JP2014223552A - 湾曲カニューレ、ロボットマニピュレーターおよび外科手術用ポート - Google Patents
湾曲カニューレ、ロボットマニピュレーターおよび外科手術用ポート Download PDFInfo
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- JP2014223552A JP2014223552A JP2014179865A JP2014179865A JP2014223552A JP 2014223552 A JP2014223552 A JP 2014223552A JP 2014179865 A JP2014179865 A JP 2014179865A JP 2014179865 A JP2014179865 A JP 2014179865A JP 2014223552 A JP2014223552 A JP 2014223552A
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- Prior art keywords
- cannula
- instrument
- surgical
- curved
- shaft
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
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Classifications
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Abstract
【解決手段】ロボット外科手術システムは、患者の身体内への同じ開口部を通って延びる、硬い湾曲カニューレ(416a)を備えるように構成される。受動的に可撓性であるシャフト(506)を備える外科手術用器具(500)が、これらの湾曲カニューレを通って延びる。これらのカニューレは、これらの器具を外科手術部位の方に向けるように配向される。これらの湾曲カニューレを1つの開口部内で支持する種々のポート構造物(1402)が開示される。
【選択図】図15D
Description
本願は、米国特許出願番号12/618,549(2009年11月13日出願)[代理人事件番号ISRG 012390/US](「Curved Cannula」を開示する)の一部継続出願であり、この米国特許出願は、米国仮特許出願番号61/245,171(2009年9月23日出願)(「Curved Cannula」を開示する)の利益を主張する。これらの両方は、本明細書中に参考として援用される。
1.発明の分野
本発明の局面は、最小侵襲性外科手術に関し、より特定すると、最小侵襲性ロボット外科手術システムに関し、そしてなおより特定すると、患者の身体内への1つの入口点を通して働く、最小侵襲性ロボット外科手術システムに関する。
最小侵襲性外科手術の利点は周知であり、そしてこれらの利点としては、従来の観血切開手術と比較して、患者の外傷が少ないこと、血液損失が少ないこと、および回復時間がより速いことが挙げられる。さらに、ロボット外科手術システム(例えば、臨場感を与える遠隔操作されるロボットシステム)(例えば、Sunnyvale,CaliforniaのIntuitive Surgical,Inc.により製造されるda Vinci(登録商標)Surgical System)の使用が公知である。このようなロボット外科手術システムは、外科医が、直感的制御で、そして手で行う最小侵襲性外科手術と比較して増大した正確さで、手術を行うことを可能にし得る。
1つの局面において、外科手術システムは、ロボットマニピュレーター、湾曲カニューレ、およびこの湾曲カニューレを通って延びる、受動的に可撓性であるシャフトを備える器具を備える。このロボットマニピュレーターは、この湾曲カニューレを、患者の身体内への開口部(例えば、切開、自然な開口部分)に配置された遠隔運動中心の周りで移動させ、その結果、この湾曲カニューレは、外科手術部位において、外科手術器具のための三角計量角度を提供する。1つの実施形態において、内視鏡および2つのこのような湾曲カニューレの遠位端を、異なる角度から外科手術部位に向けて配向させて使用し、その結果、効果的な器具三角計量が達成され、これによって、外科医は、外科手術部位で効果的に作業すること、および外科手術部位を効果的に見ることが可能になる。
本明細書は、例えば、以下の項目も提供する。
(項目1)
頂表面および底表面を備えるポート構造物本体;
該頂表面と該底表面との間で第一の方向に真っ直ぐ延びる第一のチャネル;ならびに
該頂表面と該底表面との間で第二の方向に真っ直ぐ延びる第二のチャネル;
を備え、
該第一の方向と該第二の方向とは互いに異なる、外科手術用ポート構造物。
(項目2)
前記第一のチャネルが、前記頂表面と前記底表面との間で鋭角で延びており;そして
前記第二のチャネルが、該頂表面と該底表面との間で垂直に延びている、
項目1に記載の外科手術用ポート構造物。
(項目3)
前記第一のチャネルが、前記ポート構造物本体の垂直中央部を横切って前記第一の方向に延びている、項目2に記載の外科手術用ポート構造物。
(項目4)
前記第一のチャネルが、前記ポート構造物本体のおよそ垂直中線において前記底表面と交差する、項目2に記載の外科手術用ポート構造物。
(項目5)
前記第二のチャネルが、内視鏡または手動で操作される外科手術器具を受容するように構成されている、項目2に記載の外科手術用ポート構造物。
(項目6)
前記第一のチャネルが、前記頂表面と前記底表面との間で第一の鋭角で延びており;そして
前記第二のチャネルが、該頂表面と該底表面との間で第二の鋭角で延びている、
項目1に記載の外科手術用ポート構造物。
(項目7)
前記第一の鋭角と前記第二の鋭角とが実質的に等しく;そして
前記第一の方向と前記第二の方向とが互いに実質的に逆である、
項目6に記載の外科手術用ポート構造物。
(項目8)
前記第一のチャネルが、前記ポート構造物本体の垂直中央部を横切って前記第一の方向に延びており;そして
前記第二のチャネルが、該ポート構造物本体の該垂直中央部を横切って前記第二の方向に延びている、
項目6に記載の外科手術用ポート構造物。
(項目9)
前記第一のチャネルおよび前記第二のチャネルの各々が、前記ポート構造物本体のおよそ垂直中線において前記底表面と交差している、項目6に記載の外科手術用ポート構造物。
(項目10)
前記第二のチャネルが、内視鏡または手動で操作される外科手術器具を受容するように構成されている、項目6に記載の外科手術用ポート構造物。
(項目11)
前記頂表面と前記底表面との間で垂直に真っ直ぐ延びる内視鏡チャネル;および
該頂表面と該底表面との間で垂直に真っ直ぐ延びる補助チャネル
をさらに備え;
該内視鏡チャネルおよび該補助チャネルの各々が、前記ポート構造物の垂直中線からずれている、項目1に記載の外科手術用ポート構造物。
(項目12)
前記第一のチャネル内に配置されたシールをさらに備え;
該シールが前記ポート構造物本体と一体的に成形されている、項目1に記載の外科手術用ポート構造物。
(項目13)
前記シールが、前記第一のチャネルの側壁から内向きに該第一のチャネルの中心に向かう環状突出部を備え;そして
該環状突出部が、ほぼ三角形の断面を有し、丸みを帯びた先端が該第一のチャネルの該中心に向かって配向されている、項目12に記載の外科手術用ポート構造物。
(項目14)
前記シールが、該シールの中心開口部を覆う膜を備え;そして
該膜が、気体が前記第一のチャネルを通過することを防止する、
項目12に記載の外科手術用ポート構造物。
(項目15)
前記頂表面と前記底表面との間に延びる外側壁
をさらに備え;
該側壁が、くびれた形状を有し、その結果、頂部周囲リップが該頂表面と該側壁との間に規定され、そして底部周囲リップが該底表面と該側壁との間に規定される、項目1に記載の外科手術用ポート構造物。
(項目16)
前記頂表面と前記底表面との間に延びる外側壁;および
該頂表面の下にある導電性層であって、該導電性層は、前記第一のチャネルと該側壁との間に延びる、導電性層
をさらに備える、項目1に記載の外科手術用ポート構造物。
(項目17)
前記ポート構造物が成形された1つの片である、項目1に記載の外科手術用ポート構造物。
(項目18)
前記ポート構造物本体が、約40 Shore 00〜約15 Shore Aの範囲のデュロメーター値を有する材料を含む、項目1に記載の外科手術用ポート構造物。
(項目19)
ポート配向構造物をさらに備え、該ポート配向構造物は、患者の身体内への開口部内での前記ポート構造物本体の、該患者の身体内の外科手術部位に対する適切な配向を示す、項目1に記載の外科手術用ポート構造物。
(項目20)
外科手術用ポート構造物を製造する方法であって、
ポート構造物本体の頂表面と底表面との間で真っ直ぐ第一の方向に延びる第一のチャネルを規定するアクト;および
該ポート構造物本体の該頂表面と該底表面との間で真っ直ぐ第二の方向に延びる第二のチャネルを規定するアクト
を包含し;
該第一の方向と該第二の方向とが互いに異なる、方法。
(項目21)
前記第一のチャネルが、前記頂表面と前記底表面との間で第一の鋭角で延び;そして
前記第二のチャネルが、該頂表面と該底表面との間で第二の鋭角で延びる、
項目20に記載の方法。
(項目22)
漏斗状部分;
舌状部;
該漏斗状部分と該舌状部との間のくびれ部分;および
該漏斗状部分から該くびれ部分を通って延びる少なくとも2つの外科手術器具チャネルを備える、外科手術用ポート構造物。
(項目23)
前記漏斗状部分が、長い辺および該長い辺に対向する短い辺を有する、斜めの錐形を有し;そして
前記舌状部が該長い辺とは逆の方向に延びている、
項目22に記載の外科手術用ポート構造物。
(項目24)
前記斜めの錐形が斜めの円錐形を有する、項目22に記載の外科手術用ポート構造物。
(項目25)
第二の舌状部をさらに備え;
前記くびれ部分が、前記漏斗状部分と、前記舌状部と、該第二の舌状部との間にあり;そして
該第二の舌状部が、実質的に該舌状部から離れる方向に延びている、
項目22に記載の外科手術用ポート構造物。
(項目26)
前記くびれ部分内に配置された回転部分
をさらに備え;
該回転部分が第二の舌状部を備え;
該回転部分の第一の位置において、該第二の舌状部は、前記舌状部と実質的に整列し;そして
該回転部分の第二の位置において、該第二の舌状部は、実質的に該舌状部から離れる方向に延びる、
項目22に記載の外科手術用ポート構造物。
(項目27)
前記外科手術器具チャネルのうちの少なくとも1つが、玉継手を受容するソケットを備える、項目22に記載の外科手術用ポート構造物。
(項目28)
前記外科手術器具チャネルの各々の中に配置された玉継手
をさらに備え;
各玉継手がチャネルを備え、該チャネルを通って外科手術器具が延びる、項目22に記載の外科手術用ポート構造物。
(項目29)
外科手術用ポート構造物を製造する方法であって、
漏斗状部分と舌状部分との間のくびれ部分を配置するアクト;および
該漏斗状部分から該くびれ部分を通って延びる少なくとも2つの外科手術器具チャネルを規定するアクト
を包含する、方法。
(項目30)
前記漏斗状部分を斜めの錐形として形成すること;および
前記舌状部分を該斜めの錐形の長い辺から離れる方に延びるように配置すること
をさらに包含する、項目29に記載の方法。
本発明の局面および実施形態を説明する本明細書および添付の図面は、限定するとみなされるべきではない。特許請求の範囲が、保護される発明を規定する。種々の機械的変化、組成的変化、構造的変化、電気的変化、および操作的変化が、本明細書および特許請求の範囲の趣旨および範囲から逸脱することなくなされ得る。いくつかの例において、周知の回路、構造体、および技術は、本発明を曖昧にしない目的で、詳細には図示も記載もされない。2枚以上の図中の同様の数字は、同じ要素または類似の要素を表わす。
図4Aは、湾曲カニューレと受動的に可撓性である外科手術器具との組み合わせを支持して移動させる、患者側ロボットマニピュレーターの一部分の概略図である。図4Aに図示されるように、テレロボティクス技術で操作される外科手術器具402aは、力伝播機構404a、受動的に可撓性であるシャフト406a、およびエンドエフェクタ408aを備える。器具402aは、PSM204aの器具キャリッジアセンブリ212aに設置される(先に記載された構成要素は、明りょうにするために概略的に図示される)。インターフェースディスク414aは、PSM204aのサーボアクチュエーターからの起動力を結合させて、器具402aの構成要素を動かす。エンドエフェクタ408aは、説明に役立つように、単一のDOFで作動する(例えば、顎を閉じさせる)。エンドエフェクタの1以上のDOF(例えば、縦揺れ、横揺れ;例えば、米国特許第6,817,974号(2002年6月28日出願)(「Surgical Tool Having Positively Positionable Tendon−Actuated Multi−Disk Wrist Joint」を開示する)を参照のこと。これは、本明細書中に参考として援用される)を提供するためのリストは、任意のものであり、図示されていない。多くの器具の実行は、このようなリストを含まない。このリストを省略することにより、PSM204aと器具402aとの間の起動力界面の数が簡単にされ、そしてこの省略はまた、近位の力伝播機構404aと遠位で起動される片との間に必要とされる力伝播要素の数(ならびに従って、器具の複雑さおよび寸法)を減少させる。
図14Aは、本明細書中に記載されるような、湾曲カニューレと器具との組み合わせ、ならびに内視鏡および1つ以上の他の器具と一緒に使用され得る、ポート構造物1402の代表的な実施形態の模式平面図である。図14Bは、図14Aに示される実施形態の上面斜視図である。ポート構造物1402は、患者の体壁の1つの切開に挿入される。図14Aに示されるように、ポート構造物1402は、単一の本体であり、そして頂表面1404と底表面1406との間に延びる5つのチャネルを有する。他の実施形態は、ポート構造物の種々の位置で、種々の数のポートを有し得る。第一のチャネル1408は、内視鏡チャネルとして働き、そして内視鏡カニューレを収容するためのサイズにされる。代替の実施形態において、チャネル1408は、カニューレを用いずに内視鏡を収容するためのサイズにされ得る。図14Aに示されるように、内視鏡チャネル1404は、ポート構造物1402の中心軸1410からずれている。外科手術手順が通気を必要とする場合、この通気は、内視鏡カニューレ上の周知の構造物を介して提供され得る。
マルチポート最小侵襲性外科手術において、内視鏡が代表的に、挿入されるべき第一の外科手術器具である。一旦挿入されると、この内視鏡は、器具が組織に意図されずに接触したり損傷を与えたりしないように、他のカニューレおよび器具の挿入を観察するために配置され得る。しかし、1つの切開を用いる場合、一旦、内視鏡が挿入されると、他のカニューレおよび器具は、少なくとも最初は、この内視鏡の視野の外で挿入される。さらに、湾曲カニューレについては、カニューレの先端が、他の組織に接触することなく内視鏡の視野内に直接動かされることを確実にすることは、困難である。さらに、ロボットマニピュレーターが調節され、次いでカニューレに結合(ドッキング)される際に、これらのカニューレを適切に配置および配向させて維持することは、1人より多くの人が関与する、かなりの手先の器用さを要求し得る。従って、複数の器具を1つの切開に安全かつ容易に挿入する方法が、必要とされる。いくつかの外科手術手順中に、上に記載されたもののようなポート構造物は、複数の器具を安全に挿入する適切な方法を提供し得る。例えば、ポート構造物(全高さまたは半高さ)が、体壁の内部または表面に配置され得る。このポート構造物のチャネルは、カニューレ挿入のためのガイドとして働き、そして一旦これらのカニューレが挿入されると、このポート構造物は、これらのカニューレを、それらの関連するロボットマニピュレーターに結合させるために支持する。従って、上記のようなポート構造物は、以下に記載されるように、外科手術手順の初期段階中に、挿入および安定化の固定具として働き得る。他の外科手術手順中、または外科医の好みに起因して、複数の器具を挿入および支持するための他の方法が使用され得る。
最小侵襲性外科手術用ロボットシステムの制御は公知である(例えば、米国特許第5,859,934号(1997年1月14日出願)(遠隔操作システムにおける座標系を変換するための方法および装置を開示する)、同第6,223,100号(1998年3月25日出願)(関節付き器具を用いるコンピュータ強化外科手術を実施するための装置および方法を開示する)、同第7,087,049号(2002年1月15日出願)(最小侵襲性遠隔外科手術におけるマスター/スレーブの関係の再配置および再配向を開示する)、および同第7,155,315号(2005年12月12日出願)(最小侵襲性外科手術装置におけるカメラを参照する制御を開示する)、ならびに米国特許出願公開第2006/0178559号(2005年12月27日出願)(最小侵襲性外科手術手順における共同研究および訓練のためのマルチユーザ医療ロボットシステムを開示する)を参照のこと。これらの全ては、本明細書中に参考として援用される)。外科手術用ロボットシステムを操作するための制御システムは、本明細書中に記載されるように、湾曲カニューレおよび受動的に可撓性である外科手術器具と一緒に使用するために改変され得る。1つの例示的な実施形態において、da Vinci(登録商標)Surgical Systemの制御システムが、このように改変される。
fh=人の力
xh=マスター位置
em,s=エンコーダ値(マスター、スレーブ)
im,s=モータ電流(マスター、スレーブ)
θm,x=接合位置(マスター、スレーブ)
τm,s=接合トルク(マスター、スレーブ)
fm,s=カルテシアン力(マスター、スレーブ)
xm,s=カルテシアン位置(マスター、スレーブ)
fe=環境の力
xe=スレーブ位置
である。
Claims (1)
- 本明細書に記載の発明。
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KR101181569B1 (ko) | 2010-05-25 | 2012-09-10 | 정창욱 | 단일 통로 수술 모드와 다통로 수술 모드를 실현할 수 있는 수술용 로봇 시스템 및 그 제어 방법 |
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JP6278737B2 (ja) | 2014-02-26 | 2018-02-14 | オリンパス株式会社 | 医療用システムの作動方法 |
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Cited By (2)
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JP2018506358A (ja) * | 2015-02-26 | 2018-03-08 | コヴィディエン リミテッド パートナーシップ | ソフトウェア及び誘導管を備えたロボット制御の遠隔運動中心 |
US10959794B2 (en) | 2015-02-26 | 2021-03-30 | Covidien Lp | Robotically controlling remote center of motion with software and guide tube |
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WO2011060054A3 (en) | 2011-09-01 |
US20110071473A1 (en) | 2011-03-24 |
US20140066717A1 (en) | 2014-03-06 |
KR101933191B1 (ko) | 2018-12-27 |
US8623028B2 (en) | 2014-01-07 |
EP2480147B1 (en) | 2017-05-03 |
JP2016013496A (ja) | 2016-01-28 |
JP5694353B2 (ja) | 2015-04-01 |
CN104546082B (zh) | 2017-03-29 |
JP6433409B2 (ja) | 2018-12-05 |
KR20180008892A (ko) | 2018-01-24 |
US10245069B2 (en) | 2019-04-02 |
KR101819951B1 (ko) | 2018-01-19 |
CN104546082A (zh) | 2015-04-29 |
JP5833204B2 (ja) | 2015-12-16 |
KR20190000389A (ko) | 2019-01-02 |
WO2011060054A2 (en) | 2011-05-19 |
CN102612347A (zh) | 2012-07-25 |
US20190192132A1 (en) | 2019-06-27 |
KR20170054540A (ko) | 2017-05-17 |
KR102009222B1 (ko) | 2019-08-09 |
JP2013510664A (ja) | 2013-03-28 |
EP2480147A2 (en) | 2012-08-01 |
US11504156B2 (en) | 2022-11-22 |
CN102612347B (zh) | 2015-03-25 |
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