Miniature capstan actuator for surgical instrument

Abstract

The medical device includes one or more winches spaced distally from the force transmitting member and coupled to the one or more elongate rotatable drive elements. The medical device further includes one or more tension elements each coupled to one of the one or more winches and a distal end of the medical device. The length of each of the one or more tension elements is configured to wrap the capstan to which it is coupled, thereby exerting an axial force on the distal end of the medical device.

Description

[0001] Cross-reference to related applications This application claims priority to U.S. Provisional Application No. 63 / 590,748, filed October 16, 2024, the entire contents of which are incorporated herein by reference. Technical Field

[0002] This disclosure relates to a miniature capstan actuator for use in surgical instruments. Background Technology

[0003] Minimally invasive medical techniques aim to reduce the amount of tissue damaged during medical procedures, thereby reducing patient recovery time, discomfort, and harmful side effects. These techniques can be performed through natural openings in the patient's anatomy or through one or more surgical incisions. Through these natural openings or incisions, the operator can insert minimally invasive medical instruments to reach the target tissue location. Minimally invasive medical instruments include devices such as therapeutic, diagnostic, biopsy, and surgical instruments. Medical instruments can be inserted into anatomical channels and guided toward regions of interest within the patient's anatomy.

[0004] Some anatomical pathways, such as the gastrointestinal tract (GI), are long and tortuous. Surgical instruments used in GI procedures, such as endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR), can operate through long, flexible working channels of standard or custom-made endoscopes, or otherwise along such endoscopes, exceeding 1.6 meters in length. The articulation of instruments and / or endoscopes can be achieved via tension elements (such as drive cables) wound on a rotating winch. The winch is operatively coupled to an external device, such as a robotic manipulator, and receives forces / torques from the manipulator to drive the instruments and / or endoscopes. However, with longer lengths of instruments / endoscopes and associated drive cables, winch friction from moving the tension cable through the tortuous path can impede the actuation of surgical instruments because winch friction increases exponentially based on the bending angle. Even a small increase in the bending angle can multiply the force loss to the point of causing the surgical instrument to malfunction or stop working altogether, and the cumulative bending angle reaching the cecum can, for example, exceed 360 degrees. In short, the design of flexible surgical instruments is constrained by the actuation challenges posed by winch friction.

[0005] There is an urgent need for instruments that can perform medical procedures without excessively increasing winch friction. Summary of the Invention

[0006] Consistent with some examples, the medical device may include a proximal force transmission member, an elongated shaft, one or more winches, and one or more tension elements. The proximal force transmission member may include one or more rotatable inputs configured to receive force or torque from an external device. The elongated shaft may have a proximal end coupled to the proximal force transmission member. The elongated shaft may house one or more elongated rotatable actuating elements, each coupled to one of the one or more rotatable inputs of the proximal force transmission member. One or more winches may be coupled to a distal end of the elongated shaft. Each of the one or more winches may include a first end coupled to one of the elongated rotatable actuating elements. Each of the one or more winches may be distally spaced from the force transmission member via the elongated shaft. Each of the one or more tension elements may be coupled to one of the one or more winches and coupled to a distal end of the medical device.

[0007] Consistent with some examples, the medical device may include a proximal force transmission member, an elongated shaft, one or more winches, and one or more tension elements. The proximal force transmission member may include one or more rotatable inputs configured to receive forces or torques from an external device. The elongated shaft may have a proximal end coupled to the proximal force transmission member. The elongated shaft may house one or more elongated rotatable drive elements, each coupled to one of the one or more rotatable inputs of the proximal force transmission member. One or more winches may be coupled to the distal end of the elongated shaft. Each of the one or more winches may include a first end coupled to one of the elongated rotatable drive elements. Each of the one or more tension elements may have a first end coupled to one of the one or more winches, a second end directly coupled to the distal end of the medical device, and a length configured to wind around one of the one or more winches. The second end of each of the one or more tension elements may be configured to apply an axial force on the distal end of the medical device when the length of the tension element winds around one of the one or more winches.

[0008] Consistent with some examples, the medical device includes a proximal force transmission member, an elongated shaft, one or more winches, and one or more tension elements. The proximal force transmission member may include one or more rotatable inputs configured to receive force or torque from an external device. The elongated shaft may have a proximal end coupled to the proximal force transmission member. The elongated shaft may house one or more elongated rotatable actuating elements, each coupled to one or more rotatable inputs of the proximal force transmission member. One or more winches may be coupled to a distal end of the elongated shaft. Each of the one or more winches may include a first end coupled to one of the elongated rotatable actuating elements and a winch shaft having a winch diameter. Each of the one or more tension elements may have a first end coupled to one of the one or more winches, a second end coupled to a distal end of the medical device, and a tension element diameter. The ratio of the winch diameter to the tension element diameter may be less than 10:1.

[0009] In one instance, the one or more elongated rotatable drive elements may be multiple elongated rotatable drive elements, the one or more winches may be multiple winches, and the one or more tension elements may be multiple tension elements.

[0010] In one instance, each of the one or more winches may include a shaft, and each of the one or more tension elements may be configured to slide axially downward along the axis of one of the one or more winches when winding one of the one or more winches.

[0011] In one instance, each of one or more tension elements may include a woven polymer.

[0012] In one instance, each of one or more tension elements may be lubricated.

[0013] In one instance, the slender shaft can be flexible.

[0014] In one instance, the slender shaft can be rigid.

[0015] In one instance, each of one or more tension elements can be pre-wound to one of one or more winches to achieve a substantially constant effective transmission ratio in subsequent windings.

[0016] In one example, at least one of the one or more winches may have a shaft having a cross-section that varies along a longitudinal axis, such that the effective transmission ratio changes when one of the one or more tension elements is wound around the shaft of at least one of the one or more winches.

[0017] In one instance, the medical device could be an endoscope, and the change in cross-section corresponds to a change in the bending angle of the endoscope.

[0018] In one instance, a change in cross-section can adjust the effective gear ratio to compensate for the increased friction caused by changes in the bending angle of the endoscope.

[0019] In one instance, the remote device can be manually activated when the medical device is decoupled from an external device.

[0020] In one instance, the one or more winches may be arranged in antagonistic pairs.

[0021] In one instance, the slender shaft has a length greater than or equal to one meter.

[0022] In one instance, the medical device may further include a bulkhead, and the bulkhead may include one or more winch recesses, each receiving one or more winches; and redirection orifices adjacent to each winch recess for each of the one or more tension elements.

[0023] In one example, the redirection orifice adjacent to each winch recess can be configured to redirect one of one or more tension elements from a wrap angle relative to the longitudinal axis of the winch to an axial angle substantially parallel to the longitudinal axis of the winch.

[0024] In one example, the redirection aperture adjacent to each winch recess may include a shoulder with a smooth surface.

[0025] In one instance, each of one or more winches may have a second end, the second end comprising a conical section with a spherical dome tip.

[0026] In one instance, the medical device may further include a proximal partition coupled to one or more winches, and the proximal partition may include a rotary bearing for each of the one or more winches.

[0027] In one instance, the first end of each of one or more winches may be positioned within a corresponding rotary bearing of a proximal diaphragm.

[0028] In some instances, a medical device can be a surgical instrument.

[0029] In some instances, the distal end of a medical device can be an end effector actuated by one or more tension elements.

[0030] In some instances, a medical device may include a wrist mechanism and an end effector distal to the wrist mechanism, the wrist mechanism being configured to be actuated by one or more tension elements and configured to move bidirectionally along four axes.

[0031] In some instances, the medical device may further include an elbow mechanism and an end effector distal to the elbow mechanism, the elbow mechanism being configured for bidirectional movement along four axes.

[0032] It should be understood that the foregoing general description and the following detailed description are exemplary and explanatory in nature and are intended to provide an understanding of the disclosure without limiting its scope. In this regard, additional aspects, features, and advantages of the disclosure will be apparent to those skilled in the art from the following detailed description. Attached Figure Description

[0033] The various aspects of this disclosure can be best understood from the following detailed description when read in conjunction with the accompanying drawings. It should be emphasized that, according to industry standard practice, the various features are not drawn to scale. In fact, the dimensions of the various features may be arbitrarily increased or decreased for clarity of discussion. Furthermore, reference numerals and / or letters may be repeated in various instances of this disclosure. Such repetition is for simplicity and clarity and does not in itself prescribe a relationship between the various embodiments and / or configurations discussed.

[0034] Figure 1 This is a schematic diagram of a first robot-assisted manipulator system according to the present disclosure.

[0035] Figure 2A An example of an instrument system utilizing aspects of this disclosure is provided.

[0036] Figure 2B Examples of extended embodiments of instruments according to this disclosure are provided. Figure 2A The distal part of the instrument system.

[0037] Figure 3 This is a perspective view of the control system according to this disclosure.

[0038] Figure 4 This is a schematic diagram of the manipulator system according to the present disclosure.

[0039] Figure 5 This is a perspective view of a medical device according to an embodiment.

[0040] Figure 6 yes Figure 5 A three-dimensional view of the distal portion of a medical device.

[0041] Figure 7It is a side view of multiple winches connected to the distal end of an elongated shaft that houses multiple elongated rotatable drive elements.

[0042] Figure 8 It is a perspective view of a proximal partition configured to be connected to one or more winches.

[0043] Figure 9 It is a perspective view of a distal partition configured to connect to multiple winches and multiple tension elements.

[0044] Figure 10 It is a three-dimensional view of a winch including a fixed aperture, a shaft, and a spherical dome tip.

[0045] Figure 11 It is a three-dimensional view of a winch with a tension element that has a winding mechanism.

[0046] Figure 12 This is a schematic illustration of a method for fabricating a medical device including a winch by pre-winding a tension element around the winch.

[0047] Figure 13 This is a schematic diagram illustrating a method of using a medical device, including a winch, by adjusting the effective transmission ratio.

[0048] Examples of this disclosure and its advantages are best understood by referring to the following detailed description. It should be understood that the same reference numerals are used to identify the same elements illustrated in one or more figures, wherein the illustrations in the various figures are for the purpose of illustrating examples of this disclosure and not for the purpose of limiting the scope of this disclosure. Detailed Implementation

[0049] Numerous specific details are set forth in the following detailed description of various aspects of the invention to provide a thorough understanding of the disclosed embodiments. However, it will be apparent to those skilled in the art that embodiments of this disclosure can be practiced without these specific details. In other instances, well-known methods, processes, components, and circuits have not been described in detail to avoid unnecessarily obscuring various aspects of the embodiments of the invention. Furthermore, to avoid unnecessary repetition of description, one or more components or actions described according to one illustrative embodiment may be used in other illustrative embodiments or omitted therefrom, where applicable. For brevity, multiple iterations of these combinations will not be described separately. For simplicity, in some cases, the same reference numerals are used throughout the drawings to denote the same or similar parts.

[0050] One or more miniature winches are provided, allowing mechanical power to be delivered to the distal end of a medical device to effectively actuate the device without unduly increasing winch friction. In various instances, the medical device is a surgical instrument (to which, for example, an end effector and / or optional wrist mechanism may be attached), or an elongated, flexible device such as an endoscope. Specifically, one or more tension elements coupled to the one or more winches allow rotational motion to be converted into cable tension at or near the distal end of the medical device. The one or more winches are distally spaced from a force transmission member and coupled to the force transmission member via an elongated, rotatable drive element. Rotation of the winch via the elongated, rotatable drive element causes a first end of a corresponding tension element coupled to the winch to wind around the winch, thereby causing a second end of the tension element to apply an axial force at the distal end of the medical device. When two winches are paired, the winches are capable of providing controlled bidirectional motion. Typical surgical instruments may require three or more axes of motion at their distal end. For example, a tissue gripper may include a pitch axis and two separate yaw axes. The synchronous movement of two tension elements, resulting from the synchronous rotation of their respective connected winches in the same direction along independent yaw axes, provides the pure yaw motion of the tissue gripper, while the movement of two tension elements in opposite directions along independent yaw axes, resulting from the relative rotation of their respective connected winches, provides the useful gripping motion. Other types of instruments, particularly those used in GI procedures, may utilize multiple "snake-like" bends that provide pitch and yaw motion. Each of the pitch or yaw axes typically requires a pair of bidirectional winches and corresponding tension elements. For this type of instrument, the gripping function can be actuated independently of another pair of winches and corresponding tension elements or some other actuation device. As exemplified and described herein, four pairs of winches and corresponding tension elements can be provided to provide bidirectional motion along four axes without producing undesirable winch friction that could hinder the use of surgical instruments.

[0051] Turn to the attached diagram, in which... Figure 1-6 Examples can be applied to systems and medical devices used with one or more miniature winches, and Figure 7-11 Examples of implementation methods and features of one or more miniature winches.

[0052] Figure 1 Examples are provided for use with the rotary-to-linear force articulation members described herein. This manipulator system can be used in, for example, surgical, diagnostic, therapeutic, biopsy, or non-medical procedures, and is generally indicated by reference numeral 100. Figure 1As shown, the robot-assisted manipulator system 100 may include one or more manipulator assemblies 102 for operating one or more medical device systems 104 while performing various procedures on a patient P located on a table T in a medical environment 101. For example, the manipulator assembly 102 may drive the movement of a catheter or end effector, apply treatment to target tissue, and / or manipulate control components. The manipulator assembly 102 may be a remotely operated, non-remotely operated, or hybrid remotely and non-remotely operated component having selectable degrees of freedom of motion that can be motorized and / or remotely operated and selectable degrees of freedom of motion that can be non-motorized and / or non-remotely operated. An operator input system 106, which may be located inside or outside the medical environment 101, typically includes one or more control devices for controlling the manipulator assembly 102. The manipulator assembly 102 supports the medical device system 104 and may optionally include a plurality of actuators or motors that drive input elements on the medical device system 104 in response to commands from the control system 112. The actuator may optionally include a drive system that, when coupled to the medical device system 104, advances the medical device system 104 into a naturally or surgically created anatomical opening. Other drive systems may move the distal end of the medical device in multiple degrees of freedom, including three linear degrees of motion (e.g., linear motion along the X, Y, Z Cartesian axes) and three rotational degrees of motion (e.g., rotation about the X, Y, Z Cartesian axes). The manipulator assembly 102 may support a variety of other systems for irrigation, treatment, or other purposes. Such systems may include fluid systems (including, for example, reservoirs, heating / cooling elements, pumps, and valves), generators, lasers, interrogators, and ablation components.

[0053] The robot-assisted manipulator system 100 further includes a display system 110 for displaying images or representations of the surgical site and medical device system 104 generated by the imaging system 109, which may include an endoscopic imaging system. The display system 110 and operator input system 106 can be oriented such that an operator can use telescopic perception to control the medical device system 104 and the operator input system 106. A graphical user interface can be displayed on the display system 110 and / or the display system of a separate planning workstation.

[0054] In some instances, the endoscopic imaging system component of imaging system 109 may be integrally or removably coupled to medical device system 104. However, in some instances, a separate endoscope attached to a separate manipulator assembly may be used with medical device system 104 to image the surgical site. Endoscopic imaging system 109 may be implemented as hardware, firmware, software, or a combination thereof, interacting with or otherwise executed by one or more computer processors, which may include the processor of control system 112.

[0055] The robot-assisted manipulator system 100 may also include a sensor system 108. The sensor system 108 may include a positioning / position sensor system (e.g., an actuator encoder or electromagnetic (EM) sensor system) and / or a shape sensor system (e.g., a fiber optic shape sensor) for determining the position, orientation, speed, rate, attitude, and / or shape of the medical device system 104. The sensor system 108 may also include temperature, pressure, force, or contact sensors, etc.

[0056] The robot-assisted manipulator system 100 may also include a control system 112. The control system 112 includes at least one memory 116 and at least one computer processor 114 for controlling the medical device system 104, the operator input system 106, the sensor system 108, and the display system 110. The control system 112 further includes programming instructions (e.g., a non-transitory machine-readable medium storing the instructions) to implement programs using the robot-assisted manipulator system, including for navigation, steering, imaging, deployment or retraction of engagement features, application of treatment to target tissue (e.g., by applying energy), etc.

[0057] The control system 112 may optionally further include a virtual visualization system to provide navigation assistance to the operator O when controlling the medical device system 104 in an image-guided surgical procedure. Virtual navigation using the virtual visualization system may be based on reference to acquired preoperative or intraoperative datasets of the anatomical access. The virtual visualization system processes images of the surgical site imaged using imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermal imaging, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, nanotube X-ray imaging, etc. The control system 112 may use the preoperative images to locate target tissue (using visual imaging techniques and / or by receiving user input) and create a preoperative plan that includes the optimal first location for performing the treatment. The preoperative plan may include, for example, planned dimensions for expanding the expandable device, treatment duration, treatment temperature, and / or multiple deployment locations.

[0058] Figure 2AThis is a simplified diagram of a medical device system 200 according to some embodiments. In some embodiments, the medical device system 200 can be used in image-guided medical procedures. In some instances, the medical device system 200 can be used in non-remotely operated exploratory procedures or procedures involving conventionally manually operated medical devices, such as endoscopy.

[0059] The medical device system 200 includes an elongated flexible device 202, such as a flexible catheter or endoscope, coupled to a drive unit 204. The elongated device 202 includes a flexible body 216 having a proximal end 217 and a distal or terminal portion 218. In some embodiments, the flexible body 216 has an outer diameter of approximately 8-20 mm. Other flexible bodies may have larger or smaller outer diameters. The entire length of the flexible body 216 between the distal end 218 and the proximal end 217 can be effectively divided into segments 224.

[0060] The medical device system 200 optionally includes a tracking system 230 for determining the position, orientation, velocity, rate, attitude, and / or shape of the distal end 218 and / or one or more segments 224 along the flexible body 216 using one or more sensors and / or imaging devices. The tracking system 230 may optionally be implemented as hardware, firmware, software, or a combination thereof, interacting with or otherwise executed by one or more computer processors, which may include... Figure 1 The processor of the control system 112.

[0061] Tracking system 230 may optionally use shape sensor 222 to track distal end 218 and / or one or more segments 224. In some embodiments, tracking system 230 may optionally and / or additionally use position sensor system 220, such as an electromagnetic (EM) sensor system, to track distal end 218. In some instances, position sensor system 220 may be configured and positioned to measure six degrees of freedom, such as three position coordinates X, Y, Z and three orientation angles for pitch, yaw, and roll indicating a base point, or five degrees of freedom, such as three position coordinates X, Y, Z and two orientation angles for pitch and yaw indicating a base point.

[0062] The flexible body 216 includes one or more channels 221, the size and shape of which are configured to receive one or more medical devices 226. In some embodiments, the flexible body 216 includes two channels 221 for a single device 226; however, a different number of channels 221 may be provided. Figure 2BThis is a simplified diagram of a flexible body 216 having a medical device 226 extending according to some embodiments. In some embodiments, the medical device 226 can be used for procedures such as surgery, biopsy, ablation, illumination, irrigation, or aspiration. The medical device 226 can be deployed through a channel 221 of the flexible body 216 and used at a target location within an anatomical structure. The medical device 226 may include, for example, an image capturing device, a biopsy instrument, an ablation instrument, a catheter, laser ablation fibers, and / or other surgical, diagnostic, or therapeutic tools. Medical tools may include end effectors with a single working member, such as scalpels, blunt blades, optical fibers, electrodes, etc. Other end effectors may include, for example, forceps, grippers, scissors, clamp applicators, etc. Other end effectors may further include electrically activated end effectors, such as electrosurgical electrodes, transducers, sensors, etc. The medical device 226 can be advanced from the opening of the channel 221 to perform a procedure and then retracted into the channel when the procedure is complete. The medical device 226 can be removed from the proximal end 217 of the flexible body 216 or from another optional device port (not shown) along the flexible body 216. The medical device 226 can also be used with an image capturing device (e.g., an endoscopic camera) within the flexible, steerable body 216. Alternatively, the medical device 226 itself can be an image capturing device.

[0063] Medical device 226 may additionally accommodate cables, links, or other actuation controls (not shown) extending between its proximal and distal ends to controllably bend the distal end of medical device 226. Flexible body 216 may also accommodate cables, links, or other steering controls (not shown) extending between drive unit 204 and distal end 218 to controllably bend distal end 218, as illustrated, for example, by dashed line 219 of distal end 218. In some instances, at least four cables are used to provide independent "up / down" steering to control pitch movement of distal end 218 and "left / right" steering to control yaw movement of distal end 218. In embodiments where medical device system 200 is actuated by a robot-assisted assembly, drive unit 204 may include a drive input removably coupled to and receiving power from the drive element (e.g., actuator) of the remotely operated assembly. In some embodiments, the medical device system 200 may include clamping features, manual actuators, or other components for manually controlling the movement of the medical device system 200. Information from the tracking system 230 may be sent to the navigation system 232, where it is combined with information from the visualization system 231 and / or a preoperatively acquired model to provide real-time location information to the physician or other operator.

[0064] Other configurations of the remote-controlled manipulator system have also been considered, such as systems configured for multi-port or single-port procedures. For example, the embodiments described herein can be used with da Vinci® surgical systems, such as the da Vinci X®, Xi®, or SP® surgical systems, all of which are commercially available from IntuitiveSurgical, Inc., Sunnyvale, California.

[0065] Figure 3 An exemplary embodiment of a manipulator system 300 that can be used as part of a manipulator system 100 is illustrated. The manipulator system 300 includes a base 320, a main column 340, and a main boom 360 connected to the main column 340. The manipulator system 300 also includes a plurality of manipulator arms 310, 311, 312, and 313, each of which is connected to the main boom 360. The manipulator arms 310, 311, 312, and 313 can be used as a manipulator assembly 102. Each manipulator arm 310, 311, 312, and 313 includes an instrument mounting portion 322 to which an instrument 330 can be mounted, the instrument mounting portion 322 being exemplarily attached to the manipulator arm 310. While the manipulator system 300 is depicted with four manipulator arms, various embodiments may include more or fewer manipulator arms.

[0066] According to an embodiment, the instrument mounting portion 322 may include a drive assembly 323 and a cannula mount 324, wherein the transmission mechanism 334 of the instrument 330 is connected to the drive assembly 323. The cannula mount 324 is configured to retain a cannula 336 through which the shaft 332 of the instrument 330 extends to the surgical site during the surgical procedure. The drive assembly 323 includes a plurality of drives and other mechanisms controlled to respond to input commands at the operator input system 106 and to transmit force to the transmission mechanism 334 to actuate the instrument 330. Although Figure 3 The embodiment shows a device 330 that is only attached to the manipulator arm 310 for ease of observation, but the device can be attached to any and each of the manipulator arms 310, 311, 312, 313.

[0067] Figure 4 An exemplary embodiment of a manipulator system 400 that can be used as part of a manipulator system 100 is illustrated. Figure 4 The image illustrates a portion of the manipulator arm 440 of the manipulator system 400, with two instruments 408 and 410 in their mounted positions. For simplicity, Figure 4The illustrative example depicts only two instruments, but as is well known to those skilled in the art, more than two instruments may be mounted in the mounting position at the manipulator system 400. Each instrument 408, 410 includes shafts 420, 430, which have a movable end effector or endoscope, camera or other sensing device at a distal end, and may include or exclude a wrist mechanism (not shown) to control the movement of the distal end.

[0068] exist Figure 4 In this embodiment, the distal portions of instruments 408, 410 are received via a single port structure 480 for introduction into the patient. As shown, the port structure includes a cannula and an instrument entry guide inserted into the cannula. Individual instruments are inserted into the entry guide to reach the surgical site.

[0069] Transmission mechanisms 485, 490 are located at the proximal portion of each shaft 420, 430 and are connected to drive assemblies 470, 475 via sterile adapters 450, 460. The drive assemblies 470, 475 include multiple internal mechanisms (not shown) controlled by a controller (e.g., at the control trolley of the surgical system) to transmit force to the force transmission mechanisms 485, 490 to actuate instruments 408, 410 in response to input commands at the surgeon's side console of the surgical system.

[0070] The manipulator system described in this article is not limited to Figure 1 The embodiments described herein are as follows, and various other remotely operated computer-aided manipulator configurations can be used in conjunction with the embodiments described herein. One or more diameters of the instrument shaft and end effector are typically selected based on the size of the cannula from which the instrument will be used and depending on the ongoing surgical procedure.

[0071] Figure 5 and 6 These are various views of a medical device 500 according to an embodiment. In some embodiments, the medical device 500, or any component thereof, is optionally part of an instrument of a surgical system for performing surgical procedures, and the surgical system may include a manipulator unit, a series of kinematic links, a series of cannulas, etc. The medical device 500 (and any instruments described herein) can be used in any suitable surgical system, such as the manipulator system 100 or manipulator system 200 shown and described above. The medical device 500 can be used as the medical instruments 226, 330, 408, and 410 described above. Figure 5As shown, the medical device 500 defines a distal boundary (or coverage area) 502 (or is included within a distal boundary (or coverage area) 502), which corresponds to a cannula size, or a size within the working channel of an elongated flexible device (such as a flexible catheter or endoscope), or other dimensions specified by the surgical environment. The distal boundary 502 can be a cylinder with any suitable nominal diameter (e.g., 8 mm, 5 mm, or any size in between). The medical device 500 includes a force transmission mechanism 504, a shaft 506, an optional distal wrist assembly 508, a distal actuator 510, and a set of tension elements 512 (e.g., the tension elements 512 can be cables, straps, etc.).

[0072] The medical device 500 may include a plurality of tension elements 512. For example, in some embodiments, the medical device 500 may include two tension elements 512, wherein each tension element 512 has two segments extending along the axis 506 of the device, thereby forming four proximal portions. Reference Figure 6 The corresponding tension element 512 can be wired through the wrist assembly 514 and wound around the corresponding pulley 516 or 517 of the tool members 518, 519. Each tension element 512 has a tension element segment with two proximal portions along axis 506, which, when moved in opposite directions, are capable, among other things, of causing the corresponding tool member 518 or 519 to rotate about axis A1. This arrangement may be referred to as a “four-cable” wrist, and changes in the pitch, yaw, or grip of the medical device 500 can be performed by operating the four proximal portions of the tension element 512 in a manner similar to that shown and described in U.S. Patent Publication No. 2020 / 0390430 (incorporated herein by reference). In other embodiments, the medical device 500 may include four separate tension elements 512, with two separate tension elements coupled to pulley 516 of the tool member 518 and two separate tension elements coupled to pulley 517 of the tool member 518, thereby creating four proximal tension element end portions. In some embodiments, the medical device 500 may include more than two or four tension elements 512 and more than four proximal tension element end portions. Tension elements 512 may be, for example, cables, straps, etc., connecting force transmission mechanism 504 to distal wrist assembly 508 and end effector 510. In some embodiments, tension elements 512 may be made of polymer.

[0073] The medical device 500 is configured such that movement of one or more of the tension elements 512 produces rotation of the end effector 510 about a first rotation axis A1 (see [link]). Figure 6The wrist assembly 508 rotates about a second rotation axis A2 and / or optionally about a third rotation axis A3 (which acts as a pitch axis, the term pitch being arbitrary), the tool component of the end effector 510 cuts about a first rotation axis A1, or any combination of these movements. Changing the pitch or yaw of the medical device 500 can be performed by manipulating the tension element 512 in a manner similar to that described in the co-examined international patent application serial number PCT / US2022 / 039942 entitled “Surgical Instrument Cable Control and Routing Structures” (whose disclosure is incorporated herein by reference in its entirety).

[0074] like Figure 5 As shown, the proximal force transmission mechanism 504 includes a set of drive components, such as winches 522 and 524, which rotate or “wrap” the proximal portion of any tension element 512 to produce the desired tension element movement. In some embodiments, the two proximal ends of the tension element 512, associated with opposite directions of a single degree of freedom, are connected to two separate drive winches 522 and 524. This arrangement, often referred to as an anti-drive system, allows for independent control of the movement (e.g., pull-in or release) of each end of the tension element 512. The force transmission mechanism 504 produces movement of the tension element 512, which operates to produce the desired articulated movement (pitch, yaw, or clamp) at the wrist assembly 508 and the end effector 510. Thus, the force transmission mechanism 504 includes components that move a first proximal portion of the tension element 512 in a first direction (e.g., the proximal direction) via the first winch 522 and a second proximal portion of the tension element 512 in a second opposite direction (e.g., the distal direction) via the second winch 524. The force transmission mechanism 504 can also move the two proximal portions of the tension element 512 in the same direction. In this way, the force transmission mechanism 504 is able to maintain the required tension within the tension element 512.

[0075] In some embodiments, the force transmission mechanism 504 may include any combination or component described in International Patent Application Serial No. PCT / US2022 / 039942 entitled “Surgical Instrument Cable Control and Routing Structures” (the disclosure of which is incorporated herein by reference in its entirety). However, in other embodiments, any medical device described herein may have both ends of a tension element wound around a single winch. This alternative arrangement is often referred to as a self-resisting drive system, using a single drive motor to operate both ends of the tension element.

[0076] Furthermore, while force transmission mechanism 504 is shown as including a winch, in other embodiments, the force transmission mechanism may include one or more linear actuators that produce translation (linear motion) of a portion of the cable. Such a force transmission mechanism may include, for example, a universal joint, a lever, or any other suitable mechanism to directly pull (or release) any end of the cable. For example, in some embodiments, the proximal force transmission mechanism 504 may include any proximal force transmission mechanism or component described in U.S. Patent Application Publication No. US 2015 / 0047454A1 entitled “Lever Actuated Gimbal Plate” (filed August 15, 2014) or U.S. Patent No. US 6,817,974B2 entitled “Surgical Tool Having Positively Positionable Tendon-Actuated Multi-Disk Wrist Joint” (filed June 28, 2001) (each of which is incorporated herein by reference in its entirety).

[0077] Shaft 506 can be any suitable elongated shaft coupled to force transmission mechanism 504 and optional wrist assembly 508 (if present) or end effector 510. Specifically, shaft 506 includes a proximal portion 526 coupled to force transmission mechanism 504 and a distal portion 528 coupled to optional wrist assembly 508 or end effector 510. Shaft 506 defines a channel or series of channels through which tension element 512 and other components (e.g., wires, ground wires, etc.) can be wired from force transmission mechanism 504 to wrist assembly 508. In some embodiments, shaft 506 can be a substantially rigid member, while in other embodiments, shaft 506 can be a flexible member.

[0078] Figure 7This is a side view of multiple miniature winches 600 used in medical devices or device systems (such as medical device system 104, medical device system 200, medical devices 330, 408, and 410, and medical device 500). The medical device may be a surgical instrument; it may optionally include a wrist mechanism (such as a distal wrist assembly 508) actuated by the winches 600 and configured for bidirectional movement along four axes; or it may be an elongated, flexible device (such as an endoscope).

[0079] Embodiments of one or more winches 600 are specifically discussed herein with respect to medical device 500; however, one or more winches 600 can be used with any number of medical devices, including those previously discussed. While the medical device 500 disclosed above is suitable for multiple applications, it may exhibit reduced performance within extended, tortuous paths, such as those described in the background section above. Specifically, when winches 522, 524 are rotated to linearly move tension elements 512 in a flexible medical device, the set of tension elements 512 can generate excessive winch friction. By utilizing multiple miniature winches 600 (dissimilar to winches 522 and 524, which are distally spaced from the force transmission mechanism 504) and implementing the modifications described herein, medical device 500 can be reliably used even when the medical device has a flexible shaft (e.g., shaft 506) of one meter or greater in length and traverses highly tortuous anatomical structures.

[0080] Figure 7 The one or more winches 600 shown are each coupled at a first end 604 of each of the one or more winches 600 to one of one or more elongated rotatable drive elements 601. The elongated rotatable drive elements 601 are respectively coupled to a rotatable input 605 of a proximal force transmission member 603, which is configured to receive force or torque from an external device 607. The external device 607 may be an output from a manipulator assembly of the robot-assisted manipulator system as described above. The elongated rotatable drive elements 601 may be housed within an elongated shaft 609, and... Figure 5 Corresponding to shaft 506, the elongated shaft 609 has a proximal end 611 coupled to the proximal force transmission member 603. One or more winches 600 are coupled to the distal end 613 of the elongated shaft 609. As a result, each of the one or more winches 600 is distally spaced from the force transmission member 603 via the elongated shaft 609. The elongated shaft 609 may be rigid or flexible. In some arrangements, the elongated shaft 609 may have a length greater than or equal to one meter to enable use, for example, in procedures in the gastrointestinal tract.

[0081] like Figure 7As shown, each of the one or more tension elements 602 has a first end 604 coupled to one of the one or more winches 600 and a second end 608 directly coupled to a distal portion 610 of a medical device (such as medical device 500). Specifically, in Figure 7 In this medical device, each of one or more tension elements 602 is coupled to a distal portion 610 comprising a coil tube bending section 612, an elbow mechanism 614, and a wrist mechanism 616. The wrist mechanism 616 and / or the elbow mechanism 614 may be actuated by one or more tension elements 602. For example, the wrist mechanism 616 may be actuated by one or more tension elements 602 for bidirectional movement along four axes. The medical device may be a surgical instrument. The distal portion 610 of the medical device may be an end effector actuated by one or more tension elements 602. Furthermore, the distal portion 610 may be manually actuated when the medical device is disconnected from an external device, for example, in the event of a power outage.

[0082] The length 618 of each of one or more tension elements 602 is configured to wind one of one or more winches 600, and (as...) Figure 11 (Best shown in the diagram) A winch shaft 619 is specifically wound around each of one or more winches 600. As the length 618 of the tension element 602 is wound around the winch shaft 619, the second end 608 of the tension element 602 applies an axial force to the distal portion 610 of the medical device. Each winch shaft 619 has a winch diameter Dc (e.g., ...). Figure 10 As shown), and the length 618 of each tension element 602 has a tension element diameter Dte (as shown). Figure 11 (As shown). The ratio of the winch diameter Dc to the tension element diameter Dte is less than 10:1, illustrating the miniature size of one or more winches 600, and giving a perspective that conventional winches (such as winches 522 and 524) typically have ratios as large as 400:1 (e.g., when considering a single cable) or 20:1 to 40:1 (e.g., for braided cable bundles). To bend around the miniature size of one or more winches 600 and reduce friction, one or more tension elements 602 may comprise a braided polymer, such as high-density polyethylene (HDPE), PBO, or Vectran. The winch shaft 619 may comprise stainless steel. To reduce the coefficient of friction, one or more tension elements 602 may be lubricated.

[0083] Turning Figure 8 and 9 One or more winches 600 are configured to connect to the proximal partition 620 and the distal partition 622. For example... Figure 8As shown, the proximal partition 620 includes a rotary bearing 624 for each of one or more winches 600. A first end 604 of each of the one or more winches 600 can be positioned within a corresponding rotary bearing 624. Figure 8 As shown, the distal diaphragm 622 includes a winch recess 626 for each of one or more winches 600 and a redirection aperture 628 adjacent to each winch recess 626 for each of one or more tension elements 602. Figure 9 As shown, the redirection orifice 628 is configured to redirect a respective tension element 602 of one or more tension elements 602 from a winding angle W relative to the longitudinal axis L to an axial angle A substantially parallel to the longitudinal axis L (e.g., ...). Figure 9 (As shown). The transition from the winding angle W to the axial angle A can be approximately 90 degrees. To facilitate this transition, such as... Figure 8 As shown, the redirection aperture 628 adjacent to each winch recess 626 includes a shoulder 630 with a smooth surface.

[0084] Turning Figure 10 and Figure 11 Each of one or more winches 600 may have a second end 632, the second end 632 including a conical segment 634 having a spherical dome tip 636, such as Figure 11 As shown. A spherical dome tip 636 is supported on the bottom of a winch recess 626 in a distal diaphragm 622, thereby creating a low-cost, low-friction rotary bearing. The proximal diaphragm 620 and / or the distal diaphragm 622 may comprise machined or molded acetal plastic or carbon-filled PEEK to minimize friction. Each of one or more winches 600 may further include a connection feature 633, such as a recessed area or a cavity, to which the tension element 602 may be secured by physical bonding, adhesives, and / or heat. The connection feature may have multiple pores or other guiding features that form a high-friction path for the tension element 602, which resists movement of the tension element 602 relative to the connection feature. When wiring around the high-friction path, the tension element 602 holds the tension element 602 in connection with the connection feature, thereby connecting it to the winch 600.

[0085] exist Figure 10 and Figure 11 In the arrangement shown, the winch shaft 619 has a constant winch diameter Dc (e.g., Figure 10 (As shown). The tension element 602 is configured to slide axially downward along the winch shaft 619 as the winch shaft 619 rotates, while simultaneously winding around the winch shaft 619. Figure 10As shown, the length 618 of the tension element 602 wound around the winch shaft 619 has a tension element diameter Dte. The effective transmission ratio is the amount by which the tension element 602 is wound onto or unwound from the winch shaft 619 per revolution. When the winch shaft 619 has a constant winch diameter Dc, the effective transmission ratio is generally constant because one revolution of the winch shaft 619 will result in a uniform amount of winding or unwinding of the tension element 602. However, at the beginning of winding, the amount of winding or unwinding of the tension element 602 per revolution can be non-linear due to variations in the winding angle W (discussed above and in...). Figure 9 (as in the example), so the effective gear ratio can vary. Pre-winding the tension element 602 around the winch shaft 619 until a substantially constant winding angle W is obtained ensures a substantially constant effective gear ratio (e.g., a fixed and / or effective gear ratio that varies by no more than 20% from the baseline).

[0086] In other arrangements, at least one of the winches 600 may have a winch shaft 619 having a cross-section that varies along the longitudinal axis L, such that the effective transmission ratio changes as the tension element 602 winds around the winch shaft 619—because the amount by which the tension element 602 winds or unwinds around the winch shaft 619 will depend on the winch diameter Dc of the varying cross-section. This can facilitate adjusting the force supplied to the distal portion 610 of the medical device based on its operation. For example, the medical device may be an endoscope, and the variation in the cross-section of the winch 600 can correspond to a variation in the bending angle of the endoscope. The variation in cross-section adjusts the effective transmission ratio to compensate for the increase in friction caused by the variation in the bending angle of the endoscope.

[0087] Figure 12A method 700 for fabricating a medical device having distally spaced winches by pre-winding tension elements around a winch is schematically illustrated. At block 702, method 700 includes providing a medical device (such as medical device 500) comprising a proximal force transmission member 603, one or more elongated rotatable drive elements 601 coupled to the proximal force transmission member 603, one or more winches 600 distally spaced from the force transmission member 603 and each coupled to one of the one or more elongated rotatable drive elements 601, and one or more tension elements 602, each of the one or more tension elements 602 coupled to one of the one or more winches 600, and a distal portion 610 of the medical device. At block 704, method 700 includes actuating the proximal force transmission member 603 to rotate the one or more elongated rotatable drive elements 601 and the one or more winches 600. At block 706, method 700 includes winding one or more tension elements 602 around one or more winches 600 until the one or more tension elements 602 have a substantially constant effective transmission ratio for subsequent winding.

[0088] Figure 13 A method 800 using a medical device having winches distally spaced from the proximal force transmission member is schematically illustrated. At block 802, method 800 includes providing a medical device (such as medical device 500) comprising a proximal force transmission member 603, one or more elongated rotatable actuating elements 601 coupled to the proximal force transmission member 603, one or more winches 600 distally spaced from the force transmission member 603 and each coupled to one of the one or more elongated rotatable actuating elements 601, and one or more tension elements 602, each of the one or more tension elements 602 coupled to one of the one or more winches 600, and a distal portion 610 of the medical device. At block 804, method 800 includes actuating the proximal force transmission member 603 to rotate the one or more elongated rotatable actuating elements 601 and the one or more winches 600. At block 806, method 800 includes winding one or more tension elements 602 around the one or more winches 600 to operate the distal portion 610 of the medical device. At box 808, method 800 includes changing the effective transmission ratio to correspond to the change in force required to operate the distal portion 610 of the medical device.

[0089] The specification describes specific details of some examples. Several specific details are given to provide a comprehensive understanding of the examples. However, it will be apparent to those skilled in the art that some examples can be practiced without some or all of these specific details. The specific examples disclosed herein are intended to be illustrative and not limiting. Those skilled in the art will recognize other elements that, while not specifically described herein, are within the scope and spirit of this disclosure.

[0090] Where practicable, elements described in detail with reference to one instance, embodiment, or application may optionally be included in other instances, embodiments, or applications in which they are not specifically shown or described. For example, even if an element is not described in conjunction with a second example, it may be argued that the element is included in the second example as long as it has been described in detail with reference to the first example. Therefore, to avoid unnecessary repetition in the foregoing description, unless otherwise specifically described, one or more elements shown and described in association with one instance, embodiment, or application may be incorporated into other instances, embodiments, or applications, unless the one or more elements would render the instance or embodiment inoperable, or unless two or more of the elements provide conflicting functionality. Similarly, it should be understood that, unless expressly stated otherwise, any particular component (including system components or method steps) is optional and not an essential feature indispensable to this disclosure.

[0091] Any changes and further modifications to the described apparatus, instruments, and methods, as well as any further application of the principles of this disclosure, are fully contemplated, as would normally occur to those skilled in the art as per the scope of this disclosure. In particular, it is fully understood that features, components, and / or steps described for one example may be combined with features, components, and / or steps described for other examples of this disclosure. Furthermore, the dimensions provided herein are for specific examples, and different dimensions, dimensions, and / or scales are contemplated for the implementation of the concepts of this disclosure.

[0092] While this document provides examples in the context of medical procedures, any references to medical or surgical instruments and methods are non-limiting. For example, the instruments, systems, and methods described herein can be used for non-medical purposes, including industrial use, general robotic use, and sensing or manipulating non-tissue artifacts. Other example applications include cosmetic enhancements, imaging of human or animal anatomy, collecting data from human or animal anatomy, and training medical or non-medical personnel. Additional example applications include procedures for removing tissue from human or animal anatomy (without returning it to the anatomy) and performing procedures on human or animal cadavers. Furthermore, these techniques can also be used in surgical and non-surgical medical or diagnostic procedures.

[0093] The methods described herein are exemplified as a set of operations or procedures. Not all of the example procedures may be executed in all instances of the method. Additionally, one or more procedures not explicitly exemplified or described may be included before, after, within, or as part of an example procedure. In some instances, one or more procedures may be executed by a control system (e.g., control system 112), or may be implemented at least in part in the form of executable code stored on a non-transitory, tangible, machine-readable medium, which, when run by one or more processors (e.g., the processor of control system 112), may cause one or more processors to execute one or more procedures.

[0094] One or more elements of the embodiments of this disclosure can be implemented in software to execute on a processor of a computer system, such as a control processing system. When implemented in software, the elements of the embodiments of this disclosure are essentially code segments for performing necessary tasks. The program or code segment can be stored in a processor-readable storage medium or device that has been downloaded via computer data signals embodied in a carrier wave on a transmission medium or communication link. The processor-readable storage device can include any medium capable of storing information, including optical, semiconductor, and magnetic media. Examples of processor-readable storage devices include electronic circuits; semiconductor devices, semiconductor memory devices, read-only memory (ROM), flash memory, erasable programmable read-only memory (EPROM); floppy disks, CD-ROMs, optical disks, hard disks, or other storage devices. The code segment can be downloaded via a computer network such as the Internet or an intranet. Any of a variety of centralized or distributed data processing architectures can be employed. Programming instructions can be implemented as multiple separate programs or subroutines, or they can be integrated into multiple other aspects of the system described herein. In one example, the control system supports wireless communication protocols such as Bluetooth, IrDA, HomeRF, IEEE 802.11, DECT, and wireless telemetry.

[0095] Note that the processing and display presented may not inherently relate to any particular computer or other device. Various general-purpose systems may be used with the programs taught herein, or it may prove convenient to construct more specialized devices to perform the described operations. The necessary structures for various such systems will appear in the elements of the claims. Furthermore, the examples of this disclosure are not described with reference to any particular programming language. It will be understood that various programming languages ​​may be used to implement the teachings of this disclosure.

[0096] This disclosure describes the states of various instruments, parts of instruments, and anatomical structures in three-dimensional space. As used herein, the term “position / location” refers to the position of an object or part of an object in three-dimensional space (e.g., three translational degrees of freedom along Cartesian x, y, and z coordinates). The term “orientation” as used herein refers to the rotational placement of an object or part of an object (three rotational degrees of freedom, such as roll, pitch, and yaw). The “pitch” direction and the “yaw” direction are not necessarily limited to vertical and horizontal movements, respectively, but can be any directions orthogonal to each other. As used herein, the term “attitude” refers to the position of an object or part of an object in at least one translational degree of freedom, and the orientation of the object or part of an object in at least one rotational degree of freedom (up to six total degrees of freedom). The term “shape” as used herein refers to a set of attitudes, positions, or orientations measured along the length of an object. As used herein, when used in conjunction with a reference numerical indication, the term “about” refers to a reference numerical indication plus or minus 10% of that reference numerical indication. For example, the language “about 50” covers a range of 45 to 55. Similarly, the language “about 5” covers a range of 4.5 to 5.5.

[0097] As used in this specification and the appended claims, the term "distal" refers to the direction toward the working site, while the term "proximal" refers to the direction away from the working site. Thus, for example, the end of the medical device closest to the target tissue will be the distal end of the medical device, and the end opposite the distal end will be the proximal end of the medical device.

[0098] Furthermore, the specific words chosen to describe one or more embodiments and optional elements or features are not intended to limit the invention. For example, spatially relative terms such as “below,” “below,” “below,” “above,” “over,” “near,” “far,” etc., can be used to describe the relationship of one element or feature to another, as illustrated in the examples in the figures. These spatially relative terms are intended to include different positions (i.e., translational placement) and orientations (i.e., rotational placement) 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 flipped, an element described as “below other elements or features” or “below other elements or features” will be “above other elements or features” or “above other elements or features.” Thus, the term “below” can include both above and below positions and orientations. The device may be oriented in other ways (e.g., rotated 90 degrees or otherwise), and the spatially relative descriptors used herein are interpreted accordingly. Similarly, descriptions of movement (translation) along various axes and movement (rotation) around various axes include various spatial positions and orientations. The combination of the position and orientation of the subject defines the posture of the subject.

[0099] Similarly, unless the context otherwise requires, geometric terms such as “parallel,” “perpendicular,” “circular,” or “square” do not require absolute mathematical precision. Instead, these geometric terms allow for variation due to manufacturing or equivalent functions. For example, if an element is described as “circular” or “generally circular,” components that are not strictly circular (e.g., slightly elliptical or polygonal components) are still included in this description.

[0100] Furthermore, unless the context otherwise requires, the singular forms “a,” “an,” and “the” also include the plural forms. Terms such as “comprising,” “including,” and “having” define the presence of the stated feature, step, operation, element, component, etc., but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, or groups.

[0101] Unless otherwise stated, the terms equipment, medical device, medical apparatus and variations thereof are used interchangeably.

[0102] While certain exemplary instances of this disclosure have been described and illustrated in the accompanying drawings, it should be understood that these instances are merely illustrative and not limited to the broad disclosure herein, and that instances of this disclosure should not be limited to the specific constructions and arrangements shown and described, as various other modifications may be made by those skilled in the art.

Claims

1. A medical device comprising: A proximal force transmission member, the proximal force transmission member including one or more rotatable inputs configured to receive force or torque from an external device; An elongated shaft having a proximal end connected to the proximal force transmission member, the elongated shaft accommodating one or more elongated rotatable drive elements, the one or more elongated rotatable drive elements being respectively connected to one of the one or more rotatable inputs of the proximal force transmission member; One or more winches are coupled to the distal end of the elongated shaft, each of the one or more winches including a first end coupled to one of the one or more elongated rotatable drive elements, each of the one or more winches being distally spaced from the proximal force transmission member via the elongated shaft; as well as One or more tension elements, each of which is respectively connected to one of the one or more winches and the distal end of the medical device.

2. The medical device of claim 1, wherein the one or more elongated rotatable drive elements are a plurality of elongated rotatable drive elements, the one or more winches are a plurality of winches, and the one or more tension elements are a plurality of tension elements.

3. The medical device of claim 1, wherein each of the one or more winches includes a shaft, and wherein each of the one or more tension elements is configured to slide axially downward along the shaft of one of the one or more winches when winding one of the one or more winches.

4. The medical device of claim 1, wherein each of the one or more tension elements comprises a woven polymer.

5. The medical device of claim 1, wherein each of the one or more tension elements is lubricated.

6. The medical device of claim 1, wherein the elongated shaft is flexible.

7. The medical device of claim 1, wherein the elongated shaft is rigid.

8. The medical device according to any one of claims 1 to 7, wherein each of the one or more tension elements is pre-wound to one of the one or more winches to have a substantially constant effective transmission ratio for subsequent winding.

9. The medical device according to any one of claims 1 to 7, wherein at least one of the one or more winches has a shaft having a cross-section that varies along a longitudinal axis, such that the effective transmission ratio varies when one of the one or more tension elements is wound around the shaft of at least one of the one or more winches.

10. The medical device of claim 9, wherein the medical device is an endoscope, and the change in the cross-section corresponds to a change in the bending angle of the endoscope.

11. The medical device of claim 10, wherein the change in cross-section adjusts the effective transmission ratio to compensate for the increase in friction caused by the change in the bending angle of the endoscope.

12. The medical device according to any one of claims 1 to 7, wherein the distal end of the medical device can be manually actuated when the medical device is disconnected from the external device.

13. The medical device according to any one of claims 1 to 7, wherein the one or more winches are arranged in an antagonistic pair.

14. The medical device according to any one of claims 1 to 7, wherein the elongated shaft has a length greater than or equal to one meter.

15. The medical device according to any one of claims 1 to 7, further comprising a distal partition coupled to the one or more winches, the distal partition including one or more winch recesses for receiving a respective winch of the one or more winches and redirection orifices adjacent to each winch recess for each of the one or more tension elements.

16. The medical device of claim 15, wherein the redirection orifice adjacent to each winch recess is configured to redirect one of the one or more tension elements from a winding angle relative to the longitudinal axis of the winch to an axial angle substantially parallel to the longitudinal axis of the winch.

17. The medical device of claim 16, wherein the redirection aperture adjacent to each winch recess includes a shoulder having a smooth surface.

18. The medical device according to any one of claims 1 to 7, each of the one or more winches having a second end portion comprising a conical section having a spherical dome tip.

19. The medical device according to any one of claims 1 to 7, further comprising a proximal partition coupled to the one or more winches, the proximal partition including a rotary bearing for each of the one or more winches.

20. The medical device of claim 19, wherein a first end of each of the one or more winches is positioned within a respective rotary bearing of the proximal diaphragm.

21. The medical device according to any one of claims 1 to 7, wherein the medical device is a surgical instrument.

22. The medical device of claim 21, wherein the distal end of the medical device is an end effector actuated by the one or more tension elements.

23. The medical device according to any one of claims 1 to 7, wherein the medical device includes a wrist mechanism and an end effector distal to the wrist mechanism, the wrist mechanism being configured to be actuated by the one or more tension elements and configured for bidirectional movement along four axes.

24. The medical device of claim 23, wherein the medical device further comprises an elbow mechanism and an end effector distal to the elbow mechanism, the elbow mechanism being configured for bidirectional movement along four axes.

25. A medical device comprising: A proximal force transmission member, the proximal force transmission member including one or more rotatable inputs configured to receive force or torque from an external device; An elongated shaft having a proximal end connected to the proximal force transmission member, the elongated shaft accommodating one or more elongated rotatable drive elements, the one or more elongated rotatable drive elements being respectively connected to one of the one or more rotatable inputs of the proximal force transmission member; One or more winches are coupled to the distal end of the elongated shaft, each of the one or more winches including a first end coupled to one of the elongated rotatable drive elements; as well as One or more tension elements, each of the one or more tension elements having a first end connected to one of the one or more winches, a second end directly connected to a distal end of the medical device, and a length configured to wind around one of the one or more winches, the second end of each of the one or more tension elements being configured to apply an axial force on the distal end of the medical device when the length of the respective tension element winds around one of the one or more winches.

26. The medical device of claim 25, wherein the one or more elongated rotatable drive elements are a plurality of elongated rotatable drive elements, the one or more winches are a plurality of winches, and the one or more tension elements are a plurality of tension elements.

27. The medical device of claim 25, wherein each of the one or more winches includes a shaft, and wherein each of the one or more tension elements is configured to slide axially downward along the shaft of one of the one or more winches when winding one of the one or more winches.

28. The medical device of claim 25, wherein the one or more tension elements comprise a braided polymer.

29. The medical device of claim 25, wherein the one or more tension elements are lubricated.

30. The medical device of claim 25, wherein the elongated shaft is flexible.

31. The medical device of claim 25, wherein the elongated shaft is rigid.

32. The medical device according to any one of claims 25 to 31, wherein each of the one or more tension elements is pre-wound on one of the one or more winches to have a substantially constant effective transmission ratio for subsequent winding.

33. The medical device according to any one of claims 25 to 31, wherein at least one of the one or more winches has a shaft having a cross-section that varies along a longitudinal axis, such that the effective transmission ratio changes when one of the one or more tension elements winds around the shaft of at least one of the one or more winches.

34. The medical device of claim 33, wherein the medical device is an endoscope, and the change in the cross-section corresponds to a change in the bending angle of the endoscope.

35. The medical device of claim 34, wherein the change in cross-section adjusts the effective transmission ratio to compensate for the increase in friction caused by the change in the bending angle of the endoscope.

36. The medical device according to any one of claims 25 to 31, wherein the distal end of the medical device can be manually actuated when the medical device is disconnected from the external device.

37. The medical device according to any one of claims 25 to 31, wherein the one or more winches are arranged in an antagonistic pair.

38. The medical device according to any one of claims 25 to 31, wherein the elongated shaft has a length greater than or equal to one meter.

39. The medical device according to any one of claims 25 to 31, further comprising a distal partition coupled to the one or more winches, the distal partition including one or more winch recesses for receiving respective winches of the one or more winches and redirection orifices adjacent to each winch recess for each of the one or more tension elements.

40. The medical device of claim 39, wherein the redirection orifice adjacent to each winch recess is configured to redirect one of the one or more tension elements from a winding angle relative to the longitudinal axis of the winch to an axial angle substantially parallel to the longitudinal axis of the winch.

41. The medical device of claim 40, wherein the redirection aperture adjacent to each winch recess includes a shoulder having a smooth surface.

42. The medical device according to any one of claims 25 to 31, each of the one or more winches having a second end, the second end comprising a conical section having a spherical dome tip.

43. The medical device according to any one of claims 25 to 31, further comprising a proximal partition coupled to the one or more winches, the proximal partition including a rotary bearing for each of the one or more winches.

44. The medical device of claim 43, wherein the first end of each of the one or more winches is positioned within a respective rotary bearing of the proximal diaphragm.

45. The medical device according to any one of claims 25 to 31, wherein the medical device is a surgical instrument.

46. ​​The medical device of claim 45, wherein the distal end of the medical device is an end effector actuated by the one or more tension elements.

47. The medical device according to any one of claims 25 to 31, wherein the medical device includes a wrist mechanism and an end effector distal to the wrist mechanism, the wrist mechanism being configured to be actuated by the one or more tension elements and configured for bidirectional movement along four axes.

48. The medical device of claim 47, wherein the medical device further comprises an elbow mechanism and an end effector distal to the elbow mechanism, the elbow mechanism being configured for bidirectional movement along four axes.

49. A medical device comprising: A proximal force transmission member, the proximal force transmission member including one or more rotatable inputs configured to receive force or torque from an external device; An elongated shaft having a proximal end connected to the proximal force transmission member, the elongated shaft accommodating one or more elongated rotatable drive elements respectively connected to the one or more rotatable inputs of the proximal force transmission member; as well as One or more winches are connected to the distal end of the elongated shaft, each of the one or more winches including a first end connected to the elongated rotatable drive element and a winch shaft having a winch diameter; One or more tension elements, each of the one or more tension elements having a first end connected to one of the one or more winches, a second end connected to a distal end of the medical device, and a tension element diameter; The ratio of the diameter of the winch to the diameter of the tension element is less than 10:

1.

50. The medical device of claim 49, wherein the one or more elongated rotatable drive elements are a plurality of elongated rotatable drive elements, the one or more winches are a plurality of winches, and the one or more tension elements are a plurality of tension elements.

51. The medical device of claim 49, wherein each of the one or more winches includes a shaft, and wherein each of the one or more tension elements is configured to slide axially downward along the shaft of one of the one or more winches when winding one of the one or more winches.

52. The medical device of claim 49, wherein the one or more tension elements comprise a braided polymer.

53. The medical device of claim 49, wherein one or more tension elements are lubricated.

54. The medical device of claim 49, wherein the elongated shaft is flexible.

55. The medical device of claim 49, wherein the elongated shaft is rigid.

56. The medical device according to any one of claims 49 to 55, wherein each of the one or more tension elements is pre-wound to one of the one or more winches to have a substantially constant effective transmission ratio for subsequent winding.

57. The medical device according to any one of claims 49 to 55, wherein at least one of the one or more winches has a shaft having a cross-section that varies along a longitudinal axis, such that the effective transmission ratio changes when one of the one or more tension elements winds around the shaft of at least one of the one or more winches.

58. The medical device of claim 57, wherein the medical device is an endoscope, and the change in the cross-section corresponds to a change in the bending angle of the endoscope.

59. The medical device of claim 58, wherein the change in cross-section adjusts the effective transmission ratio to compensate for the increase in friction caused by the change in the bending angle of the endoscope.

60. The medical device according to any one of claims 49 to 55, wherein the distal end can be manually actuated when the medical device is disconnected from the external device.

61. The medical device according to any one of claims 49 to 55, wherein the one or more winches are arranged in an antagonistic pair.

62. The medical device according to any one of claims 49 to 55, wherein the elongated shaft has a length greater than or equal to one meter.

63. The medical device according to any one of claims 49 to 55, further comprising a distal partition coupled to the one or more winches, the distal partition including one or more winch recesses for receiving respective winches of the one or more winches and redirection orifices adjacent to each winch recess for each of the one or more tension elements.

64. The medical device of claim 63, wherein the redirection orifice adjacent to each winch recess is configured to redirect one of the one or more tension elements from a winding angle relative to the longitudinal axis of the winch to an axial angle substantially parallel to the longitudinal axis of the winch.

65. The medical device of claim 64, wherein the redirection aperture adjacent to each winch recess includes a shoulder having a smooth surface.

66. The medical device according to any one of claims 49 to 55, each of the one or more winches having a second end, the second end comprising a conical section having a spherical dome tip.

67. The medical device according to any one of claims 49 to 55, further comprising a proximal partition coupled to the one or more winches, the proximal partition including a rotary bearing for each of the one or more winches.

68. The medical device of claim 67, wherein the first end of each of the one or more winches is positioned within a respective rotary bearing of the proximal diaphragm.

69. The medical device according to any one of claims 49 to 55, wherein the medical device is a surgical instrument.

70. The medical device of claim 69, wherein the distal end of the medical device is an end effector actuated by the one or more tension elements.

71. The medical device according to any one of claims 49 to 55, wherein the medical device includes a wrist mechanism and an end effector distal to the wrist mechanism, the wrist mechanism being configured to be actuated by the one or more tension elements and configured for bidirectional movement along four axes.

72. The medical device of claim 71, wherein the medical device further comprises an elbow mechanism and an end effector distal to the elbow mechanism, the elbow mechanism being configured for bidirectional movement along four axes.

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