WO2011069862A1 - Instrument de manipulation à usage chirurgical - Google Patents

Instrument de manipulation à usage chirurgical Download PDF

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Publication number
WO2011069862A1
WO2011069862A1 PCT/EP2010/068505 EP2010068505W WO2011069862A1 WO 2011069862 A1 WO2011069862 A1 WO 2011069862A1 EP 2010068505 W EP2010068505 W EP 2010068505W WO 2011069862 A1 WO2011069862 A1 WO 2011069862A1
Authority
WO
WIPO (PCT)
Prior art keywords
coupling
actuating
surgical manipulation
manipulation instrument
instrument according
Prior art date
Application number
PCT/EP2010/068505
Other languages
German (de)
English (en)
Inventor
Ulrich Seibold
Sophie Thielmann
Michael Strohmayr
Original Assignee
Deutsches Zentrum für Luft- und Raumfahrt e.V.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Deutsches Zentrum für Luft- und Raumfahrt e.V. filed Critical Deutsches Zentrum für Luft- und Raumfahrt e.V.
Priority to EP10785411.9A priority Critical patent/EP2509511B1/fr
Priority to US13/514,225 priority patent/US9522047B2/en
Publication of WO2011069862A1 publication Critical patent/WO2011069862A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/71—Manipulators operated by drive cable mechanisms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00477—Coupling
    • 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
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0813—Accessories designed for easy sterilising, i.e. re-usable

Definitions

  • the invention relates to a surgical manipulation instrument, with a coupling which connects an extracorporeal drive part with a partially intracorporeal manipulator part separable.
  • Surgical instruments designed not for single use but for multiple use must be sterilized after each use.
  • the sterilization can be carried out by means of non-thermal or thermal methods.
  • sterilization is essentially by thermal processes, in particular by so-called autoclaving.
  • autoclaving the instrument to be sterilized is exposed over a certain period of time to excessive water vapor, which must wet all surfaces to be sterilized.
  • the instrument to be sterilized is exposed in the autoclave temperatures of up to 156 ° C and pressures up to 2 bar over a period of up to 40 min. Autoclaving must be repeated after each use of the instrument so that up to several hundreds of autoclaves can be performed during instrument life.
  • Minimally invasive surgery offers particular advantages for the patient, namely low traumatization, short convalescence times, lower postoperative pain, lower blood loss, lower risk of infection, lower risk of wound healing disorders, better cosmetic results, etc.
  • Disadvantages of minimally invasive surgery include the limited freedom of movement of the surgical Instruments, By the fixed passage through the epidermis and adipose tissue, which forms an invariant point, resulting in reverse motion conditions or a disturbed hand-eye coordination with the monitor image. Two degrees of freedom of movement are bound by the invariant point, ie not every point in the working space can be reached with any orientation of the functional instrument end.
  • Minimally invasive manipulation instruments which offer additional degrees of freedom of movement intracorporeally, can lead to an increased intracorporeal manipulability and thus represent an important improvement for minimally invasive surgery.
  • the additional degrees of freedom must be purposefully moved. This is possible with manual operation, but this requires great skill and practice.
  • a robot-assisted telemanipulated approach where the surgeon sits away from the patient on an ergonomically designed console and uses a suitable human-machine interface to guide the surgical manipulation instrument with the aid of the monitor, without having to think about the kinematics and their actuation therefore useful.
  • the surgical manipulation instrument is actuated computer-assisted and performs the surgeon's desired movement accordingly.
  • the actuators for driving the surgical manipulation instrument can not be autoclaved in the rule. Therefore, one is Separability of the extracorporeal drive part of the partial intracorporeal manipulator part required.
  • the surgical manipulation instrument is therefore separated into two parts and separable by a clutch in an extracorporeal drive part and a partial intracorporeal manipulator part.
  • a surgical manipulation instrument with a coupling for separating the drive part of the manipulator part is known.
  • actuating elements such as rotating are rotated by the drive device and transmitted via the coupling device, the rotational and rotational movement of actuators of the Manipulatorteiis.
  • the end effector of the manipulator part is actuated.
  • the coupling parts each have rotatable coupling bodies which have axial pins or bores and are axially coupled to one another or separated from one another. Since the rotatable opposing coupling body are not coupled together, if they are not aligned exactly with each other, a Suchiauf must be performed for all clutch body pairs when engaging.
  • the coupling bodies rotate in each case until a position is found in which all coupling body pairs are in a mating coupling position.
  • a similar coupling is known from US 2001 003 1983 A1.
  • the Kupp! Unsmaschine have here semi-cylindrical shaped coupling body.
  • this game affects the operation of the manipulator instrument disadvantageous or makes an automatic control if necessary, even impossible.
  • the object of the invention is to provide a surgical manipulation instrument with both the drive side and manipulator side axially displaceable elements, wherein the actuators are interconnected by a reliable coupling device.
  • the object is achieved according to the invention by the features of claim 1.
  • the surgical manipulation instrument according to the invention which is particularly suitable for minimally invasive surgery, has an extracorporeal drive device and a partially intracorporeally arrangeable manipulator part.
  • the drive device has a plurality of axially displaceable first actuators.
  • the actuators are, for example, rods or cables, are transmitted by the axial forces.
  • the ManipulatorteiS also has a plurality of axially displaceable second actuators, which are for example also about rods and / or ropes. The actuators serve to actuate an end effector,
  • the first actuating elements are connected to each other with the second actuating elements via a coupling device.
  • the coupling device is a releasable connection of pairs of actuators.
  • the coupling device has a first Kuppiungseiement which is connected to the first actuating element.
  • the coupling device has a second coupling element which is connected to the second actuating element.
  • actuation elements connected to one another via corresponding coupling devices are provided, so that a first and a first second actuating element in each case form an actuating element pair.
  • a pivotable intermediate element is provided between the second coupling element and the second actuating element.
  • a corresponding pivotable intermediate element may also be provided between the first coupling element and the first actuating element, the invention being described below with reference to a pivotable intermediate element provided between the second coupling element and the second actuating element.
  • the pivotable intermediate element serves to convert an axial movement of the first actuating element into a pivoting movement.
  • the pivoting movement of the intermediate element then leads to an axial movement of the second actuating element.
  • the second coupling element on a swivel arm is preferably integrally connected to the intermediate element.
  • the pivot arm is connected via the first coupling element with the first actuating element, in which case in particular a rigid connection takes place.
  • the pivoting arm For connecting the pivoting arm to the first coupling element, the pivoting arm preferably has a gabeiförmige recess.
  • this fork-shaped recess engages a neck of the first coupling element.
  • the approach for example, a circular cylindrical Have cross-section.
  • the fork-shaped recess is then preferably slit-shaped and has a rounded end region, so that the projection rests as flat as possible on the recess in this region.
  • the recess and the projection are preferably adapted to one another in the exterior design in order to realize the largest possible contact surface.
  • the approach may have a cuboid, elliptical or oval cross-section.
  • the recess is again preferably designed accordingly to realize the largest possible contact surface.
  • connection of the coupling elements takes place together.
  • the projections of the first coupling elements are arranged such that by a common rotation of the coupling elements about their common pivot axis, an intervention takes place in the fork-shaped recesses.
  • the fork-shaped recesses are arranged correspondingly on a circular line, so that the lugs can be screwed into the recesses.
  • the fork-shaped recesses of the second coupling elements are open in the same direction, so that correspondingly aligned lugs of the first coupling elements can be inserted simultaneously by lateral displacement in all fork-shaped recesses.
  • the pivot axis of the intermediate element is substantially perpendicular to the direction of movement, at least one in particular of both actuating elements.
  • the actuating elements are preferably aligned such that the longitudinal axes of the actuating elements are parallel to one another, in particular coaxial.
  • the intermediate element has an at least partially circular disc element, in particular as complete circle trained Scheibenerivent on.
  • a groove is preferably provided, in which in particular a rope-shaped connecting element is arranged.
  • a pivoting of the intermediate element in particular by displacement of the pivot arm in the tangential direction thus causes a rotation or pivoting of the disk element.
  • an up or unwinding of the connecting element is effected. For example, by winding the connecting element by a very small angle, carried an axial tensile force on the second actuator.
  • the connecting element is thus in each case connected to a second actuating element or passes directly into the actuating element.
  • at least teii Vietnameseförmig trained disc element with two provided on the outer circumference connecting elements, which are arranged in particular in a groove to connect.
  • the two connecting elements are wound in different directions on the disc element or surround the disc element in different directions. It is sufficient that the connecting element surrounds the disc element by a certain angle, for example 90 degrees.
  • the pivotable intermediate element has a preferably rigidly connected to the Eiseneiement connecting arm.
  • the connecting arm is preferably arranged at an angle other than 0 degrees to the pivoting arm.
  • the connecting arm can then directly with the be connected to the second actuator or via further intermediate elements with this.
  • a transfer or reduction of the movement of the first movement element can be realized.
  • a movement of the first and second actuating elements takes place in the axial direction is carried out substantially by screwing a coupling element.
  • the fastener pairs are formed such that one of the two fasteners has an external thread and the other an approach with an internal thread to the individual fasteners do not have to screw separately from each other, a ring is provided in a further preferred embodiment, the surrounds the fasteners in the coupling area.
  • a part of the fastening elements, preferably those with the internal toothing, is rotatably mounted in the actuating element, so that no rotation of the actuating elements is necessary.
  • the weather is provided between the fasteners an elastic member which compensates for fixing tolerances and allows simultaneous tightening of all fasteners.
  • the ring has an internal toothing which engages in toothing provided on the outer circumference of the fastening elements. By turning this ring thus takes place a rotation of the individual actuating elements about its longitudinal axis. This results in a screwing of the actuator pairs.
  • the ring can be driven by a further ring, wherein between the two rings at least one gear is arranged similar to a planetary gear.
  • the outer ring has an internal toothing and have the inner ring and the intermediate rings on an outer toothing.
  • FIG. 6 is a schematic perspective view of the embodiment shown in Figure 5, wherein the
  • Actuating devices are connected to each other via the dome devices,
  • Figure 7 is a schematic perspective view of another
  • FIG. 8 shows a schematic cross-sectional view of the coupling device shown in FIG.
  • An inventive surgical manipulation instrument which is particularly suitable for minimally invasive surgery, has an extracorporeal drive device 10.
  • This can in particular have one or more electric motors and transmissions, wherein in this way actuating elements 12 (FIG. 2) are displaced in the axial direction (arrows 14).
  • first actuators 12 are formed in the illustrated embodiment as rods It may, however, also be ropes / over which then only tensile forces are transmitted.
  • the surgical manipulation instrument has a manipulator device 16 (FIG. 1). Within a tubular shaft 18 in turn rod-shaped second actuating elements are arranged. These are displaceable in the longitudinal direction 20.
  • the second actuators are connected to an end effector 22. By moving the second actuating elements thus takes place an actuation of the end effector.
  • the second actuators may in turn be bar-shaped actuators but also actuation ropes.
  • a coupling device 24 is provided to connect the first actuating elements 12 and the second actuating elements arranged within the tubular shaft.
  • the first actuation elements 12 indicated in FIG. 2 are designed as three rods extending parallel to one another. At the ends of the rods first coupling elements 26 are provided.
  • the coupling elements 26 each have a pin-shaped projection 28.
  • the pin-shaped projection 28 is cylindrical in the illustratedbrooksbeispiei and protrudes at an angle of 90 degrees to the longitudinal axis of the first actuator 12 to the outside. As can be seen from the plan view (Fig. 3 right), the three cylindrical projections 28 are arranged evenly distributed and thus have an angle of 120 degrees to each other.
  • Second coupling elements 30 whose in the illustrated,sbeispiei a pivot arm 32.
  • the pivot arm 32 has two Armteiie 34 extending parallel to each other, so that a fork-shaped recess 36 is formed in the fork-shaped recess 36, as described below, the pin-shaped projection 28 of the first coupling elements 26 is received.
  • the pivot arm 32 is fixedly connected to a disk-shaped element 38 of the intermediate element 32.
  • the disc member 38 has a groove 40 in which a cable 42 is arranged. For clarity, this is shown only on one of the discs.
  • the cable 42 corresponds to the second actuator or is at least connected to this.
  • To close the coupling device takes place in plan view (Fig. 3 right) a common rotation of all three first actuating elements 12 in a clockwise direction, so that the lugs 28 of the individual Kuppiungseiemente 26 engage in the corresponding kabeiförmigen recesses.
  • three pivotable intermediate elements 32 are held in a housing 46 only partially shown about pivot axes 48 pivotally.
  • the first actuating elements 12 are again formed rod-shaped and have lugs 28, which have a spatially different arrangement due to the arrangement of the second coupling elements 30.
  • the fork-shaped recesses 36 of the coupling elements 30 in this embodiment are arranged one behind the other in this embodiment in FIG. 5. Accordingly, the first actuating element 12, which is lower in FIG. 5, has a projection 28 which protrudes from the plane of the drawing. Behind this actuator 12 is another first Actuator 12 is arranged, the projection 28 points in the opposite direction.
  • the third in Fig. 5 upper Betchanistsseiement 12 has a extending in both directions lug 28, but has a smaller length. This approach 28 engages in the middle in Fig. 6 fork opening 36th
  • a displacement of the first actuating elements 12 in the longitudinal direction 14 causes a pivoting of the pivot arm 32 about a pivot axis 50.
  • the pivot axes 50 of all intermediate elements 32 are coaxial with each other.
  • the intermediate element 32 is rigidly connected to a connecting arm 52.
  • the connecting arm 52 of the intermediate elements 32 has a right angle to the pivot arm 32 in the illustrated embodiment.
  • the connecting arm 52 is then connected to two cables. This can be seen in particular in the upper connecting arm 52 in FIG. 6, which is connected to the two cable pulls 54, 56.
  • the two cables 54, 56 are connected on different sides with the connecting arm 52.
  • pulling on the one or the other side chain 54 or 56 occurs.
  • the intermediate element 32 is pivoted clockwise in FIG. 6, the cable 54 is pulled. This is guided by a deflection roller 58 connected to a second actuator or passes into the second actuator over.
  • both directions of movement of the first actuators can thus be used even when providing cables.
  • the two other intermediate elements are also connected in each case with two cables, which are also guided in turn via pulleys.
  • six cables are provided, can be transmitted to the elements of the end effector 22 (Fig. 1) directly or with the interposition of second actuating elements on the tensile forces.
  • a coupling device for a surgical manipulation instrument also actuator pairs are provided, wherein the first actuating elements 12 are again rod-shaped.
  • the second actuators 64 are also rod-shaped in the illustrated embodiment.
  • the first actuating elements 12 are connected to the drive device 10 shown in FIGS. 1 and 2 and the second actuating elements 64 are connected to the end effector 22.
  • the embodiment shown in FIGS. 7 and 8 is an independent invention,
  • connection of the actuator pairs 12-64 takes place in this mecanicsbeispiei by screwing.
  • the second actuating elements 64 on a pin-shaped projection 66 which is fixedly connected to the second actuating element.
  • the pin-shaped projection 66 is connected to a connection sleeve 68, which has an internal thread and is rotationally movable.
  • the first actuating elements 12 have on their in the direction of the second actuating element 64 facing the end of a pin 70 with external thread.
  • an inner ring 72 is correspondingly a sun gear provided which surrounds the externally toothed connecting sleeves 68 in the illustrated embodiment and engages in the coupling teeth in the teeth of the connecting sleeves.
  • the sun gear 72 has an internal thread which cooperates with a thread provided on the outside of the sleeves 68.
  • At least one, preferably three transmission gears 76 is provided as planet wheels, which engages in a provided on the inside of the handwheel 74 and in a provided on the outside of the sun gear 72 toothing.
  • an elastic compensation element is added between the actuating element 12 and the connecting sleeve 68, against which the connecting sleeves 68 are tensioned by rotating the sun gear 72.

Abstract

L'invention concerne un instrument de manipulation à usage chirurgical se prêtant notamment à la chirurgie à effraction minimale, qui présente un dispositif d'entraînement extracorporel (10) auquel sont reliés plusieurs premiers éléments d'actionnement (12) à déplacement axial. L'instrument présente également un élément manipulateur en partie intracorporel (16) comportant plusieurs seconds dispositifs d'actionnement (42, 54, 56) à déplacement axial pour actionner un effecteur terminal (22). Un dispositif d'accouplement (24) permet d'interconnecter de manière désolidarisable des paires d'éléments d'actionnement. Selon l'invention, un élément intermédiaire (32) pivotant est disposé entre le second élément d'accouplement (30) et le second élément d'actionnement (42, 54, 56).
PCT/EP2010/068505 2009-12-07 2010-11-30 Instrument de manipulation à usage chirurgical WO2011069862A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
EP10785411.9A EP2509511B1 (fr) 2009-12-07 2010-11-30 Instrument de manipulation à usage chirurgical
US13/514,225 US9522047B2 (en) 2009-12-07 2010-11-30 Surgical manipulation instrument

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102009056982.0 2009-12-07
DE102009056982A DE102009056982A1 (de) 2009-12-07 2009-12-07 Chirurgisches Manipulationsinstrument

Publications (1)

Publication Number Publication Date
WO2011069862A1 true WO2011069862A1 (fr) 2011-06-16

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ID=43770481

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP2010/068505 WO2011069862A1 (fr) 2009-12-07 2010-11-30 Instrument de manipulation à usage chirurgical

Country Status (4)

Country Link
US (1) US9522047B2 (fr)
EP (1) EP2509511B1 (fr)
DE (1) DE102009056982A1 (fr)
WO (1) WO2011069862A1 (fr)

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US10092359B2 (en) 2010-10-11 2018-10-09 Ecole Polytechnique Federale De Lausanne Mechanical manipulator for surgical instruments
JP5715304B2 (ja) 2011-07-27 2015-05-07 エコール ポリテクニーク フェデラル デ ローザンヌ （イーピーエフエル） 遠隔操作のための機械的遠隔操作装置
CN106659540B (zh) * 2014-02-03 2019-03-05 迪斯塔莫申股份公司 包括能互换远端器械的机械遥控操作装置
WO2016030767A1 (fr) 2014-08-27 2016-03-03 Distalmotion Sa Système chirurgical pour techniques de microchirurgie
EP4342412A2 (fr) 2014-12-19 2024-03-27 DistalMotion SA Instrument chirurgical réutilisable pour interventions mini-invasives
EP3232974B1 (fr) 2014-12-19 2018-10-24 DistalMotion SA Poignée articulée pour télémanipulateur mécanique
US11039820B2 (en) 2014-12-19 2021-06-22 Distalmotion Sa Sterile interface for articulated surgical instruments
EP3232977B1 (fr) 2014-12-19 2020-01-29 DistalMotion SA Système d'accueil pour télémanipulateur mécanique
EP4289385A3 (fr) 2014-12-19 2024-03-27 DistalMotion SA Instrument chirurgical avec organe terminal effecteur articulé
EP3280343A1 (fr) 2015-04-09 2018-02-14 DistalMotion SA Dispositif mécanique télécommandé pour manipulation à distance
US10363055B2 (en) 2015-04-09 2019-07-30 Distalmotion Sa Articulated hand-held instrument
EP3666213A1 (fr) 2015-05-11 2020-06-17 Covidien LP Unité de commande d'instrument de couplage et instrument chirurgical robotique
WO2016205452A1 (fr) 2015-06-19 2016-12-22 Covidien Lp Commande d'instruments chirurgicaux robotiques à couplage bidirectionnel
EP3340897A1 (fr) 2015-08-28 2018-07-04 DistalMotion SA Instrument chirurgical doté d'une force d'actionnement accrue
DE102017101875B4 (de) 2017-01-31 2019-04-18 Gottfried Wilhelm Leibniz Universität Hannover Linearstellmechanismus
US11058503B2 (en) 2017-05-11 2021-07-13 Distalmotion Sa Translational instrument interface for surgical robot and surgical robot systems comprising the same
KR102139021B1 (ko) * 2017-12-29 2020-07-29 더 보드 오브 리젠츠 오브 더 유니버시티 오브 텍사스 시스템 엔드 이펙터 및 엔드 이펙터 구동 장치
CN111885979A (zh) 2018-02-07 2020-11-03 迪斯透莫森公司 包括机器人远程操纵器和集成的腹腔镜检查的外科手术机器人系统
US11844585B1 (en) 2023-02-10 2023-12-19 Distalmotion Sa Surgical robotics systems and devices having a sterile restart, and methods thereof

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WO2009102102A1 (fr) * 2008-02-15 2009-08-20 Meerecompany Structure d'accouplement d'instrument chirurgical

Also Published As

Publication number Publication date
US20120296341A1 (en) 2012-11-22
DE102009056982A1 (de) 2011-06-09
EP2509511B1 (fr) 2015-08-26
US9522047B2 (en) 2016-12-20
EP2509511A1 (fr) 2012-10-17

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