Intraoperative control of robotic surgery systems

Abstract

Systems, devices and methods are provided for controlling surgical instruments remotely, such as in a robotic surgery system. One such robotic surgical system comprises a manipulator assembly having a support structure and one or more manipulators for the surgical instruments coupled to the support structure. Each of the manipulators have a remote center of motion which may be aligned with the incision point for the instrument being controlled by that manipulator. The system includes a controller configured to generate a central target position over a surgical site and a regulator mechanism for limiting a range of motion of the manipulators relative to the central target position. The system further includes an actuator for intraoperatively unlocking or releasing the central target position to move at least one of the manipulators to a location outside of its range of motion. This allows the central target position to be quickly and easily adjusted before or during the procedure by shifting the working space of the manipulators, which decreases the overall time of the procedure and increases the efficiency of the surgical team, while avoiding potential collisions between the instruments and / or the manipulators.

Description

INTRAOPERATIVE CONTROL OF ROBOTIC SURGERY SYSTEMSCROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit of U.S. Provisional Application Serial No. 63 / 566,517, filed on March 18, 2024, the complete disclosure of which is incorporated herein by reference for all purposes.TECHNICAL FIELD

[0002] This description generally relates to remotely controlled surgery systems and more particularly to systems and methods for intraoperatively controlling the range of motion of the instrument manipulators in such systems.BACKGROUND

[0003] Minimally invasive telesurgical robotic systems are being developed to increase a surgeon's dexterity when working on an internal surgical site, as well as to allow a surgeon to operate on a patient from a remote location (outside the sterile field). In a telesurgery system, the surgeon is often provided with an image of the surgical site at a control console. While viewing a three-dimensional image of the surgical site on a suitable viewer or display, the surgeon performs the surgical procedures on the patient by manipulating master input or control devices of the control console, which in turn control motion of the servo-mechanically operated slave instruments.

[0004] The servomechanism used for telesurgery will often accept input from two master controllers (one for each of the surgeon's hands) and may include two or more robotic arms. A surgical instrument is mounted on each of the robotic arms. Operative communication between master controllers and associated robotic arm and instrument assemblies is typically achieved through a control system. The control system typically includes at least one processor that relays input commands from the master controllers to the associated robotic arm and instrument assemblies and back in the case of, for example, force feedback or the like. One example of a robotic surgical system is the DA VINCI™ system commercialized by Intuitive Surgical, Inc. of Sunnyvale, California.

[0005] A variety of structural arrangements have been used to support the surgical instrument at the surgical site during robotic surgery. The driven linkage or "slave" is often calleda robotic surgical manipulator, and exemplary linkage arrangements for use as a robotic surgical manipulator during minimally invasive robotic surgery are described in U.S. Pat. Nos. 7,594,912, 6,758,843, 6,246,200, and 5,800,423, the full disclosures of which are incorporated herein by reference in their entirety for all purposes. These linkages often manipulate an instrument holder to which an instrument having a shaft is mounted. Such a manipulator structure can include a parallelogram linkage portion that generates motion of the instrument holder that is limited to rotation about a pitch axis that intersects a remote center of manipulation located along the length of the instrument shaft. Such a manipulator structure can also include a yaw joint that generates motion of the instrument holder that is limited to rotation about a yaw axis that is perpendicular to the pitch axis and that also intersects the remote center of manipulation. By aligning the remote center of manipulation with the incision point to the internal surgical site (for example, with a trocar or cannula at an abdominal wall during laparoscopic surgery), an end effector of the surgical instrument can be positioned safely by moving the proximal end of the shaft using the manipulator linkage without imposing potentially hazardous forces against the abdominal wall. Alternative manipulator structures are described, for example, in U.S. Pat. Nos. 6,702,805, 6,676,669, 5,855,583, 5,808,665, 5,445,166, and 5,184,601, the full disclosures of which are incorporated herein by reference in their entirety for all purposes.

[0006] During the surgical procedure, the telesurgical system can provide mechanical actuation and control of a variety of surgical instruments or tools having end effectors that perform various functions for the surgeon, for example, holding or driving a needle, grasping a blood vessel, dissecting tissue, or the like, in response to manipulation of the master input devices. Manipulation and control of these end effectors is a particularly beneficial aspect of robotic surgical systems.

[0007] For this reason, it is desirable to provide surgical tools that include mechanisms that provide two or three degrees of rotational movement of an end effector to mimic the natural action of a surgeon's wrist. Such mechanisms should be appropriately sized for use in a minimally invasive procedure and relatively simple in design to reduce possible points of failure. In addition, such mechanisms should provide an adequate range of motion to allow the end effector to be manipulated in a wide variety of positions. It would be further desirable to provide improved robotic systems that generally correspond to, or resemble, the individual surgical instruments being controlled to allow the user to easily and intuitively operate a variety of different surgical instruments used during a procedure.

[0008] Such a manipulator structure can constrain movement of the instrument so that the instrument pivots about a remote center of manipulation positioned in space along the length of the rigid shaft. By aligning the remote center of manipulation with the incision point to the internal surgical site (for example, with a trocar or cannula at an abdominal wall during laparoscopic surgery), an end effector of the surgical instrument can be positioned safely by moving the proximal end of the shaft using the manipulator linkage without imposing potentially dangerous forces against the abdominal wall.

[0009] The manipulators are typically provided with a range of motion over a central target position on the patient that allows the user to manipulate the surgical instruments during the surgical procedure. This range of motion is constrained such that the remote center of manipulation for each instrument cannot be moved greater than a threshold distance away from the central target position to reduce the risk of instrument collisions during the procedure. Certain procedures, however, require one or more of the arms to be moved away from the central target location a greater distance than this threshold. For example, lower anterior resections and other lower colorectal procedures require one of the instruments to have an incision point near the umbilicus and one of the manipulators to have an incision point near the anus. With certain taller patients, however, the distance between these two incision points is greater than the degree of freedom provided for the manipulators by the system.

[0010] It would, therefore, be desirable to provide robotic surgery systems that control the range of motion of the manipulator arms sufficiently to enable movement of the surgical instruments to perform the tasks required by the surgical procedure, while avoiding collisions between the instruments and / or the manipulators. It would be further desirable to provide such systems that allow the range of motion of one or more of the manipulators to be adjusted before or during the procedure to account for the unique requirements of certain surgical procedures and the individual anatomy or size of certain patients.SUMMARY

[0011] The following presents a simplified summary of the claimed subject matter to provide a basic understanding of some aspects of the claimed subject matter. This summary is not an extensive overview of the claimed subject matter. It is intended to neither identify key or critical elements of the claimed subject matter nor delineate the scope of the claimed subject matter. Its sole purpose is to present some concepts of the claimed subject matter in a simplified form asa prelude to the more detailed description that is presented later.

[0012] In one aspect, a robotic surgical system for use with one or more surgical instruments comprises a manipulator assembly having a support structure and one or more manipulators for the surgical instruments coupled to the support structure. Each of the manipulators have a remote center of motion which may be, for example, aligned with the incision point for the instrument being controlled by that manipulator. The system includes a controller configured to generate a central target position over a surgical site and a regulator mechanism for limiting a range of motion of the manipulators relative to the central target position. The system further includes an actuator for unlocking or releasing the central target position to move at least one of the manipulators to a location outside of its range of motion.

[0013] The system allows surgical teams to establish the central target position in a standard and uniform location for all surgical procedures (i.e., without having to pre-operatively calculate the degrees of freedom required for each manipulator to establish a different central target position for each procedure). In addition, this system allows the central target position to be quickly and easily adjusted before or during the procedure by shifting the working space of the manipulators, which decreases the overall time of the procedure and increases the efficiency of the surgical team, while avoiding potential collisions between the instruments and / or the manipulators.

[0014] In various embodiments, the actuator is configured to release the central target position intraoperatively while the surgical instruments are coupled to the manipulators (i.e., before or during the surgical procedure). In certain embodiments, the actuator is capable of releasing the central target position while the instruments and / or cannula are still inserted within the patient (e.g., “docked” to the patient), without causing patient injury or instrument collisions.

[0015] In various embodiments, one or more of the manipulators are automatically released or unlocked when the central target position is released. Thus, one or more of the manipulators may be moved with the central target position to a location outside of their original range of motion. In one such embodiment, movement of one of the manipulators moves the central target location therewith.

[0016] In various embodiments, one or more of the manipulators remains constrained within their original range of motion when the central target position is released. This limits the distance in which the central target position may be moved by the surgical team (i.e., any movement that would place the stationary manipulators outside of their range of motion is constrained by the system). In an exemplary embodiment, the controller is configured to preventmovement of the central target position beyond the range of motion of the stationary manipulators, which ensures that the surgical team cannot move the central target position to a location that would potentially cause instrument and / or manipulator collisions during the surgical procedure.

[0017] In various embodiments, the regulator mechanism limits a distance between the central target position and the remote center of motion of each of the manipulators. In an exemplary embodiment, this distance is a direction substantially parallel to a longitudinal axis of each of the manipulators.

[0018] In various embodiments, the system comprises a trigger or control device coupled to the actuator. In one such embodiment, an input device is remotely coupled to the first manipulator and movable to provide a desired movement of the first manipulator and the surgical instrument. The trigger is a user input, such as a button, slide, or other user interface, on the input device. Actuating the trigger unlocks the regulating mechanism to allow the surgical team to move the first manipulator (and the central target position therewith) outside of its original range of motion. In an exemplary embodiment, the other manipulators remain secured in place during movement of the central target position, which increases the working space of the manipulators.

[0019] In another embodiment, the trigger unlocks or releases the central target position based on a movement of one of the manipulator arms, such as a rotational or translational movement of the manipulator beyond a threshold limit. In this embodiment, the controller may comprise a computer-readable storage device storing program instructions to automatically unlock or release the central target position. In one such embodiment, the trigger releases the central target position upon rotation of the first manipulator beyond a threshold degree, e.g., 180 degrees around an outer pitch axis of the first manipulator. This ensures that the central target position is not accidently released during a normal movement of the manipulator during a procedure.

[0020] In another embodiment, the trigger comprises a user interface on one of the manipulators, such as the cannula mount. For example, the trigger may comprise a unique magnet code that may be inputted by the surgical team to actuate the unlocking mechanism.

[0021] In various embodiments, the system further comprises a second manipulator coupled to the support structure and having a second remote center of motion. The regulating mechanism limits a second range of motion of the second manipulator relative to the central target position. The system may comprise first and second regulators for restraining the first and second manipulators, respectively. Alternatively, a single regulator may control both manipulators. In an exemplary embodiment, the regulator(s) comprise brakes on the support structure configured tolimit the movement of the manipulators in a direction substantial parallel to their longitudinal axes.

[0022] In certain embodiments, the regulator limits a distance between the first center of motion and the second center of motion. The actuator and trigger allow this distance to be increased to shift the working space of the manipulators. In certain embodiments, the second manipulator remains fixed in position when the central target position is released, which minimizes instrument and / or manipulator collisions during the procedure.

[0023] In various embodiments, the system comprises a third manipulator configured for coupling to an endoscope and having a third remote center of motion. The controller is configured to set the central target location at the third center of motion.

[0024] In various embodiments, the surgical instrument comprises a circular stapling instrument configured for insertion into an anus of the patient. The first manipulator is configured to be coupled to the circular stapling instrument. The system may further include a second instrument configured for insertion into an abdominal cavity of the patient and a third instrument that includes an endoscope. The central target location is set at the remote center of motion of the endoscope. In this embodiment, the trigger is configured to unlock the central target location to allow the first manipulator to be moved inferior of its original range of motion so that it can be inserted into the anus of the patient. This increases the distance between the remote centers of motion of the first and second manipulators. In an exemplary embodiment, the controller automatically unlocks the central target location when the first manipulator is flipped 180 degrees into position such that the circular stapling instrument is in position for insertion into the anus of the patient.

[0025] In another aspect, a robotic surgical system for use with a surgical instrument comprises a first manipulator coupled to the support structure and having a first remote center of motion, a second manipulator coupled to the support structure and having a second remote center of motion and a regulating mechanism for limiting a range of motion of the first manipulator relative to the second manipulator. The system further includes an actuator for unlocking or releasing the first manipulator to move the first manipulator to a location outside of its range of motion.

[0026] In various embodiments, the regulating mechanism is configured to limit the distance between the centers of motion of the first and second manipulators. In an exemplary embodiment, the second manipulator remains stationary while the first manipulator is moved outside of its range of motion.

[0027] In various embodiments, the controller is configured to constrain the second manipulator such that it cannot be moved outside of its range of motion when the first manipulator has been released from its range of motion. This limits the distance in which the first manipulator may be moved by the surgical team, which ensures that the surgical team cannot move the central target position to a location that would potentially cause instrument and / or manipulator collisions during the surgical procedure.

[0028] In various embodiments, the system further includes a controller configured to generate a central target position over the surgical site. The regulating mechanism is configured to limit the range of motion of the manipulators relative to the central target position.

[0029] In this embodiment, the central target position remains fixed throughout the procedure and the range of motions of at least one of the manipulators is adjusted relative to the central target position. This allows the surgical team to shift the working space between the first and second manipulators without changing the central target position.

[0030] In another aspect, a method for controlling a robotic surgery system comprises coupling a first manipulator to the surgical instrument, generating a remote center of motion for the surgical instrument, and generating a central target position over a surgical site. The method further comprises limiting a range of motion of the remote center of motion of the first manipulator relative to the central target position and then unlocking or releasing the central target location to enable movement of the first manipulator to a location outside of the range of motion.

[0031] In various embodiments, the central target position is released during the surgical procedure. The method may further comprise moving the central target position to enable movement of the first manipulator outside of its retrained range of motion. In certain embodiment, the distance between the central target position and the remote center of motion is restrained. In an exemplary embodiment, the range of motion is in a direction substantially parallel to a longitudinal axis of the first manipulator.

[0032] In various embodiments, the method further comprises remotely coupling an input device to the first manipulator to provide a desired movement of the first manipulator and the surgical instrument. A trigger is actuated on the input device to unlock the central target position.

[0033] In other embodiments, the central target position is unlocked by moving the first manipulator beyond a threshold distance or angle. In an exemplary embodiment, the central target position is unlocked by rotating the first manipulator beyond a threshold degree.

[0034] In various embodiments, the method further comprises providing a second manipulator and generating a second remote center of motion for the second manipulator. The range of motion of the second manipulator is limited relative to the central target position. In certain embodiments, the maximum distance between the first and second centers of motion is restrained.

[0035] In various embodiments, the second manipulator remains stationary when the fixed central location is moved.

[0036] In various embodiments, the method further comprises providing a third manipulator configured for coupling to an endoscope and having a third remote center of motion. In an exemplary embodiment, the central target position is at the third center of motion.

[0037] In various embodiments, the method comprises generating the second remote center of motion at, or near, an umbilicus of a patient and moving the first remote center of motion to a location at, or near an anus of the patient.

[0038] It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the description. Additional features will be set forth in part in the description which follows or may be learned by practice of the description.BRIEF DESCRIPTION OF THE DRAWINGS

[0039] The above and other aspects, features, and advantages of the present surgical instruments will become more apparent considering the following detailed description when taken in conjunction with the accompanying drawings in which.

[0040] FIG. 1 is a top view of an operating room employing a robotic surgical system; and

[0041] FIG. 2A is a simplified side view of a robotic arm assembly.

[0042] FIG. 2B is a perspective view of an input device for the robotic surgical system;

[0043] FIG. 3 A illustrates a manipulator assembly for the robotic system of FIG. 1;

[0044] FIG. 3B is a side view of the manipulator assembly of FIG. 3 A;

[0045] FIG. 4 illustrates another view of an operating room employing a roboticsurgical system;

[0046] FIG. 5 illustrates first and second manipulator arms of the robotic surgical system with limited range of motions relative to a central target position;

[0047] FIG. 6 illustrates the first and second manipulator arms after movement of the central target position;

[0048] FIGS. 7A-7C illustrate rotation of one of the manipulator arms of the robotic surgery system;

[0049] FIG. 8 illustrates movement of the manipulator arm of FIGS. 7A-7C to a limit of a range of motion based on the central target position;

[0050] FIG. 9 illustrates a locking mechanism for the manipulator arm of FIGS. 7A-7C;

[0051] FIG. 10A illustrates a representative circular stapling device;

[0052] FIG. 10B illustrates a representative circular stapling device with a proximal housing configured for remote control; and

[0053] FIG. 11 is a partial cross-sectional view of a staple assembly for the circular stapler of FIG. 10 A;

[0054] FIG. 12 is an exploded view of an end effector of the circular stapler;

[0055] FIG. 13 A is an enlarged view of a staple pusher;

[0056] FIG. 13B is an end view of a housing for the staple assembly;

[0057] FIG. 14 illustrates the end effector of the circular stapler in an initial position;

[0058] FIG. 15 illustrates the end effector with a plurality of staples engaging an anvil;

[0059] FIG. 16 illustrates the end effector with a knife deploying past the distal end of the channel to cut tissue;

[0060] FIGS. 17A-17D illustrate the operation of an alternative embodiment of a circular stapler;

[0061] FIGS. 18A-18D illustrate the operation of an alternative embodiment of a circular stapler;

[0062] FIGS. 19A-19C illustrate the operation of an alternative embodiment of a circular stapler;

[0063] FIG. 20 is a partial cross-sectional view of another alternative embodimentof a circular staple;

[0064] FIG. 21 illustrates the circular stapler of FIG. 20 deploying a plurality of staples;

[0065] FIG. 22 illustrates the circular stapler of FIG. 20 deploying the knife to cut tissue;

[0066] FIGS. 23A-23D schematically illustrate operation of the devices described herein for sealing and cutting intestinal tissue;

[0067] FIGS 24A-24C illustrate the operation of another alternative embodiment of a circular stapler;

[0068] FIGS. 25A-25C illustrate one embodiment of a collapsible anvil for a circular stapler;

[0069] FIG. 26 illustrates another embodiment of a collapsible anvil for a circular stapler;

[0070] FIGS. 27A-27C illustrate the deployment of an anvil head of the anvil of FIG. 26;

[0071] FIGS. 28 A and 28B illustrates another embodiment of an anvil for a circular stapler;

[0072] FIG. 29A illustrates another embodiment of an anvil for a circular stapler in an expanded configuration;

[0073] FIG. 29B illustrates the anvil of FIG. 29A in an expanded configuration;

[0074] FIGS. 30A and 30B illustrate another embodiment of a collapsible anvil for a circular stapler;

[0075] FIGS. 31 A-31C illustrate deployment of the anvil of FIGS. 30A and 30B.

[0076] FIGS. 32A and 32B illustrate another embodiment of a collapsible anvil for a circular stapler;

[0077] FIGS. 33A-33C illustrate another embodiment of a collapsible anvil for a circular stapler;

[0078] FIGS. 34A and 34B illustrate another embodiment of a collapsible anvil for a circular stapler;

[0079] FIGS. 35A-35C illustrates deployment of the anvil of FIGS 34A and 34B;

[0080] FIG. 36 is a perspective view of the distal end portion of a delivery instrument for the anvil;

[0081] FIG. 37 illustrates the delivery instrument with closed jaws for advancing the anvil to a target region within a patient;

[0082] FIG. 38 illustrates the delivery instrument after expanding the anvil at the target region;

[0083] FIG. 39 illustrates the delivery instrument manipulating a shaft of an anvil of a circular stapler; and

[0084] FIG. 40 illustrates the jaws of the delivery instrument grasping the anvil shaft.DETAILED DESCRIPTION

[0085] Particular embodiments of the present surgical instruments are described hereinbelow with reference to the accompanying drawings; however, it is to be understood that the disclosed embodiments are merely exemplary and may be embodied in various forms. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the devices herein in virtually any appropriately detailed structure. Well-known functions or constructions are not described in detail to avoid obscuring the present description in any unnecessary detail. Like numbers in two or more figures represent the same or similar elements. Furthermore, elements and their associated aspects that are described in detail with reference to one embodiment may, whenever practical, be included in other embodiments in which they are not specifically shown or described. For example, if an element is described in detail with reference to one embodiment and is not described with reference to a second embodiment, the element may nevertheless be claimed as included in the second embodiment. Moreover, the depictions herein are for illustrative purposes only and do not necessarily reflect the actual shape, size, or dimensions of the system or illustrated components.

[0086] While the following is presented with respect to control systems for delivering and manipulating circular stapling instruments, it should be understood that certain features of the presently described surgical instruments may be readily adapted for use in control systems and control inputs for any type of surgical instrument, including but not limited to forceps, scissors, needle holders, cutting instruments, retractors, suturing devices, clip appliers, and clamping, cutting, ligating, dissecting, clipping, cauterizing, suturing and / or sealing instruments. The system and devices described herein, or certain components of the system and devices, mayalso be incorporated into a variety of different surgical instruments, such as those described in commonly assigned, co-pending U.S. Provisional Patent Application Nos. 63 / 499,396, 63 / 458,510, 63 / 499,786, 63 / 505,738, 63 / 505,742 and 63, 505,735; U.S. Non-Provisional Patent Application Nos. 12 / 945,541, 16 / 205,128, 16 / 331,734, 16 / 339,704, 16 / 427,427, 16 / 678,405, 16 / 904,482, 17 / 081,088, 17 / 130,464 and 17 / 084,981; and International Patent Nos. PCT / US2017 / 056075, PCT / US2017 / 050760, PCT / US2019 / 107646, PCT / US2019 / 019501,PCT / US2019 / 062344, PCT / US2020 / 54568, PCT / US2019 / 064861, PCT / US2019 / 062768,PCT / 2020 / 025655, PCT / US2020 / 056979, PCT / 2019 / 066513, PCT / US2020 / 020672,PCT / US2019 / 066530, PCT / US2020 / 033481, PCT / US2021 / 65544, PCT / US2021 / 65308the complete disclosures of which are incorporated by reference herein in their entirety for all purposes as if copied and pasted herein.

[0087] FIG. 1 illustrates, as an example, a top view of an operating room employing a representative robotic surgical system 100 including a Console (“C”) utilized by a Surgeon (“S”) while performing a minimally invasive diagnostic or surgical procedure, usually with assistance from one or more Assistants (“A”), on a Patient (“P”) who is lying down on an Operating table (“O”).

[0088] The servomechanism used for telesurgery will often accept input from two master controllers (one for each of the surgeon's hands) and may include two or more robotic arms. A surgical instrument is mounted on each of the robotic arms. Operative communication between master controllers and associated robotic arm and instrument assemblies is typically achieved through a control system. The control system typically includes at least one processor that relays input commands from the master controllers to the associated robotic arm and instrument assemblies and back in the case of, for example, force feedback or the like. One example of a robotic surgical system is the DA VINCI™ system commercialized by Intuitive Surgical, Inc. of Sunnyvale, California.

[0089] A variety of structural arrangements have been used to support the surgical instrument at the surgical site during robotic surgery. The driven linkage or "slave" is often called a robotic surgical manipulator, and exemplary linkage arrangements for use as a robotic surgical manipulator during minimally invasive robotic surgery are described in U.S. Pat. Nos. 7,594,912, 6,758,843, 6,246,200, and 5,800,423, the full disclosures of which are incorporated herein by reference in their entirety for all purposes. These linkages often manipulate an instrument holder to which an instrument having a shaft is mounted. Such a manipulator structure can include aparallelogram linkage portion that generates motion of the instrument holder that is limited to rotation about a pitch axis that intersects a remote center of manipulation located along the length of the instrument shaft. Such a manipulator structure can also include a yaw joint that generates motion of the instrument holder that is limited to rotation about a yaw axis that is perpendicular to the pitch axis and that also intersects the remote center of manipulation. By aligning the remote center of manipulation with the incision point to the internal surgical site (for example, with a trocar or cannula at an abdominal wall during laparoscopic surgery), an end effector of the surgical instrument can be positioned safely by moving the proximal end of the shaft using the manipulator linkage without imposing potentially hazardous forces against the abdominal wall. Alternative manipulator structures are described, for example, in U.S. Pat. Nos. 6,702,805, 6,676,669, 5,855,583, 5,808,665, 5,445,166, and 5,184,601, the full disclosures of which are incorporated herein by reference in their entirety for all purposes.

[0090] During the surgical procedure, the telesurgical system can provide mechanical actuation and control of a variety of surgical instruments or tools having end effectors that perform various functions for the surgeon, for example, holding or driving a needle, grasping a blood vessel, dissecting, clamping and stapling tissue, or the like, in response to manipulation of the master input devices. Manipulation and control of these end effectors is a particularly beneficial aspect of robotic surgical systems. For this reason, it is desirable to provide surgical tools that include mechanisms that provide two or three degrees of rotational movement of an end effector to mimic the natural action of a surgeon's wrist. Such mechanisms should be appropriately sized for use in a minimally invasive procedure and relatively simple in design to reduce possible points of failure. In addition, such mechanisms should provide an adequate range of motion to allow the end effector to be manipulated in a wide variety of positions.

[0091] The Console includes a monitor 104 for displaying an image of a surgical site to the Surgeon, left and right manipulatable input devices 108 and 109, a foot pedal 105, and a processor 102. The input devices 108 and 109 may include any one or more of a variety of input devices such as those described below in FIGS. 11-21B. The processor 102 may be a dedicated computer that may be integrated into the Console or positioned next to it.

[0092] The Surgeon performs a minimally invasive surgical procedure by manipulating the input devices 108 and 109 (also referred to herein as “master manipulators”) so that the processor 102 causes their respectively associated robotic arm assemblies, 128 and 129, (also referred to herein as “slave manipulators”) to manipulate their respective removably coupledsurgical instruments 138 and 139 (also referred to herein as “tools”) accordingly, while the Surgeon views the surgical site in 3-D on the Console monitor 104 as it is captured by a stereoscopic endoscope 140.

[0093] Each of the tools 138 and 139, as well as the endoscope 140, may be inserted through a cannula or other tool guide (not shown) into the Patient to extend down to the surgical site through a corresponding minimally invasive incision such as incision 166. Each of the robotic arms is conventionally formed of links, such as link 162, which are coupled together and manipulated through motor controlled or active joints, such as joint 163.

[0094] The number of surgical tools used at one time and consequently, the number of robotic arms being used in the system 100 will generally depend on the diagnostic or surgical procedure and the space constraints within the operating room, among other factors. If it is necessary to change one or more of the tools being used during a procedure, the Assistant may remove the tool no longer being used from its robotic arm, and replace it with another tool 131 from a Tray (“T”) in the operating room.

[0095] The monitor 104 may be positioned near the Surgeon's hands so that it will display a projected image that is oriented so that the Surgeon feels that he or she is actually looking directly down onto the operating site. To that end, images of the tools 138 and 139 may appear to be located substantially where the Surgeon's hands are located.

[0096] The processor 102 performs various functions in the system 100. One function that it performs is to translate and transfer the mechanical motion of control devices 108 and 109 to their respective robotic arms 128 and 129 through control signals overbus 110 so that the Surgeon can effectively manipulate their respective tools 138 and 139. Another important function is to implement various control system processes as described herein.

[0097] Robotic surgery systems and methods are further described in U.S. Pat. No. 5,797,900, filed on May 16, 1997, issued on Aug. 25, 1998, U.S. Pat. No. 6, 132,368, filed on Nov. 21 , 1997, issued on Oct. 17, 2000, U.S. Pat. No. 6,331,181, filed on Oct. 15, 1999, issued on Dec. 18, 2001, U.S. Pat. No. 6,441,577, filed on Apr. 3, 2001, issued on Aug. 27, 2002, U.S. Pat. No. 6,902,560, filed on Jan. 6, 2004, issued on Jun. 7, 2005, U.S. Pat. No. 6,936,042, filed on Apr. 16, 2002, issued on Aug. 30, 2005, and U.S. Pat. No. 6,994,703, filed on Dec. 4, 2002, issued on Feb. 7, 2006, d e full disclosures of which are incorporated herein by reference for all purposes. A suitable robotic surgical system currently in use is the da Vinci S Surgical System by Intuitive Surgical, Inc.

[0098] FIG. 2A illustrates, as an example, a side view of a simplified (not necessarily in proportion or complete) illustrative robotic arm assembly 200 (which is representative of robotic arm assemblies 128 and 129) holding a surgical instrument 250 (which is representative of tools 138 and 139) for performing a surgical procedure. The surgical instrument 250 is removably held in tool holder 240. The arm assembly 200 is mechanically supported by a base 201, which may be part of a patient-side movable cart or affixed to the operating table or ceiling. It includes links 202 and 203 which are coupled together and to the base 201 through setup joints 204 and 205.

[0099] The setup joints 204 and 205 in this example are passive joints that allow manual positioning of the arm 200 when their brakes are released. For example, setup joint 204 allows link 202 to be manually rotated about axis 206, and setup joint 205 allows link 203 to be manually rotated about axis 207.

[0100] Although only two links and two setup joints are shown in this example, more or less of each may be used as appropriate in this and other robotic arm assemblies described herein. For example, although setup joints 204 and 205 are useful for horizontal positioning of the arm 200, additional setup joints may be included and useful for limited vertical and angular positioning of the arm 200. For major vertical positioning of the arm 200, however, the arm 200 may also be slidably moved along the vertical axis of the base 201 and locked in position.

[0101] The robotic arm assembly 200 also includes three active joints driven by motors. A yaw joint 210 allows arm section 230 to rotate around an axis 261, and a pitch joint 220 allows arm section 230 to rotate about an axis perpendicular to that of axis 261and orthogonal to the plane of the drawing. The arm section 230 is configured so that sections 231 and 232 are always parallel to each other as the pitch joint 220 is rotated by its motor. Consequently, the instrument 270 may be controllably moved by driving the yaw and pitch motors to pivot about the pivot point 262, which is generally located through manual positioning of the setup joints 204 and 205 to be at the point of incision into the patient. In addition, an insertion gear 245 may be coupled to a linear drive mechanism (not shown) to extend or retract the instrument 250 along its axis 263.

[0102] Although each of the yaw, pitch and insertion joints or gears, 210, 220 and 245, is controlled by an individual joint or gear controller, the three controllers are controlled by a common master / slave control system so that the robotic arm assembly 200 (also referred to herein as a “slave manipulator”) may be controlled through user (e.g., surgeon)manipulation of its associated master manipulator.

[0103] FIG. 2B illustrates a representative input device 108 for the robotic surgical system. It will be understood that the robotic surgical system may include one, or two or more such input devices. In an exemplary embodiment, the robotic surgical system may include two such input devices 108, 109; one for each of the surgeon’s hands, as shown in FIG. 1.

[0104] Input device 108 generally comprises a mounting assembly 190 for mounting a device control 180 to a connector 170 of the robotic surgical system. Device control 180 contains the necessary internal sensors and electronics to transmit movements of device control 180 through connector 170 to processor 102 (see FIG. 1). Mounting assembly 190 is designed to locate device control 180 in an ergonomic position for the surgeon to grip and manipulate device control 180 with his / her hand 330 while viewing monitor 104 (see FIG. 1). This ergonomic position generally provides device control 180 in a position such that the surgeon can grip and manipulate device control 180 with his / her hand 300 and view monitor 104 without substantially bending his / her wrist (i.e., the user’s hand faces the same direction as the user’s eyes).

[0105] In the representative embodiment, mounting assembly 190 comprises a housing 176 for receiving device control 180 such that device control 180 may be removably attached to mounting assembly 190. Housing 176 has a first end 177 facing the user and input 180 is mounted to first end. Housing 176 has a second end 179 facing away from the user that generally does not have an electrical connection for a control input.

[0106] Housing 176 is preferably coupled to connector 190 such that control input 190 has one or more degrees of freedom for movement such that surgeon can optimize the position of control input 190 during the procedure. In the representative embodiment, mounting assembly 190 comprises a longitudinal bar or rod 174 coupling housing 176 to a movement assembly 192 that, in turn, is pivotally coupled to connector 170. Mounting assembly 190 may, for example, allow the user to move device control 180, and housing 176 therewith, forwards, backwards, laterally, rotationally, upwards and / or downwards. Such movements are translated through connector 170 to processor 102 to cause robotic arm assembly 200 to provide similar movements to the instrument 250 (see FIG. 2).

[0107] Device control 180 comprises a shaft 182 that may be rotatably coupled to housing 176 and configured to rotate around the longitudinal axis of shaft 182 by the user’s hand 330. Rotation of shaft 182 may, for example, cause processor 102 to provide the necessary control input to cause robotic arm assembly 200 to rotate surgical instrument 250. Control input 190further includes a pair of lateral arms 184, 185 that are configured to pivot inwards and outwards relative to shaft 182 by, for example, the user pinching arms 184, 185 together and / or allowing them to move apart (i.e., arms 184, 185 are generally biased laterally outward from shaft 182). This pinching movement may, for example, cause processor 202 to provide the necessary control input to cause robotic arm assembly 200 to move the end effector of surgical instrument 250, e.g., opening and closing jaws of the instrument 250. Control input 190 further includes a button 188 positioned on shaft 182. Button 188 represents a third control input that allows the user to manipulate a third movement of instrument 250, such as clamping jaws, advancing a cutting element and / or firing staples in a surgical stapling instrument.

[0108] In some embodiments, the system may include other device control inputs, such as foot pedals and the like, to provide additional control inputs to surgical instrument 250 and / or the endoscope used for the procedure. In some embodiments, the pedals are color designated, usually indicating a cautery action (blue), and cut action (yellow) for bipolar instruments. Sometimes these actions are instrument specific. For example, with a surgical stapler that performs a clamping step (blue), and then a fire step (yellow). The connotation for these colors is generally the same: blue is a lower risk or reversable action, while yellow indicates a high risk, non-reversable action.

[0109] FIG. 3 A illustrates a representative embodiment of a manipulator assembly 300 that comprises first, second, third and fourth manipulators or robotic arms 302, 304, 306, 308 mounted to a support structure 310. Support structure 310 generally comprises a floor or ceiling mounted base 312 with a vertical support arm 314 supporting a horizontal arm 316 that extends over the patient. Base 312 may be movable or fixed. Each of the arms 302, 304, 306, 308 are rotatably mounted to horizontal arm 316 at a joint 320 (shown by arrow 321). Vertical support arm 314 is movable (i.e., capable of telescoping) along its own axis (relative to base 312 as shown by arrow 324) to move horizontal arm 316 and the robotic arms up and down, and rotatable about its own axis (shown by arrow 323) to rotate horizontal arm 316 and the robotic arms around base 312. Horizontal arm 316 is also movable along its own axis (relative to base 312 shown by arrow 322) to move the robotic arms towards and away from the base. Each of the arms 302, 304, 306, 308 are independently movable about joint 320.

[0110] Referring now to FIG. 3B, each robotic arm has multiple degrees of freedom relative to horizontal arm 316. In an exemplary embodiment, each arm comprises at least first, second, third and fourth linkages 332, 334, 336, 338 that provide rotational degrees of freedom inthe direction of arrows 342, 344, 346, 348, 350. In addition, each arm further has a degree of freedom in an axial direction relative to its longitudinal axis in the direction of arrow 352. Each instrument manipulator supports and actuates its associated instrument.

[0111] For minimally invasive surgery, the instruments must remain substantially stationary with respect to the location at which they enter the patient's body, either at an incision or at a natural orifice, to avoid unnecessary tissue damage. Accordingly, the yaw and pitch motions of each instrument shaft should be centered at a single location on the manipulator assembly roll axis or instrument insertion axis that stays relatively stationary in space. This location is referred to as a remote center of motion. As described in more detail below, a surgical instrument is mounted on and actuated by each surgical instrument manipulator or robotic arm of manipulator assembly 300. The instruments are removably mounted so that various instruments may be interchangeably mounted on a particular instrument manipulator. In the representative embodiment, one instrument manipulator is configured to actuate a camera instrument, and three instrument manipulators are configured to actuate various other interchangeable surgical instruments that perform surgical and / or diagnostic work at the surgical site. More or fewer instrument manipulators may be used. In some operational configurations, one or more manipulators may not have an associated surgical instrument during some or all of a surgical procedure.

[0112] Each of the joints in the robotic arms and the support structure may include joint brakes that can be manually set (or automatically by the control system) to prevent movement about that particular joint. Base 312 may include a passive, uncontrolled "setup" portion and an actively controlled "manipulator" portion. In one example, the setup portion includes two passive rotational "setup" joints (not shown) which allow manual positioning of the robotic arms when the joint brakes (not shown) are released. A passive prismatic setup joint (not shown) may be used to allow for large vertical adjustments. Alternatively, some of these setup joints may be actively controlled, and more or fewer setup joints may be used in various configurations. The setup joints and links allow a person to place the robotic manipulator portion of the arm at various positions and orientations in Cartesian x, y, z space. The remote center of motion is the location at which yaw, pitch, and roll axes intersect (i.e., the location at which the kinematic chain remains effectively stationary while joints move through their range of motion). As described in more detail below, some of these actively controlled joints are robotic manipulators that are associated with controlling DOFs of individual surgical instruments, and others of these actively controlled jointsare associated with controlling DOFs of a single assembly of these robotic manipulators. The active joints and links are movable by motors or other actuators and receive movement control signals that are associated with master arm movements at the surgeon's console. Active joints and manipulator platform move in conjunction and / or independently so that a surgical instrument (or assembly) moves around the remote center of motion at an entry port after the remote center of motion has been established by the passive setup arms and joints. Accordingly, the passive setup joints and links may be used to properly position a remote center of motion with reference to the patient. Once the remote center of motion is properly positioned, brakes at each of the joints are set to prevent the setup portion of the arm from moving.

[0113] Referring now to FIG. 5, the system is configured to generate a general target operating location around the surgical site or OP 400 wherein the instruments will be used within the patient for a particular procedure. The system further generates a central target position or point 402 which is the center of the OP 400. In one embodiment, the center of the OP 400 is located at the endoscope cannula’s remote center of motion. The robotic arms are then restrained from moving beyond a certain distance from the center of the OP 400 to provide the most range of motion (ROM) at the center of the surgical space during the procedure and to limit the risk of instrument collisions.

[0114] As shown in FIG. 9, in certain embodiments, manipulator assembly 300 comprises one or more brakes that prevent arms 302, 304, 306, 308 from moving a certain distance away from the OP 400. The range of motion of one of the arms 306 restrained by the brakes is illustrated in the lines 440 on horizontal support arm 322 that align with the line 442 on arm 306. The brakes restrain arm 332 from moving beyond lines 440 in either direction.

[0115] FIG. 5 illustrates a representative procedure wherein robotic arm 304 has a range of motion that is limited by a certain distance, which is visually represented in this figure by a horizontal slide 404. Similarly, robotic arm 306 has a range of motion (ROM) that is limited by a certain distance, which is visually represented by a horizontal slide 406. Thus, any attempt to move arms 304, 306 beyond the range of the slides 404, 406 will be prevented by the brakes in support structure 310. The remote centers of motions are markers for where the instruments are located. The controller may be configured to place the central location 402 such that each of the arms are initially positioned at, or near, the center of their ROMs. As shown in FIG. 5, arm 304 is initially positioned at the center of horizontal slide 404, while arm 306 has been moved to the inferior end of its horizontal slide 406. Any further inferior movement of arm 306 is constrainedby the system.

[0116] As shown in FIG. 4, in some surgical procedures, such as a lower anterior resection or other lower colorectal procedure, one of the robotic arms 304 will be used to manipulate a surgical instrument or endoscope inserted through a transabdominal insertion point while another arm 306 is used to manipulate a surgical instrument inserted through transanal insertion point. The patient landmarks correspond to typical port placements for lower anterior resections and other lower colorectal procedures. In these procedures, the range of motion of arm 306 may not be long enough to allow the user to place arm 306 at the anus for insertion. If the distance between the patients’ umbilicus 410 and anus 412 (represented by arrow 420) is larger than the distance between the remote centers of motion of arms 304 and 306 (represented by arrow 422), then the user will not be able to place arm 306 at the anus. For example, with taller individuals, distance 420 may be larger than distance 422. As shown in FIG. 5, arm 3 has reached the end of its horizontal range of motion represented by slide 406. Arrow 424 represents the additional distance required to move arm 306 to insert the instrument coupled to that arm into the patient’s anus.

[0117] With a conventional robotic system, the surgical team typically has three options to provide enough room to place arm 306 between the patient legs to access the anus 412:(1) the surgical team may attempt to pre-operatively determine if the patient is outside of the working range of arms, and adjust the OP 400 so that it is biased inferiorly and closer to the patient;(2) the surgical team may undock all of the instruments and cannulas, repositions the OP 400 enough to move arm 306 into position, and then re-docks all of the instruments and cannula; (3) the surgical team may move the entire table and patient relative to the robotic system to move the patient so that the OP 400 is more inferiorly placed and closer to the patient (referred to as “table motion”).

[0118] There are downsides to all three of these options. Pre-operatively moving the OP in a more favorable position for transanal access requires knowledge of how much motion to make (knowing the patient measurements minus the remote center distance). This is not common knowledge and would require training beyond the established setup methods for surgical teams. Pre-operative setup could also cause instrument collisions, hindering the surgical capability of the surgeon. Undocking and re-docking mid-procedure adds time and complexity to the overall procedure. In an environment in which surgical teams are looking for ways to increase efficiency, redocking all four arms is not desirable as a routine part of a procedure. Finally, not all surgicalteams have “table motion” or “the capability of moving the table and patient relative to the robotic system capabilities, as it is specific to the patient table itself. This option also adjusts the working height of the patient, which is not always at the ideal height for bedside staff to interact with the patient.

[0119] The system further includes an actuator for unlocking or releasing the central target position to move at least one of the manipulators to a location outside of its range of motion. The system allows surgical teams to establish the OP 400 in a standard and uniform location for all surgical procedures (i.e., without having to pre-operatively calculate the degrees of freedom required for each manipulator to establish a different central target position for each procedure). In addition, this system allows the OP 400 to be quickly and easily adjusted before or during the procedure by shifting the working space of the manipulator arms 302, 304, 306, 308, which decreases the overall time of the procedure and increases the efficiency of the surgical team, while avoiding potential collisions between the instruments and / or the manipulators.

[0120] In various embodiments, the actuator is configured to release the central target position intraoperatively while the surgical instruments are coupled to the manipulators (i.e., before or during the surgical procedure). In certain embodiments, the actuator is capable of releasing the central target position while the instruments and / or cannula are still inserted within the patient (e.g., “docked” to the patient), without causing patient injury or instrument collisions.

[0121] In one embodiment, the system includes a locking / unlocking control input (not shown) that may be included in one of the input devices 108 and 109, the foot pedal 105 or another control device accessible by the physician or staff. The locking / unlocking control input is designed to unlock the OP 400 and one or more of the arms 302, 304, 306, 308. In one embodiment, the control input is a port clutch button that unlocks the OP 400 and arm 306. This allows the user to move the OP 400 by moving arm 306 to the desired location without harming the patient. In certain embodiments, while the OP and arms are unlocked, the user will also be able to make vertical or z-height adjustments to any of the robotic arms. Once the user has positioned arm 306 in the desired location, the OP 400 and robotic arms may be locked back up (automatically by the controller or manually by the surgical team) such that the arms are restrained from moving a certain distance away from the new location of the OP.

[0122] In certain embodiments, the system will only be unlocked after the user presses the port clutch button and moves one of the robotic arms to the end of its horizontal slide or range of motion. This unlocks the OP and one or more of the other arms. In some embodiments,only the arm that has been moved to the end of its range of motion is unlocked. In other embodiments, one or more of the other arms is unlocked.

[0123] In other embodiments, the trigger to unlock the system may be based on movement of one or more of the arms into a particular configuration. For example, the trigger may comprise a rotation of one of the arms. Thus, when the arm is upright, for example, the trigger will not be activated such that the system will not unlock the OP and the arm(s) accidentally. When the arm is flipped or otherwise rotated by a certain degree, e.g., 180 degrees, the trigger will be automatically activated to unlock the OP and the arm(s). FIGS. 7A-7C illustrate this embodiment. As shown, the user rotates arm 306 at least 90-180 degrees between the patient’s legs, thereby activating the unlocking feature of the system. As shown in FIG. 8, the user may then move arm 306 further inferiorly as the OP 400 is moved inferiorly (shown by arrow 460).

[0124] In other embodiments, the trigger comprises a user interface on one of the manipulators, such as the cannula mount. For example, the trigger may comprise a unique magnet code that may be inputted by the surgical team to actuate the unlocking mechanism.

[0125] In certain embodiments, a controller within the system can include one or more processors (e.g., microprocessor, microchip, or application-specific integrated circuit), one or more memory devices (e.g., random-access memory and / or read-only memory), an I / O processor, and a communication interface. The memory devices can include a local memory (e.g., a random-access memory and a cache memory) employed during execution of program instructions. Additionally, the controller can include at least one communication channel (e.g., a data bus) by which it communicates with the storage system, the VO processor, and the communication interface.

[0126] The processor(s) execute computer program instructions (e.g., an operating system and / or application programs), which can be stored in the memory device and / or the storage system. The controller may further include one or more computer-readable data storage device configured to execute program instructions for controlling the trigger, the control inputs, the position of the central target location and / or the range of motions of each of the manipulators.

[0127] In an exemplary embodiment, the computer program instructions are configured to generate the central location 402 of the OP 400 and the range of motion (ROM) of each of the manipulator arms (see 404 and 406 in FIG. 5). The computer program instructions are further configured to constrain movement of the arms beyond their ROM via the brakes in support structure 310. The computer program instructions may be further configured to release the centrallocation 402 and at least one of the arms upon actuation of the trigger(s) by releasing the brake for the released manipulator In an exemplary embodiment, movement of the released manipulator arm causes the computer program instructions to move the central location 402 of the OP with that arm as it is moved outside of its ROM.

[0128] In certain embodiments, the computer program instructions are configured to constrain movement of one or more of the other manipulator arms (the stationary arms) when the central location 402 has been released. The stationary arms may include one of the other arms, or all of the other arms. In exemplary embodiment, only one of the manipulator arms is released to move beyond its original ROM (see 406 in FIG. 6), while the rest of the manipulator arms remain constrained within their original ROM (see 404 in FIG. 6). Thus, the computer program instructions provide a threshold limit to how far the central location 402 may be moved relative to its original location. This concept is illustrated in FIG. 6 wherein the central target position 402 has been moved inferiorly up to the limit of the ROM 404 of arm 304. Any further inferior movement of position 402 would be constrained by the system.

[0129] FIG. 6 schematically illustrates the system after OP 400 has been moved inferiorly such that the center of OP 400 is positioned closer to anus 412. As shown, arm 306 has been moved inferiorly along with the OP 400 such that its remote center of motion is located at the anus 412. Slide 406 provides a visual representation of arm 306 positioned at the inferior end of its range of motion. Since both the OP and arm 306 have been moved with the system unlocked, the slide 406 has been moved inferiorly from its initial position (shown in FIG. 5). Slide 404 provides a visual representation of arm 304 positioned at the superior end of its range of motion. Although arm 304 has not moved, the center of OP 402 has moved inferiorly, resulting in the range of motion 404 of arm 304 to move inferiorly. Slide 404 has not moved during the movement of the OP 402 such that the range of motion of arm 304 remains the same. The distance between the remote centers of motion of arms 304 and 306 has been increased, allowing the physician to perform the procedure without harming the patient or risking a collision of instruments.

[0130] Fig. 10A illustrates a distal portion of a surgical circular stapling instrument 500 in accordance with an illustrative embodiment. Surgical instrument 500 includes an end effector 510, an elongated shaft 505 and, in some embodiments, a wrist assembly (not shown) coupling end effector 510 to shaft 505. End effector 510 generally comprises a circular stapling assembly 520, an anvil 530 and a capturing device (not shown) for advancing and retracting anvil 530 relative to stapling assembly 520. The anvil shaft 534 is insertable into an internal channel ofstaple assembly 520 and is removably and slidably securable therein. The capturing device (not shown) is configured to advance and withdraw through this internal channel to translate anvil 530 along a longitudinal axis relative to staple assembly 520 to approximate or un-approximate anvil 530 relative to staple assembly 520. The anvil head 530 includes a tissue contacting surface 536 defining staple forming pockets (not shown) for receiving staples deployed by staple assembly 520

[0131] Staple assembly 520 comprises a housing having a substantially cylindrical main body with an internal channel for receiving a cutting element assembly, a staple pusher, and a staple cartridge (not shown). Stapling assembly 520 may be removably coupled to shaft 505, or permanently affixed thereto. In certain embodiments, stapling assembly 520 is a disposable component of instrument 520 and may be removably attached to shaft 505. In other embodiments, staple cartridge is a disposable component of instrument and may be removably coupled to staple assembly 520. In other embodiments, the entire instrument 520 is manufactured together and may be either a disposable or reusable instrument. Any of the control input devices described herein may be used to control instrument 500.

[0132] With reference to FIG. 10B, an exemplary embodiment of a teleoperated surgical instrument 550 that may support the circular stapler instruments described herein will now be described. As shown, instrument 550 generally includes a proximal housing 561 at its proximal end and coupled to shaft 570 of the instrument and a circular stapling assembly 580 at the distal end of shaft 570. Circular stapling assembly 580 may comprise any known stapling assembly including the one described above in reference to FIG. 10A.

[0133] Proximal housing 561 may include an instrument memory or storage device (not shown). The memory can perform several functions when the instruments are loaded on a manipulator arm (not shown) of a robotic control system. For example, the memory can provide a signal verifying that the instrument is compatible with that particular surgical system. Additionally, the memory may identify the instrument and end effector type (whether it is a delivery instrument, circular stapler, or the like) to the surgical system so that the system can reconfigure its programming to take full advantage of the instrument's specialized capabilities. As further discussed below, the memory may include specifics on the architecture of the instrument, and include particular values that should be employed in control algorithms, such as tool compliance and gain values.

[0134] Proximal housing 561 also may include a force / torque drive transmission mechanism (not shown) for receiving output from the motors of the manipulator arm. Theforce / torque drive transmission mechanism transmits the output from the motors to an end effector 580 of the instrument through an instrument shaft 570 mounted to the transmission mechanism. Exemplary surgical robotic instruments, instrument / manipulator arm interface structures, and data transfer between the instruments and servomechanism is more fully described in U.S. Pat. No. 6,331,181, the full disclosure of which is incorporated herein by reference.

[0135] In certain embodiments, surgical instrument 500 may provide force / torque feedback to the user that can be used as a deployment diagnostic to optimize placement of the anvil or the stapling assembly at the target location. In one such embodiment, a plurality of force / torque sensors are disposed on the anvil and / or the staple assembly. The force / torque sensors are coupled to a controller located within housing 561 or remote from housing in a robotically teleoperated surgical system, such as the one described above.

[0136] In one embodiment, instrument 550 includes one or more force / torque sensors located on a component of an anvil delivery instrument. The sensors are configured to detect a force or torque applied to the anvil during deployment of the anvil into the expanded configuration. Alternatively, the sensors may detect the force or torque applied by the proximal actuator to the anvil delivery instrument. The controller is configured to receive this force / torque information from sensors and to provide user input on the amount of force applied to tissue during expansion of the anvil. In certain embodiments, the controller may include a processor that is configured to alert the user and / or automatically override the actuator within the instrument to stop the expansion of the anvil if, for example, the force exerted thereon exceeds a threshold amount.

[0137] In another such embodiment, instrument 550 includes one or more force / torque sensors located on the anvil itself. The sensors are configured to detect a force or torque applied to the anvil head as the instrument manipulates the anvil to the target site within the patient, or as the anvil head is moved into the expanded configuration. The controller is configured to receive this force / torque information from sensors and to provide user input on the amount of force applied to tissue during manipulation and / or expansion of the anvil. In certain embodiments, the controller may include a processor that is configured to alert the user and / or automatically to stop or alter the movement of the anvil if, for example, the force exerted thereon exceeds a threshold amount.

[0138] Alternatively, the processor in the controller may be configured to control the rate of expansion or collapse of the anvil by the user. For example, instrument 550 may include one or more sensors that provide velocity or rotational or longitudinal movement of the actuatorthat expands and contracts the anvil head. These sensors may transmit this information to controller and controller may be configured to ensure that the anvil is expanded or collapsed at a specified rate, and / or below a threshold rate. Alternatively, the controller may control the entire movement of the actuator such that, for example, the user simply engages with an ON / OFF type user interface (e.g., a button). Once the interface is engaged by the user, the controller takes over the operation of the actuator and ensures that anvil is expanded or collapsed at a specified rate.

[0139] The input couplers within housing 561 may interface with, and be driven by, corresponding output couplers (not shown) of a telesurgical surgery system, such as the system disclosed in U.S Pub. No. 2014 / 0183244A1, the entire disclosure of which is incorporated by reference herein. The input couplers are drivingly coupled with one or more input members (not shown) that are disposed within the instrument shaft 570. The input members are drivingly coupled with the end effector 580. Suitable input couplers can be adapted to mate with various types of motor packs (not shown), such as the stapler-specific motor packs disclosed in U.S. Pat. No. 8,912,746, or the universal motor packs disclosed in U.S. Pat. No. 8,529,582, the disclosures of both of which are incorporated by reference herein in their entirety. Further details of known input couplers and surgical systems are described, for example, in U.S. Pat. No. 8,597,280, U.S. Pat. No. 7,048,745, and U.S. Pat No. 10,016,244. Each of these patents is hereby incorporated by reference in its entirety for all purposes.

[0140] Referring now to FIGS. 23A-23D, circular stapling instrument 500 is particularly useful for joining two tubular structures in a patient, such as arteries, veins, and / or intestinal tissue 2002. For example, in a lower colon procedure, the surgeon typically uses a conventional linear stapler with two rows of staples placed on either side of the affected intestinal lesion to be removed and stapled. The target area is cut at the same time as the adjacent ends are stapled. After removing the affected area, the surgeon typically inserts anvil 530 of i n strum ent 500 into the proximal end of the lumen, proximal of the staple line. This is done by inserting anvil head 532 into an entrance that has been cut into the proximal lumen by the surgeon. In some embodiments, anvil 530 is placed transanally by placing anvil head 532 at the distal end of instrument 500 and inserting instrument 500 through the rectum.

[0141] In these procedures, the surgical team typically inserts the endoscope and any other necessary surgical instruments through entry points in the patient’s abdomen. As discussed above, based on the location of the center of the OP 402 (see FIG. 5), the range of motion of manipulator arm 306 (see FIG. 4) may not be long enough to allow the user to place arm 306 atthe anus for insertion. If the distance between the patients’ umbilicus 410 and anus 412 is larger than the distance between the remote centers of motion of arms 304 and 306, then the user will not be able to place arm 306 at the anus.

[0142] In this situation, the surgical team unlocks the OP 400 and arm 306 by actuating one of the triggers discussed above, such as a port clutch button, magnetic code or simply by rotating arm 306 beyond a threshold degree (see FIGS. 7A-7C). The surgical team may then move arm 306 inferiorly which automatically moves the center of the OP 400 inferiorly to allow this movement beyond the original range of motion of arm 306 (see FIG. 8). Once the user has positioned arm 306 in the desired location, the OP 400 and robotic arms may be locked back up (automatically by the controller or manually by the surgical team) such that the arms are restrained from moving a certain distance away from the new location of the OP.

[0143] Once anvil 530 is positioned within a first section 2004 of separated intestinal tissue 2002, staple assembly 520 is positioned within a second section 2006 of the intestinal tissue. A staple pusher within assembly 520 is advanced distally such that the staples pass through first and second sections 2004, 2006 and deform against anvil 530 to join and seal the tissue sections 2004, 2006. A knife within staple assembly 520 is also advanced distally to sever tissue structures 2004, 2006 inwardly from the staples to complete the anastomosis.

[0144] Referring now to FIGS. 11 and 12, in certain embodiments, stapling assembly 520 comprises a housing 550 having a substantially cylindrical main body 552 with an internal channel 554 for receiving a cutting element assembly 560, a staple pusher 570 and a staple cartridge 580. Housing 550 couples the stapling assembly 520 to shaft 505. In some embodiments, housing 550 may comprise an inclined surface 553 that tapers inwardly in the proximal direction to accommodate a stapling assembly 520 having a larger diameter than shaft 505.

[0145] Stapling assembly 520 may be removably coupled to shaft 505, or permanently affixed thereto. In certain embodiments, stapling assembly 520 is a disposable component of instrument 520 and may be removably attached to shaft 505. In other embodiments, staple cartridge 580 is a disposable component of instrument and may be removably coupled to staple assembly 520. In other embodiments, the entire instrument 520 is manufactured together and may be either a disposable or reusable instrument.

[0146] In an exemplary embodiment, housing 550 includes one or more keying features within channel 554 that inhibit or prevent rotation of stapler pusher 570 and cuttingelement assembly 560. In a preferred embodiment, the keying features comprise one or more projections 556 extending into channel 554 that cooperate with slots 572 in stapler pusher 570 (see FIGS. 24A and 24B). In one embodiment, cutting element assembly 560 also includes slots 561 aligned with slots 572 such that projections 556 extend through both sets of slots 561, 572 to inhibit or prevent rotation of stapler pusher 570 and cutting element assembly 560 relative to housing 550. Alternatively, housing 550 may further include additional projections (not shown) that extend into corresponding slots in cutting element assembly 560.

[0147] As shown in FIGS. 11 and 12, anvil 530 includes an anvil head 532 and an anvil shaft 534. Anvil shaft 534 is removably and slidably securable within internal channel 554 of housing 550. Capturing device 540 is configured to advance and withdraw through and internal bore 558 in housing 550 to translate anvil 530 along a longitudinal axis relative to staple assembly 520 to approximate or un-approximate anvil 530 relative to staple assembly 520. Anvil head 532 includes a tissue contacting surface 536 defining staple forming pockets (not shown) for receiving staples 2000, as discussed below in reference to FIGS. 14-16.

[0148] As shown in FIG. 13A, staple pusher 570 defines a substantially cylindrical shape and is coaxially and slidably disposed within internal channel 554 of housing 550. Staple pusher 570 includes a main body 574 and at least one annular array of distally extending fingers 576 extending from body 574. Each finger 576 is configured to be received within a slot of a staple cartridge 580 to engage staples 2000, as discussed above. Staple pusher 570 is configured to advance relative to housing 550 to engage, drive and eject staples 2000 against the staple forming pockets of anvil 530. As shown in FIG 11., fingers 576 of staple pusher 570 are preferably recessed proximally from the distal end of housing 550 to provide room for staple cartridge 580.

[0149] Staple cartridge 580 may include one, two or more than two annular arrays or rows of fingers with staple receiving slots (not shown) for receiving one or more sets of concentric staple arrays 2000 (see FIG. 12). Staple cartridge 580 is removably or permanently coupled to staple pusher 570 such that staple pusher 570 may drive staples 2000 from cartridge 580 into tissue (discussed in more detail below). In particular, distal fingers 576 of staple pusher 570 are configured to advance into the slots of cartridge 580 to drive staples 2000 distally.

[0150] In certain embodiments, staple cartridge 580 comprises an annular main body 582 with circumferential slots 584 that extend between the distal end of an array of distal fingers 576 on staple pusher 570 and the inner surface of housing 550. Slots 584 function to align staples 2000 with fingers 576 of staple pusher 570 such that distal movement of staple pusher 570causes staples 2000 to move distally to engage and deform against tissue contacting surface 536 of anvil 530.

[0151] Referring to FIG. 12, cutting element assembly 560 generally comprises an annular pusher 564 and an annular cutting element or knife 566 at the distal end of pusher 564. Pusher 564 is configured to advance relative to housing 550 to drive knife 566 through tissue disposed between anvil 530 and stapling assembly 520.

[0152] Instrument 500 further includes a driver 590 for advancing cutting element assembly 560 and staple pusher 570 towards anvil 530. Driver 590 comprises an internal lumen 598 extending therethrough. Capturing device 540 is configured for advancement through internal lumen 598 to engage and translate anvil 530 towards and away from stapling assembly 520. Driver 590 has a proximal end suitably coupled to an actuation mechanism (not shown) for rotating driver 590 relative to end effector 510. In some embodiments, instrument 500 comprises a wrist assembly (not shown) pivotally coupling end effector 510 with shaft 505. At least a portion of driver 590 is movable through the wrist assembly between shaft 505 and end effector 510. In one such embodiment, the wrist assembly comprises one or more linkages for articulating the end effector around first and second axes, respectively. The first and second axes may be, for example, yaw and pitch axes.

[0153] In embodiments, driver 590 comprises the distal portion described above for engaging the staple and knife pushers and a flexible portion (not shown) that extends through the wrist member when the distal portion is within end effector 510. The flexible portion allows the distal portion to articulate relative to the proximal portion when end effector 510 articulates about the wrist member. The drive member further comprises a proximal portion (not shown) extending through the shaft and configured for coupling to an actuator, such as instrument handle or an external control system. In various embodiments, the flexible portion of driver 590 comprises a bendable laser cut hypo tube that extends through shaft 505 of instrument 500. The hypo tube has sufficiently flexibility to bend as the end effector 510 is rotated relative to shaft 505.

[0154] As shown in FIGS. 11 and 12, driver 590 comprises an elongate rod 591 that includes proximal and distal sets of external threads 592, 594 (with proximal being defined as the direction towards shaft 505). In an exemplary embodiment, distal threads 594 of driver 590 are spaced from proximal threads 592 by a gap 596 (discussed in more detail below).

[0155] Referring again to FIGS. 11 and 14, staple pusher 150 comprises a proximal shaft 575 slidably disposed within channel 554 of housing 550. Shaft 575 includes internal threads578 configured to cooperate and engage with proximal threads 592 of driver 590 such that rotation of driver 590 causes longitudinal movement of stapler pusher 570. Similarly, cutting element assembly 560 comprises a proximal shaft 568 disposed within central bore 558 of housing 550. Shaft 568 includes internal threads 569 to cooperate and engage with distal threads 594 of driver 590 such that rotation of driver 590 causes longitudinal movement of cutting element assembly 560.

[0156] Referring now to FIGS. 14-16, in an initial position prior to deployment of staples 2000 and knife 566, the distal surface of knife 566 is proximally recessed from the distal surface of staple cartridge 580 (see FIGS. 14 and 15). As driver 590 is rotated, it causes both knife pusher 564 and stapler pusher 570 to advance distally. Since knife 566 is proximally recessed from the distal surface of staple cartridge 580, the staples 2000 are driven into the tissue and against tissue contacting surface 536 of anvil 530 before knife 566 extends distally of housing 550 (see FIG. 15). Thus, staples 2000 are fully formed through the tissue before the knife 566 cuts into the tissue. This ensures that the tissues structures are sealed or attached to each other before the knife 566 cuts through them, ensuring that the tissue structures have not displace relative to each other or instrument 500 between the time the staples are formed and the knife cuts the tissue.

[0157] As shown in FIG. 15, after the staples 2000 have been fully formed, internal threads 578 of staple pusher 570 move distally of proximal threads 592 of driver 590 such that they are aligned with gap 596. This causes staple pusher 570 to disengage from driver 590 such that further rotation of driver 590 does not move stapler pusher 570 in the distal direction.

[0158] Referring now to FIG. 15, after the staples 2000 have been fully formed in the tissue, driver 590 continues to rotate to advance knife pusher 564 and knife 566 in the distal direction until knife 566 extends beyond the distal end of housing 550 and severs the tissue.

[0159] Referring now to FIGS. 23A -23D, instrument 500 is particularly useful for j oining two tubular structures in a patient, such as arteries, veins, and / or intestinal tissue 2002. For example, in a lower colon procedure, the surgeon typically uses a conventional Linear stapler with two rows of staples placed on either side of the affected intestinal lesion to be removed and stapled. The target area is cut at the same time as the adjacent ends are stapled. After removing the affected area, the surgeon typically insens anvil 530 of instrument 500 into the proximal end of the lumen, proximal of the staple line. This is done by inserting anvil head 532 into an entrance that has been cut into the proximal lumen by the surgeon. In some embodiments, anvil 530 is placed transanally by placing anvil head 532 at the distal end of instrument 500 and inserting instrament 500 throughthe rectum. The proximal end of the intestine is then tied to anvil shaft 534 using a purse string suture or other conventional tying device and the proximal and distal ends of the intestine are tightened within the gap by closing the gap between anvil 530 and staple cartridge 580

[0160] As shown in FIG. 23 A, anvil 530 is positioned within a first section 2004 of separated intestinal tissue 2092 and staple assembly 520 is positioned with a second section 2006 of the intestinal tissue. As shown in FIGS. 23B and 23C, staple pusher 570 is advanced distally such that staples 2000 pass through first and second sections 2004, 2006 and deform against anvil 530 to join and seal the tissue sections 2004, 2006. At this point, tissue sections 2004, 2006 are stable and generally do not move relative to each other or instrument 500. As shown in FIG. 23D, knife 566 is then advanced distally to sever tissue structures 2004, 2006 inwardly from staples 200 to complete the anastomosis.

[0161] Referring now to FIGS. 24A-24C, an alternative embodiment of circular stapler 500 will now be described. In this embodiment, distal threads 594 of driver 590 have a different pitch than proximal threads 592 of driver 590 such that each single rotation of driver 590 moves staple pusher 570 a different distance than knife pusher 564. In addition, this configuration may provide a stronger mechanical advantage to either stapler pusher 570 or knife pusher depending on which thread has a higher thread count per inch. In one embodiment, proximal threads 592 have a shorter distance between adjacent threads, i.e., a higher thread count per inch, than the distance between adjacent threads of distal threads 594. Thus, staple pusher 570 will be provided with a higher mechanical advantage than knife pusher 564. In addition, knife pusher 564 will travel further (and / or faster) than staple pusher 592 for each single rotation of driver 590.

[0162] In an exemplary embodiment, the ratio of the thread count per inch between distal threads 594 and proximal threads 592 is about 1 to 1.25 to about 1 to 2, or about 1 to 1.5. Thus, the ratio of the force applied by driver 590 to knife pusher 564 relative to staple pusher 570 is about 1 to 1.25 to about 1 to 2.0, or about 1 to about 1.5.

[0163] As shown in FIG. 24A, in the initial position, the distal surface of knife 566 is recessed further from the distal surface of staple pusher 570 to account for the increased travel distance of knife 566. Rotation of driver 590 causes both pushers to move distally until staples 2000 are fully formed (see FIG. 24B). At this point, the distal surface of knife 566 is still proximal of the distal surface of staple assembly 520. In addition, proximal threads 592 of driver 590 have disengaged from 578 internal threads of stapler pusher 570 such that staple pusher 570 no longer advances distally. As shown in FIG. 24C, further rotation of driver 590 causes knife 566 toadvance distal of staple assembly 520 to sever tissue between staple assembly 520 and anvil 530.

[0164] Referring now to FIGS. 17A-17D, an alternative embodiment of a circular stapling instrument 2100 will now be described. As shown, instrument 2100 includes a staple assembly 2102 having a driver 2104, a staple pusher 2106 and a knife pusher 2108 as described above. In this embodiment, driver 2104 includes a single set of threads 2110 rather than two sets of threads as described with instrument 2100. In addition, driver 2104 is disposed laterally outward from staple pusher 2106 and knife pusher 2108. Staple pusher 2106 comprises screw threads 2112 on a laterally outward surface of staple pusher 2106 and knife pusher 2108 comprises threads 2114 on a laterally outward surface of knife pusher 2108. Threads 2112 are positioned proximally of threads 2110.

[0165] As shown in FIG. 17A, threads 2106 of driver 2104 initially engage only the distal threads 2110 on staple pusher 2106. As driver 2104 is rotated, it advances stapler pusher 2106 in the distal direction (see FIG. 17B). Once stapler pusher 2106 has advanced to the point where staples 2130 are formed against anvil 2122, threads 2110 of driver 2104 disengage from the distal threads 2112 of staple pusher 2106 and driver threads 2110 contact threads 2114 of knife pusher 2108 to advance knife pusher 2108 distally (see FIG. 17C). Further rotation of driver 2104, then causes distal movement of knife pusher 2108 until the knife 2120 contacts and severs tissue between anvil 2122 and the distal surface of staple assembly 2102 (see FIG. 17D).

[0166] Referring now to FIGS. 18A-18D, in this embodiment, an instrument 2200 includes a staple assembly 2202 having a driver 2204, a staple pusher 2206 and a knife pusher 2208 as described above. In this embodiment, driver 2204 includes a single set of threads 2210 and is disposed laterally inward from staple pusher 2206 and knife pusher 2208 (similar to the embodiment shown in FIGS. 22 and 23). Staple pusher 2206 comprises screw threads 2212 on a laterally inward surface of staple pusher 2206 and knife pusher 2208 comprises threads 2214 on a laterally inward surface of knife pusher 2208. Threads 2214 are positioned proximally of threads 2212.

[0167] As shown in FIG. 18 A, threads 2210 of driver 2204 initially engage only the distal threads 2212 on staple pusher 2206. As driver 2204 is rotated, it advances stapler pusher 2206 in the distal direction and threads 2210 move proximally (see FIG. 18B). Once stapler pusher 2206 has advanced to the point where staples 2220 are formed against anvil 2222, threads 2210 of driver 2204 disengage from the distal threads 2212 of staple pusher 2206 engage the proximal threads 2214 of knife pusher 2208 (see FIG. 18C). Further rotation of driver 2204, thencauses distal movement of knife pusher 2208 until the knife 2230 contacts and severs tissue between anvil 2222 and the distal surface of staple assembly 2202 (see FIG. 18D).

[0168] Referring now to FIGS. 19A-19C. in this embodiment, an instrument 2250 includes a staple assembly 2252 having a driver (not shown), a staple pusher 2256 and a knife pusher 2258 as described above. In this embodiment, the driver includes a single set of threads 2260 and is disposed laterally inward from staple pusher 2256 and laterally outward from knife pusher 2258 (i.e., between staple pusher 2256 and knife pusher 2258). Staple pusher 2256 comprises screw threads (not shown) on a laterally inward surface of staple pusher 2256 and knife pusher 2258 comprises threads (not shown) on a laterally outward surface of knife pusher 2258. The knife pusher threads are positioned proximally of the staple pusher threads

[0169] As shown in FIG. 19 A, threads 2260 of the driver initially engage only the distal threads on staple pusher 2256. As driver 2254 is rotated, it advances stapler pusher 2256 in the distal direction and threads 2260 move proximally (see FIG. 19B). Once stapler pusher 2256 has advanced to the point where the staples are formed against anvil 2270, threads 2260 of driver 2254 disengage from the distal threads of staple pusher 2256 and engage the proximal threads of knife pusher 2258 (see FIG. 19C). Further rotation of driver 2254, then causes distal movement of knife pusher 2258 until the knife 2272 contacts and severs tissue between anvil 2270 and the distal surface of staple assembly 2252 (see FIG. 19D).

[0170] Referring now to FIGS. 20-22, another embodiment of a circular stapling instrument 2300 will now be described. As shown, instrument 2300 comprises a circular stapling assembly 2320, an anvil 2330 and a capturing device 2340 for advancing and retracting anvil 2330 relative to stapling assembly 2320. Stapling assembly 2320 comprises a housing 2350 having a substantially cylindrical main body with an internal channel for receiving a cutting element assembly 2360, a staple pusher 2370 and a staple cartridge 2380.

[0171] Similar to the embodiment shown in FIGS. 11 and 12, anvil 2330 includes an anvil head and an anvil shaft. The anvil shaft is insertable into an inner bore of housing 2350 and is removably and slidably securable within this bore. Capturing device 2340 is configured to translate through the bore to translate anvil 2334 along a longitudinal axis relative to staple assembly 2320 to approximate or un-approximate anvil 2330 relative to staple assembly 2320. The anvil head includes a tissue contacting surface defining staple forming pockets (now shown) for receiving the staples, as discussed previously.

[0172] Staple pusher 2370 defines a substantially cylindrical shape and is coaxiallyand slidably disposed within an internal channel of housing 2350. Cutting element assembly 2360 generally comprises an annular pusher and an annular cutting element or knife. Pusher 2364 is configured to advance relative to housing 2350 to drive the knife through tissue disposed between anvil 2330 and staple assembly 2320.

[0173] Instrument 2300 further includes first and second drivers 2390, 2392 for advancing cutting element assembly 2360 and staple pusher 2370, respectively, towards anvil 2330. In this embodiment, drivers 2390, 2392 comprise compressive drive mechanisms configured to advance longitudinally through housing 2350 to advance staple pusher 2370 and the knife pusher. In an exemplary embodiment, these compressive drive mechanisms comprise a bendable laser cut hypo tube that extends through shaft 2305 of instrument 2300. The hypo tubes have a proximal end (not shown) suitably coupled to an actuator that advances and retracts drivers 590, 592. The hypo tubes may be configured to extend through a wrist (not shown) of the instrument. Therefore, they have sufficiently flexibility to bend as the end effector 2310 is rotated relative to shaft 2305.

[0174] Referring now to FIG. 20, the distal surface of knife 2366 is initially recessed from the distal end of housing 2350. In one embodiment, the distal surface of knife 2366 is recessed from the distal end of staples 2000 and substantially aligned with the distal surface of staple pusher 2370. In this embodiment, drivers 590, 592 may be configured to simultaneously drive staple pusher and knife pusher such that the staples 2000 contact anvil 2330 before knife 2366 cuts the tissue. Thus, staples 2000 are fully formed through the tissue before the knife 2366 cuts into the tissue. This ensures that the tissues structures are sealed or attached to each other before the knife 2366 cuts through them, ensuring that the tissue structures have not moved relative to each other or instrument 2300 between the time the staples are formed and the knife cuts the tissue.

[0175] In an alternative embodiment, the distal surface of knife 2366 may, or may not, be recessed from the distal surface of staple assembly 2320. In this embodiment, first and second drivers 2390, 2392 advance the knife and staple pushers sequentially. Specifically, first driver 2390 advances staple pusher until the staples engage anvil 2330 and are fully formed through the tissue. After that occurs, second driver 2392 advances knife pusher to drive knife 2366 through the tissue. Alternatively, second drive 2392 may advance staple pusher 2370 at a faster rate than knife pusher 2360 (even if they start at the same relative location) such that the staples contact the tissue before the knife.

[0176] Referring now to FIGS. 25A-25C, another embodiment of an anvil 1130 for a circular stapler includes an anvil head 1132 and an anvil shaft 1134. Anvil shaft 1134 is insertable into an internal channel of staple assembly 520 and is removably and slidably securable therein. The capturing device (not shown) is configured to advance and withdraw through this internal channel to translate anvil 1130 along a longitudinal axis relative to staple assembly 520 to approximate or un-approximate anvil 1130 relative to staple assembly 520.

[0177] In this embodiment, anvil head 1132 comprises a central component 1140 and first and second lateral components 1142, 1144. In one embodiment, central component 1140 forms the central portion of a generally circular head 1132 and lateral components 1142, 1144 each comprise a semi-circular outer portion of the circular head 1132. In an exemplary embodiment, lateral components 1142, 1144 generally have the same size and shape, although it will be understood that one of the lateral components may be larger than the other.

[0178] As shown in FIG. 25B, central component 1140 is pivotally coupled to shaft 1134 such that it is movable from a collapsed configuration, wherein central component 1140 extends in a direction transverse, or substantially parallel to. shaft 1134 (FIG. 25B), to an expanded configuration, wherein central component 1140 extends in a direction traverse to, or substantially perpendicular to. shaft 1134 (FIG. 25C). In addition, first and second lateral components 1142, 1144 are pivotally coupled to central component 1140 such that they are movable between a collapsed configuration (FIG. 25B), wherein they are folded together towards central component 1140 and extend substantially perpendicular to central component 1140, to an expanded configuration, wherein lateral components 1142, 1144 extends substantially parallel to central component 140 to form an anvil suitable for cooperation with staple assembly 520 (FIG. 25C).

[0179] Anvil 1130 is configured such that it has a smaller cross-sectional area or lateral dimension (relative to the longitudinal axis of shaft 1134) in the collapsed configuration than in the expanded configuration. Lateral dimension is herein defined as the radial distance from the longitudinal axis of shaft to the furthest radial surface or point of the anvil 1130 from the longitudinal axis. In certain embodiments, anvil 1130 has a lateral dimension (or diameter in certain embodiments) of less than about 14 mm in the collapsed configuration such that anvil 1130 may be advanced through a cannula or other percutaneous entry point in the patient. Anvil 1130 may have a lateral dimension (or diameter) of at least about 20 mm or at least about 25 mm, or about 21 to about 33 mm in the expanded configuration, although it will be recognized that the dimensions of anvil 1130 may vary depending on the surgical procedure and the size of thepercutaneous entry point into the patient.

[0180] Anvil head 1132 is configured such that when central portion 1140 and lateral portions 1142, 1144 are in the expanded configuration, they form a substantially circular disc. The disc has sufficient rigidity to withstand the forces of clamping and / or driving staples through the tissue against the staple pockets on the proximal surface of head 1132. In addition, the staples pockets are aligned with the circumferential staples that are driven against these pockets by staple assembly 120.

[0181] Anvil 1130 may further include one or more driver(s) (not shown) within shaft 1134 that have a distal end portion coupled to the pivot joints between shaft 1134 and central component 1140 and / or the pivot joints between lateral components 1142, 1144 and central component 1140 for pivoting or rotating these components relative to each other. Alternatively, the driver(s) may be disposed within the circular stapler assembly 520, or within a separate anvil delivery instrument (not shown). The driver(s) may have a proximal end coupled to a suitable actuation mechanism (discussed in more detail below).

[0182] Referring now to FIGS. 26 and 27A-27C, another embodiment of an anvil 1200 includes an anvil head 1202 and an anvil shaft 1204. Anvil shaft 1204 is insertable into an internal channel of staple assembly 520 and is removably and slidably securable therein. The capturing device (not shown) is configured to advance and withdraw through this internal channel to translate anvil 1200 along a longitudinal axis relative to staple assembly 520 to approximate or un-approximate anvil 1200 relative to staple assembly 520. Anvil head 1202 is movable between a collapsed or substantially linear configuration (see FIGS. 26 and 27C) and an expanded or circular disc-shaped configuration (see FIG. 27A). Head 1202 has a smaller cross-sectional area or lateral dimension (relative to the longitudinal axis of shaft 1204) in the linear configuration than in the circular configuration.

[0183] Anvil head 1202 comprises one or more linkages that are movable between the linear and circular configurations. In one embodiment, head 1202 comprises first, second and third linkages 1206, 1208, 1210. Each linkage comprises an outer surface 1217 and an inner surface 1218 that form at least a partial sector of a circle (or a sector of a circle having a hollow central area). All of the linkages are designed to pivot towards each other such that the linkages form a circular disc 1240 (see FIG. 27A). Each linkage 1206, 1208, 2110 further comprises a tissue contacting surface defining staple forming pockets (not shown) for receiving staples 2000 (see FIGS. 23A-23D discussed above).

[0184] In an exemplary embodiment, each linkage 1206, 1208, 1210 is substantially the same shape (i.e., sector) and thus forms one-third of the circular disc 1240 (see FIG. 38 A), although it will be recognized that each linkage may have different shapes. In addition, it will be recognized that anvil head 1202 may comprise 2 linkages or 4 or more linkages. In addition, it should be recognized that certain of the linkages may be larger than the other linkages. For example, linkage 1206 may be semicircular, i.e., forming one-half of the disc 1240, while the remaining half is formed of 2 or more linkages. The staple forming pockets are circumferentially arranged on each linkage such that they align with staple bays in staple assembly 120 when the linkages are formed into disc 1240.

[0185] First linkage 1206 includes a pin 1224 pivotally coupled to a universal joint or disc 1212 on a distal end portion 1240 of anvil shaft 1204. Second linkage 1208 is pivotally coupled to first and third linkages 1206, 1210 with connecting pins 1214, 1216, respectively. Each linkage 1206, 1208, 1210 has a distance or radius between inner and outer surfaces 1217, 1218 that may be less than the overall radius of the circular disc when the linkages have formed together. Thus, as shown in FIG. 27A, the linkages form a central opening 1232 in the expanded configuration. This configuration reduces the overall size of the linkages, which facilitates the deployment process.

[0186] In one embodiment, disc 1212 of anvil shaft 1204 is a universal joint configured to transmit rotary power from shaft 1204 or an actuator within shaft 1204. Disc 1212 is rotatably coupled to distal end portion 1240 of shaft 1204 at pin 1222. Disc 1212 may be rotatable relative to shaft 1204 such that, for example, counterclockwise (or clockwise) rotation of disc 1212 causes linkage 1206 to rotate in a clockwise (or counterclockwise) direction. This rotation further causes linkage 1208 to rotate in a clockwise direction which, in turn causes linkage 1210 to rotate in the same direction until the side surfaces of each linkage contact each other to form the circular disc 1240 (see FIGS. 27A-27C).

[0187] Disc 1212 is also configured to pivot between a first configuration, wherein disc 1212 is substantially parallel to shaft 1204, and a second configuration, wherein disc 1212 is transverse to shaft 1204, or preferably perpendicular to shaft 1204. Disc 1212 is coupled to first linkage 1206 such that this rotation, in turn, rotates circular disc 1240 until it is substantially perpendicular to anvil shaft 1204 and presents the tissue contacting surface in the proximal direction for receiving staples from staple assembly 120.

[0188] In use, disc 1212 and that attached linkages 1206, 1208, 1210 first rotateabout pin 1222 until they are substantially perpendicular to shaft 1204. Then, linkages 1206, 1208, 1210 sequentially rotate about their connecting pins 1224, 1214 and 1216 until they each contact disc 1212 to form the overall circular disc 1240.

[0189] Anvil 1200 may further include one or more driver(s) (not shown) within shaft 1204 that has a distal end portion coupled to joint 1212 for rotating and / or pivoting joint 1212. Alternatively, the driver(s) may be disposed within the circular stapler assembly 120, or within a separate anvil delivery instrument (not shown). The driver(s) may have a proximal end coupled to a suitable actuation mechanism (discussed in more detail below).

[0190] Referring now to FIGS. 28A and 28B, another embodiment of an anvil 1300 includes an anvil head 1304 and an anvil shaft 1302. As in previous embodiments, anvil shaft 1302 is insertable into an internal channel of staple assembly 120 and is removably and slidably securable therein. Anvil head 1304 comprises one or more linkages 1306, 1308 that are movable between linear and circular configurations. Each linkage comprises an outer surface 1316 and an inner surface 1318 that form a sector of a circle. All of the linkages are designed to pivot towards each other such that the linkages form a circular disc (similar to disc 1240 in FIG. 27A). Each linkage further comprises a tissue contacting surface defining staple forming pockets (not shown) for receiving staples 2000.

[0191] In an exemplary embodiment, anvil head 1302 comprises four linkages that are substantially the same shape (i.e., a partial sector of a circle) and thus form one-fourth of the circular disc, although it will be recognized that each linkage may have different shapes. In addition, it will be recognized that anvil head 1302 may comprise 2, linkages, 3 linkages or 5 or more linkages. For example, FIG. 28B illustrates an embodiment with 2 linkages 1306, 1308 that each comprise a semicircle. In addition, it should be recognized that certain of the linkages may be larger than the other linkages. For example, linkage 1306 may be a semicircular, forming one- half of the discs, while the remaining half is formed of 2 or more linkages.

[0192] Linkages 1306, 1308 are pivotally coupled to each other at a joint 1340, 1342 on their side surfaces. The proximal linkage 1306 is also pivotally coupled to a bar or rod 1320 at a joint 1330. Bar 1320 is, in turn, pivotally coupled to a head 1322 of a distal end portion 1326 of shaft 1302 by a joint 1332. Distal end portion 1326 is, in turn, is pivotally coupled to the remainder of shaft 1302 by a hinge or pin 1324 that extends through a channel (not shown) in shaft 1302 such that distal end portion 1326 may pivot between a substantially parallel orientation relative to shaft 1304 (see FIG. 39A) to a substantially perpendicular orientation (see FIG. 28B).

[0193] In use, distal end portion 1326 rotates about pin 1332 into a substantially perpendicular orientation relative to shaft 1302 (see FIG. 28B). Then, the various linkages 1306, 1308 rotate about head 1322 until they form the circular disc that presents the tissue contacting surface in the proximal direction for receiving staples from staple assembly 120.

[0194] Anvil 1300 may further include one or more driver(s) (not shown) within shaft 1304 that has a distal end portion coupled to head 1322 for rotating and / or pivoting head 1322. Alternatively, the driver(s) may be disposed within the circular stapler assembly 120, or within a separate anvil delivery instrument (not shown). The driver(s) may have a proximal end coupled to a suitable actuation mechanism (discussed in more detail below).

[0195] Referring now to FIGS. 29A and 29B, another embodiment of an anvil 1350 includes an anvil head 1352 and an anvil shaft 1354. Similar to previous embodiments, anvil shaft 1354 is insertable into an internal channel of staple assembly 520 and is removably and slidably securable therein. Anvil head 1352 is movable between a collapsed or stacked configuration (FIG. 40A) and an expanded or circular disc-shaped configuration (FIG. 29B). Head 1352 has a smaller cross-sectional area or lateral dimension (relative to the longitudinal axis of shaft 1354) in the stacked configuration than in the circular configuration.

[0196] In this embodiment, anvil head 1352 comprises one or more linkages that are movable between “stacked” and “unstacked” configurations. In one embodiment, head 1352 comprises first, second, third and fourth linkages 1356, 1358, 1360, 1362. Each linkage comprises an outer surface and an inner surface that form a sector of a circle. All of the linkages are designed to move from a stacked configuration (FIG. 29A) to an unstacked configuration such that the linkages form a circular disc (see FIG. 29B). The linkages are substantially aligned with the longitudinal axis of shaft 1354 in the stacked configuration. Anvil 1350 may further include one or more driver(s) (not shown) within shaft 1354 having a distal end portion coupled to a joint or linkage at the distal end of shaft 1354 for rotating and / or pivoting linkages 1356, 1358, 1360, 1362. Alternatively, the driver(s) may be disposed within the circular stapler assembly 520, or within a separate anvil delivery instrument (not shown). The driver(s) may have a proximal end coupled to a suitable actuation mechanism (discussed in more detail below).

[0197] As shown in FIG. 29B, in the stacked configuration, each linkage comprises proximal and distal surfaces 1382, 1380. The proximal surfaces 1382 contain staple pockets (not shown) for receiving staples from staple assembly 120. In this configuration, the proximal surface 1382 of linkage 1356 faces anvil shaft 1354 and may be in contact with shaft 1354. The proximalsurface 1382 of linkage 1358 faces the distal surface 1380 of linkage 1360 and may be in contact with this surface (and so on for each linkage in the stack).

[0198] Each linkage 1356, 1358, 1360, 1362 has a distance or radius between their inner and outer surfaces that may be less than the overall radius of the circular disc when the linkages have formed together. Thus, as shown in FIG. 29B, the linkages form a central opening 1370 in the expanded configuration. This configuration reduces the overall size of the linkages, which facilitates the deployment process.

[0199] In an exemplary embodiment, linkages 1356, 1358, 1360, 1362 are substantially the same shape (i.e., sector) and thus form one-fourth of the circular disc, although it will be recognized that each linkage may have different shapes. In addition, it will be recognized that anvil head 1352 may comprise 2 or 3 linkages or 5 or more linkages. In addition, it should be recognized that certain of the linkages may be larger than the other linkages. For example, linkage 356 may be a semicircular, forming one-half of the discs, while the remaining half is formed of 2 or more linkages.

[0200] Referring now to FIGS. 30 A, 30B and 31 A-31C, another embodiment of an anvil 1400 includes an anvil head 1402 and an anvil shaft 1404. Similar to previous embodiments, anvil shaft 1404 is insertable into an internal channel of staple assembly 120 and is removably and slidably securable therein. Anvil head 1402 is movable between a collapsed or folded configuration (see FIG. 31 A) and an expanded or dome-shaped configuration (see FIG. 31C). Head 1402 has a smaller cross-sectional area or lateral dimension (relative to the longitudinal axis of shaft 1404) in the collapsed configuration than in the expanded configuration.

[0201] As shown in FIGS. 31A-31C, anvil head 1402 comprises a plurality of leaves or petals 1406 coupled to each other such that the petals 1406 overlap with each other in the folded configuration. Upon expansion, petals 1406 are configured to form a substantially domed or umbrella shape with a convex outer surface 1440 having an apex 1442 and a concave inner surface 1436 (see FIGS. 31 A and 3 IB). Apex 1442 may be coupled to a distal end portion of shaft 1404. Alternatively, petals 1406 may be configured to expand further such that anvil head 1402 has a substantially flat or circular disc shape in the expanded configuration (similar to previous embodiments). Head 1402 may include at least two petals 1406, or three or more petals 1406.

[0202] One or more of the petals 1406 (or all of the pedals) comprise a tissue contacting surface 1436 that comprises staple forming pockets (not shown) for receiving staples from staple assembly 120. The petals 1406 are configured such that, in the expanded configuration,the staple pockets are configured to align with the staples in staple assembly 120. In certain embodiments, each of the petals 1406 comprises one or more staple forming pockets. In other embodiments, the staple forming pockets may alternate between pedals 1406 such that, for example, one pedal may contain a staple forming pocket while its adjacent pedals do not contain a staple forming pocket.

[0203] In this embodiment, petals 1406 are designed to overlap with each other in both the expanded and collapsed or folded configurations. Thus, in the expanded configuration, petals 406 overlap with each other to provide mutual support and rigidity to anvil head 1402 such that it can resist the forces of the stapling operation. Anvil 1400 may further include a driver (not shown) within shaft 1404 that has a distal end portion coupled to head 1402 for expanding and collapsing pedals 1406. For example, anvil head 1402 may include one or more rigid elements coupled to pedals 1406 designed to telescope or move radially outward to push pedals outward and expand head 1402. Alternatively, the driver(s) may be disposed within the circular stapler assembly 520, or within a separate anvil delivery instrument (not shown). The actuator may have a proximal end coupled to a suitable actuation mechanism (discussed in more detail below).

[0204] Referring now to FIGS. 32A and 32B, another embodiment of an anvil 1500 includes an anvil head 1502 and an anvil shaft 1504. As with previous embodiments, anvil shaft 1504 is insertable into an internal channel of staple assembly 120 and is removably and slidably securable therein. Anvil head 1502 is movable between a collapsed or folded configuration (see FIG. 32B) and an expanded or dome-shaped configuration (see FIG. 32A). Head 1502 has a smaller cross-sectional area or lateral dimension (relative to the longitudinal axis of shaft 1504) in the folded configuration than in the dome-shaped configuration.

[0205] Anvil head 1502 comprises a plurality leaves or petals 1506 coupled to each other such that the petals 1506 overlap with each other in the folded configuration. Upon expansion, petals 1506 are configured to form a substantially domed or umbrella shape with a convex outer surface 1508 and a concave inner surface (not shown). Alternatively, petals 1506 may be configured to expand further such that anvil head 1502 has a substantially flat or circular disc shape in the expanded configuration. Head 1502 may include at least two petals 1506, or three or more petals 1506.

[0206] One or more of the petals 1506 (or all of the pedals) have a tissue contacting surface comprising one or more staple forming pockets (not shown) for receiving staples from the staple assembly 520. The petals 1506 are configured such that, in the expanded configuration, thestaple pockets are configured to align with the staples in staple assembly 520. In certain embodiments, each of the petals 1506 comprises one or more staple forming pockets. In other embodiments, the staple forming pockets may alternate between pedals 1506 such that, for example, one pedal may contain a staple forming pocket while its adjacent pedals do not contain a staple forming pocket.

[0207] Anvil head 1502 further comprises one or more substantially rigid elements or rods 1510 extending substantially from a proximal surface edge 1512 to a central portion or apex 1514 of head 1502. Rods 1510 are configured to expand outward with petals 1506 and provide stability and rigidity to head 1502 in the expanded configuration. Rods 1510 may include one or more ridges or other surface features thereon to provide additional stability to head 1502 as it is expanded. Rods 1510 are configured to pivot at apex 1514 and proximal surface 1512 to allow transformation of anvil head 1502 between the expanded and collapsed configurations.

[0208] In some embodiments, anvil head 1502 may further include one or more cables extending around head 1502 to transition the head between the collapsed and expanded configurations. In one such embodiment, head 1502 comprise a lower cable 1530 and an upper cable 1532. Lower cable 1530 is disposed in a proximal region of pedals 1506 near proximal surface 1512 and upper cable 1532 is disposed in a distal region of head 1502 near apex 1514. Cables 1530, 1532 are coupled to one or more driver(s) (not shown) that extend through shaft 1504 of anvil 1500 and are configured to tension cables 1530, 1532 to expand anvil head 1502 into the umbrella or dome shape. The driver(s) (not shown) may have a proximal end coupled to a suitable actuation mechanism (discussed in more detail below).

[0209] Referring now to FIGS. 33A-33C, another embodiment of an anvil 1600 includes an anvil head 1602 and an anvil shaft 1604. Similar to previous embodiments, anvil shaft 1604 is insertable into an internal channel of staple assembly 520 and is removably and slidably securable therein. Anvil head 1602 is movable between a collapsed or folded configuration (see FIG. 33A) and an expanded or dome-shaped configuration (see FIGS. 33B and 33C). Head 1602 has a smaller cross-sectional area or lateral dimension (relative to the longitudinal axis of shaft 1604) in the collapsed configuration than in the expanded configuration.

[0210] As shown in FIG. 33A, anvil head 1602 comprises a plurality leaves or petals 1606 coupled to each other such that the petals 1606 overlap with each other in the collapsed configuration. Upon expansion, petals 1606 are configured to form a substantially domed or umbrella shape with a convex outer surface 1608 and a concave inner surface 1612. Alternatively,petals 1606 may be configured to expand further such that anvil head 1602 has a substantially flat or circular disc shape in the expanded configuration. Head 1602 may include at least two petals 1606, or three or more petals 1606.

[0211] One or more of the petals 1606 (or all of the pedals) comprise a tissue contacting surface 1636 defining staple forming pockets (not shown) for receiving staples 200. The petals 1606 are configured such that, in the expanded configuration, the staple pockets are configured to align with the staples in staple assembly 520 (i.e., such that the staple legs or tines align with the staple bays or pockets so that the staples form properly. In certain embodiments, each of the petals 1606 comprises one or more staple forming pockets. In other embodiments, the staple forming pockets may alternate between pedals 1606 such that, for example, one pedal may contain a staple forming pocket while its adjacent pedals do not contain a staple forming pocket.

[0212] Similar to previous embodiments, anvil 1600 may further include one or more driver(s) (not shown) within shaft 1604 that each have a distal end portion coupled to head 1602 for expanding and collapsing pedals 1606. For example, anvil head 1602 may include one or more rigid elements coupled to pedals 1606 designed to telescope or move radially outward to push pedals outward and expand head 1602. Alternatively, the driver(s) may be disposed within the circular stapler assembly 120, or within a separate anvil delivery instrument (not shown). The driver(s) may have a proximal end coupled to a suitable actuation mechanism (discussed in more detail below).

[0213] In this embodiment, anvil 1600 further comprises an expandable element 1610, such as a balloon or the like, configured to expand and apply pressure to outer surface 1608 of head 1602. This ensures that the staple pocket plane is capable of resisting the force from the clamping of tissue and then from the firing and cutting forces. Balloon 1610 may be inflated in any suitable manner, such as fluid inflation (e.g., air or other gases, or fluid), chemical inflation or (e.g., mixing certain materials together to form an expanding gas within the balloon) and the like. In one embodiment, balloon 1610 comprises a proximal end configured for coupling to a suitable fluid source, such as carbon dioxide, saline or the like. The fluid source may be any suitable source, such as a carbon dioxide tank under pressure, a syringe filled with gas to fluid, such as saline, or a source of insufflation.

[0214] Referring now to FIGS. 34A, 34B and 35A-35C, another embodiment of an anvil 1700 includes an anvil head 1702 and an anvil shaft 1704. Anvil shaft 1704 is insertable into an internal channel of staple assembly 520 and is removably and slidably securable therein.Anvil head 1702 is movable between a collapsed configuration (see FIG. 35 A) and an expanded configuration (see FIG 35C). Head 1702 has a smaller cross-sectional area or lateral dimension (relative to the longitudinal axis of shaft 1704) in the collapsed configuration than in the expanded configuration.

[0215] In this embodiment, anvil head 1702 comprises an expandable element 1710, such as a balloon or the like. Balloon 1710 may be inflated in any suitable manner, such as fluid inflation (e.g., air or other gases, or fluid), chemical inflation or (e.g., mixing certain materials together to form an expanding gas within the balloon) and the like. In one embodiment, balloon 1710 comprises a proximal end configured for coupling to a suitable fluid source, such as carbon dioxide, saline or the like. The fluid source may be any suitable source, such as a carbon dioxide tank under pressure, a syringe filled with gas to fluid, such as saline, or a source of insufflation.

[0216] Anvil 1700 further comprises an annular film 1720 having an inner surface 1722 with a larger diameter than shaft 1704. Film 1720 includes a tissue contacting surface 7136 defining staple forming pockets (not shown) for receiving staples 2000. Film 1720 preferably comprises any suitable material, such as metal or a hard polymer, having sufficient stiffness to configured to resist the forces applied by clamping of tissue and then from the firing and cutting forces of the stapler assembly.

[0217] In one embodiment, film 1720 is coupled to a proximal surface of balloon 1710 (see FIGS. 35A-35C). Film 1720 may be configured to expand radially outward as the balloon 1710 is inflated such that, in the expanded configuration, the staple pockets are configured to align with the staples in staple assembly 120 (i.e., such that the staple legs or tines align with the staple bays or pockets so that the staples form properly). In another embodiment, film 1720 is configured to advance along anvil shaft 1704 in the distal direction after balloon 1710 has been expanded. In this embodiment, film 1720 may be configured to expand via a separate actuator after film 1720 has been advanced in contact with balloon 1710. Balloon 1710 is configured to apply pressure to a distal surface of film 1720 to ensure that film 1720 resists the forces applied during the stapling operation.

[0218] The proximal end portion of the anvils described above are operatively connected to one or more drivers or actuation mechanisms (not shown), although as those skilled in the art reading this description will appreciate, components of the drivers may extend into, and / or pass through the anvil shafts and / or the stapler instrument 100. In various embodiments, the anvils and / or instrument 100 will include a proximal handle (not shown) for actuating thedrivers that move the anvils between the collapsed and expanded configurations, and, in some embodiments, for controlling the orientation and movement of the anvils. Alternatively, the system may include an anvil delivery instrument that includes one or more drivers for expanding and collapsing the anvils.

[0219] Referring now to FIG. 36, an anvil delivery instrument 1800 includes an elongate shaft 1802 sized to advance through a suitable percutaneous penetration in the patient, such as a trocar, cannular and the like. In certain embodiments, shaft 1802 has an outer dimension of less than about 14 mm, although it will be recognized that the dimensions of shaft 1802 may vary depending on the surgical procedure and the size of the percutaneous entry point into the patient.

[0220] Instrument 1800 further includes first and second jaws 1804, 1806, that are movable between open and closed positions relative to each other. In certain embodiments, second jaw 1806 is a movable jaw configured to move from an open position to a closed position relative to first jaw 1804. In other embodiments, first jaw 1804 is a movable jaw configured to move between open and closed positions relative to second jaw 1806. In the exemplary embodiment, both jaws 1804, 1806 are movable relative to each other.

[0221] Referring now to FIG. 40, jaws 1804, 1806 preferably pivot about a hinge that may include a pivot pin 1810 extending through a slot (not shown) in each of the jaws 1804, 1806. Instrument 1800 includes a driver (not shown) within shaft 1802 that opens and closes jaws 1804, 1806 about pivot pin 1810. Jaws 1804, 1806 may be opened and closed may any suitable mechanisms including, but not limited to, those described in any of the publications incorporated herein by reference. First and second jaws 1804, 1806 may also be capable of articulating together relative to shaft 1802 about an axis substantially perpendicular to the longitudinal axis (e.g., the yaw or pitch axes). In these embodiments, instrument 1800 may further include a wrist assembly (not shown) that allows jaws 1804, 1806 to articulate relative to shaft 1802.

[0222] In an exemplary embodiment, jaws 1804, 1806 are configured to move into a substantially parallel position with each other in the closed position (as shown in FIG. 40). Jaws 1804, 1806 are preferably sized such that each jaw contacts and grips onto an outer surface of anvil shaft 1134 in the closed position. This configuration provides a stronger grip on shaft 1134 and inhibits the shaft from watermelon seeding from the jaws, as is the case with typical prior art instruments that do not close in a substantially parallel orientation.

[0223] In an exemplary embodiment, jaw 1804 includes a jaw grasping portion1840 and a proximal support 1842. Proximal support 1842 extends downward towards a jaw grasping portion 1844 of jaw 1806 and is coupled thereto by pivot pin 1810. Proximal support 1842 is sized and shaped such that pivot pin 1810 is located closer to jaw grasping portion 1844 of jaw 1806 than jaw grasping portion 1842 of jaw 1804. Thus, pin 1810 and grasping portion 1842 are disposed on one side of a central longitudinal axis 1850 of shaft 1802 and jaw grasping portion 1840 is located on the other side of longitudinal axis 1850. This provides an asymmetrical location for the hinge or pivot point between jaws 1804, 1806 such that the jaws can be position in a closed position around shaft 1134 of anvil 1130 with substantially parallel surfaces facing shaft 1134.

[0224] Referring again to FIG. 37, delivery instrument 1800 includes a driver for moving anvil head 1132 between the collapsed and expanded configurations. In one embodiment, the driver comprises a rod 1820 that extends through shaft 1802. Rod 1820 includes a distal end portion 1822 configured to extend at least partially through jaws 1804, 1806. In one embodiment, rod 1820 is sized and configured to extend through an internal lumen (not shown) in anvil shaft 1134 and is configured for distal advancement through shaft 1134 to engage anvil head 1132 (see FIGS. 25A-25C). Rod 1820 includes an engagement mechanism (not shown) on distal end portion 1822 that cooperates with an engagement mechanism on anvil head 1134 to move anvil head 1132 between the collapsed and expanded configurations.

[0225] In one embodiment, rod 1820 includes a rotatable element (not shown) configured to rotate relative to rod 1820. In another embodiment, the entire rod 1820 is configured to rotate relative to shaft 1802. Rotation of rod 1820 or the rotation element causes central component 1140 of anvil head 1132 to pivot about a hinge on anvil shaft 1134 between the collapsed and expanded configurations. In addition, rotation of rod 1820 causes lateral components 1142, 1144 to pivot about hinges between lateral components 1142, 1414 and central component 1140. In an alternative embodiment, instrument 1800 includes a second driver on rod 1820 or on another element of instrument 1800 that causes lateral components 1142, 1144 to pivot relative to central component 1140 (i.e., movement of anvil head 1132 into the collapsed configuration may be caused by a single or multiple drivers in instrument 1800).

[0226] In another embodiment, distal end portion 1822 of rod 1820 is configured to actuate anvil head 1132 through a push-pull mechanism. For example, longitudinal movement of rod 1820 relative to instrument 1800 causes central component 1140 to pivot about anvil shaft 1134 and / or lateral components 1142, 1144 to pivot about central component 1140.

[0227] The proximal end portion of instrument 1800 is operatively connected to an actuation mechanism (not shown), although as those skilled in the art reading this description will appreciate, components of the actuation mechanism may extend into, and / or pass through instrument 1800. In various embodiments, instrument 1800 will include a proximal handle (not shown) for actuating jaws 1804, 1806 and rod 1820 and, in some embodiments, for controlling the orientation and movement of the distal end portion of instrument 1800. In other embodiments, instrument 1800 is adapted to be used with a robotic system. In these embodiments, instrument 1800 will generally include an actuation mechanism that controls the orientation and movement of the end effector, the opening and closing of jaws 1804, 1806 and the actuation of rod 1820. The actuation mechanism will typically be controlled by a robotic manipulator assembly that is controlled remotely by a user. For example, in one configuration, the actuation mechanism will be manipulated by the robotic manipulator assembly to either rotate rod 1820 or move rod 1820 in the longitudinal direction for expanding and collapsing anvil 1130.

[0228] While several embodiments have been shown in the drawings, it is not intended that the description be limited thereto, as it is intended that the description be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of presently disclosed embodiments. Thus, the scope of the embodiments should be determined by the appended claims and their legal equivalents, rather than by the examples given.

[0229] Further, this description's terminology is not intended to limit the devices described herein. The term “force” is to be construed as encompassing both force and torque, unless otherwise indicated herein or clearly contradicted by context. The terms “tools” and “instruments” are used interchangeably herein to refer to the surgical instruments. As used in this specification and the appended claims, the singular forms “a,” “an,” and “the,” and any singular use of any word, include plural referents unless expressly and unequivocally limited to one referent. The terms “comprising,” “having,” “including,” and “containing” are to be construed as open-ended terms (i.e., meaning “including, but not limited to,”) unless otherwise noted. The terms “connected” and “coupled” are to be construed as partly or wholly contained within, attached to, or joined together, even if there is something intervening.

[0230] Spatially relative terms — such as “proximal” and “distal — may be used to describe one element's or feature's relationship to another element or feature as illustrated in the figures. These spatially relative terms are intended to encompass different positions (i.e., locations)and orientations (i.e., rotational placements) of a device in use or operation in addition to the position and orientation shown in the figures. For example, the terms “proximal” and “distal” are relative terms, where the term “distal” refers to the portion of the object furthest from an operator of the instrument and closest to the surgical site, such as the opening of the tool cover or the end effector of the instrument. The term “proximal” indicates the relative proximity to the operator of the surgical instrument and refers to the portion of the object closest to the operator and furthest from the surgical site. In this application, an end effector refers to a tool installed at the distal end of an instrument, including but not limited to forceps or graspers, needle drivers, scalpels, scissors, spatulas, blades, and other tools, which may or may not use energy to cauterize tissue (i.e., a monopolar or bipolar tool).

[0231] Persons skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments. Various alternatives and modifications can be devised by those skilled in the art without departing from the disclosure. Accordingly, the present description is intended to embrace all such alternatives, modifications, and variances. As well, one skilled in the art will appreciate further features and advantages of the present disclosure based on the above-described embodiments. Accordingly, the present description is not to be limited by what has been particularly shown and described, except as indicated by the appended claims.

[0232] For example, in a first aspect, a first embodiment is a robotic surgical system for use with a surgical instrument. The system comprises a manipulator assembly comprising a support structure and a first manipulator for the surgical instrument coupled to the support structure and having a first remote center of motion, a controller configured to generate a central target position over a surgical site, a regulator for limiting a range of motion of the first manipulator relative to the central target position and an actuator for unlocking the central target position to move the first manipulator to a location outside of the range of motion.

[0233] A second embodiment is the first embodiment wherein the regulator limits a distance between the central target position and the first remote center of motion.

[0234] A third embodiment is any combination of the first two embodiments, wherein the range of motion is in a direction substantially parallel to a longitudinal axis of the first manipulator.

[0235] A 4thembodiment is any combination of the first 3 embodiments, wherein the regulator comprises a brake on the support structure.

[0236] A 5thembodiment is any combination of the first 4 embodiments, further comprising a trigger for activating the actuator.

[0237] A 6thembodiment is any combination of the first 5 embodiments, further comprising an input device remotely coupled to the first manipulator and being movable to provide a desired movement of the first manipulator and the surgical instrument.

[0238] A 7thembodiment is any combination of the first 6 embodiments, wherein the trigger is a user input on the input device.

[0239] An 8thembodiment is any combination of the first 7 embodiments, wherein the controller comprises a computer-readable storage device storing program instructions to activate the actuator.

[0240] A 9thembodiment is any combination of the first 8 embodiments, wherein the program instructions activate the actuator upon movement of the first manipulator.

[0241] A 10thembodiment is any combination of the first 9 embodiments, wherein the program instructions activate the actuator upon rotation of the first manipulator beyond a threshold degree.

[0242] An 11thembodiment is any combination of the first 10 embodiments, wherein the threshold degree is a 180 degree rotation of the first manipulator around an outer pitch axis of the first manipulator.

[0243] A 12thembodiment is any combination of the first 11 embodiments, further comprising a second manipulator coupled to the support structure and having a second remote center of motion.

[0244] A 13thembodiment is any combination of the first 12 embodiments, wherein the regulator limits a second range of motion of the second manipulator relative to the central target position.

[0245] A 14thembodiment is any combination of the first 13 embodiments, wherein the regulator limits a distance between the first center of motion and the second center of motion.

[0246] A 15thembodiment is any combination of the first 14 embodiments, wherein the actuator allows said distance to be increased.

[0247] A 16thembodiment is any combination of the first 15 embodiments, wherein the second manipulator remains fixed in position when the actuator is activated by the trigger.

[0248] A 17thembodiment is any combination of the first 16 embodiments, further comprising a controller configured to control the surgical instrument based on the movement of the input device.

[0249] An 18thembodiment is any combination of the first 17 embodiments, further comprising a third manipulator configured for coupling to an endoscope and having a third remote center of motion.

[0250] A 19thembodiment is any combination of the first 18 embodiments, wherein the central target position is at the third center of motion.

[0251] A 20thembodiment is any combination of the first 19 embodiments, wherein the surgical instrument comprises a circular stapling instrument.

[0252] In another aspect, a first embodiment is a robotic surgical system for use with a surgical instrument. The system comprises a first manipulator coupled to the support structure and having a first remote center of motion, a second manipulator coupled to the support structure and having a second remote center of motion, a regulator for limiting a range of motion of the first manipulator relative to the second manipulator and an actuator for releasing the first manipulator to move the first manipulator to a location outside of the range of motion.

[0253] A second embodiment is the first embodiment, wherein the regulator limits a distance between the first and second centers of motion.

[0254] A third embodiment is any combination of the first two embodiments, wherein the second manipulator remains stationary while the first manipulator is moved outside of the range of motion.

[0255] A 4thembodiment is any combination of the first 3 embodiments, wherein the range of motion is in a direction substantially parallel to a longitudinal axis of the first manipulator.

[0256] A 5thembodiment is any combination of the first 4 embodiments, further comprising a trigger for activating the actuator.

[0257] A 6thembodiment is any combination of the first 5 embodiments, further comprising an input device remotely coupled to the first manipulator and being movable to provide a desired movement of the first manipulator and the surgical instrument.

[0258] A 7thembodiment is any combination of the first 6 embodiments, wherein the trigger is a user input on the input device.

[0259] An 8thembodiment is any combination of the first 7 embodiments, furthercomprising a controller configured to control the surgical instrument based on the movement of the input device, wherein the controller comprises a computer-readable storage device storing program instructions to actuate the unlocking device.

[0260] A 9thembodiment is any combination of the first 8 embodiments, wherein the program instructions activate the actuator upon movement of the first manipulator.

[0261] A 10thembodiment is any combination of the first 9 embodiments, wherein the program instructions activate the actuator upon rotation of the first manipulator beyond a threshold degree.

[0262] An 11thembodiment is any combination of the first 10 embodiments, wherein the threshold degree is a 180 degree rotation of the first manipulator.

[0263] A 12thembodiment is any combination of the first 11 embodiments, wherein the second center of motion is at, or near, an umbilicus of a patient and said location is at, or near, an anus of the patient.

[0264] A 13thembodiment is any combination of the first 12 embodiments, wherein the surgical instrument comprises a circular stapling instrument.

[0265] In another aspect, a first embodiment is method for controlling a robotic surgery system. The method comprises coupling a first manipulator to the surgical instrument, generating a remote center of motion for the surgical instrument, generating a central target position over a surgical site, limiting a range of motion of the remote center of motion of the first manipulator relative to the central target position and unlocking the central target position to enable movement of the first manipulator to a location outside of the range of motion.

[0266] A second embodiment is the first embodiment further comprising moving the central target position.

[0267] A third embodiment is any combination of the first 2 embodiments, further comprising moving the first manipulator to said location outside of the range of motion.

[0268] A 4thembodiment is any combination of the first 3 embodiments, further comprising limiting a distance between the central target position and the remote center of motion.

[0269] A 5thembodiment is any combination of the first 4 embodiments, wherein the range of motion is in a direction substantially parallel to a longitudinal axis of the first manipulator.

[0270] A 6thembodiment is any combination of the first 5 embodiments, further comprising remotely coupling an input device to the first manipulator to provide a desiredmovement of the first manipulator and the surgical instrument.

[0271] A 7thembodiment is any combination of the first 6 embodiments, further comprising actuating a trigger on the input device to unlock the central target position.

[0272] An 8thembodiment is any combination of the first 7 embodiments, further comprising moving the first manipulator to unlock the central target position.

[0273] A 9thembodiment is any combination of the first 8 embodiments, wherein the moving is rotating the first manipulator beyond a threshold degree.

[0274] A 10thembodiment is any combination of the first 9 embodiments, wherein the threshold degree is a 180 degree rotation of the first manipulator around an outer pitch axis of the first manipulator.

[0275] An 11thembodiment is any combination of the first 10 embodiments, further comprising providing a second manipulator and generating a second remote center of motion for the second manipulator.

[0276] A 12thembodiment is any combination of the first 11 embodiments, further comprising limiting a range of motion of the second manipulator relative to the central target position.

[0277] A 13thembodiment is any combination of the first 12 embodiments, further comprising limiting a distance between the first and second centers of motion.

[0278] A 14thembodiment is any combination of the first 13 embodiments, further comprising unlocking the central target position to enable movement of the first manipulator beyond said distance.

[0279] A 15thembodiment is any combination of the first 14 embodiments, further comprising holding the second manipulator stationary when the central target position is moved.

[0280] A 16thembodiment is any combination of the first 15 embodiments, further comprising providing a third manipulator configured for coupling to an endoscope and having a third remote center of motion, wherein the central target position is at the third center of motion.

[0281] A 17thembodiment is any combination of the first 16 embodiments, further comprising generating the second remote center of motion at, or near, an umbilicus of a patient.

[0282] An 18thembodiment is any combination of the first 17 embodiments, further comprising moving the first remote center of motion to a location at, or near an anus of the patient.

[0283] In another aspect, a first embodiment includes any of the system embodiments described above, wherein the instrument comprises a circular surgical staplinginstrument comprising: a staple assembly comprising a plurality of staples and a cutting element; an anvil positioned distal to the staple assembly; and a driver configured to advance the staples and the cutting element such that the staples contact the anvil before the cutting element is advanced distal of the staple assembly.

[0284] A second embodiment is the first embodiment, wherein the driver simultaneously advances the staples and the cutting element.

[0285] A third embodiment is any combination of the above embodiments, wherein the driver advances the staples a first distance and the cutting element a second distance, wherein the second distance is greater than the first distance.

[0286] A 4thembodiment is any combination of the above embodiments, wherein the cutting element is recessed proximally from the staples before the driver advances the staples.

[0287] A 5thembodiment is any combination of the above embodiments, wherein the driver is configured to sequentially advance the staples and then the cutting element.

[0288] A 6thembodiment is any combination of the above embodiments, wherein the staples are deformed against the anvil before the cutting element advances distally of the staple assembly.

[0289] A 7thembodiment is any combination of the above embodiments, further comprising a first pusher coupled to the staples and a second pusher coupled to the cutting element, wherein the driver comprises a rotatable element coupled to the first and second pushers.

[0290] An 8thembodiment is any combination of the above embodiments, wherein the rotation of the driver causes longitudinal movement of the first and second pushers.

[0291] A 9thembodiment is any combination of the above embodiments, wherein the driver comprises a first set of threads coupled to the first pusher and a second set of threads coupled to the second pusher.

[0292] A 10thembodiment is any combination of the above embodiments, wherein the first and second sets of threads are longitudinally spaced from each other to define a gap therebetween.

[0293] An 11thembodiment is any combination of the above embodiments, wherein the first and second pushers each comprise threads configured to cooperate with the first and second sets of threads of the driver, respectively, to advance the first and second pushers upon rotation of the driver.

[0294] A 12thembodiment is any combination of the above embodiments, whereinthe first set of threads on the driver disengages from the threads on the first pusher while the second set of threads are still engaged with the threads of the second pusher.

[0295] A 13thembodiment is any combination of the above embodiments, wherein the first set of threads has a different pitch than the second set of threads.

[0296] A 14thembodiment is any combination of the above embodiments, wherein the driver is disposed within the first and second pushers and the first and second sets of threads are disposed on an outer surface of the driver.

[0297] A 15thembodiment is any combination of the above embodiments, wherein the driver is disposed laterally outward from the first and second pushers.

[0298] A 16thembodiment is any combination of the above embodiments, wherein the driver is disposed laterally outward from the second pusher and laterally inward from the first pusher.

[0299] A 17thembodiment is any combination of the above embodiments, wherein the driver defines an internal channel, the instrument further comprising a capturing device configured to advance through the internal channel to engage the anvil.

[0300] An 18thembodiment is any combination of the above embodiments, wherein the staples are disposed circumferentially around an internal channel within the stapling assembly, the instrument further comprising an annular staple alignment guide disposed between the staples and the anvil.

[0301] A 19thembodiment is any combination of the above embodiments, wherein the cutting element is disposed laterally inward from the staples and has a substantially annular shape.

[0302] A 20thembodiment is any combination of the above embodiments, wherein the driver is positioned within the channel and spaced laterally inward from the staples and the cutting element.

[0303] A 21stembodiment is any combination of the above embodiments, further comprising an elongate shaft with a wrist, wherein the stapling assembly is rotatably coupled to the shaft at the wrist.

[0304] A 22ndembodiment is any combination of the above embodiments, wherein the driver extends through the wrist and comprises a flexible portion configured to bend as the stapling assembly rotates relative to the shaft.

[0305] A 23rdembodiment is any combination of the above embodiments, whereinthe driver comprises a compressive element coupled to the first and second pushers, wherein longitudinal movement of the compressive element advances the first and second pushers.

[0306] A 24thembodiment is any combination of the above embodiments, wherein the compressive element comprises a bendable hypo tube.

[0307] A 25thembodiment is any combination of the above embodiments, further comprising an actuator coupled to a proximal end of the driver and configured to rotate the driver.

[0308] A 26thembodiment is any combination of the above embodiments, wherein the actuator is configured for coupling to a robotic surgical system.

[0309] A 27thembodiment is any combination of the above embodiments, wherein the driver comprises a first component for advancing the staples and a second component for advancing the cutting element.

[0310] A 28thembodiment is any combination of the above embodiments wherein the driver is configured to apply a first force to the staples to advance the staples and a second force to the cutting element to advance the cutting element, wherein the first force is greater than the second force.

[0311] A 29thembodiment is the 28thembodiment with any combination of the above embodiments.

[0312] A 30thembodiment is any combination of the above embodiments, wherein a ratio of the second force to the first force is about 1 : 1.25 to about 1 :2.

[0313] A 31stembodiment is any combination of the above embodiments, wherein a ratio of the second force to the first force is about 1 : 1.5.

[0314] A 32ndembodiment is any combination of the above embodiments, wherein the driver is configured to advance the staples and the cutting element such that the staples contact the anvil before the cutting element is advanced distal of the stapling assembly.

[0315] A 33rdembodiment is any combination of the above embodiments, further comprising a first pusher coupled to the staples and a second pusher coupled to the cutting element, wherein the driver comprises a rotatable element coupled to the first and second pushers.

[0316] A 34thembodiment is any combination of the above embodiments, wherein the rotation of the driver causes longitudinal movement of the first and second pushers.

[0317] A 35thembodiment is any combination of the above embodiments, wherein the driver comprises a first set of threads coupled to the first pusher and a second set of threads coupled to the second pusher.

[0318] A 36thembodiment is any combination of the above embodiments, wherein the first set of threads has a first thread pitch and the second set of threads has a second thread pitch, wherein a ratio of the second thread pitch to the first thread pitch is about 1 : 1.25 to about 1 : 2.0.

[0319] A 37thembodiment is any combination of the above embodiments, wherein the ratio is about 1 : 1.5.

[0320] A 38thembodiment is any combination of the above embodiments, wherein the first and second pushers each comprise threads configured to cooperate with the first and second sets of threads of the driver, respectively, to advance the first and second pushers upon rotation of the driver.

[0321] A 39thembodiment is any combination of the above embodiments, wherein the first set of threads on the driver disengages from the threads on the first pusher while the second set of threads are still engaged with the threads of the second pusher.

Claims

CLAIMS1. A robotic surgical system for use with a surgical instrument comprising: a manipulator assembly comprising: a support structure; a first manipulator for the surgical instrument coupled to the support structure and having a first remote center of motion; a controller configured to generate a central target position over a surgical site; a regulator for limiting a range of motion of the first manipulator relative to the central target position; and an actuator for unlocking the central target position to move the first manipulator to a location outside of the range of motion.

2. The system of claim 1, wherein the actuator is configured to unlock the central target position while the first manipulator is coupled to the surgical instrument.

3. The system of claim 2, wherein the actuator is configured to unlock the central target position while the surgical instrument is inserted within a patient.

4. The system of any one of claims 1 to 3, wherein the regulator limits a distance between the central target position and the first remote center of motion.

5. The system of any one of claims 1 to 4, wherein the range of motion is in a direction substantially parallel to a longitudinal axis of the first manipulator.

6. The system of claim 4, wherein the regulator comprises a brake on the support structure.

7. The system of any one of claims 1 to 6, further comprising a trigger for activating the actuator.

8. The system of claim 7, further comprising an input device remotely coupled to the first manipulator and being movable to provide a desired movement of the firstmanipulator and the surgical instrument.

9. The system of claim 8, wherein the trigger is a user input on the input device.

10. The system of any one of claims 7 to 9, wherein the controller comprises a computer-readable storage device storing program instructions to activate the actuator.

11. The system of claim 10, wherein the program instructions activate the actuator upon movement of the first manipulator.

12. The system of claim 11, wherein the program instructions activate the actuator upon rotation of the first manipulator beyond a threshold degree.

13. The system of claim 12, wherein the threshold degree is a 180 degree rotation of the first manipulator around an outer pitch axis of the first manipulator.

14. The system of any one of claims 1 to 13, further comprising a second manipulator coupled to the support structure and having a second remote center of motion.

15. The system of claim 14, wherein the regulator limits a second range of motion of the second manipulator relative to the central target position.

16. The system of claim 15, wherein the regulator limits a distance between the first center of motion and the second center of motion.

17. The system of claim 16, wherein the actuator allows said distance to be increased.

18. The system of any one of claims 13 to 17, wherein the second manipulator remains fixed in position when the actuator is activated by the trigger.

19. The system of any one of claims 7 to 18, further comprising a controller configured to control the surgical instrument based on the movement of the input device.

20. The system of claim 19, further comprising a third manipulator configured for coupling to an endoscope and having a third remote center of motion.

21. The system of claim 20, wherein the central target position is at the third center of motion.

22. The system of any one of claims 1 to 21, wherein the surgical instrument comprises a circular stapling instrument comprising a staple assembly and an anvil removably coupled to the staple assembly, wherein the proximal handle portion of the control input has a shape substantially the same as the staple assembly.

23. The system of claim 22, further comprising a first pusher coupled to the staples and a second pusher coupled to the cutting element, wherein the driver comprises a rotatable element coupled to the first and second pushers, wherein the rotation of the driver causes longitudinal movement of the first and second pushers.

24. The system of claim 23, wherein the driver comprises a first set of threads coupled to the first pusher and a second set of threads coupled to the second pusher, wherein the first and second sets of threads are longitudinally spaced from each other to define a gap therebetween, wherein the first and second pushers each comprise threads configured to cooperate with the first and second sets of threads of the driver, respectively, to advance the first and second pushers upon rotation of the driver.

25. The system of claim 24, wherein the first set of threads on the driver disengages from the threads on the first pusher while the second set of threads are still engaged with the threads of the second pusher.

26. The system of any one of claims 22 to 25, wherein the first set of threads has a different pitch than the second set of threads.

27. The system of any one of claims 22 to 26, wherein the anvil comprising a head and a shaft, wherein the head comprises a tissue contacting surface defining staple forming pockets; and wherein the anvil head comprises first and second components movable relative to each other and configured for deploying between a collapsed configuration with a first lateral dimension and an expanded configuration with a second lateral dimension, wherein the first lateral dimension is smaller than the second lateral dimension.

28. A robotic surgical system for use with a surgical instrument comprising: a first manipulator coupled to the support structure and having a first remote center of motion; a second manipulator coupled to the support structure and having a second remote center of motion; a regulator for limiting a range of motion of the first manipulator relative to the second manipulator; and an actuator for releasing the first manipulator to move the first manipulator to a location outside of the range of motion.

29. The system of claim 28, wherein the first and second manipulators are configured for coupling to first and second surgical instruments and manipulating said surgical instruments within a patient.

30. The system of claim 29, wherein the actuator is configured to release the first manipulator while the first and second manipulators are coupled to the first and second surgical instruments.

31. The system of any one of claims 28 to 30, wherein the actuator is configured to release the first manipulator while the first and second surgical instruments are inserted within the patient.

32. The system of any one of claims 28 to 31, wherein the regulator limits a distance between the first and second centers of motion.

33. The system of claim 32, wherein the second manipulator remains stationary while the first manipulator is moved outside of the range of motion.

34. The system of any one of claims 28 to 33, wherein the range of motion is in a direction substantially parallel to a longitudinal axis of the first manipulator.

35. The system of any one of claims 28 to 34, further comprising a trigger for activating the actuator.

36. The system of claim 35, further comprising an input device remotely coupled to the first manipulator and being movable to provide a desired movement of the first manipulator and the surgical instrument.

37. The system of claim 36, wherein the trigger is a user input on the input device.

38. The system of any one of claims 28 to 37, further comprising a controller configured to control the surgical instrument based on the movement of the input device, wherein the controller comprises a computer-readable storage device storing program instructions to actuate the unlocking device.

39. The system of claim 38, wherein the program instructions activate the actuator upon movement of the first manipulator.

40. The system of claim 39, wherein the program instructions activate the actuator upon rotation of the first manipulator beyond a threshold degree.

41. The system of claim 40, wherein the threshold degree is a 180 degree rotation of the first manipulator.

42. The system of any one of claims 28 to 41, wherein the second center of motion is at, or near, an umbilicus of a patient and said location is at, or near, an anus of the patient.

43. The system of claim 42, wherein the surgical instrument comprises a circular stapling instrument.

44. A method for controlling a robotic surgery system, the method comprising: coupling a first manipulator to the surgical instrument; generating a remote center of motion for the surgical instrument; generating a central target position over a surgical site; limiting a range of motion of the remote center of motion of the first manipulator relative to the central target position; and unlocking the central target position to enable movement of the first manipulator to a location outside of the range of motion.

45. The method of claim 44, further comprising unlocking the central target position while the first manipulator is coupled to the surgical instrument.

46. The method of any one of claims 44 to 45, further comprising inserting the surgical instrument into the patient with the first manipulator and then unlocking the central target position.

47. The method of any one of claims 44 to 46, further comprising moving the central target position.

48. The method of claim 47, further comprising moving the first manipulator to said location outside of the range of motion.

49. The method of claim 48, wherein said moving the first manipulator causes movement of the central target position.

50. The method of any one of claims 44 to 49, further comprising limiting a distance between the central target position and the remote center of motion.

51. The method of any one of claims 44 to 50, wherein the range of motion is in a direction substantially parallel to a longitudinal axis of the first manipulator.

52. The method of any one of claims 44 to 50, further comprising remotely coupling an input device to the first manipulator to provide a desired movement of the first manipulator and the surgical instrument.

53. The method of claim 52, further comprising actuating a trigger on the input device to unlock the central target position.

54. The method of any one of claims 44 to 53, further comprising moving the first manipulator to unlock the central target position.

55. The method of claim 54, wherein the moving is rotating the first manipulator beyond a threshold degree.

56. The method of claim 55, wherein the threshold degree is a 180 degree rotation of the first manipulator around an outer pitch axis of the first manipulator.

57. The method of any one of claims 44 to 56, further comprising providing a second manipulator and generating a second remote center of motion for the second manipulator.

58. The method of claim 57, further comprising limiting a range of motion of the second manipulator relative to the central target position.

59. The method of claim 58, further comprising limiting a distance between the first and second centers of motion.

60. The method of claim 59, further comprising unlocking the central target position to enable movement of the first manipulator beyond said distance.

61. The method of claim 60, further comprising holding the second manipulator stationary when the central target position is moved.

62. The method of claim 61, further comprising providing a third manipulator configured for coupling to an endoscope and having a third remote center of motion, wherein the central target position is at the third center of motion.

63. The method of claim 62, further comprising generating the second remote center of motion at, or near, an umbilicus of a patient.

64. The method of claim 63, further comprising moving the first remote center of motion to a location at, or near an anus of the patient.

Images