FR2996113A1 - MANIPULATOR FOR MINI-INVASIVE SURGERY OPERATION - Google Patents

Abstract

The invention relates to a manipulator (1) for minimally invasive surgical operation comprising a main arm (2) having: • a proximal end (3) equipped with a control interface (3a) and • a distal end (3b) insertable into the patient's body (4), the distal end (3b) carrying a controlled manipulation head (6) whose movements are controlled via the control interface (3a), the controlled manipulation head (6) comprising: ○ a base (17) hinged pivotally about a pivot axis (P) perpendicular to the longitudinal axis (II) of the main arm (2), ○ a gripper (7) comprising a first and a second gripping end (8, 9) having respective gripping surfaces (8a, 9a), the gripping ends (8, 9) being articulated about an articulation axis (10) between an open position and at least one gripping position, the gripper gripping (7) being rotatably mounted on the base (17) about an axis of rotation (R). The gripping surface (9a) of the first gripping end (9) of the gripper (7) defines at least two bearing lines (L1, L2) and the gripping surface (8a) of the second end of gripping means defines at least one opposite bearing line (L3) which is arranged in a plane (H) perpendicular to the hinge axis of the gripper (7), said perpendicular plane (H) containing the line of opposed support (L3) lying between said two bearing lines (L1, L2) of the first gripping end, and in that at least one gripping end has at least one angular positioning relief of a needle suture relative to the axis of rotation.

Description

TECHNICAL FIELD OF THE INVENTION The present invention relates to a manipulator for minimally invasive surgical operation, generally performed under endoscopy, serving in particular as a needle holder for the production of sutures. In surgery, a suture is an operation which consists, for example, in bringing the lips of a wound together and in binding the tissues, for example by a seam. To facilitate the passage of needle in the fabric, the needles are most often a curved shape, in an arc. There are thus needles having different lengths of curvature, different curvatures and different diameters. Needles are usually manipulated using a forceps called a needle holder that makes it easy to handle these small needles.

For minimally invasive endoscopic surgery, such as laparoscopic or thoracoscopic surgery, a camera and "trocars" (a surgical instrument in the form of a hollow cylindrical stem 5-12 mm in diameter) are introduced through an incision made by the practitioner in the patient's body. The camera is connected to a screen that the practitioner watches while operating. The trocars allow the passage of surgical instruments such as including a surgical needle holder suture. The surgical suture needle holder has a rectilinear main arm slidable through the trocar, a proximal end of which is manipulable by the practitioner outside the patient's body and a distal end is provided with a forceps for grasping and the manipulation of the suture needle. The movements of the distal end are controlled by manipulation of the proximal end. The suture in minimally invasive surgery is a delicate gesture. The most difficult part of the task is the passage of the needle into the tissues to be sutured. Indeed, the optimal movement of the needle passage requires 6 degrees of freedom (DDLs) in open surgery. With conventional instruments of laparoscopy, the practitioner only has 4 DDLs because of the kinematic limitations introduced by the incision point in the abdominal wall. To increase the number of degrees of freedom of the conventional instruments, it is known from the document WO 2011/013103 in the name of the Applicant, a manipulator whose distal end has a rotatable and rotatable controlled head carrying a gripper for gripping and handling of a suture needle. Thanks to the articulation in rotation and pivoting of the controlled head, the practitioner again has six degrees of freedom for the suture operation.

DISCLOSURE OF THE INVENTION However, it has been found that the placement and holding of the suture needle by the manipulator's forceps as described in WO 2011/013103 prior to performing the suture gesture can be improved. An object of the present invention is to provide a minimally invasive surgical manipulator having a rotatable and rotatably controlled manipulating head for easy positioning of the suture needle in the manipulator clamp. Another optional object of the present invention is to allow the user to place the suture needle at various points of the forceps, between the free end and the hinge axis of the forceps, so that the practitioner can adjust the accuracy or strength of the needle grip. For this purpose, the subject of the invention is a manipulator for a minimally invasive surgery operation comprising a main arm having: a proximal end equipped with a control interface and a distal end insertable in the patient's body; distal end carrying a controlled manipulation head whose movements are controlled via the control interface, the controlled manipulation head comprising: a base articulated pivotally about a pivot axis perpendicular to the axis longitudinal axis of the main arm, - 3 - o a gripper comprising a first and a second gripping ends having respective gripping surfaces, the gripping ends being articulated along an axis of articulation between an open position and at least one position for gripping, the gripper being rotatably mounted on the base around an axis of rotation, since characterized in that the gripping surface of the first gripping end of the gripper defines at least two bearing lines and in that the gripping surface of the second gripping end defines at least one opposite bearing line which is disposed in a plane perpendicular to the axis of articulation of the gripper, said perpendicular plane containing the opposite bearing line being between said two bearing lines of the first gripping end, and in that at least one gripping end has at least one angular positioning relief of a suture needle with respect to the axis of rotation.

Thanks to these characteristics, the suture needle is vertically rectified by the gripper, then by a small manipulation facilitated by bearing against the positioning relief, for example by pulling on the suture or by the instrument held by With the other hand, the suture needle can be oriented optimally to perform the suture by rotating the grasping forceps.

As a result, the needle moves in a plane that is perpendicular to the axis of rotation of the clip. More specifically, it can be provided that the axis of rotation of the gripper, the pivot axis of the base and the longitudinal axis of the main arm are concurrent.

In another embodiment, the manipulator may include a vertebral joint connecting the base to the main arm. In another aspect, the hinge pin of the gripper and the axis of rotation of the gripper are orthogonal and contained in two separate parallel planes.

In this case, for example, the distance between the two distinct parallel planes is greater than or equal to Imm. According to one aspect, the bearing line of the second gripping end has, at least on a portion, a convex shape for moving a suture needle parallel to the axis of rotation towards the free end of the ends of the suture. gripping.

Thus, the convexity or curved shape of the bearing line of the second gripping end will push the suture needle towards the free end of the gripper, in particular until it comes into abutment with a positioning relief. . According to an alternative, the gripping surface of the second gripping end has two bearing lines. This gives four points of support for a suture needle, two external supports and two internal supports (relative to the axis of rotation). The positioning relief of a first gripping end may be in the form of a stop stop, more specifically in the form of a vertically standing rod or tooth, or in the form of a detent extending transversely with respect to the first gripping end.

According to yet another embodiment, it can be provided that the first gripping end has two stop stops arranged symmetrically with respect to the longitudinal axis of the gripping end. In another aspect, the second gripping end may have a positioning relief in the form of at least one groove parallel to the axis of articulation of the gripper. According to a development, the first and second gripping ends are made in the form of jaws whose gripping surfaces define bearing lines. By jaws, we hear solid bodies. In this case, the grip surface of a jaw can be in a generally concave shape and the gripping surface of the jaw vis-à-vis can be in a generally convex shape and at least one of the surfaces gripping the jaws can be fluted in a direction parallel to the axis of articulation. According to an evolution, the gripping surfaces of the two jaws vis-à-vis are for example fluted alternately, so that the grooves of one jaw are vis-à-vis the ribs of the other jaw. According to another development, the gripping surface of the jaw vis-à-vis the one with the grooved gripping surface is smooth, the grooved gripping surface defining an alternation of ribs and consecutive grooves free flats. Thanks to the convexo-concave shape of the jaws, it is possible to straighten the suture needle vertically with respect to the jaws by a simple gesture. The fluted shape of the gripping surface of the jaw allows that the progressive approximation of the jaws, the suture needle is guided towards one or other of the grooves by the slopes of the ribs and therefore to a stable position. This is also facilitated by the jaw with smooth gripping surface which allows the needle to slide to a groove to find a stable position, either automatically or by a slight intervention of the surgeon, for example by pulling on the suture or via another instrument. The grooved gripping surface of the jaw thus makes it possible to define several stable transverse positions for the needle in which the needle is straightened with respect to the jaws and is perpendicular to the axis of rotation of the gripper. In addition, the placement of the suture needle can be performed at different distances from the free end of the gripper according to the groove that receives the needle. The practitioner can therefore select the position of the needle according to whether he wishes to develop the strength or precision of the input.

In another aspect, the jaw whose gripping surface is in a generally convex shape is arranged closer to the axis of rotation of the gripper than the jaw whose gripping surface is in a general shape. concave, in order to straighten the suture needle in the right direction.

This results in an eccentricity of the gripper which facilitates the passage of the needle into the tissue, simply by turning the gripper on itself. This circular movement approaches a rotation of the needle around its axis, which is the ideal path sought for sutures. - 6 - It can further be provided that the distance between the pivot axis of the base and the free end of the gripper is less than or equal to 20mm. This allows a good execution of the kinematics of the needle during suture in tight spaces. For example, it is expected that the gripping surface of the jaw forming a generally concave shape is smooth and that the gripping surface of the jaw vis-à-vis forming a generally convex shape is fluted, the crests ribs being inscribed in a generally convex shape. Advantageously, the grooves have an identical reentrant angle and depth.

The ribs of the corrugated grip surface have a peak to peak pitch of 0.5 to 2 millimeters to grip the needle in a plurality of transverse positions along the jaws. To obtain a good hold of most suture needles, it is expected that the grooves have a depth greater than 1mm.

The ribs have for example a general shape of triangular prism convex crest, including isosceles. It is further provided that the angles entering the grooves are between 1000 and 130 °. The protruding angles of the top of the ribs are between 100 and 130 °.

In another aspect, a jaw of the gripper is fixed. The articulated jaw vis-à-vis the fixed jaw then for example the grooved gripping surface, which facilitates the positioning of the needle before closing the articulated jaw. When the gripper is eccentric and a jaw is fixed, the articulated jaw vis-à-vis the fixed jaw is for example that which is arranged closer to the axis of rotation of the gripper. The articulated jaw then carries the gripping surface forming a generally convex shape, in order to straighten the suture needle in the right direction. According to yet another aspect, the control interface comprises biasing sensors and motor means, for example electric motors, for generating movements of the controlled manipulation head according to the movement instructions received by the sensors. solicitation of the control interface. BRIEF DESCRIPTION OF THE DRAWINGS Other advantages and characteristics will appear on reading the description of an illustrative and nonlimiting example of the invention, as well as the following figures in which: FIG. 1 represents a schematic perspective view of a manipulator for minimally invasive surgery operation, partially introduced into the body of a patient through a trocar, FIG. 2 is a cross-sectional view of an exemplary embodiment of the distal end of the manipulator of FIG. 1, FIG. 3 represents a perspective view of a gripper of the distal end of the manipulator of FIGS. 1 and 2, whose fixed parts are represented in transparency, the gripper being partially open, FIG. 3a shows a view schematic section of the jaws of the gripper of Figure 3 while grasping a suture needle, Figure 4 shows the manipulator of Figure 1 which has been shown the dotted gripper for schematizing its trajectory when performing a turn on itself, Figure 5a shows a perspective view and front of the articulated jaw of the gripper of FIG. 5b shows a sectional view AA of the articulated jaw of FIG. 5a, in a median longitudinal sectional plane of said jaw, FIG. 5c represents a rear view of the articulated jaw of FIG. 5a. Fig. 6a shows a perspective view of the fixed jaw of the gripper of Fig. 3, Fig. 6b shows a perspective view from above of the fixed jaw of Fig. 6a, Fig. 6c shows a rotated view of 90 ° of the fixed jaw of FIG. 6b, in section AA according to a median longitudinal section plane of said jaw, FIG. 7a shows a schematic view of another embodiment, FIG. Figure 8a and 8b show respectively a side and perspective view of another embodiment of the gripper, Figures 9a, 9b and 9c show views. In perspective of another embodiment of the gripper, Fig. 10 shows a perspective view of another embodiment of the gripper, Fig. 11 shows a perspective view of another embodiment of the gripper. making a jaw of the gripper, Figures 12a and 12b respectively show a side view and in perspective of a jaw of yet another embodiment of the gripper, and Figure 13 shows a view schematic perspective still another embodiment in which the pivoting movement of the clamp is performed by a vertebrae joint. DESCRIPTION OF THE PREFERRED EMBODIMENTS In the figures, the identical elements bear the same reference numbers. Figure 1 shows a manipulator 1 for minimally invasive surgical operation, such as laparoscopic or thoracoscopic surgery, performed under endoscopy, during which a camera and trocars are introduced through incisions made in the patient's body.

The manipulator 1 comprises a main arm 2, having a generally cylindrical hollow shape of longitudinal axis I-I whose diameter is of the order of 8 mm and the length of the order of 40 cm. The main arm 2 has a proximal end 3 equipped with a control interface 3a, manipulable by a practitioner outside the body of a patient and a distal end 3b inserted into the patient's body of which only a portion of the skin is represented by a line 4. The manipulator 1 is intended in particular to maintain a suture needle 16 on the side of the distal end inserted into the body of the patient 4. As seen in FIG. 1, the manipulator 1 is inserted through a surgical trocar 5 shown schematically. The main arm 2 can thus slide axially for a translational movement and possibly rotate in axial rotation about its longitudinal axis I-I. The surgical trocar 5 can itself pivot on both sides around the point of pivot constituted by the incision thanks to the flexibility of the skin. The distal end 3b, better visible in Figure 2, carries a controlled manipulation head 6 whose movements are controlled via the control interface 3a. The controlled manipulation head 6 comprises a base 17 articulated pivotally about a pivot axis P perpendicular to the longitudinal axis II of the main arm 2 and a gripper 7 for gripping and manipulating the needle. suture 16. The gripper 7 is rotatably mounted on the base 17 about an axis of rotation R concurrent with the pivot axis P of the base 17 and the longitudinal axis II of the main arm 2. L The axis of rotation R of the gripper 17 is thus centered with respect to the base 17. In FIG. 2, the axis of rotation R and the longitudinal axis II coincide, but of course this is not the case. more the case when the base 17 pivots in another position. It is therefore understood that the gripper 7 pivots with the pivoting of the base 17. Referring now to Figure 2, the gripper 7 has a first gripping end formed as a fixed jaw 9 and a second end grasping device made in the form of a movable or articulated jaw 8. By jaw is meant in the present disclosure a solid body. For the clamping or loosening movement of the gripper 7, that is to say the approaching of the first 8 and second 9 gripping ends made in FIGS. 2, 3, 5a, 5b, 6a, 6b, 6c, in the form of jaws 8, 9, an axial input shaft 31 is coupled to the control interface 3a and carries at its distal end an end bevel pinion 32 which drives a rotatable side conical bevel gear 33 around Pivot axis P. This side conical pinion 33 in turn drives a conical pinion 34 itself mounted at the end of an axially threaded output shaft 36. A nut 37 is mounted on the threaded portion of the output shaft 36, and moves axially upon rotation of the output shaft 36 to pivotally engage the gripper jaw 8 which is movable in this case, around of a hinge axis 10. The own rotation of the gripper 7 around the axis of rotation R is provided by an inlet tube 38 oriented along the longitudinal axis II, itself driven by rotation via the control interface 3a.

The inlet tube 38 is integral with a conical end pinion 39 which itself rotates a lateral conical pinion gear 40 rotatable about the pivot axis P and which drives a tubular axial conical pinion gear 41 integral with the base 17 (secured to the fixed jaw 9 in this case). In other words, the gripper 7 is mounted with its fixed jaw 9 in a fixed position on the pinion 41, which itself is rotatably mounted axially in the base 17. A bearing 42 guides the inlet tube 38 in its rotation around the axis II in the main arm 2. The base 17 is pivotally mounted around the pivot axis P on the distal end of the main arm 2.

The proximal end 3 and the controlled manipulation head 6 are mechanically connected so that the movements of the head 6 can be controlled by manipulation of the proximal end 3. For this, the manipulator 1 comprises mechanical transmission means, housed in the main arm 2, to generate movements of the controlled manipulation head 6 according to the movement instructions received by the proximal end 3. For better ergonomics, the control interface 3a is for example provided with control buttons . The control interface 3a may also comprise biasing sensors and motor means, for example electric motor means, for generating movements of the controlled manipulation head 6, according to the movement instructions received by the solicitation sensors. the control interface 3a. The motor means are powered by a power source, which can be deported to reduce congestion. The control interface 3a comprises for example three control buttons: a first to control the opening and closing of the gripper 7, a second to control the pivoting of the base 17 around the pivot axis P and a third for controlling the own rotation of the gripper 7 around the axis of rotation R. The supports and movements of the fingers of the practitioner are thus detected by the control interface 3a and transmitted to the controlled manipulation head 6 , to achieve the corresponding movements. For example, a clean rotation bias applied by the hand of the practitioner on the proximal end 3 produces a clean rotational movement of the gripper 7. A similar controlled head is for example described in the international patent application WO 2011 / 053477 of the name of the Applicant. The rotary and rotating controlled manipulation head 6 thus provides the practitioner with considerable room for maneuver, which then has six degrees of freedom for the suture operation. As can be seen more clearly in FIG. 3, the gripper 7 of the controlled manipulation head 6 comprises two jaws 8, 9 having gripping surfaces 8a, 9a facing each other.

The jaws 8, 9 are articulated along the hinge axis 10 to grip a needle or a suture approaching. The jaws 8, 9 have a rounded shape and refined at the ends, which avoids injure the flesh or organs of the patient. The gripping surface of a jaw 8, 9 of the gripper 7 (in the example shown: the jaw 9) is in a generally concave shape and the gripping surface 8a of the jaw 8 vis-à-vis -vis fits in a general convex form. In addition, a gripping surface of the jaws 8, 9 (in the example shown: the jaw 8), is grooved in a direction T parallel to the hinge axis 10, the gripping surface 9a of the jaw screw to be smooth. The grooved gripping surface 8a defines an alternation of ribs 13 and consecutive grooves 14, free of flats. The gripping surface 9a of the jaw 9 has, for example, a hollow cylindrical shape. For example, it is provided that it is the gripping surface 9a of the jaw 9 forming a generally concave shape which is smooth and that the gripping surface 8a of the jaw 8 vis-à-vis is fluted. , the ridges of the ribs 13 being inscribed in a generally convex shape.

In addition, as can be seen in Figures 1 and 2, the hinge axis 10 of the gripper 7 and the axis of rotation R of the gripper 7 are orthogonal. According to a particular embodiment, the hinge axis 10 of the gripper 7 and the axis of rotation R of the gripper are contained in two separate parallel planes.

It has been clever to provide that the distance D (FIGS. 3a, 4, 6c) between the two distinct parallel planes is greater than or equal to 1 mm, to approach a maximum of the radius of the suture needles 16. The jaw 8 whose gripping surface 8a is in a generally convex shape is then arranged closer to the axis of rotation R of the gripper 7 in order to straighten the suture needle 16 in the right direction, with the axis of the curved needle 16 located on the side of the jaw 8 whose gripping surface 8a is in a generally convex shape. An eccentricity of the gripper 7 is thus obtained which facilitates the passage of the needle 16 into the tissues during the rotation of the gripper 7. FIG. 4 schematizes the grasping gripper 7 in dotted lines when performing a rotation. This circular movement approaches a rotation of the needle 16 about its axis, which is the ideal path sought for the sutures. FIG. 3a represents a schematic view in cross section along the direction T of the gripper 7 during gripping of a suture needle 16.

It is therefore understood that the gripping surface 9a of the first gripping end, the jaw 9 of the gripper 7, defines at least two bearing lines L1 and L2 (here, these are the peripheral edges of the jaw 9) and the gripping surface 8a of the second gripping end, the jaw 8 defines at least one opposite bearing line L3 (here, the bearing line L3 is formed by the middle of the grooves 14 intersected by the ribs 13) which is disposed in a plane H perpendicular to the axis of articulation 10 of the gripper 7. The perpendicular plane H containing the opposite bearing line L3 - 13 - is between the two bearing lines L1 and L2 of the first gripping end 9. With this arrangement by at least three points of support, if one bears with the support line L3 between the lines L1 and L2, the suture needle 16 is automatically vertically rectified.

At least one of the support lines, in this case the opposite bearing line L3 has at least one relief 13 angular positioning of a suture needle 16 relative to the axis of rotation R. This positioning relief being formed by the ribs 13. Thus, when the surgeon grasps the suture needle 16 with the aid of the forceps 7 of the manipulator 1, the needle is straightened and all that is required is a slight pull on the suture with a another instrument for the suture needle 16 is perfectly rectified and contained in a plane that is perpendicular to the axis of rotation of the clamp 7. To facilitate the proper performance of the kinematics of the needle 16 during the suture in the confined spaces, it is expected that the distance between the pivot axis P of the base 17 and the free end of the gripper 7 is less than or equal to 20 millimeters.

As described above, according to the embodiment shown in Figures 2, 3, 3a, 5a, 5b, 5c, 6a, 6b, 6c, the first gripping end, the jaw 9 is fixed and the other, the jaw 8, is articulated relative to the fixed jaw 9. The hinge axis 10 of the gripper 7 is for example received through two corresponding holes 11 of the articulated jaw 8 (Figures 5a, 5b ). The articulated jaw 8 is thus able to pivot about the hinge pin 10 against or away from the fixed jaw 9 to grasp or release a suture needle 16 (the jaw joint movement articulated 8 is shown schematically by the double arrow 12 in Figure 3). It is for example the articulated jaw 8 which carries the gripping surface 8a fluted, which facilitates the positioning of the needle 16 before the closure of the articulated jaw. In the case where the gripper 7 is eccentric, the articulated jaw 8 vis-à-vis the fixed jaw 9 is that which is arranged closer to the axis of rotation R of the gripper 7. Also , the articulated jaw 8 carries the gripping surface 8a forming a generally convex shape, in order to straighten the suture needle in the right direction. - 14 - The grooved gripping surface 8a defines alternating ribs 13 and grooves 14 immediately consecutive, that is to say free of flats between the ribs 13 and grooves 14. More specifically, the grooved surface 8a grooved is a succession of consecutive ribs 13, regularly spaced, the joints of the slopes of the ribs 13 forming the grooves 14. The grooves 14 extend transversely for example over the entire width of the gripping surface 8a of the jaw 8. The crests transverse ribs 13 and the bottoms of the grooves 14 follow the bulging projecting or retracting the jaw 8, 9 which carries them. The protruding bulge of the grip surface 8a of the jaw 8 forming a convex shape is rounded transversely. It has for example a cylindrical shape. The corresponding inward bulge of the gripping surface 9a of the jaw 9 vis-à-vis has a concave shape, for example partially cylindrical and hollow (Figures 6a, 6b, 6c). The protruding bulge forming a convex general shape is narrower than the recessed bulge forming the generally concave shape (Figure 7a). As represented in FIGS. 5a and 5b, the ribs 13 and the grooves 14 are for example identical to each other, that is to say that the tops of the ribs 13 have a shape (salient angle 13) identical to each other and the grooves 14 have a shape (inward angle cc and depth Pr) identical to each other.

The fluted shape of the gripping surface 8a of the jaw 8 causes the progressive approach of the jaws 8, 9, the needle 16 will therefore "slip" on the gripping surface 9a smooth to automatically curl or by a slight intervention the surgeon in a groove 14 of the jaw 8 vis-à-vis and thus be oriented perpendicular to the axis of rotation R of the base 17. The adjacent slopes of the ribs 13 guide the needle 16 to one or the other of the grooves 14, without the needle 16 can not overlap both grooves 14. The ribs 13 can be carried by the gripping surface 8a of the jaw 8 forming a convex shape or by the gripping surface 9a of the jaw 9 forming a concave shape.

Figures 3, 5a, 5b illustrate the case of a manipulator 1 for which the gripping surface 8a of the jaw 8 forming a convex shape comprises a series of eight consecutive transverse ribs 13 whose peaks ridges are substantially aligned along a central and longitudinal axis 15 (Figure 5a). The ridges of the ribs 13 are substantially rounded so as not to damage the suture needle 16. The ribs of the grooved gripping surface 8a have a peak-to-peak pitch Pa (FIG. 5b) for example between 0.5 and 2 millimeters, such as on the order of 0.8 millimeters, to seize the suture needle 16 in several transverse positions along the jaws 8, 9. To obtain a good hold of most of the suture needles, it is expected that the grooves have a depth greater than 1 mm.

The ribs 13 have for example a general shape of triangular prism convex crest extending transversely on the gripping surface 8a of the jaw 8. The triangular prisms are for example isosceles. The shape of the bottom of the grooves 14 may have a reentrant angle 13 which is not rounded, which makes it easier to perform, the suture needle 16 resting on the sides of the grooves 14.

The slopes of the ribs 13 are shaped to guide the suture needle 16 in the groove 14. The reentrant angle of the groove 14 is for example between 100 and 130 °, such as for example of the order of 114 °. Similarly, the projecting angle 13 of the rib vertex 13 is for example between 100 and 130 °, such as for example of the order of 114 °. The angles entering and protruding oc and 13 are for example equal. The grooves 14 are shaped to receive a suture needle 16 in a stable position between the jaws 8, 9 closed. For this, the depth Pr of a groove 14 is for example greater than 1 mm. The manipulator 1 is for example made of stainless steel, such as stainless steel 17/4 PH. It could also be provided that the gripping surfaces 8a, 9a of the jaws 8, 9 are coated with tungsten carbide. During the clamping of the jaws 8, 9, the transverse engagement of the needle 16 between the jaws of convexo-concave complementary shape 8, 9 mechanically causes its vertical rectification relative to the jaws. Indeed, during the setting, the three-16-points of contact between the needle 16 and the jaws 8, 9 tend to roll the needle 16 on itself until it takes the vertical upright position. Thanks to the convexo-concave shape of the jaws 8, 9, it is possible to straighten the suture needle 16 vertically with respect to the jaws 8, 9 by a simple gesture.

The fluted shape of the gripping surface 8a of the jaw 8 allows that the progressive approximation of the jaws 8, 9, the suture needle 16 is guided towards one or other of the grooves 14 by the slopes of the ribs 13 without the suture needle 16 being able to overlap both furrows 14 at the same time. This is also facilitated by the jaw 9 with a smooth gripping surface 9a which allows the needle to slide towards a furrow to find a stable position. Once nestled in a groove 14, the suture needle 16 is correctly oriented. This phase is perceptible by an audible "click" caused by the placement of the suture needle 16 in the groove 4. In this position, the practitioner can increase the gripping force to ensure the maintenance of the needle 16.

The grip surface 8a of the jaw 8 thus makes it possible to define several stable transverse positions for the needle 16 in which the needle is straightened with respect to the jaws 8, 9 and is perpendicular to the axis of rotation R of the clamp 7. In addition, the placement of the suture needle 16 can be performed at different distances from the free end of the gripper 7 according to the groove 14 which accommodates the needle 16. The practitioner can therefore select the position of the suture needle 16 depending on whether it wishes to develop the strength or accuracy of the seizure. Of course, several alternative modes are possible without departing from the scope of the present invention.

Thus, according to an embodiment not shown, the two gripping ends, for example jaws, are movable relative to a hinge axis. According to another embodiment not shown, but easily understandable, the gripping surfaces of the two jaws vis-à-vis are fluted alternately, so that the grooves of a jaw are vis-à-vis the ribs of Fig. 7a schematically shows yet another embodiment in which the first gripping end 9 is formed by two parallel rods or tubes with the gripping surfaces defining, at least on a portion , two parallel bearing lines L1 and L2, the second gripping end 8 is also formed by a rod or a tube with a gripping surface defining an opposite bearing line L3 and having as positioning relief for example one or more rib (s) and / or groove (s). Note however that this embodiment is not optimal since it does not allow to seize a suture without the risk of breaking. FIG. 7b shows schematically yet another embodiment according to which the first gripping end 9 is formed by a U-shaped cross-section jaw with the gripping surfaces defining, at least on one portion, two parallel bearing lines. L1 and L2, the second gripping end 8 is formed by a square section rod with a gripping surface defining one or even several opposite L3 support lines and having as positioning relief for example one or more ribs (s) and / or groove (s). Thanks to the bottom of the U, it is possible, as in the other embodiments with the exception of that of Figure 7a also seize a suture, thus making the clamp more versatile in its use. Figures 8a and 8b show another embodiment that could be considered as a combination of the embodiments of Figures 3, 6a, 6b and 6c on the one hand and 7b on the other hand. Indeed, the jaw 9 is identical to that of Figures 3, 6a, 6b and 6c, while the jaw 8 is made as shown schematically in Figure 7b, that is to say by defining two opposite bearing lines L3 with two parallel rows of ribs 13 and grooves 14 forming positioning relief, separated by a central corridor 60.

According to yet another embodiment shown in FIGS. 9a, 9b and 9c, the jaw 9 is generally shaped as described in relation with FIGS. 3, 6a, 6b and 6c, with the difference that it comprises near its free end 62 a positioning relief in the form of a stopper 64 formed by a small rod 66. The jaw 8 is in this embodiment completely smooth and has a curved shape both in the longitudinal direction of the jaw 8 that in the transverse direction. In use, therefore, a suture needle is placed between the two jaws 8 and 9. By bringing the jaw 8 closer to the jaw 9, the suture needle 16 will be firstly straightened and replaced. further pushed by the convex shape of the jaw 8 to the free end 62 along the bearing lines L1 and L2 to abut with the rod 66. then simply a simple intervention of the surgeon, for example by pulling on the suture, so that the suture needle 16 is perfectly contained in a plane perpendicular to the axis of rotation of the clip 7. As an alternative to the embodiment of Figures 9a, 9b and 9c, can be provided the fixed jaw 9 has as positioning relief two rods 66 disposed symmetrically with respect to the longitudinal axis of the jaw 9 (see Figure 10). It is therefore clear that the two bearing lines L1 and L2 of the jaw 9 each have an individual stopper. According to another variant shown in FIG. 11, the articulated jaw 8 is identical to that of FIG. 9b, with the difference that it has as a positioning relief at least one groove 70 parallel to the axis of articulation 10 of the This articulated jaw 8 can be combined with the jaw 9 of FIG. 9a or with that of FIG. 10. FIGS. 12a and 12b show yet another variant of a fixed jaw 9 which can be combined with a jaw 9. articulated jaw 8 as for example shown in Figure 9b. In this variant, in addition to the concave shape described in relation to FIGS. 6a, 6b and 6c, a sloped portion 80 is provided, which terminates in a stop made in the form of a detent 82 extending transversely relative to to the jaw 9. Figure 13 shows yet another variant of the manipulator according to the invention.

In this embodiment, the gripper 7 is that described in connection with Figures H for the articulated jaw 8 and Figure 9a for the fixed jaw 9. In addition, the pivoting movement of the base 17 does not. is not realized by a single pivot axis as shown in particular in Figure 2, but by a vertebrae joint 90, also known as a so-called "snake" articulation.

In the case of Figure 13, this vertebral joint 90 has three vertebrae 92 which are pivotally connected to each other. Each vertebra 92 comprises a base body 96 which is for example formed in the form of a pellet pierced in the center for the passage of the rotation commands and the opening and closing of the gripper 7, this basic body 96 being surmounted by two uprights 98 and having two pins 100 on opposite sides cooperating in pivoting with holes 102 in the uprights 98 of the previous vertebra 92 or two holes in the uprights 98 carried by the main arm 2. In this case, it is possible to also controlling the pivoting of the gripper 7 via the control interface 3a, for example by means of traction cables and which pass through passage holes 106 formed on opposite sides of the base bodies of the vertebrae 92, 90 ° offset from the pins 100. In this embodiment, the pivot axis P of the gripper 7 is not fixed as in the other embodiments, but departs laces according to the inclination of the vertebral joint 90. It is therefore understood that thanks to the manipulator according to the invention, the surgeon has all the degrees of freedom to make a suture without hurting the surrounding tissues and being able to easily place the suture needle optimally to perform the gesture.

Claims (30)

REVENDICATIONS1. Manipulator (1) for minimally invasive surgical operation comprising a main arm (2) having: - a proximal end (3) equipped with a control interface (3a) and - a distal end (3b) insertable in the body of the patient (4), the distal end (3b) carrying a controlled manipulation head (6) whose movements are controlled via the control interface (3a), the controlled manipulation head (6) comprising: a base (17) hinged pivotally about a pivot axis (P) perpendicular to the longitudinal axis (II) of the main arm (2), o a gripper (7) comprising a first and a second gripping ends (8, 9) having respective grasping surfaces (8a, 9a), the gripping ends (8, 9) being articulated about an articulation axis (10) between an open position and at least one position of gripping, the gripper (7) being mounted ro on the base (17) about an axis of rotation (R), characterized in that the gripping surface (9a) of the first gripping end (9) of the gripper (7) defines at least one two bearing lines (L1, L2) and in that the gripping surface (8a) of the second gripping end defines at least one opposite bearing line (L3) which is arranged in a plane (H) perpendicular to the hinge axis (10) of the gripper (7), said perpendicular plane (H) containing the opposite bearing line (L3) lying between said two bearing lines (L1, L2) of the first end gripping, and in that at least one gripping end has at least one angular positioning relief of a suture needle (16) relative to the axis of rotation (R). 2. Manipulator according to claim 1, characterized in that the axis of rotation (R) of the gripper (7), the pivot axis (P) of the base (17) and the longitudinal axis ( II) of the main arm (2) are concurrent. 3. Manipulator according to claim 1, characterized in that it comprises a vertebra joint (90) connecting the base (17) to the main arm (2). 4. Manipulator according to claim 1 or 2, characterized in that the axis of articulation (10) of the gripper (7) and the axis of rotation (R) of the gripper (7) are orthogonal and contained in two separate parallel planes. 5. Manipulator according to claim 4, characterized in that the distance (D) between the two parallel parallel planes is greater than or equal to 1 mm. 6. Manipulator according to any one of claims 1 to 5, characterized in that the bearing line (L3) of the second gripping end (8) has, at least on a portion, a convex shape to move a needle suture (16) parallel to the axis of rotation (R) towards the free end (62) of the gripping ends (8, 9). 7. Manipulator according to any one of claims 1 to 6, characterized in that the gripping surface (8a) of the second gripping end (8) has two bearing lines (L3). 8. Manipulator according to any one of claims 1 to 7, characterized in that the first gripping end (9) has a positioning relief in the form of a stopper (64). 9. Manipulator according to claim 8, characterized in that the stop (64) has a positioning relief in the form of rod (66). 10. Manipulator according to claim 8, characterized in that the stop (64) has a form of detent (82) extending transversely relative to the first gripping end (9). 11. Manipulator according to claim 8 or 9, characterized in that the first gripping end (9) has two stops (64) arranged symmetrically with respect to the longitudinal axis of the gripping end (9). 12. Manipulator according to any one of claims 1 to 11, characterized in that the second gripping end (8) has a positioning relief in the form of at least a groove (70) parallel to the axis of articulation (10) of the gripper. 13. Manipulator according to any one of claims 1 to 12, characterized in that the first and second gripping ends (8, 9) are formed as jaws whose gripping surfaces (8a, 9a) define support lines (L1, L2, L3). 14. Manipulator according to claim 13, characterized in that the gripping surface (9a) of a jaw (7) is in a generally concave shape and the gripping surface (8a) of the jaw (8) screwed -said is in a generally convex shape and in that at least one of the gripping surfaces (8a) of the jaws (8, 9) is fluted in a direction parallel to the hinge axis (10) . 15. Manipulator according to claim 14, characterized in that the gripping surfaces of the two jaws vis-à-vis are alternately grooved, so that the grooves of a jaw are vis-à-vis the ribs of the other jaw. 16. Manipulator according to claim 14, characterized in that the gripping surface (9a) of the jaw (9) vis-à-vis the one carrying the grooved gripping surface is smooth, the grooved gripping surface (8a). defining an alternation of ribs (13) and consecutive grooves (14), free of flats. 17. Manipulator according to claim 14 or 16, characterized in that the jaw (8) whose gripping surface (8a) is in a generally convex shape, is arranged closer to the axis of rotation (10) of the gripper (7) that the jaw (9) whose gripping surface (9a) is in a generally concave shape. 18. Manipulator according to one of claims 16 to 17, characterized in that the gripping surface (9a) of the jaw (9) forming a generally concave shape is smooth and the gripping surface (8a) of the jaw (8) vis-à-vis in a generally convex form is fluted, the ridges of the ribs being inscribed in a generally convex shape. 19. Manipulator according to any one of claims 14 to 18, characterized in that the grooves (14) have an identical reentrant angle (cc) and depth (Pr). 20. Manipulator according to any one of claims 14 to 19, characterized in that the ribs (13) of the grooved gripping surface (8a) have a peak to peak (Pa) between 0.5 and 2mm. 21. Manipulator according to one of claims 14 to 20, characterized in that the grooves (14) have a depth (Pr) greater than 1 mm. 22. Manipulator according to one of claims 14 to 21, characterized in that the ribs (13) have a general shape of triangular prism convex crest. 23. Manipulator according to claim 22, characterized in that the triangular prisms are isosceles. 24. Manipulator according to one of claims 22 or 23, characterized in that the reentrant angles (13) of the grooves (14) are between 1000 and 130 °. 25. Manipulator according to one of claims 22 to 24, characterized in that the projecting corners (13) of the top of the ribs (13) are between 100 ° and 130 °. 26. Manipulator according to one of the preceding claims, characterized in that the distance between the pivot axis (P) of the base (17) and the free end of the gripper (7) is less than or equal to at 20mm. 27. Manipulator according to any one of the preceding claims, characterized in that a gripping end (9) of the gripper (7) is fixed. 28. Manipulator according to claim 27 together with claim 14, characterized in that the articulated jaw (8) vis-à-vis the fixed jaw (9) carries the grooved gripping surface (8a). 29. Manipulator according to one of claims 27 or 28, characterized in that the articulated jaw (8) vis-à-vis the fixed jaw (9) is arranged closer to the axis of rotation (R) of the gripper (7) that the fixed jaw (9). 30. Manipulator according to any one of the preceding claims, characterized in that the control interface (3a) comprises biasing sensors and motor means for generating movements of the controlled manipulation head (6) according to the instructions. of movements received by the bias sensors of the control interface (3a).