SURGICAL INSTRUMENT FOR BLUNT DISSECTION, DILATION OF INCISIONS, AND SEPARATION OF ADHESIONS

Abstract

Apparatus for blunt dissection, dilation of incisions, and separation of adhesions, the apparatus comprising: a frame; first and second belt supports mounted to the frame, the first and second belt supports being reconfigurable between a closed position and an open position; first and second continuous loop belts movably supported by the first and second belt supports, respectively, wherein the first and second continuous loop belts provide first and second outside surface face portions, respectively, and further wherein the first outside surface face portion is separated from the second outside surface face portion by a first distance when the first and second belt supports are in their closed position, and the first outside surface face portion is separated from the second outside surface face portion by a second, larger distance when the first and second belt supports are in their open position.

Claims

1. Apparatus for blunt dissection, dilation of incisions, and separation of adhesions, the apparatus comprising: a frame; first and second belt supports mounted to the frame, the first and second belt supports being reconfigurable between a closed position and an open position; first and second continuous loop belts movably supported by the first and second belt supports, respectively, wherein the first and second continuous loop belts provide first and second outside surface face portions, respectively, and further wherein the first outside surface face portion is separated from the second outside surface face portion by a first distance when the first and second belt supports are in their closed position, and the first outside surface face portion is separated from the second outside surface face portion by a second, larger distance when the first and second belt supports are in their open position.

2. Apparatus according to claim 1 wherein the first and second outside surface face portions extend approximately parallel to one another.

3. Apparatus according to claim 1 wherein the first and second continuous loop belts comprise first and second inside surfaces, respectively, and further wherein the first and second inside surfaces ride on the first and second belt supports, respectively.

4. Apparatus according to claim 1 wherein the first and second continuous loop belts comprise first and second outside surfaces, respectively, and further wherein the first and second outside surfaces comprise belt teeth.

5. Apparatus according to claim 1 wherein the apparatus further comprises means for moving the first and second continuous loop belts on the first and second belt supports, respectively.

6. Apparatus according to claim 5 wherein the first and second continuous loop belts comprise first and second inside surfaces, wherein the first and second inside surfaces comprise projections, wherein the apparatus further comprises a helical drive gear rotatably mounted to the frame, and further wherein the helical drive gear engages the projections of the first and second inside surfaces such that rotation of the helical drive gear causes the first and second continuous loop belts to move on the first and second belt supports, respectively.

7. Apparatus according to claim 6 wherein the apparatus further comprises a rotatable drive shaft for rotating the helical drive gear.

8. Apparatus according to claim 1 wherein the apparatus further comprises means for moving the first and second belt supports between their closed and open positions.

9. Apparatus according to claim 1 wherein the first and second belt supports each comprise four-bar linkages comprising a first link, a second link, a third link and a fourth link.

10. Apparatus according to claim 9 wherein the first link of each four-bar linkage is fixed to the frame, the second link of each four-bar linkage is pivotally mounted to the first link of each four-bar linkage, the third link of each four-bar linkage is pivotally mounted to the second link of each four-bar linkage, and the fourth link of each four-bar linkage is pivotally mounted to both the third link of each four-bar linkage and the first link of each four-bar linkage.

11. Apparatus according to claim 10 wherein, when the first and second continuous loop belts are movably supported by the first and second belt supports, the first and second outside surface face portions of the first and second continuous loop belts are disposed adjacent to the third link of a four-bar linkage.

12. Apparatus according to claim 10 wherein the second link of at least one of the four-bar linkages comprises an arcuate pin slot, wherein the apparatus further comprises a pulley mounted to the frame, wherein an eccentric pin is mounted to the pulley, and wherein the eccentric pin is disposed in the arcuate pin slot, such that rotation of the pulley causes the eccentric pin to move in the arcuate pin slot and move that second link, whereby to cause the four-bar linkage of that second link to move between its closed and open positions.

13. Apparatus according to claim 12 wherein the four-bar linkages of the first and second belt supports are connected to one another by first and second partial spur gears, such that movement of one four-bar linkage between its closed and open positions causes similar movement of the other four-bar linkage between its closed and open positions.

14. Apparatus according to claim 10 wherein the second links of the four-bar linkages each comprise an arcuate pin slot, wherein the apparatus further comprises two pulleys mounted to the frame, wherein an eccentric pin is mounted to each of the pulleys, and wherein the eccentric pins are each disposed in one of the arcuate pin slots, such that rotations of the pulleys causes their eccentric pins to move in their associated arcuate pin slots and move their associated second links, whereby to cause the four-bar linkages of the associated second links to move between their closed and open positions.

15. Apparatus according to claim 14 wherein the four-bar linkages of the first and second belt supports are connected to one another by first and second partial spur gears.

16. Apparatus according to claim 1 wherein the first and second belt supports are co-planar.

17. Apparatus according to claim 1 wherein the first and second belt supports form a convex distal end when they are in their open position.

18. Apparatus according to claim 1 wherein the first and second belt supports form a concave distal end when they are in their open position.

19. Apparatus according to claim 1 wherein the apparatus further comprises a third belt support mounted to the frame, and a third continuous loop belt movably supported by the third belt support.

20. Apparatus according to claim 19 wherein the first, second and third belt supports are not co-planar.

21. A method for separating tissue, the method comprising: providing apparatus comprising: a frame; first and second belt supports mounted to the frame, the first and second belt supports being reconfigurable between a closed position and an open position; first and second continuous loop belts movably supported by the first and second belt supports, respectively, wherein the first and second continuous loop belts provide first and second outside surface face portions, respectively, and further wherein the first outside surface face portion is separated from the second outside surface face portion by a first distance when the first and second belt supports are in their closed position, and the first outside surface face portion is separated from the second outside surface face portion by a second, larger distance when the first and second belt supports are in their open position; positioning the first and second belt supports in their closed position; positioning the apparatus between two portions of tissue; moving the first and second continuous loop belts on the first and second belt supports; and positioning the first and second belt supports in their open position.

22. A method according to claim 21 wherein the first and second outside surface face portions extend approximately parallel to one another.

23. A method according to claim 21 wherein the first and second continuous loop belts comprise first and second inside surfaces, respectively, and further wherein the first and second inside surfaces ride on the first and second belt supports, respectively.

24. A method according to claim 21 wherein the first and second continuous loop belts comprise first and second outside surfaces, respectively, and further wherein the first and second outside surfaces comprise belt teeth.

25. A method according to claim 21 wherein the apparatus further comprises means for moving the first and second continuous loop belts on the first and second belt supports, respectively.

26. A method according to claim 25 wherein the first and second continuous loop belts comprise first and second inside surfaces, wherein the first and second inside surfaces comprise projections, wherein the apparatus further comprises a helical drive gear rotatably mounted to the frame, and further wherein the helical drive gear engages the projections of the first and second inside surfaces such that rotation of the helical drive gear causes the first and second continuous loop belts to move on the first and second belt supports, respectively.

27. A method according to claim 26 wherein the apparatus further comprises a rotatable drive shaft for rotating the helical drive gear.

28. A method according to claim 21 wherein the apparatus further comprises means for moving the first and second belt supports between their closed and open positions.

29. A method according to claim 21 wherein the first and second belt supports each comprise four-bar linkages comprising a first link, a second link, a third link and a fourth link.

30. A method according to claim 29 wherein the first link of each four-bar linkage is fixed to the frame, the second link of each four-bar linkage is pivotally mounted to the first link of each four-bar linkage, the third link of each four-bar linkage is pivotally mounted to the second link of each four-bar linkage, and the fourth link of each four-bar linkage is pivotally mounted to both the third link of each four-bar linkage and the first link of each four-bar linkage.

31. A method according to claim 30 wherein, when the first and second continuous loop belts are movably supported by the first and second belt supports, the first and second outside surface face portions of the first and second continuous loop belts are disposed adjacent to the third link of a four-bar linkage.

32. A method according to claim 30 wherein the second link of at least one of the four-bar linkages comprises an arcuate pin slot, wherein the apparatus further comprises a pulley mounted to the frame, wherein an eccentric pin is mounted to the pulley, and wherein the eccentric pin is disposed in the arcuate pin slot, such that rotation of the pulley causes the eccentric pin to move in the arcuate pin slot and move that second link, whereby to cause the four-bar linkage of that second link to move between its closed and open positions.

33. A method according to claim 32 wherein the four-bar linkages of the first and second belt supports are connected to one another by first and second partial spur gears, such that movement of one four-bar linkage between its closed and open positions causes similar movement of the other four-bar linkage between its closed and open positions.

34. A method according to claim 30 wherein the second links of the four-bar linkages each comprise an arcuate pin slot, wherein the apparatus further comprises two pulleys mounted to the frame, wherein an eccentric pin is mounted to each of the pulleys, and wherein the eccentric pins are each disposed in one of the arcuate pin slots, such that rotations of the pulleys causes their eccentric pins to move in their associated arcuate pin slots and move their associated second links, whereby to cause the four-bar linkages of the associated second links to move between their closed and open positions.

35. A method according to claim 34 wherein the four-bar linkages of the first and second belt supports are connected to one another by first and second partial spur gears.

36. A method according to claim 21 wherein the first and second belt supports are co-planar.

37. A method according to claim 21 wherein the first and second belt supports form a convex distal end when they are in their open position.

38. A method according to claim 21 wherein the first and second belt supports form a concave distal end when they are in their open position.

39. A method according to claim 21 wherein the apparatus further comprises a third belt support mounted to the frame, and a third continuous loop belt movably supported by the third belt support.

40. A method according to claim 39 wherein the first, second and third belt supports are not co-planar.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0022] FIG. 1a shows a front view of a portion of the end effector of an embodiment of the present invention in the closed position, with the frame and pulley portions (see below) of the end effector removed for clarity of illustration.

[0023] FIG. 1b shows a front view of a portion of the end effector of an embodiment of the present invention in the open position, with the frame and pulley portions (see below) of the end effector removed for clarity of illustration.

[0024] FIG. 1c shows the end effector of FIG. 1a with the frame and pulley portions included in the view.

[0025] FIG. 1d is a side view of the end effector of FIG. 1c (with the frame and pulley portions included in the view).

[0026] FIG. 2a shows a front view of the end effector of an embodiment of the present invention in the closed position, with the view further including means for articulation as might be employed in a robotic surgical instrument.

[0027] FIG. 2b shows a side view of the end effector of an embodiment of the present invention in the closed position, with the view further including means for articulation as might be employed in a robotic surgical instrument.

[0028] FIG. 2c is a matrix showing the relative motions of the end effector shown in FIGS. 2a and 2b, depending on the relative motions of the pulleys (see below) of the end effector.

[0029] FIG. 3a shows an isometric view of the end effector of an embodiment of the present invention in the closed position, with the view further including means for articulation as might be employed in a robotic surgical instrument, and with the end effector being shown in an exemplary articulated position.

[0030] FIG. 3b shows the end effector of FIG. 3a being inserted into an opening in tissue while in its closed position.

[0031] FIG. 3c shows the end effector of FIGS. 3a and 3b after the end effector has been reconfigured into its open position, whereby to dilate the opening in tissue.

[0032] FIG. 4 shows a schematic view of an embodiment of the present invention, wherein the end effector presents a concave distal configuration.

[0033] FIG. 5 shows a schematic view of an embodiment of the present invention, wherein the end effector provides a convex distal configuration.

[0034] FIG. 6 shows a schematic view of an embodiment of the present invention, wherein the end effector comprises portions extending in multiple planes.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0035] FIG. 1a shows a portion of an end effector 1 of an embodiment of the present invention in a closed position. End effector 1 extends along a longitudinal axis X. In this embodiment, a first toothed belt 2 (comprising a continuous loop belt comprising an inside surface 2a and an outside surface 2b) and a second toothed belt 3 (comprising a continuous loop belt comprising an inside surface 3a and an outside surface 3b) engage a helical drive gear 4 driven by a rotatable drive shaft 5, e.g., protrusions 2c formed on inside surface 2a of first toothed belt 2, and protrusions 3c formed on inside surface 3a of second toothed belt 3, are engaged by the threads of helical drive gear 4, such that upon rotation of helical drive gear 4 by rotatable drive shaft 5, first toothed belt 2 and second toothed belt 3 will rotate. In embodiments where the end effector is articulating (described in detail below), shaft 5 is preferably a flexible torsion drive shaft.

[0036] In this embodiment, we can see that a first outside surface face portion 6 of first toothed belt 2 and a second outside surface face portion 7 of second toothed belt 3 are disposed approximately parallel to one another (and approximately parallel to longitudinal axis X). First toothed belt 2 and second toothed belt 3 have striated or textured surfaces (“belt teeth” 2d formed on outside surface 2b of first toothed belt 2 and “belt teeth” 3d formed on outside surface 3b of second toothed belt 3), are made of a compliant material (e.g., fiber-reinforced urethane or other belt material) and move in complementary continuous pathways in response to input from helical drive gear 4.

[0037] FIG. 1b shows the same portion of end effector 1 in an open position. In this view we can see first and second opposing four-bar linkages 8 and 9, respectively. Each of the first and second four-bar linkages comprises pivoting bar linkages L1-L4, and comprise rolling surfaces (not shown in FIG. 1b) concentric with the corner joints of the links over which the first and second toothed belts 2, 3 roll when driven by rotation of helical drive gear 4. As can be seen in FIG. 1b, the second link L2 of each four-bar linkage is pivotally mounted to the first link L1 of each four-bar linkage, the third link L3 of each four-bar linkage is pivotally mounted to the second link L2 of each four-bar linkage, and the fourth link L4 of each four-bar linkage is pivotally mounted to both the third link L3 of each four-bar linkage and the first link L1 of each four-bar linkage. In this embodiment the first and second opposing four-bar linkages 8, 9 are connected by first and second partial spur gears 10, 11 that assure equal and opposite reciprocal motion of the opposing four-bar linkages 8, 9 when driven by actuating means (see below) engaging first and second pin slots 12, 13 attached to first and second opposing four-bar linkages 8, 9, respectively. In this embodiment we can see that the spreading motion of first and second outside surface face portions 6, 7 of first and second opposing four-bar linkages 8, 9, respectively, approximately parallel to one another, and comprising striated or textured, compliant, and moving outside surfaces, would be useful in spreading and controlling tissues without slippage and with minimal trauma.

[0038] In other embodiments the first and second opposing four-bar linkages 8, 9, first and second toothed belts 2, 3, and/or helical drive gear 4 may be replaced by other means known to the art that impart the same or substantially equivalent properties to the first and second outside surface face portions 6, 7.

[0039] FIG. 1c shows a frame 14 which ties the pivot points of link L4 of four-bar linkage 8, link L4 of four-bar linkage 9, and helical drive gear 4 to a common frame of reference. It will be appreciated that the first link L1 of each four-bar linkage is fixed to the frame 14, the second link L2 of each four-bar linkage is pivotally mounted to the first link L1 of each four-bar linkage, the third link L3 of each four-bar linkage is pivotally mounted to the second link L2 of each four-bar linkage, and the fourth link L4 of each four-bar linkage is pivotally mounted to both the third link L3 of each four-bar linkage and the first link L1 of each four-bar linkage. In an embodiment the actuating means for causing reciprocal motion of first and second opposing four-bar linkages 8, 9 comprises a pulley 15 having an eccentric pin 17 for engaging first pin slot 12 of link L1 of four-bar linkage 8. More particularly, pulley 15 is driven by a belt or cable (not shown) so as to rotate about an axis Y fixed within the reference of frame 14, with eccentric pin 17 (shown in phantom in FIG. 1c) engaged in first pin slot 12 which is part of link L1 of first four-bar linkage 8. In an embodiment where frame 14 is fixed in space (such as to the shaft of a larger surgical instrument), rotation of pulley 15 causes reciprocal motion of four-bar linkage 8 relative to frame 14 and, by virtue of the engagement of partial spur gears 10 and 11, also causes reciprocal motion of four-bar linkage 9 relative to frame 14.

[0040] In another embodiment a second pulley 18 (FIG. 1d) is provided. Second pulley 18 also rotates about axis Y and has an eccentric pin 19 engaging pin slot 13 which is part of link L1 of second four-bar linkage 9. In a version of this embodiment, frame 14 is fixed in space (such as to the shaft of a larger surgical instrument) and partial spur gears 10 and 11 are omitted. In this embodiment four-bar linkages 8 and 9 can move independently based on independent inputs from pulleys 15 and 18. In another (and preferred) version of this embodiment, partial spur gears 10 and 11 are provided and frame 14 is free to rotate about axis Y (which is fixed to a larger instrument, not shown in FIG. 1d).

[0041] FIG. 2a shows a front view of the end effector 1 of an embodiment of the present invention as it might be disposed as part of an articulated instrument for robotic surgery with four degree of freedom movement, i.e., roll, pitch, yaw-1 and yaw-2. An elongated instrument shaft 20 rolls about axis R while the end effector pitches about axis P. FIG. 2b shows the side view of the same embodiment. The end effector moves in the yaw plane about axis Y. In an embodiment, roll, pitch and yaw movement are controlled by cables (not shown) interfacing with a surgical robot and which are in turn controlled by the inputs of a surgeon sitting at a robotic control center. The yaw axis includes first pulley 15 and second pulley 18 independently operated by the surgeon at the controller. First pulley 15 includes first eccentric pin 17 that engages first pin slot 12 connected to first four-bar linkage 8. Second pulley 18 includes off-center pin 19 (second pulley 18 and off-center pin 19 are on the opposite side of the view of FIG. 2a, and hence are not shown in FIG. 2a) that engages second pin slot 13 connected to second four-bar linkage 9. In this embodiment, first and second four-bar linkages 8, 9 are reciprocally connected by first and second partial spur gears 10, 11, assuring their motion is equal and opposite. In this way, when first and second pulleys 15, 18 rotate in the same direction (typically in response to finger movements by the surgeon at the robotic control station) the entire end effector rotates in the yaw plane. Contrary rotation of first and second pulleys 15, 18 will cause first and second outside surface face portions 6 and 7 to move apart or together.

[0042] FIG. 2c shows a table with the gross relationship of relative pulley movements from the vantage point of FIG. 2a. It should be understood that an infinite range of compound movements of the end effector, yawing, opening and closing, can be achieved by modulating rotational movements and speeds of the first and second pulleys 15, 18 as imparted by the surgeon's input.

[0043] FIG. 3a shows an example of the end effector 1 moved in the pitch and yaw direction. In this embodiment, drive shaft 5 (not shown in FIG. 3a) is flexible and bends with articulations about the P and Y axes while still retaining the ability to drive helical gear 4.

[0044] FIG. 3b shows end effector 1 advanced into a small opening 30 in a portion of tissue 31 where a surgeon requires a larger opening for surgical access. Retrograde motion of the striated or textured surfaces (belt teeth 2d, 3d) on first and second outside surface face portions 6 and 7 of toothed belts 2 and 3 help to atraumatically guide the end effector into tight, small opening 30, separating tissue in the opening as the instrument advances.

[0045] FIG. 3c shows the opening 30 in tissue portion 31 further enlarged by the separation of first and second outside surface face portions 6 and 7. As first and second outside surface face portions 6 and 7 are approximately parallel and equipped with striated or textured surfaces (belt teeth 2d, 3d), the tissue is less likely to slide off the surfaces of the spreading instrument, giving the surgeon enhanced control of the tissue in blunt dissection, dilation of incisions and separation of adhesions.

[0046] FIG. 4 shows a schematic representation of the belt and helical gear arrangement in the embodiments described above wherein the distal end (“up” as shown on the page) opens in a concave “V” configuration. Note that in this construction, the two opposing belts 2, 3 are disposed in a single plane.

[0047] FIG. 5 shows a schematic representation of another embodiment where the distal end of the instrument opens in a pointed wedge-shaped configuration (i.e., a convex “V” configuration). In this configuration the tip of the wedge shape could be introduced into an anatomical opening and the moving belt action would drive the wedge shape into the opening gently, forcing the opening to spread or dilate. Again, note that in this construction, the two opposing belts 2, 3 are disposed in a single plane.

[0048] FIG. 6 shows still another embodiment where greater than two (in this case 3) outside surfaces spread in parallel for greater effect. In other words, with the construction of FIG. 6, three or more four-bar linkages, collectively providing three or more approximately parallel outer surfaces, are provided, whereby to provide greater effect. In one form of the invention, the three or more four-bar linkages are evenly distributed about the longitudinal axis of end effector 1 (i.e., where three four-bar linkages are provided, the three four-bar linkages are set 120 degrees apart, where four four-bar linkages are provided, the four four-bar linkages are set 90 degrees apart, etc.). In another form of the invention, the plurality of four-bar linkages are not evenly distributed about the longitudinal axis of end effector 1, e.g., the plurality of four-bar linkages do not have a symmetrical disposition about the longitudinal axis of the end effector. In the preceding description and accompanying figures, first pin slot 12 and second pin slot 13 are described as being arcuate. However, if desired, one or both of first pin slot 12 and second pin slot 13 could be formed as a straight, angled slot (i.e., a straight slot angled relative to the axis of link L1).

[0049] In the preceding description and accompanying figures, first outside surface face portion 6 and second outside surface face portion 7 are described as extending substantially parallel to one another (and parallel to the longitudinal axis X of end effector 1). However, it should be appreciated that, if desired, first outside surface face portion 6 and second outside surface face portion 7 may not extend substantially parallel to one another. By way of example but not limitation, first outside surface face portion 6 and second outside surface face portion 7 may incline toward one another (and toward the longitudinal axis X of end effector 1) as first outside surface face portion 6 and second outside surface face portion 7 extend in the distal direction. By way of further example but not limitation, one of first outside surface face portion 6 and second outside surface face portion 7 may incline toward the longitudinal axis X of end effector 1 and the other of the first outside surface face portion 6 and second outside surface face portion 7 may extend approximately parallel to the longitudinal axis X of end effector 1.

MODIFICATIONS OF THE PREFERRED EMBODIMENTS

[0050] It should be understood that many additional changes in the details, materials, steps and arrangements of parts, which have been herein described and illustrated in order to explain the nature of the present invention, may be made by those skilled in the art while still remaining within the principles and scope of the invention.