the pitch and deflection orientations of the end effector relative to the longitudinal axis of the shaft. The wrist can optionally provide a roll DOF for the end effector relative to the shaft, or the end effector roll DOF can be implemented by rolling the shaft, wrist, and end effector as a unit together. The end effector can optionally have additional mechanical DOF, such as grasping or blade movement. In some cases, the wrist and end effector mechanical DOF can be combined to provide various end effector control DOF. For example, U.S. Patent No. 5,792,135 (filed May 16, 1997) discloses an apparatus in which the wrist and end effector grasping mechanical DOF are combined to provide an end effector deflection control DOF.

[0003] To enable the desired movement of the distal wrist mechanism and end effector, the instrument may include cables that extend through the instrument shaft and connect the wrist mechanism to a mechanical structure configured to move the cables to operate the wrist mechanism and end effector. For a remote operating system, the mechanical structure is generally driven by a motor and operatively coupled to a computer processing system to provide a user interface for a clinical user (e.g., a surgeon) to control the entire instrument and the components and functions of the instrument.

[0004] Further, the wrist mechanism generally provides specific degrees of freedom for the movement of the end effector. For example, for pliers or other grasping tools, the wrist may be able to change the pitch, yaw, and grasp orientation of the end effector relative to the instrument axis. More degrees of freedom can be implemented through the wrist, but additional actuation members (e.g., cables) in the wrist and the shaft will be required, and considering the size limitations desired for MIS applications, these additional members compete for the limited space available. The components required to actuate other degrees of freedom, such as the roll of the end effector or insertion / withdrawal through movement of the main tube, also compete for space on or in the shaft of the device.

[0005] Conventional architectures of wrist mechanisms in manipulator-driven medical devices use cables that are pulled and released by winches in the proximal mechanical structure to rotate portions of the wrist mechanism that are connected to the winches via the cables. For example, the wrist mechanism can be operably coupled to three winches, each for rotating about a pitch axis, a yaw axis, and a grasp axis. Each winch can be controlled by using two cables attached to the winch, such that one side releases the cable while the other side can pull an equal length of cable. With this architecture, three degrees of freedom may require a total of six cables that extend proximally rearward along the length of the instrument main shaft tube from the wrist mechanism to the proximal mechanical structure of the instrument. Effective implementation of the wrist mechanism and the proximal mechanical structure can be complex because the cables must be carefully routed through the tool members, the wrist mechanism, and the proximal mechanical structure to maintain the stability of the wrist throughout the range of motion of the wrist mechanism and to minimize the interaction (or coupling effect) of one axis of rotation on another. Additionally, for MIS applications, it is desirable to have a compact instrument outer diameter to minimize the port size required to insert the instrument into the patient. However, for more complex mechanisms, it can be challenging to meet the desired instrument diameter (e.g., 12 mm, 8 mm, 5 mm or less) while providing the desired mechanical degrees of freedom.

[0006] Some wrist mechanisms include grasping tools or jaws and are part of a closed-loop feedback system. In such devices, the jaws can be used to grasp a patient's tissue. During use of the device, it may be desirable to know the speed and angular position of the jaws. However, in a wristed medical device having a limited device diameter (e.g., a diameter of about 5 mm or less), it is challenging to incorporate sensors into the jaws to obtain accurate speed and angular position information for each jaw. For example, to provide feedback on the speed and angular position / orientation of each independently movable jaw, each jaw may need to be directly coupled to a sensor. Incorporating multiple embedded sensors in the jaws may require a larger instrument size to accommodate the sensor wiring, which may be undesirable for a given port size and also results in increased cost and complexity. If only one distal sensor is feasible due to, for example, size constraints or the configuration of the medical device jaws, it may be difficult to provide the sensor feedback needed to measure the position, speed, and / or orientation of both jaws during device use.

[0007] Accordingly, there is a need for a wrist mechanism that provides improved sensor capabilities that can measure the position, speed, and / or orientation of the jaws of the wrist mechanism while meeting the design constraints of the medical device. SUMMARY

[0008] This Summary introduces certain aspects of the embodiments described herein to provide a basic understanding. This Summary is not an extensive overview of the subject matter of the present invention and is not intended to identify key or important elements or to delineate the scope of the subject matter of the present invention.

[0009] In some embodiments, a medical device includes a distal wrist linkage, and a first jaw and a second jaw each coupled to the distal wrist linkage. A shape fiber carrier is pivotally coupled to the distal wrist linkage and defines a shape fiber cavity. The medical device includes a shape fiber having a distal end fixedly coupled within the shape fiber cavity. The shape fiber carrier is indirectly coupled to the first jaw and the second jaw, and movement of the shape fiber carrier causes the shape fiber to generate a signal related to movement of at least one of the first jaw or the second jaw.

[0010] In some embodiments, the medical device includes an intermediate coupling mechanism coupled to a shaped fiber carrier, and the shaped fiber carrier is indirectly coupled to the first jaw and the second jaw via the intermediate coupling mechanism. In some embodiments, the intermediate coupling mechanism is a differential coupled between at least one of the first jaw or the second jaw and the shaped fiber carrier, and the shaped fiber carrier is indirectly coupled to the first jaw and the second jaw via the differential. In some embodiments, the intermediate coupling mechanism includes a cam mechanism to indirectly couple the shaped fiber carrier to at least one of the first jaw or the second jaw. In some embodiments, the intermediate coupling mechanism includes a torsion spring to indirectly couple the shaped fiber to at least one of the first jaw or the second jaw.

[0011] In some embodiments, the signal generated by the shaped fiber includes a signal related to the average of the first deflection angle of the first jaw and the second deflection angle of the second jaw. In some embodiments, the shaped fiber carrier is pivotally coupled to the distal wrist link about a first axis, and the first jaw and the second jaw are each pivotally coupled to the distal wrist link about a second axis, where the second axis is offset from the first axis. In some embodiments, the distal end of the shaped fiber is positioned between the first axis and the second axis. In some embodiments, the shaped fiber carrier is indirectly coupled to the first jaw and the second jaw such that the angular position of the shaped fiber carrier relative to the second axis is associated with the average deflection angle of the first jaw and the second jaw.

[0012] In some embodiments, the differential includes a housing, a first planetary gear, a second planetary gear, and a ring gear. The medical device further includes a gear train, a first sun gear, and a second sun gear. The first sun gear is integral with the first jaw and coupled to the housing. The second sun gear is integral with the second jaw and coupled to the housing. The ring gear is integral with the housing and coupled to the gear train, and the gear train is coupled to the shaped fiber carrier. The housing is configured to rotate when one of the first jaw or the second jaw rotates relative to the other such that the average direction of the jaw positions (e.g., relative to the distal wrist link) changes, and the rotation of the housing causes the rotation of the shaped fiber carrier and the shaped fiber. The orientation of the housing is associated with the average of the first deflection angle of the first jaw and the second deflection angle of the second jaw.

[0013] In some embodiments, the rotational movement of the shaped fiber carrier is restricted by the differential. In some embodiments, the rotational movement of the shaped fiber carrier is restricted to + / - 45 degrees relative to the centerline of the shaped fiber carrier. In some embodiments, the shaped fiber carrier includes a gear operably coupled to the differential.

[0014] In some embodiments, movement of the shape fiber carrier causes the shape fibers to generate a signal related to the movement of the distal wrist link. In some embodiments, movement of the shape fiber carrier causes the shape fibers to generate a signal related to the movement of the proximal articulation joint.

[0015] In some embodiments, the medical device includes a distal wrist link, and a first jaw and a second jaw each coupled to the distal wrist link. A position sensor is coupled to the distal wrist link, and a differential is coupled to the position sensor, the first jaw, and the second jaw. Movement of one of the first jaw or the second jaw relative to the other causes sensor movement of the position sensor via the differential, and the position sensor generates a signal related to the sensor movement.

[0016] In some embodiments, the signal generated by the position sensor is associated with an average of a first deflection angle of the first jaw and a second deflection angle of the second jaw. In some embodiments, the position sensor is a shape fiber, and the medical device includes a shape fiber carrier coupled to the differential. The shape fiber is at least partially disposed within a cavity of the shape fiber carrier.

[0017] In some embodiments, the differential includes a housing, a first planetary gear, a second planetary gear, and an annular gear. The medical device further includes a gear train, a first sun gear, and a second sun gear. The first sun gear is integral with the first jaw and coupled to the housing, and the second sun gear is integral with the second jaw and coupled to the housing. The annular gear is integral with the housing and coupled to the gear train, and the gear train is coupled to the shape fiber carrier. The housing is configured to rotate when one of the first jaw or the second jaw rotates relative to the other such that the average direction of the jaw positions (e.g., relative to the distal wrist link) changes, and rotation of the housing causes rotation of the position sensor. The orientation of the housing is associated with an average of a first deflection angle of the first jaw and a second deflection angle of the second jaw.

[0018] In some embodiments, the position sensor generates a signal related to an average of a first deflection angle of the first jaw and a second deflection angle of the second jaw based on the orientation of the housing. In some embodiments, rotational movement of the position sensor is restricted by the differential. In some embodiments, rotational movement of the shape fiber carrier is restricted by the differential. In some embodiments, rotational movement of the shape fiber carrier is restricted to + / - 45 degrees relative to the shape fiber carrier centerline. In some embodiments, the position sensor is indirectly coupled to the first jaw and the second jaw such that the angular position of the position sensor is associated with an average of a first deflection angle of the first jaw and a second deflection angle of the second jaw.

[0019] In some embodiments, a medical device includes a distal wrist link, and a first jaw and a second jaw each coupled to the distal wrist link. A shape fiber carrier is coupled to the distal wrist link and defines a shape fiber cavity. Shape fibers extend from a position proximal to the distal wrist link to a distal end fixedly coupled within the shape fiber cavity. The shape fibers are spaced apart from each of the first jaw and the second jaw. Movement of the shape fiber carrier causes the shape fibers to generate a signal related to movement of at least one of the first jaw and the second jaw.

[0020] Other medical devices, related components, medical device systems, and / or methods according to embodiments will be or become apparent to those of ordinary skill in the art upon reading the following drawings and detailed description. All such additional medical devices, related components, medical device systems, and / or methods included within this description are within the scope of the present disclosure. BRIEF DESCRIPTION OF THE DRAWINGS

[0021] Figure 1 is a plan view of a minimally invasive teleoperated medical system for performing a medical procedure, such as a surgical procedure, according to an embodiment.

[0022] Figure 2 is Figure 1 a perspective view of a user console of the minimally invasive teleoperated surgical system shown.

[0023] Figure 3 is Figure 1 a perspective view of an optional auxiliary unit of the minimally invasive teleoperated surgical system shown.

[0024] Figure 4 is Figure 1 a perspective view of a manipulator unit of the minimally invasive teleoperated surgical system shown, including a plurality of instruments.

[0025] Figure 5 is a top view of a diagrammatic illustration of a distal end portion of a medical device according to an embodiment.

[0026] Figure 6 is a top view of a diagrammatic illustration of a distal end portion of a medical device according to another embodiment.

[0027] Figure 7 is a side view of a medical device according to an embodiment, wherein the wrist assembly is in a pitched configuration.

[0028] Figure 8 is Figure 7 a top view of a distal end portion of the medical device of, wherein the wrist assembly is in a straight configuration.

[0029] Figure 9 is Figure 7Perspective view of the distal end portion of a medical device, showing the wrist assembly in a pitch configuration (i.e., the distal link is rotated relative to the proximal link of the medical device).

[0030] Figure 10 is Figure 7 Perspective view of the distal end portion of a medical device, showing the distal link rotated relative to the proximal link and selected components removed for illustrative purposes.

[0031] Figure 11 is Figure 7 Perspective view of the connector link of a medical device.

[0032] Figure 12 is Figure 7 Cross-sectional perspective top view of the distal end portion of a medical device, where the distal link and the proximal link are in a straight configuration, the jaws are in a closed configuration, and selected components are removed for illustrative purposes.

[0033] Figure 13 is Figure 7 Partial cross-sectional perspective view of the distal end portion of a medical device, where the distal link is rotated relative to the proximal link, the jaws are in a closed configuration, and selected components are removed for illustrative purposes.

[0034] Figure 14 is Figure 7 Partial cross-sectional perspective top view of the distal end portion of a medical device, where the distal link and the proximal link are in a straight configuration, the jaws are in an open position, and selected components are removed for illustrative purposes.

[0035] Figure 15 is Figure 7 Partial cross-sectional perspective top view of the distal end portion of a medical device, showing the other side of the medical device, where the distal link and the proximal link are in a straight configuration, and selected components are removed for illustrative purposes.

[0036] Figure 16 is Figure 15 Partial cross-sectional top view of the distal end portion of a medical device, showing the other side of the medical device, where the distal link and the proximal link are in a straight configuration, and selected components are removed for illustrative purposes.

[0037] Figure 17 is Figure 7 Perspective view of a medical device, showing the distal link rotated relative to the proximal link and selected components removed for illustrative purposes.

[0038] Figure 18 is Figure 7Perspective view of a medical device, showing the distal link rotating relative to the proximal link and selected components removed for illustrative purposes, and showing Figure 17 the opposite side of the medical device in

[0039] Figure 19 is Figure 18 a partial exploded perspective view of the medical device.

[0040] Figure 20 is Figure 18 a partial exploded perspective view of the medical device, showing Figure 19 the opposite side of the medical device in

[0041] Figure 21 is Figure 18 a further exploded view of the medical device, showing the planetary gears of the differential.

[0042] Figures 22A - 22C are respectively Figure 7 different perspective views of the differential of the medical device.

[0043] Figure 23 A side view of the distal end portion of a medical device according to another embodiment.

[0044] Figure 24 is Figure 23 a perspective view of the distal end portion of the medical device, with one of the tool member and the cable removed for illustrative purposes.

[0045] Figure 25 is Figure 23 a side view of a part of the distal end portion of the medical device, with selected components removed for illustrative purposes.

[0046] Figure 26 is Figure 23 a partial exploded perspective view of a part of the distal end portion of the medical device.

[0047] Figure 27 is Figure 23 a partial exploded perspective view of a part of the distal end portion of the medical device, showing the opposite side as shown in Figure 26

[0048] Figures 28A - 28C respectively illustrate Figure 23 the distal end portion of the medical device, where the tool members are in different positional orientations relative to each other and / or the distal link.

[0049] Figures 29A - 29E are respectively Figure 23 ​Side view of the distal end portion of a medical device, where a portion of one of the tool members is removed for illustrative purposes, and each figure shows the tool members in different positions relative to each other and / or relative to the distal link.

[0050] Figure 30 Is a perspective view of the distal end portion of a medical device according to another embodiment.

[0051] Figure 31 Is Figure 30 Perspective view of the distal end portion of a medical device, where one of the tool members and the cable are removed for illustrative purposes.

[0052] Figure 32 Is Figure 30 Side view of a portion of the distal end portion of a medical device, where selected components are removed for illustrative purposes.

[0053] Figure 33 Is Figure 32 Side view of a portion of the distal end portion of a medical device, where one of the torsion springs is removed for illustrative purposes and a portion of the shape fiber sensor is shown.

[0054] Figure 34 Is Figure 30 Exploded perspective view of a portion of the distal end portion of a medical device.

[0055] Figure 35 Is Figure 30 Another exploded perspective view of a portion of the distal end portion of a medical device.

[0056] Figure 36A Is Figure 30 Perspective view of the shape fiber carrier and the intermediate coupling mechanism of a medical device.

[0057] Figure 36B Is Figure 36A Exploded perspective view of the shape fiber carrier and the intermediate coupling mechanism.

[0058] Figure 37 Is Figure 30 Side view of the distal end portion of a medical device, where a portion of one of the tool members is removed for illustrative purposes and the shape fiber vector is shown.

[0059] Figure 38 Is a schematic illustration showing how the shape fiber carrier is balanced by an intermediate coupling mechanism including opposing springs.

[0060] Figure 39 Is a flowchart showing a method of assembling a medical device having a shape fiber sensor.

[0061] Figure 40 It is a schematic diagram of a controller for a minimally invasive remote operating surgical system according to an embodiment.

[0062] Figure 41 It is a flowchart of an example method for generating an adjusted output signal from a shape fiber sensor according to an embodiment.

[0063] Figure 42 It is a flowchart of an example method for calibrating a shape fiber sensor of a medical device according to an embodiment. Detailed Embodiments

[0064] The embodiments described herein can be advantageously used for various grasping, cutting, and manipulation operations related to minimally invasive surgery. In some embodiments, the end effector of a medical device (e.g., an instrument) can move relative to the force transmission mechanism of the instrument in multiple mechanical DOFs. For example, the medical devices described herein can have one or more mechanical DOFs in the end effector itself—e.g., two jaws, each jaw rotating relative to the U-shaped clip (2 DOFs, which include the "grasping" DOF when the jaws rotate towards each other in a closing manner along opposite directions)—and a distal U-shaped clip rotating relative to the proximal U-shaped clip (one DOF).

[0065] In some embodiments, the medical device of the present application can achieve the movement of the distal end in three degrees of freedom (e.g., about the pitch axis, the deflection axis, and the grasping axis) using only four tension elements (e.g., cables, belts, or the like), thereby reducing the total number of tension elements required for articulation, reducing the space required for routing the tension elements within the shaft and the wrist, reducing the overall cost, and further miniaturizing the wrist and shaft assemblies to facilitate MIS procedures. As described herein, in some embodiments, the medical device includes a wrist assembly that includes a proximal link coupled to a distal link, and the distal link is coupled to an end effector. The distal link can rotate relative to the proximal link along the rolling arcuate contact surfaces of each of the distal link and the proximal link.

[0066] The medical devices described herein can include an end effector in the form of a grasping tool or jaws at the distal end of the medical device, which can be used to grasp a patient's tissue, grasp a needle (e.g., for suturing), or perform other operations. The end effector can be coupled to the wrist assembly, and the wrist assembly can be operably coupled to an instrument shaft, which can be a substantially rigid or a flexible member. In various embodiments, the medical device can have a maximum diameter of approximately 5 mm, and in other embodiments, the maximum diameter is between 4 mm and 6 mm, while in other embodiments, the maximum diameter is approximately 8 mm to 12 mm.

[0067] The end effector and wrist assembly can be part of a closed-loop feedback system for a medical device. Sensors embedded in the medical device can be integrated into a closed-loop control system that is designed to reduce hysteresis in the medical device and improve the positional accuracy of the articulation of the medical device. In various embodiments, the medical device can include one or more position or orientation sensors, such as for example one or more shape fibers or shape fiber bundles (e.g., one or more optical fibers or fiber bundles having fiber Bragg gratings), to provide information related to the position, orientation, and / or velocity of joints or linkages of the medical device (e.g., the end effector, wrist joints, wrist linkages, and / or joints and linkages of the medical device shaft). Such sensors can also provide information about the position and / or orientation of the medical device relative to the patient's anatomy (e.g., the position and / or orientation of the medical device relative to organs, cavities, and / or lumens through which the medical device may pass), as well as information about the position and / or orientation of the patient's anatomy itself (e.g., the position and / or orientation of organs, flexible cavities, movable soft tissues, etc.).

[0068] For position and / or orientation feedback of a minimally invasive medical device having an end effector with two jaws, it can be desirable to have sensor information indicating the position and / or orientation of the two jaws. However, in a wristed medical device having a restricted device diameter (e.g., a diameter of about 5 mm or less), incorporating shape fibers into the two jaws presents challenges. In some embodiments, the minimum allowable bend radius of the shape fibers in the medical device can be restricted to prevent breakage of the shape fibers during device articulation. For example, in some embodiments, the minimum allowable bend radius may be in the range of 4 mm to 5 mm. This can present challenges when routing shape fibers through the articulated jaws and articulated wrist mechanisms of a minimally invasive medical device with a reduced diameter that can move in pitch and / or yaw degrees of freedom. Additionally, the shape fibers can be provided with a straight section at the distal end of the shape fiber to accurately transmit and reflect optical signals for position and orientation determination. For example, in some embodiments, the length of the straight section can be at least 3 mm. This can present challenges in minimizing the length of the end effector and the minimum throw arm required to articulate the end effector.

[0069] The embodiments described herein overcome challenges in providing end effector position, velocity, and / or orientation sensor feedback for minimally invasive medical devices having pitch and yaw articulations. Due to size constraints, routing limitations, and / or the configuration of the jaws and wrist of the medical device, the devices described herein may include a sensor / sensor bundle positioned at the distal end of the medical device, where the sensor is spaced from the jaws of the medical device. For example, the sensor / sensor bundle may determine position, velocity, and / or orientation information of the jaws by being indirectly coupled to the jaws via one or more intervening elements (e.g., without directly embedding the sensor / sensor bundle in the jaws). In some embodiments, only a single sensor / sensor bundle is positioned at the distal end of the medical device. The position sensors and mechanisms described herein can be used to sense the average position and average velocity of the two jaws during use of the medical device without directly coupling to the jaws. In some embodiments, a spline gear differential is used to determine the average angular velocity and position of the jaws. In an alternative embodiment, a cam actuation mechanism may be coupled to the jaws and used to determine the average angular velocity and position of the jaws.

[0070] More specifically, in some embodiments, a shaped fiber carrier is pivotally coupled within a distal wrist link and coupled to a spline gear differential positioned between two jaws of the medical device. Each jaw has an integral sun gear that is connected to one of two planetary gears of the differential. The planetary gears are located within the differential housing and also mesh with each other. The outside of the gear housing has an integral ring gear that is connected to the distal shaped fiber carrier via a gear train. The shaped fiber carrier has a shaped fiber cavity, and shaped fibers extend within the shaped fiber cavity to the distal end of the cavity. Thus, the shaped fiber carrier and the shaped fibers are not directly coupled to either of the jaws, but are operably coupled to the jaws via the differential.

[0071] When the average position of the jaws changes, the differential housing will rotate accordingly, which in turn moves the shaped fiber carrier and the shaped fibers disposed therein. In addition to providing information about the jaw position, the shaped fibers can provide the orientation of the distal wrist link (e.g., relative to the proximal wrist link), as well as the position and velocity of the proximal wrist link, any elbows or other articulating joints, and any flexible instrument parts (e.g., flexible instrument shaft) through which the shaped fibers may pass. In this way, the embodiments described herein allow a single shaped fiber sensor / sensor bundle to provide information about different aspects of the distal end of a medical device, including jaw position. The embodiments described herein allow for an efficient and compact end effector design. In some embodiments, the tension elements actuating the jaws are disposed along the outside of the jaws, and the differential can be encapsulated within the jaw body to achieve a compact form. In some alternative embodiments, the gear train connecting the differential to the distal shaped fiber carrier can be replaced with a cable. In further alternative embodiments, instead of a differential, a cam actuating mechanism can be integrated into or coupled to the jaws and used to determine the average angular velocity and position of the jaws.

[0072] When a position sensor (e.g., a shaped fiber) bends in proportion to the average / differential between two jaws, a measurement of the jaw position is determined. In the case of a shaped fiber, a differential is used to restrict the movement of the shaped fiber to accommodate the limitations on the bending radius of the shaped fiber and the straight section at the distal tip of the shaped fiber. This also allows for the use of a single shaped fiber / shaped fiber bundle to determine the positions of two jaws. The differential can optionally be used with other types of position sensors.

[0073] As used herein, the term "distal" refers to the direction toward the work site, while the term "proximal" refers to the direction away from the work site. Thus, for example, the end of a medical device closest to the target tissue will be the distal end of the medical device, while the end opposite the distal end will be the proximal end of the medical device.

[0074] In addition, the specific words chosen to describe one or more embodiments and optional elements or features are not intended to limit the disclosure. For example, as illustrated in the figures, spatial relative terms such as "below", "beneath", "lower", "above", "upper", "proximal", "distal", etc., may be used to describe the relationship of one element or feature to another element or feature. These spatial relative terms are intended to cover different positions (i.e., translational arrangements) and orientations (i.e., rotational arrangements) of the device in use or operation, in addition to the positions and orientations shown in the figures. For example, if the device in the figures is tumbled, an element described as "below" or "beneath" other elements or features will then be "above" or "upper" other elements or features. Thus, the term "below" can cover both the above and below positions and orientations. The device may be otherwise oriented (e.g., rotated 90 degrees or in other orientations), and the spatial relative descriptors used herein can be interpreted accordingly. Similarly, descriptions of movement along (translation) and around (rotation) various axes include a variety of spatial positions and orientations. A combination of a body's position and orientation defines the body's posture.

[0075] Likewise, geometric terms such as "parallel", "perpendicular", "circular", or "square" are not intended to imply absolute mathematical precision, unless the context otherwise indicates. Instead, these geometric terms allow for variations due to manufacturing or equivalent functionality. For example, if an element is described as "circular" or "substantially circular", then components that are not precisely circular (e.g., a slightly elongated oval or a multi-sided polygon) are still covered by this description.

[0076] In addition, unless the context otherwise indicates, the singular forms "a", "an", and "the" are also intended to include the plural forms. The terms "comprising", "including", "having", etc., specify the presence of the stated features, steps, operations, elements, components, etc., but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, or groups.

[0077] Unless otherwise specified, the terms device, medical device, medical instrument, and their variants may be used interchangeably.

[0078] Aspects of the disclosure are described with reference to a remote operating surgical system. An exemplary configuration of such a remote operating surgical system is the da Surgical System commercialized by Intuitive Surgical, Inc. of Sunnyvale, California. Examples of such surgical systems are the da Vinci Surgical System (Model IS4000), the da Vinci Surgical System (Model IS4200), and the da Vinci Surgical system (model IS3000). However, those skilled in the art will understand that the aspects of the invention disclosed herein can be embodied and implemented in various ways - including computer-assisted, non-computer-assisted, and hybrid combinations of manual and computer-assisted embodiments and implementations. In da Embodiments on surgical systems (e.g., model IS4000, model IS3000, model IS2000, model IS1200, model SP1099) are presented only as examples and should not be considered as limiting the scope of the aspects of the invention disclosed herein. Where applicable, aspects of the present invention can be embodied and implemented in relatively small, hand-held, manually operated devices that are not mechanically grounded in a world reference frame, and can also be embodied and implemented in relatively large systems with additional mechanical support that is grounded in a world reference frame.

[0079] Figure 1 FIG. is an example of a plan view of a teleoperated surgical system 1000 (“remote surgical system”) that is operated at least in part under computer assistance. The remote surgical system 1000 and its components are all considered medical devices. The remote surgical system 1000 is a minimally invasive robotic surgery (“MIRS”) system for performing minimally invasive diagnostic or surgical procedures on a patient P lying on an operating table 1010. The system can have any number of components, such as a user control unit 1100 for use by a surgeon or other skilled clinician S during the procedure. The MIRS system 1000 can further include a manipulator unit 1200 (commonly referred to as a surgical robot) and an optional auxiliary instrument unit 1150. The manipulator unit 1200 can include one or more arm assemblies 1300 detachably coupled to a surgical instrument 1400. The manipulator unit 1200 can manipulate at least one detachably coupled instrument 1400 through a minimally invasive incision in the body or natural orifice of the patient P while the surgeon S observes the surgical site and controls the movement of the instrument 1400 through the control unit 1100. Images of the surgical site are obtained by an endoscope (not shown), and the endoscope (such as a single-field or stereoscopic endoscope) can be manipulated by the manipulator unit 1200 to orient the endoscope. The auxiliary instrument unit 1150 can be used to process the images of the surgical site for subsequent display to the surgeon S through the user control unit 1100. The number of disposable instruments 1400 will generally depend on factors such as the diagnostic or surgical procedure and space constraints in the operating room. If one or more of the instruments 1400 being used need to be replaced during the surgical procedure, an assistant removes the instrument 1400 from the manipulator unit 1200 and replaces the instrument 1400 with another instrument 1400, for example, from a tray 1020 in the operating room. Although shown as being used with the instrument 1400, any of the instruments described herein can be used with the MIRS 1000.

[0080] Figure 2 is a perspective view of the user control unit 1100. The user control unit 1100 includes a left-eye display 1112 and a right-eye display 1114 for presenting to the surgeon S a coordinated stereoscopic view of the surgical site that enables depth perception. The information presented to the surgeon S can be presented in the form of a graphical user interface through which input can be provided to the controller 1820 ( Figure 40 ). The user control unit 1100 further includes one or more input control devices 1116 which in turn cause the manipulator unit 1200 (as Figure 1 shown) to manipulate one or more tools. The input control devices 1116 provide at least the same degrees of freedom as the instruments 1400 to which they are associated to provide the surgeon S with a sense of telepresence, or a sense that the input control devices 1126 are integrated (or directly connected) with the instruments 1400. In this way, the user control unit 1100 provides the surgeon S with a strong sense of directly controlling the instruments 1400. To this end, position, force, strain, or tactile feedback sensors (not shown) or any combination of these sensations can be provided back to one or both hands of the surgeon from the instruments 1400 through the one or more input control devices 1116.

[0081] As Figure 1 shown, the user control unit 1100 is in the same room as the patient so that the surgeon S can directly monitor the procedure, be physically present if necessary, and talk directly to the assistant rather than by phone or other communication medium. However, in other embodiments, the user control unit 1100 and the surgeon S can be located in a different room from the patient, a completely different building from the patient, or other locations remote from the patient, thus allowing for a remote surgical procedure.

[0082] Figure 3 is a perspective view of the auxiliary instrument unit 1150. The auxiliary instrument unit 1150 can be coupled to an endoscope (not shown) and can include one or more processors for processing the captured images for subsequent display, such as via the user control unit 1100, or locally (e.g., on the unit 1150 itself as shown, on a wall-mounted display), and / or on another suitable display remotely. For example, in the case of using a stereoscopic endoscope, the auxiliary instrument unit 1150 can process the captured images to present to the surgeon S a coordinated stereoscopic image of the surgical site via the left-eye display 1112 and the right-eye display 1114. Such coordination can include alignment between the relative images and can include adjusting the stereoscopic working distance of the stereoscopic endoscope. As another example, the image processing can include using previously determined camera calibration parameters to compensate for imaging errors of the image capture device, such as optical aberrations.

[0083] Figure 4A perspective view of the manipulator unit 1200 is shown. The manipulator unit 1200 includes components (e.g., arms, linkages, motors, sensors, and the like) to provide manipulation of the instrument 1400 and an imaging device (not shown) for capturing images of a procedural site, such as a stereoscopic endoscope. Specifically, the instrument 1400 and the imaging device can be manipulated by a remote operating mechanism having one or more mechanical joints. Additionally, the instrument 1400 and the imaging device are positioned and manipulated through an incision or natural orifice in the patient P in such a manner that a center of motion that is remote from the manipulator and generally located along the instrument axis is held at the incision or orifice by kinematic mechanical or software constraints. In this way, the incision size can be minimized. In various embodiments, the manipulator unit 1200 can be configured as a patient-side cart having one or more arm assemblies 1300 supported and actuated by a single cart and / or a single manipulator supported and driven by a separate cart. In other embodiments, the manipulator unit 1200 can be configured as a manipulator system mounted on a workbench, where one or more arm assemblies 1300 are mounted on the operating table 1010 that supports the patient P. In further embodiments, one or more arm assemblies 1300 can be coupled to the ceiling or other objects in the environment. It should be further understood that any of the arm assembly mounting configurations in the arm assembly mounting configurations can be used in combination with each other.

[0084] Figure 5 is a schematic illustration of a portion of a medical device 2400 according to an embodiment. In some embodiments, the medical device 2400 or any component thereof is optionally part of an instrument of a surgical system that performs a surgical procedure, and the surgical system can include a manipulator unit, a series of kinematic linkages, a series of cannulas, or the like. The medical device 2400 (and any of the instruments described herein) can be used with any suitable surgical system, such as the MIRS system 1000 shown and described above. The medical device 2400 includes a shaft (not shown), a proximal wrist linkage (not shown) coupled to the shaft, a distal wrist linkage 2610 coupled to the proximal wrist linkage, a first tool member 2462, a second tool member 2482, a shape fiber carrier 2466 that defines an internal cavity 2468, and a shape fiber 2588 that extends distally within the shape fiber cavity 2468. The shape fiber 2588 can be a single optical fiber or a bundle of multiple optical fibers, which will be collectively referred to as "shape fibers". The shape fiber 2588 (and any of the shape fibers described herein) can be of the type shown and described in U.S. Patent No. 8,358,883B2, filed on February 6, 2012, titled "Fiber Optic Shape Sensor", which is incorporated herein by reference in its entirety.

[0085] Although Figure 5Although not shown, the medical device 2400 may also include one or more tension elements (not shown) coupled to the tool members 2462, 2482 (e.g., they may be cables, bands, and the like). The medical device 2400 is configured such that movement of the tension elements produces movement of the distal wrist link 2610, movement of the tool members 2462 or 2482, or both movement of the distal wrist link 2610 and movement of the tool members 2462 or 2482.

[0086] The tool members 2462, 2482 may rotate about a tool member axis of rotation ( Figure 5 not shown). The tool members 2462, 2482 may be, for example, a pair of jaws, a cauterization device, a cutting device, or other medical tools. The (one or more) tension elements are coupled to the tool members 2462, 2482, extend from the tool members 2461, 2482, and are routed through the shaft and extend proximally to a force transfer mechanism of the medical device ( Figure 5 not shown), where they are coupled to a drive component ( Figure 5 not shown) within the mechanical structure. The tension elements may be actuated by a drive component (not shown) such that the tension on the tension elements causes one or both of the tool members 2462, 2482 to rotate about the tool member axis of rotation, as described in U.S. Provisional Patent Application Serial No. 63 / 233,904, titled "Surgical Instrument Cable Control and Routing Structures", the entire content of which is incorporated herein by reference.

[0087] For example, in some embodiments, the pitch of the tool members 2462, 2482 of the medical device 2400 can be changed by moving the proximal end of the tension element to rotate the distal wrist link 2610. Specifically, a force transmission mechanism (not shown, but which can be similar to the force transmission mechanism 4700 described further below) can pull on the proximal end of one of the tension elements while also releasing the same length of the proximal end of the other tension element to rotate the distal wrist link 2610. In other embodiments, the medical device 2400 can include one or more other tension elements to change the deflection and / or grasping of the tool members 2462, 2482 relative to the distal wrist link 2610. For example, by moving the proximal ends of the various tension elements, the deflection, grasping, or both deflection and grasping can be changed. Thus, the medical device 2400 can include any suitable number of tension elements to produce the desired movement of the wrist link 2610 and the tool members 2462, 2482. For example, in some embodiments, the medical device 2400 can include two tension elements to produce the desired pitch. In other embodiments, the medical device 2400 can include four tension elements and can operate in a manner similar to that shown and described in U.S. Patent Publication No. 2020 / 0390430, titled "Low-Friction, Small Profile Medical Tools Having Easy-to-Assemble Components" (filed on August 21, 2020), the entire content of which is incorporated herein by reference. In yet other embodiments, the medical device 2400 can include six tension elements and can operate in a manner similar to that shown and described in U.S. Patent Publication No. 2020 / 0390430, which is incorporated herein by reference.

[0088] The tool members 2462, 2482 can cooperate to perform grasping, shearing, or cutting functions. Thus, when the tool members rotate relative to each other, the tool member rotation axis can also function as a cutting axis. Thus, in some embodiments, the medical device 2400 can provide at least three degrees of freedom (i.e., a deflection movement about the tool member rotation axis, a pitch rotation about the distal link rotation axis or the proximal link rotation axis, and a cutting or grasping movement about the tool member rotation axis).

[0089] The shaped fiber carrier 2466 is operably coupled to the tool member 2462 and the tool member 2482 via an intermediate coupling mechanism (such as a differential, a cam mechanism, a torsion spring mechanism, or other suitable intervening structure (not shown)). The distal end of the shaped fiber 2588 is fixedly coupled to the shaped fiber carrier 2466 within the shaped fiber cavity 2468 at the distal end of the shaped fiber cavity 2468. Thus, the shaped fiber carrier 2466 and the shaped fiber 2588 are indirectly coupled to the first tool member 2462 and the second tool member 2482. In other words, the shaped fiber carrier 2466 and the shaped fiber 2588 are spaced apart from each of the first tool member 2462 and the second tool member 2482. In operation, the intermediate coupling mechanism is coupled to the tool members 2462, 2482, and the intermediate coupling mechanism rotates due to the rotation of one or both of the tool members 2462, 2482. The shaped fiber carrier 2466 is coupled to the intermediate coupling mechanism. The rotation of the intermediate coupling mechanism causes the shaped fiber carrier 2466 and the shaped fiber 2588 coupled thereto to bend proportionally as well. The bending of the shaped fiber 2588 generates a sensor signal indicative of the amount of bending.

[0090] In some embodiments, the shaped fiber 2588 has a straight section at the distal end of the shaped fiber 2588, which helps to accurately measure the bending in other portions of the shaped fiber and can also minimize the reflection of light (e.g., laser). The straight section can have a predetermined length (e.g., at least 3 mm, between 3 mm and 6 mm), and the shaped fiber cavity 2468 is sized to accommodate the straight section. In some embodiments, the shaped fiber 2588 can have a minimum bending radius of, for example, 5 mm to 6 mm. The shaped fiber 2586 is coupled to the shaped fiber carrier 2466 such that the movement of the shaped fiber carrier 2466 causes the shaped fiber 2582 to bend and generates a signal related to the movement of the first tool member 2462, the second tool member 2482, or both. More specifically, when the position or orientation of one or both of the tool members 2462, 2482 changes, since the shaped fiber carrier 2466 is operably coupled to the tool members 2461, 2482, the shaped fiber carrier 246 will move. This will cause the shaped fiber 2588 fixedly coupled to the shaped fiber carrier 2466 to move and generate a signal related to the movement of at least one of the first tool member 2462 or the second tool member 2482.

[0091] In some embodiments, the signal generated by the shaped fiber 2588 includes a signal related to the average value of the first deflection angle θ1 of the first tool member 2462 and the second deflection angle θ2 of the second tool member 2482. As Figure 5As shown, the deflection angle is a measure of the tool member relative to the centerline CL of the distal wrist link 2610. In some embodiments, the shaped fiber carrier 2466 is pivotally coupled to the distal wrist link 2610 about a first axis (e.g., see the carrier axis C1 in Figure 12 discussed below), and both the first tool member 2462 and the second tool member 2482 are pivotally coupled to the distal wrist link 2610 about a second axis (e.g., see the axis A1 in Figure 8 and Figure 9 discussed below), where the second axis is offset from the first axis. In this way, during use, the shaped fiber carrier 2466 is capable of moving relative to the distal wrist link 2610 and relative to each of the first tool member 2462 and the second tool member 2482. In some embodiments, the distal end of the shaped fiber 2588 is positioned between the first axis and the second axis. In some embodiments, the shaped fiber carrier 2466 is indirectly coupled to the first tool member 2462 and the second tool member 2482 such that the angular position of the shaped fiber carrier 2466 relative to the second axis is associated with the average deflection angle of the first tool member 2462 and the second tool member 2482.

[0092] In some embodiments, an intermediate coupling mechanism, such as a differential mechanism ( Figure 5 not shown in the figure), is coupled to the first tool member 2462 and the second tool member 2482, and the shaped fiber carrier 2466 is pivotally coupled to the differential mechanism via a gear train (or other mechanical coupling). For example, the differential mechanism may be operably coupled between the first tool member 2462 and the second tool member 2482. Such an embodiment including a differential is described herein with reference to the medical device 4400. When the shaped fiber 2588 bends in proportion to the average / difference between the two tool members 2462, 2482, a measurement of the position of the tool members 2461, 2482 is determined (e.g., the angular position of the tool members 2463, 2482 relative to the axis of the medical device 2400). In some embodiments, the differential is used to limit the movement of the shaped fiber 2588 to accommodate limitations on the bending radius of the shaped fiber 2589 and to accommodate a straight section at the distal tip of the shaped fiber 2588. In some embodiments, the movement of the shaped fiber carrier 2466 is restricted by the differential. In some embodiments, the rotational movement of the shaped fiber carrier 2466 is relative to the centerline of the shaped fiber carrier 2466 ( Figure 5The (not shown in the figure) is restricted to + / - 45 degrees. In some embodiments, the shaped fiber carrier 2466 includes a gear (not shown) operably coupled to a differential. In some embodiments, the movement of the shaped fiber carrier causes the shaped fibers to generate a signal related to the movement of the distal wrist link. In some embodiments, the movement of the shaped fiber carrier causes the shaped fibers to generate a signal related to the movement of the proximal articulation joint.

[0093] The differential mechanism is also capable of allowing the use of a single shaped fiber 2588 to determine the positions of two tool members 2462 and 2482. Thus, as described herein, a single shaped fiber 2588 can be used to determine the position and orientation (e.g., relative to the axis of the medical device 2400) of the tool members 2462, 2482, where the shaped fiber 2588 is not directly coupled to the tool members 2461, 2482.

[0094] In alternative embodiments, instead of a differential, other intermediate coupling mechanisms can be coupled between the tool members 2462 and 2482 and the shaped fiber carrier 2466. For example, a cam actuation mechanism can be coupled to the tool members and used to average the positions of the tool members. Such embodiments are shown and described below. Figures 23 - 29E in and are described below. In another example, as described below with reference to Figures 30 - 38 as shown and described, a torsion spring mechanism can be coupled to the tool members and used to average the positions of the tool members. In some alternative embodiments, the gear train connecting the differential to the distal shaped fiber carrier can be replaced with a cable. In some alternative embodiments, the differential can be used with other types of position sensors (such as, for example, Hall effect sensors).

[0095] In some embodiments, the medical device 2400 can also include a connector link ( Figure 5 not shown in the figure) coupled between the distal wrist link 2610 and the proximal wrist link ( Figure 5 not shown in the figure). More specifically, the connector link includes a proximal end portion coupled to the proximal wrist link at the proximal link rotation axis and a distal end portion coupled to the distal wrist link 2610 at the distal link rotation axis. Thus, the distal wrist link 2610 can rotate relative to the connector link about the distal link rotation axis, and the connector link can rotate relative to the proximal wrist link about the proximal link rotation axis. Through its coupling with the connector link, the distal wrist link 2610 can also rotate about the proximal wrist link rotation axis. Embodiments including a connector link are described in more detail below with reference to the medical device 4400.

[0096] In some embodiments, the connector link defines an internal path through which the shaped fiber 2588 can extend. In some embodiments, other elongate elements can extend through the internal path of the connector link, such as, for example, wires, cables, tension elements, and the like. In some embodiments, the internal path includes a tapered inlet at the proximal end of the internal path. In some embodiments, the distal end of the connector link is disposed distal to the distal link rotation axis.

[0097] Figure 6 is a schematic illustration of a portion of a medical device 3400 according to another embodiment. In some embodiments, the medical device 3400 or any component thereof is optionally part of an instrument of a surgical system that performs a surgical procedure, and the surgical system can include a manipulator unit, a series of kinematic linkages, a series of cannulas, or the like. The medical device 3400 (and any of the instruments described herein) can be used with any suitable surgical system, such as the MIRS system 1000 shown and described above. The medical device 3400 can include a shaft ( Figure 6 (not shown), a proximal wrist link (not shown) coupled to the shaft, a distal wrist link 3610 coupled to the proximal wrist link, a first tool member 3462, a second tool member 3482, a position sensor 3588, and a differential mechanism 3800 (also referred to herein as a "differential") coupled between the tool members 3462 and 3482 and the position sensor 3582. The position sensor 3588 is coupled to the distal wrist link 3610 or is at least partially coupled within the distal wrist link 3610. The position sensor 3588 can be, for example, a shaped fiber (such as the shaped fiber 2488 described above) or a Hall effect sensor.

[0098] Although Figure 6 (not shown), the medical device 3400 can also include one or more tension elements ( Figure 6 (not shown) coupled to the tool members 3462, 3482 (which can be, for example, cables, bands, and the like). The medical device 3400 is configured such that movement of the tension elements results in movement of the distal wrist link 3610, movement of the tool member 3462 or 3482, or both movement of the distal wrist link 3610 and movement of the tool member 3460 or 3482.

[0099] The tool members 3462, 3482 can rotate about a tool member rotation axis ( Figure 6 (not shown). The tool members 3462, 3482 can be, for example, a pair of jaws, a cautery device, a cutting device, or other medical tools. The (one or more) tension elements are coupled to the tool members 3462, 3482, extend from the tool members 3460, 3482, and are routed through the shaft and extend proximally to the mechanical structure of the medical device ( Figure 6(not shown), where they are coupled to a drive member within the mechanical structure. Figure 6 (not shown). The tension element can be actuated by a drive member (not shown) such that the tension on the tension element on one or both of the tool members 3462, 3482 rotates about the tool member axis of rotation.

[0100] The tool members 3462, 3482 can cooperate to perform grasping, shearing, or cutting functions. Thus, when the tool members rotate relative to each other, the tool member axis of rotation can also serve as a cutting axis. Accordingly, in some embodiments, the medical device 3400 can provide at least three degrees of freedom (i.e., a deflecting motion about the tool member axis of rotation, a pitching rotation about the distal link axis of rotation or the proximal link axis of rotation, and a cutting or grasping motion about the tool member axis of rotation).

[0101] The differential 3800 is coupled to the first tool member 3462 and the second tool member 3482, and the position sensor 3588 is coupled to the differential 3800. The differential 3800 rotates in response to rotation of the first tool member 3462 and / or the second tool member 3482. The position sensor 3588 bends in response to rotation of the differential 3800. As described herein, the differential 3800 allows the first tool member 3462 and the second tool member 3482 to rotate independently of each other while the differential 3800 is coupled to the position sensor 3588 (and creates movement therein). In some embodiments, the differential 3800 can be coupled to the position sensor 3588 via an optional gear train ( Figure 6 not shown) serially positioned between the tool members 3462, 3482 and the position sensor 3588. Accordingly, the position sensor 3588 is indirectly coupled to the tool members 3462 and 3482 via the differential 3800 and the optional gear train. In other words, the position sensor 3588 is spaced from each of the first tool member 3462 and the second tool member 3482, but can be used to determine the orientation and position of the tool members 3462, 3482.

[0102] During use of the medical device 3400, movement of one of the first tool member 3462 or the second tool member 3482 relative to the other creates movement of the position sensor 3588 via the differential 3800, and the position sensor 3588 generates a signal related to the movement of the position sensor 3588. In some embodiments, as Figure 6 shown, the signal generated by the position sensor 3588 is associated with the average of a first deflection angle θ1 of the first tool member 3462 and a second deflection angle θ2 of the second tool member 3482. As described herein, the deflection angle is a measure of the tool member relative to the centerline CL of the distal wrist link 3610.

[0103] In some embodiments, the differential 3800 is configured such that the ratio of the movement of the first tool member 3462 and the second tool member 3482 to the movement of the position sensor 3588 is greater than 1:1. In this way, the differential 3800 can reduce the amount of movement transmitted to the position sensor 3588, thereby accommodating the space constraints within the medical device 3400. In some embodiments, the ratio of the movement of the tool members 3462, 3482 to the movement of the position sensor 3588 is about 2:1. In other embodiments, the ratio of the movement of the tool members 3462, 3482 to the movement of the position sensor 3588 is about 3:1. In some embodiments, the rotational movement of the position sensor 3588 is limited by the differential 3800. In some embodiments, the rotational movement of the tool members 3462, 3482 can be + / −110 degrees, while the rotational movement of the position sensor 3588 can be limited to + / −45 degrees relative to the centerline of the position sensor 3588 (or the centerline CL of the distal wrist link 3610).

[0104] In some embodiments, the position sensor 3588 is a shape fiber, and the medical device includes a shape fiber carrier ( Figure 6 not shown in) coupled to the differential 3800. The shape fiber can include a single shape fiber or a bundle of multiple shape fibers. The position sensor 3588 can be at least partially disposed within the cavity of the shape fiber carrier.

[0105] In some embodiments, the differential 3800 includes a housing, a first planetary gear, a second planetary gear, and an annulus gear ( Figure 6 not shown in either). The medical device further includes a gear train, a first sun gear, and a second sun gear (both not shown in Figure 6 ). The first sun gear is integral with the first tool member 3462 and is coupled to the first planetary gear within the housing of the differential, and the second sun gear is integral with the second tool member 3482 and is coupled to the second planetary gear within the housing of the differential. The first planetary gear and the second planetary gear also mesh with each other within the housing. The annulus gear is integral with the exterior of the housing and is coupled to the gear train, which is indirectly coupled to the position sensor 3588. The housing is configured to rotate when one of the first tool member 3462 or the second tool member 3482 rotates relative to the other, such that the average direction of the positions of the tool members 3462, 3482 (e.g., relative to the distal wrist link) changes, and the rotation of the housing causes the rotation of the position sensor 3588. The orientation of the housing is associated with the average of a first deflection angle of the first tool member 3462 and a second deflection angle of the second tool member 3482.

[0106] When the direction of the average position of the tool members 3462, 3482 changes, the differential housing will rotate accordingly, which in turn moves the position sensor 3588 operatively coupled thereto. The position sensor 3588 can also provide the orientation of the distal wrist link 3610 (e.g., relative to the proximal wrist link), and can also provide position and velocity data related to the proximal wrist link, any elbows or other articulating joints, and any flexible instrument parts (e.g., flexible instrument shaft) that the position sensor may pass through. In some embodiments, the tension element actuating the jaws travels along the outside of the jaws, and the differential is encapsulated within the tool members 3462, 3482. In an alternative embodiment, the gear train connecting the differential 3800 to the distal position sensor 3588 can be replaced with a cable.

[0107] As described above, the differential 3800 can allow the use of a single position sensor 3588 to determine the positions of the two tool members 3462 and 3482. As described herein, a single position sensor 3588 can be used to determine the position and orientation of the tool members 3462, 3482, where the position sensor 3588 is indirectly coupled to the tool members 3462, 3482.

[0108] In some embodiments, the medical device 3400 can also include a connector link ( Figure 6 not shown) coupled between the distal wrist link 3610 and the proximal wrist link ( Figure 6 not shown). More specifically, the connector link includes a proximal end portion coupled to the proximal wrist link at the proximal link axis of rotation, and a distal end portion coupled to the distal wrist link 3610 at the distal link axis of rotation. Thus, the distal wrist link 3610 can rotate relative to the connector link about the distal link axis of rotation, and the connector link can rotate relative to the proximal wrist link about the proximal link axis of rotation. Through its coupling to the connector link, the distal wrist link 3610 can also rotate about the proximal wrist link axis of rotation. Embodiments including the connector link are described in more detail below with reference to the medical device 4400.

[0109] In some embodiments, the connector link defines an internal path through which the position sensor 3588 can extend. In some embodiments, other elongate elements can extend through the internal path of the connector link, such as for example wires, cables, tension elements, and the like. In some embodiments, the internal path includes tapered inlets at the proximal and distal ends of the internal path. In some embodiments, the distal end of the connector link is disposed distal to the distal link axis of rotation.

[0110] Figures 7 - 22CVarious views of a medical device 4400 (and parts thereof) according to an embodiment. In some embodiments, the medical device 4400 or any component thereof is optionally part of an instrument of a surgical system that performs a surgical procedure, and the surgical system may include a manipulator unit, a series of kinematic linkages, a series of cannulas, or the like. The medical device 4400 (and any of the instruments described herein) can be used with any suitable surgical system, such as the MIRS system 1000 shown and described above. As Figure 7 shown, the medical device 4400 includes a force transmission mechanism 4700, a shaft 4410, a wrist assembly 4500, and an end effector 4460. The medical device 4400 may also include one or more tension elements ( Figures 7 - 22C not shown). The tension elements can be, for example, cables, belts, and the like, which couple the force transmission mechanism 4700 to the wrist assembly 4500 and the end effector 4460.

[0111] Reference Figure 8 and Figure 9 , the medical device 4400 is configured such that movement of one or more of the tension elements results in rotation of the end effector 4460 about a first axis of rotation A1 (also referred to herein as the "tool member axis") (this first axis of rotation acts as a deflection axis (the term deflection is arbitrary)), rotation of the wrist assembly 4500 about a second axis of rotation A2 (also referred to as the "distal wrist rotation axis") or a third axis of rotation A3 (also referred to as the "proximal wrist rotation axis"), cutting (or gripping) rotation of the tool member of the end effector 4460 about the first axis of rotation A1, or any combination of these movements. Figure 8 Illustrates the distal wrist link 4610 and the proximal wrist link 4510 in a straight configuration. Figure 9 Illustrates the distal wrist link 4610 rotated relative to the proximal wrist link 4510 (i.e., in a "pitch" configuration), where the tool members 4462, 4482 are in a closed configuration. The tension elements can be manipulated in a similar manner as described for the above-described device 2400 and as described in U.S. Provisional Patent Application Serial No. 63 / 233,904 titled "Surgical Instrument Cable Control and Routing Structures" and U.S. Patent Publication No. 2020 / 0390430 (filed August 21, 2020) titled "Low-Friction, Small Profile Medical Tools Having Easy-to-Assemble Components" to effect changes in the pitch or deflection of the medical device 4400, the disclosures of each of which are incorporated herein by reference.

[0112] The force transmission mechanism 4700 generates movement of each tension element to produce a desired movement (pitch, yaw, and / or grasp) at the wrist assembly 4500 and the end effector 4460. Specifically, the force transmission mechanism 4700 includes components that can be controlled to move some of the tension elements in the proximal direction (i.e., to pull in certain tension elements) while allowing other tension elements to move in the distal direction (i.e., to release or “pay out”). In this way, the force transmission mechanism 4700 can cause the desired movement while also maintaining a desired tension within the tension elements. As Figure 7 shown, the force transmission mechanism 4700 includes a set of drive components, such as winches 4710 and 4720, that rotate or “wind” the proximal portion of any tension element to produce the desired tension element movement. In some embodiments, the two proximal ends of the tension elements associated with opposite directions of a single degree of freedom are connected to two independent drive winches 4710 and 4720. This arrangement is generally referred to as a counterdrive system and allows independent control of the movement (e.g., pulling in or paying out) of each end of the tension element. The force transmission mechanism 4700 generates movement of the tension element that operates to produce a desired articulating movement (pitch, yaw, and / or grasp) at the wrist assembly 4500 and the end effector 4460. Thus, the force transmission mechanism 4700 includes components and control means to move a first proximal end portion of the tension element in a first direction (e.g., the proximal direction) via a first winch 4710 and to move a second proximal end portion of the tension element in an opposite second direction (e.g., the distal direction) via a second winch 4720. The force transmission mechanism 4700 can also move the two proximal end portions of the tension element in the same direction. In this way, the force transmission mechanism 4700 can maintain a desired tension within the tension elements.

[0113] In some embodiments, the force transmission mechanism 4700 can include any of the components or parts described in U.S. Provisional Patent Application Serial No. 63 / 233,904, entitled “Surgical Instrument Cable Control and Routing Structures,” the entire disclosure of which is incorporated herein by reference. However, in other embodiments, any of the medical devices described herein can have the two ends of the tension element wound around a single winch. This alternative arrangement—generally referred to as a self-counterdrive system—operates the two ends of the tension element using a single drive motor.

[0114] In addition, although the force transfer mechanism 4700 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 proximal force transfer mechanism may include, for example, a universal joint, a lever, or any other suitable mechanism to directly pull (or release) an end portion of any of the cables in the cable. For example, in some embodiments, the proximal force transfer mechanism 4700 may include any of the proximal mechanical structures or components described in U.S. Patent Application Publication No. US2015 / 0047454 A1, filed August 15, 2014, titled "Lever Actuated Gimbal Plate", or U.S. Patent No. US 6,817,974 B2, filed June 28, 2001, titled "Surgical Tool Having Positively Positionable Tendon-Actuated Multi-Disk Wrist Joint", each of the above patents being incorporated herein by reference in its entirety.

[0115] The shaft 4410 can be any suitable elongated shaft that is coupled to the wrist assembly 4500 and the force transmission mechanism 4700. Specifically, the shaft 4410 includes a proximal end portion 4411 coupled to the force transmission mechanism 4700 and a distal end portion 4412 coupled to the wrist assembly 4500 (e.g., coupled to the proximal wrist link of the wrist assembly 4500). The shaft 4410 defines a channel or series of channels through which tension elements and other components (e.g., wires, ground wires, or the like) can be routed from the force transmission mechanism 4700 to the wrist assembly 4500. In some embodiments, the shaft 4410 can be formed at least in part of a conductive material such as stainless steel. In these embodiments, the shaft 4410 can include either an inner insulating cover or an outer insulating cover. Thus, the shaft 4410 can be a shaft assembly that includes a plurality of different components. For example, the shaft 4410 can include (or be coupled to) a spacer (not shown) that provides a desired fluid seal, electrical isolation features, and any other desired components for coupling the wrist assembly 4500 to the shaft 4410. Similarly, although the wrist assembly 4500 (and other wrist assemblies or links described herein) is described as being coupled to the shaft 4410, it should be understood that any of the wrist assemblies or links described herein can be coupled to the shaft via any suitable intermediate structure such as a spacer, cable guide, additional joint, and / or link or the like. In some embodiments, the shaft 4410 can be a substantially rigid member, while in other embodiments, the shaft 4410 can be a flexible member. In some embodiments, any of the medical devices described herein can include any of the spacers, seals, cable guides, or other structures described in U.S. Provisional Patent Application Serial No. 63 / 319,926, filed on February 15, 2022, and titled "Surgical Instrument Including Electrical and Fluid Isolation Features", the disclosure of which is incorporated herein by reference in its entirety.

[0116] As Figures 7 - 21 shown, the end effector 4460 includes a first tool member 4462 and a second tool member 4482, which are a pair of jaws in the present embodiment. In alternative embodiments, the end effector 4460 can include other types of tool members such as cautery devices, cutting devices, or other medical tools. The first tool member 4462 (also referred to herein as the "first jaw") and the second tool member 4482 (also referred to herein as the "second jaw") are each rotatable about a tool member axis of rotation A1.

[0117] Referring Figures 8 - 10, the wrist assembly 4500 includes a proximal wrist link 4510, a distal wrist link 4610, and a connector link 4580 (see, for example, Figure 9 and Figure 10 ). The proximal wrist link 4510 has a proximal end portion 4511 and a distal end portion 4512. The distal wrist link 4610 has a proximal end portion 4611 and a distal end portion 4612. As described in detail herein, the connector link 4580 is coupled between the proximal wrist link 4510 and the distal wrist link 4610 to form an articulated wrist assembly 4500. The proximal wrist link 4510 is coupled to the connector link 4580 via a pin joint such that the connector link 4580 can rotate relative to the proximal wrist link 4510 about a third axis of rotation A3. The distal wrist link 4610 is also coupled to the connector link 4580 via a pin joint such that the distal wrist link 4610 can rotate relative to the connector link 4580 about a second axis of rotation A2 and can also rotate relative to the proximal wrist link 4510 about the third axis of rotation A3. In this way, during rotation of the distal wrist link 4610 relative to the proximal wrist link 4510, the connector link 4580 maintains the coupling between the proximal wrist link 4510 and the distal wrist link 4610. For example, as shown in Figure 9 and Figure 10 , the distal wrist link 4610 and the proximal wrist link 4510 can be connected in rolling contact with gear teeth. This forces the angle between the centerline of the connector link 4580 and the centerline of the distal wrist link 4610 to always be the same or substantially the same as the angle between the centerline of the connector link 4580 and the centerline of the proximal wrist link 4510. In some embodiments, the proximal wrist link 4510 is fixedly coupled to the shaft 4410 such that the proximal wrist link 4510 cannot rotate relative to the shaft. However, in other embodiments, the proximal wrist link 4510 can be rotatably coupled to the shaft 4410.

[0118] For example, as shown in Figure 11 , the connector link 4580 includes a proximal end 4581 and a distal end 4582 and defines an internal path 4583 through which one or more elongate members can extend. The elongate member can be, for example, a wire, a cable, or a position sensor such as a shape fiber as described herein. In some embodiments, as shown in Figures 12 - 16As shown, the internal path 4583 includes tapered inlets at both the proximal end and the distal end of the internal path 4583. The tapered inlets can prevent sharp bends in the shaped fiber 4588, thereby maintaining a desired minimum bend radius on the shaped fiber 4588. In some embodiments, the distal end 4582 of the connector link 4580 is disposed distal to the distal end of the distal link rotation axis A2. The connector link 4580 also includes protrusions 4587 and 4586 for rotatably coupling the connector link 4580 to the proximal wrist link 4510 and the distal wrist link 4610, respectively. For example, the protrusions 4587 and 4586 can be received within corresponding openings (not shown) in the links 4510 and 4610, respectively. In other embodiments, the connector link 4580 can include openings, and the links 4510, 4610 can include corresponding protrusions that can be received within the openings of the connector link 4580.

[0119] As Figures 12 - 20 shown, the wrist assembly 4500 also includes a differential 4800, a gear train 4830, a shaped fiber carrier 4466, and a shaped fiber 4588. The shaped fiber 4588 can be a single optical fiber or a bundle of multiple optical fibers. The shaped fiber carrier 4466 includes a shaped fiber cavity 4468, and the shaped fiber 4588 extends distally within the shaped fiber cavity 4468 (see Figure 15 ). More specifically, the shaped fiber 4588 has a straight distal end portion 4589 (see Figure 15 ), which is fixedly coupled to the shaped fiber carrier 4466 within the shaped fiber cavity 4468. The distal end portion 4589 has a desired length and aids in precisely measuring the bend in other portions of the shaped fiber 4588. For example, the straight distal end portion 4589 allows for precise transmission and reflection of optical signals for position and orientation determination. The straight distal end portion 4589 can have a predetermined length (e.g., at least 3 mm, between 3 mm and 6 mm), and the shaped fiber cavity 4468 includes a distal portion that is shaped to accommodate the straight distal end portion 4589. In some embodiments, the shaped fiber 4588 can have a minimum bend radius, for example, between 5 mm and 6 mm. The shaped fiber 4588 extends through the proximal wrist link 4510, through the internal path 4583 of the connector link 4580, and extends distally into the shaped fiber cavity 4468.

[0120] The shaped fiber carrier 4466 surrounds Figure 12The carrier axis C1 shown in [Fig. 0] is pivotally coupled to the distal wrist link 4610 and is offset or spaced from the tool member axis A1. Thus, the distal end portion 4589 of the shape fiber 4588 is positioned between the carrier axis C1 and the tool member axis A1. The shape fiber carrier 4466 is operatively coupled to the tool members 4462 and 4482 via the differential 4800 and the gear train 4830. Thus, the shape fiber carrier 4466 and the shape fiber 4588 are indirectly coupled to the first tool member 4462 and the second tool member 4482. In other words, the shape fiber carrier 4466 and the shape fiber 4588 are spaced from each of the first tool member 4462 and the second tool member 4482. The differential 4800 allows the first tool member 4462 and the second tool member 4482 to rotate independently of each other while also being coupled to the shape fiber carrier 4466 (and causing movement therein). As described above for the previous embodiments, the shape fiber 4588 is coupled to the shape fiber carrier 4466 such that movement of the shape fiber carrier 4426 causes the shape fiber 4586 to bend or move. Since the shape fiber carrier 4466 is operatively coupled to the first tool member 4462 and the second tool member 4482 via the differential 4800 and the gear train 4830, when the first tool member 4462 or the second tool member 4482 rotates relative to each other, this movement causes the shape fiber carrier 4426 to move and the shape fiber 4588 coupled thereto also moves, thereby generating a signal related to the movement of the first tool member 4462, the second tool member 4482, or both. In some embodiments, the signal generated by the shape fiber 4588 includes a signal related to the average of the first deflection angle of the first tool member 4462 and the second deflection angle of the second tool member 4482.

[0121] The gear train 4830 includes a proximal gear 4831, a distal gear 4832, and two intermediate gears 4833 and 4834. The shape fiber carrier 4466 includes a spur gear 4828 that is coupled to and engages the proximal gear 4831. The distal gear 4832 is coupled to and engages the integral ring gear 4822 of the differential 4800 to transfer motion from the differential 4800 to the shape fiber carrier 4466, which will be described in more detail below. The intermediate gear 4833 couples the distal gear 4832 to the intermediate gear 4834, and the intermediate gear 4834 in turn is coupled to the proximal gear 4831. The gears of the gear train 4830 are shown by way of example, and in alternative embodiments there may be a different number of gears or gear configurations, such as having a greater or lesser number of gears.

[0122] Differential 4800 is coupled to first tool member 4462 and second tool member 4482, and is coupled to the shaped fiber carrier 4466 (via gear train 4830). More specifically, for example Figure 13 , Figure 15 , Figure 17 and Figures 19 - 22C as shown in, differential 4800 includes a housing 4820 having an integral ring gear 4822 on the outside of the housing 4820. As described above, ring gear 4822 is matingly engaged with the distal gear 4832 of gear train 4830. Differential 4800 includes a first planetary gear 4824 and a second planetary gear 4825 disposed within housing 4820 (see Figures 19 - 22C ). Planetary gears 4824, 4825 are rotatably coupled to housing 4820 and are rotatable relative to housing 4820 about their respective axes. First planetary gear 4824 is coupled to and matingly engaged with a first sun gear 4826 integral with first tool member 4462, and second planetary gear 4825 is coupled to and matingly engaged with a second sun gear 4827 integral with second tool member 4482 (see Figures 19 - 21 ). First planetary gear 4824 and second planetary gear 4825 are also engaged with each other within housing 4820 (see Figures 22A - 22C ).

[0123] When one of first tool member 4462 or second tool member 4482 rotates relative to the other such that the average direction of the positions of tool members 4462, 4482 (e.g., relative to distal wrist link 4610) changes, the associated sun gear 4826 or 4827 of the respective tool member 4462 or 4482 will engage the corresponding planetary gear 4824 or 4825 of differential 4800, which in turn causes housing 4820 to rotate about axis A1. The rotation of housing 4820 causes gear train 4832 to rotate via the engagement of ring gear 4822 with the distal gear 4832 of gear train 4830. Then, gear train 4830 will cause shaped fiber carrier 4426 to move via the engagement between the proximal gear 4831 of gear train 4830 and the spur gear 4828 of shaped fiber carrier 4466. Specifically, shaped fiber carrier 4466 rotates about rotation axis C1 relative to distal wrist link 4610. This in turn causes shaped fiber 4588 to move.

[0124] To further exemplify the rotation of the housing 4820, an instance of the rotation of the first tool member 4462 relative to the second tool member 4482 will be described. For example, consider the case where the first tool member 4462 rotates about the axis A1 relative to the second tool member 4482 via a first tension element, where the second tool member 4482 is held fixed about the axis A1 by a second tension element. In such an instance, the rotation of the first tool member 4462 about the axis A1 causes the first sun gear 4826 (integral with the first tool member 4462) to rotate about the axis A1, and then causes the first planet gear 4824 (rotatably coupled to the first sun gear 4826) to rotate about the axis of the first planet gear 4824. At the same time, since the second tool member 4482 is held fixed, the second sun gear 4827 (integral with the second tool member 4482) is held rotationally fixed. The second planet gear 4825 (rotatably coupled to the second sun gear 4827) moves in a circular path about the second sun gear 4827 that is held fixed. Thus, as the second planet gear 4827 moves in a circular path about the second sun gear 4827 of the second tool member 4482, it rotates about its own axis. The circular motion of the second planet gear 4825 (which is contained within the housing 4820) in turn causes the housing 4820 of the differential 4800 to rotate, thereby causing the movement of the shaped fiber carrier 4466 and the shaped fibers 4588. In other instances, when the second tool member 4482 rotates relative to the first tool member 4462, the housing 4820 will rotate, and when both tool members 4461 and 4482 rotate in a deflecting manner relative to the wrist assembly 4500 together, the housing 4820 will also rotate.

[0125] When the direction of the average position of the tool members 4462, 4482 changes, the differential housing 4820 will rotate accordingly, which in turn moves the shape fiber 4588 operably coupled thereto. The rotation or orientation of the housing 4820 is associated with the average of the first deflection angle of the first tool member 4462 and the second deflection angle of the second tool member 4482. More specifically, when the shape fiber 4588 bends proportionally to the average / difference between the two tool members 4462, 4482, the position measurements of the tool members 4462, 4482 are determined. The use of the differential 4800 limits the movement of the shape fiber 4588 to accommodate the limitations on the bending radius of the shape fiber 4588 and to accommodate the straight section at the distal tip of the shape fiber 4588. In some embodiments, the differential 4800 and / or the gear train 4830 are configured such that the ratio of the rotation angles of the first tool member 4462 and the second tool member 4482 to the rotation angle of the shape fiber carrier 4466 is greater than 1:1. In this way, the differential 4800 and / or the gear train 4830 can reduce the amount of movement transferred to the shape fiber carrier 4466, thus accommodating the space constraints within the medical device 4400. In some embodiments, the ratio of the movement of the tool members 4462, 4482 to the movement of the shape fiber carrier 4466 is approximately 2:1. In other embodiments, the ratio of the movement of the tool members 4462, 4482 to the movement of the shape fiber carrier 4466 is approximately 3:1. For example, the rotational movement of the tool members 4462, 4482 can be + / −110 degrees, while the rotational movement of the shape fiber 4588 relative to the centerline of the shape fiber carrier 4466 can be limited to + / −45 degrees. When the shape fiber 4588 moves or bends, the shape fiber 4588 generates a signal related to the movement of the shape fiber 4588. In some embodiments, the signal generated by the shape fiber 4588 is associated with the average of the first deflection angle of the first tool member 4462 and the second deflection angle of the second tool member 4482.

[0126] As described herein, the differential 4800 may allow for the use of a single shape fiber sensor to determine the positions of two tool members 4462 and 4482. A single shape fiber sensor (e.g., shape fiber 4588) may be used to determine the position and orientation of the tool members 4462, 4482, where the shape fiber 4588 is not directly coupled to the tool members 4462, 4482. In addition to providing position and orientation information of the tool members 4462, 4482, in some embodiments, the movement of the shape fiber carrier 4466 also causes the shape fiber 4588 to generate a signal related to the movement of the distal wrist link 4610. In some embodiments, the movement of the shape fiber carrier 4466 also causes the shape fiber 4588 to generate a signal related to the movement of the proximal articulation joint and / or linkages (such as the proximal wrist link 4510 and other flexible instrument parts (e.g., flexible instrument shaft)). Thus, the shape fiber 4588 can be used to determine the position and orientation of the tool members 4462, 4482 and other parts of the medical device.

[0127] Figures 23 - 29E Illustrates a portion of a medical device 5400 according to an embodiment. In some embodiments, the medical device 5400 or any component thereof is optionally part of an instrument of a surgical system for performing a surgical procedure, and the surgical system may include a manipulator unit, a series of kinematic linkages, a series of cannulas, etc. The medical device 5400 (and any of the instruments described herein) can be used with any suitable surgical system, such as the MIRS system 1000 shown and described above. The medical device 5400 includes a wrist assembly 5500 and an end effector 5460, and the end effector 5460 includes a first tool member 5462 and a second tool member 5482. The medical device 5400 may also include a shaft (not shown) and a force transmission mechanism (not shown), which may be the same as or similar to the shaft 4410 and the force transmission mechanism 4700 discussed above, and serve the same or similar functions as the shaft 4410 and the force transmission mechanism 4700 discussed above. The medical device 5400 also includes one or more tension elements 5420 (see Figure 23 and Figure 24 ). The tension element 5420 may be, for example, a cable, a belt, or the like that couples the force transmission mechanism to the wrist assembly 5500 and the end effector 5460.

[0128] As discussed above for the previous embodiments, the medical device 5400 is configured such that movement of one or more of the tension elements 5420 causes rotation of the end effector 5460 about a first axis of rotation A1 (also referred to herein as the “tool member axis”), which first axis of rotation serves as a deflection axis (the term deflection being arbitrary), rotation of the wrist assembly 5500 about a second axis of rotation A2 (also referred to as the “distal wrist rotation axis”) or a third axis of rotation (not shown) (also referred to as the “proximal wrist rotation axis”), cutting (or grasping) rotation of the tool members of the end effector 5460 about the first axis of rotation A1, or any combination of these movements. Figure 23 Illustrated is the distal wrist link 5610 in a straight configuration and the tool members 5462 and 5482 in an open configuration (rotationally spaced relative to each other). The tension elements 5420 can be manipulated in a manner similar to that described for the devices 2400 and 4400 above and in U.S. Provisional Patent Application Serial No. 63 / 233,904 titled “Surgical Instrument Cable Control and RoutingStructures” and U.S. Patent Publication No. 2020 / 0390430 (filed August 21, 2020) titled “Low-Friction, SmallProfile Medical Tools Having Easy-to-Assemble Components” to effect changes in the pitch and / or deflection of the medical device 5400, the disclosures of each of the above patent applications being incorporated herein by reference.

[0129] As Figures 23 - 29E shown, in this embodiment, the first tool member 5462 and the second tool member 5482 are a pair of jaws. In alternative embodiments, the end effector 5460 can include other types of tool members, such as cautery devices, cutting devices, or other medical tools. The first tool member 5462 (also referred to herein as the “first jaw”) and the second tool member 5482 (referred to herein as the “second jaw”) are each rotatable about the tool member axis of rotation A1. More specifically, the first tool member 5462 and the second tool member 5482 are rotatably coupled to the distal wrist link 5610 via pins 5615.

[0130] The wrist assembly 5500 includes a proximal wrist link (not shown) that can be the same as or similar to the proximal wrist link 4510, a distal wrist link 5610 that can be the same as or similar to the connector link 4580, and an optional connector link (not shown). The distal wrist link 5610 has a proximal end portion 5611 and a distal end portion 5612. The optional connector link can be coupled between the proximal wrist link and the distal wrist link 5610 to form an articulated wrist assembly 5500 in the same manner as described for the wrist link assembly 4500. In some embodiments, the proximal wrist link is fixedly coupled to the shaft such that the proximal wrist link cannot rotate relative to the shaft. However, in other embodiments, the proximal wrist link can be rotatably coupled to the shaft.

[0131] For example, as Figures 24 - 25 shown, the wrist assembly 5500 further includes an intermediate coupling mechanism 5840, a shape fiber carrier 5466, and a shape fiber 5588. In this embodiment, the intermediate coupling mechanism functions as a cam mechanism 5840 described in more detail below. The shape fiber carrier 5466 is rotatably coupled to the first tool member 5462 and the second tool member 5482 via a pin 5615 such that the shape fiber carrier 5466 can rotate about the tool axis A1 together with the first jaw 5462 and / or the second jaw 5482. The shape fiber carrier 5466 defines a shape fiber cavity 5468, and the distal end of the shape fiber 5588 extends into the shape fiber cavity 5468. Thus, the shape fiber 5588 is coupled to the shape fiber carrier 5466 such that movement of the shape fiber carrier 5466 causes the shape fiber 5588 to bend or move. For example, as Figures 24 - 27 shown, the shape fiber cavity 5468 has a closed distal end. In an alternative embodiment, the shape fiber cavity 5468 can extend through the shape fiber carrier 5466 to an open end, through an opening in the pin 5615, and extend to the outside and distal end of the shape fiber carrier 5466. Further, in some alternative embodiments, the shape fiber carrier 5466 and the pin 5615 can be integrally formed as a single part. In another alternative embodiment, the shape fiber carrier 5466 is integrally formed with the pin 5615 as a single part, and the shape fiber cavity 5468 extends through the shape fiber carrier 5466 to an open end, through an opening in the pin 5615, and extends to the outside and distal end of the shape fiber carrier 5466, and the shape fiber carrier 5466 is integrally formed with the pin 5615 as a single part.

[0132] Because the shaped fiber carrier 5466 is rotatably coupled to the first tool member 5462 and the second tool member 5482, when the first tool member 5462 or the second tool member 5482 rotates relative to each other or moves relative to the distal link 5610, this movement causes the shaped fiber carrier 5466 to move, which in turn causes the shaped fiber 5588 coupled thereto to move. As described in more detail below, the shaped fiber 5588 thereby generates a signal related to the movement of the first tool member 5462, the second tool member 5482, or both. In some embodiments, the signal generated by the shaped fiber 5588 includes a signal related to the average of a first deflection angle of the first tool member 5462 and a second deflection angle of the second tool member 5482.

[0133] The shaped fiber 5588 can be a single optical fiber or a bundle of multiple optical fibers. The shaped fiber 5588 has a straight distal end portion 5589 (see Figure 25 ), and the straight distal end portion 5589 is fixedly coupled to the shaped fiber carrier 5466 within the shaped fiber cavity 5468 such that the distal end portion 5589 of the shaped fiber 5588 is spaced apart (e.g., disposed at a distance) from each of the first tool member 5462 and the second tool member 5482. In other words, the shaped fiber 5588 is indirectly coupled to the first tool member 5462 and the second tool member 5482. The distal end portion 5589 has a desired length and facilitates precise measurement of the bending in other portions of the shaped fiber 5588. For example, the straight distal end portion 5589 allows for precise transmission and reflection of optical signals for position and orientation determination. The straight distal end portion 5589 can have a predetermined length (e.g., at least 3 mm, between 3 mm and 6 mm), and the shaped fiber cavity 5468 includes a distal portion that is shaped to accommodate the straight distal end portion 5589. In some embodiments, the shaped fiber 5588 can have a minimum bending radius, for example, between 4 mm and 5 mm. The shaped fiber 5588 extends through a proximal wrist link (not shown), through an internal path of a connector link (not shown), and extends distally within the shaped fiber cavity 5468.

[0134] The cam mechanism 5840 includes a cam disk 5842 and a notch 5846. The cam disk 5842 defines cam grooves 5844 and 5845. The shaped fiber carrier 5466 is received within the notch 5846 of the cam disk 5842 such that when the cam disk 5842 rotates, the shaped fiber carrier 5466 received within the notch 5846 also rotates about the tool axis A1. Additionally, the cam disk 5842 rotates in response to rotation of the first tool member 5462 and / or the second tool member 5482 relative to each other and / or relative to the distal link 5610. Thus, the cam disk 5842 functions as an intermediate coupling mechanism to couple the shaped fiber carrier 5466 to the first tool member 5462 and the second tool member 5482. As Figure 25 shown and described in more detail below, the cam disk 5842 can also slide or translate relative to the shaped fiber carrier 5466 in a direction parallel to the centerline CLsfc of the shaped fiber carrier 5466 or in the directions of arrows T1 and T2. Thus, as described below, the cam mechanism can produce an eccentric motion of the cam disk 5842.

[0135] For example, as Figure 25- As shown in FIG. 27, the cam disk 5842 is positioned between the first tool member 5462 and the second tool member 5482. The first tool member 5462 has a cam pin 5448 received within a cam groove 5844 of the cam disk 5842, and the second tool member 5482 has a cam pin 5449 received within a cam groove 5845 of the cam disk 5842. When the first tool member 5462 rotates about the tool axis A1, the cam pin 5448 moves within the cam groove 5844, and when the second tool member 5482 rotates about the tool axis A1, the cam pin 5449 moves within the groove 5845. Thus, the rotational movement of the first tool member 5462 and the second tool member 5482 causes movement of the pins within the cam grooves 5844 and 5845 of the cam disk 5842. This movement in turn causes the cam disk 5842 to rotate. The cam grooves 5844 and 5855 are linear and are angled slightly relative to the centerline CLsfc of the shaped fiber carrier 5466, and are sized and positioned on the cam disk 5842 to provide some minimal interference between the cam disk 5842 and the tool members 5462 and 5482, but not so much interference as to negatively interfere with the movement of the tool members 5462 and 5482. If the cam grooves 5844 and 5845 were positioned to extend orthogonally to the centerline CLsfc of the shaped fiber carrier 5466, the range of motion of the tool members 5462 and 5482 would be too restricted (e.g., limited to less than the desired available range of motion of the tool members 5462, 5482), and the engagement between the cam pins 5448 and 5489 and the cam disk 5842 would be poor. Conversely, when the tool members 5462, 5428 move between fully open and closed configurations, it is desirable for the cam grooves 5844 and 5845 to be orthogonal, or as close as possible to orthogonal, to the travel paths of the cam pins 5448 and 5449. Thus, the position of the cam grooves 5844 and 5845 relative to the position of the cam pins 5448, 5489 and their movement is important for the proper operation of the cam mechanism 5840.

[0136] Although the cam grooves 5844 and 5845 are shown as being disposed on the cam disk 5842 and in the same plane as the shaped fiber carrier 5466, in alternative embodiments, the cam grooves can be offset from the shaped fiber carrier 5466. In some alternative embodiments, the shaped fiber carrier 5466 can be positioned distally of the cam grooves 5844 and 5845 rather than proximally as in the medical device 5400.

[0137] As described above, the lengths and positions of the cam grooves 5844, 5845 and the movement of the cam disk 5842 relative to the shaped fiber carrier 5466 cause the shaped fiber carrier 5466 and the shaped fibers 5588 coupled thereto to remain in a central position between the first tool member 5462 and the first tool member 5422 during the entire rotational movement of the first tool member 5462 and the second tool member 5482. Similarly, it is illustrated that the rotational position of the cam disk 5842 is associated with the average value of the first deflection angle of the first tool member 5462 and the second deflection angle of the second tool member 5482. More specifically, as Figures 28A - 29A shown, the shaped fiber vector V is defined at the center line CLsfc of the shaped fiber carrier 5466. When the first tool member 5462 and the second tool member 5482 rotate relative to the distal link 5610 ( Figure 28A ) and / or relative to each other ( Figure 28B and Figure 28C ), the center line CLsfc of the shaped fiber carrier 5466 remains centered between the first tool member 5422 and the second tool member 5482. Accordingly, the distal end 5589 of the shaped fiber 5588 (coupled to the shaped fiber carrier 5466) is oriented along the vector V related to the average value of the first deflection angle of the first tool member 5462 and the second deflection angle of the second tool member 5482, and outputs a signal related to the vector V.

[0138] Figures 29A - 29E Illustrates the exemplary positions of the first tool member 5462 and the second tool member 5482 and the position and orientation of the cam disk 5842 relative to the shaped fiber carrier 5466 during rotational movement of the first tool member 5462 and the second tool member 5482 relative to each other and / or relative to the distal link 5610. For purposes of illustration, a portion of the second tool member 5482 is not shown. Figure 29A Illustrates the first tool member 5462 and the second tool member 5482 rotating away from each other in a first orientation. In this orientation, a gap G1 is defined between the cam disk 5842 and the shaped fiber carrier 5466. Figure 29B Illustrates the first tool member 5462 and the second tool member 5482 rotating away from each other in a second orientation, where the jaws are spaced slightly further apart than in the first orientation and also rotate downward relative to the distal link 5610 about the axis A1. In this orientation, a gap G2 is defined between the cam disk 5842 and the shaped fiber carrier 5466, the gap G2 being substantially the same as the gap G1, and the cam pins 5448 and 5449 are positioned approximately at the centers of the respective cam grooves 5844 and 5845. Figure 29CIllustrated is that the first tool member 5462 and the second tool member 5482 are rotated apart from each other by a maximum distance (note that the pins 5448 and 5449 are at the maximum travel distance within the cam grooves 5844 and 5845). In this orientation, a gap G3 is defined between the cam disk 5842 and the shaped fiber carrier 5466, and this gap G3 is larger than the gap G1 and the gap G2. More specifically, as the first tool member 5462 and the second tool member 5482 are moved further apart from each other, the cam pin 5448 moves to the position at the top of the cam groove 5844, the cam pin 5449 moves to the position at the bottom of the cam groove 5845, and the cam disk 5842 translates in the T2 direction relative to the shaped fiber carrier 5466. Thus, the cam disk 5842 both rotates and translates.

[0139] Figure 29D Illustrated is that the first tool member 5462 and the second tool member 5482 are in a partially closed orientation relative to each other (i.e., rotated towards each other) and are slightly rotated relative to the distal link 5610. As the first tool member 5462 and the second tool member 5482 are moved closer together, the cam pin 5448 moves to a position near the bottom of the cam groove 5844, the cam pin 5449 moves to a position near the top of the cam groove 5845, and the cam disk 5842 slides in the direction T1 relative to the shaped fiber carrier 5466 to define a gap G4 between the shaped fiber carrier 5466 and the cam disk 5842 that is smaller than the gaps G1, G2, and G3. Figure 29E Illustrated are the first tool member 5462 and the second tool member 5482 in a fully closed orientation relative to each other. In this position, the cam pin 5448 moves to the position at the bottom of the cam groove 5844, the cam pin 5449 moves to the position at the top of the cam groove 5845, and the cam disk 5842 slides in the direction T1 relative to the shaped fiber carrier 5466 and closes the gap between the shaped fiber carrier 5466 and the cam disk 5842.

[0140] When one of the first tool member 5462 or the second tool member 5482 rotates relative to the other such that the average direction of the positions of the tool members 5462, 5482 (e.g., relative to the distal wrist link 5610) changes, due to the engagement between the cam mechanism 5840 and the first tool member 5422 and the second tool member 5482, the shaped fiber carrier 5466 will move. For example, as Figures 29A - 29E shown, the shaped fiber carrier 5466 rotates about the tool axis A1 relative to the distal wrist link 5610. This in turn causes the shaped fiber 5588 to move. The rotation or orientation of the shaped fiber carrier 5466 is associated with the average value of the first deflection angle of the first tool member 5462 and the second deflection angle of the second tool member 5482 (as Figures 28A - 29Aas exemplified by the vector V in). More specifically, when the shaped fiber 5588 is bent in proportion to the average between the two tool members 5462, 5482, a measurement of the position of the tool members 5462, 5482 is determined. The use of the cam mechanism 5840 can limit the range of motion of the first tool member 5462 and the second tool member 5482 and / or the range of motion of the shaped fiber 5588 to accommodate the limitations on the bending radius of the shaped fiber 5588 and to accommodate the straight section at the distal tip portion 5589 of the shaped fiber 5518. In some embodiments, the signal generated by the shaped fiber 5588 is associated with the average of the first deflection angle of the first tool member 5462 and the second deflection angle of the second tool member 5482.

[0141] As described herein, the cam mechanism 5840 can allow the use of a single shaped fiber sensor (e.g., the shaped fiber 5588) to determine the positions of the two tool members 5462 and 5482. A single shaped fiber sensor can be used to determine the position and orientation of the tool members 5462, 5482, where the shaped fiber 5588 is not directly coupled to the tool members 5462, 5482. In addition to providing position and orientation information of the tool members 5462, 5482, in some embodiments, the movement of the shaped fiber carrier 5466 also causes the shaped fiber to generate a signal related to the movement of the distal wrist link 5610. In some embodiments, the movement of the shaped fiber carrier 5466 also causes the shaped fiber 5588 to generate a signal related to the movement of the proximal hinge joint and / or linkages (such as the proximal wrist link and other flexible instrument parts (e.g., the flexible instrument shaft)). Thus, the shaped fiber 5588 can be used to determine the position and orientation of the tool members 5462, 5482 and other parts of the medical device.

[0142] Figures 30 - 38Illustrates a part (and multiple parts thereof) of a medical device 6400 according to an embodiment. In some embodiments, the medical device 6400 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, or the like. The medical device 6400 (and any of the instruments described herein) can be used with any suitable surgical system, such as the MIRS system 1000 shown and described above. The medical device 6400 includes a wrist assembly 6500 and an end effector 6460, and the end effector 6460 includes a first tool member 6462 and a second tool member 6482. The medical device 6400 may also include a shaft (not shown) and a force transmission mechanism (not shown), which may be the same as or similar to the shaft 4410 and the force transmission mechanism 4700 discussed above, and perform the same or similar functions as the shaft 4410 and the force transmission mechanism 4700 discussed above. The medical device 6400 also includes one or more tension elements (not shown), such as the tension element 5420 described above. The tension element may be, for example, a cable, a belt, or the like that couples the force transmission mechanism to the wrist assembly 6500 and the end effector 6460.

[0143] As discussed above for the previous embodiments, the medical device 6400 is configured such that the movement of one or more of the tension elements results in the rotation of the end effector 6460 about a first axis of rotation A1 (also referred to herein as the "tool member axis") (this first axis of rotation serves as a deflection axis (the term deflection is arbitrary)), the rotation of the wrist assembly 5500 about a second axis of rotation A2 (also referred to as the "distal wrist rotation axis") or a third axis of rotation (not shown) (also referred to as the "proximal wrist rotation axis"), the cutting (or grasping) rotation of the tool members of the end effector 6460 about the first axis of rotation A1, or any combination of these movements. Figure 30Illustrated is the distal wrist link 6610 in a straight configuration and the tool members 6462 and 6482 in a closed configuration relative to each other. The tension elements can be manipulated in a manner similar to that described above for the devices 2400 and 4400 and in U.S. Provisional Patent Application Serial No. 63 / 233,904 titled "Surgical Instrument Cable Control and Routing Structures" and U.S. Patent Publication No. 2020 / 0390430 (filed on August 21, 2020) titled "Low-Friction, Small Profile Medical Tools Having Easy-to-Assemble Components" to effect a change in the pitch or deflection of the medical device 6400, the disclosure of each of which is hereby incorporated by reference herein.

[0144] As Figures 30 - 35 and Figure 37 shown, in this embodiment, the first tool member 6462 and the second tool member 6482 are a pair of jaws. In an alternative embodiment, the end effector 6460 can include other types of tool members, such as a cauterization device, a cutting device, or other medical tools. The first tool member 6462 (also referred to herein as the "first jaw") and the second tool member 6482 (referred to herein as the "second jaw") are each rotatable about a tool member axis of rotation A1 (see Figure 30 ). More specifically, the first tool member 6462 and the second tool member 6482 are rotatably coupled to the distal wrist link 6610 via a pin 6615.

[0145] The wrist assembly 6500 includes a proximal wrist link (not shown) that can be the same or similar to the proximal wrist link 4510, a distal wrist link 6610 that can be the same or similar to the connector link 4580, and an optional connector link (not shown). The distal wrist link 6610 has a proximal end portion 6611 and a distal end portion 6612. The optional connector link is coupled between the proximal wrist link and the distal wrist link 6610 to form an articulated wrist assembly 6500 in the same manner as described for the wrist link assembly 4500. In some embodiments, the proximal wrist link is fixedly coupled to the shaft such that the proximal wrist link cannot rotate relative to the shaft. However, in other embodiments, the proximal wrist link can be rotatably coupled to the shaft.

[0146] For example, as Figures 31 to 37 shown, the wrist assembly 6500 also includes an intermediate coupling mechanism 6860, a shape fiber carrier 6466, and shape fibers 6588 (see Figure 33)。In this embodiment, the intermediate coupling mechanism 6860 is a torsion spring mechanism including a first spring 6864 and a second spring 6865, and will be described in more detail below. The shaped fiber carrier 6466 is coupled to the first tool member 6462 and the second tool member 6482 via a pin 6615 such that the shaped fiber carrier 6466 can rotate about the tool axis A1 with the first jaw 6462 and / or the second jaw 6482. The shaped fiber carrier 6466 defines a shaped fiber cavity 6468 in which the distal end of the shaped fiber 6588 extends (see Figure 33 ). Thus, the shaped fiber 6588 is coupled to the shaped fiber carrier 6466 such that movement of the shaped fiber carrier 6466 causes the shaped fiber 6588 to bend or move. The shaped fiber carrier 6466 also defines an opening 6467 to which the springs of the torsion spring mechanism 6860 are coupled as described below.

[0147] Because the shaped fiber carrier 6466 is rotatably coupled to the first tool member 6462 and the second tool member 6482, when the first tool member 6462 or the second tool member 6482 rotates relative to each other or moves relative to the distal link 6610, this movement causes the shaped fiber carrier 6466 to move, and in turn causes the shaped fiber 6588 coupled thereto to move. The shaped fiber 6588 thereby generates a signal related to the movement of the first tool member 6462, the second tool member 6482, or both, as described in more detail below. In some embodiments, the signal generated by the shaped fiber 6588 includes a signal related to the average of a first deflection angle of the first tool member 6462 and a second deflection angle of the second tool member 6482.

[0148] The shaped fiber 6588 can be a single optical fiber or a bundle of multiple optical fibers. The shaped fiber 6588 has a straight distal end portion 6589 (see Figure 33) The straight distal end portion 6588 is fixedly coupled within the shape fiber cavity 5468 to the shape fiber carrier 6466 such that the distal end portion 6539 of the shape fiber 6588 is spaced apart (e.g., disposed at a distance) from each of the first tool member 6462 and the second tool member 6482. In other words, the shape fiber 5588 is indirectly coupled to the first tool member 6462 and the second tool member 6482. The distal end portion 6589 has a desired length and facilitates precise measurement of the bending in other portions of the shape fiber 6588. For example, the straight distal end portion 6589 allows for precise transmission and reflection of optical signals for position and orientation determination. The straight distal end portion 6589 can have a length of at least 3 mm (e.g., between 3 mm and 6 mm), and the shape fiber cavity 6468 includes a distal portion that is shaped to accommodate the straight distal end portion 5589. In some embodiments, the shape fiber 6588 can have a minimum bending radius, for example, between 4 mm and 5 mm. The shape fiber 6588 extends through a proximal wrist link (not shown), through an internal path of a connector link (not shown), and extends distally within the shape fiber cavity 6468.

[0149] The intermediate coupling mechanism 6860 (also referred to as the "torsion spring mechanism") includes a first torsion spring 6864 and a second torsion spring 6865 coupled on opposite sides of the shape fiber carrier 6466. The torsion springs 6864, 6865 can be spiral torsion springs (also referred to as "clock springs"), helical torsion springs, torsion bars or fibers, or any other suitable torsion spring design. In this embodiment, the torsion spring mechanism includes two clock springs. The first clock spring 6864 includes an annular end portion 6861 and a tab portion 6868 at an opposite end of the annular end portion 6861 (see Figure 34 and Figure 36B ). Similarly, the second clock spring 6865 includes an annular end portion 6863 and a tab portion 6869 at an opposite end of the annular end portion 6863 (see Figure 34 and Figure 36B ). The annular end portion 6861 of the clock spring 6864 is coupled to the pin 6448 of the first tool member 6462 (see Figures 31 - 35 ), and the tab portion 6868 engages an opening 6467 of the shape fiber carrier 6466. The annular end portion 6863 of the clock spring 6865 is coupled to the pin 6449 of the second tool member 6482 (see Figure 35) and the tab portions 6869 are engaged with the openings 6467 of the shaped fiber carrier 6466. The engagement of the tab portions 6868 and 6869 of the clock springs 6464 and 6465, respectively, within the openings 6467 of the shaped fiber carrier 6466 acts on the shaped fiber carrier 6466 and causes it to rotate as the first tool member 6462 and / or the second tool member 6482 rotates.

[0150] As Figure 38 schematically shown, the opposing forces applied by the clock springs 6864 and 6865 balance the position of the shaped fiber carrier 6466 such that the shaped fiber carrier 6466 (and the corresponding shaped fiber 6588) is aligned with the centerline between the jaws. Specifically, the opposing forces applied by the clock springs 6864 and 6865 balance the shaped fiber carrier 6466 such that when the first tool member 6462 and the second tool member 6482 move relative to each other or relative to the distal link 6610, the centerline CLsfc of the shaped fiber carrier 6466 remains at an approximately central position between the first tool member 6462 and the second tool member 6482. Similarly stated, the rotational position of the shaped fiber carrier 6466 is associated with the average of the first deflection angle of the first tool member 6462 and the second deflection angle of the second tool member 6482. The orientation of the shaped fiber carrier 6466 relative to the average deflection angle is affected by the spring stiffnesses of the two clock springs 6864 and 6865. For example, if the clock springs 6864 and 6865 have the same spring stiffness and the friction and other losses are the same, the opposing forces applied to the shaped fiber carrier 6466 will be the same and the shaped fiber carrier 6466 will remain in the central position between the first tool member 6462 and the second tool member 6482. However, a slight difference in the spring stiffnesses between the clock springs (e.g., caused by manufacturing tolerances, etc.) may cause the rotational position of the shaped fiber carrier 6466 to deviate slightly from the average of the first deflection angle of the first tool member 6462 and the second deflection angle of the second tool member 6482. Thus, in some embodiments, any of the instruments described herein (including instrument 6400) may include an electronic circuitry as described herein (see, e.g., the electronic circuit board 1815 and method described below) that may include a calibration module to ensure that an adjustment signal representative of the average deflection angle is generated. Thus, the shaped fiber 6588 (coupled to the shaped fiber carrier 6466) is oriented along a shaped fiber vector V (as Figure 37 shown) related to the average of the first deflection angle of the first tool member 6462 and the second deflection angle of the second tool member 6482 and outputs a signal related to the vector V.

[0151] When one of the first tool member 6462 or the second tool member 6482 rotates relative to the other such that the average direction of the positions of the tool members 6462, 6482 (e.g., relative to the distal wrist link 6610) changes, the shaped fiber carrier 6466 will move via the engagement between the torsion spring mechanism 6860 and the first tool member 6462 and the second tool member 6482. The shaped fiber carrier 6466 rotates about the tool axis A1 relative to the distal wrist link 6610. This in turn causes the shaped fiber 6588 to move. The rotation or orientation of the shaped fiber carrier 6466 is associated with the average value of the first deflection angle of the first tool member 6462 and the second deflection angle of the second tool member 6482. More specifically, when the shaped fiber 6588 bends in proportion to the average value between the two tool members 6462, 6482, the measured values of the positions of the tool members 6462, 6482 are determined. The use of the torsion spring mechanism 6860 is associated with the movement of the first tool member 6462 and the second tool member 6482 and the shaped fiber 6588. In some embodiments, the clock spring design can also accommodate the limitations on the bending radius of the shaped fiber 6588, as well as accommodate the straight section at the distal tip portion 6589 of the shaped fiber 6538. When the shaped fiber 6588 moves or bends, the shaped fiber 6588 generates a signal related to the movement of the shaped fiber 6588. In some embodiments, the signal generated by the shaped fiber 6588 is associated with the average value of the first deflection angle of the first tool member 6462 and the second deflection angle of the second tool member 6482.

[0152] As described herein, the torsion spring mechanism 6860 can allow the use of a single shaped fiber sensor (e.g., the shaped fiber 6588) to determine the positions of the two tool members 6462 and 6482. A single shaped fiber sensor can be used to determine the position and orientation of the tool members 6462, 6482, where the shaped fiber 6588 is not directly coupled to the tool members 6472, 6482. In addition to providing the position and orientation information of the tool members 6462, 6482, in some embodiments, the movement of the shaped fiber carrier 6466 also causes the shaped fiber to generate a signal related to the movement of the distal wrist link 6610. In some embodiments, the movement of the shaped fiber carrier 6466 also causes the shaped fiber 6588 to generate a signal related to the movement of the proximal hinge joint and / or linkages (such as the proximal wrist link and other flexible instrument parts (e.g., the flexible instrument shaft)). Thus, the shaped fiber 6588 can be used to determine the position and orientation of the tool members 6462, 6482 and other parts of the medical device.

[0153] Figure 39is a flowchart of an example method of assembling a medical device as described herein, the medical device having shape fiber sensors (e.g., 2588, 3588, 4588, 5588, 6588) to generate signals related to movement of the shape fiber sensors associated with an average of a first deflection angle of a first tool member of the medical device and a second deflection angle of a second tool member. Method 90 includes, at 91, providing an instrument having a first tool member (e.g., a first jaw) and a second tool member (e.g., a second jaw) coupled to a distal wrist link. At 92, pivotally coupling a shape fiber carrier to the distal wrist link, wherein the shape fiber carrier defines a shape fiber cavity. At 93, coupling a distal end of the shape fiber to the shape fiber carrier such that the shape fiber is indirectly coupled to the first jaw and the second jaw and such that movement of the shape fiber carrier causes the shape fiber to generate a signal related to movement of at least one of the first jaw and the second jaw. For example, the distal end of the shape fiber may be fixedly coupled to the shape fiber carrier within the shape fiber cavity. At 94, optionally coupling an intermediate coupling mechanism to the shape fiber carrier such that the shape fiber is indirectly coupled to the first jaw and the second jaw via the shape fiber carrier and the intermediate coupling mechanism. The intermediate coupling mechanism may include, for example, a differential having a gear train, a cam mechanism, a torsion spring mechanism, or other suitable mechanism to function as described herein.

[0154] The medical device described herein can be used to control movement of tool members (e.g., jaws) and processing of signals generated by shape fiber sensors (e.g., 2588, 3588, 4588, 5588, 6588). For example, the medical device can include a first tool member and a second tool member each coupled to a distal wrist link, a shape fiber carrier pivotally coupled to the distal wrist link, and a shape fiber fixedly coupled within a shape fiber cavity of the shape fiber carrier, wherein the shape fiber is indirectly coupled to the first tool member and the second tool member (e.g., the shape fiber is spaced apart from the tool members). A method of using the medical device can include rotating at least one of the first tool member or the second tool member such that the shape fiber carrier rotates and the shape fiber generates a signal proportional to movement of the at least one of the first tool member or the second tool member. For example, the signal generated by the shape fiber can include a signal related to an average of a first deflection angle of the first jaw and a second deflection angle of the second jaw.

[0155] In some embodiments, any of the devices or systems described herein can include electronic circuitry (e.g., a device circuit board or controller) to generate an output from the shape fibers. The output can be used, for example, to generate haptic feedback at the user control unit 1100. In some embodiments, any of the devices in the device can include a circuit board that includes storage means and / or processing that can be calibrated during manufacturing such that the output from the shape fiber sensor is associated with the average of a first deflection angle of a first jaw and a second deflection angle of a second jaw. For example, Figure 40 FIG. Figure 40 is a schematic diagram illustrating one embodiment of suitable components that can be included within the electronic circuit board 1815. In some embodiments, the electronic circuit board 1815 is positioned within the device 1400 (e.g., within the proximal mechanical structure). In other embodiments, the electronic circuit board 1815 is a component of other parts of the surgical system 1000, such as the user control unit 1100 and / or the optional accessory instrument unit 1150. However, the electronic circuit board 1815 can also include a distributed computing system where at least one aspect of the electronic circuit board 1815 is at a location different from the rest of the components of the surgical system 1000. For example, at least a portion of the electronic circuit board 1815 can be an online controller.

[0156] As shown, the electronic circuit board 1815 includes one or more processors 1802 and associated (one or more) storage devices 1804 configured to perform various computer-implemented functions (e.g., execute methods, steps, calculations, etc. as disclosed herein and store relevant data). Additionally, in some embodiments, the electronic circuit board 1815 includes a jaw sensor module 1806 to facilitate communication between the electronic circuit board 1815 and various components of the surgical system 1000, such as the shape fiber sensor described herein.

[0157] As used herein, the term "processor" refers not only to integrated circuits included in computers in the art but also to controllers, microcontrollers, microcomputers, programmable logic controllers (PLCs), application-specific integrated circuits, and other programmable circuits. Additionally, the (one or more) storage devices 1804 can generally include (one or more) storage elements, including but not limited to computer-readable media (e.g., random access memory (RAM)), computer-readable non-volatile media (e.g., flash memory), floppy disks, compact disc read-only memory (CD ROM), magneto-optical discs (MOD), digital versatile discs (DVD), and / or other suitable storage elements. Such (one or more) storage devices 1804 can generally be configured to store suitable computer-readable instructions that, when implemented by the (one or more) processors 1802, configure the controller 1800 to perform various functions.

[0158] In some embodiments, the electronic circuit board 1815 may be operatively coupled to (or include) a haptic feedback controller 1820. The haptic feedback controller 1820 may be configured to deliver haptic feedback to an operator based on input received from any of the shape fiber sensors described herein, which are included in the instrument 1400.

[0159] The jaw sensor module 1806 may include a sensor interface 1810 (e.g., one or more analog-to-digital converters) to allow conversion of signals transmitted from one or more sensors (e.g., shape fiber sensors 2588, 3588, 4588, 5588, 6588) into signals that can be understood and processed by the processor 1802. The sensors may be communicatively coupled to the communication module 1806 using any suitable means. For example, the sensors may be coupled to the communication module 1806 via a wired connection and / or via a wireless connection (such as by using any suitable wireless communication protocol known in the art). The jaw sensor module 1806 may also include an output module 1812, which is configured to generate an output related to the shape fiber sensors. For example, the generated output may be one or more signals related to the average deflection position of the jaws.

[0160] In addition, in some embodiments, the communication module 1806 includes a calibration module 1814 that is configured to condition any signals in the signals generated by the shape fiber sensors herein. For example, in some embodiments, the calibration module 1814 may include a calibration table or calibration curve (e.g., an equation) that correlates the output from a shape fiber (e.g., shape fiber sensors 2588, 3588, 4588, 5588, 6588) with the actual average of a first deflection angle of a first tool member and a second deflection angle of a second tool member measured during instrument assembly. Similarly stated, the calibration table (or calibration curve) may provide a correlation between the orientation of the shape fiber sensor (e.g., the orientation of housing 4280 or shape fiber carrier 6466) and the actual average of the first deflection angle of the first tool member and the second deflection angle of the second tool member. In some embodiments, the calibration table (or calibration curve) may provide a magnification factor to account for a reduction in the range of motion of the shape fiber sensor compared to the range of motion of the jaws. For example, in some embodiments where the shape fiber sensor and the jaws move in a less than one-to-one relationship (e.g., embodiments employing a differential), the calibration table (or calibration curve) may include a magnification factor. In use, the calibration module may facilitate a method of generating an output signal that is specific to (or unique to) the adjustment of the instrument. In this way, the calibration module and method may ensure that the output of the shape fiber sensor takes into account any minute differences in the components of any intermediate coupling mechanisms described herein (e.g., due to variability between parts, minute differences in friction, manufacturing tolerances, etc.). The calibration module and method may also account for differences in the rotational range of motion between the jaws and the shape fiber sensor (e.g., in embodiments employing a differential).

[0161] In some embodiments, any of the instruments described herein may include an electronic circuitry system (e.g., system 1815) and may perform a method of conditioning the signal output from a shape fiber. For example, Figure 41FIG. 190 is a flow chart of a method 190 according to an embodiment that generates an adjusted output signal from a shape fiber sensor of a medical device. The medical device can be any of the medical devices described herein and includes a distal wrist link, a first jaw coupled to the distal wrist link, a second jaw coupled to the distal wrist link, a shape fiber carrier rotatable relative to the distal wrist link and defining a shape fiber cavity in which the shape fiber sensor is coupled, at least one storage device, and at least one processor operably coupled to the storage device. The method includes, at 192, receiving, at the processor, a signal from the shape fiber sensor in response to movement of at least one of the first jaw and the second jaw. The method includes, at 193, determining, at a calibration module stored within the storage device, an average value of a first deflection angle of the first jaw and a second deflection angle of the second jaw based on the signal. The method includes, at 194, providing an adjusted output signal associated with the average value of the first deflection angle and the second deflection angle.

[0162] Figure 42 FIG. 290 is a flow chart of a method 290 for calibrating a shape fiber sensor of a medical device according to an embodiment. The medical device can be any of the medical devices described herein and includes a distal wrist link, a first jaw coupled to the distal wrist link, a second jaw coupled to the distal wrist link, a shape fiber carrier rotatable relative to the distal wrist link and defining a shape fiber cavity in which the shape fiber sensor is coupled, at least one storage device, and at least one processor operably coupled to the storage device. The method includes, at 292, positioning the first jaw and the second jaw at a first average deflection angle. At 293, a first signal is received from the shape fiber sensor with the first jaw and the second jaw at the first average deflection angle. The method includes, at 294, associating a value of the first signal with the first average deflection angle within a calibration module stored within the storage device. At 295, the first jaw and the second jaw are positioned at a second average deflection angle. The method includes, at 296, receiving a second signal from the shape fiber sensor with the first jaw and the second jaw at the second average deflection angle. The method includes, at 297, associating a value of the second signal with the second average deflection angle within a calibration module stored within the storage device.

[0163] While various embodiments have been described above, it should be understood that these embodiments are presented by way of example only and not limitation. Where certain events and / or process patterns are indicated above as occurring in a particular order in the method and / or diagrams, the order of some of the events and / or operations may be modified. While embodiments have been shown and described in particular, it should be understood that various changes in form and detail may be made.

[0164] For example, any instrument (and components thereof) described herein is an optional part of a surgical assembly for performing minimally invasive surgical procedures, and it can include a manipulator unit, a series of kinematic linkages, a series of cannulas, or the like. Thus, any instrument described herein can be used with any suitable surgical system, such as the MIRS system 1000 shown and described above. Additionally, any of the instruments shown and described herein can be used to manipulate target tissue during a surgical procedure. Such target tissue can be cancer cells, tumor cells, lesions, vascular occlusions, thrombi, stones, uterine fibroids, bone metastases, endometriosis, or any other body tissue. The exemplary target tissues shown are not an exhaustive list. Further, the target structure can also include artificial substances (or non-tissue) within the body or associated with the human body, such as, for example, stents, a portion of an artificial tube, fasteners within the body, and the like.

[0165] For example, any of the components of the surgical instruments described herein can be constructed of any material (such as medical grade stainless steel, nickel alloy, titanium alloy, etc.). Further, any of the linkages, tool members, tension elements, or components described herein can be constructed of multiple pieces that are later joined together. For example, in some embodiments, a linkage can be constructed by joining separately constructed components. However, in other embodiments, any of the linkages, tool members, tension elements, or components described herein can be constructed as a single unit.

[0166] Although the instrument is generally shown as having a rotational axis (e.g., axis A1) of the tool member that is perpendicular to the rotational axes (e.g., axis A2, axis A3) of the wrist member, in other embodiments, any of the instruments described herein can include a rotational axis of the tool member that is offset at any suitable angle from the rotational axis of the wrist assembly.

[0167] Although the various embodiments are described as having combinations of specific features and / or components, other embodiments may also have combinations of any of the features and / or components from any of the embodiments discussed above. The various aspects have been described in the general context of medical devices, and more specifically surgical instruments, but the aspects of the invention are not necessarily limited to use in medical devices.

Claims

1. A medical device, comprising: A distal wrist link; A first jaw and a second jaw, both the first jaw and the second jaw being coupled to the distal wrist link; A shape fiber carrier pivotally coupled to the distal wrist link and defining a shape fiber cavity; And A shape fiber having a distal end fixedly coupled within the shape fiber cavity; The shape fiber being indirectly coupled to the first jaw and the second jaw, Wherein movement of the shape fiber carrier causes the shape fiber to generate a signal related to movement of at least one of the first jaw or the second jaw.

2. The medical device according to claim 1, further comprising: An intermediate coupling mechanism coupled to the shape fiber carrier; And The shape fiber being indirectly coupled to the first jaw and the second jaw via the shape fiber carrier and the intermediate coupling mechanism.

3. The medical device according to claim 2, wherein: The intermediate coupling mechanism is a differential coupled between at least one of the first jaw or the second jaw and the shape fiber carrier; And The shape fiber is indirectly coupled to the first jaw and the second jaw via the differential and the shape fiber carrier.

4. The medical device according to claim 2, wherein: The intermediate coupling mechanism includes a cam mechanism that indirectly couples the shape fiber to at least one of the first jaw or the second jaw.

5. The medical device according to claim 2, wherein: The intermediate coupling mechanism includes a torsion spring that indirectly couples the shape fiber to at least one of the first jaw or the second jaw.

6. The medical device according to claim 1, wherein: The signal generated by the shape fiber includes a signal related to the average of a first deflection angle of the first jaw and a second deflection angle of the second jaw.

7. The medical device according to claim 1, wherein: The shape fiber carrier is pivotally coupled to the distal wrist link about a first axis; And The first jaw and the second jaw are each pivotally coupled to the distal wrist link about a second axis, the second axis being offset from the first axis.

8. The medical device according to claim 7, wherein the distal end of the shape fiber is positioned between the first axis and the second axis.

9. The medical device according to claim 7, wherein: The shape fiber carrier is indirectly coupled to the first jaw and the second jaw such that an angular position of the shape fiber carrier relative to the second axis is associated with the average deflection angle of the first jaw and the second jaw.

10. The medical device according to claim 3, wherein: The differential includes a housing, a first planet gear, a second planet gear, and a ring gear; The medical device further includes: a gear train, a first sun gear, and a second sun gear; The first sun gear is integral with the first jaw and coupled to the housing of the differential, and the second sun gear is integral with the second jaw and coupled to the housing of the differential; The ring gear is integral with the housing and coupled to the gear train, and the gear train is coupled to the shaped fiber carrier; The housing of the differential is configured to rotate when one of the first jaw or the second jaw rotates relative to the other, and the rotation of the housing causes the rotation of the shaped fiber carrier and the shaped fiber; and The orientation of the housing is associated with the average of a first deflection angle of the first jaw and a second deflection angle of the second jaw.

11. The medical device according to claim 10, wherein the shaped fiber generates a signal related to the average of the deflection angle of the first jaw and the deflection angle of the second jaw based on the orientation of the housing.

12. The medical device according to claim 3, wherein: The movement of the shaped fiber carrier is restricted by the differential.

13. The medical device according to claim 12, wherein: The movement of the shaped fiber carrier is restricted to + / - 45 degrees relative to the center line of the shaped fiber carrier.

14. The medical device according to claim 3, wherein: The shaped fiber carrier includes a gear operably coupled to the differential.

15. The medical device according to claim 1, wherein: The movement of the shaped fiber carrier causes the shaped fiber to generate a signal related to the movement of the distal wrist link.

16. The medical device according to claim 1, wherein: The movement of the shaped fiber carrier causes the shaped fiber to generate a signal related to the movement of the proximal articulation joint.

17. A medical device, comprising: A distal wrist link; A first jaw and a second jaw, both the first jaw and the second jaw being coupled to the distal wrist link; A position sensor coupled to the distal wrist link; And A differential coupled to the position sensor, the first jaw and the second jaw; Wherein the movement of one of the first jaw or the second jaw relative to the other generates a sensor movement of the position sensor via the differential, and the position sensor generates a signal corresponding to the sensor movement.

18. The medical device according to claim 17, wherein: The signal generated by the position sensor is associated with the average of a first deflection angle of the first jaw and a second deflection angle of the second jaw.

19. The medical device according to claim 17, wherein: The position sensor is a shaped fiber, the medical device includes a shaped fiber carrier coupled to the differential, and the shaped fiber is at least partially disposed in a cavity of the shaped fiber carrier.

20. The medical device according to claim 17, wherein: The differential includes a housing, a first planetary gear, a second planetary gear and a ring gear; The medical device further includes a gear train, a first sun gear, and a second sun gear; The first sun gear is integral with the first jaw and coupled to the housing of the differential, and the second sun gear is integral with the second jaw and coupled to the housing of the differential; The ring gear is coupled to the housing and to the gear train, and the gear train is coupled to the shape fiber carrier; The housing of the differential is configured to rotate when one of the first jaw or the second jaw rotates relative to the other, and the rotation of the housing causes the rotation of the position sensor; and The orientation of the housing is associated with the average of a first deflection angle of the first jaw and a second deflection angle of the second jaw.

21. The medical device according to claim 20, wherein the position sensor generates a signal based on the orientation of the housing that is related to the average of the first deflection angle of the first jaw and the second deflection angle of the second jaw.

22. The medical device according to claim 17, wherein: The movement of the position sensor is restricted by the differential.

23. The medical device according to claim 19, wherein: The movement of the shape fiber carrier is restricted by the differential.

24. The medical device according to claim 23, wherein: The movement of the shape fiber carrier is restricted to + / - 45 degrees relative to the centerline of the shape fiber carrier.

25. The medical device according to claim 17, wherein: The position sensor indirectly couples the first jaw and the second jaw such that the angular position of the position sensor is associated with the average of the first deflection angle of the first jaw and the second deflection angle of the second jaw.

26. A medical device, comprising: A distal wrist link; A first jaw and a second jaw, both the first jaw and the second jaw being coupled to the distal wrist link; A shape fiber carrier that is rotatable relative to the distal wrist link and defines a shape fiber cavity; And A shape fiber that extends from a position proximal to the distal wrist link to a distal end fixedly coupled within the shape fiber cavity; Wherein the shape fiber is spaced apart from each of the first jaw and the second jaw; And Wherein movement of the shape fiber carrier causes the shape fiber to generate a signal related to the movement of at least one of the first jaw or the second jaw.

27. The medical device according to claim 26, further comprising: An intermediate coupling mechanism coupled to the shape fiber carrier; And The shape fiber carrier is coupled to the first jaw and the second jaw via the intermediate coupling mechanism such that the shape fiber is spaced apart from each of the first jaw and the second jaw.

28. The medical device according to claim 27, wherein: The intermediate coupling mechanism is a differential coupled to the first jaw, the second jaw, and the shape fiber carrier; and The shaped fiber carrier is indirectly coupled to the first jaw and the second jaw via the differential.

29. The medical device according to claim 27, wherein: The intermediate coupling mechanism includes a cam mechanism that indirectly couples the shaped fiber to the first jaw and the second jaw.

30. The medical device according to claim 27, wherein: The intermediate coupling mechanism includes a torsion spring that indirectly couples the shaped fiber to the first jaw and the second jaw.

31. A method of generating an adjusted output signal from a shaped fiber sensor of a medical device, the medical device including a distal wrist link, a first jaw coupled to the distal wrist link, a second jaw coupled to the distal wrist link, a shaped fiber carrier rotatable relative to the distal wrist link and defining a shaped fiber cavity in which the shaped fiber sensor is coupled, at least one storage device, and at least one processor operably coupled to the storage device, the method including: Receiving, at the processor, a signal from the shaped fiber sensor in response to movement of at least one of the first jaw and the second jaw; Determining, at a calibration module stored in the storage device, an average of a first deflection angle of the first jaw and a second deflection angle of the second jaw based on the signal; And Providing the adjusted output signal associated with the average of the first deflection angle and the second deflection angle.

32. The method according to claim 31, further including: Providing a tactile output at an operator input device, the tactile output being based on the adjusted output signal.

33. The method according to claim 31, wherein: The medical device further includes an intermediate coupling mechanism coupled to the shaped fiber carrier, the shaped fiber carrier being coupled to the first jaw and the second jaw via the intermediate coupling mechanism such that the shaped fiber carrier is spaced apart from each of the first jaw and the second jaw; And The signal is associated with a rotational position of the shaped fiber carrier.

34. The method according to claim 33, wherein: The intermediate coupling mechanism includes a clockwork torsion spring mechanism that indirectly couples the shaped fiber to the first jaw and the second jaw.

35. The method according to claim 31, wherein: The signal from the shaped fiber sensor is associated with an orientation of the shaped fiber sensor; and The determining includes associating the orientation of the shaped fiber sensor with the average of the first deflection angle and the second deflection angle based on either a calibration table or a calibration curve.

36. The method according to claim 31, wherein: The signal from the shaped fiber sensor is associated with an orientation of the shaped fiber sensor; and The determining includes magnifying the orientation of the shaped fiber sensor to accommodate a difference in a range of motion between the shaped fiber sensor and the first jaw and the second jaw.

37. A method of calibrating a shape fiber sensor of a medical device, the medical device including a distal wrist link, a first jaw coupled to the distal wrist link, a second jaw coupled to the distal wrist link, a shape fiber carrier rotatable relative to the distal wrist link and defining a shape fiber cavity in which the shape fiber sensor is coupled, and at least one storage device, the method including: Positioning the first jaw and the second jaw at a first average deflection angle; Receiving a first signal from the shape fiber sensor while the first jaw and the second jaw are at the first average deflection angle; Associating the value of the first signal with the first average deflection angle in a calibration module stored in the storage device; Positioning the first jaw and the second jaw at a second average deflection angle; Receiving a second signal from the shape fiber sensor while the first jaw and the second jaw are at the second average deflection angle; And Associating the value of the second signal with the second average deflection angle in the calibration module stored in the storage device.

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