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CN106473789B - 用于指示夹紧预测的系统 - Google Patents

用于指示夹紧预测的系统 Download PDF

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CN106473789B
CN106473789B CN201611024870.8A CN201611024870A CN106473789B CN 106473789 B CN106473789 B CN 106473789B CN 201611024870 A CN201611024870 A CN 201611024870A CN 106473789 B CN106473789 B CN 106473789B
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clamping
user interface
force
tissue
data processor
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CN106473789A (zh
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D·维尔
G·杜昆
K·杜伦特
P·弗拉纳干
M·尼克松
D·罗宾逊
J·扎宾斯基
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Intuitive Surgical Operations Inc
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Abstract

公开了具有闭合机构的末端执行器以及有关工具和方法。当用于微创外科手术时，所公开的末端执行器可以是特别有益的。示范性的外科手术工具包括在闭合的抓握或夹紧配置和打开配置之间可移动的第一和第二夹具。该工具还包括用于以第一力抓握组织的温和抓握模式，在温和抓握模式期间，测量夹具之间的分隔参数，该工具还包括治疗性夹紧模式，在该模式中，夹具以大于抓握力的力夹紧在身体组织上。所述方法包括在夹具部件之间抓握身体组织，测量夹具之间的分隔参数，在用户界面上指示分隔参数以用于与希望的分隔参数进行比较，并且然后响应于分隔参数指示而释放身体组织，以便重新定位或治疗性地夹紧身体组织。

Description

用于指示夹紧预测的系统
本申请是2012年1月13日提交的名称为“用于指示夹紧预测的系统”的中国专利申请201280008991.7(PCT/US2012/021342)的分案申请。
相关申请的交叉参考
本申请是2011年2月15日提交的美国临时专利申请No.61/443,159的非临时专利申请，并要求该美国临时专利申请的利益，其整个内容通过参考结合于此。
本申请涉及如下的申请：2010年2月12日提交的名称为“Cut and SealInstrument(切割和密封器械)”的美国申请No.12/705,418(律师编号No.ISRG 02180/US)；2009年11月13日提交的名称为“END EFFECTOR WITH REDUNDANT CLOSING MECHANISMS(具有冗余的封口机器的末端执行器)”的美国临时申请No.61/260,907(律师编号No.ISRG02330PROV)；2009年11月13日提交的名称为“WRIST ARTICULATION BY LINKED TENSIONMEMBERS(由张力部件链接的腕关节)”的美国临时申请No.61/260,903(律师编号No.ISRG02320PROV)，(律师编号No.ISRG 02320/US)；2009年11月13日提交的名称为“WRISTARTICULATION BY LINKED TENSION MEMBERS(由张力部件链接的腕关节)”的美国临时申请No.61/260,903，(律师编号No.ISRG 02320PROV)；2009年11月13日提交的名称为“SURGICALTOOL WITH A TWO DEGREE OF FREEDOM WRIST(具有二自由度的腕的外科手术工具)”的美国临时申请No.61/260,915(律师编号No.ISRG 02350PROV)；以及2009年11月13日提交的名称为“MOTOR INTERFACE FOR PARALLEL DRIVE SHAFTS WITHIN AN INDEPENDENTLYROTATING MEMBER(用于在独立旋转的部件内平行驱动轴的电机接口)”的美国临时申请No.61/260,919(律师编号No.ISRG 02360PROV)，其中的每个以其整体通过参考结合于此。
背景技术
微创外科手术技术的目的在于减少在诊断或外科手术期间被损坏的无关组织的量，因而减少病人的恢复时间、不舒服和有害的副作用。因此，利用微创外科手术技术可以大大缩短标准外科手术的平均住院时长。而且，利用微创外科手术也可以减少病人恢复时间、病人的不舒服、外科手术副作用和离开工作岗位的时间。
微创外科手术的通常的形式是内窥镜检查，并且内窥镜检查的通常的形式是腹腔镜检查，其包括腹腔内的微创检查和外科手术。在标准的腹腔外科手术中，病人的腹部被吹入气体，并且插管套通过小切口(约二分之一英寸或更小)以提供腹腔镜器械的进入口。
腹腔镜外科手术器械一般包括用于观察外科手术现场和工作在外科手术部位的工具。该工作工具通常类似于传统的(开放性)外科手术中所用的工具，不同的是每个工具的工作端或末端执行器与其把手之间相隔延伸的管子(通常称之为，例如，器械轴或主轴)。末端执行器可以包括：例如，夹钳、抓钳、剪刀、钉合机、烧灼工具、直线切割器或针保持器。
为了进行外科手术过程，外科医生使工作工具通过插管套到内部外科手术部位，并且从腹部的外面操纵它们。外科医生通过显示来自内窥镜的外科手术部位的图像的监控器来观察所述过程。类似的内窥镜技术用在例如关节镜检查、后腹腔镜检查、盆腔镜检查、肾盂镜检查、膀胱镜检查、脑池镜检查、窦镜检查、宫腔镜检查、尿道镜检查等。
近年来已经开发出微创机器人外科手术手术机器人系统，以便当在内部外科手术部位上工作时增加外科医生的灵活性，以及允许外科医生从远程位置(无菌区外面)对病人进行操作。在机器人外科手术手术系统中，通常在控制台为外科医生提供外科手术部位的图像。在合适的观察器或显示器上观察外科手术部位的同时，外科医生通过操纵控制台的主输入装置或控制装置对病人进行外科手术过程。每个主输入装置控制伺服机械地致动的/关节式的外科手术器械的运动。在外科手术过程期间，机器人外科手术手术系统可以为外科医生提供执行各种功能的具有末端执行器的各种外科手术器械或工具的机械致动和控制，例如，响应于主输入装置的操纵而保持或驱动针、抓握血管、切除组织等。
已经开发出用于开放性外科手术的各种工具，其中许多(虽然不必是全部)已经成功地被改进以用于微创外科手术过程。例如，手动夹钳、直线切割器和钉合机装置能够对组织施加足够的治疗夹紧力，这能够增强各种外科手术过程。遗憾的是，与本发明相关的工作表明在微创设置中采用开放式外科手术夹紧装置(和开发用于安全有效地使用它们的方法)可能比预期的更具挑战性。具体说，已经被证实非常困难的是开发和利用这样一种外科手术夹紧夹具，其能够产生希望的夹紧力，同时还为用于尺寸受限的微创外科手术接入和治疗部位提供希望的可操作性。将从外科手术钉合机、直线切割器和外科手术夹紧工具获得的优点转移到机器人外科手术设置可能涉及更大的挑战，特别是在外科医生引导的工具移动、工具致动和由新的机器人外科手术手术治疗系统提供的医生反馈中给出不同的范例。
因此，确信需要用于外科手术钉合机、直线切割器和/或其他夹紧外科手术工具的改进的方法和系统。这些工具可以在广泛的外科手术应用范围内是有益的，特别是在微创和/或机器人外科手术应用中。
发明内容
提供了改进的系统和方法以便于夹紧。要求保护的方法和系统可以用来在试图夹紧之前帮助预测以希望的夹紧力夹紧在夹具之间抓握的身体组织是否可能成功。要求保护的系统和方法在涉及在末端执行器的两个夹具之间夹紧身体组织的外科手术应用中是特别有用的。许多外科手术应用涉及以足够切割、密封和/或缝合被夹紧的组织的夹紧力夹紧身体组织。由于在夹紧失败的情况下很大的夹紧力可能潜在地损坏组织，所以本方法和系统因其在试图夹紧之前指示关于夹紧成功的可能性的预测而特别有利。虽然本文公开的各种实施例主要是关于外科手术应用来描述的，但是这些外科手术应用仅是示例性应用，并且公开的末端执行器、工具和方法可以用在人类体内和体外以及非外科手术应用等其他合适的应用中。
在第一方面中，本发明提供了指示对在第一和第二夹具之间抓握的组织的夹紧是否可能成功的方法。该方法包括确定和/或测量以抓握力抓握组织的两个夹具之间的间隔，以及响应于该间隔的确定而在用户界面上输出以希望的夹紧力夹紧被抓握的组织是否可能成功的预测的指示。在这种方法中，夹紧力大于抓握力，并且在一些实施例中，该夹紧力可以包括第一预定范围的力，其中的每个力均大于抓握力。对夹紧是否可能成功的指示符还可以包括以希望的夹紧力和以希望的夹紧间隔的夹紧是否可能成功的指示符。该希望的夹紧间隔可以包括预定范围的间隔。而且，所述间隔可以按照第一和第二夹具之间的夹角或夹具部件之间的间隔距离来表示。在许多实施例中，希望的夹紧间隔适合于发射(fire)给定尺寸的订合钉通过夹紧在夹具之间的组织、切割被抓握的组织和/或密封该被抓握的组织。所述第一和第二夹具通常是末端执行器的部件。第一和第二夹具可以包括可抵靠末端执行器的一部分铰接的第一夹具，在这种情况下，末端执行器的所述部分包括第二夹具。在一些实施例中，该预测还可以基于组织的硬度。该组织的硬度在已知的情况下可以被输入，或者当施加抓握力时可以根据抓握力和分隔，或根据分隔的变化速率来估计该组织的硬度。例如，硬度的估计可以基于根据经验得出的这些因素和组织硬度之间的关系。
要求保护的方法响应于第一和第二夹具之间的分隔参数提供夹紧成功和/或夹紧失败的指示，该第一和第二夹具具有抓握在其间的身体组织。在一些实施例中，响应于所述分隔参数和抓握力提供所述指示。该方法的一个实施例包括通常响应于来自使用者的命令而用第一和第二夹具抓握组织。该方法还包括在系统提供夹紧可能成功的指示符之后，以夹紧力将组织夹紧在第一和第二夹具之间。在系统已经提供夹紧是否可能成功或失败的指示之后，该系统通常响应于来自使用者的夹紧组织的命令而夹紧该组织。要求保护的方法的一个实施例包括在该系统已经提供夹紧失败的预测指示之后释放被抓握的组织。所述系统通常响应于来自使用者的从夹具之间释放组织的命令而释放所述被抓握的组织。
在另一方面，所述系统和方法包括第一和第二夹具以抓握力抓握身体组织的温和抓握模式，以及第一和第二夹具以夹紧力夹紧被抓握的身体组织的夹紧模式，该夹紧力大于抓握力。与夹具耦接的机构使夹具闭合以便在第一和第二夹具之间抓握和/或夹紧身体组织。该机构可以是与诸如电机等致动器耦接的一个机构，或可替换地，该机构可以包括用于施加不同幅度的力的多个机构。该致动器可以包括致动器系统，所述致动器系统包括一个或更多个致动器。致动器可以是电机、液压致动器、气动致动器和可变转矩输出致动器中的任何或全部。在具有温和抓握模式和夹紧模式的实施例中，系统通常在该系统提供夹紧被抓握的组织可能成功的指示之后响应于使用者命令而在两种模式之间转换。
在大多数实施例中，在应用抓握力或转矩期间，由所述系统测量和/或确定所述分隔参数。所述系统可以自通过控制夹具部件的机器人系统获得的位置数据来确定/测量夹具部件之间的分隔，所述机器人系统例如为美国专利申请公开No.2007/0005045中说明的机器人病人侧操纵器(PSM)系统，其整个内容通过参考结合于此。通常，夹紧力至少是抓握力的两倍，优选大于抓握力的约5至10倍。
在本发明的另一方面中，夹紧预测的指示提供在用户界面上。优选地，该指示是重叠在显示器上的视觉指示符，所述显示器在外科手术过程中提供外科手术工具的图像。在其他实施例中，夹紧预测的指示可以是任何音频的、视觉的或感觉的指示符，以便向使用者传达夹紧是否可能成功的预测。在本发明的另一方面，夹紧预测的指示还可以包括开始钉合动作是否安全的指示。例如，在夹紧是可行的预测以及夹紧已经完成之后，定时器可以被起动，使得一旦在成功夹紧之后逝去预定的时间量，则在显示器上显示进行钉合到被夹紧的组织中是安全的指示符。夹紧定时指示符可以是有利的，由于它能够随时间减少被夹紧的组织的量或者减少组织内的流体的量，以便减少钉合期间的流血并且帮助实现止血。该定时指示符还可以跟踪在夹紧的组织的钉合之后逝去的夹紧时间，以便减少流血或者帮助实现被钉合的组织的止血。
在另一方面，响应于由系统确定和/或测量的抓握的夹具之间的分隔参数而提供夹紧的预测。在许多实施例中，如果测量的分隔大于阈值或希望的抓握分隔参数，则预测指示可能的夹紧失败，而如果该抓握分隔等于或小于希望的抓握分隔参数，则预测指示可能的夹紧成功。在一些实施例中，阈值或希望的抓握分隔参数可以部分地基于显见的或估计的组织硬度。希望的分隔可以包括夹具之间的角度或夹具之间的距离，并且分隔参数可以是离散的参数或预定的数值范围。对于许多应用，该阈值或希望的抓握分隔是夹具部件的末端之间的大约8度的角度或大约6mm的距离。在一个实施例中，4度的角度产生该夹具的末端之间大约3mm的间隙。一般而言，当组织被成功地夹紧时，夹具之间的间隙为1.3mm至2mm之间，但是本领域的技术人员将会明白这个值可以根据应用而变化。在希望的分隔参数是预定的范围的实施例中，当测量的分隔在预定的范围内时，可以指示夹紧成功。例如，希望的抓握分隔参数的预定范围可以是从1到10度，优选为1到8度，或用距离来说，希望的抓握分隔参数的范围是从0.7mm到8mm，优选为2到5mm。理想地，希望的目标分隔大约为4mm。希望的分隔值或范围可以根据任意数量的变量而变化，包括但不限于：第一和第二夹具的尺寸、钉合机尺寸、关节的钉合机角度、身体组织的厚度、身体组织的类型、身体组织的特性、希望的夹紧力或希望的夹紧分隔。在许多实施例中，夹具末端之间的抓握力将在大约3lb-f至10lb-f的范围内，优选为大约5lb-f，并且夹具末端之间的夹紧力将在大约30lb-f至70lb-f的范围内，优选为大约50lb-f。抓握力和希望的夹紧力可以根据上述任何变量而变化或通过外科手术应用的类型(例如，组织切割、组织密封和/或组织的钉合)而变化。
在另一方面，本发明包括用于执行要求保护的方法的系统。理想地，该系统包括第一和第二夹具、耦接于该夹具的驱动系统、用户界面和耦接于该驱动系统的电子数据处理器。在许多实施例中，该驱动系统以预定的抓握力将该夹具闭合在组织上，该电子数据处理器测量夹具之间的距离，并且基于该夹具之间的测量的距离，电子数据处理器向用户界面输出成功以希望的夹紧力在两个夹具之间夹紧该组织的预测，其中该夹紧力在大于该抓握力的第一预定范围内，并且其中该夹紧的夹具分隔距离在第二预定范围内。理想地，该第二预定范围包括适合于对所述夹具之间的组织施加U形针的所述夹具之间的距离。
该系统还可以包括一种或多种操作模式。在一些实施例中，该系统包括温和抓握模式和夹紧模式。在温和抓握模式中，该夹具闭合或闭合以便以预定的抓握力抓握身体组织。在夹紧模式中，该夹具闭合以便以夹紧力夹紧身体组织。通常，当处于抓握模式中时，该系统仅提供夹紧成功的预测，使得外科医生可以抓握模式抓握组织，从而准备好夹紧该被抓握的组织。在具有多种模式的实施例中，该系统还可以包括用于在模式之间转换的控制器。
所述系统可以包括致动器系统，该致动器系统通过用于使夹具发生运动以便抓握和/或夹紧身体组织的机构与夹具耦接。在一些实施例中，该机构可以包括线缆和联动装置。在许多实施例中，该机构包括丝杠和凸轮。在一些实施例中，特别是在具有多种模式的实施例中，第一机构实现夹具的抓握，而第二机构用夹具实现夹紧。例如，该第一机构可以包括线缆，而第二机构可以包括丝杠。用线缆实现抓握对于用相对小的力提供快速响应是理想的，而尽管丝杠具有较长的响应时间，但是其更适合于提供较大的力。第一致动机构可以提供用于将身体组织抓握在夹具部件之间的较小的力，而第二致动结构能够提供较大的夹紧力模式。例如，在许多实施例中，由第二致动机构提供的可移动的夹具的最大夹紧力大于由第一致动机构提供的最大抓握力。
该第一和第二致动机构可以采用与用于较小的力的抓握模式和较大的力的夹紧模式的力的要求对应的不同的力传递机构。例如，由第一夹具致动机构使用以将夹具从打开移动到闭合位置的力可以包括线性力，而由第二夹具致动机构使用以将夹具从打开移动到闭合位置的力可以包括转矩。在许多实施例中，用在较小的力的抓握模式中的第一夹具致动机构包括线缆驱动机构，而用在较大的力的夹紧模式中的第二夹具致动机构包括丝杠驱动机构。
上面所述的任何方法均可以用于任何材料的夹紧并且可以用在本质上是非外科手术的应用中。例如，上面所述的方法可以在工业处理中用来指示使用者关于夹紧柔性柔顺材料的夹紧预测。
为了更充分地理解本发明的性质和优点，应当参考下面的具体实施方式和附图。从附图和下面的具体实施方式，本发明的其他方面、目的和优点将变得明显。
附图说明
图1是根据许多实施例的用来进行外科手术的微创机器人外科手术系统的俯视图。
图2是根据许多实施例的用于机器人外科手术系统的外科医生的控制台的透视图。
图3是根据许多实施例的机器人外科手术系统的电子手推车的透视图。
图4图示说明了根据许多实施例的机器人外科手术系统。
图5A是根据许多实施例的机器人外科手术系统的病人侧手推车(外科手术机器人)的主视图。
图5B是机器人外科手术工具的主视图。
图6A是根据许多实施例的具有铰接的夹具的末端执行器的透视图。
图6B是根据许多实施例的图6A的末端执行器的透视图(为了更好地示出丝杠致动机构组件，铰接的夹具被去除)。
图7A和7B示出了根据许多实施例的丝杠致动机构的组件。
图8A示出了根据许多实施例的线缆驱动的致动机构的组件。
图8B是根据许多实施例的图8A的末端执行器的透视图，其中铰接的夹具的一部分被去除，以便示出设置在该铰接的夹具后面的用于朝着闭合配置铰接该夹具的线缆驱动的致动机构组件。
图8C至8F示出了用来朝着打开配置铰接该夹具的图8A的线缆驱动的致动机构的相对侧的组件。
图9A是说明了根据许多实施例的线缆致动机构的透视图，示出了用于朝着闭合配置铰接夹具的线缆。
图9B是说明了图9A的线缆致动机构的透视图，示出了用于朝着打开配置铰接夹具的线缆。
图10是说明了根据许多实施例的丝杠致动机构的组件的剖视图。
图11是根据许多实施例的工具组件的简化的简图。
图12是根据许多实施例的安装到机器人工具操纵器的机器人工具的简化的简图。
图13A至13C描述了根据许多实施例的具有第一和第二夹具的末端执行器，并且说明了在抓握配置和夹紧配置中的夹具之间的抓握分隔。
图14A-14B说明了根据许多实施例的处于抓握配置的末端执行器。
图15A-15B说明了根据许多实施例的具有组织夹紧预测的指示符的用户界面配件。
图16A-16B说明了根据许多实施例的组织夹紧预测的指示符的示例。
图17-19说明了根据许多实施例的方法。
图20-21说明了根据许多实施例的利用方法的流程图。
图22A-22B说明了根据许多实施例的指示符的额外的示例。
具体实施方式
提供了关于身体组织的夹紧的改进的系统和方法。本发明涉及在试图夹紧组织之前提供是否可能夹紧被抓握的组织的指示符。本发明可以用在具有用于夹紧身体组织的夹具部件的系统中，特别是用在用于微创外科手术应用的外科手术系统中。通常，利用要求保护的方法的系统具有以较小的力抓握身体组织并接着以较大的力夹紧该身体组织的夹具。以较小的力抓握身体组织允许医生操纵和定位夹具部件之间的身体组织，而不导致对该组织的损坏，同时以较大的夹紧力夹紧允许医生进行各种手术，例如组织切割和密封或钉合。虽然这里公开的各种实施例主要关于外科手术应用进行描述，但是这些外科手术应用仅是示例性应用，并且所公开的系统和方法可以用在人类体内和体外以及非外科手术应用等其他合适的应用中。
在许多实施例中，所述两个夹具包括朝着末端执行器的静止部分移动的铰接的夹具。在这种实施例中，末端执行器的静止部分包括第二夹具。在许多实施例中，该系统利用两个独立的机构来铰接末端执行器的夹具。第一致动机构提供快速的响应/较小的力的模式，该模式在闭合(抓握)配置和打开配置之间改变铰接的夹具的位置。在许多实施例中，该第一致动机构是可向后驱动的。例如，在较小的力模式的抓握模式中，该第一致动机构可以被构造成在第一和第二夹具的末端之间提供5磅(lbs)的夹紧力。第二致动机构提供较大的夹紧力模式，以用于以较大的夹紧力将身体组织夹紧在该夹具之间。通常，该第二致动机构是不可向后驱动的。该第二致动机构将相对小的力或转矩(但是具有可得到的较大位移)转换成旋转末端执行器的夹具的相对大的转矩。该第二致动机构可以构造成在夹紧的夹具的末端之间提供例如50磅的夹紧力。
通常，在利用要求保护的方法的应用中，外科医生以抓握力在外科手术工具的夹具之间抓握身体组织，然后以较大的夹紧力夹紧该身体组织。定期地，夹具可能不能成功地以较大的夹紧力夹紧组织，这可能由于较大的夹紧力而潜在地导致该组织的损坏。例如，由于过分偏转，夹具可能夹紧在组织上，但是夹具末端可能比希望的相隔更远，导致潜在地组织损坏。由于各种原因，该夹具可能不能成功地夹紧组织，包括该夹具之间的不足的或过分的组织抓握，包括来自诸如骨骼等相邻组织的干扰，或组织在两个夹具之间的滑动。因此，有利的是医生能够在夹紧之前预测到何时可能发生夹紧失败，因而避免对组织的任何潜在的损坏。所述系统和方法向医生提供夹紧身体组织是否将成功的预测的指示。当夹具处于夹紧位置并且夹具之间的距离足以用于执行希望的治疗(例如发射订合钉通过被夹紧的组织)时，夹紧可以被认为是成功的。
夹紧是否更趋向于成功的指示可以完全或部分地基于当组织抓握在其间时夹具部件之间的分隔。理想地，该方法包括以抓握力抓握组织，测量和/或确定夹具部件之间的分隔，以及向医生提供关于夹紧被抓握的组织是否更趋向于成功的指示。该方法还可以包括测量或确定该被抓握的组织的相对硬度。当用在微创外科手术应用中时，本发明的这些系统和方法是特别有益的。此外，夹紧成功或失败的指示还可以包括以多个抓握力(例如，依次更大的力)的预测，使得使用者可以用被指示为可能产生成功夹紧的力来抓握。在一些实施例中，该特征可以扩展为在连续增大抓握力期间基于夹具位置考虑夹紧成功或失败的可能性。该夹紧力还可以包括基于夹具位置和抓握力之间的关系的可变的夹紧力。例如，如果夹具之间的距离大于希望的距离，诸如可能在当指示夹紧可能失败的指示时发生，则可以施加更大的夹紧力(例如，由使用者施加或自动施加)，并且测量第二数据点以确定以更大的夹紧力的夹紧预测的指示。
微创机器人外科手术
现在参考附图，其中在所有若干附图中，相同的附图标记表示相同的零件，图1是本发明的实施例的俯视图。图1说明了微创机器人外科手术(MIRS)系统10，其通常用来对躺在手术台14上的病人12进行微创诊断或外科手术过程。该系统可以包括在手术过程期间由外科医生18使用的外科医生的控制台16。一个或多个助手20也可以参与手术过程。该MIRS系统10还可以包括病人侧手推车22(外科手术机器人)和电子手推车24。病人侧手推车22可以操纵至少一个可移除地耦接的工具配件26(此后简称为“工具”)通过病人12的身体中的微创切口，同时外科医生18通过控制台16观察外科手术部位。工具配件26包括末端执行器25，该末端执行器具有用于抓握和夹紧组织的夹具。外科手术部位的图像可以通过诸如立体内窥镜等内窥镜28获得，所述内窥镜可以由病人侧手推车22操纵，以便取向该内窥镜28。电子手推车24可以用来处理随后通过外科医生的控制台16向外科医生18顺序显示的外科手术部位的图像。电子手推车24包括用于测量工具的夹具部件之间的分隔参数的处理器27。抓握分隔参数可以直接测量或间接测量。该分隔可以由处理器从实际的夹具部件或表示该夹具部件的位置的图像直接测量，或者从该系统的各种传感器直接测量。例如，霍尔效应型传感器可以定位在铁砧夹具枢轴附近以测量该夹具的闭合角。该霍尔效应型传感器可以设置在订合钉夹头中(或一对夹具中的任一个夹具中)并且磁铁对应地设置在所述铁砧夹具(或相对的夹具)中。传感器能够感测该磁铁的附近以确定该铁砧夹具是否足够闭合。在另一个示例中，形状感测光纤可以设置在夹具中，使得能够感测夹具角度。在一些实施例中，至少一个夹具可以装备有深度计并且相对的夹具可以装备有传感器，以测量该深度计。例如，该深度计可以是很小的可收缩的针，一旦组织被抓握，该针能够被展开以测量夹具之间的分隔距离。该分隔还可以通过自工具位置数据计算所述分隔而被间接测量，例如通过自PSM获得的位置数据或者其导数的计算。该处理器也可以响应于所述分隔参数提供关于夹紧是否可能成功的指示。该指示可以根据公式或算法确定，或者从预定的数值表中得到。系统10之后向医生的控制台16上的医生传达所述预测的指示符。
图2是外科医生的控制台16的透视图。该科医生的控制台16包括左眼显示器32和右眼显示器34，以用于向医生18提供能够实现深度感知的外科手术部位的带坐标的立体视图。控制台16还包括一个或多个输入控制装置36，该输入控制装置反过来又使病人侧手推车22(图1所示)能够操纵一个或多个工具。该输入控制装置36将提供与其相关联的工具26(图1所示)相同的自由度，以便为外科医生提供遥测，或提供输入控制装置36与工具26一体形成的感知，使得外科医生具有直接控制该工具26的强烈感觉。为此，可以采用位置、力和触觉反馈传感器(未示出)以通过输入控制装置36将位置、力和触觉感觉从工具26传输回外科医生的手。
外科医生的控制台16通常设置在和病人相同的房间中，使得外科医生可以直接监控手术过程，必要时可以实体地存在，并且和助手直接对话而不是通过电话或其他通信媒介。但是，外科医生可以位于不同的房间中、完全不同的建筑物中或者允许远程外科手术过程的距病人的其他远程位置(即在无菌区域外操作)。
图3是电子手推车24的透视图。该电子手推车24可以耦合内窥镜28并且可以包括处理器27，以测量和/或确定工具的夹具部件之间的分隔参数，并且响应于该测量的分隔参数而确定夹紧成功的预测。处理器27还可以处理捕捉的图像以用于随后的显示，例如在外科医生的控制台上或在本地和/或远程定位的其他任意合适的显示器上显示给外科医生。
图4图示说明了机器人外科手术系统50(例如图1的MIRS系统10)，其中处理器58和显示器60被描述为与电子手推车56和外科医生的控制台52分隔。正如上面所讨论的，在微创手术过程中，外科医生的控制台52(例如图1的外科医生的控制台16)能够被外科医生使用以控制病人侧手推车(外科手术机器人)54(例如图1中的病人侧手推车22)。在用于夹紧身体组织的准备中，外科医生能够命令病人侧手推车54的工具以将身体组织抓握在末端执行器的夹具部件之间。响应于这种命令，处理器58能够测量抓握该组织的夹具部件之间的分隔参数，并且随后完全地或部分地根据该分隔参数而确定夹紧预测。夹紧预测的确定也可以包括抓握力、希望的夹紧力和处于夹紧配置的夹具部件之间的希望的距离。处理器58然后命令显示器60向外科医生显示该预测的指示符。响应于该指示符，外科医生之后可以安全地进行身体组织的夹紧或可以中止夹紧，并且重新定位该夹具，直至显示器60指示夹紧成功的预测。
图5A和图5B分别示出了病人侧手推车22和外科手术工具62。外科手术工具26其中之一的外科手术工具62是具有用于抓握和夹紧身体组织的一组夹具部件的末端执行器的一个示例。所示的病人侧手推车22提供了对三种外科手术工具26和诸如用于捕捉手术过程的部位的图像的立体内窥镜等成像装置28的操控。操控通过具有多个机器人接头的机器人机构提供。成像装置28和外科手术工具26可以通过病身体内的切口而定位和操控，使得运动的远程中心保持在该切口处，以便使切口的尺寸最小。当外科手术工具26的远端定位在成像装置28的视场内时，外科手术部位的图像可以包括外科手术工具26的远端的图像。
通过独立的致动机构的组织抓握和夹紧
在许多实施例中，两个独立的致动机构用来控制末端执行器的铰接的夹具的铰接。第一致动机构可以用来提供快速响应/较小的力抓握模式，而第二致动机构可以用来提供较大的夹紧力模式，该夹紧力大于抓握力。在许多实施例中，用来提供快速响应/较小的力铰接模式的该第一致动机构是可向后驱动的。在许多实施例中，用来提供较大的夹紧力铰接模式的第二致动机构是不可向后驱动的。在一些外科手术应用中，利用独立的致动机构可以是有益的，例如在电灼密封、钉合等在较大的力的夹具夹紧被用于实施外科手术工具的任务之前可能要求多个较小的力的夹具布置夹紧的应用中。
在许多实施例中，在快速响应/较小的力抓握模式中的夹具的致动由包括一对牵引线缆的线缆致动机构提供。在许多实施例中，该对线缆的第一线缆的牵引运动朝着闭合(抓握)配置铰接所述被铰接的夹具，而该对线缆的第二线缆的牵引运动朝着打开(不抓握)配置铰接所述被铰接的夹具。在许多实施例中，该线缆致动机构是可向后驱动的。
在许多实施例中，处于较大的夹紧力模式中的夹具的致动由包括丝杠驱动的凸轮的丝杠致动机构提供。被驱动的凸轮与铰接的夹具上的匹配的凸轮表面接合，以便当丝杠驱动的凸轮处在其运动范围的第一端时将铰接的夹具保持在闭合(夹紧)配置中。此外，当丝杠驱动的凸轮处在其运动范围的第二端(相对的端)时，被驱动的凸轮不限制该铰接的夹具的运动。换句话说，匹配的凸轮表面被设置成使得丝杠驱动的凸轮在一个方向的运动将引起所述铰接的夹具的闭合，并且该丝杠驱动的凸轮在相反方向的运动将允许(但并非迫使)该铰接的夹具打开到由凸轮表面提供的限度。通常，丝杠致动机构是不可向后驱动的。在许多实施例中，末端执行器的夹具部件的位置能够由该线缆致动机构的位置确定，或如果由丝杠驱动，则由丝杠的位置确定。
图6A是根据许多实施例的具有由两个独立的致动机构铰接的夹具72的末端执行器70的透视图。该末端执行器70包括末端执行器底盘74、铰接的夹具72和可拆卸的固定夹具76。该末端执行器70经由第一驱动轴78、第二驱动轴80和两个驱动线缆(未示出)致动。第一驱动轴78旋转丝杠致动机构的丝杠82。第二驱动轴80旋转所述可拆卸的固定夹具/订合钉接头复载机76的另一个丝杠(未示出)。
在许多实施例中，第一驱动轴78和/或第二驱动轴80由定位在近端工具底盘中的驱动特征件驱动，末端执行器70经由器械轴与所述近端工具底盘耦接。在许多实施例中，该近端工具底盘构造成可释放地安装到机器人工具操纵器。在许多实施例中，第一驱动轴78和第二驱动轴80经由定位在近端工具底盘中的相应的驱动特征件致动。在许多实施例中，这些驱动特征件由定位在近端工具底盘中的致动器或电机系统驱动。
图6B是根据许多实施例的图6A的末端执行器70的透视图(为了更好地示出丝杠致动机构的组件，铰接的夹具72被去除)。丝杠82被安装以相对于末端执行器基座74旋转。丝杠驱动的凸轮84与丝杠82耦接，使得丝杠82的选择的旋转能够用来选择性地沿着末端执行器基座74中的凸轮槽86移动丝杠驱动的凸轮84。末端执行器70包括枢轴销88，其用来将铰接的夹具72旋转地耦接末端执行器基座74。
图7A至图10示出了致动机构，通过该致动机构，末端执行器以较小的力抓握模式在其夹具之间抓握身体组织，并且以较大的夹紧力在其夹具之间夹紧被抓握的身体组织。
图7A和图7B说明了图6A和图6B的丝杠致动机构。丝杠82具有远端轴颈表面96和与近端轴承98接合的近端轴颈表面。在许多实施例中，远端轴颈表面96被容纳在位于凸轮槽86的远端的圆柱形塞孔内。用于丝杠82的这种远端支撑物可以构造成保持丝杠82避免过分摆动，并且在远端轴颈表面96和圆柱形塞孔之间具有相对大的间隙。该近端轴承98由末端执行器基座74支撑，以便支撑丝杠82的近端。近端轴承98可以是有助于减小摩擦和磨损的滚珠轴承。远端轴承(未示出)可以由末端执行器基座74支撑以便支撑丝杠82的远端，并且远端轴承可以是滚珠轴承。丝杠驱动的凸轮84包括构造成与丝杠82的外部螺纹配合的螺纹孔。丝杠驱动的凸轮84包括构造成与凸轮槽86的对应的顶部和底部表面相互作用的顶部和底部表面。丝杠驱动的凸轮84和凸轮槽86之间的相互作用防止丝杠驱动的凸轮84相对于凸轮槽86旋转，这种旋转将使丝杠驱动的凸轮84响应于丝杠的旋转而沿凸轮槽86移动。
铰接的夹具72包括匹配的凸轮表面94，其构造成使得丝杠驱动的凸轮84沿着凸轮槽86的位置确定铰接的夹具72绕枢轴销88的旋转运动的程度被丝杠驱动的凸轮84约束。该铰接的夹具72包括第一近侧100和被中间槽分隔的第二近侧102。当铰接的夹具72经由枢轴销88与末端执行器基座74耦接时，该第一和第二近侧被设置在末端执行器基座74的相对两侧上。第一和第二近侧100、102中的每个均包括限定匹配的凸轮表面94并且提供丝杠驱动的凸轮84和近侧100、102之间的间隙的凹进区域。当丝杠驱动的凸轮84位于凸轮槽86处或在其近端附近(靠近其在图7A和图7B中所示的位置)时，丝杠驱动的凸轮84和铰接的夹具72的匹配的凸轮表面94之间的接触将该铰接的夹具保持在夹紧配置中。当丝杠驱动的凸轮84位于在凸轮槽86的远端时，该铰接的夹具绕枢轴销88的旋转位置在夹紧配置(其中在该丝杠驱动的凸轮84和铰接的夹具72的匹配凸轮表面94之间存在间隙)和打开配置(其中在丝杠驱动的凸轮84和铰接的夹具72的匹配凸轮表面94之间可以存在或可以不存在间隙)之间的旋转位置的范围内不受丝杠驱动的凸轮84的约束。对于丝杠驱动的凸轮84在凸轮槽86的近端和远端之间的位置，不受约束的运动的范围可以根据所用的凸轮表面而变化。
在每个近侧100、102中利用凹进部分限定该铰接的夹具72的匹配凸轮表面94提供了许多益处。例如，与延伸通过近侧的横向槽相对的凹进部分的使用为铰接的夹具的近侧100、102提供了连续的外表面，这比横向槽开口更少可能阻碍病人组织。没有横向槽与具有横向槽的近侧相比也有助于硬化近侧100、102，并由此提供增大的夹紧硬度。这样的近侧100、102在两个平面中可以具有增强的硬度，这能够有助于在存在外力的情况下保持铰接的夹具72的对齐。在两个平面中的这种增加的硬度在一些外科手术应用中可以是有益的，例如，在对保持订合钉和形成该订合钉的铁砧袋之间的对齐有益的组织钉合中。而且，利用凹进部分代替横向槽与具有包含横向开口槽的近侧的致动机构相比还提供了较少可能被外部材料堵塞的致动机构。
丝杠致动机构可以构造成在末端执行器的铰接的夹具和相对的夹具之间提供希望的夹紧力。例如，在许多实施例中，丝杠致动机构被构造成在铰接的夹具72的末端(距枢轴销88大约2英寸)提供至少20磅的夹紧力。在许多实施例中，丝杠致动机构被构造成在铰接的夹具72的末端提供至少50磅的夹紧力。在许多实施例中，为了在铰接的夹具72的末端产生50磅的夹紧力，对丝杠82的输入转矩是大约0.1牛米，并且丝杠82具有大约30匝。
丝杠致动机构可以用可获得的材料和组件制造。例如，丝杠致动机构的许多组件可以用可获得的不锈钢制造。丝杠驱动的凸轮84可以被涂覆(例如，TiN)以减少与其抵靠摩擦的表面(例如，丝杠82、末端执行器基座74、铰接的夹具72的近侧100、102)的摩擦。绞合的线缆可以用来驱动第一致动机构。
图8A至图8F说明了根据许多实施例的线缆致动机构110的组件。如上所述，丝杠驱动的凸轮84可以定位在凸轮槽86的远端(即，枢轴销88附近)。如上所述，对于丝杠驱动的凸轮84的这种远端位置，铰接的夹具72绕枢轴销88的旋转位置不约束铰接的夹具72的旋转位置的范围。因此，铰接的夹具72绕枢轴销88的旋转位置可以由线缆致动机构110控制。线缆致动机构110可操作为在闭合配置和打开配置之间变化铰接的夹具的旋转位置。线缆致动机构110包括一对牵引线缆112、114。线缆致动机构110还包括用来朝着闭合配置绕枢轴销88旋转铰接的夹具72的第一联动装置116，以及用来朝着打开配置绕枢轴销88旋转铰接的夹具72的类似的第二联动装置118。第一联动装置116(图8A和8B所示)包括旋转连杆120，其经由枢轴销122安装以用于相对于末端执行器基座74旋转。连接连杆124经由枢轴销126和枢轴销128将旋转连杆120耦接到铰接的夹具72。第一联动装置116经由牵引线缆112的牵引运动而铰接。在操作中，牵引线缆112的牵引运动绕枢轴销122沿顺时针方向旋转所述旋转连杆120。引起的连接连杆124的运动绕枢轴销88沿逆时针方向朝着闭合配置旋转铰接的夹具72。
线缆致动机构110的第二联动装置118(图8C至图8F中所示)包括与第一联动装置116类似的组件，例如，经由枢轴销132安装以用于相对于末端执行器基座74旋转的旋转连杆130，以及经由两个枢轴销136、138将旋转连杆130耦接到铰接的夹具72的连接连杆134。该第二联动装置118经由牵引线缆114的牵引运动而铰接。第二联动装置118构造成使得牵引线缆114的牵引运动绕枢轴销88朝着打开配置旋转铰接的夹具72。在许多实施例中，第二联动装置118的连接连杆134和旋转连杆130之间的枢轴销136与第一联动装置116的连接连杆124和旋转连杆120之间的枢轴销126的相位相差180度。线缆致动机构110的牵引线缆112、114的协同的牵引和延伸用来在打开和闭合配置之间铰接所述铰接的夹具72。为了最好地提供相等并相对的线缆运动(并且因而保持如下所述的绞盘驱动系统中的线缆张力)，用于枢轴销122、132的公共旋转轴线被构造成当铰接的夹具72闭合(或接近闭合)并且当铰接的夹具72再次打开(或接近打开)时位于包含枢轴销128、138的旋转轴线的平面内。连接连杆124、134绕用于第一和第二联动装置116、118的这个相同的平面对称地相对地装配。枢轴销122、126之间的距离和枢轴销132、136之间的距离对于第一和第二联动装置116、118两者是相同的，并且枢轴销126、128之间的距离和枢轴销136、138之间的距离对于第一和第二联动装置116、118两者是相同的。
图9A和图9B说明了根据许多实施例的经由其他线缆致动机构140的铰接的夹具72的铰接。在线缆致动机构的实施例140中，第一牵引线缆142和第二牵引线缆144与铰接的夹具72的近端直接耦接。第一牵引线缆142绕第一滑轮146缠绕，使得第一牵引线缆142的牵引运动使铰接的夹具72绕枢轴销88朝着夹紧配置旋转。第二牵引线缆144绕第二滑轮148缠绕，以便第二牵引线缆144的牵引运动使铰接的夹具72绕枢轴销88朝着打开配置旋转。因此，线缆致动机构140的第一和第二牵引线缆的协同的牵引和延伸用来在打开配置和夹紧配置之间铰接所述铰接的夹具72。为了最好地提供相等并相对的线缆运动(并且因而保持如下所述的绞盘驱动系统中的线缆张力)，由线缆142绕枢轴销88规定的圆弧的半径与由线缆144绕枢轴销88规定的半径是基本相同的。
在许多实施例中，线缆(即，较小的力)致动机构包括一对牵引线缆，其经由设置在近端工具底盘中的致动特征件致动。该近端工具底盘构造成可释放地安装到具有驱动机构的机器人工具操纵器，该驱动机构可操作地与致动特征件耦接。例如，这对牵引线缆能够绕设置在近端工具底盘中的绞盘缠绕。当近端工具底盘安装到机器人工具操纵器时，所述绞盘可以可操作地与机器人工具操纵器的绞盘驱动伺服电机耦接。绞盘驱动电机的选择的旋转可以用来产生该绞盘的对应的旋转。绞盘的旋转能够用来产生牵引线缆的协同的延伸和缩回。如上所述，牵引线缆的协同的致动能够用来产生末端执行器的铰接的夹具的对应的铰接。
在许多实施例中，快速响应/较小的力模式由可向后驱动的线缆致动机构提供。例如，施加于铰接的夹具的外力能够用来朝着夹紧配置旋转该铰接的夹具并且向后驱动线缆致动机构。通过包括绕绞盘缠绕的一对牵引线缆的线缆致动机构，朝着闭合配置旋转该铰接的夹具的外力在一个牵引线缆中产生增大的张力，而在另一个牵引线缆中产生减小的张力，因而，引起绞盘响应于此的旋转。正如所知道的，这种线缆驱动系统可以构造成具有针对可向后驱动性的足够的效率。同样，施加到铰接的夹具的外力能够用来朝着打开配置旋转铰接的夹具，并且向后驱动线缆致动机构。如上所述，可向后驱动的快速响应/较小的力致动机构提供了许多益处。
可替换的机构可以用来提供快速响应/较小的力致动模式。例如，可以使用包括推/拉杆的致动机构。
图10是说明了如上所述的丝杠致动机构的组件的剖视图。所示的组件包括丝杠82、丝杠驱动的凸轮84、末端执行器基座74中的凸轮槽86、远端轴颈表面96、末端执行器基座中的圆柱形塞孔154以及由末端执行器基座74支撑的近端轴承98。
图11是根据许多实施例的工具配件170的简化的透视简图。该工具配件170包括近端致动机构172、具有近端和远端的细长轴174、设置在该轴的远端的工具主体176、在夹紧配置和打开配置之间相对于该工具主体176可移动的夹具178、与该夹具耦接的第一致动机构和与该夹具耦接的第二致动机构。该第一致动机构是可操作的，以在夹紧配置和打开配置之间相对于工具主体改变该夹具的位置。该第二致动机构具有将夹具保持在夹紧配置的第一配置和该夹具相对于工具主体的位置不受第二致动机构的约束的第二配置。该第一致动机构与近端致动机构可操作地耦接。在许多实施例中，第一致动机构包括由近端致动机构致动的一对牵引线缆。第二致动机构与近端致动机构可操作地耦接。在许多实施例中，第二致动机构包括位于工具主体中的丝杠驱动的凸轮，所述丝杠驱动的凸轮经由从近端致动机构延伸通过细长轴174的驱动轴由近端致动机构驱动。虽然工具配件170已经描述为具有第一和第二致动机构，但是在一些实施例中，工具配件170可以构造为具有由可变力电机驱动的单个致动机构，使得该工具能够通过单个致动机构用相对小的力抓握身体组织，并且随后能够以较大的夹紧力充分夹紧被抓握的身体组织。
所述工具配件170可以构造成用于各种应用中。例如，该工具配件170可以构造成手持式装置，具有用在近端致动机构中的手动和/或自动的致动。该工具配件170还可以构造成用在外科手术应用中，例如电灼密封、钉合等。该工具配件170可以具有微创机器人外科手术之外的应用，例如，用在非机器人微创外科手术、非微创的机器人外科手术、非机器人非微创外科手术以及利用公开的冗余的夹具致动可以带来益处的其他应用。
冗余的夹具致动可以用来铰接机器人工具末端执行器的夹具。例如，图12示意地示出了利用冗余的夹具致动的机器人工具180。该机器人工具180包括近端工具底盘182、驱动电机184、器械轴186、远端末端执行器188、第一致动机构部分190和第二致动机构192。该远端末端执行器188包括铰接的夹具194。该近端工具底盘182可释放地安装到机器人工具操纵器196，该机器人工具操纵器196具有第一驱动器198以及第一致动机构部分200，当近端工具底盘182安装到机器人工具操纵器196时，第一致动机构部分200与该机器人工具180的第一致动机构部分190可操作地耦接。该器械轴186具有邻近该工具底盘182的近端和邻近该末端执行器188的远端。当工具底盘182安装到工具操纵器196以便在打开配置和闭合配置之间铰接末端执行器188时，该第一致动机构(包括部分200和部分190)将第一驱动器198耦接于铰接的夹具194。该第二致动机构192将驱动电机184耦接于铰接的夹具194，以便将末端执行器从打开配置铰接成夹紧/闭合配置。该第一致动机构可以是线缆致动机构，例如上面描述的提供快速响应/较小的力模式的线缆致动机构。在许多实施例中，该第一致动机构是可向后驱动的。第二致动机构可以包括将驱动电机184耦接于丝杠致动机构的驱动轴，例如，上面描述的提供较大的夹紧力模式的丝杠致动机构。在许多实施例中，该第二致动机构是不可向后驱动的。在两种模式中，夹具部件的位置通过与末端执行器188耦接的PSM得到。通过在身体组织与末端执行器抓握期间由PSM获得的位置数据，处理器191能够确定分隔参数和以夹紧力用末端执行器夹紧成功的关联的预测。
图13A-13C说明了末端执行器188的分隔参数的示例并且示出了在抓握和夹紧位置中的末端执行器188。图13A示出了末端执行器188的夹具，其中分隔参数是夹具部件的末端之间的距离，或者可以是夹具部件之间的角度。图13B示出了以抓握力(Fg)将身体组织(T)抓握在夹具部件之间的末端执行器188。在这个实施例中，当以已知的力Fg将身体组织T抓握在夹具部件之间时，所述系统测量所述分隔参数。作为响应，该系统在用户界面上提供关于以较大的夹紧力(Fc)夹紧该被抓握的身体组织T是否更趋向于成功的指示。夹紧成功的可能性的指示可以完全或部分地基于分隔参数，但是也可以基于额外的因素，包括但不限于：身体组织(T)的类型(例如，肠、胃)、身体组织的厚度、希望的夹紧力Fc以及在完全夹紧的状态中夹具部件之间的希望的分隔。例如，在一个实施例中，要求保护的系统可以响应于小于阈值或希望的抓握分隔的抓握分隔参数而提供关于以夹紧力Fc夹紧该被抓握的组织的可能性的指示。可选地，如果测量的分隔大于预定的分隔参数，则该系统可以向使用者提供夹紧可能不成功的指示。预定的分隔参数可以根据上面说明的任何额外的因素而变化。图13C示出了用夹紧力Fc成功地将身体组织T夹紧在夹具部件之间的末端执行器188，该夹紧力在大于抓握力Fg的希望的力的范围内。
图14A-14B示出了以抓握力Fg抓握身体组织T的末端执行器188的两个示例。图14A示出其中在抓握所述组织小于以给定的希望的夹紧力Fc和/或希望的夹紧分隔的夹紧预测确定的预定的抓握分隔或目标分隔(St)时末端执行器188的夹具之间的实际分隔(Sa)的一个示例。在这个示例中，该系统将预测成功的夹紧并且在用户界面上向外科医生提供所述预测的指示。图14B示出一个示例，其中由于在末端执行器的夹具之间的组织滑动或不足够的组织，身体组织被定位成使得夹紧可能是不成功的。在这个示例中，末端执行器188的夹具之间的实际测量的分隔(Sa)大于预定的分隔或目标分隔(St)，所述预定的分隔或目标分隔(St)通过以给定的夹紧力Fc和/或夹紧分隔的夹紧预测而确定。在这个实施例中，该系统将预测夹紧可能是不成功的并且在用户界面上向外科医生提供该预测的指示。在提供夹紧可能不成功的指示之后，在没有来自使用者的另外的输入的情况下，所述系统可以防止外科医生夹紧。
图15A-15B说明了在系统10的用户界面显示器60上的关于夹紧被抓握的组织是否可能成功的指示。通常，在外科手术期间，除了夹紧预测的指示符之外，用户界面显示器60还显示外科手术工具末端执行器的图像和/或视觉表示。在外科手术过程期间，夹紧预测的指示可以重叠在用户界面显示器上的图像上，以便无缝地将该特征并入外科手术过程中。优选地，夹紧预测指示符只有在外科医生在为夹紧做准备而实施组织抓握时才出现。夹紧预测的指示促进了在外科手术期间由外科医生成功地夹紧身体组织，同时使由于不成功的夹紧所引起的潜在的组织损坏最小。图15A示出了具有重叠在该屏幕的右下角区域上的夹紧预测指示符250的显示器60，其中该指示符预测夹紧更可能成功。图15B示出了具有重叠在该屏幕的右下角区域上的夹紧预测指示符250的显示器60，其中该指示符指示夹紧将可能不成功的预测。通常，由于与身体组织相互干扰，外科医生将不能借助于内窥镜显现整个外科手术工具，或者外科医生可以观察该工具的视觉表示。在图15A-15B中，在显示器60上的末端执行器189的夹具的图示表示被夸大，并且通常外科医生可能不能够单独从观察显示器60上的外科手术工具的图像而确定夹紧是否将成功。
图16A-16B示出了夹紧预测指示符250的额外的示例。图16A示出了指示符的一个示例，其中该夹紧预测是可能夹紧成功的梯度。该系统和方法可以根据各种因素确定该梯度内的预测，包括但不限于：抓握组织的夹具之间的实际的分隔和预定的目标分隔之间的差、组织的类型、组织的厚度或希望的夹紧力和/或夹紧分隔。例如，当夹具抓握组织时该预定的分隔可以在可接受的抓握分隔的范围内，并且明显在该预定的抓握分隔的范围之外的实际测量的抓握分隔是较少可能夹紧成功的。例如，在一个实施例中，如果实际测量的分隔在0-2度内，于是该系统将显示99％的夹紧成功的可能性的指示符。当测量的分隔从2度增加到8度时，成功可能性以单调递减的关系减小，例如从99％下降到10％。图16B示出了具有指示符的实施例，该指示符在两个设置即预测的夹紧成功设置和预测的夹紧失败设置之间转换。在这个示例中，指示符仅是灯，当照亮时，指示夹紧更可能成功，而当变暗时，指示夹紧成功是不可能的。
图17-19图示地说明了要求保护的方法的实施例。图17是示例性方法300的简化的图示。方法300包括测量以已知的抓握力抓握组织的两个夹具之间的分隔的步骤302，和当以较大的夹紧力夹紧在两个夹具之间的被抓握的组织时在用户界面上指示夹紧可能成功或失败的步骤304。图18是方法310的简化的图示，该方法310还包括通常响应于来自使用者的命令通过该系统以抓握力在两个夹具之间抓握身体组织的步骤312和步骤318，在步骤318中，在该系统已经测量了夹具之间的分隔并且分别在步骤314和316提供预测的夹紧成功的指示之后，响应于来自使用者的夹紧该组织的命令而以夹紧力在夹具之间夹紧该身体组织。图19是方法320的简化的图示，该方法320进一步包括在该系统已经进行提供夹紧可能成功的指示的步骤332之后，响应于来自使用者的重新定位该夹具的命令而将夹具重新定位在身体组织上的步骤334。
图20-21示出了说明要求保护的方法的实施例的流程图。图20是示出要求保护的方法的实施例的流程图，其中在身体组织已经抓握在夹具之间之后(MTM抓握在组织上闭合)，该系统从PSM读取该分隔(夹具角度)。如果分隔(角度)小于预定的分隔(阈值角度)，则系统指示使用者夹紧可能成功。如果该分隔(角度)不小于预定的分隔(阈值)，则该系统指示使用者夹紧可能不成功。如果使用者对系统提供输入以夹紧(按下蓝色踏板)，则该系统继续进行被抓握在夹具内的组织的夹紧。图20是示出并入在外科手术系统中的要求保护的方法的实施例的流程图，该外科手术系统用于通过将订合钉发射到被夹紧的组织中而夹紧并密封该身体组织。在图20-21中，该系统可以要求使用者输入，例如在进行选择的动作之前按下蓝色或黄色踏板。
图22A-22B说明了在系统10的用户界面显示器60上的关于继续进行被夹紧的组织的钉合是否可取的指示。该指示可以仅仅是继续进行钉合是否安全的指示符，或还可以包括用于示出在用末端执行器189夹紧组织之后逝去的时间(或可替换地为倒计时)的计时器。该指示符250可以类似于图15A-15B中示出的指示符，但是，还可以包括上面描述的特征。钉合安全指示符和/或计时器特征有利的是在可以通过挤出被钉合的组织内的液体(例如血)以稍稍减少被夹紧的组织的厚度之前允许被夹紧的组织保持夹紧达指定的时间量。减少被夹紧的组织中的液体量是有利的，因为其可以减少在钉合期间或钉合之后从订合钉插入点流血的可能性。通常，当组织被恰当地夹紧在末端执行器189的夹具之间时，需要有限的时间量以用于夹紧的组织在开始钉合之前的按压(例如，从该夹具之间的组织中挤出液体)。用于充分地按压并减少液体所需要的时间量可以根据下述方面而变化：订合钉的类型和尺寸、钉合机和/或夹紧的类型、以及被夹紧的组织的类型和厚度。例如，在进行肠组织的钉合时，已经显示出在该组织的钉合之前夹紧之后等待至少一分钟明显减少了由钉合引起的出血量；但是本领域的技术人员将会明白，等待的持续时间能够少于一分钟或多于一分钟，这通常取决于该手术过程和被钉合的组织。此外，钉合之后保持该组织的夹紧还可以减少被钉合的组织的出血并促进止血。该指示符可以提供已经逝去的时间(或从推荐的等待时间的倒计时)，使得所述系统和/或外科医生能够认识到所要求的时间已经逝去并且继续进行钉合是安全的。在其他实施例中，额外的指示符消息(例如，“等待钉合”、“继续进行钉合”)可以帮助向外科医生指示继续进行被夹紧的组织的钉合是可取的。这种指示可以包括但不限于，时间指示符显示器中的颜色的变化、该显示器上的背景颜色的变化、光线、声音或适合向外科医生传达钉合安全和/或夹紧持续时间的任何其他指示符。推荐的夹紧等待时间可以根据该手术过程的任意变量预先设置在所述系统中，或可替换地，可以由外科医生输入。
在上面描述的实施例的图22中，外科医生已经用末端执行器189的夹具成功地夹紧组织，对此的表示在显示器60上可见。在该显示器60的右下角中的指示符250指示夹紧已经完成并且还指示外科医生“等待钉合”的信息，同时计时器指示从该组织被成功地夹紧之后已经逝去的时间。在这个实施例中，钉合之前推荐的等待时间是一分钟。如图22B所示，在一分钟已经逝去之后，指示符250用“进行钉合”的消息显示逝去的时间，其后，外科医生可以继续进行该夹紧的组织的钉合。在可替换的实施例中，在组织的钉合之后，计时器可以重新起动，以便使外科医生能够保持被钉合的组织的夹紧。
应当理解，本文中描述的示例和实施例用于说明性目的，并且鉴于此的各种修改或变化将对本领域技术人员存在启示并且被包括在本申请的精神和范围内以及所附权利要求的范围内。各种不同的组合是可行的，并且这些组合被认为是本发明的部分。

Claims (35)

1.一种用于指示夹紧预测的设备，包括：
用户界面显示器；以及
电子数据处理器，其耦接到所述用户界面显示器和具有用于抓握材料的夹具的末端执行器的驱动系统；
其中所述电子数据处理器配置为：
在所述用户界面显示器上显示所述末端执行器的视觉表示；以及
响应于以抓握力抓握所述材料的命令：
在所述材料被所述末端执行器的所述夹具以所述抓握力抓握时，确定所述末端执行器的所述夹具之间的分隔参数，并且如果所述分隔参数大于阈值，则预测指示可能的夹紧失败，而如果所述分隔参数等于或小于所述阈值，则所述预测指示可能的夹紧成功；以及
在所述用户界面显示器上显示预测以大于所述抓握力的夹紧力夹紧所述材料成功或失败的指示符。
2.根据权利要求1所述的设备，其中进一步响应于以所述抓握力抓握所述材料的所述命令，所述电子数据处理器进一步配置为在所述用户界面显示器上显示是否继续以所述夹紧力夹紧的建议。
3.根据权利要求1所述的设备，其中所述指示符进一步包括音频声音或感觉指示符。
4.根据权利要求1所述的设备，其中预测成功或失败的所述指示符包括在成功设置和失败设置之间转换的视觉元件。
5.根据权利要求1所述的设备，其中所述指示符包括指示符的颜色变化、光线或音频声音。
6.根据权利要求1所述的设备，其中所述指示符指示以所述夹紧力夹紧所述材料成功或失败的可能性。
7.根据权利要求6所述的设备，其中所述电子数据处理器进一步配置为基于所述分隔参数和目标分隔参数之间的差、所述材料的类型、所述材料的厚度、期望的夹紧力或所述末端执行器的期望的夹紧分隔参数而确定所述可能性。
8.根据权利要求1所述的设备，其中响应于检测到成功夹紧所述材料，所述电子数据处理器配置为在所述用户界面显示器上显示自检测到所述成功夹紧所述材料起逝去的时间。
9.根据权利要求8所述的设备，其中所述电子数据处理器进一步配置为以倒计时显示所述逝去的时间。
10.根据权利要求8所述的设备，其中所述电子数据处理器进一步配置为在所述用户界面显示器上显示被建议继续钉合所述材料之前推荐的等待时间。
11.根据权利要求10所述的设备，其中所述电子数据处理器进一步配置为基于订合钉的类型、在所述末端执行器中钉合机的类型、所述材料的类型、所述材料的厚度、用户输入的设置、或其任意组合而确定所述推荐的等待时间。
12.根据权利要求10所述的设备，其中所述电子数据处理器进一步配置为在所述用户界面显示器上显示在所述推荐的等待时间逝去之后继续所述材料的所述钉合的指示。
13.根据权利要求12所述的设备，其中所述电子数据处理器进一步配置为以等待钉合或继续钉合的指示显示指示符消息，所述指示进一步包括所述用户界面显示器上的颜色变化、光线或音频声音。
14.一种用于指示夹紧预测的方法，包括：
通过电子数据处理器在用户界面显示器上显示具有用于抓握材料的夹具的末端执行器的视觉表示；以及
响应于以抓握力抓握所述材料的命令：
在所述材料被所述末端执行器的所述夹具以所述抓握力抓握时，由所述电子数据处理器确定所述末端执行器的所述夹具之间的分隔参数，并且如果所述分隔参数大于阈值，则预测指示可能的夹紧失败，而如果所述分隔参数等于或小于所述阈值，则所述预测指示可能的夹紧成功；以及
通过所述电子数据处理器在所述用户界面显示器上显示预测以大于所述抓握力的夹紧力夹紧所述材料成功或失败的指示符；
其中所述方法本质上是非外科手术的。
15.根据权利要求14所述的方法，其中进一步响应于检测到所述末端执行器以所述抓握力抓握所述材料的所述命令，通过所述电子数据处理器在所述用户界面显示器上显示是否继续以所述夹紧力夹紧的建议。
16.根据权利要求14所述的方法，其中所述指示符进一步包括音频声音或感觉指示符。
17.根据权利要求14所述的方法，其中预测成功或失败的所述指示符包括在成功设置和失败设置之间转换的视觉元件。
18.根据权利要求14所述的方法，所述指示符包括所述指示符的颜色变化、光线或音频声音。
19.根据权利要求14所述的方法，其中所述指示符指示以所述夹紧力夹紧所述材料成功或失败的可能性。
20.根据权利要求19所述的方法，进一步包括基于所述分隔参数和目标分隔参数之间的差、所述材料的类型、所述材料的厚度、期望的夹紧力或所述末端执行器的期望的夹紧分隔参数而确定所述可能性。
21.根据权利要求14所述的方法，进一步包括：
检测是否发生了成功夹紧所述材料；以及
响应于检测到成功夹紧所述材料，通过所述电子数据处理器在所述用户界面显示器上显示自检测到所述成功夹紧所述材料起逝去的时间。
22.根据权利要求21所述的方法，以倒计时显示所述逝去的时间。
23.根据权利要求21所述的方法，进一步包括通过所述电子数据处理器在所述用户界面显示器上显示被建议继续钉合所述材料之前推荐的等待时间。
24.根据权利要求23所述的方法，进一步包括通过所述电子数据处理器基于订合钉的类型、在所述末端执行器中钉合机的类型、所述材料的类型、所述材料的厚度、用户输入的设置、或其任意组合而确定所述推荐的等待时间。
25.根据权利要求23所述的方法，进一步包括通过所述电子数据处理器在所述用户界面显示器上显示在所述推荐的等待时间逝去之后继续所述材料的所述钉合的指示。
26.根据权利要求25所述的方法，进一步包括通过所述电子数据处理器以等待钉合或继续钉合的指示显示指示符消息，所述指示进一步包括所述用户界面显示器上的颜色变化、光线或音频声音。
27.一种外科手术系统，包括：
具有用于抓握组织的夹具的末端执行器；
耦接到所述末端执行器的驱动系统；
用户界面显示器；以及
耦接到所述用户界面显示器和所述驱动系统的电子数据处理器；
其中所述电子数据处理器配置为：
在所述用户界面显示器上显示所述末端执行器的视觉表示；以及
响应于以抓握力抓握所述组织的命令：
在所述组织被所述末端执行器的所述夹具以所述抓握力抓握时，确定所述末端执行器的所述夹具之间的分隔参数，并且如果所述分隔参数大于阈值，则预测指示可能的夹紧失败，而如果所述分隔参数等于或小于所述阈值，则所述预测指示可能的夹紧成功；以及
在所述用户界面显示器上显示预测以大于所述抓握力的夹紧力夹紧所述组织成功或失败的指示符。
28.根据权利要求27所述的外科手术系统，其中进一步响应于以所述抓握力抓握所述组织的所述命令，所述电子数据处理器进一步配置为在所述用户界面显示器上显示是否继续以所述夹紧力夹紧的建议。
29.根据权利要求27所述的外科手术系统，其中预测成功或失败的所述指示符包括在成功设置和失败设置之间转换的视觉元件。
30.根据权利要求27所述的外科手术系统，其中所述指示符包括指示符的颜色变化、光线或音频声音。
31.根据权利要求27所述的外科手术系统，其中所述指示符指示以所述夹紧力夹紧所述组织成功或失败的可能性。
32.根据权利要求27所述的外科手术系统，其中响应于检测到成功夹紧所述组织，所述电子数据处理器配置为在所述用户界面显示器上显示自检测到所述成功夹紧所述组织起逝去的时间。
33.根据权利要求32所述的外科手术系统，其中所述电子数据处理器进一步配置为在所述用户界面显示器上显示被建议继续钉合所述组织之前推荐的等待时间。
34.根据权利要求33所述的外科手术系统，其中所述电子数据处理器进一步配置为在所述用户界面显示器上显示在所述推荐的等待时间逝去之后继续所述组织的所述钉合的指示。
35.根据权利要求34所述的外科手术系统，其中所述电子数据处理器进一步配置为使用所述用户界面显示器上的颜色变化、光线或音频声音来指示从等待钉合的指示到继续钉合的所述指示的变化。
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