CN107007355B - 检测夹紧或发射失败的系统 - Google Patents

检测夹紧或发射失败的系统 Download PDF

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CN107007355B
CN107007355B CN201710351466.XA CN201710351466A CN107007355B CN 107007355 B CN107007355 B CN 107007355B CN 201710351466 A CN201710351466 A CN 201710351466A CN 107007355 B CN107007355 B CN 107007355B
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D·维尔
K·杜伦特
P·弗拉纳干
D·罗宾逊
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Intuitive Surgical Operations Inc
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Abstract

提供用于检测材料夹紧和/或订合钉发射进夹紧的材料的失败和在用户界面上将这样的失败指示给用户的系统和方法。该系统和方法特别适合与具有与致动器连接的关闭和/或发射机构的末端效应器一起使用。通过监测实现夹紧和/或发射的致动器的驱动参数，该系统和方法响应所述监测的驱动参数而提供失败的指示。在一些实施方式中，夹紧和/或发射期间当所述监测的驱动参数在期望的驱动参数的可接受的范围外面时，失败的指示被输出。当用于微创手术时，该公开的系统和方法特别有益。

Description

检测夹紧或发射失败的系统
本申请是于2012年1月13日提交的名称为“检测夹紧或发射失败的系统”的中国专利申请201280008948.0(PCT/US2012/021319)的分案申请。
相关申请的交叉引用
本申请是2011年2月15日提交的美国临时专利申请号61/443,148的非临时申请，并要求其权益，其全部内容通过引用被并入本文。
本申请涉及2010年2月12日提交的名称为“Cut and Seal Instrument”的美国申请号12/705,418(代理人案号ISRG 02180/US)；2009年11月13日提交的名称为“ENDEFFECTOR WITH REDUNDANT CLOSING MECHANISMS”的美国临时申请号61/260,907(代理人案号ISRG02330PROV)；2009年11月13日提交的名称为“WRIST ARTICULATION BY LINKEDTENSION MEMBERS”的美国临时申请号61/260,903(代理人案号ISRG02320PROV)，(代理人案号ISRG 02320/US)；2009年11月13日提交的名称为“WRIST ARTICULATION BY LINKEDTENSION MEMBERS”的美国临时申请号61/260,903(代理人案号ISRG02320PROV)；2009年11月13日提交的名称为“SURGICAL TOOL WITH A TWO DEGREE OF FREEDOM WRIST”的美国临时申请号61/260,915(代理人案号ISRG02350PROV)；和2009年11月13日提交的名称为“MOTOR INTERFACE FOR PARALLEL DRIVE SHAFTS WITHIN AN INDEPENDENTLY ROTATINGMEMBER”的美国临时申请号61/260,919(代理人案号ISRG02360PROV)；其中的每个以其全部通过引用被并入本文。
发明背景
微创外科技术旨在减少诊断或手术操作期间受损的外部组织的量，由此减少患者恢复时间、不舒适和有害的副作用。因此，利用微创外科技术，标准外科手术的住院期的平均长度可显著缩短。同时，利用微创手术还可减少患者恢复时间、患者不舒适、手术副作用和离开工作的时间。
微创手术的通常形式是内窥镜检查，而内窥镜检查的通常形式是腹腔镜检查，其是腹腔内微创的检查和手术。在标准腹腔镜手术中，将气体吹入患者的腹部，使插管套管通过小的(大约半英寸或更小)切口穿过以提供腹腔镜器械的进入口。
腹腔镜外科器械通常包括用于观察手术区的内窥镜(例如，腹腔镜)和用于在手术部位操作的工具。该操作工具通常与用于常规的(开放的)手术的操作工具相似，除了延伸管(也被称作，例如，器械轴或主轴)将每个工具的操作末端或末端效应器与其手柄分开。末端效应器可包括，例如，夹子、抓紧器、剪刀、吻合器、烧灼工具、线性切割器或持针器。
为了进行手术操作，外科医生使操作工具通过插管套管到内部的手术部位并从腹部外面操纵它们。外科医生通过显示从内窥镜获取的手术部位的图像的监视器来观察操作。相似的内窥镜技术用于，例如，关节镜检查、腹膜后检查、盆腔镜检查、肾镜检查、膀胱镜检查、脑池检查(cisternoscopy)、窦镜检查、宫腔镜检查、尿道镜检查等。
正在研发微创遥控外科机器人系统(minimally invasive telesurgicalrobotic system)以增加在内部手术部位上操作时外科医生的灵巧以及允许外科医生从远距离位置(无菌区外面)对患者进行操作。在遥控外科系统中，常常提供给外科医生在控制台的手术部位的图像。当在合适的观察器或显示器上观察手术部位的图像时，外科医生通过操纵控制台的主控端输入(master input)或控制装置而对患者进行手术操作。每个主控端输入装置均控制伺服机械地(sevo-machanically)致动的/铰接的外科器械的运动。手术操作期间，遥控外科系统可提供机械致动和控制多种具有末端效应器的外科器械或工具，该末端效应器响应主控端输入装置的操作为外科医生执行各种功能，例如，持针或推进针、抓紧血管、解剖组织等。
非机器人的线性夹紧、切割和固定装置(stapling device)已用于多种不同的手术操作。例如，这样的装置可用于从胃肠道切除癌性或异常组织。不幸的是，多种已知的外科装置——包括已知的线性夹紧、切割和固定装置——具有相对的夹爪，其可产生比期望小的夹紧力，这可减小外科装置的功效。已发展了这样的装置，其对可应用的手术操作(例如，组织固定)产生较高水平的夹紧力，然而，用高力夹爪的夹紧周期性(偶尔地，periodically)地失败。另外，封闭组织的订合钉发射(推动，firing)可能失败。然而，检测夹紧或订合钉发射的失败在一些微创外科应用中已证明是困难的，因为外科医生可能没有清楚观察到正被夹紧或固定的组织，并且插入身体的工具受限于有效的尺寸和空间限制。由于机器人系统中外科医生的触觉反馈可稍微受限，所以当失败已发生直到夹紧或发射操作完成之后，外科医生可能都没有认识到。鉴于上述，期望使外科医生能够在夹紧或失败发生时发现它们，以便操作可暂停(suspend)或改变以减少组织损伤的可能性和/或以允许外科医生减轻任何已被损伤的组织的效应。考虑到与微创外科环境相关的限制，期望从身体外部检测失败，而无需大量地增加末端效应器的轮廓(profile)。
因此，可检测失败和向用户指示失败的、而与微创操作的需要一致的方法和系统是期望的。这样的工具在外科应用，特别是微创外科应用中可以是有益的。
发明概述
提供检测和指示夹紧和/或订合钉发射失败的改进的系统和方法。要求保护的方法和系统涉及检测夹爪之间抓住的材料的夹紧或订合钉发射进夹紧的材料中是否可能失败。要求保护的系统和方法可检测夹紧或发射过程期间夹紧或发射的失败，由此减少由于失败已发生之后持续夹紧或发射订合钉带来的组织损伤的可能性。要求保护的系统和方法在涉及末端效应器的两个夹爪之间的身体组织的夹紧和订合钉发射进夹紧的组织的外科应用中特别有用。多种外科应用要求以足以切割、封闭和/或固定夹紧的组织的夹紧力来夹紧身体组织。由于夹紧和发射订合钉可需要比组织操作相对更高的力，所以夹紧或发射的失败可潜在地引起脆弱组织的损伤。本方法和系统在微创外科应用中特别有利，因为失败一发生它们就指示失败并且允许从身体外部检测失败。虽然本文公开的各种实施方式主要对于外科应用来描述，但是这些外科应用仅仅是实例应用，并且公开的末端效应器、工具和方法可用于其它合适的应用——人身体的内部和外部，以及非外科应用。
在第一方面，本发明提供检测由电动机驱动的夹爪之间的材料夹紧失败或检测订合钉发射失败的方法，发射力由致动器，如电动机驱动。方法包括在夹紧或发射力的应用期间监测致动器或电动机的驱动参数，以及响应监测的驱动参数，在用户界面上输出夹紧或发射失败的指示。通常，当监测的致动器的驱动参数，如电动机的转矩输出或驱动机构的位移在驱动参数的可接受范围之外时，夹紧或发射失败的指示发生。该指示还可以指示夹紧或发射失败的可能性，其中失败的可能性落入第一和第二可能性之间的梯度之内，第一可能性可能失败，而第二可能性可能成功。在多种实施方式中，夹紧和固定的材料是身体组织，包括外部皮肤或内脏器官，如肠、胃或肺。
在多种实施方式中，方法和系统包括在末端效应器的第一和第二夹爪之间的夹紧期间或订合钉发射进夹紧的组织期间监测驱动参数。通常，在外科订合钉行沿着切割线将组织的对侧固定以封闭组织之后，切割夹紧的组织。末端效应器通常是微创机器人外科系统的部分。第一和第二夹爪可包括两个分开的夹爪或第一夹爪可靠近末端效应器的部分铰接，在这种情况下，末端效应器的部分包括第二夹爪。一方面，方法包括：一般地响应来自用户的夹紧或发射命令，夹紧末端效应器第一和第二夹爪之间的材料或使订合钉发射进夹紧的材料。系统通过将夹紧力施加到夹子或将发射力施加到订合钉来实施夹紧或发射。当夹紧或发射发生时，系统监测施加夹紧或发射力的致动器的驱动参数。响应监测的驱动参数，系统在用户界面上输出夹紧或发射失败或夹紧或发射成功的指示。
在多种实施方式中，响应监测的驱动参数——位于致动器的期望驱动参数的可接受范围，如转矩输出的范围之外，提供可能的夹紧或发射失败的指示。通常，驱动参数的可接受范围随着致动器或电动机的位移而变化，以致于驱动参数的可接受范围可不同，这取决于末端效应器的构型。例如，在致动器或电动机的最初位移(当夹子从打开的构型开始时)的驱动参数的可接受范围可不同于在最后位移(如当夹子处于关闭/夹紧的构型时)的驱动参数的可接受范围。发射机构的不同的最初构型和最后构型也是这样。系统可通过检测(sense)实现运动的致动器，或致动器通过其实现夹紧或发射的机构的位移来检测末端效应器的构型。夹紧或发射通过一个或多个将致动器连接到末端效应器和/或订合钉的机构由驱动参数实现。机构(一个或多个)可包括缆索、皮下管(海波管，hypotube)或导螺杆。在多种实施方式中，可能的夹紧失败的指示是显示在用户界面显示器上的视觉指示符，但还可以通过音频信号、视觉信号或其它感觉指示符传达给用户。
另一方面，方法或系统可响应夹紧或订合钉发射失败或可能的失败的指示而暂停致动器的驱动。方法还可包括在指示失败之后保持驱动参数，或在暂停驱动订合钉发射的力的同时保持驱动夹紧的驱动参数。在多种实施方式中，夹紧机构是非后向可驱动的(backdriveable)，以便在它被应用或建立后不需要输入来保持夹紧力。在这样的情况下，可需要输入来松开和反转导螺杆的运动。方法可包括反转驱动力，以在输出失败指示之后松开。
在多种实施方式中，系统包括末端效应器、传感器和用户界面。末端效应器的第一和第二夹爪连接到致动器以便驱动致动器产生夹紧力，从而在第一和第二夹爪之间夹紧材料。系统还可包括致动器，如电动机，其可拆地连接到订合钉以便驱动致动器产生发射力，从而将订合钉发射进身体组织。夹紧和发射致动器可以是单一致动器或可以是分开的致动器。系统可包括用于监测将夹紧或发射力施加到末端效应器的驱动参数的传感器。传感器可以是分开的传感器或可并入机器人外科系统，还可监测电动机或机构的位移。系统还可包括用于比较监测的驱动参数与期望的驱动参数或参数范围的处理器。处理器还可确定给定位移的可接受驱动参数的范围。
系统可包括用于分别实现夹紧和发射的第一和第二致动机构。第一和第二致动机构可利用与夹紧模式和发射力模式的力需要相对应的不同的力传动机构。例如，第一夹爪致动机构使用的使夹爪从打开位置移动到关闭位置的力可包括线性力或转矩，而第二夹爪致动机构使用的发射订合钉通过组织的力可包括转矩。在多种实施方式中，第一致动机构包括用于高力夹紧模式的导螺杆驱动机构，第二致动机构包括用于订合钉发射的第二导螺杆驱动机构。可选地，夹紧和发射可利用部分机构或相同的机构。
对于本发明的性质和优势的更完全的理解，应当参考接下来详细的说明和附图。根据下面的图和详细的说明，本发明的其它方面、目的和优势将是明显的。
附图简述
图1是根据多种实施方式用于进行手术的微创机器人外科系统的平面图。
图2是根据多种实施方式的机器人外科系统的外科医生控制台的透视图。
图3是根据多种实施方式的机器人外科系统电子学手推车的透视图。
图4概略地图解了根据多种实施方式的机器人外科系统。
图5A是根据多种实施方式的机器人外科系统的患者侧手推车(外科机器人)的正视图。
图5B是机器人外科手术工具的正视图。
图6A是根据多种实施方式的具有铰接的夹爪的末端效应器的透视图。
图6B是根据多种实施方式的图6A的末端效应器的透视图(去除了铰接的夹爪以更好地显示导螺杆致动机构部件)。
图7A和7B显示根据多种实施方式的导螺杆致动机构的部件。
图8A显示根据多种实施方式的缆索致动机构的部件。
图8B是根据多种实施方式的图8A的末端效应器的透视图，其中去除了部分铰接的夹爪以显示布置在铰接的夹爪后面的缆索致动机构部件。
图8C至8F显示图8A的缆索致动机构的对侧部件。
图9A是显示根据多种实施方式的缆索致动机构的透视图，其显示用于向夹紧的构型铰接夹爪的缆索。
图9B是显示图9A的缆索致动机构的透视图，显示用于向开放构型铰接夹爪的缆索。
图10是显示根据多种实施方式的导螺杆致动机构的部件的横断面视图。
图11是根据多种实施方式的工具组件的简化图解。
图12是根据多种实施方式的安装到机器人工具机械手的机器人工具的简化图解。
图13是根据多种实施方式的遥控机器人外科系统的图解视图。
图14A-14B显示根据多种实施方式的具有夹紧失败指示符的用户界面组件。
图15A-15B显示根据多种实施方式的夹紧失败指示符的指示符的实例。
图16A-16B显示根据多种实施方式与随着电动机位移而变化的可接受电动机转矩的范围相比夹紧期间示例性电动机转矩。
图17-20显示根据多种实施方式的方法。
图21-22显示利用根据多种实施方式的方法的流程图。
详细描述
提供与夹紧和/或紧固件发射有关的改进的系统和方法。本发明涉及提供在夹紧期间给定材料的夹紧是否失败的指示符。本发明可用于具有用于夹紧材料或将订合钉发射进夹紧的材料的夹爪部件的系统。要求保护的系统和方法对于微创外科应用特别有用，因为它们允许从身体外部在受限制环境中检测失败。这样的系统常常包括具有夹爪的末端效应器，该夹爪以相对高的力夹紧身体组织和将订合钉发射进组织。以高的夹紧力夹紧允许使用者进行需要坚固夹紧的各种操作。例如，医师可在切割、封闭或固定组织之前需要坚固的夹紧身体组织。订合钉或其它紧固件的发射还可需要应用相对高的力以驱动订合钉通过身体组织。由于夹紧和订合钉发射利用施加在受限外科区域中的相对高的力，所以夹紧或发射失败可能损伤脆弱组织。要求保护的方法和系统是有利的，因为它们允许从身体外部检测夹紧或发射过程期间的夹紧或发射失败，而不增加末端效应器的轮廓。这样的方法和系统使得能力和患者的安全性增加，同时保持微创外科工具的比例减小。虽然本文公开的多种实施方式主要针对外科应用来描述，但是这些外科应用仅仅是实例应用，并且公开的系统和方法可用于其它合适的应用——人身体里面和外面，以及非外科应用。
通常，利用要求保护的发明的系统包括末端效应器，其具有用于夹紧材料和/或发射订合钉或紧固件通过夹紧的材料的两个夹爪。两个夹爪可包括连接到末端效应器的铰接的夹爪，以便使铰接的夹爪向末端效应器的部分移动，第二夹爪是末端效应器的该部分。在多种实施方式中，系统利用两个独立的机构来铰接末端效应器的夹爪。第一致动机构提供快速反应/小力模式——其改变关闭的(抓紧的)构型和打开的构型之间的铰接的夹爪的位置。在多种实施方式中，第一致动机构是后向可驱动的。例如，在小力模式抓紧模式中，第一致动机构可被设计以在第一和第二夹爪尖端之间提供5lbs的夹紧力。第二致动机构提供高的夹紧力模式，用于以较高夹紧力夹紧夹爪之间的身体组织。通常，第二致动机构是非后向可驱动的。第二致动机构将相对弱的力或转矩(但是具有大的可用位移)转化成相对高的转矩——转动末端效应器夹爪。第二致动机构可被设计以在夹紧的夹爪的尖端之间提供，例如，50磅的夹紧力。
通常，在利用要求保护的方法的应用中，外科医生以相对高的夹紧力夹紧身体组织，并且一旦夹紧，发射一系列订合钉通过夹紧的组织，由此封闭组织。周期性地，夹爪可能没有夹紧组织，潜在地导致对组织的损伤。组织的夹紧可由于多种种原因而失败，包括太多的组织被抓住或夹爪之间抓住的组织不足，包括来自邻近的组织如骨的干扰，或组织在夹爪之间滑动。即使夹紧是成功的，但是订合钉或其它紧固件的发射可由于多种种原因而失败，包括卡住的订合钉、材料不一致、来自另一种材料的干扰、或夹紧材料的滑动。因此，夹紧或发射过程期间当夹紧或发射失败发生时可检测失败和将这样的失败指示给医师，由此减小将导致的组织损伤的可能性的系统和方法将是有利的。通过使用要求保护的方法可避免组织损伤的方式包括：已指示失败之后终止夹紧或发射过程或允许使用者终止或修改过程。描述的系统和方法检测夹紧和/或将订合钉发射进夹紧的材料期间这样的失败并将失败或可能的失败的指示提供给使用者。当处于夹紧位置时，夹爪之间的距离足以进行治疗，如发射订合钉通过夹紧的组织，则夹紧可被认为是成功的。该距离可根据多种因素，包括组织类型、治疗类型或待发射通过夹紧组织的订合钉的尺寸而改变。一方面，要求保护的方法和系统通过监测驱动夹紧和/或订合钉发射的致动器或电动机的驱动参数来检测失败。在优选实施方式中，电动机给机构提供驱动参数或力输出，如转矩，以通过末端效应器实现夹紧和/或订合钉的发射。系统可确定驱动参数是否在期望驱动参数的可接受范围内。驱动参数的可接受范围可根据实现运动的电动机或机构的位移而改变。典型地，如果夹紧或发射失败，则驱动电动机的力输出降到可接受的最小值以下，如在夹紧夹爪之间没有材料的力输出，或力输出可冲到最大可接受力之上，如来自骨上的夹紧或机构的卡住的力输出。在两者任一的情况下的电动机的持续驱动可导致对周围材料或组织的损伤。通过在材料夹紧和/或发射进组织期间，监测驱动电动机的力输出，要求保护的方法和系统检测在夹紧或发射期间的失败或可能的失败并向使用者输出这样的失败或可能的失败的指示。另外，提供失败的指示之后，系统和方法可自动终止夹紧或发射或等待来自使用者的进一步输入。理想地，方法包括在夹紧或订合钉发射期间监测驱动参数，和响应监测的驱动参数，提供夹紧或发射失败的可能性的指示。
微创机器人外科手术
现在参考附图，其中在几个视图中，同样的参考数字表示同样的部件，图1是本发明实施方式的平面图图解。图1显示微创机器人外科(MIRS)系统10，通常用于在躺在手术台14上的患者12上进行微创诊断或手术操作。该系统可包括操作期间外科医生18使用的外科医生的控制台16。一个或多个助手20也可参与操作。MIRS系统10可进一步包括患者侧手推车22(外科机器人)和电子学手推车24。患者侧手推车22可操纵至少一个可移去的连接工具组件26(在下文中被简单地称作“工具”)通过患者12身体中的微创切口，而外科医生18通过控制台16观察手术部位。工具组件26包括末端效应器25，该末端效应器具有用于夹紧组织的夹爪和用于发射订合钉通过夹紧组织的机构。手术部位的图像可通过内窥镜28，如立体内窥镜获得，这可通过患者侧手推车22来操作以定向内窥镜28。电子学手推车24可用于处理手术部位的图像，用于随后通过外科医生的控制台16显示给外科医生18。电子学手推车24包括用于监测电动机输出提供给末端效应器的驱动参数的处理器27。处理器27可通过比较驱动参数与驱动参数的可接受范围来监测驱动参数。由于驱动参数的可接受范围可随着实现末端效应器运动的电动机或机构的位移而变化，所以处理器27还可在夹紧和/或发射期间接收关于电动机或末端效应器机构位移的位移数据，以便处理器27针对任何给定的位移比较监测的驱动参数与可接受驱动参数的范围。位移数据可直接测量或可根据机器人系统，如机器人患者侧机械手(PSM)系统，所获得的位置数据或其衍生数据来确定，例如，美国专利申请公开号2007/0005045——其全部内容通过引用被并入本文——中描述的。响应监测的驱动参数，处理器27可输出夹紧失败指示到用户界面。系统10然后将预测指示符传达给外科医生控制台16上的医师，以与向科医生传达夹紧或发射是否已失败。
图2是外科医生控制台16的透视图。外科医生控制台16包括左眼显示器32和右眼显示器34，用于将赋予深度感的手术部位的协调立体视图呈现给外科医生18。控制台16进一步包括一个或多个输入控制装置36，其反过来使患者侧手推车22(图1所示)操纵一个或多个工具。输入控制装置36将提供与它们连接的工具26(图1所示)相同的自由度以提供给外科医生遥现(远程呈现，telepresence)，或输入控制装置36与工具26成一体的感觉，以便外科医生具有直接控制工具26的强烈感觉。为此，位置、力和触觉反馈传感器(未显示)可用于通过输入控制装置36从工具26将位置、力和触觉传递回外科医生的手。
外科医生控制台16通常位于与患者相同的房间以便外科医生可直接监测操作，需要时身体地呈现，并直接与助手说话，而不是通过电话或其它通信媒介。然而，考虑到远距离手术操作(即，从无菌区外面操作)，外科医生可位于与患者不同的房间、完全不同的建筑物或其它远距离的位置。
图3是电子学手推车24的透视图。电子学手推车24可与内窥镜28连接并可包括处理器27以监测驱动参数和响应监测的驱动参数而确定夹紧失败的指示。处理器27还可处理捕获的图像，用于随后显示，如给外科医生控制台上的外科医生，或在位于当地和/或远处的任何其他合适的显示器上。
图4概略地图解机器人外科系统50(如图1的MIRS系统10)，其中处理器58和显示器60与电子学手推车56和外科医生控制台52分开描述。如上面所讨论的，微创操作期间，外科医生控制台52(如图1中的外科医生控制台16)可由外科医生使用以控制患者侧手推车(外科机器人)54(如图1中的患者侧手推车22)。在准备发射订合钉以封闭身体组织过程中，外科医生可命令患者侧手推车54的工具在末端效应器的夹爪部件之间夹紧。响应该命令，处理器58可命令系统开始驱动电动机以接合(engage)机构，该机构开始使夹爪一起移动并将夹紧力增加到期望的夹紧力。随着夹爪开始一起移动和夹紧力增加，随着电动机驱动夹爪以期望的夹紧力夹紧，处理器58连续地监测电动机的驱动参数和比较驱动参数与驱动参数的可接受范围电动机。如果在夹紧期间的任何点，驱动参数超过可接受驱动参数或降到可接受驱动参数以下，那么处理器58可在用户界面上输出夹紧失败的指示。响应夹紧失败的检测，处理器58还可控制另外的功能，如暂停电动机的驱动、阻止订合钉发射、在检测到的夹紧失败的点保持夹紧力、等待用户输入和松开组织。相似地，处理器58在发射订合钉成功通过夹紧组织期间连续地监测驱动参数。响应落在期望驱动参数的可接受范围之外的驱动参数，处理器58可在用户界面上输出失败指示。响应检测到的发射失败，处理器58可控制其它功能，如终止发射、暂停电动机的驱动、保持组织的夹紧，同时防止发射、或等待用户输入。
本领域技术人员将理解，夹紧失败的指示可包括夹紧失败可能有多大可能性的指示。例如，处理器58可输出夹紧失败的指示——指示失败的0％可能性到失败的100％可能性的夹紧失败的可能性，因此允许使用者在实际的失败发生之前基于如失败指示所指出的失败可能性的增加而调整或终止操作。在一些实施方式中，如果监测的驱动参数处于驱动参数的可接受范围内，那么表示失败可能性的失败指示符可表示落入0至49％范围内的失败可能性。在另一个实施方式中，该范围可被表示为梯度，包括非数值梯度，如颜色梯度。取决于如失败指示符所传达的失败可能性，外科医生可随后安全地进行身体组织的夹紧或可中止夹紧和夹爪的复位，直到显示器60指示夹紧或发射成功的较高可能性。
图5A和5B分别显示患者侧手推车22和外科工具62。外科工具62——外科工具26之一——是具有一组用于夹紧组织和发射订合钉进入夹紧的组织的夹爪部件的末端效应器的实例。显示的患者侧手推车22提供三个外科工具26和显像装置28，如用于捕获操作部位的图像立体内窥镜的操作。操作由具有多种机器人关节的机器人机构提供。显像装置28和外科工具26可在患者中定位并且通过切口操作以便将运动学的远距离中心保持在切口处从而最小化切口尺寸。手术部位的图像可包括外科工具26远端——当它们位于显像装置28的视野内时——的图像。
使用独立的致动机构夹紧组织和发射订合钉
在多种实施方式中，两个独立的致动机构用于控制末端效应器的铰接的夹爪的铰接。第一致动机构可用于提供高力夹紧模式，第二致动机构可用于提供高力发射模式。在多种实施方式中，用于提供高的夹紧力和高的发射力的第一和第二致动机构是非后向可驱动的。第一和第二致动机构可包括第一和第二导螺杆。利用独立的致动机构可在一些外科应用，例如，电烙术封闭、固定等——其在同一操作期间对不同的功能可需要不同的力——中可以是有益的。
在多种实施方式中，以高的夹紧力模式的夹爪致动由包括导螺杆驱动凸轮的导螺杆致动机构提供。当导螺杆驱动的凸轮在其运动范围的第一末端时，从动凸轮与铰接的夹爪上的配合(mating)的凸轮表面界面连接(，interface)以使铰接的夹爪保持处于关闭的(夹紧的)构型。另外，当导螺杆驱动的凸轮在其运动范围的第二末端(相对的末端)时，从动凸轮不限制铰接的夹爪的运动。换言之，排列配合的凸轮表面以便在一个方向上的导螺杆驱动的凸轮的运动将引起铰接的夹爪关闭，而相反方向上的导螺杆驱动的凸轮的运动将允许(但不强迫)铰接的夹爪打开到凸轮表面所提供的限制。通常，导螺杆致动机构是非后向可驱动的。在多种实施方式中，末端效应器的夹爪部件的位置可通过缆索致动机构的位置来确定，或者如果由导螺杆驱动，则由导螺杆的位置来确定。系统可包括双驱动电动机——具有用于以夹紧力实现夹紧的驱动器(drive)和用于以发射力实现发射订合钉的驱动器。电动机可利用现有的电动机或驱动器或利用另外的驱动器或电动机，实现订合钉的发射。要求保护的方法和系统监测正驱动夹紧或发射的任一个电动机或多个电动机的驱动参数。另外，当失败被检测到时终止或停止电动机的驱动还可包括实现另一功能的另一驱动器或电动机的持续驱动。例如，如果发射失败被指示，那么系统可停止驱动发射力，而仍然保持夹紧力的驱动和等待使用者松开组织。
图6A是根据多种实施方式的末端效应器70的透视图，末端效应器70具有通过两个独立的致动机构铰接的夹爪72。末端效应器70包括末端效应器基底74、铰接的夹爪72和可拆卸的固定夹爪76——其保持订合钉。末端效应器70通过第一驱动轴78、第二驱动轴80和两个致动缆索(未显示)来致动。第一驱动轴78转动导螺杆致动机构的导螺杆82，导螺杆82位于固定夹爪76内。第二驱动轴80转动可拆卸的固定夹爪76的另一个导螺杆(未显示)。
在多种实施方式中，第一驱动轴78和/或第二驱动轴80由位于近端工具机箱中的驱动部件驱动，末端效应器70通过器械轴与其连接。在多种实施方式中，近端工具机箱被配置以能可拆地可安装到机器人工具机械手。在多种实施方式中，第一驱动轴78和第二驱动轴80通过位于近端工具机箱中各自的驱动部件来致动。在多种实施方式中，这样的驱动部件由位于近端工具机箱中的电动机来驱动。
图6B是根据多种实施方式的图6A的末端效应器70的透视图(去除了铰接的夹爪72以更好地显示导螺杆致动机构的部件)。安装导螺杆82，用于相对于末端效应器基底74转动。导螺杆驱动凸轮84与导螺杆82连接以便导螺杆82的选择性转动可用于沿着末端效应器基底74中的凸轮槽86选择性地平移导螺杆驱动的凸轮84。末端效应器70包括枢销88——其用于将铰接的夹爪72转动地连接到末端效应器基底74。
图7A至10显示致动机构，末端效应器通过驱动机构以夹紧模式在其夹爪之间夹紧身体组织和发射订合钉进入夹紧的组织。
图7A和7B显示图6A和6B的导螺杆致动机构。导螺杆82具有远端轴颈表面96和与近端轴承98界面连接的近端轴颈表面。在多种实施方式中，远端轴颈表面96被容纳于位于凸轮槽86远端的圆柱状插孔内。这样的导螺杆82的远端支撑可被配置以使导螺杆82避免过分摇摆，并在远端轴颈表面96和圆柱状插孔之间具有相对大的间隙(clearance)(一个或多个)。近端轴承98由末端效应器基底74支撑以支撑导螺杆82近端。近端轴承98可以是球轴承，其可有助于减小摩擦和磨损。远端轴承(未显示)可由末端效应器基底74支撑以支撑导螺杆82的远端，并且远端轴承可以是球轴承。导螺杆驱动的凸轮84包括配置为与导螺杆82的外螺纹配合的带螺纹的镗孔。导螺杆驱动的凸轮84包括配置为与凸轮槽86的相应的顶面和底面相互作用的顶面和底面。导螺杆驱动的凸轮84和凸轮槽86之间的相互作用防止导螺杆驱动的凸轮84相对于凸轮槽86转动，这引起导螺杆驱动的凸轮84响应导螺杆的转动沿着凸轮槽86平移。
铰接的夹爪72包括配合的凸轮表面94，其被配置以便沿着凸轮槽86的导螺杆驱动的凸轮84的位置确定环绕枢销88的铰接的夹爪72的旋转运动受导螺杆驱动的凸轮84限制的程度。铰接的夹爪72包括由中央槽分开的第一近端面100和第二近端面102。当铰接的夹爪72与末端效应器基底74通过枢销88连接时，第一和第二近端面布置在末端效应器基底74的相对侧。第一和第二近端面100、102中的每个包括限定配合的凸轮表面94和在导螺杆驱动的凸轮84和近端面100、102之间提供间隙的凹陷区。当导螺杆驱动的凸轮84位于凸轮槽86的近端或接近凸轮槽86的近端(接近图7A和7B中显示的其位置)时，在导螺杆驱动的凸轮84和铰接的夹爪72的配合的凸轮表面94之间的接触使铰接的夹爪保持夹紧的构型。当导螺杆驱动的凸轮84位于凸轮槽86的远端时，对于夹紧的构型(其中导螺杆驱动的凸轮84和铰接的夹爪72的配合的凸轮表面94之间存在间隙)和打开构型(其中导螺杆驱动的凸轮84和铰接的夹爪72的配合的凸轮表面94之间可存在或可不存在间隙)之间的转动位置范围，铰接的夹爪环绕枢销88的转动位置不受导螺杆驱动的凸轮84限制。对于凸轮槽86的近端和远端之间的导螺杆驱动的凸轮84的位置，非限制的运动的范围可根据使用的凸轮表面而改变。
近端面100、102每个中的凹处限定铰接的夹爪72的配合的凸轮表面94的应用提供多种益处。例如，相对的凹处跨过延伸通过近端面的槽的应用为铰接的夹爪的近端面100、102提供连续的外部表面，这较横向槽开口不太可能在患者组织上粗磨(snag)。缺少横向槽与具有横向槽的近端面相比还有助于使近端面100、102变硬，并因此提供增加的夹紧刚度。这样的近端面100、102可在两个平面上具有增加的刚度，这可有助于在缺少外部力的情况下保持铰接的夹爪72的对齐。这样在两个平面上增加的刚度在一些外科应用中可以是有利的，例如，在组织固定中，其中它有益于在订合钉和形成订合钉的砧口袋之间保持对齐。另外，凹处而不是横向槽的应用还提供致动机构，其与具有带有打开的横向槽的近端面的驱动机构相比不太可能被外部材料卡住。
导螺杆致动机构可被配置以在末端效应器的铰接的夹爪和相对的夹爪之间提供期望的夹紧力以促进组织的切割或封闭。例如，在多种实施方式中，导螺杆致动机构被配置以在铰接的夹爪72的尖端(距枢销88大约2英寸)提供至少20lbs的夹紧力。在多种实施方式中，导螺杆致动机构被配置以在铰接的夹爪72的尖端提供至少50lbs的夹紧力。在多种实施方式中，为了在铰接的夹爪72的尖端72产生50lbs的夹紧力，对导螺杆82的输入转矩是大约0.2N m，并且导螺杆82具有29个转动(turn)。系统可通过检测导螺杆的位移来检测电动机的位移、夹紧或发射机构的位移或末端效应器的构型电动机。例如，在多种实施方式中，在开始操作之前校准系统以确定夹紧和发射机构的运动范围和该运动范围内导螺杆的位移。这样的校准允许系统单独地通过螺杆的位移确定末端效应器的构型或机构的位移。
导螺杆致动机构可利用可用的材料和部件来制造。例如，导螺杆致动机构的多种部件可由可用的不锈钢(一种或多种)来制造。导螺杆驱动的凸轮84可被涂层(例如，TiN)以减小对它摩擦的表面(例如，导螺杆82；末端效应器基底74；铰接的夹爪72的近端面100、102)的摩擦。多股绞合的缆索可用于驱动第一致动机构。
图8A至8F显示根据多种实施方式的缆索致动机构110的部件。如上面所描述的，导螺杆驱动的凸轮84可位于凸轮槽86的远端(即，接近枢销88)。对于导螺杆驱动的凸轮84的这样的远端位置，如上面所讨论的，铰接的夹爪72围绕枢销88的转动位置对于一些铰接的夹爪72的转动位置时是不受限制的。因此，铰接的夹爪72围绕枢销88的转动位置可由缆索致动机构110控制。缆索致动机构110是可操作的以在夹紧的构型和打开的构型之间改变铰接的夹爪的转动位置。缆索致动机构110包括一对牵引缆索112、114。缆索致动机构110还包括第一联动装置(linkage)116，其用于围绕枢销88向着夹紧的构型转动铰接的夹爪72，和类似的第二联动装置118，其用于围绕枢销88向着打开的构型转动铰接的夹爪72。第一联动装置116(图8A和8B所示)包括旋转铰链120，其通过枢销122被安装，用于相对于末端效应器基底74的转动。连接铰链124通过枢销126和枢销128将旋转铰链120连接到铰接的夹爪72。第一联动装置116通过牵引缆索112的牵拉运动而被铰接。在手术中，牵引缆索112的牵拉运动以顺时针方向围绕枢销122转动旋转铰链120。产生的连接铰链124的运动以逆时针方向围绕枢销122向着夹紧的构型旋转铰接的夹爪72。
缆索致动机构110的第二联动装置118(图8C至8F所示)包括与第一联动装置116类似的部件，例如，通过枢销132安装的用于相对于末端效应器基底74转动的旋转铰链130，和连接铰链134——其通过两个枢销136、138将旋转铰链130连接到铰接的夹爪72。第二联动装置118通过牵引缆索114的牵拉运动而被铰接。第二联动装置118被配置，以至于牵引缆索114的牵拉运动围绕枢销88向着打开的构型转动铰接的夹爪72。在多种实施方式中，第二联动装置118的连接铰链134和旋转铰链130之间的枢销136与第一联动装置116的连接铰链124和旋转铰链120之间的枢销126是180度异相(out of phase)。缆索致动机构110的牵拉缆索112、114的协调的牵拉和延伸用于在打开的和夹紧的构型之间铰接铰接的夹爪72。为了最佳地提供相等和相对的缆索运动(并由此在下面描述的绞盘驱动的系统中保持缆索张力)，用于枢销122、132的通常的旋转轴被配置，以当铰接的夹爪72关闭(或几乎关闭)和当铰接的夹爪72又打开(或几乎打开)时平放在平面上，该平面含有针对枢销128、138的旋转的轴。第一和第二联动装置116、118的连接铰链124、134围绕该同一平面被对称地相对组装。枢销122、126之间的距离与枢销132、136之间的距离对于第一和第二联动装置116、118是相同的，并且枢销126、128之间的距离与枢销136、138之间的距离对于第一和第二联动装置116、118是相同的。
图9A和9B显示根据多种实施方式通过另一个缆索致动机构140的铰接的夹爪72的铰接。在缆索致动机构的实施方式140中，第一牵引缆索142和第二牵引缆索144直接与铰接的夹爪72的近端连接。第一牵引缆索142绕着第一滑轮146缠绕，以便第一牵引缆索142的牵拉运动使铰接的夹爪72环绕枢销88向着夹紧的构型转动。第二牵引缆索144绕着第二滑轮148缠绕，以便第二牵引缆索144的牵拉运动使铰接的夹爪72环绕枢销88向着打开的构型转动。因此，缆索致动机构140的第一和第二牵拉缆索的协调的牵拉和延伸用于在打开的和夹紧的构型之间铰接铰接的夹爪72。为了最佳地提供相等和相对的缆索运动(并由此在下面描述的绞盘驱动的系统中保持缆索张力)，缆索142环绕枢轴88规定的弧形半径基本上与缆索144环绕枢轴88规定的半径相同。
虽然机构可包括导螺杆、缆索或皮下管，但是交替的机构可用于实现夹紧或订合钉发射。例如，可使用包括推杆/牵拉杆或弹簧的致动机构。
图10是显示上面讨论的导螺杆致动机构的部件的横断面视图。显示的部件包括导螺杆82、导螺杆驱动的凸轮84、末端效应器基底74中的凸轮槽86、远端轴颈表面96、末端效应器基底中的圆柱状插孔154和末端效应器基底74支撑的近端轴承98。
图11是根据多种实施方式的工具组件170的简化图解。工具组件170包括近端致动机构172、具有近端和远端的延长轴174、配置在轴远端的工具主体176、在夹紧的构型和打开的构型之间相对于工具主体176可活动的夹爪178、与夹爪连接的第一致动机构和与夹爪连接的第二致动机构。第一致动机构是可操作的，以在夹紧的构型和打开的构型之间相对于工具主体改变夹爪的位置。第二致动机构具有第一构型——其中夹爪保持处于夹紧的构型——和第二构型——其中夹爪的位置相对于工具主体不受第二致动机构的限制。第一致动机构可操作地与近端致动机构连接。在多种实施方式中，第一致动机构包括一对由近端的致动机构致动的牵拉缆索。第二致动机构可操作地与近端的致动机构连接。在多种实施方式中，第二致动机构包括位于工具主体中的导螺杆驱动的凸轮，其由近端的致动机构经从近端的致动机构延伸通过延长轴174164的驱动轴来驱动。
工具组件170可被配置用于多种应用。例如，工具组件170可被配置为用于近端的致动机构的、具有手动和/或自动致动的手持装置。工具组件170还可被配置用于外科应用，例如，电烙术封闭、缝合、固定等。工具组件170可具有微创机器人手术以外的应用，例如，非机器人微创手术、非微创机器人手术、非机器人的非微创手术以及其它应用——其中公开的多余的夹爪致动的使用将是有益的。
多余的夹爪致动可用于绞接机器人工具末端效应器的夹爪。例如，图12示意地显示利用多余的夹爪致动的机器人工具180。机器人工具180包括近端工具机箱182、驱动电动机184、器械轴186、远端末端效应器188、第一致动机构部分190和第二致动机构192。远端末端效应器188包括铰接的夹爪194。当近端工具机箱182安装到机器人工具机械手196时，近端工具机箱182可拆地安装到具有第一驱动器198的机器人工具机械手196，和与机器人工具180的第一致动机构部分190可操作地连接的第一致动机构部分200。器械轴186具有邻近工具机箱182的近端，和邻近末端效应器188的远端。当工具机箱182安装到工具机械手196时，第一致动机构(包括部分200和部分190)连接第一驱动器198与铰接的夹爪194以在打开的构型和夹紧的构型之间绞接末端效应器188。第二致动机构192连接驱动电动机184与铰接的夹爪194以将发射力施加到订合钉以从末端效应器发射订合钉通过末端效应器的夹爪内夹紧的组织。第一致动机构可以是导螺杆驱动机构，其提供相对高的力以发射订合钉通过组织。第二致动机构可包括驱动轴，其连接驱动电动机184与导螺杆致动机构，例如，上面讨论的提供高的夹紧力模式的导螺杆致动机构。系统180包括夹紧和发射期间分别用于监测第一驱动器198和驱动电动机184的驱动参数的传感器193。传感器193还可检测第一驱动器和驱动电动机的位移以根据电动机的给定的位移或末端效应器的构型来确定期望的驱动参数的可接受的范围。夹紧模式的末端效应器的构型可包括打开的构型、关闭的/夹紧的构型和其间的任何构型。发射模式的末端效应器的构型可包括预发射构型——其中一个或多个订合钉被布置在末端效应器内并通过机构可释放地与驱动电动机184连接，和后发射构型——其中一个或多个订合钉已被发射通过组织，和通常弄弯以封闭组织，订合钉已从末端效应器释放。末端效应器的构型还可包括预发射和后发射模式之间的任何构型。通过检测第一驱动器或驱动电动机的位移，传感器可确定任一模式的末端效应器的给定的构型，以更精确地确定驱动参数的可接受的范围和预测夹紧或发射的失败。
图13是结合本发明的实施方式的遥控机器人外科系统的图解视图。在图13的实例中，医师将命令输入系统以夹紧组织或发射订合钉。响应用户命令，系统开始驱动电动机210以通过夹紧和/或发射机构240驱动夹紧或发射。当机构240实现夹紧或发射时，处理器220监测电动机210的驱动参数，如转矩输出。监测可包括针对电动机或机构的给定的位移比较转矩输出与转矩输出的可接受的范围。处理器220可连接到电动机210、机构240或夹紧或发射期间用于检测电动机或机构的位移的传感器230中的任何一个或全部。响应落在转矩输出(或驱动机构的位移)的可接受的范围外面的监测的驱动参数，处理器220在用户界面的显示器60上输出失败指示250，指示夹紧或发射已失败，或失败的可能性。通常，显示器60包括夹紧或发射期间末端效应器的图像。
图14A-14B显示可出现在系统10的显示器60上的失败指示符250的两个实例。通常，除了夹紧或发射失败的指示符，手术期间外科工具末端效应器的用户界面显示器60图像和/或视觉表示。手术操作期间失败指示符可叠加在用户界面显示器上的图像上以无缝地将要求保护的发明的特征并入手术操作。优选，失败指示符只是当外科医生已命令系统10夹紧或发射订合钉进入夹紧的组织时出现。通过监测驱动参数，操作期间，系统10提供失败的指示。图14A描述显示器60，其中，夹紧失败指示符250叠加在屏幕的右下区，其中失败指示符250指示夹紧成功是可能的，并且系统正继续进行夹紧。图15B描述显示器60，其中，失败指示符250叠加在屏幕的右下区，其中指示符指示夹紧将可能失败。响应监测的在可接受的驱动参数的预设范围外面的驱动夹紧的驱动参数，失败指示符250被输出。
图15A-15B显示夹紧预测指示符250的另外实例。图15A描述以梯度显示夹紧失败的可能性的失败指示符的实例，其中在该实例中，可能性被表示为可能性的百分比。例如，实际监测的驱动参数在预设的驱动参数范围的外面越远，夹紧失败的可能性越大。例如，在一个实施方式中，如果实际的监测的驱动转矩处于预设的靶驱动转矩的5％内，那么系统将显示夹紧成功的90％可能性的指示符。当监测的驱动转矩进一步从靶驱动转矩偏离，可能性以单调的关系降低，如从90％夹紧可能性下降到0％。可选地，驱动参数可以是驱动机构的位移。在这样的实施方式中，系统可监测驱动机构的位移和当位移处于可接受的位移的预设范围外面时指示夹紧或发射失败。图15B描述具有在两种设置之间切换(toggle)的指示符的实施方式。当指示符的等变亮，指示可能的发射失败，否则不指示发射失败。
图16A-16B显示根据本发明的多种实施方式监测的与期望的驱动参数的可接受的范围相关的驱动参数的图。该实施方式显示随着电动机驱动系统的夹紧或发射，系统可仅根据监测电动机的转矩而提供夹紧和/或发射失败的指示。如所显示的，随着电动机实现末端效应器的运动，转矩的预设的范围可与电动机的位移相关而变化。夹紧过程期间系统可使电动机的位移(一个或多个)与末端效应器的位置相关。例如，夹紧期间，随着电动机的位移从si运动到sf，末端效应器的夹爪从打开的构型运动到关闭的(夹紧的)构型。相似地，电动机位移可用于追踪订合钉发射进夹紧的组织期间末端效应器的位置或构型。在多种实施方式中，在进行操作之前，系统将末端效应器的夹爪从第一构型校准到第二构型，如将夹爪从打开的位置校准到关闭的位置，以使电动机的位移与末端效应器的构型相关联。
图16A显示可接受的驱动转矩(t)——其随着电动机位移(一个或多个)而变化——的预设的范围。该范围由两个函数：上边界t上和下边界t下划界。响应与可接受的驱动转矩的预设范围相比的监测的驱动转矩T，系统输出夹紧失败的指示。如果电动机的位移达到sf和系统还未指示可能的夹紧或发射失败，那么系统可提供成功的夹紧或发射的指示。在该实例中，图描述夹紧或发射期间转矩的可接受的范围和监测的驱动转矩为T1。如所显示的，夹紧或发射期间，T1保持在驱动转矩的可接受的范围内，因此系统将输出夹紧或发射可能的成功的指示(其可包括缺少失败的指示)。
图16B显示可接受的驱动转矩(t)的相似的预设范围和两个分开的驱动转矩T2和T3(在不同时间出现)。如所显示的，T2落在转矩的可接受的范围的下边界t下之下。在组织已滑脱出末端效应器的夹爪，并且由于夹爪之间没有组织，需要较小的转矩来关闭夹爪时，这可发生。在这种情况下，系统将在失败点F2输出可能的夹紧失败的指示，在该点系统可暂停夹紧的驱动以防止在失败发生之后由于继续施加夹紧力而造成的任何可能的组织损伤。如果驱动转矩超过可接受的转矩的范围的上边界，失败也可发生，如监测的转矩T3所显示的。在夹爪已夹紧到骨上，并且需要过多量的转矩以达到关闭的/夹紧的构型——可潜在地引起对骨或周围组织的组织损伤——时，这可发生。在该实例中，监测的转矩在失败点F3超过t上，在该点系统可暂停夹紧或发射的驱动以减小组织损伤的可能性。响应失败的检测，除了提供失败的指示以外，系统可暂停驱动参数的驱动或倒转驱动力，以松开组织，。
图17-19图解地显示要求保护的方法的实施方式。图17是示例性方法300的简化表示。方法300包括监测驱动工具夹紧的电动机的驱动参数的步骤302和响应监测的驱动参数在用户界面上输出夹紧期间夹紧失败可能性的指示的步骤304。图18是示例性方法304的简化表示。方法304包括监测驱动工具发射订合钉到夹紧的材料的电动机的驱动参数的步骤305和响应监测的驱动参数在用户界面上输出发射期间发射失败可能性的指示的步骤307。图19是方法310的简化表示，其进一步包括响应用户的夹紧输入而驱动电动机以夹紧组织的步骤312、组织夹紧期间监测电动机的驱动参数的步骤314、响应监测的驱动参数输出夹紧期间夹紧失败的可能性的指示的步骤316和步骤318——如果存在可能的失败的指示暂停电动机的驱动或如果没有可能的失败的指示继续电动机的驱动。图20是方法320的简化表示，其包括响应用户输入驱动电动机夹紧或发射订合钉到夹紧的材料的步骤322、夹紧或发射期间监测驱动参数的步骤324、在用户界面上输出夹紧或发射期间夹紧或发射失败可能性的指示的步骤326。如果没有可能的失败的指示，那么方法320进一步包括继续驱动电动机夹紧或发射的步骤328和当夹紧或发射完成时输出成功信息的步骤330。如果存在可能的失败的指示，那么方法320进一步包括响应指示暂停电动机的驱动的步骤332和输出驱动参数已被暂停的指示的步骤334。
图21-22描述显示要求保护的方法的实施方式的流程图。图21是显示因为将并入微创机器人外科系统而应用到夹紧的要求保护的方法的实施方式的流程图。图22是显示因为将并入图20的机器人外科系统而应用到订合钉发射到夹紧的组织的要求保护的方法的实施方式的流程图。描述的机器人系统可需要用户输入，以命令系统夹紧和/或发射订合钉进入夹紧的组织。
应当理解本文描述的实例和实施方式是用于示例的目的，并且根据其的各种修改或改变将提示给本领域技术人员并包括在本申请的精神和范围内和所附权利要求的范围内。很多不同的组合是可能的，并且这样的组合被认为是本发明的部分。

Claims (12)

1.一种手术吻合器系统，包括：
末端效应器，其包括第一夹爪和第二夹爪以保持订合钉；
驱动系统，其经配置以施加力或转矩以使订合钉发射得以发生；以及
控制器，其连接到所述驱动系统，所述控制器经配置以：
监测施加的所述力或转矩；
确定所述驱动系统的位移；
基于确定的所述驱动系统的所述位移，确定允许成功的订合钉发射在确定的所述驱动系统的所述位移处发生的力或转矩的可接受范围；以及
基于施加的所述力或转矩与所述力或转矩的可接受范围的比较来控制所述驱动系统施加所述力或转矩。
2.根据权利要求1所述的系统，其中控制所述施加所述力或转矩包括暂停施加所述力或转矩。
3.根据权利要求1所述的系统，其中所述控制器被进一步配置为：
确定所述夹爪的位置；以及
基于所述夹爪的所述位置，进一步控制所述驱动系统施加所述力或转矩。
4.根据权利要求1所述的系统，其中所述控制器被进一步配置为保持通过所述夹爪施加夹紧力，同时暂停施加导致所述订合钉发射的所述力或转矩。
5.根据权利要求1所述的系统，其中，所述控制器还被配置为基于所述控制向用户界面输出指示符。
6.根据权利要求5所述的系统，其中，所述指示符具有固定失败的可能性。
7.根据权利要求5所述的系统，其中，所述指示符包括音频，视觉或其他感官指示符中的任何一个或全部。
8.根据权利要求1所述的系统，其中，所述驱动系统包括缆索，皮下管，驱动轴，通用的，单或双万向节以及导螺杆中的任何一个或全部。
9.根据权利要求1所述的系统，其中，大于最大可接受力或转矩的监测到的力或转矩指示卡住。
10.根据权利要求1所述的系统，其中，所述控制器还被配置为响应于所述比较而在最大夹紧时间之前终止所述驱动系统对所述力或转矩的施加。
11.根据权利要求1所述的系统，其中，所述控制器还被配置为响应于所施加的力或转矩小于所述力或转矩的可接受范围的下限而终止所述驱动系统对所述力或转矩的施加。
12.根据权利要求1所述的系统，其中，所述控制器还被配置为响应于所施加的力或转矩小于所述力或转矩的可接受范围的下限而反转所述驱动系统对所述力或转矩的施加方向。
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