CN101296649B - 用于控制施加至医疗器械的力及其操纵的系统和方法 - Google Patents

用于控制施加至医疗器械的力及其操纵的系统和方法 Download PDF

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CN101296649B
CN101296649B CN2006800403059A CN200680040305A CN101296649B CN 101296649 B CN101296649 B CN 101296649B CN 2006800403059 A CN2006800403059 A CN 2006800403059A CN 200680040305 A CN200680040305 A CN 200680040305A CN 101296649 B CN101296649 B CN 101296649B
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梅里尔·L·格雷戈里
理查德·L·坎宁安
J·迈克尔·布朗
罗伯特·F·柯亨
菲利普·G·费尔德曼
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Abstract

本发明公开了一种用于控制施加至外科手术器械的力并用于操纵该外科手术器械的设备。优选地，在本设备中感应施加至外科手术器械的运动和/或力。优选地，使用致动器向外科手术器械施加力以控制和操纵该器械。本设备反馈于沿一个或多个自由度向外科手术器械施加力而施加可变力，以便向用户提供增强的触觉体验。

Description

用于控制施加至医疗器械的力及其操纵的系统和方法
相关申请声明
本申请是由Gregory L.Merril等人于2003年3月19日提交的且题为“System and Method for Controlling Force Applied to andManipulation of Medical Instruments”的第10/390,715，号共同未决美国专利申请序列的部分继续申请，而该第10/390,715号美国专利申请序列又是分案申请并要求基于由Gregory L.Merril等人于2001年3月16日提交的且题为“Apparatus for Controlling Force ForManipulation of Medical Instruments”的第09/811,358，号美国专利申请系列(现第6,817,973，号美国专利)的优先权，该第09/811,358，号美国专利申请系列要求由Gregory L.Merril等人于2000年3月16日提交的且题为“System and Method for Controlling Force Appliedto and Manipulation of Medical Instruments”的第60/189,838，号临时专利申请系列的优先权，其所有内容结合于此作为参考。
背景技术
用于提供医疗检查和治疗的最低限度的侵入(invasive)技术常常采用内窥镜，诸如支气管内窥镜、输尿管内窥镜、或挠性乙状结肠镜。诸如这些的内窥镜通常采用光纤成像装置或CCD成像装置以使医生能够目测检查其他不可到达的人体组织(anatomy)区域，诸如肺、输尿道和肾、结肠等。这些内窥镜通常还包括被称为工作通道的管，通过该管可给予诸如麻醉剂的溶液并且通常可通过抽吸来抽出诸如粘液(mucus)的身体物质。除了用于给予和取出液体或其他物质之外，内窥镜的工作通道还被用于穿过细长的器械以在通过内窥镜的目测引导下于内窥镜的末端处执行其他功能。
以这种方式来使用的器械通常包括用于抓住物体或用于捏住并取出小的组织样本的镊子、用于取出针腔中的深处组织样本的活组织检查针、用于捕获并取出物体(诸如从肺中取出吸入的花生或从肾的肾盂(calyx)中取出肾结石)的勒除器或篮形器具(basket)，以及各种其他器具。
操纵这些器具要求随工作通道器具自身的操纵一起同时操纵或稳定内窥镜。通常可沿三个、四个或更多个自由度来操纵内窥镜，包括插入和抽出、转动、以及沿一维或二维(上/下和/或左/右)的顶端弯曲。沿额外的两个或更多个自由度来操纵工作通道器具包括插入/抽出、转动、以及器具的致动等。例如，器具的致动可包括：打开和关闭活体组织检查钳的钳爪、控制活体组织检查针的插入、起动烧灼或烧蚀器具、产生脉冲激光、或打开和关闭勒除器或篮形器具。在操纵多自由度的工作通道器具的同时，操纵和稳定内窥镜的三个或更多个自由度的任务是难以执行的，并且医生常常使用助手来操纵一个或多个自由度，诸如工作通道器具的致动。
发明内容
本发明涉及一种扩充内窥镜的工作通道的功能性的装置或系统，本装置或系统通过添加用于感应工作通道器具的运动并用于施加原动力(motive force)的装置来辅助医生在工作通道中操纵器械。
在一种使用模式中，本系统利用由电动机或其他装置驱动的驱动轮以使医生能够通过以下方式快速地更换工作通道器具，即，通过将当前的器具从工作通道中平稳地移出，且随后快速地将新的器具移入到正好将要离开工作通道的一点。此时，医生接管并执行将器具从内窥镜中移出并移入到与人体组织相互作用的位置所需的精细运动技巧。在另一种操作模式中，内科医生手动地操纵器具并通过一组驱动或制动驱动轮而提供有触觉引导。引导的一种形式是，提供器具正接近内窥镜的端部并即将从内窥镜中露出的通告。制动力或其他触觉力会作为信号告知正接近工作通道的端部，使得用户能够在工作通道内快速地移动器具，而没有由于太快而将器具从工作通道中移出的风险，由此降低了损坏或损伤邻近内窥镜的末端的组织的风险。
在另一实施例中，传感及驱动组件连接至导管，器械和器具穿过该导管进入到血管系统中。例如，在植入心脏起搏器(heart pacinglead)的过程中，心脏病专家必须对导向导管的位置进行多次精细的调节，接着试图稳定该导管，与此同时穿过稳定了的导管的腔插入额外的元件。在一种模式中，利用被动或主动制动力将传感/驱动组件控制为保持在某一位置。在另一种模式中，配备了导管的顶端并且主动机构控制了插入/抽回及滚动增量以稳定末端的实际位置。
在又一个实施例中，传感及驱动组件配备有应变仪或其他装置以检测在导管或工作通道器具的末端处遇到的力。这些力随后通过电动机或其他动力机构放大并呈现给用户。
在另一个实施例中，传感及驱动组件检测并改变运动，例如检测并过滤掉由用户引起的高频抖动。这种超稳定模式在要求精细电动机控制的情况下是有用的。
在另一个实施例中，使用来自插入到工作通道中的装置的信号来控制动力装置以维持与人体组织电接触的特定特性。在这种情况下，通过接触力改变电阻抗。所希望的接触特性最初由内科医生实现，随后本装置被控制为自动控制接触力以维持该特定的接触特性。
当考虑以下对具体实施例的详细描述时，尤其是当结合附图时，本发明的上述及更进一步的特征和优点将变得显而易见，其中，不同附图中的相似参考标号用于指出相似构件。
附图说明
结合到本说明书中并构成本说明书的一部分的附图示出了本发明的一个或多个实施例，并且与详细描述一起用于解释本发明的原理和实施方式。
附图中：
图1a示出了具有工作通道和工作通道器具的未改良的内窥镜。
图1b示出了被改良为设置有根据本发明的传感及控制元件的内窥镜。
图2示出了插入到血管组织中的、结合有根据本发明的传感及控制元件的内血管器具。
图3示出了根据本发明的轴向运动传感及控制元件。
图4示出了将转动运动传感及控制元件添加至图3中的装置。
具体实施方式
图1a示出了现有技术的未改良的内窥镜，示出了本体连接至内窥镜管组件3的内窥镜本体2。工作通道器具4被插入到内窥镜本体2内的工作通道孔6中。工作通道器具4滑动通过工作通道管1并通过工作通道孔5离开内窥镜管组件3的末端。
图1b示出了本发明的运动传感及控制元件10的一个实施例，该元件固定至内窥镜的工作通道孔6。工作通道器具4穿过运动传感及控制元件10并穿过工作通道孔6。常规地操纵和操作工作通道就可以使其穿过运动传感及控制元件10的本体。运动传感及控制元件10可有助于控制工作通道器具4，如在下文所示的实施例中举例说明的。
工作器具4可以是在内血管检查过程、内窥镜检查或其他医疗检查过程中所使用的各种医疗器械的任何一种。例如，工作器具可以是导线、导管、心脏起搏器、或管心针。进入人体并在人体上操作或与人体相互作用的器具端部可包括以下各种器具中的任何一种的一个或多个，诸如刀片、锯齿状边缘、活组织检查器具、套针顶端、超声波器具、针、振动顶端、缝合器具、牵引器、电外科刀具、电外科凝结器、镊子、针托、剪刀、冲洗器、吸引器、敷药器、激光器具、低温器具、挠性操纵或引导顶端、和/或照相机。为了简洁，如在此所使用的术语“工作通道”旨在指出可引导医疗器具的任何管道，包括导管、管子、内窥镜检查工作通道、或其他通道。
图2示出了本发明的运动传感及控制元件10的内血管应用。运动传感及控制元件10连接至引导器鞘7(在此可认为该引导器鞘是“工作通道”)，该引导器鞘7刺穿皮肤8和血管9的壁。细长的内血管器具4穿过运动传感及控制单元10、穿过引导器鞘7、并进而进入血管9的腔中。
图3示出了传感及控制元件10的一个实施例，该元件测量工作通道器具4的本体沿其平移自由度的运动并向该工作通道器具的本体施加力。运动传感及控制元件10包括用于测量工作通道4的本体的平移运动的传感器装置。当工作通道器具4的细长部分在运动传感和控制轮18与惰轮13之间穿过时，这使得每个轮子转动。轮子18固定于由支架20支撑的致动器12的轴15。而透明的光编码器盘14又固定于电动机轴15的相对端。编码器读取器16使光线穿过透明的编码器盘14。当透明的编码器盘14转动时，印在表面上的多个记号从光源的前方经过，交替地遮蔽穿过盘的光线。编码器读取器16中的多个光线传感器测量变化的光线和灰暗的图案并确定编码器盘14的转动运动量和转动运动方向。控制单元24接收来自编码器读取器16的与工作通道器具4的平移运动相对应的运动信号。
致动器12运行为，当该致动器被控制轮18传送至器具4时其沿工作通道器具4的平移自由度提供力于该工作通道器具上。致动器12被来自控制单元24的控制信号控制。在某些实施例中，控制单元24可通过检查来自编码器读取器16的当前信号(该信号表明器具4的当前位置或运动)来确定将从致动器12输出的力的总量，并且随后控制致动器12输出这个力。例如，如下文中所述的，器具4的当前位置可表明何时将输出力和/或将输出力的总量。
例如，控制单元24可包括微处理器、ASIC(application specificintegrated circuit，专用集成电路)、或者其他类型的处理器或控制器。除了上述光学类型的传感器以外，还可使用其他类型的传感器来感测工作通道器具4的位置和/或运动量以确定插入距离；例如，可使用模拟电位计、其他类型的光学传感器、磁性传感器等。某些实施例可使用绝对传感器来替代上述的相对传感器；例如，可在器具4上设置连续的记号，并且当这些记号移动经过传感器时可通过光学的或其他类型的检测器来检测这些记号以确定器具的位置。致动器12是改变器具4上的力的电子控制装置。例如，致动器12可以是直流电动机、步进电机、动磁体致动器(moving magnet actuator)、音圈、液压或气动致动器、或能够将力输出到工作器具4上的各种其他类型的致动器。致动器12还可以是被动致动器，诸如磁粉制动器、液压致动器、或其他形式的制动器，该致动器使得产生了用于抵抗器具4的基于来自控制单元24的控制信号的运动的可控阻抗。还可使用相同或不同类型的多个致动器12。
在本发明的一种模式中，通过运动传感及控制元件来测量及控制工作通道器具插入的总距离。例如，可将工作通道器具4的总插入距离提供给控制单元24，或者该控制单元可(使用传感器)测量工作通道器具的总插入距离。该距离可用于辅助对器具4的控制。例如，用户或医生可在工作通道内手动地移动器具4。然而，当器具的前端(末端)接近预置界限、点、或距离(诸如通道的出口点)时，控制信号可被传输至致动器12以产生对于减慢并随后停止运动传感和控制轮18的进一步运动所需的扭矩，且由此减慢并随后停止工作通道器具4的进一步插入。
在其他操作模式中，如果医生将器具插入到工作通道中，则致动器12可用于将器具4移动到工作通道中并穿过通道至正好将要离开该工作通道的一点，进而使该器具可供医生随时手动地使用，即，进而医生将该器具从内窥镜种移出并将其移入到与人体组织相互作用的位置。控制单元24可使用来自元件10的传感器的信号来确定器具的位置。在某些实施例中，由致动器12驱动的驱动轮可使医生能够通过以下方式快速地更换工作通道器具，即，通过将当前的器具从工作通道中平稳地移出，并随后快速地将新插入的器具移入到位于工作通道的另一端处的正好将要离开该工作通道的一点。
在又一操作模式中，内科医生可手动地操纵器具并通过致动器12而提供有触觉引导。引导的一种形式是提供器具正接近或已接近所希望的位置或已行进预定的距离的触觉通告。例如，该触觉通告可表明器具已到达工作通道或导管的端部并即将从通道中露出。制动力或阻力、或其他触觉力可作为信号告知器具正靠近工作通道的端部，使得用户能够在工作通道内快速地移动器具，而没有由于太快而将器具从工作通道中移出的风险，因而降低了损坏或损伤邻近内窥镜的末端的组织的风险。通告可采用各种形式，从单一的阻抗脉冲、阻挡力(连续的阻力)、振动、阻尼力(具有基于器具沿一个或多个方向的速度的数量级)、弹簧力、到一系列特定的摇动或致动停止(actuated detent)等。在另一个实施例中，通告可表明已由用户移动的器具的每个增量或预定距离。例如，可通过致动器12在器具被移入到工作通道中的每10厘米输出一次停止、振动、或摇动，或者可在沿通道的一半位置或四分之一位置处发出通告。
在另一个实施例中，传感及控制元件10可提供力于导管上，装置和器具穿过该导管进入到血管系统中。例如，在植入心脏起搏器的过程中，心脏病专家必须对导向导管的位置进行多次精细的调节，随后试图使该导向导管稳定，与此同时通过稳定了的导管的腔插入额外的元件(诸如引导器具)。在一种方式中，可利用来自致动器12的被动力或主动力将传感及控制元件10控制为将力输出到导管上以使该导管保持在所希望的位置处。在另一个实施例中，可配备有导管的顶端并且主动机构可以控制导管的插入/抽回以及滚动增量以稳定末端的实际位置。
在另一个实施例中，传感及控制元件10可检测并改变工作器具4的运动。例如，元件10的传感器可检测由用户引起的、基于可能由用户传递至器具的短的、不希望的运动或摆动的高频抖动。于是在检测到这些运动之后，可通过致动器12提供沿相反方向的力将它们过滤掉以抵消或减小抖动的幅度。这种超稳定模式在要求精细电动机控制的情况下是有用的。
在另一个实施例中，来自插入到工作通道中的装置或器具的信号可用来控制动力装置/器具以维持与人体组织电接触的特定特性，例如，在心脏起搏器的使用中。对于这类情况，如果器具与人体组织部分的接触力的数量级改变，则通常电阻抗也改变。本发明可用于维持或实现所希望的接触特性(或接触力)。例如，所希望的接触特性最初可由内科医生手动地使用器具实现。随后，传感及控制元件10可被控制为自动控制接触力，以通过检测由所希望的接触产生的电阻抗来维持特定的接触特性；如果电阻抗超出或低于所希望的阀值，则将来自致动器12的作用在器具上的力调节为提供所希望的电接触。其他的实施例可使用位于器具的末端上的力传感器来检测当前的接触力并维持所希望的接触力。
在本发明的另一个实施例中，测量由用户施加在工作通道器具4上的力并利用这些力来确定力，其中运动传感及控制元件10可有效地放大或缩小由用户施加给器具4的力。在这个实施例中，手柄17被设置为邻近力-扭矩传感器19，而该力-扭矩传感器又被设置为邻近工作通道器具4，以使由用户通过手柄17施加至工作通道器具4的平移力被力-扭矩传感器19感应到。下文所述的且存在于控制单元24中的控制算法接收由所施加的力(由力-扭矩传感器19测量)产生的信号并做出响应而产生控制信号，该控制信号被传输至致动器12以控制轮子18的运动。可利用由致动器12施加的力或利用通过工作通道器具4施加的摩擦力来移动轮子18。当工作通道器具4被用户保持为不动时，通过致动器12的轴15施加至轮子18的力被扭矩传感器22抵抗，且由此被该扭矩传感器感应到，该扭矩传感器22连接至支架20，而该支架又紧固于传感及控制元件10的基座11。
由控制轮18施加至工作通道器具4的力被扭矩传感器22感应到并被表示为FW。将这个力与由用户施加的力(FU)相加则得到该工作通道器具的末端处的有效力FWC，如在以下等式中所表式的：
                 FWC＝FU+FW       (1)
下文所述的且包含于控制器24中的控制算法动态地改变了由轮子18施加的力FW，以响应于由用户施加的力FU来控制工作通道器具力FWC。具体地，如果用户施加的力与工作器具力之间的所希望的关系由函数()表式为：
                 FWC＝f(FU)       (2)
联合这些等式并求解FW就提供了以下控制算法：
                 FW＝f(FU)-FU     (3)
控制单元24接收与用户施加的力FU和控制轮力FW相对应的信号并调节传输至致动器12的控制信号以执行等式3的控制算法。
在一个不同实施例中，传感及控制元件10可配备有应变计或其他装置，以检测或测量在导管或工作通道器具的末端处遇到的力。这些力随后可通过致动器12或其他动力机构放大并呈现给用户，以使医生能够更容易地控制或确定移动后的导管或器具的末端的状态。
图4示出了本发明的传感及控制元件10的另一个实施例，其中，除了如图3中所述的感应平移及控制轴向力之外，还感应及控制器具4的转动和扭矩。图4中，当工作通道器具4的细长部分在运动感应及控制轮28与惰轮26之间转动时，这使得每个轮子转动。轮子28固定于致动器30的轴29。而透明的光编码器盘34固定于致动器30的电动机轴29的相对端。。编码器读取器38使光线穿过透明的编码器盘34。当透明的编码器盘转动时，印在表面上的记号从光源的前方经过，交替地遮蔽穿过盘的光线。编码器读取器38中的多个光线传感器测量变化的光线和灰暗的图案并编码器盘34的转动运动量和转动运动方向。控制单元24接收来自编码器读取器38的与工作通道器具4的转动相对应的运动信号。控制单元24利用这些信号来测量工作通道器具4的转动。
致动器30可类似于致动器12，其中，控制单元24向致动器30提供控制信号以输出沿器具4的转动自由度的力。如上所述，传感器34/38和致动器30都可采用各种不同的形式。
在一个实施例中，当器具4接近预置的转动界限时，控制信号由控制单元24产生并被传输至致动器30，以产生对于减慢并随后停止运动感应及控制轮28的进一步运动所需的扭矩，且由此减慢并随后停止工作通道器具4的进一步转动。其他的实施例可类似于以上所述的用于器具4的平移感应和致动的那些实施例；例如，当器具4转动预定的转动距离(例如，角度数)时，可向用户输出触觉指示。
在图4的元件10的某些实施例中，可测量由用户施加至工作通道器具4的扭矩，并且可使用运动传感及控制元件10来放大和缩小由用户施加至器具4的扭矩。图4中，手柄17被设置为邻近力-扭矩传感器19，而力-扭矩传感器19又被设置为邻近工作通道器具4，以使由用户通过手柄17施加至工作通道器具4的转动力被力-扭矩传感器19感应到。下文所述的且存在于控制单元24中的控制算法接收由所施加的力(由力-扭矩传感器19测量)产生的信号并做出响应而产生控制信号，该控制信号被传输至致动器30以控制轮子28的运动。可利用由电动机12施加的力或利用通过工作通道器具4施加的摩擦力来移动轮子28。当工作通道器具4被用户者保持为不动时，通过致动器30的轴29施加至轮子28的力被扭矩传感器32抵抗，且由此被该扭矩传感器感应到，该扭矩转矩连接至支架36，而该支架又紧固于传感及控制元件10的基座11。由控制轮28施加至工作通道器具4的扭矩被扭矩传感器32感应到并被表示为TW。这个扭矩加上由用户施加的扭矩(TU)则得到该工作通道器具的末端处的有效扭矩TWC，如在以下等式中所表式的：
              TWC＝TU+TW             (4)
下文所述的且包含于控制器24中的控制算法动态地改变了由轮子28施加的扭矩TW，以响应于由用户施加的扭矩TU来控制工作通道器具扭矩TWC。具体地，如果用户施加的扭矩与工作器具扭矩之间的所希望的关系由函数q()表式为：
              TWC＝q(TU)             (5)
联合这些等式并求解TW就提供了以下控制算法：
              TW＝q(TU)-TU           (6)
控制单元24接收与用户施加的扭矩TU和控制轮扭矩TW相对应的信号并调节传输至电动机30的控制信号以执行等式6的控制算法。
在适当的实施例中传感器19可包括两个传感器：一个传感器测量由用户施加至器具4的轴向力，而另一个传感器测量由用户施加至器具4的扭矩。
因此，如图4中所示的传感及控制单元10可向工作通道器具提供转动位置或平移位置控制，以及平移力和转动扭矩控制。如图2中所示，传感及控制单元10可用于控制任何细长的医疗器械，诸如用在干涉放射检查中的导管。
尽管已根据几个优选实施例描述了本发明，但本领域技术人员应该预料到，在阅读说明书并研究附图之后，对本发明的替换、改变、以及其等同物将变得显而易见。例如，可使用多种不同类型的传感器和致动器来感应器具的位置或运动并向用户输出触觉感觉。此外，一个实施例中所述的多个特征可与其他实施例互换使用。此外，已使用的特定术语是为了描述清楚的目的，而并不是用来限制本发明。

Claims (20)

1.一种内窥镜，包括：
内窥镜本体，限定一通道，所述通道适于接收细长元件并可释放地接合插入在所述通道中的所述细长元件；
触觉反馈系统，连接至所述内窥镜本体并适于可释放地接合所述细长元件，所述触觉反馈系统包括：
致动器，适于可释放地接合所述细长元件；以及
传感器，连接至所述致动器并适于感应施加至所述细长元件的第一力，
其中，所述致动器被构造成基于感应到的第一力向所述细长元件施加第二力。
2.根据权利要求1所述的内窥镜，进一步包括可编程的控制器，所述可编程的控制器连接至所述致动器和所述传感器并适于控制所述第二力。
3.根据权利要求1所述的内窥镜，其中，所述致动器适于向沿平移自由度运动的所述细长元件施加所述第二力。
4.根据权利要求1所述的内窥镜，其中，所述致动器适于向沿转动自由度运动的所述细长元件施加所述第二力。
5.根据权利要求1所述的内窥镜，其中，所述传感器检测施加至所述细长元件的纵向引导力。
6.根据权利要求1所述的内窥镜，其中，所述传感器检测施加至所述细长元件的转动引导力。
7.根据权利要求1所述的内窥镜，其中，所述传感器适于检测所述细长元件在所述通道中沿一个自由度的运动并基于感应到的运动输出运动信号，所述致动器适于基于所述运动信号向所述细长元件施加相应的力。
8.根据权利要求1所述的内窥镜，其中，所述致动器被构造为沿与所述第一力相反的方向施加所述第二力。
9.根据权利要求1所述的内窥镜，其中，将所施加的第二力与施加至所述细长元件的所述第一力相加。
10.一种外科手术器械，包括：
本体，限定一通道，所述通道适于接收细长元件并可释放地接合插入在所述通道中的所述细长元件；
致动器，适于可释放地接合所述细长元件；以及
传感器，连接至所述致动器并适于感应所述细长元件在所述通道中的运动，
所述致动器适于基于感应到的所述细长元件的运动向所述细长元件施加力。
11.根据权利要求10所述的外科手术器械，进一步包括可编程的控制器，所述可编程的控制器适于响应于感应到的所述细长元件的运动来控制施加至所述细长元件的力。
12.根据权利要求10所述的外科手术器械，其中，所述致动器适于向沿平移自由度运动的所述细长元件施加第二力。
13.根据权利要求10所述的外科手术器械，其中，所述致动器适于向沿转动自由度运动的所述细长元件施加第二力。
14.根据权利要求10所述的外科手术器械，其中，所述传感器适于检测施加至所述细长元件的纵向引导力。
15.根据权利要求10所述的外科手术器械，其中，所述传感器适于检测施加至所述细长元件的转动引导力。
16.根据权利要求10所述的外科手术器械，其中，所述传感器适于检测沿一个自由度施加到所述细长元件的第一力并基于感应到的第一力输出力信号，所述致动器适于响应于所述力信号向所述细长元件施加第二力。
17.根据权利要求10所述的外科手术器械，其中，所述致动器适于沿与感应到的所述细长元件的的运动相反的方向施加力。
18.一种外科手术器械，包括：
本体，限定一通道，所述通道适于接收细长元件并可释放地接合插入在所述通道中的所述细长元件；
第一致动器，适于可释放地接合所述细长元件并沿一个自由度向所述细长元件施加第一力；以及
用于感应的装置，用于感应1)所述细长元件的运动以及2)在从外部向所述细长元件施加的力中的至少一个，其中，所述第一致动器基于来自所述用于感应的装置的感应信号来施加所述第一力。
19.根据权利要求18所述的外科手术器械，进一步包括第二致动器，所述第二致动器适于响应于所述感应信号沿第二自由度向所述细长元件施加第二力。
20.根据权利要求18所述的外科手术器械，进一步包括可编程的控制器，所述可编程的控制器连接至所述第一致动器和所述用于感应的装置。
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WO2007051000A3 (en) 2007-10-25
CN102204808A (zh) 2011-10-05
EP1942785A2 (en) 2008-07-16
JP2009513272A (ja) 2009-04-02
WO2007051000A2 (en) 2007-05-03
US20060161045A1 (en) 2006-07-20
CN101296649A (zh) 2008-10-29
US7819799B2 (en) 2010-10-26

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