SURGERY METHODS USING A ROBOTIC INSTRUMENT SYSTEM
Various methods for performing various surgical procedures using a robotic instrument system are disclosed. In one embodiment, the method comprises advancing a guide instrument into a patient's body and to the vicinity of a treatment area. The guide instrument may be a robotically controlled catheter which is controlled by a robotic catheter system. The guide instrument comprises an elongate flexible body having a proximal end and a distal end, and an end effector coupled to the distal end. The end effector may comprise various devices for assisting and performing the surgical procedure. For example, the end effector may be a clip applier, a laser fiber, a cryo fiber, or a needle and grasper. An image capture device may also be coupled to the distal end to assist in positioning and operating the guide instrument.
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The present application claims the benefit under 35 U.S.C. § 119 to U.S. Provisional Patent Application Ser. Nos. 60/899,048, filed on Feb. 2, 2007, and 60/900,584, filed on Feb. 8, 2007. The foregoing applications are hereby incorporated by reference into the present application in their entirety.
FIELD OF INVENTIONThe invention relates generally to robotically controlled systems, such as telerobotic surgical systems, and more particularly to a using a robotic instrument system for performing minimally invasive surgical and other therapeutic procedures.
BACKGROUNDRobotic interventional systems and devices are well suited for use in performing minimally invasive medical procedures, as opposed to conventional techniques wherein the patient's body cavity is open to permit the surgeon's hands access to internal organs. For example, there is a need for a highly controllable yet minimally sized system to facilitate imaging, diagnosis, and treatment of tissues which may lie deep within a patient, and which may be accessed transcutaneously (e.g., through a surgical port) or via naturally-occurring pathways such as blood vessels, other lumens, or combinations thereof.
SUMMARY OF THE INVENTIONThe present invention is directed to methods of performing various surgical procedures using robotic instrument systems. In one embodiment, the method comprises performing a medical procedure for repairing a detached retina in a patient's eye. The method comprises robotically maneuvering a guide instrument into the vitreous body of the eye. The guide instrument may be a robotically controlled catheter which is controlled by a robotic catheter system. The guide instrument comprises an elongate flexible body having a proximal end and a distal end, and an end effector coupled to the distal end. The end effector may comprise various devices for re-attaching the retina to the sclera of the eye. For example, the end effector may be a clip applier, a laser fiber, a cryo fiber, or a needle and grasper. An image capture device may also be coupled to the distal end to assist in positioning and operating the guide instrument. The guide instrument is used to push the detached retina toward the wall of the eye, and then the end effector is used to re-attach the detached retina to the sclera.
In another embodiment, a method for performing a minimally invasive medical procedure in the thoracic cavity of a patient and/or on the heart is provided. The method comprises advancing a first instrument assembly to vicinity of the heart, either through the thoracic cavity via the ribcage and around the lungs, or via the patient's trachea to the main bronchi and through the lung into the mediastinal or pericardial spaces. The first instrument assembly comprises a guide instrument and a sheath instrument. The guide instrument comprises an elongate flexible body having a proximal end and a distal end. The sheath instrument comprises an elongate flexible body having a working lumen therethrough. To make up the instrument assembly, the guide instrument is inserted through the lumen of the sheath instrument. An end effector is coupled to the distal end of the guide instrument for performing various functions during a procedure. For example, a needle, a grasper, an image capture device, a patch, a plurality of needles, among others, may be coupled to the distal end of the guide instrument.
A second instrument assembly may also be advanced to the same area as the first instrument assembly above, in order to utilize both instrument assemblies in performing the surgical procedure. The second instrument assembly may be the same or similar to the first instrument assembly, although it may be useful to have different end effectors to enable different of complementary functions to the end effector of the first instrument assembly.
As an example, the first and second instrument assemblies may be advanced through the inferior vena cava and into the right atrium in order to treat a patent foramen ovale (PFO), or other intracardiac procedure.
In any of the minimally invasive procedures of the present invention the guide instruments and instrument assemblies may be performed using a robotic instrument system, such as a robotic flexible catheter instrument system.
The drawings illustrate the design and utility of illustrated embodiments of the invention, in which similar elements are referred to by common reference numerals. In addition, elements having the same reference numeral but different letter identifiers [e.g. a robotic catheter assemblies (28a and 28b)], are the same or substantially similar elements, and may be described commonly without the letter identifier [e.g. robotic catheter assembly (28)].
The present invention is directed to robotic catheter systems and methods of performing various surgical procedures using such robotic catheter systems. For example,
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The instrument (18) is typically an elongate, flexible device configured to be inserted into a patient's body. As non-limiting examples, an instrument (18) may comprise an intravascular catheter, an endoscopic surgical instrument or other medical instrument. The instrument (18) may also comprise an instrument assembly (28) comprising a robotic guide instrument (18), or a coaxially coupled and independently controllable robotic sheath instrument (30) (see
Alternatively, manually steerable and operable instruments or instrument assemblies may also be utilized. Thus, all of the technologies described herein may be utilized with manually or robotically steerable instruments, such as those described in the below-referenced patent application, U.S. patent application Ser. No. 11/481,433.
Exemplary embodiments of an operator control station (2), an instrument driver (16), an instrument (18) and instrument assembly (28), a robotic sheath instrument (30), a robotic guide instrument (18), and various instruments (50), are described in detail in the following U.S. patent applications, and are incorporated herein by reference in their entirety:
U.S. patent application Ser. Nos. 10/923,660, filed Aug. 20, 2004; 10/949,032, filed Sep. 24, 2005; 11/073,363, filed Mar. 4, 2005; 11/173,812, filed Jul. 1, 2005; 11/176,954, filed Jul. 6, 2005; 11/179,007, filed Jul. 6, 2005; 11/202,925, filed Aug. 12, 2005; 11/331,576, filed Jan. 13, 2006; U.S. Provisional Patent Application Nos. 60/785,001, filed Mar. 22, 2006; 60/788,176, filed Mar. 31, 2006; U.S. patent application Ser. Nos. 11/418,398, filed May 3, 2006; 11/481,433, filed Jul. 3, 2006; 11/637,951, filed Dec. 11, 2006; 11/640,099, filed Dec. 14, 2006; and U.S. Provisional Patent Applications Nos. 60/833,624, filed Jul. 26, 2006, and 60/835,592, filed Aug. 3, 2006.
For clarity, the sheath and guide catheter instruments described in the exemplary embodiments below may be described as having a single lumen/tool/end-effector, etc. However, it is contemplated that alternative embodiment of catheter instruments may have a plurality of lumens/tools/end-effectors/ports, etc. Furthermore, it is contemplated that in some embodiments, multiple catheter instruments may be delivered to a surgical site via a single multi-lumen sheath, each of which is robotically driven and controlled by via an instrument driver. Some of the catheter instruments described herein are noted as flexible. It is contemplated that different embodiments of flexible catheters may be designed to have varying degrees of flexibility and control. For example, one catheter embodiment may have controlled flexibility throughout its entire length whereas another embodiment may have little or no flexibility in a first portion and controlled flexibility in a second portion. Similarly, different embodiments of these catheters may be implemented with varying degrees of freedom.
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Cryotherapy (freezing) and laser photocoagulation are treatments used to create a scar/adhesion around the retinal hole to prevent fluid from entering the hole and accumulating behind the retina and exacerbating the retinal detachment. Cryopexy and photocoagulation are generally interchangeable. However, cryopexy is generally used in instances where there is a lot of fluid behind the hole and laser retinopexy will not take. Laser photocoagulation uses heat, in the form of laser light, and cryotherapy uses extreme cold to seal the retina. Referring to
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Pneumatic retinopexy is a treatment method wherein a gas bubble is injected into the vitreous cavity inside of the eye, which forces the retina back into position. The retina usually reattaches within several days provided that the bubble is kept in position against the retinal detachment. The surgeon may help seal the retina back into place against the wall of the eye with laser photocoagulation or cryotherapy. A vitrectomy procedure involving removal of the vitreous humor may be required for more complicated retinal detachments. This procedure removes the vitreous jelly as well as any scar tissue, and replaces it with a gas bubble. This gas bubble sometimes helps push the retina back against the eye wall.
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As the catheter instruments (28) are retracted from the thoracic cavity at the end of these procedures, the punctures may be closed with a resorbable material such as a fibrin sealant or polyglycolide sutures available from on commercially as Vicryl, Polysorb, or Dexon sutures. Alternatively, nonabsorbable sutures or clips may also be used in some instances.
While multiple embodiments and variations of the many aspects of the invention have been disclosed and described herein, such disclosure is provided for purposes of illustration only. Many combinations and permutations of the disclosed system are useful in minimally invasive surgery, and the system is configured to be flexible. Many combinations and permutations of the disclosed system are useful in minimally invasive surgery, and the system is configured to be flexible, and it should be understood that the invention generally, as well as the specific embodiments described herein, are not limited to the particular forms or methods disclosed, but also cover all modifications, equivalents and alternatives falling within the scope of the appended claims.
Claims
1. A method for repairing a detached retina in a patient's eye, comprising:
- robotically maneuvering a guide instrument in the vitreous body of the eye, the guide instrument comprising an elongate flexible body having a proximal end, a distal end, and a clip applier couple to the distal end, the clip applier configured to dispense and apply clips into tissue;
- pushing the detached retina toward the wall of the eye using the guide instrument under robotic control;
- robotically maneuvering a guide instrument to thereby position the clip applier proximate the detached retina; and
- using the clip applier to apply clips into tissue to fasten the detached retina to the sclera of the eye.
2. The method of claim 1, wherein the clips are fabricated from resorbable material that is metabolized by the patient's body over a period of time.
3. The method of claim 2, wherein the resorbable material is polyglycolide.
4. A method for repairing a detached retina in a patient's eye, comprising:
- robotically maneuvering a guide instrument in the vitreous body of the eye, the guide instrument comprising an elongate flexible body having a proximal end, a distal end, an image capture device, an arcuate needle and a grasper coupled to the instrument distal end;
- pushing the detached retina toward the wall of the eye using the guide instrument under robotic control; and
- applying sutures to suture the retina to the sclera using the arcuate needle and grasper.
5. The method of claim 4, wherein the sutures are fabricated from resorbable material that is metabolized by the patient's body over a period of time.
6. The method of claim 5, wherein the resorbable material is a polyglycolide selected from the group of Ethicon Vicryl, Spenco Polysorb, or Syneture Dexon.
7. The method of claim 4, further comprising imaging the area of the detached retina using the image capture device to assist in positioning the guide instrument and applying the sutures.
8. A method for repairing a detached retina in a patient's eye, comprising:
- robotically maneuvering a guide instrument in the vitreous body of the eye, the guide instrument comprising an elongate flexible body having a proximal end, a distal end, an image capture device, and a laser fiber coupled to the distal end;
- pushing the detached retina toward the wall of the eye using the instrument guide catheter under robotic control;
- positioning the laser fiber to thereby aim the laser at the area of the detached retina; and
- applying laser photocoagulation to the detached retina using the laser fiber.
9. The method of claim 8, further comprising imaging the area of the detached retina using the image capture device to assist in positioning the guide instrument and aiming the laser fiber.
10. A method for repairing a detached retina in a patient's eye, comprising:
- robotically maneuvering a guide instrument in the vitreous body of the eye, said the guide instrument comprising an elongate flexible body having a proximal end, a distal end, an image capture device, and a cryo-ablation element coupled to the distal end;
- pushing the detached retina toward the wall of the eye using the guide instrument guide catheter under robotic control;
- positioning the cryo fiber at a position for applying cryotherapy to the area of the detached retina; and
- applying cryotherapy to the detached retina using the cryo fiber.
11. The method of claim 10, further comprising imaging the area of the detached retina using the image capture device to assist in positioning the instrument guide catheter and aiming the cryo fiber.
12. A method for repairing a detached retina in a patient's eye, comprising:
- advancing a guide instrument into the vitreous body of the eye,
- robotically maneuvering a distal end of the guide instrument guide within the vitreous body; and
- injecting a gas or fluid bubble into a vitreous cavity of the eye using an irrigation port disposed on a distal end portion of the guide instrument in a manner such that the bubble pushes the detached retina toward the wall of the eye.
13. The method of claim 12, further comprising imaging the area of the detached retina using an image capture device coupled to the distal end portion of the guide instrument.
14. A method for performing a medical procedure in the thoracic cavity of a patient, comprising:
- advancing a first instrument assembly into the thoracic cavity via the ribcage and around the lungs, the first instrument assembly comprising a first guide instrument and a first sheath instrument, the first guide instrument comprising an elongate flexible body having a proximal end and a distal end, the sheath instrument comprising an elongate flexible body having a working lumen therethrough, wherein the first guide instrument is inserted through the working lumen of the sheath instrument; and
- robotically maneuvering the first instrument assembly into a pericardial space so that a distal end portion of the guide instrument accesses the patient's heart.
15. The method of claim 14, further comprising:
- advancing a second instrument assembly into the thoracic cavity, the second instrument assembly comprising a second guide instrument and a second sheath instrument, the second guide instrument comprising an elongate flexible body having a proximal end and a distal end, the sheath instrument comprising an elongate flexible body having a working lumen therethrough, wherein the second guide instrument is inserted through the working lumen of the second sheath instrument; and
- robotically maneuvering the second instrument assembly into the pericardial space so that a distal end portion of the second guide instrument accesses the patient's heart.
16. A method for performing a medical procedure in the thoracic cavity of a patient, comprising:
- inserting a first instrument assembly down the patient's trachea to the main bronchi, the first instrument assembly comprising a first guide instrument and a first sheath instrument, the first guide instrument comprising an elongate flexible body having a proximal end and a distal end, the first sheath instrument comprising an elongate flexible body having a working lumen therethrough, the first guide instrument being inserted through the working lumen of the first sheath instrument; and
- robotically maneuvering a distal end portion of the first guide catheter to puncture through the lung and into the patient's pericardial space, and advancing the first instrument assembly into the pericardial space to access the patient's heart.
17. The method of claim 16, further comprising:
- advancing a second instrument assembly down the patient's trachea to the main bronchi, said second instrument assembly comprising a second guide instrument and a second sheath instrument, the second guide catheter comprising an elongate flexible body having a proximal end and a distal end, the sheath instrument comprising an elongate flexible body having a working therethrough, wherein the second guide instrument is inserted through the working lumen of the second sheath instrument; and
- robotically maneuvering the second instrument the second instrument assembly to puncture through the lung and into the patient's pericardial space, and advancing the second instrument assembly into the pericardial space to access the patient's heart.
18. The method of claim 17, wherein the first guide instrument further comprises an ablation catheter disposed on the distal end of the first guide instrument, and said method further comprises the step of ablating the heart with the ablation catheter.
19. The method of claim 17, wherein the second guide instrument comprises an image capture device, and said method further comprises imaging a treatment area of the heart with the image capture device.
20. A method for treating a patent foramen ovale (PFO) in a patient's heart, comprising:
- robotically maneuvering a guide instrument up the inferior vena cava and into the right atrium of the heart, the guide instrument comprising an elongate flexible body having a proximal end and a distal end, and a balloon coupled to the distal end;
- inflating the balloon against the septal wall of the heart; and
- advancing a needle through a lumen in said balloon and piercing both sides of the PFO.
21. The method of claim 20, wherein the needle is used to irritate the tissue surrounding the PFO to encourage closure of the PFO.
22. The method of claim 20, wherein the needle is used to apply sutures to the PFO to close the PFO.
23. A method for performing a medical procedure in the thoracic cavity of a patient, comprising:
- inserting a first instrument assembly down the patient's trachea to the main bronchi, the first instrument assembly comprising a first guide instrument and a first sheath instrument, the first guide instrument comprising an elongate flexible body having a proximal end and a distal end, the first sheath instrument comprising an elongate flexible body having a working lumen therethrough, the first guide instrument being inserted through the working lumen of the first sheath instrument; and
- robotically maneuvering a distal end portion of the first guide catheter to puncture through the lung and into the patient's mediastinal space, and advancing the first instrument assembly into the mediastinal space to access tissue structures located therein.
24. The method of claim 23, further comprising:
- advancing a second instrument assembly into the thoracic cavity, the second instrument assembly comprising a second guide instrument and a second sheath instrument, the second guide instrument comprising an elongate flexible body having a proximal end and a distal end, the sheath instrument comprising an elongate flexible body having a working lumen therethrough, wherein the second guide instrument is inserted through the working lumen of the second sheath instrument; and
- robotically maneuvering the second instrument assembly into the mediastinal space so that a distal end portion of the second guide instrument accesses tissue structures located therein.
25. The method of claim 24, wherein the first guide instrument further comprises an ablation catheter disposed on the distal end of the first guide instrument, and said method further comprises the step of ablating a tumor accessible via the mediastinal space.
Type: Application
Filed: Feb 1, 2008
Publication Date: Feb 5, 2009
Applicant: Hansen Medical, Inc. (Mountain View, CA)
Inventor: Frederic H. Moll (San Francisco, CA)
Application Number: 12/024,760
International Classification: A61B 19/00 (20060101);