Laparoscopic surgical instrument tip holder

Abstract

The instrument tip holder includes a deployment mechanism and a number of instrument carriers coupled to the deployment mechanism. Each instrument carrier has an instrument access end and a proximal end, and the deployment mechanism is adapted to selectively reconfigure the multiple instrument carriers from a linear or other elongated arrangement into a parallel cluster. The deployment mechanism can be a spring-mounted structure that interlocks the instrument carriers and collapses them into the parallel cluster when released from a constraint. Alternatively, the deployment mechanism can be an expandable structure that, when expanded, arranges the instrument carriers into the parallel cluster.

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This application claims the benefit of U.S. Provisional Application No. 63 / 298,157, filed January 10, 2022 (Attorney Docket No. 42369-708.101), the entire contents of which are incorporated herein by reference.

[0002] FIELD OF THEINVENTION The present invention relates generally to medical devices and methods. More specifically, the present invention relates to a surgical instrument tip holder for use in laparoscopic and endoscopic procedures, where a single instrument shaft can be used with multiple interchangeable surgical instrument tips. [Background technology]

[0003] Laparoscopic, endoscopic, and other minimally invasive surgical procedures have been widely adopted and have replaced many open surgical procedures. Laparoscopic procedures are performed within a body cavity, such as the abdomen or chest, and rely on introducing the shaft of a surgical instrument through tissue via a small incision, trocar, or other entry site that provides access into the cavity. In laparoscopic procedures, the shaft manipulates an instrument or end effector to perform a surgical protocol while viewing the operative field within the cavity using a laparoscopic camera. One drawback in performing laparoscopic and other minimally invasive procedures is the need to frequently exchange instruments through a limited number of access points.

[0004] It has been proposed to improve the efficiency of laparoscopic and other minimally invasive procedures by introducing multiple surgical instrument tips into a surgical field, such as an insufflated abdomen or chest, followed by exchange of instruments on a single or limited number of instrument shafts, thus avoiding the need to remove and exchange complete instruments through an access point. Such surgical instrument exchange systems and procedures are described, for example, in commonly owned U.S. Patent Publication Nos. 2013 / 0150871 and 2015 / 0216515, the entire disclosures of which are incorporated herein by reference.

[0005] U.S. Patent Publication No. 2015 / 0216515 describes the use of an instrument tip holder, referred to as a cassette, to facilitate the introduction, retention, and exchange of multiple instruments within an insufflated abdomen, thorax, or other surgical field. The instrument cassette includes up to five articulating segments, most or all of which carry deployable instrument tip holders, one of which may be an externally attached segment. The instrument cassette is introduced through an incision or port in a straightened configuration, curved for stabilization, and placed on a tissue surface or pulled against the upper wall of the thorax using manipulators attached to the externally attached segment. While functional and having significant advantages in performing laparoscopic and other minimally invasive procedures, the designs disclosed in U.S. Patent Publication Nos. 2013 / 0150871 and 2015 / 0216515 are first generation designs, and it would be advantageous to provide additional and alternative designs having improved ease of use, design simplicity, reliability, compactness, etc. At least some of these objectives will be met by the invention as described and claimed hereinafter.

[0006] U.S. Patent Publication Nos. 2013 / 0150871 and 2015 / 0216515 are discussed above. U.S. Patent Nos. 5,925,002, 6,309,397, 8,747,394, 8,858,538, 7,492,116, and U.S. Publication Nos. 2003 / 0114731, 2005 / 0043718, US2005 / 0165449, US2005 / 0209607, US2005 / 0209607, US2005 / 0216515 ... No. S2006 / 0020287, No. US2006 / 0041273, No. US2007 / 0198000, No. US2008 / 0021274, No. US No. 2008 / 0108871, No. US2008 / 0147096, No. US.2008 / 0167672, No. US2008 / 0275480, No. US. See also US 2009 / 0005638, US 2009 / 0005635, US2009 / 0182193, US2010 / 0016855, US2010 / 0057078, US2010 / 0188493, US2011 / 0087267, US2012 / 0083826, US2012 / 01322450, US2013 / 0066304, and US2013 / 0211196. [Prior art documents] [Patent documents]

[0007] [Patent Document 1] US Patent Application Publication No. 2013 / 0150871 [Patent Document 2] US Patent Application Publication No. 2015 / 0216515 Summary of the Invention [Means for solving the problem]

[0008] In a first aspect, the present invention provides an instrument tip holder or cassette comprising a deployment mechanism and a plurality of instrument carriers, the instrument carriers being coupled to the deployment mechanism, each instrument carrier having an instrument access end and a proximal end, the deployment mechanism adapted to selectively reconfigure the plurality of instrument carriers from a linear or otherwise straightened arrangement useful for introduction and removal of the tip holders from a surgical field to a parallel cluster useful for accessing instrument tips within each instrument carrier.

[0009] By "side-by-side cluster" it is meant that the longitudinal axes of multiple instrument carriers are held in a side-by-side arrangement, typically in a symmetrical pattern about a central axis. Usually, but not necessarily, the instrument carriers have access and proximal ends aligned in a plane perpendicular to the central axis, such that the side-by-side cluster has a generally cylindrical arrangement in which the instrument access ends lie within a circular perimeter at one end of the cylinder and the proximal ends lie within a circular perimeter at the other end of the cylinder. The cross-sectional perimeters will usually be circular, but in other cases they may be elliptical, polygonal, etc.

[0010] The linear or straightened arrangement of the instrument carriers has a low profile that is particularly suitable for minimally invasive introduction of the instrument tip holder assemblies through access ports into an abdominal or thoracic surgical field. The instrument tip holders can be reconfigured into a parallel cluster arrangement after introduction into the surgical field, which is particularly suitable for removal of individual surgical instrument tips from and return to the individual instrument carriers of the instrument tip holders while present within the surgical field. The deployment mechanism, as will be described in more detail below, will typically allow the instrument tip holder assemblies to be reconfigured by the surgeon either in parallel with the instrument tip holder being placed or remotely using a manipulator, insufflator, or other instrument introduced thereafter.

[0011] The instrument tip holder of the present invention will typically further comprise one or more surgical working tips that are removably mounted within at least some of the instrument carriers. The surgical instrument tips will usually be mounted within the instrument carrier prior to introduction of the instrument tip holder into the patient, although in some cases it may be possible to introduce and / or replace the surgical instrument tips after the procedure has begun. The individual instrument carriers will typically comprise a tubular body, such as a cylindrical body, but will often have flat surfaces, i.e., facets, to promote the formation of parallel clusters, as described in more detail below.

[0012] In a preferred aspect, the instrument tip holder or cassette of the present invention may further comprise a hub segment configured to occupy a central region of the parallel cluster when the instrument carrier is unconstrained, i.e., free to self-assemble or be assembled into a parallel cluster, as described in more detail below. The hub is typically further configured to be removably attached to a manipulator. The manipulator may be pre-attached to the hub of the instrument tip holder or may be introduced separately into the surgical field before or after the instrument tip holder is introduced, but prior to reconfiguration of the initial linear arrangement of the instrument carrier into the desired parallel cluster.

[0013] In some examples, the instrument carrier and the hub may each include one or more magnetic elements, with the magnetic elements on the hub configured to attract the magnetic elements on the instrument carrier and hold or stabilize the instrument carriers in their parallel cluster configuration while allowing limited displacement to facilitate removal and return of the instrument tips from the instrument carrier.

[0014] In other examples, one or more of the instrument carriers may include a mechanical latching mechanism, such as a hook, lock and key arrangement, snap, etc., configured to selectively engage the hub and allow limited displacement of one or more of the instrument carriers (typically a pair of instrument carriers joined at the top by a spring or other coupling element) to facilitate removal and return of the instrument tips from the instrument carriers while maintaining all of the instrument carriers in the cluster configuration. In preferred cases, both a magnetic element and a latching mechanism will be used, with the magnet providing the initial alignment and the latch stabilizing the cluster configuration as the instrument carriers are displaced and the surgical instruments removed and returned to their individual carriers.

[0015] In some examples, individual instrument carriers or groups of instrument carriers may be configured to be displaced away from the hub to facilitate access to instruments carried by the instrument carrier. For example, individual instrument carriers or groups of instrument carriers may be configured to be displaced away from the hub by engagement with a pusher, such as a wire, ribbon, or other elongated body, typically a flexible element, that may be advanced over or through the shaft.

[0016] In some examples, the instrument tip cassette may further comprise a tether attached to the hub and configured to temporarily support the parallel cluster of instrument carriers prior to instrument tip cassette deployment and capture by the support instrument.

[0017] In some cases, the deployment and support instruments may include a reciprocatable tip. The reciprocatable tip will typically be configured to pierce tissue when advanced distally. In other cases, the reciprocatable tip may be configured to lock, unlock, manipulate, and otherwise interact with the instrument tip holder, as described in detail herein below. For example, the reciprocatable tip may be configured to engage and release the instrument tip cassette when the cassette is in its parallel cluster configuration.

[0018] In many instances, the hub includes flat surfaces or facets arranged axially around its periphery with each flat surface configured to engage a first flat surface on one of the instrument carriers. For example, the plurality of instrument carriers may include any one of: (1) three instrument carriers with axial facets spaced 120° apart, (2) four instrument carriers with axial facets spaced 90° apart, (3) five instrument carriers with axial facets spaced 72° apart, (4) six instrument carriers with axial facets spaced 60° apart, (5) seven instrument carriers with axial facets spaced 51.4° apart, and (6) eight instrument carriers with spring axial facets spaced 45° apart. Often, each instrument carrier will include two additional flat surfaces symmetrically arranged on either side of the first flat surface and configured to mate with an adjacent instrument carrier when the instrument carriers are in a side-by-side cluster configuration.

[0019] The deployment mechanism may have any one of a variety of configurations. For example, a self-assembling deployment mechanism may include a spring element connecting the instrument access and proximal ends of adjacent carriers. The spring elements on adjacent carriers are typically circumferentially offset, causing the instrument carriers to collapse into a parallel cluster when unconstrained. In a preferred case, the spring member may include two legs having a U-shape when unconstrained, with a first leg attached to the proximal or instrument access end of one instrument carrier and a second leg attached to the proximal or instrument access end of an adjacent carrier.

[0020] The hub used in combination with the spring element is typically attached to the proximal end of the first instrument carrier by a U-shaped spring configured to collapse the multiple instrument carriers into a parallel cluster around the circumference of the hub when released from a constrained state.

[0021] Such self-assembling instrument tip holders will typically require some structure, functionality, or other means configured to apply radial constraint and maintain the instrument carriers in a generally straightened or otherwise elongated configuration for delivery to a patient, and typically include a straight overtube having a passageway for receiving and straightening multiple instrument carriers and delivering them to a surgical site. While the use of a straight overtube is generally preferred, in some cases the overtube may have low curvature or other non-linearity, so long as deflection would not interfere with introduction and / or removal of the instrument tip holder in its elongated configuration.

[0022] In other cases, the deployment mechanism may comprise an expandable structure such that the multiple instrument carriers can be straightened or axially elongated, i.e., generally axially aligned, when the expandable structure is contracted for delivery and removal of the instrument tip holder. The expandable structure would have a geometry configured to be selected and arranged in a parallel cluster when the expandable structure is expanded at a deployment site within a patient.

[0023] In particular cases, the expandable structure may comprise a ring or disk. For example, the expandable structure often has radially inwardly projecting spokes or fingers, and the instrument tip retainer may comprise an open ring with a C-shape attached to the radially inward ends of the spokes or fingers.

[0024] In yet a further aspect, the present invention provides an instrument tip delivery system including any of the instrument tip holders described above together with a support / release instrument comprising a shaft having a proximal end and a distal end and a handle at the proximal end of the shaft, the distal end of the shaft configured to releasably engage the instrument tip holder, typically a manipulator segment attached to a hub.

[0025] In some cases, the support / release instrument and manipulator segment are configured to selectively align and misalign the magnets in the hub with the magnets in the instrument carrier of the instrument tip holder to form and release the parallel cluster arrangement. For example, the magnets in the hub may be mounted for axial translation, and the support / release instrument and / or manipulator segment may include a pusher or puller for moving the hub magnet into and out of alignment with the instrument carrier magnet. In a specific example, the manipulator segment includes a puller cable and the hub magnet is spring loaded, whereby the puller cable can be tensioned to align the hub and instrument tip holder magnets while the cassette manipulator remains attached to the hub. The support / release instrument includes an actuator, such as a translatable rod, that engages the manipulator segment and allows a user to shift the magnet alignment as desired.

[0026] In a specific example, the manipulator segments and the hub may be connected via a universal joint, which is typically located at a distal end of the manipulator segment and a proximal end of the hub.

[0027] In some cases, the instrument tip cassette delivery systems of the present invention may further comprise a first interlock configured to prevent disengagement of the surgical instrument tip from the shaft when the tip is removed from the instrument carrier.

[0028] In some cases, the instrument tip cassette delivery systems of the present invention may further include a second interlock configured to prevent loss of the surgical instrument tip from the instrument carrier when the instrument tip is not engaged with the instrument driver.

[0029] In yet another aspect, the present invention provides a method of delivering surgical instruments to a surgical workspace. The method may include providing an instrument tip cassette including a plurality of instrument transporters joined end to end. The instrument tip cassette is percutaneously introduced to the surgical work site while the plurality of instrument transporters are in a linearized configuration. The plurality of instrument transporters are reconfigured from the linearized configuration into a parallel cluster while within the surgical workspace, allowing surgical instruments to be removed from and returned to individual instrument transporters while the plurality of instrument transporters remain in the parallel cluster configuration within the surgical workspace.

[0030] In some instances, the method may further include reconfiguring the multiple instrument transporters from the parallel cluster configuration to the linearized configuration while within the surgical workspace. The instrument tip cassette may be percutaneously removed from the surgical worksite while the multiple instrument transporters are in the linearized configuration.

[0031] In some cases, reconfiguring the multiple instrument transporters from a linearized configuration into a parallel cluster may include releasing the instrument tip cassettes from a constraint.

[0032] In some cases, reconfiguring the multiple instrument transporters from a linearized configuration into a parallel cluster may include applying a force to the instrument tip cassette to cause the reconfiguration.

[0033] In some instances, the method may further include capturing the instrument tip cassette with an instrument tip cassette deployment and support instrument after the multiple instrument transporters are in the parallel cluster configuration.

[0034] Typically, the instrument tip cassette deployment and support device is introduced percutaneously through a separate percutaneous passageway than that used to introduce the instrument tip cassette.

[0035] In some cases, the method may further include operating the surgical instrument drive to engage and remove the surgical instrument from each of the instrument transporters after the multiple instrument transporters are in the parallel cluster configuration.

[0036] Typically, the surgical instrument driver is introduced percutaneously through a percutaneous passageway separate from that used to introduce the instrument tip cassette and / or the instrument tip cassette deployment and support instruments. [Brief description of the drawings]

[0037] [Figure 1] FIG. 1 is a diagram of a first embodiment of a parallel cluster of articulating instrument transporters constructed in accordance with the principles of the present invention.

[0038] [Diagram 2] FIG. 2 illustrates a manipulator instrument of the present invention removably secured to the hub of an instrument transport cluster.

[0039] [Diagram 3] FIG. 3 is a perspective view showing a manipulator instrument and hub of the present invention connected to an instrument transporter cluster.

[0040] [Figure 4] FIG. 4 illustrates an instrument carrier cluster of the present invention in which the individual instrument carriers are joined end-to-end in a straightened or elongated configuration in a manner suitable for percutaneous introduction into a patient.

[0041] [Diagram 5] FIG. 5 is an exploded view of a pair of adjacent carriers illustrating a spring-mounted mechanism that collapses the instrument carriers when released from restraints for delivery to a patient within the principles of the present invention.

[0042] [Figure 6] FIG. 6 is a schematic diagram of an arrangement of instrument transporters surrounding a hub showing the relative positions of magnets in a stabilizing magnetic array when the instrument transporters are formed into a parallel cluster in accordance with the principles of the present invention.

[0043] [Figure 7-1]7A-7E illustrate steps in the release and self-folding of an instrument cluster array in accordance with the principles of the present invention. [Figure 7-2] 7A-7E illustrate steps in the release and self-folding of an instrument cluster array in accordance with the principles of the present invention.

[0044] [Figure 8] FIG. 8 is a diagram of a second embodiment of a parallel cluster of instrument carriers on an expandable structure in accordance with the principles of the present invention.

[0045] [Figure 9] 9 and 10 illustrate the instrument carrier embodiment of FIG. 8 shown with the expandable structure in partially expanded and deflated configurations, respectively. [Figure 10] 9 and 10 illustrate the instrument carrier embodiment of FIG. 8 shown with the expandable structure in partially expanded and deflated configurations, respectively.

[0046] [Figure 11] 11 and 12 show the expandable support structure of FIGS. 9 and 10 in greater detail in contracted and inflated configurations, respectively. [Figure 12] 11 and 12 show the expandable support structure of FIGS. 9 and 10 in greater detail in contracted and inflated configurations, respectively.

[0047] [Figure 13] FIG. 13 illustrates a magnetic hub that can be used to help stabilize the instrument carrier embodiment of FIG. 8 during use.

[0048] [Figure 14] 14-16 illustrate a jamming mechanism for selectively releasing the instrument carrier from the magnetic hub of FIG. [Figure 15] 14-16 illustrate a jamming mechanism for selectively releasing the instrument carrier from the magnetic hub of FIG. [Figure 16] 14-16 illustrate a jamming mechanism for selectively releasing the instrument carrier from the magnetic hub of FIG.

[0049] [Figure 17] FIG. 17 illustrates an instrument tip cassette deployment and support instrument having a shaft with a proximal end and a distal end, and a deployment handle at the proximal end.

[0050] [Figure 17A] FIG. 17A is a cross-sectional view taken along line 17A-17A in FIG.

[0051] [Figure 18] 18 is a close-up view of the deployment handle of the instrument tip cassette deployment and support instrument of FIG. 17.

[0052] [Figure 19] 19A-19B are detailed views of the deployment handle of the instrument tip cassette deployment and support instrument of FIG. 17 showing different operational configurations.

[0053] [Figure 20-1] 20A-20D are close-up views of the distal end of the shaft of the instrument tip cassette deployment and support instrument of FIG. 17. [Figure 20-2] 20A-20D are close-up views of the distal end of the shaft of the instrument tip cassette deployment and support instrument of FIG. 17.

[0054] [Figure 21] 21A and 21B show the instrument tip cassette of the present invention in its parallel cluster configuration as engaged and captured by the distal end of the instrument tip cassette deployment and support instrument of FIG. 17.

[0055] [Figure 22]Figures 22A and 22B show the instrument tip cassette of the present invention in its parallel cluster configuration in which the latch mechanism is in an open configuration in which the individual instrument carriers are not latched to the hubs (Figure 22A), and in a closed configuration in which the individual instrument carriers are latched to the hubs (Figure 22B).

[0056] [Figure 23] 23A and 23B are detailed views of the latch mechanism of FIGS. 22A and 22B shown in an open configuration (FIG. 23A) and a closed configuration (FIG. 23B).

[0057] [Figure 24] 24A and 24B are detailed views showing pushers that radially deflect the different instrument transporters from the instrument transport cassette cluster to facilitate removal of surgical instruments from the transporters.

[0058] [Diagram 25] FIG. 25 illustrates a surgical instrument driver having a shaft with proximal and distal ends and a deployment handle at the proximal end.

[0059] [Figure 26-1] 26A-26D are detailed views of the deployment handle of the surgical tool driver instrument of FIG. 25 showing different operating settings. [Figure 26-2] 26A-26D are detailed views of the deployment handle of the surgical tool driver instrument of FIG. 25 showing different operating settings.

[0060] [Figure 27-1] 27A-27E are close-up views of the distal end of the shaft of the surgical instrument driver of FIG. 25 shown in different configurations. [Figure 27-2] 27A-27E are close-up views of the distal end of the shaft of the surgical instrument driver of FIG. 25 shown in different configurations.

[0061] [Figure 28]28A-28C show the distal tip of a surgical instrument driver engaging and removing a surgical instrument from an instrument carrier.

[0062] [Figure 29] 29A and 29B show a surgical instrument being actuated by a surgical instrument driver.

[0063] [Diagram 30] 30A and 30B show a safety lock mechanism that prevents the surgical instrument from being accidentally dropped from the instrument driver when the surgical instrument is outside of the instrument carrier.

[0064] [Diagram 31] 31A and 31B show an instrument retention mechanism that retains a surgical instrument within the instrument transporter and is actuated by the surgical instrument driver to allow the instrument to be removed from the transporter. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0065] (Incorporated by reference) All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference.

[0066] Detailed Description of the Invention As shown in FIG. 1, an instrument transporter array 10 is formed as a parallel cluster of individual instrument transporters 12a-12f. Although six individual instrument transporters are illustrated, the number of transporters in the array can vary from anywhere from two to ten, or even greater. The individual instrument transporters 12 in the array are configured such that they can be grouped, or "clustered," around a central axis typically defined by an elongated hub 14. When so clustered, the instrument access end 20 of each of the instrument transporters 12 is disposed in a circular or other regular pattern adjacent the top of the hub 14. The instrument access ends are open or otherwise configured to allow access to the surgical instrument tips within the instrument transporter 12. The specific structure of the transporters is not critical and does not form a part of the present invention. Exemplary designs useful with the instrument transporter arrays of the present invention can be found in commonly owned published patent application US2015 / 0216515, the entire disclosure of which is hereby incorporated by reference herein above. The proximal ends 22 of each instrument carrier 12 are similarly arranged in a circular or other regular pattern on the lower end of the hub. As will be explained in more detail below, the hub 14 is positioned to interact with and stabilize the individual instrument carriers 12.

[0067] The hub 14 is typically connected to a manipulator segment 16, as shown in Figures 2 and 3, which is configured to removably engage a support / release instrument 30. In a preferred example, a distal end of the manipulator segment 16 is attached to a proximal end of the hub 14 by a universal joint 18. The freedom of movement provided by the universal joint 18 facilitates engagement and attachment of a support / release instrument 30 introduced through an open proximal end 24 of the manipulator segment 16.

[0068] The hub 14 typically has a tubular body 34 with a periphery provided with flat surfaces or "facets" 36 that engage the individual instrument carriers 12 when the instrument carriers 12 are aligned with the hub. The hub 14 also carries a magnetic shuttle 38 that is secured at its distal side to a spring 40 that is in turn secured to the closed distal end of the tubular body 34, thereby allowing the shuttle to translate within the hub interior under the bias from the spring. As will be explained in more detail below, the magnetic shuttle 38 carries individual magnets 44 (FIG. 6) that can align with magnets 50 (FIG. 4) on the individual instrument carriers 12, thereby helping to stabilize the instrument carrier array when instruments are removed from and returned to the carrier.

[0069] A rod 43 in the support / release instrument 30 couples to a cable 42 in the manipulator segment 16 when the instrument 30 is attached to the manipulator segment through open end 24 as shown in FIG. 2. The rod 43 can be retracted proximally using a three-ring actuator 46 on the instrument 30, drawing the cable 42 proximally and compressing the spring 40, aligning the magnets 44 with the magnets 50 on the individual carriers 12. The alignment of the magnets will pack the cluster of twelve instrument carriers from a relatively loose configuration as shown in dashed lines in FIG. 3 to a tighter cluster as shown in solid lines in FIG. 3.

[0070] The instrument carrier array 10 is shown in FIG. 4 in a straightened or elongated configuration suitable for delivery to a patient. The carrier array is typically held within a delivery tube 60 (FIGS. 7A-7E), which radially constrains and straightens the individual instrument carriers 12. Adjacent pairs of instrument carriers 12 typically have articulating connections defined by spring elements that, upon release from the constraint, cause adjacent instrument carriers to collapse toward each other. For example, the bottom 15 of the hub 14 may be connected to the bottom 22 of a first instrument carrier 12a. The top 20 of the first instrument carrier 12a may in turn be connected to the top 20 of a second instrument carrier 12b. The remaining instrument carriers are similarly coupled, allowing the structure to unfold from the straightened configuration illustrated in FIG. 4 to the clustered configuration shown in FIG. 1.

[0071] Referring now to Figure 5, adjacent instrument carriers 12a and 12b are joined by leaf springs 56 preformed into a U-shape as shown in dashed lines. Leaf springs 56 will be in their flattened configuration (solid lines) when instrument carriers 12a and 12b are axially aligned or otherwise stretched, as shown at the bottom of Figure 5. Upon release from restraint, springs 56 will revert to their U-shape, causing instrument carriers 12a and 12b to collapse as shown by arrows 62 and 64.

[0072] 6, the instrument carriers 12a-12f will typically have at least one flat surface 52 configured to engage the flat surface 36 on the hub 14. The magnets 50 on the flat surface of 52 should be oriented toward the magnets 44 of the magnetic shuttle 38. When in close alignment, the attractive force between the magnets 44 and 50 will pull the instrument carriers 12 into a tighter cluster. When the actuator 46 of the support / release instrument 30 is used to translate the magnetic shuttle 38 and reposition the magnets out of alignment, the magnetic attractive force is reduced, allowing for a greater degree of freedom for the individual instrument carriers 12a, which may be necessary for retraction of the carriers and may be useful when accessing surgical instrument tips held within the individual carriers.

[0073] 7A-7E, delivery of an instrument carrier array 10 to the chest, abdomen, or other patient cavity will be described. The instrument carrier array 10 is initially constrained in its straightened, elongated configuration within a tubular constraint 60. As shown in FIG. 7A, the hub 14 and manipulator segments 16 are initially advanced distally out of the tubular constraint 60, allowing the springs connecting the first instrument carrier 12a to the hub 14 to collapse the hub into the position shown in FIG. 7B. As the instrument carrier array 10 continues to be advanced distally out of the tubular constraint 60, successive instrument carriers 12b and 12c will be released and allowed to self-fold, as shown in FIGS. 7C and 7D. After the last instrument carrier 12e is released from the constraint, the instrument carrier array 10 will assume the cluster array configuration shown in FIG. 7E.

[0074] 8-10, an alternative embodiment of an instrument carrier array 70 includes an expandable structure 72 for supporting a plurality of instrument carriers 78. The instrument carrier array 70 typically includes a C-shaped outer expandable body 74 forming the "spine" of the structure, and a plurality of spokes or fingers that project radially inwardly from the C-shaped expandable body 74 when the expandable support structure is fully expanded, as shown in FIG. 7A. Inflation lines 80 are provided to allow for inflation after the instrument carrier array is placed in the patient. Each of the spokes or fingers 76 supports an individual instrument carrier 78. When not inflated, the expandable structure 72 can be straightened or elongated for delivery and removal, as shown in FIGS. 9 and 10. Typically, the dimensions of the expandable structure 72 and those of the instrument carriers 78 are selected to provide sufficient clearance between adjacent instrument carriers to allow the instrument carriers to axially align when tension is applied to the ends of the deflated expandable structure 72. Such alignment allows the instrument carriers to be placed end-to-end, minimizing the profile of the carrier array 70 and facilitating delivery and removal.

[0075] 11 and 12, a preferred design of an expandable support structure 72 is shown in an uninflated state in Fig. 11 and fully inflated in Fig. 12. The lengths of the individual spokes or fingers 76 vary, as best seen in Fig. 12, allowing for an increasing degree of curvature towards one end of the inflated structure.

[0076] While the expandable support 72 in Figures 8-11 may be used without additional structure, it will often be desirable to provide additional support features or components. For example, as shown in Figure 13, a hub 90 may be positioned in a central region of the array of instrument carriers 88 while the instrument carriers are supported by the expansion structure 72. The hub 90 is not mechanically coupled to the carriers 88 as is the case in conventional spring-linked embodiments, and will typically only provide magnetic stabilization to improve alignment and clustering of the instrument carriers 88 while they are supported by the expandable structure 72.

[0077] As seen in Fig. 13, the hub would have a number of magnets 92 at its proximal end that may align with magnets 94 at the bottom of the instrument carrier 88. The magnet pairs 92 / 94 can act as virtual hinges that allow the individual instrument carriers 88 to pivot outward as shown in Fig. 13. Additionally or alternatively, magnets 96 may be provided on the body of the hub 90 to align with magnets 98 on the upper portion of the instrument carrier 88. The magnetic pairs 96 / 98 would improve clustering while still allowing the instrument carrier to pivot when removing and replacing the surgical instrument tips.

[0078] Typically, the hub 90 will need to be disengaged from the instrument array 70 before the array can be removed from the patient. To facilitate such disengagement, a number of pins 100 may be located near the bottom of the hub 90, as seen in FIGS. 14-16. The pins 100 are initially retracted into receptacles 106 formed in the hub body. A piston 102 is mounted for reciprocating movement within a central passage within the hub, the piston 102 having a conical surface 104. When the piston 102 is in its upward position, as shown in FIG. 15, the pins 102 remain retracted within the outer surface of the hub 90. However, by pushing the piston 102 downward, the conical surface 104 engages the pins 102 and moves them outward, as shown in FIG. Such outward movement of pins 103 will engage and displace the lower ends of the individual instrument carriers 88, as shown in FIG. 14, disrupting the magnetic coupling between the instrument carriers 88 and the hubs 90.

[0079] 17 and 18 illustrate an instrument tip cassette deployment and support instrument 200 having a shaft 202 with a proximal end 204, a distal end 206, and a deployment handle 208 at the proximal end. The shaft 202 has a triangular cross-section, as seen in FIG. 17A, with three passages 210 at the corners of the triangle carrying pushers 234, as described below. A central passage 212 is configured to slidably receive a central member, as described below. The deployment handle 208 includes a handle grip 214, a mode selector 216, a trocar flag 218, a trocar unlocking portion 220, and three sliders 222 (only two of which are visible in FIG. 18).

[0080] As shown in Figures 17, 18, and 20A, the instrument tip cassette deployment and support instrument 200 is in its "safe" mode and the penetrating tip 230 is retracted. To enter the "penetration" mode, the trocar unlocker 220 is moved laterally to retract the pusher 234, as shown in Figures 19A and 20A, and the trocar flag 218 is flipped up, as shown in Figure 19B, to advance the penetrating tip 230 through the clamshell type nose cone 232, as shown in Figure 20B. The mode selector 216 may then be used to axially position the penetrating tip 230 to capture and release the instrument tip cassette 200, as described in more detail below, and the slider 222 is used to advance and retract the pusher 234.

[0081] Figures 21A and 21B show an instrument tip cassette 240 with an instrument carrier 242 in a parallel cluster configuration, engaged and captured by the distal end of the instrument tip cassette deployment and support instrument 200 of Figure 17. The structure of the instrument tip cassette 240 is generally as described above, with the instrument carrier 242 held on a hub 244 and joined by a spring 246. A tether 248 is provided to suspend and manipulate the instrument tip cassette 240 when it is engaged and captured by the instrument tip cassette deployment and support instrument 200.

[0082] As described with reference to the previous embodiment, the instrument carriers of the present invention may be magnetically coupled to the hub after cluster formation. The instrument tip cassettes 240 described herein typically include a mechanical latch 250 shaped as a hook that connects the free distal instrument carrier 242' of the cluster to the hub 242 (i.e., the instrument carrier in the linked chain furthest from the hub 242). As shown in Fig. 22A, the latch 250 is open, i.e., disengaged from the free distal instrument carrier 242'. The latch is shown in its closed, i.e., engaged, configuration in Fig. 22B.

[0083] 23A and 23B provide cross-sectional views of the lower portion of the instrument tip cassette 240. A hook 250 is pivotally mounted to the wall of the hub 242 and configured to be engaged by a sliding shuttle 252. After the instrument tip cassette deployment and support instrument 200 captures the instrument tip cassette 240, the trocar tip 232 is advanced from the distal end of the shaft 202, advancing the shuttle coupling 256 and causing the shuttle 252 to engage the hook 250 and pivot it from the position shown in FIG. 23A to that shown in FIG. 23B, where the hook 250 captures the hook clasp 252 on the free distal instrument carrier 242'. Prior to engaging the hook 250, alignment magnets 262a and 262b pre-position the free distal instrument carrier 242 relative to the hub 242. Magnet 262a is on the hub 242 and magnet 262b is on the free distal instrument carrier 242'.

[0084] 24A and 24B are detailed views showing the pushers 234 which radially deflect the instrument transporters 242 from the instrument transporter cassette cluster 240 and facilitate removal of surgical instruments from the instrument transporters. As previously described, the slider 222 on the handle 208 is used to selectively advance each of the three pushers 234, each one of which is configured to in turn engage a pair of instrument transporters 242 joined by a spring 246 to bias that pair of instrument transporters radially outward. In that position, the surgical instrument transporters can be engaged by a surgical instrument drive 300, as described in detail below.

[0085] The surgical instrument driver 300 is illustrated in FIGURE 25 and includes a shaft 302 having a proximal end 304, a distal end 306, and a deployment handle 308 at the proximal end. The deployment handle 308 further includes a mode selector 310, a stationary grip 312, a thumb lever 314, and a trocar flag 316. A ratchet mechanism 318 is coupled to a ratchet selector 320 and controls the movement of the thumb lever 314.

[0086] As shown in FIG. 26A, the mode selector 310 is in a first position where the surgical instrument driver 300 is in a "safe" mode where all mechanisms of the drive are disabled. As shown in FIG. 26B, by rotating the mode selector 310, the ratchet selector 320 and thumb lever 314 are enabled in the "instrument active" mode. By rotating the mode selector 310 to the "instrument active mode", the piercing tip 230 is also advanced to the state shown in FIG. 27C and then rotated as shown in FIG. 27D. This action docks the distal end 306 of the surgical instrument driver 300 to the instrument tip 350, for example, by pushing the nosecone 330 into a cavity in the shank or shaft portion of the instrument tip 350 and advancing and rotating to lock the tip in a shuttle that actuates the instrument tip jaws 352 (FIGS. 29A and 29B).

[0087] In the instrument actuation mode, the piercing tip 334 can be advanced and rotated distally, as shown in Figures 27B-27E. The thumb lever 314 can also be advanced distally to actuate the instrument, as shown in Figures 27C-27, for example, to open and close jaws 352 in a surgical instrument tip 350, as shown in Figures 29A and 29B.

[0088] The ratchet 318 and ratchet selector 320 are engaged and temporarily disengaged as shown in Figures 26C and 26D, respectively. The thumb lever 314 can only be closed when the ratchet 318 is engaged. The ratchet selector 320 is spring loaded to automatically return from the temporary OFF position (Figure 26D) to the ON position (Figure 26C) when the selector is no longer pressed.

[0089] 27A-27E are close-up views of the distal end 306 of the shaft 302 of the instrument driver 300 of FIG. 25 shown in different configurations. As shown in FIG. 26A, the surgical instrument driver 300 is in a safety mode with the piercing tip 334 retracted behind the nosecone 330. The piercing tip 334 can be advanced using the thumb lever 314 of the handle 308 as previously described, as shown in FIG. 27B. To advance the piercing tip 334, the trocar flag 316 must be in a "flipped" position, as shown in dashed lines in FIGS. 26D and 27D. With the piercing tip 334 in the position shown in FIG. 27B, the instrument driver can be introduced percutaneously through the patient's abdomen without the use of a separate cannula.

[0090] As shown in FIGS. 27D-27E, the thumb lever 314 of the handle 308 can further be manipulated to advance the penetrating tip 334 and actuate the surgical instrument tips once they are loaded onto the surgical instrument driver 300.

[0091] 28A-28C show the nosecone 330 of the surgical instrument driver 300 engaging and removing a surgical instrument 350 from the instrument carrier 242.

[0092] Figures 29A and 29B show a surgical instrument tip 350 being actuated by a surgical instrument driver 300. For example, the jaws 352 of the surgical instrument tip 350 can be actuated by advancing and retracting the piercing tip 334 of the driver 300, as shown in Figures 27D (jaws closed) and 27E (jaws open).

[0093] 30A and 30B show a safety lock mechanism that prevents the surgical instrument from being accidentally dropped from the instrument driver when the surgical instrument is outside the instrument carrier. When the surgical instrument tip 350 is removed from the instrument carrier 242 (not shown), a pair of spring-loaded nosecone clasps 338 engage a pair of clasp grooves 332 on the nosecone 330 (FIG. 30A). These clasps prevent accidental disengagement of the surgical instrument tip 350 from the shaft 302 of the surgical instrument driver 300. When the surgical instrument tip 350 is returned to the instrument carrier, the outer end 338a of each nosecone clasp 338 is pushed inwardly, removing both ends of the clasp from the clasp grooves 332 on the nosecone 330 (FIG. 30B). Thus, the instrument driver 330 can be withdrawn from the surgical instrument tip 350 when the tip is returned to be seated in the instrument carrier.

[0094] 31A and 31B show an instrument retention mechanism comprising a pair of instrument retention tabs 342 configured to retain a surgical instrument 350 in an instrument carrier (not shown) when not in use. The instrument retention mechanism can be actuated by the surgical instrument driver 300 to allow the instrument to be removed from the carrier when a particular instrument is needed for a procedure. After the nose cone 330 of the surgical instrument driver 300 is introduced into the open end of the surgical instrument tip 350, the cam lobe 336 is advanced to a position between a pair of extensions 344. The outer tips of the instrument retention tabs 342 are in a radially outward position and engage slots (not shown) in the wall of the base of the surgical instrument tip to prevent accidental disengagement of the instrument tip from the surgical instrument carrier. 31B, rotating cam lobes 336 90° causes extensions 334 to move radially outward and engage and rotate instrument retaining tabs 342, causing the free ends of the tabs to move radially inward and disengage from the slots. Once instrument retaining tabs 342 are disengaged from the slots, the surgical instrument tip can be removed from the instrument carrier.

[0095] While the above-described embodiments of both the instrument tip cassette deployment and support instrument 200 and the surgical instrument driver 300 employ a split nosecone to allow for advancement of the tissue penetrating tip, in other embodiments (not shown), a helical tip with a retractable sharp portion may be used without a splittable nosecone or other protective portion. Such a helical tip may provide easier tissue penetration for percutaneous access (puncture vs. piercing / extension) and potentially allow for a more robust connection to the instrument and cassette.

[0096] While preferred embodiments of the present invention have been shown and described herein, it will be apparent to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It is understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention. It is intended that the following claims define the scope of the invention, and that methods and structures within the scope of these claims and their equivalents be covered thereby.

Claims

1. An instrument tip cassette, said instrument tip cassette comprising: A deployment mechanism; a plurality of instrument carriers coupled to the deployment mechanism; Equipped with Each carrier has an instrument access end and a proximal end; The deployment mechanism is adapted to selectively reconfigure the plurality of instrument transporters from a linear arrangement into a parallel cluster.

2. The instrument tip cassette of claim 1 , further comprising a surgical working tip removably mounted within at least some of the plurality of instrument carriers.

3. The instrument tip cassette of claim 1 , wherein the instrument carrier comprises a tubular body, typically a cylindrical body.

4. The instrument tip cassette of claim 1 , further comprising a hub segment configured to occupy a central region of the parallel cluster of instrument transporters when the instrument transporters are unconstrained.

5. The instrument tip cassette of claim 4 further comprising a manipulator segment attached to said hub.

6. 5. The instrument tip cassette of claim 4, wherein at least one of the instrument transporters and the hub each comprise at least one magnetic element, the at least one magnetic element on the hub configured to attract the magnetic element on the at least one instrument transporter and hold the multiple instrument transporters in the parallel cluster configuration while allowing limited displacement to facilitate removal and return of instrument tips from the instrument transporter.

7. 5. The instrument tip cassette of claim 4, wherein the hub includes axial facets about its periphery, each facet configured to engage a first planar surface on one of the instrument carriers.

8. 8. The instrument tip cassette of claim 7, wherein the plurality of instrument transporters comprises one of: (1) three instrument transporters with axial facets spaced 120° apart; (2) four instrument transporters with axial facets spaced 90° apart; (3) five instrument transporters with axial facets spaced 72° apart; (4) six instrument transporters with axial facets spaced 60° apart; (5) seven instrument transporters with axial facets spaced 51.4° apart; and (6) eight instrument transporters with spring axial facets spaced 45° apart.

9. 8. The instrument tip cassette of claim 7, wherein each instrument transporter comprises two additional flat surfaces symmetrically disposed on either side of the first flat surface and configured to mate with adjacent transporters when the instrument transporters are in the parallel cluster configuration.

10. 2. The instrument tip cassette of claim 1, wherein the deployment mechanism comprises spring elements attaching the proximal end of each instrument carrier to the instrument access end of an adjacent carrier, the spring elements on adjacent instrument carriers being circumferentially offset, whereby the spring elements, when unconstrained, cause the instrument carriers to collapse into the parallel cluster.

11. 11. The instrument tip cassette of claim 10, wherein the spring member has two legs that have a U-shape when unconstrained, the first leg being attached to the proximal end of one instrument carrier and the second leg being attached to the proximal end of an adjacent carrier.

12. 5. The instrument tip cassette of claim 4, wherein the hub is attached to the proximal end of the first instrument carrier by a U-shaped spring configured to collapse the plurality of instrument carriers into the parallel cluster around the periphery of the shuttle segments when released from a constrained state.

13. The instrument tip cassette of claim 1 , further comprising an overtube having a passageway for straightening and delivering the plurality of instrument carriers to a surgical site.

14. 2. The instrument tip cassette of claim 1, wherein the deployment mechanism comprises an expandable structure, the plurality of instrument carriers being axially aligned when the expandable structure is deflated and will be disposed in the parallel cluster when the expandable structure is inflated.

15. The instrument tip cassette of claim 14 , wherein the expandable structure comprises a ring or a disk.

16. 16. The instrument tip cassette of claim 15, wherein the expandable structure comprises an open ring with spokes, with instrument tip retainers attached to radially inward ends of the spokes.

17. 5. The instrument tip cassette of claim 4, wherein individual instrument transporters or groups of instrument transporters are configured to be displaced away from the hub to facilitate access to instruments transported by the instrument transporters.

18. 18. The instrument tip cassette of claim 17, wherein the individual instrument carriers or groups of instrument carriers are configured to be displaced away from the hub by engagement with a deployment mechanism, such as a pusher.

19. 10. The instrument tip cassette of claim 1, further comprising a tether attached to the hub, the tether configured to temporarily support the parallel cluster of instrument carriers prior to instrument tip cassette deployment and capture by a support device and / or to remove the instrument tip cassette from a work site.

20. 1. An instrument tip cassette delivery system, comprising: The instrument tip cassette according to any one of claims 1 to 19; an instrument tip cassette deployment and support instrument having a shaft with a proximal end and a distal end; a handle at the proximal end of the shaft; Equipped with an instrument tip cassette delivery system, wherein the distal end of the shaft is configured to removably engage the hub of the instrument tip cassette.

21. 21. The instrument tip cassette delivery system of claim 20, wherein the deployment and support instrument is configured to engage the manipulator segments and selectively align and misalign magnets in the hub with magnets in the instrument carrier of the instrument tip cassette to form and release the parallel cluster arrangement.

22. 22. The instrument tip cassette delivery system of claim 21, wherein the magnet in the hub is mounted for axial translation, and the cassette manipulator comprises a pusher or puller that moves the hub magnet into and out of alignment with the instrument tip holder magnet.

23. 23. The instrument tip cassette delivery system of claim 22, wherein the manipulator segment comprises a puller cable and the hub magnet is spring loaded, whereby the puller cable can be tensioned to align the hub magnet and instrument tip holder magnet while the cassette manipulator remains attached to the hub.

24. 21. The instrument tip cassette delivery system of claim 20, wherein the manipulator segment and the hub are connected via a universal joint.

25. 25. The instrument tip cassette delivery system of claim 24, wherein the universal joint is located at the distal end of the manipulator segment and at the proximal end of the hub.

26. 21. The instrument tip cassette delivery system of claim 20, wherein the deployment and support instrument comprises a reciprocable tip.

27. 27. The instrument tip cassette delivery system of claim 26, wherein the reciprocable tip is configured to pierce tissue when advanced distally.

28. 27. The instrument tip cassette delivery system of claim 26, wherein the reciprocable tip is configured to engage and release the instrument tip cassette when the cassettes are in their parallel cluster configuration.

29. 21. The instrument tip cassette delivery system of claim 20, wherein the deployment and support instrument further comprises one or more pushers configured to displace individual instrument carriers or groups of instrument carriers away from the shaft to facilitate access to surgical instruments being carried by the instrument carriers.

30. and at least one surgical tool driver, the at least one surgical tool driver comprising: a shaft with a proximal end and a distal end; a handle at the proximal end of the shaft; Equipped with 21. The instrument tip cassette delivery system of claim 20, wherein the distal end of the shaft is configured to removably engage and actuate the tip of an individual surgical instrument carried by the instrument tip cassette.

31. The instrument tip cassette delivery system of claim 30, wherein the at least one surgical instrument driver comprises a reciprocable tip at the distal end of the shaft.

32. 32. The instrument tip cassette delivery system of claim 31 , wherein the reciprocable tip is configured to pierce tissue when advanced distally.

33. The instrument tip cassette delivery system of claim 30, wherein the reciprocable tip is configured to removably engage and actuate the individual surgical instrument.

34. 21. The instrument tip cassette delivery system of claim 20, further comprising a first interlock configured to prevent disengagement of the tip of the surgical instrument from the shaft when the tip is removed from the instrument carrier.

35. An instrument tip cassette delivery system as described in claim 34, further comprising a second interlocking portion, the second interlocking portion configured to prevent loss of the tip of the surgical instrument from the instrument carrier when the tip of the instrument is not engaged with the instrument drive portion.

36. 21. The instrument tip cassette delivery system of claim 20, wherein each instrument carrier comprises a magnetic element.

37. 21. The instrument tip cassette delivery system of claim 20, wherein at least one of the instrument transporters includes a latching mechanism configured to selectively engage the hub and maintain all of the instrument transporters in the cluster configuration while allowing limited displacement to facilitate removal and return of an instrument tip from the instrument transporter.

38. 1. A system for delivering surgical instruments to a surgical workspace, the system comprising: an instrument tip cassette including a plurality of instrument carriers joined end-to-end; the instrument tip cassette is configured to be percutaneously introduced into a surgical worksite while the plurality of instrument carriers are in a linearized configuration; the plurality of instrument transporters are reconfigured from the linearized configuration into a parallel cluster while within the surgical workspace; The system, wherein the instrument tip cassette is configured to allow surgical instruments to be removed from and returned to individual instrument transporters while the multiple instrument transporters remain in the parallel cluster configuration within the surgical workspace.

39. The plurality of instrument transporters are reconfigured from the parallel cluster configuration to the linearized configuration while within the surgical workspace; 39. The system of claim 38, wherein the instrument tip cassette is configured to be percutaneously removed from the surgical worksite while the plurality of instrument carriers are in the linearized configuration.

40. A system as described in claim 38 or 39, wherein the instrument tip cassette is configured to be released from constraints to reconfigure the multiple instrument transporters from the linearized arrangement to the parallel cluster.

41. A system as described in claim 38 or 39, wherein a force is applied to the instrument tip cassette to cause the reconfiguration.

42. 40. The system of claim 38 or 39, further comprising an instrument tip cassette deployment and support device configured to capture the instrument tip cassette after the plurality of instrument transporters assume the parallel cluster configuration.

43. 43. The system of claim 42, wherein the instrument tip cassette deployment and support device is percutaneously introduced through a percutaneous passage separate from that used to introduce the instrument tip cassette.

44. 40. The system of claim 38 or 39, further comprising a surgical instrument driver configured to engage and remove surgical instruments from individual instrument transporters after the plurality of instrument transporters assume the parallel cluster configuration.

45. 45. The system of claim 44, wherein the surgical instrument driver is introduced percutaneously through a percutaneous passage separate from that used to introduce the instrument tip cassette and / or the instrument tip cassette deployment and support device.

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