US20150005784A2 - Device for Supporting and Positioning of a Surgical Instrument and/or an Endoscope for Use in Minimal-Invasive Surgery and a Surgical Robotic System - Google Patents

Device for Supporting and Positioning of a Surgical Instrument and/or an Endoscope for Use in Minimal-Invasive Surgery and a Surgical Robotic System Download PDF

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US20150005784A2
US20150005784A2 US13/828,008 US201313828008A US2015005784A2 US 20150005784 A2 US20150005784 A2 US 20150005784A2 US 201313828008 A US201313828008 A US 201313828008A US 2015005784 A2 US2015005784 A2 US 2015005784A2
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Prior art keywords
instrument
mounting
surgical
drive unit
surgical instrument
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Abandoned
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US13/828,008
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US20140180309A1 (en
Inventor
Marcel Seeber
Andreas Karguth
Christian Trommer
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avateramedical GmbH
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E-SYS MEDICAL GmbH
avateramedical GmbH
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Assigned to E-SYS MEDICAL GMBH reassignment E-SYS MEDICAL GMBH ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: SEEBER, MARCEL, TROMMER, Christian
Assigned to avateramedical GmBH reassignment avateramedical GmBH CHANGE OF NAME (SEE DOCUMENT FOR DETAILS). Assignors: KARGUTH, ANDREAS, SEEBER, MARCEL, TROMMER, Christian
Publication of US20140180309A1 publication Critical patent/US20140180309A1/en
Publication of US20150005784A2 publication Critical patent/US20150005784A2/en
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30Surgical robots
    • A61B19/2203
    • A61B19/201
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/11Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50Supports for surgical instruments, e.g. articulated arms
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B25HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
    • B25JMANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
    • B25J18/00Arms
    • B25J18/007Arms the end effector rotating around a fixed point
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30Surgical robots
    • A61B2034/301Surgical robots for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30Surgical robots
    • A61B2034/302Surgical robots specifically adapted for manipulations within body cavities, e.g. within abdominal or thoracic cavities
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30Surgical robots
    • A61B2034/305Details of wrist mechanisms at distal ends of robotic arms

Abstract

The invention describes a mounting and positioning device of a surgical instrument and/or an endoscope for minimally-invasive surgery, in particular for use within a surgical robot system, comprising a first axis of rotation (3), around which a support element (4) is rotatably arranged, wherein the first axis of rotation (3) intersects with the longitudinal axis (11) of at least one surgical instrument (9; 17A, 17 b) and/or an endoscope (9; 17A, 17 b) in a pivot point (13), as the result of a deviation drive (5) being fixed on the support element (4), said deviation drive arranging an instrument drive unit (15) in rotatable fashion around a pivot point (13), and wherein a telescopic device (8) is provided at an instrument drive unit (15), which allows for the translatory movement of the surgical instrument (9; 17A, 17 b) and/or the endoscope (9; 17A, 17B) into the body, along its longitudinal axis (11) using a guide device (10, 10 s) in such fashion that the longitudinal axis (11) of the surgical instrument (9; 17A, 17 b) and/or the endoscope (9; 17A, 17 b) is variably adjustable in relation to the telescopic device (8).

Description

  • The present invention relates to a mounting and positioning device of a surgical instrument and a surgical robot system or telemanipulator for minimally invasive surgery and in particular laparoscopy.
  • Robot systems or telemanipulators for minimally invasive surgery, particularly for laparoscopic surgery, replace the surgical instruments usually operated manually by the surgeon, e.g. surgical instruments, endoscopes, or camera, with a motorized positioning mechanism. The surgical instruments to be used are guided inside a patient's body via one or several trocars. A trocar refers to an instrument used by the surgeon in minimally invasive surgery to gain access to the patient's body cavity (usually the abdomen or thorax), whereby the port is kept open by a tube, a so-called tubus. The movement mechanics and control logic of retainers provided in the robot system enables the movement of the surgical instruments about a pivot point in 2 degrees of freedom (x, y) and a translational movement of the surgical instruments along the axis of the instrument (z). The pivot point refers to the invariant point of the motion in 2 degrees of freedom (x, y). This pivot point is ideally located at the point where the trocar penetrates the patient's abdominal wall. The control logic of a robot system must know the pivot point or the pivot point must be defined by the moving mechanism's design, to limit the surgical instrument's movement in a way that keeps the biomechanical stress acting on the tissue around the trocar at a minimum.
  • Robot systems known from prior art are based on robot arms with an active movement of a surgical instrument, which on one hand require a large installation space and on the other hand, due to the typical embodiments, make it difficult to avoid collisions caused by the movements of the robot arms.
  • During a minimally invasive surgical procedure a minimum of two, usually three to four surgical instruments, such as gripper, scissors, needle holder, dissector), as well as a camera or an endoscope are used, which are each inserted into the patient's body via a separate trocar. This means that there is a robot arm for each employed surgical instrument, controlling the positions of the robot arms and active moving of the instrument.
  • The disadvantage of the prior art solutions lies in the fact that due to the space required by the construct the positioning of the instruments is limited and the surgical staff, e.g. the assisting doctor and the surgical nurse, has limited access to the patient.
  • A further disadvantage is that the invariant point in known systems is always necessarily given by a mechanical coupling between trocar and robot arm.
  • It is therefore the object of the present invention to provide a manipulator arm for positioning a surgical instrument and a surgical robot system that provides high variability and requires only a small installation space or is of a smaller and lighter embodiment, and optionally allows for the mechanical coupling of the trocar with the manipulator arm or manages without this mechanical coupling of the trocar with the manipulator arm.
  • It is a further object of the present invention to provide a robot system that allows for a larger range of prepositioning for a support structure of a manipulator arm. This enables more flexible positioning relative to each other when two or more support structures for manipulator arms are used.
  • These objects are achieved by the present invention, in accordance with the features of claim 1, by a mounting and positioning device for a surgical instrument and/or an endoscope for minimally invasive surgery, and in particular for use within a surgical robot system, which
      • comprises a first axis of rotation, around which a support element is rotatably arranged, wherein the first axis of rotation always intersects with the longitudinal axis of at least one surgical instrument and/or an endoscope in a pivot point, as the result of a feeding drive being fixed on the support element, said feeding drive arranging an instrument drive unit in rotatable fashion around a pivot point,
      • and wherein a telescopic device is provided at an instrument drive unit, which allows for the translatory movement of the surgical instrument and/or the endoscope into the body, along its longitudinal axis using a guide device in such fashion that the longitudinal axis of the surgical instrument and/or the endoscope is variably adjustable in relation to the telescopic device.
  • In addition, the objects are achieved by the present invention, in accordance with the features of claim 11 by a surgical robot system with multiple robot arms, on which at least a surgical instrument and/or an endoscope for the minimally invasive surgery can be arranged, at least two mounting and positioning devices are arranged on a mounting support system that essentially runs transversely to the mounting and positioning devices, wherein the mounting support system is constructed from one coupling point for each mounting and positioning device, and wherein the coupling points are connected rigidly or via joints with each other.
  • Further advantageous embodiments of the invention and the surgical robot system according to the invention arise from the subclaims analogous to the manipulator arm for active positioning of a surgical instrument. This is a result in particular of the fact that the manipulator arm for active positioning of a surgical instrument according to the invention can be combined or retrofitted with a robot system. According to the invention, the terms robot system and telemanipulator be used synonymously.
  • It is advantageous if the instrument drive unit on the telescopic device is pivoted by means of an instrument pivot point so that the longitudinal axis of the telescope of the telescopic device is variable in relation to the longitudinal axis of the surgical instrument and/or the endoscope in dependence on the feeding drive.
  • A further embodiment of the invention is formed and arranged in a manner such that a telescopic device comprises several telescope elements, wherein the instrument pivot point is arranged on the telescope element with the largest range of adjustment.
  • In a preferred embodiment the guide device comprises at least one instrument guide, through which the shaft of the surgical instrument and/or the endoscope extends.
  • It is especially advantageous that the feeding drive is arranged on the telescopic device by means of a feeding drive position point, in such fashion that the rotation of the instrument drive unit around the pivot point is the result of a coupling device comprising a coupling pivot point which is firmly connected with the support element.
  • The rotation of the instrument drive unit with the instruments and/or an endoscope around the pivot point as well as the coupling pivot point allows for the essentially fixed arrangement of the support element in relation top the pivot point.
  • In a preferred embodiment the mounting and positioning device is arranged in a manner such that the instrument drive unit moves the surgical instrument and/or the endoscope in several degrees of freedom, wherein the activation of the instrument drive unit is controlled by the surgeon with a control unit, by means of control and supply lines, which are guided through the support element and the feeding drive.
  • The first axis of rotation is in particular formed in that a drive unit is provided that controls the surgical instrument and/or endoscope, wherein the drive unit can be mounted on a robotic arm and a pivot joint is provided between the drive unit and the support element.
  • A further embodiment is arranged in a manner such that a coupling element is arranged on the support element, which is rotatably connected at the distal end at the pivot point with the instrument guide. Hereby the pivot point is mechanically predefined in relation to the support element, which allows for an additional fixing of the pivot point.
  • Furthermore, the present invention can be expanded in that several surgical instruments are guided through a single trocar into the body, wherein a separate instrument drive unit is provided for each surgical instrument, and wherein in particular the surgical instruments are curved in a longitudinal direction.
  • If the support element can be adjusted in its starting position by means of a prepositioning device, wherein the prepositioning device comprises one or more prepositioning elements, the position of which is adjustable in at least one axis, wherein in particular four prepositioning elements can be preset with positions that are in series and variable in relation to one another, then the mounting and positioning device can be preset to a desired position.
  • The surgical robot system according to the invention may also expanded in such a manner that the mounting support system by means of a coupling support connection is connected to an essentially vertically running main support device, for support in relation to a fixed bearing, which is movably arranged or predefined in relation to a fixed or movable operating table.
  • In another embodiment the invention the surgical robot system according comprises a central control unit, which is connected with each of the mounting and positioning devices with the appropriate surgical instruments and/or endoscopes and is coupled with a control panel for entering commands in the form of control data provided by a surgeon, which by means of a visualization unit provides image data from one or multiple endoscopes.
  • It is furthermore advantageous that the control unit and the control panel are coupled with a movable operating table, wherein both the image data as well as the control data are processed in dependence of the given positions of the mounting and positioning device and the operating table.
  • The present invention is realized in purely exemplary manner by the attached figures. Shown are:
  • FIG. 1 a shows a schematic view of the manipulator arm according to the invention for active positioning of a surgical instrument which is connected to a telescopic jib by means of a pivotably mounted drive unit, including a coupling element between the guide device for inserting a surgical instrument and the constructive device for achieving the second axis of rotation;
  • FIG. 1 b shows a schematic view of the manipulator arm according to the invention for active positioning of a surgical instrument which is connected to a telescopic jib by means of a pivotably mounted drive unit, including a coupling element between the guide device for inserting a surgical instrument and the constructive device for achieving the second axis of rotation;
  • FIG. 2 a shows a further schematic view of the manipulator arm according to the invention for active positioning of a surgical instrument which is connected to a telescopic jib by means of a pivotably mounted drive unit, including a coupling element between the guide device for inserting a surgical instrument and the constructive device for achieving the second axis of rotation, which illustrates the sliding motion that creates the rotational movement about the second axis of rotation by means of a coupling joint;
  • FIG. 2 b shows a further schematic view of the manipulator arm according to the invention for active positioning of a surgical instrument which is connected to a telescopic jib by means of a pivotably mounted drive unit, including a coupling element between the guide device for inserting a surgical instrument and the constructive device for achieving the second axis of rotation, which illustrates the sliding motion that creates the rotational movement about the second axis of rotation by means of a coupling joint;
  • FIG. 3 a shows a schematic view of the manipulator arm according to the invention for active positioning of a surgical instrument which is connected to a telescopic jib by means of a pivotably mounted drive unit, without the coupling element according to FIG. 1 a;
  • FIG. 3 a shows a schematic view of the manipulator arm according to the invention for active positioning of a surgical instrument which is connected to a telescopic jib by means of a pivotably mounted drive unit, without the coupling element according to FIG. 13;
  • FIG. 4 shows a schematic view of the manipulator arm according to the invention for active positioning of a surgical instrument without the coupling element according to FIG. 1, which illustrates the sliding motion that creates the rotational movement about the second axis of rotation by means of a coupling joint and the coupling of the instrument drive unit;
  • FIG. 5 a shows a top view of an embodiment of the manipulator arm according to the invention for active positioning of a surgical instrument, which comprises a telescopic arm on the right side;
  • FIG. 5 b shows a top view of an embodiment of the manipulator arm according to the invention for active positioning of a surgical instrument, which comprises a telescopic arm on the left side;
  • FIG. 6 shows a schematic view of embodiments of the manipulator arm according to the invention for active positioning of a surgical instrument, which comprise telescopic arm on the right side and telescopic arm on the left side for mutual use with a single port trocar;
  • FIG. 7 shows a schematic view of the flexibly adjustable support structure according to the invention;
  • FIG. 8 shows a schematic view of the prepositioning device according to the invention;
  • FIG. 9 shows a schematic view of the flexibly adjustable support structure according to the invention with a connected prepositioning device according to the invention on which a manipulator arm according to the invention for active positioning of a surgical instrument is arranged;
  • FIG. 10 shows a schematic side view of a superordinate carrying system, on which the flexibly adjustable support structure according to the invention is arranged with four connected prepositioning devices according to the invention on each of which a manipulator arm according to the invention for active positioning of a surgical instrument is arranged;
  • FIG. 11 shows a schematic front view of a superordinate carrying system, on which the flexibly adjustable support structure according to the invention is arranged with four connected prepositioning devices according to the invention on each of which a manipulator arm according to the invention for active positioning of a surgical instrument is arranged;
  • FIG. 12 shows a schematic view of the use of the superordinate carrying system in a surgical robot system for use in minimally invasive surgery, like e.g. laparoscopy.
  • The present invention is described below in exemplary manner in detail with reference to the figures described below:
  • FIG. 1 a, FIG. 2 a, FIG. 1 b and FIG. 2 b show a manipulator arm according to the invention for active positioning of a surgical instrument, including a coupling element 12 between the guide device 10 for inserting a surgical instrument 9 and the constructive device 4 for achieving the second axis of rotation. Generally 4 surgical instruments are use during a minimally invasive, laparoscopic surgery, of which 3 are surgical instruments and 1 is a camera or endoscope, controlled by the surgeon by means of the telemanipulator system. Thus, according to the invention, the system comprises preferably 4 versions of a manipulator arm. However, it goes without saying that also embodiments with 1 to 3 or more than 4 manipulator arms in accordance with the present invention may be provided, with each manipulator arm comprising at least a mounting and positioning device according to the invention.
  • Each manipulator arm has the degree of freedom 3 required for realization of a pivoting motion of an instrument 9 coupled via an instrument drive unit 15 in x- and y-direction, and for a translational movement in z-direction. To this end, each manipulator arm comprises a first drive unit 1, which enables a rotational movement of ±120° about the axis of rotation 3 via pivot joint 2, starting from the zero point position. This rotational movement about the axis 3 results in a tilting of the coupled constructive device consisting of the elements 4, 5, 6, 7, 8, 12 about an invariant point 13, the so-called pivot point. The support element 4 carries a feeding drive 5, which realizes a second rotational movement about a second pivot point 6, orthogonally to axis of rotation 3. The coupling element 12 between the support element 4 and the grommet 10 for a surgical instrument 9 is connected at the pivot point 13 with the grommet 10 in a manner such that the axis of rotation 3 extends through this pivot point 13 and the grommet 10, being forcibly actuated around the axis of rotation 3, implements the tilting. The grommet 10 implements the access for a surgical instrument 9 through the abdominal wall 14 of a patient. By means of a feeding drive 5 a force transmission to a coupling guide 7 in pivot point 55 is achieved, which realizes a rotation of the coupling guide 7 about the pivot point 6 of at least ±60°. The grommet 10 serves in particular as guide device for the surgical instrument 9 and has a guide shaft 10 s that serves to guide instrument 9 and preferably is formed in one piece with grommet 10.
  • A telescopic jib 8 is arranged on the coupling guide 7. The telescopic jib 8 comprises an actuating drive 81. The supply and control lines for the actuating drive 81 of the telescopic jib 8 are guided along the feeding drive 5 through the support element 4 and the drive unit 1. The supply and control lines for the feeding drive 5 are guided through the support element 4 and the drive unit 1.
  • An instrument drive unit 15 is rotatably arranged on the telescopic jib 8, as shown in FIG. 2 a or 2 b. The instrument drive unit 15 serves for the realization of the degree of freedom 4 of an instrument 9 coupled with it. For this purpose an instrument drive unit 15 is equipped with the respective actuating drives. The supply and control lines for the actuating drives of the instrument drive unit 15 are guided via the telescopic jib 8 along the feeding drive 5 through the support element 4 and the drive unit 1.
  • A tilting of the coupling element 7 leads to a tilting motion of the telescopic jib 8 attached thereto about the axis 6 and thus to a tilting of the instrument drive unit 15 and surgical instrument 9 coupled with it. This leads to a tilting motion of the grommet 10 in an orthogonal axis to the axis of rotation 3 about the pivot point 13 (see FIG. 2 a). The resulting position of the longitudinal axis of the instrument 11 corresponds to the axis between an instrument pivot point 56 of the instrument drive unit 15 on the telescopic jib 8 and the pivot point 13. The surgical instrument 9 is forcibly guided along the longitudinal axis of the instrument 11 by means of the grommet 10 in a manner such that by means of the drives 1 and 5 a pivotal tilting motion of the surgical instrument 9 about the pivot point 13 is realized in axes orthogonally to each other. A telescopic jib 8 is arranged on the coupling guide 7 such that the surgical instrument 9 is mounted on the telescopic jib 8 by means of the instrument drive unit 15 can be moved along the longitudinal axis of the instrument 11 and through the grommet 10 and thereby be moved in relation to abdominal wall 14. The entire design can be implemented in extremely compact manner. Surgical Instruments 9 typically have a diameter of 5 to 10 mm and a length of 250 to 300 mm. The embodiment according to the invention of the telescopic jib 8 is designed in a way that a surgical instrument 9 can be moved by preferably at least 250 mm along its axis of the instrument 11 in relation to the grommet 10 and that, in the case of the maximum penetration depth of the surgical instrument 9 into the grommet 10 the telescopic jib 8 is at its minimal length, i.e. extends only marginally beyond the proximal end of the surgical instrument 9, and thus the risk of collision between different surgical instruments 9 or telescopic jibs 8 of manipulator arms arranged side-by-side resulting from the necessary pivoting motions is minimized. The entire design has a significantly minimized installation space, compared to prior art. The full construction length 16 of a manipulator arm according to the invention as measured from the drive unit 1 to the pivot point 13 is preferably less than 500 mm. The embodiment with the coupling element 12 for forcibly guiding the pivot point 13 at the grommet 10 allows for the use of the manipulator arm according to the invention also in case of open, non-minimally invasive operations.
  • FIG. 3 a, FIG. 3 b and FIG. 4 show a manipulator arm according to the invention for active positioning of a surgical instrument 9 without mechanical coupling between the guide device 10 for insertion of a surgical instrument and the constructive device 4 for realization of the second axis of rotation. In accordance with this embodiment the tilting movements about the axes of rotation 3 and 6 produced by drive units 1 and 5 are not mechanically transferred to the pivot point 13. In this embodiment the grommet 10 acts as floating bearing within the abdominal wall 14, as is the case in manual laparoscopy with hand-held instruments. In this embodiment the orientation of the axis of the instrument between the pivot point 56 of the instrument drive unit 15 and the pivot point of the guide device 10 results in the abdominal wall 14. The pivot point 13 in or on the abdominal wall 14 eventuates from the resulting force between torque impressed from the outside and reset or holding torque of the abdominal wall. This puts less stress on the tissue of the abdominal wall, in particular if more than one instrument 9 is used, each in its own guide device 10, because there is no direct fixed mechanically coupled force exerted by the coupling element 12 acting on guide device 10 and thus the abdominal wall 14.
  • The telescopic jib 8 is used to move the instrument 9 through the guide device 10 along the axis of the instrument. The sliding motion results from moving at least 2, preferably 3 telescope elements 8 u, 8 v, 8 w in relation to each other by means of an actuating drive 81 and actuating elements 82, 83, preferably formed as toothed belts. The Instrument 9 is mounted on the outermost telescope element 8 w in pivotable manner, by means of the instrument drive unit 15 in instrument pivot point 56.
  • The resulting axis of the instrument 11 of the instrument 9 is not identical with the longitudinal axis of the telescope 58, due to the force transmission point 55 of the feeding device 5 on the telescopic jib. Due to the pivotable arrangement of the instrument drive unit 15 on the outmost telescopic jib 8 w and the resulting possible pivoting or compensating movement about the instrument pivot point 56, neither the force transmission point 55 nor the pivot point 6 of the coupling element 7 have to be on the longitudinal axis of the instrument 11. In particular, the pivotable arrangement of the instrument drive unit 15 about the instrument pivot point 56 makes it possible that the longitudinal axis of the instrument 11 and the longitudinal axis of the telescope 58 are variable to each other, wherein the force transmission point 55 and the instrument pivot point 56 are different and affect each other.
  • Omitting the coupling element 12 allows for guiding two surgical instruments 9 through a common grommet 10 by means of two manipulator arms according to the invention and represents a substantial improvement and increased flexibility in comparison to prior art.
  • FIGS. 5 a and 5 b show a top view of two different embodiments of the manipulator arm according to the invention for active positioning of a surgical instrument. The design can preferably be used in a “right-sided” or “left-sided” embodiment. Starting from the first drive unit la, 1 b with the pivot joint 2 a, 2 b, the second drive unit 4 a can be to the right of the axis of rotation 3 a—right-sided embodiment—or the second drive unit 4 b can be to the left of the axis of rotation 3 a—left-sided embodiment. The rotation movement, which is orthogonal to the axis of rotation 3 a, 3 b is created by the drive unit 5 a, 5 b. The movement of the surgical instrument 9 a, 9 b along its longitudinal axis of the instrument through the grommet 10 a, 10 b is carried out by the telescopic jib 8 a, 8 b. The surgical instrument 9 a, 9 b itself is mechanically connected with the telescopic jib 8 a, 8 b, by means of an instrument drive unit 15 a, 15 b.
  • FIG. 6 shows the use of two manipulator arms according to the invention for active positioning of a surgical instrument in the “left-handed” and “right-handed” embodiments for mutual use with a single port trocar 18 with the grommets 18 a, 18 b, 18 c. In this configuration it is preferable that curved instruments 17 a, 17 b are used in combination with a left-sided manipulator arm 1 b, 4 b, 8 b and a right-sided manipulator arm la, 4 a, 8 a, with the advantage that the surgical instruments 17 a, 17 b can be used through a mutual trocar 18—which enables access through the abdominal wall 14 of the patient—and respectively separate grommets 18 a, 18 b of the mutual trocar 18. The separate grommets 18 a, 18 b, and 18 c of the mutual trocar 18 are mounted in movable pivotable fashion relative to the trocar 18 by means of an elastic material 60. The option of using the manipulator arm according to the invention without the mechanical coupling 12 between the support element 4 on the manipulator arm and the pivot point 13 (see FIG. 1 a), makes the use of only one trocar 18 with at least two grommets 18 a, 18 b possible. Through the use of a left-sided manipulator arm 1 b, 4 b, 8 b according to the invention and a right-sided manipulator arm invention 1 a, 4 a, 8 a according to the invention the danger of the manipulator arms colliding as a result from the pivotal tilting motion can be minimized.
  • Due to the preferable use of curved instruments 17 a and 17 b in a single port trocar 18, a relative motion 62 a, 62 b of the two instruments leads towards each other, e.g. in order to connect tissue by means of a seam stitching in the surgical area, whereas a relative motion 61 a, 61 b of the two manipulator arms outside of the patient leads away from each other. This ensures that the manipulator arms cannot collide with each other.
  • The use of crossover instruments in the single port surgical technique is known from prior art. In contrast, the present embodiment as a matter of principle holds the advantage of collision avoidance while moving the instrument tips inside the body of the patient towards or away from each other.
  • FIG. 7 shows the design of a flexible carrier system or mounting support system 19-26 for preferably up to 4 prepositioning devices and manipulator arms. The flexible carrier system can be mounted to a superordinate carrying system via a coupling point 19 in such a manner that the position of the flexible carrier system about the axis of rotation 20 can be optimally adjusted by at least ±90°. The flexible carrier system consists of preferably 4 coupling points 22 a . . . d for the adaptation of up to four prepositioning devices. The outer coupling points 22 a, 22 d are connected with the coupling points 22 b, 22 c through the joints 23, 24 in a manner such that they can be pivoted by up to 30° in relation to the axis 20. The entire design is kept to an optimized minimal installation space 25, 26 of approximately 415 mm or 350 mm as an exemplary design and can preferably be formed so that, for example, the width of the flexible carrier system can be a maximum of 700 mm.
  • FIG. 8 shows a prepositioning device 29 . . . 38 according to the invention for adapting a flexible carrier system (FIG. 7) and mounting a manipulator arm according to the invention (FIG. 1 . . . 4). The prepositioning device is arranged on a coupling point (e.g. 22 d) of the flexible carrier system by means of a coupling joint 29 and allows for the twisting of a first prepositioning element 30 by preferably ±90° in relation to the flexible carrier system or the coupling point. A second prepositioning element 32 is arranged so that it can be rotated by further ±90° in relation to the first prepositioning element 30, by means of a further joint 31. The axes of rotation of the coupling point 29 and the joint 31 are preferably arranged orthogonally to each other. The second prepositioning element 32 is connected with a third prepositioning element 34 by means of a further joint 33 in such a manner that the third prepositioning element 34 is pivoted by ±90° in relation to the second prepositioning element 32. The third prepositioning element 34 is connected with a fourth prepositioning element 37 by means of a pivot joint 35. In this regard the axis of rotation 36 is preferably orthogonal to the axis of rotation of the joints 31 and 33 respectively and allows rotational movement of ±90°. The fourth prepositioning element 37 has a coupling point, which allows for a rotational movement about the axis of rotation 38 orthogonal to the axis of rotation 36. The coupling of the manipulator arm according to the invention is made at the axis of rotation 38, as shown in the FIGS. 1, 2, 3, 4, 5 a and 5 b.
  • FIG. 9 shows a preferable embodiment for the connection of the flexible mounting and carrier system 19-26 with a prepositioning device according to the invention 29-38 with an exemplary manipulator arm according to the invention 1, 2, 3, 4, 8, 10, 15 coupled thereto. The drive unit 1 is of the manipulator arm is connected at the fourth prepositioning element 37 of the prepositioning device in the axis of rotation 38. The design is formed in a manner such that either a left-sided or right-sided embodiment of the manipulator according to the invention can be connected to the axis of rotation 38 of the prepositioning device.
  • FIG. 10 and FIG. 11 shows a design of the surgical robot system according to the invention and in particular of the superordinate carrier system 39-43 to which the flexibly adjustable carrier system 22 a-22 d is coupled by means of the coupling point or coupling support connection 19. The superordinate carrier system allows for the optimal prepositioning of the flexible carrier system 22 a-22 d by means of a horizontal alignment of the preferably mobile base carrier or fixed bearing 42 in relation to the surgical table 48 (see FIG. 12) and a vertical alignment by setting the optimal angle between assembly 39 and 40 by means of the adjusting element 41. The prepositioning device according to the invention 29 d . . . 38 d is connected to the flexible carrier system by means of the coupling point 29 d and mounts the manipulator arms according to the invention at the coupling point 38 d. The entire design distinguishes itself from prior art in that all robot components are concentrated in the manipulator arm and thus the entire design requires significantly less installation space when compared to prior art, especially having a mere height 43 of exemplary 1447 mm.
  • FIG. 12 shows a schematic general view of the use of the superordinate carrier system 39 . . . 42 in a surgical robot system for use in minimally invasive surgery, such as e.g. laparoscopy. By means of an operating unit 44, the user can transmit control commands for the actuators of the manipulator arm according to the invention to a control unit 46 via a suitable data connection 45. Said control unit is connected with the superordinate carrier system 39 . . . 42 via a further data line 49 and, when equipped with a support arm or main support device 39, 40, a flexible carrier system 39, 40 connected by means of the coupling point 19 can be prepositioned according to the position of the patient on the surgical table 48 by means of a coupling point 19 so that the flexible carrier system in conjunction with the prepositioning devices allows for an optimal positioning of the manipulator arms.
  • If a manipulator arm according to the invention is fitted with e.g. an endoscopic camera the image signals can be transmitted to a processing unit 51 via the appropriate data connections 49, 45, 50, which processes the image data for presentation and feeds it back to a visualization unit 53 via a further data connection 53. The visualization unit 53 can display both 2D and 3D image data, for example separately but also combined in a single image or a single series of pictures. The control of how image data is displayed is performed by the control unit 44, according to the wish of the operator or surgeon respectively. The control commands produced by the control unit 44 for this purpose are transmitted to processing unit 51 via data connection 51.
  • The present invention therefore relates on the one hand to a mounting and positioning device of a surgical instrument and/or an endoscope, wherein one or more such mounting and positioning devices according to the invention are arranged on a surgical robot system above coupling points respectively, wherein these coupling points are connected to each other respectively, so that the required installation space of the surgical robot system advantageous is only very small. The particularly compact construction is furthermore the results of the especially light and compact practicability of the mounting and positioning device according to the invention, wherein this can furthermore be retrofitted in an existing robot system.
  • In a preferred embodiment the guide device for insertion of a surgical instrument is rigidly connected via a coupling element with the constructive device for realization of the second axis of rotation. The rotation movement of the axis of rotation 1 thus leads to a forced movement of the guide device for insertion of a surgical instrument about the invariant point in a direction x.
  • In a further preferred embodiment the guide device for insertion of a surgical instrument is not rigidly connected with the constructive device for realization of the second axis of rotation. Thus the guide device for insertion of a surgical instrument acts as floating bearing in the abdominal wall, as is normal for manual laparoscopy.
  • In a further preferred embodiment the surgical instrument is coupled with the telescopic device by means of an instrument drive that comprises a rotational actuator, through which the shaft of the surgical instrument is rotatably varied about the z-direction in relation to the starting position. Preferably, the instrument drive unit comprises three instrument actuators, through which the active component mounted on the distal end of the surgical instrument can be varied in three additional degrees of freedom. It is particularly preferred that the instrument drive unit is arranged by means of a holding device at the proximal end of the telescopic mechanism.

Claims (14)

1. Mounting and positioning device of a surgical instrument and/or an endoscope for minimally invasive surgery, in particular for use within a surgical robot system, comprising
a first axis of rotation (3), around which a support element (4) is rotatably arranged, wherein the first axis of rotation (3) intersects with the longitudinal axis (11) of at least one surgical instrument (9; 17A, 17 b) and/or an endoscope (9; 17A, 17 b) in a pivot point (13), as the result of a deviation drive (5) being fixed on the support element (4), said deviation drive arranging an instrument drive unit (15) in rotatable fashion around a pivot point (13),
and wherein a telescopic device (8) is provided at an instrument drive unit (15), which allows for the translatory movement of the surgical instrument (9; 17A, 17 b) and/or the endoscope (9; 17A, 17B) into the body, along its longitudinal axis (11) using a guide device (10, 10 s) in such fashion that the longitudinal axis (11) of the surgical instrument (9; 17A, 17 b) and/or the endoscope (9; 17A, 17 b) is variably adjustable in relation to the telescopic device (8).
2. Mounting and positioning device according to claim 1, characterized in that the instrument drive unit (15) on the telescopic device (8) by means of an instrument pivot point (56) is pivoted so that the longitudinal axis of the telescope (58) of the telescopic device (8) is variable in relation to the longitudinal axis (11) of the surgical instrument (9; 17A, 17 b) and/or the endoscope (9; 17A, 17 b) in dependence on the deviation drive (5).
3. Mounting and positioning device according to claim 1 or 2, characterized in that the telescopic device (8) comprises several telescope elements (8U, 8V, 8W), wherein the instrument pivot point (56) is arranged on the telescope element (8W) with the largest range of telescopic adjustment.
4. Mounting and positioning device according to one of the preceding claims 1 to 3, characterized in that the guide device (10, 10 s) comprises at least one instrument guide (10 s), through which the shaft of the surgical instrument (9; 17A, 17 b) and/or the endoscope (9; 17A, 17 b) extends.
5. Mounting and positioning device according to one of the preceding claims 1 to 4, characterized in that the deviation drive (5) is arranged on the telescopic device (8) by means of a deviation drive position point (55), in such fashion that the rotation of the instrument drive unit (15) around the pivot point (13) is the result of a coupling device (6, 7) comprising a coupling pivot point (6) which is firmly connected with the support element (4).
6. Mounting and positioning device according to one of the preceding claims 1 to 5, characterized in that the instrument drive unit (15) moves the surgical instrument (9; 17A, 17 b) and/or the endoscope (9; 17A, 17B) in several degrees of freedom, wherein the activation of the instrument drive unit (15) is controlled by the surgeon with a control unit (44), by means of control and supply lines, which are guided through the support element (4) and the deviation drive (5).
7. Mounting and positioning device according to one of the preceding claims 1 to 6, characterized in that the first axis of rotation (3) is formed in that a drive unit (1) is provided that can be mounted on a robotic arm, wherein a pivot joint (2) is provided between the drive unit (1) and the support element (4).
8. Mounting and positioning device according to one of the preceding claims 1 to 7, characterized in that a coupling element (12) is arranged on support element (4), which is rotatably connected at the distal end at the pivot point (13) with the instrument guide (10 s).
9. Mounting and positioning device according to one of the preceding claims 1 to 8, characterized in that several surgical instruments (17 a, 17 b) are guided through a single trocar (18) into the body, wherein a separate instrument drive unit (15 a, 15 b) is provided for each surgical instrument (17 a, 17 b), and wherein in particular the surgical instruments (17 a, 17 b) are curved in a longitudinal direction.
10. Mounting and positioning device according to one of the preceding claims 1 to 9, characterized in that the support element (4) and/or the drive unit (1) can be adjusted by means of a pre-positioning device in its starting position, wherein the pre-positioning device comprises one or more pre-positioning elements (30, 32, 34, 37), the position of which is adjustable in at least one axis, wherein in particular four pre-positioning elements (30, 32, 34, 37) can be preset with positions that are in series and variable in relation to one another.
11. Surgical robot system with multiple mounting and positioning devices according to one of the claims 1 to 10, wherein at least two mounting and positioning devices are arranged on a mounting support system (19, 20, 21, 22, 23, 24) that essentially runs transversely to the mounting and positioning devices, wherein the mounting support system (19, 20, 21, 22, 23, 24) is constructed from one coupling point (22 a-d) for each mounting and positioning device, and wherein the coupling points (22 a-d) are connected rigidly or via joints (23, 24) with each other.
12. Surgical Robot System according to claim 11, characterized in that the mounting support system (19, 20, 21, 22, 23, 24) by means of a coupling support connection is connected to an essentially vertically running main support device (39, 40), for support in relation to a fixed bearing (42), which is movably arranged or predefined in relation to a fixed or movable operating table (48).
13. Surgical Robot System according to claim 11 or 12, characterized in that a central control unit (46) is provided, which is connected with each of the mounting and positioning devices with the appropriate surgical instruments (9; 17A, 17 b) and/or endoscopes (9; 17A, 17 b) and is coupled with a control panel (44) for entering commands in the form of control data provided by a surgeon, which by means of a visualization unit (53) provides image data from one or multiple endoscopes (9; 17A, 17 b).
14. Surgical Robot system according to one of the claims 11 to 13, characterized in that the control unit (46) and the control panel (44) are coupled with a movable operating table (48), wherein both the image data as well as the control data are processed in dependence of the given positions of the mounting and positioning device and the operating table (48).
US13/828,008 2012-12-20 2013-03-14 Device for Supporting and Positioning of a Surgical Instrument and/or an Endoscope for Use in Minimal-Invasive Surgery and a Surgical Robotic System Abandoned US20150005784A2 (en)

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JP2016503678A (en) 2016-02-08
US20160184030A1 (en) 2016-06-30
RU2015129335A (en) 2017-01-24
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US9795454B2 (en) 2017-10-24
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BR112015014298A2 (en) 2017-07-11
JP6342418B2 (en) 2018-06-13

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