CN113133806A

CN113133806A - Flexible surgical instrument

Info

Publication number: CN113133806A
Application number: CN202110278032.8A
Authority: CN
Inventors: 王君臣; 曹旭昶; 孙振
Original assignee: Beihang University
Current assignee: Beihang University
Priority date: 2021-03-15
Filing date: 2021-03-15
Publication date: 2021-07-20
Anticipated expiration: 2041-03-15
Also published as: CN113133806B

Abstract

A flexible surgical instrument comprising a flexible tip portion (01) and a control box portion (02), the flexible tip portion (01) and the control box portion (02) being in mechanical connection therebetween; the flexible tip portion (01) comprises a deployment portion (011), a joint portion (012), and a tip portion (013) connected in sequence; the unfolding part (011) comprises a long rod (1), a snake-shaped piece (2), a fixing ring (3), a pair of bolts (4) and a long joint piece (5); the deployed portion (011) further comprises two ropes (1111); preferably, the two ropes pass through the components and control the unfolding action, one side of the rope is shortened, the other side of the rope is lengthened, and therefore the bending unfolding action is achieved.

Description

Flexible surgical instrument

Technical Field

The invention relates to a surgical instrument, in particular to a flexible surgical instrument which can be used at the tail end of a mechanical arm or used for a minimally invasive anus protection operation for transanal tumor resection.

Background

TEM (Transanal Endoscopic microsurgery) is a minimally invasive, pilot-operated approach to transanal resection of tumors through a specially designed proctoscope (Richard Wolf Medical Instruments corporation io)n, Knittling, Germany), combines a high quality vision system with a pressure regulated insufflation device. The proctoscope has the diameter of 4cm and the axial length of 12cm and 20cm so as to adapt to focuses at different parts, is fixed on an operating table through a fixing device, four operating holes sealed by special rubber sleeves are arranged on a proctoscope surface plate, and various special endoscope equipment comprises tissue grasping forceps, scissors, a straight and bent needle-shaped pointed electric coagulator and the like, and is used for performing operation through the operating holes. Another channel is used for the stereoscope and can be connected with the image monitoring system, low pressure (15mmHg) CO₂The rectum was inflated continuously to fully expose the rectum and the lesion, and the proctoscope is shown in fig. 1.

Compared with the traditional transanal operation, the TEM can reach the upper part of the rectum, the rectum and the focus are exposed clearly after being amplified and inflated, the tissue structure is recognized accurately, the operation of the instrument is not hindered, the needle-like electrotome can carry out accurate blood-free separation and tumor excision, the incisal margin is exposed well, the hemostatic suture of the rectal wall is accurate, and the intestinal stenosis caused by overlapping suture can be avoided. Another advantage is that the lump is not broken after being completely removed, thereby avoiding the contamination of the tumor, being more beneficial to the accurate analysis of the pathology and being helpful for the decision of further operation or radiotherapy. The TEM avoids complications and abdominal wounds caused by major operations, has no pain after the operations, is not limited in movement, is quick to recover, and has significantly shorter operation time, bleeding amount, postoperative analgesia and average hospitalization time than the transabdominal operations.

The surgical tools are two long and thin surgical forceps or surgical scissors, as shown in fig. 2, and the doctor uses the long and thin tools to penetrate through the rubber sleeve hole on the end face of the anorectal endoscope to enter the rectoscope, so as to perform surgical operation on the exposed lesion at the tail end of the anorectal endoscope. In TEM surgery, a surgeon needs to perform complicated operations such as excision of a lesion, suture knot tying, etc., and a general rigid tool is difficult to stabilize during operation due to its slim shape, and the two tools often interfere with each other during the surgeon's two-handed operation. Due to the influence of surgical tools, the TEM operation is difficult to shorten the operation time, which causes the doctor to easily generate fatigue during the operation, and influences the operation hand feeling and the operation precision.

Disclosure of Invention

In order to solve the problems, the invention provides a flexible multi-degree-of-freedom instrument which can replace a slender surgical tool used in the common TEM operation and enter a human body through a transanal rectoscope to perform the operation. When a doctor performs an operation, the flexible multi-degree-of-freedom surgical instrument can be operated to perform complex operations such as nidus excision, suture knot tying and the like. The invention can be unfolded after entering the human body, a larger operation space is obtained, the mutual interference between two tools is avoided, and a single instrument has a plurality of degrees of freedom of up-down pitching, left-right swinging, wrist twisting and clamping. The invention can completely replace common operation tools, can be arranged on a mechanical arm, and is operated and controlled remotely by a doctor under the visual field of an endoscope by using a master-slave operation method.

Embodiments of the present invention provide a flexible surgical instrument comprising a flexible tip portion (01) and a control box portion (02), a mechanical connection between the flexible tip portion (01) and the control box portion (02);

the flexible tip portion (01) comprises a deployment portion (011), a joint portion (012), and a tip portion (013) connected in sequence;

the unfolding part (011) comprises a long rod (1), a snake-shaped piece (2), a fixing ring (3), a pair of bolts (4) and a long joint piece (5); the deployed portion (011) further comprises two ropes (1111);

preferably, the two ropes pass through the components and control the unfolding action, one side of the rope is shortened, the other side of the rope is lengthened, and therefore the bending unfolding action is achieved.

According to one embodiment of the invention, for example, the articulation part (012) comprises a plurality of cardan joints comprising a pair of articulation patches (12 and 12 '), two pairs of M2x4 countersunk bolts (13 and 13'), a copper cardan shaft (14) and a short articulation (15);

preferably, the joint part (012) comprises four ropes uniformly distributed on the circumference of the cross section of the joint part (012), the four ropes are mutually matched through calculation of a control algorithm, and the tail ends of the four ropes are fixed on a tail end joint piece by knots;

preferably, the joint part (012) includes 4 cardan joints.

According to one embodiment of the invention, for example, the end part (013) comprises a conduit (22), a bolt (23), a rotating shaft (24), a bearing (25), a bolt (26), an end face retainer ring (27), a fixed clamp (28), a movable clamp (29), a tamping screw (210) and a nut (211), wherein the conduit (22) is fixedly connected to the end knuckle (1X) by a pair of M1.6 bolts (23);

preferably, the bearing (25) and the rotating shaft (24) are arranged in the conduit (22), the inner diameter of the bearing (25) is 5mm, the outer diameter is 9mm, the width is 3mm, the bearing is tightly matched with the rotating shaft (24) in an interference fit mode, and one side of the rotating shaft (24) is provided with external threads for connecting with the fixing clamp (28);

preferably, the end face retainer ring (27) is fixed to the conduit (22) by a pair of bolts (26) to limit axial movement of the bearing; the movable clamp (29) is connected to the fixed clamp (28) through the plugging screw (210) and the nut (211).

According to one embodiment of the invention, for example, the long rod (1), the snake (2), the long joint (5), the short joint (15), the end joint, and the rotation shaft (24) all have a hollow tube structure so that four ropes controlling both motions of the end tool pliers can pass therethrough;

preferably, two transverse ropes (1113) control the circumferential rotation of the tool clamp, similar to the rotation of a wrist of a person, and the two transverse ropes (1113) enter the inner part of the conduit (22) through a hollow hole at the center of the flexible tail end, are wound on the rotating shaft (24) in a left-handed mode and a right-handed mode respectively and are finally fixed on the rotating shaft (24) by knots; two longitudinal ropes (1114) pass through a hollow hole inside the rotating shaft (24) to reach the position of the movable clamp (29) at the tail end, and the two longitudinal ropes (1114) are wound on the movable clamp (29) from the inside and the outside respectively and are used for realizing the opening and closing actions.

According to one embodiment of the invention, for example, the top of the control box (02) is provided with a flange surface (31);

7 line shafts are arranged in a control box (02), and the rotating action of the 7 line shafts is transmitted to the flexible end part (01) through a rope wound on the 7 line shafts and is converted into various complex actions of the flexible end part (01); the first reel shaft (41), the second reel shaft (42), the third reel shaft (43) and the fourth reel shaft (44) are respectively wound with a rope to control the bending of the joint part (012), the two ropes on the fifth reel shaft (45) respectively control the forward and reverse twisting of the wrist part of the end tool pliers, the two ropes on the sixth reel shaft (46) control the opening and closing of the tool pliers, and the two ropes on the seventh reel shaft (47) control the unfolding and returning of the unfolding joint.

According to one embodiment of the invention, for example, a decoupling mechanism is arranged inside the control box (02), and comprises a winding sliding block (51), a spring (52), a supporting rod (53), a decoupling block (54), a first bolt (55), a fixing plate (56), a second bolt (57) and a lead block (58).

According to one embodiment of the invention, for example, the winding slider (51) has a through hole, the supporting rod (53) passes through the through hole, the spring (52) is mounted on the supporting rod (53), the supporting rod (53) is fixed on the decoupling block (54) by a first bolt (55), the fixing plate (56) is arranged above the decoupling block (54) and fixed on the decoupling block (54) by a second bolt (57), and the fixing plate (56) is designed with a sliding slot corresponding to the sliding slot on the bottom plate, so that the winding slider (51) can slide in the sliding slot;

preferably, the decoupling mechanism further comprises a pair of wire blocks (58); when the length of the rope in the flexible tail end is changed due to bending movement, the winding sliding block (51) in the decoupling mechanism moves correspondingly and presses the spring (52), so that the changed length of the rope is compensated and certain tension is always kept.

According to one embodiment of the invention, for example, the control box (02) further comprises a power driving part, wherein the power driving part comprises a motor frame (61) and a support rod (62); the motor frame (61) is connected with the bottom plate of the control box through the support rod (62); the positions of the 7 motors correspond to the positions of the 7 line shafts on the bottom plate, the motor shafts are connected with the line shafts through the couplers, and when the motors are controlled to rotate, the line shafts can be controlled, so that the action of the flexible tail end is controlled.

Drawings

Fig. 1 is a schematic view of a conventional proctoscope structure.

Fig. 2 is a surgical tool commonly used in minimally invasive anal protection surgery for transanal resection of a tumor.

Fig. 3 is a schematic view of the overall structure of the flexible surgical instrument according to the embodiment of the present invention.

Fig. 4 is a schematic view of a bolt connection structure.

Fig. 5 is a schematic view of the structure of the expanded portion.

Fig. 6 is a detailed structural diagram of the joint portion.

Figure 7 is a schematic view of the maximum bending angle of the joint portion.

Fig. 8 is a schematic view of the overall structure of the tip portion.

Fig. 9 is a schematic view of the degrees of freedom of the tip portion.

Fig. 10 is a schematic diagram of the rotation of the tool holder.

Fig. 11 is a control box top structure.

Fig. 12 is a schematic view of the internal structure of the control box.

Fig. 13 is a schematic view of the sectional structure of the inside of the control box.

Fig. 14-15 are schematic diagrams of the routing pattern in the control box.

Fig. 16 is a schematic structural view of the decoupling mechanism.

Fig. 17 is a schematic structural view of a power driving portion.

Detailed Description

In order to make the objects, technical solutions and advantages of the present invention more apparent, the present invention is described in further detail below with reference to specific embodiments and the accompanying drawings. Those skilled in the art will appreciate that the present invention is not limited to the drawings and the following examples.

In the description of the present invention, it should be noted that the orientation or positional relationship indicated by the terms "length", "width", "upper", "lower", "far", "near", etc., are based on the orientation or positional relationship shown in the drawings, and are only for convenience of description and simplification of description, but do not indicate or imply that the device or element referred to must have a specific orientation, be constructed in a specific orientation, and be operated, and should not be construed as limiting the specific scope of the present invention. Furthermore, the terms "first" and "second" are used for descriptive purposes only to distinguish technical features, have no essential meaning, and are not to be construed as indicating or implying relative importance or implicitly indicating the number of technical features.

The invention aims to solve the problems that the existing TEM operation tools interfere with each other, are difficult to stabilize, are difficult to operate accurately and are easy to fatigue after being used for a long time, and further provides a multi-degree-of-freedom flexible operation instrument which is high in flexibility and stable, and a doctor performs an operation by adopting a master-slave control method.

The flexible surgical instrument has a general structure as shown in fig. 3, and includes a flexible tip portion 01 and a control box portion 02. In order to minimize the volume of the surgical instrument entering the human body, the present embodiment controls the flexible end portion 01 by means of external linear driving, that is, no power driving element is provided inside the flexible end portion 01, all driving elements are disposed in the external control box portion 02, the driving action of the driving elements is transmitted to the flexible end portion 01 by a rope, and the flexible end portion 01 performs the desired action through a certain control algorithm, which will be described in detail below.

The present embodiment provides a flexible surgical instrument comprising a flexible tip portion 01 and a control box portion 02, which are mechanically connected, for example, by using a bolt of M4x8 standard, as shown in fig. 4. The structures of the flexible end portion 01 and the control box portion 02 will be described separately below.

As shown in fig. 3, the flexible tip portion 01 includes a deployed portion 011, an articulation portion 012, and a tip portion 013.

As shown in fig. 5, which is a schematic structural view of the expanded portion 011, and an exploded view on the left side, the expanded portion 011 includes a long rod 1, a serpentine member 2, a fixing ring 3, a pair of m1.6x3 bolts 4, and a long joint member 5. The right side is a unfolding action schematic, which comprises two ropes 1111, the two ropes pass through the components and control the unfolding action, one side of the ropes is shortened, the other side of the ropes is lengthened, and therefore the bending unfolding action is realized.

Fig. 6 is a detailed structural diagram of the joint part 012. It should be noted that the joint part 012 may include a plurality of cardan shaft joints, and fig. 6 shows the structure of one of the cardan shaft joints. In order to provide a high degree of flexibility in the redundant portion of the tip to meet the requirements of complex operations, the joint is a cardan joint, so that the tip can reach a wider range in space, reference numeral 5 in fig. 6 corresponding to the long joint member 5 in fig. 5. As shown in fig. 6, the joint part 012 includes a pair of joint patches 12 and 12 ', two pairs of M2x4 countersunk bolts 13 and 13', a copper cardan shaft 14, and a short joint 15. The bending action of the whole flexible tail end is controlled by pulling four ropes, the four ropes are uniformly distributed on the circumference of the cross section of the flexible tail end, as shown in fig. 6, 1112 indicates two ropes on one side (the other two ropes are on the opposite side), the four ropes are wound and unwound through calculation of a control algorithm and are matched with each other, and the tail end of each rope is fixed on a tail end joint piece through a knot. Each cardan joint can be bent in a horizontal or vertical plane by a maximum of 20 degrees, in space by a maximum of 27.99 degrees. In the present embodiment, there are 4 cardan joints in total in the entire joint part 012, ensuring that the joint part 012 can perform a bending motion that deviates from the axis by a maximum of 111.96 degrees, as shown in fig. 7.

The general construction of the end portion 013 is shown in fig. 8, with two degrees of freedom for gripping and axial rotation of the tool holder, as shown in fig. 9. As shown in FIG. 8, 1X is the end joint member, and the end joint member is connected with the last short joint member by a universal shaft. The tip portion 013 comprises the conduit 22, the bolt 23, the rotating shaft 24, the bearing 25, the M1.6 bolt 26, the end retainer 27, the fixed jaw 28, the moveable jaw 29, the tucking screw 210, the M2 nut 211, wherein the conduit 22 is attached to the tip joint 1X using a pair of M1.6 bolts 23. In conduit 22 is a combination of bearing 25 and shaft 24, bearing 25 having an inner diameter of 5mm, an outer diameter of 9mm and a width of 3mm, which is a tight fit with shaft 24 by interference fit, and shaft 24 having an external thread on one side for connection with retaining clip 28. The end stop 27 is shown secured to the conduit 22 by a pair of M1.6 bolts 26 to limit axial movement of the bearing. The movable jaw 29 is attached to the fixed jaw 28 by a tucker screw 210 and an M2 nut 211, which requires a loose fit to ensure the jaw's freedom to close. The details of the conduit and the tool holder are explained in the following section.

The long rod 1, the serpentine member 2, the long joint member 5, the short joint member 15, the end joint member, and the rotation shaft 24 mentioned in the foregoing are all of a hollow pipe structure so that four ropes for controlling both motions of the end tool pliers can be passed. As shown in fig. 10, two transverse cords 1113 (corresponding to the two-dot chain lines in fig. 14) control the circumferential rotation of the tool holder, similar to the rotation of a human wrist. The two transverse ropes 1113 enter the conduit 22 through the hollow hole at the center of the flexible end, and are wound on the rotating shaft 24 in a left-handed and right-handed manner respectively, and are finally fixed on the rotating shaft 24 by knots. Two longitudinal cords 1114 (corresponding to the single-dot chain lines in fig. 14) pass through the hollow inside the rotating shaft 24 to reach the position of the endmost movable jaw 29, and the two longitudinal cords 1114 are wound around the movable jaw 29 from the inside and the outside respectively for realizing the opening and closing actions respectively.

The above is the structure of the flexible end portion 01, and the structure of the control box 02 is described below.

As shown in fig. 11, the top of the control box 02 has a flange surface 31, which can be mounted at the end of the KUKA 7 robot arm, and the robot arm carries the flexible surgical instrument for movement as a whole.

Inside the control box 02, the main structure is 7 line axes, as shown in fig. 12. The rotation motion of the 7 line shafts is transmitted to the flexible end portion 01 through the rope wound thereon, and is converted into a plurality of complex motions of the flexible end portion 01. The first reel shaft 41, the second reel shaft 42, the third reel shaft 43 and the fourth reel shaft 44 are respectively wound with a rope to control the bending of the joint part 012, the fifth reel shaft 45 is respectively controlled by the two ropes to control the forward and reverse twisting of the wrist part of the end tool pliers, the sixth reel shaft 46 is controlled by the two ropes to control the opening and closing of the tool pliers, and the seventh reel shaft 47 is controlled by the two ropes to control the unfolding and returning of the unfolding joint. The structure of 7 line shafts is shown in figure 12, the center is a stepped shaft, the light color part is a line wheel, and each line wheel is fixed on the stepped shaft by a pair of M2x8 bolts. A pair of GB607 bearings are arranged at two ends of the shaft, and each line shaft is arranged on the bottom plate of the control box by using a fixed plate in an assembly mode shown in a sectional view of FIG. 13.

The specific routing manner in the control box is shown in fig. 14 and 15. A, B, C shown in fig. 15 are three pieces of wire for the wire. At B, C the middle of the guide roller is a decoupling mechanism. Due to the tandem configuration of the flexible shaft, when the flexible shaft portion is bent, the overall length of its central axis will change, creating a coupled motion that results in tightening or loosening of the four cables used to control the gripping of the end tool pliers and the rotation of the wrist. To compensate for the varying lengths, and to maintain the rope tension within a certain range, a decoupling mechanism is designed as shown in fig. 16.

The structure of the decoupling mechanism is shown in fig. 16. The decoupling mechanism comprises a winding slide block 51, a spring 52, a support rod 53, a decoupling block 54, an M4 bolt 55, a fixing plate 56, an M4 bolt 57 and a lead block 58. The winding sliding block 51 can slide on a supporting rod 53, a spring 52 is arranged on the supporting rod 53 in order to keep a certain tension of the rope, a decoupling block 54 is the main body of the whole decoupling mechanism, the supporting rod 53 is fixed on the decoupling block by an M4 bolt 55, a fixing plate 56 is arranged above the decoupling block and is fixed on the decoupling block 54 by a pair of M4 bolts 57, and a sliding groove is designed on the fixing plate 56 and corresponds to the sliding groove on the bottom plate, so that the winding sliding block 51 can slide in the sliding groove. 58 are a pair of wire blocks. When the length of the cord in the flexible end changes due to the bending movement, the winding slider 51 in the decoupling mechanism moves accordingly and presses the spring 52, so that the changed length of the cord is compensated and always kept under a certain tension.

As shown in fig. 17, a power driving part includes a motor frame 61 and a strut 62. The motor frame 61 is connected with the bottom plate of the control box by a supporting rod 62. The positions of the 7 motors correspond to the positions of seven line shafts on the bottom plate, the motor shafts are connected with the line shafts through the couplers, and when the motors are controlled to rotate, the line shafts can be controlled, so that the action of the flexible tail end is controlled.

Claims

1. A flexible surgical instrument, characterized in that it comprises a flexible tip portion (01) and a control box portion (02), a mechanical connection between the flexible tip portion (01) and the control box portion (02);

2. The flexible surgical instrument according to claim 1, wherein the joint part (012) comprises a plurality of cardan joints including a pair of joint patches (12 and 12 '), two pairs of M2x4 countersunk head bolts (13 and 13'), a copper cardan shaft (14), and a short joint (15);

preferably, the joint part (012) includes 4 cardan joints.

3. The flexible surgical instrument according to claim 1 or 2, wherein the tip portion (013) comprises a wire guide (22), a bolt (23), a rotating shaft (24), a bearing (25), a bolt (26), an end face retainer (27), a stationary jaw (28), a movable jaw (29), a setscrew (210), a nut (211), wherein the wire guide (22) is attached to the tip joint (1X) using a pair of M1.6 bolts (23);

4. The flexible surgical instrument according to any one of claims 1-3, wherein the long shaft (1), the snake (2), the long joint (5), the short joint (15), the end joint, and the rotation shaft (24) all have a hollow tube structure so that four cords controlling both motions of the end tool forceps can pass therethrough;

5. The flexible surgical instrument according to any one of claims 1 to 4, wherein the control box (02) has a flange face (31) at the top;

6. The flexible surgical instrument according to any one of claims 1 to 5, characterized in that a decoupling mechanism is arranged inside the control box (02), the decoupling mechanism comprising a winding slider (51), a spring (52), a support rod (53), a decoupling block (54), a first bolt (55), a fixing plate (56), a second bolt (57), a wire block (58).

7. The flexible surgical instrument according to claim 6, wherein the wire-wound slider (51) has a through hole through which the support rod (53) passes, the spring (52) is mounted on the support rod (53), the support rod (53) is fixed on the decoupling block (54) by a first bolt (55), the fixing plate (56) is disposed above the decoupling block (54) and fixed on the decoupling block (54) by a second bolt (57), and the fixing plate (56) is designed with a sliding slot corresponding to the sliding slot on the base plate so that the wire-wound slider (51) can slide therein;

8. The flexible surgical instrument according to any one of claims 1-7, wherein the control box (02) further comprises a powered drive portion comprising a motor mount (61) and a strut (62); the motor frame (61) is connected with the bottom plate of the control box through the support rod (62); the positions of the 7 motors correspond to the positions of the 7 line shafts on the bottom plate, the motor shafts are connected with the line shafts through the couplers, and when the motors are controlled to rotate, the line shafts can be controlled, so that the action of the flexible tail end is controlled.