JP2014236976A - 向上した巧緻性および感度で最低侵襲性外科手術を行うための連結外科手術器具 - Google Patents
向上した巧緻性および感度で最低侵襲性外科手術を行うための連結外科手術器具 Download PDFInfo
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Abstract
【課題】最低侵襲性外科手術のための連結外科手術用器具を提供すること。【解決手段】本発明は、最低侵襲性外科手術手順の動作を向上させる連結外科手術用器具(12)である。器具(12)は、高度の巧緻性、低い摩擦、低い慣性、および良好な力反映を有する。独特なケーブルおよびプーリー駆動システムにより、摩擦が減少し力反映が向上する。独特なリスト機構により、標準的な腹腔鏡器具(12)に比べて外科手術の巧緻性が向上する。システムを最適化することにより、必要なアクチュエータ数が減少し、これにより最小サイズで十分に機能的な連結外科手術用器具が製造される。【選択図】図1
Description
本発明は、広義には、最低侵襲性外科手術の遂行を高めるための方法および装置に関する。具体的には、本発明は、最低侵襲性外科手術手順を行う外科医の能力を増大させる、外科手術器具に関する。より具体的には、本発明は、高い巧緻性、小さな摩擦、小さな慣性および良好な力反映(force reflection)を提供する最低侵襲性外科手術のための新規
な連結(articulated)外科手術器具に関する。
な連結(articulated)外科手術器具に関する。
最低侵襲性医療技術は、診断上または外科手術手順の間に損傷される無関係な組織の量を低減し、これにより、患者の回復時間、不快感および有害な副作用を低減することを目的としている。今日、米国において毎年約21,000,000件の外科手術が行われている。これらの外科手術の内約8,000,000件は潜在的に最低侵襲に行うことが可能であると推定されている。しかし、最低侵襲性外科手術器具および技術ならびにこれらを修得するために必要なさらなる外科手術訓練の制限のために、現在のところ、わずかに約1,000,000件の外科手術でしかこれらの技術は用いられていない。
最低侵襲性外科手術技術の進歩は、劇的な影響をもたらし得る。標準的な外科手術の場合の平均入院日数は8日間であり、同等の最低侵襲性外科手術の場合の平均日数は4日間である。従って、最低侵襲性技術を全面的に採用することによって、28,000,000日間の入院日数ならびに入院費用だけでも年間数十億ドルを節減し得る。患者の回復時間、患者の不快感、外科的副作用および仕事から離れる時間も最低侵襲性外科手術によって低減される。
最低侵襲性外科手術の最も一般的な形態は内視鏡検査である。おそらく、最も一般的な形態の内視鏡検査は、最低侵襲性の検査および腹腔内外科手術である腹腔鏡検査である。標準的な腹腔鏡検査外科手術の場合、患者の腹部にガスを注入し、カニューレスリーブを小さな切開部(約1/2インチ)に通し、これにより、腹腔鏡検査外科手術器具のための入口を得る。
腹腔鏡検査外科手術器具は、広義には、外科手術部位(surgical field)を見るための腹腔鏡、ならびに、鉗子、把持具(graspers)、鋏、ホチキス(staplers)および把針器(needleholder)のような作業工具(working tools)を含む。作業工具は、長さ約12インチの延長チューブによって各工具の作業端がハンドルから離れていることを除けば、従来の(開腹)手術で使用されるものと同様である。
外科手術手順を行う際、外科医は、カニューレに器具を通し、カニューレを通して器具を前後に摺動させ、カニューレ内で器具を回転させ、腹壁内において器具を梃子で動かし(即ち、旋回させ)、そして器具の遠位端上のエンドエフェクタ(end effector)を作動させることによって器具を操作する。器具は、概ね腹壁筋肉内の切開部によって規定される回転中心を中心に旋回する。外科医は、腹腔鏡検査カメラによって提供される腹部作業部位(worksite)の画像を表示するテレビモニタによって、手順を監視する。
関節鏡検査、後腹膜鏡検査(retroperitoneoscopy)、骨盤鏡検査(pelviscopy)、腎盂尿管鏡検査(nephroscopy)、膀胱鏡検査、脳槽鏡検査(cisternoscopy)、洞房鏡検査(sinoscopy)、子宮鏡検査および尿道鏡検査においても同様の内視鏡検査技術が用いられる。これらの最低侵襲性外科手術技術全てに共通する特徴は、人体内の作業部位を可視化し、特別設計された外科手術器具を自然の細孔または小さな切開部を介して作業部位まで通すことにより人体の組織および器官を操作し、これにより、開腹外科手術的アクセスを形成することによって周辺組織にもたらされる付随外傷を回避することである。
現在の最低侵襲性外科手術技術には多くの欠点がある。例えば、現存のMIS器具は、開腹外科手術における工具を配置する際の柔軟性を外科医に与えない。ほとんどの腹腔鏡検査工具は、剛性シャフトを有しており、小さな切開部の方向からの作業部位への接近が制限される。さらに、多くの内視鏡検査器具の長さおよび構造は、組織および器官によって工具のエンドエフェクタ上にかかる力を感じる外科医の能力を低減する。内視鏡検査工具によって提供される巧緻性および感度の欠如は、最低侵襲性外科手術の拡張に対する大きな課題である。
外科医の巧緻性を向上するとともに、外科医が遠れた場所から患者を手術することを可能にする、外科手術用の遠隔外科手術システム(Telesurgery systems)が開発されつつある。遠隔外科手術は、外科医が工具を直接保持して動かすのではなく、外科手術器具の動きを操作する何らかの形態のサーボ機構を使用する外科手術システムの総称である。遠隔外科手術用のシステムの場合、遠れた場所にいる患者の画像が外科医に提供される。外科医は、3次元画像を見ながら、サーボ機構駆動器具(servomechanism-actuatedinstrument)の動きを制御するマスターデバイスを操作することによって患者に対して外科手術手順
を施す。行為に対して器具が位置決めされる方位と同じ方位で、手術部位の画像に対して外科医の手およびマスターデバイスを位置決めする。手術中、この器具は、組織把持具、持針器等のような様々な外科手術器具の機械的な駆動および制御を提供し、それぞれが外科医のために様々な機能、即ち、針の保持または駆動、血管の把持または組織の切開を行う。
を施す。行為に対して器具が位置決めされる方位と同じ方位で、手術部位の画像に対して外科医の手およびマスターデバイスを位置決めする。手術中、この器具は、組織把持具、持針器等のような様々な外科手術器具の機械的な駆動および制御を提供し、それぞれが外科医のために様々な機能、即ち、針の保持または駆動、血管の把持または組織の切開を行う。
このような遠隔外科手術システムは、開腹手順および内視鏡検査手順の両方のために提案されている。遠隔外科手術技術に関する最新技術の概要は"Computer Integrated Surgery: Technology And ClinicalApplications"(MIT Press,1996)に見られる。さらに、遠隔外科手術用の従来のシステムは、特許文献1、特許文献2、特許文献3、特許文献4、特許文献5、および特許文献6に記載されている。
しかし、遠隔操作器(telemanipulators)を用いた遠隔外科手術を行うための方法は、依然、外科医が遠隔外科手術システムを操作する際に、位置、力および触覚を外科手術器具から外科医の手に伝達して、外科手術器具を直接手で操作した場合と同じ感覚を外科医が持つようにすることができる巧緻性の高い外科手術器具の開発を必要とする。力反映を提供するシステムの能力は、機構内の摩擦、重力、外科手術器具の慣性および外科的切開部において器具にかかる力のような要因によって制限される。
従って、外科医が内視鏡検査外科手術手順を行う際の巧緻性を高める外科手術器具が必要である。
自由度2のリスト(wrist)を有する巧緻性の高い外科手術装置を提供することも望まれる。
外科手術器具にかかる力の敏感なフィードバックを外科医に提供するために摩擦の小さなリスト機構を提供することもさらに望まれる。
遠隔操作器機構における動作に適した最低侵襲性外科手術のためのリスト機構を有する外科手術器具を提供することもさらに望まれる。
従って、本発明の目的の1つは、外科医が内視鏡検査外科手術手順を行う際の巧緻性を高める外科手術器具を提供することである。
自由度2のリストを有する巧緻性の高い外科手術装置を提供することも本発明の目的の1つである。
外科手術器具にかかる力の敏感なフィードバックを外科医に提供するために摩擦の小さなリスト機構を提供することも本発明のさらに別の目的の1つである。
遠隔操作器機構における動作に適した最低侵襲性外科手術のためのリスト機構を有する外科手術器具を提供することも本発明のさらに別の目的の1つである。
本発明の上記目的に従って、本願出願人らは、内視鏡検査外科手術に適したコンパクトな連結外科手術器具を記載する。器具は、2つの対向する旋回顎および旋回リスト部材を有する。器具は、力反映を高感度に提供することができる。器具は、外科医が操作するマスターコントロールにサーボ機構を介して接続するように調節される。
本発明の上記およびその他の目的、特徴ならびに利点は、図面の好適な実施形態の以下のより具体的な説明から明らかになるであろう。図面を通して、同じ参照符号は、同じ部分を示す。図面は、必ずしも一定の縮尺で示されている訳ではなく、本発明の原理を説明する場所には強調を加えている。
図1は、位置決めメカニズムに取り付けられる力反映外科手術器具を含むサーボ機構外科手術システムの概略図である。
図2は、外科手術器具を患者に挿入した状態で位置決めメカニズムが前および後ろの位置にある場合の概略図である。
図3は、力反映外科手術器具の斜視図である。
図4は、力反映外科手術器具の回転運動をケーブル駆動により作動させる場合の概略図である。
図5は、力反映外科手術器具の遠位端の斜視図である。
図6は、ケーブルとプーリーとの関係を示す力反映外科手術器具の簡略化された概略図である。
図7aは、駆動モータの駆動シャフトに巻き付けられたケーブルの斜視図である。
図7bは、本発明による別の好適なケーブル駆動方法を示す概略図である。
図8は、別の好適な力反映外科手術器具のリスト部材の上面図である。
第1の実施形態の外科手術器具は、長手方向の軸に沿う近位端および遠位端を有する細長い支持部材を含む。遠位リスト部材は、リストジョイントにより、支持部材の遠位部に回転可能に連結される。第1および第2の対向する作業部材は、それぞれ第1および第2の駆動されるキャプスタンに取り付けられる。第1および第2の駆動されるキャプスタンはそれぞれ、第1および第2のキャプスタンジョイントにより、リスト部材に回転可能に取り付けられる。第1および第2のキャプスタンジョイントは、好ましくは共通の軸を有する。第1、第2、第3および第4の中間アイドラプーリーは、リストジョイントを中心に回転可能にリスト部材に取り付けられる。第1、第2、第3および第4のケーブルを含むケーブル駆動システムが設けられる。中間アイドラプーリーの各々は、1つのケーブルによって係合され、駆動されるキャプスタンの各々は、2つのケーブルによって係合されて駆動される。ケーブル駆動システムは、リスト部材をリストジョイントを中心に旋回させることができ、且つ、キャプスタンジョイントを中心に作業部材を互いに独立して旋回させることができる。
好適な実施形態では、線形ベアリングが、支持部材と摺動的に係合される状態で取り付けられ、支持部材の遠位部が支持部材の近位部に対して長手方向の軸に沿って往復運動することを可能にする。そのような実施形態では、ケーブル駆動システムは、支持部材を長手方向の軸に沿って並進させることができる。好適な実施形態では、支持部材はまた、支持部材の近位部と遠位部とを分離して、遠位部が近位部に対して長手方向の軸を中心に回転することを可能にする回転式ジョイントを含み得る。そのような実施形態では、第1から第4のケーブルは、遠位部の回転中に長手方向の軸を中心にねじれることが可能であり、ケーブル駆動システムは、遠位部を長手方向の軸を中心に回転させるための回転式ジョイントに連結される第5のケーブルを含む。
本発明はまた、第1、第2、第3および第4のケーブルを引っ張るための新規なシステムを提供する。第1の近位アイドラプーリーは、第1および第2のケーブルを回転可能に係合して引っ張る。第2の近位アイドラプーリーは、第3およいび第4のケーブルを回転可能に係合して引っ張る。第5および第6のケーブルは、第1および第2の近位アイドラプーリーに接続され、第1および第2の近位アイドラプーリーを引っ張る。第3のより近位のアイドラプーリーは、支持部材に回転可能に取り付けられ、第5および第6のケーブルを回転可能に係合して引っ張る。
外科手術器具は、複数のアクチュエータをさらに含み、アクチュエータの各々は、ケーブル駆動システムのケーブルのうちの1つを駆動する。器具は、好ましくは、器具の1自由度当たり1つのアクチュエータを含む。アクチュエータは、好ましくは、中間アイドラプーリーと近位アイドラプーリーとの間に配置されるサーボモータである。サーボモーターは、好ましくは、サーボモータの駆動シャフトに取り付けられる駆動キャプスタンによってケーブルに直接連結される。
外科手術器具は、マスターデバイスおよびコントローラによって制御されるスレーブデバイスとなるように適合される。器具およびマスターデバイスの動きと、器具およびマスターデバイスに与えられる力とは、器具とマスターデバイスとの間でスケーリング(scale)され得る。自由度2の位置決めメカニズムは、器具に取り付けられ得、作業部位に対して器具を位置決めする。位置決めメカニズムは、器具に、終点を位置決めするため余剰(redundant)自由度を与え得る。位置決めメカニズムと、本出願人の連結外科手術器具との組み合わせは、マスターデバイスを操作している外科医が、器具の位置決めおよび使用の間に器具が受ける力を、従来のシステムよりも高い感度で感じることを可能にするように適合される。
外科手術システムの好適な属性についての詳細はまた、本出願人による、「Force-ReflectingSurgical Instrument And Positioning Mechanism For Performing Minimally InvasiveSurgery With Enhanced Dexterity And Sensitivity」および「Wrist Mechanism ForSurgical Instrument For Performing Minimally Invasive Surgery With EnhancedDexterity And Sensitivity」と題された、本願と同日出願の同時係属中の出願に記載される。本明細書において、上記出願の開示を参考として援用する。
図1を参照して、遠隔外科手術システム10は、ある場所にいる外科医が、別の場所にいる患者に外科手術を行うことを可能にする。外科医は、患者と同じ手術室にいてもよく、何マイルも離れた場所にいてもよい。遠隔外科手術システム10は、ブラケット36により位置決めメカニズム14に取り付けられる力反映外科手術器具12を含む。器具12および位置決めメカニズム14は、コンピュータ11およびマスターデバイス150によって制御される。マスターデバイス150は、遠隔地にいる外科医によって操作される。器具12および位置決めメカニズム14は、駆動モータM1、M2、M3、M4、M5、M6およびM7(図3、図4、図6および図7a〜図7b)によって、一連のケーブルおよびプーリーとともに駆動される。
器具12は、低摩擦、低慣性、および高帯域幅(bandwidth)を有するが、移動範囲は小さい。位置決めメカニズム14は、移動範囲は大きいが、典型的には、器具よりも高い慣性および低い帯域幅を有する。マクロ−マイクロ作動方式において器具12と位置決めメカニズム14とを組み合わせることにより、その個々の構成要素のいずれよりも、高い動作範囲(dynamicrange)を有するシステムが得られる。位置決めメカニズム14は、余剰自由度を有する遠隔外科手術システム10を与え、外科手術作業部位において器具12を位置決めするのを助け、器具12がほぼ、必要な外科手術を行うための適切な位置にされる。このように、器具12を位置決めメカニズム14に取り付けることにより、遠隔外科手術システム10には、器具12の使用を通して良質な力制御が与えられ、それと同時に、遠隔外科手術システム10は、位置決めメカニズム14のため、大きい移動範囲を有する。器具12は、取り付けブラケット36により位置決めメカニズムに取り付けられる。好ましくは、器具12は、ねじ、ボルト、クランプなどの任意の適切な解放自在な取り付け手段を用いて位置決めメカニズム14に解放自在に取り付けられる。
器具12は、回転式ジョイント26によって遠位部28bに回転可能に連結される近位部28aを有する。近位部28aは、摺動ジョイント30を形成する摺動ブラケット96に摺動自在に連結される。摺動ブラケット96は、ブラケット36に固定される。ブラケット36は、器具12を位置決めメカニズム14に解放自在に接続する取り付けブラケットである。器具12の遠位部28bは、リストジョイント16によって管状支持部材24に回転可能に連結されるリスト部材を含む。2つの対向する作業部材20aおよび20bはそれぞれ被駆動キャプスタン18aおよび18bに固定され、被駆動キャプスタン18aおよび18bはそれぞれキャプスタンジョイント19aおよび19bを中心に回転可能にリスト部材22に連結される。作業部材20aおよび20bは、鋏、開創器、針ドライバおよび電気焼灼器具などの標準の外科手術器具の操作端であり得る。
器具12は、自由度5を有し、摺動ジョイント30が、長手方向の軸C−Cに沿って線形動作を与え、回転ジョイント26が、軸C−Cを中心とする回転動作を与え、リストジョイント16が、軸B−Bを中心とする回転動作を与え、キャプスタンジョイント19aおよび19bが、作業部材20aおよび20bに対して、軸A−Aを中心とする回転動作を与える。器具12は、マスターデバイス150に4段階の力反映を与えるため、外科医は、外科手術処置の触知(tactile)フィードバックを有し得る。これらの力反映段階は、作業部材20aおよび20bに与えられるx、yおよびzの力と、作業部材20aと20bとの間の保持力とを含む。しかし、力の反映は、任意の特定の実施形態において必要に応じてより多いまたはより少ない動作軸に与えられ得る。
位置決めメカニズム14は、自由度2のリンケージである。好ましくは、このリンケージは、軸E−Eを中心に回転する、4つのバーを有するリンケージである。位置決めメカニズム14は、ジョイント34、38、48、50、52、54および56によって結合される一連の剛性部材36、40、42、60および62を有する。位置決めメカニズム14はまた、耳部58を有する基部68を含み、耳部58は、シャフト64および66を係合して、軸E−Eを中心に旋回するジョイント57を形成する。ジョイント56は、リンク62が、軸E−Eに直交する軸D−Dを中心に回転することを可能にする。剛性部材36、40、42、60および62の4つのバーを有するリンケージは、この回転をブラケット36を介して器具12に伝え、器具12を軸E−Eおよび軸D’−D’を中心に回転させる(軸D’−D’は、軸D−Dに平行であり、軸E−Eに直交する)。このように、4つのバーを有するリンケージは、器具12の点Psを、遠隔中心111に中心を有する球体の表面の周りで移動させるように動作する。ここでは4つのバーを有するリンケージが示されているが、本発明の連結外科手術器具は、任意の適切な位置決めメカニズムによって支持され得る。侵入が最小である外科手術に適切なものとするために、位置決めメカニズムは、外科手術器具を、器具が患者に挿入される開口で交差する軸を中心に旋回させなければならない。
器具12を制御するに適した触覚型マスターデバイス150は、自由度7を有する入力器具である。使用中、マスター150は、取付が固定された基準点を提供するように、コンソールまたはカートまたは同様の支持体の適切な位置に安定的に取り付けられる。使用中、外科医はマスター機構の、静止支持体に対する位置および方向を操作する。マスターの連結部、モータおよびエンコーダは外科医の動きを検出してコンピュータに伝送する。マスターのモータは好適には、外科医への力フィードバックをさらに供給する。これは、器具12および位置決め機構14の動きを制御し、従って器具12の遠位端の、外科手術部位に対する位置を制御する。
記載しているシステムにおいてマスターとして用いられるに適した装置の1つは、参考のためここに援用する、"Force Reflecting Haptic Interface"いう名称の米国特許第5,587,937号に記載されている。別の適切なマスターデバイスは、参考のためここに援用する、"ElectromechanicalHuman-Computer Interface With Force-Feedback"という名称の米国特許第5,576,727号に記載されている。上記文献に開示された触覚型のマスター装置は、作業部材を把持することからの力反映を提供するために、より大きな(powered)更なる自由度の追加を要する。例えば、フィンガグリッパは、外科医の
別の手で操作されるように別個の機構上のモータおよびエンコーダに取り付けられ得る。あるいは、フィンガグリッパは、外科医が操作するために、同一のデバイス上のモータおよびエンコーダに取り付けられ得る。
別の手で操作されるように別個の機構上のモータおよびエンコーダに取り付けられ得る。あるいは、フィンガグリッパは、外科医が操作するために、同一のデバイス上のモータおよびエンコーダに取り付けられ得る。
腹腔鏡を用いる外科手術のために遠隔外科手術システム10を用いる場合、位置決め機構14を、手動操作セットアップジョイント(図示せず)に取り付ける。セットアップジョイントを用いてツールを位置決めしてツールを適切な位置にロックした後、外科医は、マスターデバイス150を操作して患者の腹壁110の小さい切開112を介して挿入されるカニューレ113を通して器具12を移動させる。マスターデバイス150の操作に応答して、器具12の遠位部28bが、摺動ジョイント30に沿って位置決め機構14に対して下流に並進移動して、カニューレ113および腹壁110を通って挿入される。
一旦腹部内に入ると、器具12の遠位部28bはさらに、所望の手術部位上に位置づけられる。図2は、大きな位置移動を行うために前方および後方位置における、D−D軸周りに旋回する機構14の動きを示す。位置決め機構14は、D−D軸およびE−E周りに旋回して、遠隔外科手術システム10の大きな移動を行う。その間、細かい動きは、器具12のジョイントによって行われる。器具12上のポイント111は、位置決め機構14からの回転のリモートポイントであり、これはエントリ創傷112に一致する。位置決め機構14がD軸およびE軸周りに旋回すると、器具12は点111周りに旋回する。切開112近傍のポイント111は、器具12が患者内で旋回している間、静止したままであることに留意されたい。その結果、切開112は、器具12を受け入れるに十分な大きさであればよい。
位置決め機構14が旋回すると、リスト部材22または作業部材20a/20bが組織と係合してジョイント16または19a/19b周りの回転を引き起こす場合、器具12は、器具12が位置決め機構14に対して作業スペースの中央部に維持されるように、それ自体を再び方向付ける。必要であれば、位置決め機構14は、器具12が再方向づけしている間、速度を弛め得る。
器具12が一旦適切な位置にくると、外科医は、さらにマスターデバイス150を操作することにより、器具12で患者に必要な外科手術手順を行う。器具12が受ける力は、マスターデバイス150によって外科医に戻って反映される(reflected back)。反映さ
れた力は、外科医が外科手術手順をよりよく「感じる」ことを可能にするために、スケールアップされ得る。その結果、外科医は、器具12が、あまり抵抗を与えないタイプの組織に係合することを感じることができる。さらに、マスターデバイス150の、器具12に対する移動は、器具12の精度および巧緻性が増加し得るように、スケールダウンされ得る。
れた力は、外科医が外科手術手順をよりよく「感じる」ことを可能にするために、スケールアップされ得る。その結果、外科医は、器具12が、あまり抵抗を与えないタイプの組織に係合することを感じることができる。さらに、マスターデバイス150の、器具12に対する移動は、器具12の精度および巧緻性が増加し得るように、スケールダウンされ得る。
位置決め機構14は広範囲の動きを有するように最適化されているため、器具12よりも大きい慣性、大きい摩擦、および低い分解能を有する傾向にある。さらに、カニューレ113内の摩擦力および切開112における妨げとなる力が、位置決め機構に適用され得る。しかし、出願人による好適な実施形態において、主に外科用器具が力反映のために力を検出する。そのため、位置決め機構のより大きい慣性および摩擦、ならびにそれに作用する外的な力は、力反映系から除外される。従って、器具12の先端とマスターデバイスとの間の力反映の質は、大幅に向上する。
図3、図4および図5を参照して、器具12をより詳細に述べる。遠位部の管状支持部材24はC−C軸に沿って延び、管状支持部材24の長さ方向に延びる一連のケーブルC1、C2、C3およびC4を収容している。ケーブルC1、C2、C3およびC4は、作業部材20aおよび20bの動作並びにリスト部材22の方向を制御するジョイント19a、19bおよび16の回転を制御する。リスト部材22は、2つの互いに対向する遠位の耳21aおよび21bを含む。耳21aおよび21bは、A−A軸に沿って延びるキャプスタンジョイント19aおよび19bのそれぞれにおいて、駆動されるキャプスタン18aおよび18bを支持するUリンク(clevis)を形成する。リスト部材22はさらに、2つの対向する近位の耳23aおよび23bを含む。耳23aおよび23bは、B−B軸に沿って耳23aと舌24aとの間に延びる中間アイドラプーリー70および72を、リストジョイント16において支持するUリンクを形成する。中間アイドラプーリー74および76は、耳23bと舌24aとの間で支持される。ケーブルC1、C2、C3およびC4は、以下に詳細に記載するように、駆動されるキャプスタン18a/18b、並びに中間アイドラプーリー70、72、74および76と係合する。
作業部材20aおよび20bは、それぞれの駆動されるキャプスタン18aおよび18bに取り外し可能に安定的に取り付けられる。作業部材20aおよび20bは図中グリッパとして示しているが、作業部材20aおよび20bは、鋏、カッタ、把持具、鉗子または縫合をステッチするニードルホルダなどの他のタイプの作業部材に置換され得る。典型的には、作業部材は、ねじ、クリップまたは他の適切な固定具により、駆動されるキャプスタン18aおよび18bに安定的に取り付けられる。しかし、作業部材はまた、半田付けまたは溶接などによって、駆動されるキャプスタンに恒久的に取り付けられ得、または駆動されるキャプスタンと一体的に形成され得る。
作業部材20aおよび20bは共に、1形態の外科用エンドエフェクタを含む。本発明の外科用器具において、他の外科用エンドエフェクタも用いられ得る。エンドエフェクタは単に、ハンドルが取り外された標準の外科用または内視用器具を含み、これらは、例えば、リトラクタ、電気メス(electrocautery)器具、マイクロ鉗子、マイクロニードルホルダ、切開鋏、ブレード、イリガートルおよび縫合糸を含む。エンドエフェクタは典型的には、1つまたは2つの作業部材を含む。
器具12の近位部28aは、支持ロッド100並びに2つのガイドレール104および106によって互いに連結された支持ブラケット98および102を含む。ロータリジョイント26を形成するロータリベアリング91は、管状支持部材24を支持する支持ブラケット98内に収容される。摺動ブラケット96は線形ベアリングに沿って摺動可能にガイドレール104および106に取り付けられる。図1に示すように、摺動ブラケット96は、ブラケット36によって位置決め機構14に連結される。摺動ブラケット96は好適には、外科的用途のために、約8インチの移動を行う。
駆動モータM1、M2、M3、M4およびM5は、摺動ブラケット96に取り付けられ、対応するケーブルC1、C2、C3、C4およびC5を駆動する。摺動ブラケット96は、駆動モータの各々を支持する。動作中、摺動ブラケット96は、取付ブラケット36によって位置決め機構14に連結される。器具12が位置決め機構14に取り付けられると、駆動モータは、遠位部28bを摺動ブラケット96に対して移動させるように動作する。それにより、摺動ブラケット96は外科用器具の支持ブラケットを形成する。各駆動モータM1、M2、M3、M4およびM5は、コンピュータ11にそれぞれの駆動シャフトの回転位置を供給する、対応するエンコーダE1、E2、E3、E4およびE5を含む。
図4に示すように、駆動モータM5は、ケーブルC5からなるケーブル駆動ループと係合する駆動シャフトキャプスタン93を有する。ケーブルは、後部張力プーリー83に回り掛けられている。ケーブルは、アイドラプーリー84および85、並びに、管状支持部材24の近位端を形成する駆動キャプスタン90に回り掛けられている。従って、モータM5の作動の回転は、管状支持部材24およびそれが支持するエンドエフェクタを回転させるために用いられ得る。
図6を参照して、器具12のケーブル駆動系をより詳細に述べる。作業部材20aおよび20b、リスト部材22、および器具12の長手方向C−C軸に沿った並進運動は、N+1作動方式を為して配列されているケーブルC1、C2、C3およびC4によって駆動される。N+1作動方式は、4つのケーブルを用いて自由度3を有するリストの作動を可能にする。4つのケーブルは、自由度3を駆動するために必要な張力要素の、理論的に可能な最小の数であり、従って器具が最小サイズおよび重量を有することを可能にする。異なる動きの作動に必要な力の大きさが大幅に異なる場合には、より多くのケーブルを用いる別の作動方式が望まれ得る。より多くのケーブルを用いることの不利な点は、重量、複雑さ、および最小サイズが増加することである。
図6において、ケーブルC1〜C4をより容易に示すために、ジョイント26のC−C軸周りの回転運動は省略されている。このような回転は、モータM1〜M4並びにプーリー70、72、74および76間においてケーブルC1〜C4をねじる結果となるにすぎない。しかし、ケーブルは、このねじれがケーブルの経路の長さを大幅に変更しないように、管状支持部材24内に配置されている。しかし、器具の過剰な回転を防止するように注意する必要がある。器具の過剰な回転は、ケーブルをねじれさせて互いに接触させ、ケーブル間に摩擦を引き起こす。
図6に示すように、ケーブルC1およびC2は、連続ケーブルループ44の2つの側を形成する。ループ44のケーブルC1は、近位のアイドラプーリー80、モータM1の駆動シャフト、中間アイドラプーリー70、および駆動されるキャプスタン18aと係合する。ケーブルループ44は、駆動されるキャプスタン18aからケーブルC2として戻り、中間アイドラプーリー76、モータM2の駆動シャフトおよび近位のアイドラプーリー80と係合する。
図6に示すように、ケーブルC3およびC4は、ケーブル46の連続ループの2つの側を形成する。ケーブルループ46のケーブルC3は、近位のアイドラプーリー78、モータM3の駆動シャフト、中間アイドラプーリー72、および駆動されるキャプスタン18bと係合する。ケーブルループ46は、駆動されるキャプスタン18bからケーブルC4として戻り、中間アイドラプーリー74、モータM4の駆動シャフトおよび近位のアイドラプーリー78と係合する。
図6に示すように、近位のアイドラプーリー78および80は、近位のアイドラプーリー78および80の中心に安定的に取り付けられたケーブルC7およびC6によって張力を与えられる。ケーブルC7およびC6は、近位のアイドラプーリー82と係合する単一のケーブル45の2つの側を形成する。近位のアイドラプーリー82は、シャフト82aによって支持ブラケット102に回転可能に取り付けられる。シャフト82aは好適には、リードねじなどの機構によって支持ブラケット102に移動可能に取り付けられる。リードねじは、その後、ケーブルC7およびC6を適切な張力に調節し得る。張力はまた、アイドラプーリー78および80を介してケーブルC1、C2、C3およびC4にも付与される。同様のリードねじ張力付与方式が、アイドラプーリー83の長手方向移動によって、ケーブルC5に張力を与えるために用いられ得る。これらの目的のために、アイドラプーリー82および83は、図3に示す単一のシャフト82aではなく、別々に調節可能なシャフト上に取り付けられることが必要であり得る。
駆動されるキャプスタン18aおよび18bは、ケーブルC1からC4がそれぞれの中間アイドラプーリーと適切に係合することができるように、異なる直径を有し得る。ケーブルC1およびC2は、外側中間アイドラプーリー70および76と係合し、一方、ケーブルC3およびC4は、内側中間アイドラプーリー72および74と係合する。近位アイドラプーリー78および80は、プーリー80がプーリー78よりも大きく、ケーブルを直線状に保つような大きさになっている。
駆動モータM1、M2、M3およびM4は、ケーブルC1、C2、C3およびC4を駆動させることによって、軸B−B周りのリスト部材22の回転、軸C−Cに沿った器具12の長手方向の平行移動、および軸A−A周りの互いに独立した作業部材22aおよび22bの回転を制御する。駆動モータM1およびM2は、駆動モータM3およびM4によって駆動されるケーブルC3/C4に対して同時にケーブルC1/C2を駆動させ、リスト部材22を軸B−B周りに回転させる。駆動モータM1は、駆動モータM2によって駆動されるケーブルC2に対してケーブルC1を駆動し、キャプスタン18aおよびそれに取り付けられた作業部材20aを軸A−A周りに回転させる。さらに、駆動モータM3は、駆動モータM4によって駆動されるケーブルC4に対してケーブルC3を駆動させ、キャプスタン18bおよびそれに取り付けられた作業部材20bを軸A−A周りに回転させる。4つの駆動モータM1、M2、M3およびM4はすべて、ケーブルC1、C2、C3およびC4を同時に駆動させ、器具12を長軸C−Cに沿って並進させる。
摺動ブラケット96上の位置決め駆動モータM1、M2、M3、M4およびM5は、器具12の遠位部28bが小さな移動性質量(small moving mass)を有するようにする。なぜなら、モータ自体は、器具の作動中に静止しているからである。モータは、位置決め機構14によって移動されるが、モータの重量および慣性は、力反映に影響しない。これは、上記のように、好ましい実施態様では、器具12のみが、マスターへ力を反映させるために用いられるからである。さらに、器具12を制御するためにギアの代わりにケーブルを用いると、器具12内の摩擦量およびバックラッシュ(backlash)が減少する。小さな移動性質量および低摩擦の組合せによって、器具12は、力反映をマスター装置150に高感度で与えることが可能となる。
上記のプーリー、ケーブルおよびモータの構成に対するいくつかの可能な変更は、当業者に明白である。ケーブルC1/C2、C3/C4、C5およびC7/C6は、同一のケーブル側に図示したが、ケーブルC1からC7は、それぞれ、駆動されるキャプスタン18aおよび18b、ならびに近位アイドラプーリー78、80および82に安定して取り付けられる個別のケーブルであってもよい。さらに、駆動モータM1、M2、M3およびM4は、ケーブルC1、C2、C3およびC4をそれぞれ駆動するように図示したが、いくつかの駆動モータは、ケーブルC7およびC6を駆動するために、ケーブルC1〜C4からケーブルC7およびC6に再配置され得る。特定の実施態様において用いられる特定の駆動方式の選択は、器具12によって用いられるべき力の制約、および作動中に移動する器具の部分の慣性および摩擦を減少させる必要性に依存する。
本発明の外科用器具はまた、駆動モータM1、M2、M3、M4およびM5を用いるものとして例示している。この駆動モータは、図3に示す位置エンコーダを有する標準的なサーボモータであり得る。しかし、液圧アクチュエータおよび圧電モータなどの他のアクチュエータが使用され得る。本発明の外科用器具においてアクチュエータとして用いられるためには、駆動機構は、可変かつ制御可能な力および位置制御を提供することができればよい。
ケーブルC1、C2、C3、C4、C7、C8およびC9は、それぞれの駆動モータM1、M2、M3、M4、M5,M6およびM7の駆動シャフトに巻き付けられることによって駆動される。図7aおよび図7bは、このケーブル駆動方法および他のケーブル駆動方法をさらに詳細に示す。例えば、図7aにおいて、ケーブルループ46のケーブルC4は、モータM4の駆動シャフトの周りに巻き付けられている。ケーブルC4は、好ましくは、駆動シャフトの周りに2回巻き付けられ、ケーブルC4と駆動シャフトとの間に十分な摩擦を提供し、すべりを防止する。さらにすべりを防止するために、ケーブルは、はんだ、溶接または機械的固定手段によって、一点で駆動シャフトに固定され得る。しかし、このような実施態様において、ケーブルの移動範囲は、駆動シャフトまたはキャプスタンの周りに巻き付けられたケーブルの長さによって限定されるので、ケーブルは数回巻き付けられることが通常必要である。
図7bは、駆動ケーブルの他の好ましい方法を示す。例えば、モータM4は、駆動ホイール43aおよびアイドラーホイール43bを有し、その間で細長い部材47を摩擦駆動させる。ケーブルC4は、2つのハーフ46aおよび46bからなり、これらは、部材47の対向する端部に固定されている。
図8は、他の好ましい器具117の遠位端およびリスト部材116を示す。器具117は、4個でなく8個の中間アイドラプーリーを有するという点で、器具12とは異なる。器具117は、リスト接合部16において中間アイドラプーリー76、74、72および70を有するが、さらに中間アイドラプーリー76a、74a、72aおよび70aを有し、これらは、シャフト118に沿ってつまみ24a上のアイドラプーリー76、74、72および70に隣接して配置されている。ケーブルC1、C2、C3およびC4は、各中間アイドラプーリーの周りに完全に巻き付きはしないが、その代わりに、軸16の周りのリストの移動範囲にわたって0゜と180゜との間の範囲の可変量で各プーリーの表面と接触するだけである。これによって、ケーブルが互いに交差し、共に摩擦するのが防止され、摩擦およびノイズが防止される。
本発明は、腹腔鏡外科手術を行うことに関して説明したが、本発明はさらに、開腹手術だけでなく他の形態の内視鏡手術にも用いられ得る。本発明のマニプレータはさらに、良質の力フィードバックを有する巧緻なマニプレータを必要とする任意の適切な遠隔制御の応用にも用いられ得る。さらに、本発明は、特に、好ましい実施態様を参照しながら示し説明したが、当業者には言うまでもなく、形態および詳細の様々な変更が、添付の請求の範囲に定義される発明の精神および範囲から逸脱せずになされ得る。
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US (10) | US5792135A (ja) |
JP (8) | JP3999816B2 (ja) |
CA (2) | CA2255934C (ja) |
WO (1) | WO1997043942A1 (ja) |
Families Citing this family (1958)
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- 1997-05-20 WO PCT/US1997/008379 patent/WO1997043942A1/en active Search and Examination
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1998
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1999
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2002
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2010
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