US20120303006A1 - Surgical instrument - Google Patents
Surgical instrument Download PDFInfo
- Publication number
- US20120303006A1 US20120303006A1 US13/570,317 US201213570317A US2012303006A1 US 20120303006 A1 US20120303006 A1 US 20120303006A1 US 201213570317 A US201213570317 A US 201213570317A US 2012303006 A1 US2012303006 A1 US 2012303006A1
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- Prior art keywords
- instrument
- distal
- proximal
- handle
- cable
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B50/00—Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
- A61B50/30—Containers specially adapted for packaging, protecting, dispensing, collecting or disposing of surgical or diagnostic appliances or instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
- A61B2017/2919—Handles transmission of forces to actuating rod or piston details of linkages or pivot points
- A61B2017/292—Handles transmission of forces to actuating rod or piston details of linkages or pivot points connection of actuating rod to handle, e.g. ball end in recess
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
- A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
Definitions
- the present invention relates in general to medical instruments, and more particularly to manually-operated surgical instruments that are intended for use in minimally invasive surgery or other forms of surgical or medical procedures or techniques.
- the instrument described herein is primarily for a laparoscopic procedure, however, it is to be understood that the instrument of the present invention can be used for a wide variety of other procedures, including intraluminal procedures.
- Endoscopic and laparoscopic instruments currently available in the market are extremely difficult to learn to operate and use, mainly due to a lack of dexterity in their use.
- the orientation of the tool of the instrument is solely dictated by the location of the target and the incision.
- These instruments generally function with a fulcrum effect using the patients own incision area as the fulcrum.
- common tasks such as suturing, knotting and fine dissection have become challenging to master.
- Various laparoscopic instruments have been developed over the years to overcome this deficiency, usually by providing an extra articulation often controlled by a separately disposed control member for added control.
- an object of the present invention is to provide an improved laparoscopic or endoscopic instrument in which a portion of the instrument is re-useable and a portion is disposable.
- the handle end of the instrument is re-useable and the distal portion or tip of the instrument is disposable.
- a further object of the present invention is to provide an improved laparoscopic or endoscopic surgical instrument that allows the surgeon to manipulate the tool end of the surgical instrument with greater dexterity.
- Another object of the present invention is to provide an improved surgical or medical instrument that has a wide variety of applications, through incisions, through natural body orifices or intraluminally.
- Another object of the present invention is to provide a locking feature that is an important adjunct to the other controls of the instrument enabling the surgeon to lock the instrument once in the desired position. This makes it easier for the surgeon to thereafter perform surgical procedures without having to, at the same time, hold the instrument in a particular bent configuration.
- Still another object of the present invention is to provide an improved medical instrument that can be effectively controlled with a single hand of the user.
- Still another object of the present invention is to provide an improved medical instrument that is characterized by the ability to lock the position of the instrument in a pre-selected position while enabling rotation of the tip of the instrument while locked.
- a surgical instrument comprising: an instrument shaft having proximal and distal ends; a tool disposed from the distal end of the instrument shaft; a control handle coupled from the proximal end of the instrument shaft; a distal motion member for coupling the distal end of the instrument shaft to the distal tool; a proximal motion member for coupling the proximal end of the instrument shaft to the handle; actuation means extending between the distal and proximal motion members for coupling motion of the proximal motion member to the distal motion member for controlling the positioning of the tool; and an actuation cable extending from the handle to the tool for controlling the actuation of the tool.
- the actuation cable is separated into two inter-engagable cable segments that enable the proximal motion member to be disconnected from the control handle.
- the surgical instrument may further include a rotation means disposed adjacent the control handle and rotatable relative to the control handle for causing a corresponding rotation of the instrument shaft and tool; at least the proximal motion member may comprise a proximal bendable member, the rotation means may comprise a rotation knob that is adapted to rotate the tool about a distal tool roll axis and the rotation knob may be disposed between the control handle and proximal bendable member; an actuation lever may be supported from the handle at a pivot point on the handle and for controlling the actuation cable; a slider may be provided for capturing the proximal end of said tool actuation cable and an actuation lever supported at the handle for controlling the translation of the slider and, in turn, the operation of the tool; a locking mechanism may be provided for fixing the position of the tool at a selected position and having locked and unlocked states, the locking mechanism including a ball and socket arrangement disposed about the proximal motion member and a cinch member for locking the
- a medical instrument having a proximal control handle and a distal tool that are intercoupled by an elongated instrument shaft that is meant to pass internally of an anatomic body, proximal and distal movable members that respectively intercouple the proximal control handle and the distal tool with the instrument shaft, cable control means disposed between the movable members, an actuation member at the handle for controlling the distal tool through the movable members, and a coupler for selectively engaging or disengaging separable cable segments of the actuation member.
- the coupler may include a collet attached to one of the cable segments and a capture lug on the other of the cable segments, the collet for retaining the capture lug to engage the cable segments; a pivot member may be provided on the handle including at least one link that is operable to control a cam that sets open and closed positions of the collet; the pivot member may be in the form of a horn at the top of the handle to assist in a comfort grip of the handle; and collet may include a quick disconnect mechanism having a base in which the collet is positioned and a spring that biases the base to a closed position of the collet.
- a method of controlling a medical instrument that has a proximal end including a control handle and a distal end including a distal tool, with the control handle and distal tool being intercoupled by an elongated instrument shaft and the tool actuated from a tool control cable.
- the method includes providing proximal and distal movable members that respectively intercouple the proximal control handle and the distal tool with the instrument shaft, the proximal and distal movable members being intercoupled so that a motion at the proximal movable member controls the distal movable member, dividing the tool control cable into separate cable segments and interlocking the separate cable segments so that the tool control cable is operable.
- a further step may include manually controlling, from the proximal end of the instrument, the rotation of the distal tool about its longitudinal distal tool axis.
- an instrument having a proximal control handle and a distal tool that are intercoupled by an elongated instrument shaft, proximal and distal movable members that respectively intercouple the proximal control handle and the distal tool with the instrument shaft, means disposed between the movable members so that a motion at the proximal movable member controls the distal movable member and, in turn, the distal tool, means supported at the handle for controlling the distal tool including a tool control cable that extends between the handle and distal tool, the tool control cable including separate control cable segments that are adapted to have one of an engaged state and a dis-engaged state.
- a control member at the control handle and manipulable by a user to control, via the proximal and distal movable members, the rotation of the distal tool about its distal tool axis; the proximal motion member can be disconnected from the control handle when the control cable segments are in their dis-engaged state; including a coupler for selectively engaging or disengaging the separable cable segments; wherein the coupler may include a collet attached to one of the cable segments and a capture lug on the other of the cable segments, the collet for retaining the capture lug to engage the cable segments; and wherein the collet may include a quick disconnect mechanism having a base in which the collet is positioned and a spring that biases the base to a closed position of the collet.
- FIG. 1 is a perspective view of a first embodiment of a surgical instrument constructed in accordance with the present invention with a disposable shaft portion and a reusable handle portion;
- FIG. 2 is a fragmentary exploded perspective view of the instrument and shaft of FIG. 1 ;
- FIG. 3 is a partial cross-sectional side view of the instrument as taken along line 3 - 3 of FIG. 1 and with the instrument in an engaged or locked position;
- FIG. 4 is a cross-sectional end view of the instrument taken along line 4 - 4 of FIG. 3 showing a locked and a first released position of the cinch ring;
- FIGS. 4A and 4B are further perspective views of respective positions of the release/lock lever
- FIG. 5 is a cross-sectional view like that shown in FIG. 3 but with the instrument shaft portion being released from the handle portion and with the handle moved upwardly;
- FIG. 6 is a cross-sectional view like that shown in FIG. 5 but with the instrument shaft portion being removed from the handle portion;
- FIG. 7 is a fragmentary cross-sectional end view of the instrument taken along line 7 - 7 of FIG. 6 showing a rotated and a second released position of the cinch ring and the shaft ball being removed;
- FIG. 8 is a cross-sectional view similar to that shown in FIG. 6 but with the instrument shaft portion being fully removed from the handle portion;
- FIG. 9 is a fragmentary exploded perspective detail view of the instrument on a somewhat enlarged scale.
- FIG. 10 is an exploded perspective view of one embodiment of a coupling means for the end effector actuation cable
- FIG. 11 is a cross-sectional end view of an actuation means for operating the coupling means of FIG. 10 taken along line 11 - 11 of FIG. 8 ;
- FIG. 12 is a cross-sectional end view of a means to lock the instrument shaft portion to the handle portion taken along line 12 - 12 of FIG. 8 ;
- FIG. 13 is a cross-sectional plan view of the instrument shaft locking means and the cable coupling means engaged as taken along line 13 - 13 of FIG. 3 but showing the end effector cable being pulled as in use;
- FIG. 14 is a cross-sectional plan view of the instrument shaft locking means and the cable coupling means in a released position as seen along line 14 - 14 of FIG. 8 ;
- FIG. 15 is a fragmentary exploded perspective view of a second embodiment of a means to attach the instrument shaft to the handle portion;
- FIG. 16 is an exploded cross-sectional side view of the attachment means of FIG. 15 ;
- FIG. 17 is a cross-sectional side view of the embodiment illustrated in FIGS. 15 and 16 and showing the instrument shaft attached to the handle portion;
- FIG. 18 is a fragmentary exploded perspective view of a third embodiment of a means for attaching the instrument shaft to the handle portion;
- FIG. 19 is an exploded cross-sectional side view of the attachment means of FIG. 18 ;
- FIG. 20 is a cross-sectional side view of the embodiment illustrated in FIGS. 18 and 19 and showing the instrument shaft attached to the handle portion;
- FIG. 21 is a fragmentary cross-sectional view of a means to detach the cinch ring as taken along line 21 - 21 of FIG. 18 ;
- FIG. 22 is a cross-sectional view similar to that illustrated in FIG. 21 and showing the cinch ring partially detached;
- FIG. 23 is a fragmentary exploded perspective view of a fourth embodiment of a means to attach the instrument shaft to the handle portion;
- FIG. 24 is a fragmentary exploded side view of an indexing means to match the proper instrument shaft and end effector with the correct handle configuration
- FIG. 25 is an end view of the proximal end of the instrument shaft as taken along line 25 - 25 of FIG. 24 ;
- FIG. 26 is an end view of the distal end of the rotation knob and shaft receiver as taken along line 26 - 26 ;
- FIG. 27 is a schematic end view of a first alternate embodiment of an indexing means
- FIG. 28 is a schematic end view of a second alternate embodiment of an indexing means
- FIG. 29 is a fragmentary cross-sectional side view of an alternate embodiment of a cable coupling means
- FIG. 30 is a cross-sectional view similar to that illustrated in FIG. 29 but showing the end effector cable being pulled as in use;
- FIG. 31 is an exploded perspective view of the cable coupling means of FIG. 29 ;
- FIG. 32 is a cross-sectional view similar to that illustrated in FIG. 19 but showing the cable coupling means being released;
- FIG. 33 is an exploded cross-sectional view of the embodiment of FIG. 32 and showing the instrument shaft portion removed from the handle portion;
- FIG. 34 is a cross-sectional side view of a further alternate embodiment of a cable coupling means
- FIG. 35 is a cross-sectional view similar to that illustrated in FIG. 34 but showing the end effector cable being pulled as in use;
- FIG. 36 is an exploded perspective view of the cable coupling means of FIG. 34 ;
- FIG. 37 is a cross-sectional view similar to that illustrated in FIG. 34 but showing the cable coupling means being released.
- FIG. 38 is an exploded perspective view of the embodiment of FIG. 37 and showing the instrument shaft portion removed from the handle portion.
- the present invention is illustrated in the drawings as a surgical instrument that has two portions such that a detachable instrument shaft portion may be disposable and a re-usable handle portion may be sterilized and reused numerous times. This allows for a higher quality instrument handle portion while keeping the overall price of the instrument reasonable.
- the instrument of the present invention may be used to perform minimally invasive procedures.
- “Minimally invasive procedure,” refers herein to a surgical procedure in which a surgeon operates through a small cut or incision, the small incision being used to access the operative site.
- the incision length ranges from 1 mm to 20 mm in diameter, preferably from 5 mm to 10 mm in diameter. This procedure contrasts those procedures requiring a large cut to access the operative site.
- the flexible instrument is preferably used for insertion through such small incisions and/or through a natural body lumen or cavity, so as to locate the instrument at an internal target site for a particular surgical or medical procedure.
- the introduction of the surgical instrument into the anatomy may also be by percutaneous or surgical access to a lumen, vessel or cavity, or by introduction through a natural orifice in the anatomy.
- the instrument of the present invention may be used in a variety of other medical or surgical procedures including, but not limited to, colonoscopic, upper GI, arthroscopic, sinus, thorasic, prostate, transvaginal, orthopedic and cardiac procedures.
- the instrument shaft may be rigid, semi-rigid or flexible.
- surgical instrument Although reference is made herein to a “surgical instrument,” it is contemplated that the principles of this invention also apply to other medical instruments, not necessarily for surgery, and including, but not limited to, such other implements as catheters, as well as diagnostic and therapeutic instruments and implements.
- a locking mechanism that is constructed using a ball and socket arrangement disposed about the proximal motion member that follows the bending action and in which an annular cinch ring is used to retain the ball and socket arrangement in a fixed particular position, and thus also maintain the proximal and distal bendable members in a particular bent condition, or in other words locked in that position.
- the cinch ring includes a locking lever that is conveniently located adjacent to the instrument handle and that is easily manipulated to lock and unlock the cinch ring and, in turn, the position of the end effector.
- the cinch ring is also preferably rotatable to that the locking lever can be positioned conveniently or can be switched (rotated) between left and right handed users.
- This lock control allows the surgeon one less degree of freedom to concentrate on when performing certain tasks. By locking the bendable sections at a particular position, this enables the surgeon to be more hands-free for controlling other degrees of freedom of the instrument such as manipulation of the rotation knob to, in turn, control the orientation of the end effector.
- a main feature of the present invention relates to the ability of the instrument to be partially disposable and partially re-useable. In that way the instrument cost can be substantially reduced as it is not necessary to replace the entire instrument for each procedure.
- a disconnect means is provided at the handle where the distal motion member, tool, instrument shaft and proximal motion member are separable from the handle of the instrument. This enables the distal components to be engageable and dis-engageable from the handle.
- the handle portion of the instrument is re-useable and thus the cost of that part of the instrument is essentially spread over several instrument uses.
- FIG. 1 is a perspective view of one embodiment of the surgical instrument 10 of the present invention.
- both the tool and handle motion members or bendable members are capable of bending in any direction. They are interconnected via cables (preferably four cables) in such a way that a bending action at the proximal member provides a related bending at the distal member.
- the proximal bending is controlled by a motion or deflection of the control handle by a user of the instrument.
- the surgeon grasps the handle and once the instrument is in position any motion (deflection) at the handle immediately controls the proximal bendable member which, in turn, via cabling controls a corresponding bending or deflection at the distal bendable member. This action, in turn, controls the positioning of the distal tool.
- the proximal bendable member is preferably generally larger than the distal bendable member so as to provide enhanced ergonomic control.
- the ratio of proximal to distal bendable member diameters may be on the order of three to one.
- the bendable, turnable or flexible members may be arranged to bend in opposite directions by rotating the actuation cables through 180 degrees, or could be controlled to bend in virtually any other direction depending upon the relationship between the distal and proximal support points for the cables.
- the amount of bending motion produced at the distal bending member is determined by the dimension of the proximal bendable member in comparison to that of the distal bendable member.
- the proximal bendable member is generally larger than the distal bendable member, and as a result, the magnitude of the motion produced at the distal bendable member is greater than the magnitude of the motion at the proximal bendable member.
- the proximal bendable member can be bent in any direction (about 360 degrees) controlling the distal bendable member to bend in either the same or an opposite direction, but in the same plane at the same time. Also, as depicted in FIG. 1 , the surgeon is able to bend and roll the instrument's tool about its longitudinal axis to any orientation simply by rolling the axial rotation knob 24 about a rotation direction indicated in FIG. 1 by the rotation arrow R 1 .
- bendable members These members may also be referred to as turnable members, bendable sections or flexible members.
- terms such as “bendable section,” “bendable segment,” “bendable member,” or “turnable member” refer to an element of the instrument that is controllably bendable in comparison to an element that is pivoted at a joint.
- the term “movable member” is considered as generic to bendable sections and joints.
- the bendable elements of the present invention enable the fabrication of an instrument that can bend in any direction without any singularity and that is further characterized by a ready capability to bend in any direction, all preferably with a single unitary or uni-body structure.
- a definition of a “unitary” or “uni-body” structure is—a structure that is constructed only of a single integral member and not one that is formed of multiple assembled or mated components—.
- bendable members may be in the form of unitary structures, such as of the type shown herein in FIG. 3 for the proximal bendable member, may be constructed of engageable discs, or the like, may include bellows arrangements or may comprise a movable ring assembly.
- bendable members refer to co-pending application Ser. No. 11/185,911 filed on Jul. 20, 2005; Ser. No. 11/505,003 filed on Aug. 16, 2006 and 11/523,103 filed on Sep. 19, 2006, all of which are hereby incorporated by reference herein in their entirety.
- FIG. 1 shows a preferred embodiment of the instrument of the present invention. Further details are illustrated in FIGS. 2 through 14 .
- FIG. 1 depicts the surgical instrument 10 in a perspective view, as may occur during a surgical procedure.
- the instrument may be used for laparoscopic surgery through the abdominal wall.
- an insertion site at which there is disposed a cannula or trocar.
- the shaft 14 of the instrument 10 is adapted to pass through the cannula or trocar so as to dispose the distal end of the instrument at the operative site.
- the end effector 16 is depicted in FIG. 1 .
- the embodiment of the instrument shown in FIG. 1 is typically used with a sheath 98 covering the distal member 20 to keep bodily fluids from entering the distal bending member 20 .
- the shaft 14 includes an outer shaft tube 32 and an inner shaft tube 34 as in previous applications incorporated herein.
- FIG. 2 shows a separate sheath 46 that is temporarily used to cover the entire distal bendable member and end effector.
- This sheath 46 is only used for shipping the instrument and may be discarded once the instrument is in place on the handle.
- the sheath 46 keeps the jaws in an open position, as illustrated in FIG. 2 , and also keeps the distal bendable member in a substantially straight position. By doing that the actuation cable is maintained in a particular aligned position and ready for engagement with the handle portion of the instrument.
- a biasing means in the instrument to maintain a predetermined position of the instrument cable, usually one in which the jaws are maintained open.
- a rolling motion can be carried out with the instrument of the present invention. This can occur by virtue of the rotation of the rotation knob 24 relative to the handle 12 about a longitudinal shaft axis. This is represented in FIG. 1 by the rotation arrow R 1 .
- the rotation knob 24 When the rotation knob 24 is rotated, in either direction, this causes a corresponding rotation of the instrument shaft 14 . This is depicted in FIG. 1 by the rotational arrow R 2 .
- This same motion also causes a rotation of the distal bendable member and end effector 16 about an axis that corresponds to the instrument tip, depicted in FIG. 1 as about the longitudinal tip or tool axis P.
- FIG. 1 refer to the rotational arrow R 3 at the tip of the instrument.
- the handle 12 via proximal bendable member 18 , may be tilted at an angle to the instrument shaft longitudinal center axis. This tilting, deflecting or bending may be considered as in the plane of the paper. By means of the cabling this action causes a corresponding bend at the distal bendable member 20 to a position wherein the tip is directed along an axis and at a corresponding angle to the instrument shaft longitudinal center axis.
- the bending at the proximal bendable member 18 is controlled by the surgeon from the handle 12 by manipulating the handle in essentially any direction including in and out of the plane of the paper in FIG. 1 . This manipulation directly controls the bending at the proximal bendable member.
- This manipulation directly controls the bending at the proximal bendable member.
- the control at the handle is used to bend the instrument at the proximal motion member to, in turn, control the positioning of the distal motion member and tool.
- the “position” of the tool is determined primarily by this bending or motion action and may be considered as the coordinate location at the distal end of the distal motion member. Actually, one may consider a coordinate axis at both the proximal and distal motion members as well as at the instrument tip. This positioning is in three dimensions. Of course, the instrument positioning is also controlled to a certain degree by the ability of the surgeon to pivot the instrument at the incision point or at the cannula or trocar.
- the “orientation” of the tool relates to the rotational positioning of the tool, from the proximal rotation control member, about the illustrated distal tip or tool axis P.
- the tool may include a variety of articulated tools such as: jaws, scissors, graspers, needle holders, micro dissectors, staple appliers, tackers, suction irrigation tools and clip appliers.
- the tool may include a non-articulated tool such as: a cutting blade, probe, irrigator, catheter or suction orifice.
- the surgical instrument of FIG. 1 shows a preferred embodiment of a surgical instrument 10 according to the invention in use and may be inserted through a cannula at an insertion site through a patient's skin.
- Many of the components shown herein, such as the instrument shaft 14 , end effector 16 , distal bending member 20 , and proximal bending member 18 may be similar to and interact in the same manner as the instrument components described in the co-pending U.S. application Ser. No. 11/185,911 filed on Jul. 20, 2005 and hereby incorporated by reference herein in its entirety.
- the proximal bendable member 18 is a unitary slotted structure as shown in FIG. 6 including discs 130 , nibs 131 and slots 132 .
- the control between the proximal bendable member 18 and distal bendable member 20 is provided by means of the bend control cables 100 .
- the bend control cables 100 extend through the instrument shaft 14 and through the proximal and distal bendable members.
- the bend control cables 100 may be constrained along substantially their entire length so as to facilitate both “pushing” and “pulling” action as discussed in further detail in the aforementioned co-pending application Ser. No. 11/649,352 filed on Jan. 2, 2007.
- the cables 100 may also be constrained as they pass over the conical cable guide portion of the proximal bendable member, and through the proximal bendable member itself.
- the locking means interacts with the ball and socket arrangement to lock and unlock the positioning of the cables which in turn control the angle of the proximal bending member and thus the angle of the distal bendable member and end effector.
- This lock control allows the surgeon one less degree of freedom to concentrate on when performing certain tasks. By locking the bendable sections at a particular position, this enables the surgeon to be more hands-free for controlling other degrees of freedom of the instrument such as manipulation of the rotation knob 24 and, in turn, orientation of the end effector.
- FIG. 1 The instrument shown in FIG. 1 is considered as of a pistol grip type. However, the principles of the present invention may also apply to other forms of handles such as a straight in-line handle.
- a jaw clamping or actuation means 30 that is comprised mainly of the lever 22 which may have a single finger hole in the gimbaled ball 27 .
- the ball 27 is mounted at the free end of the lever 22 .
- the surgeon uses the ball 27 for controlling the lever 22 .
- the handle end of the instrument may be tipped or deflected in any direction as the proximal bendable member is constructed and arranged to preferably enable full 360 degree bending.
- This movement of the handle relative to the instrument shaft bends the instrument at the proximal bendable member 18 .
- This action in turn, via the bend control cables 100 , bends the distal bendable member in the same direction.
- opposite direction bending can be used by rotating or twisting the control cables through 180 degrees from one end to the other end thereof.
- the handle 12 is in the form of a pistol grip and includes a horn 13 to facilitate a comfortable interface between the action of the surgeon's hand and the instrument.
- the horn has the other function of providing the actuation pivot for locking and unlocking the tool control cable, as described in more detail later.
- the tool actuation lever 22 is shown in FIG. 1 pivotally attached at the base of the handle.
- the lever 22 actuates a slider 28 (see FIG. 3 ) that controls the tool actuation cable 38 that extends from the slider to the distal end of the instrument.
- the cable 38 controls the opening and closing of the jaws, and different positions of the lever control the force applied at the jaws.
- the cable is depicted, for example, in FIG. 8 as including proximal cable portion 38 A and distal cable portion 38 B.
- the instrument 10 has a handle portion 12 and a detachable shaft portion 14 , as shown in FIG. 1 .
- the main components of the instrument may be like that shown in Ser. No. 11/649,352 filed on Jan. 2, 2007, particularly as to the construction of the bendable members, instrument shaft and end effector. This includes means for enabling rotation of the shaft and proximal bendable member within bearings or bearing surfaces 208 and 210 ( FIG. 3 ).
- the bearing 208 interfaces between the adaptor 26 and the ball 120 , while the bearing surface 210 is between the neck portion 206 and the instrument shaft.
- the separate portions 12 and 14 may be sealed in a sterile package or packages prior to storage or shipping.
- the shaft portion 14 can be easily separated from the handle portion 12 by releasing the cinch ring 200 .
- the shaft portion includes a shaft connector 212 .
- the cable portion 38 B is provided with an end connector lug 40 .
- the shaft connector 212 and cable connector lug 40 are disengaged by raising the horn 13 about a pivot 272 thus enabling the shaft portion 14 and handle portion 12 to be disengaged from each other.
- a new shaft portion can then be easily attached to the sterilized handle by insertion and locking into the handle as described in further detail below.
- FIG. 1 shows the shaft and handle portions engaged which happens when the horn 13 is pivoted to the locked or down position. See also the locked position in FIG. 3 .
- FIG. 3 shows a somewhat schematic cross-sectional view of the connections between the shaft 14 and handle portion 12 .
- the split hub 202 is constructed and arranged to allow the ball 120 to be pulled out of the split hub 202 .
- the cinch ring 200 is used to lock and unlock the split hub 202 , as described in more detail later.
- the proximal bending member 18 is mounted to the shaft connector 212 that is indexed with the handle portion, and particularly with the rotation knob 24 .
- the shaft connector 212 is shown connected to the rotation knob 24 by means of a shaft receiver portion 300 (see FIG. 8 ) of the rotation knob 24 .
- the shaft connector 212 is locked into the handle portion 12 by means of the shaft locking assembly or means 260 .
- the shaft connector is locked linearly but the assembly 260 allows rotation of the shaft portion relative to the handle portion.
- the jaw actuation distal cable portion 38 B (see also FIG. 8 ) is shown terminated at the coupling lug 40 . It is the coupling lug 40 that is captured by the cable coupling member or means 320 so as to in essence connect together both portions 38 A and 38 B of the tool actuation cable 38 .
- the split hub portions or petals 202 A- 202 D each have a tapered face 378 (see FIGS. 3 and 4 ) so as to function as a ramp to force the petals apart when the ball 120 is pushed proximally against them during an insertion of the shaft portion into the handle portion. These inward faces or edges of the portions 202 A- 202 D are beveled or tapered to allow easier passage of the ball.
- the split hub 202 is supported from the handle by means of struts 230 which are thinned as shown at 382 as illustrated in FIGS. 6 and 9 so as to function as flexible living hinges to thus allow more ready expansion of the hub petals. This structure assists in the engagement and disengagement between the shaft and handle.
- the cinch ring 200 has two flanges 201 A and 201 B, shown in FIG. 5 that ride in respective circumferential grooves 203 A and 203 B.
- the grooves 203 A and 203 B are disposed on the outer surface of the split hub 202 . This interface captures the cinch ring while allowing the split hub to be separated linearly as is discussed in more detail hereinafter.
- the cinch ring 200 is basically controlled from the angle locking member or means 140 , as shown in FIGS. 2 and 9 .
- the angle locking member 140 is pivotally attached with the cinch ring 200 .
- the angle locking member 140 is constructed and arranged to allow the cinch ring 200 to, not only be loosened enough to adjust the angle of the shaft relative to the handle, but to also expand to a size that is sufficient to allow enough expansion of the split hub portions to thus allow the ball 120 to be removed or inserted in the split hub 202 , as illustrated in FIGS. 6 and 7 . This enables the shaft portion to be dis-engaged from the handle portion.
- the cinch ring flanges 201 A and 201 B and grooves 203 A and 203 B are dimensioned so that when the cinch ring 200 is loosened enough for the ball 120 to be removed from the split hub, the cinch ring 200 cannot be removed from the split hub without detaching the ends 200 A and 200 B of the cinch ring 200 , as illustrated in the position of FIG. 23 .
- the flanges 201 are approximately the same depth and the grooves are slightly deeper so as to not impede the pressure applied at surface 384 of the cinch ring on surface 386 of the split hub portions when the cinch ring is tightened, as in the position that is illustrated in FIG. 3 .
- FIG. 4 shows the cinch ring in a locked first position in solid line.
- the phantom position shown in FIG. 4 and the position shown in solid line in FIG. 4A depict a second position in which the cinch ring has been sufficiently released so that the shaft angle can be changed or, alternatively, the cinch ring can be rotated for left or right hand use. From the position of FIG. 4A the link 390 can be rotated clockwise as seen in FIG.
- FIG. 23 The fourth position is shown in FIG. 23 where the cinch ring ends have been disconnected so It can be fully removed by itself from either the throw away shaft portion or from the handle portion.
- the connector 212 has an indexing feature that can be used to index the cables 100 to the rotation knob 24 and/or match shafts with different tools or end effectors to certain handles.
- the shaft receiver portion 300 of rotation knob 24 is provided with ribs 302 (see also FIG. 9 ) that mate with slots 306 on the outside surface of the connector 212 .
- Different rib patterns can be used as well as different thicknesses such as ribs 302 A and slots 306 A shown in FIG. 26 .
- FIG. 27 schematically shows a pattern of three ribs 302 B spaced 120 degrees apart in the receiver 300 mating with three equally spaced grooves 306 B on the outside of the connector 212 , shown in phantom outline.
- One set of ribs and grooves may be wider than the others as a further indexing feature.
- FIG. 28 depicts an arrangement of eight ribs 302 C mating with eight slots 306 C.
- the rotation knob 24 is keyed to the proximal bending member 18 and when the rotation knob is rotated through rotation angle R 1 , the shaft portion 14 and proximal bending member rotate on bearings or bearing surfaces 208 , 210 . There is also a rotation on bearing surfaces between the clearance hole 316 against post 214 . To retain the rotation knob and receiver portion in the correct position when the connector is absent there is provided a rim 234 on the proximal end of the rotation knob that fits loosely in the radial groove 236 in the handle halves, as shown in FIGS. 3 and 8 .
- the shaft connector 212 is locked in place by actuation of shaft locking member or means 260 which include a gate 262 with a semi-circular rim 264 that loosely engages the groove 218 in the post 214 when the gate is in a down position.
- the gate 262 rides in slides 266 on wall 318 .
- a link 268 pivotally connects the gate 262 to a lug 270 on the horn 13 .
- the rim 264 is clear of the groove 218 and the shaft connector is free to slide distally out of the receiver.
- the horn is hinged to the handle at pin 272 and has two positions as seen in respective FIGS. 3 and 5 .
- the horn structure includes a shroud 278 that closely fits the opening 280 in the handle to keep out contaminants.
- Other locking means may be used and may not be necessary if the split hub and cinch ring sufficiently contain the ball 120 within the split hub 202 when the lever 220 is in a relaxed position.
- FIGS. 15-17 show an alternate means of attachment between the cinch ring, hub and shaft portion.
- the split hub may be separated from the shaft portion by means of a detachable front portion or ring 420 that is removed along with the shaft portion 14 and ball 120 , as illustrated in FIG. 15-17 .
- the ring 420 is shown as including a plurality of fingers 422 on the ring that each align with recesses 424 in the split hub. This arrangement provide alignment of the ring 420 with the split hub portions and the cinch ring flanges 201 A and 201 B with their respective grooves 203 A and 203 B.
- This construction also leaves a clearance space for the ends of the split hub portions 202 A- 202 D enabling them to flex without binding against the proximal surface of the ring 420 , as illustrated in FIG. 17 .
- the fingers 422 are preferably attached to the ring 420 by living hinges 426 to allow them to flex with the split hub portions when the cinch ring 200 is tightened and the inside surface 384 of the ring exerts pressure on surfaces 386 .
- the flanges 201 and grooves 203 are dimensioned so that the ring 420 can be removed from the split hub and cinch ring, but the cinch ring can't be removed from the split hub unless the ends 200 A and 200 B are disconnected (refer to FIGS. 21-23 for an illustration of the disconnection of the cinch ring itself).
- the cinch ring 200 has different depth flanges 201 A and 201 B.
- the groove arrangement includes a groove 203 A in the ring 420 and a groove 203 B at the split hub.
- the flange 201 A has a greater depth than the flange 201 B so that the flange 201 B may clear the groove 203 B and allows the ring 420 to be removed along with the cinch ring 200 while retaining the cinch ring 200 on the ring 420 , as illustrated in FIGS. 18 and 19 .
- the cinch ring 200 can be totally detached from both the ring 420 and the split hub by detaching ends 200 A and 200 B.
- the angle locking member 140 is comprised primarily of the release/lock lever 220 which controls the length or outer circumference of the cinch ring 200 .
- the function of the lever 220 refer to the two cross-sectional views of FIGS. 4 and 7 , as well as the two perspective views of FIGS. 4A and 4B .
- FIG. 4 depicts the instrument in the position where the shaft portion is fully engaged with the handle portion and the cinch ring is locked.
- FIG. 7 depicts the instrument with the cinch ring at least partially released. In the later position an end 200 B of the cinch ring 200 can be further released, as illustrated in FIG. 23 .
- the lever 220 is pivoted at pin 222 which is connected to end 200 A of the cinch ring.
- the end 200 A is in the shape of a hook (see FIGS. 4A and 4B ) and sits in a slot 226 in the lever.
- Pushing one end or the other of the lever 220 pivots the end 200 B of the cinch ring 200 over the center line of the pivot pin 222 either tightening the cinch ring as shown in solid line in FIG. 4 or relaxing it as shown in phantom line in FIG. 4 .
- the angle of the end effector is locked in place.
- the cinch ring 200 is relaxed as shown in the phantom line position in FIG. 4 .
- the angle of the end effector is free to be changed by rotation of the ball 120 in the split hub 202 .
- the cinch ring 200 may be rotated in its grooves to allow a rotational adjustment of the position of the lever 220 for ease of use.
- Such an alternate rotational position is shown in the cross-sectional view of FIG. 7 wherein the cinch ring has been rotated clockwise from the position of FIG. 4 .
- FIG. 7 also shows the lever 220 in its relaxed position.
- the lever 220 supports a link 390 which sits in slot 226 and pivots about pin 392 at one end.
- the other end of the link 390 carries opposite posts 394 that pass through holes in the end 200 B of the cinch ring 200 . These posts are capped off by means of knobs 400 .
- Knobs 400 retain the end 200 B of the cinch ring 200 in a rotational relationship to the link 390 but end 200 B can easily be released when the cinch ring is to be removed (see FIG. 22 ).
- the post and hole arrangement also provides a grip to rotate link 390 between stations 406 and 408 . As shown in FIGS.
- the link 390 has been rotated in the direction of arrow 412 from station 406 to station 408 which in effect loosens the cinch ring enough for the split hub to be expanded enough to remove the shaft and ball.
- the end 200 B of the cinch ring can be removed by indexing the knobs 400 by means of indicators 401 ( FIG. 23 ) in the direction of arrow 414 ( FIG. 22 ) so that lugs 396 on the respective posts 394 line up with keyways 402 at the end 200 B.
- the knobs 400 can be pulled outward in the direction of arrow 416 in FIG. 22 and end 200 B can be detached as the recesses 398 in the knobs clear the posts 394 .
- Rims 404 on the knobs prevent the knobs from detaching from the end 200 B.
- the cinch ring 200 is then free to be completely removed from the split hub 202 and/or ring 420 as shown in FIG. 23 .
- FIG. 8 depicts the separation of the shaft portion 14 along with the proximal bendable member 18 , ball 120 and connector 212 from the handle portion 12 .
- the connector 212 is attached to the proximal end of the bendable member 18 and the cables 100 are illustrated as passing through the proximal bendable member 18 and connector 212 .
- the cables terminate at the resilient pads 104 (or springs) and are crimped at 102 .
- the proximal ends of the bend control cables are terminated at the connector 212 .
- the connector 212 has a post 214 that passes through a clearance hole 314 in the rotation knob and a clearance hole 316 in the radial wall 318 of the handle.
- the post 214 has a taper 216 at its' proximal end to aid in assembly.
- the post 214 also has a circumferential groove 218 that is engaged by the shaft locking member or means 260 .
- the proximal bendable member 18 and connector post 214 also carry the jaw actuation cable portion 38 B in a central bore thereof.
- FIG. 8 also shows the cable end lug 40 that is attached to the very end of the cable portion 38 B and extends outwardly from the post 214 .
- the horn 13 is shown in its locked position in FIGS. 1 and 3 and is shown in its released position in FIGS. 2 and 5 .
- the pivoting of the horn causes the locking in of the shaft portion of the instrument relative to the handle portion thereof.
- the pivoting of the horn is also used to control the inter-engagement between the cable portions by capturing the cable lug 40 . This is accomplished by a clamping or releasing via a cable coupling member or means 320 which is illustrated in at least FIGS. 3 , 10 , 11 , 13 and 14 .
- the clamping member or means 320 includes a main collet member having plurality of jaws 322 each with recesses 324 that capture the lug 40 on the cable 38 .
- the jaws are shown most clearly in the enlarged perspective view of FIG. 10 .
- the jaws are disposed at the ends of respective spring arms 328 that are circumferentially disposed about the base 330 which may, in turn, be cemented to the handle portion 38 A of cable 38 .
- the jaws 322 are normally biased to an open position such as shown in FIG. 14 by means of the action of the spring arms 328 .
- the jaws 322 of the clamping member 320 have ramped surfaces 326 on their outside surfaces that interact with the tapered surface 334 of the collet 332 . This interaction controls the opening and closing of the clamping member.
- the collet 332 is normally urged distally by spring 336 that is loaded against the wall of the carriage 338 as illustrated in FIG. 13 .
- the spring 336 is disposed in a pocket between a seat at the proximal end of the jaw members 322 and a seat in the carriage 338 .
- the neck 340 of the carriage 338 is fixedly attached to the base 330 of the jaws 322 , as well as to the cable portion 38 B. This attachment may be by a number of different means such as by being cemented together. Refer to the cross-sectional view of FIG. 13 illustrating the cementing at 342 .
- the carriage 338 is adapted for sliding motion inside of the guide 344 which is, in turn, fixed to the handle 12 .
- the guide 344 is supported by the sleeve 346 which is molded as part of the handle.
- the spring 336 is shown urging the collet 332 , with its' tapered surface 334 , against ramped surfaces 326 under the bias of the spring arms 328 . This action maintains the jaws closed, thus capturing the cable lug 40 therein and essentially thus joining together the separate cable portions 38 A and 38 B.
- the actuation cable functions as a single operable cable that is controlled from the proximal part of the instrument.
- the carriage 338 enables the cable to slide in performing its tool actuation function.
- the carriage 338 is shown as pulled proximally in the direction of arrow 348 in FIG. 13 to show the manner in which the carriage 338 with the closed jaws 322 is free to move proximally from the at rest position illustrated in FIG. 3 .
- FIG. 14 for an illustration of the release function which enables the shaft portion of the instrument to be separated or detached from the handle portion of the instrument.
- the jaws 322 are opened to release the lug 40 by the action of the cams 352 against the face 354 of the collet 332 .
- the action of the cams 352 pushes the collet 332 proximally as illustrated in FIG. 14 to release the jaws from about lug 40 .
- the spring arms 328 are constructed and arranged so as to normally urge the arms apart.
- FIG. 14 depicts a rest position of the instrument in which the slider 28 has normally urged the cable 38 in the direction of arrow 350 .
- This action places the face of the jaws 322 against posts 356 .
- This positioning ensures the proper alignment between the connector 212 and the cable coupling member 320 .
- This action pulls up on arms 366 of the yoke 364 which spread around the connector 212 .
- Yoke 364 is supported at arms 370 .
- Arms 366 carry pivot pins 368 that are attached to the arms 362 of posts 356 that are, in turn, mounted on pins 358 protruding from bosses 360 molded to the sides of the handle.
- the posts 356 act as stops for the proximal end of the shaft connector 212 and the face of the jaws 322 .
- the posts 356 have cams 352 which engage and push against the face of the collet 354 when the horn 13 is raised, as depicted in FIG. 14 .
- FIGS. 29-33 An alternate embodiment of cable coupling member is shown in FIGS. 29-33 , as coupling member 460 .
- the cable end lug 40 has been replaced with a spring loaded cable connector 440 that is contained in a passage 450 in the post 214 of the connector 212 .
- a spring 446 biases the connector 440 distally to maintain the end effector jaws in an open position when the shaft portion 14 is removed.
- the spring 446 pushes flange 448 against the proximal end of the bendable member 18 , such as depicted in FIG. 29 . This eliminates a need for a sheath 46 , as in FIG. 2 , and helps keep the jaws open at an at rest position.
- Connector 440 has a tapered end 444 to aid in assembly and a groove 442 that can be captured by a finger 462 that is shown engaged in the position of FIGS. 29 and 30 , and is normally biased to an open position as illustrated in FIG. 31 .
- the finger 462 is attached to sleeve 466 at a living hinge portion 464 that enables the finger 462 to flex inward when biased by flex arm 472 of the guide 470 . Movement of the guide 470 over the sleeve 466 drops the finger 462 into groove 442 and thus captures the connector 440 , as shown in FIG. 30 .
- the finger 462 is molded as part of the sleeve 466 and has a key 480 that slides in keyway 478 of guide 470 to ensure proper alignment of the finger 462 and the flex arm 472 .
- the sleeve 466 is cemented at 468 to the cable 38 and slides in the guide 470 which is attached to the handle 12 .
- FIG. 33 is an exploded cross-sectional view of the embodiment of FIG. 32 and showing the instrument shaft portion removed from the handle portion.
- the cam surface 474 pushes the flex arm 472 at the follower 476 , and likewise pushes the finger 462 to the position shown in FIG. 29 .
- the sleeve 466 functions as a carriage as depicted in FIG. 30 when the cable 38 is pulled by the slider 28 .
- FIGS. 29 and 30 both show the coupling lug 441 captured so that both proximal and distal portions of the actuation cable are interconnected.
- FIG. 29 shows more of an at rest position while FIG. 30 depicts the cable 38 pulled in the direction of arrow 443 so as to actuate the end effector.
- the sleeve is shown moved to the right and the spring 446 more compressed.
- FIG. 32 illustrates the horn having been raised to enable release of the distal portion of the instrument with the finger 462 and the flex arm 472 both released to a dis-engaged position.
- the shaft portion is shown separated from the handle portion.
- FIGS. 34-38 show still a further alternate embodiment of a cable coupling member or means 500 .
- the connector 440 with its end lug 441 is inserted into a bore 518 in block 502 which also functions as a carriage.
- a spring loaded gate 504 with a keyhole shaped opening 506 is slidably mounted in transverse passage 507 of the block 502 .
- the upper rim 508 of the keyhole opening is urged downward by spring 510 to engage groove 442 of the connector 440 in a rotational relationship.
- a neck 512 on the top of the gate 504 supports the spring 510 against a bracket 514 which, in turn, supports a stop 516 on the end of the neck 512 .
- This arrangement ensures that the gate 504 does not drop out of the block 502 when there is no connector 440 present.
- the carriage 502 travels in a slideway 520 which is affixed to the handle.
- a release means or member 522 is operated by rotating the horn.
- the member 522 includes a pusher 524 that riding in guides 526 and is connected to the horn 13 by link 528 which pivots in end bosses 530 .
- the at rest position which is also the clamp/release position is shown in FIG. 34 .
- the shaft portion is shown abutting the distal end of the fixed position slideway 520 , the cable 38 is at rest, the spring 446 is at an extended position, the carriage 502 is at the distal end of the slideway 520 and the pusher 524 is shown lined up beneath the gate 504 .
- FIG. 34 In the cross-sectional view of FIG.
- FIG. 35 the connector 440 is clamped by means of the gate 504 .
- FIG. 35 also illustrates the carriage 502 being pulled proximally, by arrow 534 by the cable 38 which, in turn, is connected to the slider 28 .
- the spring 510 keeps the gate 504 down and latched but the connector 440 is free to rotate within block 502 .
- FIG. 37 shows the horn raised and the pusher 524 in contact with and pushing up on the gate to align the wide portion of the keyhole opening 506 with the connector shaft so the connector 440 can be withdrawn as shown in FIG. 38 .
- the used or contaminated shaft portion 14 can be easily detached from the handle portion 12 and disposed of as hereinafter described.
- the manner in which the shaft portion is readily detachable for the purpose of replacement thereof For this explanation reference is made primarily to the first embodiment described herein.
- the cinch ring 200 is released as shown in FIGS. 2 and 5 by manipulation of the angle locking means 140 to allow the split hub portions 202 A- 202 D to be able to expand enough to allow clearance for the spherical ball 120 .
- the spherical ball can be pulled out of the split hub 202 as the shaft portion 14 is withdrawn, and thus detached from the handle portion 12 .
- the horn 13 is raised upward as shown in FIGS. 2 and 5 , releasing both the shaft locking member 260 and the cable coupling member 320 .
- the shaft portion 14 can then be grasped at the neck portion 206 of the ball 120 and pulled straight out of the handle portion 12 and disposed of. After sterilizing the handle portion 12 , a new shaft portion 14 can be easily attached to it.
- the new shaft portion 14 may be fitted with a temporary sheath 46 that is semi-rigid and snugly fits over the end effector and the distal bending member 20 to hold the end effector jaws open which ensures that the lug 40 at the proximal end of the shaft portion 14 is fully inserted into the shaft connector 212 .
- This is needed for proper alignment of the cable coupling means 320 and the lug 40 when the shaft portion 14 is inserted into the handle portion 12 .
- the sheath 46 also holds the distal bending member 20 straight and thus the proximal bending member 18 straight with respect to the shaft and shaft connector 212 for correct alignment when the shaft portion 14 is inserted into the handle portion 12 .
- an indexing means described herein in the form of ribs and grooves that ensure that the shaft connector 212 rotates in a fixed relationship to the rotation knob 24 and may also provide a matching means to ensure the correct matching of specific end effectors or tools to the proper handle configurations.
- the spherical surface 204 of the ball 120 contacts the beveled faces 378 of the respective split hub portions 202 A- 202 D and forces them apart until the spherical surface 204 can clear the points created on the inside diameter of the split hub and the angled surfaces 380 , as depicted in FIGS. 6 and 7 .
- the angled surfaces 380 allow the spherical ball 120 to clear the split hub with less expansion of the portions 202 A- 202 D to make it easier to slip the ball into and out of the split hub.
- the struts 230 that attach the split hub portions to the handle have thinned areas 382 that create living hinges that facilitate expansion of the split hub portions.
- FIG. 6 although previously described as illustrating removal of the shaft portion, can also be considered as illustrative of the relative positioning when the shaft portion 14 is inserted into the handle portion 12 .
- the shaft 14 can be rotated until the indexing features, such as ribs 302 on the shaft receiver and grooves 306 on the shaft connector 212 , mate under the urging of the split hub portions trying to return to a memory position and exerting a proximal pressure on the distal side of the spherical ball 120 .
- the ribs 302 are tapered at 304 and the connector 212 is tapered at 216 to assist in the alignment.
- the shaft connector 212 can slide proximally until the shoulder 308 on the connector contacts the seat 310 of the shaft receiver portion 300 as depicted in FIG. 5 .
- FIG. 14 also shows that the proper distance D is provided that ensures that the lug 40 is abutting and preferably contacting the portion of the cable 38 that is attached to the slider 28 . Also, this positioning provides alignment of the lug 40 with the recesses 324 in the jaws 322 so that when collet 332 is released, the jaws 322 capture the lug 40 .
- the shaft portion 14 is now ready to be locked to the handle.
- the horn 13 is rotated clockwise or downwardly to the position depicted in FIG. 3 . This releases the collet 332 and the jaws 322 capture the lug 40 while the shaft locking means 260 locks the shaft connector 212 in a rotational relationship with respect to the handle.
- the cinch ring 200 is then tightened by the release/lock lever 220 and the sheath 46 can be removed while gently squeezing the jaw clamping lever 22 while pulling on the distal end of the sheath.
- the instrument is now ready for use.
Abstract
A medical instrument having a proximal control handle and a distal tool that are intercoupled by an elongated instrument shaft that is meant to pass internally of an anatomic body, proximal and distal movable members that respectively intercouple the proximal control handle and the distal tool with the instrument shaft, cable control means disposed between the movable members, an actuation member at the handle for controlling the distal tool through the movable members, and a coupler for selectively engaging or disengaging separable cable segments of the actuation member.
Description
- The present invention relates in general to medical instruments, and more particularly to manually-operated surgical instruments that are intended for use in minimally invasive surgery or other forms of surgical or medical procedures or techniques. The instrument described herein is primarily for a laparoscopic procedure, however, it is to be understood that the instrument of the present invention can be used for a wide variety of other procedures, including intraluminal procedures.
- Endoscopic and laparoscopic instruments currently available in the market are extremely difficult to learn to operate and use, mainly due to a lack of dexterity in their use. For instance, when using a typical laparoscopic instrument during surgery, the orientation of the tool of the instrument is solely dictated by the location of the target and the incision. These instruments generally function with a fulcrum effect using the patients own incision area as the fulcrum. As a result, common tasks such as suturing, knotting and fine dissection have become challenging to master. Various laparoscopic instruments have been developed over the years to overcome this deficiency, usually by providing an extra articulation often controlled by a separately disposed control member for added control. However, even so these instruments still do not provide enough dexterity to allow the surgeon to perform common tasks such as suturing, particularly at any arbitrarily selected orientation. Also, existing instruments of this type do not provide an effective way to hold the instrument in a particular position. Moreover, existing instruments require the use of both hands in order to effectively control the instrument.
- An improved instrument is shown in U.S. Pat. No. 7,147,650 having enhanced dexterity and including, inter alia, a rotation feature with proximal and distal bendable members. Even though this instrument has improved features there remains the need for a more economically feasible instrument, and one in which the handle can be re-used while the tip of the instrument is disposable or reposable.
- Accordingly, an object of the present invention is to provide an improved laparoscopic or endoscopic instrument in which a portion of the instrument is re-useable and a portion is disposable. In embodiments described herein the handle end of the instrument is re-useable and the distal portion or tip of the instrument is disposable. By being able to re-use the handle portion, the instrument is more economically feasible.
- A further object of the present invention is to provide an improved laparoscopic or endoscopic surgical instrument that allows the surgeon to manipulate the tool end of the surgical instrument with greater dexterity.
- Another object of the present invention is to provide an improved surgical or medical instrument that has a wide variety of applications, through incisions, through natural body orifices or intraluminally.
- Another object of the present invention is to provide a locking feature that is an important adjunct to the other controls of the instrument enabling the surgeon to lock the instrument once in the desired position. This makes it easier for the surgeon to thereafter perform surgical procedures without having to, at the same time, hold the instrument in a particular bent configuration.
- Still another object of the present invention is to provide an improved medical instrument that can be effectively controlled with a single hand of the user.
- Still another object of the present invention is to provide an improved medical instrument that is characterized by the ability to lock the position of the instrument in a pre-selected position while enabling rotation of the tip of the instrument while locked.
- To accomplish the foregoing and other advantages and features of the present invention there is provided a surgical instrument comprising: an instrument shaft having proximal and distal ends; a tool disposed from the distal end of the instrument shaft; a control handle coupled from the proximal end of the instrument shaft; a distal motion member for coupling the distal end of the instrument shaft to the distal tool; a proximal motion member for coupling the proximal end of the instrument shaft to the handle; actuation means extending between the distal and proximal motion members for coupling motion of the proximal motion member to the distal motion member for controlling the positioning of the tool; and an actuation cable extending from the handle to the tool for controlling the actuation of the tool. The actuation cable is separated into two inter-engagable cable segments that enable the proximal motion member to be disconnected from the control handle.
- In accordance with other aspects of the present invention the surgical instrument may further include a rotation means disposed adjacent the control handle and rotatable relative to the control handle for causing a corresponding rotation of the instrument shaft and tool; at least the proximal motion member may comprise a proximal bendable member, the rotation means may comprise a rotation knob that is adapted to rotate the tool about a distal tool roll axis and the rotation knob may be disposed between the control handle and proximal bendable member; an actuation lever may be supported from the handle at a pivot point on the handle and for controlling the actuation cable; a slider may be provided for capturing the proximal end of said tool actuation cable and an actuation lever supported at the handle for controlling the translation of the slider and, in turn, the operation of the tool; a locking mechanism may be provided for fixing the position of the tool at a selected position and having locked and unlocked states, the locking mechanism including a ball and socket arrangement disposed about the proximal motion member and a cinch member for locking the ball and socket arrangement; the socket member may comprise a split socket and the cinch member closes the split socket to lock the socket on the ball; a horn may be provided that is pivotally supported from the handle and that is operable to engage and disengage the cable segments; and a collet may be supported in the handle for closing about the cable segments.
- In accordance with another embodiment of the invention there is provided a medical instrument having a proximal control handle and a distal tool that are intercoupled by an elongated instrument shaft that is meant to pass internally of an anatomic body, proximal and distal movable members that respectively intercouple the proximal control handle and the distal tool with the instrument shaft, cable control means disposed between the movable members, an actuation member at the handle for controlling the distal tool through the movable members, and a coupler for selectively engaging or disengaging separable cable segments of the actuation member.
- In related aspects of the present invention the coupler may include a collet attached to one of the cable segments and a capture lug on the other of the cable segments, the collet for retaining the capture lug to engage the cable segments; a pivot member may be provided on the handle including at least one link that is operable to control a cam that sets open and closed positions of the collet; the pivot member may be in the form of a horn at the top of the handle to assist in a comfort grip of the handle; and collet may include a quick disconnect mechanism having a base in which the collet is positioned and a spring that biases the base to a closed position of the collet.
- In accordance with still another embodiment of the invention there is provided a method of controlling a medical instrument that has a proximal end including a control handle and a distal end including a distal tool, with the control handle and distal tool being intercoupled by an elongated instrument shaft and the tool actuated from a tool control cable. The method includes providing proximal and distal movable members that respectively intercouple the proximal control handle and the distal tool with the instrument shaft, the proximal and distal movable members being intercoupled so that a motion at the proximal movable member controls the distal movable member, dividing the tool control cable into separate cable segments and interlocking the separate cable segments so that the tool control cable is operable. A further step may include manually controlling, from the proximal end of the instrument, the rotation of the distal tool about its longitudinal distal tool axis.
- In accordance with another embodiment of the invention there is provided an instrument having a proximal control handle and a distal tool that are intercoupled by an elongated instrument shaft, proximal and distal movable members that respectively intercouple the proximal control handle and the distal tool with the instrument shaft, means disposed between the movable members so that a motion at the proximal movable member controls the distal movable member and, in turn, the distal tool, means supported at the handle for controlling the distal tool including a tool control cable that extends between the handle and distal tool, the tool control cable including separate control cable segments that are adapted to have one of an engaged state and a dis-engaged state.
- In accordance with still other aspects of the present invention there is provided a control member at the control handle and manipulable by a user to control, via the proximal and distal movable members, the rotation of the distal tool about its distal tool axis; the proximal motion member can be disconnected from the control handle when the control cable segments are in their dis-engaged state; including a coupler for selectively engaging or disengaging the separable cable segments; wherein the coupler may include a collet attached to one of the cable segments and a capture lug on the other of the cable segments, the collet for retaining the capture lug to engage the cable segments; and wherein the collet may include a quick disconnect mechanism having a base in which the collet is positioned and a spring that biases the base to a closed position of the collet.
- Numerous other advantages can be realized in accordance with the present invention by referring to the accompanying drawings, in which:
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FIG. 1 is a perspective view of a first embodiment of a surgical instrument constructed in accordance with the present invention with a disposable shaft portion and a reusable handle portion; -
FIG. 2 is a fragmentary exploded perspective view of the instrument and shaft ofFIG. 1 ; -
FIG. 3 is a partial cross-sectional side view of the instrument as taken along line 3-3 ofFIG. 1 and with the instrument in an engaged or locked position; -
FIG. 4 is a cross-sectional end view of the instrument taken along line 4-4 ofFIG. 3 showing a locked and a first released position of the cinch ring; -
FIGS. 4A and 4B are further perspective views of respective positions of the release/lock lever; -
FIG. 5 is a cross-sectional view like that shown inFIG. 3 but with the instrument shaft portion being released from the handle portion and with the handle moved upwardly; -
FIG. 6 is a cross-sectional view like that shown inFIG. 5 but with the instrument shaft portion being removed from the handle portion; -
FIG. 7 is a fragmentary cross-sectional end view of the instrument taken along line 7-7 ofFIG. 6 showing a rotated and a second released position of the cinch ring and the shaft ball being removed; -
FIG. 8 is a cross-sectional view similar to that shown inFIG. 6 but with the instrument shaft portion being fully removed from the handle portion; -
FIG. 9 is a fragmentary exploded perspective detail view of the instrument on a somewhat enlarged scale; -
FIG. 10 is an exploded perspective view of one embodiment of a coupling means for the end effector actuation cable; -
FIG. 11 is a cross-sectional end view of an actuation means for operating the coupling means ofFIG. 10 taken along line 11-11 ofFIG. 8 ; -
FIG. 12 is a cross-sectional end view of a means to lock the instrument shaft portion to the handle portion taken along line 12-12 ofFIG. 8 ; -
FIG. 13 is a cross-sectional plan view of the instrument shaft locking means and the cable coupling means engaged as taken along line 13-13 ofFIG. 3 but showing the end effector cable being pulled as in use; -
FIG. 14 is a cross-sectional plan view of the instrument shaft locking means and the cable coupling means in a released position as seen along line 14-14 ofFIG. 8 ; -
FIG. 15 is a fragmentary exploded perspective view of a second embodiment of a means to attach the instrument shaft to the handle portion; -
FIG. 16 is an exploded cross-sectional side view of the attachment means ofFIG. 15 ; -
FIG. 17 is a cross-sectional side view of the embodiment illustrated inFIGS. 15 and 16 and showing the instrument shaft attached to the handle portion; -
FIG. 18 is a fragmentary exploded perspective view of a third embodiment of a means for attaching the instrument shaft to the handle portion; -
FIG. 19 is an exploded cross-sectional side view of the attachment means ofFIG. 18 ; -
FIG. 20 is a cross-sectional side view of the embodiment illustrated inFIGS. 18 and 19 and showing the instrument shaft attached to the handle portion; -
FIG. 21 is a fragmentary cross-sectional view of a means to detach the cinch ring as taken along line 21-21 ofFIG. 18 ; -
FIG. 22 is a cross-sectional view similar to that illustrated inFIG. 21 and showing the cinch ring partially detached; -
FIG. 23 is a fragmentary exploded perspective view of a fourth embodiment of a means to attach the instrument shaft to the handle portion; -
FIG. 24 is a fragmentary exploded side view of an indexing means to match the proper instrument shaft and end effector with the correct handle configuration; -
FIG. 25 is an end view of the proximal end of the instrument shaft as taken along line 25-25 ofFIG. 24 ; -
FIG. 26 is an end view of the distal end of the rotation knob and shaft receiver as taken along line 26-26; -
FIG. 27 is a schematic end view of a first alternate embodiment of an indexing means; -
FIG. 28 is a schematic end view of a second alternate embodiment of an indexing means; -
FIG. 29 is a fragmentary cross-sectional side view of an alternate embodiment of a cable coupling means; -
FIG. 30 is a cross-sectional view similar to that illustrated inFIG. 29 but showing the end effector cable being pulled as in use; -
FIG. 31 is an exploded perspective view of the cable coupling means ofFIG. 29 ; -
FIG. 32 is a cross-sectional view similar to that illustrated inFIG. 19 but showing the cable coupling means being released; -
FIG. 33 is an exploded cross-sectional view of the embodiment ofFIG. 32 and showing the instrument shaft portion removed from the handle portion; -
FIG. 34 is a cross-sectional side view of a further alternate embodiment of a cable coupling means; -
FIG. 35 is a cross-sectional view similar to that illustrated inFIG. 34 but showing the end effector cable being pulled as in use; -
FIG. 36 is an exploded perspective view of the cable coupling means ofFIG. 34 ; -
FIG. 37 is a cross-sectional view similar to that illustrated inFIG. 34 but showing the cable coupling means being released; and -
FIG. 38 is an exploded perspective view of the embodiment ofFIG. 37 and showing the instrument shaft portion removed from the handle portion. - The present invention is illustrated in the drawings as a surgical instrument that has two portions such that a detachable instrument shaft portion may be disposable and a re-usable handle portion may be sterilized and reused numerous times. This allows for a higher quality instrument handle portion while keeping the overall price of the instrument reasonable.
- The instrument of the present invention may be used to perform minimally invasive procedures. “Minimally invasive procedure,” refers herein to a surgical procedure in which a surgeon operates through a small cut or incision, the small incision being used to access the operative site. In one embodiment, the incision length ranges from 1 mm to 20 mm in diameter, preferably from 5 mm to 10 mm in diameter. This procedure contrasts those procedures requiring a large cut to access the operative site. Thus, the flexible instrument is preferably used for insertion through such small incisions and/or through a natural body lumen or cavity, so as to locate the instrument at an internal target site for a particular surgical or medical procedure. The introduction of the surgical instrument into the anatomy may also be by percutaneous or surgical access to a lumen, vessel or cavity, or by introduction through a natural orifice in the anatomy.
- In addition to use in a laparoscopic procedure, the instrument of the present invention may be used in a variety of other medical or surgical procedures including, but not limited to, colonoscopic, upper GI, arthroscopic, sinus, thorasic, prostate, transvaginal, orthopedic and cardiac procedures. Depending upon the particular procedure, the instrument shaft may be rigid, semi-rigid or flexible.
- Although reference is made herein to a “surgical instrument,” it is contemplated that the principles of this invention also apply to other medical instruments, not necessarily for surgery, and including, but not limited to, such other implements as catheters, as well as diagnostic and therapeutic instruments and implements.
- There are a number of unique features embodied in the instrument that is described herein. For example, there is provided a locking mechanism that is constructed using a ball and socket arrangement disposed about the proximal motion member that follows the bending action and in which an annular cinch ring is used to retain the ball and socket arrangement in a fixed particular position, and thus also maintain the proximal and distal bendable members in a particular bent condition, or in other words locked in that position. The cinch ring includes a locking lever that is conveniently located adjacent to the instrument handle and that is easily manipulated to lock and unlock the cinch ring and, in turn, the position of the end effector. The cinch ring is also preferably rotatable to that the locking lever can be positioned conveniently or can be switched (rotated) between left and right handed users. This lock control allows the surgeon one less degree of freedom to concentrate on when performing certain tasks. By locking the bendable sections at a particular position, this enables the surgeon to be more hands-free for controlling other degrees of freedom of the instrument such as manipulation of the rotation knob to, in turn, control the orientation of the end effector.
- A main feature of the present invention relates to the ability of the instrument to be partially disposable and partially re-useable. In that way the instrument cost can be substantially reduced as it is not necessary to replace the entire instrument for each procedure. In one embodiment a disconnect means is provided at the handle where the distal motion member, tool, instrument shaft and proximal motion member are separable from the handle of the instrument. This enables the distal components to be engageable and dis-engageable from the handle. The handle portion of the instrument is re-useable and thus the cost of that part of the instrument is essentially spread over several instrument uses.
-
FIG. 1 is a perspective view of one embodiment of thesurgical instrument 10 of the present invention. In this surgical instrument both the tool and handle motion members or bendable members are capable of bending in any direction. They are interconnected via cables (preferably four cables) in such a way that a bending action at the proximal member provides a related bending at the distal member. The proximal bending is controlled by a motion or deflection of the control handle by a user of the instrument. In other words the surgeon grasps the handle and once the instrument is in position any motion (deflection) at the handle immediately controls the proximal bendable member which, in turn, via cabling controls a corresponding bending or deflection at the distal bendable member. This action, in turn, controls the positioning of the distal tool. - The proximal bendable member is preferably generally larger than the distal bendable member so as to provide enhanced ergonomic control. In the illustrated embodiment the ratio of proximal to distal bendable member diameters may be on the order of three to one. In one version in accordance with the invention there may be provided a bending action in which the distal bendable member bends in the same direction as the proximal bendable member. In an alternate embodiment the bendable, turnable or flexible members may be arranged to bend in opposite directions by rotating the actuation cables through 180 degrees, or could be controlled to bend in virtually any other direction depending upon the relationship between the distal and proximal support points for the cables.
- As has been noted, the amount of bending motion produced at the distal bending member is determined by the dimension of the proximal bendable member in comparison to that of the distal bendable member. In the embodiment described the proximal bendable member is generally larger than the distal bendable member, and as a result, the magnitude of the motion produced at the distal bendable member is greater than the magnitude of the motion at the proximal bendable member. The proximal bendable member can be bent in any direction (about 360 degrees) controlling the distal bendable member to bend in either the same or an opposite direction, but in the same plane at the same time. Also, as depicted in
FIG. 1 , the surgeon is able to bend and roll the instrument's tool about its longitudinal axis to any orientation simply by rolling theaxial rotation knob 24 about a rotation direction indicated inFIG. 1 by the rotation arrow R1. - In this description reference is made to bendable members. These members may also be referred to as turnable members, bendable sections or flexible members. In the descriptions set out herein, terms such as “bendable section,” “bendable segment,” “bendable member,” or “turnable member” refer to an element of the instrument that is controllably bendable in comparison to an element that is pivoted at a joint. The term “movable member” is considered as generic to bendable sections and joints. The bendable elements of the present invention enable the fabrication of an instrument that can bend in any direction without any singularity and that is further characterized by a ready capability to bend in any direction, all preferably with a single unitary or uni-body structure. A definition of a “unitary” or “uni-body” structure is—a structure that is constructed only of a single integral member and not one that is formed of multiple assembled or mated components—.
- A definition of these bendable members is—an instrument element, formed either as a controlling means or a controlled means, and that is capable of being constrained by tension or compression forces to deviate from a straight line to a curved configuration without any sharp breaks or angularity—. Bendable members may be in the form of unitary structures, such as of the type shown herein in
FIG. 3 for the proximal bendable member, may be constructed of engageable discs, or the like, may include bellows arrangements or may comprise a movable ring assembly. For several forms of bendable members refer to co-pending application Ser. No. 11/185,911 filed on Jul. 20, 2005; Ser. No. 11/505,003 filed on Aug. 16, 2006 and 11/523,103 filed on Sep. 19, 2006, all of which are hereby incorporated by reference herein in their entirety. -
FIG. 1 shows a preferred embodiment of the instrument of the present invention. Further details are illustrated inFIGS. 2 through 14 .FIG. 1 depicts thesurgical instrument 10 in a perspective view, as may occur during a surgical procedure. For example, the instrument may be used for laparoscopic surgery through the abdominal wall. For this purpose there is provided an insertion site at which there is disposed a cannula or trocar. Theshaft 14 of theinstrument 10 is adapted to pass through the cannula or trocar so as to dispose the distal end of the instrument at the operative site. Theend effector 16 is depicted inFIG. 1 . The embodiment of the instrument shown inFIG. 1 is typically used with asheath 98 covering thedistal member 20 to keep bodily fluids from entering thedistal bending member 20. Theshaft 14 includes anouter shaft tube 32 and aninner shaft tube 34 as in previous applications incorporated herein. -
FIG. 2 shows aseparate sheath 46 that is temporarily used to cover the entire distal bendable member and end effector. Thissheath 46 is only used for shipping the instrument and may be discarded once the instrument is in place on the handle. Thesheath 46 keeps the jaws in an open position, as illustrated inFIG. 2 , and also keeps the distal bendable member in a substantially straight position. By doing that the actuation cable is maintained in a particular aligned position and ready for engagement with the handle portion of the instrument. Instead of using a pre-formed sheath one may alternatively use a biasing means in the instrument to maintain a predetermined position of the instrument cable, usually one in which the jaws are maintained open. - A rolling motion can be carried out with the instrument of the present invention. This can occur by virtue of the rotation of the
rotation knob 24 relative to thehandle 12 about a longitudinal shaft axis. This is represented inFIG. 1 by the rotation arrow R1. When therotation knob 24 is rotated, in either direction, this causes a corresponding rotation of theinstrument shaft 14. This is depicted inFIG. 1 by the rotational arrow R2. This same motion also causes a rotation of the distal bendable member andend effector 16 about an axis that corresponds to the instrument tip, depicted inFIG. 1 as about the longitudinal tip or tool axis P. InFIG. 1 refer to the rotational arrow R3 at the tip of the instrument. - Any rotation of the
rotation knob 24 while the instrument is locked (or unlocked) maintains the instrument tip at the same angular position, but rotates the orientation of the tip (tool). For a further explanation of the tip rotational feature refer to co-pending application Ser. No. 11/302,654, filed on Dec. 14, 2005, particularlyFIGS. 25-28 , which is hereby incorporated by reference in its entirety. - The
handle 12, via proximalbendable member 18, may be tilted at an angle to the instrument shaft longitudinal center axis. This tilting, deflecting or bending may be considered as in the plane of the paper. By means of the cabling this action causes a corresponding bend at the distalbendable member 20 to a position wherein the tip is directed along an axis and at a corresponding angle to the instrument shaft longitudinal center axis. The bending at the proximalbendable member 18 is controlled by the surgeon from thehandle 12 by manipulating the handle in essentially any direction including in and out of the plane of the paper inFIG. 1 . This manipulation directly controls the bending at the proximal bendable member. For further descriptions relating to the bending refer to co-pending application Ser. Nos. 11/528,134 filed on Sep. 27, 2006 and 11/649,352 filed on Jan. 2, 2007, both of which are hereby incorporated by reference in their entirety. - Thus, the control at the handle is used to bend the instrument at the proximal motion member to, in turn, control the positioning of the distal motion member and tool. The “position” of the tool is determined primarily by this bending or motion action and may be considered as the coordinate location at the distal end of the distal motion member. Actually, one may consider a coordinate axis at both the proximal and distal motion members as well as at the instrument tip. This positioning is in three dimensions. Of course, the instrument positioning is also controlled to a certain degree by the ability of the surgeon to pivot the instrument at the incision point or at the cannula or trocar. The “orientation” of the tool, on the other hand, relates to the rotational positioning of the tool, from the proximal rotation control member, about the illustrated distal tip or tool axis P.
- In the drawings a set of jaws is depicted, however, other tools or devices may be readily adapted for use with the instrument of the present invention. These include, but are not limited to, cameras, detectors, optics, scope, fluid delivery devices, syringes, etc. The tool may include a variety of articulated tools such as: jaws, scissors, graspers, needle holders, micro dissectors, staple appliers, tackers, suction irrigation tools and clip appliers. In addition, the tool may include a non-articulated tool such as: a cutting blade, probe, irrigator, catheter or suction orifice.
- The surgical instrument of
FIG. 1 shows a preferred embodiment of asurgical instrument 10 according to the invention in use and may be inserted through a cannula at an insertion site through a patient's skin. Many of the components shown herein, such as theinstrument shaft 14,end effector 16, distal bendingmember 20, and proximal bendingmember 18 may be similar to and interact in the same manner as the instrument components described in the co-pending U.S. application Ser. No. 11/185,911 filed on Jul. 20, 2005 and hereby incorporated by reference herein in its entirety. For example, the proximalbendable member 18 is a unitary slotted structure as shown inFIG. 6 includingdiscs 130,nibs 131 andslots 132. Many other components shown herein, particularly at the handle end of the instrument may be similar to components described in the co-pending U.S. application Ser. No. 11/528,134 filed on Sep. 27, 2006 and hereby incorporated by reference herein in its entirety. Also incorporated by reference in their entirety are U.S. application Ser. No. 10/822,081 filed on Apr. 12, 2004; U.S. application Ser. No. 11/242,642 filed on Oct. 3, 2005 and U.S. application Ser. No. 11/302,654 filed on Dec. 14, 2005, all commonly owned by the present assignee. - As illustrated in, for example,
FIGS. 1-3 , the control between the proximalbendable member 18 and distalbendable member 20 is provided by means of thebend control cables 100. In the illustrated embodiment foursuch control cables 100 may be provided in order to provide the desired all direction bending. However, in other embodiments of the present invention fewer or less numbers of bend control cables may be used. Thebend control cables 100 extend through theinstrument shaft 14 and through the proximal and distal bendable members. Thebend control cables 100 may be constrained along substantially their entire length so as to facilitate both “pushing” and “pulling” action as discussed in further detail in the aforementioned co-pending application Ser. No. 11/649,352 filed on Jan. 2, 2007. Thecables 100 may also be constrained as they pass over the conical cable guide portion of the proximal bendable member, and through the proximal bendable member itself. - The locking means interacts with the ball and socket arrangement to lock and unlock the positioning of the cables which in turn control the angle of the proximal bending member and thus the angle of the distal bendable member and end effector. This lock control allows the surgeon one less degree of freedom to concentrate on when performing certain tasks. By locking the bendable sections at a particular position, this enables the surgeon to be more hands-free for controlling other degrees of freedom of the instrument such as manipulation of the
rotation knob 24 and, in turn, orientation of the end effector. - The instrument shown in
FIG. 1 is considered as of a pistol grip type. However, the principles of the present invention may also apply to other forms of handles such as a straight in-line handle. InFIG. 1 there is shown a jaw clamping or actuation means 30 that is comprised mainly of thelever 22 which may have a single finger hole in thegimbaled ball 27. Theball 27 is mounted at the free end of thelever 22. The surgeon uses theball 27 for controlling thelever 22. There may also be provided a related release function controlled either directly by thelever 22 or a separate release button. The release function is used to release the actuated or closed tool or end effector. - In the instrument that is illustrated the handle end of the instrument may be tipped or deflected in any direction as the proximal bendable member is constructed and arranged to preferably enable full 360 degree bending. This movement of the handle relative to the instrument shaft bends the instrument at the proximal
bendable member 18. This action, in turn, via thebend control cables 100, bends the distal bendable member in the same direction. As mentioned before, opposite direction bending can be used by rotating or twisting the control cables through 180 degrees from one end to the other end thereof. - In the main embodiment described herein, the
handle 12 is in the form of a pistol grip and includes ahorn 13 to facilitate a comfortable interface between the action of the surgeon's hand and the instrument. In this embodiment the horn has the other function of providing the actuation pivot for locking and unlocking the tool control cable, as described in more detail later. Thetool actuation lever 22 is shown inFIG. 1 pivotally attached at the base of the handle. Thelever 22 actuates a slider 28 (seeFIG. 3 ) that controls the tool actuation cable 38 that extends from the slider to the distal end of the instrument. The cable 38 controls the opening and closing of the jaws, and different positions of the lever control the force applied at the jaws. The cable is depicted, for example, inFIG. 8 as includingproximal cable portion 38A anddistal cable portion 38B. - The
instrument 10 has ahandle portion 12 and adetachable shaft portion 14, as shown inFIG. 1 . The main components of the instrument may be like that shown in Ser. No. 11/649,352 filed on Jan. 2, 2007, particularly as to the construction of the bendable members, instrument shaft and end effector. This includes means for enabling rotation of the shaft and proximal bendable member within bearings or bearingsurfaces 208 and 210 (FIG. 3 ). The bearing 208 interfaces between theadaptor 26 and theball 120, while the bearingsurface 210 is between theneck portion 206 and the instrument shaft. Theseparate portions - As shown in
FIG. 2 , theshaft portion 14 can be easily separated from thehandle portion 12 by releasing thecinch ring 200. The shaft portion includes ashaft connector 212. Thecable portion 38B is provided with anend connector lug 40. Theshaft connector 212 andcable connector lug 40 are disengaged by raising thehorn 13 about apivot 272 thus enabling theshaft portion 14 and handleportion 12 to be disengaged from each other. A new shaft portion can then be easily attached to the sterilized handle by insertion and locking into the handle as described in further detail below.FIG. 1 shows the shaft and handle portions engaged which happens when thehorn 13 is pivoted to the locked or down position. See also the locked position inFIG. 3 . -
FIG. 3 shows a somewhat schematic cross-sectional view of the connections between theshaft 14 and handleportion 12. Thesplit hub 202 is constructed and arranged to allow theball 120 to be pulled out of thesplit hub 202. Thecinch ring 200 is used to lock and unlock thesplit hub 202, as described in more detail later. For other details of thesplit hub 202 refer also toFIGS. 2 and 9 . Theproximal bending member 18 is mounted to theshaft connector 212 that is indexed with the handle portion, and particularly with therotation knob 24. InFIG. 3 , theshaft connector 212 is shown connected to therotation knob 24 by means of a shaft receiver portion 300 (seeFIG. 8 ) of therotation knob 24. Theshaft connector 212 is locked into thehandle portion 12 by means of the shaft locking assembly or means 260. The shaft connector is locked linearly but theassembly 260 allows rotation of the shaft portion relative to the handle portion. InFIG. 3 the jaw actuationdistal cable portion 38B (see alsoFIG. 8 ) is shown terminated at thecoupling lug 40. It is thecoupling lug 40 that is captured by the cable coupling member or means 320 so as to in essence connect together bothportions - The split hub portions or
petals 202A-202D each have a tapered face 378 (seeFIGS. 3 and 4 ) so as to function as a ramp to force the petals apart when theball 120 is pushed proximally against them during an insertion of the shaft portion into the handle portion. These inward faces or edges of theportions 202A-202D are beveled or tapered to allow easier passage of the ball. Thesplit hub 202 is supported from the handle by means ofstruts 230 which are thinned as shown at 382 as illustrated inFIGS. 6 and 9 so as to function as flexible living hinges to thus allow more ready expansion of the hub petals. This structure assists in the engagement and disengagement between the shaft and handle. - The
cinch ring 200 has twoflanges FIG. 5 that ride in respectivecircumferential grooves grooves split hub 202. This interface captures the cinch ring while allowing the split hub to be separated linearly as is discussed in more detail hereinafter. Thecinch ring 200 is basically controlled from the angle locking member or means 140, as shown inFIGS. 2 and 9 . Theangle locking member 140 is pivotally attached with thecinch ring 200. Theangle locking member 140 is constructed and arranged to allow thecinch ring 200 to, not only be loosened enough to adjust the angle of the shaft relative to the handle, but to also expand to a size that is sufficient to allow enough expansion of the split hub portions to thus allow theball 120 to be removed or inserted in thesplit hub 202, as illustrated inFIGS. 6 and 7 . This enables the shaft portion to be dis-engaged from the handle portion. - The
cinch ring flanges grooves cinch ring 200 is loosened enough for theball 120 to be removed from the split hub, thecinch ring 200 cannot be removed from the split hub without detaching theends cinch ring 200, as illustrated in the position ofFIG. 23 . Theflanges 201 are approximately the same depth and the grooves are slightly deeper so as to not impede the pressure applied atsurface 384 of the cinch ring onsurface 386 of the split hub portions when the cinch ring is tightened, as in the position that is illustrated inFIG. 3 . - In the preferred embodiment of the instrument of the present invention there are actually considered to be three separate operational positions of the
cinch ring 200. Also, a fully disassembled position of thecinch ring 200 is illustrated inFIG. 23 .FIG. 4 shows the cinch ring in a locked first position in solid line. The phantom position shown inFIG. 4 and the position shown in solid line inFIG. 4A depict a second position in which the cinch ring has been sufficiently released so that the shaft angle can be changed or, alternatively, the cinch ring can be rotated for left or right hand use. From the position ofFIG. 4A thelink 390 can be rotated clockwise as seen inFIG. 4B to a third position which further relaxes the cinch ring enough for the disposable shaft portion to be removed from the handle portion with the cinch ring still loosely attached to the split hub, as inFIG. 15 , or to the ball portion of the shaft, as inFIG. 18 . The fourth position is shown inFIG. 23 where the cinch ring ends have been disconnected so It can be fully removed by itself from either the throw away shaft portion or from the handle portion. - The
connector 212 has an indexing feature that can be used to index thecables 100 to therotation knob 24 and/or match shafts with different tools or end effectors to certain handles. As illustrated in FIGS. 8 and 24-26, theshaft receiver portion 300 ofrotation knob 24 is provided with ribs 302 (see alsoFIG. 9 ) that mate withslots 306 on the outside surface of theconnector 212. There is also preferably provided atapered end 304 on each of theribs 302 and ataper 216 onconnector 212 to help align these members during assembly. Different rib patterns can be used as well as different thicknesses such asribs 302A andslots 306A shown inFIG. 26 .FIG. 27 schematically shows a pattern of threeribs 302B spaced 120 degrees apart in thereceiver 300 mating with three equally spacedgrooves 306B on the outside of theconnector 212, shown in phantom outline. One set of ribs and grooves may be wider than the others as a further indexing feature.FIG. 28 depicts an arrangement of eightribs 302C mating with eightslots 306C. When the connector is fully inserted in the receiver as shown inFIG. 3 , theshoulder 308 on theconnector 212contacts seat 310 in the receiver and the cable crimps 102 sit inrecess 312. - The
rotation knob 24 is keyed to the proximal bendingmember 18 and when the rotation knob is rotated through rotation angle R1, theshaft portion 14 and proximal bending member rotate on bearings or bearingsurfaces clearance hole 316 againstpost 214. To retain the rotation knob and receiver portion in the correct position when the connector is absent there is provided arim 234 on the proximal end of the rotation knob that fits loosely in theradial groove 236 in the handle halves, as shown inFIGS. 3 and 8 . - The
shaft connector 212 is locked in place by actuation of shaft locking member or means 260 which include agate 262 with asemi-circular rim 264 that loosely engages thegroove 218 in thepost 214 when the gate is in a down position. Thegate 262 rides inslides 266 onwall 318. Alink 268 pivotally connects thegate 262 to alug 270 on thehorn 13. When the horn is raised as shown inFIGS. 8 and 12 , therim 264 is clear of thegroove 218 and the shaft connector is free to slide distally out of the receiver. The horn is hinged to the handle atpin 272 and has two positions as seen in respectiveFIGS. 3 and 5 . There is a bump 274 on the horn that snaps intodimples 276 in the handle to hold the handle in either position. The horn structure includes ashroud 278 that closely fits theopening 280 in the handle to keep out contaminants. Other locking means may be used and may not be necessary if the split hub and cinch ring sufficiently contain theball 120 within thesplit hub 202 when thelever 220 is in a relaxed position. -
FIGS. 15-17 show an alternate means of attachment between the cinch ring, hub and shaft portion. In this embodiment the split hub may be separated from the shaft portion by means of a detachable front portion orring 420 that is removed along with theshaft portion 14 andball 120, as illustrated inFIG. 15-17 . Thering 420 is shown as including a plurality offingers 422 on the ring that each align withrecesses 424 in the split hub. This arrangement provide alignment of thering 420 with the split hub portions and thecinch ring flanges respective grooves split hub portions 202A-202D enabling them to flex without binding against the proximal surface of thering 420, as illustrated inFIG. 17 . Thefingers 422 are preferably attached to thering 420 by livinghinges 426 to allow them to flex with the split hub portions when thecinch ring 200 is tightened and theinside surface 384 of the ring exerts pressure onsurfaces 386. Theflanges 201 and grooves 203 are dimensioned so that thering 420 can be removed from the split hub and cinch ring, but the cinch ring can't be removed from the split hub unless the ends 200A and 200B are disconnected (refer toFIGS. 21-23 for an illustration of the disconnection of the cinch ring itself). - Reference is now made to
FIGS. 18-20 for still another embodiment for the connection and disconnection between the handle and shaft portions. Thecinch ring 200 hasdifferent depth flanges groove 203A in thering 420 and agroove 203B at the split hub. In this embodiment theflange 201A has a greater depth than theflange 201B so that theflange 201B may clear thegroove 203B and allows thering 420 to be removed along with thecinch ring 200 while retaining thecinch ring 200 on thering 420, as illustrated inFIGS. 18 and 19 . As shown inFIG. 23 , thecinch ring 200 can be totally detached from both thering 420 and the split hub by detachingends - The
angle locking member 140 is comprised primarily of the release/lock lever 220 which controls the length or outer circumference of thecinch ring 200. For a further explanation of the function of thelever 220 refer to the two cross-sectional views ofFIGS. 4 and 7 , as well as the two perspective views ofFIGS. 4A and 4B .FIG. 4 depicts the instrument in the position where the shaft portion is fully engaged with the handle portion and the cinch ring is locked.FIG. 7 on the other hand depicts the instrument with the cinch ring at least partially released. In the later position anend 200B of thecinch ring 200 can be further released, as illustrated inFIG. 23 . - As illustrated in
FIG. 4 , thelever 220 is pivoted atpin 222 which is connected to end 200A of the cinch ring. Theend 200A is in the shape of a hook (seeFIGS. 4A and 4B ) and sits in aslot 226 in the lever. Pushing one end or the other of thelever 220 pivots theend 200B of thecinch ring 200 over the center line of thepivot pin 222 either tightening the cinch ring as shown in solid line inFIG. 4 or relaxing it as shown in phantom line inFIG. 4 . In the solid line position oflever 220, the angle of the end effector is locked in place. When thelever 220 is pivoted in the direction ofarrow 410 inFIG. 4 (see alsoFIG. 4A ) thecinch ring 200 is relaxed as shown in the phantom line position inFIG. 4 . In this relaxed or released position the angle of the end effector is free to be changed by rotation of theball 120 in thesplit hub 202. Also, in the released position thecinch ring 200 may be rotated in its grooves to allow a rotational adjustment of the position of thelever 220 for ease of use. Such an alternate rotational position is shown in the cross-sectional view ofFIG. 7 wherein the cinch ring has been rotated clockwise from the position ofFIG. 4 .FIG. 7 also shows thelever 220 in its relaxed position. - The
lever 220 supports alink 390 which sits inslot 226 and pivots aboutpin 392 at one end. The other end of thelink 390 carries oppositeposts 394 that pass through holes in theend 200B of thecinch ring 200. These posts are capped off by means ofknobs 400.Knobs 400 retain theend 200B of thecinch ring 200 in a rotational relationship to thelink 390 but end 200B can easily be released when the cinch ring is to be removed (seeFIG. 22 ). The post and hole arrangement also provides a grip to rotate link 390 betweenstations FIGS. 4B and 7 , thelink 390 has been rotated in the direction ofarrow 412 fromstation 406 to station 408 which in effect loosens the cinch ring enough for the split hub to be expanded enough to remove the shaft and ball. From that position, theend 200B of the cinch ring can be removed by indexing theknobs 400 by means of indicators 401 (FIG. 23 ) in the direction of arrow 414(FIG. 22 ) so that lugs 396 on therespective posts 394 line up withkeyways 402 at theend 200B. Once aligned, theknobs 400 can be pulled outward in the direction ofarrow 416 inFIG. 22 and end 200B can be detached as therecesses 398 in the knobs clear theposts 394.Rims 404 on the knobs prevent the knobs from detaching from theend 200B. Thecinch ring 200 is then free to be completely removed from thesplit hub 202 and/orring 420 as shown inFIG. 23 . - In previous instrument constructions, the proximal bending
member 18 has been mounted directly to therotation knob 24 but now aconnector 212 andreceiver 300 allow the bendingmember 18 to be removed fromrotation knob 24. The exploded cross-sectional view ofFIG. 8 depicts the separation of theshaft portion 14 along with the proximalbendable member 18,ball 120 andconnector 212 from thehandle portion 12. Theconnector 212 is attached to the proximal end of thebendable member 18 and thecables 100 are illustrated as passing through the proximalbendable member 18 andconnector 212. The cables terminate at the resilient pads 104 (or springs) and are crimped at 102. Thus, the proximal ends of the bend control cables are terminated at theconnector 212. Theconnector 212 has apost 214 that passes through aclearance hole 314 in the rotation knob and aclearance hole 316 in theradial wall 318 of the handle. Thepost 214 has ataper 216 at its' proximal end to aid in assembly. Thepost 214 also has acircumferential groove 218 that is engaged by the shaft locking member or means 260. As depicted inFIG. 8 , the proximalbendable member 18 andconnector post 214 also carry the jawactuation cable portion 38B in a central bore thereof.FIG. 8 also shows thecable end lug 40 that is attached to the very end of thecable portion 38B and extends outwardly from thepost 214. - As indicated previously, the
horn 13 is shown in its locked position inFIGS. 1 and 3 and is shown in its released position inFIGS. 2 and 5 . As mentioned previously the pivoting of the horn causes the locking in of the shaft portion of the instrument relative to the handle portion thereof. Also, the pivoting of the horn is also used to control the inter-engagement between the cable portions by capturing thecable lug 40. This is accomplished by a clamping or releasing via a cable coupling member or means 320 which is illustrated in at leastFIGS. 3 , 10, 11, 13 and 14. The clamping member or means 320 includes a main collet member having plurality ofjaws 322 each withrecesses 324 that capture thelug 40 on the cable 38. The jaws are shown most clearly in the enlarged perspective view ofFIG. 10 . The jaws are disposed at the ends ofrespective spring arms 328 that are circumferentially disposed about the base 330 which may, in turn, be cemented to thehandle portion 38A of cable 38. Thejaws 322 are normally biased to an open position such as shown inFIG. 14 by means of the action of thespring arms 328. - The
jaws 322 of the clampingmember 320 have rampedsurfaces 326 on their outside surfaces that interact with thetapered surface 334 of thecollet 332. This interaction controls the opening and closing of the clamping member. Thecollet 332 is normally urged distally byspring 336 that is loaded against the wall of thecarriage 338 as illustrated inFIG. 13 . Thespring 336 is disposed in a pocket between a seat at the proximal end of thejaw members 322 and a seat in thecarriage 338. Theneck 340 of thecarriage 338 is fixedly attached to thebase 330 of thejaws 322, as well as to thecable portion 38B. This attachment may be by a number of different means such as by being cemented together. Refer to the cross-sectional view ofFIG. 13 illustrating the cementing at 342. - The
carriage 338 is adapted for sliding motion inside of theguide 344 which is, in turn, fixed to thehandle 12. Theguide 344 is supported by the sleeve 346 which is molded as part of the handle. InFIG. 13 thespring 336 is shown urging thecollet 332, with its' taperedsurface 334, against rampedsurfaces 326 under the bias of thespring arms 328. This action maintains the jaws closed, thus capturing thecable lug 40 therein and essentially thus joining together theseparate cable portions carriage 338 enables the cable to slide in performing its tool actuation function. Thecarriage 338 is shown as pulled proximally in the direction ofarrow 348 inFIG. 13 to show the manner in which thecarriage 338 with theclosed jaws 322 is free to move proximally from the at rest position illustrated inFIG. 3 . - Refer now to
FIG. 14 for an illustration of the release function which enables the shaft portion of the instrument to be separated or detached from the handle portion of the instrument. Thejaws 322 are opened to release thelug 40 by the action of thecams 352 against theface 354 of thecollet 332. The action of thecams 352 pushes thecollet 332 proximally as illustrated inFIG. 14 to release the jaws from aboutlug 40. Thespring arms 328 are constructed and arranged so as to normally urge the arms apart. -
FIG. 14 depicts a rest position of the instrument in which theslider 28 has normally urged the cable 38 in the direction ofarrow 350. This action places the face of thejaws 322 againstposts 356. This positioning ensures the proper alignment between theconnector 212 and thecable coupling member 320. This assures alignment at thecable lug 40 when thehorn 13 is either raised or lowered. Raising the horn lifts thelug 270 and along with it thepin 372 as illustrated inFIG. 11 . This action pulls up onarms 366 of theyoke 364 which spread around theconnector 212.Yoke 364 is supported atarms 370.Arms 366 carrypivot pins 368 that are attached to thearms 362 ofposts 356 that are, in turn, mounted onpins 358 protruding frombosses 360 molded to the sides of the handle. Theposts 356 act as stops for the proximal end of theshaft connector 212 and the face of thejaws 322. Theposts 356 havecams 352 which engage and push against the face of thecollet 354 when thehorn 13 is raised, as depicted inFIG. 14 . - An alternate embodiment of cable coupling member is shown in
FIGS. 29-33 , ascoupling member 460. In this embodiment, thecable end lug 40 has been replaced with a spring loadedcable connector 440 that is contained in apassage 450 in thepost 214 of theconnector 212. Aspring 446 biases theconnector 440 distally to maintain the end effector jaws in an open position when theshaft portion 14 is removed. Thespring 446 pushes flange 448 against the proximal end of thebendable member 18, such as depicted inFIG. 29 . This eliminates a need for asheath 46, as inFIG. 2 , and helps keep the jaws open at an at rest position.Connector 440 has atapered end 444 to aid in assembly and agroove 442 that can be captured by afinger 462 that is shown engaged in the position ofFIGS. 29 and 30 , and is normally biased to an open position as illustrated inFIG. 31 . - The
finger 462 is attached tosleeve 466 at aliving hinge portion 464 that enables thefinger 462 to flex inward when biased byflex arm 472 of theguide 470. Movement of theguide 470 over thesleeve 466 drops thefinger 462 intogroove 442 and thus captures theconnector 440, as shown inFIG. 30 . Thefinger 462 is molded as part of thesleeve 466 and has a key 480 that slides inkeyway 478 ofguide 470 to ensure proper alignment of thefinger 462 and theflex arm 472. Thesleeve 466 is cemented at 468 to the cable 38 and slides in theguide 470 which is attached to thehandle 12. When the horn is raised, acam surface 474 of theshroud 278 lifts offcam follower 476 on the end of theflex arm 472, allowing it to return to its at rest position as illustrated inFIG. 32 . This allows thefinger 462 to return to its at rest position thus releasing theconnector 440.FIG. 33 is an exploded cross-sectional view of the embodiment ofFIG. 32 and showing the instrument shaft portion removed from the handle portion. When thehorn 13 is pushed down, thecam surface 474 pushes theflex arm 472 at thefollower 476, and likewise pushes thefinger 462 to the position shown inFIG. 29 . This is a locked position for the cable coupler. Thesleeve 466 functions as a carriage as depicted inFIG. 30 when the cable 38 is pulled by theslider 28. -
FIGS. 29 and 30 both show thecoupling lug 441 captured so that both proximal and distal portions of the actuation cable are interconnected.FIG. 29 shows more of an at rest position whileFIG. 30 depicts the cable 38 pulled in the direction ofarrow 443 so as to actuate the end effector. InFIG. 30 the sleeve is shown moved to the right and thespring 446 more compressed.FIG. 32 illustrates the horn having been raised to enable release of the distal portion of the instrument with thefinger 462 and theflex arm 472 both released to a dis-engaged position. Finally, inFIG. 33 the shaft portion is shown separated from the handle portion. -
FIGS. 34-38 show still a further alternate embodiment of a cable coupling member or means 500. In this embodiment, theconnector 440 with itsend lug 441 is inserted into abore 518 inblock 502 which also functions as a carriage. A spring loadedgate 504 with a keyhole shapedopening 506 is slidably mounted intransverse passage 507 of theblock 502. Theupper rim 508 of the keyhole opening is urged downward byspring 510 to engagegroove 442 of theconnector 440 in a rotational relationship. Aneck 512 on the top of thegate 504 supports thespring 510 against abracket 514 which, in turn, supports astop 516 on the end of theneck 512. This arrangement ensures that thegate 504 does not drop out of theblock 502 when there is noconnector 440 present. - The
carriage 502 travels in aslideway 520 which is affixed to the handle. A release means ormember 522 is operated by rotating the horn. Themember 522 includes apusher 524 that riding inguides 526 and is connected to thehorn 13 bylink 528 which pivots inend bosses 530. The at rest position which is also the clamp/release position is shown inFIG. 34 . The shaft portion is shown abutting the distal end of the fixedposition slideway 520, the cable 38 is at rest, thespring 446 is at an extended position, thecarriage 502 is at the distal end of theslideway 520 and thepusher 524 is shown lined up beneath thegate 504. In the cross-sectional view ofFIG. 35 theconnector 440 is clamped by means of thegate 504.FIG. 35 also illustrates thecarriage 502 being pulled proximally, byarrow 534 by the cable 38 which, in turn, is connected to theslider 28. Thespring 510 keeps thegate 504 down and latched but theconnector 440 is free to rotate withinblock 502.FIG. 37 shows the horn raised and thepusher 524 in contact with and pushing up on the gate to align the wide portion of thekeyhole opening 506 with the connector shaft so theconnector 440 can be withdrawn as shown inFIG. 38 . - After use of the surgical instrument of the present invention the used or contaminated
shaft portion 14 can be easily detached from thehandle portion 12 and disposed of as hereinafter described. In this regard reference is now made to the manner in which the shaft portion is readily detachable for the purpose of replacement thereof. For this explanation reference is made primarily to the first embodiment described herein. To release theshaft portion 14, thecinch ring 200 is released as shown inFIGS. 2 and 5 by manipulation of the angle locking means 140 to allow thesplit hub portions 202A-202D to be able to expand enough to allow clearance for thespherical ball 120. Once the cinch ring is released the spherical ball can be pulled out of thesplit hub 202 as theshaft portion 14 is withdrawn, and thus detached from thehandle portion 12. Before detaching the shaft portion, thehorn 13 is raised upward as shown inFIGS. 2 and 5 , releasing both theshaft locking member 260 and thecable coupling member 320. Theshaft portion 14 can then be grasped at theneck portion 206 of theball 120 and pulled straight out of thehandle portion 12 and disposed of. After sterilizing thehandle portion 12, anew shaft portion 14 can be easily attached to it. - As shown in
FIG. 2 , thenew shaft portion 14 may be fitted with atemporary sheath 46 that is semi-rigid and snugly fits over the end effector and thedistal bending member 20 to hold the end effector jaws open which ensures that thelug 40 at the proximal end of theshaft portion 14 is fully inserted into theshaft connector 212. This is needed for proper alignment of the cable coupling means 320 and thelug 40 when theshaft portion 14 is inserted into thehandle portion 12. Thesheath 46 also holds thedistal bending member 20 straight and thus the proximal bendingmember 18 straight with respect to the shaft andshaft connector 212 for correct alignment when theshaft portion 14 is inserted into thehandle portion 12. There is also preferably provided an indexing means described herein in the form of ribs and grooves that ensure that theshaft connector 212 rotates in a fixed relationship to therotation knob 24 and may also provide a matching means to ensure the correct matching of specific end effectors or tools to the proper handle configurations. - Next is described the step of insertion of a new shaft portion with the handle portion. As the
shaft portion 14 enters thehandle portion 12 thespherical surface 204 of theball 120 contacts the beveled faces 378 of the respectivesplit hub portions 202A-202D and forces them apart until thespherical surface 204 can clear the points created on the inside diameter of the split hub and theangled surfaces 380, as depicted inFIGS. 6 and 7 . Theangled surfaces 380 allow thespherical ball 120 to clear the split hub with less expansion of theportions 202A-202D to make it easier to slip the ball into and out of the split hub. Thestruts 230 that attach the split hub portions to the handle have thinnedareas 382 that create living hinges that facilitate expansion of the split hub portions.FIG. 6 , although previously described as illustrating removal of the shaft portion, can also be considered as illustrative of the relative positioning when theshaft portion 14 is inserted into thehandle portion 12. - Continuing with the insertion step, next the
post 214 of theshaft connector 212 is guided into theclearance hole 314 of theshaft receiver portion 300 of therotation knob 24 and theclearance hole 316 in thewall 318 of the handle with the assistance of the taperedsurface 216 at the free end of thepost 214. Theshaft 14 can be rotated until the indexing features, such asribs 302 on the shaft receiver andgrooves 306 on theshaft connector 212, mate under the urging of the split hub portions trying to return to a memory position and exerting a proximal pressure on the distal side of thespherical ball 120. Theribs 302 are tapered at 304 and theconnector 212 is tapered at 216 to assist in the alignment. Once properly aligned, theshaft connector 212 can slide proximally until theshoulder 308 on the connector contacts theseat 310 of theshaft receiver portion 300 as depicted inFIG. 5 . - There is provided a
recess 312 in theshaft receiver 300 to allow clearance for the terminal wire crimps 102 andresilient pads 104. As the connector seats in the receiver, thecable connection lug 40 is guided into thecable coupling jaws 322 guided by thetaper 42 on the lug. When theconnector 212 is fully seated in thereceiver 300 the end of thepost 214 abuts and contacts one side of theposts 356, as illustrated inFIG. 14 . The faces of thejaws 322 abut the other side of theposts 356 as urged by thecarriage spring 336.FIG. 14 also shows that the proper distance D is provided that ensures that thelug 40 is abutting and preferably contacting the portion of the cable 38 that is attached to theslider 28. Also, this positioning provides alignment of thelug 40 with therecesses 324 in thejaws 322 so that whencollet 332 is released, thejaws 322 capture thelug 40. - Once the shaft portion is properly seated then the
shaft portion 14 is now ready to be locked to the handle. Thehorn 13 is rotated clockwise or downwardly to the position depicted inFIG. 3 . This releases thecollet 332 and thejaws 322 capture thelug 40 while the shaft locking means 260 locks theshaft connector 212 in a rotational relationship with respect to the handle. Thecinch ring 200 is then tightened by the release/lock lever 220 and thesheath 46 can be removed while gently squeezing thejaw clamping lever 22 while pulling on the distal end of the sheath. The instrument is now ready for use. - Having now described a limited number of embodiments relating to the principles of the present invention, it should now be apparent to one skilled in the art that numerous other embodiments and modifications thereof are contemplated as falling within the scope of the present invention, as defined by the appended claims. For example, although the horn member has been described as the means by which the cable coupling is initiated, it is to be understood that other existing instrument members or added members may be used to initiate this action. In one other example the tool actuation lever may be adapted for the cable coupling function.
Claims (4)
1-14. (canceled)
15. A method of controlling a medical instrument that has a proximal end including a control handle and a distal end including a distal tool, said control handle and distal tool being intercoupled by an elongated instrument shaft and said tool actuated from a tool control cable, said method including providing proximal and distal movable members that respectively intercouple said proximal control handle and said distal tool with said instrument shaft, said proximal and distal movable members being intercoupled so that a motion at said proximal movable member controls said distal movable member, dividing the tool control cable into separate cable segments and interlocking the separate cable segments so that the tool control cable is operable.
16. The method of claim 15 including manually controlling, from the proximal end of the instrument, the rotation of said distal tool about its longitudinal distal tool axis.
17-22. (canceled)
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US13/570,317 US20120303006A1 (en) | 2007-09-11 | 2012-08-09 | Surgical instrument |
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2008
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- 2008-08-27 CA CA2697746A patent/CA2697746A1/en not_active Abandoned
- 2008-08-27 WO PCT/US2008/010142 patent/WO2009035508A1/en active Application Filing
- 2008-08-27 CN CN200880106469A patent/CN101801278A/en active Pending
- 2008-08-27 JP JP2010524837A patent/JP2010538738A/en active Pending
- 2008-08-27 KR KR1020107005320A patent/KR20100071978A/en not_active Application Discontinuation
- 2008-08-27 AU AU2008297469A patent/AU2008297469A1/en not_active Abandoned
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2012
- 2012-08-09 US US13/570,317 patent/US20120303006A1/en not_active Abandoned
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Also Published As
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US20090069842A1 (en) | 2009-03-12 |
AU2008297469A1 (en) | 2009-03-19 |
CA2697746A1 (en) | 2009-03-19 |
WO2009035508A1 (en) | 2009-03-19 |
CN101801278A (en) | 2010-08-11 |
JP2010538738A (en) | 2010-12-16 |
EP2200517A1 (en) | 2010-06-30 |
US8257386B2 (en) | 2012-09-04 |
KR20100071978A (en) | 2010-06-29 |
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