Robotic surgical instrument holders and their usage

Abstract

A robotic surgical instrument holder interchangeably holds both conventional surgical instruments and surgical instruments specifically designed for the holder. The instrument holder will typically hold conventional instruments but will not drive them, while it will both hold and drive instruments specifically designed for the instrument holder. The instrument holder is detachably mounted on the distal end of a surgical robotic arm and has openings that detachably receive individual surgical instruments of either type. A drive train within the housing has one input driven by the surgical robotic arm and separate outputs for both the instrument gripper and the instrument drive unit.

Description

Technical Field

[0001] (Cross - Reference to Related Applications) This application claims the benefit of U.S. Provisional Application No. 63 / 524911, filed Jul. 4, 2023, which is incorporated herein by reference.

[0002] The disclosed technology generally relates to medical devices and methods of using them. More specifically, the technology relates to surgical robots and instrument holders designed to hold different types of surgical instruments.

Background Art

[0003] A variety of powered and non - powered surgical instruments are used when performing robotic surgery. Many surgical instruments used in robotic procedures are similar to or the same as those manually used by surgeons in conventional surgical procedures. Such conventional surgical instruments may be powered or non - powered and can be held directly or indirectly by a gripper or other instrument holder mounted on a robotic surgical arm. For example, as described in co - owned PCT Application No. PCT / IB2023 / 055047 (published as WO2023 / 223215) and U.S. Patent Application No. 18 / 631921, the shaft of a conventional (“off - the - shelf”) instrument may be directly gripped by a gripper, or the instrument shaft may be inserted through a tubular cannula held by the gripper. In both cases, the gripper operated by the robot is used primarily, if not solely, to position the instrument relative to the patient, and the instrument is manually operated by the surgeon in much the same way as they would be in a non - robotic surgical procedure.

[0004] In contrast, other surgical robotic systems both hold and operate surgical instruments designed to interface with specific instrument holders. Such instrument holders may have both mounting and driving features, and the instruments may be both positioned and operated by the associated surgical robotic controller.

[0005] Because instrument holding interfaces for each type of instrument are typically very different, many robotic surgeries are limited to using instruments that are either (a) designed for robotic use but specific to the particular robot being used, or (b) non-specific but not optimized for robotic use. In many cases, it may be desirable to employ a combination of both specialized (dedicated) robotic instruments and general (non-dedicated) ones, but this is often difficult or impossible with currently available surgical robotic systems.

[0006] For example, some spinal surgical procedures require a range of instruments with different purposes and varying power and speed requirements. Some applications require high speed and low torque (e.g., drilling), while others require low speed and high torque (e.g., screw insertion). Still others require reciprocating motion, such as sawing.

[0007] Furthermore, within certain categories of instruments, several specific instruments with different sizes, power levels, and other characteristics will often be required. Given the high complexity and cost of conventional surgical power instruments, supplying a full range of conventional instruments that offer surgeons a complete selection of size, power, and other characteristics is expensive.

[0008] Therefore, there is a significant need for robotic surgical systems that can be used in conjunction with conventional commercially available surgical instruments and specialized, dedicated instruments with unique instrument-robot interfaces. In particular, it would be desirable to provide instrument holders for use with robotic surgical systems that can interface with a wide variety of surgical instruments, wherein the wide variety of surgical instruments includes (a) surgical instruments designed to be held, powered, and controlled by the instrument holder and robotic surgical system, and (b) commercially available surgical instruments that are primarily intended for manual use or, for any reason, only require to be held and oriented in the surgical space. It would also be desirable to provide surgical robot systems intended for use with surgical instruments that have only mechanical elements that can be sterilized for reuse. At least some of these objectives will be achieved by the technologies disclosed herein.

[0009] Prior art documents Robotic surgical instrument holders and interfaces are described in U.S. Patents 11,832,905, 11,751,954, 10,765,486, 10,813,713, 8,479,969, and 8,142,447. Gripping devices for holding extendable surgical instruments and cannulas are described in the jointly owned PCT application PCT / IB2023 / 055047 (published as WO2023 / 223215) and U.S. Patent Application 18 / 631921 (the full disclosure thereof is incorporated herein by reference). Other jointly owned published documents and applications describing surgical robots and instruments are PCT application PCT / IB2022 / 052297 (published as WO2022 / 195460), PCT application PCT / IB2022 / 058986 (published as WO2023 / 067415), and PCT application PCT / IB2022 / 058972 (published as WO2023 / 1189 (Published as No. 84), PCT application No. PCT / IB2022 / 058982 (Published as No. WO2023 / 118985), PCT application No. PCT / IB2022 / 058978 (Published as No. WO2023 / 144602), PCT application No. PCT / IB2022 / 058980 (Published as No. WO2023 / 152561), PCT application No. PCT / IB202 Application No. 2 / 058988 (published as WO2023 / 237922), PCT application No. PCT / IB2023 / 055439 (published as WO2024 / 089473), PCT application No. PCT / IB2023 / 055662, PCT / EP2024 / 052338, PCT / IB2023 / 055663, PCT / EP2024 / 052338, PCT Including U.S. Provisional Applications No. 63 / 532,753, 63 / 568,102, 63 / 578,395, 63 / 606,001, 63 / 609,490, 63 / 615,076, and 63 / 634161 (the full disclosures of each thereof are incorporated herein by reference). [Prior art documents] [Patent Documents]

[0010] [Patent Document 1] U.S. Patent No. 11,832,905 [Patent Document 2] U.S. Patent No. 11,751,954 [Overview of the Initiative] [Means for solving the problem]

[0011] In a first aspect, the disclosed technology provides a robotic surgical instrument holder configured to (a) hold a first type of surgical instrument but not drive a first type of surgical instrument, and (b) hold and drive a second type of surgical instrument. The robotic surgical instrument holder comprises a housing configured to be removablely mounted on the distal end of a surgical robot arm, and having at least one instrument receiving opening, the at least one instrument receiving opening configured to removely receive individual surgical instruments of either the first or second type through it. A drive chain within the housing includes an input drive member configured to be coupled to an output drive member on the surgical robot arm when the housing is mounted on the distal end of the surgical robot arm. An instrument gripping mechanism controllably coupled to the drive chain is configured to selectively grip and release the outer surface of a first type surgical instrument when the surgical instrument is positioned in a central passage. An instrument drive mechanism controllably coupled to a drive chain includes an output drive element configured to mechanically engage with an input drive element on a second type of surgical instrument when the second type of surgical instrument is positioned in a central passage or otherwise attached to an instrument holder.

[0012] In many cases, it would be preferable to stabilize the driven instrument within the central passage, but such positioning is not necessary, and in some cases, the driven instrument may have one or more movable elements that protrude from the instrument housing into the surgical space without passing through the central passage of the instrument holder.

[0013] In some cases, the drive train comprises a mechanical array of gears and shafts configured to selectively transmit rotational motion and torque from the output drive member of the surgical robot arm to the instrument gripping mechanism and the instrument drive mechanism, one at a time. In such cases, the robotic surgical instrument holder may further include a selector mechanism configured to selectively couple the drive train to either the instrument gripping mechanism or the instrument drive mechanism. In other such cases, the drive train may be configured to automatically couple to either the instrument gripping mechanism or the instrument drive mechanism.

[0014] In some cases, the instrument receiving opening may be a cylindrical opening. In some cases, the instrument gripping mechanism may comprise at least one pair of opposing bodies, each having a cylindrical peripheral surface with a circumferentially oriented tapered groove formed therein. The tapered groove is similarly shaped and has a partially circular cross-section with a radius decreasing from the beginning to the end of the groove, and the opposing bodies are configured to rotate about their respective axes and to orient the tapered groove to form a gripping surface with a substantially continuous circular periphery having (1) a diameter dependent on the rotational position of the opposing body and (2) a center that remains fixed relative to the gripping mechanism regardless of the rotational position of the opposing body. In such cases, the opposing bodies of the instrument gripping mechanism may be configured to rotate in the opposite direction, for example, comprising a shaft having a distal end connected to the instrument gripping mechanism and a proximal end driven by a drive column to rotate the shaft so as to rotate the opposing bodies in the opposite direction. In a specific example, the drive train includes a vertical shaft, which has bevel gears that drive gear wheels connected to each of the opposing bodies.

[0015] In some cases, the robotic surgical instrument holder further comprises a pair of jaws pivotably mounted to a housing, each jaw supporting one of the opposing bodies of each pair. For example, the jaws may be configured to move tapered grooves on the opposing bodies closer together and further apart to facilitate the positioning of instruments between them, and the robotic surgical instrument holder may further comprise a lever assembly, which is coupled to a shaft and configured to transmit the axial translation of the shaft to open and close the jaws.

[0016] In some cases, the opposing body is configured to control the amount of friction applied to the device held by the opposing body, depending on the degree of rotation of the opposing body.

[0017] In some cases, the output drive element of the instrument drive mechanism may be rotatably driven by a drive train and, when the intervention component of the second type of surgical instrument is positioned within the instrument receiving opening, engage with an input drive element on the second type of surgical instrument, thereby rotationally driving the input drive element. For example, the input drive element and the intervention component may be separate, and the housing may have a separate opening for coupling the input drive element to the drive train.

[0018] In a second aspect, the disclosed technology provides a robotic surgical system comprising a robotic surgical instrument holder as described above in combination with at least one (often multiple) second-type surgical instruments.

[0019] In a third aspect, the disclosed technology provides a method for performing a robotic surgical procedure using at least one of a first type of surgical instrument and a second type of surgical instrument. The method provides an instrument holder mounted on the distal end of a surgical robot arm, the instrument holder comprising both (a) an instrument gripping mechanism configured to selectively grip and release the outer surface of a first type of surgical instrument, and (b) an instrument drive mechanism having an output drive element configured to mechanically engage with an input drive element on a second type of surgical instrument. A surgical instrument to be held by the instrument holder is selected. If the selected surgical instrument is of the first type, the selected surgical instrument will be removably gripped within the gripping mechanism of the instrument holder. Conversely, if the selected surgical instrument is of the second type, the selected surgical instrument will be coupled to the instrument drive mechanism of the instrument holder such that the input drive element of the selected surgical instrument is coupled to the output drive element of the instrument drive mechanism.

[0020] In some cases, the instrument holder may include a drive train, the drive train comprising an input drive member coupled to an output drive member on a surgical robot arm, and an output drive member configured to be selectively coupled to either an instrument gripping mechanism or an instrument drive mechanism. In such cases, the method may further include (a) configuring the drive train to couple the output drive member to the instrument gripping mechanism and to uncouple the output drive member from the instrument drive mechanism, and (b) coupling a first type of surgical instrument to the instrument gripping mechanism.

[0021] In some cases, such configuration may be performed manually using a mechanical selector coupled to the drive column. Alternatively, such configuration may be performed automatically.

[0022] In some instances, the disclosed method may further include (a) configuring a drive train to couple an output drive member to an instrument drive mechanism and decouple the output drive member from the instrument gripper mechanism, and (b) coupling a second type of surgical instrument to the instrument drive mechanism. For example, such configuring may be performed manually using a mechanical selector coupled to the drive train. Alternatively, such configuring may be performed automatically.

[0023] In some instances, the first type of surgical instrument does not require an external power supply. For example, the first type of surgical instrument may be any one of a cannula, a self-powered drill, a self-powered screw driver, and a self-powered saw that does not require mechanical power from a surgical robot.

[0024] In some instances, the second type of surgical instrument may include any one of a drill, a screw driver, and a saw that requires mechanical power from a surgical robot.

[0025] In some instances, performing a robotic surgical procedure may include exchanging at least one instrument of the first type and at least one instrument of the second type within the instrument holder during the procedure or vice versa. BRIEF DESCRIPTION OF THE DRAWINGS

[0026] The novel features of the present disclosure are set forth in detail in the appended claims. A more complete understanding of the features and advantages of the present disclosure will be obtained by reference to the following detailed description that sets forth illustrative embodiments in which the principles of the present disclosure are utilized, and the accompanying drawings.

[0027] [Figure 1] FIG. 1 is a perspective view of a surgical robot having first and second surgical robot arms carrying an instrument holder of the disclosed technology and a third surgical robot arm carrying a navigation camera, according to some embodiments.

[0028] [Figure 2] Figure 2 is a perspective view of an instrument holder of the disclosed technology, which, according to several embodiments, is compatible with surgical instruments that are held by the instrument holder but are not intended to be driven.

[0029] [Figure 3] Figure 3 is a perspective view of an instrument holder of the disclosed technology, in several embodiments, which is compatible with surgical instruments intended to be held and driven by the instrument holder.

[0030] [Figure 4] Figure 4 is a segregated diagram of a gear drive train configured to selectively drive both the gripper mechanism and the instrument drive mechanism within the instrument holder of the disclosed technology, according to several embodiments.

[0031] [Figure 5] Figure 5 is a cross-sectional view of an instrument holder of the disclosed technology incorporating the gear drive train of Figure 4, according to several embodiments.

[0032] [Figure 6] Figures 6A and 6B illustrate a first alternative drive train according to the disclosed technology, in several embodiments.

[0033] [Figure 7] Figures 7A, 7B, and 7C illustrate a second alternative drive train according to the disclosed technology, in several embodiments.

[0034] [Figure 8] Figure 8 is a schematic cross-sectional view of a surgical instrument, configured to be held and driven by an instrument holder of the disclosed technology in a high-speed rotational state with low torque, according to several embodiments.

[0035] [Figure 9]Figure 9 is a schematic cross-sectional view of a surgical instrument, configured to be held and driven in a rotating state by an instrument holder of the disclosed technology, in a low-speed state with torque, according to several embodiments.

[0036] [Figure 10] Figure 10 is a schematic cross-sectional view of a surgical instrument, configured to be held and driven in a reciprocating motion by an instrument holder of the disclosed technology, for use in conjunction with a surgical saw, according to several embodiments.

[0037] [Figure 11] Figure 11 illustrates, in several embodiments, how two instrument holders of the disclosed technology may be used together to coordinate the operation of separate instruments in a robotic surgical procedure of the disclosed technology.

[0038] [Figure 12] Figure 12 is a detailed view showing the combination of the two devices of Figure 11 in several embodiments. [Modes for carrying out the invention]

[0039] Detailed explanation Unless otherwise defined, all technical terms used herein have the same meaning as those generally understood by those skilled in the art to which this disclosure pertains.

[0040] As used herein, the singular forms “a,” “an,” and “the” include plural nouns unless the context explicitly indicates otherwise. Any reference to “or” herein is intended to include “and / or” unless otherwise stated.

[0041] As used herein, the term "about" refers to a quantity that is, in some cases, approximately the amount stated.

[0042] As used herein, the term “about” refers to an amount that is 10%, 5%, or 1% close to the stated amount, including any increments within it.

[0043] As used herein, the term “about” in reference to a percentage means an amount that is 10%, 5%, or 1% greater or less than the stated percentage, including any increments within it.

[0044] As used herein, the phrases “at least one,” “one or more,” and “and / or” are non-restrictive expressions that are both conjunctive and disjunctive in their operation. For example, the expressions "at least one of A, B and C", "at least one of A, B, or C", "one or more of A, B, and C", "one or more of A, B, or C", and "A, B, and / or C" all mean "A alone, B alone, C alone, A and B together, A and C together, B and C together, or A, B and C together".

[0045] An exemplary robotic surgical system 10, according to several embodiments, in particular intended for use in the methods of the disclosed technology, is shown in Figure 1. The robotic surgical system 10 may comprise a chassis 12, which is typically a single rigid frame, and the chassis 12 provides a base, i.e., a platform, for three robotic arms 20, 22, and 24, which are mounted relatively far apart on opposing longitudinal ends 14 and 16 of the upper surface 18 of the chassis 12, typically about 1 meter apart, thus enabling desirable attributes such as reachability, maneuverability, and the ability to apply significant force. In the illustrated embodiment, the robotic surgical arms 20 and 22 are on the first end 14 of the chassis 12, and the robotic surgical arm 22 is on the second end 16 of the chassis. The chassis may be movable, for example, in the form of a movable cart, as described in the jointly owned PCT application PCT / IB2022 / 052297 (published as WO2022 / 195460) (incorporated herein by reference). In other embodiments and implementations, the surgical arms 20, 22, and 24 may be mounted on the base of a surgical table or other structure. Mounting the robotic surgical arms on a common, stable platform allows the arms to be moved kinematically or otherwise within a common robotic coordinate system under the control of a surgical robot controller, typically a mounted controller having a user interface such as a display screen 32.

[0046] A single rigid chassis of the disclosed technology would typically comprise, consist of, or essentially consist of, a single mobile cart, such as disclosed in, for example, the jointly owned PCT application PCT / IB2022 / 052297 (published as WO2022 / 195460) (the full disclosure thereof is incorporated herein by reference). However, in other cases, the single rigid chassis may comprise separate modules, platforms, or components assembled on or near a surgical table, such as described in, for example, the jointly owned PCT application PCT / EP2024 / 052353, filed on 29 January 2024 and titled "Integrated Multi-Arm Mobile Surgical Robotic System" (the full disclosure thereof is incorporated herein by reference). The sole requirement of a single rigid chassis is that it provides a stable base for all surgical arms so that they can be accurately and precisely kinematically positioned and tracked within a single surgical robot coordinate space by the surgical robot controller.

[0047] The chassis 12 of the robotic surgical system 10 can be temporarily placed under a surgical table (not shown) when performing robotic surgical procedures, and can be configured to allow the robotic surgical system 10 to be stored remotely before and after the procedure. The robotic arms 20, 22, and 24 may be optionally retracted into the chassis 12 of the robotic surgical system, allowing the system to move in and out of the surgical field in a compact configuration.

[0048] A first robotic surgical arm 28 may have a flange 26 mounted on its distal end, and a second robotic surgical arm 28 may have a flange 28 mounted on its distal end. The flange 26 may hold an instrument holder 100a, and the flange 28 may hold an instrument holder 100b, which may in turn hold surgical instruments for use in a particular robotic surgical procedure being performed. The flanges 26 and 28 may contain all electronic and other sensitive system components that cannot be sterilized under harsh conditions, for example, under conditions using heat (pressure sterilization) or radiation. The instrument holder 100, in contrast, may contain only robust mechanical components that can be sterilized and reused in a conventional manner. By providing a surgical drape or other isolation barrier between the instrument holder 100 and the flange 26 or 28, the flanges can be used in a non-sterile environment and reused without requiring sufficient sterilization.

[0049] The first robotic arm 20 can hold the first instrument holder 100a, and the second robotic arm 22 can hold the second instrument holder 100b, which is typically not necessarily the same as the first instrument holder. For the sake of simplicity in this discussion, the instrument holders do not need to be identical, but a single instrument holder design will be described later and referred to by reference number 100.

[0050] The structure and use of the instrument holder 100 are central aspects of the disclosed technology, and the instrument holder is particularly suitable for use with the aforementioned movable and other surgical carts, but the disclosed instrument holder is suitable for use with most or all surgical robots, including at least one surgical arm, the at least one surgical arm for manipulating the instrument holder and the instruments held by the instrument holder in robotic surgical procedures.

[0051] Referring here to Figure 2, the surgical instrument holder 100 comprises a housing 102 having a base 103 and an input drive member 104 on the base, according to several embodiments. The base 103 can be configured to be removable to an interface such as a flange 26 or 28 at the distal end of a robotic surgical arm 20 or 22, as shown in Figure 1. The input drive member 104 can be configured to be coupled to an output drive member 112 (Figure 4) located on the flange when the instrument holder is mounted on the robotic surgical arm. The output drive member 112 can be powered, driven, and controlled by the surgical robot, but is not typically driven by a motor mounted within the flange. A mechanical drive train 160 can be located within the housing 102, as will be described in more detail with reference to Figures 4 and 5, and can be configured to selectively drive both the gripping mechanism and the instrument drive mechanism. An instrument type selector 114 can be located on the outside of the housing.

[0052] Typically, an instrument receiving opening 106 can be formed within the upper surface of the instrument holder 100 and near its distal end, the instrument receiving opening 106 having a gap 108 along one side thereof, and a separate instrument drive port 110 is also formed on the upper surface of the instrument holder and can typically be positioned a short distance proximal to the instrument receiving opening 108. The instrument receiving opening 106 can be configured to receive both robot-controlled (active) surgical instruments and physician-controlled (passive) surgical instruments.

[0053] The surgical instrument holders disclosed herein can be used to hold and manipulate two types or classes of surgical instruments, including (a) OTS, i.e., “off-the-shelf” surgical instruments, such as those having handles, motors, batteries, and equivalents, which are suitable for use in non-robot procedures and typically allow the surgical instruments to be used without mechanical power or electricity from a surgical robot or other external source, and (b) dedicated and other robotic surgical instruments that interface with a surgical robot and are specifically designed to be mechanically driven by a surgical robot.

[0054] As shown in Figure 2, the surgical instrument holder 100 can be used in conjunction with an OTS, i.e., an "off-the-shelf" surgical instrument 120, such as a handheld polisher, which can be directly installed in the instrument receiving opening 106 of the surgical instrument holder 100. In such cases, an internal gripping mechanism (described below with reference to Figures 4 and 5) may be operated to grip the outer surface of an instrument component, such as a cylindrical shaft 122. The initial position of the polisher tip 124 or other active component of the OTS surgical instrument can be kinematically aligned with robotic surgical coordinates using conventional techniques, as shown in Figure 1, and the subsequent position of the tip 124 can be kinematically tracked based on the controlled movement of the supporting robotic surgical arm 26. The surgical instrument 120 can also be optically tracked using a camera 30 or other sensor-based tracker. The positioning of the OTS instrument 120 can be controlled by or through the controller 32 of the robotic surgical system 100, but the instrument's handle 126 can remain accessible for direct manual use by the surgeon.

[0055] In other cases, the cannula 130 may be introduced directly into the instrument receiving opening 106 of the surgical instrument holder 100 and may typically be used to provide a guide for introducing and changing multiple active OTS surgical instruments. As shown by the dashed path in Figure 2, for example, the OTS polisher 120 may be introduced through the cannula 130 rather than being installed directly into the gripping mechanism of the instrument holder 100. In both cases, the selector switch 114 is turned to the "driven tool" setting (D) to properly connect the drive train 160.

[0056] Referring here to Figure 3, the robotic surgical instrument holder 100 can also be used to hold and drive a surgical instrument 140 of a type that includes both an input drive element 142 and an instrument shaft 144, according to several embodiments. Such a “driven” surgical instrument 140 can be constructed to selectively mesh with a drive column 160 within the instrument holder 100, as described with reference to Figures 4 and 5. In the illustrated embodiment, the instrument shaft 144 can be inserted through the instrument receiving opening 106 while the input drive element 142 is simultaneously inserted into the instrument drive port 110. The selector switch 114 can be turned to the “driven tool” setting (D) to properly connect the drive column 160.

[0057] Referring here to Figures 4 and 5, the mechanical drive train 160 comprises an assembly of gears and shafts that transmit rotational torque from an output transmission member 112 on a flange 26 or 28 to an input drive member 104 of the fixture holder 100, according to several embodiments. The drive train 160 can be located within the fixture holder housing 102, but for simplified representation, it is shown in isolation. The input drive member 104 may comprise a main drive shaft 162, on which a gripper drive gear 164 and a fixture drive gear 166 may be located. The main drive shaft 162 is advanced and retracted by a fixture type selector 114, as will be described in more detail below, to operate either the gripper function or the fixture drive function of the fixture holder.

[0058] As shown by the solid lines in Figure 4, in order to operate the gripper function of the instrument holder, the main drive shaft 162 can be advanced such that the gripper drive gear 164 engages with the bevel drive gear on the vertical drive shaft 172, which has upper and lower worm gears 174 (best seen in Figure 5), and the upper and lower worm gears 174 engage with worm gears 176 and 178, driving the worm gears 176 and 178 to rotate the opposing bodies 180 and 182. The rotation of the opposing body pairs 180 and 182 allows for adjustment of the diameter of the openings formed by the tapered grooves 184 and 186 to accommodate surgical instruments having shafts or other components of different sizes, as described in detail in the jointly owned PCT application PCT / IB2023 / 055047 (published as WO2023 / 223215) and U.S. Patent Application 18 / 631921 (the full disclosure thereof is incorporated herein by reference).

[0059] To perform the instrument driving function of the instrument holder 100, the selector switch is changed to its D position, as shown in Figure 3, to retract the main drive shaft 162 (moving it to the left in Figures 4 and 5), which can do both (a) disengage the gripper drive gear 164 from the bevel drive gear 170, as shown by the solid line in Figure 4, and (b) engage the instrument drive gear 166 with the drive shaft gear, with the output drive shaft 192 exposing the output coupling member 194 through the instrument drive port 110 (Figure 3). Thus, the input drive element 142 can be connected to the output coupling member 194 when the driven surgical instrument is mounted on the instrument holder housing, as shown in Figure 3. The output drive member 112 may be driven by a motor (not shown) located within a non-sterile flange 26 or 28, typically a stepper motor.

[0060] Referring now to Figure 5, some components of the drive train 160 in several embodiments are shown within a cross-section of the tool holder housing 102. Worm gears 176 and 178 are removed from the figure to expose the worm gear 174 that drives the vertical drive shaft 172 to rotate the pairs of opposing bodies 180 and 182, with only one of each pair of opposing bodies visible. Also, the gripper drive gear 164 is shown directly below the bevel drive gear 170 in Figure 5, in contrast to Figure 4 where the gripper drive gear is shown above the bevel drive gear.

[0061] Specific instrument gripping mechanisms are described, but as used herein and in the claims, the terms “gripper” and “tool gripper” refer to any mechanical closing device having a variable opening for gripping an instrument or other surgical object to be held and manipulated by the instrument gripper. A gripper comprising rotatable oppositions can be positioned or adjusted in a certain way to open and close around an instrument or other object positioned between them. The oppositions can be rotatable (configured to rotate around their respective axes) so as to orient tapered grooves 184 and 186 on their outer surfaces, forming a gripping surface with a substantially continuous circular periphery with (1) a diameter dependent on the rotational position of the oppositions and (2) a center that remains fixed to the gripper mechanism regardless of the rotational position of the oppositions.

[0062] Several embodiments of the first alternative drive train assembly 200 are illustrated in Figures 6A and 6B. Similar to the arrangement shown in Figures 4 and 5, the drive train 200 can be configured to drive a gripper unless a separate driven instrument is mounted on the instrument holder. The main drive shaft 202 can be rotated in the direction of the arrow by a motor in the flange, as described above. The umbrella instrument drive gear 204 can be fixed to rotate with the main drive shaft 202, but no meshing gears are provided in the drive train, as in the case of the instrument holder 100 described above. The umbrella gripper drive gear 206 can also be fixed to rotate with the main drive shaft 202, but the umbrella gripper drive gear 206 can be located at the distal end of the shaft, in which case the umbrella gripper drive gear 206 meshes with the umbrella gripper driven gear 208 that drives the vertical gripper drive shaft 210. The remainder of the gripper drive array may be the same as those described above.

[0063] When the driven device is mounted on the device holder including the drive train 200, the device drive shaft 212 can enter the device holder housing. The device drive shaft 212 can carry the umbrella-shaped device drive gear 214, which, upon introduction, disengages from alignment with the umbrella-shaped device drive gear 204 on the drive shaft 202. The drive shaft 202 can be spring-mounted so that when the umbrella edges of the drive gears 204 and 214 come into contact, the drive shaft 212 can be moved to the left as shown by the dashed line in Figure 6B. Such engagement can also disengage the gripper drive gear 206 from the gripper driven gear 208, as shown by the dashed line. Attaching the instrument, which carries the instrument drive shaft 212 and instrument drive gear 214, to the instrument holder automatically disengages the gripper drive portion of the drive train 200, thus enabling the use of the driven instrument without requiring the user to manually or otherwise disengage the gripper from the drive train 200 within the instrument holder. Similarly, when the driven instrument is removed from the instrument holder, the gripper drive gear 206 can be re-engaged to the gripper driven gear 208 under the spring force of the spring mounted on the main drive shaft 202 (the spring is not shown for the sake of simplicity in the figure).

[0064] Referring here to Figures 7A-7C, a second alternative drive train assembly 220, according to several embodiments, will be described. The drive train 220 may comprise a main drive shaft 222 bearing a bevel main drive gear 224 at its distal end. The bevel main drive gear 224 can engage with a lower bevel gear 230, which is located on the lower portion of a rotary drive structure 228, which also has an upper tool drive gear 232 at its upper end. The rotary drive structure 228 may be formed as a spindle, with all parts rotating freely together. The main drive gear 224 may be mounted such that it is always engaged with the lower bevel gear 230, and therefore the rotary drive structure 228 will always rotate when the main drive shaft 222 is rotated.

[0065] The drive train 220 may further include a vertical shaft 226 extending upward through the open interior of the rotary drive structure 228. However, as shown in Figures 7A and 7B, the vertical drive shaft 226 does not have to be coupled to the rotary drive structure 228 so that the vertical shaft will not rotate when the rotary drive structure is rotated. The configurations in Figures 7A and 7B are intended to drive the instrument shaft 238 and the instrument driven-side gear 240 of the driven instrument, as indicated by the arrows in Figure 7B.

[0066] To drive the gripper mechanism of the instrument holder, the coupling sleeve 236 can be raised to enter the interior of the rotary drive structure 228, as shown in Figure 7C. The coupling sleeve 236 can be configured to frictionally engage both the internal surface of the rotary drive structure 228 and the external surface of the vertical drive shaft 226, so that the rotation of the rotary drive structure 228 is transmitted to the vertical drive shaft 226, which carries a gripper drive gear at its upper end. The remainder of the gripper drive unit can be analogous to the structure described in PCT application PCT / IB2023 / 055047 (published as WO2023 / 223215) and U.S. application 18 / 631921 (the full disclosure thereof is incorporated herein by reference). The upper drive gear 232 will still rotate, but the driven gear 240 of the driven device can be removed, and therefore the gear rotation is not important. The coupling sleeve 236 can be raised and lowered in various ways, for example, using a manual linkage, spring, solenoid, and equivalent.

[0067] Referring here to Figures 8-10, several embodiments of a “driven” surgical instrument 140 are illustrated, for example, those designed to be driven by a drive shaft gear 190 and an output drive shaft 192 of an instrument holder 100. Different driven surgical instruments 140 can take various forms, but will typically share a common external design and the same interface dimensions so that they can be interchangeably mounted on an instrument holder of the disclosed technology and mechanically coupled. For example, as shown in Figure 6, a surgical polisher 250 comprises a housing 252, the housing 252 having an interior 254 that holds a drive train 256. The drive train 256 mechanically connects an input drive element 142 and an instrument shaft 144, as described in Figure 3. The drive train 256 comprises a drive gear 258 attached to the drive element 142, an idler gear 260, and a driven gear 262 attached to a rotary drive rod 264. By appropriately selecting the relative diameters of gears 258, 260, and 262, the rotational speed of the input drive element 142 can be doubled, and high-speed (e.g., each having a smaller diameter than the gear immediately preceding it in the chain) low-torque rotation of the rotating rod 264 can be achieved. This is suitable for polishing using the illustrated grinder 266, as well as in several applications including drilling, sawing with a rotating blade, polishing, and the equivalent.

[0068] As shown in Figure 9, the surgical screw drive unit 300 comprises, according to several embodiments, a housing 302, the housing 302 having an interior 304 that holds a drive train 306. The drive train 306 mechanically connects the input drive element 142 and the instrument shaft 144, as described in Figure 3. The drive train 306 comprises a drive gear 308 mounted on the drive element 142, an idler gear 310, and a driven gear 312 mounted on the rotary drive rod 314. By appropriately selecting the relative diameters of the gears 308, 310, and 312 (for example, each having a larger diameter than the gear immediately preceding it in the chain), the rotational speed of the input drive element 142 can be reduced to achieve low-speed, high-torque rotation of the rotary rod 314. This is suitable for screwing into pedicle screws and other surgical screws using the illustrated screw drive unit tip 316, as well as in other low-speed, high-torque applications.

[0069] As shown in Figure 10, in some embodiments, the surgical saw 400 comprises a housing 402, the housing 402 having an interior 404 that holds a drive train 406. The drive train 406 can mechanically connect an input drive element 142 to an instrument shaft 144, as described in Figure 3. The drive train 406 may comprise an umbrella drive gear 408, an umbrella driven gear 410, and a rotating disk 412, all mounted on the drive element 142. The input drive element 142 can rotate on a vertical axis (as visible in Figure 8), and the umbrella gears 408 and 410 can cooperate to rotate a connecting shaft 413 on a horizontal axis. The connecting shaft 413, in turn, can rotate the rotating disk 412 in a vertical plane and reciprocate a crank rod 414 in a substantially vertical direction. Details of the connection of the rotating disk 412 to the crank rod 414 are not shown, but the connection can be made in various ways known in the art. A crank rod 414 is typically located within a cover shaft 416 and reciprocates a saw blade 418, which is coupled to its distal end by a connector 420, the connector 420 which will allow for blade selection before the procedure and blade replacement during the procedure.

[0070] Referring here to Figures 11 and 12, in several embodiments, two or more instrument holders 500 and 502 can be used in combination to perform robotic surgical procedures. As described above with reference to Figure 1, instrument holder 500 can be attached to a flange 26 supported by a robotic surgical arm 20, and instrument holder 502 can be attached to a flange 28 supported by a robotic surgical arm 22. Surgical drapes 504 are positioned at the interfaces between instrument 500 and flange 26 and between instrument 502 and flange 28, exposing only the instruments to a sterile environment, and limiting sterilization for reuse to instruments containing only mechanical components. Typically, flanges 26 and 28, including instrument holders 500 and 502 as well as motors and electronics required to operate the surgical instruments themselves, may be outside the sterile field and would not require sterilization for reuse.

[0071] Individual surgical instruments can be brought into the instrument holder in a variety of ways, including both manual and robot-assisted protocols. Manual mounting would rely on the surgeon or surgical assistant selecting the desired instrument from stock and manually introducing or attaching the instrument to the gripper or drive attachment portion of the instrument holder. Robot-assisted mounting may utilize a dedicated or other mobile cart that can carry the instrument stock, select instruments from the instrument stock, and incorporate a dedicated arm for attaching the selected instruments to the instrument holder, as described in the jointly owned PCT application PCT / IB2022 / 058980 (published as WO2023 / 152561) (the full disclosure thereof is incorporated herein by reference).

[0072] The second instrument holder 502 can carry a rotary drive unit 600 having an output drive shaft 602 and an input drive element 604 (similar to the arrangement in both Figures 6 and 7), and the output drive shaft 602 may have a coupling feature 606 at its distal end, as shown in Figure 10. Thus, the robot controller 30 can be used to both position the robotic surgical arm 22 within the robotic surgical space and to control the rotation of the drive shaft 602.

[0073] The first instrument holder 500 can grip the instrument 700 using the opposing bodies 702 of the internal gripping mechanism of the first instrument holder, as generally described above with reference to Figure 3-5. The robot controller 30 can be used to align and engage the coupling feature 704 on the instrument 700 with the drive coupling 606 on the output drive shaft 602 of the rotary drive unit 600 held by the second instrument holder 502. Advantageously, the grip of the opposing body pair 702 can be adjusted by a slight change in the rotational orientation of the opposing bodies, allowing the output drive shaft 602 to both rotate and axially position the driven instrument 700 relative to the first instrument holder 500. List of reference numbers [Table 1-1] [Table 1-2] [Table 1-3] [Table 1-4]

[0074] Those skilled in the art will understand that several modifications relating to the disclosed embodiments are possible, while remaining within the boundaries of the disclosed art. Simply as embodiments, different variations in the precise dimensions and components of the mechanical drive train can be used within the scope of the disclosed art. As another embodiment, further variations of the forces applied by the mechanical gears (such as speed and torque in different applications) may be provided, while still remaining within the scope of the disclosed art. As a further embodiment, the disclosed art may take the form of a mechanical gear train for interaction with a force-applying element such as a drill bit, or as a complete power device, without departing entirely from the scope of the disclosed art. All specific embodiments described are essentially representative.

Claims

1. A robotic surgical instrument holder configured to (a) hold a first type of surgical instrument, and / or (b) hold and drive a second type of surgical instrument, A housing, the housing being configured to be removably mounted on the distal end of a surgical robot arm, having at least one instrument receiving opening, the at least one instrument receiving opening being configured to removably receive individual surgical instruments of either the first or second type through it, The drive train within the housing, the drive train having an input drive member configured to be coupled to an output drive member on the surgical robot arm when the housing is mounted on the distal end of the surgical robot arm, An instrument gripping mechanism controllably coupled to a drive chain, wherein the instrument gripping mechanism is configured to selectively grip and release the outer surface of the first type of surgical instrument when the first type of surgical instrument is positioned within a central passage, An instrument drive mechanism controllably coupled to the drive chain, wherein the instrument drive mechanism has an output drive element configured to mechanically engage with an input drive element on the second type of surgical instrument when the second type of surgical instrument is attached to the instrument holder. A robotic surgical instrument holder equipped with the necessary features.

2. The robotic surgical instrument holder according to claim 1, wherein the drive train comprises a mechanical arrangement of gears and shafts, and the mechanical arrangement of gears and shafts is configured to selectively transmit rotational motion and torque from the output drive member of the surgical robot arm to the instrument gripping mechanism and the instrument drive mechanism, one at a time.

3. The robotic surgical instrument holder according to claim 1 or 2, further comprising a selector mechanism configured to selectively couple the drive train to either the instrument gripping mechanism or the instrument drive mechanism.

4. The robotic surgical instrument holder according to claim 1 or 2, wherein the drive train is configured to automatically couple with either the instrument gripping mechanism or the instrument drive mechanism.

5. The robotic surgical instrument holder according to one of claims 1-4, wherein the instrument receiving opening comprises a cylindrical opening.

6. The aforementioned instrument gripping mechanism is The present invention comprises at least one pair of opposing bodies, each of which has a cylindrical peripheral surface with a circumferentially oriented tapered groove formed therein, The robotic surgical instrument holder according to one of claims 1-5, wherein the tapered groove is similarly molded and has a partially circular cross-section with a radius decreasing from the beginning to the end of the groove, and the opposing bodies rotate about their respective axes and are configured to orient the tapered groove to form a gripping surface with a substantially continuous circular periphery having (1) a diameter dependent on the rotational position of the opposing bodies and (2) a center that remains fixed to the gripping mechanism regardless of the rotational position of the opposing bodies.

7. The robotic surgical instrument holder according to claim 6, wherein the opposing body of the instrument gripping mechanism is configured to rotate in the opposite direction.

8. The robotic surgical instrument holder according to claim 6 or 7, further comprising a shaft, the shaft having a distal end connected to the instrument gripping mechanism and a proximal end driven by the drive train to rotate the shaft in the opposite direction to the opposing body.

9. The robotic surgical instrument holder according to one of claims 6-8, wherein the drive train includes a vertical shaft, the vertical shaft having bevel gears that drive gear wheels connected to each of the opposing bodies.

10. The robotic surgical instrument holder according to one of claims 6-9, further comprising a pair of jaw-like portions pivotably attached to the housing.

11. The robotic surgical instrument holder according to claim 10, wherein each jaw-like portion supports one of the opposing bodies of each pair of opposing bodies.

12. The robotic surgical instrument holder according to one of claims 10-11, wherein the jaw-like portion is configured to move the tapered groove on the opposing body closer together and further apart, thereby facilitating the positioning of an instrument between them.

13. A robotic surgical instrument holder according to one of claims 10-12, further comprising a lever assembly, the lever assembly being coupled to the shaft and configured to transmit axial translation of the shaft, thereby opening and closing the jaw-like portion.

14. The robotic surgical instrument holder according to claim 6-13, wherein the opposing body is configured to control the amount of friction applied to the instrument held by the opposing body according to the degree of rotation of the opposing body.

15. The robotic surgical instrument holder according to claim 1-14, wherein the output drive element of the instrument drive mechanism is rotatably driven by the drive train and is configured to mesh with the input drive element on the second type of surgical instrument and rotate the input drive element when the intervention component of the second type of surgical instrument is positioned within the instrument receiving opening.

16. The robotic surgical instrument holder according to claim 15, wherein the input drive element and the intervention component are separate, and the housing has a separate opening for coupling the input drive element to the drive column.

17. A robotic surgical system, The robotic surgical instrument holder according to claim 1, At least one of the second type of surgical instruments and A robotic surgical system equipped with [specific features / equipment].

18. The robotic surgical instrument holder according to claim 17, further comprising a plurality of the second type of surgical instruments.

19. A method for performing a robotic surgical procedure using at least one of a first type of surgical instrument and a second type of surgical instrument, To provide an instrument holder mounted on the distal end of a surgical robot arm, wherein the instrument holder includes both (a) an instrument gripping mechanism configured to selectively grip and release the outer surface of a first type of surgical instrument, and (b) an instrument drive mechanism having an output drive element configured to mechanically engage with an input drive element on a second type of surgical instrument. Selecting surgical instruments to be held by the aforementioned instrument holder, If the selected surgical instrument is of the first type, the selected surgical instrument is removably gripped within the gripping mechanism of the instrument holder, If the selected surgical instrument is of the second type, the selected surgical instrument is coupled to the instrument drive mechanism of the instrument holder such that the input drive element of the selected surgical instrument is coupled to the output drive element of the instrument drive mechanism. Methods that include...

20. The method according to claim 19, wherein the instrument holder comprises a drive row, the drive row having an input drive member coupled to an output drive member on the surgical robot arm, and an output drive member configured to be selectively coupled to either the instrument gripping mechanism or the instrument drive mechanism.

21. The method according to one of claims 19-20, further comprising: (a) configuring the drive train such that the output drive member is coupled to the instrument gripping mechanism and the output drive member is uncoupled from the instrument drive mechanism; and (b) coupling the first type of surgical instrument to the instrument gripping mechanism.

22. The method according to one of claims 19-21, wherein the configuration is performed manually using a mechanical selector coupled to the drive column.

23. The method according to claim 19-21, wherein the configuration is performed automatically.

24. The method according to one of claim 19 or 20, further comprising: (a) configuring the drive train to connect the output drive member to the instrument drive mechanism and to disconnect the output drive member from the instrument gripping mechanism; and (b) connecting the second type of surgical instrument to the instrument drive mechanism.

25. The method according to claim 24, wherein configuration is performed manually using a mechanical selector coupled to the drive column.

26. The method according to claim 24, wherein the configuration is performed automatically.

27. The method according to one of claims 19-26, wherein the first type of surgical instrument does not require an external power supply.

28. The method according to claim 27, wherein the first type of surgical instrument comprises a cannula that does not require mechanical power from the surgical robot, an independently powered drill, an independently powered screw drive unit, and an independently powered saw.

29. The method according to one of claims 19-28, wherein the second type of surgical instrument comprises a drill that requires mechanical power from the surgical robot, a screw drive unit, and a saw.

30. The method according to one of claims 19-29, wherein performing a robotic surgical procedure includes, during the procedure, exchanging or reversing at least one instrument of the first type and at least one instrument of the second type within the instrument holder.

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