CN103370014B - 用于吻合或管封闭器械中刀位置的指示符 - Google Patents

用于吻合或管封闭器械中刀位置的指示符 Download PDF

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CN103370014B
CN103370014B CN201280008768.2A CN201280008768A CN103370014B CN 103370014 B CN103370014 B CN 103370014B CN 201280008768 A CN201280008768 A CN 201280008768A CN 103370014 B CN103370014 B CN 103370014B
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D·罗宾逊
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Intuitive Surgical Operations Inc
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Abstract

本发明公开用于将被跟踪的工具的图像显示在用户界面上的系统和方法，其中在手术程序期间在任何位置该工具的至少一部分在该用户界面上的任何图像中被隐藏看不见。该工具可以包括切割工具，该切割工具具有用于夹紧物质的爪和用于切割该夹紧的物质的刀，并且在切割期间和/或之后将该刀位置的指示符叠加在显示器上。刀位置可以包括该刀的定位和/或取向，包括切割前位置、切割完成位置、切割未完成位置和露出的位置中的任何位置或全部。所公开的系统和方法允许用户在用户可能看不见刀的应用中观察刀位置，这对于在微创手术程序中用机器人外科手术系统夹紧和切割人体组织是特别有用的。

Description

用于吻合或管封闭器械中刀位置的指示符
相关申请的交叉参考
本申请是2011年2月15日提交的美国临时专利申请No.61/443,115的非临时申请，并要求该申请的利益，其整个整体内容通过参考结合于此。
本申请涉及如下的申请：2010年2月12提交的标题为“Cut and Seal Instrument”的美国申请No.12/705,418（代理案件号No.ISRG02180/US）；2009年3月31日提交的美国申请No.12/415,332（代理案件号No.ISRG01510/US）；和2006年6月29日提交的美国申请No.11/478,531（代理案件号No.ISRG0010/US），这些申请的整体内容通过参考结合于此。
背景技术
由机器人外科手术系统进行的微创外科手术是已知的，并且通常用在有利于人不直接执行外科手术的临床手术程序中。这种系统的一个示例是在标题为“CameraReferenced Control in a Minimally Invasive Surgical Apparatus”的共同拥有的美国专利US7,155,315中公开的微创机器人外科手术系统。
微创外科手术的常见形式是内窥镜检查。微创医疗技术中的内窥镜外科手术器械一般包括用于观察外科手术区的内窥镜和限定末端执行器的工作工具。作为示例，典型的外科手术末端执行器包括夹具、抓紧器、剪刀、组织切割器、缝合器或针保持器。工作工具类似于常规的（开放性）外科手术中所用的工作工具，除了每种工具的末端执行器支撑在例如大约12英寸长的延伸管的端部之外。为了操纵末端执行器，通常为外科医生的人类操作者操纵或者控制主操纵器。来自主操纵器的命令被适当转换，并且发送至从操纵器。然后从操纵器根据用户的命令操纵末端执行器。由于在一定程度上末端执行器的运动不需要外科医生，外科医生通常依靠例如内窥镜成像的反馈机构以确定外科手术工具在病人体内的位置。一般而言，在远程外科手术系统中，为外科医生提供“内部用户界面”。这种内部用户界面包括在手术程序期间能够被外科医生观察的显示器。
在微创外科手术中执行的手术程序是组织切除，该手术可以包括人体组织的夹紧、封闭和切割。在组织封闭和切割程序中，末端执行器具有用于封闭该组织的机构（例如，RF能量、缝合、吻合等）和切割构件（例如，组织切割器、刀片、烧蚀能量）。通常，封闭和切割程序涉及如下步骤：夹紧组织，在切割线的任一侧上封闭该夹紧的组织，然后沿着切割线切割该夹紧的组织。如果由于任何理由，切割过程将停止或失败，由于切割构件可能留在露出的位置，这可能存在危险。在切割构件位于该位置的情况下去除末端执行器，可能导致该装置附近的其他组织的不经意的切除，或者一旦该工具被去除时可能对外科医生或其他外科手术工作人员构成危险。由于切割失败是低发生率事件，并且外科医生对切割元件的观察可能被末端执行器遮挡，外科医生可能不能保持如何定位和移动切割元件的准确的心理模型，并且可能没有意识到由露出的切割元件产生的危险。
期望有一些系统和方法，该系统和方法在手术程序期间提供允许医生构想并且更重要的是使他们适应组织切割器的位置和定位的指示和图像。这种方法将使医生能够产生组织切割器如何操作的直观“感觉”，以便方便切割并且防止潜在的组织损害。
发明内容
提供用于指示末端执行器的工具的位置的改进系统和方法。要求保护的方法和系统涉及在用户界面上显示夹紧物质的电动工具的图像，该工具具有用于夹紧物质的第一爪和第二爪以及用于切割该物质的切割元件（例如，刀或刀片），并且在用户界面显示器上叠加该切割元件的位置的可视指示符。该切割元件（例如，刀片、刀）包括各种位置，其中位置表示该切割元件的位置和/或取向。在许多实施例中，该工具包括末端执行器，该末端执行器具有第一爪和第二爪以及设置在该末端执行器中的刀，使得该刀沿着该爪的纵轴线从切割前位置移动到切割完成位置，因而切割夹紧在爪之间的组织。刀的位置可以包括以下任一个或全部：切割前位置、切割完成位置、切割未完成位置和露出位置。即便当刀可能由于来自该物质或末端执行器的爪的干扰而看不见时，所公开的方法也允许用户构想或感觉末端执行器的刀的位置和/或取向，这在微创机器人外科手术程序中是特别有用的。由于该方法和系统允许外科医生适应切割期间刀的移动，改善外科医生对手术程序的直觉感觉，该方法和系统是有利的。这对当刀的移动停止而刀留在“露出”或“切割未完成”位置时的很少发生的情况是非常有用的，如果外科医生没有意识到这种危险，这种情况可以潜在地引起无意的组织损害。虽然本文描述的各种实施例主要是关于外科手术应用描述的，但是这些外科手术应用仅仅是示例性的应用，所公开的末端执行器、工具和方法可以用在其他合适的应用中，在人体的体内和体外以及非外科手术应用中。
在优选实施例中，在切割手术程序期间和/或之后，并且更优选在手术程序期间的所有的时间，刀位置的指示被叠加在显示器上。该指示可以包括足以将刀的位置传达给用户的任何可视指示符。刀位置可以进一步包括刀在末端执行器上的位置和/或刀的取向。理想地，刀位置的指示符包括叠加在末端执行器的图像上的刀在对应于末端执行器上的实际的刀位置和取向的位置处的合成表示。
在一个实施例中，该方法包括在环境中跟踪可移动元件，其中该元件的至少一部分在手术程序期间显示在用户界面上的环境的图像中被隐藏看不见，并且在用户界面上显示该元件的位置的指示符。被隐藏看不见的该元件部分在手术程序期间的其他时间是可以看见的。另外，被隐藏看不见的该元件部分在手术程序期间可以改变，例如，当该元件移动通过该环境时，或当该环境中可见的组织或其他工具部件相对于该元件移动时。跟踪元件可以包括确定该元件的位置或取向，通常相对于可移动地连接至该元件的工具确定。在许多实施例中，该元件包括连接至例如在微创外科手术程序中插入病人体腔中的工具的用于切割病人的人体组织的切割刀片。跟踪元件可以包括跟踪移动该元件的机构，或处理设置在该元件上的位置标记的图像。元件的位置指示符可以显示在用户界面上，以便当元件在多个位置之间移动时使用户适应该位置。在一些实施例中，位置指示符可以响应于触发（trigger）条件提供可替换的指示，例如，当元件意想不到地停止在第一和第二位置之间时提供元件已经停止的指示。在用户界面上显示指示符可以包括在显示器上显示该元件的表示，例如该元件在该环境和/或工具的视频图像上的合成表示。优选地，位置指示符是动态的，使得指示符传达该元件的运动，允许用户看见并适应在手术程序期间该元件的移动。
在许多实施例中，该方法和系统包括将组织夹紧在该工具的第一爪和第二爪之间，和响应于夹紧该组织的用户命令为工具的电机供给能量，该电机可操作地连接至刀以便相对于爪在切割前的刀位置和切割完成的刀位置之间移动该刀，由此切割该组织。由于刀通常至少部分地设置在工具的爪之间，因此在手术程序期间该爪可能妨碍在该工具的图像中观察移动的刀。通常，夹紧和切割响应于切割或夹紧的用户命令发生，然而，在成功地夹紧之后切割也可以自动发生。通常，在沿着切割线切割该组织之前，该组织被夹紧，并且然后在该切割线的任一侧上被封闭。
在一个实施例中，该方法和系统可以包括在切割程序期间和/或之后，例如当刀的移动停止而使刀露出时，在用户界面上叠加刀位置的警告指示。该警告可以是与上面所述的刀位置的指示分开的指示，以便将由在切割期间停止或失败可能引起的危险状况通知给用户。例如，显示器可以包括警告灯，该警告灯在切割程序期间当刀停止或露出时响应于刀的停止而发光。
在一个实施例中，该系统包括可移动元件、用户界面显示器和将该元件连接至用户界面显示器的处理器，使得该处理器可以在显示器上输出该元件位置的可视指示符。在许多实施例中，该系统进一步包括可移动地连接至该元件的工具和图像捕获装置，例如视频摄像机。该处理器和/或图像捕获装置可以用来测量该元件相对于该工具的位置或取向，或反之亦然。该元件在该工具的多个位置之间，优选在第一和第二位置之间，通常是可移动的。在许多实施例中，该系统处理由处理器获得的位置信息（例如，来自图像捕获装置的图像）以确定该元件和工具的相对位置。处理器可以连接至有效移动该元件的机构，使得该元件或工具的位置可以由处理器根据该机构的位移确定。
在许多实施例中，该工具包括末端执行器，该末端执行器具有用于夹紧物质的爪和用于切割该夹紧的物质的切割元件（例如，刀或刀片）。通常，该工具是具有用于夹紧组织的爪和用于切割该夹紧的组织的刀的外科手术工具。该刀被构造成在爪之间从切割前位置移动到切割完成位置，由此切割被夹紧在该爪之间的组织。在切割前位置和切割完成位置中，该刀的切割刃安全地设置在末端执行器中，以便保护邻近的组织。该刀可以包括在切割前位置和切割完成位置之间的另外的刀位置，包括但不限于“刀露出”位置和“切割未完成”位置。刀位置可以进一步包括该刀相对于末端执行器的位置和/或取向。
在许多实施例中，用户界面显示器与处理器和图像捕获装置连接，以便显示该工具的末端执行器的图像和刀位置的指示。如果由于任何原因，该工具是看不见的，用户将能够观察叠加在该工具的图像上的刀的位置指示符和表示。在优选实施例中，刀位置指示符包括叠加在该末端执行器的实际的或合成的图像上的刀的合成表示。该显示器也可以指示与刀位置指示符分开的刀已经停止并且存在危险的警告，例如刀的停止的形态或露出的切割刃。
为了更完整地理解本发明的性质和优点，应当参考下面的具体实施方式和附图。本发明的其他方面、目的和优点将从附图和下面的具体实施方式变得明白。
附图说明
图1示出包括根据许多实施例的微创远程外科手术系统的手术室的俯视图；
图2是用于图1的微创远程外科手术系统的病人手推车的前视图；
图3是表示图1的微创远程外科手术系统部件的方框图；
图4是根据许多实施例的切割和封闭外科手术工具的示意图；
图5是根据许多实施例的外科手术工具的可移除的切割和封闭夹头（cartridge）的示意俯视图；
图6是根据许多实施例的组合的切割和封闭微创外科手术器械的远端的透视图；
图7是根据许多实施例的图6的实施例的侧剖视图，其示出刀的不同位置；
图8是根据许多实施例的外科手术工具的示意图；
图9是根据许多实施例的系统的示意图；
图10图示说明根据许多实施例的用户界面显示器，其示出具有刀位置指示符的工具的图像；
图11是图示说明根据许多实施例的利用工具跟踪的组合的组织切割和封闭系统的示意图；和
图12-13是根据许多实施例的方法的示意图。
具体实施方式
在下面的描述中，将描述本发明的各种实施例。为了说明的目的，提出具体的配置和细节以便提供对实施例更彻底的理解。然而，对本领域的技术人员而言显而易见的是本发明可以在没有具体的细节的情况下实施。而且，公知的特征可以被省去或简化，以便不使描述的实施例模糊不清。
提供用于在切割程序期间指示工具上的切割元件的定位和/或取向的改进的系统和方法。要求保护的方法和系统可以与其他跟踪方法相结合使用，以便允许用户感知切割元件相对于该工具的位置或取向。这些方法和系统在切割期间用户可能不能看见切割元件的机器人系统中是非常有用的，这在利用电动的末端执行器的微创外科手术中是特别有用的。这些方法是有利的，因为这些方法允许不接触末端执行器的外科医生形成在手术程序期间切割构件如何相对于工具移动的感觉。通过产生切割构件相对于工具的位置的灵敏的指示，该方法允许外科医生适应切割构件在工具上的位置，使得如果切割程序失败，外科医生将会意识到由于切割构件而存在潜在的危险，并且能够采取适当的动作以避免这种危险。虽然本文描述的各种实施例主要是针对外科手术应用来描述的，但是这些外科手术应用仅仅是示例性的应用，所公开的末端执行器、工具和方法可以用在其他合适的应用中，在人体的体内和体外以及非外科手术应用中。
现在参考附图，在附图中相同的附图标记表示多个附图中相同的零部件。图1示出根据许多实施例的具有操作站或外科医生控制台3的微创远程外科手术系统1。该外科医生控制台3包括显示器15，外科手术部位的图像显示给外科医生S。正如所知道的，设置有支撑（未示出），外科医生S在握住两个主控制器（一手一个）时可以将其前臂搁置在该支撑物上。虽然在更多的末端执行器可用时可以提供更多控制器，但是通常外科医生仅同时操纵两个控制器；如果使用多个末端执行器，外科医生用主控制器释放一个末端执行器，并且用相同的主控制器抓住另一个。当使用外科医生控制台3时，外科医生S通常坐在该外科医生控制台前面的椅子上，将其眼定位在显示器5的前面，并且握住主控制器，一手一个，同时将其前臂搁置在支撑物上。
远程外科手术系统1的病人侧手推车5设置成邻近病人P。在使用中，病人侧手推车5设置成靠近需要外科手术的病人P。病人侧手推车5在外科手术程序期间通常是不动的，并且包括机器人组件5A、5B、5C和5D。外科医生控制台3通常设置成远离病人侧手推车5，并且可以与病人侧手推车分开很大的距离，甚至数英里远，但是通常与病人侧手推车用在相同的手术室内。每个机器人臂组件5A、5B和5C分别包括外科手术器械或工具7A、7B和7C。组件5D可以包括用于在手术程序期间使工具在显示器上成像的内窥镜。机器人臂组件5A、5B和5C的工具7A、7B和7C分别包括末端执行器9A、9B和9C。末端执行器9A、9B和9C相对于工具7A、7B和7C的轴的端部的运动也由外科医生控制台3的主控制器控制。工具7A、7B和7C中的任一个可以包括组织切割和封闭器械。这种器械可以包括具有用于夹紧组织的爪的末端执行器、用于封闭该组织的构件（例如，缝合器或RF机构）和在封闭之后用于切割该组织的构件（例如，可移动刀片、刀或任何组织切割机构），它们的例子示于图4-7中。图2示出病人手推车和相关机器人臂组件的前视图。
远程外科手术系统1包括观察手推车11。在一个实施例中，该观察手推车11包括用于操作该远程外科手术系统1的大多数计算机设备或其他控制器。作为示例，由外科医生控制台30的主控制器发送的信号可以被发送到该观察手推车11，该观察手推车11进而可以解读该信号并且产生用于末端执行器9A、9B和9C和/或机器人臂组件5A、5B和5C的命令。此外，从例如内窥镜的图像捕获装置5D发送给显示器15的视频可以由观察手推车11处理或简单地传输。
图3是远程外科手术系统1的示意图。正如能够看到的，该系统包括外科医生控制台3、病人侧手推车5和观察推车11。此外，根据实施例，可以提供附加的计算机13和显示器15。这些部件可以合并在外科医生控制台3、病人侧手推车5和/或观察手推车11中的一个或多个中。例如，计算机82的特征可以合并到观察手推车11中。此外，显示器15的特征可以合并到外科医生控制台3中，例如显示器5中，或者可以由完全分开的显示器或外科医生控制台提供，或在另一个位置上。此外，根据实施例，计算机13可以生成能够被利用的信息，而不用例如显示器15的显示器。
图4是根据本发明的一方面的示例切割和封闭外科手术器械2的示意图。如图4所示，器械2包括在近端（病人的外侧）的力传递机构4和在远端（病人内侧，靠近外科手术部位）的组合的切割和封闭末端执行器6。传递机构4以及切割和封闭末端执行器6通过器械轴8连接。切割和封闭末端执行器6通过腕机构可选地连接至器械轴8。器械2通常用来进行微创外科手术，在手术期间末端执行器6和轴8的远端部分经由小的切口或自然孔口，通常通过插管插入病人体内，以进行外科手术程序。
在所示的实施例中，力传递机构4包括圆盘12，当器械2被安装例如用在外科手术机器人系统中时，圆盘12与对应的伺服电机（未示出）配合。该伺服电机提供致动力，以移动器械2的部件。示出四个圆盘12，然而，根据器械2的期望的致动自由度，可以用更多或更少的圆盘。正如在下面详细地描述的，伺服电机可以通过外科医生移动主操纵器来控制。此外，一个或多个伺服电机14、16可以安装在器械2自身上，以提供用于该器械2的部件的致动力。轴8通常是中空的管，致动缆绳从传递机构4穿过该管到器械2的远端的部件。这种缆绳说明移动器械部件的各种方式（例如，杆、旋转轴等）。在一些实施例中，轴8旋转以提供滚动至末端执行器6。轴8和末端执行器6可以具有各种外径（例如5mm、8mm、10mm、12mm等）。虽然轴8被示出是刚性的，但是它说明可以使用的各种柔性的实施例。
在图4所示的实施例中，切割和封闭末端执行器6包括不动的爪构件18、可移动的爪构件20和可拆卸的切割和封闭夹头22，该夹头22可拆卸地连接至该不动的爪构件18。组织被夹紧在爪18和20之间，用于切割和封闭。切割和封闭夹头22包括可移动的刀24（例如，锋利的刀片或组织切割器）。可移动爪构件20可以经由通过力传递机构4传递的力而被致动，或它可以由安装在该器械2上的电机14、16其中之一被致动。同样，刀24可以经由通过力传递机构4传递的力或者由电机14、16其中之一而被致动。在一方面中，单个电机14或16可以用来致动爪20和刀24两者。在一个可替换方面中，爪18可以是可移动的而爪20可以是不动的，使得在器械操作期间夹头22被移动。在另一个可替换方面中，爪18和20两者都是可移动的。
末端执行器6还包括组织封闭能力。第一组织封闭电极26设置在夹头22的内表面上。第二组织封闭电极28设置在爪20上，与电极26相对。在下面更详细地描述电极26、28。用于组织封闭的电能通过在器械2的近端处的电连接件30提供给电极26、28。如图4所示的电连接件30说明当器械2安装至用于外科手术的机器人操纵器时该电连接件30可以设置在器械上的各种位置，并且它可能需要手动连接至组织封闭能源，或者它可以自动连接至能源。可替换地，组织封闭能力可以通过其他方式提供，例如通过由末端执行器进行的吻合或缝合提供。
图5是可拆卸的切割和封闭夹头22的示意俯视图。电极26以细长的“U形”形状被示出，使得它围绕狭槽32，刀24通过该狭槽32移动。可以使用各种其他的电极形状或构造。在许多方面，电极26设置在狭槽32的两侧上，使得被切割组织（例如血管）的两个自由端在该组织被切割之前被封闭在两个封闭之间。图5还示出刀24安装在滑板34上，该滑板34随着丝杠36转动而移动。丝杠36在夹头22的近端处连接至机械连接件38，并且当夹头22安装在器械2中时该连接件38连接至驱动轴。下面将描述连接件的细节。正如这里所描述的，刀24向近端移动以切割组织。但是，应当理解，刀24可以使用类似的滑板和丝杠操作机构向远端移动以进行其切割动作。
图5还示出，在一些方面夹头22包括电子加密装置42（例如，具有数据储存能力的集成电路，实际上有些时候它被叫做“Dallas芯片”）。电子加密装置42可以用来将关于夹头类型（如果夹头已经被使用（执行一次性使用限制））或可用的使用寿命数目（以控制多次使用限制（例如三次使用））的信息传输给切割和封闭控制系统（见下文）。电子加密装置42也可以用来确保适当制造的夹头被使用。电连接件43提供电子加密装置42的连接点。图5还示出两个卡夹配合件（snap fitting）44，其说明固定地或可拆卸地将可拆卸的切割和封闭夹头22固定在器械2上的各种方式。
图6是根据许多实施例的组合的切割和封闭微创外科手术工具的远端实施例的透视图，以上大体描述为末端执行器6。图6示出连接至器械轴52的不动的爪构件50（为了清楚起见，可选的腕机构被略去）。爪构件50中的通道54接纳可拆卸的切割和封闭夹头56。匹配的导轨57和槽（未示出）可以用在通道54中和切割和封闭夹头56上以改善对齐和固定安装。示出在通道54的近端处的用于切割和封闭夹头56的一个说明性的电连接件58（在这个透视图中，机械连接件和其他电连接件被隐藏）。当夹头56被固定在通道54内的合适位置时，必要的电连接和机械连接自动形成。
如图6所示，切割和封闭夹头56包括组织封闭电极60，其经由通道54中的电连接件接收组织封闭电能。电极60中的狭槽61允许刀（未示出）上升到电极60的表面之上并且向近侧（或远侧）移动以切割被夹紧在爪构件之间的组织。正如下面所描述的，在夹头56的近端处的升高的接片64提供用于电连接的附加的接触区域，以及用于组织切割器的安全位置。配合件66（一个被挡住）将夹头56保持在爪构件50的对应的锁键（detent）68中的合适位置。可替换地，夹头56也可以包括用于在切割前封闭组织的吻合机构。从图6中显而易见，当刀在夹紧的末端执行器中移动时，对于内窥镜或对于外科医生来说刀的移动将是看不见的。可移动爪构件70连接在铰链72处。组织封闭电极74被造形并设置在爪构件70上，使得当夹头固定在通道54中时，它与切割和封闭夹头电极60对齐。电极74和爪构件70包括狭槽（未示出），以允许在切割操作期间夹头56中的组织切割器延伸到爪构件70中。
图7是图6所示的末端执行器实施例的侧剖视图，其中切割和封闭夹头牢固地设置在不动的爪构件中。图7所示的实施例说明该组合的切割和封闭末端执行器的远端的工作方面。如图7所示，第一丝杠78操作可移动爪构件70。当丝杠78转动时（例如，被电机14、16之一致动），滑动构件向近侧移动，使爪构件70朝向爪构件50移动，以将组织夹紧在它们之间。丝杠的使用提供足够用于有效的组织封闭和切割的强夹紧力。当用足够的力（可以使用夹紧力反馈和其他反馈）夹紧组织时，可以开始封闭和切割操作。在封闭期间，电极60和74接收封闭电能以封闭该夹紧的组织。当完成封闭时，可以开始组织切割。
切割和封闭夹头56里面的第二丝杠82操作具有用于切割组织的切割刃85的刀84。刀84可以包括具有足以切割组织的切割刃的任何构件。当丝杠82转动时，滑板86从位置A向近侧移动刀84（即，锋利的刀片）到位置C，以切割夹紧在爪构件之间的组织。当刀84开始移动时，它接合接片88，这引起刀84绕铰链90转动并且延伸超过电极60和74的夹紧表面。保持组织切割刀片安全的其他方式包括，例如，当不使用时，将其包围在小的升高的罩中。在刀84移动到位置C的其近侧位置之后，接片64为刀84提供安全位置。在一些方面，在刀84已经切割组织之后，丝杠82可以沿着相反的方向转动，以将刀84返回到其远侧，准备切割位置。以此方式，可拆卸的切割和封闭夹头56的切割特征可以再使用，使得用单个夹头可以进行多于一次的切割和封闭操作。这种多次使用具有明显的节省成本的好处。
丝杠82被连接以经由机械连接件92接收机械能（例如，来自电机14、16其中之一（见图1））。机械连接件92包括迫使该连接件向远侧移动的弹簧94。当封闭夹头56首先完全插入爪构件50中时，夹头上和爪构件中的匹配的机械连接件可以不对齐（例如，键槽或各种形状可以不对齐）。由弹簧94提供的力将移动该器械侧连接件，当它一转动成适当地对齐就完全接合夹头连接件。
图7还图示说明刀的不同的位置，位置A、位置B和位置C。在当前的实施例中，当刀84从位置A向近侧移动到位置C时（如箭头所示），刀84进行切割。如图所示，丝杠82致动刀84沿着末端执行器的纵轴移动。虽然图7示出在其路径的远端处的刀处于位置A，在切割程序期间，刀84将移动通过各种其他位置，包括位置B和C（用虚线示出）。在位置A，刀84被安全地设置在该夹头的远端部分内。在位置B，刀已经绕铰链90转动并且沿其切割路径行进到中间，其切割刃85延伸到夹头之上以便切割被夹紧在其路径中的组织。在位置C，刀84处在其切割路径的近端并且被安全地设置在末端执行器的近侧部分中，其切割刃被接片64盖住。组织切割器84具有朝向末端执行器的近端的切割刃85，使得当刀84被致动以从位置A移动到位置C时，刀84切割夹紧的组织。在可替换的实施例中，切割刃85可以朝向末端执行器的远端部分设置在刀84上，使得当刀84被致动以从位置C向远处移动到位置A时切割组织。在一些实施例中，刀84可以包括朝向两个方向的切割刃，使得沿着任一方向移动刀84将切割夹紧在末端执行器内的组织。
在许多实施例中，刀84包括许多“位置”并且可以包括除了图7所示的位置之外的位置。例如，在具有向远侧移动时切割组织的刀84的实施例中，刀可以包括在位置C处的切割前位置和在位置A处的切割完成位置。刀84也可以包括另外的位置，例如在位置A和C之间的任意中间位置（例如，位置B）。由于刀84仅沿着切割路径的一部分切割组织，因此任何这种位置可以叫做“切割未完成位置”。“刀位置”也可以包括刀的取向。例如，位置B，以及位置A和C之间的任何位置可以认为是“刀露出”位置，表示刀84的切割刃85被露出以便切割组织。
正如在图7中可见，如果由于任何原因，刀84在切割程序期间停止，刀84将停留在位置A和位置C之间的某位置，例如在位置B。如果停止在位置B，刀84的切割刃85将保持露出，并且当工具被撤回时，刀84的随后移动将潜在地导致无意的组织切割。此外，一旦末端执行器被拆卸，如果外科医生没有意识到切割刃85被露出，切割刃85可能切割外科医生的手，这潜在地使外科医生遭受生物危险。但是这种危险可以通过使用要求保护的方法和系统避免。
在许多实施例中，上面描述的组织切割和封闭系统在微创外科手术机器人系统中（例如，da Vinci.RTM.外科手术系统）实施。通常，为了进行手术程序，外科医生首先将外科手术器械的末端执行器移动到外科手术部位处的合适位置，并且夹紧将要被封闭和切割的组织（例如，血管）。理想地，为了实现有效的组织封闭，应该用足够的力（例如，在100-150psi范围内）将组织夹紧在外科手术器械的电极之间。当达到合适的夹紧力时（自动地或在医生的控制下），外科医生命令封闭操作，这可以包括发送信号给电子封闭单元或施加力以开始吻合。当完成封闭时，系统可以自动产生到工具的信号，以开始切割操作，而不用来自外科医生的单独的切割命令。因此，组合的切割和封闭用来自外科医生的单个命令实施，因为切割和封闭控制器控制末端执行器的切割和封闭两方面。在本发明的另外的方面，切割和封闭控制器可以自动地发送信号至末端执行器，以松开或释放夹紧力，或者可以自动地发送信号至末端执行器，以重新设置刀，准备另一个组合的切割和封闭致动。切割和封闭控制器还可以响应于来自外科医生的单个命令信号，命令这些自动动作的各种组合或全部。此外，切割和封闭控制器可以发出更新的信息至器械中的电子加密装置以有效地管理使用限制，如上所述。
图8示意地图示说明根据本发明的实施例的机器人工具180。该机器人工具180包括具有第一驱动器198的夹紧操纵器196、具有第二驱动器184的刀控制器182、处理器191、PSM193和末端执行器188。末端执行器188通过器械轴186与第一驱动器和第二驱动器连接。器械轴包括第一机构190，该第一机构190可操作地连接第一驱动器190与末端执行器188的可相对的爪194，使得可相对的爪194当被致动时夹紧组织。器械轴进一步包括第二机构192，该第二机构192可操作地连接第二驱动器194与刀195，使得刀195当被致动时沿着夹具的爪的纵轴移动，切割夹紧的组织。夹紧操纵器和刀还与处理器191和外科医生控制台连接。处理器191可以根据PSM193（例如，通过跟踪运动链）获得的位置信息确定末端执行器188、末端执行器的爪194和刀195的位置。一旦每个部件的位置数据被确定，处理器191可以将该工具的图像的输出和刀位置的可视指示符发送至显示器。如上面所讨论的，刀的位置可以包括刀195相对于末端执行器188的位置和/或取向的指示。如之前所讨论的，各种位置可以包括但不限于切割前位置、切割完成位置、切割未完成位置和暴露位置。处理器191还可以根据第一机构190或第二机构192的位移，或第一驱动器198或第二驱动器184的电机位移确定爪194或刀195的位置。
图9是根据许多实施例的远程机器人外科手术系统的示意图。在图9的示例中，医生输入命令至该系统以夹紧或切割组织。响应于用户命令，该系统开始驱动电机210，以通过用机构240致动该爪驱动夹紧，或通过用机构240移动刀驱动组织的切割。当机构240引起夹紧或切割时，处理器220接收来自传感器230的位置信息（或其推导项）。正如在前面所讨论的，该位置信息可以根据该机构或电机的位移推导，或者可以通过传感器230直接得到，例如通过设置在爪和/或刀上的基准标记的检测。例如，位置标记可以设置在末端执行器的爪上和刀上，使得例如图像捕获装置的传感器可以跟踪刀相对于该末端执行器的运动。该元件（例如，刀）的位置也可以由设置在该元件上或其附近的传感器230追踪，例如，由一个或更多个电磁位置传感器或压敏传感器追踪。此外，绿色光纤可以并入刀机构内，以通过检测由该纤维发射的光允许刀位置可视化。如可以用在本发明的许多实施例中的关于利用基准标记的更多的信息可以在共同拥有的美国申请No.12/428,657（代理案卷编号ISRG01480/US）（2009年4月23日提交，标题为“Fiducial Marker Design and Detectionfor Locating Surgical Instrument in Images”）中得到，其整体内容通过参考结合于此。一旦刀的相对位置和/或构造（也叫做刀位置）已经确定，处理器220输出将与末端执行器的图像叠加在显示器15上的刀位置的可视指示符250。通常，在切割期间，更优选在手术程序期间的所有时间，显示器15包括末端执行器的图像，并且刀位置的可视指示符叠加在该显示器上，使得外科医生习惯或适应切割过程中刀的位置和移动。
图10根据本发明的实施例图示可视指示符250的三个示例，其在显示器15上示出刀位置，其中当刀沿着工具向远侧移动时切割组织。刀位置的指示符叠加在用户界面显示器15上，该显示器在切割手术程序期间还显示外科手术工具末端执行器的图像和/或可视表示。指示符250可以是足以向用户指示刀位置的任何指示符（例如灯、文本信息、显示器上的颜色变化等）。指示符250可以包括叠加在显示器15上显示的工具的假想表示上或实际图像上的刀的合成表示252。图10在方框Ⅰ、Ⅱ和Ⅲ中示出在组织切割手术期间显示器15上末端执行器189的三个连续的图像。在方框Ⅰ中，刀处于切割前位置，安全地设置在末端执行器189的近端部分中，同时指示符250示出刀位置为“切割前”，并且示出刀在末端执行器上的合成表示252。在方框Ⅱ中，刀沿着末端执行器的爪已经移动到中间，其中刀的切割刃露出，以便当向远侧移动时切割组织。指示符250示出刀位置指示符为“刀：露出”和沿着该工具的中间的合成表示252。如果由于任何原因，当刀从切割前位置向切割完成位置移动时刀发生故障或停止，在显示器上可以输出可选的警告。该警告可以指示刀位置为“切割未完成”、“露出”或“停止”（未示出）。在方框Ⅲ中，刀已经成功地将末端执行器189的爪移动到其切割完成位置，并且已经转动以便被安全地设置在末端执行器189的远侧部分内。指示符250示出刀位置为“切割完成”和描绘在末端执行器189上的其最远侧位置处的刀的位置和取向的合成表示252。
使用工具跟踪的刀位置指示符
在一些实施例中，该方法和系统可以包括工具跟踪。在工具跟踪中，位置部件包括在计算机中，或者与计算机关联。该位置部件提供关于例如末端执行器189的工具或例如刀的元件的位置的信息。“位置”是指末端执行器的定位和/或取向的至少其中之一。位置可以通过使用基准标记、构形标记或通过跟踪运动链来确定。被认为或不被认为是工具跟踪装置的各种不同技术可以用来提供关于末端执行器的位置的信息。在简单的实施例中，该位置部件利用来自图像捕获装置的视频供给提供关于末端执行器和/或刀的位置的信息；然而，其他信息可以用来代替这种可视信息，或除了这种可视信息之外还可以用其他信息，包括传感器信息、运动信息或其任何组合。可以用于工具跟踪部件的系统的例子公开在以下专利文件中：标题为“Methods and System for Performing3-D Tool Tracking byFusion of Sensor and/or Camera Derived Data During Minimally Invasive RoboticSurgery”的美国申请公布No.2006/0258938；标题为“System for Assisting a SurgeonDuring Surgery”的美国专利US5,950,629；标题为“Performing Cardiac SurgeryWithout Cardioplegia”的美国专利US6,468,265；和标题为“Tool Position andIdentification Indicator Displayedin a Boundary Area of a Computer DisplayScreen”的美国申请公布No.2008/0004603中。工具跟踪部件可以利用在共同拥有的标题为“Fiducial Marker Design And Detection For Locating Surgical Instrument InImages”的美国申请No.12/428,657（代理案件号No.ISRG01480/US）和标题为“Configuration Marker Design and Detection for Instrument Tracking”的美国申请No.12/428,691（代理案件号No.ISRG01910/US）中公开的系统和方法。一般而言，位置部件传输关于末端执行器的实际位置和取向的信息。这种信息被更新，取决于信息何时可用，并且可以是例如非同步信息。
在末端执行器的实际位置处的合成的刀图像
根据另一个实施例，合成的刀图像可以显示在刀的实际位置上。即便当刀在视线之外时，例如，当刀在器官的后面，或者被血覆盖时，这在刀在封闭和切割器械中是经常遇到的情况，这个特征也允许外科医生S跟随该刀。由于当爪夹紧在组织上时刀沿着末端执行器的爪移动，刀用内窥镜通常是看不见的，因为它被爪和/或夹紧的组织所遮挡。
根据实施例，刀的合成表示可以是刀的二维或三维模型，并且可以被取向以便与刀相对于工具的实际取向一致。因此，通过使用要求保护的系统和方法，在整个手术程序期间外科医生S将会意识到刀相对于末端执行器的位置，当手术停止或失败时这是特别有用的。
图11是示出根据许多实施例的用于在刀的实际位置处显示合成的刀的步骤的流程图。在步骤1100处开始，该刀处在第一位置。在步骤1102，该刀的合成表示显示在实际工具的图像上，该图像可以是例如末端执行器工具的实时视频。在步骤1104，刀移动到位置B。通常，刀移动通过在其途中的位置B到最终位置C（叫做切割完成位置）。在步骤1106接收运动的位置信息，并且在步骤1108对偏差进行调节。在步骤1109，如果末端执行器工具或刀从内窥镜中是看不见的，则显示合成图像。虽然在切割过程期间末端执行器工具通常保持在第一位置，如果由于任何原因该工具移动，则类似的工具跟踪过程可以可选地用来跟踪该工具的移动，并且如果该末端执行器工具不再是看得见的，则显示该末端执行器的合成表示。由于在其惯常操作中，刀被末端执行器的爪遮挡，该系统通常将显示刀具的合成图像。因此，刀的合成图像可以显示在末端执行器的实际图像上或者末端执行器的合成图像上，这取决于末端执行器在给定时间是否可见。在步骤1110，合成的刀显示在该工具的运动学上调节的位置。因此，根据上面描述的方法，在组织切割期间，并且优选在组织切割期间的所有时间，合成的刀图像显示在末端执行器的图像上，指示该刀的刀位置。
利用图11的方法，合成的刀的移动匹配实际的刀的移动。优选地，合成的刀的移动实时更新，使得合成的刀的移动紧密地匹配实际工具的移动，以便传输刀的移动。如上所述，虽然运动的位置信息通常不提供刀在空间中的准确位置，但是位置的变化是相对准确的。因此，通过利用参考图11所描述的合成的刀，即便当失去工具的视频或其他位置信息时，也可以相当准确地跟随刀的位置。正如前面的实施例一样，用在图11的方法中的刀的该合成表示可以是刀的三维模型，或可以是刀的线条图或者是表示该刀的部分的虚线，或者是刀的任何其他表示。
图12-13图示说明根据许多实施例的方法。图12所示的方法300包括将夹紧人体组织的工具的图像显示在用户界面显示器上的步骤301和在用该刀切割夹紧的组织期间和/或之后将刀位置的可视指示符叠加在该显示器上的步骤302。图13所示的方法310包括响应于用户的夹紧命令用工具的爪夹紧组织的步骤312，将夹紧组织的工具的图像显示在用户界面显示器上的步骤314，响应于用户切割组织的命令为电机供给能量，以便将刀从切割前位置移动到切割完成位置以切割该组织的步骤316，以及在切割该夹紧的组织期间和/或之后将刀位置的指示符叠加在用户界面显示器上的步骤318。
本文已经描述了本发明的优选实施例，包括发明人知道的用于实施本发明的最佳实施方式。对于本领域的技术人员而言在阅读了前面的描述之后，这些优选实施例的变化是显而易见的。发明人希望技术人员适当地采用这些变化，并且发明人意欲用本文具体描述之外的任何方式实施本发明。因此，本发明包括所适用的法律允许的所附权利要求中记载的主题的所有修改、可替换结构和等同物。而且，在其所有可能的变化中上述元件的任何组合包括在本发明内，除非在本文中另外指出或者在上下文中明显矛盾。

Claims (9)

1.一种机器人系统，其包括：
工具，其具有用于夹紧物质的爪和连接至所述爪的切割元件，所述切割元件相对于所述爪在切割前位置和切割完成位置之间可移动，所述爪妨碍在所述物质的切割期间观察所述切割元件；
用户界面显示器；
用于捕获包括所述爪的图像的视场的图像捕获装置，所述图像捕获装置连接至所述显示器以便显示所述视场；和
将所述工具连接至所述显示器的处理器，所述处理器：
利用运动信息跟踪所述工具的位置；并且
基于运动学调节的所述工具的位置和驱动所述切割元件的电机的位移的变化，在所述切割元件移动期间和/或之后，将所述切割元件的位置的可视指示符叠加在所述显示器上；
其中所述可视指示符包括所述切割元件的合成表示，当所述切割元件被所述爪遮挡时，所述切割元件的所述合成表示被叠加在所述爪的图像上，所述切割元件的所述合成表示与所述切割元件相对于所述工具的实际取向一致。
2.根据权利要求1所述的系统，其中所述处理器被连接至适于感测所述切割元件的位置的传感器。
3.根据权利要求1所述的系统，其进一步包括：
连接至所述元件以便实现所述切割元件的移动的机构，其中所述机构连接至所述处理器，使得所述处理器能够根据所述机构的位移确定所述切割元件的位置。
4.根据权利要求1所述的系统，其中所述系统是非外科的，并且其中所述物质包括柔性物质。
5.根据权利要求1所述的系统，其中所述系统包括用于切割人体组织的机器人外科手术系统，并且其中所述物质包括人体组织并且所述切割元件包括刀。
6.根据权利要求5所述的系统，其中所述刀设置在所述爪上，以便当所述刀从所述切割前位置移动到所述切割完成位置时切割夹紧在所述爪内的所述人体组织。
7.根据权利要求5所述的系统，其中所述切割元件的所述位置的所述可视指示符进一步指示所述刀相对于所述爪的定位。
8.根据权利要求1所述的系统，其中所述切割元件的所述合成表示表示所述切割元件的位置，所述位置包括所述切割元件的定位和取向中的任何一个或全部。
9.根据权利要求5所述的系统，其中当所述刀处在切割未完成位置时，所述处理器为用户显示刀露出的警告指示，所述警告指示与所述切割元件的所述位置的所述可视指示符是分开的。
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