US20200205849A1 - Methods and devices for soft tissue dissection - Google Patents
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
- A61B2017/00305—Constructional details of the flexible means
- A61B2017/00314—Separate linked members
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
- A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B2017/320004—Surgical cutting instruments abrasive
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
- A61B2017/320028—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments with reciprocating movements
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
- A61B2017/320032—Details of the rotating or oscillating shaft, e.g. using a flexible shaft
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B2017/320044—Blunt dissectors
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B2017/32006—Surgical cutting instruments with a cutting strip, band or chain, e.g. like a chainsaw
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, 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
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
- A61B2090/036—Abutting means, stops, e.g. abutting on tissue or skin abutting on tissue or skin
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Abstract
Methods and devices for blunt dissection include a differential dissecting instrument (DDI) comprising a rotary drive train having a distal end configured to be pointed substantially at a complex tissue and a proximal end pointed substantially at, and associated with, a mounting base. The DDI comprises a drive wheel possessing an axis of wheel rotation coaxial with a central, longitudinal axis of the rotary drive train, the drive wheel located distally to, and rotated by, the rotary drive train. The drive wheel comprises a drive point located at a non-zero radius from the axis of wheel rotation. The DDI also comprises a differential dissecting member rotatably mounted distally to the drive wheel and having an axis of member rotational oscillation.
Description
- The present application claims priority to and is a divisional of U.S. patent application Ser. No. 15/304,679, entitled “Methods and Devices for Soft Tissue Dissection,” filed on Oct. 17, 2016 and published as U.S. Patent Application Publication No. 2017/0042562, which in turn is a 35 U.S.C. § 371 national phase filing of International Application No. PCT/US2015/026466, filed Apr. 17, 2015, which claims priority to U.S. Provisional Patent Application No. 61/981,556, entitled “Instruments, Devices, and Related Methods for Soft Tissue Dissection,” filed on Apr. 18, 2014, the foregoing applications being incorporated herein by reference in their entireties.
- The present application is also related to co-pending U.S. patent application Ser. No. 14/065,191, entitled “Instruments, Devices, and Related Methods for Soft Tissue Dissection,” filed on Oct. 28, 2013, now issued as U.S. Pat. No. 9,592,069, which in turn is a continuation-in-part application of, and claims priority to, co-pending U.S. patent application Ser. No. 13/872,766 entitled “Instruments, Devices, and Related Methods for Soft Tissue Dissection, filed Apr. 29, 2013, now issued as U.S. Pat. No. 9,538,995, which in turn claims priority to the following three Provisional Applications: U.S. Provisional Patent Application No. 61/783,834, entitled “Instruments, Devices, and Related Methods for Soft Tissue Dissection,” filed on Mar. 14, 2013; U.S. Provisional Patent Application No. 61/744,936, entitled “Instrument for Soft Tissue Dissection,” filed on Oct. 6, 2012; and U.S. Provisional Patent Application No. 61/687,587, entitled “Instrument for Soft Tissue Dissection,” filed on Apr. 28, 2012, all of which are incorporated herein by reference in their entireties.
- The field of the disclosure relates to methods or devices used to dissect tissue during surgery or other medical procedures.
- Surgeons sever or separate patients' tissues as a major component of most surgical procedures. Called “dissection,” this is how surgeons tunnel from an accessible region of a patient to reach a target within. The two dominant dissection techniques are: (1) “sharp dissection,” where surgeons sever tissues with either scissors, scalpels, electrosurgical devices, and other cutting instruments; and (2) “blunt dissection,” consisting of separating tissues by controlled tearing of one tissue from another.
- The advantage of sharp dissection is that the cutting instrument easily cuts through any tissue. The cut itself is indiscriminate, slicing through all tissues to which the instrument is applied. This is also the disadvantage of sharp dissection, especially when trying to isolate a first tissue without damaging it, when the first tissue is embedded in, and is obscured by, a second tissue or, more commonly, is enveloped in many tissues. Accidental cutting of a blood vessel, a nerve, or of the bowel, for example, is a constant threat for even the most experienced surgeons and can rapidly lead to serious, even life-threatening, intra-operative complications, with prolonged consequences for the patient. When employing minimally invasive procedures, for example laparoscopy or the use of a surgical robot, the chances of surgical error increase.
- Isolation of a first tissue embedded in other tissues is thus frequently performed by blunt dissection. In blunt dissection, a blunt instrument is used to force through a tissue, to force apart two tissues, or to otherwise separate tissues by tearing rather than cutting. Almost all surgeries require blunt dissection of tissues to expose target structures, such as blood vessels to be ligated, or nerve bundles to be avoided. Examples in thoracic surgery include isolation of blood vessels during hilar dissection for lobectomy and exposure of lymph nodes.
- Blunt dissection includes a range of maneuvers, including various ways to tease apart or tear soft tissues, such as the insertion of blunt probes or instruments, inverted action (i.e., spreading) of forceps, and pulling of tissues with forceps or by rubbing with a “swab dissector” (e.g., surgical gauze held in a forceps, or a purpose-built, disposable swab stick). When needed, sharp dissection is used judiciously to cut tissues that resist tearing during blunt dissection.
- The general goal of blunt dissection is to tear or otherwise disrupt occluding tissue, such as membranes and mesenteries, away from the target structure without tearing or disrupting either the target structure or critical structures such as nearby vessels or nerves. The surgeon capitalizes on the different mechanical behaviors of tissues, such as the different stiffness of adjacent tissues, or the existence of planes of softer tissue between firmer tissues. Frequently, the surgeon's goal is to isolate a target tissue that is mechanically firm, being composed of more tightly packed fibrous components, and is embedded in a tissue that is mechanically soft, being composed of more loosely packed fibrous components (for example, loose networks of collagen, reticulin, or elastin). More tightly packed fibrous tissues include tissues composed of tightly packed collagen and other fibrous connective tissues, usually having highly organized anisotropic distributions of fibrous components, often with hierarchical composition. Examples include blood vessels, nerve sheaths, muscles, fascia, bladders, and tendons. More loosely packed fibrous tissues have a much lower number of fibers per unit volume or are composed of less well organized materials such as fat and mesenteries. Fibrous components include fibers, fibrils, filaments, and other filamentous components. When a tissue is referred to as “fibrous”, the reference is typically to extracellular filamentous components, such as collagen and elastin—proteins that polymerize into linear structures of varying and diverse complexity to form the extracellular matrix. As mentioned in the previous paragraph, the density, orientation, and organization of fibrous components greatly determine the tissue's mechanical behavior. Sometimes, tissues are referred to as “tough, fibrous tissues” indicating that the fibrous or filamentous components are densely packed, organized, and comprise a significant fraction of the bulk of the tissue. However, all tissues are fibrous, to one extent or another, with fibers and other filamentous extracellular components being present in virtually every tissue.
- What is important to the present discussion is that softer tissues tear more easily than firmer tissues, so blunt dissection attempts to proceed by exerting sufficient force to tear softer tissue but not firmer tissue.
- Blunt dissection can be difficult and is often time-consuming. Judging the force to tear a soft tissue, but not a closely apposed firm tissue, is not easy. Thus, blood vessels can be torn. Nerves can be stretched or torn. In response, surgeons attempt judicious sharp dissection, but blood vessels, nerves, and airways can be cut, especially the smaller side branches, which become exponentially more common at smaller scales. This all leads to long, tedious dissections and increased risk of complications, like bleeding, air leaks from the lungs, and nerve damage.
- Surgeons frequently use forceps for blunt dissection.
FIGS. 1A and 1B show atypical forceps 10 of the prior art.FIG. 1A shows theforceps 10 in the closed position for clamping atissue 34 between the opposingfirst clamp element 30 andsecond clamp element 31.FIG. 1B shows theforceps 10 in the open position, forcingtissue 34 apart. A first finger engager 20 and an opposing second finger engager 21 are used to actuate the mechanism. First finger engager 20 drivesfirst clamp element 30, and second finger engager 21 drivessecond clamp element 31. Apivot 40 attaches thefirst clamp element 30 and thesecond clamp element 31, permitting a scissor-like action to force thefirst clamp element 30 and thesecond clamp element 31 together or apart, thereby clampingtissue 34 between the twoclamp surfaces tissue 34 by the spreading of thefirst clamp element 30 and thesecond clamp element 31. Frequently, aratcheting clasp 50 is used to lock thefirst clamp element 30 and thesecond clamp element 31 together. - Laparoscopic and thoracoscopic (collectively referred here as “endoscopic”) instruments use a similar action.
FIG. 2 shows an example of anendoscopic forceps 60 of the prior art. A first finger engager 70 and an opposing second finger engager 71 are used to actuate the mechanism. First finger engager 70 is rigidly mounted to theinstrument body 72. Second finger engager 71 drives opposingclamp elements pivot 90 attaches the twoclamp elements forces clamp elements clamp surfaces FIGS. 1A and 1B ,endoscopic forceps 10 can be used to force a tissue apart.Clamp elements - For either instrument, forceps 10 or
endoscopic forceps 60, a surgeon performs blunt dissection by closing the forceps, pushing the closed forceps into a tissue and then, optionally, opening the forceps inside the tissue, using the force applied by opening of the jaws of the forceps to tear the tissue apart. A surgeon thus proceeds to dissect a tissue by a combination of pushing into the tissue and opening the jaws of the forceps. - Blunt dissection is commonly used for wet and slick tissues, and the smooth, passive surfaces of most surgical instruments slide easily along the tissue, impairing the instrument's ability to gain purchase and separate the tissue. Furthermore, the surgeon has only limited control, being able only to jab, move sideways, or separate. An improved instrument for blunt dissection that could differentially separate soft tissues while not disrupting firm tissues would greatly facilitate many surgeries.
- Embodiments disclosed herein include methods and devices for blunt dissection, which differentially disrupt soft tissues while not disrupting firm tissues. In particular, in one embodiment, a drive mechanism and components for a differential dissecting instrument for differentially dissecting complex tissue is disclosed. The drive mechanism for a differential dissecting instrument comprises an elongate rotary drive train having a first proximal end and a second distal end, wherein the first proximal end is connected to a mounting base for attaching to a handle or a surgical robot. The drive mechanism also comprises a differential dissecting member configured to be rotatably attached to the second distal end, the differential dissecting member comprising at least one tissue engaging surface. The drive mechanism further comprises a mechanism configured to mechanically rotate the differential dissecting member about a substantially transverse axis of member rotational oscillation, thereby causing the at least one tissue engaging surface to move in at least one direction against the complex tissue. The at least one tissue engaging surface is configured to selectively engage the complex tissue such that when the differential dissecting member is pressed into the complex tissue, the at least one tissue engaging surface moves across the complex tissue and the at least one tissue engaging surface disrupts at least one soft tissue in the complex tissue, but does not disrupt firm tissue in the complex tissue.
- In another embodiment, a differential dissecting member for dissecting a complex tissue is disclosed. The differential dissecting member comprises a body having a first end and a second end, with a central axis from the first end to the second end. The first end is configured to be directed proximally away from the complex tissue and configured to be engaged with a rotary drive train that moves the differential dissecting member such that the second end sweeps along a direction of motion. The second distal end comprises a tissue-facing surface that is configured to be directed toward the complex tissue. The tissue-facing distal-most surface comprises at least one tissue engaging surface comprised of an alternating series of at least one valley and at least one projection arrayed along the direction of motion on the tissue-facing surface such that the intersection of the at least one valley and at least one projection define at least one valley edge possessing a component of its direction perpendicular to the direction of motion. In one embodiment, the at least one valley edge is not sharp.
- In another embodiment, a differential dissecting member (DDM) for differentially dissecting complex tissue is disclosed. The DDM comprises a body and a looped oscillating drive cable affixed to the body via a tortuous path. The tortuous path comprises at least one topologically constrained loop. The looped oscillating drive cable is configured to drive the body to high speed oscillations.
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FIGS. 1A and 1B show examples of the prior art.FIG. 1A shows forceps used to grasp tissue; -
FIG. 1B shows exemplary forceps used in blunt dissection to divide tissue; -
FIG. 2 shows laparoscopic forceps of the prior art; -
FIGS. 3A through 3H-4 show an exemplary compact drive mechanism for a differential dissecting instrument for mounting on a handle, laparoscopic instrument, or surgical robot arm; -
FIG. 3A shows an oblique view of a differential dissecting attachment (cover ghosted for clarity), having an oscillating differential dissecting member disposed at the end of an oscillatory drive train, including an integral motion filter; -
FIG. 3B shows an oblique view of an oscillating differential dissecting member with motion filter; -
FIG. 3C depicts a top view of an oscillating differential dissecting member with motion filter; -
FIG. 3D shows a side view of an oscillating differential dissecting member with motion filter; -
FIG. 3E shows an end view of an oscillating differential dissecting member with integral motion filter; -
FIG. 3F-0 shows the vertical and horizontal components of the rotary motion of a portion of the rotary drive train, sectioned at a drive wheel; -
FIGS. 3F-1 through 3F-4 show a cross-section of sequential motion of the drive train engaging and driving the motion filter of the oscillating differential dissecting member; -
FIG. 3F-5 depicts a cross-section of the drive train showing the drive train engaging the motion filter via a roller bearing; -
FIGS. 3G-1 through 3G-4 show the side view of sequential motion of the oscillating differential dissecting member engaging the drive train via the integral motion filter; -
FIG. 3H-1 shows an oblique view of an oscillating differential dissecting member with an integral motion filter; -
FIG. 3H-2 depicts a top view of an oscillating differential dissecting member with an integral motion filter; -
FIG. 3H-3 shows a side view of an oscillating differential dissecting member with an integral motion filter; -
FIG. 3H-4 shows an end view of an oscillating differential dissecting member with an integral motion filter; -
FIGS. 3J-1 and 3J-2 depict oblique, top and side views of an oscillating differential dissecting member with a motion filter comprised of a hinged, rigid flat plate; -
FIG. 4A shows an oblique view of the distal portion a differential dissecting instrument (cover transparent for clarity), having an oscillating differential dissecting member connected by a motion filter to the end of an multiple-motor rotary drive train comprised of a plurality of motors, connected in mechanical series, all delivering torque; -
FIG. 4B shows a side view of a coaxial plurality of motors with their driveshafts connected by torsionally stiff, elastic joints, all arranged in a straight line and delivering torque; -
FIG. 4C shows a side view of a plurality of motors with their driveshafts connected by torsionally stiff, elastic joints, showing permitted deflections from a straight line while delivering torque; -
FIG. 4D shows a side view of a plurality of motors with their driveshafts connected by torsionally stiff universal joints, showing deflections from a straight line while delivering torque; -
FIG. 4E shows a side view of a plurality of motors with their driveshafts connected by torsionally stiff universal joints, each motor further covered and connected by its own housing segment, also articulated, and showing deflections, in one plane, from a straight line while delivering torque; -
FIG. 4F-1 shows an oblique view of a plurality of motors with their driveshafts connected by torsionally stiff, flexible universal joints, each motor further covered and connected by its own housing segment, also articulated, and showing deflections, in two planes, from a straight line while delivering torque; -
FIG. 4F-2 depicts the vertical and horizontal axes and center of rotation of an articulated housing joint, and its spatial relation to the housing segment and motor; -
FIG. 4G shows an oblique view of a plurality of motors with their driveshafts connected by torsionally stiff, flexible universal joints, and showing deflections, in two planes at once, from a straight line, and showing rotational deflections of individual motors, all while delivering torque; -
FIG. 5A-1 depicts a cable-driven, controllable differential dissecting member oscillating in a steady, symmetrical, sinusoidal fashion about a center of oscillation that points exactly forward about the longitudinal axis of the differential dissecting instrument; -
FIG. 5A-2 depicts schematically the rotational position and the rotational velocity of the differential dissecting member through time; -
FIGS. 5B-1 and 5B-2 depict a cable-driven, controllable differential dissecting member oscillating in a steady, symmetrical, sinusoidal fashion about a center of oscillation that points at a non-zero angle from the longitudinal axis of the differential dissecting instrument; -
FIGS. 5C-1 and 5C-2 depict a cable-driven, controllable differential dissecting member oscillating in a symmetrical, sinusoidal fashion, but with a varying angular velocity profile, about a center of oscillation that points exactly forward about the longitudinal axis of the differential dissecting instrument; -
FIGS. 5D-1 and 5D-2 depict a cable-driven, controllable differential dissecting member oscillating in a steady, symmetrical, sinusoidal fashion, but with a varying angular velocity profile, about a center of oscillation that points at a non-zero angle from the longitudinal axis of the differential dissecting instrument; -
FIGS. 5E-1 through 5E-3 shows three stages in time of the operation of a controllable differential dissecting attachment located at the distal end of an endoscope, oscillating about a center of oscillation, creating a direction of dissection, and dissection in that direction, and showing arbitrary control of the direction of dissection thus permitting tunneling in arbitrary directions within tissues; -
FIG. 6A-1 shows a differential dissecting member captured by, and driven to oscillate by, a continuous, circuitous loop of fine wire rope or cable passing through fenestrations made in the differential dissecting member for that purpose; -
FIG. 6A-2 further shows the complete, internal, low-stress path of the loop of fine wire rope through the differential dissecting member, forming a “cow-hitch” (or “lark's head”) knot, thereby topologically capturing the differential dissecting member without directly crossing itself; -
FIG. 6B-1 through 6B-5 depict front, back, end, bottom, and profile views of a exemplary cable-retained differential dissecting member; -
FIG. 6C-1 through 6C-3 depict oblique, side, and end views of a cable-retained differential dissecting member with a curved profile; -
FIG. 7 shows an oblique view of a cable-driven differential dissecting member, where the axis of rotation of the differential dissecting member is formed by an elastic planar member, such as a leaf spring, the end of which the differential dissecting member is operably mounted. - Specifically, “Differential Dissecting Attachments (DDA)” are disclosed. The term “differential” is used because a Differential Dissecting Attachment can disrupt Soft Tissue while avoiding disruption of Firm Tissue. The effector end of a Differential Dissecting Attachment, called a Differential Dissecting Member (DDM), can be pressed against a tissue comprised of both Firm Tissue and Soft Tissue, and the Soft Tissue is disrupted far more readily than the Firm Tissue. Thus, when a Differential Dissecting Instrument (DDI) equipped with a DDA bearing a DDM is pressed into a Complex Tissue, the Differential Dissecting Instrument disrupts Soft Tissue, thereby exposing Firm Tissues. This differential action is automatic—a function of the device's design. Far less attention is required of an operator than traditional methods for blunt dissection, and risk of accidental damage to tissues is greatly reduced.
- For the purposes of this application, “soft tissue” is defined as the various softer tissues separated, torn, removed, or otherwise typically disrupted during blunt dissection. “Target tissue” is defined as the tissue to be isolated and its integrity preserved during blunt dissection, such as a blood vessel, gall bladder, urethra, or nerve bundle. “Firm tissue” is defined as tissue that is mechanically stronger, usually including one or more layers of tightly packed collagen or other extracellular fibrous matrices. Examples of firm tissues include the walls of blood vessels, the sheaths of nerve fibers, fascia, tendons, ligaments, bladders, pericardium, and many others. A “complex tissue” is a tissue composed of both soft tissue and firm tissue and can contain a target tissue.
- Embodiments disclosed herein include methods and devices for blunt dissection, which differentially separate soft tissues while not disrupting firm tissues. We disclose a drive mechanism and related components for a differential dissecting instrument for hand use of attachment to surgical machines for the safe blunt dissection of complex tissues. A differential dissecting drive mechanism can grossly comprise first, an elongate member (which may be a housing) with a first, proximal end and a second, distal end, the first proximal end being associated with a mounting base suited to attaching to a surgical machine (for example a handheld laparoscopic instrument, or a surgical robot), second, a rotary drive train to generate rotation, third, a drive wheel to transmit that rotation, fourth, a motion filter to transform that rotation to oscillation, and finally a differential dissecting member to convert that oscillation into the dissection of complex tissues. The motion filter may further refine the rotational motion of the drive wheel into planar oscillation in one step, thereby greatly simplifying the design and manufacture of the differential dissecting attachment.
- Referring to
FIGS. 3A through 3J-2 , we disclose one embodiment of analternate drive mechanism 100 for driving oscillation of a DDM. Thisdrive mechanism 100 can be attached to a handle or to a surgical robot, or to another surgical machine.FIG. 3A disclosesdrive mechanism 100 housed within acover 385, thedrive mechanism 100 further comprising arotary drive train 304 supplyingrotary motion 390 about a central,longitudinal axis 398, with adistal end 396 of therotary drive train 304 substantially pointed at a complex tissue (not shown) and aproximal end 397 of therotary drive train 304 substantially pointed at, and associated with, a mountingbase 375; adrive wheel 150 with its axis coincident to the central,longitudinal axis 398 of therotary drive train 304, and located distally to drivetrain 304, the drive wheel'srotation 391 supplied by therotary drive train 304, thedrive wheel 150 further comprising a drive-point 155 located at a non-zero radius away from thelongitudinal axis 398 which is also the axis ofdrive wheel 150 rotation. A differential dissectingmember 110 is positioned distally from thedrive wheel 150 with the differential dissectingmember 110 being rotatable about an axis of memberrotational oscillation 112 that is substantially transverse to the central,longitudinal axis 398 of therotary drive train 304. Thedifferential dissecting member 110 further comprises a wedge-like body 111, anaxle 113 that can be substantially coincident and concentric with axis of memberrotational oscillation 112, at least one tissue-engagingsurface 120 located distalmost on thedevice 100 and substantially pointed at a complex tissue (not shown), a torque-point 130 disposed proximally to the substantially transverse axis of memberrotational oscillation 112 of the differential dissectingmember 110, the torque-point 130 being operably associated with the drive-point 155, such that the torque-point 130 travels rotatably around the central,longitudinal axis 398 withdrive wheel rotation 391; a substantiallyflat motion filter 140 operably connecting thebody 111 of the differential dissectingmember 110 and the torque-point 130, themotion filter 140 transmitting from the drive-wheel 150 through drive-point 155 only a planarcomponent output motion 392 of therotary motion input 391 of the torque-point 130 to actuate the differential dissectingmember 110 in planar rotary oscillation about its substantially transverse axis of differentialrotational oscillation 112. Thus, when therotary drive train 304 continuously rotates thedrive wheel 150, the drive-point 155 on thedrive wheel 150 also rotates continuously, which continuously rotates the torque-point 130. The torque-point 130 is attached to thebody 111 of differential dissectingmember 110 by themotion filter 140, which in this embodiment is formed of an elastic planar member resisting in-plane deformation (and so transmits motion within that plane) but permits easy out-of-plane deformation (so not transmitting motion in that plane), which thus conveys only oscillatoryplanar motion 392 to thebody 111 of differential dissectingmember 110, which, thus oscillates about the substantially transverse axis of memberrotational oscillation 112, causing thetissue engaging surface 120 to move in at least onedirection 392 against the complex tissue, here in oscillatoryplanar motion 392, thereby this embodiment convertsdifferential dissection member 110 oscillation into the dissection of complex tissues, disrupting at least one soft tissue in the complex tissue while avoiding disruption of firm tissue in the complex tissue. - It can be readily seen when referring to at least
FIGS. 3A, 3F-0 through 3F-4, 3G-1 through 3G-4, 3J-1 and 3J-2, and 4A that one complete rotation of therotary drive train 304 drives two passes (one in the opposite direction to the other) along planar motion of thetissue engaging surface 120 of the differential dissectingmember 110 against the complex tissue. Amotor 310 operating (i.e., rotating) at 100 Hz thus drives thetissue engaging surface 120 past the tissue to be dissected at 200 passes per second. Referring to thedrive wheel rotation 391 of thedrive wheel 150, if therotation 391 begins at position A, thetissue engaging surface 120 of the differential dissectingmember 110 is mechanically constrained to point to position A′. Thus, as thedrive wheel 150 rotates to position B, themotion filter 140, here depicted as a planar leaf spring, easily deflects out of its own plane, and thus transmits to the differential dissectingmember 110 only the planar component 392 (of drive wheel rotation 391) about the substantially transverse axis of memberrotational oscillation 112, thus rotating thetissue engaging surface 120 to position B′, in the same plane as position A′. As thedrive wheel 150 continues itsrotation 391 to position C, thetissue engaging surface 120 of the differential dissectingmember 110 is rotated to position C′, continuing theplanar motion 392. As thedrive wheel 150 advances to position D, thetissue engaging surface 120 moves to point D′ (identical to position B′). Finally, as thedrive wheel 150 returns to position A, thetissue engaging surface 120 of the differential dissectingmember 110 also returns to position A′, completing the cycle of oscillation ofplanar motion 392 of the differential dissectingmember 110, and so the cycle of planar oscillation of thetissue engaging surface 120 against the complex tissue to be dissected. - Continuing to refer to at least
FIG. 3A , therotary drive train 304 may further be comprised of a direct current brushed electric motor, a brushless electric motor, a pneumatic motor, or the like; therotary drive train 304 may further comprise agearhead 311, for changing the torque and rotational velocity of themotor 310, for example to reduce the speed of therotary motion 391 in exchange for higher torque at thedrive wheel 150 and so increased authority at thetissue engaging surface 120, permitting more powerful dissections if desired. If the embodiment is electric, if the embodiment is electric, power may be supplied bywires 399 to themotor 310. Themotion filter 140 can be formed of an elastic sheet, for example a leaf spring composed of, for example, metal or a rigid polymer. - In another embodiment of the multiple-motor
rotary drive train 304 that addresses these needs, therotary drive train 304 is composed of at least one commercial-off-the-shelf, integrated, small-diameterelectric motor 310 andgearhead 311, achieving a compact device. One commercially available example of such a motor-gearhead combination is the 4-millimeter-diameter, 26-millimeter-long EC4 brushless motor from Maxon USA. A differential dissecting attachment constructed with a rotary drive train employing this or a similar motor is thus compact enough for attaching to the end of most instruments regularly employed for minimally invasive surgery. - The
motion filter 140 can be formed of an elastic sheet, for example a leaf spring composed of, for example, metal or a rigid polymer. The material of themotion filter 140 may be distinct from that of the differential dissectingmember 110, in which case it may be advantageous to provide amotion filter clamp 142 for holding themotion filter 140 therein. The substantially transverse axis of memberrotational oscillation 112 might be comprised of a hole orcavity 114, for accepting an axle; if need be thehole 114 can be further fitted with a bushing or a roller bearing to reduce friction therebetween. -
FIGS. 3B through 3F-5 show several views of an oscillatingdifferential dissecting member 110 withmotion filter 140. Referring first toFIGS. 3A and 3B , the oscillatingdifferential dissecting member 110 has abody 111 that is rotatably associated with a substantiallytransverse axis 112; thebody 111 may possess abearing cavity 114 to further accept an axle 113 a bushing or roller bearing 115 (FIGS. 3A and 4A ). Thebearing cavity 114 may also be formed directly from the material of the wedge-like body 111 of the oscillatingdifferential dissecting member 110, provided that a low-friction joint can be obtained between the body material and the material forming theaxis 112; inFIG. 3A theaxis 112 is coincident with and defined by anaxle 113. In the embodiment depicted here, the tissue-engagingsurface 120 is distal-most, as it dives into and safely dissects tissue. Opposite thetissue engaging surface 120 is the proximal-most portion of the oscillatingdifferential dissecting member 110, namely the torque-point 130, which is operably associated with, and accepts rotational motion from, the drive wheel's 150 drive-point 155 (seeFIG. 3A ). The torque-point 130 can take many forms to mate with and accept the rotary input delivered via the drive-point 155. In one embodiment (shown), the torque-point 130 takes the form of a truncated ball, while the drive-point 155 (seeFIG. 3A ) can be a socket. - To attach the
motion filter 140 to thebody 111 of the oscillatingdifferential dissecting member 110, the depicted embodiment features amotion filter clamp 142. Themotion filter clamp 142 firmly grasps the distal-most end of themotion filter 140. Themotion filter 140 can be any planar item that is flexible through its own plane, but resists shearing within its own plane. In the depicted embodiment, themotion filter 140 is formed out of spring steel. Thus, the rotary input from drive-point 155 succeeds in driving the torque-point 130 in circular motion about thelong axis 398 of thedrive mechanism 100. Due to the compliant bending of the springsteel motion filter 140 and due to the fixed rotation of the differential dissectingmember 110 about the axis of rotation 112 (and also now referring also toFIG. 3F-0 ), thatvertical component 126 of thecircular motion 391 of thedrive wheel 150, since it travels perpendicular to the plane of themotion filter 140, does not convey: there is no resultingplanar motion 392 of the differential dissectingmember 110. Thathorizontal component 124 of therotational motion 391 that travels parallel to the plane of themotion filter 140, however, does convey to the differential dissectingmember 110, as the spring steel is quite stiff within its plane and because the differential dissectingmember 110 is free to rotate about its axis ofrotation 112. - Thus, given a steady
rotary motion 391 of thedrive wheel 150 and the filtering of themotion components motion filter 140, the differential dissectingmember 110 oscillates in a sinusoidal fashion, as shown byarrows FIG. 3B . In more detail, the oscillatingdifferential dissecting member 110 with its associatedmotion filter 140 is stiff as a whole within the plane defined by the substantiallyflat motion filter 140. When the torque-point 130 is driven in the direction indicated byarrow 132, the tissue-engagingsurface 120 of the differential dissectingmember 110 travels in the direction ofarrow 136, and, when the torque-point 130 is driven in the direction indicated byarrow 134, the tissue-engagingsurface 120 of the differential dissectingmember 110 travels in the direction ofarrow 138. Thus, a steady, constantrotational input 391 from the rotary drive train 304 (seeFIG. 3A ) produces bi-directionalsinusoidal motion 392 at thetissue engaging surface 120. -
FIG. 3C depicts a top view (shown by itself for clarity) of an oscillatingdifferential dissecting member 110 withmotion filter 140. Thehorizontal components 132 and 134 (shown as 124 in the section view ofFIG. 3F-0 ) of therotary motion 391 of the torque-point 130, which are parallel to the plane of the page in this view, get transmitted via themotion filter clamp 142 to thebody 111 of the oscillatingdifferential dissecting member 110, driving thetissue engaging surface 120 as shown byarrows element 126 in the section view ofFIG. 3F-0 ) of the torque-point's 130 rotary motion that in this view passes through the plane of the page do not convey. Also note that it may be advantageous to manufacture the substantiallyflat motion filter 140 as a triangular beam. Themotion filter 140 is essentially an end-loaded, cantilevered beam; the triangular form ensures that the stresses are constant along the length of the beam, preventing damage due to stress concentrations while thedrive mechanism 100 operates at hundreds of cycles per second, under varying loads during surgery. Also, the triangular form of themotion filter 140 concentrates its mass nearest the substantially transverse axis of memberrotational oscillation 112, reducing the energy required to oscillate the differential dissectingmember 110. - Referring now to
FIG. 3D , this shows a side view of an embodiment of the oscillatingdifferential dissecting member 110 withmotion filter 140. The input motion (arrows FIGS. 3B and 3C ) of the oscillatingdifferential dissecting member 110 in the depicted view (FIG. 3D ) is now into and out of the plane of the page. The compliant bending of the torque-point 130 of themotion filter 140 alongvertical component 126 is left-and-right as depicted inFIG. 3D . The shape of themotion filter clamp 142 is more clearly depicted in this view. Thebody 111 of the oscillatingdifferential dissecting member 110 further forms aprofile cam 144 impinging on the travel of themotion filter 140. The shape of theprofile cam 144 serves to control the loading of themotion filter 140; as the spring steel in this embodiment bends, it conforms to the shape of the motionfilter profile cam 144. The shape of theprofile cam 144 is arbitrary and can serve to preload the spring steel of themotion filter 140 to prevent backlash and keep the motion of thedrive mechanism 100 smooth.FIG. 3E shows an end view of an oscillatingdifferential dissecting member 110 withmotion filter 140. The rotary travel of the torque-point 130 lies substantially in the plane of the page, as is more clearly shown inFIGS. 3F-1 through 3F-4 . - For clarity,
FIG. 3F-0 depicts in section view looking distally the components of the rotary motion 391 (see alsoFIG. 3A ) of thedrive wheel 150 and drive-point 155 in relation to the differential dissectingmember 110 andmotion filter 140. Therotational motion 391 of thedrive wheel 150 is comprised of two components: avertical component 126, and ahorizontal component 124. Themotion filter 140, being an elastic flat plate, for example a steel leaf spring, bends easily out of its plane, easily accommodating thevertical component 126 of therotary motion 391; since the substantially transverse axis of member rotational oscillation 112 (seeFIG. 3A ) resists thevertical component 126, no motion aboutaxis 112 can occur. Since themotion filter 140, is an elastic flat plate possessing substantial rigidity within its own plane, and, since the substantially transverse axis of memberrotational oscillation 112 expressly permits easy rotational motion in that same plane, all of (and only) thehorizontal component 124 of therotational motion 391 is transmitted from the rotary drive train 304 (seeFIG. 3A ) to the differential dissectingmember 110, thus inducing oscillations in that plane, and so sweeping the tissue engaging surface 120 (seeFIG. 3A ) bi-directionally (parallel to the horizontal component 124) across the complex tissue to be dissected. -
FIGS. 3F-1 through 3F-4 further depict in cross-section view through thedrive wheel 150 the sequential (here, counterclockwise) motion of this portion of the rotary drive train 304 (seeFIG. 3A ). Thedrive wheel 150 drives the drive-point 155 which engages and so drives the torque-point 130, itself driving themotion filter 140 of the oscillatingdifferential dissecting member 110. InFIG. 3F-1 , thedrive wheel 150 is rotated so that the drive-point 155 is to the viewer's left (at the 9 o'clock position). The torque-point 130, being engaged to the drive-point 155, has followed the drive-point 155, forcing themotion filter 140 to the left, which in turn forces the differential dissectingmember 110 to rotate about the axis of member rotational oscillation 112 (seeFIG. 3A ). This necessarily forces the distal tissue engaging surface 120 (not visible in this view; it is at the opposite end of the differential dissecting member 110) to the right. - In
FIG. 3F-2 , thedrive wheel 150 has rotated counterclockwise so that the torque-point 130 is at the bottom of travel (the 6 o'clock position); while the entire oscillating differential dissectingmember 110 has returned to center. Note the downward-bent state of themotion filter 140, which has filtered out the (in this view) vertical component 126 (seeFIGS. 3C and 3D ) of therotational motion 391 of the torque-point 130. InFIG. 3F-3 , the drive wheel 150 (and so the drive-point 155, and the torque-point 130) has cycled counterclockwise around to the viewer's right (the 3 o'clock position), driving thetissue engaging surface 120 to the viewer's left.FIG. 3F-4 continues the cycle, with the drive-point 155, and the torque-point 130 rotating counterclockwise to the viewer's ‘up’ position (12 o'clock). Continuingrotational motion 391 clockwise will bring thedrive wheel 150 and so the drive-point 155 and so the torque-point 130 to the nine-o'clock position, completing the cycle. Thecontinuous rotation 391 of thedrive wheel 150 that drives the non-rotating torque-point 130 means that frictional losses at the drive-point 155 could cut the efficiency of thedrive mechanism 100.FIG. 3F-5 shows an embodiment of adrive mechanism 100 wherein adrive wheel 150 operably connects to a torque-point 130 via a drive-point 155′ formed by a roller bearing, greatly reducing frictional losses due to relative rotation between thedrive wheel 150 and the torque-point 130. - Referring now to
FIGS. 3G-1 through 3G-4 , we see the same process from a side view; the sequential motion of the oscillatingdifferential dissecting member 110 oscillates due to its engaging the drive train 304 (shown partially here, and fully inFIG. 3A ) via themotion filter 140. In the views ofFIGS. 3G-1 through 3G-4 , we can further see that the torque-point 130, here depicted as a truncated ball, tilts significantly within the drive-point 155, here depicted as a socket. Referring toFIG. 3G-1 (a side view of the device shown inFIG. 3F-1 ), amotor 310 has, viadriveshaft 156, rotated thedrive wheel 150 so that the drive-point 155 is farthest from viewer. The torque-point 130, being engaged to the drive-point 155, has necessarily followed the drive-point 155, forcing the motion filter 140 (in this embodiment, a leaf spring) to rotate away from the viewer, thus forcing the differential dissectingmember 110 to rotate about the axis of memberrotational oscillation 112 and so necessarily forcing the distaltissue engaging surface 120 toward the viewer. We can see that at this stage of the oscillatory cycle, the elastic, plate-like motion filter 140 is unbent; we can also see themotion filter clamp 140 formed in the body 111 (seeFIG. 3A ) of the differential dissectingmember 110 and holding themotion filter 140. At this point, theprofile cam 144 is not engaged. - In
FIG. 3G-2 , we see the side view of the stage depicted inFIG. 3F-2 where themotor 310 has caused (via driveshaft 156) thedrive wheel 150 to rotate counterclockwise so that the torque-point 130 is now at the bottom of its rotational motion 391 (seeFIG. 3A ). The oscillatingdifferential dissecting member 110 has returned to center, and at this moment thetissue engaging surface 120 points directly distally, in this view, to the viewer's right (equivalent to position B′ and D′ inFIG. 3A ). Note, however, the downward-bent state of the elastic, plate-like motion filter 140, which has filtered out the (in this view) vertical component 126 (seeFIG. 3F-0 ) of the rotational motion 391 (seeFIG. 3A ) of the torque-point 130, so that the differential dissectingmember 110 displays no rotation within the plane of the page. Note also the smooth round shape of theprofile cam 144 is now engaged and is gradually supporting the distal portion of themotion filter 140, thus controlling the loading of themotion filter 140, here a steel leaf spring. - In the next view (
FIG. 3G-3 , a side view of the part of the oscillation cycle depicted inFIG. 3F-3 ), themotor 310 has rotated, counterclockwise, viashaft 156, the drive wheel 150 (and so the drive-point 155, and so the torque-point 130) toward the viewer. Again, as inFIG. 3G-1 , themotion filter 140 is unbent. In this view themotion filter 140 has cycled counterclockwise around away from the viewer, driving thetissue engaging surface 120 away from the viewer. Again, we can see themotion filter clamp 142 formed in thebody 111 of the differential dissectingmember 110 and securely holding themotion filter 140, and, we can see that theprofile cam 144 is not engaged. - Referring to
FIG. 3G-4 , complimentingFIG. 3F-4 above, we see now the complete cycle, with the drive-point 155, and the torque-point 130 rotating counterclockwise to the viewer's ‘up’ position. Themotion filter 140 is clearly bent upward along vertical component 126 (which, due to themotion filter 140, contributes nothing to the oscillatory motion of the differential dissecting member 110). It can be seen that the bending of themotion filter 140 causes the torque-point 130 to rotate within the plane of the page inFIGS. 3G-1 throughFIG. 3G-4 . For this reason, we show that a preferred form of the torque-point 130 can be a sphere, ball, or portion thereof. - The embodiments shown can be run at high speeds; the continuous
rotational motion 391 of thedrive wheel 150 that drives the non-rotating torque-point 130 means, along with the tilting ball disclosed above, that frictional losses at the drive-point 155 could cut the efficiency of thedrive mechanism 100. Thus, employing a spherical torque-point 130 captured in a roller bearing (for example as depicted inFIG. 3F-5 ) serving as the drive-point 155 may reduce these losses to a minimum. The examples given here are not limiting; any number of schemes will serve to mate the drive-point 155 with the torque-point 130, so long as the torque-point 130 is free to both rotate and tilt within the drive-point 155, or themotion filter 140 is free to tilt at its attachment to drivewheel 150 at drive point 155 (e.g. by a flexible joint, hinge, or pivot). -
FIG. 3H-1 shows an oblique view of an alternative embodiment of oscillating differential dissectingmember 110 with anintegral motion filter 141. In this embodiment, thebody 111 of the oscillatingDDM 110 is molded to integrally include a flat elastic plane that serves as anintegral motion filter 141, making the entire oscillating differential dissectingmember 110 monolithic, which may possibly simplify manufacture. -
FIGS. 3H-2, 3H-3, and 3H-4 depict a top view, a side view, and an end view, respectively, of the alternative embodiment of an oscillatingdifferential dissecting member 110 with anintegral motion filter 141. This embodiment can be molded out a single material (for example PEEK (pollyetheretherketone)), as long as the elastic modulus is high enough to prevent buckling out-of-plane during transmission of the in-planehorizontal component 124 of therotary motion 391 while filtering out the out-of-plane,vertical component 126 of the suppliedrotary motion 391. The features of the integrally moldedmotion filter 141 are similar to that depicted inFIGS. 3B through 3E , save for the reduced complexity and time involved in producing the part for incorporation into adrive mechanism 100. -
FIGS. 3J-1 and 3J-2 depict top and side views of another embodiment of an oscillatingdifferential dissecting member 110 rotatable about substantially transverse axis of memberrotational oscillation 112, further comprising abearing cavity 114, and provided with analternative motion filter 143 comprised of a rigidflat plate 143 attached to the differential dissectingmember 110 via ahinge 149. This embodiment requires no elastic plates or gripping of same; a hinge is a well-understood mechanical feature. The operation of thismotion filter 143 is much as was disclosed above, where the torque-point 130 engages the drive-point 155 of thedrive wheel 150 driven inrotational motion 391 by the rotary drive train 304 (seeFIGS. 3A, 3F-1 to 3F-4, and 3G-1 to 3G-4 ). This hingedmotion filter 143 transmits thehorizontal component 124 ofrotational motion 391 without thevertical component 126. In this respect its operation is similar to those disclosed inFIGS. 3B to 3E, and 3H-1 to 3H-4 ), where motion of the torque-point 130 in the direction ofarrow 132 drives thetissue engaging surface 120 in the direction ofarrow 136, and motion of the torque-point 130 alongarrow 134 results in the sweep of thetissue engaging surface 120 in the direction ofarrow 138. Should elastic recoil be required, ahinge spring 148 is easily added to achieve some of the benefits disclosed above. - It will be understood by those skilled in the art that a number of substitutions can be made while preserving the spirit of a differential dissecting member driven via a motion filter, permitting planar oscillatory output of the tissue engaging surface. None of the embodiments disclosed above are meant to be limiting cases.
- Referring to
FIG. 4A , disclosed is a highly elongatecompact drive train 400 enabling differential dissection in tight confines. Modern minimally invasive surgery has reduced the diameter (and burgeoning obesity has increased the length) of the surgical instruments required, demanding elongate, narrow, specialized tools for laparoscopic, endoscopic, thoracoscopic, and robotic procedures inserted through access ports, trocars and natural orifices. For example, it is commonplace for the inner diameters of trocars to be as small as 8, 5, and even 3 millimeters. It can be challenging to provide sufficient torque in instrument shafts of these diameters using one of even the best available motors. In addition, the newer instruments sport articulating shafts, the better to maneuver in tight spaces, but requiring mechanisms that use up much of what remains of the internal space. Fitting mechanisms through articulating shafts pose stiff challenges. Perhaps because of these obstacles, minimally invasive surgical blunt dissection still employs at the ends of these instruments the same primitive forceps, probes, and cotton swabs. Disclosed herein is a compact rotary drive train comprised of a plurality of small electric motors with driveshafts emerging from both ends, laid end-to-end coaxially in a column, sharing a common axis, and further comprising couplings associating the distal end of one motor driveshaft with the proximal end of another, adjacent motor driveshaft, forming a mechanical series. Provided with matching handedness of rotation by properly matching the sense of the motor power leads, the torque output of such a mechanical series motor arrangement is proportional to the number of motors in the column. In this way any required torque can be added to a very narrow surgical instrument. This mechanical series motor can further be provided within a narrow diameter, elongate rigid steel tube, as is the norm for other minimally invasive surgical instruments. Disclosed herein is how these can form articulated instrument shafts well-suited to the contortions of minimally invasive surgery. -
FIG. 4A shows an oblique view of the components of a highly elongatecompact drive train 400 comprising the distal portion of a differential dissecting instrument for attaching to a handle or to a surgical robot. The highly elongatecompact drive train 400 is not dissimilar in part to the device depicted inFIG. 3A , save for the distinguishing features disclosed below. The highly elongatecompact drive train 400 comprises alongitudinal axis 398 having a first,proximal end 397 that may be associated with a mountingbase 375 facilitating attachment to a handheld surgical instrument or surgical robot, and a second,distal end 396 directed at a complex tissue to be dissected, and associated with an oscillatingdifferential dissecting member 110. The two ends of the highly elongatecompact drive train 400 are connected on the outside by a housing 385 (shown transparent for clarity), and largely occupied on the inside by a multiple-motorrotary drive train 305, and anoscillatory drive mechanism 303 nearer thedistal end 396. The multiple-motorrotary drive train 305 is comprised of a plurality of double-shafted motors 310 (where eachmotor 310 is affixed to thehousing 385, and eachmotor 310 further possesses adrive shaft 314 emerging from both ends of motor 310). The adjacent ends of eachadjacent motor 310'sdrive shafts 314 are coaxially connected and rotationally locked to one another by torsionally stiff,flexible joints 313, so that the entire multiple-motor rotary drive train is connected in mechanical series. Further the drive shafts all rotate as one unit, with everymotor 310 rotationally phase-locked to the others, such that all motors rotate at the same speed in thesame direction 360. - In this embodiment, the differential dissecting
member 110 possesses abody 111 and is located rotatably about a substantially transverse axis of member rotational oscillation 112 (which may be comprised of an axle 113) at thedistal end 396 of the highly elongatecompact drive train 400. Thedifferential dissecting member 110 also connects operably to theoscillatory drive mechanism 303. Theoscillatory drive mechanism 303 is itself comprised of (beginning proximally) adrive wheel 150 operatively associated with, and rotated by, thedistal-most end 396 of the multiple-motorrotary drive train 305, the drive wheel further comprising a drive-point 155 located at a non-zero radius from the longitudinal axis 398 (which is also the axis ofdrive wheel 150 rotation). The drive-point 155 engages, captures and drives inrotation 391 about long axis 398 a torque-point 130, which in this embodiment forms the proximal-most extent of amotion filter 140. Themotion filter 140 is fixed to thebody 111 of the differential dissectingmember 110 by amotion filter clamp 142. Thedifferential dissecting member 110 possesses at least one tissue-engaging surface 120 (directed at a complex tissue to be dissected). - The entirety of the series of
motors 310 are appropriately connected bypower cables 399 according to the type of motor used, and providing the power for dissecting complex tissue. The embodiment depicted also includes agear head 311 operatively associated with thedistal end 396 of the multiple-motorrotary drive train 305 and rotated by it, and the proximal-most portion of theoscillatory drive mechanism 303. This allows the multiple-motorrotary drive train 305 to run at high rotational frequencies while theoscillatory drive mechanism 303 can cycle at lower rotational frequencies, with enhanced torque 390 (and so, enhanced authority of the device during forceful blunt dissection). - Continuing to refer to
FIG. 4A , rotation of the multiple-motorrotary drive train 305 drives rotation of theoscillatory drive mechanism 303, which impartsrotational motion 391 to thedrive wheel 150, which in turn rotates the drive-point 155. The drive-point 155 captures and so also rotates the torque-point 130 comprising the proximal-most portion of themotion filter 140. - As disclosed above with the
alternate drive mechanism 100 shown inFIGS. 3A and 3F-0 , themotion filter 140 transmits only the co-planar component, i.e., thehorizontal component 124 of therotary motion 391 of the torque-point 130 to thebody 111 of the differential dissectingmember 110. As was the case with other embodiments of the device above, if we begin with thedrive wheel rotation 391 of thedrive wheel 150 at position A, thetissue engaging surface 120 of the differential dissectingmember 110 will point at position A′. As thedrive wheel 150 is driven in rotation to position B, themotion filter 140 bends out of its own plane and transmits to the differential dissectingmember 110 only thehorizontal component 124 ofdrive wheel rotation 391. Restricted to rotate only about the substantially transverse axis of memberrotational oscillation 112, the differential dissectingmember 110 thus forces thetissue engaging surface 120 to point at position B′, on center and pointing directly distally, aligned with thelongitudinal axis 398. As thedrive wheel 150 rotates on through to position C, thetissue engaging surface 120 of the differential dissectingmember 110 sweeps on to point at position C′, continuing theplanar motion 392. As thedrive wheel 150 further advances to position D, thetissue engaging surface 120 now moves to point D′ (identical to position B′, and aligned again with thelongitudinal axis 398 of the highly elongate compact drive train 400). Finally, as thedrive wheel 150 continues itsrotation 391, it cycles around back to position A, so thetissue engaging surface 120 of the differential dissectingmember 110 also returns to position A′, completing the cycle of oscillation ofplanar motion 392 of the differential dissectingmember 110. - In this way, the cycle of bi-directional, planar oscillation of the
tissue engaging surface 120 against the complex tissue to be dissected proceeds, disrupting at least one soft tissue in the complex tissue while avoiding disruption of firm tissue in the complex tissue. In this manner, the highly elongatecompact drive train 400 converts electrical power input into the safe and rapid dissection of complex tissues by otherwise unwieldy laparoscopic instruments or surgical robotic arms, to enable improved surgical outcomes. - Looking at
FIGS. 4B , through 4G, shown inFIG. 4B is a side view of an exposed multiple-motorrotary drive train 308 formed by a coaxial plurality ofrotating motors 310, focusing in this view especially on the arrangement of twoadjacent motors adjacent driveshafts motor 310 does, so doesmotor 310′. The inventors of this application have discovered that this arrangement (wheremotor 310 is connected tomotor 310′ by a flexible or compliant joint) appears to overcome cogging and stiction, possibly due to rotational misalignments between adjacent motors' rotors preventing cogging, or due to irregularities in adjacent motors startups combining to ensure a smoother, more reliable start. All of the depicted motors in this view are arbitrarily arranged in a straight line and all are actively delivering torque. Therefore, all of these motors are rotating at a single rotational velocity; this is a simple embodiment of the multiple-motorrotary drive train 305. -
FIG. 4C shows a side view of the same actively rotating multiple-motorrotary drive train 308 disclosed above inFIG. 4B , but in this view, the plurality ofmotors 310 have been purposely deflected out of a straight alignment, though the motors are still coaxial at thejoints 313 where thedriveshafts 314 touch. With thedriveshafts motors rotary drive train 305 from a straight line while still actively delivering torque downstream, for example to anoscillatory drive mechanism 303. As long as the motors are prevented from relative rotations relative to one another, all of the motors in such an arrangement will remain rotationally phase-locked, turning together as one multiple-motor rotary drive train 305 (seeFIG. 3A ). -
FIG. 4D shows a side view of a somewhat similar multiple-motorrotary drive train 306. In this embodiment, the plurality ofmotors 310 have theirdriveshafts 314 connected byuniversal joints 315, showing deflections from a straight line while delivering torque as one unit, similar to the situation depicted inFIG. 4C .Universal joints 315 are typically much more torsionally rigid than theelastomeric joints 313 shown inFIGS. 4B and 4C ; the disclosed embodiments may usefully employ either. Other means to transmit torsion while bending are known in the art, including but not limited to sliding dog-bone joints, interlaced spider joints, bellows joints, and the like. The advantages of the use ofuniversal joints 315 in multiple-motorrotary drive train 306 are that the energetic losses of deforming the material out of which are constructed the flexible joints in multiple-motorrotary drive train 308 above are that theuniversal joints 315 can be constructed with low-friction steel bearings. Further advantages ofuniversal joints 315 is that the degree of permitted deflection may be larger than for flexibleelastomeric joints 313, and that they usually withstand greater torque. -
FIG. 4E shows a cross-sectional side view of an embodiment of a similar multiple-motorrotary drive train 307 to that disclosed inFIG. 4D , here comprising a plurality ofmotors 310 each with theirdriveshafts 314 connected to adjacent drive shafts by drive shaftuniversal joints 315. Eachmotor 310 in this embodiment, however, is further covered by its own associatedhousing segment 377 within which each motor 310 is fixed. Eachhousing segment 377 is also articulated at either end by a housing joint 317, surrounding the associated drive shaftuniversal joints 315 and thereby connecting eachhousing segment 377 toadjacent housing segments 377 and eachdrive shaft 314 toadjacent drive shafts 314. Thus, this embodiment of a multiple-motorrotary drive train 307 can deflect out of alignment as can the similar embodiments above, save that eachmotor 310 is fixed within its associatedhousing segment 377, providing structure to fight the reaction torque produced when themotor 310 energizes and rotates itsdrive shaft 314. So, as the multiple-motorrotary drive train 307 bends in one plane as depicted, theconstituent motors 310 provide a combined maximum torque due to the stability provided by thehousing segments 377. Further, thehousing segments 377 provide a convenient surface to attach to a surgical robot or laparoscopic instrument, thus serving as an alternative mounting base 375 (seeFIGS. 3A and 4A ). - Illustrating this further,
FIGS. 4F-1 and 4F-2 depict a multiple-motor rotary drive train 407 (and a component of same) with a plurality ofmotors 410 similar to those inFIG. 4E , each covered and supported by itsown housing segment 477 and connected to each other by multiplanar concentricuniversal joints 418. The multiple-motorrotary drive train 407 is here shown deflecting in two planes at once, demonstrating three-dimensional flexibility appropriate for negotiating the twists and turns inside a patient. Also disclosed is a multiplanar concentricuniversal joint 419 combining auniversal joint 415 that is connectingadjacent drive shafts 414 ofadjacent motors 410, and, a similar two-axishousing segment joint 417. As is well-known to those skilled in the art, a universal joint is typically comprised of two axles oriented at right angles to one another, crossing at a geometric center, and both axles are typically oriented at right angles to the drive shafts with which they are associated, and, the axis of rotation of the associated drive shafts are aligned with that same geometric center. This is the case with the drive shaftuniversal joint 415. - Additionally, the
housing segment joint 417 of thisembodiment 407 is similarly comprised of two axes (defined by axles) 420 and 421, oriented at right angles to both one another and to the axis of rotation of thedrive shafts 414, all crossing at a geometric center ofrotation 419. What makes the multiplanar concentricuniversal joint 418 useful to the present device is that theuniversal joint 415 andhousing segment joint 417 are arranged with common geometric centers of rotation. This means that thedrive shafts 415 of themotors 410 are free to deflect while delivering torque despite being affixed in, and surrounded by, articulatedrigid housing segments 477. To reiterate, each drive shaftuniversal joint 415 and associated housing segment joint 417 share a single geometric center ofrotation 419 in all planes. Another consequence of this arrangement is that the length between these centers ofrotation 419 is invariant owing to the rigid nature of the typicallysteel drive shafts 414. Thus, the length of the multiple-motorrotary drive train 407 cannot change despite the bending. This allows the surgeon performing the blunt dissection to apply both compressive loads down a confined passage, as is often required to develop forces against the tissue to be dissected, as well as to develop tensile loads, for example to withdraw the surgical instrument from the cavity so created. - Looking again at
FIG. 4F-1 , depicted in this figure are at least onehousing segment joint 417, each comprising a ring supporting a vertically oriented pin joint 421 permitting rotation substantially in and out of the plane of the page, and a horizontally oriented pin joint 420, permitting rotation substantially within the plane of the page. The axes of the vertically oriented pin joint 421 and the horizontally oriented pin joint 420 cross exactly at a single geometric center ofrotation 419 in all planes, the same geometric center ofrotation 419 that is also used by the drive shaftuniversal joint 415. This is the arrangement that permits simultaneous phase-locked rotation of thedrive shafts 414 of all of themotors 410 whilst the entire multiple-motorrotary drive train 407 deflects three dimensionally, permitting the surgeon to more easily access any desired internal space of the patient's body to perform safer blunt dissection of complex tissues. -
FIG. 4F-2 , shows in schematic form onehousing segment joint 417 of a multiple-motorrotary drive train 407, a single center ofrotation 419, and how it is formed by the convergence of the axes of the vertically oriented pin joint 421, the horizontally oriented pin joint 420, and theuniversal joint 415. One can again see that this arrangement permits the free deflection of themotors 410 whilst they are fixed within theirhousing segments 477, and simultaneously preserving phase-locked rotation of the entire multiple-motorrotary drive train 407. - To illustrate a final detail,
FIG. 4G shows an oblique view of a multiple-motorrotary drive train 409 comprised of a plurality ofcoaxial motors 410 with theirdriveshafts 414 connected to one another and phase-locked by universal joints 416. Further, thisembodiment 409 further comprises a flexible compliant sheath 444 (here shown in transparent form) covering the plurality ofmotors 410. Thecompliant sheath 444 is alternative to therigid housing segments 477 from earlier embodiments. While thecompliant sheath 444 permits all manner of deflections, including some rotational deflections of themotors 410, it still limits those rotational deflections, allowing themotors 410 to develop and deliver useful torque to supply downstream, for example to an oscillatory drive mechanism 303 (seeFIGS. 3A and 4A ). This view shows deflections from a straight line ofmotors 410 in two planes at once, and also rotational deflections ofindividual motors 410, all while phase-locked as before and delivering torque. Such an arrangement as this can be useful. A soft cover like thecompliant sheath 444 may be preferable in some minimally invasive surgeries. One may also combine thecompliant sheath 444 with thehousing segments 477 for a smoother exterior while still preserving the full authority of the morerigid housing segments 477. Thecompliant sheath 444 and thehousing segments 477 might also be fruitfully combined in irregular fashion, where neither motor cover scheme dominates the entire length of the multiple-motorrotary drive train 409. - As more surgeries are performed via minimally invasive surgical methods, working on ever-more-complex procedures with convoluted manipulations requires enhanced access capabilities, especially intricate, safe blunt dissections and tunneling around critical structures. Referring now to
FIGS. 5A through 5E-3 , disclosed are for surgical machines such as handheld laparoscopic instruments or surgical robots, embodiments of differential dissecting instruments and components for same that can perform blunt dissection of complex tissues in any desired direction. That is, the surgeon can steer the path of differential dissection at will, even remotely from the point of access (for example an incision, port, or a natural orifice), safely creating tunnels, pockets, and throughways of any desired shape in, around, or through complex tissues. Disclosed herein are steerable differential dissectors for differential dissection of complex tissues in any desired direction, operated remotely or directly. -
FIG. 5A-1 depicts one embodiment (and basic operation) of a steerable differential dissectingassembly 500 enabling differential dissection in any desired direction. Also disclosed is a steerable differential dissectingassembly 500, comprising a differential dissectingmember 110 oscillatible about a substantially transverse axis of memberrotational oscillation 112, a drive means 160 for driving the differential dissectingmember 110 in oscillations about substantially transverse axis of memberrotational oscillation 112, and atissue engaging surface 120 forming the distal-most portion of the steerable differential dissectingassembly 500. Thedifferential dissecting member 110 has an amplitude ofoscillation 538 of the differential dissectingmember 110, a magnitude oftravel 536 of the drive means 160, a leftward swing 53T of the differential dissectingmember 110, a leftward-drivinginput 537 driving theleftward swing 537′, arightward swing 539′ of the differential dissectingmember 110, a rightward-drivinginput 539 driving therightward swing 539′, a center ofoscillation 538′ of the differential dissectingmember 110 that is substantially halfway between theleftward swing 537′ and therightward swing 539′, and a direction ofdissection 121 substantially aligned with the a center ofoscillation 538′ of the differential dissectingmember 110. - In operation, the steerable differential dissecting
assembly 500 oscillates the differential dissectingmember 110 via the a drive means 160, which can be acable drive 160 as inFIG. 6A-1 , or a oscillatory drive train as shown inFIGS. 3A and 4A . The amplitude ofoscillation 538 of the differential dissectingmember 110 is controlled by the magnitude oftravel 536 of the drive means 160, and the leftward-drivinginput 537 and the rightward-drivinginput 539 control the left andright swings 537′ and 539′, respectively. - Still referring to
FIG. 5A-1 , the differential dissectingmember 110 typically oscillates left and right to either side of the center ofoscillation 538 about a substantially transverse axis of memberrotational oscillation 112, driven by acable loop 160, and presenting atissue engaging surface 120 distally to the complex tissues to be dissected. In this view, the direction of rotation of the differential dissectingmember 110 about the substantially transverse axis of member rotational oscillation 112 (and so the motion of thetissue engaging surface 120 against the complex tissue) depends on the balance of tension applied to the ends ofcable loop 160. The authority (i.e., the surplus of force of the tissue engaging surface, relative to the force required to dissect the tissue) of the motion of thetissue engaging surface 120 against the complex tissue depends on the magnitude of the tension applied to theentire cable loop 160. The amplitude of theoscillation 538 about the center ofoscillation 538′ depends on the magnitude oftravel 536 through which thecable loop 160 travels. The overall motion of the differential dissectingmember 110 is thus a function of the motion of thecable loop 160, such that a leftward-driving input 537 (half-shaded bold arrows) results in aleftward swing 537′ of the differential dissectingmember 110, while a rightward-driving input 539 (solid black bold arrows) results in arightward swing 539′ of the differential dissectingmember 110. - Continuing with
FIG. 5A-1 , the differential dissectingmember 110 is depicted oscillating in a steady, symmetrical,sinusoidal fashion 45 degrees to either side of a center ofoscillation 538′ that points exactly distal, coincident with thelongitudinal axis 398 of the differential dissecting instrument and directed toward the tissue to be dissected. The direction ofdissection 121 in this case point forward, in that the complex tissue is dissected directly in front of the differential dissecting attachment. - Disclosed in
FIG. 5A-2 is a schematic of the regular sinusoidal motion of the differential dissectingmember 110 inFIG. 5A-1 .Time 570 forms the x-axis, the y-axis is shown on the left-hand side as theta [0],angular position 572 of the differential dissectingmember 110, in degrees away from the center ofoscillation 538′, while the y-axis is shown on the right-hand side as omega [w],rotational velocity 574 of the differential dissectingmember 110. Therotational velocity 574 of the differential dissectingmember 110 drops to zero as itsangular position 572 reaches the extreme of 45 degrees, and therotational velocity 574 of the differential dissectingmember 110 reaches its maximum when theangular position 572 crosses zero degrees. This example of motion of the differential dissectingmember 110, that is, regular sinusoidal oscillation about a center ofoscillation 538′ that is coincident with thelongitudinal axis 398 of thedifferential dissecting attachment 100, so that the direction ofdissection 121 is exactly distal, can be considered typical state of a differential dissecting attachment. That said, it is by no means a limiting case, as there is much to be gained by dynamically varying therotational velocity 574, theangular position 572, or both. - Referring to
FIGS. 5B-1 and 5B-2 , one may change the direction ofdissection 121, in this example by offsetting the center ofoscillation 538′ (here by −22.5 degrees, to the viewer's left) without changing the amplitude ofoscillation 538; this is done by shifting the cables proximal on the left side and more distally on the right. Given that the differential dissectingmember 110 now effectively points to the left, oscillation about the center ofoscillation 538′ drives dissection up and to the left. When thedifferential dissector 500 is thrust forward, resistance from the tissue to be dissected is reduced there as the tissues give way, and so thedifferential dissecting dissector 500 steers left. The direction ofdissection 121 can be changed at will by controlling the motion of the drive means 160, which in this embodiment is thecable loop 160. - Referring to
FIGS. 5B-1 and 5B-2 , these figures depict a cable-driven, controllabledifferential dissecting member 110 oscillating in a steady, symmetrical, sinusoidal fashion about an offset center ofoscillation 538′ that points at a non-zero angle (here, 22.5 degrees to the viewer's left) from the longitudinal axis of the differential dissecting instrument. The direction ofdissection 121 thus points to the left, and, as the differential dissectingmember 110 oscillates about that leftward-leaning offset center ofoscillation 538′, and so the direction ofdissection 121. Thus the tissue to be dissected gives way preferentially on the left, and the resistance of dissection decreases on the left, and the steerable differential dissectingassembly 500 tunnels to the left. In this way, the steerable differential dissectingassembly 500 can be directed to tunnel in any desired direction by controlling the offset. -
FIGS. 5C-1 and 5C-2 depict a cable-driven, controllable differential dissecting member oscillating in a symmetrical fashion, but with a varying angular velocity profile, about a center ofoscillation 538′ that points exactly forward about thelongitudinal axis 398 of the differential dissecting instrument. The varying angular velocity profile generates off-axis forces against the tissue to be dissected, thus driving the direction ofdissection 121 off-axis, and the steerable differential dissectingassembly 500 dissects preferentially in that direction.FIGS. 5D-1 and 5D-2 depict a cable-driven, controllabledifferential dissecting member 110 oscillating in a steady, symmetrical, sinusoidal fashion, but with a varying angular velocity profile, about a center ofoscillation 538′ that points at a non-zero angle from thelongitudinal axis 398 of the differential dissecting instrument. The combination also generates asymmetrical dissection, driving a change in the direction ofdissection 121, allowing the steerable differential dissectingassembly 500 to dissect in a direction chosen by the surgeon. -
FIGS. 5E-1 through 5E-3 show a controllabledifferential dissecting dissector 500 located at the distal end of an endoscope, oscillating about a center ofoscillation 501, creating a direction of dissection, and dissection in that direction, and showing arbitrary control of the direction of dissection thus permitting tunneling in arbitrary directions within complex tissues.FIG. 5E-1 shows the steerable differential dissectingassembly 500, comprising a differential dissectingmember 510 fixed to oscillate on thedistal-most portion 511 of aflexible instrument shaft 555, the oscillation possessing a center ofoscillation 501, a first extent ofoscillation 502 and a second extent ofoscillation 503, and an amplitude ofoscillation 514 defined by the angle between the first extent ofoscillation 502 and a second extent ofoscillation 503. The steerable differential dissectingassembly 500 further comprises alongitudinal axis 518 and a direction ofdissection 516. Thedifferential dissecting member 510 is not unlike the others disclosed in this document, possessing a tissue engaging surface, a substantially transverse axis of member rotational oscillation, and the like. Of interest here is the control of the direction ofdissection 516 by modulating the properties of oscillation of the differential dissectingmember 510, chiefly the offset of the center ofoscillation 501, and secondly, by varying the rotational velocity of the differential dissectingmember 510. The direction ofdissection 516 is defined as the center of the narrow region of tissue that experiences a sufficient differential dissection effect so that a complex tissue there differentiates into preserved firm or organized tissue and disrupted soft, less-well organized tissue. - In normal operation, the direction of
dissection 516 is coincident with the center ofoscillation 501. As the differential dissectingmember 510 oscillates, it typically oscillates sinusoidally about a center, usually halfway between the first extent ofoscillation 502 and a second extent ofoscillation 503; we define that halfway point as the center ofoscillation 501. The oscillations of a differential dissectingmember 510 are determined in a cable-driven device as disclosed inFIGS. 3A and 5A-1 to 5D-2 by the magnitude of the change in tension (and so, position) over time; a oscillatory drive train as disclosed inFIGS. 3A, 4A can vary motor speed. Thus, the direction of dissection 121 (or 516) is controllable at the discretion of the surgeon. - Referring now to
FIGS. 6A-1 through 6B-5 , to ensure improved performance and safety for a differential dissecting instrument, we disclose below, and first inFIG. 6A-1 , anotherembodiment 600 of a differential dissectingmember 110. This differential dissectingmember 110 is captured by, and driven to oscillate by, a continuous,circuitous loop 160 of fine wire rope or cable passing through a series of fenestrations (passages) through thebody 111 of the differential dissectingmember 110 and proximally away to a drive mechanism. The continuous,circuitous loop 160 is made up ofportions 160A-160G of a fine wire rope or cable. The circuitous route of the loop through and around thebody 111 of the differential dissectingmember 110 forms a “lark's head” or “cow-hitch” knot, a topologically constrained path that captures the differential dissectingmember 110, preventing its loss. - Describing the elements of this embodiment in detail, the differential dissecting
member 110 has alongitudinal axis 398 with a first,proximal end 397 substantially directed toward a drive mechanism on, within, or associated with a handle or surgical robot, and a second,distal end 396, substantially directed distally toward a tissue to be dissected. Thedifferential dissecting member 110 is rotatable about a substantially transverse axis of memberrotational oscillation 112 which is perpendicular to thelongitudinal axis 398 and located near thelongitudinal axis 398's second,distal end 396. Thedifferential dissecting member 110 further has a roughly wedge-like body 111, which is substantially aligned with thelongitudinal axis 398, and a tissue-engagingsurface 120 substantially directed distally toward the tissue to be dissected and forming the somewhat thinner tip of the wedge-like body. The body further possesses afirst face side 691 of the wedge-like body 111 and a second, backside 692 of the wedge-like body 111. - The
body 111 of the differential dissectingmember 110 further comprises a series of short, shallow surface troughs and through-body-holes (passages) which are adapted to accept, capture, and allow passage of a continuous loop of fine wire rope or cable that holds the differential dissectingmember 110 to the rest of the surgical instrument. The first,face side 691 has a mouth-like trough 166 and two eye-like troughs side 692 has two ear-like troughs 162′ and 164′. The mouth-like trough 166 further comprises twopassages body 111 of the differential dissectingmember 110. The eye-like trough 162 has apassage 161B passing through to the second, back side of the differential dissectingmember 110, and a longitudinally-orientedpassage 161A that travels out the bottom of the differential dissectingmember 110. The eye-like trough 164 has apassage 161E passing through to the second, back side of the differential dissectingmember 110, and a longitudinally-orientedpassage 161F that travels out the bottom of the differential dissectingmember 110. Viewing alsoFIGS. 6B-1 (a direct view of the first,face side 691 of the differential dissecting member 110) and 6B-2 (a direct view of the second, backside 692 of the differential dissecting member 110), we see that there on the second, backside 692 are two more troughs: ear-like trough 164′, further comprising thepassage 161E and thepassage 161D, and ear-like trough 162′, further comprising thepassage 161B and thepassage 161C. - Still referring to
FIGS. 6A-1, 6B-1, and 6B-2 , review now the circuitous path of thecable loop 160 depicted clearly inFIG. 6A-2 . Following thecable loop 160 around through the passages, we see that thecable loop section 160A first passes up distally throughpassage 161F into the bottom of the eye-like trough 164 in the first,face side 691 of differential dissectingmember 110. Thecable loop 160 then travels from there up distally through the eye-like trough 164 asloop section 160B and passes from the first,face side 691 throughpassage 161E, emerging asloop section 160B′ into the ear-like trough 164′ on the second, backside 692 of the differential dissectingmember 110. Thecable loop 160 then turns and travels proximally down through thattrough 164′, and, asloop section 160C′, passes throughpassage 161D, emerging asloop section 160C into the mouth-like trough 166 in the first, face side of differential dissectingmember 110. The loop then passes as loop section 166D in the mouth-like trough 166, traversing the face of the first,face side 691. - The inventors of the subject matter disclosed in this application have found it advantageous to further design the mouth-
like trough 166 to “bite” or “pinch” thecable loop 160. This feature is most clearly observed inFIG. 6B-5 , the profile view of theembodiment 600 of the differential dissectingmember 110. By providing thebody 111 of the differential dissectingmember 110 with the mouth-like trough 166, farthest from the harsh cyclic loads near the ends of thecable loop 160, the differential dissectingmember 110 can thus pinch the fine cable orwire loop 160, securing it cleat-like in the mouth-like trough 166 where the stresses that would tend to dislodge it are the lowest. This will help ensure that theentire cable loop 160 cannot reptate (i.e., slide) through the circuitous route formed by the series of passages and troughs formed in the body of the differential dissectingmember 110. We can in this view clearly observe the substantially straight, wedge-like form of thebody 111 of the differential dissectingmember 110 that helps divide and pre-tension the complex tissue to be dissected. Also visible in this view is the length of thepassage 161D traveling from the eye-like trough 164 set deeply into the first,face side 691, through to the ear-like trough 164′ set into the second, backside 692 of thebody 111 of the differential dissectingmember 110. Further visible is thepassage 161D connecting the mouth-like trough 166 in the first,face side 691 and the eye-like trough 164′ set in the second, backside 692 of thebody 111 of the differential dissectingmember 110 comprising thispreferred embodiment 600. Thebody 111 of the differential dissectingmember 110 further comprisesstabilizers 999, that help secure the differential dissectingmember 110 onto an axle whose axis is coincident with the substantially transverse axis of memberrotational oscillation 112, thestabilizers 999 further possessing a shape allowing clearance for thecable loop section 160A. - Continuing with the circuitous loop (and referring back to
FIGS. 6A-1, 6B-1, and 6B-2 ), the path of the circuitous loop can be traced substantially symmetrically through the remaining passages. Thecable loop 160 completes its traverse of the first,face side 691 in the mouth-like trough 166, then passing asloop section 160E away from the first,face side 691 throughpassage 161C to emerge on the second, backside 692 asloop section 161E′ into the proximal-most end of ear-like trough 162′. From there thecable loop 160 circuits distally along ear-like trough 162′ until it reachespassage 161B asloop section 160F′, where it passes through to emerge on the first,face side 691 asloop section 160F in the eye-like trough 162. Thecable loop 160 then leaves the first,face side 691 for last time and descends proximally down, following the eye-like trough 162 until it passes into and throughpassage 161A, until it emerges asloop section 160G, and heads proximally toward the first,proximal end 397 oflongitudinal axis 398. - Referring again to
FIG. 6A-1 , note that thisembodiment 600 of a differential dissectingmember 110 further includes developing opposedtensile forces cable loop sections tensile force 137 is greater thantensile force 139, so that an imbalance is present. This force imbalance drives the differential dissectingmember 110 to rotate about the substantially transverse axis of memberrotational oscillation 112 in the direction ofarrow 136. Conversely, if thetensile force 139 becomes greater than thetensile force 137, then the differential dissectingmember 110 rotates aboutaxis 112 in the direction ofarrow 138. The tensile forces on theends cable loop 160 are provided remotely by a drive mechanism located proximal to thisembodiment 600 of the differential dissectingmember 100. The useful cable oscillation frequencies for effective differential dissection are between 10 Hz and 1 KHz, with a preferred range between 50 Hz and 500 Hz. - Reviewing now
FIG. 6A-2 one last time, it can be seen in this view (where the differential dissectingmember 110 is transparent to expose the complete circuitous route of the cable loop 160) that nowhere does thecable loop 160 come into contact with itself, nor does thecable loop 160 bend at a radius small enough to kink, reducing the chances of thecable loop 160 damaging itself under load. Thecable loop 160 passes completely through six holes in thebody 111 of the differential dissectingmember 110, increasing greatly the odds of the complete capture of the differential dissectingmember 110, helping to prevent its loss during surgery. The five troughs are so designed as to allow the cable to wrap around and through thebody 111 of the differential dissectingmember 110 as deep into (and preferably below) the outer surfaces of the differential dissectingmember 110. - Referring now to
FIGS. 6B-1, 6B-2, 6B-4, and 6B-5 , a further feature of the design of thisembodiment 600 of a differential dissectingmember 110 is an cylindrical axle well 199. The cylindrical axle well 199 preferably faces directly proximally, and has a transverse long axis formed by the transverse axis of memberrotational oscillation 112, concentric with a bearing cavity 114 (seeFIG. 3B ). Designed to accept an axle, the axle well 199 can be seen inFIGS. 6B-1 and 6B-2 that thisembodiment 600 of a differential dissectingmember 110 requires the proximally directedtensile forces member 110 further incorporatesnearby stabilizers 999, the better to prevent dislodgement of the differential dissectingmember 110 from atop thedistal end 396 of the differential dissecting instrument. The shape of thestabilizers 999 further admit sweeping at large angles by thecable loop 160 while it is under tension, so that thestabilizers 999 cannot interfere with the smooth action of thecable loop 160. - Lastly, the short lengths of the passages can clearly be seen in
FIG. 6B-3 , which depicts a top view looking back proximally theembodiment 600. Thedifferential dissecting member 110 possesses abody 111, a substantially transverse axis of memberrotational oscillation 112, a tissue engaging surface 120 (in this view, directed at the viewer), a first,face side 691, a second, backside 692, and a plurality of troughs and passages formed in thebody 111 of the differential dissectingmember 110. One can see thatpassage 161D enters through the ear-like trough 164′ in the second, backside 692 and emerges in the mouth-like trough 166 in the first,face side 691. Thepassage 161E enters through the ear-like trough 164′ in the second, backside 692 and emerges in the eye-like trough 164 in the first,face side 691.Passage 161B enters through the ear-like trough 162′ in the second, backside 692 and emerges in the eye-like trough 162 in the first,face side 691.Passage 161C enters through the ear-like trough 162′ in the second, backside 692 and emerges in the mouth-like trough 166 in the first,face side 691. At no time do the passages require the cable loop 160 (seeFIG. 6A-2 ) to bind upon itself, so reducing the chances of cable wear and tear. - It is often useful to be able to dissect in a straight line, directly forward. In the
embodiment 600 shown again inFIGS. 6A-1 through 6B-5 , a substantially straight-bodieddifferential dissecting member 110 for dissecting a complex tissue is disclosed. Thedifferential dissecting member 110 comprises abody 111 having alongitudinal axis 398, with a first,proximal end 397 and a second, distal end, 396. Thelongitudinal axis 398 is aligned with the differential dissectingmember 110 when themember 110 is centered in its travel sweep alongplanar motion 392. The wedge-shape of thebody 111 of the differential dissectingmember 110 is designed to dissect directly in front of the differential dissecting handheld open surgical instrument, differential dissecting laparoscopic instrument, or differential dissecting surgical robot arm to which it is attached to enable differential dissection. So, again, in thisembodiment 600, the mass of thebody 111 of the differential dissectingmember 110 is arranged in a substantially straight fashion along thelongitudinal axis 398, and the differential dissection effect occurs in a region substantially directly along the axis of the differential dissectingmember 110, that is, tissues are separated by thetissue engaging surface 120 in a region directly distal to the tip of the device. A straight instrument serves well enough for many procedures most of the time. - Surgeons, however, often require access to target structures hidden behind other delicate, critical structures that must not be damaged. This kind of surgery is tedious and taxing on all involved. Surgeons are also often called upon to reach or expose critical structures that are found in tight spaces where straight instruments will simply not fit. In an embodiment related to that we disclosed above, we here further teach a curved oscillating differential dissecting member.
FIGS. 6C-1 through 6C-3 depict oblique, side, and end views of anotherembodiment 650 of a cable-retaineddifferential dissecting member 610 with a distinctly curved profile. The curveddifferential dissecting member 610 comprises abody 611 having a first end and a second end, and with acentral axis 398 from the first end to the second end. In this embodiment, however, thetissue engaging surface 620 of the differential dissectingmember 610 is arranged in a substantially curved form, away and to one side of thelongitudinal axis 398, and out of the plane ofoscillation 392 of themember 610, such that the alternating series of at least one valley and at least one projection comprising atissue engaging surface 620 is arrayed entirely on one side of the plane ofoscillation 392, so that they never cross it during oscillation of the curved differential dissecting member. This causes the differential dissection effect to occur in a region substantially to one side of the axis of the device, permitting a surgeon to perform blunt dissection around and behind otherwise occluding tissues. - The previous embodiments of differential dissecting devices have mostly relied on axles, bushings, roller bearings, and the like for creating and supporting the substantially transverse axis of member rotational oscillation of the disclosed differential dissecting members. Axles and roller bearings can clog, jam, or otherwise develop issues that could interfere with a differential dissecting member oscillating at a few hundred Hertz, under severe and variable loads, for a million cycles or more. Furthermore, it is desirable to reduce the number and complexity of the parts in the device to increase safety and reduce cost. And, reducing relative motion between what parts remain can reduce wear and tear, reduce radiated noise, and increase the performance of the device.
- Disclosed in
FIG. 7 is an alternative means for supporting a differential dissectingmember 710 under these conditions.FIG. 7 depicts an oblique view of anembodiment 700 of a cable-driven differential dissecting assembly comprising anelongate shaft 790 through which passcables 780 which are attached to a differential dissectingmember 710 disposed distal-most and near theshaft 790. Thedifferential dissecting member 710 also possesses abody 711, atissue engaging surface 720, a substantially transverse axis of memberrotational oscillation 712, and a desired plane ofoscillatory motion 792 oriented substantially perpendicular to the substantially transverse axis of memberrotational oscillation 712. Thedifferential dissecting member 710 further comprises aninternal cavity 760 admitting and capturing at least a portion of thedrive cable 780. Thisembodiment 700 also comprises an elasticplanar member 775 oriented substantially parallel to theelongate shaft 790 and with its planar form oriented substantially perpendicular to the desired plane ofoscillatory motion 792 of the differential dissectingmember 710. The elasticplanar member 775 may be made of any convenient material that is stiff within its own plane, but will deflect out-of-plane (i.e., bend) when subject to out-of-plane loading. Theelongate shaft 790 may also possess a attachment means 777 designed to accept and anchor a portion of the elasticplanar member 775. Theinternal cavity 760 of the differential dissectingmember 710 may also accept, bond with, and retain and thereby be disposed upon the distal-most portion of the elasticplanar member 775. Thus the differential dissectingmember 710 resides on the elasticplanar member 775, which itself resides at the distal-most portion of theelongate shaft 790. - It is important to note that in this
embodiment 700, the substantially transverse axis of memberrotational oscillation 712 is parallel to and coincident with the plane defined by the elasticplanar member 775; that is, the substantially transverse axis of memberrotational oscillation 712 ideally passes through the middle of the thickness of the elasticplanar member 775. There is no axle, roller bearing, or other wheel-like feature per se that enables the rotation in the desired plane ofoscillatory motion 792. Also, it is important to observe fromFIG. 7 that the cables depicted pass on either side of the elasticplanar member 775. - In operation, providing the oscillating cable tension imbalance as disclosed above at least in
FIG. 6A-1 , the differential dissectingmember 710 residing on the elasticplanar member 775 is subject to out-of-plane loading, so that the differential dissectingmember 710 residing on the elasticplanar member 775 deflects (in the desired plane of oscillatory motion 792) to that side of the elasticplanar member 775 subject to the greater tension. Thus, if thecables 780 are subject to an oscillating tension imbalance at a given frequency, the differential dissectingmember 710 and the elasticplanar member 775 will oscillate within the desired plane ofoscillatory motion 792 at the same frequency. Given that the natural frequency of oscillation of a cantilevered beam is proportional to the square root of the flexural stiffness of the beam divided by the mass of the beam, and given that the energy required to oscillate a beam is minimized (and amplitude is maximized) at the natural frequency of oscillation of that beam, it may be desirable to design the flexural stiffness, mass, length and other properties of the differential dissectingmember 710 and elasticplanar member 775 to operate at the desired frequencies that are preferable for performing safe, differential dissection. Thus, theembodiment 700 of the differential dissector can be tuned to minimize the energy required to operate the device, to maximize the amplitude of the oscillation of the differential dissectingmember 710 within the desired plane ofoscillatory motion 792, or a combination thereof, including the accommodations and requirements for particular surgical procedures. - One normally skilled in the art will appreciate that many variations and combinations of the devices and components herein are possible without violating the spirit of the invention.
Claims (28)
1. A differential dissecting instrument for differentially dissecting complex tissue comprising:
a rotary drive train, having a central, longitudinal axis;
a distal end of the rotary drive train substantially pointed at a complex tissue, and a proximal end of the rotary drive train substantially pointed at, and associated with, a mounting base;
a drive wheel, possessing an axis of wheel rotation coaxial with the central, longitudinal axis of the rotary drive train, located distally to, and rotated by, the rotary drive train;
a drive point located at a non-zero radius from the axis of wheel rotation; and
a differential dissecting member rotatably mounted distally to the drive wheel, the differential dissecting member having an axis of member rotational oscillation.
2. The differential dissecting instrument of claim 1 , wherein the differential dissecting member comprises:
at least one tissue-engaging surface substantially pointed at the complex tissue;
a torque-point disposed proximally to the axis of member rotational oscillation of the differential dissecting member, and operably associated with the drive point, such that the torque-point travels rotatably around the central, longitudinal axis; and
a motion filter operably connecting the differential dissecting member and the torque-point, and further permitting only a planar component of the rotatable travel of the torque-point to actuate the differential dissecting member, thus driving the differential dissecting member in planar rotary oscillation about the axis of member rotational oscillation;
wherein the rotary drive train rotates the drive wheel, which rotates the torque-point, which transmits oscillatory planar motion to the differential dissecting member around the axis of wheel rotation, thereby causing the at least one tissue-engaging surface to move in at least one direction against the complex tissue, and
wherein the at least one tissue-engaging surface is configured to selectively engage the complex tissue such that when the differential dissecting member is pressed distally along a forward tunneling axis into the complex tissue, the at least one tissue-engaging surface moves across the complex tissue and the at least one tissue-engaging surface disrupts at least one soft tissue in the complex tissue, but does not disrupt firm tissue in the complex tissue.
3. The differential dissecting instrument of claim 2 , wherein the motion filter is a substantially flat, elastic member.
4. The differential dissecting instrument of claim 3 , wherein the substantially flat, elastic member is a steel leaf spring.
5. The differential dissecting instrument of claim 3 , wherein the substantially flat, elastic member is formed out of a same material as, and is unitary with, the differential dissecting member.
6. The differential dissecting instrument of claim 2 , wherein the motion filter is comprised of a substantially flat plate operably connected by a hinge joint to the differential dissecting member.
7. The differential dissecting instrument of claim 6 , wherein the hinge joint is further provided with a spring.
8. The differential dissecting instrument of claim 1 , wherein the rotary drive train comprises at least one rotary electric motor possessing a driveshaft defining an axis of motor rotation.
9. The differential dissecting instrument of claim 8 , wherein the rotary drive train further comprises a gearhead operably connecting the at least one rotary electric motor to the drive wheel.
10. The differential dissecting instrument of claim 8 , wherein the rotary drive train further comprises a plurality of motors operably associated in a coaxial fashion, forming an elongate differential dissecting attachment for differentially dissecting the complex tissue.
11. The differential dissecting instrument of claim 10 , wherein the plurality of motors are rotationally phase-locked.
12. The differential dissecting instrument of claim 11 , wherein each of the plurality of motors has a respective driveshaft, and the driveshaft of each of the plurality of motors is connected to one another by a respective universal joint, each universal joint being torsionally rigid about the driveshaft and possessing a center of bending articulation, thus maintaining mutually rotationally phase-locked status of each of the plurality of motors even though one or more driveshafts may deviate from a parallel relationship to one another.
13. The differential dissecting instrument of claim 10 , further comprising a cover, the cover configured to surround, protect, and support components of the rotary drive train.
14. The differential dissecting instrument of claim 13 , further comprising a plurality of cover segments, wherein each motor of the plurality of motors possesses its own cover.
15. The differential dissecting instrument of claim 14 , wherein the plurality of cover segments are articulated with one other, permitting the elongate differential dissecting attachment for differentially dissecting the complex tissue to bend in an arbitrary fashion while each of the plurality of motors is rotating.
16. The differential dissecting instrument of claim 1 , further comprising an elastic sheath providing a smooth, compliant surface to a patient's tissues.
17. The differential dissecting instrument of claim 1 , wherein the torque-point comprises a ball, and the drive point comprises a socket.
18. The differential dissecting instrument of claim 17 , wherein either the ball or the socket is further fitted with a roller bearing.
19. The differential dissecting instrument of claim 15 , wherein a degree of bending of the elongate differential dissecting attachment is controlled.
20. The differential dissecting instrument of claim 19 , wherein a degree of bending between each of the plurality of motors is controlled.
21. The differential dissecting instrument of claim 20 , wherein the elongate differential dissecting attachment is longitudinally incompressible, allowing the entire differential dissecting instrument to be pushed forward from the proximal end, moving distally into a patient's tissues.
22. The differential dissecting instrument of claim 20 , wherein the elongate differential dissecting instrument is longitudinally stiff in tension, allowing the entire differential dissecting instrument to be either pulled forward from the distal end, moving distally into a patient's tissues, or pulled backward out of the patient's tissues from the proximal end.
23. The differential dissecting instrument of claim 1 , wherein rotational motion of the rotary drive train can be varied at will, permitting arbitrary, non-sinusoidal planar motion of the differential dissecting member.
24. The differential dissecting instrument of claim 23 , wherein the differential dissecting member is configured to differentially dissect a patient's tissue in a direction of dissection that can be operatively directed off-center.
25. The differential dissecting instrument of claim 24 , wherein the differential dissecting instrument is configured to dissect an arbitrary path through the patient's tissue.
26. The differential dissecting instrument of claim 15 , wherein the differential dissecting instrument is configured to provide operator control of a degree of bending of at least a distal-most segment of the elongate differential dissecting attachment.
27. The differential dissecting instrument of claim 26 , wherein the differential dissecting instrument is configured to differentially dissect tissue in a direction of dissection, and wherein the differential dissecting instrument is further configured to provide independent control of both rotational motion of the rotary drive train and a degree of bending of the at least the distal-most segment of the elongate differential dissecting attachment, such that the direction of dissection is not coaxial with a longitudinal axis of the elongate differential dissecting attachment.
28. The differential dissecting instrument of claim 27 , wherein the differential dissecting instrument is configured to provide asymmetrical motion which changes the direction of dissection, thus permitting an operator to arbitrarily steer the differential dissecting instrument.
Priority Applications (1)
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US201615304679A | 2016-10-17 | 2016-10-17 | |
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JP2022101607A (en) | 2022-07-06 |
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EP3131480A4 (en) | 2017-12-13 |
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