In vivo accessories for minimally invasive robotic surgery

Abstract

Surgical accessories are presented in vivo and used by surgical tools in the surgical site to perform additional tasks without the need to remove the tools from the surgical site for tool change or instrument loading. Examples of in vivo accessories include fastening accessories such as surgical clips for use with a clip applier, single working member accessories such as a blade which can be grasped and manipulated by a grasping tool for cutting, sheath accessories that fit over working members of a tool, flow tubes for providing suction or introducing a fluid into the surgical site, and a retraction member resiliently biased to retract a tissue to expose an area in the surgical site for treatment. The accessories can be introduced into the surgical site by a dedicated accessory introducer, or can be supported on the body of a surgical tool inserted into the surgical site and be manipulated using another surgical tool in the surgical site. The accessory introducer can be resiliently biased to bias the accessories toward a predetermined position in the surgical site.

What is claimed is:  
     
         1 . A method of performing minimally invasive robotic surgery in a body cavity of a patient, the method comprising: 
 introducing at least one surgical accessory into the cavity;    introducing a robotic surgical tool into the cavity; and    coupling the surgical accessory with the robotic surgical tool inside the cavity after introducing the surgical accessory and the robotic surgical tool into the cavity.    
     
     
         2 . The method of  claim 1  wherein the robotic surgical tool is manipulated by a servomechanism from outside the cavity to couple the robotic surgical tool with the surgical accessory inside the cavity.  
     
     
         3 . The method of  claim 2  wherein the robotic surgical tool is connected with a robot arm which is disposed outside the cavity and robotically controlled to manipulate the robotic surgical tool.  
     
     
         4 . The method of  claim 1  wherein the surgical accessory is coupled with the robotic surgical tool by grasping the surgical accessory with the robotic surgical tool.  
     
     
         5 . The method of  claim 1  wherein the surgical accessory is coupled with the robotic surgical tool by mating the surgical accessory with the robotic surgical tool to form a mated connection.  
     
     
         6 . The method of  claim 1  wherein the robotic surgical tool is a first robotic surgical tool, and wherein the surgical accessory is coupled with the first robotic surgical tool by introducing a second robotic surgical tool into the cavity and manipulating the surgical accessory with the second robotic surgical tool.  
     
     
         7 . The method of  claim 1  wherein the at least one surgical accessory is introduced into the cavity through a cannula.  
     
     
         8 . The method of  claim 1  wherein the at least one surgical accessory is introduced into the cavity supported by a surgical accessory support, and is removable from the surgical accessory support within the cavity.  
     
     
         9 . The method of  claim 8  wherein the surgical accessory support includes a container.  
     
     
         10 . The method of  claim 9  wherein the container includes a door, and wherein the method further comprises remotely manipulating the door between a closed position and an open position from outside the cavity.  
     
     
         11 . The method of  claim 8  wherein the surgical accessory support includes a block having a material which deflects to releasably secure one or more surgical accessories therein.  
     
     
         12 . The method of  claim 8  wherein the surgical accessory support is provided on the body of another robotic surgical tool introduced into the cavity.  
     
     
         13 . The method of  claim 8  wherein the surgical accessory support includes a cartridge releasably supporting a plurality of surgical accessories.  
     
     
         14 . The method of  claim 13  wherein the at least one surgical accessory includes a plurality of surgical clips supported on the cartridge, and wherein the robotic surgical tool comprises a clip applier, the method further comprising sequentially loading the surgical clips in the clip applier within the cavity and affixing the loaded clips to a target tissue with the clip applier.  
     
     
         15 . The method of  claim 1  wherein the at least one surgical accessory includes at least one of a scalpel, a blade, a dissection finger, an electrode, a clip, a tube, and a hook.  
     
     
         16 . The method of  claim 1  wherein the surgical accessory is introduced into the cavity through an opening in a cavity wall by connecting the surgical accessory with a distal portion of an extension line and inserting the surgical accessory and the distal portion of the extension line into the cavity through the cavity wall, the surgical accessory being movable between a first position close to the opening and a second position away from the opening.  
     
     
         17 . The method of  claim 16  wherein the surgical accessory is resiliently biased toward the first position.  
     
     
         18 . The method of  claim 1  further comprising decoupling the surgical accessory from the robotic surgical tool inside the cavity.  
     
     
         19 . The method of  claim 18  wherein the surgical accessory is supported by a surgical accessory support which is introduced into the cavity before the surgical accessory is coupled with the robotic surgical tool inside the cavity, and wherein the decoupled surgical accessory is returned to the surgical accessory support inside the cavity.  
     
     
         20 . The method of  claim 18  wherein a plurality of surgical accessories are introduced into the cavity, the method further comprising coupling another surgical accessory inside the cavity with the robotic surgical tool after the decoupling step.  
     
     
         21 . The method of  claim 1  wherein the surgical accessory comprises a tool tip which is releasably coupled with a working member of the robotic surgical tool to form a tool tip of the tool.  
     
     
         22 . The method of  claim 21  wherein the robotic surgical tool includes a pair of working members and a pair of tool tips are releasably coupled with the pair of working members of the robotic surgical tool to form tool tips of the tool.  
     
     
         23 . The method of  claim 1  wherein the surgical accessory comprises a sheath which is releasably coupled with the robotic surgical tool.  
     
     
         24 . The method of  claim 1  wherein the robotic surgical tool comprises a pair of working members, and wherein the surgical accessory comprises a pair of fingers movably supported on a collar which is releasably coupled with the robotic surgical tool in a coupled position, the pair of fingers mating with the pair of working members to be movable by the pair of working members in the coupled position.  
     
     
         25 . The method of  claim 1  further comprising: 
 manipulating the robotic surgical tool from outside the patient's body to position the surgical accessory within the body cavity; and  
 causing the surgical accessory to interact with a portion of the body cavity.  
 
     
     
         26 . The method of  claim 25  wherein the surgical accessory is caused to interact with a portion of the body cavity by a user actuating the accessory from outside the patient's body.  
     
     
         27 . The method of  claim 4  further comprising actuating a portion of a master control device located remotely from the patient by a user to control the robotic surgical tool to grasp the surgical accessory.  
     
     
         28 . The method of  claim 27  further comprising instructing the robotic surgical tool to continue to grasp the surgical accessory without requiring the user to continue to actuate the actuatable portion of the master control device.  
     
     
         29 . A method of performing minimally invasive robotic surgery in a body cavity of a patient, the method comprising: 
 introducing a robotic fastening tool into the cavity;    introducing a surgical accessory support into the cavity, the surgical accessory support supporting a plurality of fastening accessories;    loading one of the fastening accessories in the robotic fastening tool inside the cavity; and    affixing the loaded fastening accessory to a target tissue inside the cavity with the robotic fastening tool.    
     
     
         30 . The method of  claim 29  wherein the robotic fastening tool is a clip applier, and the fastening accessories include a plurality of surgical clips.  
     
     
         31 . The method of  claim 30  wherein the surgical accessory support includes a clip cartridge.  
     
     
         32 . The method of  claim 31  wherein the clip cartridge is provided on the body of another robotic surgical tool introduced into the cavity.  
     
     
         33 . A robotic surgical system for effecting a predetermined treatment of a target tissue at an internal surgical site within a patient body, the system comprising; 
 a surgical accessory adapted for effecting the treatment;    an accessory introducer having a proximal end and a distal end with an opening therebetween, the distal end of the introducer insertable into the patient body so that the opening defines a first minimally invasive aperture, the surgical accessory being coupled with the distal end of the introducer and passable through the opening to the internal surgical site; and    a robotic arm supporting a surgical tool, the surgical tool having an end effector suitable for insertion through a second minimally invasive aperture to the internal surgical site, the end effector coupleable with the surgical accessory within the internal surgical site so that the robot arm can manipulate the surgical accessory to direct the treatment to the target tissue.    
     
     
         34 . The robotic surgical system of  claim 33 , wherein the accessory comprises a member selected from the group consisting of a scalpel, a blade, a dissection finger, an electrode, a clip, a tube, and a hook.  
     
     
         35 . The robotic surgical system of  claim 33  wherein the accessory introducer includes a block having a material which deflects to releasably secure the surgical accessory therein.  
     
     
         36 . The robotic surgical system of  claim 33  wherein the accessory introducer includes a container having a door and a mechanism coupled with the door for remotely moving the door between an open position and a closed position from outside the internal surgical site.  
     
     
         37 . The robotic surgical system of  claim 33  wherein the surgical accessory is a clip and the surgical tool is a clip applier.  
     
     
         38 . The robotic surgical system of  claim 33  further comprising means for resiliently biasing the surgical accessory toward the first minimally invasive aperture.  
     
     
         39 . The robotic surgical system of  claim 33  wherein the accessory introducer includes a container having a door openable by the surgical tool, the container containing one or more surgical accessories.  
     
     
         40 . The robotic surgical system of  claim 33  wherein the accessory comprises a tool tip configured to be releasably coupled to the end effector of the surgical tool to form a tool tip for the end effector.  
     
     
         41 . The robotic surgical system of  claim 33  wherein the end effector comprises a pair of working members and the accessory comprises a pair of fingers movably supported on a collar which is configured to be releasably coupled with the surgical tool in a coupled position, the pair of fingers mating with the pair of working members to be movable by the pair of working members in the coupled position.  
     
     
         42 . An apparatus for providing a surgical accessory in vivo through a wall of a patient body into an internal cavity of the patient body for effecting a desired treatment of a target tissue in the patient body, the apparatus comprising: 
 a surgical accessory adapted for effecting the treatment;    an accessory introducer having a proximal end and a distal end with an opening therebetween, the distal end of the introducer insertable into the patient body so that the opening defines a first minimally invasive aperture, the surgical accessory being coupled with the distal end of the introducer and passable through the opening to the internal cavity; and    a resilient member connected with the accessory introducer to resiliently bias the surgical accessory to a preset desired location within the internal cavity.    
     
     
         43 . The apparatus of  claim 42  wherein the accessory introducer comprises a support member configured to be anchored to the wall of the patient body at the opening; and a slidable member coupled with the surgical accessory, the slidable member being slidable relative to the support member.  
     
     
         44 . The apparatus of  claim 43  wherein the resilient member comprises a spring coupled between the support member and the slidable member.  
     
     
         45 . The apparatus of  claim 42  wherein the accessory introducer comprises a needle portion for piercing through the wall of the patient body into the internal cavity, the needle portion including a hollow core for introducing the surgical accessory.  
     
     
         46 . A method of performing minimally invasive robotic surgery in an internal cavity of a patient body, the method comprising: 
 supporting a portion of a target tissue with a first robotic surgical tool introduced into the internal cavity, the first robotic surgical tool being electrically conductive;    contacting another portion of the target tissue with an electrically conductive cautery member introduced into the internal cavity; and    energizing the first robotic surgical tool and the cautery member for coagulating the target tissue.    
     
     
         47 . The method of  claim 46  wherein the first robotic surgical tool and the cautery member are energized by connection to opposite leads of a radiofrequency power source to form a bipolar system.  
     
     
         48 . The method of  claim 46  wherein the cautery member is held by a second robotic surgical tool.  
     
     
         49 . The method of  claim 48  wherein the second robotic surgical tool is electrically insulated from the cautery member.  
     
     
         50 . A robotic surgical system for performing a procedure on a body, the system comprising: 
 a surgical tool having an end effector comprising at least two end effector members, the members capable of grasping an object;    a master control device having an actuatable portion, the portion operatively connected to the surgical tool such that actuation of the portion causes the at least two end effector members to grasp the object; and    an input device for accepting an input from a user to cause the end effector members to continue to grasp without further actuation of the actuatable portion of the master control device.