Method and system for robotic single-port laparoscopic access

Abstract

The laparoscopic instruments have a semicircular middle section with a center point and a coincident remote center of the robotic arm to which the instruments are mounted on a common axis located between the straight proximal and distal sections. The straight proximal section of the laparoscopic instruments is rotatably mounted on a fixed side mount on the surgical robotic arm. The robotic arm is disengaged from the surgical robot to position the semicircular middle section through a percutaneous port and allow manual positioning of the robotic arm to position the center point of the semicircular middle section and the coincident remote center of the robotic arm to which the instruments are mounted at a target virtual insertion point on the patient's body. A visual aid is provided to assist in locating the center point.

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This PCT application claims priority to U.S. Patent Application No. 18 / 172,290 (Attorney Docket No. 41628-716.201), filed February 21, 2023, which claims the benefit of U.S. Provisional Application No. 63 / 335,548 (Attorney Docket No. 41628-716.101), filed April 27, 2022, the entire contents of which are incorporated herein by reference.

[0002] 1. Field of the invention The present invention relates generally to medical systems, instruments, and methods. More specifically, the present invention relates to systems and instruments for robotically assisted laparoscopic access, typically for access of multiple robotically operated instruments through a single incision in the umbilicus or other location. [Background technology]

[0003] BACKGROUND OF THEINVENTION In recent years, many open surgical procedures performed in the abdominal cavity have been replaced by minimally invasive procedures performed through several very small incisions using an endoscope, called a laparoscope, inserted through one of the incisions. Other incisions are also used to introduce surgical instruments, and the abdominal cavity is inflated to create space to perform the surgery. Such procedures are commonly referred to as "laparoscopic" and can be used for gallbladder removal, hernia repair, hysterectomy, appendectomy, gastric fundoplication, and other procedures. Similar endoscopic, thoracoscopic, and other procedures are performed in other body cavities, with or without inflating.

[0004] Despite significant advances over open surgical procedures, which may require an incision of several inches or more through the abdominal wall, such laparoscopic procedures still require incisions through muscle or fascia in several separate sites. Each incision may increase the risk for the patient of infection, bleeding trocar site hernias, increased postoperative pain, compromised cosmetic outcomes, and other adverse events.

[0005] As an improvement over such laparoscopic procedures, "single port" laparoscopy has been proposed, in which a single access port is inserted through the umbilicus (the patient's navel). Access only through the umbilicus is advantageous because it provides superior cosmetic and functional results. However, introducing the laparoscope and all other instruments required for surgery through a single port makes the procedure more difficult to perform. In particular, the use of conventional laparoscopic instruments, which are typically straight, makes it difficult to approach a single target area within the tissue to be treated with two or more instruments simultaneously.

[0006] Further improvements in the field of single-port laparoscopic surgery are described in U.S. Patent Publication Nos. 2012 / 0116362, 2016 / 0081752, and 2019 / 0307474 (assigned to the assignee of the present application, the entire disclosures of which are incorporated herein by reference). Generally, as described within these disclosures, a system for performing a single-port laparoscopic procedure includes a percutaneous seal and a plurality of instruments. The instruments include a substantially rigid tubular sleeve having a C-shaped central region and an effector core translatably and rotatably disposed within the sleeve. Typically, the C-shaped central region of the tubular sleeve, which is formed as a semicircle, physically passes through the single port while the "center point" of the semicircle is aligned with a "virtual" insertion site on the patient's abdominal wall for the instruments. Such a virtual insertion site acts as a fulcrum for the instrument as it is manipulated, even if the instrument physically passes through a single port location offset from the virtual insertion site. Two, three, or even more such instruments may have a C-shaped central region through which they physically pass through a single port, with their virtual remote centers positioned radially outward from the center defined by the single port.

[0007] Of particular interest to the present invention, US2019 / 0307474 describes a method for rigidly mounting such laparoscopic instruments, i.e., those with a C-shaped central region, to a robotic arm. However, such rigid mounting limits the surgeon's ability to manually position the surgical arm and align the instruments prior to beginning a robotic surgical procedure. Unlike conventional linear laparoscopic instruments, laparoscopic instruments with a C-shaped central region require that the center point of the C-shaped central region be aligned with the "virtual" remote center of the robotic surgical system, i.e., the site where the linear laparoscopic instrument would be inserted for manipulation by the robotic surgical system.

[0008] It would therefore be beneficial to provide improved methods, systems, and devices for robotic manipulation of laparoscopic instruments having a C-shaped central region, such as those described in U.S. Patent Publication Nos. 2012 / 0116362, 2016 / 0081752, and 2019 / 0307474 (assigned to the assignee of the present application). Improved methods, systems, and devices that allow a physician to manually position the C-shaped central region of a laparoscopic instrument carried by a robotic arm through a single port while the C-shaped section passes through the actual insertion point and freely moves the center point to an alternate virtual insertion site without the need to remove the laparoscopic instrument from the single port or pierce the patient's skin at any target virtual insertion site would be particularly desirable when manually aligning the C-shaped section center point located within the remote center of the attached robotic arm with the virtual point of insertion. Such improved methods, systems and devices would facilitate multiple instrument access to abdominal and other surgical target sites through a single port in the patient's umbilicus or elsewhere, preferably with minimal interference between adjacent instruments during performance of the procedure. At least some of these objectives will be achieved by the inventions hereinafter described.

[0009] 2. Technical Background U.S. Patent Publication Nos. 2019 / 0307474, 2012 / 0116362, and 2016 / 0081752 are described above. Surgical robotic systems of the type suitable for use with the laparoscopic instruments of the present invention are described in US2009 / 0163931, US2014 / 0188130, US2011 / 0118709, US2013 / 0116712, US2016 / 0235496, US2007 / 0021738, and US2003 / 0045778. Other patent publications of interest include US2011 / 0071541, US2007 / 0049966, and US2006 / 0167440. [Prior art documents] [Patent documents]

[0010] [Patent Document 1] US Patent Publication No. 2012 / 0116362 Summary of the Invention [Means for solving the problem]

[0011] SUMMARY OF THEINVENTION In a first aspect of the invention, a laparoscopic instrument is configured to be mounted on a surgical robotic arm including a fixed side mount (configured for removably coupling to a straight laparoscopic or other cannula) and a drive interface. The laparoscopic instrument comprises a shaft having (a) a straight proximal section, (b) a straight distal section axially aligned with the straight proximal section along a common axis, (c) a semicircular intermediate section having a center point on the common axis and located between and contiguous with the straight proximal and distal sections, and (d) a central passageway extending through the shaft. A flexible cable assembly passes through the central passageway of the shaft and is configured to accommodate the semicircular intermediate section as the flexible cable wire assembly is axially translated and rotated within the central passageway of the shaft. A drive interface on the straight proximal section of the shaft is removably connected to a drive interface on the robotic arm and configured to manipulate the flexible cable assembly, and a distal effector extends from the straight distal section of the shaft and is drivingly coupled to a distal end of the flexible cable assembly. A rotatable side mount is rotatably coupled to the straight proximal section of the shaft, the side mount configured to removably connect to a fixed side mount on the robotic arm and to allow a common axis of the shaft to be rotated about at least two axes that are orthogonal to a longitudinal axis of the surgical robotic arm.

[0012] In some cases, the side mount is coupled to a straight proximal section of the shaft by a pair of orthogonally oriented revolute joints.

[0013] In some cases, the laparoscopic instrument further comprises a telescoping section that extends distally of the distal effector end of the shaft and accommodates expansion and retraction of the flexible cable wire assembly. Typically, but not necessarily, the sections of the telescoping section have alignment features that prevent relative rotation as the sections are extended and retracted.

[0014] In some cases, the flexible cable assembly is configured to be rotatably and translatably attached to a drive interface in a surgical robotic arm such that the drive interface can axially and rotationally reposition the push / pull wires of the flexible cable wire assembly relative to a common axis of the shaft to actuate the distal effector. In such cases, the flexible cable assembly may further include a bi-directional torque tube coaxially positioned across the push / pull and configured to transmit torque and axial translational forces from the drive interface in the robotic arm to the distal effector.

[0015] In a second aspect of the invention, a laparoscopic instrument system for use with a surgical robot includes a laparoscopic instrument and an alignment instrument. The laparoscopic instrument may be configured in any of the ways described and claimed herein, and the alignment instrument is typically coupled to the shaft of the laparoscopic instrument and configured to visually "mark" the location of the center point of the semicircular midsection of the shaft and the remote center of the robotic arm to which the instrument is mounted, facilitating manual positioning of the surgical robotic arm with the mounted instrument to place the center point at the target insertion virtual point. The remote center corresponds to the "virtual" instrument insertion site, i.e., the site where abdominal wall or other cavity wall penetration would be made to accommodate a straight laparoscopic instrument.

[0016] In conventional robotic surgery using straight laparoscopic cannulas and instruments, the "remote center" (also referred to as the "remote motion center") is the point in space where the cannula and inserted instruments pass through the abdominal wall and enter the patient's body. This entry point serves as a fixed fulcrum that limits lateral repositioning of the cannula after insertion. Also, each robotic arm and instrument has a separate remote center and abdominal penetration. As described in detail below, the instruments of the present invention allow the remote center, i.e., the virtual insertion point, to be moved without requiring additional penetrations, and in many cases without even removing the instrument from the patient.

[0017] In some cases, the alignment tool is removably coupled to the shaft.

[0018] In some cases, the alignment tool is an elongate body having a proximal end that is coupled to the shaft and a distal marking tip that is positioned at a center point when the proximal end is coupled to the shaft.

[0019] In other cases, the alignment tool is configured to project a pair of visible beams that intersect at a center point of the semicircular midsection of the tool when the alignment tool is coupled to the shaft. In this manner, the center point of the semicircular midsection of the tool, which is aligned with the remote center of the robotic arm to which the tool is mounted, can be precisely positioned to a virtual point of insertion on the patient's abdominal wall by manually positioning the robotic arm such that the beams intersect precisely at a desired location of the virtual point of insertion on the patient's abdomen or other skin area.

[0020] In both cases, alignment of the midpoint of the semicircular intermediate portion of the instrument with the remote center of the robotic arm occurs at the point when the instrument is attached to the robotic arm From this point onwards, the midpoint of the semicircular intermediate portion and the remote center of the robotic arm will coincide in space, i.e., remain at the same location in space even as the laparoscopic instrument and the supporting robotic arm are moved in space.

[0021] In a third aspect of the present invention, a method for performing robotic surgery with at least one laparoscopic instrument having an axis and a remote center aligned with a target insertion virtual point on a patient's abdomen includes providing (a) a surgical robot system having at least one robotic arm including a fixed side mount and a drive interface, and (b) at least one laparoscopic instrument having a semicircular intermediate section with a center point on a common axis located between and contiguous with a straight proximal section and a straight distal section. The straight proximal section of the shaft is rotatably coupled to the fixed side mount on the robot arm such that the common axis of the shaft can be rotated about at least two axes that are orthogonal to the longitudinal axis of the surgical robot arm. The semicircular intermediate section of the shaft of the at least one laparoscopic instrument is positioned through a percutaneous passageway, and the at least one robotic arm is disengaged from the surgical robot such that the at least one robotic arm can be manually positioned.

[0022] At least one robotic arm is manually positioned to place the center point of the semicircular middle portion of the shaft (which coincides with the remote center of the robotic arm) of at least one laparoscopic instrument at a target insertion "virtual" point for the instrument on the body surface. That is, even if the instrument passes through a different location, such as a "single port" physically located through the patient's umbilicus or other location, manipulation of the instrument by the robotic arm can be controlled the same as if the instrument were straight and passing through the "virtual" point of insertion.

[0023] The laparoscopic instruments of the present invention are typically attached to a robotic arm while the semicircular intermediate portion remains positioned through a single port or other percutaneous passageway, and the common axis of the at least one laparoscopic instrument is self-rotated and aligned with the longitudinal axis of the surgical robotic arm. After the at least one robotic arm is engaged with the surgical robot, the robotic arm is manipulated to surgically interact an end effector on the at least one laparoscopic instrument with tissue while the intermediate portion of the shaft remains positioned within the percutaneous passageway and the center point remains at a pre-set remote center on the patient's abdomen.

[0024] In some instances, manually positioning the at least one robotic arm to locate the center point of the semicircular intermediate portion of the shaft and the coincident remote center of the robotic arm to which the at least one laparoscopic instrument is mounted with a virtual insertion point on the patient's abdomen includes providing a visual marker of the location of the center point on the patient's abdomen and aligning the visual marker with the location of the target insertion virtual point. For example, providing a visual marker of the location of the center point on the patient's abdomen may include coupling an extension to the shaft, the extension having a distal marking tip positioned at the center point. In another example, providing a visual marker of the location of the center point on the patient's abdomen may include projecting a pair of visual beams that intersect at the center point on the patient's abdomen.

[0025] In some cases, rotatably coupling the linear proximal section of the shaft to a fixed side mount on the robotic arm includes removably attaching a rotatable side mount to the fixed side mount on the robotic arm, the rotatably coupled to the linear proximal section of the shaft. For example, the rotatable side mount may be rotatably coupled to rotate about at least two axes orthogonal to a longitudinal axis of the surgical robotic arm.

[0026] In some cases, the method as described above may further include providing a second laparoscopic instrument having a semicircular intermediate section located between and contiguous with the straight proximal and distal sections, with a center point on a common axis. The straight proximal section of the shaft of the second laparoscopic instrument is rotatably coupled to a fixed side mount on the second robotic arm of the surgical robot such that the common axis of the shaft of the second laparoscopic instrument can be rotated about at least two axes orthogonal to the longitudinal axis of the second surgical robotic arm. The semicircular intermediate section of the shaft of the second laparoscopic instrument is positioned through the percutaneous passageway and disengaged from the second robotic arm such that the second robotic arm can be manually positioned. The second robotic arm is manually positioned to locate the center point of the semicircular intermediate portion of the shaft and the coincident remote center of the robotic arm to which the instrument of the second laparoscopic instrument is mounted with a second virtual point of insertion on the patient's abdomen while the semicircular intermediate portion remains positioned through the percutaneous passageway, and self-rotates and aligns the common axis of the second laparoscopic instrument with the longitudinal axis of the second surgical robotic arm. The second robotic arm is then re-engaged with the surgical robot such that the second robotic arm is again manipulated by the surgical robot. Once re-engaged, the surgical robot is operated to manipulate the second robotic arm to surgically interact an end effector on the second laparoscopic instrument with tissue while the intermediate portion of the shaft of the second laparoscopic instrument remains positioned within the percutaneous passageway, and the center point and the remote center of the second robotic arm remain located at the second virtual point of insertion on the patient's abdomen.

[0027] (Cited 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. [Brief description of the drawings]

[0028] The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings.

[0029] [Figure 1] FIG. 1 illustrates a commercially available robotic surgical system of the type that may be used to operate the laparoscopic instruments of the present invention.

[0030] [Diagram 2] FIG. 2 illustrates a pair of laparoscopic instruments intended for single port access and intended for manual manipulation within a surgical procedure, with a repositioned view of one of the instruments shown in dashed lines, the instruments being pivotally mounted within a support frame.

[0031] [Diagram 3] FIG. 3 is a perspective view of a laparoscopic instrument constructed in accordance with the principles of the present invention and configured for manipulation by the arms of a surgical robot.

[0032] [Figure 4] 4A-4D illustrate internal components of the laparoscopic instrument of FIG. 3, with FIGS. 4A and 4B showing the telescopic distal extension extended and retracted, respectively, and FIGS. 4C and 4D showing the flexible cables and wires configured to actuate the end effector.

[0033] [Diagram 5] FIG. 5 is a detailed view of a side connector attached to a proximal section of the shaft of the laparoscopic instrument of FIG. 3, showing, in dashed lines, rotation of the side connector about a first axis transverse to the shaft.

[0034] [Figure 6]FIG. 6 is a detailed view of a side connector of the laparoscopic instrument of FIG. 3 showing, in dashed lines, rotation of the side connector about a second axis transverse to the shaft.

[0035] [Figure 7] FIG. 7 illustrates a first embodiment of an alignment instrument attachable to the shaft of a laparoscopic instrument of the present invention that is configured to allow a user to align the center point of the instrument with a utilized remote center of a robotic system.

[0036] [Figure 8] FIG. 8 illustrates a second embodiment of an alignment instrument attachable to the shaft of a laparoscopic instrument of the present invention, configured to allow a user to align the center point of the instrument with a utilized remote center of a robotic system.

[0037] [Figure 9] FIG. 9 illustrates a laparoscopic instrument of the present invention adjacent to an arm of a surgical robotic system prior to loading of the instrument onto the arm.

[0038] [Figure 10] FIG. 10 illustrates the laparoscopic instrument and surgical robotic arm of FIG. 9 with instruments mounted on the arm.

[0039] [Figure 10A] FIG. 10A illustrates the connection of a prior art linear laparoscopic instrument to an instrument holder of a robotic surgical system, showing the location of the robotic surgical system's "remote center" characteristic marked on the linear laparoscopic instrument.

[0040] [Figure 10B] FIG. 10B illustrates the connection of a laparoscopic instrument of the present invention to an instrument holder of a robotic surgical system showing the location of the "remote center" characteristic of the robotic surgical system, which coincides with the center point of the semicircular mid-section of the laparoscopic instrument in free space.

[0041] [Figure 11A] 11A-11E illustrate a method for performing robotic surgery using laparoscopic instruments having axes aligned with a target remote center on a patient's abdomen in accordance with the principles of the present invention. [Figure 11B] 11A-11E illustrate a method for performing robotic surgery using laparoscopic instruments having axes aligned with a target remote center on a patient's abdomen in accordance with the principles of the present invention. [Figure 11C] 11A-11E illustrate a method for performing robotic surgery using laparoscopic instruments having axes aligned with a target remote center on a patient's abdomen in accordance with the principles of the present invention. [Figure 11D] 11A-11E illustrate a method for performing robotic surgery using laparoscopic instruments having axes aligned with a target remote center on a patient's abdomen in accordance with the principles of the present invention. [Figure 11E] 11A-11E illustrate a method for performing robotic surgery using laparoscopic instruments having axes aligned with a target remote center on a patient's abdomen in accordance with the principles of the present invention. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0042] Detailed Description of the Invention 1, the laparoscopic instruments and end effectors of the present invention are intended to be used in conjunction with and operated by known and commercially available robotic systems, such as the da Vinci® surgical system available from Intuitive Surgical, Inc. (Sunnyvale, Calif.). An exemplary robotic surgical system 10 includes a robotic station 12, which includes multiple robotic arms 14 (three are shown), and a controller module 16 that allows a physician to view the procedure and control the surgical arms to manipulate instruments to perform a desired laparoscopic or other surgical procedure.

[0043] 2, a prior art laparoscopic instrument system 100 of the type described in US 2016 / 0081752 (previously incorporated by reference herein) comprises an instrument mounting frame 112 having a first instrument 114 and a second instrument 120 pivotally mounted thereto. The first instrument has an intermediate portion 116 and the second instrument has an intermediate portion 122, both intermediate portions extending generally inwardly from an axis 128 of the instruments. Both intermediate portions 116 and 122 are preferably circular and have a radius emanating from an imaginary rotation point that is generally aligned with a pivot axis 152 of the assembly that is mounted to the outer periphery of the instrument mounting frame 112. Locating the imaginary rotation point of each instrument outside the periphery of the ring at the location of the dual pivots allows the generally circular intermediate portions 116 and 122 to pass and move through a central opening 118 of the frame 112 without interfering with one another. Intermediate portions 116 and 22 may alternatively have a non-circular geometric shape, e.g., elliptical or polygonal, extending radially inward relative to frame 112, but a circular shape would cause the pass-through point of the intermediate portions to remain fixed within central opening 118 of the frame as long as the instruments are constrained to move in orthogonal planes by pivot mounting, as will be explained in more detail below. In some cases, it would be conceivable to modify the arms of a surgical robot to manipulate these prior art instruments, but these instruments are intended to be manually manipulated and any attempt to directly interface the instruments with a robotic arm would be suboptimal.

[0044] 3 and 4A-4D, a laparoscopic instrument 200 constructed in accordance with the principles of the present invention comprises a shaft 202 having a straight proximal section 204 and a straight distal section 206 separated by a semicircular intermediate section 208. The straight proximal section 204 and the straight distal section 206 are aligned along a common longitudinal axis, the straight proximal section having a rotating connector 220 positioned proximal to the semicircular intermediate section 208 that allows the semicircular intermediate section and the straight distal section to rotate relative to the straight proximal section 204 about the common longitudinal axis. Such an ability to rotate is essential to allow repositioning of the laparoscopic instrument 200 to different virtual insertion points while the instrument remains attached to a robotic arm (which would act as a remote center location for the robotic system) without removal from the patient, as will be explained in more detail below. Typically, the proximal section 204 includes a sleeve 244 that telescopically cushions another portion of the proximal section to allow length adjustment.

[0045] The laparoscopic instrument 200 further includes an end effector 214, such as forceps, a cutter, an electrosurgical element, or the like, at its distal end, and the distal section 206 will typically have a telescopic construction to allow its length to be adjusted. A rotatable side mount 240 is attached to the proximal section 204 of the shaft 202 at a location proximal to the rotating connector, the rotatable side mount being configured to be removably attached to a robotic arm of a surgical robot, as will be described in more detail below. In this manner, all portions of the shaft 202 distal to the rotatable connector 220 will be free to rotate about the longitudinal axis of the shaft, and in particular the semicircular intermediate section 208 will be able to rotate to other positions, for example as shown in dashed lines in FIG. 3.

[0046] 4A-4B, the internal components of laparoscopic instrument 200 that enable manipulation of end effector 214 will be described. Shaft 202 has a hollow central passage that receives flexible cable 210. Flexible cable 210 has a hollow lumen extending from its distal end to its proximal end that receives pull and / or push wire 212 having end effector 214 at its distal end. Flexible cable 210 has a proximal attachment member 222 at its proximal end, and pull and / or push wire 212 has a proximal attachment member 224 at its proximal end. Distal section 206 of shaft 202 is preferably joined as a telescoping structure having multiple sections 216, including a distal-most section 218 that carries end effector 214. The telescoping distal section may be axially extended and retracted to accommodate full axial extension of the flexible cable 210 as illustrated in FIG. 4A and full axial retraction of the flexible cable as illustrated in FIG. 4B. The flexible cable 210, by its flexible nature, provides a conformable central region 226 to accommodate bending as the cable passes through the preferred C-shaped intermediate section 208 of the shaft. Similarly, the pull / push wire 212 will have a conformable region 228 to accommodate bending as it is extended and retracted through the conformable region 226 of the flexible cable 210. The surgical robot manipulates the end effector 214 through these internal components using a drive head 286 mounted on an instrument holder 282 that connects to a robot arm interface 242 on the laparoscopic instrument 200 when the instrument is mounted on the surgical robot's instrument holder, as illustrated in FIG. 10 described below.

[0047] The robotic arm interface 242 allows the drive head 286 of the robotic surgical system to manipulate internal components of the laparoscopic instrument 200 to mechanically drive the end effector 214. Axial translation of the cable and wire assembly (including the flexible cable 210 and the pull / push wire 212) relative to the shaft 202 can be achieved by selectively tensioning the proximal attachment member 222 at the proximal end of the flexible cable 210. Similarly, rotation of the cable and wire assembly about the longitudinal axis of the assembly can also be achieved by rotating the proximal attachment member 222 at the proximal end of the flexible cable 210. Additionally, axial translation of the pull / push wire 212 relative to the flexible cable 210 to actuate the end effector can also be achieved by manipulation of the proximal attachment 224 at the proximal end of the pull / push wire 212.

[0048] The proximal section 204 of the laparoscopic instrument 200 is secured to the instrument holder 282 through the attachment of the robotic arm interface 242 to the drive head 286, as seen in FIGS. 9 and 10, while the distal section 206 of the laparoscopic instrument is also secured to the instrument holder through the attachment of the rotatable side mount 240 to the instrument mounting head 284 at the lower end of the instrument holder, as seen in FIGS. 9 and 10. The specific connection between the robotic arm interface 242 and the drive head 286 depends on the nature of the laparoscopic instrument and does not form part of the present invention. Typically, the specific connection pattern for the instruments of the present invention will be arranged to match that of a corresponding conventional laparoscopic instrument of the same type, for example, all forceps and all cutters will be interfaced similarly, and the robotic control system will not depend on the use of the conventional instrument or the instrument of the present invention. In contrast, the rotatable side mount 240 is designed to provide one or more rotational axes to facilitate the connection of the laparoscopic instrument 200 to the instrument holder 282.

[0049] 5 and 6, the rotatable side mount 240 comprises a base cylinder 248, a base plate 250, and an insertable connector 252. The base cylinder 248 is crimped or otherwise secured to an outer surface of the proximal section 204 of the shaft 202 on the proximal side of the rotatable connector 220. The base plate 250 is pivotally attached to the base cylinder 248 at a pivot 254 such that it may tilt relative to the shaft, as shown in dashed lines in FIG. 5. The insertable connector 252 is pivotally attached to the base plate 250 at a pivot 256 such that it may rotate relative to the shaft, as shown in dashed lines in FIG. 6. In this manner, the insertable connector 252 has two orthogonal pivot axes relative to the axis of the shaft 202, allowing a laparoscopic instrument to be first connected at its lower end to the instrument holder 282 and then reoriented as the robotic arm interface 242 is connected to the drive head 286 at the upper end of the instrument holder.

[0050] 7 and 8, an alignment instrument is typically coupled to the shaft of a laparoscopic instrument and is configured to visually "mark" the location of a center point CP of the semicircular midsection of the shaft and facilitate manual positioning of a surgical robotic arm to place the center point / remote center at a target "virtual point of insertion" on the patient's body. As shown in FIG. 7, the alignment instrument 260 may be a simple straight rod or probe having a tip 262 that is located at the center point CP when a connector hub 264 is removably attached to the proximal section 204 of the shaft 202, as shown in dashed lines. As shown in FIG. 8, the alignment instrument 266 comprises a bar with a pair of light emitting diodes or other light sources 268 and 270 arranged to project beams 268a and 268b that intersect at a point 272 located at the center point CP of the semicircular midsection of the shaft 202. The laparoscopic instrument 200 can therefore be aligned by manually moving the laparoscopic instrument 200 and the instrument holder 282 until the tip 62 of the alignment instrument 260 or the intersection point 272 of the alignment instrument 266 is located at the target insertion virtual point, as will be described in more detail with reference to Figures 11A-11E below.

[0051] FIG. 9 illustrates a laparoscopic instrument 200 of the present invention adjacent to an instrument holder 282 carried by an arm 280 of a surgical robotic system, such as that illustrated in FIG. 1, prior to mounting of the instrument on the arm. The laparoscopic instrument 200 is mounted by inserting the insertable connector 252 of the rotatable side mount 240 into a mounting cavity 288 on one end of a mounting head 284 of the instrument holder 282. A mounting release lever 290 allows the instrument 200 to be released from the instrument holder 282 after the procedure is completed. Typically, the rotatable side mount 240 of the laparoscopic instrument 200 will be mounted to the mounting head 284 of the instrument holder 282 prior to mounting the robot interface 242 to the drive head 286. In this manner, the shaft 202 of the laparoscopic instrument 200 remains free to rotate about a mounting axis defined by the rotatable side mount 240, as described above with reference to FIGS. 5 and 6. 10, the laparoscopic instrument 200 will be immobilized relative to the instrument holder 282, and the laparoscopic instrument 200 and the instrument holder 282 will be moved together as a unit by the surgical robotic arm 280. The mounting head 284 of the instrument holder 282 will typically include a clutch release (not shown) that allows a user to selectively engage and disengage it so that the surgical robotic arm 282 may be manually positioned relative to a patient for initial setup, as will be described in more detail with reference to FIGS. 11A-11E.

[0052] 10A illustrates the connection of a linear laparoscopic instrument such as a linear cannula SC to the mounting head 284 of the instrument holder of a robotic surgical system, showing the location of the "remote center RC" characteristic of the robotic surgical system marked on the linear laparoscopic instrument. The location of the remote center RC is marked on the shaft of the cannula SC so that the user may place the remote center at the actual abdominal wall penetration in a conventional robotic laparoscopic surgical procedure. The remote center is characteristic of the particular surgical system being employed and is the fulcrum or pivot point of the instrument shaft and is used by the robotic surgical system to plan all manipulations of the instrument.

[0053] FIG. 10B illustrates the connection of a laparoscopic instrument of the present invention to a mounting head 284 of an instrument holder of a robotic surgical system, showing the location of the "remote center" characteristic of the robotic surgical system. However, in contrast to the conventional straight instrument illustrated in FIG. 10B, the remote center RC will coincide with the center point CP of the semicircular midsection of the laparoscopic instrument, which is located in free space. In further contrast to the conventional straight instrument illustrated in FIG. 10B, the remote center RC of the laparoscopic instrument of the present invention will be located at a virtual insertion site without the need for actual penetration. By sizing the laparoscopic instrument of the present invention to place the center point CP of the semicircular midsection at the remote center of the particular robotic surgical system to be used, the robotic surgical system will be able to manipulate the instrument as if it were straight, and therefore no modifications to the robotic surgical system are necessary (although there may be instances where modifications may be useful).

[0054] A method for positioning a laparoscopic instrument of the present invention will now be described with reference to Figures 11A-11E. As shown in Figures 11A and 11B, a laparoscopic port or seal S, such as that described in commonly owned US2019 / 0380743 (the entire disclosure of which is incorporated herein by reference), is placed through the umbilicus U in the patient's abdomen A. As shown in Figure 11C, the instrument 200 is introduced into the inflated abdomen to a level when the semicircular middle section 208 reaches the port seal S. As shown in Figure 11D, the user, after engaging the clutch, brings the robot arm 282 to a position proximate the instrument side mount 240, depresses the mounting lever 290 on the robot arm 282, engages the instrument side mount 240, and locks the instrument 200 to the robot arm by releasing the mounting lever 290. By holding the clutch engaged and not displacing the position of the semicircular middle section 208 within the seal S, the user moves the robot arm 282 to align and lock the robot interface 242 and drive head 286.

[0055] After the instrument holder 282 is attached to the laparoscopic instrument 200, the user actuates the clutch, disengages the instrument holder 282, and aligns the virtual insertion point with the center point CP of the semicircular intermediate portion 208, as shown in FIG. 11D, prior to beginning the surgical procedure. Typically, but not necessarily, the user will employ an alignment instrument, such as alignment instruments 260 and 266, described above with reference to FIGS. 7 and 8. Once the instrument 200 and holder 282 are aligned with the virtual insertion point, as shown by alignment line AL in FIG. 11D, the user can release the clutch release level and lock the instrument and holder, such that their motion will now be controlled by the robotic system (rather than manually). The laparoscopic instrument 200 is then ready for use, although the surgical procedure will often require one, two, three, or even more laparoscopic instruments to be introduced through the seal, depending on the requirements of the surgical procedure to be performed.

[0056] At any time during the surgical procedure, the user may desire to reposition the center point CP of the semicircular intermediate portion 208 with a different target virtual insertion point, as shown, for example, in FIG. 11E. The user can perform such repositioning by simply decoupling the arm 280 and the instrument holder 282 from the surgical robot using a clutch release (not shown) that is part of the surgical robot. The instrument 200 and holder 282 can then be manually repositioned until the center point CP of the instrument 200 is located at a different virtual insertion point, as shown in FIG. 11E. Such repositioning is accomplished without removing the instrument 200 from the port seal S and without the need to form a penetration through the patient's abdomen at the new target virtual insertion point. While such repositioning is limited by the radius of the semicircular intermediate portion 208, a first instrument can be replaced with a second instrument having a different semicircular intermediate portion radius, in which case instrument removal would be required.

[0057] During surgery, the robotic system will reposition the robotic arms and instruments at many different angles relative to the plane of penetration of the abdominal wall, with the pivot at the level of the abdominal wall (remote center). Once the setup is complete, the distance from the proximal part of the laparoscopic instrument held by the robotic arm to the virtual insertion point of this instrument will typically remain the same. The initial distance is selected such that the semicircular center point and the shared spatial remote center of the robotic arm 208 (FIGS. 7 and 8) are at the level of the virtual insertion point into the body cavity. From this point on, all movements of the robotic arm will maintain this distance so that the remote center remains in the same place at the virtual insertion point into the abdominal wall.

[0058] Preferred embodiments of the present invention, including the best mode known to the inventors for carrying out the invention, are described herein. Variations of those preferred embodiments may become apparent to those skilled in the art upon perusal of the foregoing description. The inventors anticipate that those skilled in the art will adopt such variations as appropriate, and the inventors intend for the invention to be practiced otherwise than as specifically described herein. Accordingly, the present invention includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Also, any combination of the above-described elements in all its possible variations is encompassed by the present invention, unless otherwise indicated herein or clearly contradicted by context.

[0059] All references cited in this specification, including publications, patent applications, and patents, are hereby incorporated by reference to the same extent as if each reference was individually and specifically indicated to be incorporated by reference and was set forth in its entirety herein.

Claims

1. 1. A laparoscopic instrument configured to be mounted on an instrument holder of a surgical robotic system having a robotic arm with a remote center, the instrument holder including a fixed side mount and a drive interface, the laparoscopic instrument comprising: a shaft having (a) a straight proximal section; (b) a straight distal section axially aligned with the straight proximal section along a common axis; (c) a semicircular intermediate portion having a center point on the common axis and located between and contiguous with the straight proximal and distal sections, the location of the center point coinciding with the remote center of the robotic arm when the laparoscopic instrument is loaded onto the instrument holder; and (d) a central passageway extending through the shaft; a flexible cable assembly passing through the central passage of the shaft and configured to accommodate the semicircular intermediate portion as the flexible cable assembly is axially translated and rotated within the central passage of the shaft; a drive interface on the straight proximal section of the shaft removably connected to the drive interface on the robotic arm and configured to manipulate the flexible cable assembly; a distal effector extending from the straight distal section of the shaft and drivingly coupled to a distal end of the flexible cable assembly; a rotatable side mount rotatably coupled to the linear proximal section of the shaft, the side mount configured to removably connect to the fixed side mount on the robotic arm and to allow the common axis of the shaft to be rotated about at least two axes that are orthogonal to a longitudinal axis of the surgical robot arm; Equipped with A laparoscopic instrument, wherein the semicircular intermediate portion is attached to the linear proximal portion by a rotatable bearing that allows the semicircular intermediate portion to rotate relative to the linear proximal portion about the common axis.

2. The laparoscopic instrument of claim 1 , wherein the side mount is coupled to the straight proximal section of the shaft by a pair of orthogonally oriented revolute type joints.

3. The laparoscopic instrument of claim 1 or 2, further comprising a telescoping section extending distally of the distal effector end of the shaft to accommodate expansion and retraction of the flexible cable wire assembly.

4. The laparoscopic instrument of claim 3 , wherein the compartments of the telescoping section have alignment features that prevent relative rotation as the compartments are extended and retracted.

5. The laparoscopic instrument of any one of claims 1-4, wherein the flexible cable assembly is configured to be rotatably and translatably mounted to the drive interface in the surgical robot arm such that the drive interface can axially and rotationally reposition push / pull wires of the flexible cable wire assembly relative to the common axis of the shaft to actuate the distal effector.

6. 6. The laparoscopic instrument of claim 5, wherein the flexible cable assembly further comprises a bi-directional torque tube positioned coaxially across the push / pull wires and configured to transmit torque and axial translation forces from the drive interface in the robotic arm to the distal effector.

7. 1. A laparoscopic instrument system for use with a surgical robot, the system comprising: A laparoscopic instrument according to any one of claims 1 to 6, an alignment tool coupled to the shaft in a fixed orientation and configured to mark the location of the center point of the semicircular intermediate portion of the shaft when coupled to the shaft, wherein a user can visualize the marked location and manually position the surgical robot arm to locate the center point of the semicircle and a corresponding remote center point of the robotic arm to which the tool is mounted with a virtual insertion point on the patient's abdomen; A system comprising:

8. The laparoscopic instrument system of claim 7 , wherein the alignment instrument is removably coupled to the shaft.

9. 9. The laparoscopic instrument system of claim 7 or 8, wherein the alignment instrument is an elongate body having a proximal end coupled to the shaft and a distal marking tip positioned at the center point when the proximal end is coupled to the shaft.

10. The laparoscopic instrument system of any one of claims 7-9, wherein the alignment instrument is configured to project a pair of visible beams that intersect at the center point when the alignment instrument is coupled to the shaft.

11. 1. A method for performing robotic surgery with at least one laparoscopic instrument having an axis aligned with a virtual insertion point on a patient's abdomen, the method comprising: A surgical robotic system including at least one robotic arm having a remote center and an instrument holder carried by the robotic arm, the instrument holder having a fixed side mount and a drive interface; providing at least one laparoscopic instrument including a shaft having a semicircular intermediate portion located between and contiguous with a straight proximal section and a straight distal section of the shaft, with a center point on a common axis, the center point coinciding with a location of the remote center of the robotic arm when the laparoscopic instrument is mounted on the instrument holder; coupling the straight proximal section of the shaft to the fixed side mount on the robotic arm, the center point of the semicircular intermediate portion being positioned at the remote center of the surgical robotic system; positioning the semicircular intermediate portion of a shaft of the at least one laparoscopic instrument through a percutaneous passageway, the percutaneous passageway being offset from the remote center of the surgical robotic system by a distance equal to a radius of the semicircular intermediate portion; disengaging the at least one robotic arm from the surgical robot such that the at least one robotic arm may be manually positioned; manually positioning the at least one robotic arm to place the center point of the semicircular intermediate portion of the shaft of the at least one laparoscopic instrument at the virtual insertion point on the patient's abdomen while the semicircular intermediate portion remains positioned through the percutaneous passageway, the semicircular intermediate portion rotating relative to the linear proximal section about the common axis while the robotic arm is being repositioned; re-engaging the at least one robotic arm with the surgical robot such that the robotic arm is operated by the surgical robot; operating the surgical robot to manipulate at least one robotic arm to cause an end effector on at least one laparoscopic instrument to surgically interact with tissue while the intermediate portion of the shaft remains positioned within the percutaneous passageway and the center point and the coincident remote center of the robotic arm to which the instrument is mounted remain located at the virtual insertion point on the patient's abdomen; A method comprising:

12. 12. The method of claim 11, wherein manually positioning the at least one robotic arm to locate the center point of the semicircular intermediate portion of the shaft and a coincident remote center of the robotic arm to which the at least one laparoscopic instrument is mounted with the virtual insertion point on the patient's abdomen includes providing a visual marker of the location of the center point on the patient's abdomen.

13. 13. The method of claim 12, wherein providing the visual marker of the location of the center point of the semicircular intermediate portion of the instrument on the patient's abdomen comprises coupling an extension to the shaft having a distal marking tip positioned at the center point.

14. 14. The method of claim 12 or 13, wherein providing a visual marker of the location of the central point on the patient's abdomen comprises projecting a pair of visible beams that intersect at the central point on the patient's abdomen.

15. The method of any one of claims 11-14, wherein rotatably coupling the straight proximal section of the shaft to the fixed side mount on the robot arm comprises removably attaching a rotatable side mount to the fixed side mount on the robot arm, the rotatably coupled to the straight proximal section of the shaft.

16. The method of claim 15 , wherein the rotatable side mount is rotatably coupled to rotate about at least two axes orthogonal to a longitudinal axis of the surgical robotic arm.

17. The method of any one of claims 11-16, wherein the straight proximal section of the shaft is rotatably coupled to the fixed side mount on the robotic arm such that the common axis of the shafts of the laparoscopic instruments can be rotated about at least two axes that are orthogonal to a longitudinal axis of the surgical robotic arm.

18. providing a second laparoscopic instrument having a semicircular intermediate portion located between and contiguous with a straight proximal section and a straight distal section, the semicircular intermediate portion having a center point on a common axis and a coincident remote center of the robotic arm to which the instrument is mounted; rotatably coupling the straight proximal section of the shaft of the second laparoscopic instrument to a fixed side mount on a second robotic arm of the surgical robot such that the common axis of the shaft of the second laparoscopic instrument may be rotated about at least two axes that are orthogonal to a longitudinal axis of the second surgical robotic arm; positioning the semicircular intermediate portion of the shaft of the second laparoscopic instrument through the percutaneous passageway; disengaging the second robotic arm from the surgical robot such that the second robotic arm may be manually positioned; while the semicircular intermediate portion remains positioned through the percutaneous passageway, manually positioning the second robotic arm to position the center point of the semicircular intermediate portion of the shaft and a coincident remote center of the robotic arm to which the instrument of the second laparoscopic instrument is mounted with a second remote center on the patient's abdomen, and self-rotating and aligning the common axis of the second laparoscopic instrument with the longitudinal axis of the second surgical robotic arm; re-engaging the second robotic arm with the surgical robot such that the second robotic arm is operated by the surgical robot; operating the surgical robot to manipulate the second robotic arm to cause an end effector on the second laparoscopic instrument to surgically interact with tissue while the intermediate portion of the shaft of the second laparoscopic instrument remains positioned within the percutaneous passageway and the center point remains located at the second remote center on the patient's abdomen; The method of any one of claims 11-17, further comprising:

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