SURGICAL ROBOT/INSTRUMENT SYSTEM

Abstract

A surgical method for operating a trocar defining an access port for a surgical instrument, using a holding arm and a number of drives. The method includes: inserting the trocar through an abdominal wall of the patient body; operating at least one drive to move the surgical instrument in the patient body; operating at least one drives to actuate an effector; and moving the holding arm to generate a pivoting movement of the trocar and surgical instrument about a pivot point defined by the abdominal wall of the patient body. The trocar is freely pivotable relative to the holding device, and the pivoting movement is caused by contact between the trocar and the abdominal wall of the patient body or an elastic membrane located on the abdominal wall of the patient body.

Claims

1. A method for performing a surgical procedure on a patient, the method comprising: providing a medical instrument comprising: a trocar defining an access port; a holding arm having a distal arm end portion; a holding device arranged on the distal arm end portion, and being configured as an interface for holding exclusively the trocar at the distal arm end portion in an exchangeable fashion, a surgical instrument comprising an instrument shaft extending along a shaft direction through the access port and into a body of the patient, the surgical instrument having a distal instrument end portion which supports an instrument tip via a joint, said instrument tip supporting or forming an effector of the surgical instrument, and a number of drives configured to actuate the effector, move the instrument shaft along the shaft direction, and move the holding arm; inserting the trocar through an abdominal wall of the patient body; operating at least one of the number of drives to move the surgical instrument in the patient body; operating at least one of the number of drives to actuate the effector; and moving the holding arm to generate a pivoting movement of the trocar and surgical instrument about a pivot point defined by the abdominal wall of the patient body; wherein the trocar is freely pivotable relative to the holding device, and the pivoting movement is caused by contact between the trocar and the abdominal wall of the patient body or an elastic membrane located on the abdominal wall of the patient body.

2. The method of claim 1, wherein the surgical instrument comprises a minimally invasive design.

3. The method of claim 1, wherein a pivoting angle of the surgical instrument is passively defined by a position of the interface relative to the pivot point.

4. The method of claim 3, wherein the pivoting angle of the surgical instrument is defined independently of an angular orientation of the holding device.

5. The method of claim 1, wherein the number of drives comprises at least one instrument-external drive that is located in or on the holding arm and is configured to move the interface holding the trocar transverse to the shaft direction and the method further comprises moving the interface transverse to the shaft direction to generate the pivoting movement of the surgical instrument.

6. The method of claim 1, wherein the number of drives comprises at least one instrument-external drive that is located in a housing of a distal end portion of the holding arm and is configured to move the holding device relative to the distal end portion of the holding arm and transverse to the shaft direction.

7. The method of claim 1, wherein the number of drives is further configured to rotate the instrument shaft around its respective longitudinal axis relative to the trocar, and the method further comprises rotating the instrument shaft around its respective longitudinal axis relative to the trocar.

8. The method of claim 1, wherein at least one of the number of drives configured to move the instrument shaft relative to the trocar along the shaft direction is provided as an instrument-external drive located in or on the holding arm.

9. The method of claim 1, wherein at least one of the number of drives configured to actuate the effector or move the instrument shaft along the shaft direction is provided as a trocar-internal drive.

10. The method of claim 1, wherein the medical instrument further comprises a passive conveying unit operatively connected between the trocar and the instrument shaft and configured to be operated via a force transmission train to move the instrument shaft relative to the trocar, and the method further comprises operating the force transmission train to move the instrument shaft relative to the trocar.

11. The method of claim 10, wherein the passive conveying unit is operatively connected to the instrument shaft and configured to move the instrument shaft relative to the trocar in the shaft direction, and the method further comprises operating the force transmission train to move the instrument shaft relative to the trocar in the shaft direction.

12. The method of claim 10, wherein the passive conveying unit is provided inside of the trocar, the trocar being a passive instrument unit.

13. The method of claim 10, wherein the trocar and the passive conveying unit are provided on a sterile side of a sterility barrier, and an instrument drive coupled to the passive conveying unit is located on a non-sterile side of the sterility barrier.

14. The method of claim 10, wherein the passive conveying unit comprises a friction wheel configured to move the surgical instrument relative to the trocar along the shaft direction, and the method further comprises moving the surgical instrument relative to the trocar along the shaft direction.

15. The method of claim 10, wherein the passive conveying unit comprises a friction wheel configured to rotate the surgical instrument relative to the trocar about the shaft direction, and the method further comprises rotating the surgical instrument relative to the trocar about the shaft direction.

16. The method of claim 1, wherein the holding arm is configured to be mounted to a stand and to swivel or rotate around a stand axis of the stand for moving the instrument shaft transverse to the shaft direction, and the method further comprises swiveling or rotating the holding arm around the stand axis.

17. The method of claim 1, wherein the number of drives comprises at least one instrument-internal drive configured: to actuate the effector, and/or to incline or bend the instrument tip relative to the shaft at the joint, and the method further comprises inclining or bending the instrument tip relative to the shaft at the joint, and/or to rotate the instrument tip around its respective longitudinal axis relative to the instrument shaft, and the method further comprises rotating the instrument tip around its respective longitudinal relative to the instrument shaft, and/or to extend and retract the instrument tip relative to the instrument shaft in a telescopic manner, and the method further comprises extending and retracting the instrument tip relative to the instrument shaft in a telescopic manner.

18. The method of claim 1, wherein the number of drives includes at least one instrument-internal drive that is mounted on a proximal shaft portion of the instrument shaft and is connected to a distal shaft portion of the instrument shaft via a power transmission train, that is at least partially located in the instrument shaft.

19. The method of claim 18, wherein the instrument shaft comprises the distal shaft portion and the proximal shaft portion that are coupled together so as to be rotatable relative to each other around a shaft axis and/or shiftable relative to each other along the shaft axis and the method correspondingly includes driving the distal shaft portion to rotate and/or shift relative to the proximal shaft portion.

Description

DESCRIPTION OF THE FIGURES

[0044] The invention will be explained in more detail below on the basis of a preferred exemplary embodiment with reference to the attached drawings.

[0045] FIG. 1 shows the distal portion of a surgical instrument realized with a minimally invasive design, such as it is used, among other things, in a surgical robot/instrument system, for explaining the required degrees of freedom.

[0046] FIG. 2 shows the basic design of a surgical robot/instrument system according to a preferred exemplary embodiment of the present invention.

[0047] FIG. 3 shows a possible surgery setup.

[0048] FIG. 4 shows the exterior structure of the surgical instrument according to FIG. 1.

[0049] FIG. 5 shows a sample trocar internal drive/drive unit according to one embodiment of the invention.

[0050] FIG. 6 schematically illustrates and instrument drive on a motor arm, a transmission train, and a conveying unit.

[0051] The surgical instrument shown in FIG. 1 which has a minimally invasive design and is formed/adapted for being used in a surgical robot/instrument system according to the preferred exemplary embodiment of the present invention, is realized in this exemplary case as an instrument in the nature of gripping pliers. However, it may also be designed as a mono- or bipolar HF instrument, a mechanical cutting instrument (knife, milling cutter, drill etc.), a loop instrument or as a surgical instrument of similar type.

[0052] In the present example, the surgical instrument having a minimally invasive design comprises an instrument shaft 10 (flexible or rigid) at whose distal end an instrument tip 12 is articulated in such a manner that the instrument tip 12 can bend like a hinge with respect to the shaft axis 10. In the following, this bending function forms according to FIG. 1 the 5th degree of freedom of the surgical instrument. Moreover, the instrument shaft 10 is held or supported such that it can rotate around its longitudinal axis (in the following, this corresponds to the 1st degree of freedom of the surgical instrument) and can translatorily move (shift) along its shaft axis, in the following corresponding to the 2nd degree of freedom of the surgical instrument.

[0053] As shown in FIG. 4, the rotational movement of the instrument shaft 10 can be achieved for instance in that the instrument shaft has a two-part design, comprising a distal (separate) shaft portion which is rotatably supported in/on/around a proximal shaft portion, so that the distal shaft portion can be rotated relative to the proximal shaft portion around the longitudinal axis of the (entire) instrument shaft.

[0054] Further, provision may be made that the distal shaft portion, in addition to or as an alternative to the previously described rotational support, is supported in/around/on the proximal shaft portion even so as to be movable in the longitudinal direction (in a telescopic manner).

[0055] Furthermore, the instrument shaft 10 can be inclined/tilted in an X-plane as well as in a Y-plane (perpendicular to the X-plane), in the following corresponding to the 3rd and 4th degree of freedom of the surgical instrument. Finally, the instrument tip 12 forms or comprises an effector of the surgical instrument, in the present case consisting of a jaw part comprising preferably two branches 16, 18 from which at least one branch 16 is pivotally supported on the effector in order to enlarge or reduce a gripping/clamping gap between the branches. This pivoting movement of the at least one branch 16 represents in the following the 6th degree of freedom of the surgical instrument.

[0056] Here, it is referred to the fact that in the case of a surgical instrument realized in some other design, such as a mechanical cutting knife, for example, the 6th degree of freedom would relate to extending or retracting the knife from or into the instrument tip, or in the case of a drill/milling cutter would relate to the rotation of the milling/drilling head, etc. It would also be conceivable to move an HF electrode or similar tool with respect to the effector.

[0057] The 5th and 6th degrees of freedom or movement possibilities defined in this way are achieved in the present exemplary embodiment preferably by mechanical ways and means, in fact preferably by means of independent power transmission trains (not shown in further detail) which may be arranged as instrument-internal trains within the instrument shaft 10.

[0058] As illustrated in FIG. 4, the surgical instrument comprises one or more drive units 20 (e.g. electric, hydraulic and/or pneumatic motors) which are connected to the instrument shaft 10 at the proximal end (end portion) thereof and to which the instrument-internal power transmission trains for the powered effectuation of the 5th and 6th degree of freedom and optionally the 1st and 2nd degree of freedom of the instrument are coupled or can be coupled. The instrument-internal drive unit(s) is/are each arranged in one housing or a shared housing 22 and may be encapsulated. The housing(s) 22 is/are connected to the instrument shaft 10 (proximal shaft portion) in a fixed or detachable manner. In the first case, the drive unit(s) together with the instrument shaft 1Oas well as the instrument tip/effector 12 articulated thereon are configured as a disposable instrument, whereas in the second case only the instrument shaft 1O complete with the instrument tip 12 is disposed after completing the surgery, the instrument-internal drive unit(s) being uncoupled and then reused after a corresponding cleaning/sterilization process.

[0059] FIG. 2 shows the basic structure of a surgical robot/instrument system or apparatus.

[0060] Accordingly, the robotic system or robotic structure comprises a holding/cantilever arm 24 which is mounted or supported on a stand 26 indicated in FIG. 3 preferably so as to be vertically adjustable/movable. In this arrangement, the holding arm 24 preferably extends in an essentially horizontal plane, but it may also be aligned so as to be inclined relative thereto. The holding arm 24 is either movable along the stand 26 or additionally extendable (in a telescopic manner) with respect to the stand axis (angularly relative to the stand) preferably in the longitudinal direction of the arm. In addition, there is the option to swivel or rotate the holding arm 26 around the stand axis.

[0061] Here, it is referred to the fact that the stand 26 may be immovably mounted or in turn may be arranged on the distal end of a further, preceding movement mechanism (and hence in a movable manner). In the latter case, the stand 26 may simply be a swivel pin where the holding arm 24 is pivotally or immovably supported/held.

[0062] It may also be provided to support the holding arm on the stand only so as to be able to pivot, but not so as to be able to extend in telescopic manner, with the option that the holding arm can also be extended in a telescopic manner.

[0063] According to the present preferred exemplary embodiment, the holding arm 24 has its distal end portion provided with a gripper or coupling piece 28 which is connected to the holding arm 24 preferably by means of a joint or hinge 30. It is preferred that the gripper 28 can be exchanged depending on the surgical instrument to be used in each case or is designed as a universal gripper (and hence in a not exchangeable manner) which is adapted to be coupled to a freely selected surgical instrument.

[0064] The robotic structure is thus designed such that it is capable of moving the gripper 28 arranged on the distal end of the holding arm 24 according to the previously mentioned 3rd and 4th degree of freedom.

[0065] Stated in other words, in the case of application of the surgical robot/instrument system according to the invention it is understood that the surgical instrument is inserted directly or through a trocar 32 into a patient cavity, e.g. through the abdominal wall. In this case, the patient’s tissue (e.g. abdominal wall) representing the penetration site serves as an abutment against any movements in the tissue plane. If the gripper 24 is moved in an X- and Y-direction transverse to the shaft axis, the instrument shaft 10 and/or the trocar 32 perform a corresponding pivoting movement around the penetration site as an imaginary pivot point. In this way, the instrument shaft/trocar may describe a sort of funnel in the course of its pivoting movement, with the penetration site as the tip of the funnel, as indicated in FIG. 2.

[0066] As an alternative or in addition to this, the abdominal wall may also be supplemented or replaced by an elastic membrane defining the imaginary pivot point. Finally, it is also possible to give the gripper a corresponding rotation by a motorized unit in order to produce a funnel-shaped pivoting movement of the instrument/trocar in superposition with the circular movement of the holding arm; in this case, the abdominal wall and/or membrane serving as the abutment would not be required any more.

[0067] In this connection, the drive unit(s) 20 is/are located with respect to the gripper 24 on an end side of the surgical instrument remote from the penetration site, so that the view onto the penetration site remains unobstructed and is slightly limited merely by the preferably filigree gripper 24 (which is constructed as a framework).

[0068] In the present exemplary embodiment of the invention, it is not the surgical instrument itself which is mounted on the gripper 24, but a trocar 32 is exchangeably mounted.

[0069] A trocar is a surgical introduction aid at least comprising a tubular shaft having a distal front edge preferably realized as a blade and an insertion funnel on the proximal end of the tubular shaft for the insertion of a surgical instrument having the previously mentioned structure.

[0070] As a general rule, the trocar is realized so as to have a smooth surface at the inner side of the shaft, preferably with a sealing edge for preventing any uncontrolled outflow of blood or for preventing an air leak in the event of pressurizing the patient cavity with air for deploying it.

[0071] Referring now to FIG. 5 and FIG. 6, in the present exemplary embodiment, however, the trocar 32 is (optionally) provided with an internal drive/drive unit by means of which the inserted surgical instrument can be (optionally) shifted in its longitudinal axis and, if applicable, can also be (optionally) rotated around its longitudinal axis. By way of example, the trocar-internal drive may consist of a number of friction wheels which act on the instrument shaft 10.

[0072] Further, the trocar-internal drive may also be designed such that it acts in one direction only, for instance in a direction toward the patient for advancing the surgical instrument into the patient body, whereas a movement of the surgical instrument in the opposite direction (out of the patient body) can be achieved for instance by a helical compression spring which is supported on the trocar 32 as well as on the drive unit 20 of the surgical instrument, as is likewise shown in FIG. 2.

[0073] The operating principle of the surgical robot/instrument system according to the invention can be explained preferably on the basis of FIG. 3:

[0074] Here, a patient is illustrated symbolically, which is penetrated at at least two points spaced apart from each other by one trocar in each case. The two trocars are each held on one holding arm 24 (or gripper) in the previously mentioned sense, in fact in such a way that the two trocars are able to perform a pivoting movement (in a funnel shape) around the respective penetration site, as has been described above. In addition, a camera is inserted into the patient body at a third penetration site.

[0075] As can be seen in this case, the pivoting movement of each of the trocars is achieved in that the gripper 28 is swiveled back and forth around its joint to the holding arm 24 in a first plane (e.g. X-plane according to FIG. 1), while at the same time the holding arm 24 itself is extended or shortened in a telescopic manner or alternatively the gripper on the holding arm 24 is retracted and extended in a telescopic manner in order to pivot the trocars in a second plane (e.g. Y-plane according to FIG. 1). Moreover, the outer form of the holding arm 24 is clearly visible in FIG. 3, the latter preferably forming a housing for receiving one or more drives designed for actuating the gripper 28 according to the above description.