JP5340553B2 - Surgical fasteners and cutters with imitation end effectors - Google Patents

Abstract

Methods and devices are provided for controlling movement of a working end of a surgical device. In one embodiment, methods and devices are provided for moving an end effector on a distal end of a surgical fastening device. Movement can include rotational movement of the end effector about an axis of the shaft, articulation of the end effector relative to the shaft, and actuation of an end effector, e.g., closing, firing, and/or cutting. In other embodiments, a single cable actuator is provided and is movable between a first position, in which it is effective to rotate an end effector without actuating (i.e., closing and firing) the end effector, and a second position, in which it is effective to actuate the end effector without rotating the end effector. In other aspects, methods and devices are provided for moving a flexible neck formed on a distal end of an accessory channel for use with an endoscope. Movement of the flexible neck can be used to control positioning of a tool extending through the flexible neck.

Description

Disclosure details

(Field of the Invention)
The present invention relates generally to a method and apparatus for controlling the movement of the working end of a surgical device.

BACKGROUND OF THE INVENTION
Endoscopic surgical instruments are often preferred over conventional open surgical devices because they use natural openings and have a short post-operative recovery time and reduce complications. Accordingly, the field of endoscopic surgical instruments suitable for accurately placing the working end of the tool through the natural opening and at the desired surgical site has developed considerably. These devices can be used to engage and / or treat tissue in a variety of ways to achieve diagnostic and therapeutic effects.

  Endoscopic surgery involves the fact that the device shaft is flexible and at the same time, the working end is articulated to direct the working end at an angle with respect to the tissue, and in some cases the working end. Need to be able to actuate and fire the working end or otherwise move the working end. The control for articulating the working end of the endoscopic device and the integration of the controls for actuating tend to be complicated by the use of a flexible shaft and the size constraints of the endoscopic instrument. In general, all control movements are transmitted through the shaft by longitudinal translation, which can compromise the flexibility of the shaft. There is also a desire to reduce the force required to articulate and / or actuate the working end to a level that can be handled by all or most surgeons. One known solution for reducing the force on firing is to use an electric motor. However, surgeons typically prefer to feel feedback from the working end and be confident of the correct operation of the end effector. The user feedback effect cannot be properly realized with a conventional motor drive device.

  Accordingly, there remains a need for improved methods and devices for controlling the movement of the working end of an endoscopic surgical device.

[Summary of the Invention]
In certain embodiments, a surgical device is provided having an elongate shaft with a proximal end and a distal end, the proximal end having a handle movably coupled to the proximal end. The distal end has a flexible neck extending from the distal end. The handle and the flexible neck can also be operatively associated such that movement of the handle is effective for articulating the flexible neck in multiple planes. In certain exemplary embodiments, the movement of the handle can also be mimicked by a flexible neck. The device can also include an actuator that extends between the handle and the flexible neck and is configured to transmit movement from the handle to the flexible neck.

  The handle of the device can have a variety of configurations, but in certain embodiments, the handle can be configured to articulate relative to the proximal end of the elongate shaft. For example, the handle can be coupled to the proximal end of the elongate shaft by a joint such as a ball and socket joint, a hinge joint, or a flexing joint. The actuator of the device can have a variety of configurations, but in certain embodiments, the actuator can be at least one cable extending along the length of the elongate shaft. For example, the device may include a plurality of cables that extend along the length of the shaft and that are equally spaced around the actuator. The cable is configured to slide relative to the axis of the elongated shaft and to bend and bend at least a portion of the elongated shaft by tensioning the elongated shaft. The handle and / or cable can optionally include a locking mechanism associated therewith, and the locking mechanism is configured to maintain the handle and / or cable in a fixed position. In an exemplary embodiment, the elongate shaft is configured to bend and bend passively when the elongate shaft is inserted through the tortuous lumen.

  The elongate shaft can also have a variety of configurations, and in certain embodiments, the device can be in the form of a surgical stapler, the elongate shaft being coupled to the distal end of the flexible neck. An end effector configured to engage tissue and carry at least one fastener to the engaged tissue. The handle and end effector can also be coupled such that the movement of the handle is mimicked by the end effector. For example, the handle can be coupled to the proximal end of the elongate shaft by a joint such as a ball and socket joint, a hinge joint, or a flexing joint, and the flexible neck is formed on the end effector. Or coupled to the end effector, which allows the end effector to imitate the movement of the handle proportionally. The apparatus can also include an actuator that extends between the handle and the end effector and is configured to transfer movement from the handle to the flexible neck. The actuator can be, for example, a plurality of cables extending along the length of the elongated shaft. The cables can also be equally spaced from one another around the elongate shaft.

  In another embodiment, the device can be in the form of an attached channel and the elongate shaft can be in the form of a tube having a lumen through which the device receives the device. It is configured as follows. A flexible neck extending from the distal end of the elongate tube can also be configured to bend to direct a tool extending through the elongate tube. Although the flexible neck can have a variety of configurations, in certain embodiments, the flexible neck includes a plurality of slits formed in the flexible neck to facilitate bending of the flexible neck. To do. The slit can also be configured to bend the flexible neck in a desired orientation. For example, the flexible neck can include a distal region of the slit and a proximal region of the slit, and the slit can cause the flexible neck to move away from the proximal region and the distal region due to tension applied to the flexible neck. It can also be configured to bend in the region. The handle can also be coupled to the proximal end of the elongated tube, and the handle can be operably associated with the flexible neck such that movement of the handle is mimicked by the flexible neck. it can. The handle can also have a variety of configurations, and in certain embodiments, the handle includes a stationary member and a movable member configured to articulate relative to the stationary member. You can also. The movable member can also be coupled to the stationary member by a joint such as a ball and socket joint, a hinge joint, or a bending joint. In use, the accessory channel can also be configured to releasably attach to the endoscope. For example, the mating element is formed on the outer surface of the accessory channel so as to engage a complementary mating element formed on a sleeve configured to receive an endoscope, along the length of the outer surface. Can extend. The device can also include an actuator extending between the handle and the flexible neck. The actuator can also be configured to transfer movement from the handle to the flexible neck. In certain exemplary embodiments, the actuator is in the form of at least one cable extending along the length of the elongated tube. Where the actuator includes a plurality of cables, the cables are preferably spaced equidistant from one another around the elongated tube. The cable can extend along an elongated tube using a variety of techniques. For example, the elongate tube can include at least one lumen formed in a side wall of the elongate tube and extending along the length of the elongate tube, and the cable is slidably disposed within the lumen. You can also. The apparatus also includes a locking mechanism positioned to engage at least one of the handle and the cable to lock the handle and cable in a fixed position.

  The present invention also provides an endoscopic system having an elongate sleeve configured to be disposed about an endoscope and an attached channel that can be removably engaged with the elongate sleeve. An accessory channel is formed in and attached to a lumen extending through the accessory channel between the proximal and distal ends of the accessory channel, a distal portion of the accessory channel, for receiving the tool. A flexible portion made flexible by a plurality of slits formed in the channel, and at least one handle coupled to the proximal end of the attached channel, wherein the handle includes at least one flexible portion. There can be at least one handle operably associated with the flexible portion so as to be articulated in one plane. The handle can also be operably associated with the flexible portion by at least one cable, and the handle can be configured to move the cable axially relative to the attached channel, the flexible portion being The cable can be tensioned to the flexible portion of the attached channel so as to articulate in at least one plane. In certain embodiments, the device can also include a single handle configured to articulate the flexible portion in multiple planes. The single handle can also include a stationary portion coupled to the proximal end of the accessory channel and a movable member configured to articulate relative to the stationary member. The single handle and the flexible portion can also be operatively associated such that the movement of the single handle is mimicked by the flexible portion. In another embodiment, the handle is configured to articulate the flexible portion in the first surface and the first member configured to articulate the flexible portion in the first surface. A second member can also be included. In particular, the handle can include a stationary member coupled to the proximal end of the accessory channel, and the first member and the second member can be rotatably coupled to the stationary member. The apparatus is coupled to the first member and is coupled to the first spool and the second member having at least one cable extending from the first member and coupled to the flexible portion, and the second member. A second spool may also be included that extends from the member and has at least one cable coupled to the flexible portion. The first member and the second member are effective for rotating the first and second spools, thereby allowing the cable to move axially and articulate the flexible portion.

  The surgical devices disclosed herein can also include a variety of other features. For example, the device can include an optical image acquisition unit disposed at the distal end of the elongate shaft. The optical image acquisition unit can also be configured to acquire images during an endoscopic procedure. The image display screen can also be configured to communicate with the optical image acquisition unit for displaying the acquired image, located at the proximal portion of the device. In other embodiments, the end effector of the device is removably disposed within the end effector and houses a plurality of staples for stapling tissue and a blade for cutting the stapled tissue. Can include a cartridge.

  In another aspect, a surgical method is provided. The surgical method includes inserting an elongate shaft into a body cavity to position a flexible neck coupled to a distal end of the elongate shaft in the vicinity of the tissue to be treated; and Moving a handle pivotally coupled to the proximal end of the elongate shaft to mimic motion. The flexible neck can move plane-symmetrically with the movement of the handle, or the movement of the flexible neck can exactly correspond to the movement of the handle. In certain exemplary embodiments, the movement is proportional.

  In an exemplary embodiment, an end effector coupled to the distal end of the elongate shaft is positioned near the tissue to be secured and a handle pivotally coupled to the proximal end of the elongate shaft. It is moved to cause the end effector to imitate the movement of the handle proportionally. The end effector can move in plane symmetry with the movement of the handle, or the movement of the end effector can just correspond to the movement of the handle. In an exemplary embodiment, the handle is articulated pivotably about the proximal end of the elongate shaft, causing the end effector to imitate the movement of the handle. The method can further include engaging tissue between opposing jaws of the end effector and driving at least one fastener from the end effector to the tissue. The tissue can also be engaged by moving a translational movement member formed on the handle from a first position to a second position to close the opposing jaws, and the fastener is formed on the handle. Can be fired by rotating the rotatable member and actuating a drive mechanism disposed within the end effector to cause the drive mechanism to drive a plurality of fasteners into the tissue. In another embodiment, before moving the translation member from the first position to the second position, the rotatable member is rotated to rotate the end effector relative to the flexible neck without activating the drive mechanism. It can also be made.

  In yet another aspect, the elongate shaft is in the form of an attached channel slidably engaged with an endoscope disposed within the body cavity, and is distal to the attached channel proximate to the distal end of the endoscope. The end can be positioned. The tool is inserted through a lumen in the accessory channel and moves a handle coupled to the proximal end of the accessory channel such that the tool extends distally beyond the distal end of the accessory channel. Thus, the flexible neck on the distal end of the accessory channel can be articulated, thereby directing the working end of the device to the desired location. The handle can be moved by pivotally articulating the handle relative to the accessory channel, or alternatively by rotating at least one rotatable member on the handle.

  The invention will be more fully understood from the following detailed description taken in conjunction with the accompanying drawings, in which:

Detailed Description of the Invention
Certain exemplary embodiments will now be described to provide a general understanding of the structure, functionality, manufacture, and use of the devices disclosed herein, and the principles of the method. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will appreciate that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments, and the scope of the present invention is defined only by the claims. Will understand. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of another embodiment. Such modifications and variations are intended to be included within the scope of the present invention.

  The present invention provides a method and apparatus for controlling the working end of an endoscopic surgical device. In general, an endoscopic surgical device includes an elongated shaft having a distal working end with a flexible neck and a handle for controlling movement of the flexible neck on the distal working end. A proximal end. In certain exemplary embodiments, this may involve, for example, the handle and the movement of the handle so as to exert a force on one or more cables causing the flexible portion to bend and thereby move the working end of the device. It can also be achieved by using one or more cables extending between the flexible necks. Various other features are also provided to facilitate use of the device. Those skilled in the art can vary the particular device being controlled and the particular configuration of the working end, and the various control techniques described herein are desirable to control the movement of the working end. It will be understood that it can be used with virtually any surgical device.

  FIGS. 1A and 1B illustrate an exemplary embodiment of a technique for controlling articulation of an end effector, particularly a technique for causing the end effector to mimic the movement of the handle while simultaneously moving the end effector with the handle. Is illustrated. In this embodiment, the device is in the form of a linear stapling / cutting device 10 for stapling tissue into a plurality of linear rows and for cutting stapled tissue. As shown, the device 10 generally includes an elongate shaft 12 having a proximal end 12a and a distal working end 12a, as described in further detail below, the proximal end 12a comprising: An end effector comprising a handle 14 coupled to the proximal end 12a, the distal working end 12a coupled to or formed on the distal working end 12a. 16. In use, the end effector 16 is configured to mimic the movement of the handle 14. The mimicking action between the handle 14 and the end effector 16 is generally an actuator (non-actuated) that extends between the handle 14 and the end effector 16 and is effective in transferring force from the handle 14 to the end effector 16. It can also be achieved by using (shown). In the exemplary embodiment, the actuator is in the form of several cables spaced around the elongate shaft 12 and extending along the length of the elongate shaft 12. Movement of the handle 14 about the proximal end 12a of the shaft 12 applies a force to one or more cables, causing the cable to exert a force against the end effector 16, thereby causing the end effector 16 to handle the handle. 14 actions are imitated. The mimic action can include a corresponding action in which the end effector 16 moves in the same direction and orientation as the handle 14, or a plane-symmetric action in which the end effector 16 moves in the opposite direction and orientation with respect to the handle 14. The imitation operation can also be proportional to the movement of the handle.

  The elongate shaft 12 of the device 10 can have a variety of configurations. For example, the elongate shaft 12 can be solid or hollow and can be formed from a single component or from multiple segments. As shown in FIG. 2, the elongate shaft 12 is hollow and formed from a plurality of connecting segments so that the elongate shaft 12 can be bent. Due to the flexibility of shaft 12, as well as its relatively small diameter, shaft 12 can be used for endoscopic procedures, whereby the device is introduced translumenally through a natural opening. The length of the shaft can also vary depending on the intended use.

  FIG. 2 illustrates an exemplary embodiment of an actuator 22 in the form of several cables 34 a, 34 b, 34 c, 34 d that are spaced around the elongate shaft 12 and extend along the length of the elongate shaft 12. Is further illustrated. The number and location of cables can also vary. For example, the three cables can be spaced approximately 120 degrees from each other around the shaft 12. In the embodiment shown in FIG. 2, the four cables 34 a, 34 b, 34 c, 34 d are spaced approximately 90 degrees from each other around the shaft 12. Each of the cables 34a-34d may also extend through a passage, such as a lumen, formed on, in, or around the elongate shaft 12. FIG. 2 illustrates each cable 34a-34d extending through a cutout formed on the outer surface of each segment of the shaft 12. As shown in FIG. Thus, each segment includes four cutouts spaced equidistantly around the shaft 12 to keep the cables 34a-34d equidistant from one another. The cutout preferably has a size that is effective because the cables 34a to 34d can slide freely with respect to the shaft 12 while holding the cables 34a to 34d inside.

  The distal ends of the cables 34 a-34 d can be engaged with the end effector 16 to control the movement of the end effector 16. The end effector 16 can have a variety of configurations, and a variety of end effectors known in the art can be used, but FIG. 3A illustrates an opposing first jaw configured to receive tissue therebetween. One exemplary embodiment of the end effector 16 is shown, generally including a portion 18 and a second jaw 20. The first jaw 18 is configured to receive a staple cartridge having a plurality of staples disposed therein and configured to be driven into tissue, the second jaw 20 being An anvil is formed to deform the staple. The specific configuration and basic operation of the end effector 16 can vary, and various end effectors 16 known in the art can be used. As a non-limiting illustration, U.S. Patent No. 6,978,921, incorporated herein in its entirety, entitled "Surgical Stapling Instrument Incorporating an E-Beam Firing Mechanism" ) Discloses certain embodiments of end effectors that can be used with the present invention.

  The end effector 16 can also be movably coupled to the distal end 12 b of the elongate shaft 12 to allow movement of the end effector 16 relative to the elongate shaft 12. For example, the end effector 16 can be pivotally coupled to the distal end 12b of the elongate shaft 12 by a pivot joint or a rotary joint. Alternatively, the end effector 16 may include a flexible neck 26 formed on the end effector 16 as shown to allow movement of the end effector 16 relative to the elongate shaft 12. The flexible neck 26 can also be formed integrally with the distal end 12b of the elongate shaft 12 and / or the proximal ends of the jaws 18, 20, or the flexible neck 26 can be a shaft. It can also be a separate member extending between 12 and jaws 18,20. As shown in FIG. 3A, the flexible neck 26 includes a first coupler 28 for engaging the flexible neck 26 with the proximal ends of the opposing jaws 18, 20, and the flexible neck 26. A second coupler 30 for engaging the distal end of the elongate shaft 12. Couplers 28, 30 can also be removably or fixedly engaged with flexible neck 26 and / or jaws 18, 20 and shaft 12. Couplers 28 and 30 also function to house certain components of end effector 16. For example, the first coupler 28 can function to secure a cable therein and actuate (eg, close and fire) the jaws 18, 20 as described below. It can also function to accommodate other gear driver assemblies.

  In order to facilitate bending of the flexible neck 26, the neck 26 may also include one or more slits 32 formed in the neck. The desired flexibility can be obtained by changing the number, position, and size of the slits 32. In the embodiment shown in FIG. 3A, the flexible neck 26 includes a plurality of rows of slits 32, each row extending radially around the flexible neck 26, each row being a flexible neck. 26 are spaced axially along the length of 26. Each row of slits accommodates two slits extending around the circumference of the neck 26, and each row of slits 32 is offset from one another in the axial direction. As a result, the flexible neck 26 includes alternating slits 32. One skilled in the art can vary the specific pattern of the slits 32, and FIG. 3A merely illustrates one pattern for forming the slits 32 to allow the flexible neck 26 to bend. You will understand that it is only. Other exemplary slit configurations are described in further detail below.

  As described above, the cables 34 a to 34 d are coupled to the end effector 16 so that the end effector 16 can move in cooperation with the handle 14. The connection position of the cables 34a to 34d and the end effector 16 can be changed according to a desired movement. In the illustrated embodiment, the distal ends of the cables 34a-34d are connected to the distal end of the flexible neck 26, and in particular, the cables 34a-34d extend into the first coupler 28, and the first coupler 28. FIG. 3B illustrates a cross-sectional view of the first coupler 28 showing four holes 28a, 28b, 28c, 28d for receiving four cables 34a, 34b, 34c, 34d, respectively. Cables 34a-34d can be coupled to coupler 28 using virtually any technique known in the art, such as adhesives, interference fits, ball socket couplings, and the like. Mechanical engagement techniques such as, screw threads, etc. In use, when an axial force is applied to the cables 34a-34d by the handle 14, the connection of the cables 34a-34d at the distal end of the flexible neck 26 causes the cables 34a-34d to flex the tension. It can be hung on the neck 26. This tension causes the neck 26 to bend in a direction determined by the amount of tension applied to each of the cables 34a-34d, as described in further detail below.

  The handle 14 of the device 10 can be used to control the movement of the end effector 16, and in particular the end effector 16 can be articulated and thus end relative to the longitudinal axis A of the elongate shaft 12. The effector 16 can be oriented at an angle. Although the handle 14 can have a variety of configurations, in certain exemplary embodiments, the handle 14 is proximal end 12a of the elongate shaft 12 such that movement of the handle 14 can be mimicked by the end effector 16. It is movably coupled to. Although various techniques can be used to movably couple the handle 14 to the shaft 12, in the embodiment shown in FIGS. 4A-4C, the ball socket connection is located between the handle 14 and the elongate shaft 12. It is formed between the upper ends 12a. As best shown in FIG. 4B, the proximal end 12 a of the elongate shaft 12 includes a socket 24 formed in the proximal end 12 a, and the handle 14 is a distal end of the handle 14. And a hemispherical ball 13a configured to be rotatably seated within the socket 24. The socket 24 can be formed integrally with the proximal end 12a of the elongate shaft, or the socket 24 couples the hollow housing 12c to the proximal end 12a of the elongate shaft 12, as shown. It can also be formed. The hemispherical ball 13 a can also be formed integrally with the handle 14, or the hemispherical ball 13 a can be a separate member coupled to the handle 14. In order to movably engage the handle 14 with the shaft 12, the hemispherical ball 13 a on the handle 14, described below, is held inside the socket 24 using cables 34 a-34 d attached to the handle 14. You can also. However, other engagement techniques can be used to movably engage the handle 14 with the shaft 12. For example, the ball 13a can be spherical and the ball 13a can be captured within a spherical socket formed at the proximal end 12a of the elongate shaft 12. Alternatively, an engaging element such as a pin can extend through the ball 13 a and hold the ball 13 a inside the socket 24. FIG. 4B illustrates a ball 13 a formed on the handle 14 and a socket 24 formed in the shaft 12, where the ball socket coupling portion, the ball is on the shaft 12, and the socket is the handle 14. It can also be reversed to be within. Furthermore, those skilled in the art will appreciate that various other techniques can be used to movably couple the handle 14 to the proximal end 12a of the elongate shaft 12.

  In use, the handle 14 can be articulated, i.e. pivotably moved with respect to the shaft 12, causing the end effector 16 to mimic the movement of the handle 14. This can also be accomplished by coupling the proximal end of the cables 34a-34d to the handle 14. The connecting position of the cables 34a to 34d and the handle 14 can be changed according to a desired movement. In the illustrated embodiment, a cable (only three cables 34a, 34b, 34c are shown in FIG. 4A) extends from the elongate shaft 12 through the hollow housing 12c and the proximal end of the hollow housing 12c. It protrudes from a slot or opening formed in the part. The cables 34a-34d then extend around the ball 13a on the handle 14 and are connected to the distal facing surface of the handle 14 surrounding the ball 13a. Cable 34a-34d can be coupled to handle 14 using substantially any technique known in the art, such as adhesives, interference fits, threads, etc. Such mechanical engagement techniques. As shown in FIG. 4A, the handle 14 includes an opening formed in the handle 14, and the proximal ends (not shown) of the cables 34a-34d are formed on the proximal end. And may have a ball or other element configured to be captured within the opening. As further illustrated in FIG. 4A, the cables (only three cables 34 a, 34 b, 34 c are shown) can remain spaced around the handle 14. This allows the movement of the handle 14 to be moved plane-symmetrically by the end effector 16, as will be described in further detail below. Alternatively, the cables 34 a-34 d can be crossed before the cables are coupled to the handle 14 to move the end effector 16 in the same direction as the handle 14. For example, the opposing cables 34a and 34c can intersect each other and can be coupled to opposing sides of the handle 14. Also, the opposing cables 34b and 34d can similarly cross each other and can be coupled to opposing sides of the handle 14. The cables 34a-34d can be crossed at any location, such as inside the hollow housing 12c on the proximal end 12a of the shaft 12.

  As further illustrated in FIGS. 4A and 4B, the handle 14 may also include other features to facilitate use of the device. For example, the handle 14 is a translation member 38 that is effective to close the jaws 18, 20 on the end effector 16, and a rotation that is effective to selectively rotate and actuate the end effector 16. Member 40 can also be included. The translation member 38 and the rotation member 40 comprise the title “Single Cable Actuator” by Mark Ortiz et al., Filed on the same day as this specification, which is incorporated herein by reference in its entirety. The Surgical Fastener And Cutter With Single Cable Actuator application is described in further detail. In other embodiments, the handle 14 can include triggers, knobs, etc. to rotate and / or actuate the end effector 16.

  Referring back to FIG. 1B, in use, the handle 14 is pivoted or angled with respect to the proximal end 12a of the elongate shaft 12 to accomplish mimicking the movement of the end effector 16. it can. In particular, turning the handle 14 about the elongated shaft 12 in a first direction applies a force to one or more of the cables 34a-34d and pulls the cable in the axial direction. As a result, the actuated cable tensions the flexible neck 26 and causes the neck 26 to bend. The flexible neck 26 can be more flexible than the elongate shaft 12 because it prevents the elongate shaft 12 from bending in response to the tension applied to the cables 34 a-34 d by the handle 14. This can be accomplished, for example, using the alternating slits 32 described above, or in other embodiments the material can be different, or the elongated shaft can extend through the elongated shaft, etc. The shaft can be made more rigid than the flexible neck.

  The direction of movement of the handle 14 is imitated by the end effector 16 in the same direction (ie, corresponding movement) or in the opposite direction (ie, plane-symmetric movement). Therefore, the user can accurately control the position of the end effector 16. In the exemplary embodiment, the specific amount of movement of the end effector 16 can be proportional to the amount of movement of the handle 14. That is, the amount of movement of the end effector 16 can be exactly equal to the amount of movement of the handle 14, or the amount of movement of the end effector 16 can be increased or decreased in proportion to the amount of movement of the handle 14. You can also. In certain embodiments, it may be desirable for the amount of movement of the end effector 16 to be increased relative to the amount of movement of the handle 14. As a result, only a small movement of the handle 14 is required, allowing a large movement of the end effector 16. While various techniques can be achieved to proportionally double, or increase, the movement of the end effector 16, one exemplary embodiment of a force augmentation mechanism is an eccentric cam coupled to a cable. This eccentric cam increases the mechanical advantage of the cables 34a-34d, such as force or displacement, when tension is applied by the handle 14 to the cables 34a-34d.

  A person skilled in the art can theoretically proportionally move the working end of the device and the handle, but in practice, some force loss occurs when the force is transmitted through an elongated shaft. You will understand that will happen. Thus, proportional movement as used herein is configured such that the handle and the working end are moved by a proportional amount, but some force loss may occur during actual operation of the device. Intended to include applications.

  The various devices disclosed herein can also include various other features to facilitate the use of these devices. For example, the device 10 of FIG. 1A can include an optical image acquisition unit disposed at the distal end of the elongate shaft 12 and configured to acquire images during an endoscopic procedure. The position of the unit can also be changed, and in some embodiments the optical image collection unit can be located in the second coupler 30. In particular, FIG. 5 illustrates a tilted housing 42 protruding from the outer surface of the coupler 30 and containing an optical image collection unit therein. An observation window 44 is formed on the distal facing surface of the housing 42 so that the unit can acquire an image of the end effector 16 and an image of the periphery of the surgical site. The image from the optical image collection unit is copied to an external image display screen. Alternatively, the device 10 can include an image display screen disposed on or coupled to the proximal portion of the device. FIG. 6 illustrates an embodiment of an image display screen 46 that protrudes outward from the handle 14.

  As described above, the various techniques disclosed herein for controlling the movement of the working end of an endoscopic surgical device can also be used in combination with various medical devices. FIG. 7 illustrates another embodiment of a medical device having an actuator for controlling the movement of the working end. In this embodiment, the medical device is in the form of an attached channel 100 for use with an endoscope. The attached channel 100 is an external device that engages with the endoscope and can slide along the endoscope, and other tools such as a glass cutter and a cutter are introduced through the attached channel, and the observation end of the endoscope is inserted. It becomes possible to be positioned close to the part. While the accessory channel 100 can have substantially any configuration, shape, and size, in the embodiment illustrated in FIG. 7, the accessory channel 100 includes an elongated tube or shaft 102, which is the elongated tube 102. Has a lumen extending between the proximal end 102a and the distal end 102b of the elongated tube and receives the device through the lumen. The accessory channel 100 also includes a mating element formed on the accessory channel for directly engaging the accessory channel 100 to an endoscope, sleeve, or other device disposed around the endoscope. You can also. While virtually any mating technique can be used, in the illustrated embodiment, the mating elements on the accessory channel 100 are in the form of rails 104 that extend along the length of the elongate shaft 102. The rail 104 is configured to be received in a complementary track formed on an endoscope or device disposed around the endoscope, such as a sleeve. One skilled in the art will appreciate that a variety of other techniques can be used to engage the accessory channel directly or indirectly to the endoscope.

  To control the movement of the working end of the accessory channel 100, the device 100 can also include features similar to those described above. In particular, the device 100 is formed or coupled to a flexible neck 108 formed on or coupled to a distal end 102b of the elongated shaft 102, or a proximal end 102a of the elongated shaft 102. Handle 106 and an actuator extending between handle 106 and flexible neck 108 may be included. In this embodiment, the actuator is configured to transmit force from the handle 106 to the flexible neck 108 such that the movement of the handle 106 is imitated by the flexible neck 108. Thereby, a tool extending through the accessory channel 100 can be positioned at a desired angular orientation.

  The flexible neck 108 can have a variety of configurations, and the flexible neck 108 can be a separate member coupled to the elongate shaft 102 or, as shown in FIG. It can also be formed integrally with the shaft 102. The neck 108 can also be made flexible using various techniques. For example, the neck 108 can be formed from one or more segments that move relative to each other and / or can be formed from a flexible material. In the exemplary embodiment shown in FIG. 8A, the neck 108 includes a number of slits 112 formed in the neck and configured to give the neck 108 maximum flexibility. Although the size, quantity, and orientation of the slit 112 can be varied to achieve the desired result, in the illustrated embodiment, the flexible neck 108 is provided with four strut posts (arrows 112a, 112b, 112c). Only three struts of the slit are shown). Each strut extends axially along the length of the flexible neck 108 and each strut includes four rows of slits spaced radially around the neck 108. Further, the respective struts of the slit 112 are displaced from each other in the axial direction, and the slits 112 can overlap each other. In use, when tension is applied to the actuator, as shown in FIGS. 8B and 8C, the slit 112 causes the neck 108 to bend, such that the neck 108 articulates against the remainder of the elongate shaft 102, or Can take a curved shape.

  In other embodiments, the slit can be positioned so that the neck can be bent at multiple positions, i.e., at multiple bending points, or so that the neck can be bent at a predetermined position. . As a non-limiting example, FIG. 9A illustrates another embodiment of a flexible neck 108 '. The flexible neck 108 'has two regions of slits 112' formed in the flexible neck 108 '. In particular, the flexible neck 108 'includes a distal slit region 112a' and a proximal slit region 112b '. Each region 112a 'and 112b' can include any number of slits positioned at any location to provide the desired degree of flexibility in one or more desired directions. As shown in FIG. 9A, each of the proximal slit region 112a ′ and the distal slit region 112b ′ is formed on opposite sides of the flexible neck 108 ′ and is flexible neck 108. It includes two rows of slits extending along the length of '. In use, when tension is applied to the flexible neck 108 ', the neck 108' bends in both the proximal region 112a 'and the distal region 112b', as described in detail below, thereby Articulate relative to the remainder of the elongated shaft 102 '. As shown in FIG. 9B, bending can also occur initially at the distal region 112a ′ of the neck 108 ′. As shown in FIG. 9C, the proximal region 112b ′ can be bent as the neck 108 ′ is further tensioned. In other embodiments, the position and / or size of the slit can be configured to cause bending at the proximal region 112b ′ before bending occurs at the distal region 112a ′. Alternatively, the slit can be configured to bend the proximal region 112b ′ and the distal region 112a ′ simultaneously. One skilled in the art will appreciate that the quantity, position, size, and shape of the slits can be adjusted to achieve the desired result. The particular shape of the cut used to form each slit can also vary. For example, the width and length of the slit can be constant from the outer surface of the elongate shaft to the inner surface of the elongate shaft. Alternatively, the width and length of the slit can be increased or decreased so that the slit tapers or otherwise changes. As a non-limiting example, the tapered shape can also be formed by forming a slit having a triangular shape, in which case the length and width of the slit is from the outer surface of the elongated shaft toward the inner surface. ,Decrease.

  As previously described, the actuator is configured to apply tension to the flexible neck 108 to articulate the neck 108. Although the actuator can have a variety of configurations, in certain exemplary embodiments, the actuator is similar to the actuator described above, such that the handle 106 and the flexible neck 108 are operatively associated. One or more cables extending between 106 and the distal end of flexible neck 108 are included. Each cable can also be configured to apply tension to the flexible neck 108 to articulate the neck 108 in an operational plane. Thus, if the device 100 includes only one cable, the flexible neck 108 can also articulate within a single motion plane. Each additional cable allows the neck 108 to articulate in different operating planes. If multiple cables are provided, the neck 108 can also articulate in multiple motion planes. In addition, the cables can be tensioned simultaneously, potentially allowing 360 degree articulation of the flexible neck 108.

  Although the number of cables can vary, the device 100 can include only one cable, and in the embodiment shown in FIG. 7, the device 100 includes four cables (cables 110a, 110b, 110c). Only three cables are shown). The portions of cables 110a, 110b, 110c, 110d are shown in more detail in FIG. As described above, the cables 110a-110d extend along the length of the elongate shaft 102 between the handle 106 and the flexible neck 108. The particular position of the cables 110a-110d can vary, and in one exemplary embodiment, the cables 110a-110d are spaced radially around the elongate shaft 102 and the furthest of the flexible neck 108 It extends between the top end and the handle 106. The cables 110a-110d can extend inwardly through the elongate shaft 102 or extend outwardly along the elongate shaft 102. Alternatively, the cables 110a-110d can extend through lumens and passages formed in the sidewalls of the elongate shaft 102. FIG. 11 illustrates a cross-sectional view of the elongate shaft 102 and shows four lumens 103a, 103b, 103c, 103d formed in the elongate shaft 102. FIG. The lumens 103a-103d are preferably sized such that the cables 116a-116d can slide within the lumen, and the lumens 103a-103d are spaced around the elongate shaft 102. Lumens 103a-103d extend between the proximal end 102a and the distal end 102b of the elongate shaft 102, and the cables 110a-110d connect the handle 106 and the most distal end of the flexible neck 108. It becomes possible to extend in between.

  The distal ends of the cables 110a-110d can be engaged with the most distal end of the flexible neck 108 using various techniques, but in one embodiment, as shown in FIG. The flexible neck 108 includes an end cap 114 that is coupled to or formed at the distal most end of the flexible neck 108. Although the configuration of the end cap 114 may vary depending on the configuration of the actuator, in the illustrated embodiment, the end cap 114 includes four holes 114a, 114b, 114c, 114d formed in the end cap 114; The holes 114a-114d are spaced around the end cap 114 to align with the lumens 103a-103d in the elongate shaft 102. Each of the holes 114a to 114d is configured to receive one of the cables 110a to 110d. The cables 110a-110d can also be held inside the holes 114a-114d using various meshing techniques. For example, FIG. 10 illustrates a ball formed at each end of the cables 110a-110d to hold the ends of the cables 110a-110d in the holes 114a-114d in the end cap 114. The end cap 114 also includes a central lumen 116 formed in the end cap 114 through which the device can be received. Lumen 116 may also function to facilitate positioning of tools inserted through accessory channel 100.

  The proximal ends of the cables 110 a-110 d can also be mated to a handle 106 that is coupled to the proximal end of the shaft 102. Although the handle 106 can have a variety of configurations, in one exemplary embodiment, as already shown in FIG. 7, the handle 106 can also be in the form of a joystick, which is an elongated shaft. 102 is movably coupled to the proximal end 102a of the 102 and is specifically configured to articulate relative to the proximal end 102a of the elongate shaft 102. The articulating movement of the handle 106 allows the movement of the handle 106 to be mimicked by the flexible neck 108, as will be described below.

  Although articulation movement can be accomplished using various types of joints, in the illustrated embodiment, a ball socket connection is formed between the handle 106 and the elongate shaft 102. In particular, as shown in further detail in FIGS. 13A and 13B, the proximal end 102a of the elongate shaft 102 includes a housing 103 formed on the proximal end, the housing 103 including the housing A socket 118 is defined at the proximal end of the. The handle 106 includes a ball 120 that is movably disposed within a socket 118, and a joystick extends proximally from the ball 120, thereby allowing the handle 106 to articulate relative to the elongate shaft 102. . A pin or other mechanism may be used to hold the ball 120 movably within the socket 118. Those skilled in the art will appreciate that the handle can have a variety of other shapes and that various other techniques can be used to movably couple the handle 106 to the elongate shaft 102. Let's go.

  As described above, the proximal ends of the cables 110 a-110 d are configured to engage the handle 106. Thus, the handle 106 can also include features for engaging the cables 110a-110d. Although specific engagement features can vary depending on the configuration of the actuator, in the exemplary embodiment, the joystick 122 on the handle 106 has four legs 124a, 124b, 124c, 124d formed on the joystick. including. The legs 124a-124d are spaced around the joystick 122 so that the legs are substantially aligned with the cable, and each leg 124a-124d is a terminal end of one of the cables 110a-110d. It is configured to engage the part. As described above for the distal ends of cables 110a-110d, ball socket connections may be used to engage cables 110a-110d with the legs, or alternatively, as known in the art. Any other meshing technique can be used.

  Referring back to FIG. 7, in use, the handle 106 is pivoted or angled relative to the proximal end 102a of the elongate shaft 102 to mimic the movement of the flexible neck 108, Can position a tool that extends through the flexible neck 108. As shown in FIGS. 7 and 13B, the joystick on the handle 106 can also include a lumen 107 formed through the joystick, the lumen 107 being connected to the lumen 102c in the elongate shaft 102. Axial alignment allows the tool to be introduced through the device 100. In other embodiments, handle 106 is coupled to a cable, but handle 106 is proximal end 102a of elongate shaft 102 so that straight access to lumen 102c in elongate shaft 102 is not prevented. It can also deviate from.

  To control the movement of the flexible neck 108, and thus the movement of the tool positioned through the flexible neck 108, the handle 106 is pivoted or articulated about the proximal end 102a of the elongate shaft 102. It is done. For example, the movement of the handle 106 in the first direction causes the legs 124a to 124d on the handle 106 to be forced against one or more of the cables 110a to 110d, and the cable is pulled in the axial direction. As a result, the actuated cable applies tension to the flexible neck 108 and causes the neck 108 to bend. The flexible neck 108 can also be more flexible than the elongate shaft 102 to prevent the elongate shaft 102 from bending in response to the tension applied to the cables 110 a-110 d by the handle 106. This can be accomplished, for example, by using the slits described above, or in other embodiments, the shaft 102 includes a stabilizing element, such as a rod extending through the shaft, to It may be more rigid than the flexible neck 108. The direction of movement of the handle 106 is imitated by the flexible neck 108 in either the same direction (ie, corresponding movement) or the opposite direction (ie, plane-symmetric movement), so that the user can position the flexible neck 108 in position. Can be accurately controlled, thereby controlling the position of the tool extending through the flexible neck 108. In the exemplary embodiment, the specific amount of movement of the flexible neck 108 may be proportional to the amount of movement of the handle 106. That is, the amount of movement of the flexible neck 108 can be exactly equal to the amount of movement of the handle 106, or can be reduced or increased in proportion to the amount of movement of the handle 106. In certain embodiments, it may be desirable for the amount of movement of the flexible neck 108 to be increased relative to the amount of movement of the handle 106. As a result, only a small movement of the handle 106 is required, allowing a large movement of the flexible neck 108. Although various techniques can be used to achieve proportionally doubling or increasing the movement of the flexible neck 108, one exemplary embodiment of the force augmentation mechanism is an eccentric cam coupled to the cable; This eccentric cam increases the mechanical advantage of either force or displacement of the cables 110a-110d when tension is applied to the cables 110a-110d by the handle 106.

  As mentioned above, the motion between the working end of the device and the handle can theoretically be proportional, but in practice, some force is applied as the force is transmitted through the elongated shaft. Loss will occur. Thus, proportional movement as used herein is configured such that the handle and working end move in proportional amounts, but some force loss may occur during actual operation of the device. Is intended to include some applications.

  1A and 7 illustrate a device where the working end mimics the movement of the handle, the handle articulates the working end of the device without causing the working end of the device to imitate the movement of the handle. It can also have various other configurations that are effective to exercise. FIGS. 14A and 14B illustrate another embodiment of a device 200 having a handle 204 that includes a rotatable member, which is one or more working surfaces relative to the elongate shaft 202 of the device. Within, it is effective to articulate the flexible neck 206. In general, the elongate shaft 202 of the device 200 is very similar to the elongate shaft 102 described above, and the elongate shaft 202 is coupled to or formed with the distal end of the elongate shaft 202. The neck 206 is generally included. Four cable actuators (not shown) extend through an elongated shaft between the handle 106 and the flexible neck 206. The shaft 102 and cable actuator are similar to the shaft 102 and cable actuators 110a-110d previously described for the device 100, and therefore will not be described in detail.

  The handle 204 of the device 200 is shown in more detail in FIGS. 15A and 15B. In general, the handle 204 includes one or more spools rotatably disposed within the handle 204. Each of the spools is configured to engage and control one of the cable actuators. Thus, the rotation of each spool winds or releases the cable, thereby flexing and articulating the flexible neck 108 in a particular direction. Although the number of spools can vary with the number of cable actuators, in the embodiment shown in FIGS. 15A and 15B, handle 204 includes four spools 208a, 208b, 210a, 210b. The two first spools 208a and 208b are coupled to each other, and the two second spools 210a and 210b are coupled to each other. The first cable 212a is coupled to the first spool 208a and is wound around the first spool 208a. The second cable 212b is coupled to the second spool 208b and is wound around the second spool 208b. The first cable 212a and the second cable 212b are positioned on opposing sides of the elongate shaft 202 and extend along the opposing sides. As a result, due to the tension applied to the first cable 212a, the flexible neck 206 is articulated in a direction within the first working plane, and due to the tension applied to the second cable 212b, the flexible neck 206 is the same. It is articulated in the opposite direction in the working plane. To allow tension to be applied to only one of the cables 212a, 212b, the first cable 212a and the second cable 212b are wound in opposite directions around the first spool 208a and the second spool 208b. Accordingly, the rotation of the first spool 208a and the second spool 208b winds up one of the cables 212a and 212b with tension, and at the same time releases the tension of the other of the cables 212a and 212b and unwinds. Similarly, in the third cable 212c and the fourth cable 212d, the rotation of the third spool 210a and the fourth spool 210b winds by tensioning one of the cables 212c and 212d, and at the same time, the cables 212c and 212d It is wound around the third spool 210a and the fourth spool 210b so as to release the other tension and unwind it. The third cable 212c and the fourth cable 212d are such that the third cable 212c and the fourth cable 212d articulate the flexible neck 206 in a second different operating plane. It can extend along the shaft 102 at a location that is radially offset from 212b. For example, the third cable 212c and the fourth cable 212d are approximately from the first cable 212a and the second cable 212b such that all of the cables 212a-212d are spaced substantially equidistant around the elongate shaft 202. It can also be shifted by 90 degrees. One skilled in the art will appreciate that the handle 204 can include any number of spools and cables to allow articulation in a desired number of planes.

  To control the spools 208a, 208b, 210a, 210b, the device can also include one or more gripping members. As shown in FIGS. 15A and 15B, the first rotation knob 214 is coupled to the first spool 208a and the second spool 208b, and the second rotation knob 216 is coupled to the third spool 210a and the fourth spool 210b. Yes. The knobs 214, 216 can be integrally formed with the spools 208a, 208b, 210a, 210b, or the knobs 214, 216 can be formed by a shaft extending through the spools 208a, 208b, 210a, 210b. , 208b, 210a, 210b. In the illustrated embodiment, the first knob 214 is formed on or coupled directly to the first spool 208a. The second knob 216 extends from the knob 216 through the first spool 208a and the second spool 208b and is coupled to the third spool 210a and the fourth spool 210b by the shaft 218, and the third spool 210a and the fourth spool 216. It is coupled to the spool 210b. In other words, the first spool 208a and the second spool 208b are rotatably arranged around the shaft 218.

  In certain exemplary embodiments, the spool and rotation knob may also be different in size. In the embodiment shown in FIGS. 15A and 15B, the first spool 208a and the second spool 208b, and the first rotation knob 214 are larger than the diameters of the third and fourth spools 210a and 210b and the second rotation knob 216. Also has a large diameter. Although not required, such a configuration can also be advantageous to separate the cables 212a-212d and prevent the cables 212a-212d from contacting each other.

  In use, the tool can also be positioned through the elongate shaft 202, rotating the knobs 214, 216 to articulate the flexible neck 206 on the shaft 202, thereby positioning the tool as desired. You can also. As shown in FIGS. 14A and 14B, the handle 204 includes a lumen 205 that extends through the handle and is aligned with the lumen in the elongate shaft 202 and passes the device through the handle 204 and the shaft 202. Can be made. In other embodiments, the handle 204 can be offset from the elongate shaft 202 to provide direct access to a lumen within the elongate shaft 202. Once the tool is positioned through the shaft 202, the knobs 214, 216 can be rotated to articulate the flexible neck 206 on the distal end of the elongate shaft 202. In particular, the first knob 214 is rotated in a first direction, e.g. clockwise, to apply tension to one of the cables, e.g. the first cable 212a, and simultaneously release the other cable, e.g. the second cable 212b. In other words, it can be unwound. As a result, tension applied to the first cable 212a pulls the distal most end of the flexible neck 206 proximally, causing the flexible neck 206 to bend and thereby articulate in the first direction. . The rotation of the first knob 214 in the opposite direction, eg, counterclockwise, unwinds the first cable 212a and simultaneously winds up the second cable 212b. The flexible neck 206 returns to the initial linear shape. Further rotation of the first knob 214 continues to wind up the second cable 212b, while unwinding the first cable 212a, thereby causing the flexible neck 206 to bend in the opposite direction along the same operating plane, Exercise. Similarly, the second knob 216 can be rotated to articulate the flexible neck in different operating planes. Also, optionally, the knobs 214, 216 can be rotated and at the same time the flexible neck 206 can be articulated in an additional motion plane different from the first and second motion surfaces.

  In other embodiments, the various devices disclosed herein lock the handle and / or actuator in a fixed position to maintain the working end of the device in the desired articulation or angular orientation. A locking mechanism can also be included. Although the locking mechanism can have a variety of configurations, in certain exemplary embodiments, the locking mechanism is lowered and secured onto the cable, thereby preventing the cable from moving and the working end to the desired orientation. It can also be in the form of a clamp that is effective to lock onto. The clamp can have various shapes and sizes and can be positioned at various locations on the device. FIGS. 16A and 16B illustrate an exemplary embodiment of a clamp 300 disposed around a hollow housing 12c on the surgical fixation / cutting device 10 of FIGS. 1A and 1B. The clamp 300 is substantially annular and engages the hollow housing 12c so that it can slide or rotate in the vicinity of an opening through which cables (only three cables 34a, 34b, 34c are shown in FIG. 16B) pass. It can also be configured as follows. In the initial position, the clamp 300 is spaced from the opening and allows free movement of the cables 34a-34d through the opening. When the working end of the device, for example, the end effector 16 is articulated to the desired position, the clamp 300 extends over the opening and engages the cables 34a-34d extending from the opening. 300 can move axially along the hollow housing 12c. Accordingly, the clamp 300 prevents the movement of the cables 34a to 34d when in the locked position. In order to move the clamp 300 axially and lock the clamp 300 to the housing 12c, the clamp 300 can also include a mating element formed on the clamp 300, the mating element formed on the housing 12c. It is configured to engage a corresponding meshing element. As shown in FIGS. 16A and 16B, the clamp includes a thread 302 formed on the clamp that is configured to engage a corresponding thread (not shown) formed on the housing 12c. ing. As a result, rotation of the clamp 300 around the housing 12c moves the clamp 300 between an initial position and a locked position. Those skilled in the art will appreciate that a variety of other engagement techniques can also be used. Furthermore, the locking mechanism can have various other configurations. For example, the handle can include a locking element formed on the handle and configured to lock the handle in an articulation fixed position.

  In other embodiments, the cable can be used to passively articulate the elongate shaft through the body cavity, and the working end of the device can be used, if desired, using a clamp 300 or other locking mechanism. Can be locked in place. In such a configuration, the device can be easily grasped simply by using the handle.

  In other embodiments, the cable actuators disclosed herein used to achieve articulation of the working end of the device can also be formed from an electroactive polymer material. Electroactive polymer (EAP), also called artificial muscle, is a material that exhibits piezoelectric, pyroelectric, or electrostrictive properties in response to an electric or mechanical field. In particular, EAP is a series of conductive doped polymers that change shape when a voltage is applied. The conducting polymer is paired with some form of ionic fluid or ion gel, and an ion electrode, and the flow of ions from the fluid / gel to the conducting polymer or the flow of ions exiting the conducting polymer changes the shape of the polymer Can also be induced. A voltage potential, typically in the range of about 1 V to 4 kV, can be applied, depending on the particular polymer used and the ionic fluid or ion gel. It is important to note that EAP does not change volume when voltage is applied, more precisely, it expands in only one direction and contracts in the lateral direction. Thus, the cable actuator previously disclosed herein can be replaced by an EAP actuator, and the handle is configured to activate an energy source to selectively deliver energy to one or more cables. You can also. In an exemplary embodiment, the movement of the handle can also be configured to indicate the amount of energy source as well as the cable that receives the energy source. As a result, the movement of the handle is still imitated by the working end of the device, and the user can have the same precise control over the position of the working end. The energy source can be an internal source such as a battery or an external source. In other embodiments, the EAP cable actuator can also supplement the axial force applied to the cable by the movement of the handle, thereby proportionally increasing the amount of movement of the working end relative to the handle.

  In other aspects, the cable actuator may be formed from a shape memory material such as Nitinol. With such a configuration, tension can be applied to the cable to articulate the end effector, and the cable can return to its initial linear shape without the need to manipulate the handle.

  In yet another embodiment, the various devices disclosed herein can include parts of those devices and can be designed to be discarded after a single use, or can be used multiple times. It can also be designed to be In either case, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembling the device, followed by cleaning or replacing certain parts, and then reassembling. By way of example, the surgical stapling / fixing device shown in FIGS. 1A and 1B can be reconditioned after being used in a medical procedure. The device can also be disassembled and any number of specific parts can be selectively replaced or removed in any combination. For example, in a surgical stapling / cutting device, a cartridge disposed within the end effector and containing a plurality of fasteners can be replaced by adding a new fastener cartridge to the end effector. Upon cleaning and / or replacement of particular parts, the device can also be reassembled at a reconditioning facility or by a surgical team immediately prior to a surgical procedure for subsequent use. One skilled in the art will appreciate that reconditioning of the device can utilize a variety of techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques and the resulting reconditioned device are all within the scope of this application.

  One skilled in the art will appreciate further features and advantages of the invention based on the above-described embodiments. Accordingly, the invention is not limited to what has been particularly shown and described, except as indicated by the appended claims. All publications and references mentioned herein are expressly incorporated herein by reference in their entirety.

Embodiment
(1) In surgical fixation devices,
An elongate shaft having a proximal end and a distal end, the proximal end comprising a handle movably coupled to the proximal end, the distal end being the distal end An elongate shaft having an end effector extending from the portion, the end effector configured to engage tissue and carry at least one fastener to the engaged tissue;
Including
The handle and the end effector are coupled such that movement of the handle is mimicked by the end effector;
Surgical fixation device.
(2) In the apparatus according to Embodiment 1,
The apparatus, wherein the movement is proportional.
(3) In the apparatus according to Embodiment 1,
The apparatus, wherein the handle is coupled to the proximal end of the elongate shaft by a joint selected from the group consisting of a ball and socket joint, a hinge joint, and a flex joint.
(4) In the apparatus according to Embodiment 1,
An actuator extending between the handle and the end effector;
Further including
The apparatus, wherein the actuator is configured to transmit movement from the handle to the flexible neck.
(5) In the apparatus according to Embodiment 4,
The apparatus, wherein the actuator includes a plurality of cables extending along a length of the elongate shaft.

(6) In the apparatus according to Embodiment 5,
A locking mechanism disposed about at least one of the elongate shaft and the handle and configured to engage the plurality of cables to lock the cables in a fixed position;
Further including
apparatus.
(7) In the apparatus according to Embodiment 5,
The plurality of cables are formed of an electroactive polymer material;
The movement of the handle selectively carries energy to the plurality of cables, causing the plurality of cables to contract axially and expand radially, thereby causing at least one of the flexible necks to An apparatus that is effective to mimic the movement of the handle.
(8) In the apparatus according to Embodiment 5,
The apparatus wherein the cables are spaced equidistant from one another around the elongate shaft.
(9) In the apparatus according to Embodiment 1,
The end effector is
A flexible neck formed on a proximal portion of the end effector and configured such that when bent, the end effector can proportionally mimic the movement of the handle;
Including the device.
(10) In the apparatus according to Embodiment 1,
An optical image acquisition unit disposed on a distal end of the end effector;
Further including
The apparatus, wherein the optical image acquisition unit is configured to acquire an image during an endoscopic procedure.

(11) In the apparatus according to Embodiment 1,
An image display screen disposed on a proximal portion of the device and configured to communicate with the optical image acquisition unit to display the acquired image
Further comprising an apparatus.
(12) In the apparatus according to Embodiment 1,
The end effector includes a cartridge removably disposed within the end effector;
The apparatus includes a plurality of staples for stapling tissue and a blade for cutting the stapled tissue.
(13) In a method of readjusting an apparatus according to embodiment 1,
Removing a cartridge removably disposed within the end effector to prepare the device for reuse;
Replacing the cartridge;
Including
The apparatus, wherein the cartridge contains a plurality of fasteners disposed within the cartridge.
(14) In a surgical fixation device,
An elongated flexible shaft;
A handle movably coupled to a proximal end of the elongated flexible shaft;
An end effector having a flexible neck formed on the end effector and coupled to a distal end of the elongate flexible shaft, the end effector comprising: An end effector including opposing jaws, the opposing jaws being configured to engage tissue between them and drive at least one fastener to the engaged tissue; ,
Extending between the handle and the end effector and effective to transmit force due to movement of the handle to the flexible neck to move the end effector in cooperation with the handle; An actuator,
A surgical fixation device comprising:
(15) In the device according to embodiment 14,
The actuator includes a plurality of cables extending between the handle and the end effector;
The apparatus wherein the cables are spaced apart from each other around the flexible shaft.

(16) In the device according to embodiment 14,
The apparatus, wherein the handle is coupled to the proximal end of the elongate shaft by a joint selected from the group consisting of a ball and socket joint, a hinge joint, and a flex joint.
(17) In surgical methods,
Inserting an elongate shaft into the body cavity and positioning an end effector coupled to the distal end of the elongate shaft in the vicinity of the tissue to be fixed;
Moving a handle pivotally coupled to a proximal end of the elongate shaft, causing the end effector to proportionally mimic the operation of the handle;
Including surgical methods.
(18) In the method of embodiment 17,
The method wherein the end effector moves in plane symmetry with the movement of the handle.
(19) In the method according to embodiment 17,
The end effector movement directly corresponds to the movement of the handle.
(20) In the method of embodiment 17,
The handle is articulated pivotably about the proximal end of the elongate shaft, causing the end effector to mimic the movement of the handle.

(21) In the method of embodiment 17,
Engaging tissue between opposing jaws of the end effector;
Driving at least one fastener from the end effector to the tissue;
Further comprising a method.
(22) In the method of embodiment 21,
Said step of engaging the tissue and said step of driving at least one fastener;
Moving a translational member formed on the handle from a first position to a second position and closing the opposing jaws; and
Rotating a rotatable member formed on the handle to actuate a drive mechanism disposed within the end effector to cause the drive mechanism to drive a plurality of fasteners to the tissue;
Including a method.
(23) In the method of embodiment 22,
Prior to moving the translation member from the first position to the second position, the rotatable member is rotated and the end effector is rotated relative to the flexible neck without actuating the drive mechanism. Step,
Further comprising a method.

FIG. 6 is a perspective view of an embodiment of a surgical stapling / cutting device, showing the working end of the device in an initial position. 1B is a perspective view of the surgical stapling / cutting device of FIG. 1A, showing the working end of the device in an articulated position. FIG. 1B is a perspective view of a portion of the flexible neck of the apparatus shown in FIGS. 1A and 1B. FIG. FIG. 3 is a perspective view of the distal portion of the apparatus shown in FIGS. 1A and 1B, showing the end effector and the flexible neck of FIG. 2 coupled to the end effector. FIG. 3B is a cross-sectional view of the end effector shown in FIG. 3A along line 3B-3B. 1B is a perspective view of the proximal portion of the device shown in FIGS. 1A and 1B, showing a handle movably coupled to the proximal end of the shaft of the device. FIG. FIG. 4B is an exploded view of the proximal portion of the device shown in FIG. 4A. 1B is a perspective view of a coupling element disposed between a flexible neck and an elongate shaft of the apparatus shown in FIGS. 1A and 1B, illustrating an optical image collection device. 1B is a perspective view of the handle of the apparatus shown in FIGS. 1A and 1B, showing an image display screen. FIG. FIG. 6 is a perspective view of an attached channel for use with an endoscope. FIG. 8 is a perspective view of the flexible neck of the device shown in FIG. 7. FIG. 8B is a perspective view of the flexible neck shown in FIG. 8A, showing the neck articulated in a first direction. FIG. 8B is a perspective view of the flexible neck shown in FIG. 8A, showing the neck articulated in the second direction. FIG. 6 is a perspective view of another embodiment of a flexible neck for use with an attached channel. 9B is a perspective view of the flexible neck shown in FIG. 9A, showing the neck articulated in a first direction. FIG. FIG. 9B is a perspective view of the flexible neck shown in FIG. 9A, showing the neck articulated in the second direction. FIG. 8 is a perspective view of a plurality of cable actuators for use with the apparatus of FIG. FIG. 8 is a cross-sectional view of the shaft of the attached channel of FIG. 7. FIG. 8 is a perspective view of an embodiment of an end cap for use with the attached channel of FIG. 7. FIG. 8 is an exploded view of the handle of the device shown in FIG. 7 and the proximal portion of the elongate shaft. FIG. 13B is a cross-sectional view of the proximal portion of the elongated shaft of FIG. 13A and the handle in an assembled configuration. FIG. 6 is a perspective view of another embodiment of an attached channel. 14B is a cross-sectional view of the attached channel shown in FIG. 14A. FIG. 15 is a side view of the handle assembly of the apparatus shown in FIGS. 14A and 14B. FIG. FIG. 15B is an exploded view of the handle assembly of FIG. 15A. FIG. 6 is a perspective view of an embodiment of a locking mechanism. FIG. 16B is a perspective view of the locking mechanism of FIG. 16A coupled to the surgical stapling / cutting device of FIGS. 1A and 1B.

Claims (17)

In surgical fixation devices,
An elongate shaft having a proximal end and a distal end, the proximal end comprising a handle movably coupled to the proximal end, the distal end being the distal end An elongate shaft having an end effector extending from the portion, the end effector configured to engage tissue and carry at least one fastener to the engaged tissue;
Including
The handle and the end effector are coupled such that movement of the handle is mimicked by the end effector;
The rotating member further includes a rotating member such that rotation of the rotating member relative to the handle selectively rotates the end effector and carries at least one fastener to the engaged tissue. it is adapted to be effective to actuate the,
A ball and socket joint positioned between the handle and the proximal end of the elongate shaft is adapted to transmit the rotation of the rotating member to the end effector via the elongate shaft ;
Surgical fixation device. The apparatus of claim 1.
The apparatus, wherein the movement is proportional. The apparatus of claim 1.
An actuator extending between the handle and the end effector;
Further including
The apparatus, wherein the actuator is configured to transmit movement from the handle to the end effector. The apparatus of claim 3 .
The apparatus, wherein the actuator includes a plurality of cables extending along a length of the elongate shaft. The apparatus according to claim 4 .
A locking mechanism disposed about at least one of the elongate shaft and the handle and configured to engage the plurality of cables to lock the cables in a fixed position;
Further comprising an apparatus. The apparatus according to claim 4 .
The plurality of cables are formed of an electroactive polymer material;
The movement of the handle selectively carries energy to the plurality of cables, causing the plurality of cables to contract axially and expand radially, thereby imitating the movement of the handle to the end effector. The device that is effective to make. The apparatus according to claim 4 .
The apparatus wherein the cables are spaced equidistant from one another around the elongate shaft. The apparatus of claim 1.
The end effector is
A flexible neck formed on a proximal portion of the end effector and configured such that when bent, the end effector can proportionally mimic the movement of the handle;
Including the device. The apparatus of claim 1.
An optical image acquisition unit disposed on a distal end of the elongate shaft;
Further including
The apparatus, wherein the optical image acquisition unit is configured to acquire an image during an endoscopic procedure. The apparatus of claim 1.
Further comprising an image display screen disposed on a proximal portion of the device and adapted to display the acquired image through the optical image acquisition unit;
apparatus. The apparatus of claim 1.
The end effector includes a cartridge removably disposed in the end effector, the cartridge containing a plurality of staples for stapling tissue and a blade for cutting the stapled tissue. ,
apparatus. The method of readjusting an apparatus according to claim 1,
Removing and replacing a cartridge having a plurality of fasteners therein removably disposed in the end effector to prepare the device for reuse;
Method. In surgical fixation devices,
An elongated flexible shaft;
A handle movably coupled to a proximal end of the elongated flexible shaft;
An end effector having a flexible neck formed on the end effector and coupled to a distal end of the elongate flexible shaft, the end effector comprising: An end effector including opposing jaws, the opposing jaws configured to engage and drive at least one fastener to the tissue therebetween. ,
Extending between the handle and the end effector and effective to transmit force due to the movement of the handle to the flexible neck to cause the end effector to mimic the movement of the handle; An actuator,
A rotating member, wherein rotation of the rotating member relative to the handle selectively rotates the end effector to actuate the end effector to carry at least one fastener to the engaged tissue. A rotating member adapted to be effective; and
Only including,
A ball and socket joint positioned between the handle and the proximal end of the elongate shaft is adapted to transmit the rotation of the rotating member to the end effector via the elongate shaft ;
Surgical fixation device. The apparatus of claim 13 .
The actuator comprises a plurality of cables extending between the handle and the end effector, the cables being spaced apart from each other around the flexible shaft;
apparatus. The apparatus of claim 1.
The rotating member is selectively moveable between a first position and a second position with respect to the elongated shaft, wherein the rotating member is rotatable to rotate the end effector; In the second position, rotatable to actuate the end effector to carry the at least one fastener to the engaged tissue;
apparatus. The apparatus of claim 15 .
A translation member coupled to the handle and effective to move the rotating member between the first position and the second position;
apparatus. The apparatus of claim 13 .
The flexible neck has a proximal region and a distal region, the proximal region of the flexible neck is bent toward a first position relative to the elongated flexible shaft; and The flexible region is configured such that the distal region of the flexible neck is configured to bend toward a position opposite the first position with respect to the elongated flexible shaft. A proximal region having a slit formed only on one side thereof and a distal region having a slit formed only on one side thereof, the proximal region slit and the distal region slit Are formed on opposite sides of the flexible neck,
apparatus.

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