CA2151789A1 - Apparatus and method for performing surgical tasks during laparoscopic procedures - Google Patents

Abstract

An apparatus is provided for performing surgical tasks during laparoscopic procedures which includes an elongated body, a mechanical hand operatively associated with a distal portion of the elongated body and including a plurality of articulated fingers, and an actuation assembly operatively associated with the proximal portion of the elongated body for controlling the operation of the mechanical hand.

Description

APPARATUS AND METUOD FOR PERFORMING SURGICAL
TASKS DURING LAPAROSCOPIC PROCEDURES

1. Technical Field An app~alus and method are provided for pclr~lll~ing surgical tasks during laparoscopic procedures, and more particularly, a ...erl-~nical hand is provided which is configured to be introduced into the abdominal cavity and n~l~ted from a remote location to perform a surgical task.

2. Des~ ;I,tionofRelatedArt In laparoscopic and endoscopic surgical procedures, a small incision is made in the patient's body to provide access for a tube or cannula device. Once extended into the patient's body, the cannula allows insertion of various surgical instruments for acting on organs, blood vessels, ducts, or body tissue far removed from the incision.
Such instruments include appa allls for applying surgical clips as disclosed in U.S. Patent No. 5,084,057; app~al~s for applying surgical staples as disclosed in U.S. Patent Nos.
5,040,715 and 5,289,963; and appalallls for retracting body tissue as disclosed in U.S.
PatentNo. 5,195,505.
In general, an endoscopic insl.ul~lc.ll has an elongated body with a tool assembly provided at the distal end thereof and an actuation assellll)ly associated with the prux-lllal end thereof for manipulating and nct~ting the tool assembly. Often, the degree of controlled manipulation of the tool assc.lll)ly is limited by the position of the trocar or cannula device through which the particular instrument is eYt~n-lef~ and the ~ccçssibility of the target tissue or organ to be acted upon.
It is recognized that it would be beneficial to provide a device capable of acting with the dexterity and mobility of a hand within the abdominal cavity to perform tasks during laparoscopic surgery. An cA~ullple of a nu~ y hand-like device capable of gripping and manipulating tissue during en~loscQpic surgery is disclosed in German Patent No. DE 42 23 792. This device is limited, however, in its ability to pclrOllll more complex surgical tasks, such as, operating surgical instn.~e~ lion within the abdominal cavity while being controlled from a remote location.

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SUMMARY
An appar~ s for p~,lr~"""llg surgical tasks during laparoscopic procedures is provided. The appar~ s inch1des an elongated body dçfining opposed p,c,x-",al and distal portions, and a ...e~h~l- csl hand operatively q~so~isted with the distal portion of the 5 elongq-ted body which inc.l~ldes a plurality of movable fingers. An actuation asse..,bly is operatively q~soeisted with the pro~.,al portion of the elongated body and inrl~1des a plurality of digit control sub-asse."blies each configured to receive an input signal from a user. Cable sets ll~lsl~ the input signals from the digit control sub--q-~mhlies to the fingers of the mechqnical hand, and preferably the input signals imparted to the digit 10 control sub-assemblies by the user are proportionally reduced .
In a p.t;rt;-.ed embodiment, the mP~.hqnical hand in~ des a hand portion in~luding a plurality of hand sections hingedly conl-e.;led to one another, a movable finger operatively associated with each of the hand sections, and an opposable thumb hingedly conl)e.;led to one of the hand sections. Pl~;relably, the opposable thumb and each of the 15 hand sections ofthe ~..e~.l.ql-icq-l hand are movable b~cell a consl-ail-ed position wherein the thumb and roiehalld sections are drawn together into a narrow formation to fr^ilitrte passage of the hand through a trocar or cannula device and a deployed position wherein the thumb and hand sections are spread out to fr^il;tqte pe-ro--"allce of surgical tasks.
A plurality of cable sets are each configured to control the movement of a 2 o respective one of the l"o~able fingers and opposable thumb. The cable sets include first, second and third control cables for independently controlling the movements of the prox~..al, medial, and distal phqlsng~sl sections of the movable fingers. A plurality of pulley assemblies each co.-e~onding to a respective one of the plurality of cable sets reduce the input signal.
Ple~lably, the actuation assembly includes a plurality of digit control sub-assemblies each co"~sl~ondil g to a respecli~e one of the movable fingers and opposable thumb of the mPcllqn:^q~l hand. Each of the digit control sub-assemblies in~h1des a distal phqlsng~qql P.~,q~ng collar, a proxill~al phqlqnp~ ql eng,q~ng ring, and an elongate support shaft for supporting the en,,qginp. collar and P.ngqging ring. Plere~ably, a first control 3 o cable extends from the distal phqlqnp~ql collar and at least a second control cable extends from the plc~xi~llal phslqngeql ~np,qging ring to frr.ilittq,te flexion and extension of a espeeli~e one of the ar~ic~ qted fingers. A third control cable can be associated with the 215178~

pro~""al çng~ing ring of the digit control asse",blies to f~ tqte abduction and ~dduction of a respective one of the movable fingers and opposable thumb of the ".~.h~ ql hand.
A method for pe,ro"",l g a surgical task during a laparoscopic procedure s is also disclosed inc~ in~ the steps of fo",~lg an incision in the peritoneum of a patient, e~ctçn~ing a cannula device through the incision into the abdominal cavity of the patient, introducing a surgical ~ lUIII~;;III into the abdominql cavity through the cannula device, introducing a me~hqnic~l hand into the abdominal cavity through the çqnnlllq device, and m.nipulating the merhqnical hand from a remote location to actuate the surgical 0 ill:~llUlll~,~lt and thereby pelru"" a surgical task.

BRIEF DESCRIPTION OF THE DRAWINGS
Various embo-1;n~P~ of the appalal~s will be described hereinbelow with rererence to the dlawings wherein:
Fig. 1 is a pe,spe.li~e view of a surgical appa,~lus constructed in acco,.lallce with a pr~re"ed embodiment with the ..,e~h~l-ical hand oriented in a neutral position;
Fig. 2 illustrates a surgeon ~1tili~ing the appalalus of Fig. 1 in the pe,ru""ance of a laparoscop c surgical procedure;
Fig. 3A is an enlarged pt;~pe.;li~e view of the .. ecl-~ical hand of the subject invention operating a surgical stapling device during the pe~ru~ ce of alaparoscopic procedure;
Fig. 3B is n ell~ed perspective view of the surgical ~l~p!inp device illustrated in Fig. 3A;
Fig. 4 is an enlalged plan view of a .. P~h~l~;c~l hand constructed in accordance with a prerel,~d embodiment;
Fig. 5 is a cross-sectional view taken along line 5-5 of Fig. 4 illustrating theconstruction of the pro~il"~l ph~ ge~l joint of the index finger of the l-~eçh~ ~ic~l hand of Fig. 4;
30Fig. 6 is an exploded pe,~ecli~e view of the mech~nic.~l hand of Fig. 4 with the Plpmpnts ofthe hand sepala~ed for ease of illustration;

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Fig. 7 is a cross-sectional view taken along line 7-7 of Fig. 4 illustrating theinterior construction ofthe index finger ofthe ...~o~h~n;cql hand;
Fig. 8 is an exploded pclspccli~e view ofthe index finger ofthe ..~,hg~- c~
hand illustrated in Fig. 4;
Fig. 9 is a cross-sectional view taken along line 9-9 of Fig. 4 illustrating thecable pdll~a~s e~ct~nd;~ through the m~.l-~ cql hand;
Fig. 10 is a pclspe~ilive view of the a~tuqtion assembly of the surgical appalal~s of Fig. 1 illustrating the trn.o-mioS;on Ao-.~ ..bly for mqnipulqtin~ the merh~ ~ic~
hand;
Fig. 11 is a cross-sectional view taken along line 11-11 of Fig. 1 illu~llaling the three levels ofthe Ir~n~ o-~;on ass~,l.ll)ly ofthe actuation assembly;
Fig. 12 is a cross-sectional view taken along line 12-12 of Fig. 1 illustrating the ~Itl~ c,e port of the elongate body portion of the surgical appal~lus;
Fig. 13 is a cross-sectional view taken along line 13-13 of Fig. 1 illusllaling the proAilllal phqlqng~ql eng~emPnt ring of the index finger control sub-assembly;
Fig. 14 is a partial cross-sectional view taken along line 14-14 of Fig. 1 illustrating the prU~illlal phqlqng~qvl ç~,q~ment ring and the adjustqhle support sha~ of the index finger control sub-asse,lll)ly;
2 o Fig. l S is a pel ~ecli~e view of the surgical apparalus illustrated in Fig. 1, with the index finger of the ...çch~n;cql hand disposed in a flexed position, articul~qted about the medial phalangeal joint thereof, in response to collcsponding movement of the index finger control sub-assembly;
Fig. 16 is a perspective view of the surgical appal~us illustrated in Fig. 1, 25 with the index finger of the mech,qnical hand disposed in a flexed position, articulqted about the ploAill~al phq~lqngeql joint thereof, in rcsponse to collesl,ollding movement of the index finger control sub-assellll)ly;
Fig. 17 is a pel~ecli~e view of the surgical appal~l~s illustrated in Fig. 1 with the index finger of the mecl.~n-cal hand disposed in an qhducted position in response 3 o to corresponding movement of the index finger control sub-assembly;

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Fig. 18 is a pc~pecli~re view ofthe .~erllAllical hand and a trocar asse",l~ly prior to folding the hand into a consl~ ed position for p~Csage through the trocar as~.,.bly;
Figs. 19-23 illustrate the se~uçnre of steps in which the mech~r cql hand is folded into a consll~il cd configuration for pacsq~e through the trocar assembly;
Fig. 24 is a pcl~ e view of the mP~hAnical hand folded in a cons~ ed position for paCssge through a trocar assembly;
Fig. 25 is a pcl~ecli~e view of the ~h~ical hand passing through a trocar assembly; and Fig. 26 is a perspective view of the m~rhqnical hand eytentlin~ from a trocar assembly and disposed in a neutral position.

DETAILED DESCRIPTION OF T~E PREFERRED EMBODIMENTS
The app~uallls shall be ~licc~lssed in terms of endoscopic procedures and appalallls~ However, use herein of terms such as "endoscopic", "çn~lQscQp ~ llyll, and "~n~1oscQpic portion", among others, should not be construed to limit the appa,alus for use only in conjunction with an endoscopic tube. To the co..l-~y, it is believed that the appa,~ s may find use in proccdures ~Lclcill access is limited to a small incision inc1~ldi~ but not limited to arthroscopic and/or lapd~oscop-c procedures.
Rcfc~ing now to the drawings wherein like Icrc cnce numerals inrlir,ate similar structural ele~ s, there is illustrated in Fig. 1 an appa~al~ls for pclrollllillg surgical tasks during laparoscopic procedures which is constructed in accordance with a prerc"cd embodiment and which is dçci~q~ed generally by rcrelcllce numeral 10.
Surgical appa.~ s 10 is particularly configured to perform complex surgical tasks within the abdominal cavity of a patient, such as operate surgical instr~ lion, with a fine degree of dexterity and accuracy similar to that of an actual hand.
Referring to Fig. 1, surgical appalalus 10 inr,l~des a frame 12 having a proxilll~l user interaction plalro"" 14 and an elongaled body 16 which extends from user interaction platform 14. The elongated body preferably has a di~n~pt~r of bclween about 3 o 5 and about 15 mm and a length of between about 10 inches and 12 inches for insertion through a trocar cq-mul~ Clearly other dimensions are contemplated. A ...ec.l-~nical hand 18 having five movable fingers extends from a distal end of elongated body 16. An 215178~

actuation assembly 20 is operatively associated with interaction plalr~,l,n 14 for msnirllstin~ and controlling the movements of ~ qn~icsl hand 18. The user interaction platform 14 and the ~n~,hAI~ical hand 18 are in sli~ment with one another to pro.llote user coll~ll and a favorable opelalh~g position. Mechanical hand 18 is pl~;r~l~bl~ one fourth the size of a human hand and is preferably cQnfi~red to function in substsntiqlly the same manner as a human hand. As will be de~ilibed in detail below, a~hnstiQnasse,llbly 20 inlr.1~ldes five control fingers which, upon mov~llenl~ cause coll esponding move"lt;"ls of the five fingers of lll~ r~r ~ D1 hand 18.
Referring to Fig. 2, during a laparoscopic procedure, the hand of the surgeon is placed within actuation assembly 20 such that each of his/her fingers fits into a re~,e~ e reception area of the achlstion assel"bly 20. That is, each of the surgeon's fingers fits into the collespol1dillg finger support of glove 199 as described below. The elongate body 16 offrame 12 is inserted through a trocar 15, and the mechqnicsl hand 18 is employed to pelrullll a particular surgical task, such as operating a fastener applying device 17, as illustrated in Fig. 3A. Fastener applying device 17 is illustrated in Fig. 3B
and inc1~1des an elongate body 17a having a fastener applying assellll,ly 17b at the distal end thereof and a controller 17c at the proxill,al end thereof. During the pelrollllance of a surgical procedure, the fingers of the mecl~n c-ql hand 18 will adv-qnt-qge~usly respond to each movement of the surgeon's fingers positioned within actuation assembly 20.
P-t;rel~bly, the surgeon will operate two of these llle~kP~ eq1 hands and will view the procedure on a video monitor or through a laparoscope introduced into the abdominal cavity.
Referring now to Figs. 4 and 5, the me~rtlqn:^s1 hand 18 incl~des hand portion 22 which inr1~des a plurality of hingedly conl~ ed hand sections each having -q-~soçiqte~ theréwilh a re~l)eili.~e finger. In particular, hand portion 22 in~1~des an inner hand section 24, a first medial hand section 26, a second medial hand section 28, and an outer hand section 30. The relative positions of hand sections 24-30 coll~spond substLqnti-q-lly to the relative positions of the second through fifth metncsrpal bones of the human hand. Hand portion 22 further inc1~ldes a proxilllal hand section 32 collt;sponding 3 o to the first metacqrpal bone of the human hand which is associated with the thumb.
ProAi,nal hand section 32 depçnds angularly from the first medial section 26 of hand portion 22. The inner hand section 24 and second medial section 28 of hand 215 17~

portion 22 are hingedly connected to hand section 26. The outer hand section 30 is hingedly conl-e~iled to the minor medial section 28. The pro~ lal end of the major medial hand section 28 is configured to be f~tçned to a flange 34 which extends distally from the elongated body 16 of frame 12 to support ...ecllqnical hand 18 Rcrellil~ to Fig. 6, the ~-.ec1-A~ gl h_nd 18 is illustrated with each of the hand sections thereof and their lespecli~e fingers separated fiom one another for ease of illustration. The five fingers of ..~I.An;cs~ hand 18 include digit 40 which collG~ponds to the thumb, digit 42 which corresponds to the index finger 42, digits 44 and 46 which coll~;s,~,ond to the middle and ring fingers respectively, and digit 48 which colltsponds to lo the little finger.
The first medi.,l hand section 26 of h. nd portion 22 is generlly r e~ lgr in configuration and defines opposed lateral surfaces 26a and 26b and opposed distal and pro,.illlal end portions 26c and 26d. PlUAilll~l end portion 26d is provided with a pair of spaced apart apcllures 36a and 36b for Ic~pe~ ely receiving rhslencl~ 38a and 38b for mo-lnting hand section 26 to flange 34. The plo~illlal hand section 32 depends angularly from the lateral surface 26b of hand section 26 and has a cavity 50 formed therein for receiving hinging flanges 52a and 52b provided on the metAcArpal portion of thumb 40. A
pin 54 extends through section 32 and lon~t Idinslly through flanges 52a, 52b to fasten thumb 40 to hand section 32 and a coiled torsion spring 56 biases thumb 40 into an 2 o outwardly spread position.
The inner hand section 24 of hand portion 22 has distal and pro~inlal hinging flariges 58a and 58b provided thereon for interfitting with collespolldil g distal hinging flange 60a and proxilllal hinging flanges 60b and 60c provided on lateral surface 26b of hand section 26 (see Fig. 4). Hinge pins 62 and 63 are provided to fasten hand 2 5 section 24 to hand section 26 and a coiled torsion spring 64 is provided for biasing hand section 24 into a normally spread position.
The second medial hand section 28 inc1~ldes a distal hinging flange 70 and a plo~llal hinging flange 72 for intelfllling with distal and pro~illlal hinging flanges 74 and 76 which depend from lateral surface 26b of hand section 26 (see Fig. 4). ~lu~nal 3 o and distal hinge pins 78 and 76 fasten fo~ehalld sections 26 and 28 to one another and a coiled torsion spring 82, associated with plo~illlal hinge pin 78, biases the two hand sections into an outwardly spread position.

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The outer hand section 30 has spaceed apart hinging flanges 84a and 84b for intereng~in~ colles~)onding hinging flanges 86a and 86b which are formed in hand section 28 (see Fig. 4). Hand sections 28 and 30 are f~cten~d to one another by a hinge pin 88 and a coiled torsion spring 90 biases the two hand SeCtiOnS into an oulv~a.dly 5 spread configuration.
The hinging of each of the sectionc of hand portion 22 fa~ tates the relative movement of the hand sections be~ween a normally outstretched or open position (also rerellèd to herein as the neutral position), shown for ~Yample in Fig. 18, and a narrow cons~ ed position, shown for P~Y~mrle in Fig. 24, to enable passage of 10 ç~,h~- c~l hand 18 through a cannula or trocar assellll~ly and into the abdominal cavity of a patient. A sequence of steps by which each of the hand sections and fingers of~ ~h~l. c~l hand 18 are manipulated or folded into a narrow consll~ed position is described in detail helèinbelow with lererence to Figs. 19-23. The movement of the fingers from the neutral position to various Opelalillg positions for use during a surgical procedure is also described below.
With continued ~ererel-ce to Figs. 4 and 6, the five fingers of "~ n ç~l hand 18 are each ~ccoçi~ted with a respeeli~e one of the sections of hand portion 22.
Digit 42 (the index finger) is operatively conl~ ed to the inner forêhal-d section 24. A
cylindrical cavity 92 is defined in forehand section 24 for receiving a cylindrical barrel joint 94 provided at the ploxilllal end of digit 42. Barrel joint 94 enables abduction and add~lction of digit 42 (see generally Fig. 17). A groove 96 is also formed in hand section 24 and depen-ls pro~iln~lly from cavity 92 to support a coiled torsion spring 98 mounted about an ~lpst~n~ling post 100. Spring 98 serves as a return spring to bias digit 42 toward its normal position when it is ab~dllçted or add~lcted during the pelr~llllance of a surgical 2 5 task.
Digit 44 is operatively connected to the first medial section 26 by a transverse hinge pin 128. Digits 46 and 48 are operatively connected to hand sections 28 and 30 respectively by seating the lespecli~e barrel joints 47 and 49 thereof within coll~l,onding reception cavities 29 and 31 formed in hand sections 28 and 30. Torsion springs 95 and 97 serve as return springs to bias digits 46 and 48 toward their normal positions when they are ahdllcted or adducted about barrel joints 47 and 49 during the pelrolll~ce of a surgical procedure.

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Referring now to Figs. 7-9, digit 42 is illustrated and eY~mrlifies the construction of the fingers of mechanical hand 18. Digit 42 in~ des distal, medial, and p,o~ phq~ l sections 102, 104, and 106. ~u~illlal section 106 is pivotably ~n~A~ed to barrel joint 94. Barrel joint 94 defines an interior cavity 94a for receiving posterior hinging flanges 107a and 107b provided on pr~,xilllal phqlq~.oq1 section 106. A
hinge pin 108 fastens the plo~lllal section 106 and barrel joint 94 to one another and enables flexion and extension of digit 42 during the pelr~ ce of a surgical task (see generally Fig. 16). A coiled torsion spring 110 is disposed about hinge pin 108 and acts to return digit 42 to its normally 1~ ngihldin~ position following the flexion o r extension thereo Anterior hinging flanges 112a and 112b are provided on prox~mal ph~l~nge~l section 106 for intere~ging collespollding posterior hinging flanges 114a and 114b on medial phalangeal section 104. A hinge pin 116 fastens the proxilllal and medial ph~lqng~l sections 106 and 104 to one another and a torsion spring 118 biases section 104 into its normal position in lon~h~din~l ~lignm~nt with section 108. Anterior hinging flanges 120a and 120b are also provided on medial section 104 for inter~.ngA~ing coll~;~onding hinging flanges 122a and 122b on distal phql~ng~l section 106 of digit 42.
The distal and medial sections 102 and 104 are f~tPned to one another by hinge pin 124 and are biased into longihl~1in~l ~lignmPnt (i.e. the position of Fig. 7) by torsion spring 126.
R~r~llhlg again to Figs. 4 and 6, digits 46 and 48, with the exception of size are subst~nti~lly identic?l in construction to digit 42. Digit 44, which coll~sponds to the middle finger, differs in construction in that it does not include a barrel joint for abduction and adduction as described above with respect to digit 42. Digit 44 can only be ~nded or flexed about hinge pin 128 which as noted above fastens the pro~illlal phql~r~.o~l section 130 of digit 44 to the distal portion 26c of hand section 26. Digit 44 is intPn~led to be utilized to palpate organs or body tissue and the construction thereof is particularly adapted for such tasks. It is also contemplated however, that alternatively digit 44 can be mollnted to hand portion 22 by a barrel joint connection for movement in 3 o the manner described above with respect to digit 42.
Digit 40, the thumb, as described above, includes a lateral hinging joint (52a, 52b) to f~rilit~te the extension and flexion thereof. Digit 40 further in~l~ldes a 21 5178~

transverse barrel joint 132 located pro~illlal of the lateral hinging joint (52a, 52b) and positioned to f~^ilit<ate eYt~r~'ioll and flexion of the thumb. An exterior torsion spring 134 is acso-,iqted with digit 40 and is mollnted on an outwardly ext~n~lin~ post 136 for biasing the thumb into an eYt~n~led position. Digit 40 also flexes about its distal, medial, and 5 prOxilllal phqlq~"q-l sections in a direction transverse to the direction of flexure of digits 42-48. That is, digit 40 flexes toward section 26 and the le~ i"i~g digits flex dowll~rdly. Such movements enable complete opposition of digit 40 and the other fingers of ~..~.hAn-~ql hand 18.
Referring now to Fig. 10, in conjunction with Fig. 1, the user interaction plalro~l" 14 of frame 12 incl~de,c a cuff 140 for s lppo~ling the user's ror~,ll. Cuff 140 in~ des an arcuate brace 142 and elongate support struts 144 and 146. Support struts 144 and 146 extend pro~il,l~ly from a gener.,lly reclA~g~.lqr ~ c...:c.~;on box 150.
Tr~q-ncmic.cion box 150 houses a plurality of pulley assemblies, 152, 154, 156, 158, and 160, which provide means to reduce the input signals generated by the user and 5 ll;n~;lled to the ~~ ical hand 18 by a plurality of control cables during the pelrolll~ce of a surgical task.
As best seen in Fig. 11, each of the pulley assemblies 152-160 in ll~n~.~. csion box 150 include three tiers of reduction pulleys, with each tier incl~1ding an input pulley and an output pulley. For ~ lplc7 pulley assembly 152 inrludes three tiers 2 o of reduction pulleys 152a, 152b, and 152c, with each tier of the pulley assembly inc~ 1ing an input pulley 162 and an output pulley 164. The liqmP~t~r of each output pulley is preferably four times greater th. n the ~iqnneter of each input pulley to achieve the desired one fourth reduction in the input signal ll-qn~...;~le~ by the control cables. Thus, for ,Aa,.lple, when the surgeon flexes his/her index finger, the co"~ponding digit of ~ AI~ -A1 hand 18 will move in the same manner through a distance equal to one fourth the dict~nce the user's finger is moved. Other pully ~i~mp~ters are contemplated if a dilIerenl input signal reduction is required.
Referring to Figs. 10 and 11, a control cable eYtçn~lin~ from act-l~tiQn assembly 20 into tr~ncmicsion box 150, for e.~ ple control cable 165, is initially dir~led around input pulley 162, and led around output pulley 164 (as shown in Fig. 11), and directed about a plilll~y orienting post 166 toward a secondary orienting post 168 (as shown in Fig. 10). Cable 165 is then led through a curved cable track 170, about a main 2I5~ 78~

orienting post 172, and into the elongate body 16 of frame 12, as illustrated in Fig. 12. A
cover 178 is also provided for Pnr,1osi~ Il;.n~ on box 150 to protect the pulley as~...blies and control cables therein, as is a cover 179 for protecting cable track 170.
~Ith contin~ed ererence to Fig. 10, in conjuncti~ n with Fig. 1, ach~-q-tion assembly 20 inrl~1des a support plate 182 which extends distally from l~n~.. e~ on box 150, a plurality of digit control sub qece.~h!ies 190-198 ndjl1st~1y mounted to support plate 182, and a form-fitting glove 199 for rl^~di~ the user's hand.
As best seen in Fig. 1, each of the digit control sub-assemblies 190-198 co,le~onds to a les~e~ e one of the user's fingers and accordingly, a resl,ecli~e one of 10 the fingers of ~er,l-~nicAl hand 18. Each digit control sub aesP,mbly inr,l~ldes three operative el~mente- For eA~ll~lc, sub-assembly 194 inr,l~de~e, a distal phqlq~Pql P.ng,qgPm~nt collar 200, a proAilllal phqlq~Pq-l çng,qgP.mPnt ring 202, and an elongate flexible support shaft 204 upon which enga~PmPnt collar 200 and Png~P~mPnt ring 202 are mounted. The elçmente- of the digit control sub-assemblies are illustrated in greater detail in Figs. 13 and 14. In particular, support shaft 204 in~ des a plurality of spaced apart teeth 206 for pellllilling selective positioning of en~agpmpnt ring 202. This feature enables the sub acsf-..hlies to be adj-leted to accommodate dirrerenl users. The other sub-asseml)lies of actuation assellll)ly 20 include the same three operative elP~mPnts (i.e.
Pn ,q~empnt collar, en~,q~gpmpnt ring, and flexible support shaft) and for clarity are not 2 o specifically labeled in the drawings.
As best seen in Fig. 13, ç~qgPmPnt ring 202 in~ des a mounting block 208 through which extends an axial slot 210 for receiving support shaft 204 and within which is disposed a deflectable locking tab 212 for selectively engqging the teeth 206 on support shaft 204. A pair of arcuate ring portions 214a and 214b are deflectablyconl~iled to mounting block 208 and include le~e~;lh~e toothed çng,qgPmçnt areas 215a and 215b for adjusting the di-qmeter of ring 202 to accommodate the user.
Referring to Fig. 1, as noted above, the sub-assemblies of a~la~ion assembly 20 are each associated with a plurality of control cables which provide means for ll~ the input signals from the digit control sub-assemblies 190-198 to the articul~ted fingers 42-48 and opposable thumb 40 of .. Pr.h~l-ical hand 18. Each of the sub-assc.l,blies, with the exception of that which coll~;~onds to digit 44 of merhqrlical hand 18, has three control cables associated therewith. Since digit 44 is not configured 21517~8~

for abduction and adduction, a third control cable is eYclllded from the corresponding control sub ~csf...hly. However, as noted above, alternately digit 44 can include a third control cable of abduction/ndduction is desirable.
In general, as iUustrated in Fig. 1, of the three control cables associated 5 with each digit control sub-ass~ bly, a first control cable eYtends from the distal phqlqng~oql coUar 200, and second and third control cables extend from the proA,l.lal phqlqng~l ring 202 of each sub-assembly (see Fig. 14). The first control cable of each sub-ass~,n-bly controls articulation of the distal phql~e~l section of the digit of the ...e~h~-ical hand with which it is associated (see generally Fig. 15). The second control 10 cable controls flexion and eYtension of the particular digit of the mec.hAn c~l hand about the hinge pin which connects the digit to the forehand (see generally Fig. 16). The third control cable controls abduction and adduction of the particular digit of the ..,~c.l-cn c~
hand about the barrel joint which com1e~ils the digit to the forehand (see generally Fig.
17).
Referring to Figs. 6-9, by way of example, digit 42 of mech~nical hand 18 is shown to illustrate the ~tt~chm~nt points of the control cables particularly associated therewilll. A first control cable 220 e~ct~n~1ing from actuation assembly 20 is f~ct~neA to the distal phql~nge~l section 106 of digit 42 by a col n~ili~e fitting 221. Second and third control cables 222 and 224 eYten-ling from actuation assembly 20 are f~cte~ed to the plOA,~ ph~l~ngeql section 102 of digit 42 by conne~ e fittings 223 and 225 (see Fig.

4). Control cable 222 is fActenlqA adj~cent the centeroidal axis of the ph~qlA~e~l section for effecting flexion and extension, while cable 224 is fiActen~A adjncent a lateral portion thereof for ~ g abduction and adduction. Digit 40, 44, 46, and 48 each include control cables ~ttaclled at similar locations on their respective digital and p.oAi",al 2 5 phql~n~eq1 sections. These control cables are illustrated in Fig. 6 but are not speciffcally labeled for clarity. As illustrated in Fig. 9, axial palh~ 226 are formed in each section of hand portion 22 to direct the control cables to the particular finger associated therewith.
As noted above, the structural elem~nts of the mer.hqnical hand are particularly adapted to be m~nir~ qteA from a normally out-spread position, shown for example in Fig. 18, to a narrow consll~ ed position, shown for example in Fig. 24, to fi~ilit7~te passage of mecl~AI~ c~l hand 18 through trocar 15, as illustrated in Figs. 25-26.

21~17~9 The sequence in which the various structural ~I~ ..c~.ls of me~hqnical hand 18 are mqnirllqted from an out-spread position to a con~ ed position is illustrated in Figs.
19-23. The circular cross-section of trocar assembly 15 is replcscllled in Figs. 19-23 to provide a frame of lcrclence for the mqnirl~lqtion sequpnce.
Initially, prior to eYtPntling mP~,~lqrlical hand 18 through trocar ~se.. l-ly 15, the outer hand section 30 of hand portion 22 is pivoted from the neutral position shown in Fig. 19 to a position disposed beneath second medial section 28, as shown in Fig. 20. Then, in co~ cl;on, sections 28 and 30 are pivoted relative to first medial section 26, as shown in Fig. 21. Subsequçntly, as illustrated in Fig. 22, the inner hand 10 section 24 is pivoted relative to first medial section 26 to a position in alignment with hand sections 28 and 30. The opposable thumb 40 is then manipulated twice to complete the sequPnce. First, thumb 40 is pivoted about hinge pin 54 and then it is flexed inwardly about barrel joint 132 into the position shown in Fig. 23. At such a time" ~ ! hand 18 will be in the con~ il ed position depicted in Fig. 24. Thelc~pon, ...er.l-~l-ical hand 18 15 can be introduced into trocar assembly 15 and PYtçnded therethrough as shown in Fig. 25.
When ...er~ -ical hand 18 is fully inserted to extend from the distal end of trocar assembly 15, the various spring biased structural ~1~."~"l~ thereof will return to their normally out-stretched orientations, as shown in Fig. 26, and lllc~'l?~;cql hand 18 will be ready to pclrOllll surgical tasks as illustrated in Fig. 3. In particular, torsion spring 56 biases digit 40 into its normal position, torsion spring 64 biases hand section 24 into its norm~l position, torsion spring 82 biases sections 26 and 28 into their normal position, and torsion spring 90 biases section 30 into its normal position.
In use, once the surgeon has placed his/her hand in glove 199, he/she can pclrOllll a wide range of surgical tasks. For example, by aGtuqting the middle finger control sub-assembly of actuation asse.-ll~ly 20 through flexion or extension of his/her own middle finger, digit 44 will flex and extend in the same manner to palpate organs or body tissue within the abdominal cavity. To pe-ro--ll more colllpl~.Y tasks, such as opcldling a stapling device, as illustrated in Fig. 3A, the user will orient his/her hand into a suitable position whclein ..~eçll~llical hand 18 can grasp stapling device 17. Once 30 grasped, the instrument can be aeh~qte~l by the surgeon through movement of his/her thumb in such a manner so as to cause digit 40 of ~..ec.llAI~ical hand 18 to depress the control assembly 17c of slapling device 17 to staple body tissue.

Although the app~ s has been described with respect to plt;re"ed embo~im~nt~, it will be readily appare,.l to those having ordin&~ skill in the art to which it appe,lains that c~ ~s and mo-lific~tions may be made thereto without depa~ g from the spirit or scope of the appended claims.

Claims (28)

THE EMBODIMENTS OF THE INVENTION IN WHICH AN EXCLUSIVE
PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:

1. An apparatus for performing surgical tasks during laparoscopic procedures comprising.
a) an elongated body defining opposed proximal and distal portions:
b) a mechanical hand operatively associated with the distal portion of the elongated body and including a plurality of movable fingers;
c) an actuation assembly operatively associated with the proximal portion of the elongated body and including a plurality of digit control sub-assemblies each configured to receive an input signal from a user;
d) means for transmitting the input signals from the digit control sub-assemblies to the movable fingers of the mechanical hand; and e) means operatively associated with the signal transmitting means for proportionally reducing the input signals imparted to the digit control sub-assemblies by the user.

2. An apparatus as recited in Claim 1, wherein the mechanical hand comprises a hand portion including a plurality of hand sections hingedly connected to one another.

3. An apparatus as recited in Claim 2, wherein each hand section has associated therewith a respective one of the plurality of movable fingers.

4. An apparatus as recited in Claim 3, wherein one of the hand sections has an opposable thumb associated therewith.

5. An apparatus as recited in Claim 3, wherein each of the movable fingers includes respective proximal, medial, and distal phalangeal sections and wherein at least one of the movable fingers includes a proximal joint connecting the proximal phalangeal section thereof to a respective hand section and configured to facilitate adduction and abduction of the finger.

6. An apparatus as recited in Claim 3, wherein each of the movable fingers includes respective proximal, medial and distal phalangeal sections at least one of the movable fingers includes a proximal joint connecting the proximal phalangeal section thereof to a respective hand section and configured to facilitate flexion and extension of the finger.

7. An apparatus as recited in Claim 1, wherein the signal transmitting means comprises a plurality of cable sets each configured to control the movement of a respective one of the movable fingers of the mechanical hand.

8. An apparatus as recited in Claim 3, wherein each of the movable fingers includes respective proximal, medial and distal phalangeal sections and the signal transmitting means corresponding to at least one of the movable finger comprises first, second, and third control cables for independently controlling the articulated movements of the proximal, medial and distal phalangeal sections thereof.

9. An apparatus as recited in Claim 7, wherein the input signal reducing means comprises a plurality of pulley assemblies each corresponding to a respective one of the plurality of cable sets.

10. An apparatus as recited in Claim 9, wherein the input signal reducing means is configured to proportionally reduce the input signal at a ratio of about 1 to 4.

11. An apparatus as recited in Claim 2, wherein the forehand sections of the mechanical hand are configured to move between a constrained position wherein the hand sections are drawn together to facilitate passage of the mechanical hand through a trocar assembly and a deployed position wherein the hand sections are spread to facilitate performance of a surgical task.

12. An apparatus as recited in Claim 11, wherein the hand sections are spring biased into the deployed position.

13. An apparatus as recited in Claim 1, wherein each of the digit control sub-assemblies includes a distal phalangeal engaging collar, a proximal phalangeal engaging ring, and an elongate support shaft for supporting the engaging collar and engaging ring.

14. An apparatus as recited in Claim 13, wherein the signal transmitting means includes a first control cable extending from the distal phalangeal engaging collar, and at least a second control cable extending from the proximal phalangeal engaging ring to facilitate flexion and extension of a respective one of the movable fingers.

15. An apparatus as recited in Claim 14, wherein the signal transmitting means associated with at least one of the digit control sub-assemblies includes a third control cable to facilitate abduction and adduction of a respective one of the movable fingers.

16. An apparatus for performing surgical tasks during laparoscopic procedures comprising:
a) a frame including an elongated body extending distally therefrom;
b) a mechanical hand operatively associated with a distal end portion of the elongated body and including a plurality of movable fingers; and c) an actuation assembly operatively associated with the mechanical hand for controlling the operation thereof including:
i) a plurality of control fingers each corresponding to a respective one of the movable fingers of the mechanical hand;
ii) a set of control cables extending from each of the control fingers to a respective one of the movable fingers of the mechanical hand for transmitting input signals; and iii) a set of pulleys operatively associated with each set of control cables for proportionally reducing the input signals imparted thereto.

17. An apparatus as recited in Claim 16, wherein the mechanical hand comprises a hand portion including a plurality of hand sections hingedly connected to one another.

18. An apparatus as recited in Claim 17, wherein each hand section has associated therewith a respective one of the plurality of movable fingers.

19. An apparatus as recited in Claim 17, wherein the mechanical hand includes an opposable thumb associated with one of the hand sections.

20. An apparatus as recited in Claim 16, wherein the set of control cables includes a first and second control cable to facilitate flexion and extension of a respective one of the movable fingers of the mechanical hand and third control cable to facilitate abduction and adduction of a respective one of the movable fingers.

21. An apparatus as recited in Claim 19, wherein the input signal reducing means is configured to proportionally reduce the input signal at a ratio of about 1 to 4.

22. A mechanical hand for use during laparoscopic surgical procedures comprising:
a) a hand portion including a plurality of hand sections hingedly connected to one another;
b) an articulated finger operatively associated with each of the hand section; and c) an opposable thumb hingedly connected to one of the hand sections, whereby the opposable thumb and each of the hand sections are movable between a constrained position wherein the thumb and hand sections are drawn together into a narrow formation to facilitate passage of the hand through a trocar and a deployed position wherein the thumb and hand sections are spread out to facilitate performance of surgical tasks.

23. An apparatus as recited in Claim 22, wherein each of the articulated fingers includes a respective proximal, medial, and distal phalangeal section.

24. An apparatus as recited in Claim 23, wherein at least one of the articulated fingers includes a proximal joint connecting the proximal phalangeal section thereof to a respective forehand section and configured to facilitate adduction and abduction of the finger.

25. An apparatus as recited in Claim 22, wherein at least one of the articulated fingers includes a proximal joint connecting the proximal phalangeal section thereof to a respective forehand section and configured to facilitate flexion and extension of the finger.

26. An apparatus for performing surgical tasks during laparoscopic procedures comprising:
a) an elongated body;
b) a first hand extending from a distal end portion of the elongated body and having a plurality of movable fingers, said first hand being of a first size;
c) a second hand positioned proximally of the elongated body and having a plurality of control fingers for actuating the movable fingers of the first hand, said second hand being of a second size which is greater than the first size of said first hand; and d) a plurality of control cables operatively connecting the movable fingers of the first hand and the control fingers of the second hand, whereby movement of one of the control fingers in a first direction causes the control cables to effect corresponding movement of the respective movable finger in the first direction.

27. An apparatus as recited in Claim 26, further comprising a reduction assembly operatively associated with the control cables for reducing input signals imparted to the control cables by the control fingers of the first hand.

28. An apparatus as recited in Claim 27, wherein the first hand is approximately one fourth of the size of the second hand.