THAT ALLOWS SEVEN AXIAL MOTIONS

Technical Field

The present invention relates to a wrist compatible hand operated laparoscopic mechanical surgical hand instrument that can be used in closed surgical operations, that provides tactile sensation, that can perform all seven axis motions of the human hands' wrist and that can be produced ergonomically customized for surgeons.

State of the Art

Laparoscopic surgery is a type of operation performed with the aid of camera systems. During surgical operations, small incisions are made through the skin and soft tissue and through these incisions a valvular tubing called trocar is placed through the operating area. In these surgical operations during which three incisions are made and three trocars are used generally, one of the trocars placed through the body is used for a camera which allows the surgeon to have a view of internal organs while the other two trocars are used for laparoscopic hand instruments.

For laparoscopic surgery which is colloquially known as closed surgery, custom-engineered thin instruments having long shafts are utilized.

While the laparoscopic surgery is clearly advantageous in terms of patient outcomes, it is relatively difficult from surgeons' point of view due to instruments utilized when compared to conventional surgical interventions. One of the reasons for this is the loss of manual dexterity of the surgeon due to using of laparoscopic instruments that allow certain motions only on the operative field.

While by means of laparoscopic surgery instruments available in the state of the art only the motion of turning around its own axis can be performed in addition to carrying and jaw open-close motions on all planes, these instruments do not allow rotating motion on x and y axes. The ability of performing rotating motion around all axes is called wrist motion performing capability. Suturing is one of the most essential processes performed during the completion period of the surgical operation and the fact that and the fact that surgical instruments available in the state of the art do not allow rotating motion around x and y axes i.e. being unable to performing all of wrist motions is one of the major problems encountered. Consequently, existing surgical instruments do not fulfil their functions completely. Electronic systems that allow rotating motion in three axes have been developed in the state of the art in order to eliminate this shortcoming. These systems that allow electronic control are called robotic surgery systems. The downside of electronic control systems is that these systems completely eliminate surgeon's direct contact to the tissue. This prevents the surgeon who performs the operation from having feedback regarding the precision and the accuracy of the operation by taking away the tactile sensations of the surgeon to the tissue.

In electronically controlled robotic devices tactile sensation is provided by virtual contact sense called haptic control or tactile feedback. However, this insufficient feedback never provides the surgeon the tactile contact feedback which is the direct contact sensation to the tissue. During operations surgeons are required to utilize virtual tools in order to interact with the tissue instead of manipulating it directly by their hands. This may result in inability to make an accurate perception regarding how much force is applied to the tissue which constitutes the risk of damaging the tissue by applying redundant force. This restriction also prevents the surgeon from having an accurate perception of tactile contact sensation by obstructing the surgeon from feeling the tissue (which is an important means of diagnosis when palpating for some tumors).

Therefore, the necessity of a mechanical surgical hand instrument that can perform all motions compatible with a wrist and can perform all these motions mechanically at the same time and that also allows receiving feedback brought forth the need for the emergence of the present invention.

Medical hand instrument mentioned in the American patent application bearing the number of US5263967A has the capability of moving distal and proximal ends towards one another and in the opposite direction during the operation. Additionally, the grasping feature is provided to the aforementioned medical device through the means of performing open-close action.

In the American patent application bearing the number of US4258716 A, a microsurgical hand instrument that can be used by a surgeon is mentioned. It relates to a mechanical instrument that can be used as cutting scissors of forceps located on the handle as an extension which is grabbed by the surgeon. The abovementioned surgical instrument comprises the capability of turning around its own axis so that it can be aligned in the desired location.

In the patent application bearing the number of DE4235602 in the state of the art, a mechanical surgical hand instrument used for the suturing of incisions located inside uterus, ovaries, tubes and stomach is mentioned. It comprises a jaw mechanism that provides for easy handling and for a quicker knotting of the thread during the process of suturing. The jaw mechanism can perform the open-close jaw action through an angle around 60 degrees. End portion of mechanical surgery instruments used in the state of the art have the capability of moving towards three axes in directions of left-right, forward-backward and up-down. These tools which perform rotating motion on z axis only, have certain shortcomings in terms of not being compatible with the wrist motion of the surgeon and not being able to perform rotating motion on x and y axes.

Because of the abovementioned problems present in the state of the art, inventions that are capable of moving on further axes were needed. In the patent application bearing the number of EP3038542 (Al) an electromechanical hand instrument that is not completely mechanical is mentioned. While the abovementioned hand instrument held by the surgeon in his/her hand can perform rotating motion on shaft axes x and z, it cannot perform rotating motion on the spatial y axis, i.e. it does not have the ability of moving on 7 axes. Moreover, since no cord-pulley-joint system is utilized in this invention, there may be a substantial amount of loss while the tissue contact sensation is being transmitted to the surgeon's hand due to the friction during the transferring of force.

Hand instrument mentioned in the patent application bearing the number of US6132441 provides the motion that can be utilized in applications such as grasping, making incisions, etc. While the abovementioned instrument can only perform full rotation on z axis just like all the other standard laparoscopic instruments, it can perform limited rotation in the first quadrant only (0-90 degrees) on the y axis according to the coordinate system, however, this rotating motion cannot proceed to the second quadrant (90-180 degrees) on y axis. Furthermore, it has no rotational capability on x axis.

The application bearing the number of US8540748B2 relates to a laparoscopic surgery console in which the surgical instrument is used as a robotic manipulator arm through a small incision during the surgical operation wherein the robotic manipulator arm performs rotating motion by means of servo motors.

While the wrist motions necessary in a surgical operation can be performed through electronic systems only, the fact that these systems provide no tactile contact sensation feedback not only fails to satisfy the need but also constitutes further disadvantages. Furthermore, disadvantages such as advanced technology requirements of these electronic systems and high costs limit the area of use. Consequently, an invention of which all components are mechanical, that allows receiving tactile contact sensation feedback and that can perform all the motions that a wrist can do is set forth. Problems the Invention Seeks to Solve

The object of the present invention to enable the subject matter device to perform seven axial motions just like a human wrist by means of the guiding system present within the structure of laparoscopic mechanical surgical instrument. It is therefore an object of the present invention to provide ease of use to the surgeon during the operation by performing the production specifically customized for the surgeon by means of providing the laparoscopic mechanical surgical hand instrument a modifiable mechanism.

It is therefore another object of the present invention to allow the surgeon to feel tissues, suturing materials, the suture and the coordination of these by means of the tactile contact sensation feedback characteristic that cannot be provided by robotic surgery systems and which is one of the major problems encountered. Thus, performing of a surgical operation with minimized error rate is aimed.

It is therefore another object of the present invention to provide an ergonomic usage to the surgeon by means of the palm and finger guiding mechanism of the laparoscopic mechanical surgical hand instrument.

It is therefore another object of the present invention, differently from the robotic and electronic systems, to provide the tactile contact sensation feedback, to allow the laparoscopic mechanical surgical hand instrument to be carried easily to wherever desired, to be used wherever desired and to be sterilized by means of the fact that the laparoscopic mechanical surgical hand instrument is not dependent on any control device or a unit.

Description of the Figures

Figure 1: General view of the mechanical, wrist compatible haptic feedback laparoscopic surgical hand instrument that allows seven axial motions of the human hands' wrist. Figure 2: Side view of the jaw mechanism

Figure 3: Top view of the jaw mechanism

Figure 4: Side view of the hand control mechanism

Figure 5: Top view of the hand control mechanism Description of References in Figures

A: Jaw mechanism

B: Housing

C: Hand control mechanism

la: Lower jaw

lb: Upper jaw

2: Front row pulleys integrated to lower and upper jaws

3: guiding jaw portion intermediate member on y axis

4: Jaw mechanism middle row pulleys

5: First connector

6a: Jaw mechanism front row fixed shaft

6b: Jaw mechanism middle row pulley fixed shaft

6b: Jaw mechanism rear row pulley fixed shaft

7: Jaw mechanism rear row pulleys

8: guiding cord on y axis

9a: Rear row pulley controlling the lower jaw

9b: Rear row pulley controlling the upper jaw

10a: Jaw mechanism portion guiding cord

10b: Hand control mechanism portion guiding cord

11a: Right control ring intermediate member

lib: Left control ring intermediate member

12: Knob body held in palm

13: guiding hand control mechanism intermediate member on y axis

14a: Hand control mechanism front row pulleys fixed shaft

14b: Hand control mechanism middle row pulleys fixed shaft

14c: Hand control mechanism rear row pulleys fixed shaft

15: Second connector

16a: Right control ring

16b: Left control ring

17: Hand control mechanism front row pulleys

18: Hand control mechanism middle row pulleys Disclosure of the Invention

The present invention relates to a wrist compatible hand operated laparoscopic mechanical surgical hand instrument that can be used in closed surgical operations, that provides tactile sensation, that can perform all seven axis motions of the human hands' wrist and that can be produced ergonomically customized for surgeons.

The present invention comprises of the mechanical combination of the jaw mechanism (A) which is positioned inside the body during the surgery, that is a proximal end and that performs all the functions such as grasping, making incisions and/or suturing, hand control mechanism (C) which is the distal end and that allows the surgeon to handle this mechanism and the housing (B) that connects these to portions to one another.

Motions of the mechanical surgical hand instrument on seven axes performed by a wrist are as follows:

1. rotational motion on x axis 2. Open-Close motion

3. rotational motion on y axis

4. rotational motion on z axis

5. Carrying motion on XY plane

6. Carrying motion on YZ plane 7. Carrying motion on XZ plane

Open-Close Motion: is performed in the lower jaw (la) and the upper jaw (lb) located in the jaw mechanism (A) portion of the laparoscopic mechanical surgical hand instrument.

Rotational Motion on X Axis; is performed in the lower jaw (la) and the upper jaw (lb) located in the jaw mechanism (A) portion of the laparoscopic mechanical surgical hand instrument. Rotational Motion on Y Axis; is performed in the upper jaw (lb) and the lower jaw (la) and guiding jaw portion intermediate member on y axis (3) that is connected thereto of the laparoscopic mechanical surgical hand instrument.

Rotational Motion on Z Axis; is performed in the hand control mechanism (C), housing (B) and the jaw mechanism (A) of the laparoscopic mechanical surgical hand instrument. Carrying motions on XY, YZ and XZ planes; are performed in the jaw mechanism (A), housing (B) and the hand control mechanism (C) of the laparoscopic mechanical surgical hand instrument.

The lower jaw (la) and the upper jaw (lb) positioned on the end portion of the laparoscopic mechanical surgical hand instrument which is in direct contact with surgical suture needle, surgical suture and the tissue are located on the jaw mechanism (A) of the laparoscopic mechanical surgical hand instrument. Additionally, the subject matter invention comprises; jaw mechanism guiding cord (10a), front row pulleys (2) integrated to lower and upper jaws, guiding jaw portion intermediate member on y axis that allows the movement of lower jaw (la) and upper jaw (lb) on y axis, jaw mechanism middle row pulleys (4) that are positioned on the y axis guiding jaw portion intermediate member (3), first connector (5), jaw mechanism front row pulley fixed shaft (6a) that allows the connecting of lower jaw (la) and upper jaw (lb) to the guiding jaw portion intermediate member (3) on y axis, jaw mechanism middle row pulley fixed shaft (6b) that connects the jaw mechanism middle row pulleys (4) to the mechanism and jaw mechanism rear row pulley fixed shaft (6c) that connects the jaw mechanism rear row pulleys (7) to the mechanism.

Hand control mechanism (C) of the laparoscopic mechanical surgical hand instrument comprises; knob body (12) that is held inside the palm and that acts as a support arm for the motion on y axis and which allows the laparoscopic mechanical surgical hand instrument to be held inside the palm by setting the mechanism into surgeon's palm, hand control mechanism front row pulleys fixed shaft (14a) that connects the second connector (15) to the guiding hand control mechanism intermediate member (13) on the y axis and that allows its motion thereon and that retains the hand control mechanism front row pulleys (17), hand control mechanism middle row pulleys fixed shaft (14b) that connects the hand control mechanism middle row pulleys (18) to the guiding hand control mechanism intermediate member (13) on y axis and that allows its motion thereon, hand control mechanism rear row pulleys fixed shaft (14c) that connects the rear row pulley (9a) which controls the lower jaw and the rear row pulley (9b) which controls the upper jaw to the guiding hand control mechanism intermediate member (13) on y axis and that allows its motion thereon, right control ring intermediate member (11a) that allows the connecting of right control ring (16a) and left control ring (16b) with the rear row pulley (9a) that controls the lower jaw and rear row pulley that controls the upper jaw, and left control ring intermediate member (lib), hand control mechanism portion guiding cord (10b).

Surgical needle, surgical suture or lower jaw (la) and upper jaw (lb) that directly comes into contact with tissue are the most distal components in the jaw mechanism (A). Motions on seven axes which are performed by the subject matter invention mechanical surgical hand instrument and coordination between other elements that function in performing of these motions and their operation methods are described below. a. Rotation of Laparoscopic Mechanical Surgical Hand Instrument on X Axis:

Right control ring (16a) and left control ring (16b) of the hand control mechanism (C) are designed to be controlled the thumb and index finger.

By means of the first motion of index finger and the thumb going in to the right control ring (16a) and left control ring (16b), right control ring intermediate member (11a) which is in contact with the right control ring (16a) and left control ring intermediate member (lib) which is in contact with the left control ring (16b) are moved.

Right control ring intermediate member (11a) transfers the first motion to rear row pulleys (9a) that are in contact with itself and that controls the lower jaw and invariably, left control ring intermediate member (lib) transfers the first motion to rear row pulleys (9b) that are in contact with itself and that controls the upper jaw.

This motion in the hand control mechanism (C) is transferred to hand control mechanism portion guiding cord (10b). Transferred motion is transmitted to hand control mechanism middle row pulleys (18) first and then to hand control mechanism front row pulleys (17) afterwards and passes through the housing (B) and transmitted to jaw mechanism (A).

Motion transmitted to jaw mechanism portion guiding cord (10a) crosses over the jaw mechanism rear row pulleys (7) first and jaw mechanism middle row pulleys (4) afterwards in the jaw mechanism (A) and transmitted to lower jaw (la) and upper jaw (lb) and rotation (rotating motion) of the jaw mechanism (A) on the x axis is performed in a manner that it will be in the same direction with the finger motion in the hand control mechanism (C).

If both fingers positioned on right control ring (16a) and left control ring (16b) are moved clockwise, the jaw mechanism (A) of the laparoscopic mechanical surgical hand instrument is rotated clockwise on x axis.

If both of right control ring (16a) and left control ring (16b) are moved counterclockwise, jaw mechanism (A) of the laparoscopic mechanical surgical hand instrument rotates counterclockwise on x axis. b. Open-Close Motion of the Laparoscopic Mechanical Surgical Hand Instrument: If fingers positioned on right control ring (16a) and left control ring (16b) are moved in the opposite direction to each other on x axis, lower jaw (la) and upper jaw (lb) on the laparoscopic mechanical surgical hand instrument (A) rotate in the opposite direction to each other on x axis i.e. they perform open-close motion.

If this motion in the opposite direction is performed in a manner that brings right control ring (16a) and left control ring (16b) closer to each other, lower jaw (la) and upper jaw (lb) are drawn together i.e. the jaw performs the open-close motion.

If it is performed in a manner in which right control ring (16a) and left control ring (16b) are moved away from each other, lower jaw (la) and upper jaw (lb) are drawn away from each other, i.e. the jaw performs open motion.

By means of drawing right control ring (16a) and left control ring (16b) together and away from each other, open-close motion is performed by the jaw mechanism (A).

c. Rotation of Laparoscopic Mechanical Surgical Hand Instrument on Y Axis:

By holding the positions of right control ring (16a) and left control ring (16b) stationary by means of surgeon's fingers;

• rotating the knob body (12) that is held inside the palm and

• together with guiding hand control mechanism intermediate member on y axis (13), on the axis of the hand control mechanism (C) front row pulleys fixed shaft (14a), hand control mechanism (C) rotates on y axis.

This motion is transferred to guiding cord on the y axis (8) by means of the hand control mechanism (C).

The motion that is transferred to the guiding cord on the y axis (8) passes through the housing (B) and is transferred to guiding jaw potion intermediate member on y axis (3) on the jaw mechanism (A).

By means of rotating the motion of guiding jaw portion intermediate member on y axis (3) on the axis of jaw mechanism rear row pulleys fixed shaft (6c) in the same direction with the guiding hand control mechanism intermediate member on y axis (13), the jaw mechanism (A) is rotated on y axis. Thus, when guiding hand control mechanism intermediate member on y axis (13) located on the hand control mechanism (C) is rotated clockwise on y axis, guiding jaw portion intermediate member on y axis (3) located on the jaw mechanism (A) and lower jaw (la) and upper jaw (lb) interconnected thereto are rotated clockwise.

When guiding hand control mechanism intermediate member on y axis (13) located on the hand control mechanism (C) is rotated counterclockwise on y axis, guiding jaw portion intermediate member on y axis (3) located on the jaw mechanism (A) and lower jaw (la) and upper jaw (lb) interconnected thereto are rotated counterclockwise. d. Rotation of Laparoscopic Mechanical Surgical Hand Instrument on Z Axis:

As a consequence of rotating hand control mechanism (C) and housing (B) which serves as its extension and jaw mechanism (A) around their own axis, laparoscopic mechanical surgical hand instrument performs a complete rotating motion on z axis.

e. Carrying Motion of Laparoscopic Mechanical Surgical Hand Instrument on XY. YZ and XZ

Planes.

All laparoscopic instruments are used with a valvular tubing system called trocar which is fixed to the skin after a small incision is made. Jaw portions of these laparoscopic instruments that are passed through this tubing system remain inside the body, whereas hand-controlled portions remain outside the body and held by surgeons. Trocar's contact point with the skin serves as a point of support for laparoscopic instrument.

All of these principles are valid for the subject matter mechanical invention laparoscopic surgical hand instrument that can perform seven axial motions.

If the surgeon moves the hand control mechanism (C) in any direction and on any plane, the jaw mechanism (A) is also moved on the same plane in the opposite direction and with the correlated angle.

For example; if the hand control mechanism (C) is moved on XZ plane according to x axis, jaw mechanism (A) is also moved on XZ plane according to x axis with the correlated angle. Another example in this regard; if the hand control mechanism (C) is moved on YZ plane according to y axis, jaw mechanism (A) is also moved on YZ plane according to y axis with the correlated angle.

Yet another example; when laparoscopic mechanical surgical hand instrument is moved inwards or outwards inside trocar, laparoscopic mechanical surgical hand instrument is moved together with all its components according to z axis in - (negative) or + (positive) direction.

All motions in directions of intervention that are desired to be carried out by the surgeon i.e. motions in seven axes can be performed by means of motions performed by above-described mechanical surgical hand instrument on seven axes and by coordination between other elements with each other that function in performing of these motions.

The subject matter invention laparoscopic mechanical surgical hand instrument constitutes advantages in terms of ergonomic design since it can be manufactured customizable by means of measuring the wrist-thumb joint and thumb-fingertip distances of surgeon who will utilize the hand instrument. By this means surgeon can use the laparoscopic mechanical surgical hand instrument easily without going through an orientation period. Additionally, because long-lasting and durable materials suitable for surgical use are utilized in the manufacturing process, the subject matter invention laparoscopic mechanical surgical hand instrument may not of single use and it can be used many times after the sterilization process.

Since all laparoscopic surgical hand instruments are held in hand because of their nature, the fact that the subject matter invention provides tactile contact feedback or in other words by means of the fact that the hand that holds the hand instrument can feel that whether there is contact or not and that the amount of force applied when an object held in hand is touched, surgeon can feel the tissue and surgical materials that he/she contacts with during the surgery. By this means surgeon does not have the sensation of using a separate console, he/she feels as if he/she handles the patient personally and thus, the entire operation is carried out through the surgeon's own tactile sense.