CN101242789B - 消毒手术帷帘 - Google Patents

消毒手术帷帘 Download PDF

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CN101242789B
CN101242789B CN2006800302132A CN200680030213A CN101242789B CN 101242789 B CN101242789 B CN 101242789B CN 2006800302132 A CN2006800302132 A CN 2006800302132A CN 200680030213 A CN200680030213 A CN 200680030213A CN 101242789 B CN101242789 B CN 101242789B
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J·P·奥尔班三世
L·希顿
S·C·安德森
T·G·库珀
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Abstract

本发明提供了改进的消毒帷帘，系统和遮盖部分遥控机器人手术系统的方法。在一个实施例中，消毒帷帘包括邻近执行手术过程的消毒区的外表面，和形成接收机器人手术系统的非消毒部分(如操纵器)的空腔的内表面。该帷帘进一步包括紧固件，该紧固件连接到外表面上从而固定消毒帷帘至机器人手术系统的非消毒部分同时减小消毒帷帘体积。有利地，该帷帘能够快速并且简单地安装，并通过以更多形式的配合特征减小帷帘的尺寸从而增加对病人的可视化，同时允许操纵器的自由移动。

Description

消毒手术帷帘
技术领域
【0001】本发明一般涉及手术机械人系统，且更具体地涉及覆盖手术机械人系统的部分的消毒帷帘。
背景技术
【0002】在机械人辅助或遥控机械人手术中，外科医生通常在远离病人的位置操作主控制器遥控手术器械在手术点的移动(如跨过手术室，在与病人不同的房间或完全不同的建筑物内)。主控制器通常包括一个或多个手动输入装置，如操纵杆、外骨骼手套(exoskeletal glove)等，这些都连接到带伺服马达的手术器械上从而铰接手术点的器械。这些伺服马达通常是机电装置或手术操纵器(从装置)的一部分，该机电装置或手术操纵器支撑并控制手术器械，这些手术器械直接导入开放手术点或通过穿刺套管(trocar sleeve)伸入体腔，如病人腹腔。在手术过程中，手术操纵器提供机械铰接和对多种手术器械的控制，所述手术器械如组织抓钳、针驱动器(needle driver)、电灼探针等，每种器械为外科医生执行不同的功能，如持有或驱动针，抓取血管，或切断、烧灼或凝固(coagulate)组织。
【0003】当然，通过遥控操纵执行遥控机械人手术的这种新方法产生了很多新的挑战。一个这样的挑战源自下述事实：机电手术操纵器的一部分将与手术器械直接接触并邻近手术点被定位。因此，手术操纵器可能在手术过程中被污染且通常被丢弃或在手术之间要消毒。从成本的角度看，优选对装置进行消毒。然而，机器人控制马达所需的伺服马达、传感器、编码器、电联接件通常不能用如蒸汽、加热和加压(heat and pressure)或化学消毒的传统方法来消毒，因为系统构件会在消毒过程中被损伤或破坏。
【0004】消毒帷帘已经用于覆盖手术操纵器，但有时帷帘难于安装或安装耗费时间、限制手术操纵器的移动或妨碍外科医生察看手术点。现有帷帘有时也妨碍监视屏的可视性或接触监视屏。
【0005】因此，需要的是，最小化消毒需求的遥控机械人系统、设备和方法，从而在保护系统和手术病人的同时改善成本效率。此外，这些系统和方法应设计成安装简单并且最小化安装时间，同时允许手术过程中最大的移动自由和可视性。因此高度需要用于机械人手术并具有改善的效率和效力的消毒帷帘、系统和方法。
发明内容
【0006】本发明提供改进的覆盖遥控机器人手术系统的部分的消毒帷帘、系统和方法。
【0007】根据本发明的一个实施例，提供了覆盖机器人手术系统的非消毒部分的消毒帷帘，该消毒帷帘包括邻近供执行手术过程的消毒区域的外部表面，以及形成接收机器人手术系统的非消毒部分的空腔的内表面。帷帘进一步包括一个紧固件，该紧固件被连接到外表面来固定消毒帷帘至机器人手术系统的非消毒部分同时减少消毒帷帘的体积。
【0008】根据本发明另一个实施例，提供了在消毒区域内执行手术过程的机器人手术系统，该系统包括与操纵器臂、监视器和与上述类似的消毒帷帘，其包括形成接收操纵器臂和监视器的空腔的内表面，以及多个用于固定消毒帷帘至操纵器臂和监视器的紧固件。
【0009】根据本发明的又一个实施例，提供了遮盖机器人手术系统的方法，该方法包括提供与上述类似并包括具有一体翻边(cuff)的开口端的消毒帷帘，将开口端设置在机器人手术系统的一部分上，支承一体翻边从而在机器人手术系统的该部分上展开消毒帷帘，并用紧固件固定消毒帷帘至机器人手术系统的该部分上。
【0010】有利地，本发明提供改进的帷帘安装以及改进的手术点和监视器的可视性，同时允许手术操纵器的自由移动。
【0011】本发明的范围是由权利要求限定的，权利要求包括到本节中供参考。通过考虑下面一个或多个实施例的详细说明，本领域技术人员可更完整地理解本发明实施例，并可认识到其中额外的优点。下面简单说明附图并参考附图。
附图说明
【0012】图1是手术室示意图，其示出根据本发明的一个实施例的遥控机器人手术系统和方法。
【0013】图2是图1中手术室的放大图，其示出根据本发明的连接到手术台的一对安装接头(mounting joint)。
【0014】图3A是根据本发明的一个实施例的机器人手术操纵器的透视图，其被消毒帷帘部分覆盖。
【0015】图3B是图3A中机器人手术操纵器的透视图，其中无消毒帷帘从而示出连接驱动组件的多自由度臂，其中驱动组件有腕部单元和手术工具。
【0016】图4示出图3A-3B中机器人手术操纵器，包括供察看手术点的摄像机和内窥镜。
【0017】图5是图3A-3B中机器人操纵器的局部视图，其示出臂和腕部单元之间的机械和电气联接件。
【0018】图6是图3A和图3B中操纵器的前臂和载架(carriage)的部分断面图。
【0019】图7是根据本发明的一个实施例的腕部单元的透视图。
【0020】图8是机器人操纵器的一部分的侧面剖视图，其示出臂和驱动组件。
【0021】图9A-9E是根据本发明的一个实施例的监视器帷帘的视图。
【0022】图10A-10J是根据本发明的一个实施例的摄像机臂(cameraarm，ECM)帷帘的视图。
【0023】图11A-11L是根据本发明的一个实施例的PSM帷帘的视图。
【0024】通过参考下面详细描述可最佳地理解本发明的实施例及它们的优点。应该意识到，相似的标识号用来表示一个或多个图中相似的元件。也应该意识到，附图不必按比例示出。
具体实施方式
【0025】本发明提供一种对病人执行机器人辅助手术过程的多部件系统和方法，具体地包括开放手术过程、如立体定位术的神经外科手术过程和如腹腔镜术、关节内窥镜术、胸腔镜术等的内窥镜手术过程。本发明的系统和方法作为遥控机器人手术系统的部分是特别有用的，该遥控机器人手术系统允许外科医生通过伺服机构从远离病人的位置操纵手术器械。为了这个目的，本发明的操纵器设备或从装置通常由运动等效主装置(kinematically-equivalent master)驱动，从而形成具有力反馈(force reflection)的远程呈现系统(telepresence system)。合适的主从系统的描述可在1995年8月21日申请的美国专利申请No.08/517,053中找到，其全部公开内容被包括在此以供参考。
【0026】参考附图细节，其中相似的标识号指示相似的元件，遥控机器人手术系统2是根据本发明的一个实施例被示出的。如图1所示，遥控机器人系统2通常包括安装在手术台O上或其附近的一个或多个手术操纵器组件4，以及允许外科医生S察看手术点并控制操纵器组件4的控制组件6。系统2也包括一个或多个观察器(viewing scope)组件19和多个手术器械组件20，这些手术器械组件20适于可拆卸地连接到操纵器组件4上(如下面详细讨论)。遥控机器人系统2通常包括至少两个操纵器组件4并且优选地三个操纵器组件4。操纵器组件4的准确数目取决于手术过程和手术室内空间限制以及其他因素。如下面所详细讨论的，组件4中的一个通常操作一个观察器组件19(如内窥镜手术过程)以便察看手术点，同时其他操纵器组件4操作手术器械20以便对病人P执行不同过程。
【0027】控制组件6可位于外科医生的控制台C上，控制台C通常和手术台O位于同一房间内，以便外科医生可对他/她的助手(们)A说话并直接监视手术过程。然而，应该理解外科医生S可位于与病人P不同的房间或完全不同的建筑物内。控制组件6通常包括支架8、向外科医生S显示手术点的图像的监视器10，以及用于控制操纵器组件4的一个或多个控制器12。控制器12可包括多种输入设备，如操纵杆、手套、触发枪(trigger-gun)、手动操纵控制器、语音识别设备等。优选地，控制器12具有与相关的器械组件20相同的自由度从而向外科医生提供控制器12与器械20是一体的远程呈现或感知，以便外科医生有强烈的直接控制器械20的感觉。位置、力和触觉反馈传感器(未示出)也可用在器械组件20上，从而在外科医生操作遥控机器人系统时，从手术器械反馈位置、力和触觉至外科医生的双手。一种提供远程呈现给操作人员的合适系统和方法在1995年8月21日申请的美国专利申请No.08/517,053中公开，该专利申请预先包括在此以供参考。
【0028】监视器10将适当地连接到观察器组件19上，以便手术点的图像被提供在外科医生手附近的外科医生控制台C上。优选地，监视器10在显示器18上显示颠倒的图像，显示器18被定向以便外科医生感觉他或她在直接向下观看手术点。为了该目的，手术器械20的图像看起来基本位于操作员手的位置处，即使观察点(即，内窥镜或察看摄像机)不在图像的察看点。此外，实时图像优选地转换为透视图，以便操作员可操纵末端受动器和手动控制，如同察看基本真实呈现的工作空间。通过真实呈现，意味着图像的呈现是模拟物理操纵手术器械20的操作员观察点的真实透视图。因此，控制器(未示出)转换手术器械20的坐标至被观察位置，以便透视图是一个人能看到摄像机或内窥镜是否直接位于手术器械20后面的图像。提供该虚拟图像的合适坐标转换系统在1994年5月5日申请的美国专利申请No.08/239,086，即现在的美国专利No.5,631,973中公开，其全部公开内容包括在此以供参考。
【0029】如图1所示，伺服机构16被提供来传递控制器12的机械运动至操纵器组件4。伺服机构16可独立于操纵器组件4或与其一体。伺服机构16通常提供来自手术器械20的力和扭矩反馈至手动操作控制器12。此外，伺服机构16包括安全监视控制器(未示出)，该安全监视控制器可响应识别的条件(如对病人施加的力过度、操纵器组件4的失控(running away)等)冻结或至少约束所有机器人运动。伺服机构优选地具有截止频率为至少10hz的3dB的伺服带宽以便系统可快速并准确地响应快速的外科医生的快速手动运动。为了有效操作该系统，操纵器组件4具有相对低的惯性，且驱动马达170(参看图8)具有相对低传动比的齿轮或滑轮联接件。任何合适的传统或专用的伺服机构均可用来实施本发明，其中它们的合力和合扭矩反馈特别优选地用于远程呈现系统操作。
【0030】参考图7，每个手术器械组件20都包括腕部单元22和可拆卸连接到腕部单元22的手术工具24(图3A和3B)。如下面所详细讨论的，每个腕部22通常包括细长轴56，该细长轴56具有近端盖(proximalcap)58和可转动连接到手术工具24的远端腕部60。每个腕部单元22基本相同，并且根据手术过程的要求，连接到其上的手术工具24可以是不同或同样的。可替换地，腕部单元22可以具有专门腕部60，这些专门腕部60被设计用于个别手术工具24，以便腕部单元22可与传统工具24一起使用。如图1所示，器械组件20通常组装在工作台T上或其他邻近手术台O的合适支架上。根据本发明的一种方法(下面说明)，腕部单元22和它们关联的手术工具24可在手术过程中通过连接和分离腕部单元轴56与操纵器组件4而快速更换。
【0031】参考图2，每个操纵器组件4优选地通过安装接头30安装在手术台O上。安装接头30为组件4提供多个自由度(优选至少5个)，并且他们包括制动器(未示出)从而组件4可以固定在相对病人的合适位置和方向。接头30安装在托座(receptacle)32上以便将接头30安装到手术台O上，并用于连接每个操纵器组件4至伺服机构16。此外，托座32可连接接头30至其他系统，如RF电源、吸灌(suction-irrigation)系统等。托座32包括可滑动地沿手术台O的外轨36设置的安装臂34。操纵器组件4也可以同其他机构被设置在手术台O上。例如系统可包括支架系统(连接到手术室的天花板或墙壁上)，该支架系统移动或支承一个或多个操纵器组件4在病人上方。
【0032】参考图3-8，下面进一步详细描述操纵器组件4。操纵器组件4是三部件设备，其包括非消毒驱动和控制部件、可消毒末端受动器或手术工具(即，手术器械组件20)，以及中间连接器部件。中间连接器包括机械元件，这些机械元件用于连接手术工具24与驱动和控制部件，并用于传递驱动部件的运动至手术工具24。如图3B所示，驱动和控制部件通常包括驱动组件40和连接到安装托架(bracket)44的多自由度机器人臂42，其适于安装到安装接头30(图2)上。优选地，驱动组件40和机器人臂42绕X轴可转动地连接到托架44，X轴延伸通过球形旋转(spherical rotation)45的远中心(参看图8，下面进一步详细讨论)。操纵器组件4进一步包括固定到臂42的远端48的前臂组件46，以及腕部单元转接件52，该腕部单元转接件52连接到前臂组件46上以供安装腕部单元22和手术工具24至操纵器组件4。
【0033】对于内窥镜手术过程，操纵器组件4还包括套管转接件64，该套管转接件64连接到前臂46下部以供安装套管66至操纵器组件4。可替换地，套管66可以是内置在前臂组件46内的一体套管(未示出)(即，不可拆卸)。套管66可包括安装到套管66内的环形轴承上的力感测元件(未示出)，如应变仪或力感测电阻器(force-sensing resistor)。力感测轴承在手术过程中支撑手术工具24，允许该工具通过轴承的中央孔轴向旋转和移动。此外，轴承传递手术工具24施加的横向力至力感测元件，该力感测元件连接到伺服机构16以传递这些力至一个(或多个)控制器12。以该方式，可在无来自作用于套管66的力干扰下，如包围手术切口的组织或作用在操纵器组件4上重力和惯性力，检测作用在手术工具24上的力。这促进在机器人系统中使用操纵器组件4，因为外科医生将直接感测反作用于手术工具24上的力。
【0034】如图3A所示，操纵器组件4进一步包括尺寸适于基本覆盖整个操纵器组件4的消毒帷帘70。帷帘70有一对孔72、74，其成尺寸并被配置成腕部单元转接件52和套管转接件64可以延伸穿过孔72、74从而安装腕部单元22和套管66至操纵器组件4。消毒帷帘70包括一种材料，该材料被配置成有效地隔离开操纵器组件4与手术点，以便组件4的大部分部件(即臂42、驱动组件40和前臂组件46)不必在手术过程之前或之后消毒。
【0035】如图3A所示，腕部单元转接件52和套管转接件64延伸通过帷帘70的孔72、74，以便前臂组件46和操纵器组件4的剩余部分在手术过程中保持被遮蔽在病人之外。在一个实施例中，腕部单元转接件52和套管转接件64被制造成可再用部件，这些部件将被消毒因为它们都延伸入手术点的消毒区。腕部单元和套管转接件52、64可通过常规方法消毒，即蒸汽、加热和加压、化学消毒等。再参考图3B，腕部单元转接件52包括开口80供接收腕部单元22的轴56。如下面的详细讨论，轴56可被横向推动通过开口80并插配到转接件52中，这样腕部单元转接件52的非暴露部分保持消毒状态(即保持在相对消毒区的帷帘70的消毒侧)。腕部单元转接件52也可包括栓件(未示出)以固定腕部单元22于其中。类似地，套管转接件64包括开口82以供插配套管66在其中，以便转接件64的未暴露部分在手术过程中保持消毒状态。
【0036】如图4所示，腕部单元转接件52也可被配置成接收观察器100以便观察手术点。对于内窥镜手术过程，观察器100可以是传统的内窥镜，其通常包括刚性、细长管子102，该管子102包括透镜系统(未示出)和在管子102近端的摄像机安装座104。小型视频摄像机106优选地固定到摄像机安装座104并连接到视频监视器10，从而提供该过程的视频图像。优选地，观察器100具有远端(未示出)，其被配置成允许相对管子102横向或成角度观察。观察器也可具有可引导尖端，可通过操纵在管子102近端的致动器而偏转或旋转该可引导尖端。这类观察器可从伊利诺伊州Deerfield的Baxter Healthcare，Corp或加利福尼亚州Menlo Park的Origin Medsystem，Inc购买。
【0037】如图4所示，观察器100进一步包括观察器转接件110以连接观察器100至腕部单元转接件52。观察器转接件110是可消毒的，环氧乙炔(ETO)和可高压加热灭菌，且它包括多个运动馈通器(motionfeed-through)(未示出)以传递驱动组件40的运动至观察器100。在优选构型中，运动包括倾斜(pitch)和摇摆(yaw)运动、绕Z轴的旋转和沿Z轴的移动。
【0038】现参考图5和6，前臂组件46将在下面更详细地说明。如图5所示，前臂组件46包括固定到臂42的壳体120和可滑动地连接到壳体120的可移动载架122。载架122可滑动地安装腕部单元转接件52至壳体120以便在Z方向上移动腕部单元转接件52和腕部单元20。此外，载架122限定大量开口123以传递来自前臂组件46的运动和电信号至腕部单元转接件52。如图6所示，多个可旋转轴124安装在壳体120内以便通过开口123传递来自臂42的运动至腕部单元转接件52和腕部单元22。旋转轴124优选地为腕部单元22提供至少4个自由度，包括手术工具24绕腕部单元22的腕部60的摇摆和倾斜运动、腕部单元22绕Z轴的旋转和工具24的致动。如果需要，该系统也可被配置成提供更多或更少的自由度。工具24的致动可包括多种运动，如张开和关闭夹钳(jaw)、抓钳或剪刀，应用夹子或搭扣(staple)等。腕部单元22和工具24在Z方向的运动通过一对载架缆线驱动器126被提供，载架缆线驱动器126在前臂壳体120每端的可旋转滑轮128、129之间延伸。缆线驱动器126用来在Z方向上相对前臂壳体120移动载架122和腕部单元22。
【0039】如图6所示，臂42的远端48包括一个联接组件130，该联接组件130具有多个运动馈通器132以传递来自臂42的运动至前臂组件46。此外，联接组件130包括大量电连接器(未示出)以传递来自臂42的电信号至腕部单元22。类似地，腕部单元转接件52包括多个运动馈通器(未示出)和多个电联接件(未示出)以传递运动并用于发送电信号至腕部单元22和从腕部单元22接收电信号(如在手术点和控制器12之间发送和接收力和扭矩反馈信号)。联接组件130和腕部单元转接件52的任一侧的部件均具有有限的运动范围。通常，这个运动范围是至少一个回转(revolution)，并且优选地大于一个回转。当前臂组件46机械连接到联接组件130且腕部单元转接件52机械连接到前臂46时，这些运动范围彼此对齐。
【0040】下面参考图7详细说明腕部单元22。如图所示，腕部单元22包括空心轴56，其具有固定到其近端的盖58和固定到其远端的腕部60。腕部60包括一个联接件(未示出)以便可拆卸地连接多种手术工具24至轴56。轴56可旋转地连接到盖58以便提供轴56和工具24绕轴56的纵轴(即Z轴)的旋转。盖58容纳传递腕部单元转接件52的运动至轴56内驱动缆线(未示出)的机构(未示出)。这些驱动缆线适于连接到轴56内的驱动滑轮上从而绕腕部60转动工具24，并启动工具24上的末端受动器140。腕部60也可由其他机构操作，如差动齿轮、推杆等。
【0041】工具24可拆卸地连接到腕部单元22的腕部60。工具24将优选地包括末端受动器65(图3A和3B)，其具有触觉传感器阵列(未示出)以提供触觉反馈给外科医生。工具24可包括多种铰接工具，如夹钳、剪刀、抓钳、持针器、微解剖器、搭扣安装器、钉钉器、吸灌工具、夹子安装器，它们具有末端受动器，这些末端受动器由线连接、偏心凸轮、推杆或其他机构驱动。此外，工具24可包括非铰接器械，如切割刀片、探针、灌注器、导液管或吸孔(suction orifice)。可替换地，工具24可包括电切探针(electrosurgical probe)来消融、切除、切割或凝固组织。在后面的实施例中，腕部单元22将包括导电元件，例如连接到延伸通过轴56到工具24的引线或杆的近端香蕉插头。
【0042】下面参考图4和8进一步详细说明本发明的驱动和控制部件的特定构型(即机器人臂42和驱动组件40)。如上所述，臂42和驱动组件40可绕从安装托架44延伸的一对插销150被旋转地连接。臂42优选地包括细长的基本刚性体152，该刚性体152具有连接到前臂组件48的远端48和转动连接到驱动组件40和托架44以便绕倾斜轴和摇摆轴或X轴和Y轴旋转的近端154(注意Y轴垂直于页面并延伸通过点45，参看图8)。臂40可具有其他构型，如肘臂(elbow arm)(类似于人手臂)、棱柱臂(prismatic arm)(可直向延伸)等。固定的摇摆马达156安装在安装托架44上以便绕X轴旋转臂42和驱动组件40。驱动组件40也包括倾斜马达158，该倾斜马达158被连接到臂42以便绕Y轴旋转臂。一对基本刚性联动元件(linkage element)160、124从托架44延伸到机器人臂42从而绕Y轴转动地连接臂42至托架44。一个联动元件160被转动地连接到臂42，另一个联动元件124被转动地连接到平行于臂42延伸的第三联动元件164。优选地，机器人臂42是沟槽形刚性元件，其至少部分容纳第三联动元件164。联动元件160、124和164以及臂42形成平行四边形联动装置，其中这些构件以平行四边形的形式连接到一起，以便仅在构件形成的平面内相对运动。
【0043】固定在臂42的远端48的腕部单元22的Z轴与上述平行四边形联动装置的x轴交叉。腕部单元22具有绕图8中标号45指示位置的球形旋转的远中心。因此，腕部单元22的远端可绕其自身轴或X和Y轴旋转，同时旋转45的远中心保持在同一位置。远中心定位装置更完整的描述可在1995年7月20申请的美国专利申请No.08/504,301，即现在的美国专利No.5,931,832中找到，该专利的全部内容包括在此以供参考。应该注意臂42和驱动组件40可与上面所述并在图8中示出的装置以外的多种定位装置一起使用，如立体定位器、固定万向节等。
【0044】再参考图8，驱动组件40进一步包括多个连接到臂42并随其旋转的驱动马达170。倾斜和摇摆马达156、158控制臂42(和驱动马达170)绕X轴和Y轴的运动，且驱动马达170控制腕部单元22和手术工具24的运动。优选地，至少五个驱动马达170连接到臂42以便为腕部单元22提供至少5个自由度。驱动马达170优选地包括响应伺服机构16的编码器(未示出)以及传输力和扭矩反馈至外科医生S的力传感器(未示出)。如上所述，五个自由度优选地包括载架122和腕部单元22在Z方向的运动、腕部单元22绕Z轴的旋转、手术工具24绕腕部60的倾斜和摇摆运动，以及工具24的致动。
【0045】如图所示，缆线172从每个马达170延伸出绕马达驱动滑轮174、臂42内的惰轮176并沿着相对大的罐式绞盘机(pot capstan)178，从而最小化缆线172上的摩擦扭矩的影响。每个缆线172延伸绕过臂42远端48的另一个惰轮180，绕过联接件驱动滑轮182并返回到马达170。缆线172优选地张紧并锚定在马达驱动滑轮174和联接件驱动滑轮182上。如图8所示，联接件驱动滑轮182经多条缆线186连接至联接组件130内多个较小的滑轮184，以便传递马达170的运动至腕部单元转接件52。
【0046】下面参考图1-8说明根据本发明对病人执行手术过程的一种方法。如图2所示，安装接头30固定到托座32上，托座32通过沿轨道36的滑动安装臂34被固定到手术台O。然后，每个操纵器组件4固定到它的相应的安装接头30上并铰接到相对病人P的适当位置和方向。然后托座32连接到伺服机构16和手术过程中可能需要的其他系统，如RF电源、吸/灌系统等。在病人已经麻醉前、麻醉过程中或麻醉后，消毒帷帘70设置在操纵器组件4上(图3A)。为了准备手术过程，操纵器组件4可在以帷帘70覆盖它们之前被化学清洗或不被化学清洗。腕部单元转接件52、套管转接件64和观察器转接件110被咬合到操纵器组件4的前臂组件46上(参看图3B和5)。当然，观察器转接件110和腕部单元转接件52的数目和相对位置取决于具体手术过程(如，对于开放手术过程可能不要求套管转接件64)。
【0047】在手术过程中，通过横向推动每个相应的腕部单元轴56穿过腕部单元转接件52的开口80，手术器械组件20被连接到它们相应的操纵器组件4。每个腕部单元22将具有适当的识别装置(未示出)从而快速并容易地指示连接到腕部单元22的工具24的类型。当外科医生希望改变手术工具24时，他或她操纵一个(或多个)控制器12以便载架122移到沿前臂组件46移动的顶部或近端位置(参考图3B)。在该位置，手术工具24在套管66内，或在开放手术过程中，手术工具24从手术点移开。然后一名(或多名)助手A向上拉动腕部盖58从而释放栓件(未示出)，因而允许腕部单元22进一步向上滑动并滑出套管66。然后一名(或多名)助手A可横向拉动腕部单元22从而与腕部单元转接件52分开。当腕部单元22不再与转接件52连接时，控制机构认为该系统处于“工具更换模式”，且如果外科医生没有移动载架122至近端位置则控制机构将其驱动至近端位置。
【0048】为了连接另一个手术器械组件20至操纵器组件4，一名(或多名)助手A从工作台T抓取另一个组件20，横向推动腕部单元轴56至腕部单元转接件52的开口80中，然后向下移动腕部单元22以便手术工具24驻存在套管66中(参考图1和图3B)。腕部单元22的这个向下运动自动匹配电联接件以及腕部盖58和腕部单元转接件52内的运动馈通器(未示出)。系统可包括控制机构，其被配置成锁定载架122在顶部或近端位置处移动，例如通过启动制动器(未示出)，直到联接件匹配且腕部单元22不再向下移动。基于这点，外科医生S可继续手术过程。
【0049】本发明的系统和方法优选地包括计算腕部单元22与腕部单元转接件52分离和连接次数的机构。以该方式，制造商可限制腕部单元22被使用的次数。在特定构型中，集成电路芯片(未示出)装在腕部盖58内。电路芯片计算腕部单元22连接到腕部单元转接件52的次数，如20次，并在外科医生控制台C上显示警告。然后通过减小控制系统传递的负载或增加明显的后冲或空转(backlash)来降低系统的性能。
【0050】现参考图9A-9E，其示出监视器帷帘包(package)200，其包括监视器帷帘204，监视器帷帘204是消毒帷帘70的一部分(参考图3A在上面被描述)。监视器帷帘204可以是消毒帷帘70的连接的或断开的部件。图9A示出监视器帷帘包200，该监视器围帘包200包括监视器帷帘袋202，监视器帷帘204折叠在其中。监视器帷帘204是可丢弃消毒帷帘组件，该消毒帷帘组件设置在监视器上和监视器安装座上从而在监视器/监视器安装座和手术过程的消毒区之间保持消毒屏障。有利地，监视器帷帘的多种特征辅助覆盖和安装过程。
【0051】图9B示出从袋202取出的监视器帷帘204，且帷帘204包括要设置在监视器(如图1的监视器10)的屏附近的触摸屏窗口206。触摸屏窗口206在监视器帷帘204的两个襟翼(flap)208之间，且没有折叠以减小折痕并增加对监视屏的附着。在一个例子中，触摸屏窗口206是要设置在监视屏前面的透明的静电贴附窗口(static-clingwindow)。透明窗口允许用户看到并使用触摸屏监视器同时保持消毒屏障。窗口206具有保持静电贴附功能的静电电荷，从而允许窗口206平贴着这监视屏，从而减少反射和炫光并保持使用触摸屏的窗口固定。
【0052】图9C示出监视器帷帘204，其中襟翼208打开。如前面指出的那样，监视器帷帘204是以确保屏窗口部件不折叠的的方式折叠，从而减少材料折痕并允许更平地设置在监视屏上。
【0053】图9D示出四个环形紧固件212、两个出风口214、绑带216、永久翻边220、翻边220边缘上的蓝带218和内置到翻边220上的系绳222。环形紧固件212被包括在帷帘内侧上屏窗口206的任一侧上。环形紧固件212包括Velcro条，这些Velcro条匹配位于监视器安装座背部的钩式紧固件(未示出)。这些钩式和环形紧固件允许用户快速拉动讲授的并固定在监视屏前面的位置上的帷帘。出风口214允许监视器产生的热从监视器帷帘204排出。这些出风口在监视器区上面和下面从而允许对流热排出。出风口214也允许声音从消毒区传输到靠近监视器安装的麦克风。绑带216帮助控制帷帘204并减小帷帘的视觉尺寸(即，减小展开帷帘占据的体积或空间)。蓝带218用作帷帘上指示消毒端和非消毒端的物理标记。通过将蓝带218用作标记，如果要帮助消毒擦洗护士，则非消毒的人可知道拉动非消毒侧。系绳222允许用户绕帷帘端部的监视器安装座紧紧地拉上监视器帷帘204。
【0054】图9E示出帷帘区最近翻边220的放大图，包括开口条224。翻边220与帷帘端部一体。在将帷帘拉到监视器上时，消毒擦洗护士可将他或她的手放到这些翻边中。通过这些翻边，用户可确保他们在沿监视器工作时手不接触非消毒物品。开口条224被用来在安装的过程中控制帷帘的展开。开口条224将帷帘保持在其折叠的位置(例如图9C所示的示例)，且在用户安装帷帘时，随着帷帘被拉回到监视器上开口条224被撕裂。
【0055】再参考图10A-10J，其示出了内窥镜摄像机操纵器(endoscopecamera manipulator，ECM)(摄像机臂)帷帘包300，该ECM帷帘包300包括ECM帷帘304，该ECM帷帘304是消毒帷帘70(上面参考图3A说明)的一部分。ECM帷帘304可以是消毒帷帘70的连接或断开的部件。图10A示出ECM帷帘包300，该ECM帷帘包300包括其中折叠了ECM帷帘304的ECM帷帘袋302。ECM帷帘是可丢弃的消毒帷帘组件，其被设计成在非消毒ECM摄像机臂和手术过程的消毒区之间建立消毒屏障。有利地，ECM帷帘304的多种特征辅助遮盖和安装过程。
【0056】图10B示出从袋子302取出的ECM帷帘304。ECM帷帘304以两个襟翼308折叠，且箭头标签表示襟翼308打开的方向。图10C示出ECM帷帘304，其中襟翼308打开。图10D示出视觉指示符310用于在ECM臂上安置或定位ECM帷帘304。视觉指示符310包括补片(patch)312和补片314，如下面参考图10F更详细的说明。图10E示出部分打开的ECM帷帘304的闭合端。图10F示出增强补片312，其用来在安装摄像机至ECM臂上时防止ECM帷帘304的干扰。同样示出了用于固定摄像机消毒转接件的即撕即贴补片314。
【0057】图10G示出限定帷帘的主入口/出口的开口条316，ECM臂通过这些开口条316伸入或撤出ECM帷帘304。ECM帷帘304被打包以便最初折叠的帷帘能够放置在ECM臂上。通过使用开口条316帷帘被设置在其初始位置，开口条316允许在以必要的力拉动时能够撕开而控制帷帘的打开。通过将手伸入到翻边323中(图10I)并沿ECM臂拉动帷帘，用户沿ECM臂的长度拉动ECM帷帘304。图10H示出ECM帷帘304完全打开。
【0058】图10I示出ECM帷帘304的端部处的绑带318、翻边323边缘处的蓝带320、用于绕监视器安装座包裹ECM帷帘的翻边323中的切口322，以及即撕即贴补片314。ECM帷帘304包括帷帘端部的一体翻边323。在沿ECM臂拉动帷帘时，消毒擦洗护士可将他或她的手伸入到这些翻边中，从而确保用户在沿ECM臂工作时手不接触非消毒的物品。蓝带320用作帷帘上指示消毒和非消毒端部的物理标记。通过将该蓝带320用作标记，在辅助消毒擦洗护士时，非消毒人员可知道拉动非消毒侧。
【0059】图10J示出帮助控制ECM帷帘并减小帷帘视觉尺寸(即减小展开的帷帘占据的体积或空间)的绑带318。有一个绑带接近套管安装区，另一个绑带接近ECM臂的“链节(link)3”，还有一个绑带接近“装配臂(setup arm)”(如图4和图5中的臂42)，ECM臂安装在该装配臂上。
【0060】现在参考图11A-11M，其示出病人侧操纵器(patient sidemanipulator，PSM)帷帘包400，该PSM帷帘包400包括PSM帷帘404，该PSM帷帘是消毒帷帘70的一部分(参考图3A在上面说明)。PSM帷帘404可以是与消毒帷帘70的连接的或断开的部件。图11A示出PSM帷帘包400，该PSM帷帘包400包括PSM帷帘带402，且PSM帷帘404折叠在PSM帷帘带402中。PSM帷帘被设计成在非消毒PSM臂和手术过程中消毒区之间建立消毒屏障。PSM帷帘404包括用来啮合手术工具并永久地固定在帷帘上的一体器械消毒转接件(instrumentsterile adaptor，ISA)，其中完整组件包括ISA。可应用转接件、工具或附件的实施例在例如美国专利No.6,331,181、6,491,701和6,770,081中说明，这些专利的全部公开内容(包括这里已经包括进来供参考的公开内容)包括在此以供参考。因此，在一个实施例中，帷帘可完全丢弃。有利地，PSM帷帘的多种特征辅助帷帘遮盖和安装过程。
【0061】图11B示出从袋402中移出的PSM帷帘404。图11C示出永久安装在靠近PSM帷帘404闭合端的PSM帷帘404上的消毒转接件406的例子。图11D示出开口条408和折叠襟翼410，其中开口条408限定折叠PSM帷帘中的主孔。图11E示出打开的襟翼410，图11F示出完全打开的PSM帷帘404。PSM帷帘404被打包以便折叠的帷帘最初可设置在PSM臂上，且然后通过首先将前舌状件设置在PSM臂的托架上，接着摆动消毒转接件的另一端直到其啮合PSM臂上的栓件，从而永久安装的消毒转接件406被固定到PSM臂上。通过使用开口条408，PSM帷帘404保持在其初始位置，这些开口条408允许在以必须的力拉动时通过撕扯而控制打开帷帘。通过将手放置在一体翻边412中(图11G)并沿PSM臂拉动帷帘，用户可以沿PSM臂的长度拉动帷帘。
【0062】图11G1和图11G2示出在PSM帷帘404开口端的一体翻边412，翻边412的边缘包括蓝带411。在沿PSM臂拉动PSM帷帘时，消毒擦洗护士可能将他或她的手伸入翻边，并通过使用该翻边，用户可确保在沿PSM臂工作时他们的手不接触非消毒物品。蓝带411作为帷帘上指示消毒和非消毒端的物理标记。通过该标记非消毒人员可在辅助消毒擦洗护士时知道拉动非消毒侧。
【0063】图11H示出帷帘上绑带414，这些绑带414用来帮助控制帷帘并减小帷帘视觉尺寸(即，减小展开的帷帘占据的体积或空间)。一个绑带靠近套管安装区，另一个绑带靠近PSM臂的“链节3”，还有一个绑带沿“装配臂”(如图4和5的臂件42)，PSM臂安装在该装配臂上。
【0064】图11I示出沿插入轴的条416和套管安装袋418。可采用的套管安装袋在2005年9月30申请的共同未决的美国专利申请No.11/240,087中公开，其内容包括在此以供参考。若干条416是在插入轴区中帷帘上的可延展条。这些条416固定到消毒转接件和套管安装区之间的帷帘上。一旦帷帘安装在PSM臂上，用户可改变可延展条416的形状从而帮助将过多的帷帘材料折起来。通过能够将过多的帷帘材料折起来并固定，帷帘可接近匹配PSM臂的形状。有利地，这减小系统的视觉尺寸并使得外科医生或其他用户(们)能够更好的观察病人及其周围环境。条416也是可充分延展从而能够展开使得系统可以实现最大范围的运动而无需撕开帷帘。
【0065】图11J示出在条416被用户弯回之前，PSM臂417的一部分上的PSM帷帘404和在适当位置的消毒转接件406。图11K示出条416，此时条416已被用户弯回，以便PSM帷帘404更接近地配合PSM臂的形状，从而减小系统的尺寸。图11L示出条416的另一个视图，这些条416足够柔软从而可张开供最大范围的运动，并可由用户在手术过程中按照需要再塑形。
【0066】上述帷帘200、300和400优选地包括足够刚性和强度的材料，从而允许适当地设置在相应的监视器和监视器安装座、ECM臂和PSM臂上并且抗撕扯，即使是在不同方向内施加周期载荷的情况下，但是优选地不包括足够柔性以致允许随操纵器臂的活动部件移动的材料。帷帘200、300和400可包括多种耐用材料，且在一个例子中包括聚乙烯、聚亚安酯、聚碳酸酯或它们的混合物。在一个实施例中，帷帘200、300和400可以是真空形成的，作为单个帷帘的一部分或分开的帷帘，这些分开的帷帘可由粘合剂、热、RF焊接或其他方法被固定到主消毒帷帘70上。在另一个实施例中，帷帘200、300和400可用作断开的帷帘(但可以彼此靠近或交叠)从而覆盖手术机器人系统的不同部分。
【0067】有利地，本发明的帷帘通过更多形式的装配特征减小帷帘的尺寸从而增加对病人的观察，允许了快速而简单的安装，并改进器械消毒转接件特征。本发明的帷帘也保持监视屏的无菌性，特别是触摸屏监视器，允许声音传递到监视器帷帘上的麦克风，同时保持无菌性，并减少监视屏前帷帘的眩目和褶皱。
【0068】上述实施例说明但不限制本发明。也可以理解的是，根据本发明的原理，可以有多种修改和变化。例如，虽然上面实施例描述了机器人手术系统的特定部件的帷帘，但接收其他手术系统部件的其他形状和空腔在本发明的范围内。因此，本发明的范围仅由权利要求限定。

Claims (28)

1.一种覆盖机器人手术系统的非消毒部分的消毒帷帘，所述消毒帷帘包括：
一个外表面，该外表面邻近执行手术过程的消毒区域；
一个内表面，该内表面形成接收所述机器人手术系统的所述非消毒部分的空腔；
在所述空腔的开口端处的永久一体翻边和在所述永久一体翻边上指示所述消毒帷帘的消毒侧和非消毒侧的物理标记，以及
一个紧固件，该紧固件连接到所述外表面以便固定所述消毒帷帘至所述机器人手术系统的所述非消毒部分同时减小所述消毒帷帘的体积。
2.如权利要求1所述的消毒帷帘，其中所述外表面包括一个即撕即贴补片。
3.如权利要求1所述的消毒帷帘，其中所述消毒帷帘由从包含聚乙烯、聚亚安酯和聚碳酸酯的组中选择的一种材料形成。
4.如权利要求1所述的消毒帷帘，其中所述机器人手术系统的所述非消毒部分是从由监视器和操纵器臂组成的组中选择的。
5.如权利要求1所述的消毒帷帘，其中所述消毒帷帘是一个更大帷帘的真空形成部分或一个独立模制的部分。
6.如权利要求1所述的消毒帷帘，其中所述紧固件包括多个可延展条和多个绑带。
7.如权利要求1所述的消毒帷帘，其中所述外表面和所述内表面包括靠近监视屏设置的一个窗口。
8.如权利要求7所述的消毒帷帘，其中所述窗口具有静电电荷。
9.如权利要求1所述的消毒帷帘，其中所述外表面和所述内表面包括一个器械消毒转接件，该器械消毒转接件用于啮合一个手术工具和所述机器人手术系统的操纵器臂。
10.如权利要求1所述的消毒帷帘，其中所述外表面和所述内表面包括一个出风口部分。
11.如权利要求1所述的消毒帷帘，其中所述开口端进一步包括一条系绳。
12.如权利要求1所述的消毒帷帘，其中所述开口端进一步包括一个开口条。
13.如权利要求1所述的消毒帷帘，其中所述永久一体翻边包括一个视觉标记。
14.如权利要求1所述的消毒帷帘，其中所述机器人手术系统的所述非消毒部分包括内窥镜摄像机操纵器臂。
15.一个在消毒区域内执行手术过程的机器人手术系统，所述系统包括：
一个操纵器臂；
一个监视器；和
一个消毒帷帘，其覆盖所述操纵器臂和所述监视器从而将所述操纵器臂和所述监视器与所述消毒区域隔离开，所述消毒帷帘包括：
一个外表面，该外表面邻近执行手术过程的消毒区域；
一个内表面，该内表面形成接收所述操纵器臂和所述监视器的空腔；
在所述空腔的开口端处的永久一体翻边和在所述永久一体翻边上指示所述消毒帷帘的消毒侧和非消毒侧的物理标记，以及
多个紧固件，这些紧固件用于固定所述消毒帷帘至所述操纵器臂和所述监视器。
16.如权利要求15所述的系统，其中所述操纵器臂是一个病人侧操纵器臂或一个内窥镜摄像机操纵器臂。
17.如权利要求15所述的系统，其中所述外表面包括一个即撕即贴补片。
18.如权利要求15所述的系统，其中所述消毒帷帘从由从包含聚乙烯、聚亚安酯和聚碳酸酯的组中选择的一种材料形成。
19.如权利要求15所述的系统，其中所述多个紧固件包括多个可延展条和多个绑带。
20.如权利要求15所述的系统，其中所述外表面和所述内表面包括靠近监视屏设置的一个窗口。
21.如权利要求20所述的系统，其中所述窗口具有静电电荷。
22.如权利要求15所述的系统，其中所述外表面和所述内表面包括一个器械消毒转接件，其被配置为啮合手术工具。
23.如权利要求15所述的系统，其中所述外表面和所述内表面包括一个出风口部分。
24.一种遮盖机器人手术系统的方法，该方法包括：
提供一个消毒帷帘，其包括：
一个外表面，该外表面邻近执行手术过程的消毒区域；
一个内表面，该内表面形成接收所述机器人手术系统的一非消毒部分的一个空腔；
一个开口端，该开口端具有一个永久一体翻边和所述永久一体翻边上指示所述消毒帷帘的消毒侧和非消毒侧的物理标记；以及
一个紧固件，该紧固件用于固定所述消毒帷帘至所述机器人手术系统的非消毒部分；
在所述机器人手术系统的所述非消毒部分上设置所述开口端；
支承所述永久一体翻边从而在所述机器人手术系统的所述非消毒部分上展开所述消毒帷帘；以及
用所述紧固件固定所述消毒帷帘至所述机器人手术系统的所述非消毒部分。
25.如权利要求24所述的方法，进一步包括连接与所述消毒帷帘一体的一个器械消毒转接件至所述机器人手术系统的一个操纵器臂。
26.如权利要求24所述的方法，进一步包括紧接所述机器人手术系统的一个监视器设置所述消毒帷帘的一个窗口和一个出风口部分。
27.如权利要求26所述的方法，进一步包括展开所述消毒帷帘以便所述窗口不起皱或折叠。
28.如权利要求26所述的方法，进一步包括通过静电电荷将所述窗口靠近一个监视屏设置。
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