US20060100501A1 - System for positioning on a patient an observation and/or intervention device - Google Patents
System for positioning on a patient an observation and/or intervention device Download PDFInfo
- Publication number
- US20060100501A1 US20060100501A1 US10/514,353 US51435305A US2006100501A1 US 20060100501 A1 US20060100501 A1 US 20060100501A1 US 51435305 A US51435305 A US 51435305A US 2006100501 A1 US2006100501 A1 US 2006100501A1
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- Prior art keywords
- patient
- respect
- base
- mobile ring
- axis
- Prior art date
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Images
Classifications
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- B—PERFORMING OPERATIONS; TRANSPORTING
- B25—HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
- B25J—MANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
- B25J18/00—Arms
-
- 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
-
- 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
- A61B90/50—Supports for surgical instruments, e.g. articulated arms
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
- A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
-
- 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
- A61B2017/3407—Needle locating or guiding means using mechanical guide means including a base for support on the body
-
- 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
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
-
- 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
- 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
- A61B90/10—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 for stereotaxic surgery, e.g. frame-based stereotaxis
- A61B90/11—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 for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints
-
- 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
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/361—Image-producing devices, e.g. surgical cameras
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S901/00—Robots
- Y10S901/19—Drive system for arm
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
- Y10T74/00—Machine element or mechanism
- Y10T74/20—Control lever and linkage systems
- Y10T74/20207—Multiple controlling elements for single controlled element
- Y10T74/20305—Robotic arm
Definitions
- the first portion comprises a semi-circular rail having its ends pivotally assembled on the base along an axis substantially tangent to the patient's body.
- the motions of the first and second portions are controlled by cables driven by actuators located at a distance from the patient.
- FIG. 3B shows a front view of the system of FIG. 3A ;
- FIGS. 4B and 4C shows side views of the system of FIG. 4A at two different positions.
- System 10 comprises a substantially planar base 18 comprising a planar ring-shaped central portion 20 , surrounding incision 16 , from which four arms 21 extend.
- a cylindrical opening 22 is formed at the end of each arm 21 . Openings 22 may be used to maintain base 18 on the patient's body via straps, cables, etc. attached to the table on which the patient is laid or directly attached to the patient.
- Base 18 may also be glued on the patient's abdomen.
- Central annular portion 20 supports a mobile ring 24 of axis ⁇ substantially perpendicularly to the plane tangent to the abdomen at the level of incision 16 .
- Mobile ring 24 is rotatably assembled around axis ⁇ on central portion 20 via a bearing 25 .
- a stirrup 26 is pivotally assembled on mobile ring 24 according to an axis ⁇ substantially perpendicular to axis ⁇ , and substantially comprised in the plane tangent to the abdomen at the level of incision 16 .
- Stirrup 26 comprises a head 28 on which is attached trocar 14 by any known attachment means, which enables simple and fast connection and separation of trocar 14 and of head 28 .
- Said means will for example be flexible tongues 27 .
- the inner diameters of mobile ring 24 and of ring-shaped central portion 20 are selected to enable removal of system 10 during an intervention without displacing trocar 14 , or to enable removal of trocar 14 from the patient's abdomen without displacing system 10 .
- Head 28 prolongs in two arms 30 , 31 , each comprising at one end a sliding surface 32 , corresponding to a cylindrical portion, likely to slide on a profile 34 , 35 shaped as a half-cylinder of axis ⁇ .
- Each profile 34 , 35 moves along with a base 36 , 37 attached on ring 24 , for example, by screwing.
- Each arm 30 , 31 comprises at its free end a cap 38 , 39 (not shown in FIG. 1C ) which forms with sliding surface 32 of the associated arm 30 , 31 a housing receiving profile 34 , 35 .
- Endoscope 12 is assembled to freely slide along axis ⁇ in trocar 14 .
- a hold element 55 is attached to endoscope 12 .
- a compression spring 56 bears at one end against hold element 55 and at the opposite end against trocar 14 .
- a cable 57 is connected at one end to hold element 55 and at its opposite end to a rack (not shown) meshing in with the output shaft of an electric motor.
- a guide 58 attached on head 28 of stirrup 26 receives the end of a protection sheath 59 in which cable 57 slides.
- a traction on cable 57 makes endoscope 12 slide in trocar 14 along axis ⁇ and compresses spring 56 .
- spring 56 relaxes and brings endoscope 12 back to an idle position.
- Hold element 55 can easily be removed from endoscope 12 to enable removal of endoscope 12 from trocar 14 , for example, to clean its lens, or to replace it with another endoscope having a different length or viewing cone.
- the three motors and the racks are for example arranged in a package distant from the patient.
- the motor control may be performed in any known fashion and will not be detailed hereafter. It may for example be a vocal control, a manual control by lever or buttons, a foot control, etc.
- the motor control may be performed in open or closed loop.
- system 10 may also comprise a location means to detect the position and the orientation of incision 16 , of endoscope 12 , and of an intervention instrument handled by the surgeon.
- the location means may be connected to a calculator capable of controlling motors.
- the endoscope is then displaced to, for example, transmit an image permanently following the end of the intervention instrument.
- the motors are preferably clutch releasable to enable the surgeon to manually displace positioning system 10 .
- the present alternative of the first embodiment enables completely freeing the patient's abdomen during the surgical intervention.
- FIGS. 3A to 3 C very schematically show a second embodiment of system 10 for positioning trocar 14 in which the endoscope (not shown) slides, the trocar and the endoscope penetrating into the patient's abdomen through incision 89 .
- the means for controlling the sliding of the endoscope in trocar 14 are not shown in FIGS. 3A to 3 C and may be identical to those of the first embodiment.
- the rotating motions of endoscope 12 in trocar 14 around its axis ⁇ may also be controlled by an actuator.
- trocar 14 is maintained on stirrup 26 by a mounting flange 90 , for example, screwed on stirrup 26 .
- Trocar 14 comprises a protrusion 92 located on the side of mounting flange 90 opposite to ring-shaped base 18 .
- Protrusion 92 may represent handles, tightness valves, connectors, etc.
- a fixed ring 95 is arranged between ring-shaped base 18 and mobile ring 24 .
- Fixed ring 95 forms one piece with base 18 .
- Mobile ring 24 is rotatably assembled on fixed ring 95 .
- Fixed ring 95 comprises a peripheral toothing (not shown) on its external lateral surface.
- a first electric motor 96 intended to rotate mobile ring 24 with respect to fixed ring 95 , is assembled to move along with mobile ring 24 via a stage 98 .
- First motor 96 is controlled and supplied by means not shown, for example, by electric wires.
- a toothed wheel 100 is arranged at the end of shaft 102 of first motor 96 .
- Shaft 102 is substantially parallel to axis A of mobile ring 24 .
- Toothed wheel 100 meshes in with the toothing of fixed ring 95 . Since toothed wheel 100 cooperates with fixed ring 95 , the rotating of toothed wheel 100 by first motor 96 rotates mobile ring 24 with respect to fixed ring 95 .
- a second electric motor 104 is attached to stirrup 26 , on the side of stirrup 26 opposite to mounting flange 90 , via a stage 106 .
- the shaft (not visible in the drawings) of second motor 104 is oriented along pivoting axis ⁇ of stirrup 26 .
- Stage 106 comprises an opening (not visible in the drawings) enabling passing of the shaft of second motor 104 .
- Second motor 104 is controlled and supplied by means not shown, for example, electric wires.
- a drive element 108 comprises a circular arc 109 having its ends connected by a rectilinear portion 110 attached to mobile ring 24 .
- Drive element 108 substantially extends in a plane perpendicular to the plane containing mobile ring 24 .
- the axis of circular arc 109 corresponds to pivoting axis ⁇ of stirrup 26 .
- the wall of circular arc 109 opposite to rectilinear portion 110 comprises a toothing (not shown).
- the shaft of second motor 104 supports a toothed wheel (not shown) which cooperates with the toothing of circular arc 109 so that, when the toothed wheel is rotated by second motor 104 , stirrup 26 is pivoted with respect to mobile ring 24 .
- the toothing is provided inside of drive element 108 for security reasons and to increase the compactness of positioning system 10 .
- ring-shaped base 18 is maintained on the patient via four curved tongues 126 radially extending from ring-shaped base 18 .
- a support arm oriented by the surgeon before the beginning of the operation, may be provided to support positioning system 10 and avoid for the entire weight of positioning system 10 to be applied on the patient.
- the system according to the present invention has many advantages.
- the system enables applying no force on the patient's abdomen at the level of the incision through which the endoscope penetrates into the abdomen.
- the present invention is likely to have various alterations and modifications which will occur to those skilled in the art.
- the electric motors may be replaced with any type of actuators.
- the system according to the present invention enables positioning devices other than an endoscope. It may be, for example, a separator, a clip, etc.
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- Health & Medical Sciences (AREA)
- Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Engineering & Computer Science (AREA)
- Heart & Thoracic Surgery (AREA)
- Animal Behavior & Ethology (AREA)
- Veterinary Medicine (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Pathology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Robotics (AREA)
- Mechanical Engineering (AREA)
- Endoscopes (AREA)
- Accommodation For Nursing Or Treatment Tables (AREA)
Abstract
Description
- The present invention relates to a system for positioning on a patient an observation and/or intervention device having a portion penetrating into the patient's body. It for example applies to medical analysis systems, such as endoscopic systems, and it will more specifically be described in the case of a use of an endoscope in a laparoscopy.
- In such a type of operation, an endoscope formed of a thin optical tube is inserted into the patient's abdomen through a small incision performed at the level of the patient's abdomen. The optical tube is generally connected to an external video camera. Other incisions may be performed to introduce surgical instruments handled by a surgeon. The endoscope is used to visualize the patient's internal organs and the surgical instruments. Since the surgeon generally has both hands occupied by the surgical instruments, an assistant is necessary to maintain the endoscope in a desired position.
- Robotic systems have been developed to handle the endoscope instead of the assistant. Such systems are generally formed of massive, complex, and expensive robots comprising a base attached to the ground and an arm handling the endoscope. In the limited space of an operation table, the base of such a robot takes up a considerable place next to the patient. Further, the robot's arm maintaining the endoscope may hinder the access to the patient's abdomen.
- It is thus desirable to provide a system for positioning on a patient an observation and/or intervention instrument taking up a small volume to limit the space required in the operation theatre and clear the access to the patient as much as possible.
- International patent application WO0105319 assigned to the Universite Joseph Fourier describes, in an embodiment, a system for positioning an observation and/or intervention device, for example, an endoscope. The system comprises a mount placed on the patient's body, supporting a trocar in which the observation and/or intervention device slides, the trocar being likely to pivot with respect to the mount. An actuator assembly controls the trocar movement with respect to the mount. It may be formed of pneumatic or hydraulic actuators, each actuator being directly connected to the mount and to the trocar. It may also be formed of cables. Each cable then extends between the trocar and a guide attached on the mount, and is driven at its free end by an actuator placed at a distance from the patient.
- A disadvantage of such a system is the difficulty to impose significant movements to the trocar. Indeed, in the case where the actuators are placed directly on the mount, the volume taken up by the actuators limits the trocar movements. In the case where the actuators are placed at a distance from the patient, the trocar movements are obtained by the application of tractions of different amplitudes on the cables connected to the trocar. A difficulty then results, in large movements, from the high flexion angles imposed to the cables at the level of the guides. This may result in a fast deterioration of the cables. Further, with such a system, the forces exerted by the cables or the actuators on the trocar are the origin of a pressure exerted by the trocar on the patient's abdomen that may be undesirable. Another disadvantage of such a system is that it is generally not possible to remove the positioning system while leaving in place the trocar and the observation and/or intervention devices.
- The present invention provides a system, taking up a small volume, for positioning on a patient's body an observation and/or intervention device having a portion penetrating into the patient's body, enabling obtaining significant movements of the observation device and enabling removal of the positioning system while leaving in place the observation and/or intervention device.
- The present invention also provides a positioning system limiting the application of pressure forces on the patient's abdomen.
- To achieve these objects, the present invention provides a system for positioning with respect to a patient's body an observation and/or intervention device having a portion penetrating into the patient's body comprising a base laid on the patient's body; a means for supporting the device formed of a first portion movably assembled on the base according to a connection with one degree of freedom, and of a second portion movably assembled on the first portion according to a connection with one degree of freedom and connected to the device; and means for actuating the first portion with respect to the base, and the second portion with respect to the first portion, in which the base surrounds at a distance at least partially the device and in which the device is detachably connected to the second portion to enable removal of the positioning system with respect to the device while leaving in place the device with respect to the patient's body.
- According to an embodiment of the present invention, the base delimits a circular opening around the device and the first portion is a mobile ring with an axis substantially perpendicular to the patient's body and with an inner diameter substantially corresponding to the circular opening, the mobile ring being rotatably assembled on the base around its axis.
- According to an embodiment of the present invention, the second portion comprises a head connected to the device prolonging at least in an arm pivotally assembled on the mobile ring along an axis substantially tangent to the patient's body.
- According to an embodiment of the present invention, the first portion comprises a semi-circular rail having its ends pivotally assembled on the base along an axis substantially tangent to the patient's body.
- According to an embodiment of the present invention, the second portion comprises a carriage slidably assembled on the rail and connected to the device.
- According to an embodiment of the present invention, the device is movably assembled on the second portion according to a connection with one degree of freedom.
- According to an embodiment of the present invention, the motions of the first and second portions are controlled by cables driven by actuators located at a distance from the patient.
- According to an embodiment of the present invention, the rotating motion of the mobile ring with respect to the base is controlled by an actuator attached to the mobile ring, the actuator extending to be substantially parallel to the mobile ring axis.
- According to an embodiment of the present invention, the pivoting motion of the arm with respect to the mobile ring is controlled by an actuator attached to the second portion and extending to be substantially parallel to the pivoting axis of the arm with respect to the mobile ring.
- According to an embodiment of the present invention, the device extends substantially longitudinally along a direction perpendicular to the pivoting axis of the arm with respect to the mobile ring and the device is movably assembled with respect to the second portion, to slide along said direction, the device sliding with respect to the second portion being controlled by an actuator attached to the second portion and extending to be substantially parallel to the pivoting axis of the arm with respect to the mobile ring.
- The foregoing objects, features, and advantages, as well as others of the present invention will be discussed in detail in the following non-limiting description of specific embodiments in connection with the accompanying drawings, among which:
-
FIG. 1A shows a perspective view of a first embodiment of a positioning system according to the present invention; -
FIG. 1B shows a partial top view with a partial cross-section view of the system ofFIG. 1A ; -
FIG. 1C shows a partial lateral cross-section view of the system ofFIG. 1A ; -
FIG. 2A shows a partial top view with a partial cross-section view of an alternative of the system according to the first embodiment; -
FIG. 2B shows a partial lateral cross-section view of the system ofFIG. 2A ; -
FIG. 3A shows a very simplified side view of a second embodiment of the system according to the present invention; -
FIG. 3B shows a front view of the system ofFIG. 3A ; -
FIG. 3C shows a top view of the system ofFIG. 3A ; -
FIG. 4A shows a perspective view of an alternative of the first embodiment of a positioning system according to the present invention; -
FIGS. 4B and 4C shows side views of the system ofFIG. 4A at two different positions; and -
FIG. 4D shows a top view of the system ofFIG. 4C . -
FIGS. 1A to 1C show a first embodiment of asystem 10 for positioning anendoscope 12 placed in atrocar 14,endoscope 12 andtrocar 14 penetrating into a patient's abdomen through asmall incision 16.Endoscope 12 has the aspect of a cylindrical tube of axis Ω of a length of some forty centimeters and of a diameter of a few centimeters. InFIG. 1B , a portion only oftrocar 14 is shown. InFIG. 1C , only axis Ω ofendoscope 12 is shown. A camera, not shown, is attached to the end ofendoscope 12 external to the abdomen. -
System 10 comprises a substantiallyplanar base 18 comprising a planar ring-shapedcentral portion 20, surroundingincision 16, from which fourarms 21 extend. Acylindrical opening 22 is formed at the end of eacharm 21.Openings 22 may be used to maintainbase 18 on the patient's body via straps, cables, etc. attached to the table on which the patient is laid or directly attached to the patient.Base 18 may also be glued on the patient's abdomen. - Central
annular portion 20 supports amobile ring 24 of axis Δ substantially perpendicularly to the plane tangent to the abdomen at the level ofincision 16.Mobile ring 24 is rotatably assembled around axis Δ oncentral portion 20 via abearing 25. - A
stirrup 26 is pivotally assembled onmobile ring 24 according to an axis Γ substantially perpendicular to axis Δ, and substantially comprised in the plane tangent to the abdomen at the level ofincision 16.Stirrup 26 comprises ahead 28 on which is attachedtrocar 14 by any known attachment means, which enables simple and fast connection and separation oftrocar 14 and ofhead 28. Said means will for example beflexible tongues 27. The inner diameters ofmobile ring 24 and of ring-shapedcentral portion 20 are selected to enable removal ofsystem 10 during an intervention without displacingtrocar 14, or to enable removal oftrocar 14 from the patient's abdomen without displacingsystem 10.Head 28 prolongs in twoarms surface 32, corresponding to a cylindrical portion, likely to slide on aprofile profile base ring 24, for example, by screwing. Eacharm cap 38, 39 (not shown inFIG. 1C ) which forms with slidingsurface 32 of the associatedarm 30, 31 ahousing receiving profile -
Mobile ring 24 comprises on its external cylindrical wall agroove 42 receiving acable 43. Aguide 44 assembled onbase 18 receives the ends of twosheaths cable 43 slides.Guide 44 is arranged onbase 18 so thatcable 43, as it comes out of one ofsheaths mobile ring 44. The ends ofcable 43 are connected to the ends of a rack (not shown) meshing in with the output shaft of an electric motor. The displacement ofcable 43 by the motor rotatesring 24 with respect to centralannular portion 20 around axis Δ. - A
pulley sector 47, substantially corresponding to a cylindrical sector, is attached to one ofarms 31 ofstirrup 26. A groove 48 is formed on the lateral wall, corresponding to a cylinder portion ofpulley sector 47. Groove 48 receives twocables cable cables mobile ring 24 and each receives the end of asheath cables Supports cables sheaths pulley sector 47. When the electric motor displaces the rack, a traction is exerted on one ofcables other cable Cables pulley sector 47 and, accordingly,stirrup 26. The sliding surfaces 32 ofarms profiles stirrup 26 generally pivots with respect to axis Γ. -
Endoscope 12 is assembled to freely slide along axis Ω introcar 14. Ahold element 55 is attached toendoscope 12. Acompression spring 56 bears at one end againsthold element 55 and at the opposite end againsttrocar 14. Acable 57 is connected at one end to holdelement 55 and at its opposite end to a rack (not shown) meshing in with the output shaft of an electric motor. Aguide 58 attached onhead 28 ofstirrup 26 receives the end of aprotection sheath 59 in whichcable 57 slides. A traction oncable 57 makesendoscope 12 slide introcar 14 along axis Ω and compressesspring 56. Whencable 57 is released,spring 56 relaxes and bringsendoscope 12 back to an idle position. Holdelement 55 can easily be removed fromendoscope 12 to enable removal ofendoscope 12 fromtrocar 14, for example, to clean its lens, or to replace it with another endoscope having a different length or viewing cone. - The three motors and the racks are for example arranged in a package distant from the patient. The motor control may be performed in any known fashion and will not be detailed hereafter. It may for example be a vocal control, a manual control by lever or buttons, a foot control, etc. The motor control may be performed in open or closed loop. For example,
system 10 may also comprise a location means to detect the position and the orientation ofincision 16, ofendoscope 12, and of an intervention instrument handled by the surgeon. The location means may be connected to a calculator capable of controlling motors. The endoscope is then displaced to, for example, transmit an image permanently following the end of the intervention instrument. - The motors are preferably clutch releasable to enable the surgeon to manually displace
positioning system 10. -
Cables cable assembly endoscope 12.Cables pulley sector 47 has a sufficiently large radius, preferably greater than 50 mm, to limit the curvature ofcables cables -
Base 18 andstirrup 26 may be made of steel to increase their durability and ease their sterilization.Cables Teflon sheaths -
FIGS. 2A and 2B are similar, respectively, toFIGS. 1B and 1C and show an alternative ofpositioning system 10 according to the first embodiment. Only the differences with respect to the first embodiment will be described. - According to this alternative, the electric motors driving the actuating cables are directly arranged at the level of
positioning system 10. The motors are arranged to hinder as little as possible the movements ofendoscope 12. For example, afirst motor 60, comprising acylindrical package 61 and anoutput shaft 62, is assembled on asupport 63 connected to base 18 so thatoutput shaft 62 substantially extends along an axis parallel to axis Δ.Output shaft 62 rotates apulley 64.Pulley 64 is connected tomobile ring 24 by acable 65 to drivemobile ring 24 similarly to the first embodiment. - A
second motor 66, comprising acylindrical package 67 and anoutput shaft 68, is assembled on asupport 69 connected tomobile ring 24 so thatoutput shaft 68 extends substantially along an axis perpendicular to axes Δ and Ω.Output shaft 68 rotates apulley 70.Pulley 70 is connected topulley sector 47 by acable 71 to drivepulley sector 47 similarly to the first embodiment. The supply and control means ofmotors Motors endoscope 12 introcar 14 may also be controlled by a third motor (not shown) directly placed at the level ofhold element 55. - The present alternative of the first embodiment enables completely freeing the patient's abdomen during the surgical intervention.
-
FIGS. 3A to 3C very schematically show a second embodiment ofsystem 10 for positioningtrocar 14 in which the endoscope (not shown) slides, the trocar and the endoscope penetrating into the patient's abdomen through incision 89. - According to the second embodiment,
system 10 comprises a “C”-shapedbase 80 resting on the patient's abdomen. Asemi-circular rail 82 is pivotally assembled onbase 80 around an axis substantially tangent to the patient's abdomen. The two ends ofrail 82 are substantially connected to the two ends ofbase 80 by twopivotal connections carriage 88 is slidably assembled onrail 82.Carriage 88supports trocar 14. - The means for controlling the sliding of the endoscope in
trocar 14 are not shown inFIGS. 3A to 3C and may be identical to those of the first embodiment. - The sliding of
carriage 88 onrail 82, and the pivoting ofrail 82 with respect tobase 80, may be controlled by cable driven by actuators placed at a distance from the patient as for the first embodiment, or by directly arranging the actuators at the level ofpositioning system 10 as for the previously-described alternative of the first embodiment. - According to an alternative of the present invention, the rotating motions of
endoscope 12 introcar 14 around its axis Ω may also be controlled by an actuator. - According to the second embodiment, the removal of the positioning system is eased by the fact that
base 80 is “C” shaped. -
FIGS. 4A to 4D show views of an alternative ofpositioning system 10 according to the first embodiment. InFIGS. 4A to 4D, the incision made on the patient for the placing ofendoscope 12 has not been shown. InFIGS. 4B to 4D, only axis Ω ofendoscope 12 is shown. - According to the present alternative of the first embodiment,
trocar 14 is maintained onstirrup 26 by a mountingflange 90, for example, screwed onstirrup 26.Trocar 14 comprises aprotrusion 92 located on the side of mountingflange 90 opposite to ring-shapedbase 18.Protrusion 92 may represent handles, tightness valves, connectors, etc. A fixedring 95 is arranged between ring-shapedbase 18 andmobile ring 24. Fixedring 95 forms one piece withbase 18.Mobile ring 24 is rotatably assembled on fixedring 95. Fixedring 95 comprises a peripheral toothing (not shown) on its external lateral surface. - A first
electric motor 96, intended to rotatemobile ring 24 with respect to fixedring 95, is assembled to move along withmobile ring 24 via astage 98.First motor 96 is controlled and supplied by means not shown, for example, by electric wires. Atoothed wheel 100 is arranged at the end ofshaft 102 offirst motor 96.Shaft 102 is substantially parallel to axis A ofmobile ring 24.Toothed wheel 100 meshes in with the toothing of fixedring 95. Sincetoothed wheel 100 cooperates with fixedring 95, the rotating oftoothed wheel 100 byfirst motor 96 rotatesmobile ring 24 with respect to fixedring 95.Motor 96 moves along withmobile ring 24 and thus remains fixed with respect tomobile ring 24 upon rotation thereof. Upon sole rotation ofmobile ring 24, there thus is no risk fortrocar 14 andfirst motor 96 to collide. It is thus possible to pivotmobile ring 24 by more than 360 degrees. - A second
electric motor 104 is attached tostirrup 26, on the side ofstirrup 26 opposite to mountingflange 90, via astage 106. The shaft (not visible in the drawings) ofsecond motor 104 is oriented along pivoting axis Γ ofstirrup 26.Stage 106 comprises an opening (not visible in the drawings) enabling passing of the shaft ofsecond motor 104.Second motor 104 is controlled and supplied by means not shown, for example, electric wires. Adrive element 108 comprises acircular arc 109 having its ends connected by arectilinear portion 110 attached tomobile ring 24.Drive element 108 substantially extends in a plane perpendicular to the plane containingmobile ring 24. The axis ofcircular arc 109 corresponds to pivoting axis Γ ofstirrup 26. The wall ofcircular arc 109 opposite torectilinear portion 110 comprises a toothing (not shown). The shaft ofsecond motor 104 supports a toothed wheel (not shown) which cooperates with the toothing ofcircular arc 109 so that, when the toothed wheel is rotated bysecond motor 104,stirrup 26 is pivoted with respect tomobile ring 24. The toothing is provided inside ofdrive element 108 for security reasons and to increase the compactness ofpositioning system 10. - The free end of
endoscope 12 comprises acylindrical stop 112 from which apin 114 projects.Compression spring 56 bears at one end againstcylindrical stop 112 and at the opposite end againsttrocar 14. A thirdelectric motor 116 is attached tostirrup 26, next tosecond motor 104, via astage 118.Stage 118 comprises anopening 120 enabling passing ofshaft 122 ofthird motor 116.Shaft 122 ofthird motor 116 is oriented along pivoting axis Γ ofstirrup 26.Third motor 116 is controlled and supplied by means not shown, for example, by electric wires. A windingcylinder 124 is arranged at the free end ofshaft 122. A helical threading (not shown) is formed on the outer surface of windingcylinder 124. A cable 125 (only shown inFIG. 4A ) is connected at its ends to pin 114 and tocylinder 124 and wound aroundcylinder 124. Thirdelectric motor 116 is arranged betweensecond motor 104 andprotrusion 92 to avoid forcable 125 to contactsecond motor 104. Whenthird motor 116 rotatesshaft 122,cable 125, guided by the threading ofcylinder 124, winds aroundcylinder 124 and bringscylindrical stop 112 closer totrocar 14.Endoscope 12 then slides introcar 14 along axis Ω and compressesspring 56. Whenthird motor 116 is no longer actuated,spring 56 relaxes and bringsendoscope 12 back to an idle position.Cylindrical stop 112 may be disassembled fromendoscope 12 to enable removal ofendoscope 12 fromtrocar 14.Cylindrical stop 112 may move along withendoscope 12. The cable end connected to pin 114 can then be detached to releaseendoscope 12 fromtrocar 14.Stages stirrup 26 and/or be provided on a same side ofstirrup 26. - The rotating motions of
endoscope 12 introcar 14 around its axis Ω may also be controlled by an actuator. - In
FIGS. 4A to 4D, ring-shapedbase 18 is maintained on the patient via fourcurved tongues 126 radially extending from ring-shapedbase 18. A support arm, oriented by the surgeon before the beginning of the operation, may be provided to supportpositioning system 10 and avoid for the entire weight ofpositioning system 10 to be applied on the patient. - A
notch 128 is provided at the level ofmobile ring 24, substantially in diametrically opposite position with respect to firstelectric motor 96.Notch 128 is intended to receive a portion oftrocar 14 when the latter is inclined to a maximum with respect to ring-shapedbase 18, as shown inFIG. 4B . A maximum inclination angle greater than in the absence ofnotch 128 has then been achieved.Notch 128 may be replaced by a hollow print performed inmobile ring 24 and the shape of which is complementary to the shape oftrocar 14. - In
FIGS. 4C and 4D ,trocar 14 is shown as inclined with respect to the plane of ring-shapedbase 18 to a position where the second andthird motors first motor 96.Trocar 14 being attached tostirrup 26 by mountingflange 90 on the side opposite to second andthird motors positioning system 10.Stirrup 26 being maintained in a thrust position againstfirst motor 96, an obstacle-free region 130 is freed betweenstirrup 26 and ring-shapedbase 18, enabling removal ofpositioning system 10 while leaving inplace trocar 14, the dimensions of the obstacle-free region being sufficient to enable removal ofpositioning system 10 despite the presence ofprotuberance 92 andcylindrical stop 112. - The system according to the present invention has many advantages.
- First, the positioning system according to the present invention takes up a small volume, is formed of a relatively simple structure, and has a small weight. As an example, the applicant has formed a positioning system according to the present invention comprised in a cylinder with a 70-mm diameter and with a 75-mm height, with a weight approximately smaller than 600 g (to which must be added the weights of the endoscope, of the trocar, and possibly of the camera). Several positioning systems according to the present invention may thus be placed simultaneously on a patient's body, each system enabling positioning an observation and/or intervention device.
- Second, the pivoting axis of the endoscope with respect to the patient's body is substantially tangent to the patient's body, which enables reducing to a minimum the dimensions of the incision to be performed for the introduction of the trocar and of the endoscope into the patient's body.
- Third, the positioning system according to the present invention enables obtaining movement angle of the endoscope between axes Ω and Δ greater than 80°, with a 0.5° accuracy and a pivoting axis on the order of 25°/s, and a sliding of
endoscope 12 introcar 14 along axis Ω greater than 200 mm, with a 5-mm accuracy and a sliding speed on the order of 25 mm/s. - Fourth, the system enables applying no force on the patient's abdomen at the level of the incision through which the endoscope penetrates into the abdomen.
- Fifth, only three actuators are necessary to control the endoscope displacements. This enables simple and accurate control of the actuators.
- Sixth, the system according to the present invention may easily be arranged on the patient's body and removed from the patient's body while maintaining in place the trocar and the endoscope.
- Of course, the present invention is likely to have various alterations and modifications which will occur to those skilled in the art. In particular, the electric motors may be replaced with any type of actuators. Further, the system according to the present invention enables positioning devices other than an endoscope. It may be, for example, a separator, a clip, etc.
Claims (10)
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
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US13/172,700 US8591397B2 (en) | 2002-05-13 | 2011-06-29 | System for positioning on a patient an observation and/or intervention device |
US14/087,724 US9643325B2 (en) | 2002-05-13 | 2013-11-22 | System for positioning on a patient an observation and/or intervention device |
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
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FR0205848A FR2839440B1 (en) | 2002-05-13 | 2002-05-13 | POSITIONING SYSTEM ON A PATIENT OF AN OBSERVATION AND / OR INTERVENTION DEVICE |
FR0205848 | 2002-05-13 | ||
PCT/FR2003/001455 WO2003094759A1 (en) | 2002-05-13 | 2003-05-13 | System for positioning on a patient an observation and/or intervention device |
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Application Number | Title | Priority Date | Filing Date |
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PCT/FR2003/001455 A-371-Of-International WO2003094759A1 (en) | 2002-05-13 | 2003-05-13 | System for positioning on a patient an observation and/or intervention device |
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US13/172,700 Expired - Lifetime US8591397B2 (en) | 2002-05-13 | 2011-06-29 | System for positioning on a patient an observation and/or intervention device |
US14/087,724 Active 2024-12-21 US9643325B2 (en) | 2002-05-13 | 2013-11-22 | System for positioning on a patient an observation and/or intervention device |
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US14/087,724 Active 2024-12-21 US9643325B2 (en) | 2002-05-13 | 2013-11-22 | System for positioning on a patient an observation and/or intervention device |
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US (3) | US20060100501A1 (en) |
AU (1) | AU2003249406A1 (en) |
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FR2839440B1 (en) | 2005-03-25 |
US20110257475A1 (en) | 2011-10-20 |
US20140076088A1 (en) | 2014-03-20 |
FR2839440A1 (en) | 2003-11-14 |
AU2003249406A1 (en) | 2003-11-11 |
US8591397B2 (en) | 2013-11-26 |
US9643325B2 (en) | 2017-05-09 |
WO2003094759A1 (en) | 2003-11-20 |
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