JP2020096893A - 超精巧外科システム - Google Patents
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Abstract
Description
本出願は、そのすべてが参照により全体として本明細書に組み込まれ、本明細書の一部と見なされるべきである、2013年3月15日に出願された米国仮出願第61/791248号と、2013年11月20日に出願された米国仮出願第61/906802号と、2013年11月26日に出願された米国仮出願第61/908888号と、2013年12月12日に出願された米国仮出願第61/915403号と、2014年2月5日に出願された米国仮出願第61/935966号との米国特許法第119条(e)項の下での優先権の利益を主張する。
本明細書で説明する超精巧外科システムは、特に、外科医が患者のベッドサイドにいながら用手ツールと超精巧外科ツールを同時に使用することを可能にするという点で、既存の市場にあるロボット外科システムとは基本的に異なる概念フレームワークを提供する。患者のベッドサイドに、すなわち、手術テーブルのそばにいるこの能力は、外科チームとの連絡の改善から;患者の直接モニタリングまで;(例えば、用手ツールと超精巧外科ツールとの間の)ツール交換を可能にすることまで:いくつかの利点を提供する。その上、以下で説明する超精巧外科システムは、外科医が、外科医によって所望されるかまたは外科的タスクによって必要とされるように、超精巧外科ツールのみを使用することと、用手ツールと超精巧外科ツールの組合せを同時に使用することと、用手ツールのみを使用することとの間で、相互作用連続体に沿って外科的手技をシームレスに実施することを有利に可能にする、フレキシブルで、より自然で、より相互作用的なシステムを一緒に提供するいくつかのサブシステムを含む。
超精巧外科システム100は、より自然で、より相互作用的で、より多用性のある外科システムを提供することによって、患者と相互作用する外科医の能力を向上させることなど、本明細書で説明する利益を達成するために協働し得る多くの構成要素を含むことができる。超精巧外科システム100は、1つまたは複数の超精巧外科アーム200を含むことができ、各超精巧外科アーム200は超精巧外科ツール300を操作することができる。超精巧外科システム100は、1つまたは複数の超精巧外科ツール300と用手ツール350との操作を制御する際に外科医を助ける視覚的手がかりを操作者に提供する制御システムおよびディスプレイ600、702を含む。外科医などの操作者は、場合によっては、操作領域中の様々なロケーションにおいて超精巧外科ツール300と用手ツール350を同時に操作することができる。
超精巧外科システム100は、超精巧外科アーム200を支持するための取付けを提供することができる。取付けは、患者に対する超精巧外科アーム200および/または超精巧外科ツール300の配置を可能にする。超精巧外科アーム200は、可動または固定であり得るいくつかのフィクスチャに取り付けられ得る。超精巧外科アーム200および/または超精巧外科ツール300を取り付けることにおけるフレキシビリティは、患者の外部の操作領域および自由空間を設計することにおける多用性を提供する。
超精巧外科システム100とともに使用される超精巧外科アーム200は、冗長自由度を有することができる。冗長自由度は、有利には、超精巧外科アーム200が様々な所望のポーズで置かれることを可能にすることができる。さらに、冗長自由度は、有利には、患者の周りのより多くの自由空間を可能にすることができる。冗長自由度は、より多くの超精巧外科アーム200(例えば、複数の超精巧外科アーム200)の使用を可能にすることができる。冗長自由度は、患者2の上方の自由空間内のより多くの超精巧外科アーム200の配置を可能にすることができる。冗長自由度はまた、患者内のより大きい作業空間を可能にすることができる。冗長自由度は、(単一の超精巧外科アーム200の構成要素間の)自己衝突と、他の衝突(超精巧外科アーム200と患者2との間、超精巧外科アーム200間の)とを低減することができる。
超精巧外科アーム200の設計は超精巧外科システム100に有意な属性を提供する。超精巧外科アーム200に対する回転中心250のロケーションは、デッドゾーンが患者から離れて置かれることを可能にする。超精巧外科アーム200の小さいサイズは、患者の周りの自由空間を最大にすることを可能にし、それにより、用手ツールおよび/または超精巧外科ツールの同時使用が可能になる。ショルダーロール機構202によって提供される冗長自由度は、バックラッシュの影響を低下させること、超精巧外科アーム200の実際のバンド幅を改善することなどの領域において、本システムの性能を高めることができる。
超精巧外科アームは多くの構成を有することができる。図14〜図16に、超精巧外科アームの代替構成を示す。超精巧外科アームは、本明細書で説明するように、遠隔中心250を維持することができる。超精巧外科アームは、本明細書で説明する超精巧外科システムに組み込まれ得る。超精巧外科アームは入力デバイス500によって制御され得、それにより、操作者は移動可能になることが可能になる。
超精巧外科ツール300および回転/並進機構208は超精巧外科システム100に4つの自由度を提供する。回転/並進機構208は、超精巧外科ツール300を回転させることも並進させることもできる。回転/並進機構208のより小さいサイズは、有利には、前に説明したように、超精巧外科アーム200のサイズがより小さくなることを可能にする。回転/並進機構208の小さいサイズは、超精巧外科アーム200がより小さく軽量になることを可能し、それは特に、患者2の周りのより多くの自由空間を可能にする。
MA+=T++R+ 式1
MB+=T++R− 式2
MA++MB+=2T+ 式3
1/2MA−+1/2MB+=R− 式4
入力デバイス500は、超精巧外科アーム200および/または超精巧外科ツール300を制御する。入力デバイス500はワイヤレスおよび/またはポータブルであり得、それにより、操作者が患者2の周りを移動することが可能になる。入力デバイス500は、操作者が操作領域内の様々なロケーション(例えば、患者のベッドサイドにおける様々なロケーション)にいることを可能にする。入力デバイス500は、操作者が超精巧外科ツール300と用手ツール350を同時に制御することを可能にする。超精巧外科ツール300と用手ツール350の同時の操作は、有利には、操作者が超精巧外科ツール300を制御しながら外科アシスタントが用手ツール350を操作する必要を低減する。本発明の入力デバイス500は、ピンチャー502(図32A参照)およびコントローラ514(図2参照)を含むいくつかの形態を取ることができる。
超精巧外科システム100は、(例えば、入力デバイス500、ディスプレイ600を介した)ユーザ入力を出力(例えば、制御ポイントの動き、画像)に変換する制御システム400を含むことができる。制御システム400は、いくつかのユーザ入力をいくつかの制御可能対象にペアリングすることができる。様々な超精巧外科ツール300の移動を実行しているとき、制御システム400は1つまたは複数の制約を維持し得る。制御システム400は、1つまたは複数の超精巧外科ツール300を単一のツール(例えば、超精巧外科ツール300または用手ツール350)にロックすることができる。有利には、制御システム400により、超精巧外科システム100は、外科的手技を実施するために操作者(例えば、外科医)に提供されるフレキシビリティを可能にすることが可能になる。例えば、以下でより詳細に説明するように、制御システム400により、外科医は、様々な基準系(例えば、没入型カメラ搭載の基準系、ワールドグラウンド基準系)と、様々な基準系の間を移動する能力とを使用して超精巧外科ツール300を制御することが可能になり、この能力は、有利には外科医が、外科的タスクを実施するためにカメラ搭載の基準系を用いて超精巧外科ツール300を操作することと、外科医自身に対する超精巧外科ツール300の位置の認識を保ちながら、外科医が別の位置に外科医自身を再配置することを可能にするワールドグラウンド基準系にと、次いで、外科的タスクを続けて異なる外科的タスクを開始するためにカメラ搭載の基準系に戻ることとの間でシームレスに移動することを可能にする。さらに、制御システム400により、有利には、外科医は、超精巧外科ツール300の制御を(例えば、右と左との間で)切り替えることと、最適な位置への外科医の再配置を可能にすることと、それに応じてカメラビューを回転することとが可能になる。さらに、制御システム400により、有利には、1つまたは複数の超精巧外科ツール300は、それが別のツール(例えば、別の超精巧外科ツール300、または用手ツール350)と同期して移動するように制御されることが可能になり得、それにより、外科医は、ツールを仮想的につなぎ留め、ツールを別の手術部位に移動するときなどにそれらを同時に移動することが可能になり得る。
制御システム400は、有利には、操作者1が超精巧外科ツール300および/または用手ツール350を自然に制御することを可能にする。自然で有効な制御を可能にする、以下の少なくとも2つの相互接続された部片がある:視覚的手がかり、および人体にとって自然であり人間の脳によって容易に処理される基準系において移動すること。脳は、人の手首に関連付けられた基準系を容易に理解することができる。制御システム400は、有利には、超精巧外科ツール300および/または用手ツール350に関係する視覚的手がかりを操作者1に提供し、その視覚的手がかりにより、操作者は、超精巧外科ツール300および/または用手ツール350の移動に関連付けられた基準系をより良く理解することが可能になる。
上記で説明したように、基準系が手首に結合されている場合、人間の脳は移動を容易に理解することができる。図41A〜図41Dを参照すると、脳は、対象に達するために、手首が対象のほうへ移動されるべきであることを理解する。脳は、手首の配向に基づいて、手首をどの方向へ移動すべきかを理解する。
人間の脳は、適切な情報を用いて、用手ツール350と超精巧外科ツール300とをどのように移動すべきかを決定することが可能である。この情報は、ユーザが超精巧外科ツール300の移動を自然に理解することを可能にするはずである。制御システム400は、例えば、超精巧外科ツール300の自然な制御を可能にするために、操作者に提示される画像を配向することによって、または前記画像において提供される情報を変化させること(例えば、操作者1がツールの配向を理解するのを助けるために患者2の体の少なくとも一部を示すこと)によって、有利にはそのような視覚的手がかりを操作者1(例えば、外科医)に提供する。このようにして、制御システム400は、操作者1のどんなロケーションからでも超精巧外科ツール300の自然な制御を可能にすることができる。
情報の1つのソースは、操作領域またはディスプレイ600、702のいずれかを観測することを通して操作者1によって見られる視覚的手がかりである。追加の情報が、超精巧外科ツール300と用手ツール350との動きについての操作者の理解を増補することができる。視覚的手がかりは制御システムによって供給され、ディスプレイ600、702上に示され得る。
いくつかの実施形態では、同じ作業空間において1つまたは複数の超精巧外科ツール300とともに1つまたは複数の用手ツール350が使用される。用手ツール350の一例はステープラ354である、図39参照。ステープラ354は超精巧外科ツール300とともに使用され得る。結腸切除外科的手技において両方のタイプのツールを使用しているときのワークフローが、方法5を示す図39に示されている。図39は、超精巧外科ツール300と用手ツール350とを使用する1つの方法を示している。本方法は、特定の位置に結腸を保持し、結腸にわたってステープルラインを置くことに関する。本システムは、第1のグラスパ312と、第2のグラスパ314と、カメラ304と、ステープラ354とを含む。本システムは、2つの入力デバイス500と、第1のコントローラ516と、第2のコントローラ518とを含む。
Claims (30)
- フィクスチャに結合可能な1つまたは複数の電気機械アームと;
1つまたは複数の電気機械アームおよびツールアセンブリを画成するために前記1つまたは複数の電気機械アームによって支持される1つまたは複数の電気機械ツールと;
前記1つまたは複数の電気機械アームおよびツールアセンブリと電子的に通信するように構成された電子制御システムであって、前記電子制御システムが、前記1つまたは複数の電気機械アームおよびツールアセンブリの操作を制御するように構成される、電子制御システムと;
前記1つまたは複数の電気機械アームおよびツールアセンブリを操作するために前記電子制御システムを介して前記1つまたは複数の電気機械アームおよびツールアセンブリに1つまたは複数の制御信号を通信するように作動可能な1つまたは複数のポータブルハンドヘルドコントローラと
を備える、外科システムであって、
前記1つまたは複数のポータブルハンドヘルドコントローラは、操作領域の複数のロケーションから、外科医が外科的手技中に移動可能になることと前記操作領域の様々なロケーションから前記1つまたは複数の電気機械アームおよびツールアセンブリを操作することとを可能にする前記1つまたは複数の制御信号を提供するように構成された、
外科システム。 - 前記複数のロケーションのうちの1つが患者の手術テーブルのそばにある、請求項1に記載の外科システム。
- 前記複数のロケーションのうちの1つが遠隔制御スタンドである、請求項1に記載の外科システム。
- 前記1つまたは複数のポータブルハンドヘルドコントローラが前記手術テーブルのそばから操作可能であり、それにより、前記外科医が一方の手で用手ツールを、ならびに別の手で前記1つまたは複数のポータブルハンドヘルドコントローラを介して電気機械アームおよびツールアセンブリを同時に操作することが可能になる、請求項2に記載の外科システム。
- 前記電気機械アームおよびツールアセンブリと前記用手ツールとが、互いに独立してまたは互いに同期して操作される、請求項4に記載の外科システム。
- 前記電気機械アームおよびツールアセンブリと前記用手ツールとが、整合されたか部分的に整合されたかまたは互いに独立した基準系において操作される、請求項4に記載の外科システム。
- 前記1つまたは複数の電気機械アームおよびツールアセンブリが、同じ外科的作業空間において同時に操作可能である、請求項1に記載の外科システム。
- 前記1つまたは複数のポータブルハンドヘルドコントローラのうちの少なくとも1つがワイヤレスであり、前記1つまたは複数の制御信号をワイヤレスに通信する、請求項1に記載の外科システム。
- 前記フィクスチャが手術テーブルに結合された、請求項1に記載の外科システム。
- 前記1つまたは複数の電気機械アームがそれぞれ3つの自由度を備える、請求項1に記載の外科システム。
- 前記1つまたは複数のポータブルハンドヘルドコントローラの前記操作領域内の位置がトラッキングされる、請求項1に記載の外科システム。
- 1つまたは複数のカメラを備える1つまたは複数のソースから入力信号を受信するように構成された可視化システムをさらに備え、前記可視化システムが、前記外科医の視線内の1つまたは複数のモニタ上に外科的作業空間の画像を表示するように構成された、請求項1に記載の外科システム。
- 前記1つまたは複数のポータブルハンドヘルドコントローラが、前記1つまたは複数の電気機械アームおよびツールアセンブリを選択的に操作するように構成された、請求項1に記載の外科システム。
- 前記1つまたは複数のポータブルハンドヘルドコントローラを前記1つまたは複数の電気機械アームおよびツールアセンブリと選択的に係合および離脱し、それにより、前記1つまたは複数の電気機械アームおよびツールアセンブリを選択的に操作するように作動可能なクラッチをさらに備える、請求項13に記載の外科システム。
- 前記1つまたは複数のポータブルハンドヘルドコントローラのうちの1つを、異なる電気機械アームおよびツールアセンブリを操作することの間で選択的に切り替えるように操作可能なユーザインターフェースをさらに備える、請求項1に記載の外科システム。
- 前記ユーザインターフェースがディスプレイである、請求項15に記載の外科システム。
- フィクスチャに結合可能な1つまたは複数の電気機械アームと;
1つまたは複数の電気機械アームおよびツールアセンブリを画成するために前記1つまたは複数の電気機械アームによって支持される1つまたは複数の電気機械ツールと;
前記1つまたは複数の電気機械アームおよびツールアセンブリと電子的に通信するように構成された電子制御システムであって、前記電子制御システムが、前記1つまたは複数の電気機械アームおよびツールアセンブリの操作を制御するように構成される、電子制御システムと;
前記電子制御システムと通信するように構成された可視化システムであって、前記可視化システムが、1つまたは複数のカメラを備える1つまたは複数のソースから入力信号を受信し、外科医の視線内の1つまたは複数のモニタ上に外科的作業空間の1つまたは複数の画像を表示するように構成される、可視化システムと
を備える、外科システムであって、
前記電子制御システムは、複数の基準系において前記1つまたは複数の電気機械アームおよびツールアセンブリを電子的に制御し、前記1つまたは複数の電気機械アームおよびツールアセンブリと1つまたは複数のカメラとのために異なる基準系の間で動的に切り替わり、それにより、前記外科医が外科的手技中に患者に対して異なる配向に移動することを可能にし、前記異なる配向から前記1つまたは複数の電気機械アームおよびツールアセンブリを制御するように構成された、
外科システム。 - 前記制御システムが、前記外科的作業空間中でカメラの基準系において前記1つまたは複数の電気機械アームおよびツールアセンブリを制御し、それにより、前記外科医に前記外科的作業空間の没入型ビューを提供するように構成された、請求項17に記載の外科システム。
- 前記制御システムが、患者の体の外部の基準系において前記1つまたは複数の電気機械アームおよびツールアセンブリを制御するように構成された、請求項17に記載の外科システム。
- 前記制御システムが、前記カメラの前記基準系と患者の体の外部の基準系との間で動的に切り替わりながら、前記1つまたは複数の電気機械アームおよびツールアセンブリを制御するように構成された、請求項18に記載の外科システム。
- 前記制御システムは、前記1つまたは複数の電気機械アームおよびツールアセンブリ間で前記外科医によって保持される1つまたは複数のポータブルハンドヘルドコントローラのマッピングを切り替え、それにより、前記外科医が自分自身を前記患者に対して異なる視点に再配置することが可能になるように構成された、請求項17に記載の外科システム。
- 前記可視化システムが、前記外科医に従う基準系において前記外科的作業空間の1つまたは複数の画像を表示する、請求項17に記載の外科システム。
- フィクスチャに結合可能な1つまたは複数の電気機械アームであって、前記1つまたは複数の電気機械アームの各々が、前記電気機械アームのベースに近接した冗長ロール機構を備える3つの自由度を有する、電気機械アームと;
1つまたは複数の電気機械アームおよびツールアセンブリを画成するために前記1つまたは複数の電気機械アームによって支持される1つまたは複数の電気機械ツールと;
前記1つまたは複数の電気機械アームおよびツールアセンブリと電子的に通信するように構成された電子制御システムであって、前記電子制御システムが、前記1つまたは複数の電気機械アームおよびツールアセンブリの操作を制御するように構成される、電子制御システムと
を備える、外科システムであって、
前記1つまたは複数の電気機械アームおよびツールアセンブリが前記フィクスチャに結合されるとき、前記冗長ロール機構が、患者上の切開ポイントに近接して画成される遠隔中心の下方に垂直方向に配置され、それにより、前記患者の体の外部に前記1つまたは複数の電気機械アームおよびツールアセンブリのデッドゾーンを画成し、このようにして、前記1つまたは複数の電気機械アームおよびツールアセンブリが前記患者の体の内部の外科的作業空間のすべての4つの象限にアクセスすることを可能にし、前記1つまたは複数の電気機械アームおよびツールアセンブリの前記外科的作業空間を最大にする、
外科システム。 - 操作領域の様々なロケーションから前記1つまたは複数の電気機械アームおよびツールアセンブリを操作するために前記電子制御システムを介して前記1つまたは複数の電気機械アームおよびツールアセンブリに1つまたは複数の制御信号を通信するように前記操作領域の複数のロケーションから外科医によって作動可能な1つまたは複数のポータブルハンドヘルドコントローラをさらに備える、請求項23に記載の外科システム。
- 前記複数のロケーションのうちの1つが患者の手術テーブルのそばにある、請求項24に記載の外科システム。
- 前記1つまたは複数のポータブルハンドヘルドコントローラが前記手術テーブルのそばから操作可能であり、それにより、前記外科医が一方の手で用手ツールを、ならびに別の手で前記1つまたは複数のポータブルハンドヘルドコントローラを介して電気機械アームおよびツールアセンブリを同時に操作することが可能になる、請求項25に記載の外科システム。
- 前記1つまたは複数の電気機械アームの各々が、前記3つの自由度に関連する3つの軸を有し、前記3つの軸が前記遠隔中心において交差する、請求項23に記載の外科システム。
- フィクスチャに選択的に結合可能な1つまたは複数の電気機械アームと;
1つまたは複数の電気機械アームおよびツールアセンブリを画成するために前記1つまたは複数の電気機械アームによって支持される1つまたは複数の電気機械ツールと;
前記1つまたは複数の電気機械アームおよびツールアセンブリと電子的に通信するように構成された電子制御システムであって、前記電子制御システムが、前記1つまたは複数の電気機械アームおよびツールアセンブリの操作を制御するように構成される、電子制御システムと
を備える、外科システムであって、
前記1つまたは複数の電気機械アームおよびツールアセンブリは、モジュラー様式で前記フィクスチャに結合し、それにより、外科的手技中に前記1つまたは複数の電気機械アームおよびツールアセンブリの複数の組合せが前記外科的手技によって必要とされるように使用されることが可能になり、それにより、外科的手技中に患者の外部の作業空間の増大を可能にするように構成された、
外科システム。 - 前記1つまたは複数の電気機械アームの各々が、前記電気機械アームのベースに近接した冗長ロール機構を備える3つの自由度を有し、このようにして、前記外科的手技中に前記1つまたは複数の電気機械アームおよびツールアセンブリが患者から離れて移動されることが可能になり、それにより、前記患者の外部の前記作業空間が増大される、請求項28に記載の外科システム。
- 前記1つまたは複数の電気機械アームおよびツールアセンブリの各々が、前記1つまたは複数の電気機械アームの2つの異なるポーズを介して前記1つまたは複数の電気機械ツールのための所望の位置を達成し、それにより、前記患者上のロケーションへのより大きいアクセスを提供するように構成された、請求項28に記載の外科システム。
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