CN106361391B - 用于钉仓状态和存在检测的方法和系统 - Google Patents

用于钉仓状态和存在检测的方法和系统 Download PDF

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CN106361391B
CN106361391B CN201610860574.5A CN201610860574A CN106361391B CN 106361391 B CN106361391 B CN 106361391B CN 201610860574 A CN201610860574 A CN 201610860574A CN 106361391 B CN106361391 B CN 106361391B
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D·W·韦尔
K·杜伦特
W·伯班克
P·弗拉纳干
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Intuitive Surgical Operations Inc
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A61B34/37—Master-slave robots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B50/00—Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
    • A61B50/10—Furniture specially adapted for surgical or diagnostic appliances or instruments
    • A61B50/13—Trolleys, e.g. carts
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00039—Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00477—Coupling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07271—Stapler heads characterised by its cartridge
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07285—Stapler heads characterised by its cutter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/064—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0804—Counting number of instruments used; Instrument detectors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0807—Indication means
    • A61B2090/0808—Indication means for indicating correct assembly of components, e.g. of the surgical apparatus

Abstract

外科手术系统和相关的方法验证安装到外科手术器械上的未发射的外科手术钉仓的存在。钉仓包含在发射方向上致动以操作钉仓的输入。产生限于小于或等于预定大小的致动输入。致动输入包含扭矩或力的至少一个。致动输入被转移到外科手术器械的输出，以尝试在与发射方向相反的方向上以预定量致动该输出。当钉仓被安装到外科手术器械时，输出与钉仓输入传动地耦接。得到的输出的致动被测量并且与阈值致动量比较。当得到的输出的致动小于阈值致动量时，确定钉仓存在且未发射。

Description

用于钉仓状态和存在检测的方法和系统
本申请是于2012年8月26日提交的名称为“用于钉仓状态和存在检测的方法和系统”的中国专利申请201280052714.6(PCT/US2012/062299)的分案申请。
本申请要求2011年10月26日提交的美国临时申请No.61/551,880和2011年11月15日提交的美国临时申请No.61/560,213的利益，这些申请整体并入本文以供参考。
背景技术
微创外科手术技术旨在减少诊断或外科手术程序期间损伤的外部组织的量，从而减少病人恢复时间、不舒服和有害的副作用。因此，利用微创外科手术技术可以显著地缩短用于标准外科手术的平均住院时间。另外，利用微创外科手术也可以减少病人恢复时间、病人不舒服、外科手术副作用和旷工时间。
微创外科手术的常见形式是内窥镜检查，而内窥镜检查的常见形式是腹腔镜检查，其是在腹腔内的微创检查和外科手术。在标准的腹腔镜检查外科手术中，病人的腹部吹入气体，并且套管套筒穿过小的(大约二分之一英寸或更小)切口，以提供用于腹腔镜检查器械的进入端口。
腹腔镜外科手术器械通常包含用于观察外科手术区域的内窥镜(例如，腹腔镜)和用于在外科手术部位工作的工具。除了通过伸缩管(也称为，例如，器械轴或主轴)将每一个工具的工作末端或末端执行器与它的手柄分离之外，工作工具通常类似于在常规的(开放式)外科手术中使用的那些工具。例如，末端执行器可以包含夹具、抓取器、剪刀、吻合器、烧灼工具、线性切割器或持针器。
为了执行外科手术程序，外科医生将工作工具穿过套管套筒到内部的外科手术部位并且从腹部外部操纵它们。外科医生从显示由内窥镜获得的外科手术部位图像的监视器观察手术程序。例如，在关节镜检查、腹膜后镜检查、盆腔镜检查、肾镜检查、膀胱镜检查、脑池镜检查(cisternoscopy)、窦镜检查、子宫镜检查、尿道镜检查、等等中采用类似的内窥镜检查技术。
正在开发微创远程手术机器人系统，以便当在内部外科手术部位工作时增加外科医生的敏捷度，以及允许外科医生从远程位置(无菌区域之外)为病人手术。在远程手术系统中，常常在控制台上为外科医生提供外科手术部位的图像。在适当的观察器或显示器上观察外科手术部位的三维图像时，外科医生通过操纵控制台的主控输入或控制设备对病人进行外科手术程序。每一个主控输入设备控制伺服-机械致动式/铰接式外科手术器械的运动。在外科手术程序期间，响应于主输入设备的操纵，远程手术系统可以提供多种外科手术器械或工具的机械致动和控制，其中所述外科手术器械或工具具有为外科医生执行多种功能(例如，握持或驱动针、抓取血管、解剖组织等)的末端执行器。
这些末端执行器的操纵和控制是机器人外科手术系统的特别有益的方面。为此，期望提供外科手术工具，其包含提供末端执行器的三个自由度的旋转运动以模仿外科医生的手腕的自然动作的机构。这样的机构应该被适当设计尺寸以用于微创程序中并且应该在设计上相对简单以减少可能的故障点，另外，这样的机构应该提供足够的运动范围，以便允许在许多位置中操纵末端执行器。
已经在很多不同的外科手术程序中采用外科手术夹持和切割器械(例如，非机器人线性夹持、吻合和切割设备，也称为外科手术吻合器；和电外科血管闭合设备)。例如，外科手术吻合器可以用于从胃肠道切除癌组织或异常的组织。包含已知的外科手术吻合器的很多已知的外科手术夹持和切割器械具有夹持组织的相对的钳和切割夹住的组织的铰接式手术刀。
很多外科手术夹持和切割器械被配置成与有限范围的病人组织相互作用。例如，外科手术吻合器通常被配置成用于夹持、吻合和切割有限长度的病人组织，特别是其中外科手术吻合器具有适于部署到限制性体腔内的紧凑大小的位置(例如，通过套管部署到骨盆内)。然而，涉及的外科手术程序可能需要超出有限长度的病人组织的吻合，因此必须使用另一外科手术吻合器和/或必须在可重新使用外科手术吻合器之前将吻合钉重装到吻合器内。为了利于再次使用，很多外科手术吻合器采用可拆卸地附连到末端执行器钳的吻合器钉仓(stapler cartridge)。这样的吻合器钉仓能够包含需要的吻合钉和驱动机构，以部署吻合钉并且铰链手术刀，从而切割吻合的组织。在使用后，用过的吻合器钉仓能够被新吻合器钉仓替代，并且再利用外科手术吻合器。
为了在腹腔镜检查外科手术器械中重新装载吻合器钉仓，必须从外科手术部位和从套管收回外科手术器械。移除是耗时的并且延误外科手术程序。同样地，期望的是，当外科手术器械具有还没有被发射的钉仓时，不发生器械的移除。然而，在外科手术程序中，可能发生的是，存在关于具体的外科手术器械是具有使用过的钉仓还是未使用过的钉仓的不确定性。另外，即使当外科手术器械易于检查钉仓时，钉仓是用过的还是未用过的可能不明显，特别是，对于未经训练过的眼睛。
因而，确信需要一种验证安装到外科手术器械上的未发射的外科手术钉仓的存在的方法。优选地，这样的方法应该是自动化的并且能够合并到用于操纵外科手术器械的机器人外科手术系统中。
发明内容
公开一种自动验证安装到外科手术器械上的未发射的外科手术钉仓的存在的外科手术系统以及相关的方法。公开的方法尝试在与钉仓的发射方向相反的方向上以预定量驱动外科手术器械的致动输出。如果钉仓已经被发射或不存在，则致动输出能够被致动预定量。如果存在未发射的外科手术钉仓，则在尝试的致动停转之前，致动输出仅被致动小于阈值致动量。方法能够用于自动验证未发射的外科手术钉仓的存在，因此节约与手动验证相关联的时间和花费并且能够在不从外科手术部位移除外科手术器械的情况下验证安装到部署的外科手术器械上的未发射的外科手术钉仓的存在。该方法能够在任何适当的时间使用。例如，该方法能够用作初始检查。该方法也能够在周期基础上使用。该方法也能够在连续的基础上使用，诸如通过利用低致动水平(例如，力和/或扭矩)并且检查移动。
因而，在一个方面中，公开了验证安装到外科手术器械上的未发射的外科手术钉仓的存在的方法。钉仓包含在发射方向上致动以操作钉仓的输入。该方法包含产生限于小于或等于预定大小的致动输入。致动输入包含扭矩或力的至少一个。致动输入被转移到外科手术器械的输出，以尝试在与发射方向相反的方向上以预定量致动输出。当钉仓被安装到外科器械上时，输出与钉仓输入传动地耦接。得到的输出的致动被测量并且与阈值致动量比较。当得到的输出的致动量小于阈值致动量时，做出钉仓存在且未发射的决定。
在方法的很多实施例中，致动输入由电动机产生，该电动机被控制以限制产生的致动输入。例如，致动输入的产生可以包含限制供应给用于产生致动输入的电动机的电流。
致动输入的预定大小能够基于用于将致动输入转移给外科手术器械输出的传动系的特征选择。例如，用于将致动输入转移给输出的传动系的摩擦力能够被测量，并且预定大小能够被设定为大于测量的摩擦力。
在方法的很多实施例中，预定大小被设定为小于外科手术器械的正常的操作极限。例如，在很多实施例中，预定大小被设定为小于外科手术器械的正常操作极限的40％。并且在很多实施例中，预定大小被设定为小于正常操作极限的20％。
在方法的很多实施例中，传感器用于测量得到的输出致动。例如，霍尔传感器可以用于追踪传动系的致动，所述传动系用于将致动输入转移给外科手术器械输出。作为另一个示例，编码器能够用于追踪传动系的致动，所述传动系用于将致动输入转移给外科手术器械输出。传动系的致动能够通过追踪与传动系传动地耦接的致动源(例如，马达)的运动而被直接或间接追踪。
在方法的很多实施例中，输出的移动被追踪和处理，以监视尝试的输出致动的停转。当检测到尝试致动的停转时，致动输入的产生能够被终止。
在方法的很多实施例中，外科手术钉仓包含铰接的手术刀。在很多实施例中，预定的致动量小于当应用于发射配置中的外科手术钉仓时可能导致手术刀的暴露的量。
在另一方面中，公开了机器人外科手术系统。机器人外科手术系统包含主控输入设备、包含致动输出的外科手术器械、被配置为响应于主控输入设备的用户操纵移动外科手术器械的机器臂、与外科手术器械致动输出传动地耦接的驱动源、被配置为测量外科手术器械致动输出的移动的传感器以及与传感器和驱动源通信地耦合的控制器。外科手术器械被配置为接收和支撑外科手术钉仓。外科手术钉仓包含在发射方向上致动(例如，旋转、平移)以操作外科手术钉仓的输入。当外科手术钉仓被安装到外科器械上时，钉仓与致动输出传动地耦接。控制器包含处理器和实体存储介质，所述实体存储介质含有何时执行以引起处理器控制驱动源以便驱动源产生小于或等于预定大小的致动输入的指令。致动输入包含扭矩或力的至少一个。致动输入被转移到外科手术器械致动输出，以尝试在与发射方向相反的方向上以预定量移动致动输出。控制器将得到的致动输出的致动量与阈值致动量比较，并且当得到的致动输出的致动量少于阈值致动量时，确定钉仓存在和未发射。
在系统的很多实施例中，致动输入由电动机产生，该电动机被控制以限制产生的致动输入。例如，致动输入的产生能够包含限制供应给用于产生致动输入的电动机的电流。
在系统的很多实施例中，预定大小被设定为小于外科手术器械的正常操作极限。例如，在很多实施例中，预定大小被设定为小于外科手术器械的正常操作极限的40％。并且在很多实施例中，预定大小被设定为小于正常操作极限的20％。
在系统的很多实施例中，传感器用于测量得到的输出的致动量。控制器能够监视传感器的输出信号，以便确定得到的致动输出的致动量是否小于阈值致动量。例如，传感器能够包含霍尔传感器。控制器能够计算霍尔传感器计数并且将霍尔传感器计数与预定数字比较，以便确定得到的致动输出的致动量是否小于阈值致动量。作为另一个示例，能够使用编码器，并且由控制器监视编码器的输出信号，以便确定得到的致动输出的致动量是否小于阈值致动量。作为另一个示例，传感器能够是速度传感器，诸如感应速度传感器或流速计。控制器能够从测量的速度得出相对位置。作为另一个示例，传感器能够是加速计，并且能够从测量的加速度得出位置。
在系统的很多实施例中，输出的移动被追踪，以监视尝试的致动的停转。当在预定的时间段中致动输出移动小于最小量时，能够检测到尝试的致动的停转。当检测到尝试的致动的停转时，致动输入的产生能够被终止。
在系统的很多实施例中，外科手术钉仓包含铰接的手术刀。在很多实施例中，预定的致动量小于当应用于发射配置中的外科手术钉仓时可能导致手术刀的暴露的量。在很多实施例中，钉仓包含吻合钉，当操作钉仓时所述吻合钉被部署到夹持的组织内。在很多实施例中，铰接的手术刀被配置为切割部署的吻合钉的行之间的夹持组织。在很多实施例中，钉仓被配置为闭合血管并且包含被配置为切割闭合的血管的铰接的手术刀。
为了本发明的性质和优势的更完整的理解，应该参考随后的详细描述和附图。本发明的其他方面、目标和优势将通过后面的附图和详细描述显而易见。
附图说明
图1是根据很多实施例用于执行外科手术的微创机器人外科手术系统的平面图。
图2是根据很多实施例用于机器人外科手术系统的外科医生的控制台的透视图。
图3是根据很多实施例的机器人外科手术系统电子设备推车的透视图。
图4示意地图示根据很多实施例的机器人外科手术系统。
图5A是根据很多实施例的机器人外科手术系统的病人侧推车(外科手术机器人)的前视图。
图5B是根据很多实施例的机器人外科手术工具的前视图。
图6是根据很多实施例包含具有相对的钳的末端执行器的机器人外科手术工具的透视图。
图7是根据很多实施例具有六行吻合钉的线性吻合和切割外科手术器械的可拆卸附连钉仓(cartridge)的透视图。
图8是根据很多实施例图7的钉仓和附连的吻合钉固定器的透视图。
图9是显示根据很多实施例图7的钉仓和末端执行器组件之间的附连细节的横截面图。
图10列出根据很多实施例的验证安装到外科手术器械上的未发射的外科手术钉仓的存在的方法的行为。
图11列出图10的方法的可选的行为。
图12图示用于发射的外科手术钉仓的示例性的铰接手术刀配置。
图13是根据很多实施例的提供与实施安装到机器人外科手术系统的外科手术器械上的未发射的外科手术钉仓的存在的验证有关的部件的高水平图的简化示意图。
具体实施方式
在具体实施方式中，将描述本发明的多个实施例。为了解释的目的，阐明具体的配置和细节，以便提供对实施例的全面理解。然而，本领域的技术人员将显而易见，可以在没有具体的细节的情况下实施本发明。此外，熟知的特征可以被省略或简化以便不模糊正在描述的实施例。
微创机器人外科手术
现在参考附图，其中在几个图中相同的参考数字代表相同的部件，图1是微创机器人外科手术(MIRS)系统10的平面图图示，其典型地用于对病人12执行微创诊断或外科手术程序，其中所述病人12躺在手术台14上。系统可以包括在程序期间供外科医生18使用的外科医生控制台16。一个或更多助手20也可以参与该程序。MIRS系统10可以进一步包含病人侧推车22(外科手术机器人)和电子设备推车24。在外科医生18通过控制台16观察外科手术部位时，病人侧推车22可以通过病人12身体上的微创切口操纵至少一个可移除地耦接的工具组件26(在下文中简单地称为“工具”)。外科手术部位的图像可以通过内窥镜28(诸如立体内窥镜)获得，所述内窥镜28可以由病人侧推车22操纵以对内窥镜28定向。电子设备推车24可以用于处理外科手术部位的图像，用于随后通过外科医生控制台16向外科医生18显示。除其他因素，同时使用的外科手术工具26的数目通常将取决于诊断或外科手术程序和手术室内的空间限制。如果必须改变在程序期间正在使用的一个或更多工具26，助手20可以从病人侧推车22移除工具26，并用来自手术室内的托盘30的另一工具26代替它。
图2是外科医生控制台16的透视图。外科医生控制台16包含用于给外科医生18呈现能够深度感知的外科手术部位的协调立体视图的左眼显示器32和右眼显示器34。控制台16进一步包含一个或更多输入控制设备36，其又引起(图1示出的)病人侧推车22操纵一个或更多工具。输入控制设备36可以提供与(图1示出的)它们的相关的工具26相同的自由度从而为外科医生提供远程呈现，或提供输入控制设备36与工具26整合以便外科医生具有直接控制工具26的强烈感觉的感知。为了这个目的，位置、力和触觉反馈传感器(没有显示)可以被采用，以将来自工具26的位置、力和触觉通过输入控制设备36传递回到外科医生的手。
外科医生控制台16通常位于与病人相同的房间，以便外科医生可以直接监视程序，如果必要的话则实际出现，并且直接对助手说话，而不是通过电话或其他通信介质。然而，外科医生可以位于不同的房间，完全地不同的建筑或允许远程外科手术程序的远离病人的其他远程场所中。
图3是电子设备推车24的透视图。电子设备推车24可以与内窥镜28耦接，并且电子设备推车24可以包含处理器，用于处理捕获的图像以便诸如随后在外科医生控制台上或在位于本地和/或位于远距离的另一个适当的显示器上显示给外科医生。例如，在使用立体内窥镜的地方，电子设备推车24可已处理捕获的图像，以便给外科医生呈现外科手术部位的协调立体图像。这样的协调可以包含相对的图像之间的校准并且可以包含调整立体内窥镜的立体焦距。作为另一示例，图像处理可以包含使用之前确定的照相机校准参数补偿图像捕获设备的成像误差，诸如光学象差。
图4示意地图示机器人外科手术系统50(诸如图1的MIRS系统10)。如上述讨论的，外科医生控制台52(如图1中的外科医生控制台16)可以由外科医生使用，以在微创程序期间控制病人侧推车(外科手术机器人)54(诸如图1中的病人侧推车22)。病人侧推车54可以使用成像设备(诸如立体内窥镜)捕获程序部位的图像并将捕获的图像输出给电子设备推车56(诸如图1中的电子设备推车24)。如上述讨论的，电子设备推车56可以在任何随后的显示之前以多种方式处理捕获的图像。例如，电子设备推车56可以在通过外科医生控制台52向外科医生显示组合的图像之前，将捕获的图像与虚拟控制界面重叠。病人侧推车54可以输出捕获的图像，用于在电子设备推车56外部处理。例如，病人侧推车54可以向处理器58输出捕获的图像，该处理器58可以用于处理捕获的图像。图像也可以通过电子设备推车56和处理器58的组合处理，电子设备推车56和处理器58可以耦合在一起，以便共同，按顺序和/或其组合处理捕获的图像。一个或更多单独的显示器60可以与处理器58和/或电子设备推车56耦合，用于图像(诸如程序部位的图像或其他相关的图像)的本地和/或远程显示。
图5A和5B分别显示病人侧推车22和外科手术工具62。外科手术工具62是外科手术工具26的示例。显示的病人侧推车22提供对外科手术工具26和成像设备28(诸如用于程序部位的图像的捕获的立体内窥镜)的操纵。操纵通过具有许多机器人接头的机器人机构提供。成像设备28和外科手术工具26可以通过病人的切口定位和操纵，以便在切口处维持运动学远程中心，从而最小化切口的大小。当外科手术工具26被定位在成像设备28的视野内时，外科手术部位的图像可以包含外科手术工具26的远端的图像。
组织抓持末端执行器
图6显示外科手术工具70，其包含近侧底盘72、器械轴74和具有可被铰接以便抓持病人组织的钳78的远侧末端执行器76。近侧底盘包含输入耦接器，该输入耦接器被配置为与病人侧推车22的相应的输出耦接器相连接并通过其驱动的。将输入耦接器与设置在器械轴74内的驱动轴传动地耦接。将驱动轴与末端执行器76传动地耦接。
线性吻合和切割外科手术器械
图7显示根据很多实施例的线性吻合和切割外科手术器械的可拆卸附连钉仓(cartridge)100。钉仓100能够用于在适当的外科手术系统中使用的适当的外科手术工具中，诸如本文中描述的外科手术工具和外科手术系统中(例如，外科手术系统10、外科手术系统50)。钉仓100被配置为可移除地附连到末端执行器的钳上。钉仓具有附连到末端执行器的钳上的近端102和设置在末端执行器的钳的相应远端处的远端104。钉仓100包含六行吻合钉开口106、纵向狭槽108、近侧手术刀库110、远侧手术刀库112和可旋转输入/输入端114。在很多实施例中，吻合钉被设置在每个吻合钉开口中，用于从开口部署。随着手术刀构件从近侧手术刀库110移动至远侧手术刀库112，纵向狭槽108容纳从纵向狭槽延伸的手术刀构件(未显示)的切割刀片。在手术中，吻合钉被部署为起始于钉仓近端102并继续到钉仓远端104。切割刀片被移动以追踪组织的吻合，从而确保只切割完全吻合的组织。图8显示具有附连的吻合钉固定器116的钉仓100，该吻合钉固定器116在利用钉仓100之前被移除。
图9是显示根据很多实施例的钉仓100至末端执行器118的附连的细节的横截面视图。末端执行器118包含下部钳120、上部钳122、两个自由度的腕部124、可旋转驱动的夹持机构126和弹簧加载连接件128。下部钳120被配置为容纳和支撑钉仓100，以及相对于弹簧加载连接件128定位钉仓100。上部钳122与下部钳120可枢转地耦接，以便相对于下部钳120铰接，从而夹持组织。上部钳122包含相对于吻合钉开口106配置和定位的吻合钉形成凹槽，以便在吻合钉部署时使吻合钉形成“B”形状。
两个自由度的腕部124提供末端执行器118至细长器械轴130的附连，用于末端执行器118相对于器械轴130关于两个正交轴线的铰接。可使用的适当的两个自由度的腕部的细节在2010年11月12日提交的标题为“SURGICAL TOOL WITH A TWO DEGREE OF FREEDOMWRIST”的美国申请No.12/945,748(代理机构案号No.ISRG02350/US)中公开，其全部公开被并入本文以供参考。
可旋转驱动的夹持机构126相对于下部钳120致动上部钳122，以便在上部钳和下部钳之间牢固地夹持组织。夹持机构126通过设置在器械轴130内部的第一驱动轴132可旋转地驱动。可使用的适当的可旋转驱动的夹持机构的细节在2010年11月12日提交的标题为“END EFFECTOR WITH REDUNDANT CLOSING MECHANISMS”的美国申请No.12/945,541(代理机构案号No.ISRG02330/US)中公开，其全部公开被并入本文以供参考。
弹簧加载连接件128将钉仓100的导螺杆134与延伸轴136可旋转地耦接，所述延伸轴136通过设置在器械轴130内部的第二驱动轴138驱动。弹簧加载连接件128包含螺旋弹簧140和连接配件142。在显示的实施例中，连接配件142采用与可旋转输入端114和延伸轴136的三侧外表面相连接的三叶齿条(three-lobe spline)接收器。弹簧加载连接件142容许可能在钉仓100安装到末端执行器118内时出现的三叶齿条角偏差。当旋转到角对准时，弹簧加载连接件142完全接合三叶齿条。导螺杆134的旋转用于将钉仓100的驱动构件144从图示的它的初始近侧位置向钉仓100的远端104平移。产生的驱动构件144的远侧移动用于部署吻合钉并且用于向远侧推进手术刀，以沿部署的吻合钉的行的中心向下切割夹持组织。
末端执行器118包含第一万向接头组件148和第二万向接头组件150。第一万向接头组件148将夹持机构126可旋转地耦接至第一驱动轴132。第二万向接头组件150将延伸轴136可旋转地耦接至第二驱动轴138。第一和第二万向接头组件148、150的每一个被配置为相对于器械轴130在适于末端执行器118的俯仰与偏摆的范围的角范围内传递扭矩。可能使用的适当的万向接头组件的细节在2010年11月12日提交的标题为“DOUBLE UNIVERSALJOINT”的美国申请No.12/945,740(代理机构案号No.ISRG02340/US)中公开，其全部公开被并入本文以供参考。
第一和第二驱动轴132、138偏离器械轴130的中心线设置，其可独立地旋转。可用于致动第一和第二驱动轴132、138的适当的驱动机构的细节在2010年11月12日提交的标题为“MOTOR INTERFACE FOR PARALLEL DRIVE SHAFTS WITHIN AN INDEPENDENTLY ROTATINGMEMBER”的美国申请No.12/945,461(代理机构案号No.ISRG02360/US)中公开，其全部公开被并入本文以供参考。
钉仓状态和存在检测方法
如图9图示的，当未发射的钉仓100被安装到末端执行器118时，驱动构件144被设置为沿导螺杆134在其可能位置的范围的近端处或附近。因此，将未发射的钉仓100的驱动构件144朝近端102推进超过可预测的量是不可能的，从而限制了第二驱动轴138的相应的旋转的量。与此相反，当发射的钉仓100被安装到末端执行器118上时，驱动构件144被设置为沿导螺杆134在其可能位置的范围的远端处或附近。因此，将发射的钉仓100的驱动构件144朝近端推进的量更多于利用未发射的钉仓100所推进的量是可能的，从而允许第二驱动轴138的充分更大量的相应的旋转。并且当没有钉仓100安装到末端执行器118时，第二驱动轴138能基本自由地旋转。未发射的钉仓100的驱动构件144的有限可能的行程能用于验证安装到末端执行器118上的未发射的钉仓100的存在。
图10列出根据很多实施例的用于验证安装到外科手术器械的未发射的外科手术钉仓的存在的方法200的行为。钉仓包含在发射方向被致动以便操作钉仓的输入。包含安装到外科手术器械上的致动的钉仓的任何适当的外科手术器械能够用于实施方法200。例如，本文描述的适当的外科手术系统和外科手术器械能够用于实施方法200。
在行为202中，产生限于小于或等于预定大小的致动输入。致动输入包含扭矩或力的至少一个。在行为204中，致动输入被转移到外科手术器械的输出，以便尝试以预定量沿与发射方向相反的方向致动输出。当钉仓被安装到外科手术器械上时，输出与钉仓输入传动地耦接。在行为206中，测量产生的输出的致动量。在行为208中，将产生的输出的致动量与阈值致动量比较。并且在行为210中，当产生的输出的致动量小于阈值致动量时，做出钉仓存在且未发射的判断。
图11列出根据很多实施例的可在方法200中实施的可选的行为。在可选行为212中，限制供应给用于产生致动输入的电动机的电流，从而用于限制可通过电动机产生的致动输入。在可选行为214中，测量用于将致动输入转移给输出的传动系中的摩擦力，并且预定大小被设定为大于测量的摩擦力。在可选行为216中，预定大小被设定为小于外科手术器械的正常操作极限(例如，扭矩极限、力极限)的设定百分比。例如，在很多实施例中，预定大小小于正常操作极限的40％。并且在很多实施例中，预定大小小于正常操作极限的20％。作为具体的示例，在具有100mNm发射扭矩极限的外科手术器械中，预定大小能够被设定在15mNm。在可选的行为218中，产生的输出致动量的测量包含追踪传感器(例如，霍尔传感器、编码器)的输出，该传感器的输出被配置为追踪用于将致动输入转移到输出的传动系的致动。传动系的致动可以被直接或间接追踪(例如，通过追踪驱动源，诸如通过追踪与传动系传动地耦接的马达的旋转)。在可选行为220中，产生的输出致动量的测量包含追踪输出的移动，并且处理追踪的输出的移动，以便监视尝试的输出致动的停转。在可选行为222中，当检测到尝试的致动的停转时，终止致动输入的产生。
本文公开的方法可以在任何适当的应用中采用。例如，能够在用于开放式或微创(单个或多个端口)程序的手动或电动手持式或自动的直接控制的或远程操纵的外科手术器械中采用此处公开的方法。
尝试的致动考虑事项
在很多实施例中，预定致动(例如，旋转)量被选择为大于可能需要的最大量，以将驱动构件144沿导螺杆134向近侧驱动到其可能的近侧行程的末端，并且驱动成与钉仓100的外壳接合，从而停转导螺杆134的任何进一步的旋转。可能需要的最大旋转量取决于驱动构件144相对于沿导螺杆134的其可能的近侧行程的末端的可能开始位置的范围，用于将产生的致动扭矩转移给导螺杆134的传动系中的反冲，和由传送的扭矩引起的传动系中的柔量/顺从(compliance)。通过将产生的扭矩的预定大小限制按实际设定为低而仍然足够高到考虑传动系的摩擦特征，能够减少传动系中的柔量。并且通过适当注意钉仓100的制造，能够减少驱动构件144相对于沿导螺杆134的其可能的近侧行程的末端的可能开始位置的范围，以便确保驱动构件144被设置得尽可能接近沿导螺杆134的其可能的近侧行程的末端(例如，通过增加其中旋转输入114尽可能以与发射旋转方向相反的方向被旋转的任务)。即使当驱动构件144被放置在沿导螺杆134的其可能的近侧行程的末端处时，由于用于对准旋转输入114与三叶连接件142的旋转输入114在发射方向上的旋转，三叶连接件142的使用也可能导致驱动构件144从沿导螺杆134的其可能的近侧行程的末端偏移某些量。在一个示例性的实施例中，预期需要的旋转最大量小于旋转输入114的1.5匝。
在很多实施例中，预定旋转量也被选择为小于当应用于发射配置中的外科手术钉仓时可能导致手术刀的暴露的旋转量。例如，图12图示说明用于发射的外科手术钉仓的示例性的铰接手术刀配置。如显示的，驱动构件144被设置在导螺杆134的远端处，从而使手术刀构件的切割刀片178遮蔽在钉仓100的远侧库112内。在所示的实施例中，在暴露切割刀片178之前，导螺杆134以与发射方向相反的方向旋转2.9匝。因此，在其中使尝试旋转的旋转停转需要的最大旋转量是1.5匝并且可能导致手术刀的切割刀片的暴露的旋转量是2.9匝的示例性实施例中，选择的预定旋转量可以在这两个数字之间，例如2.0匝。在导螺杆134被(与发射方向相反地)驱动选择的预定旋转量以检测发射的钉仓之后，导螺杆134被向前驱动相同的选择的预定旋转量，以便将手术刀恢复到最初完全发射的位置。完成这个，以便在相继地插入发射的钉仓之后防止将手术刀驱动离开库。
钉仓状态和存在检测系统
图13是根据很多实施例提供与实施安装到机器人外科手术系统(例如，外科手术系统10，外科手术系统50)的外科手术器械上的未发射的外科手术钉仓的存在的验证有关的部件的高水平图的简化示意图。机器人外科手术系统包含外科医生控制台16、电子设备推车24、病人侧推车22、器械控制箱(ICB)230、外科手术器械232、外科手术钉仓100和马达组234。
外科手术器械232被配置为接收和支撑外科手术钉仓100。外科手术器械232包含旋转输出。外科手术钉仓100包含以发射方向旋转以便操作外科手术钉仓100的输入。当外科手术钉仓100被安装到外科手术器械232上时，钉仓输入与旋转输出传动地耦接。马达组234被安装到外科手术器械232上，并且包含与外科手术器械232的旋转输出传动地耦接的马达236。马达组234包含被配置为测量外科手术器械232的旋转输出的旋转的传感器238(例如，位置传感器、速度传感器、加速度传感器)。并且马达组234包含与ICB 230通信耦合的本地处理器240、传感器238和马达236。在很多实施例中，传感器通过测量马达236的旋转而测量外科手术器械232的旋转输出的旋转。
通过马达组本地处理器240，ICB 230与传感器238和马达236通信耦合。ICB 230包含处理器242和实体存储介质244。实体存储介质244含有当执行时引起处理器242控制马达236以便马达236产生小于或等于预定大小的致动扭矩(例如，小于(包含外科手术钉仓100的)外科手术器械232的正常操作扭矩极限的40％，小于正常操作扭矩极限的20％)的指令。在很多实施例中，供应给马达236的电流限于限制由马达236产生的可能的扭矩的量。产生的致动扭矩被转移给外科手术器械旋转输出，以便尝试使旋转输出以与外科手术钉仓100的发射方向相反的方向旋转通过预定旋转量。ICB处理器242将得到的旋转输出的旋转与阈值旋转量比较，并且确定当得到的旋转输出的旋转小于阈值旋转量时，钉仓100存在且未发射。
在很多实施例中，传感器238能够是位置传感器并且包含霍尔传感器。ICB处理器242可以计算霍尔传感器计数并且将霍尔传感器计数与预定数字比较，以便确定得到的外科手术器械232的旋转输出的旋转，或其得出的量是否小于阈值量(例如，旋转或得出的速度值的预定数字)。其他适当的位置传感器也能够使用。例如，位置传感器可以包含编码器。
在很多实施例中，传感器238可能是速度传感器，并且例如包含感应速度传感器或流速计(tachometer)。ICB处理器242能够确定速度传感器的输出或其得出的量是否小于阈值量(例如，预定的速度值或得出的位置值)。
在很多实施例中，传感器238能够是加速度传感器，并且例如包含加速计。ICB处理器242能够确定加速度传感器的输出或其得出的量是否小于阈值量(例如，预定的加速度值或得出的位置值)。
ICB处理器242被配置为监视尝试的旋转输出的旋转的停转。ICB处理器242追踪旋转输出的旋转并且处理追踪的旋转，以便检测旋转输出在预定的时间段中何时旋转小于最小量。
在很多实施例中，外科手术钉仓100包含铰接的手术刀。预定旋转量能够被选择为小于当应用于发射配置中的外科手术器械时可能导致手术刀暴露的旋转。钉仓能够包含当操作钉仓时部署到夹持的组织内的吻合钉。铰接的手术刀能够被配置为切割部署的吻合钉的行之间的夹持的组织。钉仓能够被配置为闭合血管并且包含被配置为切割闭合的血管的铰接的手术刀。
用于验证安装到外科手术器械上的未发射的外科手术钉仓的存在的本文描述的控制系统能够在本文描述的任何适当的外科手术系统中采用。并且本文描述的方法能够通过使用本文描述的任何适当的外科手术系统、外科手术器械和/或外科手术钉仓实施。
其他变体在本发明的精神内。因而，在本发明易受多种修改和可替换的构造影响时，其某些图示的实施例在图中显示并已经在上面详细描述。然而，应该理解，不意图将本发明限于具体的形式或公开的形式，而是相反，本发明包含落入如所附的权利要求限定的本发明的精神和范围内的所有修改、可替换的构造和等价物。
除非本文另外指出或通过上下文明确地否认，术语“力”应该被解释为包含力和扭矩(特别是在下列权利要求的背景中)。除非本文另外指出或通过上下文明确地否认，术语“一”、“一个”和“所述”以及相似的指示物在描述本发明的背景中(特别是在下列权利要求的背景中)的使用应该被解释为包含单数和复数。除非另外指出，术语“包括”“具有”、“包含”和“含有”应该被解释为开放式术语(即，意味着“包含，但不限于”)。即使存在某些介入，术语“连接”应该被解释为部分地或完全地包含在、附连到或结合在一起。除非本文另外指出，本文的值的范围的阐述仅意在用作单独涉及落入范围内的每个单独值的简写方法，并且每个单独的值被包括在说明书内，如同它是被单独地列举在本文。除非本文另外指出或通过上下文明确地否认，本文描述的所有的方法能够以任何适当的顺序执行。除非另外要求，本文提供的任何和所有的示例或示例性语言(例如，“诸如”)的使用仅意在更好地说明本发明的实施例而不对本发明的范围造成限制。说明书中的语言都不应被解释为将任何非请求保护的元件指示为本发明的实施必不可少的。
本文描述本发明的优选的实施例，包含发明者已知的用于实施本发明的最好的模式。在本领域的技术人员阅读前述描述时，那些优选实施例的变体对本领域的技术人员来说变得显然易见。发明人预期到技工按需要采用这样的变体，并且发明人意图以本文具体描述的之外的方式实施本发明。因此，如通过应用的法律允许的，本发明包含所附权利要求中引用的主题的所有的修改和等价物。此外，除非本文另外指出或通过上下文明确地否认，本发明包含其所有可能变体中的上述描述的元素的任何组合。
因此，通过参考相同的程度包括本文引用的所有的参考文献，包含出版物、专利申请书和专利，如同每个参考文文献单独地和特别地指出被并入本文作为参考并且以其整体阐述在本文中。

Claims (25)

1.一种检测外科手术钉仓存在且未发射的方法，所述方法包含：
经由致动输入来尝试驱动构件的第一移动，所述致动输入被限制于小于或等于预定大小，所述驱动构件的所尝试的第一移动与所述驱动构件的发射移动处于相反的方向；
通过确定所述驱动构件在与所述驱动构件的所述发射移动相反的方向上实现的移动小于阈值移动量，检测到所述驱动构件不能完成所尝试的第一移动；以及
响应于检测到所述驱动构件不能完成所尝试的第一移动，确定钉仓存在且未发射。
2.根据权利要求1所述的方法，其中所述预定大小被设定为小于所述外科手术钉仓安装到的外科手术器械的正常操作扭矩极限的设定百分比。
3.根据权利要求1所述的方法，其中经由所述致动输入来尝试所述驱动构件的所述第一移动包括限制供应给电动机的电流，所述电动机用于产生所述致动输入。
4.根据权利要求1所述的方法，其进一步包括：
测量用于致动所述驱动构件的传动系中的摩擦力；以及
将所述预定大小设定为大于所测量的摩擦力。
5.根据权利要求1所述的方法，进一步包括将所述预定大小设定为小于所述外科手术钉仓安装到的外科手术器械的正常操作极限。
6.根据权利要求5所述的方法，包括将所述预定大小设定为小于所述正常操作极限的20％。
7.根据权利要求1所述的方法，其中确定所述驱动构件在与所述驱动构件的所述发射移动相反的方向上实现的移动小于所述阈值移动量包括追踪被配置为追踪传动系的致动的传感器的输出，其中所述传动系用于产生所述驱动构件的所述第一移动。
8.根据权利要求7所述的方法，其中追踪所述传感器的所述输出包括监视用于所述传动系的致动的停转的所述传感器的输出。
9.根据权利要求8所述的方法，其进一步包括：
响应于检测到所述传动系的致动的停转，终止所述传动系的致动。
10.根据权利要求1所述的方法，其中：
所述外科手术钉仓包括铰接的手术刀；并且
所述驱动构件的所述第一移动小于当应用于发射配置中的所述外科手术钉仓时可能导致所述手术刀的暴露的量。
11.一种可操作用于致动外科手术钉仓的外科手术器械，其中所述外科手术钉仓安装到所述外科手术器械，所述外科手术器械包括：
致动输出，当所述外科手术钉仓被安装到所述外科手术器械上时，所述外科手术钉仓的钉仓输入与所述致动输出传动地耦接，所述钉仓输入在发射方向上致动以操作所述外科手术钉仓；
与所述外科手术器械致动输出传动地耦接的驱动源；
被配置为检测所述外科手术器械致动输出的移动的传感器；和
与所述传感器和所述驱动源通信地耦合的控制器，所述控制器包括处理器和实体存储介质，所述实体存储介质含有当执行时进行以下操作的指令：促使所述处理器控制所述驱动源，以便所述驱动源产生被限制于小于或等于预定大小的致动输入，以便尝试在与所述发射方向相反的方向上以预定致动量致动所述致动输出；所述控制器比较得到的所述致动输出的致动量与阈值致动量，并且当得到的所述致动输出的致动量小于所述阈值致动量时，确定所述钉仓存在且未发射。
12.根据权利要求11所述的外科手术器械，其中所述预定大小被设定为小于所述外科手术钉仓安装到的外科手术器械的正常操作扭矩极限的设定百分比。
13.根据权利要求11所述的外科手术器械，其中所述致动输入的产生包括限制供应给用于产生所述致动输入的电动机的电流。
14.根据权利要求11所述的外科手术器械，其中所述预定大小小于所述驱动源的正常操作极限。
15.根据权利要求14所述的外科手术器械，其中所述预定大小小于所述驱动源的所述正常操作极限的20％。
16.根据权利要求11所述的外科手术器械，其中所述传感器包括位置传感器、速度传感器或加速度传感器的至少一个。
17.根据权利要求11所述的外科手术器械，其中：
所述传感器包括位置传感器；并且
所述位置传感器包括霍尔传感器或编码器的至少一个。
18.根据权利要求11所述的外科手术器械，其中：
所述传感器包括速度传感器；并且
所述速度传感器包括感应速度传感器或流速计的至少一个。
19.根据权利要求11所述的外科手术器械，其中：
所述传感器包括加速度传感器；并且
所述加速度传感器包括加速计。
20.根据权利要求11所述的外科手术器械，其中所述控制器监视所述传感器的输出，以便确定得到的所述致动输出的致动量是否小于所述阈值致动量。
21.根据权利要求11所述的外科手术器械，其中当执行所述指令时，所述指令使所述控制器：
追踪所述致动输出的移动；和
处理所追踪的移动，以监视所述致动输出的尝试的致动的停转。
22.根据权利要求21所述的外科手术器械，其中当在预定时间段中所述致动输出移动小于最小量时，检测到停转。
23.根据权利要求11所述的外科手术器械，其中：
所述外科手术钉仓包括铰接的手术刀；和
所述预定致动量小于当应用于发射配置中的所述外科手术钉仓时可能导致所述手术刀的暴露的致动量。
24.根据权利要求11所述的外科手术器械，其中所述钉仓包括：
多个吻合钉，当操作所述钉仓时，所述多个吻合钉被部署到夹持的组织内；和
铰接的手术刀，其被配置为切割所述部署的吻合钉的行之间的所夹持的组织。
25.根据权利要求11所述的外科手术器械，其中所述钉仓被配置为闭合血管并且包含被配置为切割所述闭合的血管的铰接的手术刀。
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