WO2007111571A1 - Surgical robotic system for flexible endoscopy - Google Patents

Surgical robotic system for flexible endoscopy Download PDF

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Publication number
WO2007111571A1
WO2007111571A1 PCT/SG2007/000081 SG2007000081W WO2007111571A1 WO 2007111571 A1 WO2007111571 A1 WO 2007111571A1 SG 2007000081 W SG2007000081 W SG 2007000081W WO 2007111571 A1 WO2007111571 A1 WO 2007111571A1
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WIPO (PCT)
Prior art keywords
apparatus
endoscope
member
end
shaped member
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PCT/SG2007/000081
Other languages
French (fr)
Inventor
Soo Jay Louis Phee
Soon Chiang Low
Shouwei Tang
Khek Yu Ho
Sheung Chee Chung
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Nanyang Technological University
National University Of Singapore
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Priority to US78598506P priority Critical
Priority to US60/785,985 priority
Application filed by Nanyang Technological University, National University Of Singapore filed Critical Nanyang Technological University
Publication of WO2007111571A1 publication Critical patent/WO2007111571A1/en

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30Surgical robots
    • A61B34/35Surgical robots for telesurgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30Surgical robots
    • A61B34/37Master-slave robots
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70Manipulators specially adapted for use in surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70Manipulators specially adapted for use in surgery
    • A61B34/72Micromanipulators
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70Manipulators specially adapted for use in surgery
    • A61B34/74Manipulators with manual electric input means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70Manipulators specially adapted for use in surgery
    • A61B34/75Manipulators having means for prevention or compensation of hand tremors
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70Manipulators specially adapted for use in surgery
    • A61B34/76Manipulators having means for providing feel, e.g. force or tactile feedback
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70Manipulators specially adapted for use in surgery
    • A61B34/77Manipulators with motion or force scaling
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017Electrical control of surgical instruments
    • A61B2017/00022Sensing or detecting at the treatment site
    • A61B2017/00026Conductivity or impedance, e.g. of tissue
    • A61B2017/00035Conductivity or impedance, e.g. of tissue pH
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238Type of minimally invasive operation
    • A61B2017/00269Type of minimally invasive operation endoscopic mucosal resection EMR
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238Type of minimally invasive operation
    • A61B2017/00278Transorgan operations, e.g. transgastric
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/00296Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0042Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping
    • A61B2017/00442Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping connectable to wrist or forearm
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00464Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable for use with different instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00477Coupling
    • A61B2017/00482Coupling with a code
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2927Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2932Transmission of forces to jaw members
    • A61B2017/2939Details of linkages or pivot points
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30Surgical robots
    • A61B2034/301Surgical robots for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30Surgical robots
    • A61B2034/305Details of wrist mechanisms at distal ends of robotic arms
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06Measuring instruments not otherwise provided for
    • A61B2090/064Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension

Abstract

Apparatus for robotic endoscopy comprising an endoscope having a proximal end and a distal end is disclosed. At least one end-effector is able to be coupled to the distal end of the endoscope. An actuator is able to be coupled to the end- effector. At least one mechanical human interface is able to be coupled to the actuator for actuating the at least one end-effector using the actuator. A corresponding mechanical human interface and methods are also disclosed.

Description

Surgical Robotic System for Flexible Endoscopy Technical Field

[001] This invention relates to systems, methods and apparatus usable to perform surgery and/or endoscopy and more particularly, though not exclusively, the present invention relates to remotely controlled systems, apparatus and related methods for performing surgery and/or endoscopy.

Background

[002] In line with minimally invasive surgery ("MIS"), flexible endoscopy is used to inspect and treat disorders of the gastrointestinal ("GI") tract without the need for creating an artificial opening on the patient's body. The endoscope is introduced via the mouth or anus into the upper or lower GI tracts respectively. A miniature camera at the distal end captures images of the GI wall that help the clinician in their diagnosis of GI diseases.

[003] Simple surgical procedures such as, for example, polypectomy and biopsy can be performed by introducing a flexible tool via a working channel to reach the site of interest at the distal end. The types of procedures that can be performed in this manner are limited by the lack of maneuverability of the tool. More technically demanding surgical procedures such as, for example, hemostasis for arterial bleeding, suturing to close a perforation, and fundoplication for gastrooesophageal reflux cannot be effectively achieved with flexible endoscopy. These procedures are often performed under opened or laparoscopic surgical procedures. [004] With the invention of medical robots clinicians are now able to maneuver surgical tools within the human body. Operating from a master console, the clinician is able to control the movements of laparoscopic surgical tools in real time. These tools (also known as the slaves) allow the clinician to perform procedures with minimal technical difficulties.

[005] Thus far, master-slave surgical robotic systems are rigid. The slave manipulators enter the human body by means of incisions.

[006] The invention of the flexible endoscope was a breakthrough in minimally invasive surgery. The tool enabled endoscopists to diagnose and treat ailments of the GI tract without the need for an artificial opening in the body. The scope is introduced via natural openings (mouth, nostrils, and anus) and traversed to the area of interest in the GI tract. However, flexible endoscopy does have a few disadvantages. There is technical difficulty involved in traversing the scope efficiently into the GI tract.

Furthermore, due to space constraints, only very primitive and simple tools could be introduced to the distal tip of the scope. This results in a small range of surgical procedures that are able to be performed with flexible endoscopy.

[007] Since 1995, locomotive mechanisms have been developed which enable a robotic endoscope to propel itself into the GI tract. Such a robot would relieve the endoscopist from technical difficulties associated with the insertion, and greatly reduce the pain and discomfort of the patient. [008] Apart from flexible endoscopes, ingestible capsules with onboard cameras are also available. They can obtain and transmit images as they travel through the GI tract by means of peristalsis. The orientation of the capsule within the GI tract is at the mercy of the peristaltic action. As such, images of poor quality may result and the clinician may not be able to see what was intended to be seen.

[009] Diseases of the gastrointestinal tract such as, for example, peptic ulcer, gastric cancer, colorectal neoplasms, and so forth, are common in most countries. These conditions can be diagnosed with the aid of the flexible endoscopes. Endoscopes incorporate advanced video, computer, material, and engineering technologies.

[010] However, endoscopists often still complain of the technical difficulties involved in introducing long, flexible shafts into the patient's anus or mouth. Virtual endoscope systems with force sensation have been developed to train inexperienced doctors. Various academic institutions and industries have also developed locomotion devices and steerable mechanisms in their quest to propel the conventional GI endoscope automatically.

[011] Presently, many therapeutic procedures can be performed with conventional GI endoscopy. All these involve the manual introduction of a tool into the working channel of the endoscope. The tool protrudes from the distal end of the endoscope and comes into view of the scope's camera. By steering the distal end, the endoscopist can direct the tool to the point of interest within the GI tract. As the tools are operated manually, the tools normally have only one degree of freedom ("DOF"). Due to the lack of maneuverability, only technically uncomplicated procedures are able to be performed. For example, biopsy and polypectomy. Other more complicated procedures such as endoscopic hemostatic therapy for arterial bleeding, endoluminal placation for gastrooesophageal reflux, endoscopic mucosal therapy for early upper GI cancer, and endoscopic repair of GI perforation, are only able to be performed in specialised centres and even then only by highly trained experts due mainly to the technical difficulties in handling the endoscope and the accessories at the same time.

[012] Acute GI bleeding is a common medical emergency. Therapeutic endoscopy has become the first line treatment for this condition. Endoscopic hemostatic therapy has been shown to improve outcomes in upper GI bleeding. It provides benefits in terms of achieving initial hemostasis, preventing rebleeding, and reducing the need for emergency surgery with its attendant morbidity and mortality. Studies have shown that cost-benefits can be achieved through the use of endoscopic hemostatic therapy.

[013] Haemostatic devices used include contact thermal devices (heater probe and multipolar electrocautery probes), non-contact thermal devices (argon plasma coagulator and lasers), injection needles, and mechanical devices (band ligators, clips, and loops). Most of these methods are relatively easy to use. However, mechanical devices such as hemoclips and detachable loops have more complex delivery devices and require a higher degree of coordination between the endoscopist and endoscopy assistant. [014] Although haemostatic therapy is often successful in controlling bleeding, it may be unsuccessful in arterial bleeding where bleeding is often torrential. In such patients, emergency surgery with undersewing of the bleeding site often successfully arrests the bleeding. Epidemiologic studies have demonstrated that the incidence of emergency surgery has not changed despite major improvements with endoscopic treatment. There are no proven alternatives to an emergency operation for bleeding normally uncontrollable by endoscopic procedures. The main advantage the surgeon has, which endoscopist does not have, is the high degree of freedom when manipulating surgical tools close to the bleeding site. Oversewing of a bleeding lesion using an endoscope is possible if the lesion could be grasped and stitches applied at the same time. This must be able to be achieved in as short a time as possible since time is an essence during acute GI bleeding.

[015] This could be achieved if a robot tool could be delivered via the working channel of the endoscope, and which has a high degree of freedom and allows easy execution by a single operator.

[016] Gastrooesophageal reflux disease results when there is increased exposure of the esophageal mucosa to reflux of gastroduodenal contents. Surgical approaches are used to create barriers to impede reflux. One of the most tested techniques is endoluminal plication.

[017] Endoluminal plication employs mechanical techniques to impede reflux by approximation of tissue at or below the gastroesophageal junction. At the selected site and by use of suction, tissue is drawn into a suction capsule cavity and a suture is inserted by a needle driver. The suction is released and the tissue is withdrawn from the capsule. The procedure is repeated on an adjacent site. Drawing the two adjacent sutured sites together creates a plication. The sutures are 'tied' together using a suture- securing tag system and excess suture material is removed.

[018] The technique is one of the most technically demanding endoscopic therapies. It requires a high degree of operator dexterity, and close coordination of the operator and the assistant. A typical treatment session lasts about 60 minutes. Lengthy procedure times, and procedure related discomfort, might require sedation beyond that used for routine upper GI endoscopy.

[019] The technique requires further improvement and refinement for it to be acceptable to more patients. Since most of the technical complexity relates to the limited degree of freedom afforded by existing apparatus, a robot tool may help to make the procedure simpler and safer.

[020] Endoscopic mucosal resection (EMR) techniques allow the endoscopist to resect lesions not previously amenable to standard biopsy or excisional techniques. It is now widely used to treat early GI cancer, obviating the need for surgery. Most EMR techniques incorporate a submucosal injection to separate the lesion from the muscle layer. Snare polypectomy, or one of the suction techniques, can then be applied. The "lift-and-cut" technique is generally performed with a double-channel endoscope using a forceps and a snare. An opened snare is placed around the lesion; the forceps is passed through the second channel and used to grasp and lift the lesion which is then excised with the snare.

[021] EMR is a complex interventional technique. The features and location of the lesion may further increase the degree of difficulty. The use of a robot endoscopic tool that allows grasping of the lesion and precise resection of the tissue at the same setting would advance the technology.

[022] Perforation of the upper GI tract related to dilation of strictures occurs in 4% of cases. It is associated with a mortality rate that approximates 25%. Colonic perforation during colonoscopy may result from mechanical forces against the bowel wall, barotraumas, or as a direct result of therapeutic procedures. In a survey of over 25,000 diagnostic colonoscopies, the rate of perforation from diagnostic colonoscopy was estimated at 0.2%. In the same survey, polypectomy was performed in over 6000 patients and was associated with a 0.32% rate of perforation.

[023] Perforation often requires surgical repair. Perforations may be closed with clipping devices. Such treatment is not recommended for large perforations due to the difficulty in securing the tissues together to close the perforation. This difficulty may be able to be overcome if the endoscopist is able to grasp the tissues together using one

"arm" of the robot tool while deploying the clips using the other "arm" of the robot tool at the same setting.

Summary [024] According to an exemplary embodiment there is provided apparatus for robotic endoscopy comprising an endoscope having a proximal end and a distal end. At least one end-effector is able to be coupled to the distal end of the endoscope. An actuator is able to be coupled to the end-effector. At least one mechanical human interface is able to be coupled to the actuator for actuating the at least one end-effector using the actuator.

[025] The endoscope may comprises a tool channel through which the at least one end effector may be passed. The at least one end effector may be drivable by a robotic manipulator. Each robotic manipulator may be able to be attached to the distal end of the endoscope using an attachment that is attachable to the distal end to support the robotic manipulators. The robotic manipulator may be able to be actuated by tendon-sheath cables connected to motors at their proximal ends.

[026] Each robotic manipulator may comprise two orthogonal rotational joints, an elbow joint and, at a distal end of the robotic manipulator, a further rotational joint about a longitudinal axis and a final rotational joint about a vertical axis.

[027] The at least one end-effector may be in accordance with a surgical procedure to be performed and may be at least one of: pincers, forceps, hook, basket, knife, monopolar electrodes and bipolar electrodes.

[028] The actuator may comprise motors, sensors and mechatronic devices for actuating the at least one robotic manipulator, the at least one robotic manipulator being operatively attached to the actuator at its proximal end. [029] The at least one mechanical human interface may comprise a console and at least one mechanical device. The at least one mechanical device may comprise a first member that, at its distal end, has rotatably attached thereto a U-shaped member extending generally forwardly of the first member and, at an outer end of the U-shaped member, there is a handle. The handle may comprise a pair of generally U-shaped members opposed to the U-shaped member and pivotally attached to it with each of the pair of U- shaped members being independently pivoted to the U-shaped member.

[030] Each of the pair of U-shaped members may comprise a plate able to have finger or thumb pressure applied to it for the pivotal movement of at least one of the pair of U- shaped members to effect the corresponding movement of the at least one end-effector.

[031] The first member may be in two parts that are able to slide relative to each other to enable extension or shortening of the length of the first member.

[032] The apparatus may further comprise a base to which is pivotally attached to first member. The at least one mechanical device may comprise an exoskeleton able to be attached to an arm of a clinician. The at least one mechanical device may further comprise a plurality of rotary encoders for sensing angular displacement at each of the joints.

[033] The U-shaped member may be in two parts that are able to slide relative to each other to enable extension or shortening of the length of the U-shaped member [034] According to another exemplary aspect there is provided a method of endoscopic surgery comprising using the apparatus described above.

[035] According to a further exemplary aspect there is provided a method of insertion of an endoscope. The method comprises attaching at least one robotic manipulator to the endoscope and introducing the endoscope with the attached at least one robotic manipulator.

[036] According to a penultimate exemplary aspect there is provided a method of insertion of an endoscope comprising introducing the endoscope and subsequently introducing at least one robotic manipulator, the at least one robotic manipulator being introduced after a site of interest has been reached by the endoscope.

[037] The methods may further comprise attaching at least one hollow, flexible tube to the endoscope, the at least one robotic manipulator being threaded through the at least one hollow, flexible tubes to reach a distal end of the endoscope.

[038] A final exemplary aspect comprises a mechanical human interface for endoscopic surgery. The mechanical human interface comprises a first member that, at its distal end, has rotatably attached thereto a U-shaped member extending generally forwardly of the first member and, at an outer end of the U-shaped member, there is a handle.

[039] The handle may comprise a pair of generally U-shaped members opposed to the U- shaped member and pivotally attached to it with each of the pair of U-shaped members being independently pivoted to the U-shaped member. Each of the pair of U-shaped members may comprise a plate able to have finger or thumb pressure applied to it for the pivotal movement of at least one of the pair of U-shaped members to effect the corresponding movement of at least one end-effector. The first member may be in two parts that are able to slide relative to each other to enable extension or shortening of the length of the first member. The interface may further comprise a base to which is pivotally attached to first member. The at least one mechanical device may comprise an exoskeleton able to be attached to an arm of a clinician. The U-shaped member may be in two parts that are able to slide relative to each other to enable extension or shortening of the length of the U-shaped member. The interface may further comprise a plurality of rotary encoders for sensing angular displacement at each of the joints.

Brief Description of the Drawings

[040] In order that the invention may be fully understood and readily put into practical effect there shall now be described by way of non-limitative example only preferred embodiments of the present invention, the description being with reference to the accompanying illustrative drawings.

[041] In the drawings: Figure 1 is an illustration of an exemplary embodiment of a robotic endoscopy system;

Figure 2 is a schematic layout of the exemplary embodiment of a robotic endoscopy system; Figure 3 is a view of an exemplary embodiment of a slave robotic manipulator for use with the system of Figures 1 and 2;

Figure 4 is a perspective view of other exemplary embodiments of slave manipulators attached to an endoscope; Figure 5 is a top view of the exemplary embodiment of Figure 4;

Figure 6 is a perspective view of an exemplary embodiment of an end effector;

Figure 7 is a photographic perspective view of another exemplary embodiment of an end effector;

Figure 8 is a photographic top view of the exemplary embodiment of Figure 7; and

Figure 9 is a photograph of a further exemplary embodiment of an end effector as a master human interface.

Detailed Description of Exemplary Embodiments [042] Throughout the description like reference numerals are used for like components but with a prefix number indicating the drawing figure.

[043] The systems, devices and methods according to the invention enable an endoscopist to perform technically demanding therapeutic procedures (currently possible only with open surgery) using conventional flexible endoscopes.

[044] In the exemplary embodiment shown in Figures 1 and 2, the robotic system consists of a master console 112 able to be operated by a clinician 110. It also has an actuator/sensor console 122 of slave system 132, the slave system including an endoscope 114 that has a distal end 124 inserted into the patient 116, the patient being supervised by an assistant 118. The endoscope 114 has a tool channel (not shown) into which can be inserted a slave comprising a cable (not shown) to drive a robotic manipulator 130 (see Figure 3) with slave manipulators 126 (pincers) and 128 (hook). The endoscope 114 is inserted by the clinician 110 who can observe progress on a monitor 120. When the endoscope 114 has traversed to the area of interest within the GI tract, the slave is inserted by the clinician 110 until the robotic manipulator appears 130 at the distal end 124 of the endoscope 114. The clinician 110 then moves to the master console 112 where he uses his hands to control ergonomically designed mechanical human machine interfaces as is described below.

[045] Figures 4 and 5 show an exemplary embodiment of a slave robotic manipulator 430. This is able to operate with the required number of degrees of freedom to accurately replicate the hand and wrist motions of the clinician 410 within the GI tract in real time. Together with a real time endoscopic view, the endoscopist would have the sensation of having both hands inside the GI tract and would be capable of performing more intricate and difficult surgical procedures.

[046] The exemplary embodiment illustrated has six degrees of freedom and is anthropomorphic to the human arm. Two slave manipulators 426, 428 attach to the distal end 424 of a conventional flexible endoscope 414 using an attachment 440 that attaches to the distal end 424 and supports the manipulators 426, 428. The manipulators 426, 428 are actuated by tendon-sheath cables 442 connected to motors 444 at the proximal ends. Although tendon-sheath actuation is preferred, other forms of actuation may be used such as, for example, signal cables to actuators at the distal end, wireless communication to actuators, and so forth. Variations may depend on the procedure required. For a simple procedure, only one arm may be used.

[047] The base 446 of each slave manipulator 426, 428 is anthropomorphic to the shoulder, and has two orthogonal rotational joints 448, 450. Further along base 446 is an elbow joint 452, which has one rotational degree of freedom about a vertical pivot 454. The exemplary end effector 426, 428, at the distal end of the manipulator, has a first rotational degree of freedom 456 about the longitudinal axis and a second rotational degree of freedom 458 about a vertical axis 460 to represent the wrist. The last degree of freedom is that of the gripper 426 to open and close as their actuators 462, 464 are vertically offset, and may be driven simultaneously, or separately.

[048] As shown, the slave manipulator 426 is fixed with pincers, which are used to grab tissue. The distal tip of the other slave 428 is fixed with a hook with which monopolar, cautery and cutting can be performed.

[049] Because different surgical procedures require different tools, the end effectors are interchangeable. In various exemplary embodiments of the invention, the end-effector can take the form of pincers, forceps, hook, knife, and so forth in accordance with the procedure to be performed. In various exemplary embodiments of the invention, monopolar or bipolar electrodes could also be attached to the end effector for procedures involving cautery. [050] In various embodiments, the slave manipulators can be attached to the endoscope and introduced into the patient together. In other exemplary embodiments, the endoscope can be introduced first into the patient with the manipulators being introduced after the site of interest has been reached. In various exemplary embodiments, hollow, flexible tubes can be attached to the endoscope, and manipulators can be threaded through these tubes to reach the distal end. Some endoscopes have two tool channels which can potentially accommodate two robotic arms. Alternatively, endoscopes may be custom designed to accommodate the robotic manipulator.

[051] The actuator/sensor console 122 is provided to house the motors, sensors and other mechatronic devices required to actuate the slave robotic manipulators 426, 428. The manipulator's proximal end is affixed to this console.

[052] The master human machine console 112 is an interface that enables the clinician to communicate with the slave or robotic system, as shown in Figure 1. The master human machine interface 112 includes mechanical devices made up of passive joints and slides as shown in Figure 6.

[053] The devices have a first device 601 for use by the left arm, and a second device 603 for use by the right arm.

[054] The first device 601 has a base 605 for attachment to a support surface of console

112. Pivotally attached to base 605 by a first, vertically-oriented pivot 607 is a first L- shaped member 609 extending generally to the left and upwardly of base 605. At its distal end the first member 609 is pivotally attached to the proximal end of a second L- shaped member 613 by a second, horizontally-oriented pivot 611. The second member 613 extends generally forwardly and to the right of pivot 611. The member 613 may be in two parts 613a and 613b that slide relative to each other to enable extension or shortening of the length of the member 613. At its distal end the second L-shaped member 613 has a third pivot 615 that is generally horizontally oriented and enables a U-shaped member 617 to be rotatably mounted to the distal end of second L-shaped member 613. The U-shaped member 617 extends generally rearwardly of the pivot 615.

[055] At the inner end of the two arms of the U-shaped member 617 is a left handle 619. The left handle 619 will correspond to the manipulator used on the left side of the endoscope. When the manipulator is grippers 426, the left handle 619 comprises a pair of generally U-shaped members 625, 627 that are opposed to the U-shaped member 617 and pivotally attached to it by pivots 621. Each of the pair of members 625, 627 comprising the handle 619 is independently pivoted to the U-shaped member 617, and has a plate or the like 623 able to have finger or thumb pressure applied to it for the pivotal movement of the members 625, 627 about pivots 621 to thus effect the corresponding movement of the jaws of the gripper 426.

[056] The second device 603 is, to a certain extent, a mirror image of the first device 601. It has a base 655 for attachment to a support surface of console 112. Pivotally attached to base 655 by a first, vertically-oriented pivot 657 is a first L-shaped member

659 extending generally to the right and upwardly of base 655. At its distal end the first member 659 is pivotally attached to the proximal end of a second L-shaped member 663 by a second, horizontally-oriented pivot 631. The second member 663 extends generally forwardly and to the left of pivot 661. The member 663 may be in two parts 663a and 663b that slide relative to each other to enable extension or shortening of the length of the member 663. At its distal end the second L-shaped member 663 has a third pivot 665 that is generally horizontally oriented and enables a U-shaped member 667 to be rotatably mounted to the distal end of second L-shaped member 663. The U-shaped member 667 extends generally rearwardly of the pivot 665.

[057] At the inner end of the two arms of the U-shaped member 667 is a right handle 669. The right handle 669 will correspond to the manipulator used on the right side of the endoscope 114. When the manipulator is a pair of scissors, the right handle 669 comprises a pair of generally U-shaped members 675, 677 that are opposed to the U- shaped member 667 and pivotally attached to it by pivots 671. Each of the pair of members 675, 677 comprising the handle 669 is independently pivoted to the U-shaped member 667, and has a plate or the like 673 able to have finger or thumb pressure applied to it for the pivotal movement of the members 675, 677 about pivots 671 to thus effect the corresponding movement of the blades of the scissors.

[058] The clinician places his hands onto the devices 601, 603 and can freely move his wrists and fingers due to joins 621 and 671 for the fingers, and joints 615, 665 for the wrist. With the vision system, the clinician would be able to see the slave robotic manipulator protruding from the endoscope's distal tip. The movements of the robotic manipulator would be in strict accordance to how the clinician manipulates the devices 601, 603. The devices 601, 603 are embedded with an array of linear and rotary encoders which sense the orientation of the clinician's hands, wrists and fingers (fingers being takes as including the thumbs). This information is fed into a microprocessor 134 for further processing. Some or all of the joints of the devices 601, 603 may be connected to motors which would exert resisting forces on the clinician's hand movements. This mechanical feature enables the clinician to have a force feedback during the operation. As such, the wall of the GI tract can be 'felt' by the clinician when the end effector comes in contact with it. The devices 601, 603 have the six rotational degrees of freedom, and all of the angular displacements may be sensed by rotary encoders.

[059] As shown in Figure 9, the devices 601, 603 may be in the form of an exoskeleton which can be attached to the clinician's arms. In this exemplary embodiment of the invention, similar to the slave manipulator, the devices 601, 603 have the same six rotational degrees of freedom, and all of the angular displacements are sensed by rotary encoders.

[060] Figures 7 and 8 show second exemplary embodiments of the devices 701, 703. In this exemplary embodiment the two devices 701, 703 are substantially the same. Each device 701, 703 has a base 705 for attachment to a support surface of console 112.

Pivotally attached to base 705 by a first, vertically-oriented pivot 707 is a first member 713. The first member 713 extends generally outwardly of the base 705 and may be in two parts 713a and 713b that slide relative to each other to enable extension or shortening of the length of the member 713. At its distal end the first member 713 has a second pivot 715 that is generally horizontally oriented and enables a U-shaped member 717 to be rotatably mounted to the distal end of first member 713. The U-shaped member 717 extends generally forwardly of the pivot 715. The U-shaped member 717 may be in two parts 717a and 717b that slide relative to each other to enable extension or shortening of the length of the U-shaped member 717.

[061] At the outer end of the two arms of the U-shaped member 717 is a left handle 719 and right handle 769 respectively. The left handle 719 will correspond to the manipulator used on the left side of the endoscope. When the manipulator is grippers 426, the left handle 719 comprises a pair of generally U-shaped members 725, 727 that are opposed to the U-shaped member 717 and pivotally attached to it by pivots 721. Each of the pair of members 725, 727 comprising the handle 719 is independently pivoted to the U-shaped member 717, and has a plate or the like 723 able to have finger or thumb pressure applied to it for the pivotal movement of the members 725, 727 about pivots 721 to thus effect the corresponding movement of the jaws of the gripper 426.

[062] The right handle 769 will correspond to the manipulator used on the right side of the endoscope 114. When the manipulator is a hook, the right handle 769 comprises a generally U-shaped member 775 that is opposed to the U-shaped member 717 and pivotally attached to it by pivots 721. The member 775 comprising the handle 769 has a plate or the like 773 able to have finger or thumb pressure applied to it for the pivotal movement of the member 775 about pivots 771 to thus effect the corresponding movement of the hook. [063] The systems according to this invention include the microprocessor 134. The microprocessor 134 may also be a motion controller. In one exemplary embodiment, it is a console and is essentially the 'brain' of the system. It reads information from the master human machine interface. Software calculates the required kinematics of the robot manipulator. Output signals are then sent to the motion controller to actuate the motors and other prime movers accordingly. Input signals from the robot manipulator's sensors are also constantly being read by the microprocessor to ensure that the former is moving in the required manner. Other functions of this microprocessor 134 include scaling down of the clinician's movements. Ideally, the robotic manipulator should move by significantly less that the movement of the clinician movement for accuracy and safety.

[064] In various exemplary embodiments of the invention, in order to further enhance the system, force sensors and biosensors can be incorporated into the end effectors. Information from the former could be used to give the clinician tactile sensations during the operation. In various exemplary embodiments of the invention, biosensors, on the other hand, enable the clinician to know the pH or the presence of certain chemicals at the operating site. With the robotic manipulator, the clinician can, for example, confidently use one of the end effectors to pinch onto the GI wall while the other, for example, holds onto a needle to perform suturing.

[065] The systems, devices and methods of the various exemplary embodiments of applicant's robotic system in tandem with current flexible endoscopes. Because the surgical procedures would be performed through natural orifices, the systems, devices, and methods of applicants robotic system can perform what may be characterized as "no-hole surgery", which is less invasive than key-hole surgeries.

[066] The robotic system may be used for procedures other than those of the GI tract. It may be used for any surgical procedure able to be performed with flexible scopes. These include appendectomy (removal of appendix), removal of gall bladder, tying of fallopian tubes, and so forth. The robotic system may give the surgeon more dexterity and maneuverability.

[067] Whilst there has been described in the foregoing description preferred embodiments of the present invention, it will be understood by those skilled in the technology concerned that many variations in details of design, construction and/or operation may be made without departing from the present invention.

Claims

THE CLAIMS
1. Apparatus for robotic endoscopy comprising: an endoscope having a proximal end and a distal end; at least one end-effector able to be coupled to the distal end of the endoscope; an actuator able to be coupled to the end-effector; and at least one mechanical human interface able to be coupled to the actuator for actuating the at least one end-effector using the actuator.
2. Apparatus as claimed in claim 1, wherein the endoscope comprises a tool channel through which the at least one end effector may be passed.
3. Apparatus as claimed in claim 1 or claim 2, wherein the at least one end effector is drivable by a robotic manipulator.
4. Apparatus as claimed in claim 3, wherein each robotic manipulator is able to be attached to the distal end of the endoscope using an attachment that is attachable to the distal end to support the robotic manipulators.
5. Apparatus as claimed in claim 3 or claim 4, wherein the robotic manipulator are able to be actuated by tendon-sheath cables connected to motors at their proximal ends.
6. Apparatus as claimed in any one of claims 3 to 6, wherein each robotic manipulator comprises two orthogonal rotational joints, an elbow joint and, at a distal end of the robotic manipulator, a further rotational joint about a longitudinal axis and a final rotational joint about a vertical axis.
7. Apparatus as claimed in any one of claims 1 to 6, wherein the at least one end- effector is in accordance with a surgical procedure to be performed.
8. Apparatus as claimed in any one of claims 1 to 7, wherein the at least one end- effector is at least one selected from the group consisting of: pincers, forceps, hook, basket, knife, monopolar electrodes and bipolar electrodes.
9. Apparatus as claimed in any one of claims 1 to 8, wherein the actuator comprises motors, sensors and mechatronic devices for actuating the at least one robotic manipulator, the at least one robotic manipulator being operatively attached to the actuator at its proximal end.
10. Apparatus as claimed in any one of claims 1 to 9, wherein the at least one mechanical human interface comprises a console and at least one mechanical device.
11. Apparatus as claimed in claim 10, wherein the at least one mechanical device comprises a first member that, at its distal end, has rotatably attached thereto a U-shaped member extending generally forwardly of the first member and, at an outer end of the U-shaped member, there is a handle.
12. Apparatus as claimed in claim 11, wherein the handle comprises a pair of generally U-shaped members opposed to the U-shaped member and pivotally attached to it with each of the pair of U-shaped members being independently pivoted to the U-shaped member.
13. Apparatus as claimed in claim 12, wherein each of the pair of U-shaped members comprises a plate able to have finger or thumb pressure applied to it for the pivotal movement of at least one of the pair of U-shaped members to effect the corresponding movement of the at least one end-effector.
14. Apparatus as claimed in any one of claims 11 to 13, wherein the first member is in two parts that are able to slide relative to each other to enable extension or shortening of the length of the first member.
15. Apparatus as claimed in any one of claims 11 to 14 further comprising a base to which is pivotally attached to first member.
16. Apparatus as claimed in any one of claims 11 to 14 wherein the at least one mechanical device comprises an exoskeleton able to be attached to an arm of a clinician.
17. Apparatus as claimed in any one of claims 11 to 16, wherein the at least one mechanical device further comprises a plurality of rotary encoders for sensing angular displacement at each of the joints.
18. Apparatus as claimed in any one of claims 11 to 17, wherein the U-shaped member is in two parts that are able to slide relative to each other to enable extension or shortening of the length of the U-shaped member
19. A method of endoscopic surgery comprising using the apparatus of any one of claims 1 to 18.
20. A method of insertion of an endoscope, the method comprising attaching at least one robotic manipulator to the endoscope and introducing the endoscope with the attached at least one robotic manipulator.
21. A method of insertion of an endoscope, the method comprising introducing the endoscope and subsequently introducing at least one robotic manipulator, the at least one robotic manipulator being introduced after a site of interest has been reached by the endoscope.
22. A method as claimed in claim 20 or claim 21 further comprising attaching at least one hollow, flexible tube to the endoscope, the at least one robotic manipulator being threaded through the at least one hollow, flexible tubes to reach a distal end of the endoscope.
23. A mechanical human interface for endoscopic surgery comprising a first member that, at its distal end, has rotatably attached thereto a U-shaped member extending generally forwardly of the first member and, at an outer end of the U-shaped member, there is a handle.
24. A mechanical human interface as claimed in claim 23, wherein the handle comprises a pair of generally U-shaped members opposed to the U-shaped member and pivotally attached to it with each of the pair of U-shaped members being independently pivoted to the U-shaped member.
25. A mechanical human interface as claimed in claim 24, wherein each of the pair of
U-shaped members comprises a plate able to have finger or thumb pressure applied to it for the pivotal movement of at least one of the pair of U-shaped members to effect the corresponding movement of at least one end-effector.
26. A mechanical human interface as claimed in any one of claims 23 to 25, wherein the first member is in two parts that are able to slide relative to each other to enable extension or shortening of the length of the first member.
27. A mechanical human interface as claimed in any one of claims 23 to 26 further comprising a base to which is pivotally attached to first member.
28. A mechanical human interface as claimed in any one of claims 23 to 26, wherein the at least one mechanical device comprises an exoskeleton able to be attached to an arm of a clinician.
29. A mechanical human interface as claimed in any one of claims 23 to 28, wherein the U-shaped member is in two parts that are able to slide relative to each other to enable extension or shortening of the length of the U-shaped member.
30. A mechanical human interface as claimed in any one of claims 23 to 29 further comprising a plurality of rotary encoders for sensing angular displacement at each of the joints.
PCT/SG2007/000081 2006-03-27 2007-03-26 Surgical robotic system for flexible endoscopy WO2007111571A1 (en)

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