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EP-4473995-B1 - A METHOD OF MAKING A STEERABLE INSTRUMENT COMPRISING A CYLINDRICAL DIAMETER ADAPTATION SECTION

EP4473995B1EP 4473995 B1EP4473995 B1EP 4473995B1EP-4473995-B1

Inventors

  • THISSEN, Mattheus Hendrik Louis

Dates

Publication Date
20260513
Application Date
20170531

Claims (5)

  1. A method of making a steerable instrument (10) for endoscopic and/or invasive type of applications, such as in surgery, the instrument comprising an elongated tubular body (18) having at least one actuation zone (14; 15) at a proximal side of the steerable instrument and at least one bendable zone (16; 17) at a distal side of the steerable instrument, said at least one actuation zone (14; 15) being arranged to control bending of said at least one bendable zone (16; 17) by means of a plurality of longitudinal elements, the method comprising making slits (605) in a first cylindrical element (619) such as to define a first set of one or more adjacent longitudinal elements (602) which may be used as pushing / pulling wires in the assembled state of the steerable instrument, cutting open spaces (631) in a second cylindrical element (621) such as to render a sliding island (618) in each open space (631), which are defined by rigid, cylindrical portions (612a, 612b) and connection elements (617), each open space (631) being associated with one longitudinal element (602), such that when the cutting process is finished, each sliding island (618) is still attached to at least one of an adjacent connection element (617) and rigid, cylindrical portion (612a, 612b) by means of one or more break islands (616; 620), aligning every sliding island (618) with one longitudinal element (602) and connecting or attaching every sliding island (618) to one longitudinal element (602) of the first set of longitudinal elements, and moving the longitudinal elements (602) and respective sliding islands (618) together such as to cause the one or more break islands (616; 620) to break off during moving the longitudinal elements (602) relative to the second cylindrical element (621).
  2. The method according to claim 1, wherein said at least one actuation zone (15) is flexible and arranged to control deflecting of said at least one bendable zone (17) by deflecting said actuation zone (15) about a first angle relative to said axis of symmetry (692) such that said at least one bendable zone (17) is deflected about a second angle which is different from said first angle.
  3. The method according to claim 1 or 2, wherein the method comprises: cutting slits (650) in a third cylindrical element (623) such as to define a second set of one or more adjacent longitudinal elements (635), tangentially and longitudinally aligning the second cylindrical element (621) and third cylindrical element (623) such that every sliding island (618) is aligned with one longitudinal element (635) of the second set of adjacent longitudinal elements (635), and connecting or attaching every sliding island (618) to one longitudinal element (635) of the second set of adjacent longitudinal elements (635).
  4. The method according to claim 3, wherein the steerable instrument has a cylindrical diameter adaptation section (164) comprising a first side and a second side, said one or more longitudinal elements of the first set of longitudinal elements (602) being located at a first distance from an axis of symmetry (692) of the steerable instrument at said first side and said one or more longitudinal elements of the second set of longitudinal elements (635) being located at a second distance from said axis of symmetry (692) at said second side, said first distance being different from said second distance, said one of the second set of longitudinal elements (635) is attached to a flexible longitudinal element (633) which is also part of said third cylindrical element (623) and located outside said cylindrical diameter adaptation section (164) and inside said actuation zone (15).
  5. The method according to any of the preceding claims, wherein said elongated tubular body (18) has at least one other actuation zone (14) at said proximal side of the steerable instrument and at least one other bendable zone (16) at said distal side of the steerable instrument, said at least one other actuation zone (14) being arranged to control bending of said at least one other bendable zone (16) by means of an other plurality of longitudinal elements (677).

Description

The invention relates to a method of making a steerable instrument for endoscopic and/or invasive type of applications, such as in surgery, the instrument comprising an elongated tubular body having a cylindrical diameter adaptation section. The steerable instrument according to the invention can be used in both medical and non-medical applications. Examples of the latter include inspection and/or repair of mechanical and/or electronic hardware at locations that are difficult to reach. Hence, terms used in the following description such as endoscopic application or invasive instrument, must be interpreted in a broad manner. Transformation of surgical interventions that require large incisions for exposing a target area into minimal invasive surgical interventions, i.e. requiring only natural orifices or small incisions for establishing access to the target area, is a well-known and ongoing process. In performing minimal invasive surgical interventions, an operator such as a physician, requires an access device that is arranged for introducing and guiding invasive instruments into the human or animal body via an access port of that body. In order to reduce scar tissue formation and pain to a human or animal patient, the access port is preferably provided by a single small incision in the skin and underlying tissue. In that respect the possibility to use a natural orifice of the body would even be better. Furthermore, the access device preferably enables the operator to control one or more degrees of freedom that the invasive instruments offer. In this way, the operator can perform required actions at the target area in the human or animal body in an ergonomic and accurate manner with a reduced risk of clashing of the instruments used. Surgical invasive instruments and endoscopes through which these instruments are guided towards the target area are well-known in the art. Both the invasive instruments and endoscopes can comprise a steerable tube that enhances its navigation and steering capabilities. Such a steerable tube preferably comprises a proximal end part including at least one flexible zone, a distal end part including at least one flexible zone, and a rigid intermediate part, wherein the steerable tube further comprises a steering arrangement that is adapted for translating a deflection of at least a part of the proximal end part relative to the rigid intermediate part into a related deflection of at least a part of the distal end part. Furthermore, the steerable tube preferably comprises a number of co-axially arranged cylindrical elements including an outer element, an inner element and one or more intermediate elements depending on the number of flexible zones in the proximal and distal end parts of the tube and the desired implementation of the steering members of the steering arrangement, i.e. all steering members can be arranged in a single intermediate element or the steering members are divided in different sets and each set of steering members is arranged in a different intermediate member. In most prior art devices, the steering arrangement comprises conventional steering cables with, for instance, sub 1 mm diameters as steering members, wherein the steering cables are arranged between related flexible zones at the proximal and distal end parts of the tube. However, as steering cables have many well-known disadvantages, it is preferred to avoid them and to implement the steering members by one or more sets of longitudinal elements that form integral parts of the one or more intermediate elements. Each of the intermediate elements can be fabricated either by using a suitable material addition technique, such as injection moulding or plating, or by a suitable material removal technique, such as laser cutting, photochemical etching, deep pressing, conventional chipping techniques such as drilling or milling or high-pressure water jet cutting systems. Of the aforementioned material removal techniques, laser cutting is very advantageous as it allows a very accurate and clean removal of material under reasonable economic conditions. Further details regarding the design and fabrication of the abovementioned steerable tube and the steering arrangement thereof have been described for example in WO 2009/112060 A1, WO 2009/127236 A1, US 13/160,949, and US 13/548,935 of the applicant. Steerable invasive instruments typically comprise a handle that is arranged at the proximal end part of the steerable tube for steering the tube and/or for manipulating a tool that is arranged at the distal end part of the steerable tube. Such a tool can for example be a camera, a manual manipulator, e.g. a pair of scissors, forceps, or manipulators using an energy source, e.g. an electrical, ultrasonic or optical energy source. In this application, the terms "proximal" and "distal" are defined with respect to an operator, e.g. a physician that operates the instrument or endoscope. For example, a proximal end part is to b