Stapler beam structure

Abstract

To provide a surgical tool.SOLUTION: The surgical tool has an end effector, a wrist, and an actuation assembly. The end effector can have an upper jaw portion and a lower jaw portion. A wrist can connect the end effector to the elongate shaft. A beam member may be arranged to translate within the upper and lower jaw portions. The actuating assembly may include a pushing assembly configured to transmit a compressive force to the beam member and a pulling assembly configured to transmit a tensile force to the beam member.SELECTED DRAWING: Figure 8

Description

[Technical Field]

[0001] (Cross-reference to related application data) This application claims the benefit of U.S. Provisional Application No. 62 / 385,636, filed September 9, 2016, the entire disclosure of which is incorporated herein by reference in its entirety for all purposes. [Background technology]

[0002] Minimally invasive surgical techniques aim to reduce the amount of extraneous tissue damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and adverse side effects. As a result, the average length of hospital stays for standard surgeries can be significantly reduced using minimally invasive surgical techniques. Patient recovery time, patient discomfort, surgical side effects, and time away from work can also be reduced with minimally invasive surgery.

[0003] A common form of minimally invasive surgery is endoscopy, and a common form of endoscopy is laparoscopy, which is minimally invasive examination and / or surgery within the abdominal cavity. Reloadable stapling devices can be used in conjunction with laparoscopic surgery. Telesurgically controlled stapling devices can include a servo-controlled wrist joint that yaws and pitches through relatively large angles (e.g., up to and greater than 90 degrees). Articulation of such a wrist joint can impose large strains on working components extending through the wrist. Summary of the Invention

[0004] The embodiments disclosed herein relate to a surgical device having a wrist capable of yaw and pitch rotation through relatively large angles. Such a wrist can have a yaw axis spatially separated from a pitch axis, the yaw and pitch axes being perpendicular to each other and to a longitudinal axis defining the extension of the arm or shaft of the remotely controlled surgical device. In some cases, the yaw and pitch angles can be up to 45, 60, or 90 degrees.

[0005] In many embodiments, a flexible actuation assembly extending through a wrist capable of yaw and / or pitch at relatively large angles includes a tension assembly and a push assembly. The flexible actuation assembly can be used to open and close the jaws of a surgical device and / or to actuate other instruments, such as cutting and / or stapling devices. In many embodiments, the push element can transmit a compressive force while having a significant amount of bending induced through a large wrist yaw angle and / or wrist pitch angle. In many embodiments, the push assembly does not transmit a significant amount of tensile force, and the tension element is used to transmit tensile force for proximal movement and actuation of the surgical device. Similarly, the tension component may not transmit a significant amount of compressive force. In many embodiments, the combination of the push assembly and the tension assembly into a flexible actuation assembly enables the use of the flexible actuation assembly for the application of both compressive and tensile forces (i.e., pushing and pulling) to actuate components of an end effector of a surgical device.

[0006] The pressure assembly and tension component can be integrated along a common axis, with the pressure component concentrically disposed about the tension component. In some embodiments, the pressure component includes a coil spring and the tension component includes a braided cable. Alternatively, the tension component can be concentrically disposed about the pressure component.

[0007] To enable a high degree of wrist flexibility, the wrist assembly can be composed of outer links that define the yaw and pitch geometry for the wrist assembly. The outer links can accommodate flexible portions of the actuation mechanism. However, compression of the actuation mechanism within the wrist can cause buckling and reduce the efficiency of force transmission. To help mitigate such issues, inner links can be provided that connect the outer links to each other. The inner links can define a path that constrains and limits lateral movement of the actuation mechanism, thereby mitigating buckling.

[0008] Thus, in one aspect, an apparatus is described that includes an end effector, a beam member, a tensioning assembly, and a pressing assembly. The end effector includes an upper jaw portion and a lower jaw portion. A wrist portion connects the end effector to an elongated shaft. The beam member is disposed for translation within the upper and lower jaw portions. The beam member has a first portion for movably coupling to the upper jaw portion and a second portion for movably coupling to the lower jaw portion. The tensioning assembly is connected to the beam member. The tensioning assembly is flexibly housed within the wrist and applies a tension force to the beam member. The pressing assembly is connected to the beam member. The pressing assembly is flexibly housed within the wrist and applies a compression force to the beam member. In many embodiments, the wrist portion is configured to pitch and yaw with the tensioning and pressing assemblies housed therein.

[0009] The tensioning assembly of the device can have any suitable configuration. For example, the tensioning assembly can include an elongated cable. The tensioning assembly can include a braided sheath. The tensioning assembly can include a plurality of sheet metal bands. The bending stiffness of the tensioning assembly can be the same for wrist actuation to pitch the end effector relative to the elongated shaft and for wrist actuation to yaw the end effector relative to the elongated shaft.

[0010] The pressure assembly of the device can have any suitable configuration. For example, the pressure assembly can include a lumen surrounding the tension assembly. The pressure assembly can include a close-coiled spring. The close-coiled spring can have a cylindrical outer surface. The close-coiled spring can have interfacing convex and concave surfaces. The close-coiled spring can include a spiral cut tube. The pressure assembly can include a tube with a pattern of recesses that reduces the bending stiffness of the tube while maintaining sufficient axial stiffness to transmit compressive forces to the beam member. The pressure assembly can include multiple pressure elements that separate under tension. The pressure assembly can include multiple spherical members. The tension assembly can define a lumen that houses the multiple spherical members. The spherical members can be connected by a flexible rod. The pressure assembly can include multiple separate elements with interfacing surfaces that limit relative lateral sliding between the elements in one direction. The presser assembly can include multiple separate elements having interfaces that prevent relative twisting between the elements. The presser assembly can include a stack of flat washers. The presser assembly can include a stack of annular disks. The presser assembly can include a stack of rectangular washers defining a lumen through which multiple sheet metal bands extend. The bending stiffness of the presser assembly can be the same for actuation of the wrist to pitch and yaw the end effector relative to the elongate shaft.

[0011] In another aspect, a surgical tool is described that includes an end effector, a beam member, and an actuation assembly. The end effector includes an upper jaw portion and a lower jaw portion. A wrist portion connects the end effector to an elongated shaft. The beam member is disposed for translation within the upper and lower jaw portions. The beam member has a first portion for movably coupling to the upper jaw portion and a second portion for movably coupling to the lower jaw portion. The actuation assembly includes a pressing assembly that transfers a compressive force to the beam member and a tensioning assembly that transfers a tensile force to the beam member. In many embodiments, the wrist portion is configured to pitch and yaw with the actuation assembly housed therein.

[0012] The actuation assembly of the surgical tool can have any suitable configuration. For example, the tensioning assembly can include an elongated cable. The tensioning assembly can include a braided sheath. The tensioning assembly can include a plurality of sheet metal bands. The bending stiffness of the tensioning assembly can be the same for actuating the wrist to pitch the end effector relative to the elongated shaft and for actuating the wrist to yaw the end effector relative to the elongated shaft. The pressure assembly can include a lumen surrounding the tensioning assembly. The pressure assembly can include a tightly wound spring. The tightly wound spring can have a cylindrical outer surface. The tightly wound spring can have bounding convex and concave surfaces. The tightly wound spring can include a helically cut tube. The pressure assembly can include a tube having a pattern of recesses that reduce the bending stiffness of the tube while maintaining sufficient axial stiffness to transmit compressive forces to the beam member. The pressure assembly can include a plurality of pressure elements that separate under tension. The pressure assembly can include a plurality of spherical members. The tensioning assembly can define a lumen that accommodates the plurality of spherical members. The spherical members can be connected by flexible rods. The pressure assembly can include a plurality of separate elements having interfaces that limit relative lateral sliding between the elements in one direction. The pressure assembly can include a plurality of separate elements having interfaces that prevent relative twisting between the elements. The pressure assembly can include a stack of flat washers. The pressure assembly can include a stack of annular disks. The pressure assembly can include a stack of rectangular washers defining a lumen through which a plurality of sheet metal bands extend. The bending stiffness of the pressure assembly can be the same for actuation of the wrist to pitch and yaw the end effector relative to the elongated shaft. A one-dimensional array of flexible rods can be used as both the tension and pressure assemblies. Nickel-titanium rods can be used as both the tension and pressure assemblies. [Brief explanation of the drawings]

[0013] [Figure 1] 1 shows a diagram of a surgical tool according to some embodiments. [Figure 2] 1 shows a diagram of a surgical tool according to some embodiments. [Figure 3] 1 shows a diagram of a surgical tool according to some embodiments. [Figure 4] 1 shows a diagram of a surgical tool according to some embodiments. [Figure 5] 1 shows a diagram of a surgical tool according to some embodiments. [Figure 6] 1 shows a diagram of a surgical tool according to some embodiments. [Figure 7] 7 shows a cross-sectional view of the surgical tool of FIGS. [Figure 8] 7 shows a cross-sectional view of the surgical tool of FIGS. [Figure 9] 7 illustrates an embodiment of an actuation assembly of the surgical tool of FIGS. 1-6 according to some embodiments. [Figure 10] 10 shows a cross-sectional view of the actuation assembly of FIG. 9. [Figure 11] 10 shows a cross-sectional view of a distal portion of the actuation assembly of FIG. 9. [Figure 12] 10 shows a cross-sectional view of a proximal portion of the actuation assembly of FIG. 9. [Figure 13] 7 illustrates an embodiment of a pusher assembly of the actuation assembly of the surgical tool of FIGS. [Figure 14] 7 illustrates an embodiment of a pusher assembly of the actuation assembly of the surgical tool of FIGS. [Figure 15] 10 illustrates another embodiment of a pusher assembly of the actuation assembly of the surgical tool of FIGS. [Figure 16] 10 illustrates another embodiment of a pusher assembly of the actuation assembly of the surgical tool of FIGS. [Figure 17] 7 illustrates an embodiment of a pusher assembly of the actuation assembly of the surgical tool of FIGS. [Figure 18] 10 illustrates another embodiment of a pusher assembly of the actuation assembly of the surgical tool of FIGS. [Figure 19] Another embodiment of the pressing assembly of the operating assembly of the surgical tool of FIGS. 1 to 6 is shown. [Figure 20] A view of another embodiment of the operating assembly of the surgical tool of FIGS. 1 to 6 is shown. [Figure 21] Another embodiment of the pressing assembly of the operating assembly of the surgical tool of FIGS. 1 to 6 is shown. [Figure 22] Another embodiment of the pressing assembly of the operating assembly of the surgical tool of FIGS. 1 to 6 is shown. [Figure 23] Another embodiment of the pressing assembly of the operating assembly of the surgical tool of FIGS. 1 to 6 is shown. [Figure 24] A cross-sectional view of the pressing assembly of FIG. 23 is shown. [Figure 25] Another embodiment of the pressing assembly of the operating assembly of the surgical tool of FIGS. 1 to 6 is shown. [Figure 26] A view of the individual elements of the pressing assembly of FIG. 25 is shown. [Figure 27] A cross-sectional view of another embodiment of the operating assembly of the surgical tool of FIGS. 1 to 6 is shown. [Figure 28] A top view of a part of the operating assembly of FIG. 27 disposed at the wrist portion of the surgical tool is shown. [Figure 29] A top view of a part of the operating assembly of FIG. 27 disposed at the wrist portion of the surgical tool is shown. [Figure 30] Another embodiment of the operating assembly of the surgical tool of FIGS. 1 to 6 is shown. [Figure 31] A view of another embodiment of the operating assembly of the surgical tool of FIGS. 1 to 6 is shown. [Figure 32] A view of another embodiment of the operating assembly of the surgical tool of FIGS. 1 to 6 is shown. [Figure 33] Another embodiment of the operating assembly of the surgical tool of FIGS. 1 to 6 is shown. [Figure 34] A cross-sectional view of another embodiment of the operating assembly of the surgical tool of FIGS. 1 to 6 is shown. [Figure 35] A view of the wrist portion assembly of the surgical tool of FIGS. 1 to 6 is shown. [Figure 36] FIG. 36 shows a cross-sectional view of the wrist assembly of FIG. 35. [Figure 37] FIG. 1 illustrates a perspective view of an outer link assembly according to some embodiments of the present invention. [Figure 38] 10 illustrates a method of assembling a wrist assembly according to some embodiments of the present invention. [Figure 39] 10 illustrates a method of assembling a wrist assembly according to some embodiments of the present invention. [Figure 40] 10 illustrates a method of assembling a wrist assembly according to some embodiments of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0014] In the following description, various embodiments are described. For purposes of explanation, specific configurations and details are set forth to provide a thorough understanding of the embodiments. However, it will also be apparent to those skilled in the art that the embodiments may be practiced without the specific details. Furthermore, well-known features may be omitted or simplified so as not to obscure the described embodiments.

[0015] 1-3 illustrate a surgical tool 10 including a proximal chassis 12, an instrument shaft 14, and a distal end effector 16 having an upper jaw 18 that can be articulated to grasp patient tissue. The proximal chassis 12 includes an input coupler 22 that can interface with and be driven by a corresponding output coupler of a telesurgical system, such as the system disclosed in U.S. Patent Application Publication No. 2014 / 0183244, incorporated herein by reference. The input coupler 22 is drivingly coupled to one or more input members disposed within the instrument shaft 14. The input members are drivingly coupled to the end effector 16. As shown in FIGS. 2 and 3, the input coupler 22 of the proximal chassis 12 can be configured to mate with various types of motor packs 13, such as a stapler-specific motor pack disclosed in U.S. Patent No. 8,912,746 or a general-purpose motor pack disclosed in U.S. Patent No. 8,529,582, both of which are incorporated herein by reference.

[0016] 4-6 show perspective, side, and top views of the distal end of surgical tool 10, including end effector 16. End effector 16 is movably connected to instrument shaft 14 by wrist assembly 24. Wrist assembly 24 has at least two degrees of freedom and provides attachment of end effector 16 to elongated instrument shaft 14 for articulation of end effector 16 about two axes orthogonal to instrument shaft 14. Wrist assembly 24 is configured to yaw rotate end effector 16 relative to instrument shaft 14 about axis 2, which is perpendicular to axis 1 along which instrument shaft 14 extends. Wrist assembly 24 is also configured to pitch rotate end effector 16 relative to instrument shaft 14 about axis 3, which is perpendicular to axes 1 and 2. As shown, yaw axis 2 is proximal (farther from end effector 16) than pitch axis 3, although this is not a requirement, and in some embodiments, yaw axis 2 is distal to pitch axis 3.

[0017] 7 and 8 are cross-sectional views showing details of the end effector 16, including the upper jaw portion 18 and the lower jaw portion 26. The lower jaw portion 26 can be configured to receive and support a removable or non-removable staple cartridge. The upper jaw portion 18 is pivotally coupled to the lower jaw portion 26 for articulation relative to the lower jaw portion 26 to clamp tissue. A beam member 28 is actuated from a proximal state shown in FIG. 7 to a distal state shown in FIG. 8 to articulate the upper jaw portion. Movement of the beam member 28 can act to forcefully secure the upper jaw portion 18 onto the tissue relative to the lower jaw portion 26. Optionally, the beam member 28 can also cut tissue and allow staples to be deployed from the cartridge into the cut tissue.

[0018] The beam member 28 includes an upper beam portion 30 configured to slide within a rail mechanism 32 of the upper jaw portion 18. The rail mechanism 32 includes a ramp 34 for engagement of the upper beam portion 30 from a proximal-most garage region 36. The open position shown in FIG. 7 can be maintained by a resilient device, such as a spring, or can be opened and closed by a secondary mechanism (not shown). Partial closure of the upper jaw portion 18 can be affected by distal movement of the upper beam portion 30 onto the ramp 34. Full closure of the upper jaw portion 18 is achieved when the upper beam portion 30 is moved distally on the rail mechanism 32 over the ramp 34. Proximal movement of the upper beam portion 30 away from the ramp 34 relieves the closure force applied to the upper jaw portion 18 by the beam member 28. The resilient device or secondary mechanism can then cause the closed or partially closed upper jaw portion 18 to open. Thus, movement of the upper beam portion 30 back and forth along the ramp 34 can toggle the end effector 16 open or closed.

[0019] Beam member 28 also includes a lower beam portion 38 configured to slide within a rail mechanism of lower jaw 18. Lower beam portion 38 can actuate a sled (such as disclosed in U.S. Patent Application Publication No. 2014 / 0183244) configured to eject staples from lower jaw 26 during distal movement of beam member 28. Alternatively, lower beam portion 38 can be integral with such a sled.

[0020] FIG. 9 shows a diagram of the beam member 28. Here, the upper beam portion 30 includes an integral cutting member 40 configured to cut tissue. However, in other embodiments, the tissue cutting device can be separate from the beam member 28 or can be mounted within the beam member 28 in a different manner. The upper beam portion 30 includes an upper flange 42 extending laterally from the integral cutting member 40. The upper flange portion 42 is configured to directly couple with the rail mechanism 32 and ramp 34. In a similar manner, a lower flange 44 is provided to slide on the rail mechanism of the lower jaw 26. An elongated actuation assembly 46 is attached to the beam member 28 to provide distal and proximal movement to the beam member 28.

[0021] 10-12 show cross-sectional views of the beam member 28 and the actuation assembly 46. The actuation assembly 46 includes a push assembly 48 and a tension assembly 50. In the illustrated embodiment, the push assembly 48 is configured as a tightly wound coil spring and is adapted to transmit a compressive force from the drive rod 52 to the beam member 28. The push assembly 48 can be externally constrained by a sheath 54, which can be constructed of any suitable material, such as a lubricious polymer material such as PTFE. The coiled design of the push assembly 48 allows the compressive force to be efficiently transmitted to the beam member 28 to push the beam member 28 distally. The push assembly 48 can be configured in any suitable manner. For example, in some embodiments, the push assembly 48 can be constructed from coiled wire. In some embodiments, the push assembly 48 is helically cut from a tube. In some cases, the compressive element (e.g., a coil) of the push assembly will separate under tension; in such cases, the push assembly may be used primarily to transmit the compressive force.

[0022] The tensioning assembly 50 can be constructed of any suitable material or element capable of resisting tensile loads (e.g., braided cable or flexible rod). In some embodiments, the tensioning assembly 50 can be held within the beam member 28 by a crimp portion 56. In some cases, the tensioning assembly 50 can be relatively ineffective at transmitting compressive forces from the drive rod 52 to the beam member 28 because it may have a tendency to collapse or buckle; therefore, in such cases, the tensioning assembly 50 can be used primarily to transmit tensile forces. The tensioning assembly 50 is adapted to transmit tensile forces applied to the beam member 28 by the drive rod 52. The drive rod 52 is disposed within the instrument shaft 14 and is drivingly coupled to one or more of the input couplers 22 shown in FIG. 1 . The tensioning assembly 50 allows tensile forces to be effectively transmitted from the drive rod 52 to the beam member 28, pulling the beam member 28 in a proximal direction. The push assembly 48 and tension assembly 50 operate in a complementary manner to provide distal and proximal movement to the beam member 28 by transmitting tension forces through the tension assembly 50 and compression forces through the push assembly 48. Transmitting tension forces through the tension assembly 50 and compression forces through the push assembly 48 allows for a very flexible and compact design of the actuation assembly 46, a characteristic that allows the actuation assembly 46 to translate within the wrist 24, which can be positioned at relatively large yaw and pitch angles during operation.

[0023] The press assembly 48 can have a cylindrical outer diameter to provide a substantially continuous outer shape and larger / stiffer wire sections for a given fixed inner and outer diameter. For example, Figures 13 and 14 show a press assembly 48a having a cylindrical outer surface 48aos. Any suitable technique can be used to manufacture the press assembly 48a, such as grinding a coil spring to form the cylindrical outer surface 48aos.

[0024] The pressure assembly 48 can include a tightly wound spring with convex / concave borders. For example, Figures 15 and 16 show a pressure assembly 48b with convex / concave borders that fit together with adjacent portions of the coil to increase distributed contact stress and improve column stability for round wire coil springs.

[0025] The pressure assembly 48 is not limited to the tightly wound coil spring design shown in FIGS. 10-16. For example, FIGS. 17-19 show flexible pressure assemblies 48c, 48d, 48e that can be formed from a solid tube by locally cutting a pattern into the solid tube near the wrist 24 to increase the bending flexibility of the pressure assembly at the wrist 24 without substantially reducing its compressive stiffness. The pressure assemblies 48c, 48d, 48e can be formed by laser cutting a pattern into a tube made from any suitable material (e.g., a suitable metal, a suitable polymer-based material). In the pressure assembly 48c shown in FIG. 17, the pattern enhances flexibility where gaps are formed in the tube while maintaining axial stiffness where material is left in place. The pressure assembly 48d shown in FIG. 18 has multiple circumferential slits arranged in a helical pattern. In the pusher assembly 48e shown in Figure 19, the pattern forms separate interlocking segments that provide flexibility while constraining relative displacement of the interlocking segments.

[0026] The press assembly 48 can be formed from any suitable configuration of discrete, abutting segments. For example, FIG. 20 shows a press assembly 48f made from a stack of flat washers. FIGS. 21 and 22 show a press assembly 48g made from a stack of annular disks. FIGS. 23 and 24 show a press assembly 48h made from a stack of conical washers. Each of the conical washers has a non-planar interfacing surface (e.g., a spherical interfacing surface) that interacts to constrain relative lateral movement of the conical washers and enhance alignment of the conical washers with the tension assembly 50, which extends through the center of the conical washers. As a result of the shape of the conical washers, the press assembly 48h accommodates bending of the press assembly 48h in any direction transverse to the local axial direction of the actuation assembly 46 via relative sliding movement between adjacent conical washers in any direction.

[0027] The press assembly 48 can be formed from a stack of any suitable non-axisymmetric interfacing segments. For example, FIG. 25 shows a press assembly 48i made from a stack of separate non-axisymmetric members 70. FIG. 26 shows different views of one of the members 70. In the illustrated embodiment, the members 70 have laterally protruding regions 72 and laterally recessed regions 74 shaped to accommodate and interface with the protruding regions 72 of adjacent members 70. The protruding and recessed regions 72, 74 are shaped to limit relative sliding between adjacent members 70 in a direction in which the regions 72, 74 extend transversely to the local extension direction of the press assembly 48i. The interfacing regions 72, 74 also serve to constrain relative twisting between adjacent members 70 about the local extension direction of the press assembly 48i, thereby constraining twisting of the press assembly 48i between its proximal and distal ends.

[0028] The actuation assembly 46 may include a stack of elongated sheet metal strips. For example, FIG. 27 shows a cross-sectional view of the actuation assembly 46j of the surgical tool of FIGS. 1-6. The actuation assembly 46j includes elongated sheet metal strips 76 configured to react to both compressive and tensile loads while accommodating flexure of the actuation assembly 46j across the plane of the sheet metal strips 76 as well as torsion of the actuation assembly 46j along its length. The actuation assembly 46j includes an outer sheath 78 having a rectangular channel 80 through which the sheet metal strips 76 extend from the proximal end of the actuation assembly 46j to the distal end of the actuation assembly 46j. The outer sheath 78 constrains the stack of sheet metal strips 76 to prevent lateral buckling of the sheet metal strips 76 when the sheet metal strips are loaded in compression during distal advancement of the beam member 28. Figure 28 illustrates twisting of the actuation assembly 46j and associated twisting of the sheet metal strip 76 that may occur in response to rotation of the end effector 16 relative to the instrument shaft 14. Figure 29 illustrates deflection of the sheet metal strip 76 near the wrist assembly 24 that may occur in response to reorientation of the end effector 16 relative to the instrument shaft 14.

[0029] Actuation assembly 46 may include a stack of elongated sheet metal bands for transferring tensile loads between drive rod 52 and beam member 28 and a stack of rectangular washers for transferring compressive loads between drive rod 52 and beam member 28. For example, FIG. 30 shows an isometric view of actuation assembly 46k including a stack of sheet metal strips 76 attached to and extending between drive rod 52 and beam member 28. In actuation assembly 46k, sheet metal strips 76 transfer tensile loads from drive rod 52 to beam member 28 during proximal retraction of beam member 28. Actuation assembly 46k further includes a stack of rectangular washers 82 that transfer compressive loads from drive rod 52 to beam member 28 during distal advancement of beam member 28. Actuation assembly 46k further includes an inner sheath 84 having a lumen that houses rectangular washers 82 and an outer sheath 86 having a lumen that houses inner sheath 84. In the illustrated embodiment, the outer sheath 86 has a series of recesses 88 near the wrist assembly 24 to increase the flexibility of the outer sheath 86 to bend across the plane of the sheet metal strip 76 in response to reorientation of the end effector 16 relative to the instrument shaft 14 via the wrist 24.

[0030] The actuation assembly 46 can include multiple flexible actuation rods. For example, FIG. 31 shows a side view of a distal portion of the actuation assembly 46m of the surgical tool of FIGS. 1-6. The actuation assembly 46m includes three flexible actuation rods 90 adapted to transmit both tension forces from the drive rod 52 to the beam member 28m and compression forces from the drive rod 52 to the beam member 28m. The three flexible actuation rods 90 are aligned in a common plane, thereby accommodating deflection of the actuation rods 90 across the common plane. The three flexible actuation rods 90 are separately routed between the drive rod 52 and the beam member 28m, thereby accommodating twisting of the actuation rods 90 that may be induced in response to rotation of the end effector 16 relative to the instrument shaft 14. FIG. 32 shows an end view of the beam member 28m of the actuation assembly 90g, showing the openings 92 in the beam member 28m through which the actuation rods 90 are coupled to the beam member 28m.

[0031] Instead of the tensioning assembly 50, the actuation assembly 46 can use an element that transfers both compressive and tensile loads from the drive rod 52 to the beam member 28. For example, FIG. 33 shows an actuation assembly 46n that includes a nitinol wire 50a instead of the tensioning assembly 50. The nitinol wire 50a transfers both compressive and tensile loads from the drive rod 52 to the beam member 28 to both advance the beam member 28 distally and retract the beam member 28 proximally. In the illustrated embodiment, the actuation assembly 46n includes a spring 48n, which may be, but need not be, a closed coil spring. The spring 48n can be configured to share with the nitinol wire 50a the transfer of compressive loads from the drive rod 52 to the beam member 28 during distal advancement of the beam member 28. The spring 48n can also be configured not to share with the nitinol wire 50a the transfer of compressive loads from the drive rod 52 to the beam member 28 during distal advancement of the beam member 28. In many embodiments, the primary function of spring 48n is to provide radial support to nitinol wire 50a so that the nitinol wire can have a diameter that matches the diameter of drive rod 52. Any suitable technique can be used to attach nitinol wire 50a to beam member 28 and drive rod 52, respectively, such as, for example, crimping, soldering, welding, etc.

[0032] In some embodiments of the actuation assembly 46, the push member 48 is disposed within a lumen of the tension member 50. For example, FIG. 34 illustrates an actuation assembly 46o that includes a push assembly 48o and a tension assembly 50o having a lumen in which the push assembly 48o is disposed. The configuration of the actuation assembly 46o differs from other embodiments described herein, in which the push assembly 48 concentrically surrounds the tension assembly 50. In the actuation assembly 46o, the tension assembly 50o has a sheath (e.g., a braided sheath) that encloses the push assembly 48o. The push assembly 48o includes multiple spherical members (e.g., ball bearings) joined by a flexible rod 66. Both the push assembly 48o and the tension assembly 50o are actuated by a drive rod 52 that is drivingly coupled to one or more of the input couplers 22 shown in FIG. 1.

[0033] 35 and 36 show perspective and cross-sectional views of the wrist assembly 24. The wrist assembly 24 includes a proximal outboard link 100, an intermediate outboard link 102, and a distal outboard link 104. These three links determine the kinematic pitch and yaw motion of the wrist assembly 24. As shown, the interface between the proximal outboard link 100 and the intermediate outboard link 102 determines the yaw motion of the wrist assembly 24. The interface between the outer distal link 104 and the intermediate outboard link 102 determines the pitch motion of the wrist assembly 24. However, in alternative wrist configurations, this relationship can be reversed (e.g., by rotating the end effector 16 90 degrees relative to the wrist assembly 24) so ​​that the wrist assembly 24 pitches between the proximal outboard link 100 and the intermediate outboard link 102 and yaws between the distal outboard link 100 and the intermediate outboard link 102.

[0034] The cable portions 106 are actuated to apply tension to the wrist assembly 24 and impart movement to the wrist assembly. In one embodiment, the cable portions 106 can be individually secured to a portion of the distal outer link 104. In a functionally equivalent alternative embodiment, as shown in FIG. 35 , the cable portions 106 are looped around a portion of the distal outer link 104 as shown. Looping the cable portions 106 around the distal outer link 104 secures the cable portions 106 to the distal outer link 104 and prevents the cable portions 106 from slipping. In either embodiment, tension is applied to the individual cable portions 106 that are to be pulled to articulate the wrist. Differential forces applied to the cable portions 106 can actuate the wrist assembly to pitch and yaw at various angles. The cable portions 106 can be drivingly coupled to one or more of the input couplers 22 shown in FIG. 1 . The wrist assembly also includes a proximal inner link 108 and a distal inner link 110, which are discussed in detail below.

[0035] Attention is now directed to FIG. 37, which illustrates an exemplary embodiment of a joint 112 representing the interface between the outer links shown in FIGS. 35 and 36B. The joint 112 includes a first link 114 and a second link 116. The first link 114 may include teeth 116, 118 and a bearing (support) projection 122. The disk 720 includes pins 124, 126, 128 and a bearing projection 130. According to an exemplary embodiment, the projections 122, 130 of the first and second links 114, 116 may include passages that allow the cable portion 106 to pass through. Because the bearing projections 122, 130 are positioned outboard relative to the central openings 134, 136, the cable portion 106 extending through the passage adjacent the bearing projections 122, 130 is also positioned outboard. This allows for routing of other features through the central openings 134, 136. The actuation kinematics between the links are determined by the shape of the pins and teeth that engage and disengage during movement. The bearing protrusions 122, 130 included curved surfaces that engage at several points throughout all angular movement to help reduce compressive strain on the pins and teeth.

[0036] The expanded range of motion provided by joint 112 allows a wrist including joint 112 to provide a desired amount of motion, such as ±90 degrees, in the pitch or yaw direction in a more efficient manner with fewer parts. In conventional wrist structures where each joint is limited to a maximum roll angle of approximately 45 degrees, several such joints in series are required for relatively large roll angles for the entire wrist mechanism. In the illustrated embodiment, a single joint can provide a maximum roll angle limit of 90 degrees. As a result, the manufacturing cost and complexity of a wrist including one or more joints 112 is reduced while still achieving the desired control over joint motion. Additionally, the multiple teeth and corresponding multiple pins included on links 114, 116 of joint 112 can provide improved timing to help precisely position links 114, 116, including, for example, returning disks to a neutral position (e.g., zero-angle roll alignment), and to increase the smoothness of movement between links 114, 116, such as when links 114, 116 are rotated relative to one another. According to an exemplary embodiment, the wrist may include multiple joints 112 to achieve a higher range of motion (up to a roll limit angle), such as a wrist with a range of motion of up to ±180 degrees in pitch or yaw. Further details of joint 112, and other joints usable with the embodiments disclosed herein, are disclosed in WO 2015 / 127250, which is incorporated herein by reference.

[0037] As shown in FIG. 36 , the proximal inner link 108 and the distal inner link 110 are spatially separated along axis 1 and offset 90 degrees from each other. Therefore, the proximal inner link 108 is only partially shown. The radial surfaces of the proximal and distal inner links 108, 110 include protrusions (e.g., configured as clevis pins 140). The clevis pins connect between recesses (e.g., configured as clevis joints 142) on the inner surfaces of the outer links. The clevis pins 140 and joints 142 set the distance between the joints of the outer links but are otherwise passive and do not change the joint kinematics of the outer links, which are determined by the tooth and pin geometry. Each side of the proximal and distal inner links 108, 110 includes a commonly aligned pair of clevis pins for each connection to the outer link, for a total of four clevis pins 140 per inner link 108, 110. Each pair of clevis pins 140 is separated to provide an internal passageway 144 for the actuation assembly 46 .

[0038] An additional inner sheath 146 can be used to further support the actuation assembly 46. The actuation assembly 46 slides axially within the inner sheath 146. The inner sheath 146 is fixed to the distal end portion of the wrist assembly 24 and is flexible enough to bend with movement of the wrist assembly 24, but does not move axially. The inner sheath 146 and inner passage 144 provided by the inner link act to guide and constrain the actuation assembly 46 during axial movement. The inner sheath 146 and inner passage 144 prevent the actuation assembly from buckling under compressive loads (i.e., distal movement during cutting and stapling). Conventional wrist designs, such as those disclosed in the aforementioned International Publication No. 2015 / 127250, rely on tensioned cables to maintain the outer links in position. This is insufficient here because the resulting compressive force can induce slack in the cables when the actuation assembly 46 moves distally. However, as the actuation assembly 46 moves distally, the clevis pins 140 on the inner links 108, 110 advantageously maintain the outer links in place, thus maintaining the structure of the wrist assembly 24.

[0039] Each inner link can have a two-piece construction, as shown in FIGS. 38-40 , which also illustrate a technique for assembling the inner links to the outer links. In FIG. 38 , the first link portion 108a and the second link portion 108b of the proximal inner link 108 are positioned to place the clevis pin 140 within the clevis joint 142 of the intermediate outer link 102. The first link portion 108a and the second link portion 108b are inserted at an angle so that the gear teeth 148 on each portion interdigitate with each other, aligning the portions into the configuration shown in FIG. 39 . The gear teeth 148 are assembly aids that eliminate the need for pins or other fasteners and are not used for movement beyond assembly. However, in some embodiments, fasteners can be used in place of the gear teeth. After the link portions 108a, 108b are assembled into the complete inner proximal link 108, the proximal outer link 100 is assembled onto the remaining exposed clevis pin 140, resulting in the configuration shown in FIG. 40 . In one embodiment, as shown in FIG. 40, the proximal outer link 100 is also a two-piece construction.

[0040] Other variations are within the spirit of the invention. Various aspects, embodiments, implementations, or features of the described embodiments may be used separately or in any combination. Various aspects of the described embodiments relating to the operation of the telesurgery tool may be implemented by software, hardware, or a combination of hardware and software. Accordingly, while the invention is susceptible to various modifications and alternative constructions, specific illustrative embodiments thereof have been shown in the drawings and described above in detail. It should be understood, however, that there is no intention to limit the invention to the particular forms disclosed, but rather, the intention is to cover all modifications, alternative constructions, and equivalents falling within the spirit and scope of the invention, as defined by the appended claims.

[0041] Use of the terms "a," "an," "the," and similar referents in the context of describing the present invention (particularly in the context of the claims below) should be construed to encompass both the singular and the plural unless otherwise indicated herein or clearly contradicted by context. The terms "comprising," "having," "including," and "containing" should be construed as open-ended terms (i.e., meaning "including, but not limited to") unless otherwise noted. The term "connected" should be construed as partially or wholly contained within, attached to, or joined together, even if there is intervening material. Recitation of ranges of values ​​herein is merely intended to serve as a shorthand method of individually referring to each separate value falling within the range, unless otherwise specified herein, and each separate value is incorporated herein as if it were individually set forth herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or clearly contradicted by context. Any and all examples provided herein, or the use of exemplary language (e.g., "such as"), are intended merely to better illuminate embodiments of the invention and do not pose a limitation on the scope of the invention unless specifically recited in the claims. No language in the specification should be construed as indicating any non-claimed element as essential to the practice of the invention.

[0042] Preferred embodiments of the present invention are described herein, including the best mode known to the inventors for carrying out the invention. Variations of these preferred embodiments will become apparent to those skilled in the art upon reading the foregoing description. The inventors expect those skilled in the art to employ such variations as they see fit, and the inventors intend to practice the invention otherwise than as specifically described herein. Accordingly, this invention includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above-described elements in all possible variations thereof is encompassed by the invention unless otherwise indicated herein or clearly contradicted by context.

[0043] The following additional note is added: (Supplementary Note 1) An end effector having an upper jaw portion and a lower jaw portion, wherein a wrist portion connects the end effector to an elongate shaft; and a beam member disposed for translation within the upper jaw portion and the lower jaw portion, the beam member having a first portion for movably coupling to the upper jaw portion and a second portion for movably coupling to the lower jaw portion; a tensioning assembly connected to the beam member and flexibly received within the wrist for applying a tensioning force to the beam member; a pressure assembly connected to the beam member and flexibly received within the wrist for applying a compressive force to the beam member; having Device. (Supplementary Note 2) The tensioning assembly includes an elongated cable. 10. The apparatus described in Appendix 1. (Supplementary Note 3) The pressing assembly has an inner lumen surrounding the elongated cable. 1. The apparatus described in Appendix 2. (Supplementary Note 4) The pressing assembly includes a tightly wound spring. 10. The apparatus described in Appendix 1. (Supplementary Note 5) The densely wound spring has a cylindrical outer surface. 10. The apparatus described in Appendix 4. (Supplementary Note 6) The tightly wound spring has a convex surface and a concave surface that are in contact with each other. 10. The apparatus described in Appendix 4. (Supplementary Note 7) The tightly wound spring includes a tube cut into a spiral shape. 10. The apparatus described in Appendix 1. (Supplementary Note 8) The pressing assembly includes a tube having a pattern of recesses. 10. The apparatus described in Appendix 1. (Supplementary Note 9) The tension assembly has a braided sheath. 10. The apparatus described in Appendix 1. (Supplementary Note 10) The pressing assembly has a plurality of pressing elements that separate under tension. 10. The apparatus described in Appendix 1. (Supplementary Note 11) The pressing assembly has a plurality of spherical members. 10. The apparatus described in Appendix 1. (Supplementary Note 12) The tension assembly defines an inner cavity that accommodates the plurality of spherical members. 12. The apparatus of claim 11. (Supplementary Note 13) The spherical members are connected by a flexible rod. 13. The apparatus of claim 12. (Supplementary Note 14) The pressing assembly includes a plurality of separate elements, the separate elements having interfaces that limit relative lateral sliding between the elements in one direction. 10. The apparatus described in Appendix 1. (Supplementary Note 15) The pressing assembly includes a plurality of separate elements, the separate elements having interfaces that prevent relative twisting between the elements. 10. The apparatus described in Appendix 1. (Supplementary Note 16) The pressing assembly includes a stack of flat washers. 10. The apparatus described in Appendix 1. (Supplementary Note 17) The pressing assembly includes a stack of annular discs. 10. The apparatus described in Appendix 1. (Supplementary Note 18) The pressing assembly includes a plurality of sheet metal bands. 10. The apparatus described in Appendix 1. (Supplementary Note 19) The pressing assembly includes a stack of rectangular washers defining a lumen through which the plurality of sheet metal bands extend. 19. The apparatus of claim 18. (Supplementary Note 20) The wrist is configured to pitch and yaw together with the tension assembly and the pressure assembly housed therein. 10. The apparatus described in Appendix 1. (Supplementary Note 21) The bending stiffness of the tension assembly and the pressure assembly is the same in pitch and yaw. 21. The apparatus of claim 20. (Supplementary Note 22) An end effector having an upper jaw portion and a lower jaw portion, wherein a wrist portion connects the end effector to an elongate shaft; and a beam member disposed for translation within the upper jaw portion and the lower jaw portion, the beam member having a first portion for movably coupling to the upper jaw portion and a second portion for movably coupling to the lower jaw portion; an actuation assembly having a pressing assembly that transfers a compressive force to the beam member and a tensioning assembly that transfers a tensile force to the beam member; having Surgical equipment. (Supplementary Note 23) The tensioning assembly includes an elongated cable. 23. The surgical apparatus of claim 22. (Supplementary Note 24) The pressing assembly has an inner lumen surrounding the elongated cable. 24. The surgical apparatus of claim 23. (Supplementary Note 25) The elongated cable has a braided lumen. 24. The surgical apparatus of claim 23. (Supplementary Note 26) The pressing assembly includes a tightly wound spring. 23. The surgical apparatus of claim 22. (Supplementary Note 27) The densely wound spring has a cylindrical outer surface. 27. The surgical device of claim 26. (Supplementary Note 28) The tightly wound spring has a convex surface and a concave surface that are in contact with each other. 27. The surgical device of claim 26. (Supplementary Note 29) The densely wound spring includes a tube cut into a spiral shape. 27. The surgical device of claim 26. (Supplementary Note 30) The pressing assembly includes a tube having a pattern of recesses. 23. The surgical apparatus of claim 22. (Supplementary Note 31) The pressing assembly has a plurality of pressing elements that separate under tension. 23. The surgical apparatus of claim 22. (Supplementary Note 32) The pressing assembly has a plurality of spherical members. 32. The surgical device of claim 31. (Supplementary Note 33) The tension assembly defines an inner cavity that accommodates the spherical member. 33. The surgical device of claim 32. (Supplementary Note 34) The spherical members are connected by a flexible rod. 34. The surgical device of claim 33. (Supplementary Note 35) The pressing assembly includes a plurality of separate elements having interfaces that limit relative lateral sliding between the elements in one direction. 23. The surgical apparatus of claim 22. (Supplementary Note 36) The pressing assembly includes a plurality of separate elements, the separate elements having interfaces that prevent relative twisting between the elements. 23. The surgical apparatus of claim 22. (Supplementary Note 37) The pressing assembly includes a stack of flat washers. 23. The surgical apparatus of claim 22. (Supplementary Note 38) The pressing assembly includes a stack of annular discs. 23. The surgical apparatus of claim 22. (Supplementary Note 39) The tension assembly includes a plurality of sheet metal bands. 23. The surgical apparatus of claim 22. (Supplementary Note 40) The pressing assembly includes a stack of rectangular washers defining a lumen through which the plurality of sheet metal bands extend. 39. The surgical apparatus of claim 39. (Supplementary Note 41) The pressing assembly has a one-dimensional array of flexible rods; the tensioning assembly includes a one-dimensional array of the flexible rods; the one-dimensional array of flexible rods transmitting the tensile force to the beam member; the one-dimensional array of flexible rods transmits the compressive force to the beam member; 23. The surgical apparatus of claim 22. (Supplementary Note 42) The pressing assembly includes a nickel-titanium rod; the tension assembly includes the nickel-titanium rod; the nickel-titanium rods transmit the tensile force to the beam members; the nickel-titanium rods transmit the compressive force to the beam members; 23. The surgical apparatus of claim 22.

Claims

[Claim 1] an end effector having an upper jaw portion and a lower jaw portion, a wrist portion connecting the end effector to an elongate shaft; a beam member disposed for translation within the upper jaw portion and the lower jaw portion, the beam member having a first portion for movably coupling to the upper jaw portion and a second portion for movably coupling to the lower jaw portion; a tensioning assembly connected to the beam member and flexibly housed within the wrist for applying a tensioning force to the beam member; a pressure assembly connected to the beam member and flexibly received within the wrist for applying a compressive force to the beam member; having Device.

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