METHOD AND APPARATUS FOR ORGAN MANIPULATION USING A SURGICAL ROBOTIC SYSTEM

Abstract

In a robotic surgical system, an organ manipulation device such as a uterine manipulator with a colpotomy cup is positionable on a first robotic manipulator while a surgical instrument is positionable on a second robotic manipulator. During the course of surgery, a user inputs instructions to the robotic surgical system to cause movement of the organ manipulator and surgical instrument.

Claims

1. A surgical robotic system comprising: a plurality of robotic manipulator arms; an organ manipulator on a first one of the robotic manipulator arms; a surgical instrument on a second one of the robotic manipulator arms; and user input devices allowing a surgeon to input instructions to the robotic surgical system to cause movement of the organ manipulator and surgical instrument in response to the instructions.

2. The system of claim 1, wherein the system includes a user console and the user input devices include a first input handle and a second input handle, the robotic surgical system configured such that input to the first input handle results in movement of the organ manipulator and input to the second input handle results in movement of the surgical instrument.

3. The system of claim 1, wherein the system includes a first input handle, the robotic surgical system configured such that the first input handle is selectively paired with a first one of the robotic arms such that input to the first input handle results in movement of the organ manipulator, and selectively paired with a second one of the robotic arms such that input to the first input handle results in movement of the surgical instrument.

4. The system of claim 2 wherein movement of the organ manipulator is laparoscopic movement relative to a fulcrum.

5. The system of claim 4, wherein the surgical system is configured to determine the fulcrum about an anatomical feature.

6. The system of claim 5, wherein the anatomical feature is an incision site.

7. The system of claim 5, wherein the anatomical feature is a natural orifice.

8. The system of claim 7, wherein the organ manipulator is a uterine manipulator and the natural orifice is a vaginal opening.

9. A surgical method comprising: positioning an organ manipulator on a first robotic manipulator arm; positioning a surgical instrument on a second robotic manipulator arm; and using user input devices, inputting instructions to the robotic surgical system to cause movement of the organ manipulator and surgical instrument in response to the instructions.

10. The method of claim 9, wherein the system includes a user console and the method includes inputting instructions using a first input handle of the user console to cause movement of the organ manipulator, and inputting instructions to the second input handle to cause in movement of the surgical instrument.

11. The method of claim 10, where a single person operates the first and second input handles to input the instructions.

12. The method of claim 9, wherein the system includes a first input handle, the robotic surgical system configured such that the first input handle is selectively paired with a first one of the robotic arms such that input to the first input handle results in movement of the organ manipulator, and selectively paired with a second one of the robotic arms such that input to the first input handle results in movement of the surgical instrument.

13. The method of claim 9, wherein movement of the organ manipulator is laparoscopic movement relative to a fulcrum.

14. The method of claim 13, further including the steps of positioning the organ manipulator within an organ, determining a fulcrum along an axis of the organ manipulator relative to an anatomical feature, and then pivoting the organ manipulator relative to the fulcrum.

15. The method of claim 14, wherein the anatomical feature is an incision site.

16. The method of claim 14, wherein the anatomical feature is a natural orifice.

17. The method of claim 16, wherein the organ manipulator is a uterine manipulator and the natural orifice is a vaginal opening.

18. The method of claim 9, wherein the organ manipulator is a uterine manipulator having a culpotomy ring, and the surgical instrument is a cutting instrument, and wherein the method further includes using user input devices, inputting instructions to the robotic surgical system to cause movement of the organ manipulator and surgical instrument in response to the instructions, and using the cutting instrument to cut around the culpotomy ring.

19. An apparatus for mounting an organ manipulator to a robotic surgical arm, the apparatus comprising a member removable attachable to an end effector of a robotic surgical arm, the member configured to removable receive an organ manipulator.

20. The system of claim 1 wherein the organ manipulator is a uterine manipulator.

21. The system of claim 20 wherein the organ manipulator is a uterine manipulator and includes a colpotomy cup.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0020] FIG. 1 is a schematic view of a robotic surgery system.

[0021] FIGS. 2 and 3 show uterine manipulators of the prior art.

[0022] FIG. 4 shows a uterine manipulation system of the prior art.

[0023] FIG. 5 shows an exemplary system using a uterine manipulator on a robotic surgical system.

DETAILED DESCRIPTION

[0024] The invention comprises an apparatus and method for manipulating a uterus or other organ with a surgical robotic system. A surgical system employing the concepts described here includes one or more robotic arms, and surgical instruments mountable to and moveable by the arms in response to input from a user input device. The system includes features allowing attachment of an organ manipulator such a uterine manipulator to one of the robotic arms. The uterine manipulator may be an existing commercially-available device, such as a RUMI, V-Care Cup, a uterine sound, or an alternate device that can engage and move or reposition a uterus or other body organ within the body.

[0025] FIG. 5 shows a robotic manipulator arm of the type shown in FIG. 1. The robotic arm 11 may be part of a robotic surgical system of the type shown in FIG. 1. The surgical system may be a multi-arm system, with one arm supporting an organ manipulator such as a uterine manipulator, at least one arm supporting another surgical instrument such a cutting instrument, electrosurgical instrument etc., and a third supporting a camera for positioning within the patient. The organ manipulator 32 is removably attachable to the end effector 30 of the robotic arm. FIG. 5 shows an intermediate member or adaptor 34 that mounts to the end effector 32 and that receives the organ manipulator 32. Adaptor 34 and manipulator 32 may be provided as sterile piece, while the end effector 30 may be a non-sterile component covered by a sterile drape or barrier. A clip 40, lock, interlocking feature, or other type of attachment device is used to attach the uterine manipulator to the adaptor or to the end effector where no adaptor is used. This attachment device may be a permanent part of the robotic arm or adaptor, or it may be interchangeable with other attachment devices, each allowing attachment of a different type of uterine/organ manipulator to the robotic arm or manipulator. In other implementations, the uterine manipulator and attachment may be more integrated (or may even be a single piece).

[0026] In the implementation shown in FIG. 5, the end effector of the robotic arm is positioned above the abdomen of the patient, pointed down toward the patient's legs. In another implementation, the end effector may be positioned between the patient's legs, pointed up toward the pelvic region.

[0027] The invention also comprises a method of manipulating the uterus with a robotic input. In some implementations, the surgeon is able to use laparoscopic-style motion to manipulate the uterus, almost as if it were a laparoscopic instrument. For example, using hands on the input devices 17, 18, the surgeon uses one input device 17 to control one robotic arm to control the position and/or orientation of the uterine manipulator (via the robotically moveable uterine manipulator), and the other input device 18 to control a different robotic arm to control the position, orientation and/or operation of a surgical device being used to treat the uterus or surrounding tissue. In a laparoscopic hysterectomy, therefore, the surgeon can use one hand to control manipulation of the uterus and the other hand to perform the cutting. In one configuration, the motion of the uterine manipulator is mapped to the user input device so that the robotic uterine manipulator, pointed toward the feet of the patient, moves in the manner of a laparoscopic instrument, moving relative to a fulcrum. In a second configuration, in which the robotic end effector is pointed up toward the vagina, the robot control system may perform mathematical operations/kinematics to map the motion differently to accomplish the same user experience. In some implementations, the motion may be mapped to Cartesian style motion which the user may not perceive to be moving about a fulcrum.

[0028] In some implementations, the robotic system may be able to determine a fulcrum/remote-center-of-motion that is located at an anatomical landmark, such as at the vaginal opening, in order to minimize tissue trauma, distension, or post-operative pain. This determination may be accomplished via methodologies similar to those described in US Publication No. 2010/0094312 which is attached at the Appendix and incorporated herein by reference. In other implementations, the surgeon may be able to manually set the fulcrum location.

[0029] In certain procedures, two robotic arms may be employed to move the uterus. For example, one robotic arm might be used to control an instrument placed internal to the uterus (RUMI®, uterine sound, etc.) and another robotic arm might be used to control an instrument used to grasp the exterior of the uterus (rat-tooth grasper/tenaculum, etc.). In this implementation, manipulation of a single input 17 or 18 from the surgeon may cause two of the robotic arms to move in concert. This may be simple position control and tracking, or may be enhanced with force control means to minimize potentially-traumatic forces to the body. Alternatively, the surgeon might give input for one device using the left hand control 17 and give input for the other device using the right hand control 18.

[0030] The concepts described in this application allow the surgeon to directly manipulate the uterus, rather than relying on an assistant, allowing for stable control of the uterus, and allowing the surgeon to directly coordinate movement of the uterus/organ with the other instruments being operated by the surgeon.