US20090105639A1 - Catheter driver system - Google Patents
Catheter driver system Download PDFInfo
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- US20090105639A1 US20090105639A1 US12/344,149 US34414908A US2009105639A1 US 20090105639 A1 US20090105639 A1 US 20090105639A1 US 34414908 A US34414908 A US 34414908A US 2009105639 A1 US2009105639 A1 US 2009105639A1
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- catheter
- robotic device
- control
- patient
- handle
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M25/1002—Balloon catheters characterised by balloon shape
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12027—Type of occlusion
- A61B17/1204—Type of occlusion temporary occlusion
- A61B17/12045—Type of occlusion temporary occlusion double occlusion, e.g. during anastomosis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/12136—Balloons
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
- A61M25/0113—Mechanical advancing means, e.g. catheter dispensers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M25/1011—Multiple balloon catheters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M25/1018—Balloon inflating or inflation-control devices
- A61M25/10184—Means for controlling or monitoring inflation or deflation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B2017/12127—Double occlusion, e.g. for creating blood-free anastomosis site
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22072—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other
- A61B2017/22074—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel
- A61B2017/22075—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel with motorized advancing or retracting means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
- A61B2017/3405—Needle locating or guiding means using mechanical guide means
- A61B2017/3409—Needle locating or guiding means using mechanical guide means including needle or instrument drives
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/30—Surgical robots
- A61B2034/301—Surgical robots for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0807—Indication means
- A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/70—Manipulators specially adapted for use in surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M2025/0004—Catheters; Hollow probes having two or more concentrically arranged tubes for forming a concentric catheter system
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M2025/0008—Catheters; Hollow probes having visible markings on its surface, i.e. visible to the naked eye, for any purpose, e.g. insertion depth markers, rotational markers or identification of type
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M2025/0175—Introducing, guiding, advancing, emplacing or holding catheters having telescopic features, interengaging nestable members movable in relations to one another
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M25/1011—Multiple balloon catheters
- A61M2025/1015—Multiple balloon catheters having two or more independently movable balloons where the distance between the balloons can be adjusted, e.g. two balloon catheters concentric to each other forming an adjustable multiple balloon catheter system
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M2025/1043—Balloon catheters with special features or adapted for special applications
- A61M2025/1052—Balloon catheters with special features or adapted for special applications for temporarily occluding a vessel for isolating a sector
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M2025/1043—Balloon catheters with special features or adapted for special applications
- A61M2025/1059—Balloon catheters with special features or adapted for special applications having different inflatable sections mainly depending on the response to the inflation pressure, e.g. due to different material properties
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M2025/1043—Balloon catheters with special features or adapted for special applications
- A61M2025/1072—Balloon catheters with special features or adapted for special applications having balloons with two or more compartments
Definitions
- Catheters are used extensively in the medical field in various types of medical procedures, as well as other invasive procedures.
- minimally invasive medical procedures involve operating through a natural body opening or orifice of a body lumen, or through small incisions, typically 5 mm to 10 mm in length, through which instruments are inserted.
- minimally invasive surgery is less traumatic than conventional surgery, due, in part, because no incision is required in certain minimally invasive procedures, or the significant reduction in the incision size in other procedures.
- hospitalization is reduced and recovery periods are shortened as compared with conventional surgical techniques.
- Catheters may be provided in a variety of different shapes and sizes depending upon the particular application. It is typical for a clinician to manipulate the proximal end of the catheter to guide the distal end of the catheter inside the body, for example, through a vein or artery. Because of the small size of the incision or opening and the remote location of the distal end of the catheter, much of the procedure is not directly visible to the clinician. Although clinicians can have visual feedback from the procedure site through the use of a video camera or endoscope inserted into the patient, or through radiological imaging or ultrasonic imaging, the ability to control even relatively simple instruments remains difficult.
- the surgeon manually places the distal end of an extension, such as a catheter, at a site of interest in the patient's body.
- the distal end of the catheter can be coupled to an energy generator to treat the site of interest.
- the catheter can be connected to a detector which receives signals from the distal end of the catheter for diagnostic purposes.
- the catheter is typically connected to a handle that includes control devices such as dials that enable the surgeon to articulate the catheter, and thus, to maneuver the catheter through the patient.
- robotic tele-surgery to perform minimally invasive procedures.
- these robotic systems use arms that reach over the surgical table and manipulate the surgical instruments inserted into the patient, while the surgeon sits at a master station located a distance from the table and issues commands to the arms.
- An apparatus for performing medical procedures on an anatomical body includes an extension with an element near its distal end to be extended into the body, and a driver that moves the extension axially into the body, and that causes flexure of the distal end of the extension.
- the movement and flexure of the extension is driven by the driver from the proximal end of the extension, and an electronic controller directs the operation of the driver.
- the driver includes control devices which may include conventional handle dials.
- a first control device is coupled to a first control wire, and a second control device is coupled to a second control wire.
- the first and second control wires extend along the length of the extension, and the terminal ends of the first and second control wires are coupled to the distal end of the extension.
- the first and second control devices are operated to control the flexure movements of the distal end of the extension with at least two degrees-of-freedom.
- the first and second control devices can be part of a handle which is a plug-in module that is removable from the driver.
- the driver moves the extension with a rotational movement.
- the driver may include a first drive mechanism and a second drive mechanism that are coupled to a motor array.
- the motor array in turn may be coupled to the controller, which directs the operation of the motor array and consequent operation of the drive mechanisms to move the extension with the axial and rotational movements.
- the element may receive RF energy from an RF generator for delivery to a target site in the body.
- the element provides signals from the target site to a detector. The signals are typically related to properties of the target site.
- FIG. 1 illustrates a manual catheter system
- FIG. 1A a close-up view of the terminal end of the catheter shown in FIG. 2 ;
- FIG. 2 is a block and schematic diagram of a catheter drive system in accordance with the present invention.
- FIG. 2A is a variation of the configuration shown in FIG. 3 ;
- FIG. 3 is a block and schematic diagram of another version of a catheter drive system in accordance with the present invention.
- FIG. 4 is a perspective view of an illustrative embodiment of the catheter drive system of FIG. 3 ;
- FIG. 4A is a top view of the catheter drive system of FIG. 4 ;
- FIG. 4B is a front view of the catheter drive system of FIG. 4 .
- the present invention provides a drive system that can be used to manipulate a surgical implement from its proximal end.
- a manually operable instrument can be coupled to the drive system without requiring any modification to the instrument.
- the drive system can be operated by a surgeon at a master station of a master-slave telerobotic system.
- the drive apparatus is in the form of a housing in which the instrument is inserted, which is then driven as the surgeon manipulates the housing.
- a extension such as a catheter 30 is used for diagnostic purposes or sensing conditions at a predetermined target site 31 as the catheter 30 extends through an artery or vein 34 .
- the distal end 36 of the catheter 30 can be considered as an operative segment of the catheter and thus is capable of flexing or bending to assist guiding the catheter through the anatomic body, and curving to a desired location, for example, to lean against an inner surface of the heart.
- wiring 40 may extend along the length of the catheter 30 that transmits mechanical inputs of a manual handle 60 . As shown in FIG.
- the RF generator 45 couples energy through the handle 60 by way of the catheter 30 to the elements 62 a , 62 b , and 62 c at the distal end 36 for the application of RF energy at the target site 31 for therapeutic purposes.
- the detector 50 may receives signals from a probe, such as the elements 62 a , 62 b , and 62 c , positioned at the target site. Typically, these signals are related to physiological properties at the target site.
- the handle 60 has wheels or dials 62 and 64 that can be manually operated by the surgeon during a procedure. Manipulation of the dials 62 and 64 are transmitted through the control wiring 40 to the distal end 36 to control the flexing or bending of the distal end in respective orthogonal directions.
- the operation of the drive system of FIG. 1 is automated. That is, the system shown in FIG. 2 modifies the construction of that shown in FIG. 1 by providing for automatic control of a catheter 130 , which at its distal end is substantially the same as the catheter 30 shown in FIGS. 1 and 1A .
- the catheter 130 is able to move at its end with at least two degrees-of-freedom under control of wires 128 a and 128 b .
- the catheter 130 is coupled at its distal end to a support block 132 that includes wheels 134 that provide linear translation of the catheter 130 in the direction 136 .
- a further mechanism 137 provides rotational motion of the catheter 130 , such as depicted by the arrow 138 .
- a guide wire is not used, nor is a guide wire used in the device shown in FIGS. 1 and 1A . Accordingly, only a single support block 132 is used with this catheter construction. However, the particular catheter 130 is provided with the flex control, and hence is provided with control wires that extend through the catheter 130 like those described previously in reference with FIG. 1 .
- the support or drive block 132 is coupled to an electromechanical drive member or motor array 120 .
- an input device 124 is coupled to a controller 122 which in turn is coupled to the motor array 120 .
- instructions from the input device 124 are received by the controller 122 which then directs the operation of the motor array 120 .
- movement of the motors of the array 120 is transmitted to the catheter 130 through mechanically cabling extending through the catheter.
- a mechanical cabling 126 coupled directly to the block 132 controls the rotational and linear degrees-of-freedom of the catheter 130 through the mechanism 137 and wheels 134 , respectively.
- one cable 128 a may be used to control the bending movements of the catheter with one degree-of-freedom
- another cable 128 b may control the bending movements with a second degree-of-freedom.
- the input device 124 may include separate manipulators for the different movements of the catheter 130 . As described in connection with FIG. 1 , the input device can take on one of many different forms including joysticks, wheels, dials, and other types of manual interfaces. For the control desired in FIG. 2 , one input member controls the mechanical cabling 126 for providing the two degrees-of-freedom of action of the catheter 130 , in particular, the linear and rotational movement. Another input member in input device 124 controls the flexing and bending of the catheter 130 by way of the mechanical cabling 128 . The input instructions from the input device 124 are transmitted to the motor array 120 by way of the controller 122 which may be a microprocessor.
- an intermediate drive device 59 may be interposed between the motor array 120 and the catheter 130 .
- the motor array 120 communicates with the drive device 59 over the lines 128 , which may be electrical.
- the drive device 59 is coupled to the cabling extending through the length of the catheter, and actuates the cabling to cause the distal end of the catheter 130 to bend and flex with one or more degrees-of-freedom.
- FIG. 3 there is shown a further embodiment of a catheter drive system.
- like reference characters are used to identify like features shown in FIG. 2 .
- FIG. 3 also depicts the support block 132 which provides both linear and rotational movement of the catheter 130 . As before, these movements are provide by wheels 134 for the linear translation as noted by the arrow 136 , and the member or mechanism 137 for the rotational translation as noted by the arrow 138 .
- the handle 60 is depicted with its pair of actuating wheels or dials 62 and 64 shown earlier in FIG. 1 .
- the handle 60 here remains intact so that the wheels 62 and 64 are used to control the flexing and bending of the catheter 130 .
- Each of the drive pieces engages its corresponding wheel to drive the wheels in either direction to provide the appropriate flex control of the catheter 130 .
- the separate lines 127 and 129 which may be mechanical or electrical, coupling the drive pieces 65 and 63 to the motor array 120 .
- actuation of respective drive units in the motor array 120 results in a consequent actuation of the wheels 62 and 64 via the control line 129 and drive piece 63 , and the control line 127 and drive piece 65 , respectively.
- the proper support and housings are provided such that the drive pieces 63 and 65 maintain proper engagement with the wheels 62 and 64 .
- the existing catheter construction need not be modified. Rather, the drive system shown in FIG. 3 is simply coupled to an existing catheter system, such as the handle 60 and catheter 130 combination.
- the handle 60 may have only a single control dial. In such implementations, there may be only a single line and associated drive piece that couples the motor array 120 to the handle 60 .
- the catheter typically flexes only in a single plane.
- the catheter support block 132 provides for rotational movement of the catheter 130 , the movement of the catheter is not limited to this single plane, since as the catheter is being rotated it moves out of this plane.
- FIGS. 4 , 4 A, and 4 B A particular embodiment of the system of FIG. 3 is illustrated in FIGS. 4 , 4 A, and 4 B, where like reference characters are used to identify like features shown in FIG. 3 .
- the handle 60 is clamped in a clamp or vise 200 with a screw 202 .
- the clamp 200 is connected to a shaft 201 supported in a carriage 202 that moves back and forth on a guide bar 204 mounted in the drive block 132 .
- Associated with the shaft 201 is a set of gears 206 that engage with another set of gears 208 of the rotary drive mechanism 137 .
- the drive mechanism 137 includes a motor 210 driven by the array 120 located in the drive block 132 and under the direction of the controller 122 as it receives instructions from the user through the input device 124 .
- a motor 210 rotates the gears 208 , a consequent rotary motion is induced in the gears 206 to rotate the clamp 200 , and hence the handle 60 and catheter 130 , in the rotational direction 138 .
- the linear drive mechanism 134 of this embodiment includes a motor 212 connected to a screw drive 214 .
- the motor 212 and screw drive 214 are mounted to the drive block 132 in a manner to allow the screw drive 214 to rotate.
- the screw drive 214 has threads 215 about its periphery that engage with the carriage 202 . Accordingly, under the direction of the controller 122 via the array 120 , the motor 212 rotates the screw drive 214 to induce the carriage 202 , and hence the handle 60 and catheter 130 , to move back and forth in the linear direction 136 .
- the drive pieces 63 and 65 engage with the dials or wheels 62 and 64 of the handle 60 so that upon instructions from the user through the input device 124 , the drive pieces 63 and 65 manipulate the dials 62 and 64 to control the desired bending and flexing movements of the catheter 130 .
- the catheter need not be limited for use in electrophysiology procedures. That is, there may be other types of probes or end effectors located at the distal end of the catheter.
- the end effector may be, for example, an articulated tool such a grasper, scissor, needle holder, micro dissector, staple applier, tacker, suction irrigation tool, and clip applier.
- the end effector can also be a non-articulated tool, such as a cutting blade, probe, irrigator, catheter or suction orifice, and dilation balloon.
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Abstract
An apparatus for performing medical procedures on an anatomical body includes an extension with an element near its distal end to be extended into the body, and a driver that moves the extension axially into the body, and that causes flexure of the distal end of the extension. The movement and flexure of the extension is driven by the driver from the proximal end of the extension, and an electronic controller directs the operation of the driver.
Description
- This application is a continuation of U.S. application Ser. No. 10/270,743, which claims the benefit of U.S. Provisional Application No. 60/332,287, filed Nov. 21, 2001, and is a continuation in part of U.S. application Ser. No. 10/216,067, filed Aug. 8, 2002, which claims the benefit of U.S. Provisional Application No. 60/313,497, filed Aug. 21, 2001, and is a continuation in part of U.S. application Ser. Nos. 10/023,024 (now abandoned), 10/011,371 (now U.S. Pat. No. 7,090,683), 10/011,449 (now abandoned), 10/010,150 (now U.S. Pat. No. 7,214,230), 10/022,038 (now abandoned), and 10/012,586, all filed Nov. 16, 2001, and all of which claim the benefit of U.S. Provisional Application Nos. 60/269,200, filed Feb. 15, 2001, 60/276,217, filed Mar. 15, 2001, 60/276,086, filed Mar. 15, 2001, 60/276,152, filed Mar. 15, 2001, and 60/293,346, filed May 24, 2001.
- Catheters are used extensively in the medical field in various types of medical procedures, as well as other invasive procedures. In general, minimally invasive medical procedures involve operating through a natural body opening or orifice of a body lumen, or through small incisions, typically 5 mm to 10 mm in length, through which instruments are inserted. In general, minimally invasive surgery is less traumatic than conventional surgery, due, in part, because no incision is required in certain minimally invasive procedures, or the significant reduction in the incision size in other procedures. Furthermore, hospitalization is reduced and recovery periods are shortened as compared with conventional surgical techniques.
- Catheters may be provided in a variety of different shapes and sizes depending upon the particular application. It is typical for a clinician to manipulate the proximal end of the catheter to guide the distal end of the catheter inside the body, for example, through a vein or artery. Because of the small size of the incision or opening and the remote location of the distal end of the catheter, much of the procedure is not directly visible to the clinician. Although clinicians can have visual feedback from the procedure site through the use of a video camera or endoscope inserted into the patient, or through radiological imaging or ultrasonic imaging, the ability to control even relatively simple instruments remains difficult.
- In some procedures, such as electrophysiology, the surgeon manually places the distal end of an extension, such as a catheter, at a site of interest in the patient's body. The distal end of the catheter can be coupled to an energy generator to treat the site of interest. Alternatively, or additionally, the catheter can be connected to a detector which receives signals from the distal end of the catheter for diagnostic purposes. The catheter is typically connected to a handle that includes control devices such as dials that enable the surgeon to articulate the catheter, and thus, to maneuver the catheter through the patient.
- In view of the above, some have proposed using robotic tele-surgery to perform minimally invasive procedures. Typically, these robotic systems use arms that reach over the surgical table and manipulate the surgical instruments inserted into the patient, while the surgeon sits at a master station located a distance from the table and issues commands to the arms.
- An apparatus for performing medical procedures on an anatomical body includes an extension with an element near its distal end to be extended into the body, and a driver that moves the extension axially into the body, and that causes flexure of the distal end of the extension. The movement and flexure of the extension is driven by the driver from the proximal end of the extension, and an electronic controller directs the operation of the driver.
- In some embodiments, the driver includes control devices which may include conventional handle dials. A first control device is coupled to a first control wire, and a second control device is coupled to a second control wire. The first and second control wires extend along the length of the extension, and the terminal ends of the first and second control wires are coupled to the distal end of the extension. The first and second control devices are operated to control the flexure movements of the distal end of the extension with at least two degrees-of-freedom. The first and second control devices can be part of a handle which is a plug-in module that is removable from the driver.
- In certain embodiments, the driver moves the extension with a rotational movement. The driver may include a first drive mechanism and a second drive mechanism that are coupled to a motor array. The motor array in turn may be coupled to the controller, which directs the operation of the motor array and consequent operation of the drive mechanisms to move the extension with the axial and rotational movements.
- In some embodiments, the element may receive RF energy from an RF generator for delivery to a target site in the body. In particular embodiments, the element provides signals from the target site to a detector. The signals are typically related to properties of the target site.
- Since the movements of the driver are under the direction of the controller, these movements may be gentler than those produced by the surgeon when the instrument is manually driven through the patient. Furthermore, with the assistance of the driver, the surgeon is less likely to become fatigued during the procedure.
- The foregoing and other objects, features and advantages of the invention will be apparent from the following more particular description of preferred embodiments of the invention, as illustrated in the accompanying drawings in which like reference characters refer to the same parts throughout the different views. The drawings are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention.
-
FIG. 1 illustrates a manual catheter system; -
FIG. 1A a close-up view of the terminal end of the catheter shown inFIG. 2 ; -
FIG. 2 is a block and schematic diagram of a catheter drive system in accordance with the present invention; -
FIG. 2A is a variation of the configuration shown inFIG. 3 ; -
FIG. 3 is a block and schematic diagram of another version of a catheter drive system in accordance with the present invention; -
FIG. 4 is a perspective view of an illustrative embodiment of the catheter drive system ofFIG. 3 ; -
FIG. 4A is a top view of the catheter drive system ofFIG. 4 ; and -
FIG. 4B is a front view of the catheter drive system ofFIG. 4 . - A description of preferred embodiments of the invention follows.
- The present invention provides a drive system that can be used to manipulate a surgical implement from its proximal end. For example, a manually operable instrument can be coupled to the drive system without requiring any modification to the instrument. The drive system can be operated by a surgeon at a master station of a master-slave telerobotic system. In some embodiments, the drive apparatus is in the form of a housing in which the instrument is inserted, which is then driven as the surgeon manipulates the housing.
- In electrophysiology procedures, as shown in
FIG. 1 , a extension such as acatheter 30 is used for diagnostic purposes or sensing conditions at apredetermined target site 31 as thecatheter 30 extends through an artery orvein 34. Thedistal end 36 of thecatheter 30 can be considered as an operative segment of the catheter and thus is capable of flexing or bending to assist guiding the catheter through the anatomic body, and curving to a desired location, for example, to lean against an inner surface of the heart. In this regard, there is schematically illustratedwiring 40 that may extend along the length of thecatheter 30 that transmits mechanical inputs of amanual handle 60. As shown inFIG. 1A , there can beadditional wiring respective electrophysiology elements distal end 36 to anRF generator 45, as well as adetector 50, associated with the handle 60 (FIG. 1 ). - In some embodiments, the
RF generator 45 couples energy through thehandle 60 by way of thecatheter 30 to theelements distal end 36 for the application of RF energy at thetarget site 31 for therapeutic purposes. In association with theRF generator 45, thedetector 50 may receives signals from a probe, such as theelements - As can be seen in
FIG. 1 , thehandle 60 has wheels or dials 62 and 64 that can be manually operated by the surgeon during a procedure. Manipulation of thedials control wiring 40 to thedistal end 36 to control the flexing or bending of the distal end in respective orthogonal directions. In a particular embodiment, as shown in FIG. 2, the operation of the drive system ofFIG. 1 is automated. That is, the system shown inFIG. 2 modifies the construction of that shown inFIG. 1 by providing for automatic control of acatheter 130, which at its distal end is substantially the same as thecatheter 30 shown inFIGS. 1 and 1A . - Like the
catheter 30, thecatheter 130 is able to move at its end with at least two degrees-of-freedom under control ofwires catheter 130 is coupled at its distal end to asupport block 132 that includeswheels 134 that provide linear translation of thecatheter 130 in thedirection 136. Afurther mechanism 137 provides rotational motion of thecatheter 130, such as depicted by thearrow 138. Moreover, there are also wires extending through thecatheter 130 associated with theRF generator 145 and thedetector 150. - In the embodiment illustrated in
FIG. 2 , a guide wire is not used, nor is a guide wire used in the device shown inFIGS. 1 and 1A . Accordingly, only asingle support block 132 is used with this catheter construction. However, theparticular catheter 130 is provided with the flex control, and hence is provided with control wires that extend through thecatheter 130 like those described previously in reference withFIG. 1 . - As shown in
FIG. 2 , the support or driveblock 132 is coupled to an electromechanical drive member ormotor array 120. Also included in the system is aninput device 124 at which a surgeon provides control actuations. Theinput device 124 is coupled to acontroller 122 which in turn is coupled to themotor array 120. Thus, instructions from theinput device 124 are received by thecontroller 122 which then directs the operation of themotor array 120. - As mentioned previously, movement of the motors of the
array 120 is transmitted to thecatheter 130 through mechanically cabling extending through the catheter. In particular, amechanical cabling 126 coupled directly to theblock 132 controls the rotational and linear degrees-of-freedom of thecatheter 130 through themechanism 137 andwheels 134, respectively. In addition, there is a cabling 128 from themotor array 120 to theblock 132 which controls the bending and flexing movement of thecatheter 130. As such, onecable 128 a may be used to control the bending movements of the catheter with one degree-of-freedom, and anothercable 128 b may control the bending movements with a second degree-of-freedom. - The
input device 124 may include separate manipulators for the different movements of thecatheter 130. As described in connection withFIG. 1 , the input device can take on one of many different forms including joysticks, wheels, dials, and other types of manual interfaces. For the control desired inFIG. 2 , one input member controls themechanical cabling 126 for providing the two degrees-of-freedom of action of thecatheter 130, in particular, the linear and rotational movement. Another input member ininput device 124 controls the flexing and bending of thecatheter 130 by way of themechanical cabling 128. The input instructions from theinput device 124 are transmitted to themotor array 120 by way of thecontroller 122 which may be a microprocessor. - In an alternative arrangement, as shown in
FIG. 2A , anintermediate drive device 59 may be interposed between themotor array 120 and thecatheter 130. In such an arrangement, themotor array 120 communicates with thedrive device 59 over thelines 128, which may be electrical. In turn, thedrive device 59 is coupled to the cabling extending through the length of the catheter, and actuates the cabling to cause the distal end of thecatheter 130 to bend and flex with one or more degrees-of-freedom. - Details of an automated catheter drive system are describe in the U.S. Application entitled “Coaxial Catheter System,” by Weitzer, Rogers, and Solbjor, U.S. application Ser. No. 10/270,740, filed Oct. 11, 2002, now abandoned, the entire contents of which are incorporated herein by reference. Details of an imaging system that aids the movement of the catheter through an anatomic body are described in the U.S. application entitled “Catheter Tracking System,” by Weitzner and Lee, U.S. application Ser. No. 10/270,741, filed Oct. 11, 2002, the entire contents of which are incorporated herein by reference.
- Referring now to
FIG. 3 , there is shown a further embodiment of a catheter drive system. InFIG. 3 , like reference characters are used to identify like features shown inFIG. 2 . Thus, in the embodiment ofFIG. 3 , there is aninput device 124, acontroller 122, and amotor array 120.FIG. 3 also depicts thesupport block 132 which provides both linear and rotational movement of thecatheter 130. As before, these movements are provide bywheels 134 for the linear translation as noted by thearrow 136, and the member ormechanism 137 for the rotational translation as noted by thearrow 138. - In the embodiment of
FIG. 3 , thehandle 60 is depicted with its pair of actuating wheels or dials 62 and 64 shown earlier inFIG. 1 . Rather than replacing thehandle 60, as in the embodiment ofFIG. 2 , thehandle 60 here remains intact so that thewheels catheter 130. For this purpose, there are includeddrive pieces wheels catheter 130. Note inFIG. 3 , theseparate lines drive pieces motor array 120. Hence, actuation of respective drive units in themotor array 120 results in a consequent actuation of thewheels control line 129 and drivepiece 63, and thecontrol line 127 and drivepiece 65, respectively. Note that with this embodiment the proper support and housings are provided such that thedrive pieces wheels - With the particular arrangement shown in
FIG. 3 , the existing catheter construction need not be modified. Rather, the drive system shown inFIG. 3 is simply coupled to an existing catheter system, such as thehandle 60 andcatheter 130 combination. - Although the
motor array 120 is illustrated as having two separate lines for two separate drive pieces, in other embodiments, thehandle 60 may have only a single control dial. In such implementations, there may be only a single line and associated drive piece that couples themotor array 120 to thehandle 60. Thus, unlike thehandle 60 withwheels catheter support block 132 provides for rotational movement of thecatheter 130, the movement of the catheter is not limited to this single plane, since as the catheter is being rotated it moves out of this plane. - A particular embodiment of the system of
FIG. 3 is illustrated inFIGS. 4 , 4A, and 4B, where like reference characters are used to identify like features shown inFIG. 3 . In this embodiment, thehandle 60 is clamped in a clamp orvise 200 with ascrew 202. Theclamp 200 is connected to ashaft 201 supported in acarriage 202 that moves back and forth on aguide bar 204 mounted in thedrive block 132. Associated with theshaft 201 is a set ofgears 206 that engage with another set ofgears 208 of therotary drive mechanism 137. Thedrive mechanism 137 includes amotor 210 driven by thearray 120 located in thedrive block 132 and under the direction of thecontroller 122 as it receives instructions from the user through theinput device 124. Thus, as themotor 210 rotates thegears 208, a consequent rotary motion is induced in thegears 206 to rotate theclamp 200, and hence thehandle 60 andcatheter 130, in therotational direction 138. - The
linear drive mechanism 134 of this embodiment includes amotor 212 connected to ascrew drive 214. Themotor 212 andscrew drive 214 are mounted to thedrive block 132 in a manner to allow thescrew drive 214 to rotate. Thescrew drive 214 hasthreads 215 about its periphery that engage with thecarriage 202. Accordingly, under the direction of thecontroller 122 via thearray 120, themotor 212 rotates thescrew drive 214 to induce thecarriage 202, and hence thehandle 60 andcatheter 130, to move back and forth in thelinear direction 136. - As previously mentioned, the
drive pieces wheels handle 60 so that upon instructions from the user through theinput device 124, thedrive pieces dials catheter 130. - This invention can be implemented and combined with other applications, systems, and apparatuses, for example, those discussed in greater detail in U.S. Provisional Application No. 60/332,287, filed Nov. 21, 2001, the entire contents of which are incorporated herein by reference, as well as those discussed in greater detail in each of the following documents, all of which are incorporated herein by reference in their entirety:
- U.S. application Ser. No. 09/783,637 filed Feb. 14, 2001, which is a continuation of PCT application Serial No. PCT/US00/12553 filed May 9, 2000, which claims the benefit of U.S. Provisional Application No. 60/133,407 filed May 10, 1999; U.S. application entitled “Articulated Apparatus for Telemanipulator System,” by Brock and Lee, U.S. application Ser. No. 10/208,087, filed Jul. 29, 2002, now abandoned, which is a continuation of U.S. application Ser. No. 09/827,503 filed Apr. 6, 2001, which is a continuation of U.S. application Ser. No. 09/746,853 filed Dec. 21, 2000, which is a divisional of U.S. application Ser. No. 09/375,666 filed Aug. 17, 1999, now U.S. Pat. No. 6,197,017 which issued on Mar. 6, 2001, which is a continuation of U.S. application Ser. No. 09/028,550 filed Feb. 24, 1998, which is now abandoned; PCT application Serial No. PCT/US01/11376 filed Apr. 6, 2001, which claims priority to U.S. application Ser. No. 09/746,853 filed Dec. 21, 2000, and U.S. application Ser. No. 09/827,503 filed Apr. 6, 2001; U.S. application Ser. Nos. 10/014,143, 10/012,845, 10/008,964, 10/013,046, 10/011,450, 10/008,457, and 10/008,871, all filed Nov. 16, 2001 and all of which claim benefit to U.S. Provisional Application No. 60/279,087 filed Mar. 27, 2001; U.S. application Ser. No. 10/077,233 filed Feb. 15, 2002, which claims the benefit of U.S. Provisional Application No. 60/269,203 filed Feb. 15, 2001; U.S. application Ser. No. 10/097,923 filed Mar. 15, 2002, which claims the benefit of U.S. Provisional Application No. 60/276,151 filed Mar. 15, 2001; U.S. application Ser. No. 10/034,871 filed Dec. 21, 2001, which claims the benefit of U.S. Provisional Application No. 60/257,816 filed Dec. 21, 2000; U.S. application Ser. No. 09/827,643 filed Apr. 6, 2001, which claims the benefit of U.S. Provisional Application No. 60/257,869 filed Dec. 21, 2000, and U.S. Provisional Application No. 60/195,264 filed Apr. 7, 2000.
- While this invention has been particularly shown and described with references to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the invention encompassed by the appended claims. For example, the catheter need not be limited for use in electrophysiology procedures. That is, there may be other types of probes or end effectors located at the distal end of the catheter. The end effector may be, for example, an articulated tool such a grasper, scissor, needle holder, micro dissector, staple applier, tacker, suction irrigation tool, and clip applier. The end effector can also be a non-articulated tool, such as a cutting blade, probe, irrigator, catheter or suction orifice, and dilation balloon.
Claims (31)
1. A system for remotely controlling the positioning within the body of a patient of an elongated medical device having a control handle, the system comprising: a robotic device configured to position the medical device within the body of the patient; and a remote control mechanism configured to control the robotic device, wherein the robotic device comprises a handle controller to receive the control handle.
2. The system of claim 1 , wherein the remote control mechanism comprises a remote control station and a robotic device controller, an operator using the remote control station to control the robotic device.
3. The system of claim 2 , wherein the remote control mechanism includes one or more transmitters, receivers, and/or transceivers to communicate information between the remote control station and the robotic device controller.
4. The system of claim 1 , wherein the robotic device is controlled from a remote control station at a location that is remote from the location of the patient.
5. The system of claim 2 , wherein the remote control station comprises a joystick that can be an operated by an operator to control the robotic device.
6. The system of claim 1 , wherein the robotic device is further configured to insert the medical device within the body of the patient.
7. The system of claim 1 , wherein the medical device is a catheter and the robotic device comprises a catheter control device.
8. The system of claim 7 , wherein the handle controller of the robotic device engages the control handle of the catheter.
9. The system of claim 8 , wherein the handle controller uses the standard features of the catheter control handle to, within the body of the patient, insert the catheter, steer the catheter, rotate the catheter, place the catheter, shape the catheter, or deflect the catheter, or a combination of two or more thereof.
10. The system of claim 7 , wherein the catheter is an electrophysiology catheter.
11. The system of claim 7 , wherein the catheter control device is further configured to feed the catheter within the patient's circulatory system.
12. The system of claim 7 , wherein the catheter is used for a cardiac procedure.
13. The system of claim 12 , wherein the catheter is an interventional catheter used to deliver therapy for the cardiac procedure.
14. The system of claim 10 , wherein the catheter is used for mapping and catheter ablation.
15. The system of claim 7 , wherein the catheter is used for a dilation procedure.
16. The system of claim 8 , wherein the handle controller further comprises: means for holding said catheter firmly; means for rotating said catheter; and means for shaping, deflecting, steering, placing, or positioning the catheter, or a combination of two or more thereof, within the patient.
17. The system of claim 10 , wherein the electrophysiology catheter is a mapping and/or ablation catheter.
18. The system of claim 17 , which can be used to perform atrial fibrillation ablation.
19. The system of claim 17 , which can be used to perform ventricular tachycardia ablation.
20. The system of claim 17 , which can be used to perform atrial flutter ablation.
21. The system of claim 17 , which can be used to perform atrial tachycardia ablation.
22. The system of claim 17 , which can be used to perform pulmonary vein isolation.
23. The system of claim 17 , which can be used to perform simple ablations.
24. The system of claim 17 , which can be used to perform complex ablations.
25. The system of claim 24 , which can be used to perform complex ablations for accessory pathway mediated tachycardias.
26. The system of claim 1 , wherein the robotic device comprises: a handle controller effective to receive a control handle of a catheter, the catheter having at least three ranges of motion and a distal end; a first motor connected to the handle controller and effective to at least move the catheter forward and/or backward; a second motor connected to the handle controller and effective to at least rotate the catheter; a third motor connected to the handle controller and effective to at least deflect the distal end in at least a first direction; and a controller unit connected to the first, second and third motors.
27. The system of claim 26 , wherein: the first motor is connected to an externally threaded drive screw; the handle controller is connected to an internally threaded drive support; and the drive screw is mated with the drive support.
28. The system of claim 26 , wherein the catheter includes at least one control member effective to control deflection of the distal end and the third motor is connected to the at least one control member.
29. In an improved method for mapping and catheter ablation by inserting a mapping and ablation catheter into a patient, the improvement wherein a remote positioning control system of claim 1 is used to position the catheter.
30. A system for remotely controlling the positioning of a medical device within the body of a patient, the system comprising: a robotic device configured to position the medical device within a body of a patient, the robotic device comprising a handle controller effective to manipulate controls on the medical device; a driver effective to move the medical device forward and backward inside the body; and a remote control mechanism effective to control the robotic device.
31. A system for remotely controlling the positioning within the body of a patient of an elongated medical device having a proximal end, the system comprising: a robotic device configured to position the medical device within the body of the patient; and a remote control mechanism configured to control the robotic device, wherein the robotic device comprises a handle controller to receive the proximal end of the medical device.
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US31349501P | 2001-08-21 | 2001-08-21 | |
US10/011,371 US7090683B2 (en) | 1998-02-24 | 2001-11-16 | Flexible instrument |
US10/010,150 US7214230B2 (en) | 1998-02-24 | 2001-11-16 | Flexible instrument |
US10/023,024 US20020095175A1 (en) | 1998-02-24 | 2001-11-16 | Flexible instrument |
US10/022,038 US20020087148A1 (en) | 1998-02-24 | 2001-11-16 | Flexible instrument |
US10/012,586 US7371210B2 (en) | 1998-02-24 | 2001-11-16 | Flexible instrument |
US10/011,449 US20020087048A1 (en) | 1998-02-24 | 2001-11-16 | Flexible instrument |
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Also Published As
Publication number | Publication date |
---|---|
US20070233045A1 (en) | 2007-10-04 |
US20120226227A1 (en) | 2012-09-06 |
US20070239105A1 (en) | 2007-10-11 |
US7766894B2 (en) | 2010-08-03 |
US8603068B2 (en) | 2013-12-10 |
US8187229B2 (en) | 2012-05-29 |
US7955316B2 (en) | 2011-06-07 |
US20070239106A1 (en) | 2007-10-11 |
US20080119824A1 (en) | 2008-05-22 |
US20070060879A1 (en) | 2007-03-15 |
US7727185B2 (en) | 2010-06-01 |
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