US20130317519A1

US20130317519A1 - Low friction instrument driver interface for robotic systems

Info

Publication number: US20130317519A1
Application number: US13/481,536
Authority: US
Inventors: Enrique Romo; J. Scot Hart, JR.; Travis Covington
Original assignee: Hansen Medical Inc
Current assignee: Hansen Medical Inc
Priority date: 2012-05-25
Filing date: 2012-05-25
Publication date: 2013-11-28
Also published as: US20160338783A1; US11147637B2; US20220087755A1

Abstract

A medical robotic system includes a base having a first opening, and a first protrusion next to the first opening, a first rotary member configured for detachably coupling to a component of the medical robotic system in a manner such that the first rotary member is rotatable relative to the base and at least a part of the first rotary member is located in the first opening of the base when the first rotary member is coupled to the system component, and a cover coupled to the base, wherein the first rotary member comprises a first end, a second end, a body extending between the first and second ends, and a flange disposed circumferentially around a part of the body, the flange having a first circumferential slot for receiving the first protrusion.

Description

INCORPORATION BY REFERENCE

All of the following U.S. Patent Applications are expressly incorporated by reference herein for all purposes:

U.S. patent application Ser. No. 13/173,994, filed on Jun. 30, 2011,
U.S. patent application Ser. No. 11/179,007, filed on Jul. 6, 2005,
U.S. patent application Ser. No. 12/079,500, filed on Mar. 26, 2008,
U.S. patent application Ser. No. 11/678,001, filed on Feb. 22, 2007,
U.S. Patent Application No. 60/801,355, filed on May 17, 2006,
U.S. patent application Ser. No. 11/804,585, filed on May 17, 2007,
U.S. patent application Ser. No. 11/640,099, filed on Dec. 14, 2006,
U.S. patent application Ser. No. 12/507,727, filed on Jul. 22, 2009,
U.S. patent application Ser. No. 12/106,254, filed on Apr. 18, 2008,
U.S. patent application Ser. No. 12/192,033, filed on Aug. 14, 2008,
U.S. patent application Ser. No. 12/236,478, filed on Sep. 23, 2008,
U.S. patent application Ser. No. 12/833,935, filed on Jul. 9, 2010,
U.S. patent application Ser. No. 12/822,876, filed on Jun. 24, 2010,
U.S. patent application Ser. No. 12/614,349, filed on Nov. 6, 2009,
U.S. patent application Ser. No. 11/690,116, filed Mar. 22, 2007,
U.S. patent application Ser. No. 11/176,598, filed Jul. 6, 2005,
U.S. patent application Ser. No. 12/012,795, filed Feb. 1, 2008,
U.S. patent application Ser. No. 12/837,440, Jul. 15, 2010,
U.S. Patent Application No. 61/513,488, filed Jul. 8, 2011, and
U.S. patent application Ser. No. 13/174,605, filed Jun. 30, 2011.

FIELD

The application relates generally to robotically controlled surgical systems, and more particularly to flexible instruments and instrument drivers that are responsive to a master controller for performing surgical procedures to treat tissue, such as tissue in the livers.

BACKGROUND

Robotic surgical systems and devices are well suited for use in performing minimally invasive medical procedures, as opposed to conventional techniques wherein the patient's body cavity is open to permit the surgeon's hands access to internal organs. For example, there is a need for a highly controllable yet minimally sized system to facilitate imaging, diagnosis, and treatment of tissues which may lie deep within a patient, and which may be preferably accessed only via naturally-occurring pathways such as blood vessels or the gastrointestinal tract.
In some cases, a robotic surgical system may include a steerable catheter with a steering wire, and an instrument driver for applying tension to the steering wire to steer the catheter. Applicant of the subject application determines that it would be desirable to sense a characteristic that corresponds with an amount of force or torque being applied to pull a steering wire of a robotic surgical system.

SUMMARY

In accordance with some embodiments, a medical robotic system includes a base having a first opening, and a first protrusion next to the first opening, a first rotary member configured for detachably coupling to a component of the medical robotic system in a manner such that the first rotary member is rotatable relative to the base and at least a part of the first rotary member is located in the first opening of the base when the first rotary member is coupled to the system component, and a cover coupled to the base, wherein the first rotary member comprises a first end, a second end, a body extending between the first and second ends, and a flange disposed circumferentially around a part of the body, the flange having a first circumferential slot for receiving the first protrusion.
In accordance with other embodiments, a medical robotic system includes an instrument driver having an actuatable element, a sensor coupled to the instrument driver, and a device configured for detachably coupling to the instrument driver, the device comprising a base having a first opening, and a rotary member configured for detachably coupling to the actuatable element of the instrument driver, wherein the rotary member is rotatable relative to the base, and at least a portion of the rotary member is located within the first opening of the base, wherein when the device is coupled to the instrument driver, the actuatable element is configured to rotate the rotary member in response to a command signal received from a user interface, and wherein the sensor is configured to sense a characteristic that corresponds with an amount of force or torque being applied to the actuatable element in order to rotate the rotary member.
In accordance with other embodiments, a method of steering a distal end of an elongate member includes determining a desired bending to be achieved by the distal end of the elongate member, determining an amount of tension to be applied to a steering wire located within the elongate member based on the desired bending to be achieved, using an actuatable element to apply a torque to turn a rotary member that is detachably coupled to the actuatable element, the steering wire having one end is secured to the rotary member and another end secured to the elongate member, wherein the application of the torque by the actuatable element causes tension to be applied to the steering wire, and using a sensor coupled to the actuatable element to sense a characteristic that corresponds with an amount of force or torque being applied by the actuatable element to turn the rotary member.
Other and further aspects and features will be evident from reading the following detailed description of the embodiments.

BRIEF DESCRIPTION OF THE DRAWINGS

The drawings illustrate the design and utility of embodiments, in which similar elements are referred to by common reference numerals. These drawings are not necessarily drawn to scale. In order to better appreciate how the above-recited and other advantages and objects are obtained, a more particular description of the embodiments will be rendered, which are illustrated in the accompanying drawings. These drawings depict only typical embodiments and are not therefore to be considered limiting of its scope.

FIG. 1 illustrates a robotic surgical system in which apparatus, system and method embodiments may be implemented.

FIG. 2 illustrates how the adapter base plate assembly is utilized to attach a support assembly and instrument driver to an operating table or surgical bed.

FIG. 3 a sheath and guide catheter assembly, and an elongate member manipulator mounted on an instrument driver

FIG. 4 illustrates an example of an operator workstation of the robotic surgical system shown in FIG. 1 with which a catheter instrument can be manipulated using different user interfaces and controls.

FIG. 5A further illustrates the instrument driver shown in FIG. 3 without the elongate member manipulator mounted on an instrument driver.

FIG. 5B further illustrates the instrument driver shown in FIG. 5A without the sheath and guide catheter assembly.

FIG. 5C further illustrates the instrument driver shown in FIG. 5B with skins removed.

FIGS. 6A and 6B illustrate a sheath and guide catheter assembly positioned over respective sterile adaptors and mounting plates from top and bottom perspectives respectively

FIGS. 7A and 7B illustrate top and bottom perspectives respectively of a portion of an instrument driver with a sheath splayer positioned over a sterile adaptor.

FIG. 7C illustrates an exploded view of the sheath splayer shown in FIG. 7A without a purge tube.

FIG. 7D illustrates top and bottom views of a pulley assembly positioned over a floating shaft.

FIG. 7E illustrates the floating shaft of FIG. 7D installed and un-installed onto a sleeve receptacle.

FIG. 8 illustrates a guide carriage of the instrument driver shown in FIG. 5C with pulleys and guide articulation motors.

FIG. 9 is a perspective view of a slidable carriage or funicular assembly of an instrument driver and sleeve receptacles configured to receive and engage with floating shafts.

FIG. 10 illustrates a sheath block, sheath insert motor, guide insert motor and leadscrews removed from the instrument driver shown in FIG. 5C.

FIGS. 10A and 10B illustrate different perspective views of the sheath block with sheath output plate positioned over receptacle sleeves.

FIG. 10C illustrates sheath articulation motors coupled to motor driven interfaces and receptacle sleeves.

FIGS. 11A-11H illustrate side and cross-sectional views of a catheter bent in various configurations with pull wire manipulation.

FIG. 12 illustrates an open loop control model.

FIG. 13 illustrates a control system in accordance with some embodiments.

FIG. 14 illustrates a user interface for a master input device.

FIG. 15 illustrates some components of a robotic system that includes tension sensing capability in accordance with some embodiments;

FIG. 16 illustrates some components of a robotic system that includes tension sensing capability in accordance with other embodiments;

FIG. 17 illustrates some components of a robotic system that includes tension sensing capability in accordance with other embodiments;

FIG. 18 illustrates a frictionless interface at a sterile adaptor in accordance with some embodiments;

FIG. 19 illustrates some components of a robotic system that includes tension sensing capability in accordance with other embodiments;

FIG. 20 illustrates some components of a robotic system that includes tension sensing capability in accordance with other embodiments;

FIG. 21 illustrates some components of a robotic system that includes tension sensing capability in accordance with other embodiments;

FIG. 22A illustrates driving mode(s) in accordance with some embodiments.

FIG. 22B illustrates driving mode(s) in accordance with other embodiments.

FIG. 22C illustrates driving mode(s) in accordance with other embodiments.

FIG. 22D illustrates driving mode(s) in accordance with other embodiments.

FIG. 23A-23F illustrates a method of using a robotic system to treat tissue in accordance with some embodiments.

DESCRIPTION OF THE EMBODIMENTS

Various embodiments are described hereinafter with reference to the figures. It should be noted that the figures are not drawn to scale and that elements of similar structures or functions are represented by like reference numerals throughout the figures. It should also be noted that the figures are only intended to facilitate the description of the embodiments. They are not intended as an exhaustive description of the invention or as a limitation on the scope of the invention. In addition, an illustrated embodiment needs not have all the aspects or advantages shown. An aspect or an advantage described in conjunction with a particular embodiment is not necessarily limited to that embodiment and can be practiced in any other embodiments even if not so illustrated.
I. Robotic system
Embodiments described herein generally relate to apparatus, systems and methods for robotic surgical systems. A robotic surgical system in which embodiments described herein may be implemented is described with reference to FIGS. 1-10C.
Referring to FIG. 1, a robotically controlled surgical system 10 in which embodiments of apparatus, system and method may be implemented includes an operator workstation 2, an electronics rack 6 and associated bedside electronics box 9, a setup joint or support assembly 20 (generally referred to as “support assembly”), and a robotic instrument driver 16 (generally referred to as “instrument driver”). A surgeon is seated at the operator workstation 2 and can monitor the surgical procedure, patient vitals, and control one or more robotic surgical devices.
Referring to FIG. 2, the instrument driver 16, setup joint mounting brace 20, and bedside electronics box are shown in greater detail. Referring to FIG. 3, the instrument driver 16 is illustrated including an elongate member manipulator 24 and a robotic catheter assembly 11 installed. The robotic catheter assembly 11 includes a first or outer robotic steerable complement, otherwise referred to as a sheath instrument 30 (generally referred to as “sheath” or “sheath instrument”) and/or a second or inner steerable component, otherwise referred to as a robotic catheter or guide or catheter instrument 18 (generally referred to as “catheter” or “catheter instrument”). The sheath instrument 30 and catheter instrument 18 are controllable using the instrument driver 16. During use, a patient is positioned on an operating table or surgical bed 22 (generally referred to as “operating table”) to which the support assembly 20, instrument driver 16, and robotic catheter assembly 11 are coupled or mounted.
In the illustrated embodiments, the elongate member manipulator 24 (generally referred to as “manipulator”) is configured for manipulating an elongate member 26. In some embodiments, the elongate member 26 may be a guidewire. In other embodiments, the elongate member 26 may be a treatment device (e.g., an ablation catheter) that is configured to deliver energy to treat tissue, such as tissue at a liver. In further embodiments, the elongate member 26 may be any of other instruments for medical use. During use, at least a part of the elongate member 26 is disposed within a lumen of the catheter instrument 18, and the proximal end of the elongate member 26 is removably coupled to the manipulator 24. In some embodiments, the manipulator 24 is configured to advance and retract the elongate member 26 relative to the catheter instrument 18. In other embodiments, the manipulator 24 may also be configured to roll the elongate member 26 so that it rotates about its longitudinal axis.
Various system components in which embodiments described herein may be implemented are illustrated in close proximity to each other in FIG. 1, but embodiments may also be implemented in systems 10 in which components are separated from each other, e.g., located in separate rooms. For example, the instrument driver 16, operating table 22, and bedside electronics box 9 may be located in the surgical area with the patient, and the operator workstation 2 and the electronics rack 6 may be located outside of the surgical area and behind a shielded partition. System 10 components may also communicate with other system 10 components via a network to allow for remote surgical procedures during which the surgeon may be located at a different location, e.g., in a different building or at a different hospital utilizing a communication link transfers signals between the operator control station 2 and the instrument driver 16. System 10 components may also be coupled together via a plurality of cables or other suitable connectors 14 to provide for data communication, or one or more components may be equipped with wireless communication components to reduce or eliminate cables 14. In this manner, a surgeon or other operator may control a surgical instrument while being located away from or remotely from radiation sources, thereby decreasing the operator's exposure to radiation.
Referring to FIG. 4, one example of an operator workstation 2 that may be used with the system 10 shown in FIG. 1 includes three display screens 4, a touch screen user interface 5, a control button console or pendant 8, and a master input device (MID) 12. The MID 12 and pendant 8 serve as user interfaces through which the surgeon can control operation of the instrument driver 16 and attached instruments. By manipulating the pendant 8 and the MID 12, a surgeon or other operator can cause the instrument driver 16 to remotely control the catheter instrument 18 and/or the sheath instrument 30 mounted thereon. Also, in some embodiments, by manipulating one or more controls at the station 2, the surgeon or operator may cause the manipulator 24 to remotely move the elongate member 26. A switch 7 may be provided to disable activity of an instrument temporarily. The console 2 in the illustrated system 10 may also be configurable to meet individual user preferences. For example, in the illustrated example, the pendant 8 and the touch screen 5 are shown on the left side of the console 2, but they may also be relocated to the right side of the console 2. Various numbers of display screens may be provided. Additionally or alternatively, a bedside console 3 may be provided for bedside control of the of the instrument driver 16 if desired. Further, optional keyboard may be connected to the console 2 for inputting user data. The workstation 2 may also be mounted on a set of casters or wheels to allow easy movement of the workstation 2 from one location to another, e.g., within the operating room or catheter laboratory. Further aspects of examples of suitable MID 12, and workstation 2 arrangements are described in further detail in U.S. patent application Ser. No. 11/481,433 and U.S. Provisional Patent Application No. 60/840,331, the contents of which were previously incorporated herein by reference.
As shown in FIG. 1, the support assembly 20 is configured for supporting or carrying the instrument driver 16 over the operating table 22. One suitable support assembly 20 has an arcuate shape and is configured to position the instrument driver 16 above a patient lying on the table 22. The support assembly 20 may be configured to movably support the instrument driver 16 and to allow convenient access to a desired location relative to the patient. The support assembly 20 may also be configured to lock the instrument driver 16 into a certain position.
In the illustrated example, the support assembly 20 is mounted to an edge of the operating table 22 such that a catheter and sheath instruments 18, 30 mounted on the instrument driver 16 can be positioned for insertion into a patient. The instrument driver 16 is controllable to maneuver the catheter and/or sheath instruments 18, 30 within the patient during a surgical procedure. The distal portion of the setup joint 20 also includes a control lever 33 for maneuvering the setup joint 20. Although the figures illustrate a single guide catheter 18 and sheath assembly 30 mounted on a single instrument driver 16, embodiments may be implemented in systems 10 having other configurations. For example, embodiments may be implemented in systems 10 that include a plurality of instrument drivers 16 on which a plurality of catheter/ sheath instruments 18, 30 can be controlled. Further aspects of a suitable support assembly 20 are described in U.S. patent application Ser. No. 11/481,433 and U.S. Provisional Patent Application No. 60/879,911, the contents of which are expressly incorporated herein by reference. Referring to FIG. 2, the support assembly 20 may be mounted to an operating table 22 using a universal adapter base plate assembly 39, similar to those described in detail in U.S. Provisional Patent Application No. 60/899,048, incorporated by reference herein in its entirety. The adapter plate assembly 39 mounts directly to the operating table 22 using clamp assemblies, and the support assembly 20 may be mounted to the adapter plate assembly 39. One suitable adapter plate assembly 39 includes two large, flat main plates which are positioned on top of the operating table 22. The assembly 39 provides for various adjustments to allow it to be mounted to different types of operating tables 22. An edge of the adapter plate assembly 39 may include a rail that mimics the construction of a traditional surgical bedrail. By placing this rail on the adapter plate itself, a user may be assured that the component dimensions provide for proper mounting of the support assembly 20. Furthermore, the large, flat surface of the main plate provides stability by distributing the weight of the support assembly 20 and instrument driver 16 over an area of the table 22, whereas a support assembly 20 mounted directly to the operating table 22 rail may cause its entire load to be placed on a limited and less supportive section of the table 22. Additionally or alternatively, a bedside rail 13 may be provided which may couple the support assembly 20 to the operating table 22. The bedside rail may include a leadscrew mechanism which will enable the support assembly to translate linearly along the edge of the bed, resulting in a translation of the instrument driver 16 and ultimately a translation in the insert direction of the catheter and sheath instruments 18/30.
FIGS. 5A-C illustrate the instrument drive 16 with various components installed. FIG. 5A illustrates the instrument driver 16 with the instrument assembly 11 installed including the sheath instrument 30 and the associated guide or catheter instrument 18 while FIG. 5B illustrates the instrument driver 16 without an attached instrument assembly 11. The sheath instrument 30 and the associated guide instrument 18 are mounted to associated mounting plates 37, 38 on a top portion of the instrument driver 16. FIG. 5C illustrates the instrument driver 16 with skins removed to illustrate internal components. Embodiments described are similar to those described in detail in U.S. patent application Ser. Nos. 11/678,001, 11/678,016, and 11/804,585, each incorporated by reference herein in its entirety.
Referring to FIGS. 6A-B, the assembly 11 that includes the sheath instrument 30 and the guide or catheter instrument 18 positioned over their respective mounting plates 38, 37 is illustrated removed from the instrument driver 16. Additionally a sterile adaptor 41 can be used to couple each of the sheath and guide instruments to their respective mounting plates. The catheter instrument 18 includes a guide catheter instrument member 61 a, and the sheath instrument 30 includes a sheath instrument member 62 a. The guide catheter instrument member 61 a is coaxially interfaced with the sheath instrument member 62 a by inserting the guide catheter instrument member 61 a into a working lumen of the sheath catheter member 62 a. As shown in FIG. 6A, the sheath instrument 30 and the guide or catheter instrument 18 are coaxially disposed for mounting onto the instrument driver 16. However, it should be understood that the sheath instrument 16 may be used without a guide or catheter instrument 18, or the guide or catheter instrument 18 may be used without a sheath instrument 30. In such cases, the sheath instrument 16 or the catheter instrument 18 may be mounted onto the instrument driver 16 individually. With the coaxial arrangement as shown in FIG. 6A, a guide catheter splayer 61 is located proximally relative to, or behind, a sheath splayer 62 such that the guide catheter member 61 a can be inserted into and removed from the sheath catheter member 61 b.
The splayers 61, 62 are configured to steer the members 61 a, 61 b, respectively. In the illustrated embodiments, each of the splayers 61, 62 includes drivable elements therein configured to apply tension to different respective wires inside the member 61 a/61 b to thereby steer the distal end of the member 61 a/61 b. In some embodiments, the drivable elements may be actuated in response to a control signal from a controller, which receives an input signal from the work station 2, and generates the control signal in response to the input signal. Also, in the illustrated embodiments, the splayers 61, 62 may be translated relative to the instrument driver 16. In some embodiments, the instrument driver 16 may be configured to advance and retract each of the splayers 61, 62, so that the catheter instrument 18 and the sheath instrument 30 may be advanced distally and retracted proximally.
FIGS. 7A and 7B illustrate the sheath splayer 62 of one embodiment illustrated with the sterile adaptor 41 and mounting plate 38 coupled to a portion of the instrument driver shown with only a set of actuation mechanisms that will be described later in detail. As shown in FIG. 6A, the sheath and guide splayers 62, 61, appear similar physically in construction with the exception of differences in a valve purge tube 32. It should be noted that the purge tube 32 may or may not be included for either the guide or sheath splayer. The sheath splayer 62 will be described herein. However it should be understood that the guide splayer 61 is of similar construction, and components of the sheath splayer 62 can be repeated for the guide splayer 61.
As illustrated in FIG. 7C, the splayer 62 includes a splayer cover 72 fixably coupled to a splayer base assembly 78 using four screws 79. The splayer base 78 having four cavities to receive and house pulley assemblies 80 is used for both the guide splayer 61 and sheath splayer 62. For this embodiment of a sheath splayer 62, four cavities of the splayer base 78 are populated with pulley assemblies 80 but it should be understood that varying numbers of cavities may be populated leaving remaining cavities open. The guide splayer 61 may have all its cavities populated with four pulley assemblies 80 for pulling four respective wires, as can be seen in FIG. 6B. The splayer base 78 of this implementation can be constructed from injection molded polycarbonate.
During splayer 62 assembly, the pulley assembly 80 is put together and mated with a catheter pull wire or control element (not shown). The pull wire (not shown) runs down the length of a catheter from distal to proximal end then is wound about the pulley. By rotating the pulley, the pull wire bends the distal tip of the catheter controlling its bend.
Referring back to FIGS. 6A-6B, when a catheter is prepared for use with an instrument, its splayer is mounted onto its appropriate mounting plate via a sterile adaptor. In this case, the sheath splayer 62 is placed onto the sheath mounting plate 38 and the guide splayer 61 is place onto the guide mounting plate 37 via sterile adaptors 41. Referring to FIG. 7A-B, the pulley assemblies 80 are configured to couple to floating shafts 82 on the splayer adaptor 41 which in turn are configured to couple to sleeve receptacles 90. In the illustrated example, each mounting plates 37, 38 has four openings 37 a, 38 a that are designed to receive the corresponding floating shafts 84 attached to and extending from the sterile adaptors 41 coupled to the splayers 61, 62. In the example illustrated in FIG. 6B, four floating shafts 82 of the sterile adaptor 41 are insertable within the openings 38 a of the sheath mounting plate 38 as the splayer 62 is mounted onto the RCM. Similarly, four floating shafts 82 of the sterile adaptor 41 are insertable within the four apertures or openings 37 a of the guide interface plate 37. Referring to FIGS. 7D-E, the coupling of the pulley assemblies 80 to floating shafts 82 and floating shafts 82 to sleeve receptacles 90 is illustrated. FIG. 7D illustrates top and bottom perspective views of the pulley assembly 80 positioned above the floating shaft 82 where the bottom of the pulley assembly 80 is configured to mate with splines on the top of the floating shaft 82. FIG. 7E illustrates the floating shaft 82 installed and un-installed onto the sleeve receptacle 90. The sleeve receptacles can include a notch 90 a shaped to accept a pin 84 on the floating shaft 82.
Referring back to FIGS. 7A-B, the sheath splayer 62 is shown having latches 73 which may couple to hooks 86. By depressing the latches 73, the splayer 62 may be locked and unlocked to the sterile adaptor 41. The sterile adaptor in turn is configured having mounting hooks 88 which couple to sliding latches 77 on the mounting plate 83. The sliding latches 77 can be spring loaded to allow the adaptor plate 41 to be locked to the mounting plate 38 by applying downward force on the adaptor plate 41. The sliding latches can be depressed to release the adaptor plate 41 when desired.
The sheath interface mounting plate 38 as illustrated in FIGS. 6A and 6B is similar to the guide interface mounting plate 37, and thus, similar details are not repeated. One difference between the plates 37, 38 may be the shape of the plates. For example, the guide interface plate 37 includes a narrow, elongated segment, which may be used with, for example, a dither mechanism or the elongate member manipulator 24. Both plates 37, 38 include a plurality of openings 37 a, 38 a to receive floating shafts 82 and latches 73 from sterile adaptors 41. The splayers 61/62, sterile adaptors 41, and mounting plates 37/38 are all described in greater detail in U.S. patent application Ser. No. 13/173,994, filed on Jun. 30, 2011, the entire disclosure of which is expressly incorporated by reference herein.
Referring back to FIG. 5C the instrument driver 16 is illustrated with mounting plates 37,38 fixably coupled to a guide carriage 50, and a sheath drive block 40, respectively. FIG. 8 illustrates the guide carriage 50 removed from the instrument driver 16 coupled to cabling (not shown) and associated guide motors 53. The guide carriage 50 includes a funicular assembly 56 which is illustrated in FIG. 9. The funicular assembly 56 includes the four sleeve receptacles 90. As previously described, the floating shafts 82 of the sterile adaptor 41 first insert through the openings 37 a in the mounting plate 37. They then engage with the sleeve receptacles 90
Referring back to FIG. 8, a set of cables (not shown) wound around a set of pulleys 52, are coupled on one end to a set of guide motors 53 and the other end to the sleeve receptacles 90. Note that only two of four motors can be seen in FIG. 8. The drive motors 53 are actuated to rotationally drive the sleeves 90. The catheter assembly 18 with its splayer 61 mounted onto the instrument drive 16 would have its pulley assemblies 80 coupled to corresponding sleeves 90 via floating shafts 82. As the sleeves 90 are rotated, the pins 84 of the floating shafts 82 are seated in the V-shaped notches and are engaged by the rotating sleeves 90, thus causing the floating shafts 82 and associated pulley assemblies 80 to also rotate. The pulley assemblies 80 in turn cause the control elements (e.g., wires) coupled thereto to manipulate the distal tip of the catheter instrument 30 member in response thereto. FIGS. 10A and 10B illustrate top and bottom perspective views of the sheath output plate 38 exploded from the sheath block 40 and motor driven interfaces 42 which are coupled to sheath articulation motors 43. FIG. 10C illustrates sheath articulation motors 43 coupled to the motor driven interfaces 42 which includes a set of belts, shafts, and gears which drive receptacle sleeves 90 (which are similar in construction and functionality to the receptacle sleeves previously described for the guide funicular assembly). When the sheath splayer pulley assemblies 80 and sterile adaptor floating shafts 82 are coupled to the receptacle sleeves 90, the sheath articulation motors 43 drive the receptacle sleeves 90 causing the sheath instrument 30 to bend in the same manner described for the guide instrument.
During use, the catheter instrument 18 is inserted within a central lumen of the sheath instrument 30 such that the instruments 18, 30 are arranged in a coaxial manner as previously described. Although the instruments 18, 30 are arranged coaxially, movement of each instrument 18, 30 can be controlled and manipulated independently. For this purpose, motors within the instrument driver 16 are controlled such that the drive and sheath carriages coupled to the mounting plates 37, 38 are driven forwards and backwards independently on linear bearings each with leadscrew actuation. FIG. 10 illustrates the sheath drive block 40 removed from the instrument driver coupled to two independently-actuated lead screw 45, 46 mechanisms driven by guide and sheath insert motors 47 a,47 b. Note the guide carriage is not shown. In the illustrated embodiment, the sheath insertion motor 47 b is coupled to a sheath insert leadscrew 46 that is designed to move the sheath articulation assembly forwards and backwards, thus sliding a mounted sheath catheter instrument (not shown) forwards and backwards. The insert motion of the guide carriage can be actuated with a similar motorized leadscrew actuation where a guide insert motor 47 a is coupled to the guide insert leadscrew 45 via a belt.
Referring back to FIGS. 1, 4 and 6A, in order to accurately steer the robotic sheath 62 a or guide catheter 61 a from an operator work station 2, a control structure may be implemented which allows a user to send commands through input devices such as the pendant 8 or MID 12 that will result in desired motion of the sheath 62 a and guide 61 a. In some embodiments, the sheath 62 a and/or the guide 61 a may each have four control wires for bending the instrument in different directions. Referring to FIGS. 11A-H, the basic kinematics of a catheter 120 with four control elements 122 a, 122 b, 122 c, 122 d is shown. The catheter 120 may be component 61 a or component 62 a in some embodiments. Referring to FIGS. 11A-B, as tension is placed only upon the bottom control element 122 c, the catheter bends downward, as shown in FIG. 11A. Similarly, pulling the left control element 122 d in FIGS. 11C-D bends the catheter left, pulling the right control element 122 b in FIGS. 11E-F bends the catheter right, and pulling the top control element 122 a in FIGS. 11G-H bends the catheter up. As will be apparent to those skilled in the art, well-known combinations of applied tension about the various control elements results in a variety of bending configurations at the tip of the catheter member 120.
The kinematic relationships for many catheter instrument embodiments may be modeled by applying conventional mechanics relationships. In summary, a control-element-steered catheter instrument is controlled through a set of actuated inputs. In a four-control-element catheter instrument, for example, there are two degrees of motion actuation, pitch and yaw, which both have + and − directions. Other motorized tension relationships may drive other instruments, active tensioning, or insertion or roll of the catheter instrument. The relationship between actuated inputs and the catheter's end point position as a function of the actuated inputs is referred to as the “kinematics” of the catheter.
To accurately coordinate and control actuations of various motors within an instrument driver from a remote operator control station such as that depicted in FIG. 1, a computerized control and visualization system may be employed. The control system embodiments that follow are described in reference to a particular control systems interface, namely the SimuLink™ and XPC™ control interfaces available from The Mathworks Inc., and PC-based computerized hardware configurations. However, one of ordinary skilled in the art having the benefit of this disclosure would appreciate that many other control system configurations may be utilized, which may include various pieces of specialized hardware, in place of more flexible software controls running on one or more computer systems.
FIGS. 12-13 illustrate examples of a control structure for moving the catheter 61 a and/or the sheath 62 a in accordance with some embodiments. In one embodiment, the catheter (or other shapeable instrument) is controlled in an open-loop manner as shown in FIG. 12. In this type of open loop control model, the shape configuration command comes in to the beam mechanics, is translated to beam moments and forces, then is translated to tendon tensions given the actuator geometry, and finally into tendon displacement given the entire deformed geometry.
Referring to FIG. 13, an overview of other embodiment of a control system flow is depicted. A master computer 400 running master input device software, visualization software, instrument localization software, and software to interface with operator control station buttons and/or switches is depicted. In one embodiment, the master input device software is a proprietary module packaged with an off-the-shelf master input device system, such as the Phantom™ from Sensible Devices Corporation, which is configured to communicate with the Phantom™ hardware at a relatively high frequency as prescribed by the manufacturer. Other suitable master input devices, such as the master input device 12 depicted in FIG. 2 are available from suppliers such as Force Dimension of Lausanne, Switzerland. The master input device 12 may also have haptics capability to facilitate feedback to the operator, and the software modules pertinent to such functionality may also be operated on the master computer 126.
Referring to FIG. 13, in one embodiment, visualization software runs on the master computer 126 to facilitate real-time driving and navigation of one or more steerable instruments. In one embodiment, visualization software provides an operator at an operator control station, such as that depicted in FIG. 2, with a digitized “dashboard” or “windshield” display to enhance instinctive drivability of the pertinent instrumentation within the pertinent tissue structures. Referring to FIG. 14, a simple illustration is useful to explain one embodiment of a preferred relationship between visualization and navigation with a master input device 12. In the depicted embodiment, two display views 142, 144 are shown. One preferably represents a primary 142 navigation view, and one may represent a secondary 144 navigation view. To facilitate instinctive operation of the system, it is preferable to have the master input device coordinate system at least approximately synchronized with the coordinate system of at least one of the two views. Further, it is preferable to provide the operator with one or more secondary views which may be helpful in navigating through challenging tissue structure pathways and geometries.
Referring still to FIG. 14, if an operator is attempting to navigate a steerable catheter in order to, for example, contact a particular tissue location with the catheter's distal tip, a useful primary navigation view 142 may comprise a three dimensional digital model of the pertinent tissue structures 146 through which the operator is navigating the catheter with the master input device 12, along with a representation of the catheter distal tip location 148 as viewed along the longitudinal axis of the catheter near the distal tip. This embodiment illustrates a representation of a targeted tissue structure location 150, which may be desired in addition to the tissue digital model 146 information. A useful secondary view 144, displayed upon a different monitor, in a different window upon the same monitor, or within the same user interface window, for example, comprises an orthogonal view depicting the catheter tip representation 148, and also perhaps a catheter body representation 152, to facilitate the operator's driving of the catheter tip toward the desired targeted tissue location 150.
In one embodiment, subsequent to development and display of a digital model of pertinent tissue structures, an operator may select one primary and at least one secondary view to facilitate navigation of the instrumentation. By selecting which view is a primary view, the user can automatically toggle a master input device 12 coordinate system to synchronize with the selected primary view. In an embodiment with the leftmost depicted view 142 selected as the primary view, to navigate toward the targeted tissue site 150, the operator should manipulate the master input device 12 forward, to the right, and down. The right view will provide valued navigation information, but will not be as instinctive from a “driving” perspective.
To illustrate: if the operator wishes to insert the catheter tip toward the targeted tissue site 150 watching only the rightmost view 144 without the master input device 12 coordinate system synchronized with such view, the operator would have to remember that pushing straight ahead on the master input device will make the distal tip representation 148 move to the right on the rightmost display 144. Should the operator decide to toggle the system to use the rightmost view 144 as the primary navigation view, the coordinate system of the master input device 12 is then synchronized with that of the rightmost view 144, enabling the operator to move the catheter tip 148 closer to the desired targeted tissue location 150 by manipulating the master input device 12 down and to the right. The synchronization of coordinate systems may be conducted using fairly conventional mathematic relationships which are described in detail in the aforementioned applications incorporated by reference.
Referring back to embodiment of FIG. 13, the master computer 126 also comprises software and hardware interfaces to operator control station buttons, switches, and other input devices which may be utilized, for example, to “freeze” the system by functionally disengaging the master input device as a controls input, or provide toggling between various scaling ratios desired by the operator for manipulated inputs at the master input device 12. The master computer 126 has two separate functional connections with the control and instrument driver computer 128: one connection 132 for passing controls and visualization related commands, such as desired XYZ (in the catheter coordinate system) commands, and one connection 134 for passing safety signal commands. Similarly, the control and instrument driver computer 128 has two separate functional connections with the instrument and instrument driver hardware 130: one connection 136 for passing control and visualization related commands such as required-torque-related voltages to the amplifiers to drive the motors and encoders, and one connection 138 for passing safety signal commands. Also shown in the signal flow overview of FIG. 13 is a pathway 140 between the physical instrument and instrument driver hardware 130 back to the master computer 126 to depict a closed loop system embodiment wherein instrument localization technology is utilized to determine the actual position of the instrument to minimize navigation and control error.
II. Tension Sensing.
As discussed with reference to FIGS. 6-7, the robotic system 10 includes an instrument driver (or drive assembly) 16 with sleeve receptacles 90 for turning the respective shafts 82 at the sterile adaptor 41, which in turn, rotates the respective pulley assemblies 80 at the splayer 61/62. In some embodiments, the robotic system 10 may further include a sensor for sensing a characteristic that corresponds with an amount of force or torque being applied to turn the sleeve receptacles 90. FIG. 15 illustrates some components of the robotic system 10 that includes tension sensing capability in accordance with some embodiments. As shown in the figure, the instrument driver 16 includes the sleeve receptacles 90, which are actuatable elements that are actuated by respective motors 200. The instrument driver 16 also includes sensors 202 coupled to the respective motors 200. Each sensor 202 is configured to sense a characteristic that corresponds with an amount of force or torque being applied to the actuatable element 90. The sensor 202 is illustrated schematically as being coupled to the motor 200. In some embodiments, the sensor 202 may be located internally inside a motor. In other embodiments, the sensor 202 may be secured to an exterior of a motor. In other embodiments, the sensor 202 may be attached to a component that is coupled to the motor. For example, in some embodiments, the motor 200 may be mounted to a ring structure (like the ring structure 300 shown in FIG. 19) that is attached to the instrument driver 16. In such cases, the sensor 202 may be attached to the ring structure, and the sensor 202 may be considered as being coupled to the motor 200 (indirectly, in this example).
The robotic system 10 also includes the sterile adaptor 41, which has a base 220 with a plurality of openings 224 for housing respective rotary members 82. In the illustrated embodiments, the rotary members 82 are shafts configured for detachably coupling to respective sleeve receptacles 90. In particular, each rotary member 82 has a first end 210 for insertion into the sleeve receptacle 90, a second end 212, and a body 214 extending between the first and second ends 210, 212. The sterile adaptor 41 also includes a cover 222 that is coupled to the base 220, and a flexible sheet (membrane) 226 for providing a sterile barrier so that after the splayer assembly 61/62 is used, the sterile adaptor 41 and the splayer assembly 61/62 may be discarded, while leaving the instrument driver 16 sterile.
The robotic system 10 also includes the splayer 61/62, which includes a base 78 with a plurality of openings 230 for housing respective pulley assemblies 80, and a cover 72 for coupling to the base 78. When the cover 72 is coupled to the base 78, it covers the pulley assemblies 80. The splayer 61/62 also includes an elongate member 61 a /62 a coupled to the base 78 (e.g., either directly to the base 78, or indirectly to the base 78 through the cover 72). The elongate member 61 a /62 a may be a catheter, a sheath, or any elongate instrument having a lumen extending therethrough. The robotic system 10 also includes a plurality of steering wires 204 disposed in the elongate member 61 a/62 a. Each steering wire 204 has a distal end coupled to a distal end of the elongate member, and a proximal end coupled to one of the pulley assemblies 80. During use, the pulley assembly may be rotated to apply tension to the steering wire 204 to thereby apply tension to the steering wire 204, which in turn, causes the distal end of the elongate member 61 a /62 a to bend. Although two pulley assemblies 80 are shown, it should be understood that in other embodiments, the splayer 61/62 may have more than two pulley assemblies 80 (e.g., four pulley assemblies 80), with respective steering wires 204 connected thereto. Also, in other embodiments, the splayer 61/62 may have only one pulley assembly 80, and the elongate member 61 a /62 a may have only one steering wire 204 connected to the pulley assembly 80.
As shown in the figure, the actuatable element 90 is configured to turn the pulley assembly 80 indirectly through the rotary member 82 at the sterile adaptor 41 to thereby apply tension to the steering wire 204 at the catheter 61 a /sheath 62 a. The sensor 202 is configured to sense a characteristic that corresponds with an amount of force being applied to the actuatable element 90. By means of non-limiting examples, the characteristic may be an actual force, a torque (which is force times distance), a strain, a stress, an acceleration, etc. The sensed characteristic may be used to correlate an amount of tension being applied to the steering wire 204. In some embodiments, the sensed characteristic may be transmitted from the sensor 202 to the user interface 2, and the value of the sensed characteristic may be displayed on a screen for presentation to a user. Also, in some embodiments, the sensed characteristic may be transmitted from the sensor 202 in a form of a signal to a processor, which processes the signal, and controls an amount of torque/force being applied to the motor 200 in response to the processed signal.
In some embodiments, in order to accurately correlate the sensed characteristic by the sensor 202 with an amount of tension being applied at the steering wire 204, it may be desirable to minimize, or at least reduce an amount of friction between the shaft 82 and the base 220 at the sterile adaptor 41. In the illustrated embodiments, the sterile adaptor 41 includes an interface between each rotary member 82 and the base 220 for reducing an amount of friction therebetween (i.e., between the shaft body 214 of the rotary member 82 and the wall in the opening 224 defined by the base 220). As shown in the figure, each rotary member 82 includes a flange 240 disposed circumferentially around the shaft body 214, and a plurality of slots 242 at the flange 240. Two slots 242 are shown, which are defined by a partition 244 extending round the shaft body 214 of the rotary member 82. The partition 244 may have a ring configuration. For example, the partition 244 may have a continuous ring structure, or alternatively, a plurality of structures that form a ring configuration. Each slot 242 has a ring configuration that extends around the shaft body 214 of the rotary member 82. Also, as shown in the figure, the base 220 includes a protrusion 246 next to (e.g., within 5 cm or less from) the opening 224. The protrusion 246 has a ring configuration around the opening 224, and extends into a slot 242. For example, the protrusion 246 may have a continuous ring structure, or alternatively, may have a plurality of structures that form into a ring configuration. Although one protrusion 246 is shown in the example, in other embodiments, the sterile adaptor 41 may include a plurality of protrusions 246 that extend into respective ones of the slots 242 at the flange 240. Also, in other embodiments, the flange 240 of the rotary member 82 may include more than two slots 242, or less than two slots 242 (e.g., only one slot 242).
In the illustrated embodiments, the cross sectional dimension of the shaft body 214 is less than the cross sectional dimension of the opening 224 (e.g., by 3 mm, and more preferably by 2 mm, and even more preferably by 1 mm or less). The partition(s) 244 at the flange 240 and the protrusion(s) 246 at the base 220 cooperate with each other (e.g., engage with each other) to prevent the shaft 214 from touching the surrounding wall at the opening 224. Accordingly, the shaft body 214 essentially “floats” within the space defined by the opening 224. In the illustrated embodiments, the partition 244 abuts against the protrusion 246 while the shaft body 214 is maintained within the opening 224 so that it is spaced away from the wall of the opening 224. In other embodiments, the partition 244 may not abut against the protrusion 246. Instead, there may be a small gap between the partition 244 and the protrusion 246 to reduce friction between the partition 244 and the protrusion 246. The gap may be large enough to allow some movement of the shaft body 214 relative to the base 220, while small enough to prevent the shaft body 214 from touching the wall at the opening 224.
In some embodiments, to further provide a frictionless interface, the partition(s) 244 and/or the protrusion(s) 246 may be coated with a hydrophobic material to allow fluid to glide easily along the surfaces of these components. Also, in some embodiments, a lubricant, such as oil, may be applied to the surface of the partition(s) 244 and/or the protrusion(s) 246.
During use, the sterile adaptor 41 is detachably coupled to the instrument driver 16. Such may be accomplished by inserting the first ends 210 of the respective rotary members 82 into respective openings at the acutatable elements 90 (like that shown in FIG. 7E). The membrane 226 provides a barrier to prevent the instrument driver 16 from being contaminated during a medical procedure. Also, during use, the splayer 61 is detachably coupled to the sterile adaptor 41. Such may be accomplished by inserting the second ends 212 of the respsective rotary members 82 into respective openings at the end of the rotary members 80 (like that shown in FIG. 7D).
The same setup may be performed for the splayer 62. In particular, during use, another sterile adaptor 41 is detachably coupled to the instrument driver 16. Such may be accomplished by inserting the first ends 210 of the respective rotary members 82 into respective openings at the acutatable elements 90 (like that shown in FIG. 7E). Also, the splayer 62 is detachably coupled to the sterile adaptor 41. Such may be accomplished by inserting the second ends 212 of the respective rotary members 82 into respective openings at the end of the rotary members 80 (like that shown in FIG. 7D).
After the splayers 61, 62 are mounted to respective sterile adaptors 41, and after the sterile adaptors 41 are mounted to the instrument driver 16, the robotic system 10 may then be used to perform a medical procedure. For example, in some embodiments, the splayer 61 and/or splayer 62 may be controlled to position the catheter 61 a and/or the sheath 62 a at desired position(s) within the patient. Once the catheter 61 a and/or the sheath 62 a have been desirably positioned, the catheter 61 a and/or the sheath 62 a may then be used to deliver an instrument (e.g., an ablation device) or a substance (e.g., occlusive device, drug, etc.) to treat the patient.
Various techniques may be employed to move the catheter 61 a and/or the sheath 62 a to thereby place these instruments at desired positions(s) in the patient. In some embodiments, the instrument driver 16 may be configured to translate the splayer 61 to thereby translate the catheter 61 a in an axial direction. Also, the instrument driver 16 may be configured to translate the splayer 62 to thereby translate the sheath 62 a in an axial direction. Thus, by moving the splayer 61 and/or splayer 62, the instrument driver 16 may advance or retract the catheter 61 a relative to the sheath 62 a, and vice versa. Also, if the movements of the splayers 61, 62 are synchronized, both the catheter 61 a and the sheath 62 a may be moved by the same amount in some embodiments. In some embodiments, the translation of the splayer 61 and/or the splayer 62 may be performed by the instrument driver 16 in response to a command signal received from the user interface. For example, in some embodiments, the instrument driver 16 may be configured to receive a command signal input from a user at the user interface, and generate a control signal in response to the command signal to move one or both of the splayers 61, 62.
Also, in some embodiments, the instrument driver 16 may be configured to bend a distal end of the catheter 61 a, a distal end of the sheath 62 a, or both. For example, in some embodiments, the instrument driver 16 may actuate one or more motors at the instrument driver 16 to turn one or more respective actuatable elements 90, thereby turning one or more respective rotary members 80 at the splayer 61 indirectly through the one or more respective rotary members 82 at the sterile adaptor 41. The turning of the one or more rotary members 80 at the splayer 61 applies tension to one or more respective steering wires to thereby bend the catheter 61 a towards a certain direction.
Similarly, in some embodiments, the instrument driver 16 may actuate one or more motors at the instrument driver 16 to turn one or more respective actuatable elements 90, thereby turning one or more respective rotary members 80 at the splayer 62 indirectly through the one or more respective rotary members 82 at the sterile adaptor 41. The turning of the one or more rotary members 80 at the splayer 62 applies tension to one or more respective steering wires to thereby bend the sheath 62 a towards a certain direction.
In some embodiments, as the rotary member 80 is being turned to apply tension to the steering wire 204, the sensor 202 senses a characteristic that correlates with an amount of force or torque being applied by the actuatable element 90. For example, in some embodiments, the sensor 202 may be a torque sensor configured to measure an amount of torque being applied to the actuatable element 90. The measured torque may be divided by a moment arm (e.g., a radius of the actuatable element 90) to derive a force value. In some embodiments, the force value may correlate with an amount of tension being applied to the steering wire 204. For example, in some cases, the force value may be considered to be the amount of tension being applied to the steering wire 204. In other embodiments, the sensor 202 may be a force sensor configured to measure a force vector that is in opposite direction as the tension force at the steering wire 204. Because of the frictionless interface at the sterile adaptor 41, the force sensed by the sensor 202 may be substantially equal to (e.g., at least 80%, and more preferably at least 90%, and even more preferably at least 99% of) the amount of tension at the steering wire 204.
In some embodiments, the sensed characteristic by the sensor 202 may be used in a process to steer the distal end of the catheter 61 a/sheath 62 a so that the distal end achieves a desired amount of bending. For example, in some embodiments, in a method of steering the distal end of the catheter 61 a/sheath 62 a (elongate member), an amount of bending to be achieved by the distal end of the elongate member may first be determined. Such may be accomplished by a user of the system 10. Alternatively, such may be accomplished automatically by a processor based on an anatomy of the patient, and the location of the elongate member 61 a/62 a. Next, an amount of tension to be applied to the steering wire 204 located within the elongate member 61 a/62 a may be determined based on the amount of bending that is desired to be achieved. In general, the more tension is being applied to the steering wire 204, the more the amount of bending will be achieved at the distal end of the elongate member 61 a/62 a. In some embodiments, the amount of tension may be calculated automatically by the processor based on structural properties (e.g., bending stiffness) of the elongate member 61 a/62 a. Next, the instrument driver 16 actuates the actuatable element 90 to apply a torque to turn the rotary member 80 that is detachably coupled (directly or indirectly through element 82) to the actuatable element 90. The application of the torque by the actuatable element 90 causes tension to be applied to the steering wire 204. While the actuatable element 90 is being actuated, the sensor 202 senses a characteristic that corresponds with an amount of force or torque being applied by the actuatable element 90 to turn the rotary member 80. In the illustrated embodiments, the act of using the actuatable element 90 to apply the torque comprises increasing the amount of force or torque being applied by the actuatable element 90 until the sensed characteristic by the sensor 202 indicates that the determined amount of tension at the steering wire 204 has been achieved. The above technique for bending the elongate member 61 a/62 a is advantageous because it obviates the need to determine how much axial movement (e.g., due to axial strain of the steering wire 204, and relative movement between the steering wire 204 and the elongate member 61 a/62 a) needs to be achieved by the steering wire 204 in order to achieve a certain desired amount of bending. In particular, the above technique involving use of the sensor 202 is advantageous over another technique of achieving a desired amount of bending, which involve determining how much tension is needed at the steering wire 204, and then determining a required amount of axial movement by the steering wire 204 that corresponds with the determined tension. Then the system monitors an amount of axial movement by the steering wire 204 until the required amount of axial movement by the steering wire 204 is achieved. However, calculating the required amount of axial movement needs to be achieved by the steering wire based on the required tension may be difficult, computational intensive, and may not be accurate.
Also as illustrated in the above embodiments, the frictionless interface at the sterile adaptor 41 is advantageous because it significantly remove all or most of the friction between the rotary member 82 and its surrounding wall in the opening 224. Thus, the frictionless interface at the sterile adaptor 41 is preferred over rubber seal, and the robotic system 10 does not include any rubber seal between the rotary member 82 and the base 220 of the sterile adaptor 41.
In the above embodiments, the rotary member 80 at the splayer 61/62 has been described as having an opening at one end of the rotary member 80 for receiving the second end 212 of the rotary member 82 at the sterile adaptor 41. In other embodiments, the configuration of the coupling may be reversed. For example, in other embodiments, the rotary member 80 at the splayer 61/62 may have an end for insertion into an opening at the second end 212 of the rotary member 82 at the sterile adaptor 41 (FIG. 16).
Also, in the above embodiments, the first end 210 of the rotary member 82 at the sterile adaptor 41 has been described as being inserted into an opening at the actuatable element 90 at the instrument driver 16. In other embodiments, the configuration of the coupling may be reversed. For example, in other embodiments, the first end 210 of the rotary member 82 at the sterile adaptor 41 may have an opening for receiving an end of the actuatable element 90 at the instrument driver 16 (FIG. 17). Furthermore, in other embodiments, the second end 212 of the rotary member 82 in the embodiments of FIG. 17 may be configured for insertion into an opening at the end of the rotary member 80 (like that shown in FIG. 15).
In the above embodiments, the frictionless interface at the sterile adaptor 41 includes two slots 242 and a protrusion 246 inserted into one of the slots 242. In other embodiments, the frictionless interface may include an additional protrusion 246 extending into the second slot 242. Also, in further embodiments, the frictionless interface may include only one slot 242 (FIG. 18).
As discussed, the sensor 202 is coupled to the motor 200, either directly or indirectly. Various techniques may be employed for coupling the sensor 202 to the motor 200. In some embodiments, the sensor 202 may be a strain gauge mounted to an output shaft. In other embodiments, the sensor 202 may be a torque sensor mounted in series with the output shaft.
In further embodiments, the motor 200 (with optional gearbox) may be mounted to the instrument driver 16 (e.g., to a chassis of the instrument driver) through a mounting structure 300 (FIG. 19). In such cases, the sensor 202 may be attached to the mounting structure 300. Such configuration is advantageous because it allows torque to be measured at the output shaft by measuring the reaction forces from the entire gear train. This is because at static equilibrium, the measured reaction torque may be equal to the output shaft torque. The mounting structure 300 has a ring configuration in some embodiments. In other embodiments, the mounting structure 300 may have other configurations. Also, in some embodiments, the mounting structure 300 may be considered to be a part of the sensor 202. The sensor 202 (and optionally with the mounting structure 300) may be a torque sensor, a hinge or flexure based structure with integrated load cell(s) or strain gauge(s), or a strain gauge mounted to an otherwise rigid mounting structure.
In some cases, the sensor 202 may pick up inertial forces from the acceleration and deceleration of the motor 200. Options for minimizing this contamination include (1) low-pass filtering the measured signal, (2) using only data collected when the motor 200 is stationary or moving at an approximately constant velocity, and/or (3) modeling the inertial effects of the motor 200, and compensating the measured signal based upon a measured acceleration by an encoder at the motor 200 and/or motor back-EMF.
In other embodiments, by mounting the axis of the motor 200 at 90° relative to the axis of the output shaft, the inertia forces due to acceleration and deceleration of the motor 200 will be decoupled from the measured reaction torque (FIG. 20). As shown in the figure the robotic system 10 may optionally further include a gear box 310 for transmitting torque from the motor 200 to the output shaft that is axially aligned with the actuatable element 90. In such cases, the acceleration of the output shaft, pulley, etc., may still contaminate the measurement of wire tension, but these contributions will be relatively small compared to the acceleration of the motor rotor, especially because of the effects of gear reduction between motor and output shaft. The sensor 202 (and optionally with the mounting structure 300) may be a torque sensor, a hinge or flexure based structure with integrated load cell(s) or strain gauge(s), or a strain gauge mounted to an otherwise rigid mounting structure.
In further embodiments, the instrument driver 16 may include a differential gearbox 320 mechanically coupled to the motor 200 (FIG. 21). The gearbox 320 is configured to turn a first output shaft 322 that is coupled to the actuatable element 90, while a second output shaft 324 extending from the gearbox 320 is fixed to the instrument driver 16 (e.g., to a chassis of the instrument driver 16). In some embodiments, the second output shaft 324 may be fixed to the instrument driver 16 through the sensor 202 (see option A in figure), which may be a torque sensing element in some embodiments. Alternatively, the second output shaft 324 may be fixed to the instrument driver 16 without using the sensor 202, in which cases, the sensor 202 (which may be a strain gauge in some embodiments) may be secured to the second output shaft 324 (see option B in figure). The gearbox 320 is advantageous because it allows the sensor 202 to be coupled to a component that experiences torque from the gearbox 320, but does not spin (which is beneficial because it obviates the need to implement complicated signal connection, such as a slip connection, that may otherwise be needed if the sensor 202 is coupled to a spinning shaft). In some embodiments, the gearbox 320 may be similar to that used in transferring power to both wheels of an automobile while allowing them to rotate at different speeds. In some cases, the difference between the torque in the upper and lower output shafts 322, 324 may be due to inefficiencies of the differential gearbox 320. In such cases, by maximizing the efficiency of the differential gearbox 320, the sensor 202 may provide a good estimate of the pullwire tension without having to deal with routing signal connections to a sensor that is moving. Also, in some embodiments, the configuration of the embodiments shown in FIG. 21 may be simplified by incorporating the secondary (fixed) output shaft 324 and the sensor 202 entirely within a housing of the differential gearbox 320. This may provide for a compact gearbox with integrated output shaft torque sensing and no limitations on output shaft motion.
III. Driving Modes
As discussed, the system 10 may be configured to move the sheath 62 a distally or proximally, move the catheter 61 a distally or proximally, and to move the elongate member 26 distally or proximally. In some cases, the movement of the sheath 62 a may be relative to the catheter 61 a, while the catheter 61 a remains stationary. In other cases, the movement of the catheter 61 a may be relative to the sheath 62 a while the sheath 62 a remains stationary. Also, in other cases, the sheath 62 a and the catheter 61 a may be moved together as a unit. The elongate member 26 may be moved relative to the sheath 62 a and/or the catheter 61 a. Alternatively, the elongate member 26 may be moved together with the sheath 62 a and/or the catheter 61 a.
In some embodiments, the workstation 2 is configured to provide some or all of the following commanded motions (driving modes) for allowing the physician to choose. In some embodiments, each of the driving modes may have a corresponding button at the workstation 2 and/or the bedside control 402.
Elongate member Insert—When this button/command is selected, the manipulator 24 inserts the elongate member 26 at a constant velocity.
Elongate member Roll—When this button/command is selected, the manipulator 24 rolls the elongate member 26 at a constant angular velocity
Elongate member Size—When the size or gauge of the elongate member 26 is inputted into through the user interface, the system will automatically alter roll and insert actuation at the proximal end of the elongate member 26 accordingly to achieve desired commanded results. In one implementation, when a user inputs the elongate member's size, the system automatically changes its kinematic model for driving that elongate member 26. So if the user commands the elongate member 26 to move to a certain position, the system will calculate, based on the kinematic model, roll and insert commands, which may be different for different elongate member sizes (e.g., elongate members 26 with different diameters). By inputting the elongate member's size, the system knows which kinematic model to use to perform the calculation. Such feature is beneficial because different sized elongate members 26 behave differently.
Leader/Sheath Select—When this button/command is selected, it allows the user to select which device (e.g., catheter 61 a, sheath 62 a, elongate member 26, or any combination of the foregoing) is active.
Leader/Sheath Insert/Retract—When this button/command is selected, the instrument driver assembly inserts or retracts the catheter 61 a/sheath 62 a while holding the elongate member 26 and any non-active device fixed relative to the patient. When this motion causes the protruding section of the catheter 61 a to approach zero (due to insertion of the sheath 62 a or retraction of the catheter 61 a), the system automatically relaxes the catheter 61 a as part of the motion.
Leader/Sheath Bend—When this button/command is selected, the instrument driver assembly bends the articulating portion of the catheter 61 a/sheath 62 a within its currently commanded articulation plane.
Leader/Sheath Roll—When this button/command is selected, the instrument driver assembly uses the pullwires to “sweep” the articulation plane of the device (catheter 61 a and/or sheath 62 a) around in a circle through bending action of the device. Thus, this mode of operation does not result in a true “roll” of the device in that the shaft of the device does not roll. In other embodiments, the shaft of the device may be configured to rotate to result in a true roll. Thus, as used in this specification, the term “roll” may refer to an artificial roll created by seeping a bent section, or may refer to a true roll created by rotating the device.
Leader/Sheath Relax—When this button/command is selected, the instrument driver assembly gradually releases tension off of the pullwires on the catheter 61 a/sheath 62 a. If in free space, this results in the device returning to a straight configuration. If constrained in an anatomy, this results in relaxing the device such that it can most easily conform to the anatomy.
Elongate Member Lock—When this button/command is selected, the elongate member 26 position is locked to the catheter 61 a position. As the leader is articulated or inserted, the elongate member 26 moves with the catheter 61 a as one unit.
System Advance/Retract—When this button/command is selected, the instrument driver assembly advances/retracts the catheter 61 a and sheath 62 a together as one unit. The elongate member 26 is controlled to remain fixed relative to the patient.
Autoretract—When this button/command is selected, the instrument driver assembly starts by relaxing and retracting the catheter 61 a into the sheath 62 a, and then continues by relaxing and retracting the sheath 62 a with the catheter 61 a inside it. The elongate member 26 is controlled to remain fixed relative to the patient.
Initialize Catheter—When this button/command is selected, the system confirms that the catheter 61 a and/or the sheath 62 a has been properly installed on the instrument driver assembly, and initiates pretensioning. Pretensioning is a process used to find offsets for each pullwire to account for manufacturing tolerances and the initial shape of the shaft of the catheter 61 a and/or the sheath 62 a.
Leader/Sheath Re-calibration—When this button/command is selected, the instrument driver assembly re-pretensions the catheter 61 a and/or the sheath 62 a in its current position. This gives the system the opportunity to find new pretension offsets for each pullwire and can improve catheter driving in situations where the proximal shaft of the catheter 61 a has been placed into a significant bend. It is activated by holding a relax button down for several seconds which ensures that the device is fully de-articulated. Alternatively the re-calibration may be activated without holding down the relax button to de-articulate the device.
Leader Relax Remove—When this button/command is selected, the instrument driver assembly initiates a catheter removal sequence where the catheter 61 a is fully retracted into the sheath 62 a, all tension is released from the pullwires, and the splayer shafts (at the drivable assembly 61 and/or drivable assembly 62) are driven back to their original install positions so that the catheter 61 a can be reinstalled at a later time.
Leader Yank Remove—When this button/command is selected, the instrument driver assembly initiates a catheter removal sequence where the catheter 61 a is removed manually.
Emergency Stop—When this button/command is selected, the instrument driver assembly initiates a gradual (e.g., 3 second) relaxation of both the catheter 61 a and the sheath 62 a. The components (e.g., amplifier) for operating the catheter 61 a, elongate member 26, or another device are placed into a “safe-idle” mode which guarantees that no power is available to the motors that drive these elements, thereby bringing them rapidly to a stop, and allowing them to be manually back-driven by the user. Upon release of the emergency stop button, the system ensures that the catheter 61 a is still in its allowable workspace and then returns to a normal driving state.
Segment control: In some embodiments, the workstation 2 allows a user to select individual segment(s) of a multi-segment catheters (such as the combination of the catheter 61 a and the sheath 62 a), and control each one. The advantage of controlling the catheter in this way is that it allows for many options of how to control the movement of the catheter, which may result in the most desirable catheter performance. To execute this method of catheter steering, the user selects a segment of the catheter to control. Each segment may be telescoping or non-telescoping. The user may then control the selected segment by bending and inserting it using the workstation 2 to control the position of the end point of the catheter. Other segment(s) of the catheter will either maintain their previous position (if it is proximal of the selected section) or maintain its previous configuration with respect to the selected section (if it is distal of that section) (FIG. 22A).
Follow mode: In some embodiments, the workstation 2 allows the user to control any telescoping section while the more proximal section(s) follows behind automatically. This has the advantage of allowing the user to focus mostly on the movement of a section of interest while it remains supported proximally. To execute this method of catheter steering, the user first selects a telescoping section of the elongate instrument (e.g., catheter 61 a and sheath 62 a) to control. This section is then controlled using the workstation 2 to prescribe a location of the endpoint of the segment. Any segment(s) distal of the section of interest will maintain their previous configuration with respect to that section. When the button on the workstation 2 is released, any segment(s) proximal of the section of interest will follow the path of the selected section as closely as possible until a predefined amount of the selected section remains (FIG. 22B). As an alternative to this driving mode, the segment(s) of the elongate instrument which is proximal of the section of interest could follow along as that segment is moved instead of waiting for the button to be released. Furthermore, with either of these automatic follow options, the system may optionally be configured to re-pretension the sections that have been driven out and re-align the sections that are proximal of the driven section.
Follow mode may be desirable to use to bring the more proximal segments of the elongate instrument towards the tip to provide additional support to the distal segment. In cases where there are three or more controllable sections of the elongate instrument, there are several options for how to execute a “follow” command. Consider the example in FIG. 22D where the distal segment (which may be a guidewire or a steerable instrument in some embodiments) has been driven out as shown in frame 1. The “follow” command could be executed by articulating and/or inserting only the middle segment (which may be the catheter 61 a in some embodiments) of the elongate instrument as shown in frame 2. The “follow” command could be executed by articulating and/or inserting only the most proximal segment (which may be the sheath 62 a in some embodiments) of the elongate instrument as shown in frame 3. The “follow” command could also be executed by coordinating the articulation and/or insertion of multiple proximal segments of the elongate instrument as shown in frame 4. Combining the motion of multiple sections has several potential advantages. First, it increases the total degrees-of-freedom available to the algorithm that tries to fit the shape of the following section(s) to the existing shape of the segment being followed. Also, in comparison to following each segment sequentially, a multi-segment follow mode simplifies and/or speeds up the workflow. In addition, multi-segment increases the distance that can be followed compared to when only one proximal segment is used to follow the distal segment.
Mix-and-match mode: In some embodiments, the workstation 2 allows the user to have the option of mixing and matching between articulating and inserting various sections of a catheter. For example, consider the illustration in FIG. 22C, and assuming that the distal most section of the elongate instrument is the “active” segment. If the user commands a motion of the tip of the elongate instrument as indicated by the arrow in Frame 1, there are several options available for how to achieve this command: (1) Articulate and extend the “active” segment, which is illustrated in frame 3 and is likely considered the normal or expected behavior; (2) Articulate the active distal most segment and insert one of the other proximal segments, as illustrated in frames 2 and 4; (3) Articulate the active distal most segment and combine inserting motion of some or all of the segments, as illustrated in frame 5.
There are multiple potential reasons why the user might want to choose some of these options. First, by “borrowing” insert motion from other segments, some of the segments could be constructed with fixed lengths. This reduces the need for segments to telescope inside of each other, and therefore reduces the overall wall thickness. It also reduces the number of insertion degrees-of-freedom needed. Also, by combining the insert motion from several segments, the effective insert range-of-motion for an individual segment can be maximized. In a constrained space such as the vasculature, the operator may likely be interested in “steering” the most distal section while having as much effective insertion range as possible. It would simplify and speed up the workflow to not have to stop and follow with the other segments.
In other embodiments, the “follow” mode may be carried out using a robotic system that includes a flexible elongated member (e.g., a guidewire), a first member (e.g., the catheter 61 a) disposed around the flexible elongated member, and a second member (e.g., the sheath 62 a) disposed around the first member. The flexible elongated member may have a pre-formed (e.g., pre-bent) configuration. In some embodiments, the flexible elongated member may be positioned inside a body. Such may be accomplished using a drive mechanism that is configured to position (e.g., advance, retract, rotate, etc.) the flexible elongated member. In one example, the positioning of the flexible elongated member comprises advancing the flexible elongated member so that its distal end passes through an opening in the body.
Next, the first member is relaxed so that it has sufficient flexibility that will allow the first member to be guided by the flexible elongated member (that is relatively more rigid than the relaxed first member). In some embodiments, the relaxing of the first member may be accomplished by releasing tension in wires that are inside the first member, wherein the wires are configured to bend the first member or to maintain the first member in a bent configuration. After the first member is relaxed, the first member may then be advanced distally relative to the flexible elongated member. The flexible elongated member, while being flexible, has sufficient rigidity to guide the relaxed first member as the first member is advanced over it. The first member may be advanced until its distal end also passes through the opening in the body.
In some embodiments, the second member may also be relaxed so that it has sufficient flexibility that will allow the second member to be guided by the flexible elongated member (that is relatively more rigid than the relaxed second member), and/or by the first member. In some embodiments, the relaxing of the second member may be accomplished by releasing tension in wires that are inside the second member, wherein the wires are configured to bend the second member or to maintain the second member in a bent configuration. After the second member is relaxed, the second member may then be advanced distally relative to the flexible elongated member. The flexible elongated member, while being flexible, has sufficient rigidity to guide the relaxed second member as the second member is advanced over it. The second member may be advanced until its distal end also passes through the opening in the body. In other embodiments, instead of advancing the second member after the first member, both the first member and the second member may be advanced simultaneously (e.g., using a drive mechanism) so that they move together as a unit. In further embodiments, the acts of advancing the flexible elongated member, the first member, and the second member may be repeated until a distal end of the flexible elongated member, the first member, or the second member has passed through an opening in a body.
In the above embodiments, tension in pull wires in the second elongated member is released to make it more flexible than the first elongated member, and the second elongated member is then advanced over the first elongated member while allowing the first elongated member to guide the second elongated member. In other embodiments, the tension in the pull wires in the first elongated member may be released to make it more flexible than the second elongated member. In such cases, the more flexible first elongated member may then be advanced inside the more rigid second elongated member, thereby allowing the shape of the second elongated member to guide the advancement of the first elongated member. In either case, the more rigid elongated member may be locked into shape by maintaining the tension in the pull wires.
In some of the embodiments described herein, the flexible elongated member may be a guidewire, wherein the guidewire may have a circular cross section, or any of other cross-sectional shapes. Also, in other embodiments, the guidewire may have a tubular configuration. In still other embodiments, instead of a guidewire, the flexible elongated member may be the member 26. In further embodiments, the robotic system may further include a mechanism for controlling and/or maintaining the preformed configuration of the guidewire. In some embodiments, such mechanism may include one or more steering wires coupled to a distal end of the guidewire. In other embodiments, such mechanism may be the catheter 61 a, the sheath 62 a, or both. In particular, one or both of the catheter 61 a and the sheath 62 a may be stiffened (e.g., by applying tension to one or more wires inside the catheter 61 a and/or the sheath 62 a). The stiffened catheter 61 a and/or the sheath 62 a may then be used to provide support for the guidewire.
Also, in some of the embodiments described herein, any movement of the elongate member 26, the catheter 61 a, and/or the sheath 62 a may be accomplished robotically using a drive assembly. In some embodiments, the drive assembly is configured to receive a control signal from a processor, and actuate one or more driveable elements to move the elongate member 26, the catheter 61 a, and/or the sheath 62 a.
It should be noted that the driving modes for the system are not limited to the examples discussed, and that the system may provide other driving modes in other embodiments.
IV. Treatment Methods
FIGS. 23A-23F illustrate a method of treating tissue using the robotic system 10 in accordance with some embodiments. As an example, the method will be described with reference to treating liver tissue. However, it should be understood that the system 10 may be used to treat other types of tissue.
First, the robotic system 10 is setup by placing the catheter 61 into the lumen of the sheath 62, and by placing the elongate member 26 into the lumen of the catheter 61. Next, an incision is then made at a patient's skin, and the distal end of the catheter 61 is then inserted into the patient through the incision. In particular, the distal end of the catheter 61 is placed inside a vessel 2000 (e.g., a vein or an artery) of the patient. In some embodiments, the liver may be accessed from the femoral vein or femoral artery from either groin. In other embodiments, the liver may be accessed from the right sub-clavin in vein or the right jugular vein. In some embodiments, the initial insertion of the catheter 61 into the patient may be performed manually. In other embodiments, the initial insertion of the catheter 61 may be performed robotically using the system 10. In such cases, the user may enter a command at the workstation 2, which then generates a user signal in response thereto. The user signal is transmitted to a controller, which then generates a control signal in response to the user signal. The control signal is transmitted to the driver to drive the catheter 61 so that it advances distally into the patient. In some embodiments, while the catheter 61 is being inserted into the patient, the distal end 2300 of the elongate member 26 may be housed within the lumen of the catheter 61. In other embodiments, the distal end 2300 of the elongate member 26 may extend out of the lumen of the catheter 61 (which the flexible section 320 of the elongate member 26 is housed within the lumen of the catheter 61) as the catheter 61 is being inserted. In such cases, the sharp distal tip of the elongate member 26 may facilitate insertion through the patient's skin. In other embodiments, the tip of the elongate member 26 may not be sharp enough, or the distal section of the elongate member 26 may not be stiff enough, to puncture the patient's skin. In such cases, a separate tool may be used to create an incision at the patient's skin first, as discussed.
In some embodiments, after the catheter 61 a is placed inside the patient, the sheath 62 a may be advanced distally over the catheter 61 a. Alternatively, both the catheter 61 a and the sheath 62 a may be advanced simultaneously to enter into the patient.
Once the catheter 61 a and the sheath 62 a are inserted into the patient, they can be driven to advance through the vasculature of the patient. At sections of the vessel 2000 that are relatively straight, both the catheter 61 a and the sheath 62 a may be driven so that they move as one unit. Occasionally, the catheter 61 a and/or the sheath 62 a may reach a section of the vessel 2000 that has a bend (e.g., a sharp bend). In such cases, the catheter 61 a and the sheath 62 a may be driven in a telescopic manner to advance past the bend.
FIGS. 23A-23B illustrate such telescopic technique for advancing the sheath 62 a and the catheter 61 a over a bend 2002 along a length of the vessel 2000. In this technique, the catheter 61 a is positioned with its distal articulation section traversing the bend 2002 and it is locked in this position (FIG. 23A). Next, the sheath 62 a is advanced over the catheter 61 a (FIG. 23B), and the catheter 61 a acts as a rail held in a fixed shape for the sheath 62 a to glide over. As the sheath 62 a is advanced further, sections with higher bending stiffness on the sheath 62 a will pass over the articulated section of the catheter 61 a, putting an increase load on the catheter 61 a. The increase in load on the catheter 61 a may tend to straighten the catheter 61 a. In some embodiments, the drive assembly of the robotic system 10 maintains the bent shape of the catheter 61 a by tightening the control wire(s), which has the effect of stiffening the catheter 61 a. In some embodiments, the robotic system 10 is configured to detect the increased load on the control wires (due to the placement of the sheath 62 a over the catheter 61 a) to be detected. The operator, or the robotic system 10, can then apply an equal counteracting load on all the control wires of the catheter 61 a to ensure that its bent shape is maintained while the sheath 62 a is advanced over the bend. In other embodiments, the sheath 62 a may be extremely flexible so that it does not put any significant load on the catheter 61 a as the sheath 62 a is advanced over the catheter 61 a, and/or distort the anatomy.
Once the distal end of the catheter 61 a reaches the target location (FIG. 23C), the distal end of the catheter 61 a may be steered to create a bend so that the distal opening at the catheter 61 a faces towards a tissue 2010 that is desired to be treated (FIG. 23D). The steering of the distal end of the catheter 61 a may be accomplished by receiving a user input at the workstation 2, which generates a user signal in response to the user input. The user signal is transmitted to the controller, which then generates a control signal in response to the user signal. The control signal causes the drive assembly to apply tension to one or more wires inside the catheter 61 a to thereby bend the distal end of the catheter 61 a at the desired direction.
Next, the distal end 2300 of the elongate member 26 is deployed out of the lumen of the catheter 61 a by advancing the elongate member 26 distally (FIG. 23E). This may be accomplished robotically using the manipulator 24, and/or manually. The sharp distal tip of the elongate member 26 allows the distal end 2300 to penetrate into the target tissue 2010. Also, the flexible section 320 of the elongate member 26 allows the elongate member 26 to follow the curvature of the catheter 61 a as the elongate member 26 is advanced out of the lumen of the catheter 61 a. In some embodiments, the distal advancement of the elongate member 26 may be accomplished by receiving a user input at the workstation 2, which generates a user signal in response to the user input. The user signal is transmitted to the controller, which then generates a control signal in response to the user signal. The control signal causes the elongate member manipulator 24 to turn its roller(s) to thereby advance the elongate member 26 distally.
After the distal end 2300 of the elongate member 26 is desirably positioned, the RF generator 350 is then activated to cause the distal end 2300 to deliver RF ablation energy to treat the target tissue 2010. In some embodiments, if the system 10 includes the return electrode 352 that is placed on the patient's skin, the system 10 then delivers the energy in a monopolar configuration. In other embodiments, if the elongate member 26 includes the two electrodes 370 a, 370 b, the system 10 may then deliver the energy in a bipolar configuration. The energy is delivered to the target tissue 2010 for a certain duration until a lesion 2020 is created at the target site (FIG. 23E).
In some embodiments, while energy is being delivered by the elongate member 26, cooling fluid may be delivered to the target site through the lumen in the elongate member 26, and out of the distal port 310 and/or side port(s) 312 at the elongate member 26. The cooling fluid allows energy to be delivered to the target tissue in a desired manner so that a lesion 3020 of certain desired size may be created. In other embodiments, the delivery of cooling fluid is optional, and the method does not include the act of delivering cooling fluid.
After the lesion 3020 has been created, the elongate member 26 may be removed from the catheter 61 a, and a substance 2030 may then be delivered to the target site through the lumen of the catheter 61 a (FIG. 23F). In some embodiments, the removal of the elongate member 26 from the catheter 61 a may be accomplished by receiving a user input at the workstation 2, which generates a user signal in response to the user input. The user signal is transmitted to the controller, which then generates a control signal in response to the user signal. The control signal causes the elongate member manipulator 24 to turn its roller(s) to thereby retract the elongate member 26 proximally until the entire elongate member 26 is out of the lumen of the catheter 61 a.
In some embodiments, the substance 2030 may be an embolic material for blocking supply of blood to the target site. In other embodiments, the substance 2030 may be a drug, such as a chemotherapy drug, for further treating tissue at the target site. In further embodiments, the substance 2030 may be one or more radioactive seeds for further treating tissue at the target site through radiation emitted from the radioactive seed(s). In other embodiments, the delivery of the substance 2030 may be optional, and the method may not include the act of delivering the substance 2030.
In some embodiments, if there is another target tissue (e.g., tumor) that needs to be treated, any or all of the above actions may be repeated. For example, in some embodiments, after the first tumor has been ablated, the distal end of the catheter 61 a may be steered to point to another direction, and the elongate member 26 may be deployed out of the catheter 61 a again to ablate the second tumor. Also, in other embodiments, the catheter 61 a may be moved distally or retracted proximally along the length of the vessel 2000 to reach different target sites.
In other embodiments, instead of the telescopic configuration, the robotic system 10 may be configured to drive the catheter 61 a and the sheath 62 a in other configurations. For example, in some embodiments, the sheath 62 a may be bent and acts as guide for directing the catheter 61 a to move in a certain direction. In such cases, the robotic system 10 may be configured to relax the wires in the catheter 61 a so that the catheter 61 a is flexible as it is advanced distally inside the lumen of the sheath 62 a. Also, in other embodiments, the sheath 62 a may not be involved in the method. In such cases, the robotic system 10 may be configured to drive the catheter 61 a without the sheath 62 a to advance the catheter 61 a through the vasculature of the patient.
Also, in other embodiments, a guidewire may be used in combination with the catheter 61 a and/or the sheath 62 a for advancement of the catheter 61 a and/or the sheath 62 a inside the vessel of the patient. In such cases, the elongate member 26 is not inserted into the catheter 61 a. Instead, the guidewire is coupled to the elongate member manipulator 24, and the guidewire is placed inside the lumen of the catheter 61 a. The manipulator 24 may then be used to drive the guidewire to advance and/or retract the guidewire. In some cases, the robotic system 10 may advance the guidewire, the catheter 61 a, and the sheath 62 a in a telescopic configuration, as similarly discussed.
If a guidewire is initially used to access the interior of the patient, the guidewire may be later exchanged for the elongate member 26. For example, in some embodiments, the guidewire may be exchanged for the elongate member 26 after initial access of the main hepatic artery (or vein). After the distal end of the catheter 61 a reaches the target site, the guidewire may then be removed from the lumen of the catheter 61 a, and decoupled from the elongate member manipulator 24. The proximal end of the elongate member 26 is coupled to the elongate member manipulator 24, and the elongate member 26 is then inserted into the lumen of the catheter 61 a. The elongate member manipulator 24 is then used to drive the elongate member 26 distally until the distal end 2300 of the elongate member 26 exits out of the distal end of the catheter 61 a, as similarly discussed.
In further embodiments, the elongate member 26 may not be needed to treat tissue. For example, in other embodiments, after the distal end of the catheter 61 a is desirably placed at a target site, the catheter 61 a may then be used to deliver a substance (e.g., an agent, a drug, radioactive seed(s), embolic material, etc.) to treat tissue at the target site without ablating the tissue. In some embodiments, the catheter 61 a itself may be directly used to deliver the substance. In other embodiments, another delivery device (e.g., a tube) may be placed inside the lumen of the catheter 61 a, and the delivery device is then used to deliver the substance. In such cases, the catheter 61 a is used indirectly for the delivery of the substance.
In some embodiments, during the treatment method, a localization technique may be employed to determine a location of the instrument inside the patient's body. The term “localization” is used in the art in reference to systems for determining and/or monitoring the position of objects, such as medical instruments, in a reference coordinate system. In one embodiment, the instrument localization software is a proprietary module packaged with an off-the-shelf or custom instrument position tracking system, which may be capable of providing not only real-time or near real-time positional information, such as X-Y-Z coordinates in a Cartesian coordinate system, but also orientation information relative to a given coordinate axis or system. For example, such systems can employ an electromagnetic based system (e.g., using electromagnetic coils inside a device or catheter body). Other systems utilize potential difference or voltage, as measured between a conductive sensor located on the pertinent instrument and conductive portions of sets of patches placed against the skin, to determine position and/or orientation. In another similar embodiment, one or more conductive rings may be electronically connected to a potential-difference-based localization/orientation system, along with multiple sets, preferably three sets, of conductive skin patches, to provide localization and/or orientation data. Additionally, “Fiberoptic Bragg grating” (“FBG”) sensors may be used to not only determine position and orientation data but also shape data along the entire length of a catheter or shapeable instrument. In other embodiments, imaging techniques may be employed to determine a location of the instrument inside the patient's body. For examples, x-ray, ultrasound, computed tomography, MRI, etc., may be used in some embodiments.
In other embodiments not comprising a localization system to determine the position of various components, kinematic and/or geometric relationships between various components of the system may be utilized to predict the position of one component relative to the position of another. Some embodiments may utilize both localization data and kinematic and/or geometric relationships to determine the positions of various components. The use of localization and shape technology is disclosed in detail in U.S. Patent application Ser. Nos.: 11/690,116, 11/176,598, 12/012,795, 12/106,254, 12/507,727, 12/822,876, 12/823,012, and 12/823,032, the entirety of all of which is incorporated by reference herein for all purposes.
Also, in one or more embodiments described herein, the system may further include a sterile barrier positioned between the drive assembly and the elongate member holder, wherein the drive assembly is configured to transfer rotational motion, rotational motion, or both, across the sterile barrier to the rotary members to generate the corresponding linear motion of the elongate member along the longitudinal axis of the elongate member, rotational motion of the elongate member about the longitudinal axis, or both linear motion and rotational motion.
As illustrated in the above embodiments, the robotic technique and system 10 for treating liver tissue is advantageous because it allows the ablation device to reach certain part(s) of the liver through the vessel that may otherwise not be possible to reach using conventional rigid ablation probe. For example, in some embodiments, using the robotic system 10 and the above technique may allow the distal end of the elongate member 26 to reach the lobus quatratus or the lobus spigelii of the liver, which may not be possible to reach by conventional ablation probe. Also, using the elongate member manipulator 24 to position the elongate member 26 is advantageous because it allows accurate positioning of the distal end 2300 of the elongate member 26.
V. Other Clinical Applications
The different driving modes and/or different combinations of driving modes are advantageous because they allow an elongate instrument (catheter 61 a, sheath 61 b, elongate member 26, or any combination thereof) to access any part of the vasculature. Thus, embodiments of the system described herein may have a wide variety of applications. In some embodiments, embodiments of the system described herein may be used to treat thoracic aneurysm, thoracoabdominal aortic aneurysm, abdominal aortic aneurysm, isolated common iliac aneurysm, visceral arteries aneurysm, or other types of aneurysms. In other embodiments, embodiments of the system described herein may be used to get across any occlusion inside a patient's body. In other embodiments, embodiments of the system described herein may be used to perform contralateral gait cannulation, fenestrated endograft cannulation (e.g., cannulation of an aortic branch), cannulation of internal iliac arteries, cannulation of superior mesenteric artery (SMA), cannulation of celiac, and cannulation of any vessel (artery or vein). In further embodiments, embodiments of the system described herein may be used to perform carotid artery stenting, wherein the tubular member may be controlled to navigate the aortic arch, which may involve complex arch anatomy. In still further embodiments, embodiments of the system described herein may be used to navigate complex iliac bifurcations.
In addition, in some embodiments, embodiments of the system described herein may be used to deliver a wide variety of devices within a patient's body, including but not limited to: stent (e.g., placing a stent in any part of a vasculature, such as the renal artery), balloon, vaso-occlusive coils, any device that may be delivered over a wire, an ultrasound device (e.g., for imaging and/or treatment), a laser, any energy delivery devices (e.g., RF electrode(s)), etc. In other embodiments, embodiments of the system described herein may be used to deliver any substance into a patient's body, including but not limited to contrast (e.g., for viewing under fluoroscope), drug, medication, blood, etc. In one implementation, after the catheter 61 a (leader) is placed at a desired position inside the patient, the catheter 61 a and the elongate member 26 may be removed, leaving the sheath 61 b to provide a conduit for delivery of any device or substance. In another implementation, the elongate member 26 may be removed, leaving the catheter 61 a to provide a conduit for delivery of any device or substance. In further embodiments, the elongate member 26 itself may be used to deliver any device or substance.
In further embodiments, embodiments of the system described herein may be used to access renal artery for treating hypertension, to treat uterine artery fibroids, atherosclerosis, and any peripheral artery disease. Also, in other embodiments, embodiments of the system described herein may be used to access the heart. In some embodiments, embodiments of the system may also be used to deliver drug or gene therapy.
In still further embodiments, embodiments of the system described herein may be used to access any internal region of a patient that is not considered a part of the vasculature. For example, in some cases, embodiments of the system described herein may be used to access any part of a digestive system, including but not limited to the esophagus, liver, stomach, colon, urinary tract, etc. In other embodiments, embodiments of the system described herein may be used to access any part of a respiratory system, including but not limited to the bronchus, the lung, etc.
In some embodiments, embodiments of the system described herein may be used to treat a leg that is not getting enough blood. In such cases, the tubular member may access the femoral artery percutaneously, and is steered to the aorta iliac bifurcation, and to the left iliac. Alternatively, the tubular member may be used to access the right iliac. In one implementation, to access the right iliac, the drive assembly may be mounted to the opposite side of the bed (i.e., opposite from the side where the drive assembly is mounted in FIG. 1). In other embodiments, instead of accessing the inside of the patient through the leg, the system may access the inside of the patient through the arm (e.g., for accessing the heart).
In any of the clinical applications mentioned herein, the telescopic configuration of the catheter 61 a and the sheath 61 b (and optionally the elongate member 26) may be used to get past any curved passage way in the body. For example, in any of the clinical applications mentioned above, a guidewire placed inside the catheter 61 a may be advanced first, and then followed by the catheter 61 a, and then the sheath 61 b, in order to advance the catheter 61 a and the sheath 61 b distally past a curved (e.g., a tight curved) passage way. Once a target location is reached, the guidewire may be removed from the catheter 61 a, and the elongate member 26 may optionally be inserted into the lumen of the catheter 61 a. The elongate member 26 is then advanced distally until its distal exits from the distal opening at the catheter 61 a. In other embodiments, the catheter 61 a may be advanced first, and then followed by the sheath 61 b, in order to advance the catheter 61 a and the sheath 61 b distally past a curved (e.g., a tight curved) passage way. In still further embodiments, the guidewire may be advanced first, and then followed by the catheter 61 a the sheath 61 b (i.e., simultaneously), in order to advance the catheter 61 a and the sheath 61 b distally past a curved (e.g., a tight curved) passage way.
Each of the individual variations described and illustrated herein has discrete components and features which may be readily separated from or combined with the features of any of the other variations. Modifications may be made to adapt a particular situation, material, composition of matter, process, process act(s) or step(s) to the objective(s), spirit or scope of the present application. Also, any of the features described herein with reference to a robotic system is not limited to being implemented in a robotic system, and may be implemented in any non-robotic system, such as a device operated manually.
Methods recited herein may be carried out in any order of the recited events which is logically possible, as well as the recited order of events. Furthermore, where a range of values is provided, every intervening value between the upper and lower limit of that range and any other stated or intervening value in that stated range is encompassed. Also, any optional feature described may be set forth and claimed independently, or in combination with any one or more of the features described herein.
All existing subject matter mentioned herein (e.g., publications, patents, patent applications and hardware) is incorporated by reference herein in its entirety except insofar as the subject matter may conflict with that described herein (in which case what is present herein shall prevail). The referenced items are provided solely for their disclosure prior to the filing date of the present application. Nothing herein is to be construed as an admission that any claimed invention is not entitled to antedate such material by virtue of prior invention.
Reference to a singular item, includes the possibility that there are plural of the same items present. More specifically, as used herein and in the appended claims, the singular forms “a,” “an,” “said” and “the” include plural referents unless the context clearly dictates otherwise. It is further noted that the claims may be drafted to exclude any optional element. As such, this statement is intended to serve as antecedent basis for use of such exclusive terminology as “solely,” “only” and the like in connection with the recitation of claim elements, or use of a “negative” limitation. Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art in the field of this application.
Although particular embodiments have been shown and described, it will be understood that they are not intended to limit the claimed inventions, and it will be obvious to those skilled in the art having the benefit of this disclosure that various changes and modifications may be made. The specification and drawings are, accordingly, to be regarded in an illustrative rather than restrictive sense. The claimed inventions are intended to cover alternatives, modifications, and equivalents.

Claims

1. A medical robotic system, comprising:

a base having a first opening, and a first protrusion next to the first opening;

a first rotary member configured for detachably coupling to a component of the medical robotic system, the first rotary member rotatable relative to the base and at least a part of the first rotary member is located in the first opening of the base; and

a cover coupled to the base;

wherein the first rotary member comprises a first end, a second end, a body extending between the first and second ends, and a flange disposed circumferentially around a part of the body, the flange having a first circumferential slot for receiving the first protrusion.

2. The medical robotic system of claim 1, wherein the base has a second opening, and the system further comprises a second rotary member that is at least partially located in the opening.

3. The medical robotic system of claim 1, further comprising the component, wherein the component comprises an instrument driver configured for actuating the first rotary member when the first end of the first rotary member is coupled to the instrument driver.

4. The medical robotic system of claim 3, wherein the instrument driver is configured to actuate the first rotary member in response to a command signal received from a user interface.

5. The medical robotic system of claim 3, wherein the instrument driver comprises an actuatable member for actuating the first rotary member, and a sensor for sensing a characteristic that corresponds with an amount of force or torque being applied to the actuatable member.

6. The medical robotic system of claim 5, wherein the sensor comprises a force sensor.

7. The medical robotic system of claim 1, wherein the first end of the first rotary member comprises a slot for mating with an actuatable member of the component.

8. The medical robotic system of claim 1, wherein the first end of the first rotary member comprises a protrusion for mating with an actuatable member of the component.

9. The medical robotic system of claim 1, wherein the base, the first rotary member, and the cover are respective parts of a sterile adaptor, the sterile adaptor further comprising a flexible sheet coupled to the base.

10. The medical robotic system of claim 9, wherein the cover has a first opening sized and configured for allowing the second end of the first rotary member to extend therethrough when the first rotary member is coupled to the component.

11. The medical robotic system of claim 9, further comprising:

a splayer assembly having a first splayer rotary member; and

an instrument driver,

wherein the second end of the first rotary member is configured to detachably couple to the first splayer rotary member, and the first end of the first rotary member is configured to detachably couple to the instrument driver.

12. The medical robotic system of claim 11, wherein the second end of the first rotary member extends through an opening at the cover, and comprises a plurality of keys configured for mating with corresponding slots in the first splayer rotary member.

13. The medical robotic system of claim 11, wherein when the first rotary member of the sterile adaptor is coupled to the first slayer rotary member, the instrument driver is configured to actuate the first rotary member in response to a command signal received from a user interface to thereby rotate the first splayer rotary member.

14. The medical robotic system of claim 1, wherein the base has a second protrusion, and the flange has a second circumferential slot for receiving the second protrusion.

15. A medical robotic system, comprising:

an instrument driver having an actuatable element;

a sensor coupled to the instrument driver; and

a device configured for detachably coupling to the instrument driver, the device comprising:

a base having a first opening, and

a rotary member configured for detachably coupling to the actuatable element of the instrument driver, wherein the rotary member is rotatable relative to the base, and at least a portion of the rotary member is located within the first opening of the base;

wherein when the device is coupled to the instrument driver, the actuatable element is configured to rotate the rotary member in response to a command signal received from a user interface; and

wherein the sensor is configured to sense a characteristic that corresponds with an amount of force or torque being applied to the actuatable element in order to rotate the rotary member.

16. The medical robotic system of claim 15, wherein

the base comprises a protrusion next to the first opening; and

the rotary member comprises a first end, a second end, a body extending between the first and second ends, and a flange disposed circumferentially around at least a portion of the body, the flange having a first circumferential slot for receiving the protrusion.

17. The medical robotic system of claim 16, wherein the base has a second protrusion, and the flange has a second circumferential slot for receiving the second protrusion.

18. The medical robotic system of claim 15, wherein the sensor comprises a force sensor.

19. The medical robotic system of claim 15, wherein the rotary member has a slotted end configured for mating with the actuatable member of the instrument driver.

20. The medical robotic system of claim 15, wherein the rotary member comprises a protrusion configured for mating with the actuatable member of the instrument driver.

21. The medical robotic system of claim 15, wherein the base and the rotary member are respective parts of a sterile adaptor, the sterile adaptor further comprising a flexible sheet coupled to the base.

22. The medical robotic system of claim 21, further comprising a splayer assembly having a splayer rotary member, wherein the rotary member has a first end configured for detachably coupling to the actuatable element of the instrument driver, and a second end configured for detachably coupling to the splayer rotary member.

23. The medical robotic system of claim 22, wherein the second end of the rotary member comprises a plurality of keys configured for mating with corresponding slots in the splayer rotary member.

24. The medical robotic system of claim 22, wherein when the sterile adaptor rotary member is coupled to the splayer rotary member and to the actuatable element, the instrument driver is configured to actuate the actuatable element to thereby indirectly rotate the splayer rotary member through the sterile adaptor rotary member.

25. The medical robotic system of claim 22, wherein the splayer assembly further comprises:

an elongate member having a distal end, a proximal end, and a lumen extending between the distal and proximal ends of the elongate member; and

a first control wire having a distal end coupled to the distal end of the elongate member, and a proximal end coupled to the splayer rotary member.

26. A method of steering a distal end of an elongate member, comprising:

determining a desired bending to be achieved by the distal end of the elongate member;

determining an amount of tension to be applied to a steering wire located within the elongate member based on the desired bending to be achieved;

using an actuatable element to apply a torque to turn a rotary member that is detachably coupled to the actuatable element, the steering wire having one end is secured to the rotary member and another end secured to the elongate member, wherein the application of the torque by the actuatable element causes tension to be applied to the steering wire; and

using a sensor coupled to the actuatable element to sense a characteristic that corresponds with an amount of force or torque being applied by the actuatable element to turn the rotary member.

27. The method of claim 26, wherein the act of using the actuatable element to apply the torque comprises increasing the amount of force or torque being applied by the actuatable element until the sensed characteristic indicates that the amount of tension at the steering wire has been achieved.

28. The method of claim 26, wherein the sensor is coupled indirectly to the actuatable element through a mechanical component.