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WO2025096793A1 - Instrument médical avec chemins d'écoulement de nettoyage - Google Patents

Instrument médical avec chemins d'écoulement de nettoyage Download PDF

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Publication number
WO2025096793A1
WO2025096793A1 PCT/US2024/053910 US2024053910W WO2025096793A1 WO 2025096793 A1 WO2025096793 A1 WO 2025096793A1 US 2024053910 W US2024053910 W US 2024053910W WO 2025096793 A1 WO2025096793 A1 WO 2025096793A1
Authority
WO
WIPO (PCT)
Prior art keywords
axial flow
medical device
flow director
outer tube
fluid
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
PCT/US2024/053910
Other languages
English (en)
Inventor
Craig Keith TSUJI
David I. Moreira Ridsdale
Harsukhdeep Singh Ratia
Kristopher Yee
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Intuitive Surgical Operations Inc
Original Assignee
Intuitive Surgical Operations Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Intuitive Surgical Operations Inc filed Critical Intuitive Surgical Operations Inc
Publication of WO2025096793A1 publication Critical patent/WO2025096793A1/fr
Pending legal-status Critical Current
Anticipated expiration legal-status Critical

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A61B2034/301—Surgical robots for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A61B2034/305—Details of wrist mechanisms at distal ends of robotic arms
    • 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
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/064—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension
    • 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
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/371—Surgical systems with images on a monitor during operation with simultaneous use of two cameras
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2217/00—General characteristics of surgical instruments
    • A61B2217/002—Auxiliary appliance
    • A61B2217/007—Auxiliary appliance with irrigation system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
    • A61B2218/002—Irrigation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A61B34/37—Leader-follower robots
    • 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
    • A61B34/71—Manipulators operated by drive cable mechanisms

Definitions

  • the embodiments described herein relate to medical instruments, and more specifically to medical instruments adapted for use with teleoperated surgical systems. More particularly, the embodiments described herein relate to medical instruments that include cleaning fluid ports and fluid routing structures adapted to support cleaning of such instruments.
  • MIS Minimally Invasive Surgery
  • telesurgical systems Many known MIS instruments include a therapeutic or diagnostic end effector (e.g., forceps, a cutting tool, or a cauterizing tool) mounted on an optional wrist mechanism at the distal end of a long shaft.
  • end effector e.g., forceps, a cutting tool, or a cauterizing tool
  • the end effector, optional wrist mechanism, and the distal end of the shaft are typically inserted through a small incision or a natural orifice to position the end effector at a surgical work site within a patient.
  • Force sensing medical instruments are known, and together with associated telesurgical systems, they provide force feedback sensations to a surgeon performing a procedure with such instruments during a MIS procedure.
  • the force feedback increases the surgeon’s sense of immersion, realism, and intuitiveness while performing the procedure.
  • Various force sensing instrument architectures are known.
  • a resiliently flexible beam is coupled between the distal end of the instrument’s shaft and the instrument’s operative distal end components.
  • Sensor elements mounted on the beam e.g., electric strain sensors, such as Wheatstone bridge circuits and the like, optical fiber Bragg gratings, etc.
  • sense indications of strain in the beam as it laterally deflects due to instrument-tissue interaction and outputs from the sensor elements are used as input for rendering force feedback sensations to the surgeon.
  • a mechanical hard stop structure may be used to limit the beam’s lateral deflection and so protect the beam and the sensor elements, as well as to limit the sensed strain used to generate the force feedback to the surgeon.
  • Hard stop structures and force sensor elements are further described in U.S. Patent Publication No. 2021/0353373, filed May 17, 2021, entitled “Hard Stop that Produces a Reactive Upon Engagement for Cantilevered-Based Force Sensing,” the disclosure of which is incorporated herein by reference.
  • Force sensing elements can include additional structures, such as connection members and cable routing structures, for improving the accuracy of the force measurement.
  • medical instruments that do not include force sensing capability can include an intricate structure at the distal end to improve cable routing, sensing of a position of the jaws, or other purposes.
  • a force sensing instrument includes an outer tube surrounding an inner body. The proximal end of the inner body can be coupled to an inner shaft of the instrument (or other component) such that there is a closed end in the gap between the inner body and an outer shaft.
  • a distal fluid port opening in the outer shaft may be too small to provide adequate fluid flow to reach the proximal portion of the gap to remove contaminants and residue that may enter the instrument during use. It may also be difficult to push the cleaning fluid proximally a sufficient distance to reach areas in the gap near the proximal end of the gap. Further, efforts to move the fluid proximally may prevent fluid remaining at the distal end of the instrument to clean contaminants that can build up around the inner body.
  • Such issues can be present in any medical instrument that has an outer tube surrounding an inner body (e.g., a tubular or solid structure) where there is a gap between the inner body and outer tube where contaminants and other residue can be trapped.
  • a medical device includes a distal body and an elongate inner body extending proximally from the distal body and including an outer surface.
  • An elongate outer tube extends proximally from the distal body and includes an inner surface.
  • a fluid port is included in the distal body or the outer tube.
  • An axial flow director is on the outer surface of the inner body, or on the inner surface of the outer tube.
  • the outer tube surrounds the inner body to define a gap between the outer surface of the inner body and the inner surface of the outer tube and the axial flow director is positioned to direct fluid from the fluid port proximally within the gap.
  • the fluid port is in the distal body, and the outer tube includes a distal end portion and an opening at the distal end portion of the outer tube.
  • the opening at the distal end portion of the outer tube is aligned with the fluid port such that fluid from the fluid port flows through the opening at the distal end portion of the outer tube and through the gap.
  • the opening at the distal end portion of the outer tube is a first opening and the outer tube includes a second opening proximal of the first opening. The second opening is configured to receive fluid therethrough, and the axial flow director is positioned to direct fluid from the second opening proximally within the gap.
  • the axial flow director has a length that extends along at least half the length of the inner tube.
  • the medical device includes a first axial flow director on the outer surface of the inner body and a second axial flow director on the inner surface of the outer tube.
  • the medical device further includes a force sensor that includes an axial beam and a strain sensor positioned to measure a strain on the beam.
  • the inner body includes the beam, and the axial flow director is positioned on the outer surface of the inner body and distal of the strain sensor.
  • the outer tube is a first outer tube
  • the gap is a first gap
  • the medical device further includes a second outer tube at least partially surrounding the first outer tube to define a second gap between the first outer tube and the second outer tube. Fluid from the fluid port flows proximally along the axial flow director within the first gap and then distally through the second gap.
  • the second outer tube is axially moveable with reference to the inner body.
  • the axial flow director is spaced from the distal body to define a circumferential distal flow region between the axial flow director and the distal body and such that a portion of the fluid from the fluid port flows within the circumferential distal flow region.
  • the medical device is a telesurgical system instrument.
  • the axial flow director has an outer surface and on the condition that the axial flow director is on the outer surface of the inner body, a gap is defined between the outer surface of the axial flow director and the inner surface of the outer tube. On the condition that the axial flow director is on the inner surface of the outer tube, a gap is defined between the outer surface of the axial flow director and the outer surface of the inner body.
  • the medical device has a first axial flow director and a second axial flow director on the outer surface of the inner body or on the inner surface of the outer tube.
  • the first axial flow director and the second axial flow director together define an axial flow path within the gap for at least a portion of the fluid conveyed from the fluid port.
  • the fluid port is in the distal body
  • the outer tube includes a distal end portion and an opening at the distal end portion of the outer tube, and the opening is aligned with the axial flow path such that fluid from the opening flows proximally along the axial flow path.
  • the first axial flow director and the second axial flow director are each spaced from the distal body to define a circumferential flow region between the distal body and the first axial flow director and the second axial flow director. A portion of the fluid from the fluid port flows circumferentially within the circumferential flow region.
  • the outer tube is a first outer tube
  • the medical device includes a second outer tube at least partially surrounding the first outer tube and the fluid from the fluid port flows proximally along the axial flow path and then distally between the second outer tube and the first outer tube.
  • the fluid flows proximally along the axial flow path and then distally within the gap and outside the axial flow path.
  • first axial flow director and the second axial flow director are parallel. In some embodiments, the first axial flow director and the second axial flow director are nonparallel.
  • a first cross-sectional area is defined by the axial flow path, and a second cross-sectional area is defined exclusive of the first cross-sectional area.
  • An average velocity of the fluid from the fluid port through the first cross-sectional area is greater than an average velocity of the fluid from the fluid port through the second cross-sectional area.
  • the medical device further includes a force sensor that includes an axial beam and a strain sensor positioned to measure a strain on the beam.
  • the inner body of the medical device includes the beam, and the first axial flow director and the second axial flow director are positioned on the outer surface of the inner body and distal of the strain sensor.
  • the medical device is a telesurgical system instrument.
  • the first axial flow director and the second axial flow director are spaced from the distal body to define a circumferential distal flow region between the distal body and the first axial flow director and the second axial flow director such that a portion of the fluid from the fluid port flows within the distal flow region.
  • the first axial flow director and the second axial flow director each have an outer surface.
  • a gap is defined between the outer surfaces of the first axial flow director and the second axial flow director and the inner surface of the outer tube.
  • a gap is defined between the outer surfaces of the first axial flow director and the second axial flow director and the outer surface of the inner body.
  • FIG. 1 is a plan view of a minimally invasive teleoperated surgery system according to an embodiment being used to perform a medical procedure such as surgery.
  • FIG. 2 is a perspective view of an optional auxiliary unit of the minimally invasive teleoperated surgery system shown in FIG. 1.
  • FIG. 3 is a perspective view of a user control console of the minimally invasive teleoperated surgery system shown in FIG. 1.
  • FIG. 4 is a front view of a manipulator unit, including a plurality of instruments, of the minimally invasive teleoperated surgery system shown in FIG. 1.
  • FIG. 5 is a diagrammatic illustration of a medical device, according to an embodiment.
  • FIG. 6 is a diagrammatic illustration of a medical device, according to an embodiment.
  • FIG. 7 is a diagrammatic illustration of a medical device, according to an embodiment.
  • FIG. 8 is a diagrammatic illustration of a medical device, according to an embodiment.
  • FIG. 9 is a diagrammatic illustration of a medical device, according to an embodiment.
  • FIG. 10 is a diagrammatic illustration of a medical device, according to an embodiment.
  • FIG. 11 is a perspective view of a medical device, according to another embodiment.
  • FIG. 12 is an enlarged perspective view of a distal end portion of the medical device of
  • FIG. 13 A is a top view of a distal end portion of the medical device of FIG. 11.
  • FIG. 13B is a perspective view of the medical device of FIG. 11 with the outer shaft removed for illustration purposes.
  • FIG. 14A is an enlarged perspective view of a distal end portion of the medical device of FIG. 11 with the shroud removed for illustration purposes.
  • FIG. 14B is a perspective view of the shroud of the medical device of FIG. 11.
  • FIG. 15A is a perspective view of a distal end portion of the medical device of FIG.l 1 with the outer shaft, shroud and end effector removed for illustration purposes.
  • FIG. 15B is a perspective view of the shroud of the medical device of FIG. 11.
  • FIG. 16A is a perspective view of the distal force sensor unit of the medical device of
  • FIG. 16B is an exploded perspective view of the distal force sensor unit of FIG. 16A.
  • FIG. 16C is a top view of the distal force sensor unit of FIG. 16A.
  • FIG. 17 is a perspective cross-sectional view of the medical device of FIG. 11 taken along line 17-17 in FIG. 13A.
  • FIG. 18 is a side cross-sectional view of the medical device of FIG. 11 taken along line
  • FIG. 19 is an enlarged view of the distal end of the cross-sectional view of FIG. 18.
  • FIG. 20 is a top view of a distal end portion of a medical device according to another embodiment.
  • FIG. 21A is a partial exploded perspective view of the distal end portion of the medical device of FIG. 20.
  • FIG. 21B is a perspective view of the shroud of the medical device of FIG. 20.
  • FIG. 22A is a perspective view of a force sensor unit of the medical device of FIG. 20.
  • FIG. 22B is a partially exploded perspective view of the force sensor unit of FIG. 22A.
  • FIG. 22C is an enlarged side view of a distal portion of the force sensor unit of FIG.
  • FIG. 23 is a perspective cross-sectional perspective view of the medical device of FIG. 20 taken along line 23-23 in FIG. 20.
  • FIG. 24 is a side cross-sectional view of the medical device of FIG. 20 taken along line 23-23 in FIG. 20.
  • FIG. 25 is an enlarged view of the distal end of the cross-sectional view of FIG. 24.
  • FIG. 26 is a perspective view of a portion of a distal end portion of a medical device according to an embodiment.
  • FIG. 27 is a perspective view of a distal portion of the force sensor unit of the medical device of FIG. 26.
  • the embodiments described herein can advantageously be used in a wide variety of instruments, including force sensing instruments, such as for grasping, cutting, and manipulating operations associated with minimally invasive surgery.
  • the embodiments described herein can also be used in a variety of non-medical applications such as, for example, teleoperated systems for search and rescue, remotely controlled submersible devices, aerial devices, automobiles, etc.
  • the medical instruments or devices of the present application enable motion in three or more degrees of freedom (DOFs).
  • DOFs degrees of freedom
  • an end effector of the medical instrument can move with reference to the main body of the instrument in three mechanical DOFs, e.g., pitch, yaw, and roll (shaft roll).
  • DOFs there may also be one or more mechanical DOFs in the end effector itself, e g., two jaws, each rotating with reference to a clevis (2 DOFs) and a distal clevis that rotates with reference to a proximal clevis (one DOF).
  • the medical instruments or devices of the present application enable motion in six DOFs.
  • the embodiments described herein can further be used to determine the forces exerted on (or by) a distal end portion of the instrument during use.
  • Embodiments described herein relate to structures and methods of cleaning a distal end portion of a medical instrument.
  • the medical instruments include one or more flush ports at a distal end of the instrument, one or more flush ports at a proximal end of the instrument, or both.
  • the medical instrument is a force sensing medical instrument for determining forces applied to the medical instrument to control a surgical system, such as a minimally invasive teleoperated surgery system.
  • structures are provided at a distal end portion of the instrument to limit the range of motion of a force sensor beam and reduce force artifacts that affect the accuracy of force feedback. Such structures can also be adapted to promote efficient and thorough cleaning of the medical instrument.
  • a force sensing medical instrument includes a force sensor system that includes a distal force sensor unit that can provide an indication of forces affecting the instrument. This indication of the force(s) can be used by the system to deliver force feedback to a user control unit of the system.
  • the distal force sensor unit can include a strain sensor coupled to a resiliently deformable beam. The beam is configured to deform in response to a load affecting at a distal end portion of the instrument.
  • the strain sensor includes one or more strain gauges that measure the resultant strain in the beam due to the deflection.
  • a sensor signal cable is optionally coupled to the distal force sensor unit, extends proximally, and is coupled to an electronic circuit board of the medical device.
  • medical devices described herein include a force sensor unit having a beam and one or more strain sensors on the beam.
  • the medical devices include a shroud (which can be an outer tube) that surrounds at least a portion of the beam and is coupled to the beam.
  • the shroud is optionally a super elastic shape-memory material, and it is resiliently bendable along a longitudinal axis of the shroud and resiliently deformable radially inward.
  • An outer shaft surrounds at least a portion of the shroud. During use of the medical device, contact between the shroud and the distal end portion of the outer shaft limits lateral deflection of the distal end portion of the beam while also limiting distortion of the sensed forces.
  • the shroud is coupled to the beam, as the beam bends due to forces exerted on the distal end portion of the medical device, the shroud will move with the beam until the shroud contacts the outer shaft.
  • the shroud s resiliency allows it to deform (e.g., bend) as it contacts the outer shaft and then revert to its original linear shape when no longer in contact with the outer shaft.
  • the shroud has a biased linear shape and can deform through contact with the outer shaft and revert to its biased linear shape when there is no longer contact with the outer shaft. Deformation of the shroud allows for limitation of the deflection of the beam while also limiting the distortion of the sensed forces.
  • the shroud surrounds the beam to define a gap through which a cleaning fluid flows.
  • medical devices are described herein that include a fluid flush port at a distal end portion of the medical device.
  • the distal flush port provides for cleaning fluid to be introduced into the interior of the medical device to provide effective cleaning of the interior components that may otherwise be blocked from access.
  • the shroud can function to direct the fluid proximally from the distal fluid port.
  • the distal flush port is located on a distal body coupled to a distal end portion of the shroud.
  • the distal body can be, for example, a link of a wrist assembly or component of an end effector.
  • the size and the location of the distal flush port are selected to enable easy access and connection to a standard luer fitting so as to connect a cleaning fluid source to the medical device.
  • medical devices are described herein that have a distal body, an elongated outer tube, and an elongated inner body.
  • the inner body extends from the distal body, and the outer tube surrounds the inner body.
  • the inner body has an outer surface, and the outer body has an inner surface.
  • the outer tube surrounds the inner body proximal end portion of a distal force sensing structure and can present challenges for cleaning and reprocessing the force sensing instrument.
  • a proximal end of the inner body is coupled to an inner shaft of the medical device (or other component) such that there is a closed end in a gap between the inner body and an outer tube.
  • a flush port is in the outer tube or the distal body and can receive fluid therethrough that can be used to clean the area within the gap.
  • An axial flow director is on the outer surface of the inner body or on the inner surface of the outer tube and is positioned to direct fluid form the fluid port proximally in the gap.
  • the medical instrument includes two axial flow directors. In some embodiments, there are four axial flow directors. Other embodiments may include a number of flow directors different from one, two, or four. In some embodiments with multiple flow directors, the flow directors are positioned parallel to each other. In yet other embodiments, two flow directors can be positioned nonparallel to each other. In some embodiments, the flow directors have a length that extends substantially the length of the inner body. In some embodiments, the flow directors have a length that is equal to at least half the length of the inner body. In some embodiments, the flow directors have a length that is less than half the length of the inner body. Various different embodiments and configurations for the flow directors are described herein.
  • the term “about” when used in connection with a referenced numeric indication means the referenced numeric indication plus or minus up to 10 percent of that referenced numeric indication.
  • the language “about 50” covers the range of 45 to 55.
  • the language “about 5” covers the range of 4.5 to 5.5.
  • a part such as a mechanical structure, component, or component assembly
  • the term means the part can be repeatedly bent and restored to an original shape without harm to the part.
  • Certain flexible components can also be resilient.
  • a component e.g., a flexure
  • a component is said to be resilient if it possesses the ability to absorb energy when it is deformed elastically, and then releases the stored energy upon unloading (i.e., returning to its original state).
  • Many “rigid” objects have a slight inherent resilient “bendiness” due to material properties, although such objects are not considered “flexible” as the term is used herein.
  • distal refers to direction towards a work site
  • proximal refers to a direction away from the work site.
  • the end of a tool that is closest to the target tissue would be the distal end of the tool
  • the end opposite the distal end i.e., the end manipulated by the user or coupled to the actuation shaft
  • spatially relative terms such as “beneath”, “below”, “lower”, “above”, “upper”, “proximal”, “distal”, and the like — may be used to describe the relationship of one element or feature to another element or feature as illustrated in the figures. These spatially relative terms are intended to encompass different positions (i.e., translational placements) and orientations (i.e., rotational placements) of a device in use or operation in addition to the position and orientation shown in the figures.
  • a device in the figures is turned over, elements described as “below” or “beneath” other elements or features would then be “above” or “over” the other elements or features.
  • the term “below” can encompass both positions and orientations of above and below.
  • a device may be otherwise oriented (e.g., rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly.
  • descriptions of movement along (translation) and around (rotation) various axes include various spatial device positions and orientations. The combination of a body’s position and orientation defines the body’s pose.
  • geometric terms such as “parallel”, “perpendicular”, “round”, or “square”, are not intended to require absolute mathematical precision, unless the context indicates otherwise. Instead, such geometric terms allow for variations due to manufacturing or equivalent functions. For example, if an element is described as “round” or “generally round,” a component that is not precisely circular (e.g. , one that is slightly oblong or is a many-sided polygon) is still encompassed by this description.
  • the singular forms “a”, “an”, and “the” are intended to include the plural forms as well, unless the context indicates otherwise.
  • the terms “comprises”, “includes”, “has”, and the like specify the presence of stated features, steps, operations, elements, components, etc. but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, or groups.
  • inventive aspects are described with reference to a teleoperated surgical system.
  • An example architecture of such a teleoperated surgical system is the da Vinci® surgical system commercialized by Intuitive Surgical, Inc., Sunnyvale, California.
  • inventive aspects disclosed herein may be embodied and implemented in various ways, including computer-assisted, non-computer-assisted, and hybrid combinations of manual and computer-assisted embodiments and implementations. Implementations are merely presented as examples, and they are not to be considered as limiting the scope of the inventive aspects disclosed herein.
  • inventive aspects may be embodied and implemented in both relatively smaller, hand-held, hand-operated devices and relatively larger systems that have additional mechanical support.
  • FIG. l is a plan view illustration of a teleoperated surgical system (“system”) 1000 that operates with at least partial computer assistance (a “telesurgical system”). Both telesurgical system 1000 and its components are considered medical devices.
  • Telesurgical system 1000 is a Minimally Invasive Robotic Surgical (MIRS) system used for performing a minimally invasive diagnostic or surgical procedure on a Patient P who is lying on an Operating table 1010.
  • the system can have any number of components, such as a user control unit 1100 for use by an operator of the system, such as a surgeon or other skilled clinician S, during the procedure.
  • the MIRS system 1000 can further include a manipulator unit 1200 (popularly referred to as a surgical robot) and an optional auxiliary equipment unit 1150.
  • the manipulator unit 1200 can include an arm assembly 1300 and a surgical instrument tool assembly removably coupled to the arm assembly.
  • the manipulator unit 1200 can manipulate at least one removably coupled medical instrument (instrument) 1400 (e.g., a force sensing medical instrument) through a minimally invasive incision in the body or natural orifice of the patient P while the surgeon S views the surgical site and controls movement of the instrument 1400 through control unit 1100.
  • An image of the surgical site is obtained by an endoscope (not shown), such as a stereoscopic endoscope, which can be manipulated by the manipulator unit 1200 to orient the endoscope.
  • the auxiliary equipment unit 1150 can be used to process the images of the surgical site for subsequent display to the Surgeon S through the user control unit 1100.
  • the number of instruments 1400 used at one time will generally depend on the diagnostic or surgical procedure and the space constraints within the operating room, among other factors. If it is necessary to change one or more of the instruments 1400 being used during a procedure, an assistant removes the instrument 1400 from the manipulator unit 1200 and replaces it with another instrument 1400 from a tray 1020 in the operating room. Although shown as being used with the instruments 1400, any of the instruments described herein can be used with the system 1000.
  • FIG. 2 is a perspective view of the user control unit 1100.
  • the user control unit 1100 includes a left eye display 1112 and a right eye display 1114 for presenting the surgeon S with a coordinated stereoscopic view of the surgical site that enables depth perception.
  • the user control unit 1100 further includes one or more input control devices 1116 (input device), which in turn causes the manipulator unit 1200 (shown in FIG. 1) to manipulate one or more tools.
  • the input devices 1116 provide at least the same degrees of freedom as instruments 1400 with which they are associated to provide the surgeon S with telepresence, or the perception that the input devices 1116 are integral with (or are directly connected to) the instruments 1400.
  • the user control unit 1100 provides the surgeon S with a strong sense of directly controlling the instruments 1400.
  • position, force, strain, or tactile feedback sensors (not shown) or any combination of such sensations, from the instruments 1400 back to the surgeon's hand or hands through the one or more input devices 1116.
  • FIG. 1 is a perspective view of the auxiliary equipment unit 1150.
  • the auxiliary equipment unit 1150 can be coupled with the endoscope (not shown) and can include one or more processors to process captured images for subsequent display, such as via the user control unit 1100, or on another suitable display located locally (e.g., on the unit 1150 itself as shown, on a wall-mounted display) and/or remotely.
  • the auxiliary equipment unit 1150 can process the captured images to present the surgeon S with coordinated stereo images of the surgical site via the left eye display 1112 and the right eye display 1114.
  • Such coordination can include alignment between the opposing images and can include adjusting the stereo working distance of the stereoscopic endoscope.
  • image processing can include the use of previously determined camera calibration parameters to compensate for imaging errors of the image capture device, such as optical aberrations.
  • FIG. 4 shows a front perspective view of the manipulator unit 1200.
  • the manipulator unit 1200 includes the components (e.g., arms, linkages, motors, sensors, and the like) to provide for the manipulation of the instrument 1400 and an imaging device (not shown), such as a stereoscopic endoscope, used for the capture of images of the site of the procedure.
  • an imaging device such as a stereoscopic endoscope, used for the capture of images of the site of the procedure.
  • the instruments 1400 and the imaging device can be manipulated by teleoperated mechanisms having one or more mechanical joints.
  • the instruments 1400 and the imaging device are positioned and manipulated through incisions or natural orifices in the patient P in a manner such that a center of motion remote from the manipulator and typically located at a position along the instrument shaft is maintained at the incision or orifice by either kinematic mechanical or software constraints. In this manner, the incision size can be minimized.
  • FIG. 5 is a schematic illustration of a medical device 2400, according to an embodiment.
  • the medical device 2400 or any of the components therein are optionally parts of a surgical system that performs surgical procedures, and which can include a manipulator unit, one or more kinematic linkages, one or more cannulas, or the like.
  • the medical device 2400 (and any of the instruments described herein) can be used in any suitable surgical system, such as the MIRS system 1000 shown and described above.
  • the medical device 2400 includes an elongated inner body 2810, an elongated outer tube 2900, a distal body 2510, and an axial flow director 2838.
  • the inner body 2810 extends proximally from the distal body 2510 and has an outer surface 2815
  • the outer tube 2900 has an inner surface 2915.
  • the outer tube 2900 surrounds at least a portion of the inner body 2810 such that a gap G is defined between the inner surface 2915 of the outer tube 2900 and the outer surface 2815 of the inner body 2810.
  • the axial flow director 2838 is positioned on the outer surface 2815 of the inner body 2810 as shown in FIG 5.
  • an axial flow director can be positioned on the inner surface of the outer tube, such as shown in FIG. 6 and described below.
  • a fluid port 2515 is defined in the distal body 2510 as shown in FIG. 5, and in alternative embodiments, a fluid port is defined in the outer tube 2900, such as shown in FIG. 7 and described below.
  • the axial flow director 2838 directs a flow of fluid FF from the fluid port 2515 proximally within the gap G to clean an interior component or component surface of the medical device 2400.
  • residual contaminants or soil can accumulate in areas of the medical device 2400 within the gap G.
  • the proximal end of the inner body 2810 is coupled to another component, creating a closed end at a distal end of the gap G. Residual soil can accumulate in this closed end area.
  • cleaning fluid is introduced through the fluid port 2515 and the axial flow director 2838 helps to efficiently and effectively direct the flow of fluid FF proximally to the closed end at the distal end of the gap G.
  • the fluid port 2515 is in fluid communication with the gap G.
  • the axial flow director 2838 optionally can be positioned circumferentially at various locations on the inner body 2810 or the outer tube 2900 depending on the desired design of the device and the required fluid flow. For example, it may be advantageous to position the axial flow director at a location to avoid interference with cables or other structures of the device. In another example, in an embodiment of a medical device having a force sensor unit with strain gauges on the inner body 2810, the axial flow director 2810 can be positioned distally of the strain gauges such that the axial flow director 2810 does not interfere with the force sensing.
  • a distal end portion of the outer tube 2915 is coupled to the distal body 2510 and has an opening (not shown in FIG. 5) aligned with the fluid port 2515.
  • the opening of the outer tube 2900 is in fluid communication with the gap G such that when fluid is introduced into the fluid port 2515, the fluid flows through the opening in the outer tube 2900 and into the gap G.
  • the opening at the distal end portion of the outer tube 2900 is a first opening and the outer tube 2900 includes a second opening (not shown in FIG. 5) that is positioned proximally of the first opening.
  • the second opening is configured to receive fluid therethrough and into the gap G, and the axial flow director is positioned to direct fluid from the second opening proximally within the gap G.
  • medical device 6400 Such an embodiment is described below with reference to medical device 6400.
  • axial flow directors there are two or more axial flow directors. In some embodiments, there are four axial flow directors. Other embodiments may include a number of axial flow directors other than one, two, or four. In some embodiments having multiple flow directors, at least two of the axial flow directors are positioned parallel to each other. In other embodiments having multiple flow directors, two axial flow directors are positioned nonparallel to each other. In some embodiments, a medical device includes one or more axial flow directors on the outer surface of the inner body and one or more axial flow directors on the inner surface of the outer tube.
  • the axial flow director(s) have a length that extends substantially the length of the inner body. In some embodiments, the axial flow director(s) have a length that is equal to at least half the length of the inner body. In some embodiments, the axial flow directors have a length that is less than half the length of the inner body.
  • the medical device 2400 is a force sensing medical device and includes a force sensor that includes an axial beam and a strain sensor positioned to measure a strain on the beam.
  • the inner body 2810 includes the beam, and the axial flow director 2838 is positioned on the outer surface 2815 of the inner body 2810 and positioned distally of the strain sensor.
  • the medical device 2400 includes a second outer tube (not shown in FIG. 5) that at least partially surrounds the outer tube 2900 to form a second gap between the second outer tube and the outer tube 2900.
  • fluid introduced into the fluid port 251 flows proximally along the axial flow director 2838 within the gap G and then distally through the second gap.
  • the distal end portion of the gap G can be closed such that the fluid flows to the closed end and then is moved distally within the second gap.
  • the second outer tube is axially moveable with reference to the inner body 2810.
  • the axial flow director 2838 is spaced from the distal body 2510 to define a circumferential distal flow region (described in more detail below for medical device 5400) between the axial flow director 2838 and the distal body 2515.
  • the circumferential distal flow region allows for a portion of the fluid from the fluid port 2515 to clean and remove any soil build up in the gap G distally of the axial flow director 2838.
  • the axial flow director 2838 has an outer radial surface (a localized top surface for the protruding flow director), and when the axial flow director 2838 is on the inner surface 2815 of the inner body 2810, a gap is defined between the outer radial surface of the axial flow director 2838 and the inner surface 2915 of the outer tube 2900.
  • the axial flow director 2838 has an outer radial surface (a localized top surface for the protruding flow director), and when the axial flow director 2838 is on the inner surface 2915 of the outer tube 2910, a gap is defined between the outer radial surface of the axial flow director 2838 and the outer surface 2815 of the inner body 2810.
  • FIGS. 6-10 illustrate various alternative embodiments of a medical device having an axial flow director(s).
  • FIG. 6 illustrates an alternative medical device 2400’ that includes an elongated inner body 2810’, an elongated outer tube 2900’, a distal body 2510’, and an axial flow director 2838’.
  • the medical device 2400’ can be configured the same as or similar to, and can function the same as or similar to, the medical device 2400.
  • the inner body 2810’ extends proximally from the distal body 2510’ and has an outer surface 2815’
  • the outer tube 2900’ has an inner surface 2915’.
  • the outer tube 2910’ surrounds at least a portion of the inner body 2810’ such that a gap G’ is defined between the inner surface 2915’ of the outer tube 2900’ and the outer surface 2815’ of the inner body 2810’.
  • the axial flow director 2838’ is positioned on the inner surface 2915’ of the outer tube 2900’ and at a spaced distance from the distal body 2510’ to define a circumferential flow region CFR’ .
  • a fluid port 2515’ is defined by the distal body 2510’ and can receive a volume of fluid therethrough and the axial flow director 2838’ directs a flow of the fluid FF’ from the fluid port 2515’ proximally within the gap G’ to clean interior component of the medical device 2400’.
  • FIG. 7 illustrates an alternative medical device 3400 that includes an elongated inner body 3810, an elongated outer tube 3900, a distal body 3510, and an axial flow director 3838.
  • the medical device 3400 can be configured the same as or similar to, and can function the same as or similar to, the medical device 2400.
  • the inner body 3810 extends proximally from the distal body 3510 and has an outer surface 3815
  • the outer tube 3900 has an inner surface 3915.
  • the outer tube 3910 surrounds at least a portion of the inner body 3810 such that a gap G is defined between the inner surface 3915 of the outer tube 3900 and the outer surface 3815 of the inner body 3810.
  • FIG. 8 illustrates an alternative medical device 3400’ that includes an elongated inner body 3810’, an elongated outer tube 3900’, a distal body 3510’, and an axial flow director 3838’.
  • the medical device 3400’ can be configured the same as or similar to, and can function the same as or similar to, the medical device 2400.
  • the inner body 3810’ extends proximally from the distal body 3510’ and has an outer surface 3815’
  • the outer tube 3900’ has an inner surface 3915’.
  • the outer tube 3910’ surrounds at least a portion of the inner body 3810’ such that a gap G’ is defined between the inner surface 3915’ of the outer tube 3900 and the outer surface 3815’ of the inner body 3810’.
  • the axial flow director 3838’ is positioned on the inner surface 3815 of the outer tube 3900’ and at a spaced distance from the distal body 3510’ to define a circumferential flow region CFR’.
  • a fluid port 3516’ is defined by the outer tube 3900’.
  • the fluid port 3516’ can receive a volume of fluid therethrough and the axial flow director 3838’ directs a flow of the fluid FF from the fluid port 3515’ proximally within the gap G’ to clean interior component of the medical device 3400’.
  • FIG. 9 illustrates an alternative medical device 4400 that includes an elongated inner body 4810, an elongated outer tube 4900, a distal body 4510, and a first axial flow director 4838 and a second axial flow director 4839.
  • the medical device 4400 can be configured the same as or similar to, and can function the same as or similar to, the medical device 2400.
  • the inner body 4810 extends proximally from the distal body 4510 and has an outer surface 4815
  • the outer tube 4900 has an inner surface 4915.
  • the outer tube 4910 surrounds at least a portion of the inner body 4810 such that a gap G is defined between the inner surface 4915 of the outer tube 4900 and the outer surface 4815 of the inner body 4810.
  • first axial flow director 4838 and the second axial flow director 4839 are positioned parallel to each other on the outer surface 4815 of the inner body 4810 and define a flow path FP.
  • the first axial flow director 4838 and the second axial flow director 4839 are positioned at a spaced distance from the distal body 4510 to define a circumferential flow region CFR.
  • the outer tube 4900 is coupled to the distal body 4510 such that a distal end portion of the outer tube 4900 is within the distal body 4510.
  • the distal body 4510 defines a fluid port 4515 and the outer tube 4900 defines an opening 4941 that is aligned with the fluid port 4515.
  • the fluid port 4515 receives a volume of fluid therethrough, and the axial flow directors 4838 and 4839 direct a flow of the fluid FF from the fluid port 4515, through the opening 4914, through the flow path FP, and proximally within the gap G to clean interior component of the medical device 4400.
  • a portion of the fluid from the fluid port 4515 flows circumferentially within the circumferential flow region CFR.
  • FIG. 10 illustrates an alternative medical device 4400’ that includes an elongated inner body 4810’, an elongated outer tube 4900’, a distal body 4510’, and a first axial flow director 4838’ and a second axial flow director 4839’.
  • the medical device 4400’ is configured the same as or similar to, and functions the same as or similar to, the medical device 2400.
  • the inner body 4810’ extends proximally from the distal body 4510’ and has an outer surface 4815’
  • the outer tube 4900’ has an inner surface 4915’.
  • the outer tube 4910’ surrounds at least a portion of the inner body 4810 such that a gap G is defined between the inner surface 4915’ of the outer tube 4900’ and the outer surface 4815’ of the inner body 4810’.
  • the first axial flow director 4838’ and the second axial flow director 4839’ are positioned nonparallel to each other on the outer surface 4815 ’ of the inner body 4810’ and define a flow path FP’ .
  • the first axial flow director 4838 and the second axial flow director 4839 are positioned at a spaced distance from the distal body 4510 to define a circumferential flow region CFR’.
  • the outer tube 4900’ is coupled to the distal body 4510’ such that a distal end portion of the outer tube 4900’ is within the distal body 4510’.
  • the distal body 4510 defines afluid port 4515’ and the outer tube 4900’ defines an opening 4914’ that is aligned with the fluid port 4515’.
  • the fluid port 4515’ can receive a volume of fluid therethrough and the axial flow directors 4838’ and 4839’ can directs a flow of the fluid FF’ through the flow path FP’ and proximally within the gap G’ to clean interior component of the medical device 4400’.
  • a portion of the fluid from the fluid port 4515’ flows circumferentially within the circumferential flow region CFR’.
  • the medical device includes a second outer tube that at least partially surrounds the outer tube (4900, 4900’) to define a second gap between the second outer tube and outer tube (4900, 4900’).
  • fluid from the fluid port (4515, 4515’) flows proximally along the axial flow path and then distally between the second outer tube and the outer tube (4900, 4900’).
  • the fluid flows proximally along the axial flow path (FP, FP’) and then distally within the gap (G, G’) between the inner body (4810, 4810’) and the outer tube (4900, 4900’) and outside the axial flow path (FP, FP’).
  • the axial flow directors increase a velocity of the flow of fluid within the gap.
  • a first cross-sectional area is defined by the axial flow path
  • a second cross-sectional area is defined exclusive of the first cross-sectional area.
  • An average velocity of the fluid from the fluid port (4515, 4515’) through the first cross-sectional area is greater than an average velocity of the fluid from the fluid port (4515, 4515’) through the second cross-sectional area.
  • the medical device is a force sensing medical device and includes a force sensor unit that has an axial beam and a strain sensor positioned to measure a strain on the beam.
  • the inner body (4810, 4810’) can include the beam and the axial flow directors (4838, 4839., 4838’, 4839’) can be positioned on the outer surface (4815, 4815’) of the inner body (4810, 4810’) and positioned distally of the strain sensor.
  • FIGS. 11-19 illustrate a medical device 5400, according to another embodiment.
  • the medical device 5400 includes various components as described above for previous embodiments that provide for improved fluid flush capabilities.
  • the medical device 5400 or any of the components therein are optionally parts of a surgical system that performs surgical procedures, and which can include a manipulator unit, one or more kinematic linkages, one or more cannulas, or the like.
  • the medical device 5400 (and any of the instruments described herein) can be used in any suitable surgical system, such as the MIRS system 1000 shown and described above.
  • the medical device 5400 includes an outer shaft 5910 (see, e.g., FIG. 13A), a proximal mechanical structure 5700 (FIG. 11), a handle 5919, a distal force sensor unit 5800 (FIGS. 16A-16C) including a beam 5810 (see FIG.
  • FIG. 11 shows the medical device 5400 with the outer shaft removed for illustration purposes
  • a wrist assembly 5500 shows the medical device 5400 with the outer shaft removed for illustration purposes
  • an end effector 5460 at a distal end portion of the medical device 5400.
  • medical device 5400 also includes one or more end effector actuation elements 5420 (also referred to herein as “actuation elements”) that couple the proximal mechanical structure 5700 to the wrist assembly 5500 and end effector 5460.
  • the actuation elements 5420 can be, for example, a cable, a band, rod, or the like.
  • the medical device 5400 is configured such that select movements of the actuation elements 5420 produce rotation of the wrist assembly 5500 (i.e., pitch rotation) about a first axis of rotation Al (see FIG.
  • the inner shaft 5410 includes a proximal end portion 5411 that is coupled to the handle 5919, and a distal end portion 5412 that is coupled to a beam 5810 of the distal force sensor unit 5800.
  • the beam 5810 can include or have coupled thereto one or more strain sensors 5830 (see FIG. 16B) to measure forces imparted on the surgical instrument in the x and y directions during a surgical procedure.
  • the proximal end portion 5411 of the inner shaft 5410 is coupled (via the handle) to the proximal mechanical structure 5700 in a manner that allows translational movement of the inner shaft 5410 along a z-axis direction relative to the proximal mechanical structure 5700.
  • the inner shaft 5410 also defines a lumen (not shown) and/or multiple passageways through which the actuation elements 5420 and other components (e.g., electrical wires, ground wires, or the like) can be routed from the proximal mechanical structure 5700 to the wrist assembly 5500.
  • actuation elements 5420 and other components e.g., electrical wires, ground wires, or the like
  • the wrist assembly 5500 includes a proximal first link 5510 and a distal second link 5610.
  • the first link 5510 is coupled to the second link 5610 such that the second link 5610 can rotate relative to the first link 5510 about the first axis of rotation Ai (which functions as the pitch axis; the term pitch is arbitrary).
  • the proximal first link 5510 includes a proximal portion that is coupled to a distal end portion of the beam 5810.
  • the distal second link 5610 is coupled to the end effector 5460 such that the end effector 5460 can rotate about the second axis of rotation A2 (see FIG. 12).
  • the end effector 5460 includes first tool member 5462 and a second tool member 5482 forming jaws for engaging, grasping and/or manipulating tissue during a surgical procedure.
  • the end effector 5460 is operatively coupled to the proximal mechanical structure 5700 such that the tool members 5462 and 5482 rotate relative to inner shaft 5410 about the first axis of rotation Al.
  • the end effector 5460 includes tool members 5462, 5482 that are jaws or grippers (which can be used as a needle driver, for example), in alternative embodiments, the end effector 5460 can include other types of tools, such as a cutter, an energized tool member that is used for cauterization or electrosurgical procedures, etc.
  • the tools 5462, 5482 of the end effector 5460 can contact anatomical tissue, which may result in x, y, or z direction forces (see, e.g., x, y, and z axes directions shown in FIG. 12) being imparted on the tools 5462, 5482.
  • the strain sensor(s) 5830 measure strain in the beam 5810 during operation of the medical device 5400. The measured beam strain is used to determine forces imparted on the tools 5462, 5482 in the x- and y-axis directions.
  • the proximal first link 5510 of the wrist assembly 5500 also defines a fluid port 5515 (see e.g., FIGS. 13A-14A), through which a cleaning fluid is introduced into the distal end portion of the medical device 5400 to clean interior components of the medical device 5400 as described in more detail below.
  • the proximal mechanical structure 5700 includes a chassis that supports components configured to actuate the actuation elements 5420, which in turn cause one or more components of the surgical instrument to move, such as, for example, the wrist assembly 5500 or the tools 5462, 5482.
  • the actuation elements 5420 extend from the proximal mechanical structure 5700 to the wrist assembly 5500 and drive pulleys 5467, 5487 of the tool members 5462, 5482 of the end effector 5460 (see FIG. 12).
  • the proximal mechanical structure 5700 also includes an instrument support structure that includes a base 5770.
  • various support structures optionally may be used, such as a chassis, a frame, a bed, a unitized surrounding outer body of the proximal mechanical structure, and the like.
  • the outer shaft 5910 can be any suitable elongated shaft that can be positioned over the inner shaft 5410, and includes a proximal end portion that is coupled to the handle 5919 and a distal end portion.
  • the outer shaft 5910 defines a lumen between the proximal end portion and the distal end portion.
  • the inner shaft 5410 extends within the lumen of the outer shaft 5910 and can move relative to the outer shaft 5910.
  • the inner shaft 5410 can translate longitudinally in a direction parallel to a center axis of the inner shaft 5410.
  • the outer shaft 5910 translates longitudinally relative to the inner shaft 5410.
  • the shroud 5900 includes a distal end portion 5934, which is coupled to the first link 5510 and to the beam 5810, and a proximal end portion 5933, which extends proximally over the beam 5810 (and over an optional overmold component 5820 as discussed below).
  • the shroud 5900 includes a pair of tabs 5940, and openings 5941. One of the openings 5941 is aligned with the fluid port 5515 of the first link 5510.
  • the tabs 5940 couple the shroud 5900 to a connector 5813 (see e.g., FIGS.
  • the tabs 5940 are captured or sandwiched between the first link 5510 and the connector 5813, securing the shroud 5900 to the distal end portion of the beam 5810 and to the first link 5510. This eliminates the need for additional attachment mechanisms, such as welding for securing the shroud 5900.
  • the shroud 5900 is tubular and defines an interior volume 5937.
  • the shroud 5900 includes a circumferential side wall, and multiple slits (not shown) are defined through the side wall of the shroud 5900.
  • Such slits can be, for example the same as and function the same as the slits described in U.S. Provisional Patent Application No. 63/447,379, entitled “Medical Instrument,” filed February 22, 2023, which is incorporated herein by reference in its entirety.
  • the shroud 5900 is positioned to cover and protect at least a portion of the strain sensor 5830 on the beam 5810 and the actuation elements 5420, electrically conductive wires, etc. that are located at the distal end portion of the medical device 5400. More specifically, the shroud 5900 surrounds the overmold 5820 to define a gap Gl. Said another way, the shroud 5900 functions as an outer tube that surrounds the beam 5810 and/or the overmold 5820 (i.e., which together as an assembly are an elongate inner body).
  • the shroud 5900 can be formed with a super elastic, shape-memory material, such as Nitinol alloy.
  • the shroud 5900 is made of a silicone material.
  • the super elastic material of the shroud 5900 provides more tolerance for misalignment between the shroud 5900 and the inner shaft 5410 due to its flexibility, which also provides more sensing range for the force sensor unit 5800.
  • the shroud 5900 can also have a relatively thin wall thickness to enhance the sensing range and to provide more clearance to other components for cleaning the medical device 5400, as described in more detail below.
  • the wall thickness of the shroud 5900 is about 0.076 mm (0.003 inches).
  • the super elastic material and the thin wall thickness provide more flexibility to the shroud 5900, allowing the shroud 5900 to also deflect or deform during cleaning for better flow of cleaning fluid within the medical device 5400.
  • the outer shaft 5910 extends distally over and surrounds the distal end portion 5412 of the inner shaft 5410, a portion of the beam 5810 (and overmold 5820), and a portion of the shroud 5900.
  • the portion of the outer shaft 5910 surrounding the shroud 5900 defines a gap G2 between an inner surface 5914 of the outer shaft 5910 and an outer surface 5916 of the shroud 5900.
  • the inner shaft 5410 can translate within the outer shaft 5910 within a range of motion defined between a proximal range of motion limit and a distal range of motion limit, and within this range of motion of the inner shaft 5410, the proximal end portion 5933 of the shroud 5900 remains within or surrounded by the outer shaft 5910.
  • the proximal end portion 5933 of the shroud 5900 remains surrounded by the outer shaft 5910.
  • the force sensor unit 5800 includes the beam 5810, the strain sensor 5830, and an overmold component 5820 over the beam 5810 to protect the beam 5810 and strain sensor 5830 from damage and exposure to bodily fluids and material.
  • the beam 5810 also includes an anchor 5825 at a proximal end of the beam 5810, to which the overmold 5820 is coupled.
  • FIG. 16B shows the beam 5810 without the overmold 5820 for illustration purposes.
  • the anchor 5825 is coupled to the distal end portion 5412 of the inner shaft 5410.
  • the anchor 5825 includes openings 5821 (see e.g., FIG.
  • the distal end portion of the beam 5810 includes a connector 5813 that includes openings for routing the actuation elements 5420 and optional wires.
  • the connector 5813 also includes cutouts 5823 which are in fluid communication with the openings 5941 of the shroud 5900 and the fluid port 5515.
  • the connector 5813 is used to couple the beam 5810 to the shroud 5900 and to the first link 5510, as described in more detail below.
  • the overmold 5820 also provides a seal (not shown) for the actuation elements 5420 extending through the openings 5821 to prevent fluids and other material from passing in a proximal direction through the openings 5821.
  • the force sensor unit 5800 also includes a first axial flow director 5838 and a second axial flow director 5839 on one side of the overmold 5820, and it further includes a third axial flow director 5838’ (see, e.g., FIGS. 17-19) and a fourth axial flow director 5839’ (see e.g., FIGS. 15A, 16A and 16B) on an opposite side of the overmold 5820 (e.g., opposite side of a centerline of the medical device 5400).
  • the axial flow directors 5838, 5839, 5838’, and 5839’ are integral with the overmold 5820 as a single monolithic piece.
  • the axial flow directors are positioned to direct a flow of fluid FF from the fluid port 5515 proximally within the gap G1 to clean interior components of the medical device 5400 and define axial flow paths FP (see e.g., FIG. 16C).
  • the axial flow directors 5838 and 5839 define a first flow path FP and the axial flow directors 5838’ and 5839’ define a similar second flow path.
  • residual contaminants or soil can accumulate in areas of the interior of the medical device 5400.
  • a proximal end region 5920 near the anchor 5825 of the force sensor unit 5800 where it is coupled to the inner shaft 5410, a closed end is formed where residual soil can accumulate.
  • cleaning fluid is introduced through the fluid port 5515, through the opening 5941 of the shroud 5900, and then the axial flow directors 5838, 5839, 5838’, 5839’ help direct at least a portion of the flow of fluid FF proximally within the gap G1 and to the region 5920 so that a more effective flow volume and flow velocity reaches region 5920 for cleaning.
  • the axial flow directors 5838, 5839, 5838’, 5839’ increase a velocity of the flow of fluid FF within the gap G1 and within the interior of the medical device 5400 as the fluid travels in a proximal direction.
  • a first cross-sectional area can be defined at an axial location within the flow path FP defined by the axial flow directors 5838 and 5839, and a second (different) cross-sectional area can be defined at an axial location exclusive of the flow path FP.
  • An average velocity of the fluid introduced through the fluid port 5515 through the first cross-sectional area is larger than an average velocity of the fluid from the fluid port 5515 through the second cross-sectional area (due to the difference in cross-sectional areas).
  • the axial flow directors 5838, 5839, 5838’, 5839’ are positioned on the overmold 5820 at a spaced distance from a distal end of the overmold 5820 and connector 5813 to define a circumferential distal flow region CFR (see FIG. 16C) between a distal end of the axial flow directors 5838, 5839, 5838’, 5839’ and the connector 5813.
  • the circumferential distal flow region CFR allows a portion of a cleaning fluid introduced into the fluid port 5515 to clean and remove any soil build up in the area of gap Gl distal of the axial flow directors 5838, 5839, 5838’, 5839’.
  • the axial flow directors 5838, 5839, 5838’, 5839’ are also positioned distally of the strain sensor 5830 on the beam 5810 to prevent the structure of the flow directors from interfering with the force sensing. Specifically, because the flow directors have additional material (and therefore stiffness) than the remainder of the overmold 5820, maintaining the flow directors spaced apart from the region of the strain sensor(s) 5830 improves accuracy of the force sensing.
  • the axial flow directors 5838, 5839, 5838’, 5839’ each have rounded corners and each have an outermost (top) surface, 5840, 5841, 5840’, 5841’, respectively.
  • the outermost surfaces are spaced from the inner surface 5915 of the shroud 5900 such that fluid can also flow over axial flow directors between the outermost surfaces of the flow directors and the inner surface 5915 of the shroud 5900.
  • cleaning fluid is introduced through the fluid port 5515, which is in fluid communication with the openings 5941 of the shroud 5900 and the cutout 5823 of the connector 5813 of the beam 5810.
  • the fluid port 5515 when fluid is introduced through the fluid port 5515, the fluid flows through the openings 5941 and cutouts 5823, and into the gap Gl.
  • the axial flow directors 5838, 5839, 5838’, 5839’ help direct the flow of fluid FF proximally within the gap Gl and proximally to the region 5920 at the proximal end portion of the force sensor unit 5800 (see FIG. 18).
  • the fluid is also directed by the shroud 5900 into an interior volume 5925 of the distal bushing 5924 prior to reaching the region 5920.
  • the axial flow directors 5838, 5839, 5838’, 5839’ can also increase the velocity of the fluid flow FF.
  • the fluid flows proximally, the fluid is prevented from flowing past the anchor 5825 near region 5920, and is routed back distally to an exit location at the distal end of the medical device 5400, as shown by arrows BF.
  • a backflow BF of fluid can travel distally within the gap Gl, and some fluid can flow distally within the gap G2 between the outer shaft 5910 and the shroud 5900 and distally to the distal end of the medical device 5400.
  • FIGS. 20-25 illustrate a medical device 6400, according to another embodiment.
  • the medical device 6400 includes various components as described above for previous embodiments that provide for improved fluid flush capabilities.
  • the medical device 5400 or any of the components therein are optionally parts of a surgical system that performs surgical procedures, and which can include a manipulator unit, one or more kinematic linkages, one or more cannulas, or the like.
  • the medical device 6400 (and any of the instruments described herein) can be used in any suitable surgical system, such as the MIRS system 1000 shown and described above and can include the same or similar components and function the same or similar to the medical devices described herein. Thus, some components of the medical device 6400 are not described below. As shown, for example, in FIGS.
  • the medical device 6400 includes an outer shaft 6910 (see, e.g., FIGS. 20 and 21A), a distal force sensor unit 6800 (see, e.g., FIGS. 22A and 22B) including a beam 6810, a shroud 6900, and a wrist assembly 6500.
  • the medical device 6400 can also include an inner shaft, a proximal mechanical structure (not shown) and an end effector (not shown) at a distal end portion of the medical device 6400 similar to or the same as medical device 5400.
  • medical device 6400 also includes one or more end effector actuation elements 6420 (also referred to herein as “actuation elements”) that couple the proximal mechanical structure to the wrist assembly 6500 and end effector.
  • the actuation elements 6420 can be, for example, a cable, a band, rod, or the like.
  • the medical device 6400 is configured such that select movements of the actuation elements 6420 produce rotation of the wrist assembly 6500 (i.e., pitch rotation) about a first axis of rotation Al (see FIG.
  • the inner shaft is coupled to a proximal end portion of the beam 6810 of the distal force sensor unit 6800.
  • the beam 6810 can include or have coupled thereto one or more strain sensors (not shown) to measure forces imparted on the surgical instrument in the x and y directions during a surgical procedure.
  • a proximal end portion of the inner shaft can be coupled to the proximal mechanical structure in a manner that allows translational movement of the inner shaft along a z- axis direction relative to the proximal mechanical structure.
  • the inner shaft also defines a lumen (not shown) and/or multiple passageways through which the actuation elements 6420 and other components (e.g., electrical wires, ground wires, or the like) can be routed from the proximal mechanical structure to the wrist assembly 6500.
  • the wrist assembly 6500 includes a proximal first link 6510 and a distal second link 6610.
  • the first link 6510 is coupled to the second link 6610 such that the second link 6610 can rotate relative to the first link 6510 about the first axis of rotation Ai (which functions as the pitch axis, the term pitch is arbitrary).
  • the proximal first link 6510 includes a proximal portion that is coupled to a distal end portion of the beam 6810.
  • the tools of the end effector can contact anatomical tissue, which may result in x, y, or z direction forces (see, e.g., x, y, and z axes directions shown in FIG. 12) being imparted on the tools.
  • the strain sensor(s) can measure strain in the beam 6810 during operation of the medical device 6400. The measured beam strain can be used to determine forces imparted on the tools in the x- and y-axis directions. These x- and y-axis forces are transverse (e.g., perpendicular) to the z-axis (which is parallel or collinear with a center axis of the beam).
  • the proximal first link 6510 of the wrist assembly 6500 defines a fluid port 6515 (see e.g., FIGS. 20 and 21A), through which a cleaning fluid can be introduced into the distal end portion of the medical device 6400 to clean interior components of the medical device 6400 as described in more detail below.
  • the proximal mechanical structure can include the same or similar components and can function the same or similar to the proximal mechanical structure 5700 described above.
  • the actuation elements 6420 extend from the proximal mechanical structure to the wrist assembly 6500 and end effector.
  • the outer shaft 6910 can be any suitable elongated shaft that can be disposed over the inner shaft and defines a lumen between a proximal end portion and a distal end portion.
  • the inner shaft extends within the lumen of the outer shaft 6910 and can move relative to the outer shaft 6910.
  • the inner shaft can translate longitudinally in a direction parallel to a center axis of the inner shaft.
  • the outer shaft 6910 translate longitudinally relative to the inner shaft.
  • the shroud 6900 includes a distal end portion 6934 coupled to the first link 6510 and to the beam 6810, and a proximal end portion 6933 that extends proximally over the beam 6810 (and overmold component 6820 described below). As shown in FIGS. 21A and 21B, the shroud 6900 includes multiple openings 6918 positioned circumferentially around the shroud 6900. In this embodiment, there are four openings 6918 evenly spaced around the circumference of the shroud 6900, but in alternative embodiments, there can be a single opening 6918, or a different number of openings 6918. In addition, the openings can be positioned at different axial locations on the shroud 6900. The openings 6918 can be used to introduce a fluid for cleaning an interior of the medical device 6400 as described in more detail below.
  • the shroud 6900 also includes a pair of tabs 6940, and openings 6941.
  • One of the openings 6941 is aligned with the fluid port 6515 of the first link 6510.
  • the tabs 6940 couple the shroud 6900 to a connector 6813 (see e.g., FIGS. 22A and 22B) of the beam 6810 and to the first link 6510. More specifically, the tabs 6940 are captured or sandwiched between the first link 6510 and the connector 6813, securing the shroud 6900 to the distal end portion of the beam 6810 and to the first link 6510. This eliminates the need for additional attachment mechanisms such as, for example, welding for securing the shroud 6900.
  • the shroud 6900 is tubular and defines an interior volume 6937.
  • the shroud 6900 also defines multiple slits (not shown) through a wall the wall the shroud 6900.
  • Such slits can be, for example the same as and function the same as the slits described in U.S. Provisional Patent Application No. 63/447,379, which is incorporated herein by reference above.
  • the shroud 6900 is positioned to cover and protect the strain sensor on the beam 6810, and the actuation elements 6420, wires, etc. that may be located at the distal end portion of the medical device 6400.
  • the shroud 6900 surrounds the overmold 6820 to define a gap G1 (see FIG. 24).
  • the shroud 6900 can be formed with a super elastic, shape-memory material, such as, for example, Nitinol alloy.
  • the shroud 6900 is formed with a silicone material.
  • the super elastic material of the shroud 6900 provides more tolerance for misalignment between the shroud 6900 and the inner shaft due to its flexibility, which also provides more sensing range for the force sensor unit 6800.
  • the shroud 6900 can also be formed with a relatively thin wall thickness to enhance the sensing range and to provide more clearance to other components for cleaning the medical device 6400 as described in more detail below.
  • the wall thickness of the shroud 6900 can be about 0.076 mm (0.003 inches).
  • the super elastic material and the thin wall thickness provide more flexibility to the shroud 6900 allowing the shroud 6900 to also deflect or deform during cleaning for better flow of cleaning fluid within the medical device 6400.
  • the outer shaft 6910 extends distally over and surrounds a portion of the beam 6810 (and overmold 6820), and a portion of the shroud 6900.
  • the portion of the outer shaft 6910 surrounding the shroud 6900 defines a gap G2 between an inner surface 6914 of the outer shaft 6910 and an outer surface 6916 of the shroud 56900.
  • the inner shaft can translate within the outer shaft 6910 within a range of motion defined between a proximal range of motion limit and a distal range of motion limit, and within this range of motion of the inner shaft , the proximal end portion 6933 of the shroud 6900 remains within or surrounded by the outer shaft 6910.
  • the proximal end portion 6933 of the shroud 6900 remains surrounded by the outer shaft 6910.
  • the force sensor unit 6800 includes the beam 6810, the strain sensor and an overmold component 6820 disposed on the beam 6810 to protect the beam 6810 and strain sensor from damage and exposure to bodily fluids and material.
  • the beam 6810 also includes an anchor 6825 at a proximal end of the beam 6810 to which the overmold 6820 is coupled.
  • FIG. 22B shows the beam 6810 without the overmold 6820 for illustration purposes.
  • the anchor 6825 is coupled to the distal end portion of the inner shaft.
  • the anchor 6825 includes openings 6821 (see, e.g., FIG.
  • the distal end portion of the beam 6810 includes a connector 5813 that includes openings 6821 for routing the actuation elements 620 and other wires.
  • the connector 6813 also defines cutouts 6823 which are in fluid communication with the openings 6918 of the shroud 6900 and the fluid port 6515.
  • the connector 6813 is used to couple the beam 6810 to the shroud 6900 and to the first link 6510, as described in more detail below.
  • the overmold 6820 also provides a seal 6822 for the actuation elements 6420 extending through the openings 6821 to prevent fluids and other material from passing through the openings 6821 proximally.
  • the force sensor unit 6800 also includes a first axial flow director 6838 and a second axial flow director 6839 on an opposite side of the overmold 6820 (e.g., opposite side of a centerline of the medical device 6400).
  • the axial flow directors 6838 and 6839 are formed integrally with the overmold 6820.
  • the axial flow directors 6838 and 6839 are each a single component that extend substantially the length of the overmold 6820 and beam 6810).
  • the axial flow directors 6838 and 6839 are positioned to direct a flow of fluid FF from the fluid port 6515 proximally within the gap G1 to clean interior components of the medical device 6400 and each define a flow path FP (see, e.g., FIG. 24). Similarly stated, each flow director has raised sides (or edges) that define a groove, which functions as the flow path FP.
  • the axial flow directors 6838 and 6839 are also positioned to be aligned with one of the openings 6918 of the shroud 6900. As described above, contaminants or residual soil can accumulate in areas of the interior of the medical device 6400.
  • a closed end is formed where residual soil can accumulate.
  • cleaning fluid can be introduced through the fluid port 6515, through the opening 6941 of the shroud 6900, and the axial flow directors 6838 and 6839 can help direct the flow of fluid FF proximally within the gap G1 and to the region 6920.
  • a cleaning fluid can in addition to, or alternatively, be introduced into one or more of the openings 6918 of the shroud 6900.
  • the axial flow directors 6838 and 6839 can be aligned with one or more openings 6918 such that when fluid is introduced through an opening 6918, the axial flow directors 6838 and 6839 can direct the flow of fluid FF proximally within the gap G1 along the flow paths FP and to the region 6920.
  • the axial flow directors 6838 and 6839 can increase a velocity of the flow of fluid FF within the gap G1 and within the interior of the medical device 6400 as the fluid travels proximally.
  • a first cross-sectional area can be defined at an axial location within a flow path FP defined by one of the axial flow directors 6838 and 6839, and a second (different) cross-sectional area can be defined at an axial location exclusive of the flow path FP.
  • An average velocity of the fluid introduced through the fluid port 6515 through the first cross-sectional area is greater than an average velocity of the fluid from the fluid port 6515 through the second cross-sectional area.
  • the axial flow directors 6838 and 6839 are positioned on the overmold 6820 at a spaced distance from a distal end of the overmold 6820 and connector 6813 to define a circumferential distal flow region CFR (see, e.g., FIG. 22C) between a distal end of the axial flow directors 6838 and 6839 and the connector 6813.
  • the circumferential distal flow region CFR allows for a portion of a cleaning fluid introduced into the fluid port 6515 to clean and remove any soil build up in the area of gap G1 distally of the axial flow directors 5838, 5839, 5838’, 5839’.
  • the axial flow directors 5838, 5839, 5838’, 5839’ are also positioned distally of the strain sensor 5830 on the beam 5810 to prevent any interference with the force sensing.
  • the axial flow directors 6838 and 6839 have an outermost surface 6840 and 6841, respectively, that are spaced from an inner surface 6915 of the shroud 6900 such that fluid can also flow over the axial flow directors between the outer surfaces 6840, 6841 of the axial flow directors 6838, 6839 and the inner surface 6915 of the shroud 6900.
  • cleaning fluid can be introduced through the fluid port 6515, which is in fluid communication with the openings 6941 of the shroud 6900 and the cutout 6823 of the connector 6813 of the beam 6810 and /or through an opening 6918 of the shroud 6900.
  • the fluid port 6515 when fluid is introduced through the fluid port 6515, the fluid flows through the openings 6941 and cutouts 6823, and into the gap Gl.
  • the axial flow directors 5838, 5839, 5838’, 5839’ help direct the flow of fluid FF proximally within the gap Gl and proximally to the region 5920 at the proximal end portion of the force sensor unit 5800 (see FIG. 18).
  • the fluid is also directed by the shroud 6900 into an interior volume 6925 of the distal bushing 6924.
  • the axial flow directors 6838, 6839 can also increase the velocity of the fluid flow FF.
  • the fluid flows proximally, the fluid is prevented from flowing past the anchor 6825 near region 6920, and is routed back distally to an exit location at the distal end of the medical device 6400 as shown by arrows BF.
  • a backflow of fluid BF can travel distally within the gap G1 and some fluid can flow distally within the gap G2 between the outer shaft 6910 and the shroud 6900 and distally to the distal end of the medical device 5400.
  • FIGS. 26 and 27 illustrate a portion of a medical device 7400, according to another embodiment.
  • the medical device 7400 includes various components as described above for previous embodiments that provide for improved fluid flush capabilities.
  • the medical device 7400 or any of the components therein are optionally parts of a surgical system that performs surgical procedures, and which can include a manipulator unit, one or more kinematic linkages, one or more cannulas, or the like.
  • the medical device 7400 (and any of the instruments described herein) can be used in any suitable surgical system, such as the MIRS system 1000 shown and described above.
  • the medical device 7400 can also include all of the same or similar features as described above for medical device 5400. For example, although not shown in FIGS.
  • the medical device 7400 can include an outer shaft, a proximal mechanical structure, a shroud, and a handle as described above for previous embodiments.
  • the medical device 7400 includes a distal force sensor unit 7800 that includes a beam (not shown in FIGS. 26 and 27), an overmold component 7820 disposed over the beam.
  • the medical device 7400 also includes a distal bushing 7924, an inner shaft 7410 (FIG. 27 shows the medical device 7400 with the outer shaft removed for illustration purposes), a wrist assembly 7500, and an end effector (not shown) coupled to the wrist assembly 7500 at a distal end portion of the medical device 7400.
  • medical device 7400 also includes one or more end effector actuation elements 7420 (also referred to herein as “actuation elements”) that couple the proximal mechanical structure to the wrist assembly 7500 and end effector.
  • the actuation elements 7420 can be, for example, a cable, a band, rod, or the like.
  • the medical device 7400 is configured such that select movements of the actuation elements 7420 produce rotation of the wrist assembly 7500 (i.e., pitch rotation) about a first axis of rotation Al (see, e.g., FIG.
  • the inner shaft 7410 includes a proximal end portion (not shown) that is coupled to the handle, and a distal end portion 7412 that is coupled to a beam of the distal force sensor unit 7800.
  • the beam can include or have coupled thereto one or more strain sensors (not shown) to measure forces imparted on the surgical instrument in the x and y directions during a surgical procedure.
  • the proximal end portion of the inner shaft 7410 is coupled (via the handle) to the proximal mechanical structure (not shown, but which can be similar to the proximal mechanical structure 5700) in a manner that allows translational movement of the inner shaft 7410 along a z-axis direction relative to the proximal mechanical structure.
  • the inner shaft 7410 also defines a lumen (not shown) and/or multiple passageways through which the actuation elements 7420 and other components (e.g., electrical wires, ground wires, or the like) can be routed from the proximal mechanical structure to the wrist assembly 7500.
  • actuation elements 7420 and other components e.g., electrical wires, ground wires, or the like
  • the wrist assembly 7500 includes a proximal first link 7510 and a distal second link 7610.
  • the first link 7510 is coupled to the second link 7610 such that the second link 7610 can rotate relative to the first link 7510 about the first axis of rotation Ai (see, e.g., FIG. 12, which functions as the pitch axis; the term pitch is arbitrary).
  • the proximal first link 7510 includes a proximal portion that is coupled to a distal end portion of the beam.
  • the distal second link 7610 is coupled to the end effector such that the end effector can rotate about the second axis of rotation A2 (see, e .g., FIG. 12).
  • the end effector can include one or more tools and can be constructed the same as or similar to, and function the same as or similar to, other embodiments of an end effector described herein.
  • the end effector can contact anatomical tissue, which may result in x, y, or z direction forces (see, e.g., x, y, and z axes directions shown in FIG. 12) being imparted on the tools of the end effector.
  • the strain sensor(s) measure strain in the beam during operation of the medical device 7400.
  • the measured beam strain is used to determine forces imparted on the tools of the end effector in the x- and y-axis directions.
  • These x- and y-axis forces are transverse (e.g., perpendicular) to the z-axis (which is arbitrarily defined as parallel or collinear with a center axis of the beam).
  • the proximal first link 7510 of the wrist assembly 7500 also defines a fluid port 7515 through which a cleaning fluid is introduced into the distal end portion of the medical device 7400 to clean interior components of the medical device 7400 as described in more detail below.
  • the proximal mechanical structure, the outer shaft and the shroud can be the constructed the same as or similar to and function the same as or similar to such components in other embodiments described herein.
  • the outer shaft can be any suitable elongated shaft that can be positioned over the inner shaft 7410.
  • the shroud has a distal end portion coupled to the first link 7510 and to the beam, and a proximal end portion, which extends proximally over the beam (and over the overmold 7820).
  • the shroud can be coupled between the first link 7510 and a connector (e.g., connector 5813 described above) in the same manner as described above for shroud 5900.
  • the force sensor unit 7800 includes the beam (not shown), the strain sensor (not shown), and the overmold component 7820 over the beam to protect the beam and strain sensor from damage and exposure to bodily fluids and material.
  • the beam includes an anchor (not shown) at a proximal end of the beam, to which the overmold 7820 is coupled.
  • the anchor is coupled to the distal end portion of the inner shaft 7410.
  • the anchor includes openings (not shown), through which actuation elements 7420 and other components such as electrically conductive wires can be routed, and a shoulder (not shown) that is coupled to the distal bushing 7924. As shown in FIG.
  • the distal end portion of the beam includes a connector 7813 that includes openings for routing the actuation elements 7420 and optional wires.
  • the connector 7813 also includes cutouts 7823 which are in fluid communication with the openings of the shroud and the fluid port 7515 as described above for medical device 5400.
  • the connector 7813 is used to couple the beam to the shroud and to the first link 7510, as described above for medical device 5400.
  • the overmold 7820 also provides a seal (not shown) for the actuation elements 7420 extending through the openings in the anchor at the proximal end portion of the shaft 7410 to prevent fluids and other material from passing in a proximal direction through the openings.
  • the force sensor unit 7800 includes two axial flow directors. More specifically, a first axial flow director 7838 and a second axial flow director 7839 are both disposed on one side of the overmold 7820 as shown in FIGS. 26 and 27.
  • the axial flow directors 7838 and 7839 are integral with the overmold 7820 as a single monolithic piece.
  • the axial flow directors 7838 and 7839 can be spaced at other various radial positions relative to each other on the overmold 7820.
  • the flow directors 7838 and 7839 can be on opposite sides of the overmold 7820.
  • the flow directors 7838 and 7839 can be positioned, for example, at 45 degrees, 90 degrees, 180 degrees, and/or other positions therebetween relative to each other.
  • the axial flow directors are positioned to direct a flow of fluid from the fluid port 7515 proximally (within a gap similar to the gap G1 shown in FIG. 17) to clean interior components of the medical device 7400 and define axial flow paths FP (see e g., FIG. 16C) in the same manner as describe above for flow directors of medical device 5400.
  • the axial flow directors 7838 and 7839 define a first flow path FP.
  • residual contaminants or soil can accumulate in areas of the interior of the medical device 5400. For example, as described for medical device 5400 at a proximal end region 5920 shown in FIG.
  • a closed end is formed where residual soil can accumulate.
  • cleaning fluid is introduced through the fluid port 7515, through the opening of the shroud, and then the axial flow directors 7838 and 7839 help direct at least a portion of the flow of fluid FF proximally within the gap G1 and to, for example, the region 5920 so that a more effective flow volume and flow velocity reaches region 5920 for cleaning.
  • the axial flow directors 7838 and 7839 increase a velocity of the flow of fluid FF within the gap G1 and within the interior of the medical device 7400 as the fluid travels in a proximal direction in the same manner as described above for previous embodiments.
  • the axial flow directors 7838 and 7839 are positioned on the overmold 7820 at a spaced distance from a distal end of the overmold 7820 and connector 7813 to define a circumferential distal flow region CFR (see e.g., CFR in FIG. 16C) between a distal end of the axial flow directors 7838 and 7839 and the connector 7813.
  • the circumferential distal flow region CFR allows a portion of a cleaning fluid introduced into the fluid port 7515 to clean and remove any soil build up in the area of gap G1 distal of the axial flow directors 7838 and 7839.
  • the axial flow directors 7838 and 7839 are also positioned distally of the strain sensor on the beam to prevent the structure of the flow directors from interfering with the force sensing. Specifically, because the flow directors have additional material (and therefore stiffness) than the remainder of the overmold 7820, maintaining the flow directors spaced apart from the region of the strain sensor(s) improves accuracy of the force sensing.
  • the axial flow directors 7838 and 7839 each have rounded corners and each have an outermost (top) surface that are spaced from an inner surface of the shroud such that fluid can also flow over axial flow directors between the outermost surfaces of the flow directors 7838 and 7839 and the inner surface of the shroud.
  • the medical device 7400 can be cleaned in the same manner as described herein for other embodiments by introducing fluid through the fluid port 7515.
  • any of the instruments described herein are optionally parts of a telesurgical system that performs minimally invasive surgical procedures, and which can include a manipulator unit, a series of kinematic linkages, a series of cannulas, or the like.
  • any of the instruments described herein can be used in any suitable surgical system, such as the MIRS system 1000 shown and described above.
  • any of the instruments shown and described herein can be used to manipulate target tissue during a surgical procedure.
  • target tissue can be cancer cells, tumor cells, lesions, vascular occlusions, thrombosis, calculi, uterine fibroids, bone metastases, adenomyosis, or any other bodily tissue.
  • a target structure can also include an artificial substance (or non-tissue) within or associated with a body, such as for example, a stent, a portion of an artificial tube, a fastener within the body or the like.
  • an artificial substance or non-tissue
  • any of the components of a surgical instrument as described herein can be constructed from any material, such as medical grade stainless steel, nickel alloys, titanium alloys or the like.
  • any of the links, tool members, beams, shafts, connectors, cables, or other components described herein can be constructed from multiple pieces that are later joined together.
  • a link can be constructed by joining together separately constructed components.
  • any of the links, tool members, beams, shafts, connectors, cables, or components described herein can be monolithically constructed.
  • any of the instruments described herein can include a tool member axis of rotation that is offset from the axis of rotation of the wrist assembly by any suitable angle.

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Abstract

La présente invention porte sur un dispositif médical qui comprend un corps distal et un corps interne allongé s'étendant de manière proximale à partir du corps distal et comprenant une surface externe. Un tube externe allongé s'étend de manière proximale à partir du corps distal et comprend une surface interne. Un orifice de fluide est inclus dans le corps distal ou le tube externe. Un guide d'écoulement axial se trouve sur la surface externe du corps interne, ou sur la surface interne du tube externe. Le tube externe entoure le corps interne pour définir un espace entre la surface externe du corps interne et la surface interne du tube externe et le guide d'écoulement axial est positionné pour diriger le fluide de l'orifice de fluide de manière proximale à l'intérieur de l'espace.
PCT/US2024/053910 2023-11-03 2024-10-31 Instrument médical avec chemins d'écoulement de nettoyage Pending WO2025096793A1 (fr)

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8821480B2 (en) 2008-07-16 2014-09-02 Intuitive Surgical Operations, Inc. Four-cable wrist with solid surface cable channels
US20210353373A1 (en) 2020-05-18 2021-11-18 Intuitive Surgical Operations, Inc. Hard stop that produces a reactive moment upon engagement for cantilever-based force sensing
CN114681025A (zh) * 2022-04-02 2022-07-01 江苏人冠医疗科技有限公司 具有镜头组件的循环过滤穿刺器
US20220386859A1 (en) * 2018-10-02 2022-12-08 Covidien Lp Multi lumen access device

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8821480B2 (en) 2008-07-16 2014-09-02 Intuitive Surgical Operations, Inc. Four-cable wrist with solid surface cable channels
US20220386859A1 (en) * 2018-10-02 2022-12-08 Covidien Lp Multi lumen access device
US20210353373A1 (en) 2020-05-18 2021-11-18 Intuitive Surgical Operations, Inc. Hard stop that produces a reactive moment upon engagement for cantilever-based force sensing
CN114681025A (zh) * 2022-04-02 2022-07-01 江苏人冠医疗科技有限公司 具有镜头组件的循环过滤穿刺器

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