WO2023280031A1 - 一种介入手术机器人从端装置 - Google Patents

一种介入手术机器人从端装置 Download PDF

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Publication number
WO2023280031A1
WO2023280031A1 PCT/CN2022/102248 CN2022102248W WO2023280031A1 WO 2023280031 A1 WO2023280031 A1 WO 2023280031A1 CN 2022102248 W CN2022102248 W CN 2022102248W WO 2023280031 A1 WO2023280031 A1 WO 2023280031A1
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WIPO (PCT)
Prior art keywords
catheter
guide wire
driving mechanism
drive mechanism
main body
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PCT/CN2022/102248
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English (en)
French (fr)
Inventor
欧永红
任文永
Original Assignee
深圳市爱博医疗机器人有限公司
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 深圳市爱博医疗机器人有限公司 filed Critical 深圳市爱博医疗机器人有限公司
Priority to EP22773391.2A priority Critical patent/EP4137088A4/en
Priority to JP2022555861A priority patent/JP7540119B6/ja
Priority to US17/956,914 priority patent/US20230022245A1/en
Publication of WO2023280031A1 publication Critical patent/WO2023280031A1/zh

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    • 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
    • A61B34/30—Surgical robots
    • A61B34/37—Master-slave robots
    • 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
    • A61B34/30—Surgical robots
    • A61B34/35—Surgical robots for telesurgery
    • 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
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0116—Steering means as part of the catheter or advancing means; Markers for positioning self-propelled, e.g. autonomous robots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/09—Guide wires
    • A61M25/09041—Mechanisms for insertion of guide wires
    • 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
    • A61B34/30—Surgical robots
    • A61B2034/301—Surgical robots for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
    • 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
    • A61B34/30—Surgical robots
    • A61B2034/303—Surgical robots specifically adapted for manipulations within body lumens, e.g. within lumen of gut, spine, or blood vessels
    • 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
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
    • A61B90/57—Accessory clamps

Definitions

  • the invention relates to the field of medical robots, and is applied to a master-slave vascular interventional surgery robot, in particular to a slave end device of an interventional surgery robot.
  • Minimally invasive vascular interventional surgery means that under the guidance of the digital subtraction angiography (DSA) system, the doctor manipulates the movement of the catheter guide wire in the human blood vessel to treat the lesion, achieve embolization of malformed blood vessels, dissolve thrombus, and dilate narrow blood vessels. etc. purpose.
  • DSA digital subtraction angiography
  • interventional surgery has played an important role in the diagnosis and treatment of hundreds of diseases such as tumors, peripheral blood vessels, large blood vessels, digestive tract diseases, nervous system, and non-vascular diseases.
  • the scope of interventional surgery can be said to cover the human body “from head to toe". "The treatment of all diseases, and has become the first choice for the treatment of some diseases.
  • Interventional surgery does not need to cut human tissue, and its incision (puncture point) is only the size of a grain of rice. It can treat many diseases that could not be treated or have poor curative effect in the past. It has the characteristics of no surgery, small trauma, fast recovery, and good curative effect. Medical circles at home and abroad attach great importance to it.
  • the technical problem to be solved by the present invention is to provide a slave device for an interventional surgery robot that assists doctors in performing interventional surgery.
  • the present invention provides a slave device for an interventional surgery robot, which includes a main body, a first drive mechanism mounted on the main body in sequence, a second drive mechanism, and a front gripper close to the first drive mechanism;
  • the first driving mechanism is used to clamp and rotate the first guide wire and the second guide wire
  • the second drive mechanism is used to clamp and rotate the first guide wire and the second guide wire
  • the first guide wire passes through the first catheter and is respectively clamped by the second driving mechanism and the first driving mechanism and moves in place on the main body along the same axial direction toward the front clamper, the first catheter,
  • the first guide wire is removed from the first driving mechanism and the second driving mechanism respectively, and the first guide wire is clamped by the front clamper, so that the second guide wire is inserted into the first guide wire, the second guide wire is inserted into the second guide wire and
  • the second catheter and the second guide wire are respectively clamped by the first driving mechanism and the second driving mechanism and move on the main body along the same axial direction towards the clamper.
  • the slave end device of the interventional surgery robot further includes a plurality of front grippers, and the plurality of first catheters that are pushed into place one by one by the first driving mechanism are respectively gripped by the plurality of front grippers.
  • the second driving mechanism is used to clamp and rotate the first conduit and the second conduit together with the first driving mechanism.
  • the second driving mechanism includes a first assembly for clamping and rotating the first guide wire and the second guide wire, and a second assembly for clamping and rotating the first guide wire and the second guide wire.
  • first component of the second driving mechanism is used to clamp the Y valve connected to the first conduit and the second conduit to clamp the first conduit and the second conduit and rotate the Y-valve Luer connector to drive the first conduit.
  • One conduit and the second conduit rotate.
  • the second component is a rubbing device for the guide wire catheter at the slave end of the interventional surgery robot.
  • the slave end device of the interventional surgery robot also includes a rear clamper, which is used to clamp the first The second guide wire does not move.
  • front clamp and the rear clamp are respectively located at the front and rear of the main body, wherein:
  • Both the front clamper and the rear clamper are mounted on the main body and can move relative to the main body;
  • one of the front clamper and the rear clamper is installed on the main body and can move relative to the main body, and the other is installed separately from the main body;
  • both the front holder and the rear holder are installed separately from the main body.
  • the slave end device of the interventional surgery robot also includes a third drive mechanism installed on the main body, the third drive mechanism is used to clamp and rotate the first guide tube and the second guide tube together with the first drive mechanism .
  • the third driving mechanism is used to clamp the first conduit and the second conduit does not move.
  • the third driving mechanism moves along the same axial direction as the first driving mechanism and the second driving mechanism.
  • the third drive mechanism is located between the first drive mechanism and the second drive mechanism.
  • first drive mechanism, the second drive mechanism and the third drive mechanism are all active drive types.
  • first driving mechanism and the second driving mechanism are active driving, and the third driving mechanism is passive following.
  • the interventional surgery robot slave device further includes a switching mechanism, and the switching mechanism is a fast switching mechanism or a coaxial switching mechanism.
  • the exchange mechanism is detachably fixed to the second drive mechanism, or the exchange mechanism and the second drive mechanism are designed in one piece.
  • the present invention allows the doctor to remotely control the first driving mechanism and the second driving mechanism and move along the same axis on the main body, so that the coordinated movement of multiple catheters and multiple guide wires can be in place, and when the catheters and guide wires are replaced by
  • the front gripper clamps the first catheter and does not move, which not only protects health from X-ray radiation, but also controls the catheter and guide wire movement more accurately, reducing work intensity and avoiding major mistakes.
  • Fig. 1 is a schematic diagram of a first embodiment of an interventional surgery robot slave device of the present invention
  • Fig. 2 is another schematic diagram of Fig. 1;
  • FIG. 3 is a schematic diagram of a second embodiment of a slave device for an interventional surgery robot according to the present invention.
  • Fig. 4 is another schematic diagram of Fig. 3;
  • Fig. 5 is the schematic diagram when adding two driving mechanisms in Fig. 3;
  • Fig. 6 is a schematic diagram of Fig. 3 when only two drive mechanisms are removed.
  • connection In the present invention, unless otherwise specified and limited, the terms “installation”, “connection”, “connection” and “fixation” should be understood in a broad sense, for example, it can be a fixed connection or a detachable connection, Or into one, or even a connection that can move relative to each other; it can be a mechanical connection or an electrical connection; it can be directly connected or indirectly connected through an intermediary, and it can be the internal communication of two components or the mutual connection of two components role relationship. Those of ordinary skill in the art can understand the specific meanings of the above terms in the present invention according to specific situations.
  • the direction “distal” is a direction toward the patient, and the direction “near” is a direction away from the patient.
  • the terms “upper” and “upper” refer to an Yin direction away from the direction of gravity, and the terms “bottom”, “lower” and “lower” refer to an Yin direction of gravity.
  • the term “advance” refers to the direction in which the guidewire or catheter is displaced into the body of the surgical patient.
  • the term “backward” refers to the direction in which the guidewire or catheter is displaced out of the surgical patient's body.
  • the term “inwardly” refers to the interior portion of a feature.
  • the term “outwardly” refers to the outer portion of a feature.
  • rotation includes “forward rotation” and “reverse rotation”, where “forward rotation” refers to the direction that the guidewire or catheter is rotated into the body of the surgical patient, and “reverse rotation” refers to the direction that the guidewire or catheter is rotated Exit the orientation of the surgical patient's body.
  • first”, second, etc. are used for descriptive purposes only, and should not be understood as indicating or implying relative importance or implicitly specifying the quantity of the indicated technical features.
  • a feature defined as “first”, “second”, etc. may expressly or implicitly include one or more of that feature.
  • “multiple” or “plurality” means two or more.
  • the guide wires here include but not limited to guide wires, micro guide wires and stents and other guidance and support interventional medical devices
  • catheters include but not limited to guide catheters, micro catheters, contrast catheters, multifunctional tubes (also known as intermediate catheters) , thrombolytic catheters, balloon dilatation catheters and ball expansion stent catheters and other therapeutic interventional medical devices.
  • the first embodiment of a slave end device of an interventional surgery robot of the present invention includes a main body 10, a drive mechanism 12, 14, 16 and a front gripper 18 movably mounted on the main body 10 , Rear clamper (not shown).
  • the main body 10 is long and narrow, and a linear guide rail 102 is arranged on it.
  • These driving mechanisms 12 , 14 , 16 are successively fixed on the guide rail 102 and can slide along the guide rail 102 .
  • Each drive mechanism is used for clamping, pushing (including forward and backward) and rotating (including forward and reverse) catheter or guide wire, and can also be used for simultaneously clamping, pushing (including forward and backward) and rotating (including Forward rotation and reverse rotation) catheters and guide wires to realize coordinated movement of multiple catheters and multiple guide wires.
  • the specific structures of the driving mechanisms 12, 14, 16 are not limited to be the same, and may also be different, as long as they can realize the clamping, pushing and/or rotating of the catheter and the guide wire. In this embodiment, the specific structures of the driving mechanisms 14 and 16 are the same, and the specific structures of the driving mechanism 12 are different.
  • the driving mechanism 14 includes a first component that cooperates with the driving mechanism 12 to clamp and rotate the same catheter, and a second component that clamps and rotates another catheter.
  • the driving mechanism 16 includes a first component for clamping and rotating the other catheter in cooperation with the second component of the driving mechanism 14, and a second component for clamping and rotating the guide wire.
  • the drive mechanism 16 includes a quick change mechanism 162 that cooperates with the first component of the drive mechanism 16.
  • the driving mechanism 12 and the second component of the driving mechanisms 14 and 16 are a guide wire catheter rubbing device for an interventional surgery robot as described in Chinese patent application 202110674959.3, the entire content of which is incorporated into the present invention.
  • a front gripper 18 is located at the front of the body 10 , adjacent to the drive mechanisms 12 , 14 .
  • the rear clamper is located at the rear of the main body 10 , for details, please refer to the description of the rear clamper 70 below.
  • the front clamper 18 and the rear clamper are fixed on the main body 10 and can move relative to the main body 10 when needed.
  • the front holder 18 and the rear holder can also be installed separately from the main body 10 .
  • first catheter When preparing for surgery, the doctor comes to the cath lab for preoperative preparation.
  • Select appropriate (such as length, diameter) first catheter, second catheter and first guide wire and perform physiological saline flushing and exhaust on the first catheter and the second catheter.
  • the driving mechanism 12, 14, 16 in a reasonable position, put the first catheter, the second catheter and the first guide wire into the puncture sheath (such as penetrating into the femoral artery, radial artery or other) of the patient together, and let the driving mechanism
  • the mechanism 12 cooperates with the first assembly of the drive mechanism 14 to clamp the first conduit
  • the second assembly of the drive mechanism 14 cooperates with the first assembly of the drive mechanism 16 to clamp the second conduit
  • the second assembly of the drive mechanism 16 clamps The first guide wire, so as to realize the fixation of the first guide wire, the second guide wire and the first guide wire.
  • the doctor comes to the operating table outside the catheter room, and uses the main console (such as the main end operation handle of the interventional surgery robot described in Chinese patent application 202110654379.8 and the main end control module of the interventional surgery robot described in 202110649908.5, all of which Introduce the present invention) remote operation drive mechanism 12,14,16 motion.
  • the driving mechanism 12, 14, 16 cooperates with clamping the first catheter, the second catheter and the first guide wire to move along the guide rail 102 to drive the first catheter, the second catheter and the first guide wire to advance, drive them simultaneously or not simultaneously.
  • Mechanisms 12, 14, 16 rotate the first catheter, the second catheter, and the first guidewire, thereby advancing the first catheter, the second catheter, and the first guidewire cooperatively.
  • the first components of the driving mechanisms 14 and 16 clamp the first conduit and the second conduit respectively through the Y valve. That is, the first conduit and the second conduit are respectively connected to the Y valve, and the Y valve is fixed to the driving mechanism 14, 16.
  • the first assembly of the driving mechanism 14, 16 clamps the Y valve and rotates the Y valve Luer connector.
  • the second assembly of the driving mechanism 14 to drive the first conduit and the second conduit to rotate.
  • the doctor comes to the catheterization room and manually removes the first catheter from the first assembly of the driving mechanism 12 and the driving mechanism 14, and is clamped by the front clamp 18 and does not move.
  • the driving mechanism 16 can be controlled remotely through the console at the main end or the first guide wire can be retreated manually. When retreating to the puncture sheath, the first guide wire is taken out from the second component of the driving mechanism 16 and soaked in heparin water. Be careful not to push the first catheter during this process, and avoid the head of the first catheter moving in the blood vessel.
  • the third conduit is connected to the Y-valve.
  • the Y-valve is fixed to the driving mechanism 16 and clamped by its first assembly. With cooperation, the third conduit is driven to rotate.
  • the front gripper 18 gripping the first catheter it can also rotate the first catheter by turning the Y-valve luer connector.
  • the doctor comes to the operating table outside the catheter room again, and uses the main console to remotely control the movement of the driving mechanisms 12, 14, and 16.
  • the specific process is the same as the above-mentioned advancing process of the first catheter, the second catheter and the first guide wire, and will not be repeated here.
  • the second catheter is further advanced to the farther blood vessel, and the third catheter and the second guide wire are assisted to advance to the farther lesion of the surgical patient (also called the target blood vessel stenosis).
  • the front gripper 18 it may be necessary for the front gripper 18 to drive the first guide tube in rotation.
  • Angiography confirms the position of the second guide wire.
  • the front holder 18, the driving mechanism 12, 14, 16 Fix the first catheter, the second catheter, the third catheter, and the second guide wire without moving. If do not arrive designated position, then repeat remote control driving mechanism 12,14,16 motions, until the second guide wire arrives designated position.
  • the driving mechanism 16 is remotely controlled through the console at the main end to allow the third guide wire to retreat while keeping the second guide wire from moving. sports.
  • the doctor came to the catheterization room to manually take out the third catheter from the driving mechanism 14, 16 and soak it in heparin water.
  • the second guide wire can be clamped by the driving mechanism 16, and the front holder, the driving mechanism 12, 14, and the driving mechanism 16 can be fixed to fix the first guide wire, the second guide wire, and the second guide wire without moving respectively.
  • the driving mechanisms 12, 14, and 16 can be controlled remotely through the console at the main end, so that the second catheter and the first guide wire can be retreated together.
  • the doctor came to the catheterization room and manually took out the second catheter and the first guide wire from the driving mechanism 14, 16 and soaked in heparin water. Then choose the appropriate two catheters, a guide wire, thread them together and place the first catheter.
  • Make the driving mechanism 12, 14, 16 in a reasonable position let the driving mechanism 12, 14, 16 cooperate to clamp the two catheters and one guide wire, so as to realize the fixing of the two catheters and one guide wire.
  • the subsequent advancing process is the same as the advancing process of the first catheter, the second catheter and the first guide wire. I won't repeat them here.
  • multiple front grippers 18 are provided at the front of the main body 10, so the above-mentioned first conduit moving process can be performed multiple times. After the catheter has been pushed into place, a front gripper 18 holds the catheter.
  • the doctor came to the catheterization room again, manually let the tail of the second guide wire pass through the rapid exchange balloon dilation catheter, and the rapid exchange balloon dilation catheter advanced along the second guide wire, at this time, the rapid exchange balloon was held by the rapid exchange mechanism 162 Dilation catheter.
  • the doctor comes to the operating table outside the catheter room again, and uses the main terminal console to remotely control the rapid exchange mechanism 162, so that the rapid exchange balloon dilation catheter advances to the patient's lesion (not exceeding the second guide wire head).
  • the rapid exchange balloon dilatation catheter reaches the lesion of the surgical patient, the rapid exchange balloon dilation catheter is filled with contrast agent in the catheterization room for pre-dilation, and the effect of vasodilation is confirmed by angiography. If the vasodilation effect is achieved, the contrast agent is withdrawn from the rapid exchange balloon dilation catheter.
  • the doctor When the doctor comes to the operating table outside the catheter room, he uses the main console to remotely control the fast exchange mechanism 162 to retreat to the puncture sheath. During the retraction of the rapid exchange balloon dilatation catheter, the position of the second guide wire remains unchanged. For some procedures, multiple vasodilations may be required, so there will be multiple advances and retractions of the rapid exchange balloon dilatation catheter.
  • the doctor came to the catheterization room again, manually removed the rapid exchange balloon dilation catheter from the rapid exchange mechanism 162, and then manually threaded the rapid exchange balloon expansion catheter through the second guide wire and clamped it to the rapid exchange mechanism 162.
  • the process is the same as the above-mentioned rapid exchange balloon dilatation catheter, and will not be repeated here.
  • the doctor comes to the operating table outside the catheter room again, and uses the main terminal console to remotely control the rapid exchange mechanism 162, so as to push the rapid exchange ball expansion stent catheter along the second guide wire to the patient's lesion (the expanded vascular stenosis) ).
  • the rapid exchange ball expansion stent catheter reaches the patient's lesion (extended blood vessel)
  • the position of the rapid exchange ball expansion stent catheter is fine-tuned, and after confirmation, the rapid exchange ball expansion stent catheter is filled with contrast medium in the catheterization room to allow the stent to form.
  • the contrast agent can be drawn out and the rapid exchange mechanism 162 is controlled to drive the rapid exchange ball expansion stent catheter back to the puncture sheath, while the ball expansion stent remains at the lesion of the surgical patient.
  • the doctor comes to the cath room to manually take out the quick exchange ball expansion stent catheter from the quick exchange mechanism 162 and put it into heparin water.
  • the doctor then comes to the operating console outside the catheter room, and uses the main console to remotely control the movement of the driving mechanisms 12, 14, and 16, so that the second catheter and the second guide wire are retracted to the puncture sheath. Finally, the doctor returns to the catheterization room, manually pulls out the first catheter to the puncture sheath, takes out the first catheter, the second catheter, and the second guide wire from the front holder 18, the driving mechanism 12, 14, and 16, and puts them into Heparin water, and then pull out the puncture sheath and post-operative treatment to complete the operation.
  • the quick-exchange catheter is selected above, so the quick-exchange mechanism 162 needs to be used to clamp, push and rotate. If it is a coaxial exchange catheter, let the tail of the second guide wire pass through the coaxial exchange catheter, and the coaxial exchange mechanism will clamp, push and rotate the coaxial exchange catheter, so that the coaxial exchange catheter advances along the second guide wire to the proper position or back to the puncture sheath. Whether it is the quick exchange mechanism 162 or the coaxial exchange mechanism, the roller driving method can be used to realize the clamping, shifting and rotation of the quick exchange catheter and the coaxial exchange catheter.
  • How to remotely control the movement of the drive mechanism 12, 14, 16 and the quick exchange mechanism 162 from the main console can be the same as the main control module of the interventional surgery robot described in Chinese patent application 202110649908.5, which includes two joysticks, one of which operates The lever is used to control the driving mechanism 12 , 14 and the quick exchange mechanism 162 , and the operating lever can control the driving mechanism 12 , 14 and the quick switching mechanism 162 in time through the switching device, and the other operating lever is used to control the driving mechanism 16 .
  • the main console includes more than two operating levers, such as four operating levers, which are respectively used to remotely control the driving mechanisms 12 , 14 , 16 and the quick exchange mechanism 162 .
  • the above is to illustrate the motion and control process of the present invention by taking the "ball expansion stent forming operation" as an example.
  • the present invention can also be used in various operations such as radiography, embolization, and thrombectomy.
  • the driving mechanisms 12, 14, 16, and the front gripper 18 can be freely allocated by the doctor according to the actual needs of the operation, that is, the driving mechanisms 12, 14, 16, and the front gripper 18 can be easily disassembled. For example, when more complicated operations are performed, more driving mechanisms and front grippers can be added. After adding more driving mechanisms and front grippers, multiple catheters can correspond to one guide wire or multiple catheters can correspond to multiple catheters.
  • a quick exchange mechanism is provided, which is detachably installed on the driving mechanism or made into an integrated structure with the driving mechanism. And when implementing simple inspection operation, only use two in these drive mechanisms, as drive mechanism 12 and 16 (also can be drive mechanism 12 and 14, can be provided with quick exchange mechanism on the drive mechanism 14 as required), and The front clamp 162 removes other driving mechanisms from the main body 10 .
  • two catheters one thick and one thin
  • two guide wires one thick and one thin
  • appropriate diameter and length were selected according to the location of the vascular lesion, and the two catheters were flushed with normal saline and exhausted.
  • the doctor comes to the operating table outside the catheter room, and uses the main terminal console to remotely operate the driving mechanisms 12 and 16 to move.
  • the thick catheter and the thick guide wire are respectively advanced to the stenosis of the blood vessel. Refer to the aforementioned "ball expansion stent forming operation" for the process. Keep the head of the thick catheter and the thick guidewire within the imaging field of view.
  • the doctor manually removes the thick catheter from the first assembly of the driving mechanism 12 and the driving mechanism 16, and is clamped by the front clamper 18 so that it does not move. Be careful not to push the thick catheter during this process, and avoid the head of the thick catheter moving in the blood vessel.
  • the driving mechanism 16 can be controlled remotely through the console at the main end or the thick guiding wire is retracted to the puncture sheath manually, the thick guiding wire is taken out from the second assembly of the driving mechanism 16 and soaked in heparin water.
  • the thin catheter is connected to the Y valve, and the Y valve is fixed to the driving mechanism 16 and its first component clamps the Y valve. With the cooperation of the driving mechanism 14, the luer connector of the Y valve is turned to drive the thin catheter turn.
  • the doctor comes to the operating table outside the catheter room again, and uses the main console to remotely control the movement of the driving mechanisms 12 and 16.
  • the specific process is the same as the above-mentioned advancing process of the thick catheter and the thick guide wire, and will not be repeated here.
  • Let the thin catheter and thin guide wire go to the farther lesion of the surgical patient also known as the target vessel stenosis.
  • Angiography confirms the position of the thin catheter and thin guide wire, and if the designated position is reached (in general, the thin guide wire will pass through the lesion of the surgical patient, except for embolism), then the driving mechanisms 12 and 16 will respectively fix the thin catheter and the thin guide wire so that they do not move.
  • the doctor came to the catheterization room again, and manually let the tail of the thin guide wire pass through the rapid exchange ball expansion stent catheter, and the rapid exchange ball expansion stent catheter advanced along the thin guide wire and penetrated into the thin catheter, specifically the Y valve connected to the thin catheter, The quick exchange ball expansion stent catheter is clamped by the quick exchange mechanism 162 .
  • the doctor comes to the operating table outside the catheter room again, and uses the main terminal console to remotely control the quick exchange mechanism 162, so that the quick exchange ball expansion stent catheter can advance to the operation patient's lesion (not beyond the head of the thin guide wire).
  • the quick exchange ball expansion stent catheter can advance to the operation patient's lesion (not beyond the head of the thin guide wire).
  • always pay attention to the position and angle of the thin catheter and thin guide wire and make fine adjustments in time by forward rotation, reverse rotation, forward and backward rotation if necessary.
  • the rapid exchange ball expansion stent catheter reaches the patient's lesion, the position of the rapid exchange ball expansion stent catheter is fine-tuned, and after confirmation, the rapid exchange ball expansion stent catheter is filled with contrast medium in the catheterization room to allow the stent to form.
  • the contrast agent can be drawn out and the rapid exchange mechanism 162 is controlled to drive the rapid exchange ball expansion stent catheter back to the puncture sheath, while the ball expansion stent remains at the lesion of the surgical patient.
  • the rapid exchange mechanism 162 is controlled to drive the rapid exchange ball expansion stent catheter back to the puncture sheath, while the ball expansion stent remains at the lesion of the surgical patient.
  • the doctor comes to the cath room to manually take out the quick exchange ball expansion stent catheter from the quick exchange mechanism 162 and put it into heparin water.
  • the doctor then comes to the operating console outside the catheter room, and uses the main console to remotely control the movement of the driving mechanisms 12 and 16, so that the thin catheter and thin guide wire are retracted to the puncture sheath. Finally, when the doctor returns to the catheterization room, he can manually pull out the thick catheter to the puncture sheath, take out the thick catheter, thin catheter, and thin guide wire from the front holder 18, driving mechanism 12, 16, put them into heparin water, and then carry out The puncture sheath is pulled out and the post-operative treatment is completed to complete the operation.
  • the tail of the thin guide wire is inserted into the coaxial exchange catheter, and the coaxial exchange mechanism clamps, pushes and rotates the coaxial exchange catheter so that the coaxial exchange catheter runs along the thin
  • the guidewire is advanced to the appropriate position or retracted to the puncture sheath.
  • the second embodiment of the slave device of an interventional surgery robot of the present invention includes a main body 19, a drive mechanism 20, 30, 40, 50, 60 movably mounted on the main body 19, a rear Clamp 70 , quick exchange mechanism 80 and front clamp 82 .
  • the main body 19 is narrow and long, and has a straight channel 192 .
  • These driving mechanisms 20, 30, 40, 50, 60 are successively placed in the channel 192 and can move along the channel.
  • these driving mechanisms 20, 30, 40, 50, 60 can slide directly on the main body 19, such as fixing a linear guide rail on the main body 19, these driving mechanisms 20, 30, 40, 50, 60 can be Slide along the rails.
  • Each drive mechanism is used for clamping, pushing (including forward and backward) and rotating (including forward and reverse) catheter or guide wire, and can also be used for simultaneously clamping, pushing (including forward and backward) and rotating (including Forward rotation and reverse rotation) catheters and guide wires to realize coordinated movement of multiple catheters and one guide wire.
  • Each drive mechanism includes a clamping assembly for holding the catheter or guidewire and a rotating assembly for rotating the catheter or guidewire, and the rotating assembly can be either actively driven or passively followed, or all actively driven , or some are actively driven, and the other is passively followed, and the clamping of the catheter by the driving mechanism 20, 40 does not affect its rotation.
  • the clamping assembly and the rotating assembly of the driving mechanism 20, 30, 40, 50, 60 can be an interventional surgery robot guide wire catheter rubbing device as described in Chinese patent application 202110674959.3, the entire content of which is incorporated into the present invention.
  • the specific structures of the driving mechanisms 20 , 30 , 40 , 50 , 60 are not limited to being the same, and may also be different, as long as they can realize the clamping, pushing and/or rotating of the catheter and guide wire. It is also possible that only the clamping components are the same and the rotating components are different, or the clamping components are different and the rotating components are the same, or multiple clamping components and rotating components are the same, and other clamping components and rotating components are different.
  • the driving mechanisms 20 and 30 are spaced at a certain distance back and forth for cooperating to clamp, push and rotate the same guiding catheter 90 (ie, the first catheter) so that it does not bend.
  • drive mechanisms 20 and 30 preferably move guide catheter 90 synchronously so that it straightens and does not bend.
  • the driving mechanisms 40 and 50 cooperate with each other at a certain distance back and forth, and are used for clamping, pushing and rotating the same multi-functional tube 91 (that is, the second conduit, also called the middle conduit).
  • the driving mechanism 60 is used to clamp, push and rotate the guide wire 92 .
  • Posterior gripper 70 is used to grip and advance guide wire 92 .
  • the quick exchange mechanism 80 is detachably fixed together with the driving mechanism 50, and is used for clamping and pushing the quick exchange catheter.
  • the rear holder 70 is located at the rear of the main body 19 .
  • Front gripper 82 is located at the front of said body 19 , close to drive mechanism 20 , 30 .
  • the front clamper 82 and the rear clamper 70 are fixed on the main body 10 and can move relative to the main body 10 when needed.
  • the front holder 82 and the rear holder 70 can also be installed separately from the main body 10 .
  • the doctor comes to the cath lab for preoperative preparation. If suitable (such as length, diameter) guide catheter 90, multifunctional tube 91 and guide wire 92 are selected, the guide catheter 90 and multifunctional tube 91 are flushed with physiological saline and exhausted. Manually thread the multifunctional tube 91 into the guide catheter 90 and extend the guide catheter 90 for a certain distance, and guide the guide wire 92 into the multifunctional tube 91 and extend the multifunctional tube 91 for a certain distance, such as the head of the guide wire 92 It is about 10cm beyond the multifunctional tube 91.
  • suitable (such as length, diameter) guide catheter 90, multifunctional tube 91 and guide wire 92 are selected, the guide catheter 90 and multifunctional tube 91 are flushed with physiological saline and exhausted. Manually thread the multifunctional tube 91 into the guide catheter 90 and extend the guide catheter 90 for a certain distance, and guide the guide wire 92 into the multifunctional tube 91 and extend the multifunctional tube 91 for a certain distance, such as the head of the guide wire 92
  • the doctor comes to the operating table outside the catheter room, and uses the main console (such as the main end operation handle of the interventional surgery robot described in Chinese patent application 202110654379.8 and the main end control module of the interventional surgery robot described in 202110649908.5, all of which Introducing the present invention) remote operation drive mechanism 20, 30, 40, 50, 60, rear gripper 70 and quick exchange mechanism 80 movement.
  • the driving mechanisms 20 and 30 clamp the guide tube 90 together and move along the channel 192 to drive the guide tube 90 to advance, while or not at the same time, the rotating components of the drive mechanisms 20 and 30 rotate the guide tube 90.
  • the drive mechanism 30 clamps the guide tube 90 and does not move.
  • the clamping assembly of the driving mechanism 20 clamps the guiding catheter 90 again, so that the driving mechanisms 20 and 30 together drive the guiding catheter 90 forward, simultaneously or not at the same time.
  • the rotating assembly of 20 and 30 rotates the guide tube 90, and so on, until advancing into place.
  • the driving mechanisms 40 and 50 clamp the multifunctional tube 91 and move along the channel 192 to drive the multifunctional tube 91 forward, and at the same time or at different times, the rotating components of the driving mechanisms 40 and 50 rotate the multifunctional tube 91 , when the driving mechanism 40 moves to a limit position (for example, the distance from the driving mechanism 30 is close to the threshold) to be reset and the multifunctional tube 91 is released, the driving mechanism 50 clamps the multifunctional tube 91 and does not move.
  • a limit position for example, the distance from the driving mechanism 30 is close to the threshold
  • the clamping assembly of the driving mechanism 40 clamps the multifunctional tube 91 again, so that the driving mechanism 40 and 50 together drive the multifunctional tube 91 forward, simultaneously or not at the same time.
  • the rotating assembly of 40 and 50 rotates the multi-functional pipe 91, so reciprocating, until advancing in place.
  • the driving mechanism 60 and the rear clamper 70 together clamp the guide wire 92 and move along the channel 192 to drive the guide wire 92 forward, and at the same time or at different time, the rotating assembly of the driving mechanism 60 rotates the guide wire. silk92.
  • the driving mechanism 60 moves to a limit position (for example, the distance from the driving mechanism 50 is close to the threshold) to be reset and the guide wire 92 is released, the guide wire 92 is clamped by the rear clamper 70 and does not move.
  • the clamping assembly of the drive mechanism 60 clamps the guide wire 92 again, so that the drive mechanism 60 and the rear clamper 70 together drive the guide wire 92 forward, and the rotating assembly of the drive mechanism 60 simultaneously or not simultaneously Rotate guide wire 92, so reciprocate, until advance in place.
  • initially only the guide wire 92 is gripped by the drive mechanism 60, and then the gripper 70 is not gripped.
  • the driving mechanism 60 is to be reset, the guide wire 92 is clamped by the rear clamper 70 instead.
  • the driving mechanism 60 is reset and clamps the guide wire 92 again, the rear clamper 70 releases the guide wire 92 , so reciprocating, the driving mechanism 60 and the rear clamper 70 alternately clamp the guide wire 92 .
  • How to remotely control the movement of the driving mechanism 20, 30, 40, 50, 60, the rear gripper 70 and the quick exchange mechanism 80 on the main console can be the same as the main terminal control module of the interventional surgery robot described in Chinese patent application 202110649908.5. It includes two operating levers, one of which is used to control the driving mechanism 20, 30, 40, 50 and the quick exchange mechanism 80, and the operating lever can control the driving mechanism 20, 30, driving mechanism 40, 50 and a quick exchange mechanism 80, another operating lever is used to manipulate the drive mechanism 60 and the rear gripper 70. It may also be that the main end console includes more than two operating levers, such as four operating levers, which are used to remotely control the driving mechanism 20, 30, the driving mechanism 40, 50, the driving mechanism 60 and the rear clamper 70, respectively. Rapid exchange mechanism 80.
  • the driving mechanisms 30 and 50 clamp the guiding catheter 90 and the multifunctional tube 91 respectively through the Y valve. That is, the guide tube 90 and the multifunctional tube 91 are respectively connected to the Y valve, and the Y valve is fixed to the driving mechanism 30, 50, and the clamping assembly of the driving mechanism 30, 50 clamps the Y valve, and the rotating assembly rotates the Y valve Luer connector. Drive guide tube 90, multifunctional tube 91 to rotate.
  • the multifunctional tube 91 and the guiding wire 92 In the process of moving the guiding catheter 90, the multifunctional tube 91 and the guiding wire 92 together, it is necessary to keep the multifunctional tube 91 protruding from the guiding catheter 90 by a certain distance, and the guiding wire 92 extending from the multifunctional tube 91 by a certain distance. .
  • the guide catheter 90, the multifunctional tube 91 and the guide wire 92 reach some parts of the blood vessel, it may be necessary to remotely control the driving mechanism 20, 30, 40, 50, 60 and the rear gripper 70 through the console at the main end, so that The guiding catheter 90, the multi-functional tube 91 and the guiding wire 92 are repeatedly advanced, retreated, forward rotated and reversed.
  • the fixed guiding catheter 90 does not move.
  • the driving mechanism 60 and the rear gripper 70 are remotely controlled through the console at the main end to make the guide wire 92 retreat, and the retreat process is basically similar to the above-mentioned forward process.
  • the doctor came to the catheter room and manually took out the guide wire 92 from the clamping assembly of the driving mechanism 60 and the rear holder 70 and soaked in heparin water.
  • the doctor manually takes out the guiding catheter 90 from the clamping assembly of the driving mechanism 20, 30, and is clamped by the front clamper 82 so that it does not move. Note that during this process, do not push the guide catheter 90 to prevent the head of the guide catheter 90 from moving in the blood vessel. Manually take out the multifunctional tube 91 from the clamping assembly of the driving mechanism 40,50, and replace it with the clamping assembly of the driving mechanism 20,30.
  • the front gripper 82 can be made telescoping, protruding from the concealed space when the catheter needs to be gripped.
  • the front gripper 82 that grips the guide catheter 90 it can also rotate the guide catheter 90 by turning the Y-valve Luer connector of the guide catheter 90 .
  • the above catheter moving process can be performed multiple times. A front gripper 82 holds each conduit as it is pushed into place.
  • Adjustment drive mechanisms 40, 50, 60 and rear gripper 70 are in place.
  • Select finer microcatheter 94 and microguide wire 96 (such as 0.014in) for use. Manually thread the micro-guide wire 96 into the micro-catheter 94 and pass it into the multifunctional tube 91 together, so that the micro-catheter 94 and the micro-guide wire 96 are respectively clamped on the clamping components of the driving mechanism 40, 50, the clamping component of the driving mechanism 60 and the Rear clamper 70, so as to realize the fixation of microcatheter 94 and micro guide wire 96.
  • the microcatheter 94 is connected to the Y valve, the Y valve is fixed to the driving mechanism 50 and clamped by its clamping component, and the rotating component rotates the Luer connector of the Y valve to drive the microcatheter 94 to rotate.
  • the doctor comes to the operating table outside the catheter room again, and uses the main end console to remotely control the movement of the driving mechanisms 20, 30, 40, 50, 60 and the rear gripper 70.
  • the specific process is the same as that of the guide catheter 90 , the multifunctional tube 91 and the guide wire 92 described above, and will not be repeated here.
  • Angiography confirms the position of the micro guide wire 96, and if it reaches the designated position (generally speaking, the micro guide wire 96 will pass through the lesion of the surgical patient, except for possible treatment of aneurysm embolism), then the drive mechanism 20, 30, drive mechanism 40, 50, The mechanism 60 and the rear clamper 70 respectively fix the multifunctional tube 91, the microcatheter 94, and the microguide wire 96 from moving. If the specified position is not reached, the remote control drive mechanism 20, 30, 40, 50, 60 and the movement of the rear gripper 70 are repeated until the micro guide wire 96 reaches the specified position.
  • the driving mechanism 40 , 50 , 60 and the rear gripper 70 can be controlled remotely through the console at the main end, so that the multifunctional tube 91 and the guide wire 92 can be retreated together.
  • the doctor came to the catheterization room and manually removed the multifunctional tube 91 and the guide wire 92 from the clamping assembly and the rear clip of the driving mechanism 40, 50, 60. Take it out from the holder 70 and soak it in heparin water. Manually take out the guide tube 90 from the clamping assembly of the driving mechanism 20, 30, and clamp it by the front clamp 82 so that it does not move.
  • the driving mechanism 40, 50 is controlled remotely through the console at the main end to make the micro-catheter 94 retreat while keeping the micro-guide wire 96 from moving.
  • the holder 70 clamps the micro guide wire 96 and does not move.
  • the micro guide wire 96 can be clamped by the driving mechanism 60, and the front holder 82, the driving mechanisms 20, 30 and the driving mechanism 60 can be fixed to fix the guide catheter 90, the multifunctional tube 91, and the micro guide wire 96 respectively. sports.
  • the doctor came to the catheterization room again, and manually let the tail of the micro guide wire 96 pass through the rapid exchange balloon dilation catheter 98, and the rapid exchange balloon dilation catheter 98 advanced along the micro guide wire 96. At this time, the rapid exchange mechanism 80 clamped the rapid exchange Balloon dilation catheter 98 .
  • the doctor comes to the operating table outside the catheter room again, and uses the main terminal console to remotely control the rapid exchange mechanism 80, so that the rapid exchange balloon dilation catheter 98 is advanced to the operation patient's lesion (not beyond the head of the micro guide wire 96). During this process, pay attention to the position and angle of the micro guide wire 96 at all times, and make fine adjustments in time by forward rotation, reverse rotation, forward and backward rotation if necessary.
  • the rapid exchange balloon dilation catheter 98 arrives at the lesion of the surgical patient, the rapid exchange balloon dilation catheter 98 is filled with a contrast agent in the catheter room for pre-dilation, and angiography is performed to confirm the vasodilation effect.
  • the contrast medium is extracted from the rapid exchange balloon dilation catheter 98 .
  • the doctor comes to the operating table outside the catheter room, and uses the main terminal console to remotely control the quick exchange mechanism 80 to retreat to the puncture sheath.
  • the position of the microguide wire 96 is kept unchanged. For some procedures, multiple vasodilations may be required, so there will be multiple advances and retractions of the rapid exchange balloon dilatation catheter.
  • the doctor came to the catheterization room again, manually removed the rapid exchange balloon expansion catheter 98 from the rapid exchange mechanism 80, and then manually threaded the rapid exchange balloon expansion stent catheter on the micro guide wire 96 and clamped it to the rapid exchange mechanism 80, The specific process is the same as the rapid exchange balloon dilatation catheter 98 described above, and will not be repeated.
  • the doctor comes to the operating table outside the catheter room again, and uses the main terminal console to remotely control the rapid exchange mechanism 80, so as to push the rapid exchange ball expansion stent catheter along the micro guide wire 96 to the patient's lesion (the narrowed place of the expanded blood vessel). ).
  • the rapid exchange ball expansion stent catheter reaches the patient's lesion (extended blood vessel)
  • the position of the rapid exchange ball expansion stent catheter is fine-tuned, and after confirmation, the rapid exchange ball expansion stent catheter is filled with contrast medium in the catheterization room to allow the stent to form.
  • the contrast agent can be drawn out and the rapid exchange mechanism 80 is controlled to drive the rapid exchange ball expansion stent catheter back to the puncture sheath, while the ball expansion stent remains at the lesion of the surgical patient.
  • the doctor comes to the catheterization room to manually take out the quick exchange ball expansion stent catheter from the quick exchange mechanism 80 and put it into heparin water.
  • the doctor then comes to the operation console outside the catheter room, and uses the console at the main end to remotely control the movement of the driving mechanism 20, 30, 40, 50, 60 and the rear gripper 70, so that the multifunctional tube 91 and the micro guide wire 96 are moved back to the puncture sheath. .
  • the doctor finally returns to the catheterization room, manually takes out the multifunctional tube 91 and the micro guide wire 96 from the clamping assembly of the driving mechanism 20, 30, 60 and the rear clamper 70, and removes the guide catheter 90 from the front clamper 82. Take it off, withdraw to the puncture sheath and withdraw it into heparin water, then pull out the puncture sheath and perform post-operative treatment to complete the operation.
  • the quick-exchange mechanism 80 needs to be used to clamp, push and rotate. If it is a coaxial exchange catheter, after the tail of the micro guide wire 96 is inserted into the coaxial exchange catheter, the coaxial exchange mechanism clamps, pushes and rotates the coaxial exchange catheter, so that the coaxial exchange catheter advances along the micro guide wire 96 to the proper position or back to the puncture sheath. Regardless of the quick exchange mechanism 80 or the coaxial exchange mechanism, the roller driving method can be used to realize the clamping, shifting and rotation of the quick exchange catheter and the coaxial exchange catheter.
  • the above is to illustrate the motion and control process of the present invention by taking the "ball expansion stent forming operation" as an example.
  • the present invention can also be used in various operations such as radiography, embolization, and thrombectomy.
  • the driving mechanism 20, 30, 40, 50, 60, the rear clamper 70 and the quick exchange mechanism 80 can be freely deployed by the doctor according to the actual needs of the operation, that is, the driving mechanism 20, 30, 40, 50, 60, the rear clamping
  • Both the device 70 and the quick exchange mechanism 80 can be easily disassembled. For example, when performing more complex operations, more driving mechanisms, rear grippers, and quick exchange mechanisms can be added.
  • multiple catheters can correspond to one guide wire or multiple A catheter corresponds to the coordinated movement of multiple guide wires.
  • two driving mechanisms are added to clamp and rotate more catheters.
  • the driving mechanism is provided with a quick exchange mechanism, which is detachably mounted on the driving mechanism or made into an integrated mechanism with the driving mechanism.
  • only two of the driving mechanisms 20, 30, 40, 50, 60 are used, such as the driving mechanisms 30 and 60, referring to Fig. 6, then the other driving mechanisms, the rear clip Holder 70 and quick exchange mechanism 80 are removed from main body 19.
  • the console at the main end and the console for placing the console at the main end are located outside the catheterization chamber. In fact, they can also be placed in a separate space in the catheterization room, as long as they can isolate X-ray radiation and allow doctors to avoid X-ray radiation.
  • the present invention allows the doctor to remotely control the first driving mechanism and the second driving mechanism and move them along the same axis on the main body, so that the coordinated movement of multiple catheters and multiple guide wires can be in place, and when the catheter is replaced, When guiding the wire, the first catheter is clamped by the front gripper and does not move. Not only is it protected from X-ray radiation that affects health, but also the robot controls the catheter and the guide wire moves more accurately, reducing work intensity and avoiding major mistakes.

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Abstract

一种介入手术机器人从端装置，包括主体(10)及安装于主体(10)上的第一驱动机构(12)、第二驱动机构(14)、前夹持器(18)，当第一导丝穿入第一导管且第一导管、第一导丝分别被夹持于第一驱动机构(12)、第二驱动机构(14)并在主体(10)上沿同一轴向运动到位后，第一导管、第一导丝分别从第一驱动机构(12)、第二驱动机构(14)取下，前夹持器(18)夹持第一导管不运动，第二导管穿入第一导管、第二导丝穿入第二导管且第二导管、第二导丝分别被夹持于第一驱动机构(12)、第二驱动机构(14)并在主体(10)上沿同一轴向推移。让医生可远程操控机器人，免受X射线辐射，而且控制更精准，可避免大的失误。

Description

一种介入手术机器人从端装置
本申请要求申请日为2021年07月05日、申请号为202110759062.0、发明名称为“一种介入手术机器人从端装置”的中国专利申请，以及申请日为2021年08月31日、申请号为202111009755.4、发明名称为“一种介入手术机器人从端装置”的中国专利申请的优先权，此两件中国专利申请的全部内容通过引用结合在本申请中。
技术领域
本发明涉及医疗机器人领域，应用于主从式血管介入手术机器人，尤其涉及一种介入手术机器人从端装置。
背景技术
微创血管介入手术是指医生在数字减影血管造影成像(DSA)系统的导引下，操控导管导丝在人体血管内运动，对病灶进行治疗，达到栓塞畸形血管、溶解血栓、扩张狭窄血管等目的。目前介入手术治疗已经在肿瘤、外周血管、大血管、消化道疾病、神经系统、非血管等数百种疾病的诊疗中发挥着重要作用，介入手术治疗范围可以说是囊括了人体“从头到脚”的所有疾病治疗，并且已经成为部分疾病治疗的首选方案。介入手术不用切开人体组织，其切口(穿刺点)仅有米粒大小，就可治疗许多过去无法治疗或疗效欠佳的疾病，具有不开刀、创伤小、恢复快、疗效好的特点，受到了国内外医学界高度重视。
当前，微创血管介入手术辅助机器人，由于涉及高端医疗设备和机器人技术，发展迅猛。我们也投入了研发。
发明内容
本发明要解决的技术问题是提供一种辅助医生进行介入手术的介入手术机器人从端装置。
为了解决上述问题，本发明提供了一种介入手术机器人从端装置，其包括主体、逐次地安装于主体上的第一驱动机构、第二驱动机构以及靠近第一驱动机构的前夹持器；
第一驱动机构用于夹持和转动第一导管、第二导管，第二驱动机构用于夹持和转动第一导丝、第二导丝；
当第一导丝穿入第一导管且分别被夹持于第二驱动机构、第一驱动机构并在所述主体上沿同一轴向向前夹持器的方向运动到位后，第一导管、第一导丝分别从第一驱动机构、第二驱动机构取下，换由前夹持器夹持第一导管，让第二导管穿入第一导管、第二导丝穿入第二导管且第二导管、第二导丝分别被夹持于第一驱动机构、第二驱动机构并在所述主体上沿同一轴向向前夹持器的方向运动。
进一步地，所述介入手术机器人从端装置还包括多个前夹持器，由第一驱动机构逐个推移到位的多个第一导管分别被夹持于多个前夹持器。
进一步地，所述第二驱动机构用于与第一驱动机构一起夹持和转动第一导管、第二导管。
进一步地，所述第二驱动机构包括夹持和转动第一导管、第二导管的第一组件、夹持和转动第一导丝、第二导丝的第二组件。
进一步地，所述第二驱动机构的第一组件用于夹持连接于第一导管、第二导管的Y阀来夹持第一导管、第二导管并转动Y阀鲁尔连接器而带动第一导管、第二导管转动。
进一步地，所述第二组件为介入手术机器人从端导丝导管搓动装置。
进一步地，所述介入手术机器人从端装置还包括后夹持器，当所述第二驱动机构运动到极限位置要复位而松开第二导丝时，所述后夹持器用于夹持第二导丝不运动。
进一步地，所述前夹持器和所述后夹持器分别位于所述主体的前部和后部，其中：
所述前夹持器和所述后夹持器均安装于所述主体并可相对所述主体移动；
或者所述前夹持器和所述后夹持器中的一个安装于所述主体并可相对所述主体移动，另一个与所述主体分离安装；
或者所述前夹持器和所述后夹持器均与所述主体分离安装。
进一步地，所述介入手术机器人从端装置还包括安装于主体上的第三驱动机构，所述第三驱动机构用于与所述第一驱动机构一起夹持和转动第一导管、第二导管。
进一步地，当所述第一驱动机构运动到极限位置要复位而松开第一导管、第二导管时，所述第三驱动机构用于夹持第一导管、第二导管不运动。
进一步地，所述第三驱动机构与所述第一驱动机构和第二驱动机构沿同一轴向运动。
进一步地，所述第三驱动机构位于第一驱动机构和第二驱动机构之间。
进一步地，所述第一驱动机构、第二驱动机构和第三驱动机构均为主动驱动型。
进一步地，所述第一驱动机构和第二驱动机构为主动驱动型，所述第三驱动机构为被动跟随型。
进一步地，所述介入手术机器人从端装置还包括交换机构，所述交换机构为快速交换机构或者同轴交换机构。
进一步地，所述交换机构可拆卸地固定于所述第二驱动机构，或者所述交换机构与所述第二驱动机构为一体化设计。
本发明可让医生通过远程操控第一驱动机构和第二驱动机构并在所述主体上沿同一轴向运动，从而让多导管、多导丝的协同运动到位，在撤换导管、导丝时由前夹持器夹持第一导管不运动，不仅免受X射线辐射而影响健康，而且机器人控制导管、导丝运动更精准，减轻工作强度，也可避免大的失误。
附图说明
图1是本发明一种介入手术机器人从端装置的第一实施例示意图；
图2是图1的另一示意图；
图3是本发明一种介入手术机器人从端装置的第二实施例示意图；
图4是图3的另一示意图；
图5是图3中增加两个驱动机构时的示意图；
图6是图3中拆除只剩两个驱动机构时的示意图。
具体实施方式
为了使本发明所要解决的技术问题、技术方案及有益效果更加清楚明白，以下结合附图及实施例，对本发明进行进一步详细说明。应当理解，此处所描述的具体实施例仅仅用以解释本发明，并不用于限定本发明。
在本发明中，除非另有明确的规定和限定，术语“安装”、“相连”、“连接”、“固定”等应做广义理解，例如，可以是固定连接，也可以是可拆卸连接，或成一体，甚至是可相对运动的连接；可以是机械连接，也可以是电连接；可以是直接相连，也可以通过中间媒介间接相连，可以是两个元件内部的连通或两个元件的相互作用关系。对于本领域的普通技术人员而言，可以根据具体情况理解上述术语在本发明中的具体含义。
在本发明的描述中，术语“长度”、“直径”、“上”、“下”、“前”、“后”、“左”、“右”、“竖直”、“水平”、“顶”、“底”、“内”、“外”等指示的方位或位置关系为基于附图所示的方位或位置关系，仅是为了便于描述本发明和简化描述，而不是指示或暗示所指的装置或元件必须具有特定的方位、以特定的方位构造和操作，因此不能理解为对本发明的限制。
本发明所使用的方向“远”为朝向患者的方向，方向“近”是远离患者的方向。术语“上”和“上部”指的是背离重力的方向的一殷方向，术语“底部”、“下”和“下部”指的是重力的一殷方向。术语“前进”指的是让导丝或导管位移进入手术病人身体的方向。术语“后退”指的是让导丝或导管位移退出手术病人身体的方向。术语“向内地”指的是特征的内部部分。术语“向外地”指的是特征的外面的部分。术语“转动”包括“正转”和“反 转”，其中，“正转”指的是让导丝或导管旋转进入手术病人身体的方向、“反转”指的是让导丝或导管旋转退出手术病人身体的方向。
此外，术语“第一”、“第二”等仅用于描述目的，而不能理解为指示或暗示相对重要性或者隐含指明所指示的技术特征的数量。由此，限定有“第一”、“第二”等的特征可以明示或者隐含地包括一个或者更多个该特征。在本发明的描述中，“多”或“多个”的含义是两个或两个以上。
最后需要说明的是，如果不冲突，本发明实施例以及实施例中的各个特征可以相互结合，均在本发明的保护范围之内。另外，上述方法中的全部或部分步骤可以在诸如一组计算机可执行指令的计算机系统中执行，并且，虽然所述步骤按照1、2、3…顺序列出，但是在某些情况下，可以以不同于此处的顺序执行所示出或描述的步骤。
这里的导丝包括但不限于导引导丝、微导丝和支架等引导、支撑类介入医疗器械、导管包括但不限于导引导管、微导管、造影导管、多功能管(亦称中间导管)、溶栓导管、球囊扩张导管和球扩支架导管等治疗类介入医疗器械。
如图1和图2所示，本发明一种介入手术机器人从端装置的第一实施例包括主体10、可运动地安装于主体10上的驱动机构12、14、16和前夹持器18、后夹持器(图未示)。
所述主体10呈狭长型，其上设有线性导轨102。这些驱动机构12、14、16先后渐次地固定于所述导轨102上并可沿导轨102滑动。
每一驱动机构用于夹持、推移(包括前进和后退)和转动(包括正转与反转)导管或导丝，也可以用于同时夹持、推移(包括前进和后退)和转动(包括正转与反转)导管、导丝，实现多个导管、多个导丝协同运动。驱动机构12、14、16的具体结构不限于相同，也可以不同，只要能实现导管、导丝的夹持、推移和/或转动即可。本实施例中，驱动机构14、16的具体结构相同，驱动机构12的具体结构不相同。驱动机构14包括与驱动机构12配合夹持和转动同一导管的第一组件、夹持和转动另一导管的第二组件。驱动机构16包括与驱动机构14的第二组件配合夹持和转动该另一导管的第一组件、夹持和转动导丝的第二组件。所述驱动机构16包括与驱动机构16的第一组 件配合的快速交换机构162。
本实施例中，驱动机构12、驱动机构14、16的第二组件为如中国专利申请202110674959.3描述的一种介入手术机器人从端导丝导管搓动装置，其全部内容引入本发明。
前夹持器18位于所述主体10的前部，靠近驱动机构12、14。后夹持器位于所述主体10的后部，具体可参以下对后夹持器70的描述。在本实施例中，前夹持器18和后夹持器固定于所述主体10，需要时可相对所述主体10移动。在其它实施例中，前夹持器18和后夹持器也可以与所述主体10分离安装。
准备手术时，医生来到导管室进行术前准备。选用合适(比如长度、直径)的第一导管、第二导管和第一导丝，对第一导管、第二导管进行生理盐水冲水排气。手动将第二导管穿入第一导管并伸出第一导管一定距离、将第一导丝穿入第二导管并伸出第二导管一定距离，如第一导丝头部超出第二导管约10cm左右。使驱动机构12、14、16处于合理位置，将第一导管、第二导管和第一导丝一起置入穿入手术病人的穿刺鞘(如穿入股动脉、桡动脉或者其他)内，让驱动机构12与驱动机构14的第一组件一起配合夹持第一导管、驱动机构14的第二组件与驱动机构16的第一组件一起配合夹持第二导管、驱动机构16的第二组件夹持第一导丝，从而实现第一导管、第二导管和第一导丝的固定。
开始手术时，医生来到导管室外的操作台前，利用主端操控台(如中国专利申请202110654379.8描述的介入手术机器人主端操作手柄和202110649908.5描述的介入手术机器人主端控制模组，其全部内容引入本发明)远程操作驱动机构12、14、16运动。具体地，驱动机构12、14、16配合夹持第一导管、第二导管和第一导丝沿导轨102移动而带动第一导管、第二导管和第一导丝前进、同时或者不同时驱动机构12、14、16转动第一导管、第二导管和第一导丝转动，从而将第一导管、第二导管和第一导丝协同推移前进。在此过程中，需要始终保持第二导管伸出第一导管一定距离、第一导丝伸出第二导管一定距离。当第一导管、第二导管和第一导丝到达血管某些部位时，可能需要通过主端操控台远程操控驱动机构12、14、16，让第一导 管、第二导管和第一导丝多次进行前进、后退、正转、反转进行微调。
在本实施例中，驱动机构14、16的第一组件通过Y阀来分别夹持第一导管、第二导管。即第一导管、第二导管分别连接于Y阀，Y阀固定于驱动机构14、16，驱动机构14、16的第一组件夹持Y阀并转动Y阀鲁尔连接器，在驱动机构12、驱动机构14的第二组件的配合下，从而带动第一导管、第二导管转动。
当第一导管前进到位后，医生来到导管室手动将第一导管从驱动机构12、驱动机构14的第一组件上取下，由前夹持器18夹持不运动。手动将第二导管从驱动机构14的第二组件、驱动机构16的第一组件上取下，让驱动机构12、14沿导轨102后退而夹持第二导管。可通过主端操控台远程操控驱动机构16或者手动让第一导丝后退，后退到穿刺鞘时，将第一导丝从驱动机构16的第二组件上取出并浸泡于肝素水中。注意在此过程中，不要推移第一导管，避免第一导管头部在血管中移动。
让驱动机构16后退至合理位置。选用更细的第三导管(如微导管)和第二导丝(0.014in的微导丝)。手动将第二导丝穿入第三导管并一起穿入第二导管，让第三导管、第二导丝分别夹持于驱动机构14的第二组件、驱动机构16的第一组件与驱动机构16的第二组件，从而实现第三导管、第二导丝的固定。在本实施例中，第三导管连接于Y阀，Y阀固定于驱动机构16并由其第一组件夹持Y阀，通过转动Y阀鲁尔连接器，在驱动机构14的第二组件的配合下，从而带动第三导管转动。对于夹持第一导管的前夹持器18，其也可以通过转动Y阀鲁尔连接器而转动第一导管。
医生再次来到导管室外的操作台前，利用主端操控台远程操控驱动机构12、14、16运动。具体过程同上述第一导管、第二导管和第一导丝的前进过程，在此不再赘述。让第二导管进一步前进到更远的血管处，协助第三导管、第二导丝推移至更远的手术病人病灶处(也称靶血管狭窄处)。在此过程中，可能需要前夹持器18驱动第一导管转动。造影确认第二导丝位置，若到达指定位置(一般而言第二导丝要穿过手术病人病灶处，可能治疗动脉瘤栓塞除外)则由前夹持器18、驱动机构12、14、16分别固定第一导管、第二导管、第三导管、第二导丝不运动。若没有到达指定位置，则重复远程操控驱动机 构12、14、16运动，直到第二导丝到达指定位置。
在第二导丝到达指定位置后，通过主端操控台远程操控驱动机构16，让第三导管后退，同时保持第二导丝不运动，比如换由后夹持器夹持第二导丝不运动。当第三导管头部后退到穿刺鞘时，医生来到导管室手动将第三导管从驱动机构14、16上取出并浸泡于肝素水中。这时，可换由驱动机构16夹持第二导丝，并保持前夹持器、驱动机构12、14、驱动机构16分别固定第一导管、第二导管、第二导丝不运动。
在其它实施例中，当前夹持器18夹持第一导管不运动时，可以通过主端操控台远程操控驱动机构12、14、16，让第二导管、第一导丝一起后退。当第二导管、第一导丝的头部后退到穿刺鞘时，医生来到导管室手动将第二导管、第一导丝从驱动机构14、16上取出并浸泡于肝素水中。再选择合适的两个导管、一个导丝，将它们穿在一起并置入第一导管。使驱动机构12、14、16处于合理位置，让驱动机构12、14、16配合夹持两个导管、一个导丝，从而实现两个导管、一个导丝的固定。后续的前进过程如同前述第一导管、第二导管和第一导丝的前进过程。在此不再赘述。
在其它实施例中，所述主体10前部设有多个前夹持器18，则上述第一导管推移过程可以进行多次。当导管推移到位后，让一前夹持器18夹持该导管。
医生再次来到导管室，手动让第二导丝尾部穿入快速交换球囊扩张导管，快速交换球囊扩张导管顺着第二导丝前进，这时由快速交换机构162夹持快速交换球囊扩张导管。
医生再次来到导管室外的操作台前，利用主端操控台远程操控快速交换机构162，从而让快速交换球囊扩张导管前进至手术病人病灶处(不超出第二导丝头部)。在此过程中，时刻注意第二导丝的位置和角度，有需要及时通过正转、反转、前进、后退来进行微调整。当快速交换球囊扩张导管到达手术病人病灶处时，在导管室内给快速交换球囊扩张导管充填造影剂做预扩张，造影确认血管扩张效果。若达到血管扩张效果，则从快速交换球囊扩张导管内抽出造影剂。医生来到导管室外的操作台前，利用主端操控台远程操控快速交换机构162后退至穿刺鞘处。此快速交换球囊扩张导管后退过程中， 保持第二导丝位置不变。对于某些手术，可能需要多次血管扩张，因此会有多次的快速交换球囊扩张导管前进和后退过程。
医生再次来到导管室，手工将快速交换球囊扩张导管从快速交换机构162取下，再手动将快速交换球扩支架导管穿设于第二导丝并夹持到快速交换机构162上，具体过程同上述快速交换球囊扩张导管，不再赘述。
医生再次来到导管室外的操作台前，利用主端操控台远程操控快速交换机构162，从而顺着第二导丝将快速交换球扩支架导管推移至手术病人病灶处(已经扩展的血管狭窄处)。在此过程中，时刻注意第二导丝的位置和角度，有需要及时通过正转、反转、前进、后退来进行微调整。当快速交换球扩支架导管到达手术病人病灶处(已经扩展的血管处)时，微调快速交换球扩支架导管位置，确定后在导管室内给快速交换球扩支架导管充填造影剂，让支架成形。造影确认球扩支架放置无误，即可抽出造影剂并操控快速交换机构162带动快速交换球扩支架导管后退至穿刺鞘处，而球扩支架留在手术病人病灶处。医生来到导管室手动将快速交换球扩支架导管从快速交换机构162上取出并放入肝素水中。
医生再来到导管室外的操作台，利用主端操控台远程操控驱动机构12、14、16运动，让第二导管、第二导丝后退至穿刺鞘处。医生最后回到导管室，手动拉出第一导管至穿刺鞘处，并将第一导管、第二导管、第二导丝从前夹持器18、驱动机构12、14、16上取出，放入肝素水中，然后进行穿刺鞘拔出及手术后处理，完成手术。
以上选用的是快速交换导管，因此需要用快速交换机构162来夹持、推移和转动。若是同轴交换导管，则让第二导丝尾部穿入同轴交换导管后，由同轴交换机构来夹持、推移和转动同轴交换导管，让同轴交换导管顺着第二导丝前进至合适位置或后退至穿刺鞘处。不管是快速交换机构162，还是同轴交换机构，都可以采用滚轮驱动方式来实现快速交换导管和同轴交换导管的夹持、推移和转动。
对于主端操控台如何远程操控驱动机构12、14、16和快速交换机构162运动，可如中国专利申请202110649908.5描述的介入手术机器人主端控制模组一样，其包括两个操作杆，其中一操作杆用于操控驱动机构12、14和快速 交换机构162，且该操作杆可通过切换装置分时操控驱动机构12、14和快速交换机构162，另一操作杆用于操控驱动机构16。也可以为，所述主端操控台包括两个以上操作杆，如四个操作杆，分别用于远程操控驱动机构12、14、16和快速交换机构162。
以上是以“球扩支架成形手术”为例说明本发明的运动和控制过程。事实上，本发明也可以用于造影、栓塞、取栓等等多种手术。驱动机构12、14、16、前夹持器18可以根据手术实际需要，由医生自由调配，也即驱动机构12、14、16、前夹持器18均可方便地拆装。如实施更复杂的手术时，可以增设更多的驱动机构、前夹持器，如增设更多的驱动机构、前夹持器后，可以实现多个导管对应一个导丝或者多个导管对应多个导丝的协同运动；对应始终夹持导管的每一驱动机构均设置快速交换机构，其可拆卸地安装于驱动机构或者与驱动机构制成一体化结构。而在实施简单的检查手术时，只使用这些驱动机构中的两个，如驱动机构12和16(也可以为驱动机构12和14，根据需要驱动机构14上可设有快速交换机构)，以及前夹持器162，则把其他驱动机构从主体10上拆除。
以下描述本发明只有驱动机构12、16和前夹持器162协同推移两个导管、一个导丝的控制过程：
准备手术时，根据血管病灶位置选用合适直径和长度的两个导管(一粗一细)、两个导丝(一粗一细)，对两个导管进行生理盐水冲水排气。启动介入手术机器人，完成初始化。对手术病人进行穿刺鞘置入。手动将粗导丝穿入粗导管并伸出粗导管一定距离，并将它们一起置入穿刺鞘内。让驱动机构12和驱动机构16的第一组件配合夹持粗导管(连接于Y阀)、驱动机构16的第二组件夹持粗导丝，从而实现粗导管、粗导丝的固定。
开始手术时，医生来到导管室外的操作台前，利用主端操控台远程操作驱动机构12、16运动。分别让粗导管、粗导丝协同前进到血管狭窄处。过程参前述“球扩支架成形手术”。保持粗导管、粗导丝的头部在影像视野范围内。这时，医生手动将粗导管从驱动机构12和驱动机构16的第一组件上取出，由前夹持器18夹持不运动。注意在此过程中，不要推移粗导管，避免粗导管头部在血管中移动。可通过主端操控台远程操控驱动机构16或者手动让 粗导丝后退到穿刺鞘时，将粗导丝从驱动机构16的第二组件上取出并浸泡于肝素水中。
让驱动机构12、16后退至合理位置。手动将细导丝穿入细导管并一起穿入粗导管，让细导管、细导丝配合夹持于驱动机构12、16，从而实现细导管、细导丝的固定。在本实施例中，细导管连接于Y阀，Y阀固定于驱动机构16并由其第一组件夹持Y阀，在驱动机构14的配合下，转动Y阀鲁尔连接器而带动细导管转动。
医生再次来到导管室外的操作台前，利用主端操控台远程操控驱动机构12、16运动。具体过程同上述粗导管和粗导丝的前进过程，在此不再赘述。让细导管、细导丝推移至更远的手术病人病灶处(也称靶血管狭窄处)。造影确认细导管、细导丝位置，若到达指定位置(一般而言细导丝要穿过手术病人病灶处，栓塞除外)则由驱动机构12、16分别固定细导管、细导丝不运动。
医生再次来到导管室，手动让细导丝尾部穿入快速交换球扩支架导管，快速交换球扩支架导管顺着细导丝前进穿入细导管内，具体为连接细导管的Y阀内，由快速交换机构162夹持快速交换球扩支架导管。
医生再次来到导管室外的操作台前，利用主端操控台远程操控快速交换机构162，从而让快速交换球扩支架导管前进至手术病人病灶处(不超出细导丝头部)。在此过程中，时刻注意细导管、细导丝的位置和角度，有需要及时通过正转、反转、前进、后退来进行微调整。当快速交换球扩支架导管到达手术病人病灶处时，微调快速交换球扩支架导管位置，确定后在导管室内给快速交换球扩支架导管充填造影剂，让支架成形。造影确认球扩支架放置无误，即可抽出造影剂并操控快速交换机构162带动快速交换球扩支架导管后退至穿刺鞘处，而球扩支架留在手术病人病灶处。在此快速交换球扩支架导管后退过程中，保持粗导管、细导管、细导丝位置不变。医生来到导管室手动将快速交换球扩支架导管从快速交换机构162上取出并放入肝素水中。
医生再来到导管室外的操作台，利用主端操控台远程操控驱动机构12、16运动，让细导管、细导丝后退至穿刺鞘处。医生最后回到导管室，可手动 拉出粗导管至穿刺鞘处，并将粗导管、细导管、细导丝从前夹持器18、驱动机构12、16上取出，放入肝素水中，然后进行穿刺鞘拔出及手术后处理，完成手术。
上述过程中，若是采用同轴交换导管，则让细导丝尾部穿入同轴交换导管后，由同轴交换机构来夹持、推移和转动同轴交换导管，让同轴交换导管顺着细导丝前进至合适位置或后退至穿刺鞘处。
如图3和图4所示，本发明一种介入手术机器人从端装置的第二实施例包括主体19、可运动地安装于主体19上的驱动机构20、30、40、50、60、后夹持器70、快速交换机构80和前夹持器82。
所述主体19呈狭长型，设有直线型通道192。这些驱动机构20、30、40、50、60先后渐次地置于通道192内并可沿通道移动。在本实施例中，这些驱动机构20、30、40、50、60可直接在主体19上滑动，如在主体19上固定一线性导轨，这些驱动机构20、30、40、50、60均可沿导轨滑动。
每一驱动机构用于夹持、推移(包括前进和后退)和转动(包括正转与反转)导管或导丝，也可以用于同时夹持、推移(包括前进和后退)和转动(包括正转与反转)导管、导丝，实现多个导管、一个导丝协同运动。每一驱动机构包括用于夹持导管或导丝的夹持组件和转动导管或导丝的转动组件，所述转动组件既可以为主动驱动型也可以为被动跟随型、或者全部为主动驱动型、亦或部分为主动驱动型、另外的为被动跟随型，驱动机构20、40对导管的夹持不影响其转动。
驱动机构20、30、40、50、60的夹持组件和转动组件可为如中国专利申请202110674959.3描述的一种介入手术机器人从端导丝导管搓动装置，其全部内容引入本发明。
在其它实施例中，驱动机构20、30、40、50、60的具体结构不限于相同，也可以不同，只要能实现导管、导丝的夹持、推移和/或转动。也可以只是夹持组件相同、转动组件不相同，或者夹持组件不相同、转动组件相同，亦或多个夹持组件、转动组件相同、另外的夹持组件、转动组件不相同。
在本实施例中，驱动机构20和30前后间隔一定距离、用于配合夹持、推移和转动同一导引导管90(即第一导管)，让其不致弯曲。事实上，驱动 机构20和30最好同步推移导引导管90，以便使其拉直不弯曲。同样地，驱动机构40和50前后间隔一定距离配合、用于配合夹持、推移和转动同一多功能管91(即第二导管，亦称中间导管)。驱动机构60用于夹持、推移和转动导引导丝92。后夹持器70用于夹持和推移导引导丝92。快速交换机构80与驱动机构50可拆卸地固定在一起，用于夹持和推移快速交换导管。
后夹持器70位于所述主体19的后部。前夹持器82位于所述主体19的前部，靠近驱动机构20、30。在本实施例中，前夹持器82和后夹持器70固定于所述主体10，需要时可相对所述主体10移动。在其它实施例中，前夹持器82和后夹持器70也可以与所述主体10分离安装。
准备手术时，医生来到导管室进行术前准备。如选用合适(比如长度、直径)的导引导管90、多功能管91和导引导丝92，对导引导管90、多功能管91进行生理盐水冲水排气。手动将多功能管91穿入导引导管90并伸出导引导管90一定距离、将导引导丝92穿入多功能管91并伸出多功能管91一定距离，如导引导丝92头部超出多功能管91约10cm左右。使驱动机构20、30、40、50、60处于合理位置，将导引导管90、多功能管91和导引导丝92一起置入穿入手术病人的穿刺鞘(如穿入股动脉、桡动脉或者其他)内，让驱动机构20和30的夹持组件夹持导引导管90、驱动机构40和50的夹持组件夹持多功能管91、驱动机构60的夹持组件和后夹持器70夹持导引导丝92，从而实现导引导管90、多功能管91和导引导丝92的固定。
开始手术时，医生来到导管室外的操作台前，利用主端操控台(如中国专利申请202110654379.8描述的介入手术机器人主端操作手柄和202110649908.5描述的介入手术机器人主端控制模组，其全部内容引入本发明)远程操作驱动机构20、30、40、50、60、后夹持器70和快速交换机构80运动。具体地，驱动机构20和30一起夹持导引导管90沿通道192移动而带动导引导管90前进、同时或者不同时驱动机构20和30的转动组件转动导引导管90，当驱动机构20移动到极限位置(比如驱动机构20运动至通道192的远端)要复位而松开导引导管90时，驱动机构30夹持导引导管90不运动。待驱动机构20复位到更靠近驱动机构30的位置时，驱动机构20的夹持组件再次夹持导引导管90，让驱动机构20和30一起带动导引导管90前 进、同时或者不同时驱动机构20和30的转动组件转动导引导管90，如此往复，直到前进到位。
在此过程中，同时或者不同时驱动机构40和50一起夹持多功能管91沿通道192移动而带动多功能管91前进、同时或者不同时驱动机构40和50的转动组件转动多功能管91，当驱动机构40移动到极限位置(比如与驱动机构30的距离接近阈值)要复位而松开多功能管91时，驱动机构50夹持多功能管91不运动。待驱动机构40复位到更靠近驱动机构50的位置时，驱动机构40的夹持组件再次夹持多功能管91，让驱动机构40和50一起带动多功能管91前进、同时或者不同时驱动机构40和50的转动组件转动多功能管91，如此往复，直到前进到位。
在上述过程中，同时或者不同时驱动机构60和后夹持器70一起夹持导引导丝92沿通道192移动而带动导引导丝92前进、同时或者不同时驱动机构60的转动组件转动导引导丝92。当驱动机构60移动到极限位置(比如与驱动机构50的距离接近阈值)要复位而松开导引导丝92时，由后夹持器70夹持导引导丝92不运动。待驱动机构60复位后，驱动机构60的夹持组件再次夹持导引导丝92，让驱动机构60和后夹持器70一起带动导引导丝92前进、同时或者不同时驱动机构60的转动组件转动导引导丝92，如此往复，直到前进到位。在其它实施例中，开始时，只由驱动机构60夹持导引导丝92，而后夹持器70不夹持。待驱动机构60要复位时，换由后夹持器70夹持导引导丝92。当驱动机构60复位后而再次夹持导引导丝92时，后夹持器70松开导引导丝92，如此往复，驱动机构60和后夹持器70交替夹持导引导丝92。
对于主端操控台如何远程操控驱动机构20、30、40、50、60、后夹持器70和快速交换机构80运动，可如中国专利申请202110649908.5描述的介入手术机器人主端控制模组一样，其包括两个操作杆，其中一操作杆用于操控驱动机构20、30、40、50和快速交换机构80，且该操作杆可通过切换装置分时操控驱动机构20、30、驱动机构40、50和快速交换机构80，另一操作杆用于操控驱动机构60和后夹持器70。也可以为，所述主端操控台包括两个以上操作杆，如四个操作杆，分别用于远程操控驱动机构20、30、驱动机 构40、50、驱动机构60和后夹持器70、快速交换机构80。
在其它实施例中，驱动机构30、50通过Y阀来分别夹持导引导管90、多功能管91。即导引导管90、多功能管91分别连接于Y阀，Y阀固定于驱动机构30、50，驱动机构30、50的夹持组件夹持Y阀、转动组件转动Y阀鲁尔连接器而带动导引导管90、多功能管91转动。
在上述将导引导管90、多功能管91和导引导丝92协同推移过程中，需要始终保持多功能管91伸出导引导管90一定距离、导引导丝92伸出多功能管91一定距离。当导引导管90、多功能管91和导引导丝92到达血管某些部位时，可能需要通过主端操控台远程操控驱动机构20、30、40、50、60和后夹持器70，让导引导管90、多功能管91和导引导丝92多次进行前进、后退、正转、反转调换。
当导引导管90前进到位后，固定导引导管90不运动。通过主端操控台远程操控驱动机构60和后夹持器70，让导引导丝92后退，后退过程跟上述前进过程基本类似。当导引导丝92头部后退到穿刺鞘时，医生来到导管室手动将导引导丝92从驱动机构60的夹持组件和后夹持器70上取出并浸泡于肝素水中。
医生手动将导引导管90从驱动机构20、30的夹持组件上取出，由前夹持器82夹持不运动。注意在此过程中，不要推移导引导管90，避免导引导管90头部在血管中移动。手动将多功能管91从驱动机构40、50的夹持组件上取出，换由驱动机构20、30的夹持组件夹持。
在其它实施例中，前夹持器82可做为伸缩式的，当需要夹持导管时，从隐藏空间伸出来。对于夹持导引导管90的前夹持器82，其也可以通过转动导引导管90的Y阀鲁尔连接器而转动导引导管90。另外，若所述主体19前部设有多个前夹持器82，则上述导管推移过程可以进行多次。当每一导管推移到位后，让一前夹持器82夹持该导管。
调整驱动机构40、50、60和后夹持器70处于合理位置。选用更细的微导管94和微导丝96(如0.014in)。手动将微导丝96穿入微导管94并一起穿入多功能管91，让微导管94、微导丝96分别夹持于驱动机构40、50的夹持组件、驱动机构60的夹持组件和后夹持器70，从而实现微导管94、微导 丝96的固定。在其它实施例中，微导管94连接于Y阀，Y阀固定于驱动机构50并由其夹持组件夹持Y阀、转动组件转动Y阀鲁尔连接器而带动微导管94转动。
医生再次来到导管室外的操作台前，利用主端操控台远程操控驱动机构20、30、40、50、60和后夹持器70运动。具体过程同上述导引导管90、多功能管91和导引导丝92的前进过程，在此不再赘述。让多功能管91进一步前进到更远的血管处，而微导管94、微导丝96前进到多功能管91头部时，进一步将微导管94、微导丝96推移至手术病人病灶处(也称靶血管狭窄处)。造影确认微导丝96位置，若到达指定位置(一般而言微导丝96要穿过手术病人病灶处，可能治疗动脉瘤栓塞除外)则由驱动机构20、30、驱动机构40、50、驱动机构60和后夹持器70分别固定多功能管91、微导管94、微导丝96不运动。若没有到达指定位置，则重复远程操控驱动机构20、30、40、50、60和后夹持器70运动，直到微导丝96到达指定位置。
在其它实施例中，可以通过主端操控台远程操控驱动机构40、50、60和后夹持器70，让多功能管91、导引导丝92一起后退。当多功能管91、导引导丝92的头部后退到穿刺鞘时，医生来到导管室手动将多功能管91和导引导丝92从驱动机构40、50、60的夹持组件和后夹持器70上取出并浸泡于肝素水中。再手动将导引导管90从驱动机构20、30的夹持组件上取出，由前夹持器82夹持不运动。注意在此过程中，不要推移导引导管90，避免导引导管90头部在血管中移动。再选择合适的两个导管、一个导丝，将它们穿在一起并置入导引导管90。使驱动机构20、30、40、50、60处于合理位置，让驱动机构20和30的夹持组件夹持其中一个导管、驱动机构40和50的夹持组件夹持另一个导管、驱动机构60的夹持组件和后夹持器70夹持导丝，从而实现两个导管、一个导丝的固定。后续的前进过程如同前述导引导管90、多功能管91和导引导丝92的前进过程。在此不再赘述。
在微导丝96到达指定位置后，通过主端操控台远程操控驱动机构40、50，让微导管94后退，同时保持微导丝96不运动，比如驱动机构60随着后退时换由后夹持器70夹持微导丝96不运动。当微导管94头部后退到穿刺鞘时，医生来到导管室手动将微导管94从驱动机构40、50上取出并浸泡于肝 素水中。这时，可换由驱动机构60夹持微导丝96，并保持前夹持器82、驱动机构20、30和驱动机构60分别固定导引导管90、多功能管91、微导丝96不运动。
医生再次来到导管室，手动让微导丝96尾部穿入快速交换球囊扩张导管98，快速交换球囊扩张导管98顺着微导丝96前进，这时由快速交换机构80夹持快速交换球囊扩张导管98。
医生再次来到导管室外的操作台前，利用主端操控台远程操控快速交换机构80，从而让快速交换球囊扩张导管98前进至手术病人病灶处(不超出微导丝96头部)。在此过程中，时刻注意微导丝96的位置和角度，有需要及时通过正转、反转、前进、后退来进行微调整。当快速交换球囊扩张导管98到达手术病人病灶处时，在导管室内给快速交换球囊扩张导管98充填造影剂做预扩张，造影确认血管扩张效果。若达到血管扩张效果，则从快速交换球囊扩张导管98内抽出造影剂。医生来到导管室外的操作台前，利用主端操控台远程操控快速交换机构80后退至穿刺鞘处。此快速交换球囊扩张导管98后退过程中，保持微导丝96位置不变。对于某些手术，可能需要多次血管扩张，因此会有多次的快速交换球囊扩张导管前进和后退过程。
医生再次来到导管室，手工将快速交换球囊扩张导管98从快速交换机构80取下，再手动将快速交换球扩支架导管穿设于微导丝96并夹持到快速交换机构80上，具体过程同上述快速交换球囊扩张导管98，不再赘述。
医生再次来到导管室外的操作台前，利用主端操控台远程操控快速交换机构80，从而顺着微导丝96将快速交换球扩支架导管推移至手术病人病灶处(已经扩展的血管狭窄处)。在此过程中，时刻注意微导丝96的位置和角度，有需要及时通过正转、反转、前进、后退来进行微调整。当快速交换球扩支架导管到达手术病人病灶处(已经扩展的血管处)时，微调快速交换球扩支架导管位置，确定后在导管室内给快速交换球扩支架导管充填造影剂，让支架成形。造影确认球扩支架放置无误，即可抽出造影剂并操控快速交换机构80带动快速交换球扩支架导管后退至穿刺鞘处，而球扩支架留在手术病人病灶处。医生来到导管室手动将快速交换球扩支架导管从快速交换机构80上取出并放入肝素水中。
医生再来到导管室外的操作台，利用主端操控台远程操控驱动机构20、30、40、50、60和后夹持器70运动，让多功能管91、微导丝96后退至穿刺鞘处。医生最后回到导管室，手动将多功能管91、微导丝96从驱动机构20、30、60的夹持组件和后夹持器70上取出，并将导引导管90从前夹持器82上取下，退出至穿刺鞘处而撤出放入肝素水中，然后进行穿刺鞘拔出及手术后处理，完成手术。
以上选用的是快速交换导管，因此需要用快速交换机构80来夹持、推移和转动。若是同轴交换导管，则让微导丝96尾部穿入同轴交换导管后，由同轴交换机构来夹持、推移和转动同轴交换导管，让同轴交换导管顺着微导丝96前进至合适位置或后退至穿刺鞘处。不管是快速交换机构80，还是同轴交换机构，都可以采用滚轮驱动方式来实现快速交换导管和同轴交换导管的夹持、推移和转动。
以上是以“球扩支架成形手术”为例说明本发明的运动和控制过程。事实上，本发明也可以用于造影、栓塞、取栓等等多种手术。驱动机构20、30、40、50、60、后夹持器70和快速交换机构80可以根据手术实际需要，由医生自由调配，也即驱动机构20、30、40、50、60、后夹持器70和快速交换机构80均可方便地拆装。如实施更复杂的手术时，可以增设更多的驱动机构、后夹持器和快速交换机构，如增设更多的驱动机构、后夹持器后，可以实现多个导管对应一个导丝或者多个导管对应多个导丝的协同运动，如图5中增加两个驱动机构来夹持、转动更多的导管，具体可参上述“球扩支架成形手术”；对应始终夹持导管的每一驱动机构均设置快速交换机构，其可拆卸地安装于驱动机构或者与驱动机构制成一体化机构。而在实施简单的检查手术比如血管造影手术时，只使用驱动机构20、30、40、50、60中的两个，如驱动机构30和60，参图6，则把其他驱动机构、后夹持器70和快速交换机构80从主体19上拆除。
上面的描述中，主端操控台和放置主端操控台的操作台位于导管室外。其实，它们也可以放置于导管室内一个独立的空间，只要能够隔离X射线辐射，让医生免除X射线辐射即可。
以上仅是描述了一些情况下导管导丝的拆换方式。实际上，导管导丝的 拆换完全可由医生根据手术实际需要以及个人操作习惯而定。并不仅以以上导管导丝的拆换方式而限。
由此可见，本发明可让医生通过远程操控第一驱动机构和第二驱动机构并在所述主体上沿同一轴向运动，从而让多导管、多导丝的协同运动到位，在撤换导管、导丝时由前夹持器夹持第一导管不运动，不仅免受X射线辐射而影响健康，而且机器人控制导管、导丝运动更精准，减轻工作强度，也可避免大的失误。
本领域普通技术人员可以理解上述方法中的全部或部分步骤可通过程序来指令相关硬件完成，所述程序可以存储于计算机可读存储介质中，如只读存储器、磁盘或光盘等。可选地，上述实施例的全部或部分步骤也可以使用一个或多个集成电路来实现。相应地，上述实施例中的各模块/单元可以采用硬件的形式实现，也可以采用软件功能模块的形式实现。本发明不限制于任何特定形式的硬件和软件的结合。
当然，本发明还可有其他多种实施例，在不背离本发明精神及其实质的情况下，熟悉本领域的技术人员当可根据本发明作出各种相应的改变和变形，但这些相应的改变和变形都应属于本发明的权利要求的保护范围。
以上所述仅为本发明的较佳实施例而已，并不用以限制本发明，凡在本发明的精神和原则之内所作的任何修改、等同替换和改进等，均应包含在本发明的保护范围之内。

Claims (16)

  1. 一种介入手术机器人从端装置，包括主体、逐次地安装于主体上的第一驱动机构、第二驱动机构以及靠近第一驱动机构的前夹持器；
    第一驱动机构用于夹持和转动第一导管、第二导管，第二驱动机构用于夹持和转动第一导丝、第二导丝；
    当第一导丝穿入第一导管且分别被夹持于第二驱动机构、第一驱动机构并在所述主体上沿同一轴向向前夹持器的方向运动到位后，第一导管、第一导丝分别从第一驱动机构、第二驱动机构取下，换由前夹持器夹持第一导管，让第二导管穿入第一导管、第二导丝穿入第二导管且第二导管、第二导丝分别被夹持于第一驱动机构、第二驱动机构并在所述主体上沿同一轴向向前夹持器的方向运动。
  2. 如权利要求1所述的一种介入手术机器人从端装置，其特征在于，还包括多个前夹持器，由第一驱动机构逐个推移到位的多个第一导管分别被夹持于多个前夹持器。
  3. 如权利要求1所述的一种介入手术机器人从端装置，其特征在于，所述第二驱动机构用于与第一驱动机构一起夹持和转动第一导管、第二导管。
  4. 如权利要求3所述的一种介入手术机器人从端装置，其特征在于，所述第二驱动机构包括用于夹持和转动第一导管、第二导管的第一组件、用于夹持和转动第一导丝、第二导丝的第二组件。
  5. 如权利要求4所述的一种介入手术机器人从端装置，其特征在于，所述第二驱动机构的第一组件用于夹持连接于第一导管、第二导管的Y阀来夹持第一导管、第二导管并转动Y阀鲁尔连接器而带动第一导管、第二导管转动。
  6. 如权利要求4所述的一种介入手术机器人从端装置，其特征在于，所述第二组件为介入手术机器人从端导丝导管搓动装置。
  7. 如权利要求6所述的一种介入手术机器人从端装置，其特征在于，还包括后夹持器，当所述第二驱动机构运动到极限位置要复位而松开第二导丝时，所述后夹持器用于夹持第二导丝不运动。
  8. 如权利要求7所述的一种介入手术机器人从端装置，其特征在于，所述前夹持器和所述后夹持器分别位于所述主体的前部和后部，其中：
    所述前夹持器和所述后夹持器均安装于所述主体并可相对所述主体移动；
    或者所述前夹持器和所述后夹持器中的一个安装于所述主体并可相对所述主体移动，另一个与所述主体分离安装；
    或者所述前夹持器和所述后夹持器均与所述主体分离安装。
  9. 如权利要求1所述的一种介入手术机器人从端装置，其特征在于，还包括安装于主体上的第三驱动机构，所述第三驱动机构用于与所述第一驱动机构一起夹持和转动第一导管、第二导管。
  10. 如权利要求9所述的一种介入手术机器人从端装置，其特征在于，当所述第一驱动机构运动到极限位置要复位而松开第一导管、第二导管时，所述第三驱动机构用于夹持第一导管、第二导管不运动。
  11. 如权利要求9所述的一种介入手术机器人从端装置，其特征在于，所述第三驱动机构与所述第一驱动机构和第二驱动机构沿同一轴向运动。
  12. 如权利要求9所述的一种介入手术机器人从端装置，其特征在于，所述第三驱动机构位于第一驱动机构和第二驱动机构之间。
  13. 如权利要求9所述的一种介入手术机器人从端装置，其特征在于，所述第一驱动机构、第二驱动机构和第三驱动机构均为主动驱动型。
  14. 如权利要求9所述的一种介入手术机器人从端装置，其特征在于，所述第一驱动机构和第二驱动机构为主动驱动型，所述第三驱动机构为被动跟随型。
  15. 如权利要求1所述的一种介入手术机器人从端装置，其特征在于，还包括交换机构，所述交换机构为快速交换机构或者同轴交换机构。
  16. 权利要求15所述的一种介入手术机器人从端装置，其特征在于，所述交换机构可拆卸地固定于所述第二驱动机构，或者所述交换机构与所述第二驱动机构为一体化设计。
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US20230022245A1 (en) 2023-01-26
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