SURGICAL SYSTEM FOR MICROSURGICAL TECHNIQUES

Abstract

This system is composed by mechanical telemanipulators, with master-slave configurations, working together with suitable solutions for image acquisition and display, which are able to transmit, with optional magnification, images from the surgical area to the surgeon. Therefore, the surgeon's capacities and comfort are increased by enhancing the surgeon's motor and visual skills as well as the ergonomics while doing different surgical tasks through access incisions on the patient body. Aside from offering improved performance during procedures involving microsurgical techniques, this system also brings safety, intuitiveness, and cost-effectiveness advantages over current alternatives. Due to the compatibility with current visualization systems for microsurgery, together with the light weight and the compact configuration of the mechanical telemanipulator, this surgical system can be very easily brought to and removed from the surgical area, which enables its intermittent use on several surgical procedures requiring microsurgical techniques. Therefore, it does not require drastic changes in the workflow and setup of current operating rooms and can be more easily adopted by several surgical teams.

Claims

1. A surgical system for performing microsurgical techniques comprising at least one mechanical telemanipulator and a visualization system.

2. The surgical system according to claim 1, wherein the vision system includes image acquisition means and image display means.

3. The surgical system according to claim 2, wherein the image acquisition means consists of a microscope's objective.

4. The surgical system according to claim 2, wherein the image acquisition means consists of an endoscopic camera.

5. The surgical system according to claim 2, wherein the image acquisition means includes a system with at least one digital camera.

6. The surgical system according to claim 2, wherein the image display means consists of a microscope's eyepieces.

7. The surgical system according to claim 2, wherein the image display means consists of a video display screen.

8. The surgical system according to claim 2, wherein the image display means consists of components whereby a different stereoscopic image is projected to each eye of the surgeon.

9. The surgical system according to claim 2, wherein the vision system consists of magnifying loupes, used by the surgeon to visualize the surgical area through a free line of sight between the eyes of the surgeon and the surgical area.

10. The surgical system according to any one of claims 1 to 9, characterized in that each of the at least one mechanical telemanipulators is mounted on an articulated structure so that it can be precisely and stably positioned over the patient.

11. The surgical system according to claim 10, wherein the articulated structure is mounted on a wheeled base, enabling the system to be easily brought to and removed from the surgical area during the a surgical procedure.

12. The surgical system according any one of claims 1 to 11, characterized in that the amplitude of the movement applied by the surgeon on each of the at least one mechanical telemanipulators is reproduced at the surgical site at a predetermined scaled down ratio.

13. The surgical system according to any one of claims 1 to 12, wherein each of the at least one mechanical telemanipulators comprises a master unit, a slave unit and mechanical transmission means arranged to kinematically connect the master unit and the slave unit such that movement applied at the master unit is reproduced at the slave unit.

14. The surgical system of claim 13, wherein the master unit of the at least one mechanical telemanipulator comprises a plurality of links connected by a plurality of joints and wherein the slave unit comprises a plurality of links connected by a plurality of joints, wherein the number of links and joints in the slave unit corresponds to the number of links and joints in the master unit and wherein motion applied at a particular link or joint in the master unit is reproduced at the corresponding link or joint in the slave unit.

15. The surgical system of claim 14, wherein the at least one mechanical telemanipulator further comprises one or more constraint means applied to the slave unit, thus creating a remote center of motion whereby rotation about a predetermined point in the master unit produces rotation about a predetermined point in the slave unit.

Description

BRIEF DESCRIPTION OF FIGURES

[0028] The invention will be better understood thanks to the following detailed description of several embodiments of the invention with reference to the attached drawings, in which:

[0029] FIG. 1 shows a perspective view of the mechanical telemanipulator composing the surgical system for microsurgical techniques according to a preferred embodiment of the invention;

[0030] FIG. 2 shows a second perspective view of the mechanical telemanipulator composing the surgical system for microsurgical techniques according to a preferred embodiment of the invention;

[0031] FIG. 3 shows a perspective view of the full surgical system for microsurgical techniques operated by a surgeon during a surgical procedure requiring microsurgical techniques;

[0032] FIG. 4 shows a second perspective view of the full surgical system for microsurgical techniques operated by a surgeon during a surgical procedure requiring microsurgical techniques;

[0033] FIG. 5 shows a schematic view with kinematical connections between the corresponding joints of the master and slave units of the mechanical telemanipulator;

[0034] FIG. 6 shows a perspective view of the handle connected to the distal end of the master unit of the mechanical telemanipulator;

[0035] FIG. 7 shows a perspective view of the end-effector connected to the distal end of the slave unit of the mechanical telemanipulator;

[0036] FIG. 8 shows a different possible kinematic configuration of the mechanical telemanipulator according to different embodiments of the invention, having a remote center of motion for minimally invasive surgical procedures;

[0037] FIG. 9 shows a second different possible kinematic configuration of the mechanical telemanipulator according to different embodiments of the invention, having a remote center of motion for minimally invasive surgical procedures;

[0038] FIG. 10 shows a third different possible kinematic configuration of the mechanical telemanipulator according to different embodiments of the invention, having a remote center of motion for minimally invasive surgical procedures;

[0039] FIG. 11 shows a perspective view of the surgical system for microsurgical techniques where the configuration of the mechanical telemanipulators ensures a free path line between the eyes of the surgeon and the surgical area.

[0040] FIGS. 12 to 14 show three different perspective views of the mechanical systems comprising the mechanical telemanipulators.

DETAILED DESCRIPTION OF THE INVENTION

[0041] A surgical system for microsurgical techniques, constructed in accordance with a preferred embodiment of the present invention, is described herein, and is seen generally in FIGS. 3 and 4. This system includes preferably two identical mechanical telemanipulators 1a, 1b configured to be operated independently from the other, and a surgical microscope 5 through which the surgeon can have a magnified view of the surgical area, being able to perform microsurgical techniques. While the present embodiment of the inventive system is shown with a surgical microscope, the skilled person will understand that other magnification optics are possible, such as surgical loupes. In certain applications, use of the naked eye for visualization will also be possible.

[0042] According to FIGS. 1 and 2, the two mechanical telemanipulators 1a, 1b are respectively mounted on an articulated structure 2 so that the angles between them and the patient can be tuned and they can be accurately positioned. The articulated structure 2 is mounted on a wheeled base 3, enabling the telemanipulators 1a, 1b to be easily transported and stored within the operating room and hospital. The wheeled base 3 also enables the telemanipulators 1a, 1b to be brought to, and removed from, the surgical area during the part of the surgical procedures requiring microsurgical techniques and precise manipulation. When brought to the surgical area, the articulated structure 2 can be attached to the surgical table with appropriate hardware so that the telemanipulators 1a, 1b can be more steadily supported.

[0043] With reference to FIGS. 3 and 4, the surgeon will perform the procedure directly manipulating two handles 4 in the proximal part of each telemanipulator 1a, 1b, viewing the operation through a surgical microscope 5. The movements applied by the surgeon on the two handles 4 (FIG. 6) are replicated (and scaled down) by two multi-articulated surgical instruments 6 (FIG. 7) that reach the surgical area on the patient. Their movements are acquired by the microscope's objective 7 and displayed on the eyepieces 8 as shown in FIG. 3. This surgical system improves the ergonomics for surgeons, enabling them to position their hands in a natural orientation to each other, providing improved hand-eye coordination and intuitive manipulation with scaled down, tremor-reduced movements. The comfort of the surgeons can also be improved by forearm support 9 as shown in FIG. 3.

[0044] Although the size and configuration of the mechanical telemanipulators 1a, 1b make it compatible with current surgical microscopes 5, they also may ensure a free line of sight between the eyes of the surgeon and the surgical area (FIG. 11), enabling the surgeon to visualize the procedure with magnifying loupes or even with unaided vision.

[0045] In another embodiment of this invention, the surgical system may also comprise a solution where the microscope's objective 7 is replaced by an endoscopic camera (in open surgeries) or by a system with digital cameras to acquire the image on the surgical area. The image can then be displayed to the surgeon on a screen (2D or 3D) or through a head-mounted display (or a similar system where a different stereoscopic image is projected on each eye of the surgeon).

[0046] The inventive embodiments include a master-slave configuration of each mechanical telemanipulator 1a, 1b. A slave unit 11 and a master unit 10 are configured to work together, achieving a force-reflecting tele-operation. Given that the two telemanipulators 1a, 1b are structurally and functionally identical, the description hereafter will refer to one mechanical telemanipulator only.

[0047] FIG. 5 schematically illustrates the kinematic configuration of the teleoperated device according to the preferred embodiment of the invention. This device comprises a slave unit 11 and a master unit 10 connected to each other by a connecting link 12. This connecting link 12 comprises a joint 13 which connects the teleoperated device to a ground 14.

[0048] The slave unit 11 comprises a number of slave links 15, 16, 17 interconnected by a plurality of slave joints 18, 19, 20 whereas the master unit 10 comprises a corresponding number of master links 21, 22, 23 interconnected by a plurality of master joints 24, 25, 26. First mechanical transmission means 27, 28, 29 are arranged to kinematically connect the slave unit 11 with the master unit 10 such that the movement (angle of the joint) applied on each master joint 24, 25, 26 of the master unit 10 is reproduced by the corresponding slave joint 18, 19, 20 of the slave unit 11.

[0049] In reference to FIG. 5, the multi-articulated end-effector 6 is connected at the distal end of the slave unit 11 whereas the handle 4 is connected at the distal end of the master unit 10 for operating the mechanical teleoperated device wherein the amplitude of the movements applied on the handle 4 by the surgeon is reproduced, at a predetermined scaled ratio, by end-effector 6. Ratios between the slave and the master units 11, 10 can be advantageously chosen according to the use. For instance, not only 1:1 can be used but also 2:1, 4:1 etc. in order to increase the precision of the telemanipulation and filter tremors of the surgeon.

[0050] FIGS. 12 to 14 show three different perspective views of the mechanical systems comprising the mechanical telemanipulators 1a, 1b connected to a fixed table by two articulated structures 2a, 2b.

[0051] With reference to FIG. 6, the handle 4 of the telemanipulator has a configuration similar to a current instrument for microsurgical techniques, with a “tweezers-like” shape.

[0052] The end-effector 6 as shown in FIG. 7 is a surgical tool and comprises two blades 27, 28 coaxially mounted to each other. The handle 4 is kinematically connected to the surgical tool 6 through second mechanical transmission means 31, 32 in a manner that the movement applied on the second and third handle link 29, 30 by the tips of the thumb and the index finger are reproduced by the two blades 27, 28.

[0053] The surgical tool 6 is interchangeable and can be of several types, such as scissors, scalpels, cutters, needle holders and other accessories to be connected to the distal end of salve unit 11, like energy surgical instruments suction devices, etc. The surgical tool 6 which enters the patient's body should be bio-compatible and reusable after sterilization. Disposal surgical tool can also be used.

[0054] In other embodiments of this invention (FIG. 8, FIG. 9 and FIG. 10), there can be constraint means 33 of the teleoperated device which are configured to constrain movements of the distal end of the slave unit so that, when the mechanical telemanipulator is in operation, a certain master link 34 of the master unit 10 always translates along and rotates about a single point 37 so that the corresponding link 36 of the slave unit 11 always translates along and rotates about a single virtual point 38, also known as remote renter of motion, RCM. Even during an open surgical procedure, an RCM 38 or other kinematic constraints can be useful to minimize the clashing of instruments when passing through a narrow body incision (for instance in brain surgery or ENT surgical procedures).

[0055] The seven independent degrees of freedom of the telemanipulator according to this preferred embodiment, as thoroughly described hereafter, provide the desired dexterity needed to perform complicated surgical procedures, such as pulling, cutting and/or suturing tissues. With the aim of being as intuitive as possible, the distal degrees of freedom of both the master and slave units 10, 11 are designed to resemble a simplified human forearm, with an articulated wrist and a distal tool.

[0056] For each degree of freedom of the mechanical telemanipulator according to the preferred embodiment of the invention, different types of mechanical transmission can be used resulting in the same functional outcome.

[0057] Mechanical transmissions means can be partly in the form of pulley-routed flexible elements configured such that each driven pulley of each degree of freedom of the slave unit 11 is connected to the equivalent driving pulley of the master 10 unit, by a single closed cable/tendon loop transmission. A solution using rigid transmission may also be employed, where the transmission is mainly based on articulated linkages or geared elements, which may guarantee an increased stiffness of the system.

[0058] The kinematic model of the master and slave manipulators may also take different configurations (for example, the ones shown in FIG. 8, FIG. 9 and FIG. 10) and different number of degrees of freedom, keeping the same principle of working.

[0059] In some embodiments, as shown in FIG. 2, counterweights 39 are connected to some links of the master 10 and slave 11 units, in order to compensate the telemanipulator, minimizing gravity forces felt by the surgeon when manipulating the system.

[0060] In some embodiments, the mechanical telemanipulator comprises brake means, allowing the system to be fixed in several positions of its workspace, when the surgeon is not holding the handle.

[0061] In some embodiments, the mechanical teleoperated device comprises force sensors capable of measuring the forces exerted on the moving links and/or position sensors capable of measuring the movement of the different joints, in order to allow a reconstruction of the movement of the entire telemanipulator.

[0062] The surgical system according to the invention has been described for performing microsurgical techniques in different fields of surgery, which can further include ophthalmology, brain surgery, cardiology, orthopedics and dentistry, to name a few.

[0063] The surgical system according to the invention could also be employed for any suitable remote actuated application requiring a dexterous manipulation with high precision and dexterity, such as micro-assembly manipulation, manipulation in narrow places, manipulation in dangerous or difficult environments, and manipulation in contaminated or clean environments. In this configuration, the surgical tool may be replaced by a suitable multi-articulated holder or gripper.

[0064] Moreover, while this invention has been particularly shown and described with references to particular embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the spirit and scope of the invention as defined by the appended claims.