CN116546936A

CN116546936A - Surgical tool for robotic surgery and robotic surgical assembly

Info

Publication number: CN116546936A
Application number: CN202180081923.2A
Authority: CN
Inventors: 马西米利亚诺·西米; 朱塞佩·玛利亚·普里斯科; 乔基奥·拉扎里
Original assignee: Medical Micro Instruments Co
Current assignee: Medical Micro Instruments Co
Priority date: 2020-12-22
Filing date: 2021-12-17
Publication date: 2023-08-04
Also published as: JP2023554516A; WO2022137052A1; EP4267033A1

Abstract

A robotic surgical assembly (100) comprising a medical instrument (60, 160, 260) comprising: a frame (57), and an articulating device (70) having a degree of freedom relative to the frame, and at least one tendon (90, 190) made of polymer fibers for actuating the degree of freedom; wherein the at least one tendon (90) comprises a tendon end point (92) connected to the medical instrument to apply a tensile load for actuating the degree of freedom; to actuate the degrees of freedom, the at least one tendon (90, 190) slides over at least a portion of the articulating device (70) while in contact with the at least a portion; the at least one tendon (90) is made of a braided strand, which strand consists of the polymer fibers.

Description

Surgical tool for robotic surgery and robotic surgical assembly

Technical Field

The present invention relates to a robotic surgical assembly.

In particular, the robotic surgical assembly according to the invention comprises at least one tendon-actuated medical instrument.

Background

Robotic assemblies for surgery or microsurgery that include an articulated robotic arm terminating in a surgical instrument are known in the art. For example, document US-71553116-B2 discloses a robotic assembly for performing brain microsurgery under MRI (magnetic resonance imaging) guidance, comprising an MRI-based image acquisition system and two multi-articulated arms, each having three rotational joints with vertical axes to avoid direct gravitational loading (as shown for example in fig. 7 of said document US-7155316-B2), each rotational joint being connected to its respective end effector, which is given an internal degree of freedom of movement for gripping.

The solutions available in the prior art, while providing some advantages, require a movement strategy that involves multiple independent movements simultaneously, even for small movements of the surgical instrument in the surgical workplace, which results in difficulties in controlling the accuracy of the movements and in a great deal of obstruction in the surgical workplace that effectively renders the surgeon inaccessible. Indeed, most of the fields of application of robotic assemblies for surgery based on master-slave paradigms are dedicated to minimally invasive surgery (or MIS), such as laparoscopic or endoscopic surgery. In both applications, the kinematics of the robotic assembly is intended to optimize the access of the surgical instrument to the surgical field through a surgical port or aperture, which is a technique that requires coordination of multiple degrees of freedom of movement. In contrast, surgical and microsurgical applications in open surgery require precise kinematic control of translational motion over a working space limited by the field of view of the surgical microscope, without restricting the kinematic constraints represented by the surgical port or natural orifice, and thus benefit from the ability of the surgeon to directly access the surgical field.

It is also notable that the performance of the primary surgical elements (e.g., tissue tensioning and stomal suturing) requires the ability to orient the surgical instrument tip in a large spatial cone direction and rotate (turn) the instrument about its longitudinal axis, for example, to guide the needle through the tissue with the tip of the needle-holding instrument in a manner similar to human hand engagement at the wrist and elbow joints.

Robotic assemblies for surgery or microsurgery comprising a teleoperated master-slave system are generally known, as described for example in document US-6963792-a, and more specifically, the microsurgery applications of US-6385509-B2 and US-2014-0135794-A1 describe a kinematic solution for the movement of the surgical instrument tip, which requires coordination of a plurality of joints in a continuous kinematic chain of a cluttered surgical zone. This impeding effect becomes more pronounced as the joint of the articulating instrument tip is further from the tip itself. Furthermore, the microsurgical system does not allow for proper movement, and more particularly, proper reorientation, of the instrument tip at the surgical site within lesions as small as 10 centimeters from the skin surface.

In general, even a professional operator needs a long training to grasp the master instruction device employed in the known master-slave system. In fact, the known master devices have a long learning curve, mainly because they are mechanically linked to the motion recording station, which necessarily limits their motion in an unfamiliar way and tend to have a large size. Thus, the known master devices are not inherently suitable for replicating the function of conventional open surgical instruments and lack the ability to perform large linear and angular motion spectrums in three dimensions.

For example, document US-8521331-B2 discloses a robotic device for laparoscopic surgery, wherein the main instruction device has a shape allowing the surgeon to wear it as a glove on his-her fingers. According to another embodiment shown in fig. 2B of said patent, the main command device has the shape of a joystick, a portion of which is attached to the wrist of the surgeon and extends so as to hold it with only one hand, comprising a cylindrical shank with a pair of lateral wings that can register the gripping movement. The surgeon utilizes a laparoscopic display device integral with the instruction device.

The above solution, while partially advantageous for laparoscopic surgery, does not fully solve the problem, and thus long-term training of the surgeon is still necessary before the instruction device is skillfully operated rather than a familiar open surgical instrument.

It is well known that the implementation of microsurgery requires a high level of dexterity and experience by using optical microscopes or magnifiers, surgeons who are required to work with the limitations of physiological tremors and the precision achievable by human hand movements on such scales.

The adoption of the robot technology can bring great benefits, not only can realize the high-degree miniaturization of the instrument, but also can enlarge the movement range in the operation area, thereby eliminating the influence of physiological tremors and simplifying the manual task. For example, microsurgical procedures are performed in several stages of reconstructing biological tissue, such as in performing vascular anastomosis involving small diameter vessels and nerves. These procedures are performed in order to reconstruct the anatomy, reattach the limb, and re-vascularize the tissue after a traumatic wound or a wound created by surgical excision of the tissue, all in an open surgical device with a pre-existing surface wound.

Other examples of applications of microsurgical techniques may be found in implantation, neurosurgery, or vascular surgery, as well as in surgery around and within the eye and in the inner ear, such as in the case of cochlear implants. In addition, the prominent surgical procedure for cardiac bypass involves a critical step in coronary anastomosis. The need for miniaturization of instruments can also be felt in other surgical techniques, for example in minimally invasive surgical procedures aimed at limiting the invasiveness of the surgical instrument on biological tissues, such as laparoscopic and endoscopic procedures. Regarding laparoscopic surgery, the technical solutions known in the art are not satisfactory in terms of miniaturization of the diameter of laparoscopic instruments used in single incision laparoscopic surgery or single port surgery. Furthermore, it is notable that endoscopes commonly used in MIS have instrument channels between 1mm and 3.2mm in diameter. These dimensions limit the functionality of current surgical instruments available through endoscopic instrument channels, which are currently generally only capable of performing a grasping action.

Medical devices including articulating devices suitable for use in operation on a patient are generally known in the art. For example, document WO-2010-009221-A2 shows a robotic surgical instrument comprising a distal articulation device capable of providing three degrees of freedom of movement using only four actuation cables, pitch, yaw and grip (grip), respectively. Such cables slide inside a guide channel or sheath present in the body of the articulated device.

The solution limits the miniaturization of the robotic articulated device, since the friction between the surface of the guide channel and the cables sliding inside it limits the positioning accuracy achievable by the articulated device. As is known in the art, as the physical size of medical devices decreases, difficulties arise in connection with an increase in the correlation of surface forces (e.g., friction forces) that predominate over volumetric forces. This phenomenon requires a solution that resorts to minimizing friction and at the same time minimizing the ineffective movement of the mechanical device. The loss of positioning accuracy of the articulating device is a fundamental technical obstacle to further miniaturization of the articulating instrument, since with miniaturization the stiffness of the driving member (tendon) decreases in the quadratic sense of its diameter, making it more difficult to overcome friction for accurate positioning of the instrument tip. Furthermore, this solution requires a tendon guiding system comprising channels and guiding surfaces around the cable, which makes the pitch and yaw links and the instrument shaft very difficult to miniaturize using known manufacturing methods (e.g. injection molding and machining) and prone to mechanical weaknesses in several locations.

In order to simplify the miniaturization of surgical instruments, said document WO-2010-009221-A2 presents an advantageous opportunity: the number of actuating tendon ends associated with three degrees of freedom is reduced from six to four, actuation of the torque exerted on the pitch links by the cables terminating on the yaw links (see fig. 4-a of the cited document), and selective pulling and releasing of these cables is required for this purpose due to the kinematic mechanism comprising a plurality of gears. Furthermore, the described drive system requires that each end of the actuation tendon is attached to a capstan that selectively winds up the tendon causing the pulling. The presence of mechanical aspects (such as the capstan and the toothing, which are known to be affected by lost motion) makes it difficult to drive the micro-hinges, since the lost motion in the drive system is translated into angular play of the joint, which increases as the articulation becomes smaller. The drive system is also not adapted to maintain a low preload on the actuation cable to further limit friction and wear.

Moreover, the described solution for tendon ends comprises a tortuous path for trapping the tendon in some sections. Such solutions require the use of cables that are sufficiently resistant to such capture, such as steel cables or cables with diameters greater than other requirements.

Further examples of actuation cables for surgical instruments are disclosed in documents US-6371952-B1, US6394998-B1 and WO-2010-005657-A2, which are adapted to slide when pulled or pushed within a sheath or guide channel, for example obtained on a side surface of a pulley. In particular, the latter document discloses a solution in which the actuation cables follow a trajectory that is traversed when the actuation cables travel around pulleys comprising guide channels, in order to avoid the cables interfering with each other, limiting the efficacy of their transmission of motion to the articulated device, for example in the case of binding or sliding one tendon onto another. The provision of an idler wheel, which must have a diameter close to half the diameter of the instrument (as shown in figure 4 of the cited document WO-2010-005657-A2) and be attached to a link (e.g. a link integral with the instrument shaft) or to a pitch link to guide the tendon across, is a considerable obstacle to miniaturisation. Furthermore, providing grooves and walls to achieve a channel for actuation cables is another obstacle to miniaturization of the shaft or cannula diameter of a medical or surgical instrument.

Document US-2003-0034748-a discloses a solution suitable for reducing the diameter of a surgical instrument to 5.1 mm. The instrument is foreseen to use a series of discs for use as vertebrae, providing a certain flexibility.

Nevertheless, this solution is not suitable for realizing a compact joint that can extend about one instrument diameter (or in other words has a radius of curvature similar to its diameter). This can alternatively be achieved by those hinges described in the above-cited documents based on a pivoting joint consisting of a pure axis of rotation.

Another obstacle to miniaturization of articulating or articulating devices is the challenge of manufacturing and assembling three-dimensional micromechanical components with sufficient precision at reasonable process costs. The need to generate relatively high forces at the tip in devices having sub-millimeter dimensions suggests the use of very rigid metals, such as tool steel, for such components.

It is well known that biomedical devices are commonly manufactured using manufacturing techniques from the microelectronics industry. For example, laser or water jet cutting is not suitable for three-dimensional rapid machining. Injection molding does not now produce sufficiently high tolerance parts. In contrast, electro-discharge machining (EDM) can produce satisfactory performance in terms of geometric tolerances required for surface finishing and mechanical design. EDM generally requires a slow and expensive process. For example, document US-6768076-B2 discloses a clamp for EDM capable of supporting a workpiece to be cut in a single plane.

However, the clamps are not suitable for repeated placement of the workpiece, e.g., laborious manufacturing processes requiring complex recalibration operations each time a cut is made in a different plane, because the clamps cannot be rotated when the workpiece is being processed in a manner that allows the EDM to work in multiple cutting planes. This results in loss of precision and thus in reduced precision of dimensional and geometric tolerances.

There is a strong need for a surgical robotic assembly that is capable of performing precise movements and simply controlling a wrist medical instrument of a surgical workspace (e.g., within an anatomical region of a patient). At the same time, there is a need to develop a reliable robotic assembly featuring a simple driving method without degrading its accuracy. Further, there is a need for a robotic assembly that is more versatile than known assemblies and capable of performing a wider variety of surgical procedures.

Accordingly, there is an urgent need to provide a driving device for microsurgery that is adapted to form a main interface in a robotic assembly for microsurgery that includes a master-slave teleoperational system that is simpler and more intuitive to manipulate microsurgery than known solutions without limiting its functionality. Also, there is an urgent need to provide a main interface that can be grasped more quickly and easily by the surgeon. Furthermore, there is an urgent need to provide a command device that is more versatile than the known solutions and that can be applied to different types of microsurgery.

Accordingly, there is a strong need to provide an articulating or articulated medical instrument, or an assembly comprising an articulating or articulated device, which is structurally and functionally suitable for extreme miniaturization without compromising its reliability and safety. There is also a strong need to provide an articulating or articulating medical instrument or assembly including an articulating device that is suitable for performing a wide variety of medical surgical procedures. Finally, there is a great need to provide an articulating or articulating medical instrument or assembly comprising an articulating or articulating device that is durable and capable of periodic maintenance without compromising its sterility or reliability.

There is an urgent need to provide an articulating or articulating medical instrument or assembly comprising an articulating device that is simplified in manufacture compared to known solutions.

There is an urgent need to provide a method of manufacturing such medical devices that is more efficient than known solutions and guarantees the level of precision required for assembly.

There is an urgent need to provide a manufacturing method for medical devices that ensures a faster machining process without compromising the precision of production.

Further, there is an urgent need to provide a manufacturing method suitable for producing extremely miniaturized components without reducing the precision of fine manufacturing and the ease of assembly of the produced components.

Accordingly, there is an urgent need to provide a tendon-or actuation cable-based driving device for medical instruments that is suitable for extreme miniaturization without compromising its accuracy or reliability in use.

Furthermore, there is an urgent need to provide a tendon-or actuation cable-based driver device for a medical instrument that ensures a predetermined preload of the tendons, even if slight, and wherein the force of the preload can be defined for each of the tendons individually.

Furthermore, there is an urgent need to provide a tendon-or actuation cable-based drive system for medical devices that can ensure a proper level of sterility for the medical device itself, in particular for the parts of the medical device intended to come into contact with the anatomy of the patient.

Furthermore, there is an urgent need to provide a tendon-based drive system without gaps.

Furthermore, there is an urgent need to provide a tendon-based drive system that can replicate the drive accuracy achieved, for example, by a precision micrometer cutter or piezoelectric drive system.

Accordingly, there is a strong need to provide a tendon or actuation cable for medical devices characterized by being adapted for extreme miniaturization without compromising resistance or reliability in use.

Furthermore, there is an urgent need to provide a tendon for a medical device, which is adapted to slide over at least a portion of the device and which has improved friction properties with respect to known solutions.

Furthermore, there is an urgent need to provide a solution for a tendon of a medical device that works exclusively with a tensile load applied at its end points, without including a deflection of the path of the tendon that may cause it to reduce its resistance.

Furthermore, there is an urgent need to provide a tendon for a medical device and a method for replacing a tendon which is adapted to increase the service life of the medical device relative to known solutions without compromising its performance in terms of sterility and reliability.

There is an urgent need to miniaturize medical devices.

There is an urgent need to reduce the known size of medical devices.

For example, document WO-2014-151952-A1 shows a medical instrument comprising a plurality of links forming an articulated device, the medical instrument having an actuation cable wound around a plurality of pulleys rotatably supported on shafts of which cantilevers are provided on the links of the medical instrument. This solution is characterized by a large number of components and the layout of the pulleys provided on the shaft forces the machining of the shaft against the stresses due to the use of medical instruments, so that it results unsuitable for miniaturization, in fact the device cannot measure diameters smaller than 10 mm. Similar solutions are shown, for example, in documents US-6676684-A, US-2009-012230-a and US-2003-135204-A1.

There is therefore an urgent need to reduce the number of components forming the medical device.

For example, document WO-03-001986-A1 shows a medical instrument comprising a plurality of disc-shaped links forming an articulated device, wherein each of said links comprises a plurality of holes for guiding actuation cables. Thus, this solution is not suitable for miniaturization, since the execution of the micrometric holes in such connecting rods is very unsatisfactory, and at the same time, the provision of actuation cables that slide within these holes without damage is unsatisfactory.

There is therefore an urgent need to obtain an accurate guidance of the actuation cable without providing micro holes on the links and at the same time reduce the number of parts forming the medical device.

For example, document US-2008-177285-A1 discloses a medical instrument comprising a plurality of links, wherein some links comprise two protruding pins adapted to guide the deflection of an actuation cable. Although satisfactory in some respects, such a solution is also not suitable for miniaturization, since the dimensions of the protruding pins cannot be reduced without compromising the integrity of the links constituting the medical device. Accordingly, there is a strong need to provide a miniaturized medical device having a plurality of links actuated by means of actuation cables without compromising the structural resistance and safety of the medical device in use.

Miniaturization of surgical articulating instruments requires miniaturization of all components, including actuation devices in the case of cable drive mechanisms, such as tendons. Metal multi-strand cables are commonly used to actuate articulating end effectors, endoscopes, or catheters of robotic wrist instruments; however, with all the components that make up the surgical articulating instrument, the metal cables or tendons are difficult to miniaturize and present some functional drawbacks.

In particular, the friction between the micro-metal tendons and other miniaturized components is very high, requiring very high tensile forces, and even causing severe wear of the metal tendons and the instrument components, thereby greatly reducing the reliability, lifetime and limiting performance of the instrument.

Furthermore, it is known that the bending radius of the metal multi-strand tendons is extremely limited, thereby affecting the possibilities of miniaturizing the instrument design.

Disclosure of Invention

It is an object of the invention described herein to overcome the limitations of the known solutions described above and to provide a solution to the needs mentioned with reference to the prior art.

This and other objects are achieved by an assembly according to claim 1.

Some advantageous embodiments are the object of the dependent claims.

A robotic surgical assembly comprising a medical instrument, the medical instrument comprising: a frame; and an articulating device having a degree of freedom relative to the frame; and at least one tendon made of polymer fibers designed to actuate the degree of freedom, wherein the at least one tendon comprises a tendon endpoint connected to the medical device to apply a tensile load for actuating the degree of freedom. Preferably, the at least one tendon that actuates the degree of freedom is a pair of tendons. The at least one tendon is designed to slide over at least a portion of the articulating device while in contact therewith to actuate the degree of freedom, and the degree of freedom is preferably a rotational joint. The degrees of freedom may be "snake" joints and/or spinal joints. The articulating mechanism may include multiple degrees of freedom. To actuate the degrees of freedom, the at least one tendon slides over at least a portion of the articulating device while in contact with the at least a portion.

According to one embodiment, said at least one portion of the articulated device, in which said at least one tendon slides upon contact, is formed by a convex ruled surface formed by a plurality of linear generator lines parallel to the axis of said rotary joint. According to one embodiment, said at least one portion of the articulated device, in which said at least one tendon slides upon contact, is formed by a convex ruled surface formed by a plurality of linear generator lines orthogonal to the axis of said rotary joint.

According to one embodiment, the at least one tendon is made of strands, e.g. strands entangled together. Strands may be composed of the polymer fibers. Strands, also known as yarns, may have a circular cross-section, such as a circular or oval cross-section, and/or a flattened cross-section with rounded edges. The strands may have different dimensions/sizes, e.g., different transverse dimensions, such as diameters. According to one embodiment, all strands may be substantially identical.

According to one embodiment, the at least one tendon is braided with a section per inch (PPI) typically ranging from 3-100. Local relatively high PPI may increase the local stiffness of the braided tendon. Various portions of the braided tendon may have different PPIs, resulting in local stiffness changes.

According to one embodiment, the at least one tendon is woven with a PPI ranging from 20-60. In other words, tendons are made by braiding polymer fibers with 20-60 PPI.

Preferably, the PPI of the at least one tendon is higher at a distal portion of the at least one tendon, wherein the distal portion is located near the tendon endpoint along the tendon length, and more preferably, the distal portion of the tendon comprises a distal endpoint. According to one embodiment, the length of the distal portion with higher PPI is equal to or lower than 1/3 of the tendon length, and preferably equal to or lower than 1/10 of the tendon length, and more preferably equal to or lower than 1/20 of the tendon length.

Preferably, the at least one tendon has an elastic modulus between 50GPa and 100 GPa. Tendon stiffness may vary along the length of the tendon, resulting in local stiffness variation.

According to one embodiment, the articulated device comprises a tendon fastening point to which tendon endpoints of the respective tendons are connected, and wherein the frame comprises a shaft, and wherein the at least one tendon is more flexible near or at the tendon fastening point and the at least one tendon is stiffer near or inside the shaft. The distal portion of the at least one tendon is preferably braided with a PPI ranging from 25-100 and more preferably with a PPI ranging from 50-100. According to one embodiment, the at least one tendon further comprises a proximal end point and a longitudinal portion located between said end points. The tendon longitudinal portion may be woven with PPI ranging from 3-30.

Preferably, the at least one tendon has a radius of curvature of less than or equal to one millimeter.

According to one embodiment, the at least one tendon has a transverse dimension, e.g. its diameter, that is variable in different parts of the tendon. According to one embodiment, at least one tendon is thinner at the tendon end point, wherein at least one tendon is thicker in the longitudinal section.

According to one embodiment, the diameter of the at least one tendon is between 0.05mm and 0.3 mm.

According to one embodiment, the at least one tendon has a composition that is variable in different parts thereof.

According to one embodiment, the at least one tendon has a core and a jacket. The jacket may be made of braided polymer strands. According to one embodiment, the core is also made of braided polymer strands. The polymer used to construct the braid may be Polyethylene (PE). The polymer used to construct the braid may be Ultra High Molecular Weight Polyethylene (UHMWPE). According to one embodiment, the core is not braided, but the jacket is braided. According to one embodiment, the jacket is not woven, but the core is woven, and the jacket is in the form of a coating, preferably a chemical coating, made of Polydimethylsiloxane (PDMS) and/or Polytetrafluoroethylene (PTFE). The braided jacket may have a PPI ranging from 25-100. According to one embodiment, the braided core has a PPI ranging from 3-30. According to one embodiment, the lateral dimension (e.g., diameter) of the strands of the braided jacket is lower than the lateral dimension (e.g., diameter) of the strands of the braided core. According to one embodiment, the linear density of the strands of the braided jacket is lower than the linear density of the strands of the braided core. According to one embodiment, the jacket is braided and further comprises a coating, preferably a chemical coating, made of PDMS and/or PTFE, and the core may be braided.

Preferably, the convex ruled surface is made in one piece with the connecting rod of the articulated device. The articulating device preferably does not include any sheath, groove or channel for guiding the at least one tendon. Thus, the tendons not received within the sheath do not form bowden cables, rather the tendons slide on one or more convex straight faces of the links of the articulating device to actuate the degrees of freedom of the articulating device.

The tendon ends are preferably locked by a knot formed by the tendon itself, which knot is located at the tendon fastening point of the articulating device. When the linkage of the articulating device includes a winding surface, the tendon is wound around the winding surface, and the knot may be located on the winding surface, e.g., the knot rests on the winding surface. The junction may be heated to locally melt the material of the surface portions of the tendons that are in relative contact at the junction, thereby promoting adhesion of the surface portions of the tendons that are in relative contact at the junction.

The at least one tendon may be made of a material that is less stiff (in other words, softer) than the material of the articulating device.

The solution proposed in the present invention is an articulating medical instrument comprising tendons made of polymer fibers, which allow for minimum bending radii and very low friction, and enable extreme miniaturization.

Along with the benefits of a truly miniaturized tendon in size and diameter, polymer tendons may have the disadvantages of creep, low stiffness, limited wear resistance, and poor tip strength.

The present invention provides a series of fibers and materials suitable for low friction, low bending radius and high stiffness polymer tendons, such as PE, UHMWPE, PBO orVectran。

In particular, the present invention proposes different designs of multi-strand polymer tendons to maximize stiffness, reduce creep effects, and have good wear resistance, and not affect low friction characteristics and flexibility, thereby achieving the best effect of miniaturization of articulating medical devices.

Drawings

Other features and advantages of the invention will be made apparent from the following description of preferred embodiments, given by way of example and not meant to be limiting, with reference to the accompanying drawings, in which:

FIG. 1A is a perspective view illustrating a surgical robot assembly according to one aspect of the present invention;

FIG. 1B is a perspective view illustrating a surgical robot assembly according to one aspect of the present invention;

FIG. 1C is a perspective view illustrating a surgical robot assembly according to one aspect of the present invention;

FIG. 2A is a perspective view illustrating a surgical robot assembly associated with other elements of an operating room in accordance with an aspect of the present invention;

FIG. 2B is a front view illustrating a surgical robot assembly associated with other elements of an operating room in accordance with an aspect of the present invention;

FIG. 3A is a perspective view illustrating a portion of a pair of articulating or articulated devices according to one aspect of the invention;

FIG. 4A is a front view illustrating a portion of a surgical robot assembly associated with other elements of an operating room and a patient in accordance with one aspect of the present invention;

FIG. 4B is a top view illustrating a portion of a surgical robotic assembly associated with other elements of an operating room and a patient in accordance with an aspect of the present invention;

FIG. 5 is a perspective view illustrating a portion of a surgical robot assembly associated with other elements of an operating room and a patient in accordance with one aspect of the present invention;

FIG. 6 is a perspective view illustrating a portion of a surgical robotic assembly associated with other elements of an operating room, a surgeon, and a patient in accordance with one aspect of the present invention;

FIG. 7 is a perspective view illustrating a control device according to one aspect of the present invention;

FIG. 8 is a perspective view illustrating a macro positioning arm according to one aspect of the present invention;

FIG. 9A is a perspective view illustrating a portion of a robotic assembly in accordance with an aspect of the present invention;

FIG. 9B is a perspective view illustrating a portion of a robotic assembly in accordance with an aspect of the present invention;

FIG. 9C is a perspective view illustrating a portion of a robotic assembly associated with a microscope in accordance with an aspect of the present invention;

FIG. 9D is a perspective view illustrating a portion of a robotic assembly associated with an endoscope in accordance with an aspect of the present invention;

FIG. 9E is an enlarged view of a detail shown by arrows E-E of FIG. 9C;

FIG. 10 is a perspective view illustrating a portion of a robotic assembly in accordance with an aspect of the present invention;

FIG. 11 is a perspective view illustrating a medical device according to one aspect of the present invention;

FIG. 12 is a perspective view and a diagram illustrating separate components of a medical device according to one aspect of the present invention;

FIGS. 13A and 13B illustrate in perspective view portions of a drive system according to one aspect of the present invention;

FIG. 14A is a schematic cross-sectional view of a portion of a drive system according to one aspect of the invention;

FIG. 14B is a schematic cross-sectional view of a portion of a drive system according to one aspect of the invention;

FIG. 15A is a perspective view illustrating a medical device according to one aspect of the present invention;

FIG. 15B is a perspective view illustrating a medical device according to one aspect of the present invention;

FIG. 15C is a diagram illustrating in perspective a medical instrument according to one aspect of the present invention;

FIG. 15D is a diagram illustrating in perspective a medical instrument according to one aspect of the present invention;

FIG. 15E illustrates a portion of a medical instrument for robotic surgery according to one embodiment;

FIG. 15F illustrates a portion of a medical instrument for robotic surgery according to one embodiment;

fig. 16 is a schematic view from the top showing tendon paths of two tendons according to an aspect of the present invention and having a part that is partially transparent;

FIG. 17 is a perspective view of an articulating device according to one aspect of the invention;

fig. 18-20 are perspective views of a separation member having some embodiments of a hinge device according to aspects of the present invention;

FIG. 21 illustrates a profile of an articulating device according to an aspect of the invention;

FIGS. 22-24 illustrate several poses of some embodiments of articulating devices according to aspects of the invention;

FIGS. 25-27 illustrate several embodiments of an end tool according to aspects of the present invention;

FIG. 28 shows a perspective view of a detail of a tendon according to an aspect of the present invention;

FIG. 29 shows a perspective view of a detail of a tendon according to an aspect of the present invention;

FIG. 30 shows a perspective view of a detail of a tendon according to an aspect of the present invention;

fig. 31-36 are schematic diagrams illustrating pathways of tendons according to some aspects of the present invention;

FIG. 37 is a schematic diagram illustrating in perspective view a machining fixture according to one aspect of the present invention;

FIG. 38 is a schematic diagram illustrating a contour of a machining cut in accordance with an aspect of the present invention;

FIG. 39 is a schematic diagram showing in perspective view stages of a method of manufacture in accordance with one aspect of the invention;

FIG. 40A is a plan view showing details of a machining fixture according to one aspect of the invention;

FIG. 40B is a perspective view showing details of a machining fixture according to one aspect of the invention;

FIG. 41 is a schematic diagram showing in perspective view one stage of a method of manufacture according to one aspect of the invention;

FIG. 42 is a front view of a tool according to one aspect of the invention;

FIG. 43 is a schematic perspective view of a tendon with a collet and core according to one embodiment;

FIG. 44 shows a schematic diagram of a tendon according to one embodiment;

fig. 45 is a schematic view of a tendon distal end point according to one embodiment.

Detailed Description

According to one embodiment, the term "tendon" or "actuation cable" refers to an element having a main longitudinal extension and adapted to work under a tensile load applied at its end point. According to one embodiment, the term "opposite tendon" or "opposite actuation cable" refers to another tendon adapted to work in an antagonistic manner with respect to said tendon. According to one embodiment, in the drawings, the tendon will generally be indicated by the reference numeral "90", and the opposite tendon will be indicated by the one hundred increase in this reference numeral (i.e. "190"). Nevertheless, in the figures in which the distinction between the tendon and the opposite tendon is irrelevant, both the tendon and the opposite tendon will be denoted by reference numeral 90. According to one embodiment, the concept of "relative" extends itself to multiple elements and/or portions of elements, such as for the "tendons" described above. According to one embodiment, tendons comprised in the first pair of tendons will be denoted with reference numerals "90, 190" and tendons belonging to the second pair of tendons will be denoted with reference numerals "191, 192".

According to one embodiment, the terms "master-slave", "master" and "slave" refer to known remote operating systems.

According to one embodiment, the term "end tool" refers to a tool adapted to perform a dispensing task, e.g. forming part of an interaction with at least a part of a patient. For example, in a master-slave type teleoperational system, the end tool or end portion or end member is at least part of an "end effector".

According to one embodiment, the term "articulated or articulated device" refers to a wrist, elbow or shoulder joint of a robot or an electromechanical integrated structure, in other words to an interconnected assembly of members and joint couplings adapted to support and/or orient and/or position and/or influence the position of the end tool.

According to one embodiment, the components of the articulating or articulated device will be represented by progressive annotations "first component," "second component," etc., to indicate their position within the kinematic chain, where "first component" represents the most proximal component; in other words, "first member" means a member farthest from the end organ. According to one embodiment, the terms "wrist member", "elbow member" or "end member" will be used to refer to the member of the articulating device to denote the function performed by the member. For example, the same member may be both a "second member" and a "wrist member".

According to one embodiment, the term "working volume" or "working space" or "working area" or "working space volume" refers to a set of cartesian poses accessible to the end section of an articulated or articulated device. According to one embodiment, the volume has a substantially parallelepiped shape. According to one embodiment, the working volume has a substantially cylindrical shape.

According to one embodiment, the term "macro positioning" refers to an initial operation of positioning at least a portion of a medical instrument from any location to a working location within or near an operating area; in other words, "macro positioning" refers to an operation of coinciding the working volume with the operation region.

According to one embodiment, the term "micro-positioning" refers to the operation of positioning at least a portion of a medical instrument in a finer manner than "macro-positioning". According to one embodiment, the micro-positioning is performed in real time and under direct control of the control means (master) in a more limited space.

According to one embodiment, the prefix "micro" preceding an object means that the object is primarily, but not exclusively, meant to operate on the sub-millimeter scale.

According to one embodiment, the term "rotary joint" refers to a joint between two elements adapted to allow relative torque between the two elements about an articulation axis.

According to one embodiment, the term "medical device" refers to a device suitable for use during at least one phase of a medical procedure and/or cosmetic treatment. According to one embodiment, the term "surgical instrument" refers to a medical instrument that is particularly suitable for use in at least one stage of a surgical treatment in general. According to one embodiment, the term "microsurgical instrument" or "surgical microscale instrument" refers to a medical instrument that is particularly suitable for use in at least one stage of microsurgical therapy.

According to one embodiment, the term "frame" refers to a portion of a medical device that is primarily adapted to have a structure retaining function. According to one embodiment, the "frame" may comprise at least one shaft, which is a long rigid or flexible element with a mainly longitudinal extension. According to one embodiment, the shaft may for example have a hollow and/or tubular shape.

According to one embodiment, the term "ruled surface" refers to a surface that is achieved by the combination of multiple straight lines. According to one embodiment, the term "ruled surface" refers to a surface realized by the union of a plurality of straight lines substantially parallel to each other, or in other words, the ruled surface of a substantially parallel generatrix (also referred to as "generator"), if not explicitly stated otherwise.

Hereinafter, when referring to a device or assembly or method for microsurgery, it is meant a device, assembly or method suitable for microsurgery, i.e. using an optical magnification device (e.g. a magnifying glass or microscope) at the same time, but also suitable for other surgical therapies, such as general surgery, laparoscopic surgery or endoscopic surgery.

According to one embodiment, in order not to burden the text or the figures, when referring to "first" or "second" elements (e.g. "first micro-positioning means" and "second micro-positioning means"), they will be denoted by the same reference numerals as long as they are functionally indistinguishable (e.g. "41" above); sometimes, as will be clear, reference numerals will be represented by one hundred additions (e.g., "141" and "241" described above); thus, for example, reference numeral "41" will be representative of the "first micro-positioning device" and the "second micro-positioning device", as well as the "third micro-positioning device". And when a specific marking is used, such as "141", it will refer to the specific element, in this case the "first micro-positioning device". Similarly, in order not to unduly burden text, reference numerals associated with "opposing" elements will be omitted if the elements are functionally indistinguishable from their opposing elements.

According to a general embodiment, a medical instrument 60, 160, 260, 360 for use in surgery includes at least one frame 57 and at least one articulating device 70, 170, 270.

The articulating mechanism 70, 170, 270 includes:

at least one first articulation member 71 or first link 71 adapted to be connected to at least a portion of said frame 57;

at least one second articulation member 72 or second link 72.

The first joint member 71 is connected to the second joint member 72 by means of a rotary joint 171.

The medical device 60, 160, 260, 360 further comprises at least one pair of tendons 90, 190 adapted to move the second joint member 72 relative to the first joint member 71 to pull it. The tendon serves as an actuation cable adapted to work only under traction.

Each of the first and second joint members 71, 72 includes a primary structure that includes one or more convex contact surfaces 40, 80, 86, 140, 180 in a single piece.

Each of the convex contact surfaces 40, 80, 86, 140, 180 is a straight textured surface formed by straight portions that are parallel to each other and to the articulation axis P-P, Y-Y.

According to one embodiment, all of said convex contact surfaces 40, 80, 86, 140, 180 at least partially define a single convex volume with their extensions. In other words, the extension of said convex contact surface 40, 80, 86, 140, 180 of the single main structure together with said contact surface 40, 80, 86, 140, 180 defines a convex volume. According to one embodiment, the expression "convex volume" refers to a given pair of points selected within said convex volume, within which the shorter rectilinear junctions between them are integrated. This avoids providing grooves or channels on the pulley for guiding tendons, thereby miniaturizing the main structure and the articulated device. According to one embodiment, all of the convex contact surfaces 40, 80, 86, 140, 180 of the main structure define with their extensions a convex hull of the main structure.

According to one embodiment, wherein two tendons of the pair of tendons 90, 190 are parallel to each other and in contact with the same convex contact surface 40, 80, 86, 140, 180.

According to one embodiment, each tendon of the pair of tendons 90, 190 comprises: a first tendon end 91 associated with the frame 57, a second tendon end 92 secured to the second member 72, and a main portion extending between the first tendon end 91 and the second end 92.

And wherein a major portion of each tendon of a pair of tendons 90, 190 is in contact with the articulating device 70, 170, 270 only on the convex contact surface 40, 80, 86, 140, 180.

According to one embodiment, the contact surfaces 40, 80, 86, 140, 180 are ruled surfaces formed by straight portions parallel to each other and substantially parallel to the articulation axis P-P, Y-Y of the rotary joint 171 that is closer to the contact surfaces 40, 80, 86, 140, 180.

According to one embodiment, the contact surface 40, 80, 86, 140, 180 is a sliding surface 40, 80, 140, 180 or a winding surface 86.

According to one embodiment, the sliding surface 40, 80, 140, 180 is a side sliding surface 40, 140 adapted to extend from the articulating device 70, 170, 270 for sliding or sliding at least one tendon portion in air into contact with the articulating device 70, or the sliding surface 40, 80, 140, 180 is an articulating sliding surface 80, 180 at least partially about an articulation axis.

According to one embodiment, on the joint sliding surface 80, 180, the two or more tendons 90, 190 overlap at least partially on a plane orthogonal to the direction of the articulation axis of the closer rotary joint 171.

According to one embodiment, at least two tendons of the at least two pairs of tendons 90, 190, 191, 192 are in contact with the same convex contact surface 40, 80, 86, 140, 180 and are parallel to each other. According to one embodiment, two tendons of the pair of tendons are parallel to each other over the length of their tendon paths in which they both are in contact with the same convex contact surfaces 40, 80, 140, 180 of the joint member 71 and the second joint member 72.

According to one embodiment, the pair of tendons connected to the same joint member are in contact with the same convex contact surface 40, 80, 86, 140, 180.

According to one embodiment, the main structure is a rigid body.

According to one embodiment, the medical device 60, 160, 260, 360 comprises another pair of tendons, thereby comprising at least a third pair of tendons.

According to one embodiment, the convex contact surface 40, 80, 86, 140, 180 is a sliding surface 40, 80, 140, 180 on which the tendon substantially slides. Alternatively, the convex contact surface 40, 80, 86, 140, 180 is a winding surface 86 on which the tendon is substantially wound on itself without sliding.

According to one embodiment, the projection of the tendon path T-T of a first tendon of the two pairs of tendons 90, 190, 191, 192 and the projection of the tendon path T-T of a second tendon of the same pair of tendons 90, 190 on a plane orthogonal to the direction of the articulation axis 171 cross each other.

According to one embodiment, the medical device 60, 160, 260, 360 comprises a pair of tendons 90, 190 for each joint member 71 or 72 or 77.

According to one embodiment, the contact surfaces 40, 80, 86, 140, 180 at least partially define a convex shell of the joint member 71 or 72 or 77 or 78;

according to one embodiment, each tendon 90, 190 defines a tendon path T-T that remains stationary relative to the joint member 71 or 72 or 77 or 78 that is closer thereto.

According to a general embodiment, the medical instrument 60, 160, 260, 360 comprises:

at least one articulation member 71, 72, 73, 74 of the articulation device 70,

a frame 57, comprising a shaft 65,

tendons 90, 190 adapted to move the joint members 71, 72, 73, 74 relative to the frame 57,

a plunger 96, which moves along a degree of freedom with respect to the frame 57, is in contact with the tendons 90, 190 and is adapted to actuate the tendons 90, 190,

A pushing element 95, which moves along a linear trajectory and comprises an actuator,

a sterile barrier 87 adapted to substantially hinder mutual bacterial contamination of the two environments from which it separates, located between said pushing element 95 and said plunger 96,

wherein the plunger 96 is free to move away from the sterile barrier 87 and/or pushing element 95, and the pushing element 95 pushes the sterile barrier 87 into contact with the plunger 96 and thereby moves the plunger 96.

According to one embodiment, the pushing element 95 pushes the plunger 96 in a pushing direction towards the inside of the frame 57, so that the plunger 96 moves along its degree of freedom with respect to the frame 57.

According to one embodiment, the pushing element 95 exchanges with the plunger 96 a force always pointing in the pushing direction. In other words, the pushing element 95 is not adapted to exchange pulling forces with the plunger 96, in other words, the pushing element 95 cannot pull the plunger 96.

According to one embodiment, the pushing element 95 comprises a lead screw and a nut type actuator.

According to one embodiment, the actuator comprises a ball screw.

According to one embodiment, the pushing element 95 comprises a piston.

According to one embodiment, the plunger 96 has two parts, a first part of the plunger 145 being adapted to be in contact with the pushing element 95 and a second part of the plunger 146 being adapted to be in contact with the tendons 90, 190.

According to one embodiment, the first portion of plunger 145 is exposed from frame 57 to be pushed by the pushing element 95.

According to one embodiment, the first portion of the plunger 145 extends outside the frame 57 to be accessible by the pushing element 95.

According to one embodiment, the first portion of plunger 145 is flush with the frame 57 to be accessible by the pushing element 95.

According to one embodiment, the first portion of the plunger 145 includes a pushing surface 147 adapted to engage the pushing element 95.

According to one embodiment, the pushing element 95 has a reciprocating pushing surface 148.

According to one embodiment, the pushing element 95 pushes the plunger 96 to transfer linear forces through the reciprocating pushing surface 148.

According to one embodiment, said pushing element 95 comprises at least one pushing element idler wheel, not shown, adapted to push said pushing surface 147.

According to one embodiment, the pushing element 95 pushes the plunger 96 to transmit linear force through the one pushing element idler.

According to one embodiment, the pushing surface 147 and reciprocating pushing surface 148 are flat.

According to one embodiment, the pushing surface 147 and the reciprocating pushing surface 148 are curved surfaces that mate with each other.

According to one embodiment, the pushing surface 147 and the reciprocating pushing surface 148 are sliding surfaces that slide relative to each other as the pushing element 95 moves along a linear trajectory.

According to one embodiment, the second portion of the plunger 96 is in contact with the tendons 90, 190.

According to one embodiment, the medical device 60, 160, 260, 360 comprises at least one tensioning element 99 adapted to exert a preload on the tendon 90.

According to one embodiment, the tensioning element 99 is a spring.

According to one embodiment, the tensioning element 99 is adapted to apply a force between the frame 57 and the plunger 96 in the direction of moving the plunger 96 in order to apply a preload to the tendon 90.

According to one embodiment, the tensioning element 99 is adapted to apply a force between the frame 57 and the plunger 96 in a direction that moves the plunger 96 away from the pushing element 95.

According to one embodiment, the tensioning element 99 is adapted to apply a force between the frame 57 and the plunger 96 in a direction that moves the plunger 96 towards the inside of the frame 57.

According to one embodiment, the preload is substantially proportional to the compression movement of the spring 99.

According to one embodiment, the second portion of the plunger 146 pushes on at least one tendon deflectable portion 93 of the tendon 90.

According to one embodiment, the tendon deflectable portion 93 of the tendon 90 extends from a first guide pulley 197 and a second guide pulley 297.

According to one embodiment, the second portion of the plunger 146 moves in a space provided between the first guide pulley 197 and the second guide pulley 297.

According to one embodiment, the plunger 96 varies the length of the tendon 90 path between the first guide pulley 197 and the second guide pulley 297 by an amount that is linearly proportional to the movement of the plunger 96 along the degree of freedom of the plunger 96 relative to the frame 57.

According to one embodiment, the second portion of the plunger 146 includes at least one plunger idler 98 adapted to push the tendon deflectable portion 93.

According to one embodiment, the tendon 90 has a first tendon end point 91 fastened to the joint member 71, 72, 73, 74.

According to one embodiment, the tendon 90 has a second tendon end point 91 fastened to the frame 57.

According to one embodiment, the first tendon end point 91 is fastened to the second portion of the plunger 146 instead of the frame 57.

According to one embodiment, the frame 57 comprises an upper frame portion 58 and a lower frame portion 59, the latter comprising a shaft 65.

According to one embodiment, the plunger 96 moves along a degree of freedom relative to the frame 57.

According to one embodiment, the plunger 96 is connected to the upper frame portion 58 by a linear joint.

According to one embodiment, the plunger 96 is connected to the lower frame portion 58 by a rotational joint, not shown.

According to one embodiment, the plunger 96 moves linearly along a degree of freedom relative to the frame 57.

According to one embodiment, the plunger 96 is maintained in proper alignment by means of a linear bushing, not shown, inserted into the first frame section 58.

According to one embodiment, the plungers 96 are held in proper alignment with the upper frame 58 by means of the corresponding shoulder surfaces 88.

According to one embodiment, the plunger 96 is a rocker that pivots about the pivot of the frame 57.

According to one embodiment, the sterile barrier 87 has a shape and material suitable for pushing the pushing element 95 to the plunger 96.

According to one embodiment, the sterility barrier 87 is a layer of flexible continuous material.

According to one embodiment, the sterile barrier 87 is interposed between the pushing elements 95.

According to one embodiment, the sterile barrier 87 is captured between the pushing surface 147 and the reciprocating pushing surface 148.

According to one embodiment, the medical device 60, 160, 260, 360 comprises a plurality of tendons 90 and pairs of plungers 96 and associated pushing elements 95.

According to one embodiment, the sterility barrier 87 is captured between each plunger 96 and the associated pushing element 95.

According to one embodiment, the sterile barrier 8 is made of a stretchable material that stretches when the plunger 96 moves relative to the frame 57 to apply a force that does not substantially impede the movement of the plunger 96.

According to one embodiment, the sterile barrier 87 is a drape.

According to one embodiment, the sterility barrier 87 is made of a loose-fitting drape that stretches as the plunger 96 moves relative to the frame 57 to apply a force that does not substantially impede the movement of the plunger 96.

The provision of a pushing element 95 of a medical device 60, 160, 260, 360 according to an aspect of the invention is adapted to move the articulated arrangement across the sterile barrier allowing the production of highly reliable and sterile medical devices.

Due to the provision of the plunger 96 of the medical device 60, 160, 260, 360 according to an aspect of the invention, a simple sterile barrier in the shape of a drape or a continuous flexible sheet can be employed.

Since the plunger 96 of the medical instrument 60, 160, 260, 360 according to an aspect of the present invention is provided, the pushing element having a high-precision linear actuator can be used to improve the precision of the commanded motion.

Thanks to the provision of the plunger 96 of the medical device 60, 160, 260, 360 according to an aspect of the invention, the tendons 90 inside the frame 57 can be protected while allowing the sterile barrier 87 outside the frame.

Since the plunger 96 of the medical device 60, 160, 260, 360 according to an aspect of the present invention is provided, the tensioning of the tendons 90, 190 can be provided for any joint member 71 position of the articulated device 70.

Thanks to the provision of the plunger 96 of the medical device 60, 160, 260, 360 according to an aspect of the invention, lost motion and play effects associated with a change of direction of movement can be avoided, together with a continuous pushing action on the plunger by the pushing element.

Due to the provision of the sterility barrier 87 of the medical device 60, 160, 260, 360 according to an aspect of the present invention, a sterility barrier can be provided which is not attached to the pushing element and thus easier for the operator to deploy.

According to one embodiment, the pushing element 95 comprises a sensor 150.

According to one embodiment, the pushing element 95 comprises a sensor 150 adapted to detect contact between the pushing element 95 and the plunger 96 through the sterility barrier 87.

According to one embodiment, the pushing element 95 comprises a force sensor 151 adapted to measure the thrust exchanged between the pushing element 95 and the plunger 96 through the sterility barrier 87.

According to one embodiment, the force sensor 151 is a single axis load sensor that measures the thrust component along the linear motion profile of the pushing element 95.

According to one embodiment, the pushing element 95 comprises a pressure sensor 152 adapted to measure the pressure exchanged between the pushing element 95 and the plunger 96 through the sterility barrier 87.

According to one embodiment, the pressure sensor 152 is a thin film pressure sensor glued to the reciprocating pushing surface 148 of the pushing element 95.

According to one embodiment, the pushing element 95 comprises a non-contact proximity sensor 153 adapted to measure the distance between the reciprocating pushing surface 148 and the pushing surface 147 through the sterility barrier 87.

Due to the provision of the sensor 150 of the medical instrument 60, 160, 260, 360 according to one embodiment, a sensing amount related to the interaction between the articulating device 70 and the anatomy of the patient 201 can be sensed through the sterile barrier.

Due to the provision of the sensor 150 of the medical instrument 60, 160, 260, 360 according to one embodiment, contact between the pushing element 95 and the plunger 96 can be detected by the sterility barrier.

Since the sensor 150 of the medical instrument 60, 160, 260, 360 according to one embodiment is provided, the pushing force through the sterile barrier in relation to the tension of the tendons 90, 190 can be sensed.

According to a general embodiment, the robotic surgical assembly 100 includes at least one medical instrument 60, 160, 260, 360 according to any of the previous embodiments.

According to one aspect of the invention, the surgical robot assembly 100 includes;

-at least one micro-positioning device 41, 141, 241, 341 having at least a plurality of translational degrees of freedom;

at least one medical instrument 60 comprising one articulating device 70 or articulating device 70 having multiple degrees of rotational freedom.

The medical device 60 is connected in series to the micro-positioning device 41 such that the articulating device 70 reaches a predetermined position in the working volume 7 with its end portion 77.

According to one embodiment, the robotic assembly 100 includes a support 104 and at least one macro positioning arm 30 connected to the support 104, the macro positioning arm 30 providing multiple degrees of freedom of macro positioning relative to the support.

According to one embodiment, the micro-positioning devices 41, 141, 241 and 341 are cascade (i.e., in series) connected to the macro positioning arm 30.

Providing a kinematic chain 30 comprising a macro positioning arm 30 connected in series with at least one micro positioning device 41 comprising at least a plurality of translational degrees of freedom, connected in series with a medical instrument 60, allows decoupling a positioning movement of the end portion 77 of the medical instrument 60 in a translation within the working volume 7 from a positioning movement of the end portion 77 of the medical instrument 60 in an orientation within the working volume 7.

According to one embodiment, the micro-positioning device 41 comprises only translational degrees of freedom.

According to one embodiment, the micro-positioning device 41 is a cartesian motion mechanism adapted to determine translational motion along at least two mutually orthogonal directions. According to one embodiment, the micro-positioning device 41 is a cartesian motion mechanism adapted to determine translational motion along at least three mutually orthogonal directions.

According to one embodiment, the micro-positioning device 41 comprises an X-Y-Z Cartesian movement mechanism and another degree of rotational freedom about an axis of rotation substantially coinciding with the longitudinal direction in which the medical instrument is deployed.

According to one embodiment, the at least one medical instrument 60 comprising one articulating device 70 has only multiple degrees of rotational freedom.

According to one embodiment, the robotic surgical assembly 100 includes an additional micro-positioning device 41 such that it includes at least a first micro-positioning device 141 and a second micro-positioning device 241.

According to one embodiment, the at least two micro-positioning devices 141, 241 are placed parallel to each other. According to one embodiment, the at least two micro-positioning devices are placed side by side to move one medical instrument on the right side and one medical instrument on the left side.

According to one embodiment, the surgical robotic assembly 100 comprises a further medical instrument 60 so as to comprise at least a first medical instrument 160 connected in cascade or in series to said first micro-positioning device 141 and at least a second medical instrument 260 connected in cascade or in series to said second micro-positioning device 241.

According to one embodiment, the first medical device 160 includes one articulating mechanism 170 and the second medical device includes a second articulating mechanism 270.

According to one embodiment, the first and second micro-positioning devices 141, 241 are placed such that the respective end portion 77 of each articulated device 70 reaches the respective working volume 7, which must at least partially overlap.

Providing at least partially overlapping working volumes 7 allows for operation with at least two medical instruments being used on a single site on a patient.

According to one embodiment, the at least two medical instruments 160, 260 are placed parallel to each other.

According to one embodiment, the respective working volumes 7 substantially coincide.

According to one embodiment, the macro positioning arm 30 comprises at least one support member 38 comprising at least one attachment feature 39 adapted to retain at least a portion of at least one micro positioning device 41.

According to one embodiment, the support member 38 is adapted to simultaneously carry/receive at least a portion of the first micro-positioning device 141 and at least a portion of the second micro-positioning device 241.

According to one embodiment, the support member 38 comprises at least one other attachment feature 39 such that it comprises at least three attachment features 39, the further attachment feature 39 being adapted to hold at least a portion of a further micro-positioning device 41.

According to one embodiment, the robotic assembly 100 comprises at least three micro-positioning devices 41, 141, 241, 341.

According to one embodiment, the robotic assembly 100 includes at least three medical instruments 60, 160, 260, 360.

According to one embodiment, the three medical devices 60, 160, 260, 360 are positioned in cascade or in series with the common respective micro-positioning device 41, 141, 241, 341 of the at least three micro-positioning devices 41, 141, 241, 341.

According to one embodiment, the first, second and third micro-positioning devices 141, 241, 341 are positioned such that the end position 77 of each articulated device 70 reaches respective working volumes that at least partially overlap.

According to one embodiment, the support member 38 comprises at least three attachment features 39, each adapted to hold at least a portion of a micro-positioning device 41.

According to one embodiment, the macro positioning arm 30 has three degrees of freedom.

According to one embodiment, the macro positioning arm 30 has five degrees of freedom, and wherein the five degrees of freedom are all rotations in translation.

According to one embodiment, the five degrees of freedom of the macro positioning arm 30 are a substantially vertical translational movement, three movements substantially rotatable about the first, second and third axes of movement of the arms a-a, b-b, c-c, and at least one rotational movement about the fourth axis of movement of the arm d-d.

According to one embodiment, the axis of motion of the arm may be fixed or movable relative to a common reference system.

According to one embodiment, the macro positioning arm 30 is a passive mechanism. In other words, according to one embodiment, the macro positioning arm 30 is meant to be manually moved by an operator.

According to one embodiment, the macro positioning arm 30 has six degrees of freedom, at least one of which is rotational. As shown in the non-limiting example in fig. 1C, providing such a feature allows for the formation of an active anthropomorphic robot. According to one embodiment, the macro positioning arm 30 is an active anthropomorphic robot. In other words, according to one embodiment, the macro positioning arm is moved by a motorized system comprising a stepper motor or a servo motor.

According to an alternative embodiment, the macro positioning arm 30 is a passive anthropomorphic robot.

According to one embodiment, the macro positioning arm 30 has a range of motion radius of 650 mm.

According to one embodiment, the macro positioning arm 30 comprises;

a first arm member 31 connected to said support 104 and movable along a linear sliding guide 36 with respect to said support 104,

a second arm member 32 connected to said first arm member 31 about a first axis of movement a-a.

The provision of the first member of the arm 31 to move along the linear sliding guide 36 relative to the support 104 allows to move up and down to be closer to or further from the operating zone.

According to one embodiment, the macro positioning arm 30 further comprises a third arm member 33 connected to the second arm member 32 and movable relative to the second arm member 32 about a second axis of motion b-b of the arm.

According to one embodiment, the macro positioning arm 30 further comprises a fourth arm member 34 connected to the third arm member 33 and movable relative to the third arm member 33 about a third axis of motion c-c of the arm.

According to one embodiment, the macro positioning arm 30 further comprises at least one rotary scale nut 43, which is movable about a fourth axis of movement d-d of the arm and is adapted to be manipulated to move the support member 38 about the fourth axis of movement d-d of the arm.

According to one embodiment, the five degrees of freedom of the macro positioning arm 30 are a substantially vertical translational movement, three substantially rotational movements about the first, second and third axes of movement a-a, b-b, c-c of the arm, and at least one rotational movement about the fourth axis of movement d-d of the arm.

According to one embodiment, the rotary scale nut 43 comprises a click or discontinuous movement mechanism defining a preformed displacement.

According to one embodiment, the transmission of rotational movement between the rotary scale nut 43 and the support member 38 is reduced. In other words, the large angle movement of the rotary scale nut corresponds to the small angle movement of the support member 38 in a similar manner to the object of the camera.

The provision of moving the support member 38 by a rotational movement about the fourth axis of movement d-d of the arm allows the distal portion 77 of the at least one medical instrument 60 associated with the macro positioning arm 30 to be positioned proximate to a predetermined location of the patient 201 at an advantageous angle (steeper or slower) between the instrument shaft and the anatomical plane to facilitate suturing on different anatomical planes.

According to one embodiment, the rotary scale nut 43 comprises at least one milling handle. This provides finer control.

According to one embodiment, the first axis of motion a-a of the arm, the second axis of motion b-b of the arm and the third axis of motion c-c of the arm are substantially parallel to each other.

According to one embodiment, the fourth axis of motion d-d of the arm is substantially orthogonal to the third axis of motion c-c of the arm.

According to one embodiment, a manual knob 37, which moves a rack and pinion mechanism, controls the movement of the first member of the arm 31 in the linear sliding guide 36 by means of its rotational movement.

According to one embodiment, the macro positioning arm 30 comprises at least one braking system adapted to prevent relative movement of at least two of the support 104, the first member 31 of the arm, the second member 32 of the arm, the third member 33 of the arm, the fourth member 34 of the arm.

According to one embodiment, the braking system comprises at least one electromagnetic braking device.

According to one embodiment, the macro positioning arm 30 comprises at least one release button 35 or unlock button, which can be switched between a braking (or locked) position and a release (or unlocked) position.

According to one embodiment, the braking system may be released by a release button 35.

According to one embodiment, the release button 35 is switchable between a braking position and a release position.

According to one embodiment, the release button 35, when in the release position, allows an operator to move at least one degree of freedom of the macro positioning arm 30 by bringing it on the body.

According to one embodiment, the release button 35 is capable of releasing the brake system when in a release position, allowing simultaneous relative movement of the support 104 and at least two of the first member 31 of the arm, the second member 32 of the arm, the third member 33 of the arm and the fourth member 34 of the arm.

According to one embodiment, the release button 35 is adapted to deactivate the braking system when in the release position, allowing simultaneous relative movement of the first member 31 of the arm, the second member 32 of the arm, the third member 33 of the arm and the fourth member 34 of the arm.

According to one embodiment, the release button is adapted to be operated by pressure, it being in the release position when the release button 35 is pressed and in the braking position when the release button is lifted or not pressed.

According to one embodiment, the robot assembly 100 includes:

the macro positioning arm 30, which is passively moved by releasing the release system,

the at least one micro-positioning device 41 and the at least one articulated device 70, which are actively controlled by master-slave remote operation from the movements of the control instrument 21 performed by the surgeon 200.

According to one embodiment, the micro-positioning device 41, 141, 241 has three translational degrees of freedom.

According to one embodiment, the micro-positioning device 41, 141, 241 has four degrees of freedom, three of which are translational.

According to one embodiment, each micro-positioning device 41 comprises a spherical joint 173, said spherical joints 173 being positioned in cascade or in series upstream of each micro-positioning device 41.

According to an embodiment, such as shown in fig. 2B, each micro-positioning device 41, 141, 241 comprises a spherical joint 173 adapted to change the orientation of the medical instrument 60, 160, 260 by moving the micro-positioning device 41, 141, 241 from its base (i.e. proximal-most portion). According to one embodiment, the spherical joint 173 is a universal joint that may be blocked.

According to one embodiment, the micro-positioning device 41 comprises a first motorized slide 51 moving along a first sliding direction f-f along a first sliding rail 54.

According to one embodiment, the micro-positioning device 41 comprises a second motorized slide 52, which second motorized slide 52 moves along a second sliding rail 55 along a second sliding direction g-g.

According to one embodiment, the micro-positioning device 41 comprises a third motorized slide 53, which third motorized slide 53 moves along a third sliding rail 56 along a third sliding direction h-h.

According to one embodiment, the first sliding direction f-f is substantially linear.

According to one embodiment, the second sliding direction g-g is substantially linear.

According to one embodiment, the second sliding direction g-g is substantially orthogonal with respect to the first sliding direction f-f.

According to one embodiment, the third sliding direction h-h is substantially linear.

According to one embodiment, the third sliding direction h-h is substantially orthogonal with respect to both the first sliding direction f-f and the second sliding direction g-g. According to one embodiment, the third sliding direction h-h is aligned with the axis 65.

According to one embodiment, the micro-positioning device 41 is adapted to work with a stepper motor or a servo motor. According to one embodiment, the micro-positioning device 41 is adapted to work with a piezoelectric motor or an ultrasonic motor.

According to one embodiment, at least one of said first, second and third motorized sliders 51, 52, 53 is connected to the motor via a transmission mechanism comprising a ball screw rotating with respect to the respective slide rail 54, 55, 56 and held by a nut. According to one embodiment, the nut is solid (i.e. integral) to at least one of the first, second and third motorized slides 51, 52, 53.

The provision of a transmission mechanism comprising a preloaded ball nut or guide nut type coupler gives improved motion control and reduced play to the motorized slide.

According to one embodiment, at least one of said first, second and third motorized sliders 51, 52, 53 is connected to the motor by a transmission mechanism comprising a toothed belt.

According to one embodiment, the motorized sliders 51, 52, 53 are precision micro-sliders having a stroke between 1cm and 10cm and having a precision in the range of 0.1 to 25 microns.

According to one embodiment, the motor is a servo motor. According to one embodiment, the motor is a stepper motor.

According to one embodiment, the medical device 60 comprises a motorized rotational joint 46 adapted to move the medical device 60 about a longitudinal rotational axis r-r.

According to one embodiment, the micro-positioning device 41 further comprises a motorized rotational joint 46 adapted to move the medical instrument 60 about a longitudinal rotational axis r-r.

According to one embodiment, the longitudinal rotation axis r-r substantially coincides with its longitudinal deployment axis, or the instrument axis X-X, or the longitudinal axis X-X of the shaft of the medical instrument 60. According to one embodiment, the axis angle θ is defined as the angle between the axis direction X-X of the axis 65 of the first medical instrument 160 and the axis direction X-X of the axis 65 of the second medical instrument 260.

According to one embodiment, the medical device 60 includes an articulating mechanism 70 having two degrees of rotational freedom. According to one embodiment, the medical instrument 60 includes an articulating device 70 having two rotational degrees of freedom orthogonal to each other to form an articulated wrist.

According to one embodiment, the medical device 60 includes an articulating mechanism 70 having at least three degrees of freedom. According to one embodiment, the articulating device 70 has three degrees of rotational freedom, with two degrees of rotational freedom about axes parallel to each other and a third degree of rotational freedom about the longitudinal axis of rotation r-r.

According to one embodiment, the articulating device 70 has three rotational degrees of freedom, with one first rotational degree of freedom being parallel to the first rotational axis about a first rotational axis orthogonal to the instrument axis X-X, one second rotational degree of freedom being parallel to the first rotational axis, and a third rotational degree of freedom being orthogonal to the second rotational axis such that the second and third rotational degrees of freedom approach each other and form a sub-articulation of the wrist.

According to one embodiment, the medical device 60 comprises an articulating mechanism 70 having a further degree of freedom in its end portion 77 that allows for opening and/or closing movements of the end portion 77. According to one embodiment, the articulating device 70 comprises an end device 77 in the distal portion, wherein the end device 77 comprises the further degree of freedom to open and/or close. For example, the further degree of freedom determines the opening and/or closing of forceps or cutting instruments (e.g. scissors).

According to one embodiment, the at least one medical instrument 60 is detachably connected to the robotic assembly 100.

According to one embodiment, the medical device 60 comprises at least one shaft 65 adapted to connect the frame 57 with the articulating mechanism 70.

According to one embodiment, the medical device 60 comprises at least one shaft 65 for positioning its articulating means 70 at a predetermined distance from the micro-positioning means 41. According to one embodiment, the shaft 65 is adapted to space the articulating device 70 a predetermined distance from the micro-positioning device 41.

According to one embodiment, the predetermined distance is a multiple of the longitudinal extension of the articulating device 70. According to one embodiment, the predetermined distance is equal to at least five times the longitudinal extension of the articulating device 70. According to one embodiment, the predetermined distance is equal to at least twenty-five times the longitudinal extent of the articulating device 70. According to one embodiment, the predetermined distance is substantially equal to twenty times the longitudinal extension of the articulating device 70. According to one embodiment, the predetermined distance is measured along the longitudinal direction of the axis X-X. According to one embodiment, the predetermined distance is substantially equal to fifty times the longitudinal extent of the articulating device 70.

The provision of the shaft 65 at a distance from the micro-positioning device 41 and the articulated device 70 allows to manufacture the micro-positioning device 41 and the articulated device 70 with dimensions suitable for performing the function under operating conditions. When the robotic assembly 100 includes a plurality of medical instruments 60, 160, 260, 360, the placement of the shaft 65 in each medical instrument 60, 160, 260, 360 separating the respective micro-positioning device 41, 141, 241, 341 from the associated articulated device by a distance allows the tip portion 77 of each medical device to reach its own working volume while maintaining its ability to move independently.

According to one embodiment, the shaft 65 is adapted to connect the frame with the end device 77 at a predetermined distance from the frame 57.

According to one embodiment, the shaft 65 is rigid.

According to one embodiment, the shaft 65 has a longitudinal extension of between 30mm and 250mm and preferably between 60mm and 150 mm.

According to one embodiment, the shaft 65 has a longitudinal bore. According to one embodiment, the shaft 65 has a hollow tubular shape.

According to one embodiment, the medical device 60 comprises a motor compartment 61 adapted to house at least one drive system of at least the articulation device 70 of the medical device 60. In this way, actuation of the articulating device 70 occurs within the medical instrument 60.

According to one embodiment, the robotic assembly 100 comprises at least one control device 20 adapted to determine the movement of at least a portion of said medical instrument 60, 160, 260 by means of a master-slave communication system.

According to one embodiment, the assembly comprises further control means 20 such that it comprises at least two input means 20. According to one embodiment, the control device 20 is adapted to determine the movement of the articulating device 70 of the medical instrument 60. According to one embodiment, the control device 20 is adapted to determine the movement of the micro-positioning device 41. The provision of said features allows the translational movement of the control instrument 21 registered by the detection means 22 to be correlated with the translational movement of the end device 77 within its working space 7, 17.

According to one embodiment, the control device 20 is adapted to determine the movement of the micro-positioning device 41 and the medical instrument 60.

This feature is provided to allow moving at least a part of the micro-positioning device 41 and at least a part of the medical device 60 by means of the control device 21 in order to determine both a rotational movement and a translational movement of the end device 77 in the working volume 7.

According to an alternative embodiment, the micro-positioning device 41 includes a plurality of passive degrees of freedom that may be braked or otherwise blocked. According to one embodiment, the plurality of degrees of freedom are placed just upstream of the micro-positioning device 41 and in series with the micro-positioning device 41.

According to one embodiment, the robotic assembly 100 is adapted to cooperate with a vision system 103 that may be associated with the robotic assembly 100.

According to one embodiment, the vision system 103 is a microscope 103.

The provision of a microscope 103 associable with the robotic assembly allows retrofitting with a pre-existing microscope, making the robotic assembly 100 more versatile. For example, the robotic assembly 100 may be used with a microscope having a focusing distance between 100mm and 500mm, depending on the focal length of the objective lens used. Furthermore, the swept volume of the robotic assembly 100 is allowed to decrease during a surgical procedure where as many parts as possible are missing assuming that a relatively large motion is required during the motion of the tip portion of the instrument.

According to one embodiment, the microscope 103 is an optical microscope 103.

According to one embodiment, the microscope 103 is adapted to frame the end portion 77 of the first medical device 160 and/or the end portion 77 of the second medical device 260 and/or the end portion of the third medical device 360 in its field of view.

According to one embodiment, the microscope 103 is adapted to frame the working volume 7.

According to one embodiment, at least one video camera 45 is connected to the support member 38.

According to one embodiment, the camera 45 is adapted to frame the end portion 77 of the first medical device 160 and the end portion 77 of the second medical device 260.

According to one embodiment, the support 104 comprises at least one display 111 adapted to form a machine input interface.

According to one embodiment, the display 111 is adapted to visualize images acquired by the video camera 45.

According to one embodiment, the video camera 45 is adapted to cooperate with the macro positioning arm 30 to allow for a correct positioning of the at least one medical instrument 60. This feature is provided to facilitate the positioning process of at least a portion of the at least one medical instrument 60 within the working volume 7.

According to one embodiment, the first medical instrument 160, the second medical instrument 260 and the support member 38 are arranged such that they form substantially a triangle. This arrangement allows the same triangulation existing between the surgeon's eyes and arms to be reproduced by means of the robotic assembly 100.

According to one embodiment, the support 104 is at least one of: the device comprises a movable trolley, a microscope supporting structure, an operating table and an operating table.

According to one aspect of the present invention, a control device 20 for microsurgery of a robotic assembly 100, wherein the control device 20 is adapted to at least partially form a master interface for a master-slave pair of the robotic assembly 100 for microsurgery, comprising;

at least one control instrument 21 movable in space, shaped and sized to be held and handled like a conventional surgical instrument, that is, a surgical instrument adapted to operate directly on at least a portion of the patient's anatomy 201,

at least one detection device 22 adapted to detect the position of the control instrument 21 in at least a part of the space.

The control instrument 21 comprises at least one position sensor 28 cooperating with the detection means 22 for sensing at least the position of the control instrument 21.

According to one embodiment, the detection means 22 generate an electromagnetic field in order to detect at least the position of the control instrument 21 by detecting the position of the at least one position sensor 28. According to one embodiment, the detection means 22 detect at least the position of the control instrument 21 by detecting the position of the position sensor 28 by measuring at least inertial acceleration components. According to one embodiment, the position sensor 28 comprises an accelerometer.

According to one embodiment, the detection device 22 is located in the base structure 67 of the control device 20.

According to one embodiment, the control device 21 is connected to the detection means 22 by at least one electromagnetic communication system.

According to one embodiment, the control instrument 21 comprises at least one forceps hinge 69 which acts in the tip portion 68 of the control instrument 21 in order to allow a gripping or cutting movement of the tip portion 68.

According to one embodiment, at least one top end sensor 29 measures the opening angle of the forceps hinge 69.

According to one embodiment, the control instrument 21 has a shape that substantially replicates the shape of a conventional surgical instrument.

According to one embodiment, the control instrument 21 has the shape of a surgical clamp.

According to one embodiment, the control instrument 21 has the shape of a surgical knife.

According to one embodiment, the control instrument 21 has the shape of a surgical needle holder.

According to one embodiment, the control instrument 21 has the shape of a surgical scissors.

According to one embodiment, the control instrument 21 has the shape of a surgical blade.

According to one embodiment, the control device 20 comprises at least one ergonomic support element 27 for an operator, said ergonomic support element comprising at least one support surface 25 for an operator, adapted to support at least a portion of the forearm of the micro-surgeon 200 at least when in operating conditions, so as to provide ergonomic support for the micro-surgeon 200. This arrangement of features allows for improved comfort for the micro-surgeon, thereby determining improved operating efficiency.

According to one embodiment, the ergonomic support element 27 comprises at least a portion made of soft material or foam.

According to one embodiment, the control device 21 is connected to the detection means 22 by at least one electromagnetic communication system. According to one embodiment, the position sensor is an electromagnetic position sensor having a micro-spool, and the sensor device comprises a magnetic field generator and electronic circuitry reading circuitry induced in the micro-spool by the magnetic field. This feature arrangement allows the control instrument 21 to maintain its function as a conventional surgical instrument without affecting the response time to the detection device 22.

According to one embodiment, the control device 21 is connected to the detection means 22 by a wired connection or cable.

According to one embodiment, the control device 21 is connected to the detection means 22 by a wireless connection.

According to one embodiment, the detection means 22 are adapted to measure the position in space by means of induced currents, or it is an optical measurement or an ultrasonic measurement or a measurement by means of ionizing radiation.

According to one embodiment, the control device 20 comprises a switch-type switch, realized as a pedal or as a button, which is selectively adapted to activate or deactivate an input from the control device 20.

According to one embodiment, the robot assembly 100 includes:

at least one control device 20 as described in one embodiment above,

at least one surgical micro-instrument 60, 160, 260, 360 comprising at least one end portion 77.

According to one embodiment, the end portion 77 is adapted to operate on at least a portion of the patient 201.

According to one embodiment, the end portion 77 is adapted to handle a surgical needle 202, as shown for example in fig. 3A-3B.

According to one embodiment, the control instrument 21 is of the same size and provides the same handling experience as a conventional surgical instrument (i.e., a surgical instrument that is available to operate directly on at least a portion of the patient 201), and the surgical micro-instrument 60 is adapted to replicate the same overall motion capabilities of the control instrument 21.

According to one embodiment, the robotic assembly 100 is adapted to decouple the motion of the control instrument 21 and the motion of the surgical micro-instrument 60 such that when the motion of the control instrument 21 is large and includes vibrations, the motion of the surgical micro-instrument 60 is filtered out vibrations and reduces the motion to millimeter or micrometer scale. The provision of a zoom motion introduced between the master and slave interfaces allows to reduce tremors and to improve the precision of the surgical micro-instrument without reducing the ease of operation of the surgeon 200.

According to one embodiment, the control instrument 21 is adapted to cooperate with the surgical micro-instrument 60 such that, when in an operational state, a first 3D movement of the control instrument 21 relative to the detection device corresponds to a second 3D movement of the surgical micro-instrument 60.

According to one embodiment, the control instrument 21 is adapted to cooperate with the surgical micro-instrument 60, 160, 260 such that, when in an operative state, a first translational movement of the control instrument 21 corresponds to a second translational movement of the surgical micro-instrument 60, 160, 260, the second translational movement being equal to a portion of the amplitude of the first movement of the control instrument 21. In this way, the tremors or vibrations transmitted by the control instrument 21 to the surgical micro-instrument 60 can be limited.

According to one embodiment, the control instrument 21 is adapted to cooperate with the surgical micro-instrument 60, 160, 260 such that, when in an operative state, a first translational movement of the control instrument 21 corresponds to a second translational movement of the surgical micro-instrument 60, 160, 260, the amplitude of the second translational movement being substantially equal to one tenth of the amplitude of the first movement of the control instrument 21.

According to one embodiment, the control instrument 21 is adapted to cooperate with the surgical micro-instrument 60, 160, 260 such that, when in an operative state, a first translational movement of the control instrument 21 corresponds to a second translational movement of the surgical micro-instrument 60, 160, 260, the amplitude of the second translational movement being equal to one-thirtieth of the amplitude of the first movement of the control instrument 21.

According to one embodiment, the control instrument 21 is adapted to cooperate with the surgical micro-instrument 60, 160, 260 such that when in an operational state, a first angular movement of the control instrument 21 corresponds to a second angular movement of the surgical micro-instrument 60, 160, 260, the magnitude of the second angular movement being substantially equal to the magnitude of the first movement of the control instrument 21. This feature is provided to enable the use of the control instrument 21 familiar to the surgeon 200.

According to one embodiment, the control instrument 21 is adapted to cooperate with the surgical micro-instrument 60 such that, when in an operative state, a first angular movement of the forceps hinge 69 of the control instrument 21 corresponds to a second angular movement of a hinge located on the distal portion 77 of the surgical micro-instrument 60, the magnitude of the second movement being substantially equal to the first angular movement of the forceps hinge of the control instrument 21.

According to one embodiment, the portion of the control instrument 21 has a shape that substantially reproduces the shape of the end portion 77 of the surgical micro-instrument 60, 160, 260.

According to one embodiment, the surgical micro-device 60, 160, 260 comprises at least one articulation means 70, and the control device 21 is adapted to cooperate with the articulation means 70, 170, 270 such that a first movement of the control device 21 relative to the detection device 22 corresponds to a second movement of the articulation means 70, 170, 270 when in an operative state.

According to one embodiment, the robotic assembly 100 further comprises

The support member 104 is configured to be coupled to a support member,

at least one macro positioning arm 30 connected to the support 104, the macro positioning arm having a plurality of degrees of freedom,

At least one micro-positioning device 41, 141, 241 having a plurality of translational degrees of freedom.

According to one embodiment, the at least one control device 20 is connected to at least a portion of the microsurgical robotic assembly 100.

According to one embodiment, the at least one control device 20 is freely positionable with respect to the support 104.

According to one embodiment, the surgical micro-device 60, 160, 260 comprises at least one micro-device sensor adapted to cooperate with the detection means 22 such that a position in space of at least a portion of the surgical micro-device 60, 160, 260 may be detected with respect to the detection means 22.

According to one embodiment, said micro-positioning means 41, 141, 241 comprise at least one micro-manipulator sensor adapted to cooperate with the detection means 22 in order to detect the position in space of at least a part of said micro-positioning means 41, 141, 241 with respect to said detection means 22.

According to one embodiment, the macro positioning arm 30 comprises at least one macro positioning arm sensor adapted to cooperate with the detection means 22 for detecting a position in space of at least a part of the macro positioning arm 30 relative to the detection means 22.

According to one embodiment, the micro-surgical robotic assembly 100 is adapted to cooperate with a sensor adapted to detect a position in space relative to a single reference system of at least one of; the position sensor 28, the tip sensor 29, the macro positioning arm sensor, the micro positioning device sensor, the micro instrument sensor. According to one embodiment, the micro-surgical robotic assembly 100 is adapted to cooperate with a sensor adapted to detect a position in space relative to a single reference system of at least two of; the position sensor 28, the tip sensor 29, the macro positioning arm sensor, the micro positioning device sensor, the micro instrument sensor. This feature arrangement allows the remote operation of the master-slave system to function adequately independent of the exact position of the detection means 22, the support 104, the macro positioning arm 30 and the micro positioning means 41. In other words, the medical instrument 60 is able to follow the movement of the control instrument 21 with respect to the same common reference frame.

According to one embodiment, the at least one surgical micro-device 60, 160, 260 is detachably connected to the robotic assembly 100.

According to one embodiment, the microsurgical robotic assembly 100 further comprises;

a further control device 21, for example comprising a first control device 121

And a second control instrument 221;

additional surgical micro-instruments 60, 160, 260, for example comprising a first surgical micro-instrument 160 and a second surgical micro-instrument 260.

According to one embodiment, the first control instrument 121 is adapted to cooperate with the first surgical micro-instrument 160 such that a first movement of the first control instrument 121 relative to the detection device 22 corresponds to a second movement of the first surgical micro-instrument 160 when in an operational state.

According to one embodiment, the second control instrument 221 is adapted to cooperate with the second surgical micro-instrument 260 such that the first movement of the second control instrument 221 relative to the detection device 22 corresponds to the second movement of the surgical micro-instrument 260 when in the operational state.

According to one embodiment, the first control instrument 121 is adapted to form a main interface of the robotic assembly 100 for a first hand of a surgeon 200.

According to one embodiment, the second control instrument 221 is adapted for use with a main interface of the robotic assembly 100 of a second hand of the surgeon 200 different from the first hand.

According to one embodiment, the first control instrument 121 and the second control instrument 221 are substantially mirrored in shape and position to form a main interface of the robotic assembly 100 for the surgeon's hands. In this way, the interface improves ergonomics and is more familiar to the surgeon.

According to one embodiment, the control device 20 comprises at least two control instruments 21, 121, 221.

According to one embodiment, the micro-surgical robotic assembly 100 comprises a further detection device 22, for example comprising at least two detection devices.

According to one embodiment, the control device 20 comprises at least two detection devices 22.

According to one embodiment, the micro-surgical robotic assembly 100 comprises at least one further control device 20, for example comprising a first control device 120 and a second control device 220.

According to one embodiment, the first control means 120 is adapted to form a main interface of the robotic assembly 100 for a first hand of a surgeon 200.

According to one embodiment, the second control means 220 is adapted to form a main interface of the robotic assembly 100 of a second hand of the surgeon 200 different from the first hand.

According to one embodiment, the first control 120 and the second control 220 have substantially mirror image shapes so as to form a main interface of the robotic assembly 100 for both hands of the surgeon. In this way, the interface improves ergonomics and is more familiar to the surgeon.

According to one aspect of the invention, the medical device 60, 160, 260, 360 includes at least one frame 57 and one articulating mechanism 70.

The articulating device 70 comprises at least one first articulating member 71 or first link 71 and at least a second articulating member 72 or second link 72 adapted to be coupled to at least a portion of the frame 57.

The first link 71 is connected to the second link 72 via a rotary joint 171.

The medical device 60 further comprises at least one tendon 90, 190 adapted to move at least the second link 72 relative to the first link 71 by pulling the at least one tendon.

At least one of the first and second links 71, 72 includes at least one sliding surface 40, 80, 140, 180 adapted to allow at least a portion of the tendons 90, 190 to slide thereon.

The sliding surface 40, 80, 140, 180 is a ruled surface 40, 80, 140, 180, in particular a ruled surface formed by a plurality of rectilinear portions all parallel to each other and to the articulation axis P-P, Y-Y.

According to one embodiment, the sliding surface 40, 80, 140, 180 is a ruled surface 40, 80, 140, 180 formed by a plurality of rectilinear portions all parallel to each other and substantially parallel to the articulation axis P-P of the rotary joint 171 connecting the first link 71 to the second link 72.

According to one embodiment, the sliding surface 40, 80, 140, 180 is a ruled surface 40, 80, 140, 180 formed by a plurality of rectilinear portions all parallel to each other and substantially orthogonal to the articulation axis Y-Y of the rotary joint 171 connecting the first link 71 to the second link 72. In this case, the rotary joint may be a rotary joint connecting the second link 72 and the third link 73 and/or between the second link 72 and the end member 77. The second link 72 is preferably a wrist member 78 defining two orthogonal axes P-P and Y-Y.

According to one embodiment, the sliding surface 40, 80, 140, 180 is a ruled surface 40, 80, 140, 180, in particular a ruled surface formed by a plurality of rectilinear portions all parallel to each other and substantially parallel to the articulation axis P-P, Y-Y of the rotary joint 171 closest to the sliding surface 40, 80, 140, 180. According to one embodiment, the closest rotational joint 171 is defined by taking measurements along the direction of the tendon path T-T.

According to one embodiment, the articulation axis may be fixed or movable relative to a base reference system.

According to one embodiment, the at least one second link 72 is a wrist member 78, and the wrist member 78 includes at least one sliding surface 40, 80, 140, 180 formed by a plurality of straight portions parallel to each other and to the first articulation axis.

According to one embodiment, the wrist member 78 includes at least one engagement portion 172 adapted to form at least a portion of a second rotational joint 171 having a second articulation axis that is non-parallel to the first articulation axis.

According to one embodiment, the first articulation axis and the second articulation axis are substantially orthogonal to each other.

According to one embodiment, the first articulation axis is a pitch axis P-P.

According to one embodiment, the second articulation axis is a yaw axis Y-Y.

According to one embodiment, the medical device 60, 160, 260 has at least one end member 77.

According to one embodiment, the end member 77 is adapted to contact a portion of the patient 201 when in an operative state.

According to one embodiment, the end member 77 is adapted to handle a surgical needle 202.

According to one embodiment, the end member 77 includes a cutting surface or blade and may be used as a surgical knife.

According to one embodiment, the end member 77 includes at least one winding surface 86 that is comprised of a plurality of straight portions that are all parallel to each other and to the articulation axis. According to one embodiment, the winding surface 86 is adapted to allow at least a portion of the tendons 90, 190 to be wound therearound.

According to one embodiment, the second joint member 72 is a tip member 77.

According to one embodiment, the articulating device 70, 170, 270 comprises a third articulating member 73 adapted to be coupled to at least the second articulating member 72 by a rotational joint 171.

According to one embodiment, the third joint member 73 is an end member 77.

According to one embodiment, the tip member 77 is connected to the wrist member 78 by a rotary joint 171.

According to one embodiment, the at least one articulation member 72 is an elbow member 75 and the elbow member 75 includes a plurality of sliding surfaces 40, 80, 140, 180 formed from a plurality of straight portions that are all parallel to each other and to a single articulation axis.

According to one embodiment, the elbow member 75 includes at least one engagement portion 172 adapted to form at least a portion of a rotational joint 171.

According to one embodiment, the articulating device 70 comprises a third articulating member 73 adapted to be coupled to at least the second articulating member 72 by a rotational joint 171, wherein the second articulating member 72 is an elbow member 75 and the third articulating member 73 is a wrist member 78.

According to one embodiment, the elbow member 75 is connected to the first joint member 71 by a rotational joint 171, and wherein the wrist member 78 is connected to the elbow member 75 via the rotational joint 171.

According to one embodiment, the articulated device 70 comprises a fourth joint member 74 adapted to be connected to at least the third joint member 73 via a rotational joint 171.

According to one embodiment, the fourth joint member 74 is an end member 77.

According to one embodiment, the end member 77 comprises at least one winding surface 86 formed by a plurality of straight portions parallel to each other and substantially parallel to the articulation axis, wherein the winding surface 86 is adapted to allow at least a portion of the tendons 90, 190 to be wound therearound.

According to one embodiment, the articulating device 70 comprises the first member 71 connected to the wrist member 78 via a rotational joint 171 and to the end member 77 via a rotational joint 171.

According to one embodiment, the articulating device 70 includes the first member 71 connected to the elbow member 75 by a rotational joint 171, to the wrist member 78 by a rotational joint 171, and to the end member 77 itself by a rotational joint 171. It will be apparent to those skilled in the art that using joint members similar to 71, 72, 73, the articulating device 70 may be assembled to include a continuous sequence of members from zero to a plurality of elbow joint members 75, preferably orthogonal pairs of wrist members 78 and at least one distal joint member 77.

According to one embodiment, the winding surface 86 is a textured surface.

According to one embodiment, the winding surface is substantially unsuitable for the tendons 90, 190 to slide thereon. This is because the tendons 90, 190 terminate near the winding surface 86 on the articulating member including the winding surface 86.

According to one embodiment, the medical device 60 comprises at least one pair of tendons comprising one tendon 90 and one opposite tendon 190, and the tendons 90 and the opposite tendons 190 are adapted to connect their second termination points 92 or second tendon ends 92 to respective tendon fastening points 82 or tendon termination points 82 of the second joint member 72 for movement of the second joint member 72 in opposite directions about its joint axis.

According to one embodiment, the medical device 60 comprises at least one pair of tendons comprising one tendon 90 and one opposing tendon 190, and the tendons 90 and the opposing tendons 190 are adapted to be connected at their second termination points 92 to respective tendon fastening points 82 or tendon termination features 82 of the end member 77 for movement thereof in opposite directions about its joint axis.

This provision of features ensures that the tendons 90 and the opposing tendons 190 can work in a antagonistic manner, e.g. both the tendons 90 and the opposing tendons 190 move the end members about the yaw axis Y-Y. Thus, no passive or free articulation occurs, but only active guided and controlled motion.

According to one embodiment, the tendons 90 and opposing tendons 190 are adapted to be connected by means of their second termination points 92 to respective tendon fastening points 82 or tendon termination features 82 in at least one of the first, second, third and fourth joint members 71, 72, 73, 74.

According to one embodiment, the tendons 90 and opposing tendons 190 are adapted to be connected by means of their second termination points 92 in respective tendon fastening points 82 or tendon termination features 82 of at least one of the elbow member 75, wrist member 78 and end member 77.

According to one embodiment, the medical device 60 comprises at least one shaft 65 adapted to guide the at least one tendon 90, 190. The shaft 65 is a shaft according to any of the previous embodiments.

According to one embodiment, the shaft 65 has a substantially circular cross-section and has a diameter of less than 4 millimeters. This can make the medical instrument extremely miniaturized.

According to one embodiment, the shaft 65 comprises a longitudinal hole to allow the passage of the at least one tendon 90, 190 inside it.

According to one embodiment, the shaft 65 is integral with the frame 57.

According to one embodiment, the articulating device 70 has a longitudinal extension of less than 10 millimeters.

According to one embodiment, the articulating device 70 has a volume of less than 10 cubic millimeters.

According to one embodiment, the end member 77 includes at least a first portion of the end member 177 and at least a second portion of the end member 277. According to one embodiment, the first portion of the end member 177 and the second portion of the end member 277 move relative to each other about an articulation axis to determine a grasping or cutting motion. According to one embodiment, the articulation axis is the yaw axis Y-Y.

According to one embodiment, the medical device 60 comprises at least one pair of tendons comprising a tendon 90 and an opposing tendon 190, wherein one of the tendon 90 and the opposing tendon 190 is adapted to be connected by means of its second end point 92 to a respective tendon fastening point 82 or tendon termination feature 82 on the first end member 177, and wherein the other of the tendon 90 and the opposing tendon 190 is adapted to be connected by means of its second end point 92 to a respective tendon fastening point 82 or tendon termination feature 82 on the second end member 277 in order to move the first portion of end member 177 and the second portion of end member 277 in opposite directions.

According to one embodiment, each of the first portion of end member 177 and the second portion of end member 277 includes at least one winding surface 86.

According to one embodiment, the medical device 60 comprises at least one pair of tendons comprising one tendon 90 and one opposing tendon 190, wherein the tendons 90 and the opposing tendons 190 are adapted to be connected by means of their second end points 92 to respective tendon fastening points 82 or tendon termination features 82 of the end member 77 for moving the third joint member 73 relative to the fourth joint member 74 for determining a grasping or cutting motion.

According to one embodiment, the tendons 90 and the opposing tendons 190 wrap their distal portions around at least a portion of the at least one wrapping surface 86 of the end member 77.

According to one embodiment, the sliding surface 40, 80, 140, 180 is a lateral sliding surface 40, 140 adapted to extend away from the central volume of the articulating device 70, 170, 270 so as to determine deflection of at least a portion of the tendon and travel out of contact with the articulating device 70.

According to one embodiment, said lateral sliding surfaces 40, 140 connect the surface of the component on which it is built with at least one continuous surface 64 sharing a local tangential plane. According to one embodiment, said lateral sliding surfaces 40, 140 form at least one sharp edge 63 together with the component on which they are built.

According to one embodiment, said lateral sliding surfaces 40, 140 connect the surface of the component on which they are built with the continuous surface 64 on one side and form a sharp edge 63 with the component on which they are built on the other side.

According to one embodiment, the sliding surface 40, 80, 140, 180 is an articulating sliding surface 80, 180 at least partially surrounding an articulation axis. According to one embodiment, the sliding surface 40, 80, 140, 180 is an articular sliding surface 80, 180 at least partially surrounding at least one of the pitch axis P-P and the yaw axis Y-Y, and wherein the articular sliding surface 80, 180 is oppositely oriented with respect to at least one of the pitch axis P-P and the yaw axis Y-Y so as to allow at least one intersection between a tendon path T-T of the tendon 90 and a tendon path T-T of the opposing tendon 190. In other words, the articulation sliding surfaces 80, 180 are not adapted to face the articulation axis of the closest rotary joint 171 when in an operative state.

According to one embodiment, the articular sliding surface is convex and partly surrounds at least one of the pitch axis P-P or yaw axis Y-Y, so as to allow at least one intersection of two opposite tendons on itself.

According to one embodiment, the term "closest joint" refers to the rotational joint 141 closest to the sliding surface 40, 80, 140, 180 along the tendon path T-T.

According to one embodiment, on the joint sliding surface 80, 180, the tendon paths T-T of the tendons 90 and the tendon paths T-T of the opposite tendons 190, although disjoint, at least partly overlap in a projection plane orthogonal to the direction of the joint movement axis of the closest rotary joint 171.

According to one embodiment, on the joint sliding surface 80, 180, the tendon path T-T of the tendon 90 and the tendon path T-T of the opposite tendon 190 are different from each other and parallel to a projection surface parallel to the articulation axis of the closest rotary joint 171.

According to one embodiment, the tendon path T-T of the tendon 90 overlaps with the tendon path T-T of the opposite tendon 190 at least in a projection plane orthogonal to the direction of the joint movement axis of the closest joint. According to one embodiment, the tendon path T-T of the tendon 90 is substantially parallel to the tendon path T-T of the opposite tendon 190 on a projection plane parallel to the articulation axis of the closest rotary joint.

According to one embodiment, the tendon paths T-T of each tendon 90 are substantially parallel to each other on a projection plane parallel to the articulation axis of the closest rotary joint 171.

According to one embodiment, each tendon path T-T is substantially stationary above the joint member it contacts. In other words, even when the tendons 90 slide, the total tendon path T-T is substantially always in the same position with respect to the joint member of the medical apparatus 60 with which it is in contact.

This feature is uniquely achieved by providing the sliding surface 40, 80, 140, 180 of the winding surface 86 with a mating geometric relationship with the tendon termination feature 82 (which in turn is properly positioned on a portion of the medical device).

According to one embodiment, the tendon path T-T remains substantially stationary over the joint members where it contacts the tendon 90 and the opposing tendon 190, which determine the relative joint movement.

According to one embodiment, the tendon path T-T of each tendon 90 is essentially stationary in its section above the frame 57, except for the deflectable portion 93. The deflectable portion 93 is actually adapted to be deflected by the pushrod assembly 94, unlike a guitar string.

According to one embodiment, when in an operational state, the at least one tendon 90, 190 follows a tendon path T-T consisting entirely of a continuous straight flight section 9 that is not in contact with any sliding surface 40, 80 or winding surface 86 and a curved section that is in contact with the sliding surface 40, 80 or winding surface 86 of the joint member 71, 72, 73, 74, 75, 77, 78.

According to one embodiment, the at least one tendon 90, 190 describes a path around the first joint member 71 so as to wrap at least partially around itself on the joint sliding surface 40, 140 of the first joint member 71.

According to one embodiment, the at least one tendon 90, 190 describes a path around the distal second joint member 72 so as to wrap at least partially around itself on the joint sliding surface 80, 180 of the second joint member 72.

According to one embodiment, the medical device 60 comprises a plurality of tendons.

According to one embodiment, the projections of the tendon paths T-T of the tendons 90 and the tendon paths T-T of the opposite tendons 190 on a plane orthogonal to the articulation axis of the closest rotary joint 171 overlap at least at the intersection point 16,

According to one embodiment, the flight section 9 of the tendon path T-T of the tendon 90 is substantially parallel to at least one of the flight sections 9 of the opposing tendon 190.

According to one embodiment, the tendon paths T-T of each tendon 90 are substantially parallel to each other on a projection plane parallel to the direction of the joint axis of the joint motion of the closest rotary joint 171.

According to one embodiment, each of the tendon termination features 82 is positioned to support each tendon 90, 190 so as to keep its tendon path T-T substantially orthogonal to the articulation axis of the closest rotary joint 171, so as to allow the tendon 90 to slide on the at least one sliding surface 40, 80 following a tendon path T-T that is substantially parallel to the tendon path T-T of any other tendon.

According to one embodiment, each tendon termination feature 82 is positioned to support each tendon 90, 190 such that its tendon path T-T is stationary relative to the joint member closest thereto.

According to one embodiment, the tendon termination feature 82 is positioned to maintain the tendon path T-T of each tendon 90 thereof substantially always in contact with the winding surface 86 when in an operative state.

According to one embodiment, the tendon termination feature 82 is positioned such that the tendon path T-T of each tendon 90, 190 is not in contact with the tendon path T-T of any other tendon 90, 190 when in the operational state.

According to one embodiment, the tendon termination features 82 are positioned such that when in an operational state, each tendon 90 slides on at least one sliding surface 40, 80 that describes a curved section of the tendon path T-T that is substantially parallel to the curved section of the tendon path T-T described by any other tendon 90, 190 when sliding on the same sliding surface 40, 80.

According to one embodiment, the medical device 60 is a surgical device suitable for use in at least one of the following fields: microsurgery, minimally invasive surgery, and laparoscopic surgery.

According to one embodiment, the medical device 60 is adapted for biopsy. According to one embodiment, the medical device 60 is adapted for endoscopic surgery.

According to one embodiment, the tendons 90, 190 have a substantially circular cross section. According to one embodiment, the diameter of the tendons 90, 190 is variable in different parts of the tendons 90. According to one embodiment, the mechanical properties of the tendons 90, 190 are variable in different parts of the tendons 90, 190. According to one embodiment, the tendons 90, 190 are obtained by connecting tendon portions having different characteristics. According to one embodiment, the composition of the tendons 90, 190 is variable in different parts of the tendons 90, 190.

According to one embodiment, in each operating state, said tendon path T-T in at least a part of the tendon is substantially locally orthogonal to the generatrix of the sliding surface 40, 80, 140, 180 on which the tendon slides, i.e. for any rotation angle of the rotary joint 171. These features help to avoid the tendon path T-T of each of the tendons from deflecting at times, that is, it does not bend in a direction parallel to the articulation axis of the closest rotary joint 171.

According to one embodiment, the tendon path T-T is substantially locally orthogonal to the generatrix of the sliding surface 40, 80, 140, 180 on which it slides.

According to one embodiment, the articulating device 70 is made primarily of a metallic material.

According to one embodiment, the joint member is adapted to be polished in order to further reduce friction generated by sliding of the at least one tendon when the tendon slides thereon.

According to one aspect of the present invention, the tendon drive system 50 for a medical instrument 60, 160, 260 includes at least one push rod assembly 94.

The medical device 60, 160, 260 comprises a frame 57 and at least one tendon 90, 190 specifically adapted to operate under a tensile load applied at its end points, wherein a tendon direction T-T or tendon path T-T is defined, which tendon direction or tendon path substantially coincides with the direction of longitudinal deployment of the tendon 90, and wherein the tendon 90 is fastened to the frame 57 at its first end point 91 or proximal tendon end point 91 or first tendon end point 91.

The push rod assembly 94 is adapted to exert a force on at least a portion of the deflectable portion 93 of the tendon 90 in a pushing direction across the tendon path T-T in order to deflect the tendon path T-T and induce an increased tensile load in the tendon 90.

When the push rod assembly is pushed in the pushing direction transverse to the tendon path T-T, its area extends locally, only locally, the tendon path. This partial path lengthening creates a larger partial tendon ring, which is directly related to the amount of advancement of the push rod assembly. A larger localized tendon loop is created at the opposite end of the tendon in proportion to the rearward movement of the distal end point of the tendon 92, which is secured to the termination feature 82 on the joint member and thus creates movement of the joint member.

According to one embodiment, the push rod assembly 94 serves as a unilateral constraint for the tendon 90.

According to one embodiment, the push rod assembly 94 lengthens or shortens the substantially straight tendon path T-T in at least a portion of the tendon path T-T.

According to one embodiment, the push rod assembly 94 is adapted to retract the tendon 90 of a determined length. According to one embodiment, the push rod assembly 94 is adapted to release a determined length of the tendon 90.

According to one embodiment, the push rod assembly 94 is adapted to be retracted onto the tendon deflectable portion 93 of the tendon 90 in a direction transverse to the tendon path T-T such that deflection of the tendon path T-T is reduced and strain in the tendon 90 is reduced. In this manner, controlled movement of at least a portion of the articulating device 70 of the medical instrument 60 is permitted.

The terms "retraction" and "retracting" mean that the push rod assembly shortens the tendon path locally and only locally when pushed in said pushing direction transverse to the tendon path T-T. This partial shortening forms a tapered partial ring which is directly related to the amount of pull back of the push rod assembly and, at the opposite end of the tendon, which, with its distal end point 92 secured to the joint member it acts on, allows movement away from the distal end point and thus movement of the joint member.

According to one embodiment, the tendon 90 and the opposing tendon 190 have such lengths: the articulating device 70 of the medical instrument 60 is held in a reference position when the tendon 90 and the opposing tendon 90 are tensioned by the respective tensioning elements 99, 199.

According to one embodiment, the frame 57 comprises at least one shaft 65 in which a longitudinal axis direction X-X is defined, said direction coinciding or being parallel with the longitudinal development axis of the shaft 65.

According to one embodiment, said tendon 90 comprises at least one longitudinal tendon portion 19, wherein the tendon path T-T is substantially parallel to the longitudinal direction of the axis X-X, thereby determining a movement of at least said longitudinal portion of the tendon 19 with respect to said axis 65 at least in the axial direction X-X.

According to one embodiment, the pushing direction is parallel to the longitudinal direction of the axis X-X.

According to one embodiment, the pushing direction is orthogonal to the longitudinal direction of the axis X-X.

According to one embodiment, the tendon 90 is pretensioned. In this way, the tendon 90 remains substantially under tension when the push rod assembly 90 ceases to exert its pushing action on the tendon deflectable 93. The provision of pre-tensioned tendons allows a simple calibration of the tendon drive system 50 enabling to determine which pose of the articulated device to position the zero push action pose at will.

According to one embodiment, the push rod assembly 94 always exerts minimal forward tension on the tendon 90. In this way, the tendon 90 is substantially always in tension when the push rod assembly contacts the tendon deflectable portion 93. The provision of pre-tensioned tendons allows for effective control of the tendon path within the medical apparatus 60 under any operating conditions.

According to one embodiment, the tendon 90 further comprises a second tendon end point 92 or a distal tendon end point 92 adapted to pull a movement element, which movement element is connectable to the second distal tendon end point 92.

According to one embodiment, the tendon first encounters the first tendon end point 91, then the at least tendon deflectable portion 93 and then the second tendon end point 92 along its tendon path T-T.

According to one embodiment, the moving element is at least a part of the medical instrument 60, 160, 260, which is movable relative to the frame 57.

According to one embodiment, the tendon 90 determines movement of at least a portion of the articulating device 70 relative to the frame 57 when the tendon deflectable portion 93 is deflected by the push rod assembly 94.

According to one embodiment, the push rod assembly 94 comprises at least one pushing element 95 movable relative to the frame 57 and adapted to push a plunger 96 such that the plunger 96 pushes the at least one tendon deflectable portion 93 of the tendon 90.

According to one embodiment, at least one body is placed between the pushing element 95 and the plunger 96. According to one embodiment, the pushing element 95 is in contact with the plunger. In other words, the at least one pushing element 95 is adapted to directly or indirectly push the plunger 96.

According to one embodiment, the pushing element 95 is movable relative to the plunger 96 within a contact position in which the pushing element 95 is adapted to exert a pushing action on the plunger 96 and a non-contact position in which the pushing element 95 is separated from the plunger 96 and it is not adapted to exert any pushing action on the plunger 96. According to one embodiment, in the contact position, the pushing element 95 is not necessarily in contact with the plunger 96. In other words, according to one embodiment, the pushing element 95 performs the pushing action via at least one intermediate body placed between the pushing element 95 and the plunger 96.

According to one embodiment, the push rod assembly 94 further comprises at least one sterility barrier 87 adapted to substantially prevent mutual bacterial contamination of its separate two environments.

According to one embodiment, the sterility barrier 87 is placed between the pushing element 95 and the plunger 96.

According to one embodiment, the sterile barrier has a shape and material suitable for pushing the pushing element 95 to the plunger 96.

According to one embodiment, the pushing element 95 is movable relative to the frame 57 along a substantially linear trajectory.

According to one embodiment, the pushing element 95 is a piston.

According to one embodiment, the drive system 50 comprises at least two tendon guide elements 97 or guide pulleys positioned along the tendon direction T-T such that when the push rod assembly determines deflection of the tendon path T-T, the at least two tendon guide elements 97 cooperate to limit deflection of the tendon path T-T to a tendon path section between the two guide elements 97.

According to one embodiment, the plunger 96 comprises at least one plunger idler 98 adapted to push the tendon deflectable portion 93, and wherein the plunger idler 98 is adapted to rotate freely about its axis and in this way reduce sliding friction on the tendon deflectable portion 93 at least when pushed by the plunger 96.

According to one embodiment, the plunger idler 98 is a ball bearing.

According to one embodiment, the second tendon end point 92 is a boss or a ring or a knot.

According to one embodiment, the tendon 90 is adapted to be pretensioned.

According to one embodiment, the tendon drive system 50 comprises at least one pretensioning element 99 adapted to keep the tendon 90 pretensioned.

According to one embodiment, the pretensioning element 99 is a spring adapted to apply a force between the frame 57 and the plunger 96 to exert a preload on the tendon 90 substantially proportional to the compression movement of the spring 99.

According to one embodiment, the push rod assembly 94 comprises a motor adapted to move the push element 95.

According to one embodiment, the push rod assembly 94 includes a lead screw and a nut type actuator. According to one embodiment, the actuator comprises a ball screw.

According to one embodiment, the tendon 90 is at least partially made of a softer material than the material of the surface on which it slides. In other words, the tendon 90 is at least partially made of a material that is less rigid than the surface over which it slides.

According to one embodiment, the tendon 90 is at least partially made of a polymeric material. For example, the provision of tendons made at least in part of polymeric material allows to reduce the wear of the surface on which they slide, with respect to tendons made for example of metal.

According to a variant of one embodiment, the first tendon end point 91 is fastened to the plunger 96 instead of to the frame 57.

According to one embodiment, the tendon driving system 50 comprises at least one further tendon 190 or opposing tendon 190, which is opposite to the tendon 90 and is fastened or constrained to the frame 57 in its first end point 91 or proximal end point, the tendon 190 extending along a tendon direction T-T or tendon path T-T.

According to one embodiment, the tendon driving system 50 comprises at least one further push rod assembly 94 or an opposite push rod assembly 194 opposite the push rod assembly 94 and adapted to push at least a portion of the tendon deflectable portion 93 of the opposite tendon 190 in a tendon lateral pushing direction T-T in order to deflect the tendon path T-T and to induce an increased tensile load in the opposite tendon 190 and the tendon 90. In other words, the tendons 90 and the opposing tendons are adapted to work against each other, e.g. opposing muscles of a human body that cooperate to determine adduction and abduction movements of the joint.

According to one embodiment, the opposing push rod assembly 194 pushes the tendon deflectable portion 93 of the opposing tendon 190 in a pushing direction across the tendon path T-T, deflecting the tendon path T-T, causing a tensile load in the opposing tendon 190 from its proximal portion 18 and a tensile load in the tendon 90 from its distal portion 19.

According to one embodiment, the tendons 90 and 190 are structurally connected distally by a joint between the tendons and the opposite tendons. According to one embodiment, both the tendon and the opposing tendon are distally structurally connected to a common engagement element, such that transmission of force to the opposing tendon through the tendon is ensured.

According to one embodiment, the opposing tendon 190 comprises a second end point 92 or distal end point 92 adapted to pull a moving element associated with the second tendon end point 92 of the opposing tendon 190.

According to one embodiment, the opposing tendon 190 comprises a second end point 92 or distal end point adapted to pull a common single moving element, which may be associated with the second tendon end point 92 of the tendon 90 and the second tendon end point 92 of the opposing tendon 190. According to one embodiment, the tendons 90 and the opposite tendons 190 have a length such that the common single movable element is in a reference position when the tendons 90 and the opposite tendons 190 are pre-tensioned by their respective pre-tensioning elements.

According to one embodiment, the tendon 90 and the opposing tendon 190 are two parts of a single tendon 90.

According to one embodiment, the second tendon end point 92 of the tendon 90 and the second end point 92 of the opposite tendon 190 coincide and are adapted to pull a common movement element that may be associated with the second end point 92 of the tendon 90 and with the second tendon end point 92 of the opposite tendon 190.

According to one embodiment, the opposing tendon 190 comprises at least one longitudinal portion 19, wherein the tendon path T-T is substantially parallel to the longitudinal direction of the axis X-X, such that at least the longitudinal portion 19 of the opposing tendon 190 is moved relative to the axis 65 at least along the longitudinal direction of the axis X-X.

According to one embodiment, the tendon drive system 50 comprises at least one pair of tendons 90, 190 for each degree of freedom, wherein the tendon pair comprises a tendon 90 and an opposing tendon 190.

According to one embodiment, the tendon 90 and the opposing tendon 190 are adapted to be pulled simultaneously, such that the force transferred by both the tendon 90 and the opposing tendon 190 to a common movement element is the sum of the forces transferred by the tendon 90 and the opposing tendon 190.

According to one embodiment, the tendon 90 and the opposing tendon 190 are adapted to be pulled simultaneously with substantially the same amount of force.

According to one embodiment, the tendon 90 and the opposing tendon 190 are adapted to be pulled with a force wherein one force is higher than the other force.

According to one embodiment, the tendon 90 and the opposing tendon 190 are adapted to be pulled simultaneously, thereby withdrawing substantially the same tendon length from the proximal portion thereof.

According to one embodiment, the tendon 90 is adapted to be pulled, thereby retrieving a first tendon length from its proximal section, and at the same time the opposite tendon 190 is adapted to be released through its proximal section, thereby releasing a second tendon length from the opposite tendon, the second tendon length being substantially equal to the first tendon length.

According to one embodiment, the tendon drive system 50 comprises opposing pretensioning elements 199 adapted to keep the opposing tendons 190 pretensioned.

According to one embodiment, the opposing pretensioning element 199 is a spring 99.

According to one embodiment, the pretensioning element 99 and the opposing pretensioning element 199 are adapted to cooperate to simultaneously keep the tendon 90 and the opposing tendon 190 pretensioned, such that the push rod assembly 94 and the opposing push rod assembly 194 can operate simultaneously.

The provision of the pretensioning element 99 and the opposing pretensioning element 199 allows the tendon 90 and the opposing tendon 190 to remain in their pretensioned state, wherein the pretensioning value is adapted to counteract the weight of the common moving element attached to them. In this way, gravity does not play a role in the drive system.

According to one embodiment, the tendons 90 and the opposing tendons 190 are adapted to connect their second end points 92 to their respective tendon fastening points 82 or tendon termination features 82 to one of the following; the second joint member 72 and the stop member 77 are configured to move in opposite directions. The cooperation of said features with the arrangement of said pretensioning element 99 and said opposite pretensioning element 199 allows all movements to be reliably guided and controlled, avoiding any passive or free articulation, e.g. from a return spring.

According to one embodiment, the tendon driving system 50 includes a plurality of tendons 90 and a plurality of opposing tendons 190.

According to one embodiment, the tendon drive system 50 includes a plurality of push rod assemblies 94 and a plurality of opposing push rod assemblies 194.

According to one embodiment, the plurality of tendons 90 and the plurality of opposing tendons 190 are positioned on a portion of the drum 59 or on the drum 59 of the frame 57 such that the tendon path T-T of each tendon 90, 190 travels separately relative to the path of all other tendons 90, 190.

According to one embodiment, the plurality of tendons 90 and the plurality of tendons 190 are positioned substantially radially or radially on the drum 59. According to one embodiment, the plurality of tendons 90 and the plurality of opposing tendons 190 are configured as one of the drums 59, such as a cylinder of a radial engine, and wherein the paths of the tendons 90 and the opposing tendons 190 do not intersect each other on the drum 59.

According to one embodiment, each tendon 90 of the plurality of tendons 90 is adapted to be engaged by its respective push rod assembly 94 independent of the other tendons 90.

According to one embodiment, the tendons 90 of the plurality of tendons 90 are adapted to be engaged by their respective push rod assemblies 94 irrespective of the associated opposing tendons 190.

According to one embodiment, a drive system assembly for a medical instrument 60, 160, 260 includes:

according to at least one tendon driving system 50 of any of the embodiments described previously,

at least one medical device 60, 160, 260 comprising at least one articulating device 70, 170, 270, wherein the articulating device 70, 170, 270 comprises at least one rotational joint.

According to one embodiment, the tendon 90, 190 is fastened or constrained at its second end point 92 to at least a portion of the articulated device 70, 170, 270 that is movable relative to the frame 57 such that the tendon 90, 190 is adapted to pull on at least a portion of the articulated device 70, 170, 270 to move relative to the frame 57.

According to one embodiment, both the tendons 90 and the opposing tendons 190 are fastened to the same portion of the articulated device 70, 170, 270 that is movable in their respective second end points 92 with respect to the frame 57, such that the opposing tendons 190 are adapted to pull at least a portion of the articulated device 70, 170, 270 so as to move it with respect to the frame 57 by a movement opposite to the movement determined by the tendons 90.

According to one embodiment, the drive system assembly comprises a tendon pair 90, 190, and the tendon pair comprises a tendon 90 and an opposing tendon 190 for each degree of freedom of movement of the articulating device 70, 170, 270.

According to one embodiment, movement of at least a portion of the articulating device 70, 170, 270 of the medical instrument 60, 160, 260 is impeded when the tendon 90 and the opposing tendon 190 are simultaneously pulled and have substantially the same amount of force.

According to one embodiment, the controlled movement of at least a portion of the articulating device 70, 170, 270 of the medical instrument 60, 160, 260 occurs when the tendon 90 and the opposing tendon 190 are simultaneously pulled with different amounts of force, one of which is greater than the other.

According to one embodiment, the medical instrument 60, 160, 260 is at least one of: surgical instruments, microsurgical instruments, instruments for laparoscopic surgery, endoscopic instruments, instruments for biopsy.

According to one aspect of the invention, tendons 90, 190 for the medical apparatus 60 (the medical apparatus 60 comprising at least one articulating device 70 and one frame 57) are adapted to move at least a portion of the articulating device 70 relative to the frame 57.

The articulating mechanism 70 has at least one degree of freedom of movement relative to the frame 57.

The tendon 90 is specially adapted for operation under tensile load.

The tendon 90 is made of a material that is not harder than the material of the articulating device 70.

This provision of features allows for the manufacture of a medical instrument 60 comprising an articulating device 70 having greater wear resistance caused by sliding of tendons 90 over at least a portion of the articulating device 70. In addition, this feature avoids any wear and loss of material of the surface over which the tendons of the articulating device 70 slide. In other words, this feature is provided to avoid the articulated device 70 from being scratched in the operating state due to the influence of the tendon 90 sliding thereon.

According to one embodiment, the tendon 90 slides over at least a portion of the articulating device 70 when in an operational state.

According to one embodiment, the articulating device 70 comprises at least two articulating links 71, 72, 73, 74, 75, 77, 78, 177, 277, and wherein the at least one tendon 90, 190 slides over the at least two articulating links. The at least two articulated links may define degrees of freedom, such as a rotational joint, actuated by the at least one tendon 90, 190. Alternatively, the at least two articulated links may define a further degree of freedom, e.g. a rotational joint, which is not actuated by the at least one tendon 90, 190 and is actuated, e.g. by a further tendon.

The sliding of the at least one tendon preferably occurs on the convex ruled surface 40, 80, 140, 180 of the articulating device 70.

According to one embodiment, the at least two articulated links are in contact with each other. The at least two articulated links may define a snake-type articulation. The at least two articulated links may define a wrist-type device.

According to one embodiment, the tendon 90 is made of a construction not suitable for transmitting thrust.

According to one embodiment, the tendon 90 is made of a softer material than the material of the articulating device 70.

According to one embodiment, the tendon 90 is made of a polymeric material. The provision of tendons made at least partly of polymeric material allows to reduce the wear of the surface over which the tendons slide, with respect to tendons made of metal for example, and helps to maintain the geometrical tolerances established during the design phase and subsequently to extend the life of said tendons 90, 190 and of said medical apparatus 60, 160, 260.

According to one embodiment, the tendons 90, 190 are made of polyethylene. According to one embodiment, the tendons 90, 190 are made of high molecular weight polyethylene or UHMWPE. According to one embodiment, the tendons 90, 190 are made of aramid. According to one embodiment, the tendons 90, 190 are made of vinylon. According to one embodiment, the tendons 90, 190 are made of Chai Long or PBO. According to one embodiment, the tendons 90, 190 are made of a combination of the above materials.

According to one embodiment, the tendons 90, 190 are made of polymer fibers.

According to one embodiment, the articulating device 70 is made from a metallic material.

According to one embodiment, the articulating device 70 is made from at least one of the following: INOX steel or stainless steel; ultra-fast steel; tungsten carbide hard alloy; hardening the steel; tempering steel; titanium.

According to one embodiment, the articulating device 70 is made from a ceramic conductive material.

According to one embodiment, the tendon 90 comprises at least one tendon end point 91 adapted to be glued to the frame 57.

According to one embodiment, the tendon 90 is unraveled into strands around its first tendon end point 91 to maximize the gluing surface.

According to one embodiment, the tendon 90 comprises at least a second tendon end point 92 adapted to be connected to at least a portion of the articulating device 70.

According to one embodiment, the second end 92 is a boss. According to one embodiment, the second tendon end point is a ring. According to one embodiment, the second tendon end 92 is a knot, as shown in FIG. 28, for example.

According to one embodiment, the second tendon end point 92 is glued to at least a portion of the articulating device 70.

According to one embodiment, the first tendon end point 91 is terminated by wrapping the tendon around a portion of the medical device 60 a plurality of times. According to one embodiment, the second end point 92 terminates by wrapping the tendon around a portion of the medical device 60 a plurality of times. According to one embodiment, the tendon is wound with a radius of curvature approximately equal to its diameter.

According to one embodiment, the tendons 90, 190 have a diameter between 0.05mm and 0.3 mm.

According to one embodiment, the tendons 90, 190 have an elastic module between 50GPa and 100 GPa.

According to one embodiment, the tendons 90, 190 are manufactured with a radius of curvature of less than or substantially equal to 1 millimeter.

According to one embodiment, the tendon 90 is specially adapted to work under tensile loads applied at the end points, thereby avoiding the tendon from being clamped, guided laterally in the channel, or including a sheath.

According to one embodiment, the tendons 90, 190 are adapted to be pre-stretched under a load cycle comprising at least two loads of a solid body equal to at least half the tensile breaking strength of the tendons 90, 190.

According to one embodiment, the tendon 90 has a transverse dimension, which is a substantially orthogonal dimension with respect to the tendon path T-T, which is variable in different tendon portions.

According to one embodiment, the tendons 90, 190 have a substantially circular cross section.

According to one embodiment, the diameter of the tendon 90 is variable in different parts of the tendon 90.

According to one embodiment, the tendon 90 is thinner at the second tendon end point 92. According to one embodiment, the tendon 90 is thinner at the distal portion 92' thereof. According to one embodiment, the tendon 90 is thicker in the longitudinal section 19. In this way, the tendons 90, 190 are adapted to be more flexible near or at the tendon fastening point 82 and stiffer near or on the inside of the shaft 65.

According to one embodiment, the mechanical properties of the tendon 90 are variable in different parts of the tendon 90.

According to one embodiment, the tendons 90, 190 are obtained by connecting or juxtaposing tendon portions having different characteristics.

According to one embodiment, the composition of the tendons 90, 190 is variable in different parts of the tendons 90, 190.

According to one embodiment, the tendons 90, 190 have a diameter between 0.1mm and 0.3 mm.

According to one embodiment, the tendon 90 is adapted to cooperate with an opposing tendon 190 to move at least a portion of the articulating device 70, 170, 270.

According to one embodiment, the controlled movement of the articulating device 70, 170, 270 or at least a portion of the medical instrument 60, 160, 260 occurs when the tendon 90 and the opposing tendon 190 are adapted to be pulled simultaneously with one force being greater than the other.

According to one embodiment, movement of at least a portion of the articulating device 70 of the medical instrument 60 is resisted when the tendon 90 and the opposing tendon 190 are simultaneously pulled by the same force.

According to one embodiment, tendon pairs 90, 190, each pair comprising a tendon 90 and an opposing tendon 190, are contemplated for each degree of freedom of movement of the articulating device 70.

According to one embodiment, the tendons 90, 190, 191, 192 of the medical apparatus 60, 160, 260, 360 of the robotic surgical assembly 100 are made of braided strands, preferably braided polymer strands. Strands, also known as yarns, may have different sizes. Each strand or yarn may be formed from polymeric fibers that form the strand or yarn. Preferably, the polymer of the fibers is UHMWPE. According to one embodiment, the polymer of the fibers is Polyethylene (PE). The tendons and strands may be made from the following fibers: PE, UHMWPE, kevlar, vectran, zylon or PBO, combinations of the foregoing. The fibers forming the strands may have an elastic modulus of up to 150Gpa per fiber. When the fibers are gathered to form the strands and the strands are braided together to form the tendons 90, 190, 191, 192, the tendons may have a modulus of elasticity equal to or lower than 130Gpa, or typically between 50Gpa and 100 Gpa. The braiding of the polymer strands may be achieved by using a braiding apparatus (see, e.g., H.A. McKenna et al (2004), "fiber rope technical Manual", woodhead Press, ISBN 978-1-85573-606-1), e.g., a braiding machine comprising a mandrel for braiding tendons and multiple spools each for strands/yarns.

According to one embodiment, the tendons 90, 190, 191, 192 comprise a collet 90 'and a core 90", wherein the collet 90' is braided. The core 90 "may be braided. According to one embodiment, the core 90 "is not braided.

When both the jacket 90' and the core 90 "are braided, such as shown in fig. 43, the strands or yarns forming the jacket 90' are braided together, thereby avoiding braiding with the strands forming the core 90 '. Thus, the jacket 90' and the core 90 "are not woven with each other, but are woven independently of each other. This may allow localized relative movement of the collet 90' and the core 90 ". Preferably, when the core 90 "is formed of braided strands, the number of strands forming the jacket 90' is greater than the number of strands forming the core 90".

According to one embodiment, the collet 90 'is primarily designed to obtain the desired sliding friction, because the collet 90' of the tendon 90, 190, 191, 192 is designed to slide over a portion of the articulation device 70, 170, 270 and preferably over one or more convex ruled surfaces 40, 80, 140, 180 of the link 71, 72 of the articulation device 70, 170, 270. According to one embodiment, the core 90 "is primarily designed to withstand tensile loads. Preferably, the braided jacket 90' also helps to withstand tensile loads to mate with the braided or unbraided core 90 ". The braiding pitch may be different for collet 90' and core 90 ". According to one embodiment, the braiding jacket pitch is greater than the braiding core pitch. According to one embodiment, the braiding jacket pitch is lower than the braiding core pitch.

The jacket is preferably coated with Polydimethylsiloxane (PDMS), and/or Polytetrafluoroethylene (PTFE), and/or other suitable materials, such as resins, to improve wear resistance without impact sliding friction. For example, PDMS and/or PTFE coating 90' "may also reduce the roughness of the braided tendon, where roughness is caused by the presence of strands braided together, thereby increasing the wear resistance of the tendon during sliding.

According to one embodiment, at least one tendon 90, 190, 191, 192 is routed around at least some of the links 71, 72, 73, 74, 75, 77, 78, 177, 277 of the articulating device 70, 170, 270 and a tortuous path is described at its distal portion 92', and the distal portion 92' is in contact with and slides over one or more convex straight faces of the links while the primary longitudinal portion 19 of the tendon 90, 190, 191, 192 received within the instrument shaft 65 has a substantially straight path. Preferably, the distal portion 92' of at least one tendon 90, 190, 191, 192 describing the tortuous path is braided at a higher section per inch (PPI) than the longitudinal portion 19 of the same tendon 90, 190, 191, 192 when slid and wrapped around one or more convex contact surfaces 40, 80, 86, 140, 180 of the connecting rod.

As is well known, "PPI" refers to the cut-off per inch of braid (see, e.g., a.biking et al, (2012), "variables and methods of braid aesthetic design," journal of textiles and clothing (JTATM), technology and management, volume 7, phase 4). The cut-off (PPI) is typically expressed in terms of a cut-off per unit length (inch) of the braid in a line parallel to the braid axis, which represents the number of crossings of the strand with the length of the braided tendon per inch. The parameter PPI may also be related to the "pitch" of the braid and the "cycle length" of the braid (see e.g., H.A. McKenna et al, et al (2004) "fiber rope technical Manual", woodhead Press, ISBN 978-1-85573-606-1). The parameter PPI may also be related to the "braiding angle".

The higher the PPI, the smoother the braid, but according to the analysis performed by the inventors, too high a section will typically decrease tendon stiffness.

Having a higher PPI allows for greater resistance to flattening (i.e., lateral compression). According to a preferred embodiment, the distal portion 92' of each tendon describes the tortuous path with a high PPI in the range of 25-100. According to one embodiment, the longitudinal main portion 19 of each tendon describes a substantially straight path with a PPI in the range of 3-25. Preferably, the distal portion 92' of each tendon describing the tortuous path has a greater resistance to flattening (i.e., lateral compression) than the tendon main longitudinal portion 19, so as to better describe the tortuous path and slide thereon upon contact with the articulating device 70.

The distal portion 92' of the tendons 90, 190, 191, 192 can have a length of 3-5 millimeters. The length of the distal portion 92' of the tendons 90, 190, 191, 192 may be in the range of 5% -10% (1/20-1/10) of the entire length of the tendons (i.e. from the proximal end point 91 to the distal end point 92). According to one embodiment, the tendon is about 20 cm long. The distal portion 92' of the tendons 90, 190, 191, 192 can be about one third (1/3) of the length of the tendons.

The linear density of the strands forming the tendons 90, 190, 191, 192 may be in the range of 10-55dTex (i.e., "deciTex": grams/10 km ratio) and preferably 10-25 dTex. The procedure for measuring the linear density is as follows: mcKenna et al, (2004) "fiber rope technical handbook", woodhead Press, ISBN 978-1-85573-606-1.

The tendons 90, 190, 191, 192 may not comprise any braiding jackets and may thus comprise a braiding core 90", e.g. a polyethylene braiding core, formed of 6-12 braided wires having PPI in the range 10-60.

The stiffness of the tendons 90, 190, 191, 192 can vary along its longitudinal extension. Local PPI and/or local linear density of the collet and/or core and/or number of braided strands may affect the local stiffness of the tendon. Thus, by adjusting the local PPI and/or local linear density of the jacket and/or core and/or the number of braided strands, tendons 90, 190, 191, 192 with desired local mechanical properties can be obtained. For example, the local PPI should not be too high as it would compromise the tensile stiffness of the braided tendon, and should not be too low as it would reduce the flattening (crush) resistance and wear resistance. Flattening may alter the tendon characteristics, particularly sliding friction, because it may change the cross-section of the circular tendons 90, 190, 191, 192 to oblong and/or elliptical, thereby increasing the contact area with the articulating device 70. According to the present inventors, a good compromise is to flatten the tendon by an amount that does not exceed twice the outer diameter of the circular tendon in its lateral dimension. Thus, the jacket may be suitably woven to mechanically contain the tendency of the core to flatten.

For example, as shown in fig. 15E and 15F, the PPI (represented by light grey) of the tendon main longitudinal portion 19 of each tendon 90, 190, 191, 192 may be reduced compared to the tendon distal portion 92' (represented by black) near the tendon end 92 and at the tendon end 92. The distal tendon portion 92' near and at the distal tendon end 92 is designed to describe a tortuous path and to slide upon contact with one or more convex ruled surfaces of the articulating device, at least one of which is preferably made in one piece with the links 71, 72, 73, 74, 75, 77, 78, 177, 277 of the articulating device 70.

For example, as shown in fig. 44, the tendon main longitudinal portion 19 may have a reduced PPI compared to the tendon distal portion 92' near the tendon end 92 and at the tendon end 92, the tendon end 92 being designed to have a tortuous path that slides over a portion of the articulating device 70.

The external dimensions (diameters) of the braided tendons 90, 190, 191, 192 may be less than 0.5 mm, preferably less than 0.4, more preferably equal to or less than 0.3.

The distal ends 92 of the tendons 90, 190, 191, 192 are designed to transfer loads to links for actuating the degrees of freedom of the articulating device 70. Preferably, the distal tip 92 forms a knot formed by the tendon itself, and the distal tip is preferably heated (i.e., heat treated) to strengthen the knot. The knot may be a stop knot. Heating may locally melt tendon segments that together form the junction. Thus, the distal end points 92 of the polymer tendons 90, 190 (i.e., at the junction) may have segments that melt together due to such heat treatment (heating).

According to one embodiment, the distal tip 92 is heated when the knot has been achieved. According to one embodiment, the distal tip 92 is heated when the knot has been achieved and before or while severing tendon segments farther from the knot. Heating may be achieved by any conventional means, such as laser heating, torch heating, or oven, etc.

Preferably, where the tendons comprise a jacket and/or coating, the heating determines the localized melting of the jacket 90 'and/or jacket coating 90' "such that at the junction the jackets 90 'or coatings 90'" of the different tendon segments melt together, thereby reducing the relative sliding of the tendon segments forming the junction, thereby enhancing the tensile strength of the junction and thus the ultimate tensile strength of the tendons 90, 190, 191, 192 as a whole.

The knot at distal end point 92 serves as a transmission element of the actuation force to the link to which distal end point 92 is connected, e.g., any of second link 72, third link 73, tip members 177, 277, wrist member 78, as the case may be, as discussed in this disclosure.

The knots may represent weak points of the ultimate tensile strength of tendon 90. The type of junction can be chosen to balance the requirements as small as possible while ensuring that the weaknesses of the tendons 90, 190 are minimized. The heating of the knot at the distal end point 92, which promotes localized melting of the tendon segments forming the knot itself, increases the strength of the knot. After tying a knot at the distal end point 92 of the tendon 90, a tendon segment distal to the knot may still be present, and in this case, heating of the knot and the tendon segment distal to the knot melts the tendon material and the segment distal to the knot melts with the knot, thereby further improving the adhesion at the knot and shortening or cutting the segment distal to the knot.

When the linkage of the articulating device 70 includes a winding surface 86 on which the tendon distal portion 92' winds/unwinds without sliding thereon, the tendon 90 winds around the winding surface and the knot may be located on the winding surface 86, e.g., the knot rests on the winding surface 86, e.g., as shown in fig. 28.

Preferably, the braided tendon collet 90 'has a variable PPI, wherein the PPI of the distal portion 92' of the tendon 92 is in the range of 50-100, while the PPI of the longitudinal portion 19 of the same tendon is lower, in the range of about 10-20. According to the analysis performed by the present inventors, this allows to reduce the total tendon elongation to achieve the desired total axial stiffness and acceptable axial inelastic elongation.

When a tensile load is applied, the braided tendons can generally be evaluated for inelastic, so that the tendons 90, 190, 191, 192 are preferably preloaded with a load pre-tensioning cycle in order to make inelastic deformation of the tendons predictable under operating conditions, thereby simplifying control of the robotic surgical assembly 100, i.e., digital control. The pretension load may be about half the ultimate tensile strength of the tendons 90, 190, 191, 192.

The relatively high PPI of the collet allows the core to be compressed at the bending of the tendons 90, 190, 191, 192 (i.e. at the distal portions 92' of the tendons 90 and 190, 191 and 192) and allows the tendons 90, 190, 191 and 192 to have a substantially circular cross-section, avoiding having an oblong cross-section under operating conditions. The term "circular cross section" as used herein is clearly a simplification, as tendons composed of braided yarns will have an irregular profile in a given cross section, while the term "circular" as used herein also indicates this unique profile shape. Preferably, the term "diameter" as used herein also refers to the cross-sectional profile of the braided tendon, which is not completely circular, as the cross-section of the braid may deviate locally from an ideal circle.

Preferably, the tendon core 90″ may be formed of a single strand having a higher linear density or a plurality of strands having a lower linear density, and the collet 90 'may have strands having a lower linear density than the tendon core 90″ but a greater number, and the strands of the tendon collet 90' may be braided with a higher PPI. The relatively high PPI of the collet 90 'allows the core 90 "to be compressed at the bend of the tendons 90, 190, 191, 192 (i.e., at the distal portion 92' thereof) while allowing the core 90" to be satisfactorily covered to avoid exposing the core 90 "and thereby avoiding forcing the core 90" to slide over the medical apparatus 60, 160, 260, 360. According to one embodiment, the linear density of each strand comprising braided jacket 90' is in the range of 10 to 25 dTex.

Hereinafter, a method for connecting the polymer tendon 90 to the links 72, 73, 74, 75, 77, 78, 177, 277 of the articulating device 70 to actuate the links (degree of freedom of the articulating device 70) is described. Tendons may be formed from braided polymer fibers and/or braided polymer strands formed from polymer fibers.

The method comprises the following steps: providing at least one tendon 90, 190 made of polymer fibers, designed for actuating said degrees of freedom; and connecting the tendon distal end point 92 to the articulating device 70 of the medical instrument to apply a tensile load for actuating the degrees of freedom.

The connecting step may include connecting the distal end points 92 of the polymer tendons 90, 190 to the fastening points 82 (i.e., termination features 82) of the links of the articulating device 70 to which the tendons are to be connected.

The connecting step includes tying a knot at the tendon distal end 92. At this stage, an additional segment distal to the knot may occur due to the knotting process.

The step of attaching further comprises heating the junction. The heating step may be performed after knotting.

Heating determines localized melting of the tendon segments forming the junction, thereby reducing localized relative sliding of the tendon portions forming the junction. Heating determines the localized melting of the tendon segments forming the junction, thereby strengthening the junction.

Heating may be performed while severing the tendon segment distal to the junction. The tendon segment distal to the junction may also be heat treated (heated) to melt the segment distal to the junction, which may be melted together with the junction. In this way, the knot is further reinforced while the additional distal section is severed.

Heating may be by laser heating, torch heating, oven, any combination of the above.

In the case where the tendon 90 includes a collet 90', the heating may cause the heating to determine localized melting of the collet 90' such that the collet 90' of the different tendon segments melt together at the junction.

Where the tendon 90 includes a coating 90' ", the heating may cause the heating to determine localized melting of the coating 90 '" such that the coatings 90' "of different tendon segments melt together at the junction.

The driving method for the robot assembly 100 is described below.

The driving method of the surgical robot assembly comprises the following stages:

providing a robotic assembly 100 according to any of the previously described embodiments.

At least a vision system associated with the robotic assembly 100 for visualizing at least a portion of the patient 201 is employed.

Positioning the macro positioning arm 30 such that the working volume 7 reached by at least a portion of the end portion 77 is within the field of view of the at least one vision system 103 associated with the robotic assembly 100;

-driving at least one micro-positioning device 41, 141, 241, 341;

-actuating at least one articulating device 70, 170, 270 of a medical instrument 60, 160, 260, 360.

According to one possible mode of operation, the method of driving the surgical robot assembly comprises at least one of the following further phases listed in a preferred, but not required, order:

Releasing the macro positioning arm 30 so that it can be dragged.

Positioning the macro positioning arm 30 such that the working volume 7 reached by the at least one end portion 77 is located within the field of view of the at least one vision system 103 associated with the robotic assembly 100;

-locking the macro positioning arm 30;

-driving said at least one micro-positioning device 41, 141, 241 by means of said at least one control device 20;

-driving the at least one articulation device 70, 170, 270 of the medical instrument 60, 160, 260 by means of the control device 20.

A control method of a control device for a microsurgery of a microsurgical robot assembly is described below.

The control method of the control device for microsurgery of the microsurgical robotic assembly comprises the following phases listed in a preferred, but not required, order:

-providing at least one microsurgical control device 20 according to any of the embodiments described previously;

-manipulating the control instrument 21;

-moving at least a portion of the control instrument 21 relative to the detection device 22.

According to one possible mode of operation, a method comprises at least one of the following further phases:

providing a microsurgical robotic assembly 100 according to one of the foregoing embodiments;

-moving the surgical micro-device 60, 160, 260 by means of the control device 21;

-moving the micro-positioning device 41, 141, 241 by means of the control instrument 21;

-using a microscope 103 associable with the robotic assembly 100 to visualize at least a portion of a patient 201;

-activating a teleoperational state or mode according to which a movement of the control instrument 21 in a first direction with respect to a coordinate system associated with at least one of the detection device 22 and the microscope 103 corresponds to a movement of the surgical micro-instrument 60, 160, 260 in the same direction with respect to said coordinate system.

According to one embodiment, the portion of the patient 201 is contained in the working volume 7.

According to one possible mode of operation, a method comprises the following further phases:

-providing further control means 20 so as to comprise first control means 120 and second control means 220;

-manipulating the first control means 120 with a first hand;

-manipulating the second control means 220 with a second hand.

providing a further control device 21 so as to comprise a first control device 121 and a second control device 221;

-manipulating the first control instrument 121 with one hand;

-manipulating the second control instrument 221 with the other hand.

According to one embodiment, the joint members 71, 72, 73, 74 are obtained by wire electrical discharge machining.

According to one embodiment, the joint members 71, 72, 73, 74 are obtained by micro-injection molding.

According to one embodiment, the joint members 71, 72, 73, 74 are obtained by 3D printing.

The following describes a method for manufacturing the medical device 60, 160, 260.

According to one possible mode of operation, the manufacturing method for the medical device 60, 160, 260 comprises a stage of manufacturing the medical device 60, 160, 260 by at least one added manufacturing technique according to any of the embodiments described previously.

According to one possible mode of operation, the method of manufacturing the medical device 60, 160, 260 comprises a stage of manufacturing the medical device by micro injection moulding. In other words, the manufacturing method for the medical device 60, 160, 260 comprises a stage of manufacturing the medical device by means of micro-forming.

A driving method of the tendons 90, 190 for the medical apparatus 60, 160, 260 is described below.

The driving method for the tendons 90 of the medical apparatus 60, 160, 260 comprises the following phases listed in a preferred but not necessary execution order:

-a') providing a tendon driving system 50 according to any of the preceding embodiments;

-B') pushing at least a portion of said tendons 90, 190 so as to deflect their tendon paths T-T;

-C') generates a tensile load in said tendons 90, 190.

According to one possible mode of operation, a method comprises the further stage of providing a drive system assembly according to any of the preceding embodiments.

-D') pretensioning the tendon 90 prior to phase B;

-E') driving the push rod assembly 94 before stage B and after stage D;

-F') moving at least a portion of the articulating device 70, 170, 270 of the medical instrument 60, 160, 260 after stage C;

-G ') after stage F'), driving the opposite push rod assembly 194;

-H ') after stage G '), moving the at least a portion of the articulated device 70, 170 of the medical instrument 60, 160, 260 of stage F ') in the opposite direction.

According to one possible mode of operation, a method comprises the further phases:

-I') simultaneously driving the push rod assembly 94 and the opposite push rod assembly 194.

-J') pulling the tendon 90 and the opposite tendon 190 with different amounts of force, one force being greater than the other;

-K') moving at least a portion of the articulating device 70, 170, 270 of the medical instrument 60, 160, 260 by a controlled motion.

-L ') replaces phase J'), pulling the tendons 90 and 190 with substantially the same amount of force;

-M ') replaces phase K'), impeding the movement of at least a portion of the articulated device 70, 170, 270 of the medical instrument 60, 160, 260.

According to one possible mode of operation, a method comprises the following phases instead of phases I '), J '), K ');

-N') simultaneously driving the push rod assembly 94 and the opposite push rod assembly 194;

o') simultaneously pulling the tendons (90) to withdraw a first tendon length from its proximal portion and releasing the opposite tendons (190) through its proximal portion to release a second length of opposite tendons, the second length being substantially equal to the first tendon length,

-P') moving at least a portion of the articulating device 70, 170, 270 of the medical instrument (60, 160, 260) by controlled movements with respect to the tendon length and relative tendon length.

-driving the opposing tendons 190 by means of the opposing push rod assembly 194;

-moving at least a portion of the medical instrument 60, 160, 260 by means of the push rod assembly 94.

A method for replacing tendons 90, 190 of a medical instrument is described below.

According to one possible mode of operation, the method of replacing the tendons 90, 190 comprises the following phases:

-providing a further tendon 90, 190 according to any of the embodiments described previously;

-a ") separating the tendons 90, 190 from the medical apparatus 60;

-B ") mounting the further tendons 90, 190 on the medical apparatus 60.

According to one possible mode of operation, the tendon 90 is first attached at the second tendon end point 92 and then at the first tendon end point 91.

According to one mode of operation, a method comprises the following further phases:

-C ") prior to stage a"), locking the plunger 96 in a position suitable for eliminating any pretension on the associated tendon 90.

According to one embodiment, the plunger 96 is locked by using a pin inserted into the plunger locking aperture 48.

-D ") between stage a") and stage B "), cleaning the medical device 60.

According to one possible mode of operation, the phase D ") comprises another sub-phase requiring the medical device 60 to be immersed in a bath of organic solvent.

According to one possible mode of operation, said phase a ") comprises another sub-phase of dissolving said any remaining portion of the tendon 90.

According to one possible mode of operation, the phase a ") includes introducing the medical device 60 into an autoclave or another sub-phase of the other sterilization system.

According to one possible mode of operation, the phase a ") comprises another sub-phase of introducing the medical device 60 into an oven having a temperature between 25 ℃ and 150 ℃.

According to one possible mode of operation, the phase a ") comprises a sub-phase of immersing the medical device 60 in a bath of chemical organic solvent.

According to one possible mode of operation, the phase B ") comprises the following sub-phases, preferably but not necessarily in the following order:

locking the articulating device 70 in a reference position and/or locking the plunger 96 in its locked position;

-connecting the second end point 92 to the articulating device 70;

threading the further tendons 90, 190 inside the shaft 65,

-connecting the first tendon end point 91 to the frame 57.

-E ") after stage B"), calibrating the medical instrument 60, 160, 260 identifying a new zero position of the plunger.

A method of manufacturing the articulating device 70, 170, 270 is described below.

According to one aspect of the invention, a method of manufacturing the articulating device 70, 170, 270 includes at least the following stages in the order of preference shown below:

- (a' ") providing a machining fixture 112 on an EDM machine and disposing a plurality of workpieces 117 on said machining fixture 112.

- (B' ") cutting the desired geometry on said workpiece 117 with cutting lines parallel to each other.

The provision of a single cutting step on the workpiece with cutting lines parallel to each other allows to machine surfaces parallel to each other on the workpiece with extremely precise parallelism.

According to one possible mode of operation, the machining method described above allows machining of a ruled surface featuring parallel generatrix on the workpiece 117.

According to one possible mode of operation, a machining method as described above allows cutting workpieces of very small dimensions, for example workpieces of millimeter or sub-millimeter dimensions.

According to one embodiment, the machining method is adapted to manufacture at least one articulating device 70 comprising a plurality of articulating members 71, 72, 73, 74, 75, 76, 77, 78.

According to one possible mode of operation, the machining method is adapted to machine parallel cuts on the workpiece 117 in order to form an articulation member comprising surfaces parallel to each other.

According to one possible mode of operation, the machining method is adapted to make parallel cuts on the workpiece 117 in order to form joint members adapted to be assembled in a complementary manner, since they comprise surfaces parallel to each other.

According to one possible mode of operation, the EDM machine is adapted to perform wire EDM and comprises a cutting line 115.

According to one embodiment, the cutting wire 115 or EDM wire 115 or electric discharge machine wire 115 has a diameter between 30 and 100 microns, and preferably 50 microns.

Providing a machining method as described above allows transferring only thermal energy to the machined part 117, thereby avoiding transferring any mechanical energy to the machined part 117, e.g. causing deflection, as is the case when cutting is performed with a milling machine.

According to one embodiment, the machining method is adapted to manufacture at least one articulating device for use in the medical procedure field.

According to one embodiment, the machining method is adapted to manufacture at least one articulated device suitable for use in the field of precision machinery, for example in the watchmaking industry. According to one embodiment, the machining method is adapted to manufacture at least one articulated device suitable for use in the jewelry and/or fashion jewelry field. According to one embodiment, the machining method is adapted to manufacture at least one articulating device suitable for use in an electromechanical product component.

According to one possible mode of operation, stage (a' ") comprises the following sub-stages:

mounting a plurality of workpieces on the machining fixture 112 in their respective component seats 116.

According to one possible mode of operation, during said phase (a' ") a sub-phase is first performed:

- (A1' ") disposing the machining fixture 112 on an EDM machine;

then the sub-phase is performed:

- (A2' ") disposing a plurality of workpieces 117 on the machining fixture 112.

According to a possible mode of operation, a method comprises the following further phases between the sub-phase (A1 '") and the sub-phase (A2'"):

- (C' ") performing the calibration.

According to one possible mode of operation, a method comprises the following further phases between phase (a '") and phase (B'"):

- (C' ") performing the calibration.

According to one possible mode of operation, a method comprises the following further stages after stage (B' ").

- (D' ") rotating the machining jig 112.

-repeating said phase (B' ").

According to one possible mode of operation, the stage of rotating the machining fixture 112 includes a further stage of using a rotary table to rotate the machining fixture 112, thereby avoiding the disassembly of the machining fixture 112 from the cutter to perform the following stages:

-rotating the machining fixture 112;

performs a second calibration or cutting calibration only on the reference rod 118,

-repeating said phase (B' ").

According to one possible mode of operation, said phase (C' ") of performing the calibration comprises the following sub-phases:

-turning on the EDM machine;

-providing a reference rod 118, the axis of which is parallel to said member seat 116 of the workpiece 117;

-bringing the cutting line 115 into contact with a first portion 122 of the reference rod 118 or a portion facing the line approaching 122 side;

-measuring or registering the position of the line;

and/or

-measuring or registering the position of the cutting line 115 when the cutting line is in contact with a first portion or a portion facing the wire access side of a first workpiece to be processed; performing a previous stage for each workpiece 117;

And/or

-bringing the cutting line 115 into contact with the second rod portion 123 of said reference rod 118 or with a portion facing the line deviation 123 side opposite to said first rod portion 122;

-measuring or registering the position of the cutting line 115;

-calculating the position of the axis of the reference rod 118 as the midpoint between the position of the line when in contact with the first rod portion and the position of the line when in contact with the second rod portion.

And/or

-measuring or registering the position of the cutting line 115 when in contact with the second portion of the first workpiece or the portion facing the line deviation side;

-calculating the position of the first workpiece as the midpoint between the position of the line when in contact with the first portion of the workpiece and the position of the line when in contact with the second portion of the workpiece;

and/or

-performing a previous stage for each workpiece 117;

and/or

Repeating the procedure for all cutting planes X-Y, Y-Z, X-Z.

According to one embodiment, the machining fixture 112 of the articulating device 70, 170, 270 is adapted to be mounted on a machine for EDM.

According to one embodiment, the machining fixture 112 is adapted to perform at least two cuts on different cutting planes on the workpiece 117 by using a single cutting profile 110 at each cutting plane.

According to one implementation, the machining fixture 112 includes a first pair of fixed surfaces 113, 114 that are trimmed to be opposite and substantially parallel to each other and substantially orthogonal to the first cutting plane X-Y.

According to one embodiment, the machining fixture 112 includes a second pair of fixation surfaces 134, 135 that are trimmed to be opposite and substantially parallel to each other and substantially orthogonal to the second cutting plane Y-Z.

According to one embodiment, the first pair of fixation surfaces 113, 114 and the second pair of fixation surfaces 134, 135 are trimmed.

According to one embodiment, each pair of locating surfaces includes at least one base fixation surface 113, 135 and at least one clamp fixation surface 114, 134.

According to one embodiment, the plurality of component seats 116 are arranged sequentially such that a translation line substantially orthogonal to the first cutting plane X-Y or substantially orthogonal to the second cutting plane Y-Z intersects at most one of the workpieces 117 at a time when the workpieces are mounted in the respective component seats 116.

According to one embodiment, the component seats 116 are substantially parallel to each other.

According to one embodiment, the machining fixture 112 further includes a pair of locating surfaces that are opposite and substantially parallel to each other and substantially orthogonal to the third cutting plane X-Z.

According to one embodiment, the third pair of locating surfaces includes at least one guide hole 125 and the EDM wire 115 of the EDM machine is inserted into at least one of the guide holes 125 to avoid contact of the EDM wire with at least one machining fixture 112 during cutting.

According to one embodiment, the machining fixture 112 further comprises:

a plurality of component holders 116, each adapted to receive at least one workpiece 117, the workpiece 117 being adapted to implement at least a portion of the articulating device 70, 170, 270.

According to one embodiment, the machining fixture 112 further comprises at least one reference bar 118 adapted to allow for a cutting calibration.

According to one embodiment, the machining fixture 112 comprises at least one fixing or fastening element adapted to firmly connect the at least one workpiece 117 in its respective component seat 116.

According to one embodiment, the at least one fastening element is a conductive glue.

According to one embodiment, the at least one fastening element is a grub screw.

According to one embodiment, the grub screw is adapted to be mounted in a threaded bore provided in the at least one fastening surface.

According to one embodiment, the fastening grub screw is adapted to penetrate into the threaded hole of the fastening surface.

According to one embodiment, the machining fixture 112 includes four component seats 116 and a reference bar 118.

According to one embodiment, each component seat 116 is positioned substantially at the same distance from its corresponding fastening surface.

According to one embodiment, the fastening surfaces are positioned in a stepwise manner so as to form a stepped shape in the profile. In other words, the fastening surfaces are positioned in a stepwise manner so as to form a stepped shape in the profile with respect to at least one cutting plane X-Y, Y-Z, X-Z.

According to one embodiment, the machining fixture 112 has a surface facing any cutting plane X-Y, Y-Z, X-Z below 10000 square millimeters.

According to one embodiment, the machining fixture 112 has a surface facing any cutting plane X-Y, Y-Z, X-Z below 5000 square millimeters.

Known microsurgery is performed manually by the surgeon 200 or the microsurgery 200 through the use of manual instruments such as forceps, scissors, and needle holders for manipulating very delicate tissues and tubing having diameters of 1mm or less. The most common microsurgical step is anastomosis, in which two small severed blood vessels are sutured together to reestablish blood flow. The procedure is performed by holding two adjacent vessel stubs with a specific clamp and suturing with a small gauge needle. Thus, the micro-surgeon 200 must perform very little motion in an attempt to limit the natural tremors of the hands and maintain a high level of concentration and sensitivity in order to finely manipulate the delicate tissues with which he/she interacts via the instrument. It is clear that robotics can significantly improve the performance of complex microsurgery.

According to one embodiment, the robotic assembly 100 has the function of supporting the surgeon 200 to perform microsurgery by using articulating and robotic devices that ensure extremely precise movements, which reduces the actual hand movements of the surgeon 200, eliminates tremors, while reproducing movements of the human wrist in small orders of magnitude.

According to one embodiment, the surgical robot assembly 100 includes a support 104, an articulating macro positioning arm 30, and a pair of micro positioning devices 41, 141, 241. A medical instrument 60, 160, 260 comprising a motor compartment 61 and a sterile articulating device 70, 170, 270 is attached to each micro-positioning device 41, 141, 241.

Two control devices 20 adapted for robotically controlling the two medical instruments 60, 160, 260 and the micro-positioning devices 41, 141, 241 are connected to the support 104 by means of communication cables 109. All electronic control circuit boards and power supplies of the robot assembly 100 are integrated in the support 104, while a control panel 108 for opening and closing and managing user messages of the robot assembly 100 by an operator is located on its surface. The dedicated external video microscope portal allows the integration of any conventional external microscope 103 for microsurgery. The digital microscope 103 is integrated in the system to visualize the substantially overlapping working volumes 7 of the two sterile articulating devices 70, 170, 270.

According to one embodiment, possible configurations of the surgical robotic assembly 100 are particularly dedicated to performing microsurgery on a limb end or free flap. This configuration consists of an operating table 102 on which the limb or free flap to be operated is placed and which includes the use of a pair of articulating devices 70, 170, 270 connected to the micro-positioning devices 41, 141, 241 and remotely controlled in real time by the microscope 200 through their respective control devices 20. Note that microscope 103 is not part of surgical robotic assembly 100, but is an important independent element for visualizing working volume 7 during the performance of a procedure.

According to one embodiment, possible configurations of the surgical robotic assembly 100 (particularly suitable for breast reconstruction surgery, but also suitable for performing microsurgery on all other body parts) include: a support 104 that allows for supporting the surgical robot assembly 100 and for transferring it to a location in the operating room adjacent to the mobile operating table 102 where the patient 201 is located; a passive articulating macro positioning arm 30 extending from the support 104 and allowing the moving parts of the surgical robotic assembly 100 to reach the anatomy involved in the procedure. A pair of precision micro-positioning devices 41, 141, 241 or micro-positioning devices 41, 141, 241, each having four degrees of freedom, to which respective medical instruments 60, 160, 260 are attached, are placed at the end of the surgical robotic assembly 100 and which are used by the surgeon 200 to perform micro-surgery by treating both tissue and small suture needles. The entire procedure is performed under visual guidance provided by an external conventional surgical microscope 103.

According to one embodiment, the support 104 has structure and transport functions for the surgical robotic assembly 100, while the macro positioning arm 30 connected thereto allows for simultaneous positioning of a pair of micro positioning devices 41, 141, 241 and medical instruments 60, 160, 260 near the anatomical region to be operated. The micro-positioning device 41, 141, 241 and the medical instrument 60, 160, 260 are actively moved and controlled in real time by the control device 20.

According to one embodiment, each control device 20 is equipped with a support clamp or bracket that can be positioned independently, for example, by connecting it to the surgical table 102. The control device 20 is connected to the surgical robotic assembly 100 by means of a power cable 107, which is also adapted to transmit control data.

According to one embodiment, to simplify transport of the surgical robot assembly 100, the retractable handle 106 and the foot platform 105 are positioned on the rear side. The cart 104 has a control panel 108 on the rear surface for managing parameters of the surgical robot assembly 100 by a user and for displaying messages or warnings of the machine itself. The on/off switch (power button) and the emergency stop button are located on the same side. The power cable 107 supplies current to the overall system, while video data collected by the digital microscope is routed to the surgical robotic assembly 100 via the communication cable 109 so that visually derived information can be integrated into the control. According to one embodiment, the surgical robot assembly 100 comprises a foot platform 105 adapted for use with or in place of a telescoping handle 106 for transportation of the robot assembly 100 during its positioning in an operating room, which foot platform is placed at the bottom of the rear side of the cart.

The foot platform 105 allows the operator's foot responsible for the movement of the robotic assembly 100 to rest thereon so that the robotic assembly 100 can also be pushed from the base, thereby eliminating the risk of tipping over as it moves.

According to one embodiment, the control device 20 has the function of controlling the robotic movements of the micro-positioning device and the medical instrument 60, 160, 260. The control device 20 comprises a control instrument 21 whose position in space is detected in real time by means of a magnetic tracking sensor. The magnetic tracking sensor is made of a magnetic field generator and a wired marker containing a micro-bobbin, such as, but not limited to, the product "NDI AURORA V3 tracking system" from NDI-northern digital limited of Randall Drive Waterloo, N2V1C5, canada, including "planar field generator" and sensor "Mini 6 DOF. The control instrument 21 integrates all the markings required for detecting the six spatial coordinates of the control instrument 21 relative to the base structure 67 and includes an additional gripping degree of freedom in its tip portion 68, the aperture angle of which is measured by the tip sensor 29. The tip sensor 29 is a position sensor or a proximity sensor. The connection tendon 23 connects the control device 21 to a base structure 67 containing a magnetic field generator, which is adapted for power and data transmission between the control device 21 and said base structure 67, in particular when it comprises the detection means 22, but not necessarily. The power and communication tendons 24 connect the magnetic field generator to an external power source at the cart 104 of the robotic assembly, thereby communicating data relative to the position and orientation of the control instrument and the aperture angle of the forceps of the control instrument 21. Another marker for detecting the six spatial coordinates of the cart relative to the base structure 67 is present on the support 104 and is connected to the base structure 67 by the power and communication tendons 24. The status signal lights 26 are integrated into the base structure 67 and communicate the activity of the control device to the user. The flexible, dedicated, ergonomic operator support 27 is manufactured to allow ergonomic use of the control device 20, while the control instrument 21 reproduces the geometry of conventional micro-instruments (e.g., forceps and needle holders) to make its handling more intuitive and familiar to the surgeon.

According to one embodiment, the macro positioning arm 30 allows access to an anatomical region involved in a surgical procedure by moving parts of the robotic assembly 100 (e.g., the micro positioning device 41, 141, 241 and the medical instrument 60, 160, 260). The macro positioning arm 30 comprises four members 31, 32, 33, 34 connected in series with each other by passive rotational joints each having vertical and parallel arm movement axes a-a, b-b, c-c. Inside each rotary joint, an electromagnetic brake allows the position of each individual member to be locked in space. A dedicated brake release button 35 positioned below the underside of the fourth arm member 34 to facilitate gripping and activation thereof allows all joint brakes to be released simultaneously and thus each arm member to be repositioned in space as desired by the user. The new position may then be frozen by releasing the pressure of release button 35.

According to one embodiment, the first member 31 of the macro positioning arm 30 is connected to the cart 104 by a rack and pinion mechanism that allows manual control of the movement of the macro positioning arm 30 within the dedicated linear slide guide 36 along a preferably vertical linear displacement axis when the manual knob 37 is turned.

According to one embodiment, the fourth member 34 of the macro positioning arm 30 has a rotary joint at its top end, which is manually activated by a dedicated rotary scale nut 43, which rotates about a fourth arm movement axis d-d perpendicular to the third arm movement axis c-c.

According to one embodiment, the macro positioning arm 30 is connected to the support member 38 via a rotary joint that is manually activated via movement of said rotary scale nut 43. A pair of micro-positioning devices 41, 141, 241 are connected to the two ends of the support member 38, which also carries, in its intermediate section, a video camera 45 capable of displaying an enlarged image of the working volume 7 in which the micro-surgery is performed. The medical instrument 60, 160, 260 is rigidly attached to the distal portion of the micro-positioning device 41, 141, 241.

According to one embodiment, the micro-positioning device 41, 141, 241 comprises: three motorized slides 51, 52, 53, which are connected orthogonally to each other and are each independently movable along a respective three linear displacement axes f-f, g-g, h-h; and motorized rotary joint 46.

According to one embodiment, the motorized sliders 51, 52, 53 are motorized micro-sliders. The medical device 60, 160, 260 is rigidly connected to the micro-positioning device 41, 141, 241 by a motorized rotational joint 46 that rotates the micro-positioning device about its longitudinal rotational axis r-r.

According to one embodiment, the medical device 60 has a motor compartment 61 containing at least one tendon actuation system 50, which is equipped to actuate the articulation means 70 of said medical device 60 and its end means 77. According to one embodiment, a transmission mechanism integrated inside the mechanical transmission box 62, connected to the motor compartment 61, transmits the motion to the medical instrument 60, to the articulation device 70 and to the end device 77 via the shaft 65.

According to one embodiment, the medical instrument 60 is made of a motor compartment 61 containing an actuator for driving the medical instrument 60, an associated electronic control board and a motor driver board. A mechanical transmission box 62 is connected to the motor compartment 61, said mechanical transmission box comprising means dedicated to transmitting motor movements to the articulation device and end device 77 along the longitudinal axis direction X-X via the shaft 65.

According to one embodiment, the motor compartment 61 contains six pushing elements 95 associated with three degrees of freedom of the medical instrument 60. Specifically, the pusher member is moved by at least one pusher assembly 94 that includes an electric micro-motor having a linear drive train lead screw. The actuating piston 95 protrudes from the wall of the motor chamber 61 facing the gear box 62 and actuates a gear mechanism integrated into the mechanical gear box 62.

As shown in fig. 12, according to one embodiment, the motor compartment 61 and the mechanical transmission 62 are separated by a sterility barrier 87 and may be integrally connected to each other by a connection feature (e.g., via a bayonet connection).

According to one embodiment, the shaft 65 is hollow, made of metal, itself extends along the longitudinal axis direction X-X and inserts itself into the mechanical transmission case 62. The articulating device 70, 170, 270 having the end device 77 at the tip is inserted into the other shaft end or tip.

According to one embodiment, six pushing elements 95 realized as actuating pistons connected to the motor are coupled with respective plungers 96 of the mechanical transmission case 62, thereby connecting the motor chamber 61 with the mechanical transmission case 62.

According to one embodiment, the pushing element 95 and the plunger 96 are separated by a sterile barrier 87.

According to one embodiment, the plunger 96 is linearly movable along the piston axis of motion and is maintained in proper alignment by means of a linear bushing, not shown, inserted into the first frame section 58 or upper frame 58 and by means of the corresponding shoulder surface 88.

According to one embodiment, actuation of the articulation device 70 is distributed to six tendons 90 or actuation cables 90 that are independent and travel from the tendon fastening surface 84 in the mechanical transmission case 62 to the articulation device 70 of the medical instrument 60 via the mechanical transmission case 62, tendon passage holes, and hollow shaft 65.

According to one embodiment, each tendon 90 is wound around each respective four guide pulleys 97 mounted on said lower frame 59 in the section in which it travels inside the mechanical transmission box 62, so as to change its path direction until aligned with the instrument axis X-X. Such guide pulleys 97 may be fixed pulleys or idler pulleys, and in a preferred construction, they are idler pulleys in addition to the first guide pulleys 197, which are positioned closest to the first tendon end point 91 as a fixed guide pulley 197.

According to one embodiment, another plunger idler 98 is positioned on each plunger 96 and moves integrally therewith along the linear piston pulley axis of motion. Each actuation tendon 90 is also wrapped partially around a respective plunger idler 98 secured to a respective plunger 96. The plunger idler 98 is located between the first guide pulley 197 and the second guide pulley 297.

According to one embodiment, movement of plunger 96 (and thus movement of plunger idler 98) caused by actuation piston 95 pushes tendon 90 and thus changes its path length between first guide pulley 197 and second guide pulley 297. This length change is transmitted to the distal articulation of the medical instrument 60, 160, 260 by means of the transmission mechanism, causing actuation thereof.

According to one embodiment, a spring 99 adapted to operate by compression is interposed around the plunger 96 between the plunger idler 98 and the upper frame 58.

According to one embodiment, the spring 99 generates a force directed along the plunger movement direction axis and establishes a sufficient variable preload on each plunger 96 sufficient to always keep the tendon 90 under light tension and avoid its derailment from the guiding elements 97, 98, 197, 297 during its change in tensile load.

According to one embodiment, the tendon guide elements 89 hold each tendon 90 in place and prevent its derailment, even in the event of an abnormality (e.g., a loss of tension in the tendon 90).

According to one embodiment, the articulating device 70 uses six low friction, low minimum radius of curvature and high stiffness polymer tendons as motion transfer means for actuating three degrees of freedom of motion that the articulating device 70, 170, 270 is capable of. Each actuation cable or tendon 90 is glued to the tendon fastening surface 84 of the lower frame 59 with a low viscosity acrylic glue and changes its direction by passing through four consecutive guiding elements 97, 197, 297 integral with the lower frame 59 until it reaches the centre of the gear box 62 and down into the articulation means 70, 170, 270 through a central hole in the shaft 65 of the medical instrument 60, 160, 260 travelling in the direction of instrument X-X.

As shown in fig. 13, the first guide pulley 197 of each actuation cable 90 is a fixed pulley 197 around which the tendon 90 is wound. The continuous guiding element is an idler wheel on which the tendon 90 is partially wound. A space is provided between the first guide pulley 197 and the second guide pulley 297 to allow linear movement of the plunger 96 actuated by the actuating piston 95.

According to one embodiment, at least one tendon 90 is wrapped around at least four guide pulleys 197, 297, 397, 497, thereby defining a third guide element 397 and a fourth guide element 497. Between the third guiding element 397 and the fourth guiding element 497, the tendon guiding element 89 keeps the tendon 90 in the correct position and prevents derailment of the tendon 90 even in case of e.g. abnormal tension loss.

According to one embodiment, the joint members forming the articulating devices 70, 170, 270 and their end devices 77 reproduce the kinematics of the human wrist for a total of three degrees of freedom of motion, thereby increasing the degree of freedom of gripping motion at the tip.

According to one embodiment, the first joint member 71 and the second joint member 72 are connected to each other by a rotary joint 171 about a first axis of rotation P-P, then a first portion 177 of the end member and a second portion 277 of the end member, both connected to said second joint member 72, are free to rotate about a second axis of articulation Y-Y orthogonal to the first axis of articulation P-P, and an end device 77 is provided at the tip.

According to one embodiment, the first member 71 is locked or connected concentric with the shaft 65 of the medical instrument 60 and rigidly attached to said shaft via a fastening pin 76.

According to one embodiment, six actuation cables 90 run through medical instrument shafts respectively arranged on a triad of two planes symmetrically arranged with respect to the axial section defined by the axis of the instrument X-X and its first joint axis P-P.

According to one embodiment, the tendons 90 and the opposite tendons 190 associated with the second articulation member 72 provide a clockwise and a counter-clockwise rotation about said first articulation axis P-P, which tendons and opposite tendons are arranged opposite each other with respect to said section plane, slide over the two opposite lateral sliding surfaces 40 of the first member 71, then all pass through said section plane before said first articulation axis P-P, then they are wrapped around at least one articulation sliding surface 80 of the second member 72 and finally they are attached to said second member 72.

According to one embodiment, the tendons associated with the first portion of the end member 177 and the opposite tendons 90 (as with the two tendons 90 associated with the second portion of the end member 277) both run on the same side of the shaft profile, they both slide on the same lateral sliding surfaces 40, 140 of the first member 71, then they both pass through the profile before the first articulation axis P-P, then they both wrap around at least one same sliding surface 80 of the second member 72 and continue their path to end the wrapping in the opposite direction on the wrapping surface 86 of the end member 77. When only the first portion 177 of the end member or only the second portion 277 of the end member is actuated, the tendons 90 associated with said first portion 177 of the end member and with said second portion 277 of the end member slide along the sliding surface 80 of the second member 72.

According to one embodiment, movement of the articulating device 70 is accomplished by a polymer actuation cable 90 or polymer tendon 90. These tendons 90 travel through the mechanical gear box 62, along the entire hollow shaft 65 and to the articulation device 70 and end device 77.

According to one embodiment, the transmission of motion to the joints of the articulating device 70 is a function of the path of the tendons 90 in the articulating device.

By utilizing the low friction, very small radius of curvature of the tendons 90, the tendons slide over the joint members making up the articulating device and they wrap around the respective articulation axes P-P, Y-Y.

According to one embodiment, the components comprising the articulating device 70 are in fact rotatably coupled to one another by the shaft support features of the rotational joint 171. Each member has either an articulating sliding surface 80 or an articulating wrapping surface 86 for tendon 90, both about an articulation axis P-P, Y-Y and along its body.

According to one embodiment, by providing an elbow joint member 75 characterized by two different parallel joint motion axes P-P, P-P, another elbow joint member 75 positioned before the wrist joint member 78 that is adapted to reproduce the kinematic features of a human wrist may be included. According to one embodiment, the first member 71 is coupled to the elbow member 75 having two distinct and parallel axes of articulation P-P, P-P, one proximal and the other distal and first and second joints, respectively. The elbow member 75 has two lateral sliding surfaces 40, 140 disposed laterally opposite each other with respect to a second cross-section defined as a plane containing the first axis P-P and the second articulation axis Y-Y.

According to one embodiment, there are eight actuation cables 90, 190. The eight actuation cables or tendons travel on the lateral sliding surfaces 40, 140 of the first member, are arranged in one set of four actuation cables or tendons and another set of four actuation cables or tendons relative to the first profile, and they pass through the profile before the first articulation axis P-P, so they travel on the first articulation sliding surface 80 of the elbow member 75.

According to one embodiment, two actuation cables 90, 190 dedicated to the movement of the rotary joint 171 of the elbow member terminate at said elbow member 75. The remaining six cables 90, 190 run along the lateral sliding surfaces 40, 140 of the rotary joint 171 of the elbow, passing through the second section before said second joint axis. The tendons that next advance around the second member 72, the third member 73 and the fourth member 74 to the first portion 177 of the tip member and the second portion 277 of the tip member are similar to what was described previously in the presentation of the wrist configuration.

According to one embodiment, all of the components forming the articulating device 70 and the end device 77 are fabricated by wire EDM performed on two orthogonal work planes X-Y, Y-Z.

According to one embodiment, the first member 71 is manufactured starting from the cylindrical piece 117 to be machined, presenting two circular surfaces allowing its concentric insertion into the shaft 65.

According to one embodiment, said circular surface presents on the lower portion a matching feature, for example a through hole, which allows rigid attachment of said first member of the shaft 65 by means of a fastening pin 76. The first member 71 presents on the distal portion two features for supporting the rotary joint 171, each feature being a cylindrical seat centered about the first articulation axis P-P and a lateral shoulder surface.

According to one embodiment, all holes machined by wire EDM (e.g., pin holes 79) have additional machined grooves 49 created by the passage of cut wire 115.

According to one embodiment, by defining said first section comprising the axis X-X of the instrument and the first articulation axis P-P, the first member 71 presents two opposite tendon sliding surfaces 40, 140, each having a circular shape symmetrically opposite (i.e. corresponding to a mirror image of said section).

According to one embodiment, each sliding surface 80, 180, 40, 140 is produced by a sweeping motion of a parallel straight generatrix that moves directly along the cutting profile 110, by machining by wire EDM.

According to one embodiment, the actuation cables 90 slide along the two lateral sliding surfaces 40, 140, respectively, in two groups of three, one opposite the other on the first member 71, and they pass through the profile before the first rotation axis and then continue onto the second member 72.

According to one embodiment, the second member 72 has a proximal articulation sliding surface 80 disposed about the first articulation axis P-P having a cylindrical portion.

According to one embodiment, the articulating sliding surface 80 is formed by parallel straight generatrix following a linear EDM cutting profile.

According to one embodiment, the pin retaining feature 76 and the lateral shoulder surface characterize the articulation of the first member 71 about the first articulation axis P-P. Two tendon termination features 82 are laterally derived from the second component 72, allowing the second tendon end point 92 of the second member to be fastened by knotting or gluing. Distally, both support features for the third and fourth rotary joints have pin holes 79 about the second joint axis of motion Y-Y and a lateral shoulder surface.

According to one embodiment, the second articulation axis Y-Y is orthogonal to the first articulation axis P-P. The pin bore 79 has machined grooves 49 created by cut lines 115 by machining by wire EDM.

According to one embodiment, the third member 73 has pin holes 79 positioned about the second articulation axis Y-Y. The third member 73 mates with the second member 72 through a seat for the joint pin and an associated lateral shoulder surface. The winding surface 86 of the actuation cables 90, 190 allows the actuation cables 90, 190 to be wound around the winding surface 86 concentric with the second articulation axis Y-Y.

A tendon termination feature 82 and tendon fastening points 82 are obtained on the side of the third member 73. The tendon termination feature 82 allows passage of the tendon 90 and the tendon fastening point 82 holds the second tendon ends 92, 192 of the third member 73 defined by the knot.

According to one embodiment, the first portion 177 of the end member and the second portion 277 of the end member are connected to the second member 72 so as to share the same second articulation axis Y-Y.

According to one embodiment, the first portion 177 of the end member mirrors the shape of the second portion of the end member 277.

According to one embodiment, if the end device 77 present on the third member 73 is a surgical or microsurgical type medical instrument 60 similar to, for example, a surgical blade, the third member 73 may be mated with the second member 72 alone.

According to one embodiment, the end device 77 may be connected to said second member 72 solely only if the end member 77 itself is a surgical or microsurgical type medical instrument 60, like for example a surgical blade or like a fiber optic tendon carrier for laser treatment. In this case, the articulating device 70 will include only two degrees of freedom of movement, particularly of pitch and yaw, but lose the degrees of freedom of grip.

As shown in fig. 25-27, according to one embodiment, the first portion 177 of the end member and the second portion 277 of the end member may be mated with each defining a different end device 77 (e.g., a micro device for cutting, an end micro device providing a straight grip, a micro device providing an angled grip, a needle holder, and other conventional micro surgical instruments). The tip device reproduces the shape, scale and function of the tip of a conventional microsurgical instrument to facilitate their identification and use by the microsurgery 200.

According to one embodiment, the securing pin 76 is inserted into a pin hole 79 of a component of the articulating device 70. The fastening pin 76 is preferably made of hard metal, which is trimmed and polished to reduce sliding friction.

According to one embodiment, the securing pin 76 is interference fit with a pin bore 79 corresponding to the articulation axis P-P, Y-Y of the rotary joint 171.

According to one embodiment, the fastening pin 76 has a margin or gap in the pin bore 79 associated with the winding surface 86.

According to one embodiment, the connection between the first member 71 and the second member 72 by the fastening pin 76 forms a rotary joint adapted to rotate about the second articulation axis P-P, wherein the relative actuation angle is substantially between +90° and-90 °.

According to one embodiment, the connection between the second joint member 72, the first portion 177 of the end member and the second portion 277 of the end member by a single fastening pin forms a rotary joint between the three members 72, 177, 277 having an associated actuation angle range substantially between +90° and-90 °. The joints define two degrees of freedom that characterize the deflection and grasping of the medical instrument 60.

According to one embodiment, the polymer tendons 90, 190 can terminate in several ways as long as they can be tensioned due to the firm fastening and such tension is also transferred to the joint member or to the component to which the joint member is connected, driving its movement.

According to one embodiment, the tendon 90 travels through the tendon termination feature 82 and is locked by the knot formed by the tendon 90 itself at the tendon fastening point 82.

According to one embodiment, a second method for fastening the tendons 90, for example for actuating the second member 72, provides for a passage of the tendons 90 around the tendon fastening points 82 and applies tension to both ends of the tendons 90 such that both sides of the tendons 90 act as a single tendon 90, halving the load it receives.

According to one embodiment, the third fastening method of the tendon 90 provides for the tendon portion to be inserted into the tendon fastening point 82 for this purpose, and glue specific to the polymer from which the tendon 90 is made is used, such as those used for gluing the first end point 91 to the lower frame 59 of the mechanical transmission box 62 of the tendon drive system 50.

According to one embodiment, the articulating device 70 has three degrees of freedom of movement, and in particular one degree of freedom of pitch between the first member 71 and the second member 72, one degree of freedom of deflection between the second member 72 and the third member 73, one degree of grasping or gripping between the first portion 177 of the end member and the second portion 277 of the end member.

According to one embodiment, the second articulation member 72, the first portion 177 of the end member and the second portion 277 of the end member are independently movable about the first articulation axis P-P and the second articulation axis Y-Y, respectively. The movement of the medical instrument 60 is performed by an actuation cable 90 that runs over members connected to each other by a rotary joint.

According to one embodiment, the pair of tendons 90, 190 comprises a tendon 90 and an opposing tendon 190 adapted to function as a pair of fight and fight tendons associated with the first portion 177 of the end member, and the other pair of tendons 90, 190 comprising a tendon 90 and an opposing tendon 190 is adapted to function as a pair of fight and fight tendons associated with the second portion 277 of the end member, and the other pair of tendons 90, 190 comprising a tendon 90 and an opposing tendon 190 is adapted to function as a pair of fight and fight tendons associated with the second joint member 72.

According to one embodiment, a pair of tendons 90, 190 comprising a tendon 90 and an opposing tendon 190 are adapted to act as a pair of fighting and countermeasure tendons which transmit rotational movement to the second portion 277 of the end member, travel on the lateral sliding surface 40 of the first joint member 71 about said second articulation axis Y-Y, travel through said section plane, on the joint sliding surface 80 of said second joint member 72, and then diverge to wind them in opposite directions around the winding surface 86 of the second portion 277 of the end member, respectively, and terminate in knots. When one of the two tendons 90, 190 is tensioned or released, it slides on the sliding surface 40 of the first joint member 71 and on the sliding surface 80 of the second joint member 72 while it winds or unwinds itself on the winding surface 86 of the fourth joint member, as on a fixed pulley.

According to one embodiment, the other tendon pair 90, 190 consisting of the tendon 90 and the opposite tendon 190 actuates the first portion of the end member 177 in a similar manner as the second portion of the end member 277.

According to one embodiment, a further tendon pair 90, 190 consisting of a tendon 90 and an opposing tendon 190, suitable for acting as a pair of fight and countermeasure tendons, moves the second joint member 72 about the first articulation axis P-P, travelling on the lateral sliding surface 40, 140 of the first member 71 on one side with respect to the section of the medical instrument 60, intersecting the section, wrapping themselves in opposite directions on the sliding surface 80 of the second joint member 72 and terminating at the tendon fastening point 82. In particular, each actuation tendon 90, 190 of the second joint member 72 is formed as a loop that follows a path similar to that followed by the opposing tendon around the respective tendon fastening point 82 and doubles back, traveling over the wrapping surface 86, the articulation sliding surface 80, and the lateral sliding surface 40.

According to one embodiment, when the second joint member 72 is moved in one rotational direction about the first articulation axis P-P, both ends of the tendons 90, 190 are under tension. Further, unlike the two tendon pairs 90, 190 which actuate the first portion 177 of the joint member and the second portion 277 of the joint member, respectively, in the case of the tendon 90 of the second joint member 72, the tendon 90 does not slide on the sliding surface of the second joint member 72 when it moves, but winds or unwinds around the joint sliding surface 80 as if it were a pulley.

According to one embodiment, six independent tendons 90 are used for actuating three degrees of freedom of movement of the articulation device 70, but eight cables intersect on the cross-section between the lateral sliding surface 40 of the first articulation member and the lateral sliding surface 80 of the second articulation member 72, because the two looped ends of the actuation cables 90, 190 of the second member 72 are tensioned during movement in one direction about the first articulation axis P-P.

According to one embodiment, the sliding surfaces 80, 180 between the actuation cable 90 and the components of the articulating device 70 are reduced to a minimum surface area in order to reduce friction. The tendons 90, 190 terminate at their second tendon end points 92 such that their tendon paths T-T remain as parallel as possible to the instrument axis X-X, thereby avoiding lateral forces.

According to one embodiment, the intersection of the tendons 90 and its cross-section between the joint sliding surface 40 and the first rotation axis P-P prevents the tendons 90 from leaving the joint sliding surface 80 during their movement and ensures a constant length and angle of the tendons 90, 190.

The following describes a method of machining three-dimensional assemblable mechanical micro-components by EDM. In particular, it relates to the manufacture of an articulating device 70 having a characteristic outer diameter of less than 4mm for microsurgery. Furthermore, the main features of the specific machining fixture 112, which is an essential element for establishing the production process in an economically sustainable manner and which is capable of ensuring the required precision, are described below.

According to one embodiment, the need to produce micro-components with many mechanical details and high levels of precision requires the use of hard metal as the structural material and wire EDM as the machining process for the components. As is known, EDM is a subtractive manufacturing process in which material is removed by a conductive sheet having a series of current discharges between the conductive sheet itself and an electrode that maintain a voltage differential, separated by a dielectric liquid (such as water or oil) until the desired shape is obtained. In particular, during wire EDM machining, the workpiece 117 remains fixed and immersed in a bath of dielectric liquid, while the metal cutting wire 115, which is made of copper or brass for example and varies in diameter between 0.5mm and 0.02mm, travels continuously between the two spools. The cutting line 115 is maintained by upper and lower guides driven by a computer digital control system in the horizontal plane, performing a two-dimensional cutting profile. The motion of the guide is very precise and the overall machining resolution is close to 1 micrometer (μm), but the planar cut substantially limits the fabrication of three-dimensional parts. Although some advanced machines have upper guides that are independently movable in a horizontal plane, the ability to produce complex 3D parts is not substantially increased.

The main advantages of wire EDM include:

the possibility of working hard metals,

no direct contact between tool and workpiece 117

Fine details can be processed without distortion,

a good surface finish can be obtained,

complex shapes that are difficult to produce with conventional cutting tools can be produced while keeping the tolerances very low.

The manual phase for fastening each single metal workpiece 117 to be machined to the machine for each cutting plane, and the subsequent calibration of the machine itself, is a very slow phase during the manufacturing of the component, and also a phase that results in the largest geometrical errors that prevent perfect matching between the individually produced micro-components.

According to one embodiment, to significantly reduce manufacturing time and ensure the precision required for proper matching of the manufactured micro-components, a machining fixture 112 is provided that is dedicated to this purpose. It provides a mechanical support that allows all of the workpieces 117 to be fastened and machined simultaneously, thereby simplifying the assembly of at least a portion of the articulating device 70 in one or more different planes, with a single cutting profile 110 and a single calibration step.

According to one possible mode of operation, the front plane of the machining fixture 112 has a component hole 116 adapted to hold the workpiece 117 with very tight tolerances (i.e., at least H6H 5).

According to one possible mode of operation, the front plane of the machining fixture 112 has a "stepped" profile to allow for passage of short through holes in a stepped transverse plane.

According to one possible mode of operation, the grub screw M2 secures the workpiece 117 to the machining fixture 112 and ensures perfect electrical conductivity with said machining fixture 112, which is essential for a successful EDM process.

According to one possible mode of operation, the grub screws disappear, i.e. are headless, below the planes in which they are screwed, in order to avoid restraining the clamp with the vice of the EDM machine along these planes.

According to one possible mode of operation, an alternative to the grub screw and the threaded hole associated with the grub screw is to use conductive glue to fasten the workpiece 117 to the machining fixture 112 and to ensure perfect electrical conductivity by said machining fixture 112.

According to one possible mode of operation, the arrangement of the workpieces 117 on the machining fixture 112 is such that they do not overlap in the working plane (e.g., in the X-Y plane and the Y-Z plane) so that different and independent details or profiles can be cut for each plane on each workpiece 117 by providing a single and continuous cutting profile 110 for the wire.

According to one possible mode of operation, the gap or non-overlapping section between two adjacent workpieces is minimized to keep the size of the machining fixture 112 as compact as possible. In this way, the distance between the upper and lower guides can be minimized, thereby improving machining accuracy.

According to one possible mode of operation, once the machining fixture 112 and workpiece 117 are mounted on the machine, a metal reference rod 118 is inserted into the machining fixture 112 and used for calibration of the EDM machine.

According to one possible mode of operation, a first calibration is provided which is performed only once for a given machining fixture 112 loaded with all workpieces 117 and a given EDM machine for machining. The first calibration is capable of identifying and compensating for all errors associated with the EDM machine as well as geometric errors of the machining fixture 112, such as those associated with the relative position between the reference rod 118 and the workpiece 117.

According to one possible mode of operation, the cutting profile 110 is generated once the position of the workpiece 117 is defined in the respective cutting plane with respect to the reference bar 118, taking into account any differences in the actual position from the nominal position.

According to one possible mode of operation, the first calibration will be repeated only when the EDM machine is changed or a new machining fixture 112 is being used.

According to one possible mode of operation, each time the machining fixture 112 loaded with the workpiece 117 is secured to the vise of the EDM machine prior to cutting, a second calibration procedure is foreseen or a cutting calibration is performed on the calibration rod 118 only. The cutting calibration process eliminates geometric offset and errors associated with manual tightening of the clamp and identifies the origin of the machine reference system relative to the reference rod axis.

According to one possible mode of operation, in order to allow the correct fastening of the machining clamp 112 to the vice of an EDM machine, said machining clamp 112 has at least one pair of fastening or fixing surfaces 113, 114 opposite and parallel to each other and is trimmed, which means gripped by the jaws of the vice, and the flat rear X-Z surface is trimmed and orthogonal to the fixing surfaces 113, 114, which means flush with the reference surface of the machine's clamp orthogonal to the vice.

According to one possible mode of operation, by not using a rotary table in the EDM machine, the machining fixture 112 must have a pair of fixed surfaces 113, 114 that are flat, parallel and trimmed, opposite each other for each cutting plane provided for manufacturing the micro-component.

According to one possible mode of operation, other cutting planes may be created by appropriate modification of the machining fixture 112.

According to one possible mode of operation, for machining in the third orthogonal plane, it is necessary to provide an opening 125 in the machining fixture, which allows the cutting line 115 to be inserted inside the machining fixture and thus avoids cutting, for example, a portion of the machining fixture 112. However, several separate cutting profiles have to be used without further calibration. At the end of each cutting profile 110 in the plane, however, the cutting line 115 must be cut and reinserted into the next opening 125.

According to one possible mode of operation, the manufacturing process for manufacturing the components of the articulated device 70 provides for inserting four workpieces 117, constituted by metal cylinders made of tool steel, into the component holes 116 on the front side of the machining fixture 112, and then fastening with flat head screws of M2 size.

According to one possible mode of operation, all three-dimensional micro-components forming the articulating device 70 for micro-medical applications are machined from a metal workpiece 117, particularly a steel cylinder of 3 mm outside diameter and 12 mm length, machined by wire EDM in two planes X-Y and Y-Z.

According to one possible mode of operation, the calibration in the X-Y plane is performed by fixing the machining fixture 112 loaded with the workpiece 117 on the vice of the EDM machine using the fixing surfaces 113, 114 as reference planes for fastening, and then using the axis of the reference rod 118 rigidly attached to the machining fixture 112 as a reference. The first cutting profile 110 is performed in the X-Y plane to machine all of the workpieces 117 secured to the machining fixture 112.

According to one possible mode of operation, the machining fixture 112 is then removed from the machine and reinstalled to the machine along the second plane Y-Z of the machining fixture 112 by 90 ° of rotation.

According to one possible mode of operation, a second calibration for the second working plane Y-Z is performed, and then the cutting of the second cutting profile 210 is performed.

According to one possible mode of operation, by equipping the EDM machine with a rotating or orientable table, it is possible to perform a cutting calibration procedure only once and to rotate the work plane as required between one cutting profile and the next.

According to one possible mode of operation, at the end of the second cutting profile 210, the produced component is completely detached from the workpiece and can be collected in an EDM machine vat.

According to one aspect of the present invention, as a result of the provision of the robotic assembly, the positioning and movement of at least one articulating medical instrument within the working volume can be controlled in a reliable, accurate and easily controlled manner.

According to one aspect of the invention, as a result of the provision of the robotic assembly, the positioning and simultaneous movement of at least two articulated medical instruments can be controlled in a reliable, accurate and easily controllable manner, each articulated medical instrument comprising one articulated device operable within a working space, potentially reaching each body part of a patient with an end portion of the medical instrument.

Since a robotic assembly including an image capture system according to one aspect of the invention is provided but lacking an integrated microscope, the cost and physical volume of the assembly can be limited, resulting in a compact platform compatible with installation of pre-existing microscopes, thus allowing retrofit operations.

Since a robot assembly according to one aspect of the present invention is provided with as few moving parts as possible, which require a large range of movement during the movement of the end portion of the medical instrument, a low-obstruction microsurgical robot assembly can be provided to improve the comfort of the microsurgeon, who can e.g. remotely operate in the vicinity of the operating table and thus see and directly access the operating field, and to improve the overall working conditions of the operating team, or the flow of personnel or air around the robot assembly, e.g. by avoiding collisions with the movable parts of the robot and simplifying the transportation of the robot assembly when accessing the operating field. Also, two or more robotic assemblies can be used simultaneously on one patient.

Since the control device according to an aspect of the present invention is provided, it is possible to simplify the remote operation main interface and make it more intuitive and comfortable without restricting its function. At the same time, the training time required by the surgeon is reduced without the need for special training for microsurgery to achieve a sufficient level of control.

According to one aspect of the present invention, since a microsurgical robotic assembly is provided that includes a control instrument adapted to replicate the shape of a conventional surgical or microsurgical instrument, a familiar master interface for remote manipulation can be provided to a surgeon without affecting the accuracy of the manipulation.

At the same time, according to one aspect of the invention, the control device is also adapted to replicate the functionality of a conventional surgical or microsurgical instrument, thanks to the provision of at least one sensor coupled to an electromagnetic 3D tracking device, while allowing a complete free movement in three spatial dimensions and allowing an easy repositioning of the control device, for example between an operating table and a microscope, while still guaranteeing a good performance of the robotic system in terms of response time.

At the same time, according to one aspect of the invention, since a compact control device and at least one sensor are provided which are adapted to associate the robot assembly and the detection device with a common reference system, the control device can be freely positioned in a simple manner, for example, the control device can be positioned against an operating table or on a support table close to the microscope or in a position considered ergonomic for a surgeon looking at the microscope.

Since a control instrument according to an aspect of the present invention (e.g., forceps equipped with at least one hole sensor) that replicates the shape of a conventional micro-surgical instrument having at least one joint at the tip is provided, the opening and closing and grasping movements of the articulating medical device can be controlled in a familiar and accurate manner.

The provision of a medical device comprising an articulating device for movement through a tendon according to one aspect of the invention reduces the complexity of its machining, for example by eliminating the provision of channels or sheaths, allowing for extreme miniaturization of the medical device without reducing its reliability during use or assembly.

Since the articulated device including the actuation cable or tendon made of a non-metallic material (e.g., a polymer material) according to one aspect of the present invention is provided, it is possible to reduce the radius of curvature of the tendon and the coefficient of friction of the tendon, and thus further miniaturize the articulated device.

Since an articulated device according to one aspect of the invention is provided comprising a ruled surface with all parallel generatrix for the sliding of the tendons and tendon termination features arranged in a specific geometrical relationship with the surface, it is possible to have no tendon guide channels or sheaths, still guaranteeing parallelism of the tendons and thus it is possible to miniaturize the articulated device extremely.

Since a manufacturing method according to an aspect of the present invention and a machining jig adapted to ensure that a plurality of workpieces are positioned simultaneously in a manner that allows their cutting lines to remain parallel to each other are provided, a single cutting path can be obtained on the plurality of workpieces by means of an EDM cutting line for each cutting plane. In this way, parallel surfaces with high tolerances can be produced on the workpiece even in the case of very detailed small shapes being machined.

Thanks to the provision of the manufacturing method according to one aspect of the invention, micromechanical components guaranteeing high precision and surfaces suitable for medical and/or surgical applications can be produced.

As a result of the provision of the manufacturing method of one aspect of the invention, medical devices can be produced more quickly and thus more cost-effectively than known solutions.

Thanks to the provision of the machining fixture and the manufacturing method according to one aspect of the invention, a fast and efficient process can be obtained even for the repeated positioning of the workpiece within the machine.

Since an improved machining fixture for EDM is provided according to one aspect of the invention, which accelerates the cutting process on multiple cutting planes, the number and duration of stages dedicated to calibrating the machine can be reduced.

By providing a manufacturing method for electroetching according to one aspect of the invention, which allows machining of micromechanical components comprising cavities and ridges that are suitable for forming pin-holding features without machining holes, even when a groove is left between two prongs 81 of material, the machining time can be significantly shortened.

Since the tendon driving system according to an aspect of the present invention is provided, the movement of the tendon can be ensured only by the push rod assembly adapted to push the tendon and generate a tensile load on at least a portion of the tendon. In this way, the drive system avoids pulling the tendon, for example by attaching to a portion of the tendon or by winding a portion of the tendon on a capstan.

Since the tendon driving system according to one aspect of the present invention is provided, the number and complexity of components of the driver are reduced, and any gaps of the components when not loaded can be avoided, making the system suitable for extreme miniaturization without degrading the reliability or accuracy thereof.

The provision of a tendon according to one aspect of the present invention allows to reduce the outer diameter size of the tendon and thereby the outer diameter size of the medical device without reducing its performance in terms of durability or reliability.

Since a tendon according to one aspect of the present invention is provided, an improved performance of the tendon in terms of sliding friction over at least a portion of the medical device can be ensured with respect to known solutions.

According to one aspect of the invention, the working life of the instrument can be increased relative to known solutions, as a tendon and tendon replacement method are provided.

Since the tendon made of a nonmetallic material (e.g., a polymer material) according to one aspect of the present invention is provided, it is possible to reduce the radius of curvature of the tendon and the coefficient of friction of the tendon, and thus enhance miniaturization of a medical instrument including the tendon.

Since the tendons according to one aspect of the present invention are provided, it is possible to ensure parallelism between the tendons without providing a tendon catheter or sheath in the medical apparatus, and thus allow for extreme miniaturization of the medical apparatus.

Since the tendon 90 comprising the second tendon end 92 as described above is provided, an articulated device 70 can be obtained, wherein its components do not require tendon guides or channels to facilitate the routed travel of the tendon 90, whereas the tendons 90 do not interfere with each other. In fact, the geometrical position of the tendon end points 92 is chosen in such a way that the tendons 90 are substantially parallel to each other and to the sliding surfaces 40, 80.

Since sliding surfaces, such as the lateral sliding surface 40 and the articular sliding surface 80 as previously described, are provided, the tendons can slide on the articular device with low friction.

Thanks to the cooperation between the geometrical positions of the sliding surfaces 40, 80 and the first and second tendon ends 91, 92, friction between the tendon and the sliding surfaces can be ensured, and the fastening reactions at the first and second tendon ends 91, 92 are substantially parallel to each other and along the same axis.

Due to the cooperation between the sliding surfaces 40, 80 and the geometrical positions of the first tendon end point 91 and the second tendon end point 92, extreme miniaturization of the medical instrument 60 can be achieved. For example, pulleys and/or other tendon guides unsuitable for miniaturization beyond a certain threshold can be eliminated in this way. For example, according to one embodiment, the shaft 65 of the medical device may measure an outer diameter of 3 millimeters.

Since tendons 90 are provided which maintain a radius of curvature of less than or substantially equal to 1 millimeter, tendon paths T-T which are wrapped at least partially around the members 71, 72, 73, 74, 75, 77, 78, 177, 277 of the articulating device 70 can be designed to avoid loop formation, for example, when at least a portion of the articulating device 70 is moved relative to the axis of motion P-P, Y-Y.

Since the tendon driving system 50 and the tendons 90, 190 having the first tendon end point 91 and the second tendon end point 92 being bosses and/or knots and/or being glued as described before are provided, the tendons 90, 190 can be installed with high accuracy and easily replaced, thereby extending the working life of the medical apparatus 60. Furthermore, since tendons made of polymeric materials are provided, the components of the articulating device 70 are not damaged during operating conditions.

Since the tendon drive system 50 is provided comprising at least one push rod assembly 94 adapted to push while resting on the tendon deflectable portion 93 of the tendon 90, the tendons can be actuated without squeezing them or winding them on a capstan.

In this way it is possible to avoid damaging them under working conditions and thus to increase the life of the tendons and of the medical apparatus 60, thus reducing maintenance costs.

Since the tendon driving system 50 as described above is provided, the gap within the tendon driving system 50 can be minimized to always provide a defined preload.

Because of the provision of a substantially linear push rod assembly, micro-measurement actuation systems (e.g., sliders and piezoelectric actuators) can be integrated to control the tensile load of the tendon and to release and pull the exact length of the tendon, allowing at least a portion of the medical device to be moved by a desired amount, e.g., about an axis of motion.

Providing a tendon drive system adapted to cooperate with an articulating device across a sterile barrier allows for the production of highly reliable and sterile medical devices.

Since the EDM-based manufacturing method as described above is provided, the entire articulating device can be manufactured with only one placement step in the machine, thereby reducing manufacturing time and cost without reducing the reliability or accuracy of the machining.

Since a manufacturing method according to an aspect of the present invention is provided, it is possible to manufacture a joint member of an articulated device having a ruled surface with parallel generatrix, to allow tendons sliding above the ruled surface to maintain a stationary path with respect to the joint member. This allows the friction between the tendon and the sliding surface of the joint member to be minimized, thereby promoting miniaturization of the joint device.

Due to the provision of EDM-based manufacturing methods adapted to deliver only thermal stimuli to the workpieces as described previously, sub-millimeter sized components can be obtained, allowing for extreme miniaturization of the medical instrument 60 while still maintaining satisfactory cutting accuracy due to the provision of cutting multiple workpieces in a single pass.

Thanks to the provision of a tool and an EDM method according to an aspect of the invention adapted to cut in a single line over a plurality of workpieces to be machined, which will be assembled together after machining, a match with millimeter-scale precision can be obtained, which is particularly adapted to build up the profile of rotating joint features, such as forks, pivot holes, joint members, allowing reliable mounting of the workpieces by means of a bayonet fitting or with a controllable gap between the same components.

Since the robotic assembly 100 is provided comprising at least one control instrument replicating a conventional surgical instrument and a control device comprising an ergonomic support element for an operator, familiarity and ergonomics of the surgeon can be improved, thereby improving the results of the surgical procedure and patient comfort.

Since the robot assembly including the macro positioning arm having the mechanical structure of the arm member and the highly rigid joint according to one aspect of the present invention is provided, it is possible to avoid mechanical vibration of the structure at the distal end portion of the instrument and thus facilitate the work of the surgeon.

Although some combinations of the above embodiments may be seen in the drawings, an expert in the field should also be able to construct combinations not shown in the drawings without departing from the scope of the appended claims.

Numerous modifications, adaptations and substitutions of the elements with other functionally equivalent elements can be made by those skilled in the art to meet specific and temporary needs without departing from the scope of the appended claims.

List of reference numerals:

7. working volume or common working space volume

9. Flight segment of tendon

16. Intersection point

18. Proximal tendon portion

19. Distal tendon portion

20. Control device

21. Control apparatus

22. Detection device

23. Connection cable

24. Communication and power cable

25. Operator support surface

26. Status signal lamp

27. Operator support element

28. Position sensor

29. Tip sensor

30. Macro positioning arm

31. First arm component

32. Second arm component

33. Third arm component

34. Fourth arm component

35. Release button or brake release button

36. Linear sliding guide

37. Manual knob

38. Support member

39. Attachment features

40. Sliding surface

41. Micro positioning device

43. Rotary scale nut

45. Video camera

46. Motorized rotary joint

47. Base portion

48. Plunger locking hole

49. Machining grooves

50. Tendon driving system

51. First motorized slider or first motorized micro-slider

52. Second motorized slider or second motorized micro-slider

53. Third motorized slider or third motorized micro-slider

54. First slide rail

55. Second slide rail

56. Third slide rail

57. Frame

58. A first or upper frame part

59. A second frame part, drum part or lower frame

60. Medical or micro-or surgical micro-instruments

61. Motor chamber

62. Mechanical transmission case

63. Sharp edges of lateral sliding surfaces

64. Continuous surface of lateral sliding surface

65. Shaft or hollow shaft

67. Control device base structure

68. Tip portion of control device

69. Pliers hinge for control device

70. Articulated or articulated devices

71. First member or first joint member or first link

72. A second member or a second joint member or a second link

73. Third member or third joint member or third link

74. Fourth member or fourth joint member or fourth link

75. Elbow members or connecting rods

76. Fastening pin

77. End devices or end members or end portions

78. Wrist or wrist joint member

79. Pin hole

80. Sliding surface or articulation sliding surface

81. Fork-shaped article

82. Tendon termination characteristics or tendon fastening points.

83. Surface of the body

84. Tendon fastening surface

86. Winding or straight-line winding surfaces

87. Sterile barrier

88. Shoulder surface

89. Tendon guiding element

90 tendons or actuation cables or tendons of first pair of tendons

90' jacket

90' core

90' "coating

91. A first end point or a first tendon end point or a proximal tendon end point or a first tendon end

92. A second endpoint or a second tendon endpoint or a distal tendon endpoint or a second tendon endpoint

92' tendon distal portion

93. Tendon deflectable or deflectable portion

94. Push rod assembly or pushing device

95. A pushing element, a piston, an actuating piston or a linear actuating piston.

96. Plunger or sliding shaft

97. Guiding element or tendon guiding element and guiding pulley

98. Plunger idler

99. Tensioning or pretensioning elements or springs

100. Robotic surgical assembly or surgical robotic assembly, robotic assembly for microsurgery or microsurgery robotic assembly

102. Operating table

103. Visual system, microscope or surgical microscope

104. Support or trolley

105. Foot platform

106. Telescopic handle

107. Power cable

108. Control panel

109. Communication cable

110. Cutting contours or lines

111. Display device

112. Machining fixture

113. A first fixing surface of the first pair of fixing surfaces

114. Second fixing surface of the first pair of fixing surfaces

115. Cutting or EDM or electric discharge machine tool lines

116. Component hole or component seat

117. Work or work to be machined

118. Reference bar

120. First control device

122. A first rod part

123. A second rod part

125. Guide holes or openings

134. First fixing surface of the second pair of fixing surfaces

135. A second fixing surface of the second pair of fixing surfaces

141. First micro-positioning device

145. First portion of plunger

146. Second portion of plunger

147. Pushing surface

148. Reciprocating pushing surface

150. Sensor for detecting a position of a body

151. Force sensor

152. Pressure sensor

153. Proximity sensor

160. First medical instrument

170. First joint type device

171. Rotary joint

172. Joint portion

173. Spherical joint

177. First portion of end member

190. Opposite tendons or opposite tendons of first pair of tendons

191. Tendons of the second pair of tendons

192. Opposite tendons of the second pair of tendons

194. Relative push rod assembly or relative pushing device

197. First guiding element or first guiding pulley

199. Opposite tensioning element, opposite pretensioning element or opposite spring

210. Second cutting profile

220. Second control device

221. Second control device

241. Second micro-positioning device

260. Second medical instrument

270. Second joint type device

277. Second portion of end member

297. Second tendon guide element or second tendon guide pulley

397. A third tendon guide element or a third tendon guide pulley.

497. Fourth tendon guide element or fourth tendon guide pulley

200. Surgeon or micro-surgeon

201. Patient(s)

202. Surgical needle

341. Third micro-positioning device

360. Third medical instrument

T-T tendon direction or tendon path

X-X longitudinal axis direction or instrument axis

Pitch or first axis of P-P articulation

Yaw axis or second axis of Y-Y articulation

First axis of movement of a-a arm

Second axis of motion of b-b arm

Third axis of c-c arm motion

Fourth axis of d-d arm motion

Longitudinal axis of base portion of e-e macro locator arm

f-f first sliding direction

g-g second sliding direction

h-h third sliding direction

r-r longitudinal axis of rotation

X-Y first cutting plane

Y-Z second cutting plane

X-Z third cutting plane

Angle of theta axis

Claims

1. A robotic surgical assembly (100) comprising a medical instrument (60, 160, 260), the medical instrument comprising:

a frame (57)

An articulating device (70) having a degree of freedom relative to the frame, an

At least one tendon (90, 190) made of polymer fibers for actuating the degrees of freedom;

Wherein:

the at least one tendon (90) comprises a tendon end point (92) connected to the medical instrument to apply a tensile load for actuating the degrees of freedom;

to actuate the degrees of freedom, the at least one tendon (90, 190) slides over at least a portion of the articulating device (70) while in contact with the at least a portion;

the at least one tendon (90) is made of a braided strand, said strand being composed of the polymer fibers.

2. The robotic surgical assembly (100) according to claim 1, wherein the degree of freedom is a rotational joint.

3. The robotic surgical assembly (100) of claim 2, wherein the at least a portion of the articulating device (70) in which the at least one tendon (90, 190) slides is formed by a convex ruled surface (40, 80, 140, 180) formed by a plurality of linear generator lines parallel to the axis of the rotational joint.

4. The robotic surgical assembly (100) of claim 2, wherein the at least one portion of the articulating device (70) in which the at least one tendon (90, 190) slides is formed by a convex ruled surface (40, 80, 140, 180) formed by a plurality of linear generator wires parallel or orthogonal to the axis of the rotational joint.

5. The robotic surgical assembly (100) of any of the preceding claims, wherein the articulating device (70) comprises at least two articulating links, and wherein the at least one tendon (90, 190) slides over the at least two articulating links.

6. The robotic surgical assembly (100) according to claim 5, wherein the at least two articulating links contact each other.

7. The robotic surgical assembly (100) of any of the preceding claims, wherein the at least one tendon (90, 190) has a PPI ranging from 20-60.

8. The robotic surgical assembly (100) of any of the preceding claims, wherein the PPI of the at least one tendon (90, 190) is higher at its distal portion (92 '), the distal portion (92') being located near the tendon end point (92).

9. The robotic surgical assembly (100) of claim 8, wherein the length of the distal portion (92') with the higher PPI is equal to or lower than 1/3 of the tendon length, and preferably equal to or lower than 1/10 of the tendon length, and more preferably equal to or lower than 1/20 of the tendon length.

10. The robotic surgical assembly (100) of any of the preceding claims, wherein the tip (92) is a knot.

11. The robotic surgical assembly (100) of claim 10, wherein the knot is heated to locally melt a segment of the tendon (90, 190) forming the knot.

12. The robotic surgical assembly (100) of claim 10 or 11, wherein the linkage of the articulating device (70) comprises a winding surface (86) and the knot rests on the winding surface (86), wherein preferably the winding surface (86) is a straight-line face formed by straight-line generators all parallel to each other.

13. The robotic surgical assembly (100) of any of the preceding claims, wherein the articulating device (70) comprises a tendon fastening point (82) to which the tendon end point (92) is connected, and wherein the frame (57) comprises a shaft (65), and wherein the at least one tendon (90, 190) is more flexible near or at the tendon fastening point (82) and stiffer near or inside the shaft (65).

14. The robotic surgical assembly (100) of any of the preceding claims, wherein the at least one tendon (90, 190) comprises a distal portion (92 ') located near the tendon end point (92), the distal portion (92') being braided with a PPI ranging from 25-100, preferably with a PPI ranging from 50-100.

15. The robotic surgical assembly (100) of any of the preceding claims, wherein the at least one tendon (90, 190) comprises a longitudinal portion (19) woven with PPI ranging from 3-25.

16. The robotic surgical assembly (100) of any of the preceding claims, wherein the at least one tendon (90, 190) is thinner at the tendon end point (92) and/or at the tendon distal portion (92').

17. The robotic surgical assembly (100) of any of the preceding claims, wherein the at least one tendon (90, 190) has a core (90 ") and a collet (90 '), and wherein the collet (90') and/or the core (90") is made of braided polymer strands.

18. The robotic surgical assembly (100) of claim 17, wherein the collet (90') is braided with a PPI ranging from 25-100.

19. The robotic surgical assembly (100) of claim 17 or 18, wherein the core (90 ") is braided with a PPI ranging from 3-30.

20. The robotic surgical assembly (100) of any of claims 17-19, wherein a lateral dimension, e.g., diameter, of the strands of the braided jacket (90') is lower than a lateral dimension, e.g., diameter, of the strands of the braided core (90 ").

21. The robotic surgical assembly (100) of any of claims 17-20, wherein the linear density of strands of the braided jacket (90') is lower than the linear density of strands of the braided core (90 ").

22. The robotic surgical assembly (100) according to claim 17 or 19, wherein the jacket (90') is or comprises a coating, preferably made of PDMS and/or PTFE.