CN102028545B - 外科手术机器人的铰接和可调换内窥镜 - Google Patents

外科手术机器人的铰接和可调换内窥镜 Download PDF

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CN102028545B
CN102028545B CN201010578301.4A CN201010578301A CN102028545B CN 102028545 B CN102028545 B CN 102028545B CN 201010578301 A CN201010578301 A CN 201010578301A CN 102028545 B CN102028545 B CN 102028545B
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wrist
endoscope
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C·哈塞
N·斯瓦鲁普
T·库珀
S·C·安德森
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Abstract

本发明旨在提供一种具有至少一自由度的挠性手腕的铰接微创手术内窥镜。当与具有多个机器人手臂的手术机器人一起使用时，内窥镜可被用于多个手臂中的任意手臂，从而允许使用通用手臂设计。通过将被用于控制至少一自由度动作的参照系附连至挠性手腕以进行与所述至少一自由度相关的手腕动作，从而根据本发明的内窥镜可对用户而言更加直观。通过基于绕邻近挠性手腕的旋转点旋转的参照系获取与所述至少一自由度相关的物体图像，根据本发明的内窥镜可减少其后/近端的不需要的动作。

Description

外科手术机器人的铰接和可调换内窥镜
本申请是申请日为2006年12月20日的名称为：“外科手术机器人的铰接和可调换内窥镜”的中国专利申请200680047756.5的分案申请。
相关美国申请
本申请是2005年3月3日提交的专利申请第11/071,480号的部分延续案，后者是要求享有2002年12月6日提交的临时申请第60/431,636号的优先权的2003年12月2日提交的专利申请第10/726,795号的部分延续案。本申请也是2004年11月1日提交的专利申请第10/980,119号的部分延续案，后者是要求享有2001年6月29日提交的临时申请第60/301,967号和2001年10月5日提交的临时申请第60/327,702号的优先权的2004年11月16日授权的美国专利第6,817,974号的延续案。本申请涉及以下专利和专利申请，其公开全文结合于此以供参考。
2004年3月2日授权的名称为“Platform Link Wrist Mechanism(《平坦连杆手腕机构》)”的美国专利第6,699,235号；
2004年9月7日授权的名称为“Robotic Apparatus(《机器人设备》)”的美国专利第6,786,896号；
2001年12月18日授权的名称为“Surgical Robotic Tools，DataArchitecture，and Use(《外科手术机器人工具、数据架构和使用》)”的美国专利第6,331,181号；
2004年9月28日授权的名称为“Image Shifting Apparatus and Methodfor aTelerobotic System(《远程机器人系统的像移设备和方法》)”的美国专利第6,799,065号；
2004年4月13日授权的名称为“Stereo Imaging System and Method forUse inTelerobatic System(《用于远程机器人系统的立体成像系统和方法》)”的美国专利第6,720,988号；
2004年3月30日授权的名称为“Master Having Redundant Degrees ofFreedom(《具冗余自由度的主动设备》)”的美国专利第6,714,839号；
2003年12月9日授权的名称为“Cooperative Minimally InvasiveTelesurgerySystem(《协作微创远程外科手术系统》)”的美国专利第6,659,939号；
2002年7月23日授权的名称为“Camera Referenced Control in aMinimallyInvasive Surgical Apparatus(《微创外科手术设备中的摄像机参照控制》)”的美国专利第6,424,885号；
2002年5月28日授权的名称为“Surgical Tools for Use in MinimallyInvasiveTelesurgical Applications(《用于微创远程外科手术应用中的手术工具》)”的美国专利第6,394,988号；以及
1998年9月15日授权的名称为“Endoscopic Surgical Instrument andMethodfor Use(《内窥镜外科手术器械和使用方法》)”的美国专利第5,808,665号；以及
1998年9月15日授权的名称为“Endoscopic Surgical Instrument andMethodfor Use(《内窥镜外科手术器械和使用方法》)”的美国专利第5,808,665号；以及
2003年2月18日授权的名称为“Devices and Methods for PresentingandRegulating Auxiliary Information on An Image Display of aTelesurgical Systemto Assist an Operator in Performing a SurgicalProcedure(《呈现并管理远程外科手术系统图像显示器上的辅助信息以有助于手术人员执行外科手术过程的装置和方法》)”的美国专利第6,522,906号。
2002年4月2日授权的名称为“Alignment of Master and Slave in aMinimallyInvasive Surgical Apparatus(《微创外科手术设备中主动和从动的校准》)”的美国专利第6,364,888号。
技术领域
本发明一般涉及内窥镜，更具体地，涉及执行机器人外科手术的可操纵/铰接并可调换的内窥镜。
背景技术
微创手术技术的发展可以大幅增加以微创的方式执行的外科手术数量。微创医疗技术的目的是减少诊断或手术过程期间无关组织受损量，从而减少病人的恢复时间、不适以及有害副作用。使用微创手术技术也可大幅缩短标准外科手术的平均住院时间。因此，增加采用微创技术可节省大量的住院时间，且仅在医院住宿成本上每年就能节省上百万美元。病人恢复时间、病人的不适、手术副作用以及不工作时间也可因使用微创手术而减少。
微创手术的最普通形式是内窥镜检查。内窥镜检查的最普通形式可能是腹腔镜检查，即在腹腔内进行微创检查和手术。在标准腹腔镜手术中，向病人的腹部吹入气体，套管套筒通过小切口(约1/2英寸)插入以便为腹腔镜手术器械提供入口端。腹腔镜手术器械一般包括(用于观察手术区的)腹腔镜和工作工具。工作工具与用于常规(开放式)外科手术的工具相似，除了每个工具的工作端或末端执行器均通过延伸管与其手柄分离。本文使用的术语“末端执行器”指手术器械的实际工作部分，且可包括如夹钳、抓钳、剪刀、打钉器和针固定器等。为执行外科手术过程，外科医生将这些工作工具或器械穿过套管套筒至内部手术部位并在腹部之外操纵他们。外科医生通过监控器监控手术过程，该监控器显示由内窥镜获取的手术部位的图像。类似内窥镜技术可用于如关节镜检查、后腹膜镜检查、骨盆镜检查、肾镜检查、膀胱镜检查、脑槽镜检查、鼻窦内视镜检查、宫腔镜检查、尿道镜检查等。
目前微创手术(MIS)技术存在许多缺点。例如，现有的MIS器械不能为外科医生提供如开放式手术中的工具更换的灵活性。目前腹腔镜工具多数具有刚性轴，使其很难通过较小切口接近工作部位。另外，许多内窥镜器械的长度和结构降低了外科医生感觉组织和器官施加于相关工具末端执行器上力的能力。内窥镜工具缺乏灵活性和敏感性是微创手术发展的主要障碍。
正在开发微创远程外科手术机器人系统以提高外科医生在内部手术部位工作时的灵活性，并允许外科医生从远程位置对病人进行手术。在远程手术系统中，通常在计算机工作站向外科医生提供手术部位的图像。当在适当观察仪或显示器上观察手术部位的三维图像时，外科医生通过操纵工作站的主动输入或控制装置对病人执行手术过程。主动装置控制伺服机械操作的手术器械的动作。在手术过程期间，远程手术系统可机械启动并控制具有末端执行器的各种手术器械或工具，这些末端执行器如组织抓钳、针驱动器等响应主动控制装置的操纵从而为外科医生执行如固定并驱动针、抓取血管或切割组织等的各种功能。
尽管如加利福尼亚州桑尼维尔(Sunnyvale)市的Intuitive Surgical公司的da等微创手术机器人系统可在外科手术期间为外科医生提供比常规腹腔镜手术更多的关节和质量更佳的二维和三维视频图像，但是目前该手术机器人系统在特定功能上的灵活性可能受到更多限制。特别是因为其尺寸和重量，具有“专用”机器人手臂的手术机器人架构要求固定内窥镜和其摄像头(camera heard)，如美国专利第6,451,027号所述。因此，外科医生不能如常规腹腔镜手术的通常情况那样在端口间更换内窥镜。另外，内窥镜的尺寸和重量使得很难拆卸并手动调整内窥镜特别是观看难以到达或隐藏区域时。灵活性的损失意味着尽管微创手术机器人系统在如心和骨盆等有限区域内的复杂重建手术中具有优势，但其不太适用于在接近较大解剖区域(如腹部的多个部分)和/或从不同方向接近时的手术过程。
另外，目前机器人内窥镜是刚性的，指向正前(即零(0)度角)或与内窥镜的长轴成三十(30)度角，这允许外科医生更容易地向下或向上观看。因此，在许多手术过程中，外科医生可要求在正前镜和三十度镜间多次来回转换以获得手术部位内的不同观察角度。该观察镜的转换增加了外科手术过程的持续时间、操作和逻辑复杂性以及甚至安全问题。但是，即使可转换观察镜，但外科医生仍限于仅仅几个可视角度，并且因而可视区域较少。另外，外科医生不能获得隐藏于障碍物周围(如妇产科手术过程期间)或要求隧穿的组织之间(如心房纤维性颤动或腔内诊断和治疗期间)的身体组织的所需视野。
因此，需要允许简化未来外科手术机器人架构、提供更加灵活的端口布置、提供更多可视区域、提供多视角而不增加操作和逻辑复杂性或安全问题，以及提供隐藏的身体组织的最佳视野的外科手术机器人内窥镜系统和方法。
发明内容
因此，本发明提供了允许简化未来外科手术机器人架构、提供更灵活的端口布置、提供更多可视区域、提供多视角而不增加操作和逻辑复杂性或安全问题并提供隐藏身体组织的最佳视野的铰接的且可调换外科手术机器人内窥镜系统和方法。
本发明用微创铰接外科手术内窥镜满足了上述需求，该微创铰接外科手术内窥镜包括长轴、挠性手腕、内窥镜摄像机镜头和多个传动连杆(actuaction link)。长轴具有工作端、近端以及工作端与近端之间的轴线。挠性手腕具有远端和近端。手腕的近端连于长轴的工作端。内窥镜摄像机镜头安装于手腕的远端。多个传动连杆连于手腕和长轴的近端之间使得连杆是可启动的以向手腕提供至少一自由度(如手腕的俯仰和偏转动作)，其中用于控制所述至少一自由度动作的参照系与挠性手腕附连以进行与该至少一自由度相关的手腕动作，从而在所述至少一自由度动作期间向用户提供更多直观。反过来，用于控制与内窥镜相关的其它自由度(如笛卡尔空间插入/抽出动作和轴旋转)的参照系被附连于物体。微创铰接手术内窥镜可释放地连于多个手臂中的任一手臂，且设计为可在多个手臂间交换使得外科手术机器人系统可使用一标准手臂设计。
当铰接手术内窥镜用于获取与所述至少一自由度相关的解剖图像(如轨道图像)时，该图像的参照系为绕靠近挠性手腕处的旋转点旋转的参照系以最小化内窥镜近端处不需要的动作。用于控制该至少一自由度的参照系与挠性手腕附连时可进一步减少这样的不需要的动作。
根据结合所附附图说明的优选实施例的以下详细说明，本发明的所有部件和优点将是显而易见的。
附图说明
图1是根据本发明实施例的手术工具的透视图。
图2是根据本发明实施例的手腕的剖视图。
图3是沿III-III方向图2所示手腕的剖视图。
图4是根据本发明另一实施例的手腕的透视图。
图4A和4B分别是与图4所示相似的手腕示例的远端部分的平面图和正视图，示出了缆线排布的细节。
图5是根据本发明另一实施例的手腕的透视图。
图6是根据本发明另一实施例的手腕的平面图；
图7是根据本发明另一实施例的手腕的剖视图。
图8是根据本发明另一实施例的手腕的平面图。
图9是具有工具轴和万向节板的图8所示手腕的正视图。
图10是根据本发明另一实施例的手腕的平面图。
图11是图10所示手腕的正视图。
图12是根据本发明另一实施例的手腕的正视图。
图13是根据本发明另一实施例的手腕的平面图。
图14是根据本发明另一实施例的手腕的一部分的剖视图。
图15是图14所示手腕弯曲时的局部剖视图。
图16是根据本发明另一实施例的手腕的透视图。
图17是图16所示手腕的平面图。
图18是根据本发明另一实施例的手腕的一部分的剖视图。
图19是根据本发明另一实施例手腕的透视图。
图20是根据本发明另一实施例的手腕的平面图。
图21是根据本发明另一实施例的手腕的透视图。
图22是根据本发明另一实施例的手腕的一部分的剖视图。
图23和24是图22所示手腕中圆盘的平面图。
图25是图22所示手腕外部零件的透视图。
图26是图25所示外部零件的剖视图。
图27是根据本发明另一实施例的手腕的透视图。
图28是根据本发明实施例的手腕盖的剖视图。
图29是根据本发明另一实施例的手腕盖的剖视图。
图30是根据本发明另一实施例的手腕盖的一部分的透视图。
图31示出了根据本发明用于机器人微创手术中的铰接内窥镜的实施例。
图32示出了通过一系列可释放夹环320可释放地连于内窥镜310的导管321。
图33示出了通过一系列可释放夹环320可释放地连于内窥镜310的导管导向装置331。
图34是根据本发明的示出视频连接实施例的视频框图。
图35示出了根据本发明用于机器人微创手术中的铰接内窥镜的实施例。
图36是相对于机器人微创内窥镜不同参照系的直观与反直观的简化示例性说明。
图37示出了根据本发明的内窥镜310”的不同潜在旋转点。
图38示出了实际组合成与自行车车把相同方式操作的两个主动输入装置。
具体实施方式
本文使用的“末端执行器”指可实际工作远端部分，通过用于如对目标组织执行预定处理等医疗功能的手腕构件的手段可操纵该实际工作远端部分。例如，一些末端执行器具有单个工作构件，如解剖刀、刀片或电极等。其它末端执行器具有成对或多个工作构件，如镊子、抓钳、剪刀或施夹器等。在特定实施例中，圆盘或椎骨被配置成具有开口来共同确定沿手腕的纵向内腔或空间，为与末端执行器操作相关的多种可选元件或工具中的任一种提供管道。示例包括电动末端执行器(如电外科电极、换能器、传感器等)的导线，流体、气体或固体的管道(如用于抽吸、注气、灌洗、治疗流体、附件引入、活组织检查抽取等)，传动运动末端执行器构件的机械元件(如缆线，操作夹钳、镊子、剪刀的挠性元件或铰接元件)，波导器，音速传导元件，光纤元件等等。这样的纵向管道可具有衬管、绝缘体或导向元件，如弹性聚合物管、螺旋绕丝管等。
本文使用的术语“手术器械”、“器械”、“手术工具”或“工具”指具有工作端的构件，该工作端承载需引入病人体腔内手术部位的一个或多个末端执行器且可从体腔外部驱动来操纵末端执行器以对手术部位内的目标组织执行所需的处理或医疗功能。器械或工具一般包括在末端承载末端执行器的轴，且优选由远程外科手术系统伺服机械传动以执行如固定或驱动针、抓取血管和切割组织等功能。
本文所述挠性手腕的各种实施例意图是相对便宜地制造并可用于烧灼，但其不限于用于烧灼。对于MIS应用，工具的可插入部分的直径较小，一般为等于或小于约12mm，优选为等于或小于5mm，以允许切口较小。应理解，尽管详细所述示例说明了这个尺寸范围，但实施例可按比例缩放以包括较大或较小器械。
一些手腕实施例使用一系列圆盘或类似元件，其在俯仰或偏转时以蛇形方式移动(如图14和22)。圆盘为环状圆盘，可具有圆内直径和外直径。这些手腕一般各自包括一系列圆盘，例如，约13个圆盘，这些圆盘可为约0.005英寸至约0.030英寸厚的蚀刻不锈钢圆盘。中间可使用较薄圆盘，但末端区域需要使用较厚圆盘来增加强度以吸收缆线力，这些缆线力如施于绕末端圆盘的缆线U形转弯处的力。末端圆盘可包括埋头孔(如约0.015英寸深)，中心弹簧可插入该埋头孔以将来自缆线的负载传输为中心弹簧的压缩。圆盘可旋在内弹簧上，其用作为夹钳、烧灼连接或固定尖端于其上的绳索等末端执行器拉动缆线的内腔。内弹簧也提供轴向硬度，使得夹钳力或绳索力不扭曲手腕。在一些实施例中，圆盘包括由内弹簧捕获的一对相对放置的内突舌或舌片。内弹簧处于压并高度(solid height)(当弹簧不偏斜时具有连续节距的螺旋线相继接触)，除了在插入圆盘的突舌的位置处在弹簧中产生缺口。圆盘沿突舌的方向改变以允许改变俯仰和偏转旋转。一般的内弹簧由0.01英寸直径的金属线制造而成，且相邻圆盘由四个弹簧线圈相互隔开。如果弹簧是由线边绕制扁平金属线(如软弹簧)制造，则可通过缆线施加大的轴向力而不会使相邻线圈弹跳越过彼此。
在一些实施例中，每个圆盘均具有十二个均匀隔开的孔，以接收传动缆线。三条缆线足以沿任何所需方向弯曲手腕，单个缆线上的张力相互协同以产生所需的弯曲动作。因金属线直径较小且因手术力施于手腕的力矩，三条缆线中的应力相当大。一般使用三条以上缆线来减少各缆线(包括多余的用于控制的附加缆线)内的应力。在下文所示一些示例中，使用了十二条或更多缆线(见以下图4的讨论)。为驱动缆线，可使用万向节板或摇板。万向节板使用两个标准输入来操纵缆线相对俯仰和偏转轴以任意角度弯曲手腕。
一些手腕由挠性足以在俯仰和偏转方向内弯曲的管状构件制造(如图2和4)。可包括内弹簧。管状构件可包括镂空图案以减少结构硬度从而有助于弯曲(如图5和19)。制造手腕的方法之一是将金属线和亚管心轴(hypotube mandrel)插入中心孔和传动线孔内。可制造模具，且组装可使用两部分铂硫化硅橡胶在烤箱中硫化(如约165℃)而包覆成型。心轴在成型后拉出以产生通道，从而形成拉动缆线的中心内腔和外围内腔。这样，手腕没有暴露的金属部件。橡胶可经受高压灭菌，且在手腕弯曲时可经受拉长，一般约30％的应变。
在特定实施例中，管状构件包括多个轴向滑动构件，每个轴向滑动构件均具有接收传动缆线的内腔(如图8)。管状构件可由具有线圈的多个轴向弹簧形成，这些轴向弹簧的线圈与相邻弹簧的线圈重叠以提供接收传动缆线的内腔(如图10)。管状构件可由成堆的波形弹簧形成(如图12)。管状构件内的内腔可由轴向弹簧的内部形成(如图16)。管状构件的外部可以是编织的以提供抗扭硬度(如图27)。
A.具有由金属线圈支承的金属线的手腕
图1示出了连于远端末端执行器12和手术工具的近端工具轴或主管14之间的手腕10。所示末端执行器12包括安装于远端马蹄钩18上的夹钳16，如图2最佳所示。远端马蹄钩18包括侧面凹陷槽20来容纳多条金属线或缆线24的远端卷边22，这些金属线或缆线24近端连于亚管26，这些亚管26延伸穿过平台或导向装置30以及工具轴14的内部。导向装置30定向亚管26和金属线组件，并固定于器械的工具轴14上。导向装置30也在工具轴14滚动移动时使得手腕10开始滚动运动。侧面凹陷槽20便利地允许卷边22被按压到位。当然，在其它实施例中也可使用其它方式将金属线24固定至远端马蹄钩18上，如激光焊接。
图2和3示出了四条金属线24，但另一实施例中也可使用不同数量的金属线。金属线24可由镍钛合金或其它适当材料制成。金属线24形成手腕10的接头，且被刚性固定在远端马蹄钩18和亚管26之间。金属线圈34与螺旋弹簧相似地缠绕金属线24并在远端马蹄钩18和亚管26之间延伸。收缩管36覆盖金属线圈34以及部分的远端马蹄钩18和导向装置30。当推拉亚管26以使手腕10在俯仰和偏转方向内移动时，金属线圈34和收缩管36将金属线24保持在距彼此的固定距离处。他们也为手腕10提供抗扭的且一般的硬度以允许其随工具轴14滚动移动并抵抗外部的力。在其它实施例中金属线圈和收缩管可以设置成不同方式(一优选实施例见图27所示并且在下文J部分被描述)。例如，可改变为五内腔挤压成型，其中金属线24作为内部部件。金属线圈或等效结构的功能是使金属线24在手腕10滚动、俯仰和/或偏转移动时与中心线保持恒定距离。收缩管也可提供电绝缘。
B.具有由传动缆线弯曲的挠性管的手腕
图4示出了手腕40，其包括管42，该管42具有沿圆周分布的孔或内腔43以接收可由镍钛合金制成的传动缆线或金属线44。管42具挠性以允许通过拉动缆线44而在俯仰和偏转方向内弯曲。手腕40优选包括刚性远端终止圆盘41(如图4B的可选实施例所示)或基本比挠性管42更硬的其它强化物以在挠性管42上均匀分布缆线力。管42的空心中心提供了如夹持缆线等末端执行器缆线的空间。一般具有至少四个内腔。可提供内弹簧47。
图4示出了具体实施例的十二个内腔，以容纳在管42远端形成U形转弯45的六条缆线44。大量使用缆线使得管42在相同缆线拉力下实现相同俯仰和偏转弯曲时具有更高硬度。例如，使用十二条缆线代替四条缆线意味着对于相同缆线拉力管42可为三倍硬。或者，如果管42的硬度保持不变，则使用十二条缆线代替四条缆线将使所需缆线拉力减少为三分之一。注意尽管材料属性和缆线应力级别可允许U形转弯45直接施压于管42的末端，但可包括强化远端终止板41来更平稳地分布缆线力于管42上。缆线44的近端可连于传动器机构，如包括2002年6月27日提交的美国专利申请第10/187,248号公开的万向节板46的组件，其全部公开内容被结合于此以供参考。该机构有助于所选多条缆线以协同方式(incoordinatedmanner)传动，来控制可弯曲或可操纵构件，如控制挠性手腕的弯曲角度和方向。申请第10/187,248号的传动器机构的示例可被改成以成比例的方式来传动大量的外周缆线，以提供挠性构件的协同操纵而不需要同等的大量线性传动器。或者，独立控制的线性传动机构可用于张紧环绕滑轮并随旋转传动器移动的各缆线或缆线对，其中通过调整线性传动器来控制操纵。
管42一般可由弹性模数足够低以允许充分俯仰和偏转弯曲的塑料材料或弹性体制成，且可由多内腔挤压成型制成以包括多个内腔，如十二个内腔。管需要具有较高抗弯硬度以限制如S形弯曲等的不需要的变形，但这增加了所需俯仰和偏转弯曲要求的缆线力。如下所述，可使用比多于所需数量的缆线来在俯仰和偏转方向操纵手腕(即多于三条缆线)以提供足够大的缆线力来克服管的高抗弯硬度。
图4A和4B示意性示出了与图4所示相似的手腕实施例中两个不同缆线排布的示例。注意对于恒定的总缆线剖面区域，包括成对缆线并包括数量较多的成比例缩小的缆线均允许缆线相对于手腕中心线终止于较大横向偏移处。图4A和4B分别示出了手腕实施例的平面图和正视图，由分割线划分使得各图右侧示出手腕示例1，各图的左侧示出手腕示例2。在各示例中，管42具有相同外半径R和限定中心内腔的相同内半径r
在示例1中，手腕40.1内缆线44的数量等于四(n1＝4)，各缆线单独终止于设置在远端终止板41的埋头孔内的远端锚点44.5，各缆线延伸穿过在远端终止板41和挠性管42内的相应横向缆线内腔43。锚点44.5可为型锻珠或其它任何常规缆线锚点。
在示例2中，手腕40.2内缆线44’的数量等于十六(n2＝16)，缆线被排布成八个对称隔开的成对部分44’，各对由挤压在相邻缆线内腔43’之间的远端终止板41’上的远端“U形转弯”末端环45终止。内腔43’开口处的远端终止板41’的边缘可成圆形以减少应力集中，并且环45可以部分地或全部地被装埋在远端终止板41内。十六条缆线44’的直径可为四条缆线44的直径的1/2，以便总剖面缆线面积在各示例中相等。
比较示例1和2，终端环45的使用消除了用于缆线锚点44.5的远端容积，且允许缆线内腔43’比缆线内腔43更接近管42的半径R。另外，各缆线44’的直径较小使得缆线的中心线更靠近缆线内腔43’的外边缘。这些属性均允许示例2中的缆线相对于管42的中心作用于比示例1中的相应力矩臂L1更大的力矩臂L2。对于管42上的相同总弯曲力矩而言，这个较大的力矩臂L2允许更低的缆线应力(允许更长的缆线寿命或更广的可选缆线材料的范围)，或者，对于相同的缆线应力而言，允许更大的弯曲力矩(允许更大的手腕定位硬度)。另外，直径较小的缆线比相对较粗的缆线更具挠性。因此，手腕40的优选实施例包括的缆线多于三条，优选为至少6条(如三对成环缆线)且更优选地是十二条或更多。
注意，远端终止板41处所示的锚点或终端点是示例性的，且如果所选材料属性适合所施应力，则缆线可(由锚点或环)终止以直接挤压在管42的材料上。或者，缆线可远端延伸超过管42和/或远端终止板41以通过连至更远的末端执行器构件(未示出)而终止，缆线张力足以被偏压以保持末端执行器构件在手腕动作的操作范围内牢固连于手腕40。
结构上减少管硬度的方式之一是提供镂空图案，如图5所示。管50包括位于两侧且沿两个正交方向交错以分别有助于在俯仰和偏转方向内弯曲的多个镂空图案。多个内腔54沿圆周分布以容纳传动缆线。
在图6所示的另一实施例中，管60形成为绕由硬度高于管60的材料制成的内弹簧62的外护罩。管60包括接收传动缆线的内槽64。提供独立成型的挠性管可简化组装。与具有穿过缆线的孔的管相比，该管更易于挤压成型或以其它方式成型。管也可用于使用具有形成的终端结构或锚点的传动缆线，因缆线可从中心内腔被放置到位，之后向缆线内插入内弹簧以保持缆线的间隔和固定。在一些情况下，管60可为消过毒的但不必高压灭菌的单个使用部件。
图7示出了具有与图5所示管50中镂空图案52相似的镂空图案72的管70。管70可由塑料或金属制成。外盖74绕管50放置。外盖74可为Kapton(聚酰亚胺)盖等，且一般为具有嵌入镂空图案72内的褶皱的高模数材料。
C.具有轴向舌槽滑动构件的手腕
图8和9示出了具有多个挠性轴向滑动构件82的手腕80，这些滑动构件82通过轴向舌槽连接84相互连接或互锁从而形成管状手腕80。各滑动构件82形成管80的纵向部分。轴向连接84允许滑动构件82相对彼此轴向滑动，同时保持各构件相对于手腕纵向中心线的横向定位。每个滑动构件82包括接收传动缆线的孔或内腔86，该传动缆线终止于手腕80远端附近。图9示出了手腕80在缆线90的缆线拉力下弯曲，该缆线拉力是由滑动构件82的滑动动作而产生的。缆线90延伸穿过工具轴92，且近端连于如万向节板94的传动机构以进行传动。手腕80弯曲期间，因滑动构件82的曲率半径不同，滑动构件82弯曲程度不同。或者，具有轴向滑动构件的手腕的一个实施例可具有整体缆线和滑动构件，例如滑动构件作为整体滑动元件整体形成在缆线周围(如通过挤压成型)，或传动机构连于滑动构件的近端，滑动构件直接传输力至手腕的远端。
图13示出了具有一般由挠性塑料材料制成的多个轴向构件132的手腕130。轴向构件132可共挤压成型于缆线134上，使得缆线可为金属的且仍为绝缘的。轴向构件132通过轴向舌槽连接136而相互连接从而形成管状手腕130。手腕130在俯仰和偏转弯曲期间，可允许轴向构件132相对彼此滑动。手腕130和图8所示手腕80相似，但结构稍有不同且部件形状不同。
D.具有重叠轴向弹簧构件的手腕
图10和11示出了手腕100，该手腕100由绕圆周排布以形成管状手腕100的多个轴向弹簧102形成。弹簧102为沿相同方向或更可能沿相反方向卷绕的螺旋弹簧。缆线104延伸穿过每对相邻弹簧102的重叠区域，如图11更清晰所示。如果手腕在缆线张力下充分压缩，则因重叠，手腕100的压并高度为单个弹簧102的压并高度的两倍。弹簧102一般被压缩预载使得缆线不松弛并增加手腕的稳定性。
在一可选方案中，手腕处于空档或未弯曲状态时，弹簧通过缆线预张而被偏压至充分压缩的压并高度状态。手腕一侧控制且协同减少缆线张力或释放缆线会允许一侧扩展使得手腕100一侧的弹簧扩展以形成弯曲手腕100的外半径。重新施加外侧缆线拉力时手腕返回到笔直结构。
在另一可选方案中，手腕处于空档或未弯曲状态时，弹簧通过缆线预张而被偏压至部分压缩状态。手腕一侧控制且协同增加缆线张力或拉动缆线会允许该侧收缩使得手腕100一侧的弹簧缩短以形成弯曲手腕100的内半径。任选地，这可与外半径上的张力释放相结合，如上述第一可选方案所述。恢复原始缆线拉力时手腕返回笔直结构。
E.具有波形弹簧构件的手腕
图12示出了波形弹簧120形式的手腕，该波形弹簧120具有堆叠或卷绕以形成管状波形弹簧手腕120的多个波形弹簧部分或部件122。在一实施例中，波形弹簧由扁平金属线的连续件以类螺旋方式制成并卷绕，其中每一圈的波形是变化的以便一个循环的高点接触下一循环的低点。这样的弹簧可从例如Smalley Spring公司购得。波形弹簧手腕120内形成孔以接收传动缆线。或者，多个独立的圆盘状波形弹簧部分可以以串珠方式被串在传动缆线上(通过缆线定位或相互粘合)。
所示波形弹簧部分122各自具有90度隔开的两个相对的高点和两个相对的低点。该结构有助于在俯仰和偏转方向内弯曲。当然波形弹簧部分122可具有其它结构，如波型更密且具有绕手腕120圆周的附加高点和低点。
F.具有带球面配合表面的圆盘的手腕
图14示出了手腕140的几个部分或圆盘142。内弹簧144被提供在圆盘142的内部空间内，多个缆线或金属线145用于在俯仰和偏转方向内弯曲手腕140。圆盘142旋于或连于内弹簧144上，该内弹簧144作为内腔来为末端执行器拉动缆线。内弹簧144提供轴向硬度，使得通过拉动缆线施于末端执行器的力不会扭曲手腕140。在可选实施例中，可使用堆叠的实心分隔器代替弹簧144以实现该功能。每个圆盘142均包括弯曲的外配合表面146来配合相邻圆盘的弯曲的内配合表面148。图15示出了手腕140随圆盘142间相关的相对旋转而产生的弯曲。圆盘142可由例如塑料或陶瓷制成。球面配合表面146、148之间的摩擦力优选不会大到干涉手腕140的运动。减轻该潜在问题的方法之一是选择适当的内弹簧144，该内弹簧144要能在传动缆线145以弯曲手腕140期间在圆盘142上施加一些压缩负载并避免过度压缩负载。内弹簧144可由硅树脂橡胶等制成。附加硅树脂构件150也可环绕传动缆线。在可选实施例中，独立圆盘142可由一连续螺旋带代替。
在可选实施例中，手腕160内的每个缆线均可被容纳于弹簧卷162内，如图16和17所示。也提供了内弹簧164。圆盘170可不具有环状凸缘和接收缆线的孔(如图14和15所示圆盘142)。弹簧卷162内的实心心轴金属线172可沿圆盘170周边被放置到位。中心金属线心轴174处于中间以卷绕内弹簧164。组件可封装于硅树脂等中，且之后可移除心轴金属线172、174。可使用某种形式的盖子等来防止硅树脂粘于圆盘170的球面配合表面上。小的心轴弹簧172可卷绕成留下小缺口(而不是压并高度)以提供手腕160弯曲时收缩的空间。理性地，硅树脂可充分良好地粘合于圆盘170上以向粘合的圆盘170和弹簧172、174组件提供抗扭硬度。绝缘硅树脂材料可用于结合了手腕160的烧灼工具的烧灼绝缘。
G.具有由弹性体构件分隔的圆盘的手腕
图18示出了具有由弹性体构件184分隔的多个圆盘182的手腕180。弹性体构件184可为环状构件，或可包括绕圆盘182圆周分布的多个档块。与图14所示手腕140相似，内弹簧186位于圆盘182和弹性体构件184的内部空间内，多条缆线或金属线188用于在俯仰和偏转方向内弯曲手腕180。圆盘182被旋于或连于内弹簧184上，该内弹簧184作为内腔用于为末端执行器拉动缆线。内弹簧184提供了轴向硬度，使得通过拉动缆线施加于末端执行器的力不扭曲手腕180。与手腕140相比，这个手腕180的结构与人脊柱更加相似。弹性体构件184弹性变形以允许手腕180在俯仰和偏转方向内弯曲。使用弹性体构件184消除了对于圆盘182之间配合表面以及相关摩擦力的需要。
H.具有交错肋支承圆盘以俯仰和偏转弯曲的手腕
图19示出了包括多个圆盘192的手腕190，所述多个圆盘192由以正交方向定位以有助于手腕190俯仰和偏转弯曲的交错梁或肋194、196支承。手腕190可由移除相邻圆盘192之间的镂空图案以留下相邻圆盘192之间的基本正交肋194、196的交错层的管制成。圆盘192具有其中穿过传动缆线的孔198。圆盘192和肋194、196可由如钢、铝、镍钛合金或塑料等各种材料制成。在图20所示手腕200的可选实施例中，圆盘202包括代替孔来接收缆线的槽204。这样的管比具有其中穿过缆线的孔的管更易于挤压成型。弹簧206卷绕于圆盘202以支承缆线。
图21中，手腕210包括由交错梁或肋214、216支承的圆盘212，所述肋的两侧具有伸入圆盘212的切口或狭槽217以使肋214、216长于圆盘212之间的间隔。对于相同长度的手腕而言该结构可有助于曲率半径小于图19所示手腕190的弯曲，或者该结构有助于使用较短手腕实现相同曲率半径。这些实施例中相邻圆盘212之间的弯曲角一般约为15度。圆盘212具有接收传动缆线的孔218。
I.使用沿螺旋弹簧分布的薄圆盘的手腕
图22示出了手腕220的一部分，该手腕220包括带多个薄圆盘224的螺旋弹簧222，这些薄圆盘224沿弹簧222的长度分布。从图22所示手腕部分仅可见两个圆盘224，其包括以突舌226相互正交来定位的224A、224B，如图23和24所示。弹簧222在压并高度上盘卷，除了其中为插入圆盘224提供了缺口。弹簧222连于圆盘224靠近内边缘处和圆盘224的突舌226上。圆盘224可通过蚀刻成型，且包括接收传动缆线的孔228。手腕220在俯仰和偏转方向内弯曲期间突舌226作为支点允许弹簧222在特定点弯曲。在一些实施例中，圆盘224可相对较硬，但在其它实施例中可以是足够挠性的以便弯曲并在手腕220弯曲期间作为弹簧元件。可绕螺旋弹簧222和圆盘224提供硅树脂外盖作为介电绝缘体。另外，弹簧222和圆盘224组件可通过由图25和26所示外部部件或铠装部件250形成的外部结构保护。各铠装部件250包括外配合表面252和内配合表面254。一铠装部件250的外配合表面252配合相邻铠装部件250的内配合表面254。铠装部件250沿弹簧222的长度堆叠，并在其因手腕220弯曲而旋转时保持接触。
J.具有外交织金属线的手腕
为了准确相对于施加的负载而言挠性手腕决于各种材料的硬度。即，使用的材料越硬和/或手腕的长度越短和/或手腕的直径越大，则施加给定手术力时手腕的侧向变形越少。如果拉动缆线的柔顺性可以被忽略，则可准确确定手腕末端的角度；但在力作用下可能存在缆线不能抵消的偏斜或侧向变形。例如在手腕笔直且施加了一个力时，手腕可成S形变形。抵消的方法之一是手腕使用具有足够硬度和适当几何形状的适当材料。另一方法是使这些拉动缆线的一半沿手腕长度终止在中间，且仅拉动其余缆线一半的长度，如美国专利申请第10/187,248号所述。更耐S形变形将会损失承受力矩的能力。但避免S形变形的另一方法是在手腕外侧提供交织盖。
图27示出了具有卷于外金属线274内的管272的手腕270。金属线274各卷绕以覆盖管272末端之间大约360度旋转。为增加手腕270的抗扭硬度并避免手腕270的S形变形，则外金属线274可卷绕成形成管272上的交织盖。为形成交织盖，包括右手组和左手组(即一顺时针，一逆时针)的两组金属线相互交错。交错或交织避免了顺时针和逆时针的金属线相对彼此径向移动。例如，会产生抗扭硬度，因为扭转时一组金属线在直径上会增加，而另一组收缩。交织避免了一组与另一组产生不同，并阻止了抗扭变形。需要的是，使外金属线274的铺设长度等于手腕270的长度，以便交织的各独立金属线不必随手腕270在圆弧上弯曲而在长度上增加，尽管外金属线274需轴向滑动。交织阻止手腕270的S形变形，因为其要求外金属线274在长度上增加。另外，交织也可作为铠装保护手腕不被擦凿或切割。如果交织盖不导电，则其可为最外层并作为手腕270的铠装。增加了抗扭硬度并避免了S形变形的手腕也可通过分层弹簧而实现，这些分层弹簧开始于右手缠卷，该右手缠卷被左手缠卷覆盖，之后又覆盖另一右手缠卷。这些弹簧不交织。
K.手腕盖
以上公开了手腕的一些铠装(armor)或盖。图28和29示出了手腕盖的附加示例。图28中，手腕盖280由如塑料或陶瓷等不导电材料制成的扁平螺旋形成。手腕弯曲时，螺旋盖280的不同线圈在彼此上方滑动。图29示出了包括弯曲或卷曲边缘292以确保相邻螺旋层之间重叠的手腕盖290。为向手腕提供抗扭硬度，手腕盖300可包括平行手腕轴定向的凸脊或沟槽302。凸脊302作为从螺旋层至另一螺旋层的花键，并组成手腕的扭转稳定器。增加了对类似支架配置的镍钛合金激光盖的说明。
因此，图1-30示出了具有挠性手腕的手术器械的不同实施例。尽管参照特定示例性实施例进行说明，但这些实施例仅是对本发明的说明，而不应被认为是限制本发明的范围。相反，本发明的原理可应用于多种具体系统和实施例中。
图31-34示出了手术器械(如内窥镜和其它)的不同实施例，该手术器械具有挠性手腕以有助于在心脏组织消融(CTA)治疗时安全放置消融导管或其它装置并对其提供视觉确认。图31-34所示本发明的一些部件与图1-30所示相应的对应部件相似，且相同元件通过加单引号的参考数字指示。当相似性存在时，与图1-30所示相似且以相似方式起作用的图31-34所示本发明的结构/元件将不再详细说明。应理解，本发明不限于CTA治疗的应用，而是也具有其它手术应用。另外，尽管本发明最适用于微创机器人手术范围，应理解本发明也可用于没有手术机器人的任何微创手术。
L.铰接/可操纵和内窥镜
现参照图31，其示出了根据本发明用于机器人微创手术的内窥镜310的实施例。内窥镜310包括长轴14’。挠性手腕10’位于轴14’的工作端。外壳53’允许手术器械310可释放连于位于轴14’相对末端的机器人手臂(未示出)。内窥镜摄像机镜头位于挠性手腕10’的远端。内腔(未示出)沿轴14’的长度延伸，该轴14’连接挠性手腕10’的远端和外壳53’。在“光纤镜”实施例中，内窥镜310的一个(或多个)成像传感器如电荷耦合器件(CCD)可被安装于外壳53’内部，其中所连光纤在内腔内沿轴14’长度延伸并基本终止于挠性手腕10’的远端。之后CCD经位于外壳53’末端的连接器314被连于摄像机控制单元。在另一可选“芯片位于操纵杆上的(chip-on-a-stick)”实施例中，内窥镜310的一个(或多个)成像传感器可被安装于挠性手腕10’的远端，其中至摄像机控制单元的硬连线或无线电连接在外壳53’末端处被连于连接器314。所述一个(或多个)成像传感器可为二维或三维。
内窥镜310具有盖罩312来覆盖并保护在挠性手腕10’远端尖端处的内窥镜镜头314。可为半球形、圆锥形等的盖罩312允许器械在手术部位内/附近运行时可偏离组织。可由玻璃、透明塑料等制成的盖罩312是透明的以便允许内窥镜310可清晰地观察并捕获图像。在允许清晰观察并捕获图像的特定条件下，盖罩312也可是半透明的。在可选实施例中，盖罩312可被充气(如至其正常尺寸的三倍)以提高/增加内窥镜310的观察能力。可充气盖罩312可由制造血管重建气球的挠性透明聚乙烯或相似材料制成。这样，可最小化盖罩312的尺寸并因此最小化插入内窥镜310的微创手术端口的尺寸。将内窥镜310插入手术部位后，盖罩312可被充气以增加/提高观察能力。因此，盖罩312可被连于流体源(如盐水、空气或其它气体源)以根据需要为充气盖罩312提供适当压力。
挠性手腕10’具有至少一自由度以允许内窥镜310绕内部身体组织、器官等轻松地铰接并操纵从而到达所需目的地(如心外膜或心肌组织)。挠性手腕10’可为以上相对图1-30所述任一实施例。外壳53’也容纳铰接(容纳内窥镜的)挠性手腕10’远端部分的驱动机构。驱动机构可为缆线驱动、齿轮驱动、履带驱动或其它类型机构。示例性驱动机构和外壳53’见美国专利第6,394,998号所述，其全文结合于此以供参考。示例性驱动机构为挠性手腕10’提供了两个自由度，并允许轴14’绕沿轴长度的轴线旋转。在CTA手术过程中，铰接内窥镜310绕内部器官、组织等操纵并铰接以获得难以观察和/或难以到达位置的视觉图像。所获图像被用于辅助消融导管在所需心脏组织上的定位。铰接内窥镜可以是使用的唯一观察镜或也它也可以被用作第二或第三观察镜以相对于主内窥镜所获主图像提供手术部位的备用图像。
M.具有可释放固定的消融导管/装置的铰接内窥镜
作为上述铰接内窥镜的延伸，导管可以被可释放地连于铰接内窥镜上以进一步有助于消融导管在所需心脏组织上的放置。图32示出了通过一系列可释放夹环320可释放连于内窥镜310上的导管321。其它类型的可释放接头(机械或其它方式)也可以被使用，并且也属于本发明的范围内。如图32所示，夹环320允许消融装置/导管321可释放地被固定在内窥镜310上以便在CTA手术过程中当绕结构(如肺部血管等)驱动、操纵并铰接以到达所需手术目的地时消融装置/导管321跟随内窥镜310。当铰接内窥镜310和固定的消融装置/导管321到达目的地时，导管321被支承/保持到位，例如通过连于机器人手臂的另一器械，同时内窥镜310从消融装置/导管321释放并被移除。这样，操纵期间内窥镜310捕获的难以观察和/或难以到达位置的图像可用于导向目的。另外，内窥镜的铰接还有助于消融装置/导管321在难以到达的心脏组织上的放置。
在可选实施例中，不是装置/导管自身，而是导管导向装置331被可释放地固定于内窥镜310。如图33所示，之后如上所述导管导向装置331通过铰接内窥镜310以相似方式被引导至最终目的地。当铰接内窥镜310和固定的导管导向装置331到达目的地时，导管导向装置331被支承/保持到位，例如通过连于机器人手臂的另一器械，同时内窥镜310从导管导向装置331释放并被移除。之后消融导管/装置使用其近端332处的导管导向装置331滑动到位。在一实施例中，导管导向装置331使用可释放接头如夹环320以允许导管滑动到位。在另一实施例中，导管导向装置331使用嵌入内窥镜310的内腔，在其中导管导向装置331可滑入并被引导到达目标。
N.具有内腔以引导内窥镜的铰接器械
在又一实施例中，不具有铰接内窥镜，而是末端执行器被固定于挠性手腕以便为器械提供所需铰接。这个铰接器械例如上述关于图1-2被描述。但是，铰接器械还包括沿器械的轴延伸的内腔(例如空腔、工作通道等)，外部内窥镜可被插入其中并被导向至挠性手腕的尖端。该实施例实现了与上述具有可释放固定的消融导管/装置或具有可释放固定的导管导向装置的铰接内窥镜基本相同的功能。不同之处在于消融导管/装置被用于驱动并操纵，此时内窥镜通过插入嵌入内腔被可释放地固定于消融装置。使用嵌入内腔，省去了可释放接头(如夹环)。
现参照图34，示出了视频框图，其示出了根据本发明的视频连接的实施例。如图34所述，摄像机控制单元342控制铰接内窥镜310的操作，如放大、缩小、分辨率模式、图像捕获等。铰接内窥镜310捕获的图像在输入主显示监视器343和/或辅助显示监视器344之前被提供至摄像机控制单元342以供处理。系统中的其它可用内窥镜345如主内窥镜以及其它内窥镜以相似方式被其自身的摄像机控制单元组346控制。所获图像以相似方式被输入主显示监视器343和/或辅助显示监视器344。一般主监视器343显示可为三维的从主内窥镜获得的图像。从铰接内窥镜310(或插入铰接器械内腔内的内窥镜)获取的图像可被显示于辅助显示监视器344上。或者从铰接内窥镜310(或插入铰接器械内腔内的内窥镜)获取的图像可作为辅助信息被显示在主显示监视器343上(参见美国专利第6,522,906号的详细说明，其全文结合于此以供参考)。
上述铰接器械/内窥镜可由像避孕套的可选择的无菌护套覆盖以保持铰接器械/内窥镜清洁、无菌，从而避免必须在随后的手术过程使用中消毒这些器械/内窥镜。这样的无菌护套需为半透明的以允许内窥镜清晰地观察并捕获图像。因此，无菌护罩可由乳胶状材料(如聚氨酯等)制成。在一实施例中，无菌护罩和盖罩312可由相同材料制成并结合在一起成为一个整体。之后盖罩312可通过机械或其它类型紧固件被紧固在轴14’上。
因此，图31-34示出了手术器械(如内窥镜和其它器械)的不同实施例，其具有挠性手腕以有助于在心脏组织消融(CTA)治疗中消融导管或其它装置的安全放置并为其提供视觉确认。尽管参照特定示例性实施例进行说明，但这些实施例仅是本发明的说明，不应被认为是限制本发明的范围。相反，本发明的原理可应用于多种具体系统和实施例。
图35-37示出了根据本发明的铰接/可操纵和可调换内窥镜。图35-37所示本发明的一些部件与图1-34以及结合以供参考所述的其它附图所示相应的对应部件相似，且相似元件通过加双引号的参照数字被指示。当相似性存在时，与图1-34所示相似且以相似方式起作用的图35-37所示本发明的结构/元件将不再被详细说明。
O.铰接/可操纵和可调换内窥镜
现参照图35，其示出了根据本发明的在机器人微创手术中使用的铰接和可调换内窥镜310”的实施例。内窥镜310”包括长轴14”。挠性手腕10”位于轴14”的工作端。外壳53”允许手术器械310可释放地连于位于轴14”的相对末端的机器人手臂(未示出)，如美国专利第6,331,181号和第6,394,998号所述。与美国专利第6,451,027号所述的被设计成支承更重且更大的内窥镜摄像机的机器人手臂不同，美国专利第6,331,181号和第6,394,998号所述的机器人手臂被设计用于较轻的手术器械，其全文结合于此以供参考。为实现可互换性/可调换性，与美国专利第6,331,181号和第6,394,998号所述相似的机器人手臂设计被用于所有手术机器人手臂。换言之，不使用主要被设计用于承载手术内窥镜的机器人手臂，而是被设计用于较小负载的通用/标准机器人手臂被用于承载包括手术内窥镜的所有类型手术器械。这样，手术内窥镜可被安装于手术机器人的多个手术机器人手臂中的任一手臂上，从而在手术过程期间根据需要允许手术内窥镜可在不同手术手臂之间调换。因此外科医生现在可在端口之间更换内窥镜，如一般发生在常规腹腔镜手术中。更换可通过如下方式被轻松地执行：从一手臂释放并拆卸内窥镜，且之后固定并锁定内窥镜至一个不同的手臂上，该不同的手臂允许内窥镜被插入到病人体内不同手术端口内。另外，机器人手术系统的机械和构造设计可被简化，因为不再需要容纳不同类型的器械手臂。
为实现此目的，内窥镜需要被制造地更小且更轻。根据本发明，内窥镜摄像机镜头位于挠性手腕10”的远端。内腔(未示出)沿连接挠性手腕10”的远端和外壳53”的轴14”的长度延伸。在优选“芯片位于操纵杆上的”实施例中，内窥镜310”的一个(或多个)成像传感器可被安装于挠性手腕10’的远端，此时硬连线或无线电连接至被连于外壳53”末端处连接器314”的摄像机控制单元上。一个(或多个)成像传感器可为二维(2D)或三维(3D)。一些复杂信号处理技术可用于从一个(或多个)2D成像传感器推导出3D图像。一些示例性商业可购得“芯片位于操纵杆上的”内窥镜解决方法包括纽约州Melville市的Olympus America公司、以色列Petach Tiqua的Visionsens及其它。这样的“芯片位于操纵杆上的”实施例可将内窥镜的尺寸减少成原有尺寸的一小部分，并将重量减少一个数量级。因此，内窥镜的尺寸和重量在安装/拆卸以及操纵内窥镜时不再成为难题。在可选“光纤镜”实施例中，内窥镜310”的一个(或多个)成像传感器如电荷耦合器件(CCD)可被安装于外壳53”内部，此时所连光纤在内腔内沿轴14”长度延伸并基本终止于挠性手腕10”的远端。
内窥镜310”可具有盖罩312”以覆盖并保护挠性手腕10”远端尖端处的内窥镜镜头314”。可为半球形、圆锥形等的盖罩312”允许器械在手术部位内/附近操纵时偏离组织。可由玻璃、透明塑料等制成的盖罩312”是透明的以允许内窥镜310”清晰地观察并捕获图像。在允许清晰地观察并捕获图像的特定条件下，盖罩312”也可是半透明的。在可选实施例中，盖罩312”可被充气(如至其正常尺寸的三倍)以提高/增加内窥镜310”的观察能力。可充气盖罩312”可由制造血管重建气球的挠性透明聚乙烯或相似材料制成。这样，可最小化盖罩312”的尺寸并因此最小化插入内窥镜310”的微创手术端口的尺寸。将内窥镜310”插入手术部位后，盖罩312”可被充气以增加/提高观察能力。因此，盖罩312”可被连于流体源(如盐水、空气或其它气体源)以根据要求为充气盖罩312”提供适当压力。
挠性手腕10”提供了附加自由度以允许内窥镜310绕内部身体组织、器官等轻松铰接并操纵以到达所需目的地(如心外膜或心肌组织)。挠性手腕10”可为以上相对图1-30所述任一实施例，或美国专利第6,817,974号所述，具有多个接头的其它实施例等。外壳53”也容纳铰接(容纳内窥镜的)挠性手腕10”远端部分的驱动机构。驱动机构可为缆线驱动、齿轮驱动、履带驱动或其它类型机构。示例性驱动机构和外壳53”见美国专利第6,394,998号所述，其全文结合于此以供参考。示例性驱动机构为挠性手腕10”提供了二自由度(俯仰和偏转)，并允许轴14”绕沿轴长度的轴线旋转(滚动)。俯仰和偏转自由度(即手腕10”靠近内窥镜镜头尖端分别绕虚构横轴线和竖轴线的弯曲)是对插入/抽出动作(如x、y和z笛卡尔动作)以及器械轴旋转(如滚动动作)的补充。这样，内窥镜310”的自由度与其它机器人手术器械(如抓钳等)相同，这提出了如下问题：如何向外科医生提供控制内窥镜附加自由度的直观方法。
P.从动器械的摄像机参照控制范例
需要向外科医生提供控制复杂手术机器人的直观方法。因外科医生全神贯注于精细且复杂的手术过程，所以他不需要意识到手术机器人如何执行工作，且有时可能由于机器人根据外科医生的指导操纵和执行其任务方式的直观性而忘记正在使用机器人执行手术过程。作为直观和反直观的简化示例性说明，图36示出了内窥镜水平凝视指向正前时，全局参照(也称为图像参照)控制和摄像机参照(如固定至内窥镜远端尖端的参照系)控制之间没有不同。但是，摄像机旋转时，例如顺时针旋转90度时，则在摄像机参照系中基于从动器械移动使得在保持器械运动对外科医生的直观性时有很大不同，因为如果器械基于全局参照，那么外科医生手部的左右动作将看似引起手术器械的上下运动。因此，美国专利第6,364,888号(以下称为‘888专利)和美国专利第6,424,885号(以下称为‘885专利)说明了控制在内窥镜摄像机参照系内所有从动器械动作和定位以提供该直观性，其全文结合于此以供参考。但是，‘888专利和‘885专利所述内窥镜不具有本发明中内窥镜所具有的俯仰和偏转自由度。因此，与这些自由度有关的挑战以及因此产生的范例是意料之外的。
接下来将说明第一范例。当根据本发明的内窥镜进行俯仰或偏转动作时，如果从摄像机参照系观察图像，则对于外科医生来说，观察是反直观的。这是因为如果内窥镜上仰，则从摄像机参照系的观察看似向下看而不是外科医生直观期望的向上观察。如果内窥镜下俯，则从摄像机参照系的观察看似向上看而不是外科医生直观期望的向下观察。同样，如果内窥镜向左偏转，则从摄像机参照系的观察看似向右看而不是外科医生直观期望的向左观察。如果内窥镜向右偏转，则从摄像机参照系的观察看似向左看而不是外科医生直观期望的向右观察。这样的反直观性是不期望的，且要求为内窥镜的俯仰和偏转动作将从动手术器械的参照系从摄像机参照系改为全局/图像参照，以保持本发明所需的直观性。从动手术器械的参照系对本发明所有其它内窥镜自由度(如x、y和z笛卡尔插入/抽出动作和器械轴滚动动作)而言，是摄像机参照系。换句话说，附加自由度的参照系与手术机器人内窥镜相关的传统自由度的参照系分离。但是，应理解，根据本发明，对于一些应用可以有益地在摄像机参照系和全局参照系之间提供选择从而控制铰接/可操纵和可调换内窥镜的六自由度中一个或任意自由度。换句话说，铰接/可操纵和可调换内窥镜的六自由度中任意或所有自由度可在摄像机参照系或全局参照系中被控制。
在主从手术机器系统中，如da系统，如果六自由度中任意(或所有)自由度在摄像机参照系中被控制，那么参照系随摄像机的移动改变位置和/或方向。换句话说，主动(即外科医生的眼睛)相对从动(内窥镜摄像机)的关系因摄像机的移动而变化，如果不补偿这些变化那么摄像机的移动可反过来影响外科医生相对其输入的感觉的直观性。该补偿是通过控制转换来重新定位主动输入装置而被执行的。更具体地，主动/眼睛转换被调整以符合改变的从动/摄像机转换。该主动校准补偿优选在摄像机控制(即实时或接近实时)期间被持续地并递增地(经递增转换)执行，而不是在摄像机控制(即顺序)之后进行较大补偿，因为相关延迟时间被最小化。应理解在非挠性和不可操纵内窥镜系统中或在所有六自由度在全局参照系中被控制时是不要求该主动校准补偿的，原因是参照系在这些情况下是不变的。
主动输入装置可使用至少六(6)自由度被操纵，如美国专利第6,714,839号所述，其全文结合于此以供参考。如果如图38所示用户的左右手使用独立主动输入装置，则因实际组合两个主动输入装置来控制内窥镜摄像机的位置和方向以及聚焦、光圈等功能，总共至少十二(12)自由度可用。图38示出了所述两个主动输入装置，其实际上被组合以与自行车车把相似方式操作。由于摄像机可沿X、Y和Z轴线移动并绕其旋转，需要实际组合的主动输入装置提供的六(6)自由度来使用速度(也称为速率)或位置控制从而支配这六个位置和方向。另外，需要实际组合的主动输入装置提供的三(3)自由度来执行/处理组合主动输入装置的几何约束。因此，至少三(3)备用自由度保持可用以支配其它摄像机功能(如聚焦、光圈等)。在优选实施例中，用于支配这些其它摄像机功能的三自由度为：扭曲手柄(即两个主动输入装置)、弯曲手柄以及在相反方向滚动各主动输入装置。
对于本领域普通技术人员而言，应明确与参照系改变相关的任何数学改变(如参照系位置/方向转换)以及控制系统改变(如控制算法)可根据‘888专利和‘885专利的相关详细说明获得并执行。因此，为简单和清晰的目的，本文不对此提供附加说明。
Q.俯仰和偏转动作的旋转点
第二控制范例包括对于铰接/可操纵和可调换内窥镜的旋转点的选择。旋转点是指内窥镜图像观察参照系旋转所绕的点。选择这个旋转点以便向外科医生提供直观感和手术部位最佳观察图像。对于根据本发明的铰接和可调换内窥镜，摄像机镜头的附加俯仰和偏转动作(无论独立或同时)与适当选择的旋转点结合可被用于操纵内窥镜(可能结合其它自由度)以提供手术部位内相对摄像机参照系的解剖的轨道观察图像(与绕行星轨道运行的卫星观察的视角相似)。应注意，传统机器人手术内窥镜(如不具俯仰和偏转动作的内窥镜)不要求像这样选择旋转点，因此不需预先考虑。候选的旋转点包括：可为内窥镜最大工作范围内一点的手术部位的假定中心(如距Olympus内窥镜远端尖端近似三十八(38)mm)、挠性手腕10”最近区域内的点、内窥镜手术部位入口点等等。
现在参照图37，其示出了根据本发明的内窥镜310”的不同潜在旋转点。如图37所示，内窥镜310”已被插入器官372周围手术部位处的端口371内。点373是假定中心，点374是挠性手腕10”附近或其上的点，并且点375是内窥镜310”从其进入手术部位的点。
假定中心旋转点可为最合理的，因为手术部位的多数行为可能在内窥镜尖端周围最近区域发生，且给定本发明的铰接/可操纵内窥镜的六自由度以及缩放能力，可快速进行较小调整以获得所需最佳观察图像。但该选择的缺点在于，摄像机镜头进行俯仰和/或偏转动作时，与内窥镜310”近端(后端)以及更重要地与可释放地连接了内窥镜的机器人手臂相关的过活跃动作(over-active motion)。承载内窥镜310”的机器人手臂的过活跃动作可能是不需要的，因其妨碍了手术期间同时移动的系统的所有其它机器人手臂，导致手臂碰撞。
移动旋转点至内窥镜手术部位入口点看似减少了机器人手臂动作，因旋转点和机器人手臂之间的距离被大幅减少(通过减少连接旋转和平移动作量)，但因物理和几何约束，同样看似产生的手术部位观察图像并非最佳。经过比较，旋转点位于挠性手腕10”的中心周围时，旋转点和机器人手臂之间的距离被减少，从而也减少了手臂动作，但因物理和几何约束较少所以观察图像较好。因此，绕挠性手腕10”中心的点为本发明铰接可调换内窥镜的优选旋转点。说明了主动控制点对从动控制点的映射的‘885专利中提供了旋转点的示例性实施方式。
设备和方法的上述安排仅为本发明原理应用的说明，可做出许多其它实施例和修改而不背离权利要求所界定的本发明的精神和范围。因此本发明的范围不应参照上述说明被限定，而应参照所附权利要求及其等效物的完整范围被限定。

Claims (8)

1.一种用于提供手术部位的轨道观察图的设备，所述设备包含：
可插入身体孔的长轴；
在至少一自由度内可弯曲的挠性手腕，所述挠性手腕的近端连至所述长轴；
位于所述挠性手腕的远端的图像捕获装置，所述图像捕获装置被配置为获取所述手术部位的多个图像观察图；
机器人手臂，其被配置为关于所述身体孔操纵所述长轴，且被配置为在所述至少一自由度内控制所述挠性手腕的运动，所述机器人手臂进一步被配置为围绕所述挠性手腕上的旋转点移动所述图像捕获装置，其中所述图像观察图的参考系围绕所述旋转点旋转。
2.根据权利要求1所述的设备，所述至少一自由度包含偏转运动，所述机器人手臂被配置为控制所述挠性手腕的偏转运动。
3.根据权利要求2所述的设备，所述至少一自由度进一步包含俯仰运动，所述机器人手臂被进一步配置为控制所述挠性手腕的俯仰运动。
4.根据权利要求1所述的设备，所述机器人手臂被进一步配置为通过进一步围绕所述旋转点移动所述挠性手腕而获取所述手术部位的连续图像。
5.根据权利要求1所述的设备，所述机器人手臂是远程外科手术系统的一个部件。
6.根据权利要求1所述的设备，所述旋转点位于所述挠性手腕的中心周围。
7.一种用于提供手术部位的轨道观察图的设备，所述设备包含：
在远端具有带至少一动作自由度的挠性手腕的铰接手术内窥镜；
机器人手臂，所述机器人手臂被配置为通过控制所述内窥镜基于绕邻近所述挠性手腕的旋转点旋转的参照系获取物体的图像，从而减少所述铰接手术内窥镜的近端动作。
8.根据权利要求7所述的设备，其中所述物体的所述图像为轨道观察图。
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