Mounting support assembly for suspending a medical instrument driver above an operating table

[0001] The present application is a continuation of U.S. patent application Ser. No. 13/437,716, filed Apr. 2, 2012, which is a continuation of U.S. patent application Ser. No. 12/024,883, now issued U.S. Pat. No. 8,146,874, filed Feb. 1, 2008, which 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.

[0002] The invention relates generally to robotically controlled medical instrument systems, such as telerobotic surgical systems, and more particularly to a mounting support assembly for suspending a robotically controlled instrument driver over an operating table for performing minimally invasive diagnostic and therapeutic medical procedures.

[0003] Robotic 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 via naturally-occurring pathways such as blood vessels, other lumens, via surgically-created wounds of minimized size, or combinations thereof.

[0004] The present invention is directed to an adapter plate assembly which provides a convenient interface between a mounting support assembly for suspending an instrument driver of robotic instrument system above a operating table. The adapter plate securely mounts to the operating table, and may be adjustable so that it can be adjusted to fit various sizes and models of operating tables. Then, a component of the robotic instrument system, such as a support assembly having a plurality of adjustable arms for supporting an instrument, may be secured to the adapter plate assembly.

[0005] In one embodiment, an adjustable mounting assembly for suspending an off-center load above a patient table includes a load distributing plate configured for resting on, and being supported by, a top surface of the patient table. A first clamp assembly is adjustably coupled to a first side of the load distributing plate and configured for removable attachment to a first side rail of the patient table. By way of non-limiting example, the first clamp assembly may be mounted on one or more adjustment rods that are slidably received in the first side of the load distributing plate so that the first clamp assembly may be extended from, and retracted into, the load distributing plate so as to adjust a width of the mounting assembly to accommodate a width of the patient table. Respective locking devices may be provided for securing the one or more adjustment rods in a desired position relative to the load distributing plate. A second clamp assembly is coupled to a second side of the load distributing plate and configured for removable attachment to a second side rail of the patient table. By way of non-limiting examples, the first and second clamp assemblies may each comprise an L-shaped clamp body configured to engage the respective side rail of the patient table. An adapter rail is fixed to the second side of the load distributing plate and configured to detachably couple to a support assembly interface, such that an adjustable support assembly may be coupled to the load distributing plate to thereby allow for an off-center load attached to the support assembly to be moved relative to the patient table while the load remains substantially supported by the table surface.

[0006] In another embodiment, an adjustable mounting assembly for suspending an off-center load above a patient table includes a load distributing plate configured for resting on, and being supported by, a top surface of the patient table. A first clamp assembly configured for removable attachment to a first side rail of the patient table is mounted on one or more adjustment rods that are slidably received in a first side of the load distributing plate to thereby allow the first clamp assembly to be extended from, and retracted into, the load distributing plate so as to adjust a width of the mounting assembly to accommodate a width of the patient table. Respective locking devices may be provided for securing the one or more adjustment rods in a desired position relative to the load distributing plate. A second clamp assembly is coupled to a second side of the load distributing plate, and a third clamp assembly is also coupled to the second side of the load distributing plate at a location spaced apart from the second clamp assembly, wherein the second and third clamp assemblies are configured for removable attachment to the second side rail of the patient table. By way of non-limiting examples, the first, second and third clamp assemblies may each comprise an L-shaped clamp body configured to engage the respective side rail of the patient table. An adapter rail is fixed to the second side of the load distributing plate and configured to detachably couple to a support assembly interface, such that an adjustable support assembly may be coupled to the load distributing plate to thereby allow for an off-center load attached to the support assembly to be moved relative to the patient table while the load remains substantially supported by the table surface.

[0028] The present invention is directed to various embodiments of mounting platforms for mounting an instrument driver of a robotic instrument system to an operating table. The mounting platform, along with the mounted support assembly can be used to support and adjust the position of the instrument driver on or near an operating table. It is to be understood that each of the embodiments described herein may be utilized with robotic instrument systems, which can control the positioning of the devices within a patients body, and may also control the operation of other functions of the devices, such as imaging devices, ablation devices, cutting tools, or other end effectors, including without limitation all of the robotic instrument systems incorporated by reference below.

[0029] Referring to FIG. 1A, one embodiment of a robotic instrument system (32), includes an operator control station (2) located remotely from an operating table (22), and a robotic instrument assembly (1002). The robotic instrument assembly (1002) comprises an instrument driver (16) and an instrument (18) coupled to the operating table (22) by an instrument driver mounting brace (20). A communication link (14) transfers signals between the operator control station (2) and instrument driver (16). The instrument driver mounting brace (20) of the depicted embodiment is a relatively simple, arcuate-shaped structural member configured to position the instrument driver (16) above a patient (not shown) lying on the table (22).

[0030] In FIG. 1B, another embodiment of a robotic instrument system (32) is depicted, wherein the arcuate-shaped member (20) is replaced by a movable support assembly (26). The support assembly (26) is configured to movably support the instrument driver (16) above the operating table (22) in order to position the instrument driver (16) for convenient access into desired locations relative to a patient (not shown). The support assembly (26) in FIG. 1B is also configured to lock the instrument driver (16) into position once it is positioned.

[0031] 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 and a robotic guide instrument (18), as described in the U.S. Patent Applications incorporated by reference below. The instrument (18) or instrument assembly (28) is configured to be operable via the instrument driver (16) such that the instrument driver (16) can operate to steer the instrument (18) or instrument assembly (28) and also to operate tools and devices which may be provided on the instrument assembly (18) or instrument assembly (28) (e.g. an imaging device or cutting tool disposed on the distal end of the instrument (18) or instrument assembly (28)). Alternatively, manually steerable and operable instruments or instrument assemblies may also be utilized. Thus, the procedures described herein may be utilized with manually or robotically steerable instrument systems, such as those described in the below-referenced U.S. patent application Ser. No. 11/481,433.

[0032] Exemplary embodiments of an operator control station (2), an instrument driver (16), an instrument (18) or instrument assembly (28), a robotic sheath instrument, a robotic guide instrument (18), various instruments (50), are described in detail in the following U.S. Patent Applications, and are incorporated herein by reference in their entirety:

[0033] U.S. patent application Ser. Nos. 10/923,660, filed Aug. 20, 2004; Ser. No. 10/949,032, filed Sep. 24, 2005; Ser. No. 11/073,363, filed Mar. 4, 2005; Ser. No. 11/173,812, filed Jul. 1, 2005; Ser. No. 11/176,954, filed Jul. 6, 2005; Ser. No. 11/179,007, filed Jul. 6, 2005; Ser. No. 11/202,925, filed Aug. 12, 2005; Ser. No. 11/331,576, filed Jan. 13, 2006; 60/785,001, filed Mar. 22, 2006; 60/788,176, filed Mar. 31, 2006; Ser. No. 11/418,398, filed May 3, 2006; Ser. No. 11/481,433, filed Jul. 3, 2006; Ser. No. 11/637,951, filed Dec. 11, 2006; Ser. No. 11/640,099, filed Dec. 14, 2006; 60/833,624, filed Jul. 26, 2006, and 60/835,592, filed Aug. 3, 2006.

[0034] FIG. 1C provides a closer view of the support assembly (also referred to as a setup joint) (26) depicted in the embodiment of FIG. 1B. The support assembly (26) comprises a series of rigid links (36) coupled by electronically braked joints (34). The joints (34) allow motion of the links (36) when energized by a control system (not shown), but otherwise prevent motion of the links. The control system may be activated by a switch (e.g., a footswitch or thumbswitch), or computer interface. In another embodiment, the rigid links (36) may be coupled by mechanically lockable joints, which may be locked and unlocked manually using, for example, locking pins, screws, or clamps. The rigid links (36) preferably comprise a light but strong material, such as high-gage aluminum, shaped to withstand the stresses and strains associated with precisely maintaining a three-dimensional position of the approximately ten pound weight of a typical embodiment of the instrument driver (16) once the position of the link (36) is fixed. An instrument driver support shaft (17) is provided near the distal end of the support assembly (26), and is coupled to a pivotable instrument driver mounting interface (21) for attaching the instrument driver (16). The support assembly (26) also has an interface surface (1036) which may comprise one or more mounting clamps each generally comprising a fixed upper body portion having a mating surface, and upper and lower clamp toe portions configured for detachably coupling to a rail of an operating table (22).

[0035] Referring now to FIGS. 2-3, an exemplary operating table (1003) is illustrated. The designs and specifications of operating tables vary widely from manufacturer to manufacturer. Operating tables (1003) not only differ between manufacturers but also between different models from the same manufacturer. Thus it is desirable to have a uniform mounting platform upon which the support assembly (26) for the above described robotic instrument system (32) may be deployed, regardless of the brand of a operating table. Furthermore, it is desirable to have a universal mounting platform that is easily adjustable and adaptable to as many different tablerails as possible. As illustrated in FIG. 1C, one embodiment of a setup joint (26) is designed to mount directly to a tablerail (1004). As a result, variations in tablerail dimensions including cross section on rails, vertical elevation, and width result in a complicated, adjustable design for the setup joint tablerail clamp (89). In some instances, the tablerails (1004) of some operating tables have shown to be weak, thus providing inadequate stiffness to support the weight of the support assembly (26) and robotic instrument assembly (1002). This may result in an unstable support assembly.

[0036] Referring to FIGS. 4-9, embodiments of a support arm adapter base plate assembly (1005) for attaching a support assembly to a operating table (1003). Adapter plate assembly (1005) mounts directly to the operating table (1003). In turn, the support assembly (26) is mounted to the adapter plate assembly (1005). In one embodiment, the adapter plate assembly (1005) comprises a large, flat main plate (1006) which lays on top of a operating table (1003). In one implementation, the assembly (1005) is designed with various adjustments to allow it to be mounted to different types of operating table. On a first edge of the adapter plate assembly (1005) is an adapter plate rail (1007) that is the same or similar to the construction of a traditional operating table rail (1004). By placing this rail (1007) on the adapter plate (1005) itself, a user may be assured that the rail on which a support assembly (26) will be mounted will have having consistent dimensions. The plate rail (1007) may be attached to the main plate (1006), such as by bolting, welding, or other suitable method, or it may be integral to the main plate (1006). Furthermore, the large, flat surface of the main plate (1006) of this embodiment provides stability by distributing the weight of the support assembly (26) and robotic instrument assembly (1002) over a relatively large area of the table, whereas a support assembly (26) mounted directly to the operating table rail (1004) causes its entire load to be placed on a limited portion of the table rail (1004). In order to mount this embodiment of an adapter plate assembly (1005), a clamp assembly (1008) and a clamp assembly (1009) are located on opposing sides of the adapter plate assembly (1005) and are configured to clamp the assembly to the operating table (1003). The clamp assembly (1008) is attached to one side of the main plate (1006) such that the first clamp assembly (1008) is located on one side of the operating table when the adapter plate assembly (1005) is installed; and the clamp assembly (1009) is attached to the opposing side of the main plate (1006) such that the clamp assembly (1009) is located on the other side of the operating table (1003) when the adapter plate assembly (1005) is installed. In this embodiment, a single clamp assembly (1008) is used on the surgeon (1010) side of the assembly while two assemblies (1009) are used on the opposite side. It is contemplated that in alternative embodiment, varying numbers of clamp assemblies (1008 and 1009) may be employed on each side of the plate assembly (1005). In this example, a single clamp assembly (1008) is used on the surgeon side of the table (1003) to minimize the amount of tableside space taken up by the adapter plate assembly (1005).

[0037] To mount the adapter plate assembly (1005), the clamp assembly (1008) on the surgeon side (1010) of the table may be removed or extended out of the way and the adapter plate assembly (1005) is placed on the top surface of the operating table (1003). The clamp assembly (1008) is repositioned on the adapter plate assembly (1005) and the clamp assemblies (1008 and 1009) on both the surgeon side 1010 and the opposing side of the table are tightened onto the operating table rails (1004). The support assembly (26) may then be mounted to the adapter plate rail (1007) and placed over the entire adapter plate assembly (1005). FIG. 9 illustrates a operating table (1003) with adapter plate assembly (1005) installed from the surgeon (1010) side of the table (1003).

[0038] Referring to FIGS. 9A and 10, one embodiment of a clamp assembly (1008/1009) is illustrated. FIG. 9A illustrates a first perspective view of a clamp assembly (1008) mounted to a table rail (1004). FIG. 20 illustrates another perspective view of a clamp assembly (1008). In one embodiment, the clamp assemblies (1008/1009) on both sides of the adapter plate assembly (1005) are identical in design. Each clamp assembly (1008/1009) comprises an upside down L-shaped metal clamp (1011) which hooks around the top of the table rail (1004). The clamp assembly (1008) fits on top of the table rail (1004) and a large knob (1012) threaded through clamp (1011) may be adjusted to tighten directly against the table rail (1004), thus pulling the hook of the clamp (1011) against the table rail (1004) and locking the clamp (1011) in place. Another knob (1013) is threaded through the clamp (1011) directly below the large knob (1012) but is threaded through at an upward angle. This angled knob (1013) catches the underside (1014) of the table rail (1004). The knob (1013) serves as a secondary locking mechanism to the main knob (1012) and also prevents any twisting due to an unexpected large moment about the operating table.

[0039] FIGS. 11-13 illustrate a first manner of adjustment of an embodiment of the adapter plate assembly (1005) which allows the plate assembly (1005) to be installed on operating tables (1003) that have different widths. FIGS. 11 and 12 illustrate another perspective view of one embodiment of the adapter plate assembly (1005) in a first, retracted configuration. FIG. 13 illustrates the adapter plate assembly in a second, extended configuration. The first adjustable element of the adapter plate assembly (1005) concerns the width (1017) of the adapter plate assembly (1005). In this embodiment, the plate assembly (1005) is adjustable to fit the width (1015) of the operating table (1003) (see FIG. 8). In order to accomplish this, the surgeon side clamp assembly (1008) is mounted on two adjustable rods (1019/1031) that fit in two holes (1020) that run parallel to the width (1017) of the adapter main plate (1006) on one end, and are coupled to a split clamp (1022) on the other end. The rods (1019/1031) are held in place by two set knobs (1021) threaded into the main plate (1006). By loosening both set knobs (1021), the rods (1019/1031) are able to slide in and out, thereby essentially increasing and decreasing the effective width of the adapter plate (1005). When the desired width is achieved, the set knobs (1021) are tightened and the rods (1019/1031) are locked into place. Two adjustable rods (1019 and 1031) are used instead of a single rod to prevent the surgeon side clamp (1008) from rotating about the rod (1019) axis. Having two rods also allows for redundancy so that if one rod (1019 or 1031) breaks or if one knob (1021) fails, the other remains to preserve the functionality of the system. Similarly, the one or more clamp assemblies (1009) may also be adjustable to adjust the width of the plate assembly (1005).

[0040] FIGS. 14-15 illustrate the split clamp (1022) and associated rods (1019/1031). The adjustable rods (1019/1031) are held at their distal ends with a split clamp (1022). The split clamp (1022) is tightened with screws (1023) that sandwich and tighten the split clamp (1022) around the rods (1019 and 1031). One of the rods (1019) extends beyond the main split clamp (1022) to the distal end of the assembly where it couples to the clamp assembly (1008). In one embodiment, the adjustable rods (1019/1031) are configured such that the adapter plate assembly (1005) may extend its width (1017) to about 36 inches, or more. In a case where a table may be wider than 36 inches, the rods (1019/1031) may be replaced with longer length rods.

[0041] FIG. 16 illustrates an enlarged perspective view of the portion of one embodiment of a plate assembly (1005) near the surgeon side. FIGS. 17-18 illustrate an enlarged perspective view o the clamp assembly (1008) of one embodiment. In this implementation, the clamp assemblies (1008/1009) for a single plate assembly are identical. A clamp assembly is now described. Each clamp assembly (1008/1009) also allows for a vertical adjustment. Because the distance between the top surface of the table (1003) and the table rail (1004) can vary as much as 3-4 inches from table-to-table, a height adjustment on the clamp assembly (1005) is needed in order to be able to mount the adapter plate clamps (1008/1009) to different types of tables. The vertical adjustment is achieved by providing the clamp component (1011) with a split clamp (1023) that can slide up and down on a vertical rod (1024). The split clamp (1023) in its relaxed state has an inner diameter that is larger than the outer diameter of the vertical rod (1024). A threaded set knob (1025) passes through a through-hole in one side of the clamp (1023) and threads into the other side so that when the knob is tightened, the split clamp (1023) closes, decreasing its inner diameter and locking it onto the vertical rod (1024). The maximum vertical adjustment is obtained by sliding the clamp assembly (1008/1009) to the bottom of the vertical rod (1024). If it becomes necessary to extend the vertical maximum for extremely thick tablerails, the vertical rods (1024) could be swapped out for longer rods. Although currently the vertical rods (1024) are pressed and pinned into the clamp component (1011), an alternative embodiment may include swappable rods. In another embodiment, the interface between the rod (1024) and the small split clamp (1032) may be threaded together with a locking nut to lock the rod in place.

[0042] FIG. 19 illustrates another perspective view of one embodiment of the plate assembly (1005). FIGS. 20-21 illustrate different views of one embodiment of the adjustment knob (1021/1025). The set knobs (1021) are used for adjustment of the clamp assemblies (1008 and 1009) and the set knobs (1025) are used for adjustment of the adapter plate width adjustment rods (1019/1031). The set knobs (1021/1025) may be a ratchet type knob for safety wherein the knob does not engage its threads by simply spinning the knob. In order to engage the threads, the knob has to be forced down into the threads along its spinning axis while spinning the knob. A locking element (1027) is threaded on the distal end of the adjustment knob (1021 and 1025). The locking element (1027) comprises a groove (1028) that matches the adjustable rods (1019/1031) and vertical rod (1024) such that the groove can press up against the respective rod and lock it into place. The locking element (1027) is threaded onto the knob (1021/1025) to capture it in the assembly so when the rod (1019/1031/1024) is removed from the assembly the locking element (1027) does not fall out. In one embodiment, the threads on the distal portion (1033) of the adjustment knob are reversed from the threads on the proximal end (1034), i.e. left handed threads to prevent the locking element (1027) from loosening when the adjustment knob (1021/1025) is tightened into place to lock the adjustment rod (1019/1031/1024).

[0043] FIGS. 22-23 illustrate different views of one embodiment of the main plate (1006) of the adapter assembly (1005). From a top view, the adapter main plate (1006) is shaped like a rectangle that tapers off to create a neck like portion (1029). The main plate (1006) is shaped so that its width dimension in the neck like portion (1029) is smaller on the surgeon (1010) side of the table and has a much wider width (1018) on the opposite side of the table. The wide length (1018) on the opposite side of the table is intended to increase stability and safety. First, the wide edge (1018) allows for two clamp assemblies (1009) that can be spaced further apart. Second, increasing the overall size of the plate gives the plate (1006) some size and weight to safely hold the support arm assembly (26) and instrument driver (1002) in place even if the clamp assemblies (1008/1009) are mistakenly loosened or insufficiently tightened. The smaller width neck (1029) of the main plate (1006) in this example is intended to reduce the amount of table rail (1004) space used on the surgeon side of the table (1003). In some instances, a operating table (1003) may have several pendants mounted to its table rail (1004) on the surgeon side (1010) for flouroscopy, display screens, ablation tools, etc. Thus the necking (1029) in one embodiment of a plate reduces the need of the table rail (1004) space to approximately 3 inches. In alternative embodiments, this necking may be reduced or eliminated such that the surgeon side of the plate may be resized to wider dimensions as desired. Additionally, one of the adjustable rods (1019) is extended to hold the clamp assembly (1008). The rod (1019) is extended to be able to achieve the minimal three inch tablerail (1004) space taken by the single clamp assembly (1008). A smaller split clamp (1032) holds the distal end of the fixed rod (1019) and functions identically to the split clamp (1022). For one implementation, the thickness of the main plate (1006) is chosen to be ¾″ inch. Because the plate is installed underneath a patient's feet, it is important that the thickness of the plate does not elevate the feet significantly. With more clinical data, the thickness of the main plate (1006) can be increased. When the adjustable rods (1019/1031) are pulled out to extend the width of the plate assembly (1005), the extended portion (1035) (see FIG. 24) of the assembly does not include the thickness of the main plate (1006). Should a patient lying on the surgical table have one foot elevated by the main plate a greater amount than the other foot, a block can be placed over the rods to correct for this height discrepancy. The main plate (1006) also includes a pair of cut-outs (1030) which can be used as handles for handling the plate assembly (1005) and also to reduce the overall weight of the main plate (1006).

[0044] FIG. 24 illustrates yet another view of one embodiment of the adapter plate assembly (1005). In one implementation, the main plate (1006) is aluminum and the adapter plate rail (1007) is steel. In alternative embodiments, other types of materials, metallic or non-metallic, may be used to construct the various elements of the adapter plate assembly (1005). The adjustment rods (1019/1031/1024) (both for width and vertical adjustments) of this embodiment may be constructed of steel. The split clamps (1022/1032) holding the rod (1024) and the adjustable rods (1019/1031) may also fabricated from steel in this embodiment. In other embodiments non-metallic materials such as carbon fibers may be used instead of aluminum and steel. In alternative embodiments, an assembly with a minimal amount of metal may be desirable to reduce interference with any imaging modalities that may be used during a surgical procedure.

[0045] FIG. 25 illustrates the support assembly (26) of one embodiment. FIG. 26 illustrates one embodiment of an adapter plate assembly (1005) oriented to receive the support assembly (26) of FIG. 25. FIG. 27 illustrates an enlarged view of the support assembly interface surface (1036) for the support assembly (26) of FIG. 25. FIG. 28 illustrates a close up view of the adapter plate rail (1007) for the adapter plate assembly (1005) of FIG. 26. In order to prevent a user from accidentally installing the setup joint (26) directly onto the operating table rail (1004) instead of first installing the adapter plate assembly (1005) and then installing onto the adapter plate rail (1007), the interface between the adapter plate rail (1007) and the support assembly interface (1036) may be specifically keyed. For example, the support assembly interface (1036) can be angled or keyed to match a mirror image shaped surface on the adapter plate rail (1007), so that the setup joint (26) can only be mounted to the adapter plate assembly (1005). Another advantage of this adapter plate platform apparatus is the ability to be able to mount a support assembly (26) anywhere on the operating table, whether it be surgeon side, far side, center of table, etc.

[0046] Another embodiment for this adapter plate assembly (1005) is designed to hold multiple support assemblies (26) and multiple instrument drivers (16). By altering the main plate (1006), another rail (1007) may be added to the other side of the table. Furthermore, an additional rail could be added to mount a support assembly (26) that extends from between the patients legs, etc. If desired, a secondary rail can be added on the same side of the adapter plate assembly (1005) that extends further from original rail (1007) such that a pair of support assemblies (26) may be mounted on the same side of the table; or the rail (1007) can be lengthened such that it can accommodate two or more support assemblies (26). Furthermore, the adapter plate assembly (1005) may be configured such that the main plate (1006) is place underneath the operating table (1003), instead of on top of the operating table (1003).

[0047] 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, 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.