ATTACHMENT APPARATUS FOR REMOTE ACCESS TOOLS

Abstract

Apparatuses and methods for attaching a minimal access tool to a user's boy (e.g., wrist or forearm) so that movements of the user's forearm, wrist, hand and fingers can control movements at a distal end of the minimal access tool. In particular, described herein are forearm attachment devices (which may be used with or integrated into) a minimal access tool including a cuff configured to secure to the user's forearm and a coupling joint configured to connect the cuff to the frame so that the cuff may move relative to the frame with between 1 and 4 degrees of freedom.

Claims

1. A forearm attachment device for a minimal access tool, the device comprising: a frame comprising an elongate tool shaft having a tool axis; an outer gimbal rotationally coupled to the frame, and an inner gimbal rotationally coupled or coupleable to the outer gimbal, wherein the inner gimbal, when coupled to the outer gimbal, is configured to rotate about a first rotational axis containing the at least one releasable attachment coupling the inner gimbal to the outer gimbal, and wherein the outer gimbal is configured to rotate about a second rotational axis, and wherein the first rotational axis and the second rotational axis intersect at a point of intersection; a cuff within the inner gimbal configured to hold a user's arm therein so that the point of intersection is within the user's arm; and a securement configured to secure the user's arm in the cuff so that the cuff moves with the user's arm.

2. The device of claim 1, wherein the inner gimbal is configured to releasably snap into the outer gimbal.

3. The device of claim 1, wherein the inner gimbal comprises at least one projection extending from the inner gimbal and configured to releasably mate with the outer gimbal.

4. The device of claim 1, wherein the inner gimbal comprising at least one projection receiver on an outer surface of the inner gimbal configured to receive and releasably mate with a projection from the outer gimbal.

5. The device of claim 1, wherein the inner gimbal comprises at least one projection or projection receiver on an outer surface of the inner gimbal configured to mate with a projection or projection receiver on the outer gimbal, wherein the at least one projection or projection receiver are in the first rotational axis.

6. The device of claim 1, wherein the inner gimbal is configured to be compressed to decouple from the outer gimbal.

7. The device of claim 1, wherein the cuff is part of the inner gimbal.

8. The device of claim 1, wherein the cuff is C-shaped.

9. The device of claim 1, further comprising a sleeve configured to rigidly attach within an opening formed by the inner gimbal, further wherein the sleeve is configured to couple the user's wrist or forearm to the cuff.

10. The device of claim 1, further comprising a bearing between the cuff and the frame that is configured to slide so that there is a roll rotational degree of freedom between the frame and the cuff about a long axis of the tool shaft.

11. A method of attaching a minimal access tool to a user's arm, the method comprising: securing a user's wrist or forearm within a cuff that is uncoupled from the minimal access tool, so that the user's hand extends out of the cuff while the user's wrist or forearm is secured within the cuff; attaching the cuff into a frame of the minimal access tool, wherein the cuff is part of or coupled to a first coupling joint that can rotate about a first rotational axis relative to the frame; rotating the frame relative to the cuff about the first rotational axis as the user moves the user's wrist or forearm; and rotating the frame relative to the cuff about a second rotational axis as the user moves the user's wrist or forearm, wherein the first rotational axis and the second rotational axis intersect at a point of intersection that is within the user's wrist or forearm.

12. A method of attaching a minimal access tool to a user's arm, the method comprising: securing a user's wrist or forearm within an inner gimbal so that the user's wrist or forearm extends through the inner gimbal; wherein the inner gimbal member forms part of a gimbal assembly comprising the inner gimbal, a frame and an outer gimbal, wherein the outer gimbal is rotationally coupled to the frame and the inner gimbal is rotationally coupled to the outer gimbal; rotating the inner gimbal about a first rotational axis of the gimbal assembly as the user moves the user's wrist or forearm; and rotating the outer gimbal about a second rotational axis of the gimbal assembly as the user moves the user's wrist or forearm, wherein the first rotational axis and the second rotational axis intersect at a point of intersection that is within the user's wrist or forearm.

13. The method of claim 12, further comprising attaching the inner gimbal member into the gimbal assembly so that the inner gimbal can rotate about the first rotational axis after securing the user's forearm within the inner gimbal.

14. The method of claim 12, further comprising snapping the inner gimbal member into the gimbal assembly so that the inner gimbal can rotate about the first rotational axis after securing the user's forearm within the inner gimbal.

15. The method of claim 12, further comprising attaching the inner gimbal member into the gimbal assembly by mating a projection or projection receiver on an outer surface of the inner gimbal with a complementary projection or projection receiver on an inner surface of the outer gimbal so that the inner gimbal can rotate about the first rotational axis through the projection or projection receiver after securing the user's forearm within the inner gimbal.

16. The method of claim 12, further comprising attaching, after securing the user's forearm within the inner gimbal, the inner gimbal member into the gimbal assembly by compressing the inner gimbal so that it fits into the outer gimbal member and releasing the compression to mate the inner gimbal with the outer gimbal so that the inner gimbal can rotate about the first rotational axis.

17. The method of claim 12, further comprising securing the user's forearm within the inner gimbal so that the inner gimbal moves with the user's arm.

18. The method of claim 12, further comprising securing a cuff at least partially around a user's forearm so that the cuff moves with the user's forearm, wherein placing the user's forearm within the inner gimbal comprises securing the cuff within the inner gimbal so that the inner gimbal moves with the user's forearm.

19. The method of claim 12, wherein securing a user's forearm within the inner gimbal comprises placing the user's forearm into a cuff within the inner gimbal and securing the user's forearm in the cuff using a securement.

20. The method of claim 12, wherein rotating the inner gimbal about the first rotational axis comprises rolling the inner gimbal around a yaw axis.

21. The method of claim 12, wherein rotating the outer gimbal around the second rotational axis comprises rolling the outer gimbal around a pitch axis.

22. The method of claim 12, further comprising rotating a bearing between the frame and the inner gimbal, configured to permit roll of the frame about the user's forearm.

23. A method of attaching a minimal access tool to a user's wrist or forearm, the method comprising: coupling an inner gimbal member to a user's wrist or forearm so that the user's forearm passes through the inner gimbal, wherein the inner gimbal member is uncoupled from the minimal access tool; attaching the inner gimbal member coupled to the user's wrist or forearm into a gimbal assembly comprising a frame and an outer gimbal, wherein the outer gimbal is rotationally coupled to the frame, so that the inner gimbal is rotationally coupled to the outer gimbal; rotating the inner gimbal about a first rotational axis and rotating the outer gimbal about a second rotational axis wherein the first rotational axis and the second rotational axis intersect at a point of intersection that is within the user's wrist or forearm.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0083] The novel features of the invention are set forth with particularity in the claims that follow. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings of which:

[0084] FIGS. 1, 2 and 3 illustrate prior art minimally invasive/remote access tools.

[0085] FIGS. 4, 5, 6A-6C, 7A, 7B, 8A, 8B, and 9 show different degrees of freedom on a user's arm (wrist, forearm and fingers).

[0086] FIG. 10 illustrates the translation of arm movement using a minimally access tool (e.g., remote access tool).

[0087] FIGS. 11 and 12 illustrate orientation of a minimal access tool that may be difficult to achieve with prior art devices, such as those shown in FIGS. 1-3.

[0088] FIGS. 13A-13C and 14A-14B illustrate arm movements that may be difficult or impossible to achieve using prior art minimal access tools such as those shown in FIGS. 1-3.

[0089] FIGS. 15, 16, 17, and 18 schematically illustrate minimal access tools including a forearm attachment assembly that may allow greater than 1 degree of freedom between the forearm attachment portion (e.g., cuff) and the frame.

[0090] FIGS. 19 and 20 illustrate a first embodiment of forearm attachment assemblies (components) that may be used with a minimal access tool as descried herein. FIG. 19 shows one variation of an assembly of coupling joints including two gimbals and a bearing, that may provide a coupling between a cuff (integrated into the inner gimbal) and a frame allowing rotation in pitch, yaw and roll, where the frame may be configured (as shown in FIG. 21A) for roll about the tool axis. FIG. 20 shows a bearing comprising a plurality of rollers.

[0091] FIG. 21A illustrates another example of a forearm attachment assembly integrated into a minimal access tool, showing 3 axes of rotation (pitch, yaw, roll).

[0092] FIGS. 21B-21G schematically illustrate six different degrees of freedom between a generic cuff and a frame. FIGS. 21B-21D show translational DoFs: axial (FIG. 21B), horizontal (FIG. 21C), and vertical (FIG. 21D). FIGS. 21E-21G show rotational DoFs: roll (FIG. 21E), pitch (FIG. 21F) and yaw (FIG. 21G).

[0093] FIGS. 22, 23, 24A-24B, 25, 26, 27, 28, and 29 all illustrate another example of a minimal access tool including a forearm attachment assembly that may be used with a minimal access tool.

[0094] FIG. 30 is another example of a forearm attachment assembly that may be used with a minimal access tool.

[0095] FIGS. 31A-31B is another example of a forearm attachment assembly that may be used with a minimal access tool.

[0096] FIGS. 32, 33, 34, 35 and 36 illustrate examples of forearm attachment assemblies that may be used with a minimal access tool.

[0097] FIGS. 37 and 38 show another example of forearm attachment assembly that may be used with a minimal access tool.

[0098] FIG. 39 schematically illustrates an example of forearm attachment assembly that may be used with a minimal access tool.

[0099] FIGS. 40A-40B illustrate a comparison between the prior at attachment apparatus and the forearm attachment assemblies having one or more degrees of freedom described herein.

[0100] FIG. 41 schematically illustrates another example of a forearm attachment assembly that may be used with a minimal access tool.

[0101] FIG. 42 schematically illustrates one embodiment of the forearm attachment assembly that may be used with a minimal access tool in addition to the user's wrist, forearm, and hand.

[0102] FIG. 43 illustrates the plurality of gimbals, shown as rings, and axes that make up one embodiment of the forearm attachment assembly that may be used with a minimal access tool.

[0103] FIG. 44 schematically illustrates the plurality of rings that make up one embodiment of the forearm attachment assembly and the sequence of assembly for the various components that may be used with a minimal access tool.

[0104] FIG. 45 schematically illustrates a method for one mechanism used to retain the cuff within the deviation ring which may be found on one embodiment of the forearm attachment assembly which may be used with a minimal access tool.

[0105] FIG. 46 illustrates a perspective view of one embodiment of the cuff and the various components that comprise the fitted strap for affixing the cuff to the user's forearm during use with a minimal access tool. In this example, the cuff is formed as a part of the gimbal and includes a fitted strap for affixing the cuff to the user's forearm during use with a minimal access tool.

[0106] FIG. 47 illustrates an overall laparoscopic instrument with a particular embodiment of the forearm attach apparatus (exploded view) installed for use as a minimal access tool.

[0107] FIG. 48 illustrates a cross-sectional view of one variation of a forearm attach assembly.

[0108] FIG. 49 illustrates the Roll Ring component of the assembly.

[0109] FIG. 50 illustrates the translation of Axis 2 with respect to Axis 3 to demonstrate the source of binding between components.

[0110] FIG. 51 illustrates the three-axis gimbal type arrangement may be used by a user for controlling a remote end-effector in remote access tool e.g. a surgical tool.

[0111] FIGS. 52A-52G illustrate an exemplary minimum access tool including a body (e.g., forearm) attachment assembly as described herein, having pitch, yaw and roll rotation, as described herein. This example includes a parallel kinematic input joint having two DoF.

[0112] FIGS. 53A-53D illustrate another variation of a cuff that is integrated into a coupling joint (configured in this example as a gimbal) that is removably attachable/detachable from the tool (e.g., a minimal access tool). FIGS. 53A and 53B shows a front and side profiles, respectively, of the gimbal including the cuff opening and a pair of spring-loaded pins that secure it into another gimbal, as illustrated in FIG. 53D so that it may rotate about a rotational axis. FIG. 53C show a sectional view of a second gimbal into which the spring-loaded pins may be inserted.

[0113] FIGS. 54A and 54B illustrate another variation of a forearm attachment assembly. In this example, the forearm attachment assembly includes a pair of gimbals that are serially connected by a fixed, but compliant member; thus the entire assembly may be formed from a single piece (e.g., by molding, injection molding, etc.). Pivoting about the first and second (e.g., pitch and yaw) axes may be permitted based on the compliance of the connecting regions (tabs).

[0114] FIG. 55 illustrates another wrist cuff including a securement.

[0115] FIG. 56 illustrates one variation of a minimal access device having including a body (e.g., forearm) attachment assembly between the cuff configured to hold an arm and a frame including (or attached to) an elongate tool shaft having a tool axis. This device also includes a parallel kinematic 2 DoF input joint. The axes of rotation of the forearm attachment assembly (a yaw axis of the coupling joint and a pitch axis of the coupling joint, as well as a roll axis of the tool shaft) all intersect at a point of intersection within the user's wrist or forearm; the two axes of rotation of the parallel kinematic input joint also intersect at this same point.

DETAILED DESCRIPTION

[0116] In general, described herein are body attachment apparatuses (e.g., devices, systems, assemblies, tools, etc.) including forearm attachment assemblies that may be used with (and/or integrated into) a minimal access tool (a minimal access tool) to provide up to four degrees of freedom, e.g., three rotational and one translational, between a body attachment such as a cuff that may be part of the forearm attachment assembly and a frame of the tool. These degrees of freedom (DoF) may be achieved via a connection (which may be referred to as a joint and/or mechanism) between the cuff and the frame. This connection may also be referred to herein as a coupling joint. The remaining two translational motions may be constrained and therefore transmitted directly between the cuff and the frame. For convenience, the body attachment assemblies described herein may be referred to as arm attachment assemblies or forearm attachment assemblies, although they may be adapted for use in other body regions, including the legs (lower leg, ankle, upper leg), or other portions of the arm (wrist, forearm, upper arm). In ordinary usage herein, unless the context makes clear otherwise, a forearm attachment assembly may attach to either the wrist or forearm.

[0117] Although four degree of freedom variations are described herein, additional variations of these body attachment apparatuses, and therefore of the minimal access tools incorporating them, may instead provide fewer than four DoF. For example, a minimal access tool as described herein may include three rotational degrees of freedom (yaw, pitch and roll), or two rotational degrees of freedom (e.g., yaw and roll, pitch and roll or yaw and pitch). IN some variation only one rotational degree of freedom (e.g., roll) is provided.

[0118] As mentioned, in general a forearm attachment assembly may be used as part of an apparatus such as a minimal remote access tool. In general, the minimal remote access tool may include a shaft which may be integral and/or rigidly connected to the frame. The frame may be considered the apparatus mechanical ground. Alternatively, in some variations the shaft may be connected to the frame by a joint (e.g., a universal joint).

[0119] Some variations of the apparatuses described herein that may be particularly useful are configured such that the tool shaft is integral with or rigidly connected to the frame and has an elongate (long) tool axis. Such variations may include a body (e.g., forearm) attachment assembly that is configured to permit roll between the cuff and the tool shaft, so that the roll axis is the same as the tool axis, and this axis passes through the cuff (e.g., a center region of the user's wrist and/or forearm when operating the apparatus). In some variations the forearm attachment assembly also permits rotation about one or more additional axes, such as pitch or yaw. These additional axes may also intersect the roll axis at a point within the user's wrist and/or forearm. Alternatively, in some variations the roll axis intersects the user's wrist and/or forearm, but the additional pitch and/or yaw axes do not. Thus, although the pitch and yaw rotational DoF between the frame and the cuff have been described to intersect with the roll axis at the user's wrist, in an alternate embodiment these two axes of rotation may be at a location separate from the user's wrist. For example, a minimal access tool may be configured so that the roll rotation is about a tool axis that passes through the wrist region of the user, but the pitch and yaw degrees of freedom may be between the tool frame and tool shaft, or along any other location along the extent of the tool frame or tool shaft. In such a case the roll, pitch and yaw axes would no longer intersect at one point that lies in the user's wrist region.

[0120] A cuff may be part of the body attachment assembly or it may be separate and attachable to the body attachment assembly. For example when the cuff is part of a forearm attachment assembly which links to a minimal access tool, the cuff may be securely attached to the forearm of a user, thereby allowing up to 4 DoF between the user's forearm and the frame of the minimal access tool. The coupling joint(s) forming the forearm attachment assembly portion of the tool may be configured so that the two rotational DoF (pitch and yaw) are centered at the wrist joint of the user, the third rotational DoF (roll) is centered around some desirable axis of the frame (e.g., a tool shaft attached to frame) and the translational DoF is along some desirable axis of the frame (e.g. tool shaft attached to frame). The two translational DoF constrained the upward/downward motion at the forearm and the side to side motion at the forearm.

[0121] As described above in reference to FIGS. 4-9, the forearm, as it pertains to the apparatuses herein, may be defined as the distal region of a user's arm leading up to, but not inclusive of, the wrist joint along the arm axis. The forearm may be unconstrained in space and offers 4 DoF, rotation about the arm axis accomplished through rotational pronation and supination, as well as forward/reverse translation, upward/downward translation, and side/side translation (as shown in the figures above). The arm axis intersects the hand axis at the user's wrist joint. The wrist joint is defined as an articulating joint between the user's forearm and hand and grants the user 2 rotational DoF relative to the forearm accomplished through flexion/extension and deviation. The hand is defined as the member of the user's arm that is just distal, but not inclusive of, the wrist joint. The hand axis is controlled by the articulation at the wrist joint while intersecting the arm axis.

[0122] In general, the frame of an apparatuses including a minimal access tool may be a rigid elongate extension which cantilevers (i.e. extends) from the user's forearm and interfaces with the forearm via the coupling joint(s) of the body attachment apparatus and can serve as a ground reference for various other components, e.g., sub-systems, joints, or the like in a remotely steerable tool. The frame helps transmit certain DoF directly from the user input at the forearm and hand. For example, the two translational motions (numbered 2 and 3 in FIG. 5) driven by the user's forearm can be directly transmitted by the frame to a remote location.

[0123] The coupling joint serves as the interface between the frame and the cuff. This coupling joint may offer up to 3 rotational DoF and one axial translational DoF, and constrains the remaining translational motions. The ability to constrain the translational motions enables the transmission of these specific motions directly from the forearm to the frame by way of the cuff.

[0124] In general, the cuff is the interface between the connection mechanism and the user's forearm. The cuff is a semi-rigid body that provides a secure and comfortable fit to the user's forearm, and captures all the motions of the forearm. The cuff is tethered to the forearm such that it does not hinder the articulation occurring at the user's wrist joint while ensuring that the rotational axes of all the rotational DoF of the coupling joint pass through the user's wrist joint.

[0125] In contrast to the attachment mechanisms previously described (e.g., U.S. Pat. No. 8,668,702) the forearm attachments described herein, the forearm attachments described herein typically include a cuff assembly (coupling joint) configured to attach to the forearm and provide one or more degrees of freedom between the frame and the forearm, so that the only some of the possible motions (DoF) of the forearm are transmitted to the frame, and vice versa, as described herein.

[0126] For example, compare FIG. 16 (generically describing an attachment mechanism as described herein) with FIG. 1, above. In FIG. 1, the frame is securely and rigidly attached to the forearm by the fore-arm cuff. In contrast, in FIG. 16 the frame is connected to the forearm via a coupling joint. The coupling joint is a joint between a cuff (which is securely yet comfortably attached to the forearm) and the frame. The cuff in FIG. 16 is analogous to the forearm cuff/attachment member in FIG. 1. All other structure of the overall remote/minimal access tool and associated functionality and underlying rationale as explained in the prior patent and in the above background remains the same between FIG. 1 and FIG. 16.

[0127] Thus, in general, the apparatuses described herein includes a cuff and one or more coupling joint(s) 1601 that has one or more (e.g., between one and four) degrees of freedom, so that a cuff (or, when the cuff is attached to a user's forearm, the forearm connected to the cuff) may move in at least one degree of freedom relative to the frame. Specifically, in some variations, the coupling joint may include a gimbal, pivot, bearing (e.g., slider, rail, track), or any other movable element to allow the cuff (and/or forearm in the cuff) to move in one or more directions (e.g., axis) relative to the track. The coupling joint may prevent transmission of movement in one or more directions, and thereby transmit these movements. In some variations the coupling joint may include an elastic material allowing limited movement of the cuff (and/or forearm) relative to the frame. The examples provided below illustrate various embodiments of cuff apparatuses (that may have one or more degrees of freedom) that may be used with or incorporated into a minimal access tool.

[0128] In general, the cuff apparatuses described herein modify how the frame is attached to the forearm, and may overcome the limitations described above. For example, the coupling joints described herein can have up to two rotational degrees of freedom associated with articulation (pitch and yaw). The coupling joint may ensure that these two rotations coincide with the articulation of the user's wrist joint. In other words, the axes of rotation of these two articulating DoF may pass through the user's wrist joint. As shown below in FIG. 17 (in a side view), a pitch rotational DoF at the coupling joint 1601 may allow the frame to pitch rotate with respect to the forearm. This in turn allows the tool shaft axis 1703 (yellow) to be held at an angle with respect to the forearm axis 1709 (red). Thus, the user can orient the tool shaft in a direction required by the application (e.g. a surgical procedure) while keeping his forearm in a comfortable orientation.

[0129] In FIG. 18, in a top view, a yaw rotational DoF at the coupling joint allows the frame to yaw rotate with respect to the forearm. This in turn allows the tool shaft axis 1805 (yellow) to be held at an angle with respect to the forearm axis 1803 (red). Thus, the user can orient the tool shaft in a direction required by the application (e.g. a surgical procedure) while keeping his forearm in a comfortable orientation.

[0130] Furthermore, the coupling joint may additionally have a rotational DoF about an axis of the frame (or tool axis or device axis). Consider such a coupling joint in conjunction with a tool input joint (the virtual center, or VC, mechanism) that does not have a similar roll rotational DoF between the handle and the frame. In other words, the input joint transmits the roll rotational DoF from the handle to the frame. When such a device is interfaced with a user, i.e., the frame of the device is connected to the forearm via the coupling joint, and the user's hand holds or interfaces with the handle, then for any given orientation of the user's wrist (nominal or articulated) and position and orientation of the forearm (nominal or displaced), if the user twirls his fingers without producing any other motion, then this twirl is transmitted from the handle to the frame via the input joint. Since the frame has a roll DoF with respect to the cuff, which in turn is attached to the forearm, the frame exhibits a roll rotation about a frame axis with respect to the forearm.

[0131] This arrangement may provide for a significant amount of roll rotation (up to 360 degrees, i.e. a full rotation) about the tool axis. This roll rotation comes from two sources or has two components. First, since the cuff is attached to the forearm, any pronation and supination of the forearm produces roll rotation at the cuff. Even though the frame has a roll rotation DoF with respect to the cuff, the frame moves along with the cuff due to friction at the coupling joint. Second, as the user reaches the limit of his pronation/supination, he can continue to roll the frame about the tool axis via simply twirling his fingers. Now the frame rolls about the tool/device/frame axis with respect to the cuff.

[0132] During use, the user may choose to employ either one or both (in any preferred combination) components of roll to achieve the desired application objective (e.g. in a surgical procedure). Since both components of roll happen at the tool frame, these are directly transmitted and exhibited as roll rotation about a tool axis at the end-effector at the tool shaft distal end.

[0133] It is important to note that this desired enhanced roll functionality is produced via the specific combination of a roll DoF between the frame and the cuff and a roll constraint (i.e., the ability to transmit) between the handle and the frame.

[0134] Similarly, the coupling joint may additionally have a translational DoF along an axis of the frame (or tool axis or device axis). Consider such a coupling joint in conjunction with a tool input joint (the VC mechanism) that does not have a similar translational DoF between the handle and the frame. In other words, the input joint transmits the translational DoF along the tool axis from the handle to the frame. When such a device is interfaced with a user, i.e. the frame of the device is connected to the forearm via the coupling joint, and the user's hand holds or interfaces with the handle, then for any given orientation of the user's wrist (nominal or articulated) and position and orientation of the forearm (nominal or displaced), if the user pecks with his fingers without producing any other motion, then this pecking motion is transmitted from the handle to the frame via the input joint. Since the frame has a translational DoF with respect to the cuff, which in turn is attached to the forearm, the frame exhibits a translational motion along the frame axis with respect to the forearm.

[0135] This arrangement provides for an additional amount of axial translation along the tool axis. This axial translation comes from two sources or has two components. First, since the cuff is attached to the forearm, any in and out motion of the forearm (direction 1 in FIG. 5) produces axial translation at the cuff (since the cuff is secured to the forearm). Even though the frame has a translational DoF with respect to the cuff, the frame moves along with the cuff due to friction at the coupling joint. Second, in addition to moving his forearm in and out, the user can continue to axially translate the frame along the tool axis simply via pecking with his fingers while holding the handle. Now the frame axially translates along the tool/device/frame axis with respect to the cuff.

[0136] During use, the user may choose to employ either one or both (in any preferred combination) components of axial translation to achieve the desired application objective (e.g. in a surgical procedure). Since both components of axial translation happen at the tool frame, these are directly transmitted and exhibited as axial translation along a tool axis at the end-effector at the tool shaft distal end.

[0137] It is important to note that this desired enhanced axial translation functionality is produced via the specific combination of a translational DoF between the frame and the cuff and an axial translation constraint (i.e. the ability to transmit) between the handle and the frame.

[0138] It is necessary to observe that there is a distinct difference between the input joint (i.e., which may be a virtual center mechanism) and the coupling joint(s) of the forearm attachment assemblies described herein, although the two may be desirably used together. The axes of pitch and yaw rotations provided by the input joint are made to be coincident with the user's wrist joint via a virtual center mechanism. The axes of two rotations (pitch and yaw) enabled by the forearm attachment assembly i.e. the coupling joint may also be coincident with the user's wrist joint. This is illustrated, for example, in FIG. 56. In this example, the virtual center mechanism of the parallel kinematic apparatus shown is necessary to drive the output joint (i.e. the end-effector articulating in the pitch and yaw rotational directions with respect to the tool shaft) as the user hand rotates about the user wrist joint with respect to the user forearm to provide input articulation in the pitch and yaw directions. The input joint is a connection between the handle and the frame while the coupling joint is a connection between the cuff and the frame. Both joints share the frame as a common reference ground.

[0139] In this example, the parallel kinematic input joint has two degrees of freedom (pitch and yaw) an includes two independent paths for transmission of motion coupling the handle 5603 to the tool frame 5601, wherein the at least two independent paths 5605, 5605 comprise a first path and a second path. A first intermediate body may be present in the first path that is connected to the tool frame by a first connector and to the handle by a third connector; and a second intermediate body is in the second path that is connected to the frame by a second connector and to the handle by a fourth connector; wherein the first connector and the fourth connector both allow rotation in a first rotational direction and restrict rotation in a second rotational direction. Further wherein the second and third connectors allow rotation in the second rotational direction and restrict rotation in the first rotational direction.

[0140] In this example, because the VC mechanism allows for 2 DoF about two orthogonal axes input, the third axis of rotation (i.e. roll) is constrained and permitted to drive rotation of the end effector about the tool shaft axis. The rotation of the tool shaft is a direct result of the VC mechanism's ability to rotate the tool frame about the same axis. The coupling joint of the forearm apparatus enables this attribute by decoupling the forearm axis from the tool frame axis and allowing the hand to rotate the tool handle driving the tool shaft and frame about a known tool/frame axis. For this reason, the input joint and the coupling joint share the same common ground, i.e., the tool frame, and are separate entities albeit symbiotic when considering overall device function. Another critical design aspect related to the coupling joint is, not only the coincidence of the pitch and yaw axes of the input joint and the coupling joint with each other and with respect to the user's wrist joint, but also the concentricity of the axis of the roll DoF of coupling joint with respect to the frame/tool axis of the device. This specific feature is critical to enable consistent and predictable rotation about this axis so that the end effector can be manipulated as desired by the surgeon. When these axes are not concentric, but eccentric, one axis revolves about the other and results in an unpredictable lurching of the tool shaft and end effector.

[0141] Summarizing the two points above, in general, the device can have a coupling joint that provides any combination of these four DoF (two articulating rotational DoF (pitch and yaw) centered at the user's wrist joint, rotational roll DoF about a tool/device axis, an axial translational DoF along a device/tool axis). Any motions that are not provided as a DoF are constrained. For example, if all these four DoF are provided then the two translational DoF at the forearm (indicated by directions 2 and 3 in FIG. 5) are constrained and therefore transmitted from the forearm to the frame via the coupling joint. The overall rationale of a one to one mapping of the user's input motions to corresponding output motions at the device end-effector (tool output) is maintained and achieved more effectively.

[0142] Any DoF or motion that is provided at the wrist joint may be achieved via very well defined joints (e.g. pivots, pins, slides, slots, etc.) or may be provided simply via a lack of constraint using some soft/elastic attachment (e.g. bands, stretchy Velcro, etc.).

[0143] Various embodiments of the coupling joint are described below, with different combinations of DoFs shown and various ways of achieving these DoF.

Embodiment 1

[0144] FIG. 19 shows a three axis gimbal (3 DoF), and FIG. 20 shows a spherical roller bearing (3 DoF) that may be used with this variation.

[0145] The forearm attachment assembly as previously described comprises a frame, a connection mechanism, and a cuff. One embodiment that offers 3 DoF is shown above. The apparatus interfaces the frame at the instrument interface (10) and makes a secure rigid attachment to the frame. Within the apparatus, rotation of the forearm about the arm axis and rotation about the hand axis are enabled by the rotation axis (12). This is accomplished in one embodiment but not limited to a keyed track system where one surface slides across another with minimal resistance and is confined by the keying system, in this case a T-slot, to this one axis of rotation. Within the apparatus, the axes identified by (14) and (16) are analogous to the two axes of the wrist itself. These axes offer unhindered rotation during wrist flexion/extension (14) as well as wrist deviation (16). This is accomplished in one embodiment but not limited to concentric rings that are pinned along the axis for which they permit rotation. The innermost ring is identified as the cuff which serves as the semi-rigid interface between the user's forearm and the connection mechanism. The cuff is intended to be comfortable to wear and offer a secure fit for varying wrist sizes. Through a compression or tethering system, the cuff is intended to temporarily retain the user's forearm when the user desires to control the steerable device and transmit input through the connection mechanism and virtual center mechanism.

[0146] As it relates to minimal access tools, the apparatus with 3 DoF enables the user to be translationally constrained to the common ground at the ground reference established at the wrist joint and unconstrained in all degrees of rotation. This newly established ground reference at the wrist joint allows the user to apply forces to the tool handle and control movements of the end-effector independent of the frame. The ground reference of the wrist joint allows the user to leverage the handle against the ground held constant by the forearm when applying motion forces for input. The internal force feedback loop created between the handle, and forearm is advantageous for any of the minimal access tool devices because it reduces or eliminates forces that may have previously been transmitted from the frame to an external ground such as the trocar cannula and ultimately the patient. By reducing these forces the device may offer less trauma to the patient during particularly suture-intensive MIS procedures.

Embodiment 2

[0147] FIG. 21A shows a generic minimal access tool having a frame 2101 including an elongate tool shaft 2100 with a tool axis 2102. A cuff 2108 is formed as part of an inner gimbal 2106. The inner gimbal 2106 and an outer gimbal 2104 and a bearing (shown as a plain bearing configured as a slide 2112) are connected between the frame 2101 and the cuff 2106. In this example, the inner gimbal forms the seat of the cuff and is pivotably connected through a pair of pins to the outer gimbal. The outer gimbal is pivotably connected through a pair of pins to the bearing (slide 2112) and the bearing slides in a track formed by the frame to allow roll rotation. Alternatively a different type of bearing, such as the roll bearing of FIG. 20 may be used. Thus, the body (e.g., forearm) attachment in this example is configured for pitch, yaw and roll DoF, and is arranged so that the roll axis is the same as the tool axis. The tool axis (roll axis), pitch axis of rotation and the yaw axis of rotation all intersect at a point within the opening formed in the cuff to hold the user's wrist or forearm.

[0148] FIGS. 21B-21G generically illustrate degrees of freedom between a cuff 2156 and a frame 2151. There are six total degrees of freedom in this example, three translational, and three rotational. FIG. 21B shows axial translation 2180 between the cuff 2156 and the frame 2151. FIG. 21C shows horizontal translation 2182 between the cuff 2156 and the frame 2151. FIG. 21D shows axial translation 2184 between the cuff 2156 and the frame 2151. FIG. 21E shows a roll rotation 2186 between the cuff 2156 and the frame 2151. FIG. 21F shows a pitch roll rotation 2188 between the cuff 2156 and the frame 2151. FIG. 21G shows a yaw rotation 2190 between the cuff 2156 and the frame 2151.

Embodiment 3

[0149] The forearm attachment assembly shown in FIGS. 22 and 23 offers 2 DoF and is similar to the device previously described in Embodiment 2, however it does not enable the deviation rotation of the wrist (16). In this embodiment, a keyed track system is also present however it utilizes a ball-in-track system where the 2 DoF occur at the same instance as opposed to the stacking of concentric rings in the previous example. This loss of one DoF is not necessarily a detriment to the device but it does restrict some motion that the user may require. To limit one DoF does not mean that this axis, the deviation rotation, could be the only axis to be constrained. As it applies to the minimal access tool device described herein, the rotation typically occurring about the deviation axis is minimal, approximately 5-10 degrees. When this axis is constrained the device can be manipulated in space and fully supported by one hand. This is advantageous because surgeons may choose to introduce and remove the tool shaft from the trocar cannula without support (grounding) from their other hand. This is not as easily accomplished with the device previously described (3 DoF apparatus) as the tool frame can fall about this axis until it is grounded by a second point along the tool shaft either by the trocar cannula or the surgeon's opposite hand.

[0150] In this embodiment, the cuff is a semi-rigid body that comfortably and securely mounts to the wrist through a tethering system such as Velcro straps or wrist watchband style closure. The cuff maintains the location of the axes of rotation and the wrist center with respect to the forearm, wrist joint, and hand. The cuff enables the user to snap in to the ring or track system where the two balls, located at opposite ends of the axis as it runs through the wrist, act as pins to key the user's wrist to the track and also become the articulating surface of rotation. To disengage the cuff, the user simply overcomes the outward spring force of the semi-rigid cuff to snap out of the ring. The outward spring force of the cuff retains the cuff and the user's wrist in place provides the connection mechanism with the attributes previously described.

[0151] FIGS. 24A and 24B show a wrist cuff installed on the forearm using a Velcro strap. FIG. 25 illustrates the apparatus (including the cuff and coupling joint as described above), with the cuff separate from the frame (and attached ring). FIG. 26 shows the device prior to being interfaced (i.e. mounted/held) with the user. Finally, FIG. 27 shows the device with the cuff installed and interfaced with user. FIG. 28 shows how the coupling joint enables the tool axis to be at a different orientation compared to the forearm axis. FIG. 29 shows how the coupling joint enables the tool axis to be at a different orientation compared to the forearm axis. The coupling joint enables the tool axis to be at a different orientation compared to the forearm axis.

Embodiment 4

[0152] FIG. 30 shows a similar variation as embodiment 3, above, but with an additional axial translational DoF provided by the coupling joint as shown in FIG. 30. A linear guide, slot, or bearing (18, in the figure below) provides the axial translation DoF. In this variation the coupling joint 301 is a gimbal that allows rotation in a first axis 14 due to the pair of pins separated by 180 degrees (not visible in FIG. 30). These pins are also configured as bearings that may slide or roll within a track on the frame to provide roll rotation 12 of the hybrid coupling joint. A cuff (not shown) may be formed within the gimbal or it may be attached rigidly to it.

Embodiment 5

[0153] In the variation shown in FIGS. 31A and 31B, the forearm attachment assembly offers one DoF and is similar to the two devices previously described however it does not enable flexion/extension (14) or deviation (16) of the wrist. Limiting to 2 DoF does not mean that these are the only 2 axes to be constrained. This embodiment utilizes a keyed T-slot system where the inner ring slides across the outer ring and confines the rotation about one axis. This option restricts some motion that the user may require.

Embodiment 6

[0154] Another example of a forearm attachment assembly (e.g., forearm attachment assembly) is shown in FIGS. 54A-54B, which is configured to allow pitch and yaw rotational movement between a cuff (part of the inner gimbal 5401 in this example) and a frame 5405; a bearing may also be included (e.g., between the cuff and the inner gimbal 5407 or between the frame 5405 and the outer gimbal 5409). In this example, pitch and yaw rotations are enabled for the coupling joint due to the compliance of the connections, tabs 5411, 5413 between cuff and gimbal frame. Since these two rotations need not be continuous, compliant/flexure joints rather than pin joints may be used, as shown.

[0155] In FIG. 54B the translation in pitch 5422 and yaw 5421 are shown. This variation of a 2-axis (pitch and yaw) gimbal assembly includes compliant members complying to provide both pitch and yaw rotational degree of freedom. The compliant member between each of cuff/inner gimbal and outer gimbal, and outer gimbal and gimbal frame provide the axis of rotation and realize the design with minimal components. The integral cuff/inner gimbal 5401 and the outer gimbal 5409 are connected by a pair of compliant members 5411 (along the yaw axis between the inner and outer gimbal) providing yaw rotation. Similarly, pair of compliant members 5413 (along the pitch axis) between outer gimbal and gimbal frame provides pitch rotation. These compliant members may be made out of an elastic or plastic or rubbery material which can twist and comply in respective orientations. Based on different design of the compliant members, the pitch rotation axis may be formed by the compliant members between inner gimbal and outer gimbal and the yaw rotation axis may be formed by the compliant members between outer gimbal and gimbal frame.

[0156] FIGS. 32 and 33 illustrate variations of cuffs that may be considered a single point elastic tether. In this example, the attachment uses a silicone band and offers similar constraints as the single point elastic tether described above.

[0157] FIGS. 34 and 35 show another example of a single point tether. In this example, the attachment is a Velcro watchband style cuff which applies similar constraints as the single point tethers described above.

[0158] FIG. 36 illustrates how a single point tether based coupling joint may enable the tool axis to be at a different orientation compared to the forearm axis.

Embodiment 7

[0159] FIGS. 37-38 illustrate another variation. In this embodiment the frame is equipped with a ring that goes around the forearm but does not interface with the forearm via a cuff. This appears to have no joint or connection between the frame and forearm. However, the inside diameter of the ring touches and rides against the periphery of the forearm during use, and can provide the necessary transmission of upward/downward translation and side to side translation between the forearm and the frame. Similarly, the air gap and occasional contact between the forearm and frame allows for the frame to be roll rotated about a frame/device axis with respect to the forearm. The inside diameter of the ring may be padded with an appropriate material to make the interface (when it happens) with the forearm comfortable and minimize any friction during relative sliding between the frame ring and forearm.

Embodiment 8

[0160] Another variation may be similar to Embodiment 1 (FIGS. 19 and 20), above, where the three rotations are produced by a ball and socket joint instead of the three independent rotational joints shown in Embodiment 1. The coupling joint may simply be a ball and socket joint. The limitation of this design would be that it is tricky to get all three axes of rotations associated with the ball and socket joint to be centered at the wrist joint of the user.

Embodiment 9

[0161] FIG. 39 illustrates another design, in which the forearm attachment assembly can be relevant to other kinds of minimal access (surgical or other) devices. Consider the basic concept of FIG. 15 and all the associated attributes of the frame, cuff, and coupling joint. The frame can serve as a ground reference for purposes other than what is described for the articulating minimal access device of U.S. Pat. No. 8,668,702.

[0162] In FIG. 39, the apparatus includes a handle with a control, such as a switch, button or the like for operating an end effector. In this example, rather consider a device that does not have any articulation (pitch and yaw rotation) at the input joint and only has an open/close motion that has to be transmitted from the user's fingers/thumb to the tool end-effector open/close motion.

[0163] In this example, the tool may not include an input joint. Instead, the handle is equipped with a means to produce open/close motion e.g. scissor grip, or pressing a thumb lever, or pressing a finger lever etc. This closure action can be transmitted to the corresponding closure motion of the end-effector via a flexible cable conduit system that goes from the handle to some point on the tool frame or shaft, and then is routed through the frame and shaft to the end-effector. Refer again to FIG. 39.

[0164] In a typical non-articulating minimal access device (e.g. a laparoscopic surgical instrument), the tremors associated with the hand are amplified at the end-effector, producing a sub-optimal surgical outcome. In general, natural tremors are greater at the hands/fingers/thumb compared to the forearm. However, with the proposed arrangement, the tool frame is stabilized on the forearm via the forearm attachment assembly, while keep the hands/fingers/thumb free for any other independent action. This ensures lower tremors being transmitted to the end-effector at the distal end of the tool shaft. In this case, one possible independent action of the hands/fingers/thumb can be that of closing a lever at the handle via the thumb/fingers. The fact that the hands/fingers/thumb is connected to the frame via only a flexible cable conduit results in the fact that tremors associated with the hands/fingers/thumb are not transmitted to the frame and therefore the end-effector, for example, see FIGS. 40A-40B.

[0165] FIG. 40A shows a forearm and hand tremor transmission in a traditional laparoscopic instrument (the number of wiggles/little lines indicate a qualitative magnitude of tremors). FIG. 40B illustrates a forearm and hand tremor transmission in the proposed arrangement (number of wiggles/little lines indicate a qualitative magnitude of tremors). In addition to minimizing the transmission of hand tremors, this arrangement further helps isolate the user's hand movement from the frame, so they do not exert forces on the tool shaft or frame. Many steerable and non-steerable instruments have buttons, levers, triggers or other activation switches that are commonly located on the handle. The user will exert forces to grip the handle and/or activate these switches. In a typical instrument, these forces are transmitted to the entire tool body (shaft and end-effector) and influences the position and movements of the end-effector thereby compromising precision in surgery. The proposed arrangement helps overcome this challenge by isolating or decoupling the motions of the user's hand from that of the tool frame/shaft.

[0166] Even though the frame/tool axis and the forearm axis are shown aligned in the above figure, note that as described previously, the coupling joint can have two rotational DoF (pitch and yaw) that will allow the user to orient the frame/tool axis in a direction different from the forearm axis. In this case, since the roll rotation is not transmitted from the handle to the frame (given the absence of an input joint), twirling of fingers will not be transmitted to the frame and therefore to the end-effector.

Embodiment 10

[0167] FIG. 41 schematically illustrates an embodiment in which the forearm attachment assembly can be relevant to other kinds of minimal access (surgical or other) devices. For example, these devices may not include a tool axis, but may instead hold or support a tool having a tool axis. For example, the frame may include a mount to which a tool may be fit (e.g., a hole, opening, etc.) which may be secured within the mount. Consider the basic concept of FIG. 15 and all the associated attributes of the frame, cuff, and coupling joint. The frame can serve as a ground reference for purposes other than what is described for the articulating minimal access device of U.S. Pat. No. 8,668,702.

[0168] Rather consider a device that does not have any articulation (pitch and yaw rotation) at the input joint and only has an open/close motion that has to be transmitted from the user's fingers/thumb to the tool end-effector open/close motion. The tool has a shaft with an axis and a handle that is rigidly connected to the shaft.

[0169] The frame of FIG. 15 (which is connected to the fore-arm via the previously described coupling joint) now serves an extended ground support for the tool shaft to help stabilize the tool shaft. Between the frame and the tool shaft, there is an axial sliding joint. This axial sliding joint ensures that the tool axis and the frame axis are aligned with each other and that the tool can translate axially with respect to the frame. This arrangement is different from prior arrangements (e.g. FIG. 16) in the sense that the tool shaft is attached to the handle directly and not to the frame.

[0170] Additionally, the handle may be equipped with a means to produce open/close motion e.g. scissor grip, or pressing a thumb lever, or pressing a finger lever etc. This closure action can be transmitted to the corresponding closure motion of the end-effector via a transmission system that goes from the handle to the end-effector via the tool shaft. For example, refer to FIG. 41.

[0171] Even though the frame/tool axis and the forearm axis are shown aligned in FIG. 41, note that as described previously, the coupling joint can have two rotational DoF (pitch and yaw) that will allow the user to orient the frame/tool axis in a direction different from the forearm axis. In this case, since the tool shaft is directly connected to the handle, any twirling or pecking motion of the fingers/thumb are directly transmitted to the tool shaft and the end-effector at the distal end of the tool shaft. The coupling joint need not have any additional DoF beyond the pitch and roll rotations.

[0172] Referring to FIG. 42 and FIG. 43, another embodiment of the forearm attachment assembly, a variation of Embodiment 1, is shown. Much like the apparatus previously described, it provides 3 degrees of freedom (DoF) at the wrist cuff with respect to the common ground (i.e. tool frame). The apparatus can comprise an outer guide ring which is understood to be rigidly affixed to a tool frame. The outer guide ring is a rigid body with a raised inner track which acts as a bearing surface between subsequent rings. The raised track of the outer ring guides and constrains (keys) the subsequent ring which is the roll ring. The raised track of the outer ring further offers a low friction or lubricious bearing surface for uninhibited rotation about the axis defined by the outer ring (Axis 3 in FIG. 44). When this forearm attachment assembly is attached to the forearm of a user, as previously described, the outer ring axis is the same as the tool axis (as shown in FIG. 17) which is the same axis about which the user would drive roll rotation of the frame via pronation, supination, or any twisting occurring at the fingertips.

[0173] In one implementation of a bearing, the bearing is a roll ring (See FIG. 49). In this example there can be a slight outward compressive fit between an outer slot of sled on the roll ring and the raised inner track of the outer ring (as shown in FIG. 44). The interface between these two rings is such that only line on line contacts (See FIG. 48) are made where any DoF's are constrained with respect to each ring thus reducing frictional resistances between rings. It is understandable that these contacts might also be surface contacts or multiple point contacts such that frictional resistances are minimized between components. The roll ring (See FIG. 49 and FIG. 44) can comprise one or more primary members (also referred to as sleds) which ride opposite walls of the raised inner track on the outer guide ring. These members contain an outer slot which mates accordingly with the raised inner track of the outer guide ring. Each sled member may support a sled pin (FIG. 48, FIG. 50. FIG. 43) where any given pair of diametrically opposing sled pins define an axis (Axis 2) intersecting the rotational axis (Axis 3) defined by the roll ring rotation about the outer guide ring. As shown in FIG. 43, the roll ring can further comprise a secondary member made up of one or more continuous rings which connect the primary sled members. FIG. 44 shows only one such ring. The continuous ring or rings which support the sleds assist in constraining the sled members to equal rates of rotation about Axis 3 in the same direction (CW or CCW) and prevents any undesirable translation of Axis 2 such that it no longer intersects Axis 3 (See FIG. 50). When the sled members are not connected by a continuous ring there is a possible tendency to rotate and/or translate about Axis 3 at different rates which may cause binding between the outer ring and sled ring. The translation and unequal rate of rotation of the sleds is prevented by the continuous ring since the ring is radially constrained by the outer guide ring.

[0174] Axis 2, defined by the two pins supported within the roll ring (referred to as sled pins in FIG. 43), is the axis of rotation for the subsequent ring known as the deviation ring. In use, when the forearm attachment assembly is attached to a user forearm, Axis 2 will approximately coincide with the user's deviation axis at their wrist joint (shown in FIGS. 42 and 43). The deviation ring is a rigid body which is free to rotate about Axis 2 defined by the sled pins. Appropriate fits exist between the sled pins and the receiving holes within the deviation ring as well as between the sled pins and the roll ring, such that the deviation ring is free to rotate, with respect to the roll ring, about Axis 2 established by the sled pins. FIG. 44 demonstrates the locations within each of the rings that the sled pins are constrained and thereby establishing an axis of rotation (Axis 2). The deviation ring contains two slightly greater than semi-circular cutouts 5404 which define an axis orthogonal to the axis defined by the sled pins as shown in FIG. 45. The cutouts 5404 on the deviation ring demonstrate one method for quick installation and removal of the subsequent cuff from the deviation ring. The deviation ring can be manufactured from a variety of plastic materials. The slightly greater than semi-circular geometry 5404 and elastic properties of the variety of plastic materials enable a snap-fit mechanism between snap-fit pins of the cuff (referred to as Snap-Fit Pins in FIG. 45, 46) and the receiving holes on the deviation ring, which provides adequate retention with low frictional resistance to rotation. The snap-fit pin design of the cuff may include pressed pins or integrated cylindrical bodies which extend from the cuff to define Axis 1. After the snap-fit pins have snapped into the receiving features on the deviation ring, the interface serves as a rotational joint about Axis 1 (See FIGS. 44 and 46). Adequate retention of the corresponding pins within this mechanism is necessary as this forearm attachment assembly supports the overall weight of any device or instrument attached to the common ground/tool frame/outer ring and overcomes resistances between the tool frame/outer ring and wrist cuff attached to the user forearm. Each semi-circular cutout 5404 can be preceded by a V-shaped cutout which acts as a guide ramp for the corresponding snap-fit pins as the user aligns the pins and secures the subsequent cuff into the deviation ring. The retention structure described herein is only one example for retention. The retention structure includes but is not limited to a ball-in-track, spring-pin/thru hole, clasp style, snap-fit style, axially aligned pairs of magnets, or other arrangements of magnets, or any other structure which may offer only 1 rotational DoF and potentially 1 translational DoF along the axis of rotation while constraining all other DoF. The retention structure may take many other forms without deviating from the scope of the disclosure.

[0175] Axis 1 defined by the two snap-fit pins which snap into the deviation ring, is the axis of rotation for the subsequent ring known as the wrist cuff. In use, when the forearm attachment assembly is attached to a user forearm, Axis 1 will approximately coincide with the user's flexion/extension axis at their wrist joint (as shown in FIGS. 42 and 43). The wrist cuff is a rigid body which is free to rotate, with respect to the deviation ring, about Axis 1 defined by two pins protruding from opposite ends of its curvature when they are constrained to their corresponding cutouts on the deviation ring. The specific geometry of both the wrist cuff and the deviation ring allows the user to insert their hand through the deviation ring and install the wrist cuff into the retention mechanism thereby constraining the user's wrist to the intersection point of the 3 axes of the forearm attachment assembly. The intent of the wrist cuff is to interface with the user's wrist as comfortably and securely as possible. These requirements can be met by a woven strap which is adhered to the outer surface of the cuff and continues through two channels to the inside of the wrist cuff (See FIG. 46). The woven strap terminates at a specific length on each end that it may be secured without excess for any wrist size by a hook-and-loop (Velcro) closure mechanism by overlapping the male and female portion of the hook-and-loop respectively. The woven strap is wrapped about the user's forearm as previously defined, under slight tension to provide a secure fit. Secure fit for each user can be determined by selecting the appropriate sized strap which includes a padding. The padding includes but is not limited to three sizes, small, medium, and large based on anthropometric data which measured wrist widths and breadth. The padding not only acts as a cushion for the user's wrist, its primary function is to act as a shim and align various wrist sizes to the center of the cuff ultimately keeping the center axes of the users wrist, forearm, and hand coincident with the intersection of the wrist attachment apparatus' axes. The woven strap with hook-and-loop closure and the padding described herein is just one example for affixing the user's forearm to the cuff. There are many attachment options for affixing the user's forearm to the cuff including, but not being limited to, any combination of a woven strap, molded silicone band, metal link band or elastic strap with any clasp, prong, press-fit, or snap-fit type mechanism, ratcheting mechanism, etc. which may accommodate a variety of wrist sizes while providing adequate tethering to the wrist. See FIG. 46, showing a cuff including an integrated securement (snaps).

[0176] As mentioned above, the pins coupling the gimbals described above to the frame and/or to other coupling joints (e.g., other gimbals) may permit removal of the coupling joint(s) e.g., gimbals, from the tool, so that, for example, a user may put the cuff over the hand and onto the wrist or forearm, so that it can be attached thereto. Once attached, it can be inserted into to tool, for example, snapping into the frame or other coupling joint(s). FIGS. 53A-53D illustrate another example of coupling joint forming a cuff (e.g. a gimbal with integral cuff) that can be releasably attached/detached from a tool (e.g., from an outer gimbal). In this example, a rigid cuff is formed onto a C-shaped gimbal body with a pair of spring-loaded pins 5302, 5302 along the rotational axis. This gimbal with a cuff can be securely placed on the user's forearm. This can be followed by inserting the cuff (now seated on the forearm) along the forearm axis into a ramp feature 5306 on the outer gimbal such that both the spring loaded pins get pressed by running on the ramp feature. As the cuff translates further along the forearm axis, the pins that were compressed by the reaction force from the inner gimbal come back to their nominal position secures the cuff such that the axis passing through the center of both the pins (rotational axis on cuff) coincide with the axis passing through the center of both the slot/holes on the outer gimbal (rotational axis on inner gimbal) to form the common rotational axis between the cuff and outer gimbal. This provided proper securement of cuff with the outer gimbal and still maintains the rotational DOF about first rotational axis. To disengage cuff from outer gimbal, the user presses the pin by compressing the spring in it and then translating the cuff back along the same forearm axis.

[0177] Another alternative embodiment of an outer gimbal design might comprise a recessed inner track within which a roll ring is constrained to only one degree of rotation about the axis described above. Also referring to FIG. 44, we see a sequential arrangement of components from Outer Guide ring to the Wrist Cuff, which sequentially produces Axis 3, Axis 2, and Axis 1. However, one may envision a different sequence of components that will result in a different sequence of these three axes between Outer Ring and Wrist Cuff. For example the axis sequence could be Axis 3, Axis 1, Axis 2 or Axis 2, Axis 1, Axis 3, etc.

[0178] Now refer to FIG. 47, these figures show the forearm attachment assembly in conjunction with a surgical tool/instrument. In use, a surgeon will strap on the wrist cuff to his forearm. He will then insert his hand through the deviation ring (which is already assembled with the roll ring, which is already assembled with the outer ring), and will snap the snap-fit pins of the wrist cuff into the corresponding receiving features in the deviation ring. The outer ring is rigidly coupled/attached to the tool frame, which in turn is coupled/attached to the tool shaft. The surgeon's hand/palm holds the tool handle. Once the tool is interfaced with the user in this manner, the tool shaft axis can be oriented in any arbitrary direction with respect to the user's forearm axis (refer to FIGS. 17 and 18). Furthermore, as the surgeon holds the handle and rotates the handle about his forearm axis (1709 in FIG. 17) or hand axis (1707 in FIG. 17) using either a pronation/supination action of his forearm or twirl action of his fingers, this rotation is transmitted from the handle to tool frame/outer ring via the input joint (a VC mechanism in this case). This rotation of the tool frame about the tool axis is guided by the rotational sliding joint (about Axis 3) between the outer ring and roll ring. Thus, the tool axis and Axis 3 become coincident. The Axis 3 joint provided by the forearm attachment assembly allows a smooth, defined, and low-friction/resistance roll rotation of the entire tool frame about the user's hand and forearm. FIGS. 52A-52G further illustrate many variations of the forearm attachment assembly with a surgical tool/instrument, e.g., a surgical tool including an end effector, a serpentine output joint, and an input joint that is a parallel kinematic, 2 DOF input joint.

[0179] An additional aspect of this invention involves appropriate weight distribution of the overall tool and in particular the frame and outer ring, such that the center of gravity (CG) lies on or close to the tool axis (i.e. Axis 3). This ensures that as the surgeon rolls the entire tool about Axis 3 driving this roll by his hand, he feels as little resistance to roll due to gravity as possible. If indeed the CG was off-axis, then during certain stretches/portions of the roll, the surgeon would be trying to lift the weight of the overall tool against gravity, while during other stretches/portions the tool would fall under its own weight as it rolls. Also when the CG traverse in the vertical up condition, there would be an over the top falling feeling (which can be distracting to the surgeon). Therefore an important design goal and performance metric for the overall tool is that we design the overall tool such that the weight is balanced, i.e. CG is at or close to tool axis i.e. Axis 3 . . . . This may dictate the design/size/shape/geometry of the outer ring and tool frame.

[0180] Another aspect of device level functionality enabled by the forearm mount apparatus is that it helps to isolate the wrist articulation motion (two rotations) and twirling motion of a surgeon from the forearm motions (three translations, plus forearm pronation/supination i.e. roll rotation). The former corresponds to finer and more delicate motion, while the latter correspond to power moves. Such separation of fine/delicate motions and coarse/power motions are of great help to the surgeon while performing complex procedures.

[0181] In yet another application/use (different from FIG. 47) of the forearm attach apparatus embodiment of FIGS. 42 and 43, the three-axis gimbal type arrangement may be used by a user for controlling a remote end-effector in remote access tool e.g. a surgical tool (See FIG. 51)

[0182] The wrist cuff can be attached to the forearm of the user, and therefore the frame has 3 rotational DoF with respect to the wrist and forearm of the user. User may articulate and rotate his forearm with respect to the frame to generate the three rotations about their respective axes in the forearm attachment joint. Some or all three of these rotations/DoF (about Axis 1, Axis 2, and Axis 3) of the apparatus may be captured mechanically or electronically and transmitted to corresponding rotations/DoF at a remote end-effector. See FIG. 51.

[0183] Note that in this case, the forearm attachment joint serves as the input joint of the remote access tool and there is no additional input joint between a tool handle held in the hand and the tool frame (as was the case in FIG. 47). Also, note that this is an example of a serial kinematic (S-K) input joint.

[0184] However, the key unique functionality of this arrangement of S-K input joint is that it leaves the hand free to hold any other device, while all the rotations/DoF are generated by action of the forearm. Also, the forearm has lower tremors compared to the handle and is capable of generating higher driving forces.

[0185] Even though in all embodiments described here, the cuff is attached to the forearm and thus, the cuff, the coupling joint, and the frame may be borne by the forearm, other embodiments in which the cuff is attached at the hand (i.e. at a location distal with respect to the wrist joint) or attached at the wrist joint of the user may also be used.

[0186] When a feature or element is herein referred to as being on another feature or element, it can be directly on the other feature or element or intervening features and/or elements may also be present. In contrast, when a feature or element is referred to as being directly on another feature or element, there are no intervening features or elements present. It will also be understood that, when a feature or element is referred to as being connected, attached or coupled to another feature or element, it can be directly connected, attached or coupled to the other feature or element or intervening features or elements may be present. In contrast, when a feature or element is referred to as being directly connected, directly attached or directly coupled to another feature or element, there are no intervening features or elements present. Although described or shown with respect to one embodiment, the features and elements so described or shown can apply to other embodiments. It will also be appreciated by those of skill in the art that references to a structure or feature that is disposed adjacent another feature may have portions that overlap or underlie the adjacent feature.

[0187] Terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. For example, as used herein, the singular forms a, an and the are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms comprises and/or comprising, when used in this specification, specify the presence of stated features, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups thereof. As used herein, the term and/or includes any and all combinations of one or more of the associated listed items and may be abbreviated as /.

[0188] Spatially relative terms, such as under, below, lower, over, upper and the like, may be used herein for ease of description to describe one element or feature's relationship to another element(s) or feature(s) as illustrated in the figures. It will be understood that the spatially relative terms are intended to encompass different orientations of the device in use or operation in addition to the orientation depicted in the figures. For example, if a device in the figures is inverted, elements described as under or beneath other elements or features would then be oriented over the other elements or features. Thus, the exemplary term under can encompass both an orientation of over and under. The device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly. Similarly, the terms upwardly, downwardly, vertical, horizontal and the like are used herein for the purpose of explanation only unless specifically indicated otherwise.

[0189] Although the terms first and second may be used herein to describe various features/elements (including steps), these features/elements should not be limited by these terms, unless the context indicates otherwise. These terms may be used to distinguish one feature/element from another feature/element. Thus, a first feature/element discussed below could be termed a second feature/element, and similarly, a second feature/element discussed below could be termed a first feature/element without departing from the teachings of the present invention.

[0190] Throughout this specification and the claims which follow, unless the context requires otherwise, the word comprise, and variations such as comprises and comprising means various components can be co-jointly employed in the methods and articles (e.g., compositions and apparatuses including device and methods). For example, the term comprising will be understood to imply the inclusion of any stated elements or steps but not the exclusion of any other elements or steps.

[0191] As used herein in the specification and claims, including as used in the examples and unless otherwise expressly specified, all numbers may be read as if prefaced by the word about or approximately, even if the term does not expressly appear. The phrase about or approximately may be used when describing magnitude and/or position to indicate that the value and/or position described is within a reasonable expected range of values and/or positions. For example, a numeric value may have a value that is +/0.1% of the stated value (or range of values), +/1% of the stated value (or range of values), +/2% of the stated value (or range of values), +/5% of the stated value (or range of values), +/10% of the stated value (or range of values), etc. Any numerical range recited herein is intended to include all sub-ranges subsumed therein.

[0192] Although various illustrative embodiments are described above, any of a number of changes may be made to various embodiments without departing from the scope of the invention as described by the claims. For example, the order in which various described method steps are performed may often be changed in alternative embodiments, and in other alternative embodiments one or more method steps may be skipped altogether. Optional features of various device and system embodiments may be included in some embodiments and not in others. Therefore, the foregoing description is provided primarily for exemplary purposes and should not be interpreted to limit the scope of the invention as it is set forth in the claims.

[0193] The examples and illustrations included herein show, by way of illustration and not of limitation, specific embodiments in which the subject matter may be practiced. As mentioned, other embodiments may be utilized and derived there from, such that structural and logical substitutions and changes may be made without departing from the scope of this disclosure. Such embodiments of the inventive subject matter may be referred to herein individually or collectively by the term invention merely for convenience and without intending to voluntarily limit the scope of this application to any single invention or inventive concept, if more than one is, in fact, disclosed. Thus, although specific embodiments have been illustrated and described herein, any arrangement calculated to achieve the same purpose may be substituted for the specific embodiments shown. This disclosure is intended to cover any and all adaptations or variations of various embodiments. Combinations of the above embodiments, and other embodiments not specifically described herein, will be apparent to those of skill in the art upon reviewing the above description.