Integration of robotic arms with surgical probes

Abstract

To provide favorable integration of robotic arms with surgical probes.SOLUTION: Embodiments of the present disclosure provide improved methods and apparatus for coupling a probe to an instrument device manipulator (e.g., robotic arm). In some embodiments, a probe, which may be carried by a handpiece, is configured to couple to an end of a device manipulator of a robotic arm. A transmission can be provided that is configured to couple to the probe and also couple to the instrument device manipulator. The transmission can be configured to receive motion input from the instrument device manipulator and translate the motion input into motion of the probe. The transmission can provide improved movement of the probe. By decreasing the number of components on the handpiece and the probe, the handpiece and the probe can be provided as a sterile, single-use consumable device and the transmission can be reused.SELECTED DRAWING: Figure 6C

Description

[Technical Field]

[0001] (Related Applications) This application claims priority to U.S. Patent Application No. 16 / 940,085, filed July 27, 2020, and U.S. Provisional Application No. 63 / 044,914, filed June 26, 2020, the disclosures of which are incorporated herein by reference in their entireties.

[0002] The subject matter of this application is related to International Application No. PCT / US2015 / 048695, filed September 4, 2015, and published March 10, 2016 as WO2016 / 037137, and International Application No. PCT / US2020 / 021756, filed March 9, 2020, and published September 10, 2020 as WO2020 / 181290, entitled "ROBOTIC ARMS AND METHODS FOR TISSUE RESECTION AND IMAGING," the entire contents of which are incorporated herein by reference. [Background technology]

[0003] The field of the disclosure relates to the treatment of tissue with energy, and more particularly to surgical implements used in such treatment. Previous approaches to performing such treatment utilize one or more instruments that may be manually controlled or, in some cases, attached to an instrument device manipulator, such as a robotic arm.

[0004] Research relevant to the present disclosure suggests that at least some previous treatment devices are sub-ideally suited for coupling with a robotic arm. Robotic arms used in surgical systems typically have motors on the end of the arm. Because these motors are on the end of the arm, their size and performance characteristics are somewhat limited. Also, at least some previous surgical instruments are less suited for installation on a robotic arm. For example, at least some previous instruments may have performance requirements that are not easily met by previous robotic arms.

[0005] In light of the above, there is a need for an instrument that can be easily coupled to a robotic arm and provide improved performance.

[0006] At least some of these shortcomings may be remedied with the present disclosure. Summary of the Invention [Means for solving the problem]

[0007] Embodiments of the present disclosure provide improved methods and apparatus for coupling a probe to an instrument device manipulator (e.g., a robotic arm). In some embodiments, a probe, which may be carried by a handpiece, is configured to couple to the end of the device manipulator of the robotic arm. A translation device can be provided that couples to the probe and is also configured to couple to the instrument device manipulator. The translation device can be configured to receive motion input from the instrument device manipulator and convert the motion input into motion of the probe. The translation device can provide improved movement of the probe. In some embodiments, the translation device can linearly and rotationally move the probe and oscillate the probe according to a predetermined treatment plan. In some embodiments, the translation device is configured to be reusable, and the handpiece and treatment probe are configured as consumables. By reducing the number of components on the handpiece and probe, the handpiece and probe can be provided as sterile, single-use consumable devices, and the translation device can be reused. The present invention provides, for example, the following. (Item 1) 1. A system for treating or imaging a patient, the system comprising: a probe sized for insertion into the patient; a transducer configured to couple to the probe; an instrument device manipulator configured to operably couple to the translation device, the instrument device manipulator comprising one or more motors configured to engage the translation device; Equipped with The system wherein the transducer is configured to receive input from the one or more motors and further configured to transmit input from the one or more motors to the probe to rotate, translate, articulate, or a combination of the probe. (Item 2) Item 10. The system of item 1, wherein the probe is a treatment probe and further comprises an imaging probe sized for insertion into the patient. (Item 3) Item 3. The system of item 2, wherein the imaging probe is a cystoscope. (Item 4) Item 3. The system of item 2, wherein the imaging probe is a TRUS probe. (Item 5) 3. The system of claim 2, wherein the treatment probe is configured for tissue sample collection. (Item 6) 3. The system of claim 2, wherein the conversion device is configured to receive the input from the one or more motors and rotate, translate, articulate, or a combination of the treatment probe. (Item 7) 7. The system of claim 6, wherein the conversion device is configured to receive the input from two or more motors and add the inputs from the two or more motors to an output of the conversion device. (Item 8) Item 10. The system of item 1, wherein the conversion device is configured to provide electrical communication between the instrument device manipulator and the treatment probe. (Item 9) 9. The system of claim 8, wherein the electrical communication comprises an encoder signal from the treatment probe associated with one or more of a position, a translation, and a rotation of the treatment probe. (Item 10) 9. The system of claim 8, wherein the electrical communication includes delivering power to the treatment probe. (Item 11) Item 10. The system of item 1, wherein the conversion device comprises a drive gear on a drive shaft and a driven gear on a driven shaft, the drive shaft and the driven shaft being substantially perpendicular to each other. (Item 12) Item 12. The system of item 11, wherein the drive gear and the driven gear comprise bevel gears. (Item 13) Item 12. The system of item 11, wherein the drive gear and the driven gear comprise spiroid gears. (Item 14) Item 12. The system of item 11, wherein the drive gear and the driven gear comprise worm gears. (Item 15) Item 1, wherein the conversion device comprises a drive gear or drive pulley on a drive shaft and a driven gear or driven pulley on a driven shaft, the drive shaft and the driven shaft being generally parallel to each other. (Item 16) Item 16. The system of item 15, wherein the drive gear and the driven gear comprise spur gears. (Item 17) Item 16. The system of item 15, wherein the drive gear and the driven gear comprise helical gears. (Item 18) Item 16. The system of item 15, wherein the drive pulley and the driven pulley comprise timing pulleys connected by a timing belt. (Item 19) Item 16. The system of item 15, wherein the drive pulley and the driven pulley comprise timing sprockets connected by a timing chain. (Item 20) Item 10. The system of item 1, wherein the probe further comprises a coupling portion for releasably coupling the probe to the conversion device. (Item 21) 21. The system of claim 20, wherein the coupling is a quick release coupling. (Item 22) 21. The system of claim 20, wherein the coupling provides a locking engagement. (Item 23) Item 10. The system of item 1, wherein the conversion device further comprises a coupling portion for releasably coupling the conversion device to the instrument device manipulator. (Item 24) Item 24. The system of item 23, wherein the coupling comprises a quick release coupling. (Item 25) Item 10. The system of item 1, further comprising one or more force sensors operably coupled to the probe and one or more computing devices, for detecting compression of the patient's tissue using the probe. (Item 26) Item 26. The system of item 25, wherein the one or more force sensors are operably coupled to the instrument device manipulator. (Item 27) Item 1 , the system of item 1, wherein the conversion device is configured to receive the input from one motor of the instrument device manipulator and cause rotational movement of the probe. (Item 28) Item 10. The system of item 1, wherein the conversion device is configured to receive input from two or more motors of the instrument device manipulator to cause rotational movement of the probe. (Item 29) Item 29. The system of item 28, wherein the two motors rotate at the same speed in opposite directions. (Item 30) 30. The system of claim 29, wherein the transducer selectively couples outputs from the two motors to the probe. (Item 31) Item 31. The system of item 30, wherein the conversion device selectively engages outputs from the two motors to the probe in sequence. (Item 32) Item 32. The system of item 31, wherein the conversion device is configured to selectively engage one of the two motors with the probe at a time. (Item 33) Item 31. The system of item 30, wherein the conversion device further comprises a clutch configured to selectively engage outputs from the two motors to the probe. (Item 34) Item 34. The system of item 33, wherein the clutch is a power-operated clutch. (Item 35) Item 31. The system of item 30, wherein the conversion device further comprises a torsional impact spring configured to absorb at least a portion of torsional stresses as the probe is rotated. (Item 36) Item 31. The system of item 30, wherein a first of the two motors comprises a first rotary inertia flywheel carried by a first output shaft. (Item 37) Item 37. The system of item 36, wherein a second of the two motors comprises a second rotary inertia flywheel carried by a second output shaft. (Item 38) Item 10. The system of item 1, wherein the conversion device is a step-down conversion device. (Item 39) Item 1, wherein the converter is a step-up converter. (Item 40) Item 10. The system of item 1, wherein the conversion device is configured to rotate the probe at a rate of up to 10 revolutions per second. (Item 41) Item 10. The system of item 1, wherein the conversion apparatus further comprises a rotational / linear conversion device. (Item 42) Item 42. The system of item 41, wherein the rotary / linear conversion device comprises a rack and pinion system. (Item 43) Item 42. The system of item 41, wherein the rotary / linear conversion device comprises a belt drive. (Item 44) Item 42. The system of item 41, wherein the rotary / linear conversion device comprises a chain drive. (Item 45) Item 42. The system of item 41, wherein the rotary / linear conversion device comprises a lead screw. (Item 46) Item 42. The system of item 41, wherein the rotary / linear conversion device comprises a ball screw. (Item 47) Item 42. The system of item 41, wherein the rotary / linear conversion device comprises a roller screw. (Item 48) Item 10. The system of item 1, further comprising an imaging probe. (Item 49) Item 49. The system of item 48, wherein the translation device is configured to receive input from one of the one or more motors to linearly translate the imaging probe. (Item 50) Item 1, wherein the instrument device manipulator is a first instrument device manipulator and the system further comprises a second instrument device manipulator. (Item 51) Item 51. The system of item 50, wherein the first instrument device manipulator is configured to provide movement of the probe and the second instrument device manipulator is configured to provide movement of an imaging probe. (Item 52) Item 52. The system of item 51, wherein the probe and the imaging probe are carried by a handpiece. (Item 53) Item 53. The system of item 52, wherein the first instrument device manipulator is coupled to the handpiece by a first translation device. (Item 54) Item 54. The system of item 53, wherein the second instrument device manipulator is coupled to the handpiece by a second translation device. (Item 55) Item 43. The system of item 42, wherein one or more of the first translation device and the second translation device is a right-angle shaft translation device. (Item 56) Item 43. The system of item 42, wherein one or more of the first conversion device and the second conversion device are parallel shaft conversion devices. (Item 57) Item 10. The system of item 1, wherein the transducer is operably coupled to the probe by a shaft coupler. (Item 58) Item 10. The system of item 1, wherein the probe is configured to be coupled to the conversion device before the conversion device is coupled to the instrument device manipulator. (Item 59) Item 10. The system of item 1, wherein the probe is configured to be coupled to the conversion device after the probe is inserted into the patient. (Item 60) Item 10. The system of item 1, wherein the probe is positionable by the instrument device manipulator in an X direction, a Y direction, a Z direction, or a combination. (Item 61) Item 61. The system of item 60, wherein the probe is positionable by the instrument device manipulator based at least in part on instructions from a computing device. (Item 62) Item 61. The system of item 60, wherein the probe is positionable by the instrument device manipulator based at least in part on manual manipulation. (Item 63) Item 63. The system of item 62, wherein the instrument device manipulator is manually adjustable to adjust the probe in one or more of at least one rotational axis or at least one translational axis. (Item 64) Item 10. The system of item 1, wherein the conversion device further comprises an electrical connector configured to electrically couple the conversion device to the instrument device manipulator. (Item 65) Item 65. The system of item 64, wherein the electrical connector is a first electrical connector and the conversion device further comprises a second electrical connector configured to electrically couple the conversion device to the probe. (Item 66) Item 66. The system of item 65, wherein the conversion device is configured to electrically couple the instrument device manipulator and the probe. (Item 67) Item 10. The system of item 1, wherein the probe is a water jet and further comprises a pressure regulator configured to dynamically vary water pressure to the water jet. (Item 68) 1. A translation device configured to couple a probe to an instrument device manipulator, the translation device comprising: a first coupler for selectively engaging the instrument device manipulator; a second coupler for selectively engaging the probe; a first linkage configured to engage the tool device manipulator and receive motion input from the tool device manipulator; a second linkage configured to operably couple with the probe; Equipped with The translation device is configured to transfer motion input received from the instrument device manipulator to the probe. (Item 69) Item 69. The conversion device of item 68, wherein the probe is a treatment probe and further comprises an imaging probe coupled to the conversion device. (Item 70) 70. The conversion device of item 69, wherein the motion input is a rotational input and the conversion device is configured to receive the rotational input from the instrument device manipulator and rotate, translate, articulate, or perform a combination of the treatment probe. (Item 71) Item 69. The conversion device of item 68, wherein the conversion device is configured to provide electrical communication between the instrument device manipulator and the probe. (Item 72) Item 69. The conversion device of item 68, further comprising an electrical connector for establishing electrical communication with the instrument device manipulator when the conversion device is coupled to the instrument device manipulator. (Item 73) Item 73. The conversion device of item 72, further comprising an electrical signal processor for processing the position encoding signal and providing an improved position measurement of the probe. (Item 74) Item 73. The conversion device of item 72, further comprising an electrical signal processor for processing camera signals from an imaging system arrayed alongside the probe. (Item 75) Item 73. The conversion device of item 72, further comprising an electrical signal processor for processing the position encoding signal and providing an improved position measurement of the second treatment probe. (Item 76) Item 69. The conversion device of item 68, wherein the conversion device comprises a driven gear on a driven shaft, the driven gear being in meshing contact with a drive gear on a drive shaft of the instrument device manipulator. (Item 77) Item 77. The conversion device of item 76, wherein the drive shaft and the driven shaft are positioned substantially perpendicular to each other. (Item 78) Item 77. The conversion device of item 76, wherein the drive shaft and the driven shaft are substantially parallel to each other. (Item 79) Item 77. The conversion apparatus of item 76, wherein a drive gear of the instrument device manipulator provides rotational movement of the probe and the driven gear provides linear translation. (Item 80) Item 77. The conversion apparatus of item 76, wherein a drive gear of the instrument device manipulator provides rotational motion of the probe and the driven gear provides rotational motion. (Item 81) Item 77. The conversion apparatus of item 76, wherein a drive gear of the instrument device manipulator provides rotational movement of the probe and the driven gear provides linear translation. (Item 82) Item 69. The conversion device of item 68, wherein the first coupler is a quick release coupler. (Item 83) Item 69. The conversion device of item 68, wherein the conversion device receives input from two motors of the instrument device manipulator, the two motors configured to rotate in opposite directions. (Item 84) Item 84. The conversion device of item 83, wherein the conversion device transmits input from two motors of the instrument device manipulator to the probe, causing the probe to oscillate a predetermined number of degrees about the longitudinal axis of the probe. (Item 85) Item 85. The conversion device of item 84, wherein the conversion device is configured to selectively engage and disengage the two motors and the probe therefrom. (Item 86) Item 86. The conversion device of item 85, further comprising a clutch mechanism operable to selectively engage and disengage the two motors and the probe therefrom. (Item 87) Item 87. The conversion device of item 86, wherein the clutch mechanism is electrically actuatable. (Item 88) Item 85. The conversion device described in item 84, wherein the conversion device transmits inputs from two motors of the instrument device manipulator to the probe in response to instructions from a computing device. (Item 89) Item 69. The conversion device of item 68, wherein the probe is an imaging probe and the conversion device is configured to convert motion input received from the instrument device manipulator into linear motion of the imaging probe. (Item 90) Item 69. The conversion device of item 68, wherein the conversion device is configured to receive two or more inputs from the instrument device manipulator. (Item 91) Item 91. The conversion device of item 90, wherein the conversion device is configured to receive the two or more inputs and combine the two or more inputs into a single output. (Item 92) Item 91. The conversion device of item 90, wherein the conversion device is configured to receive five or more inputs from the instrument device manipulator. (Item 93) 76. The conversion apparatus of claim 74 or 75, wherein the input from the instrument device manipulator comprises a rotational input. (Item 94) Item 94. The conversion device of item 93, wherein each of the rotational inputs comprises a gear coupled to a motor. (Item 95) A conversion device, a first coupling portion configured to operably couple to the probe; a second coupling portion configured to operably couple to an instrument device manipulator; an electrical system interface configured to provide electrical communication between the probe and the instrument device manipulator; A conversion device comprising: (Item 96) Item 96. The conversion device of item 95, wherein the conversion device is configured to convert input motion from the instrument device manipulator into motion of the probe. (Item 97) Item 97. The conversion device of item 96, wherein the input motion is a rotational motion and the motion of the probe is a rotational motion. (Item 98) Item 97. The conversion device of item 96, wherein the input motion is rotational motion and the probe motion is linear motion. (Item 99) 1. A system for treating or imaging a patient, comprising: a probe sized for insertion into the patient; an instrument device manipulator configured to operably couple to the probe, the instrument device manipulator comprising one or more motors configured to engage the probe; Equipped with The system wherein the probe is configured to receive input from the one or more motors and further configured to transmit rotational input from the one or more motors to the probe to rotate, translate, articulate, or a combination thereof. (Item 100) Item 99. The system of item 99, further comprising a conversion device coupled between the probe and the instrument device manipulator, the conversion device configured to transmit the output of the one or more motors to the probe. (Item 101) 10. The system of claim 1, wherein the probe is configured to provide energy for hemostasis of the treated tissue. (Item 102) Item 102. The system of item 101, wherein the energy for hemostasis is applied without simultaneous image guidance. (Item 103) 2. The system of claim 1, wherein the probe is configured to treat or remove kidney stones. (Item 104) 20. The system of any one of the preceding items, wherein the probe is configured to treat or remove cancer. (Item 105) 10. The system of claim 1, wherein the conversion device is at least partially enclosed within a housing. (Item 106) Item 106. The system of item 105, wherein the housing includes one or more openings through which one or more inputs and / or one or more outputs can extend to operably couple the conversion device to another component. (Item 107) Item 106. The system of item 105, wherein the conversion device is configured to be decoupled from the instrument device manipulator and the probe in a freestanding configuration of the conversion device, and the housing at least partially encloses the conversion device. (Incorporated by reference)

[0008] All patents, applications, and publications referenced and identified herein are incorporated by reference in their entirety and shall be considered incorporated by reference in their entirety even if referenced elsewhere in this application. [Brief explanation of the drawings]

[0009] A better understanding of the features, advantages, and principles of the present disclosure will be obtained by reference to the following detailed description and accompanying drawings that set forth illustrative embodiments.

[0010] [Figure 1] FIG. 1 shows a front view of a system for performing tissue ablation in a patient, according to some embodiments.

[0011] [Figure 2] FIG. 2 diagrammatically illustrates a system for performing tissue ablation in a patient, according to some embodiments.

[0012] [Figure 3] 3A and 3B show perspective views of a common base or mount for supporting one or more robotic arms, according to some embodiments.

[0013] [Figure 4A] 4A and 4B illustrate perspective and side views, respectively, of a system for performing tissue resection in a patient, including a mobile base, according to some embodiments. [Figure 4B] 4A and 4B illustrate perspective and side views, respectively, of a system for performing tissue resection in a patient, including a mobile base, according to some embodiments.

[0014] [Figure 5] 5A and 5B show top views of the coupling between a treatment probe and a first robotic arm according to some embodiments, with FIG. 5A showing the treatment probe and first robotic arm uncoupled and FIG. 5B showing the treatment probe and first robotic arm coupled.

[0015] [Figure 6A]FIG. 6A diagrammatically illustrates an exemplary end of an instrument device manipulator having five links and an electrical port, according to some embodiments.

[0016] [Figure 6B] FIG. 6B diagrammatically illustrates a system for coupling a handpiece to an instrument device manipulator using a right-angle shaft translation apparatus, according to some embodiments.

[0017] [Figure 6C] FIG. 6C diagrammatically illustrates a system for coupling a handpiece to an instrument device manipulator using a right-angle translation device, according to some embodiments.

[0018] [Figure 7A] FIG. 7A diagrammatically illustrates a system for coupling a handpiece to an instrument device manipulator by a parallel shaft translation apparatus, according to some embodiments.

[0019] [Figure 7B] FIG. 7B diagrammatically illustrates a system for coupling a handpiece to an instrument device manipulator by a parallel shaft translation apparatus, according to some embodiments.

[0020] [Figure 8] FIG. 8 diagrammatically illustrates a system for coupling a handpiece to an instrument device manipulator by a right-angle shaft translation device with a motorized scope, according to some embodiments.

[0021] [Figure 9] FIG. 9 diagrammatically illustrates a system for coupling a handpiece to an instrument device manipulator by a parallel shaft translation apparatus with a motorized scope, according to some embodiments.

[0022] [Figure 10]FIG. 10 diagrammatically illustrates a system for coupling a handpiece to an instrument device manipulator by a right-angle shaft translation apparatus that provides two rotary motors for coupling to a surgical instrument, according to some embodiments.

[0023] [Figure 11] FIG. 11 diagrammatically illustrates a system for coupling a handpiece to an instrument device manipulator by a parallel shaft translation apparatus that provides two rotary motors for coupling to a surgical instrument, according to some embodiments.

[0024] [Figure 12] FIG. 12 diagrammatically illustrates a system for coupling a handpiece to an instrument device manipulator by a right-angle shaft translation device providing two rotary motors coupled to a surgical instrument with a motorized scope, according to some embodiments.

[0025] [Figure 13] FIG. 13 diagrammatically illustrates a system for coupling a handpiece to an instrument device manipulator by a parallel shaft translation device providing two rotary motors coupled to a surgical instrument with a motorized scope, according to some embodiments.

[0026] [Figure 14] FIG. 14 schematically illustrates a system for coupling a handpiece to an instrument motor driver that provides two rotary motors, according to some embodiments.

[0027] [Figure 15] FIG. 15 schematically illustrates a system for coupling a handpiece to an instrument motor driver that provides two rotary motors that provide high speed motor direction switching, according to some embodiments.

[0028] [Figure 16]FIG. 16 diagrammatically illustrates a system for coupling a handpiece to an instrument device manipulator by a parallel shaft translation apparatus providing two rotary motors, according to some embodiments.

[0029] [Figure 17] FIG. 17 diagrammatically illustrates a system for coupling a handpiece with two instrument device manipulators and a driven scope, according to some embodiments.

[0030] [Figure 18] FIG. 18 diagrammatically illustrates a system for coupling a handpiece with two instrument device manipulators, with a right-angle shaft translation device and a scope actuated by one instrument device manipulator, according to some embodiments.

[0031] [Figure 19] FIG. 19 diagrammatically illustrates a system for coupling a handpiece and two instrument device manipulators with a right-angle translation device coupled to one instrument device manipulator for controlling the handpiece and a second instrument device manipulator for controlling a second treatment probe, according to some embodiments.

[0032] [Figure 20] FIG. 20 diagrammatically illustrates a system for coupling a handpiece and two instrument device manipulators, according to some embodiments, where one instrument device manipulator is coupled to the handpiece using a right-angle translation device and another instrument device manipulator is coupled to an imaging probe.

[0033] [Figure 21] FIG. 21 diagrammatically illustrates a system for coupling a handpiece to an instrument device manipulator and an imaging probe to another instrument device manipulator by a right-angle translator, according to some embodiments.

[0034] [Figure 22] FIG. 22 diagrammatically illustrates coupling a handpiece and imaging probe to three instrument device manipulators, according to some embodiments. DETAILED DESCRIPTION OF THE INVENTION

[0035] Detailed Description The following detailed description provides a deeper understanding of the features and advantages of the invention described in this disclosure in accordance with the embodiments disclosed herein. While the detailed description includes many specific embodiments, these are provided by way of example only and should not be construed as limiting the scope of the invention disclosed herein.

[0036] Embodiments of the present disclosure provide improved methods and devices for performing tissue diagnostic or therapeutic procedures, such as tissue ablation, e.g., prostate tissue ablation. The methods and devices disclosed herein are well suited to many types of surgical procedures and can be incorporated into many previous systems and methods. While some implementations of the present disclosure are directed to transurethral treatment of the prostate, some aspects of the disclosure may also be used in conjunction with instruments used to treat and modify other tissues and associated organs, such as, but not limited to, the brain, heart, lungs, intestines, eyes, skin, kidneys, liver, pancreas, stomach, uterus, ovaries, testes, bladder, ears, nose, mouth, bone marrow, adipose tissue, muscle, glandular and mucosal tissue, spinal cord and nerve tissue, soft tissue such as cartilage, hard biological tissue such as teeth and bone, and body lumens and passageways such as sinuses, ureters, colon, esophagus, pulmonary passageways, blood vessels, and throat. The devices disclosed herein may be inserted through existing body lumens or through openings created in body tissue.

[0037] The disclosed methods and devices are highly suitable for use in devices used to treat many types of tissue using an energy source. The tissue may include soft tissue, such as glandular or capsular tissue, or hard tissue, such as bone or obstructions like kidney stones. The energy source may include one or more of a laser beam, a water jet, an electrode, ultrasound, high-intensity focused ultrasound, mechanical vibration, radiofrequency (RF) energy, an ultrasound transducer, microwave energy, cavitation energy, such as a cavitation-forming water jet or ultrasonic cavitation, radiation, such as ionizing radiation from a radioisotope, or ion energy from an ionizing electrode, or plasma energy from a plasma electrode. The disclosed methods and devices are highly suitable, for example, for performing lithotripsy and destroying kidney stones. The disclosed methods and devices are also highly suitable for treatment using radiation, such as a radioisotope on a treatment probe. Radiation therapy can be delivered to the probe, removed using the probe, or implanted from the treatment probe, for example, for the treatment of cancer.

[0038] The disclosed methods and devices are highly suitable for attaching a therapeutic probe to a robotic arm for use in diagnostic or therapeutic procedures. For example, the robotic arm can be coupled to a suitable therapeutic probe to treat and / or remove kidney stones by performing procedures such as shock wave lithotripsy, cystoscopy and ureteroscopy, transurethral nephroureterolithotripsy, or other therapeutic methodologies for treating and / or removing kidney stones. Similarly, the disclosed methods and devices are highly suitable for attaching a therapeutic probe to a robotic arm for use in diagnosing, treating, and / or removing cancer. For example, the disclosed methods and devices are highly suitable for use in ultra-chemotherapeutic targeted radiation, selective tissue removal, implantation of ablative materials, or other suitable techniques for diagnosing, treating, or removing cancer. In some cases, the robotic arm can be used to perform ablation or coagulation using a suitable energy delivery probe, such as RF, laser, ultrasound energy, water jet, microwave energy, cavitation energy, or other forms of energy. These procedures may be performed with or without simultaneous image guidance. For example, the robotic arm can follow the same or a similar path as the robotic arm used for resection. The location, orientation, and path of the robotic arm can be tracked, stored, and repeated so that subsequent procedures can be performed using the robotic arm without image guidance. For example, an energy source can provide tissue hemostatic treatment after or during a tissue ablation procedure using a water jet or the like. Tissue hemostatic treatment may be performed without image guidance because the controller of the robotic arm has already determined the ablated cavity and can apply hemostatic treatment by following the contours of the ablated cavity. Hemostatic treatment may be performed while the water jet ablation is occurring, such as by a coupled probe following the water jet probe, or after the tissue ablation procedure is complete.

[0039] In some embodiments, the image-guided therapy system includes a therapy probe and an imaging probe. The imaging probe may be configured to provide images of a target site before, during, and / or after the therapy probe performs any of several suitable therapy procedures, such as tissue collection, ablation, cauterization, hemostasis, or resection of the target tissue. The therapy probe and imaging probe may each be coupled to a robotic arm, also referred to herein as an instrument device manipulator, under the control of one or more computing devices to enable more precisely controlled movement of one or both arms and improve the safety and efficiency of therapy using the therapy system. The therapy probe and imaging probe may alternatively or additionally be under the control of signals received from a joystick, GUI, or other form of manual controller. The therapy probe and imaging probe may be coupled to a single instrument device manipulator, or each may be coupled to a separate instrument device manipulator.

[0040] The robotic arm can be configured in many ways. Research relevant to this disclosure suggests that a transrectal ultrasound (TRUS) probe can exert a force on the robotic arm. In some embodiments, this force is related to a force from the patient on the probe. In some embodiments, this force is related to a force caused by the performing surgeon moving the probe relative to the tissue, displacing the tissue, for purposes of improving imaging or tissue positioning for the intended treatment. The length of the probe can result in a corresponding torque on the robotic arm.

[0041] The inventors have conducted experiments to determine the amount of force that can be applied to the robotic arm from a TRUS probe. This force can be measured, for example, at a motor mount external to the patient. The force can range from 0 to approximately 5 kilograms (0 to 49 Newtons), depending on the surgical placement of the probe and the patient. In some embodiments, the distance from the arm to the point of contact with the prostate corresponds to the amount of torque on the arm.

[0042] Instrument positioning can have three categories of motion control and capabilities according to some embodiments disclosed herein. The three categories of motion generally include: 1) coarse motion capabilities for movement, retraction, and surgical preparation, 2) intermediate motion capabilities for aligning the probe with and inserting the probe into the patient, and 3) fine motion capabilities to accommodate positional tolerances for precise surgery.

[0043] The coarse movement capability allows for retraction, for example, below and adjacent to the table during patient positioning.

[0044] The intermediate motion allows for instrument positioning relative to a surgical support structure, e.g., a patient on an operating room ("OR") table, for example, when the system is prepared and positioned for patient entry. A typical range of positions for a TRUS probe or any suitable surgically invasive probe is one with free motion for insertion into a patient, which can be described using an X, Y, Z coordinate system. Using an appropriate coordinate reference system, entry into the patient's lumen may correspond to a value of 0, 0, 0 in the X, Y, Z coordinate system. The coordinate reference may also include an X', Y', Z' angular coordinate reference. Entry into the lumen may include the patient's anus. With the anal inlet at 0, 0, 0 and the probe collinear with the patient axis, the intermediate motion may include an X motion tolerance of + / - 2 to 15 cm, a Y motion tolerance of + / - 2 to 15 cm, and a Z motion tolerance of + / - 2 to 30 cm. In some embodiments, the X and Y motions correspond to translation of the probe along the X and Y coordinate references. The Z-axis position corresponds to movement along the axis of the lumen and may correspond to advancement and retraction of the probe along the body lumen, e.g., translation into and out of the patient. Using X', Y', and Z' angular adjustments, the angular position capabilities may comprise X' + / - 0 to 30 degrees, Y' + / - 0 to 30 degrees, and Z' + / - 0 to 30 degrees relative to the patient's natural axes. Research relevant to the present disclosure suggests that probes with these angular capabilities may be manipulated by a user for insertion into a patient.

[0045] In some embodiments, the fine movement capabilities and tolerances correspond to the configuration of the robotic probe and arm when the probe is positioned within the patient, for example, during tissue ablation and imaging. When the system is used in conjunction with instruments positioned for diagnosis and treatment, the sensors and controls described herein can be configured to prevent tissue damage and position the treatment and imaging probes to obtain reliable, e.g., optimal, images, and the treatment and imaging probes can be precisely positioned and held rigidly in place against tissue pressure. The X, Y, and Z reference frames can be centered on the lumen entrance (and the probe collinear with the patient axis) at 0,0,0. In some embodiments, the X motion tolerance is + / - 0 to 5 cm, the Y motion tolerance is + / - 0 to 5 cm, and the Z motion tolerance is + / - 0 to 15 cm. The X and Y motions generally correspond to translation of the probe, and the Z axis corresponds to advancement and retraction of the probe into and out of the patient. The corresponding angular adjustment ranges for X', Y', and Z' are, for example, X' + / - 0 to 10 degrees, Y' + / - 0 to 10 degrees, and Z' + / - 0 to 15 degrees relative to the patient's natural axes, referenced to the patient's midline with the Z axis extending along the patient's midline. While the above values ​​represent exemplary ranges of motion, robotic arms and surgical probes may provide tighter tolerances for fixed-position configurations of the probe. For example, when the probe is intended to be held in a fixed position, rotational tolerances can be maintained within a + / - 5° tolerance or less, e.g., + / - 3°, for one or more of X', Y', and Z'. For translation, manually set positions can be maintained to a positional tolerance of, for example, 5 mm or less, 3 mm or less, or 2 mm or less for one or more of the X, Y, and Z axes. In some embodiments, these tolerances are maintained for X, Y, Z, and X', Y', and Z'. In some embodiments, the probe is manually set and translation and rotation tolerances are maintained within the values ​​above, which can improve the accuracy of tissue treatment and associated imaging.These tolerances may correspond, for example, to the maximum structural slack or load of the arm with the probe mounted thereon.

[0046] The probe can be manipulated and inserted into the patient in many ways. For example, the probe can be manipulated manually, or a robotic arm can be moved to align with the probe and coupled to it, with the probe maintaining the above tolerances when released by the user, and the arm then supporting the full weight of the patient and probe. The arm can be aligned with the probe manually or with at least some automation, in which sensors and guidance circuitry are used to align the arm with the probe held by the user. The arm may include a coupling structure for engaging the probe with six degrees of freedom, such that the coupling structure on the arm can be precisely aligned with the coupling structure on the probe. The coupling structures can then be engaged and coupled to each other in response to detecting alignment. In some embodiments, a sensor is provided on one or more of the arm or probe to detect alignment between the arm and the probe, and the coupling structure is engaged in response to the detected alignment. The robotic arm may include a linkage coupled to a processor, which controls movement of the arm and aligns the arm with the probe held by the user.

[0047] In some embodiments, the urethral probe has similar dimensional, movement, and tolerance capabilities as a TRUS probe.

[0048] In some embodiments, the probe has a mass in the range of approximately 250 grams to 1,500 grams, and the arm maintains the tolerances described herein with probes having masses within this range.

[0049] A robotic arm as described herein can improve alignment between a therapy probe and an imaging probe, which may include the sagittal plane of the imaging TRUS probe. For example, the therapy probe can be aligned in approximately the same plane along the sagittal plane of the imaging probe. This coplanarity can provide imaging and alignment of the therapy and imaging probe coordinates. In some embodiments, the tolerance for this coplanarity is related to the combination of the width of the therapy probe and the width of the imaging plane capability, e.g., the width of the image captured using ultrasound beamforming. The relative position of the TRUS probe to the therapy probe can be approximately parallel and aligned within an angular tolerance. Alignment can be within a range of + / - 0 (parallel) to about 30 degrees. In some embodiments, the extension axes of the therapy probe and TRUS probe are aligned in an approximately coplanar configuration, with the separation distance between the probes varying along the length of the imaging and therapy probes. For example, the distal tip of the therapy probe can be furthest from the TRUS probe, and the proximal end can be closer to the TRUS probe, with the two probes tilted relative to each other but still approximately coplanar. The inclination between the two probes may be related to the tissue constraints of each unique human natural ostium. The distance between the entrances to the naturally accessible ostium may vary, for example, within a range of about 5 cm to about 25 cm separation.

[0050] In some embodiments, the imaging probe and the therapy probe are aligned such that the therapy probe is within the field of view of the imaging probe. In some embodiments, the alignment is configured to maintain the therapy probe within the field of view of the imaging probe. In some embodiments, the therapy probe is configured to move to a position and the imaging probe is configured to maintain the therapy probe within the field of view.

[0051] FIG. 1 illustrates an exemplary embodiment of a system 400 for performing tissue ablation in a patient. The system 400 may include a treatment probe 450 and an imaging probe 460. The treatment probe 450 may be coupled to a first arm 442, and the imaging probe 460 may be coupled to a second arm 444. One or both of the first arm 442 and the second arm 444 may comprise a robotic arm, also referred to herein as an instrument device manipulator, whose movement may be controlled by one or more computing devices operably coupled to the arms. The treatment probe 450 may comprise a device for performing any suitable diagnostic or therapeutic procedure, which may include cutting, harvesting, ablating, cauterizing, or a combination of these or other treatments, tissue from a target site within a patient. The treatment probe 450 may be configured to deliver sufficient energy from the treatment probe 450 to the target tissue to ablate the target tissue. For example, the treatment probe 450 may comprise an electrosurgical ablation device, a laser ablation device, a transurethral needle ablation device, a water jet ablation device, or any combination thereof. The imaging probe 460 may be configured to deliver sufficient energy from the imaging probe 460 to the target tissue to image the target tissue. The imaging probe 460 may comprise, for example, an ultrasound probe, a magnetic resonance probe, an endoscope, or a fluoroscopy probe. The first arm 442 and the second arm 444 may be configured to be independently adjustable, adjustable according to a fixed relationship, adjustable according to a user-selected relationship, independently lockable, simultaneously lockable, or any combination thereof. The first arm 442 and the second arm 444 may have multiple degrees of freedom, e.g., six degrees of freedom, for manipulating the treatment probe 450 and the imaging probe 460, respectively. The treatment system 400 may be used to perform tissue ablation in a patient's organ, such as the patient's prostate. The patient may be positioned on a patient support 449, such as a bed, table, chair, or platform.The treatment probe 450 may be inserted into a patient's target site along an entry axis coincident with the treatment probe's extension axis 451. For example, the treatment probe 450 may be configured for insertion into the patient's urethra to position the treatment probe's energy delivery region within the patient's prostate. The imaging probe 460 may be inserted into the patient along an entry axis coincident with the imaging probe's extension axis 461 at or adjacent to the patient's target site. For example, the imaging probe 460 may comprise a transrectal ultrasound (TRUS) probe configured for insertion into the patient's rectum to visualize the patient's prostate and surrounding tissue. As shown in FIG. 1 , the first arm 442 and the second arm 444 may be covered with sterile drapes to provide a sterile surgical environment, keep the robotic arms clean, and reduce the risk of damaging the robotic arms. Further details regarding the various components of system 400 suitable for incorporation with embodiments as disclosed herein can be found in U.S. Pat. No. 7,882,841, U.S. Pat. No. 8,814,921, U.S. Pat. No. 9,364,251, and PCT Publication No. WO2013 / 130895, the entire disclosures of which are incorporated herein by reference.

[0052] FIG. 2 schematically illustrates an exemplary embodiment of a system 400 for performing tissue ablation on a patient. The system 400 includes a treatment probe 450 and, optionally, an imaging probe 460. The treatment probe 450 is coupled to a console 420 and a linkage 430. The linkage 430 may include one or more components of a robotic arm 442. The imaging probe 460 is coupled to an imaging console 490. The imaging probe may be coupled to a second robotic arm 444, for example. The patient treatment probe 450 and the imaging probe 460 can be coupled to a common base 440. The patient is supported using a patient support 449. The treatment probe 450 is coupled to the base 440 using a first arm 442. The imaging probe 460 is coupled to the base 440 using a second arm 444. One or both of the first arm 442 and the second arm 444 may comprise a robotic arm whose movement may be controlled by one or more computing devices operably coupled to the arm, as described in further detail herein.

[0053] Although a common base is referenced, the robotic arms can be coupled to a bed rail, a console, or any suitable support structure to support the base of the robotic arms.

[0054] In some embodiments, the system 400 includes a user input device 496 coupled to the processor 423 for a user to manipulate a surgical instrument on the robotic arm. The user input device 496 can be located in any suitable location, for example, on a console, on the robotic arm, or on a mobile base, and there may be one, two, three, four, or more user input devices used in conjunction with the system 400 to provide either redundant means of input, unique input commands, or a combination. In some embodiments, the user input device includes a controller for moving the end of the treatment or imaging probe in response to mechanical movement of the user input device. The end of the probe can be shown on the display 425, and the user can manipulate the end of the probe. For example, the user input device may include a six-degrees-of-freedom input controller, allowing the user to move the input device in six degrees of freedom, with the distal end of the probe moving in response to movement of the controller. In some embodiments, the six degrees of freedom include three translational degrees of freedom and three rotational degrees of freedom. The processor can be configured with instructions for probe control to be switched between automatic image-guided therapy with the energy source and therapy with the energy source, for example, in response to user movement of a user input device.

[0055] The patient is positioned on a patient support 449 so that the treatment probe 450 and the ultrasound probe 460 can be inserted into the patient. The patient can be positioned in one or more of a number of positions, such as prone, supine, upright, or inclined. In some embodiments, the patient is positioned in a lithotomy position, e.g., stirrups may be used. In some embodiments, the treatment probe 450 is inserted into the patient in a first direction on a first side of the patient, and the imaging probe is inserted into the patient in a second direction on a second side of the patient. For example, the treatment probe can be inserted into the patient's urethra from the front of the patient, and the imaging probe can be inserted transrectally into the patient's intestine from the back of the patient. The treatment probe and imaging probe can be positioned within the patient with one or more of urethral tissue, urethral wall tissue, prostate tissue, intestinal tissue, or intestinal wall tissue extending therebetween.

[0056] The treatment probe 450 and the imaging probe 460 can be inserted into a patient in one or more of many ways. During insertion, the first and second arms, respectively, may have a substantially unlocked configuration so that the treatment or imaging probe can be rotated and translated as desired to insert the probe into the patient. When the probe is inserted at a desired location, the arms can be locked. In the locked configuration, the probes can be oriented relative to each other in one or more of many ways, such as parallel, skewed, horizontal, oblique, or non-parallel. It can be useful to determine the orientation of the probe using an angle sensor as described herein to map the imaging probe image data to the treatment probe coordinate reference. Mapping tissue image data to the treatment probe coordinate reference space can enable precise targeting and treatment of tissue identified for treatment by an operator, such as a physician.

[0057] In some embodiments, the treatment probe 450 is coupled to the imaging probe 460 to align the treatment probe 450 based on images from the imaging probe 460. Coupling can be achieved using a common base 440 as shown. Alternatively, or in combination, the treatment probe and / or the imaging probe may include magnets to hold the probe in alignment through the patient's tissue. In some embodiments, the first arm 442 is a movable and lockable arm so that the treatment probe 450 can be positioned at a desired location within the patient. When the probe 450 is positioned at a desired location on the patient, the first arm 442 can be locked using an arm lock 427. The imaging probe can be coupled to the base 440 using a second arm 444, which can be used to adjust the alignment of the imaging probe when the treatment probe is locked in place. The second arm 444 may include a lockable and movable probe, for example, under the control of the imaging system, or console and user interface. The movable arm 444 may be micro-actuable so that the imaging probe 460 may be adjusted relative to the treatment probe 450 with movements as small as, for example, one millimeter.

[0058] In some embodiments, the therapy probe 450 and the imaging probe 460 are coupled to angle sensors so that therapy can be controlled based on the alignment of the imaging probe 460 and the therapy probe 450. A first angle sensor 495 may be coupled to the therapy probe 450 using a support 438. A second angle sensor 497 may be coupled to the imaging probe 460. The angle sensor may comprise one or more of many types of angle sensors. For example, the angle sensor may comprise a goniometer, an accelerometer, and combinations thereof. In some embodiments, the first angle sensor 495 comprises a three-dimensional accelerometer for determining the orientation of the therapy probe 450 in three dimensions. In many embodiments, the second angle sensor 497 comprises a three-dimensional accelerometer for determining the orientation of the imaging probe 460 in three dimensions. Alternatively, or in combination, the first angle sensor 495 may comprise a goniometer for determining the angle of the therapy probe 450 along the extension axis 451 of the therapy probe. The second angle sensor 497 may comprise a goniometer for determining the angle of the imaging probe 460 along the extension axis 461 of the imaging probe 460. The first angle sensor 495 is coupled to the controller 424 of the treatment console 420. The second angle sensor 497 of the imaging probe is coupled to the processor 492 of the imaging console 490. Alternatively, or in combination, the second angle sensor 497 may be coupled to the controller 424 of the treatment console 420.

[0059] The console 420 includes a display 425 coupled to a processor system within the components used to control the treatment probe 450. The console 420 includes a processor 423 having a memory 421. A communication circuit 422 is coupled to the processor 423 and the controller 422. The communication circuit 422 is coupled to the imaging console 490 via a communication circuit 494 of the imaging console. An arm lock 427 of the console 420 may be coupled to the first arm 442 to lock the first arm or to allow the first arm to be freely movable for inserting the probe 450 into a patient.

[0060] Optionally, the console 420 may include components of an endoscope 426 that are coupled to anchors 24 of the treatment probe 450. The endoscope 426 may include components of the console 420 and an endoscope that is insertable with the treatment probe 450 to treat a patient.

[0061] Optionally, console 420 may include one or more modules operably coupled to treatment probe 450 to control aspects of treatment with the treatment probe. For example, console 420 may include one or more of an energy source 22 for providing energy to the treatment probe, a balloon inflation control 26 for affecting inflation of a balloon used to anchor the treatment probe at the target treatment site, an injection / irrigation control 28 for controlling injection and irrigation of the probe, an aspiration control 30 for controlling suction by the probe, an insufflation control 32 for controlling insufflation of the target treatment site (e.g., the prostate), or a light source 33, such as an infrared, visible, or ultraviolet light source, for providing light energy to the treatment probe.

[0062] The processor, controller, and control electronics and circuitry can include one or more of many suitable components, such as one or more processors, one or more field programmable gate arrays (FPGAs), and one or more memory storage devices. In some embodiments, the control electronics controls a graphic user interface (hereinafter "GUI") control panel to provide pre-procedure planning according to user-defined treatment parameters and to provide user control over the surgical procedure.

[0063] The treatment probe 450 may include an anchor 24. The anchor 24 can anchor the distal end of the probe 450 while energy is being delivered to the energy delivery region 20 with the probe 450. The probe 450 may include a nozzle 200.

[0064] The treatment probe 450 may be coupled to the first arm 442 using a linkage 430. The linkage 430 may comprise components for moving the energy delivery region 20 to a desired target location on a patient, for example, based on an image of the patient. The linkage 430 may comprise a first portion 432, a second portion 434, and a third portion 436. The first portion 432 may comprise a substantially fixed tethering portion. The substantially fixed tethering portion 432 may be fixed to a support 438. The support 438 may comprise a frame of reference for the linkage 430. The support 438 may comprise a rigid chassis or frame or housing for firmly or rigidly coupling the first arm 442 to the treatment probe 450. The first portion 432 can remain substantially fixed, while the second portion 434 and the third portion 436 can move and direct energy from the probe 450 to the patient. The first portion 432 may be fixed a substantially constant distance 437 to the anchor 24. The substantially fixed distance 437 between the anchor 24 and the fixed first portion 432 of the linkage allows the treatment to be precisely placed. The first portion 432 may comprise a linear actuator for precisely positioning the high-pressure nozzle 200 within the energy delivery region 20 at a desired axial location along the extension axis 451 of the treatment probe 450.

[0065] The extension axis 451 of the probe 450 generally extends between a proximal portion of the probe 450 near the coupling 430 and a distal end having the anchor 24 attached thereto. The third portion 436 can control a rotation angle 453 about the extension axis 451. During treatment of a patient, a distance 439 between the energy delivery region 20 and the first portion 432 of the coupling can vary with reference to the anchor 24. The distance 439 may be adjusted in a manner 418 responsive to a computer control to set a target location along the extension axis 451 of the treatment probe with reference to the anchor 24. The first portion of the coupling remains fixed, while the second portion 434 adjusts the position of the energy delivery region 20 along the axis 451. The third portion of the coupling 436 adjusts the angle 453 about the axis with reference to the controller 424 so that the distance along the axis at the angle of treatment can be controlled very precisely with reference to the anchor 24. The probe 450 may include a rigid member, such as a spine, extending between the support 438 and the anchor 24 so that the distance from the coupling 430 to the anchor 24 remains substantially constant during treatment. The treatment probe 450 is coupled to a treatment component as described herein to enable treatment with one or more forms of energy, such as mechanical energy from a jet, electrical energy from an electrode, or light energy from a light source, such as a laser source. The light source may include infrared, visible, or ultraviolet light. The energy delivery region 20 can be moved under the control of the coupling 430, such as to deliver a desired form of energy to the patient's target tissue.

[0066] The imaging console 490 may include a memory 493, a communication circuit 494, and a processor 492. The processor 492 in corresponding circuitry is coupled to the imaging probe 460. An arm controller 491 is coupled to the arm 444 for precisely positioning the imaging probe 460. The imaging console may further include a display 495-1.

[0067] To facilitate precise control of the treatment probe and / or imaging probe during patient treatment, the treatment probe and imaging probe may each be coupled to a robotic, computer-controllable arm. For example, with reference to system 400 shown in FIG. 2 , one or both of first arm 442 coupled to treatment probe 450 and second arm 444 coupled to imaging probe 460 may comprise a robotic, computer-controllable arm. The robotic arms may be operably coupled to one or more computing devices configured to control movement of the robotic arms. For example, first robotic arm 442 may be operably coupled to processor 423 of console 420, or second robotic arm 444 may be operably coupled to processor 492 of imaging console 490 and / or to processor 423 of console 420. One or more computing devices, such as processors 423 and 492, may comprise computer-executable instructions for controlling movement of one or more robotic arms. The first and second robotic arms may be substantially similar in structure and function, or they may differ to accommodate the specific functional requirements for controlling movement of the treatment probe versus the imaging probe.

[0068] One or both of the robotic arms may be equipped with six, seven, or more joints to allow the arms to move under computer control. Suitable robotic arms are commercially available from several manufacturers, such as RoboDK Inc., Kinova Inc., and other manufacturers.

[0069] One or more computing devices operably coupled to the first and second robotic arms may be configured to automatically control the movement of the treatment probe and / or imaging probe. For example, the robotic arms may be configured to automatically adjust the position and / or orientation of the treatment probe and / or imaging probe during patient treatment according to one or more pre-programmed parameters. The robotic arms may be configured to automatically move the treatment probe and / or imaging probe along a pre-planned or programmed treatment or scan profile, which may be stored on the memory of the one or more computing devices. As an alternative to, or in addition to, automatic adjustment of the robotic arms, the one or more computing devices may be configured to control the movement of the treatment probe and / or imaging probe in response to user input, for example, through a graphical user interface of the treatment device. As an alternative to, or in addition to, automatic adjustment of the robotic arm, the one or more computing devices may be configured to control movement of the treatment probe and / or imaging probe in response to real-time positioning information, for example, in response to anatomical structures recognized in one or more images captured by an imaging probe or other imaging source (from which an acceptable range of motion of the treatment probe and / or imaging probe can be established), and / or position information of the treatment probe and / or imaging probe from one or more sensors coupled to the probe and / or robotic arm.

[0070] 3A and 3B show exemplary embodiments of a common base or mount 440 for supporting one or more robotic arms of an image-guided therapy system as disclosed herein. FIG. 3A shows a patient support 449 including one or more rails 452. The patient support 449 may include a surgical table or platform. One or more robotic arms associated with one or more of the treatment probes or imaging probes may be mounted to the rails 452 such that the rails function as the common base 440. FIG. 3B shows the common base 440 including a floor stand 454 configured to couple to a first robotic arm connected to the treatment probe and / or a second robotic arm connected to the imaging probe. The floor stand 454 may be positioned between the patient's legs during a therapy procedure.

[0071] 4A and 4B illustrate an exemplary embodiment of a treatment system 400 as described herein that includes a mobile base 470. FIG. 4A is a front view of the treatment system 400, and FIG. 4B is a side view. The treatment system 400 includes a treatment probe 450 coupled to a first robotic arm 442 and an imaging probe 460 coupled to a second robotic arm 444. The first robotic arm 442 and the second robotic arm 444 each include a proximal end and a distal end, the distal ends coupled to the treatment probe 450 and the imaging probe 460, respectively, and the proximal ends coupled to a common base 440 that includes the mobile base 470. The first robotic arm 442 may include a first arm coupling structure 504 for coupling to the treatment probe 450, and the second robotic arm 444 may include a second arm coupling structure 505 for coupling to the imaging probe 460. The treatment probe 450 may be coupled to a distal end of the first robotic arm 442 via a mounting device 500, which may include a linkage configured to affect the movement (e.g., rotation, translation, pitch, etc.) of the treatment probe as described herein. The coupling of the treatment probe 450 to the first robotic arm 442 may be fixed, releasable, or user-adjustable. Similarly, the coupling of the imaging probe 460 to the second robotic arm 444 may be fixed, releasable, or user-adjustable.

[0072] The first robotic arm 442 may articulate at one or more first arm joints 443. The imaging arm 444 may articulate at one or more second arm joints 445. Each arm joint 443 or 445 may be operatively coupled to a computer-controllable actuator, such as a stepper motor, to affect movement at the joint. Each arm joint 443 or 445 may comprise one of a variety of kinematic joints, including, but not limited to, a rectangular, revolute, parallel cylinder, cylindrical, spherical, planar, edge slider, cylindrical slider, point slider, spherical slider, or cross cylinder joint, or any combination thereof. Each arm joint 443 or 445 may also comprise a linear, orthogonal, revolute, torsional, or revolute joint, or any combination thereof.

[0073] System 400 may further include a console 420 as described herein, which may be supported by a mobile support 480 separate from the mobile base 470. The console 420 may be operably coupled to the mobile base 470 via a power and communication cable 475 to enable control of a treatment probe 450 coupled to the mobile base via a first robotic arm. The treatment console 420 includes a processor and memory having stored thereon computer-executable instructions for execution by the processor to control various modules or functions of the treatment console, such as the energy source, infusion / irrigation control, aspiration control, and other components as described herein with reference to FIG. 2. The treatment console 420 may further include a display 425 in communication with the processor. The display 425 may be configured to display one or more of the following: subject vital signs, such as heart rate, respiratory rate, temperature, blood pressure, oxygen saturation, or any physiological parameter, or any combination thereof; procedure status; one or more pre-captured images or sequences of images of the treatment site from one or more views; one or more real-time images or sequences of images of the treatment site from one or more views obtained by the imaging probe 460; a treatment mode, such as, but not limited to, cut or coagulation; treatment intensity; time elapsed between treatments; time remaining between treatments; treatment depth; area or volume of the treatment site that has been treated; area or volume of the treatment site that will be treated; area or volume of the treatment site that will not be treated; a set of treatment parameters, including location information for the treatment probe 450 or the imaging probe 460 or both; treatment adjustment controls, such as means for adjusting the treatment depth, treatment intensity, location and / or orientation of the treatment probe 450, imaging depth, or location and / or orientation of the imaging probe 460, or any combination thereof; or system configuration parameters.

[0074] The mobile base 470 may further include one or more computing devices for controlling the movement of one or more robotic arms. For example, the mobile base may include a processor and a memory having computer-executable instructions stored thereon for execution by the one or more processors. The memory may have instructions stored thereon for operating one or more robotic arms coupled to the mobile base. The processor may be operably coupled to the robotic arms via suitable electromechanical components to affect the movement of the robotic arms. For example, one or more joints of the robotic arms may each include a stepper motor, and the processor may be operably coupled to the stepper motor at each joint to actuate the motor by specified increments in specified directions. Alternatively, the one or more robotic arms may be operatively coupled to one or more processors of console 420 or a separate imaging console (such as imaging console 490 shown in FIG. 2), and the one or more console processors may be configured to execute instructions for controlling movement of the one or more robotic arms and may communicate the instructions to the robotic arms via communications circuitry (such as communications circuitry 422 of console 420 or communications circuitry 494 of console 490 shown in FIG. 2). The computer-executable instructions for controlling movement of the robotic arms may be pre-programmed and stored on memory, or may be provided by a user via one or more user inputs before or during treatment of a patient using the treatment system.

[0075] One or more computing devices operably coupled to the first and / or second robotic arms may be configured to control movement of the arms to adjust the pitch, yaw, roll, and / or linear position of the treatment probe and / or imaging probe along the target site.

[0076] The mobile base 470 may include one or more user input devices to allow a user to control the movement of the robotic arms under computer command. For example, as shown in FIGS. 4A and 4B , the mobile base may include a keyboard 474 and / or a footswitch 471, which is operably coupled to the mobile base via a footswitch cable 472. The keyboard 474 and the footswitch 471 may be configured independently or in combination to control the movement of the first robotic arm 442 and / or the second robotic arm 444, for example, via articulation of one or both robotic arms at one or more joints. The keyboard and footswitch may be in communication with one or more processors configured to control the movement of the robotic arms. When a user inputs commands into the keyboard and / or footswitch, the user commands can be received by the one or more processors and converted into electrical signals, which may be transmitted to one or more computer-controllable actuators operably coupled to one or more robotic arms. The keyboard and / or footswitch may control the movement of one or both arms towards or away from a treatment position, a position of interest, a predetermined location, or a user-defined location, or any combination thereof.

[0077] Optionally, the keyboard 474 and footswitch 471 may be configured to independently or in combination to control the operation of the treatment probe 450 and / or the imaging probe 460. For example, the keyboard 474 and / or footswitch 471 may be configured to start, stop, pause, or resume treatment with the treatment probe. The keyboard 474 and / or footswitch 471 may be configured to begin capturing, or to freeze, save, or display on the display 425, an image or sequence of images previously acquired or currently being acquired by the imaging probe.

[0078] The mobile base 470 and mobile support 480 of the console 420 may be independently positionable around a patient supported by a patient support 449, such as a platform. For example, the mobile base 470, which supports the first and second robotic arms and the treatment and imaging probes, may be positioned between the patient's legs, while the mobile support 480, which carries the console 420 and display 425, may be positioned to the side of the patient, such as near the patient's torso. The mobile base 470 or mobile support 480 may include one or more movable elements, such as multiple wheels, that allow the base or support to move. The mobile base 470 may be covered with sterile draping throughout the treatment procedure to prevent contamination and fluid ingress.

[0079] 5A-5B show an exemplary coupling between a treatment probe 450 and a first robotic arm 442. FIG. 5A shows the treatment probe uncoupled from the robotic arm. FIG. 5B shows the treatment probe coupled to the robotic arm. As shown, the treatment probe 450 may be coupled to the robotic arm 442 with an attachment device 500, which may include a reusable motor pack. The treatment probe 450 may be removably coupled to the attachment device 500. The attachment device may further include a connector 502 configured to couple to the robotic arm and lock the attachment device in place. The robotic arm 442 may include a coupling structure 504 disposed at the distal end of the arm configured to lock and receive the connector 502 of the attachment device 500. Once the treatment probe and robotic arm are coupled together, movement of the treatment probe may be controlled by moving the robotic arm (e.g., by articulating one or more joints of the robotic arm under computer control).

[0080] In some embodiments, the treatment probe is coupled to the robotic arm via a quick-release mechanism so that the connection between the probe and the robotic arm can be quickly disconnected to prevent injury to the patient if the robotic arm loses position or is otherwise unable to operate properly. The treatment probe and the robotic arm may be coupled to each other in a number of ways, such as mechanically (e.g., a broom clip) and / or magnetically. For example, in the embodiment shown in FIGS. 5A and 5B , the coupling structure 504 may include a slot 506 having a magnet 508 disposed therein, and the connector 502 may include a ferromagnetic fastener configured to fit within the slot 506 and engage the magnet 508. The coupling structure 504 may further include a latching mechanism 510 for selectively engaging or disengaging the connector 502 with the magnet 508. For example, as shown in FIGS. 5A and 5B , the latching mechanism 510 may include a rotatable knob that can be rotated to affect engagement of the magnet 508 of the coupling structure 504 with the connector 502 of the attachment device 500. The latching mechanism may be engaged or disengaged automatically or manually by a user to respectively couple or uncouple the attachment device 500, and therefore the treatment probe 450 coupled thereto, to the robotic arm 442. In some embodiments, the coupling structure 504 may be operatively coupled to one or more computing devices configured to control the robotic arm, and the one or more computing devices may comprise instructions to release the coupling of the coupling structure to the probe when an error is detected in the operation of the robotic arm.

[0081] In some embodiments, the first robotic arm 442 may be configured to automatically locate the treatment probe 450 in response to sensor location data from one or more of the attachment device 500 or coupling structure 504. The first robotic arm 442 may be operated in a “search” mode, for example, to locate the attachment device 500. In some embodiments, the probe comprises one or more reference targets, and the robotic arm comprises corresponding sensors of sufficient resolution and positioning to identify the relative position of the probe in 3D space. In some embodiments, the processor is configured with instructions to search for the treatment or imaging probe with a mounting structure on the robotic arm, for example, while a user holds the probe stationary as the probe is positioned within a patient.

[0082] The sensors on a robotic arm, such as first robotic arm 442, and on a probe, such as a treatment probe, can be arranged in many ways.

[0083] The processor can be coupled to a sensor near the end of the robot arm or on the probe to dynamically update the relative location during movement of the robot arm while attempting to engage the probe on the arm. The sensor on the robot arm may include multiple sensors, including one or more of capacitance, capacitance displacement, Doppler, inductive, magnetic, optical, radar, sonar, ultrasonic, or Hall-effect sensors, to determine the relative distance between the robot arm and the probe. In some embodiments, the probe includes multiple targets, and the sensor is configured to generate a signal in response to distance from the multiple targets. Alternatively, or in combination, sensors can be located on the probe and targets on the robot arm. In some embodiments, the sensor includes a close-contact mechanical sensor for confirming docking of the probe on or near the robot arm, for example, to sense the position of the probe relative to the robot arm when the probe and arm are within a few millimeters of docking with each other. The close-contact mechanical sensor may include one or more of a micro-motion switch, a whisker touch sensor, or a pin-in-hole contact switch. In some embodiments, the probe and robotic arm include an integrated locking mechanism for providing a non-moving locking engagement in the final position of contact. The integrated locking mechanism may include one or more of magnetic, electromagnetic, latching, screws such as multiple turn latch screws or 1 / 4 turn latch screws, vacuum, or other mechanical means of reversible attachment as would be understood by one of ordinary skill in the art.

[0084] In some embodiments, multiple sensors are used, such as one or more sensors for close separation distances between the probe and the robotic arm, one or more sensors for intermediate separation distances, and one or more sensors for far separation distances. A coarse location sensor, e.g., a beacon, can be used to determine the approximate location of the probe. One or more sensors, e.g., a proximity sensor, can be used for fine location positioning of the probe relative to the robotic arm. In some embodiments, one or more markers on the probe are used in conjunction with a camera and machine vision detection of the one or more markers.

[0085] In some embodiments, a coarse location sensor may be provided, which may be an infrared (IR) beacon, that enables a coarse spatial location for homing detection of the robotic arm to the probe. In some cases, a homing beacon such as an IR beacon enables homing across longer distances compared to sensors that may rely on visual recognition as a baseline.

[0086] In some embodiments, a docking detection sensor confirms that the robotic arm is engaged with or in close proximity to the probe. As an example, a Hall effect sensor can be used in conjunction with a permanent magnet to affect the sensor output. In some embodiments, the Hall effect sensor is noise-resistant, contactless, and has a consistent detection range. Any of several different types of Hall sensors may be utilized; in many cases, the sensor functions as a simple switch and linear range measurement and detection, with the overall output voltage set by the supply voltage and varying proportionally to the strength of the magnetic field. This provides a distance measurement between the sensor and the location magnet, which may be used to measure the distance between the robotic arm and the probe and assist in docking. The sensor and beacon may be located in separate housings on the robotic arm and the probe.

[0087] In some embodiments, position sensing of the robotic arm is performed by an inertial measurement unit (IMU), which may include detection of up to nine axes. In some cases, a six-axis IMU, which may be located within a joint of the robotic arm, can be used for motion detection, vibration detection, position orientation information, redundancy, and backup of the primary encoder signal. The IMU may perform the dual function of docking with the robotic arm and probing the probe for force detection and motion compensation as described herein. The described sensors can be used in combination with any robotic arm or probe described herein.

[0088] According to some embodiments, the procedure for docking the robotic arm with the probe may include an IR beacon to provide a coarse position and spatial location for homing detection, fiducials on either the arm or the probe, optical sensors for viewing the fiducials that can be used to enable fine alignment of the location in the XY plane, and a Hall Effect sensor to detect Z-direction proximity for docking. The IR beacon enables longer-range seeking of the robotic arm's home position relative to the probe. The fiducials and optical sensors may enable high-speed, low-latency detection of the probe's 2D location and orientation by the robotic arm. A user interface, which may be located on the robotic arm, the probe, or the robotic arm control unit, may indicate distance, position, docked status, or other information. In some embodiments, the user interface includes one or more visual cues, such as LED indicators, to indicate the relative positions and / or docking status of the arm and probe.

[0089] 5A and 5B are described in the context of coupling a treatment probe to a first robotic arm, a substantially similar mechanism may also be used to couple an imaging probe to a second robotic arm 444. For example, the coupling structure of the second robotic arm 444 may include a similar coupling mechanism for engaging an attachment device connected to the imaging probe.

[0090] 6A-6C illustrate an exemplary coupling between a handpiece 600 and an instrument device manipulator 602. Throughout this description of various embodiments, the handpiece 600 may comprise any of a variety of instruments, such as, for example, imaging probes, treatment probes, surgical tools, catheters, energy delivery systems, implants, visualization systems, and other instruments that may be desirable to use during patient diagnosis or treatment. In some embodiments, the handpiece 600 may be similar to the mounting device 500 described herein. Also, while references are made to the handpiece 600 being coupled to a translation device, the surgical probe coupled to the translation device may comprise any suitable probe, as described herein. As used throughout this description, references to the instrument device manipulator 602 may refer to a robotic arm. The instrument device manipulator 602 may have one or more motors associated therewith, which may be internally or externally carried by the instrument device manipulator 602. In some embodiments, the tool device manipulator 602 may carry one, two, three, four, five, six, seven, eight, or more motors. One or more of the motors may have an output shaft that is rotatably pivoted by the motor. One or more of the motors of the tool device manipulator 602 may include a linkage (e.g., a gear) on the motor's output shaft. The linkage may include a pinion gear, a bevel gear, a spur gear, a helical gear, a worm drive gear, a planetary gear, or some other type of linkage. The linkage may be coupled to another linkage, a chain, a belt, or some other type of linkage associated with the conversion device 610, to convert the rotational motion of the motor into motion of one or more parts of the handpiece 600. In some cases, the rotational motion of the motor is converted into rotational motion of a component of the handpiece 600, while in some cases, the rotational output of the motor is converted into linear motion of a component of the handpiece 600.The following figures provide exemplary systems for coupling an instrument device manipulator 602 to one or more instruments, such as a handpiece 600, a probe, a scope, or other instruments.

[0091] 6A shows an example end 604 of an instrument device manipulator 602 having five linkages 606 and an electrical port 608. While the illustrated embodiment shows five linkages 606, it should be understood that the instrument device manipulator 602 may have any suitable number of linkages 606, such as two, three, four, five, six, seven, eight, nine, or more. While the linkages 606 are shown as gears, any type or combination of suitable linkages 606 may be used. Examples of linkages for rotational movement include, but are not limited to, round shafts with flats, round shafts with keyhole slots, square or rectangular shafts, splined connections, pentagonal shafts, hexagonal shafts, and the like. The linkages 606 may also provide translational movement. The electrical port 608 may provide power and communications to the handpiece 600, such as to allow signals to pass between the handpiece 600 and a computing device that may implement a treatment plan and control the operation of the instruments in the handpiece 600.

[0092] In some embodiments, each of the plurality of linkages 606 comprises an output of the instrument device manipulator 602, the output comprising an engagement structure for coupling a corresponding engagement structure of an input to a translation device as described herein. In some embodiments, the engagement structure and the corresponding engagement structure comprise a rotatable engagement structure such as one or more of a pinion gear, a bevel gear, a spur gear, a helical gear, a worm drive gear, a planetary gear, a formed shaft, a round shaft with flats, a round shaft with a keyhole slot, a square or rectangular shaft, a splined connection, a pentagonal shaft, a hexagonal shaft, and corresponding structures as described herein.

[0093] 6B shows an exemplary coupling between the handpiece 600 and the instrument device manipulator 602. A translation device 610 couples the handpiece 600 to the instrument device manipulator 602 and transmits output from one or more motors 612 associated with the instrument device manipulator 602 to the handpiece 600. In some embodiments, the translation device 610 is configured to be decoupled from the instrument device manipulator 602 and probe, e.g., the handpiece 600, in a freestanding configuration of the translation device 610, with a housing 611 at least partially enclosing the translation device. The translation device 610 may include deceleration or acceleration capabilities to effectively couple between the motors 612 of the instrument device manipulator 602 and the R-drive, Z-drive, or both of the handpiece 600. In some cases, the translation device 610 can be configured to couple the handpiece 600 to the instrument device manipulator 602 in several configurations. For example, the conversion device 610 can be configured to receive output from one or more motors 612 associated with the instrument device manipulator 602 and transmit motion to any of a variety of handpieces 600. In this manner, the handpiece 600 need not be manufactured to mate with a specific instrument device manipulator 602; rather, the conversion device 610 can be configured to mate with both, so that the handpiece 600 and its associated instrument can be manufactured regardless of the instrument device manipulator 602 to which it may ultimately be coupled.

[0094] In any of the numerous embodiments disclosed herein, the conversion device 610 may be enclosed, e.g., surrounded, at least in part, within a housing 611 that covers the internal components of the conversion device 610. The housing 611 encloses the conversion device internal functions and may comprise any suitable housing, such as a plastic housing, shown in dotted lines throughout the figures. In some cases, an output from the instrument device manipulator 602 passes through the housing and couples to an input of the conversion device 610. The output of the instrument device manipulator comprises an engagement structure and couples to a corresponding engagement structure of the input of the conversion device, which may comprise any suitable shape, as described herein, and generally comprise a rotatable structure. Similarly, an output from the conversion device 610 may extend through the housing to couple to the handpiece 600, in which case the output of the conversion device and the input of the handpiece comprise corresponding engagement structures, as described herein, to couple the handpiece to the conversion device.

[0095] Similarly, the input of the instrument device manipulator 602 may extend through the housing for coupling with the instrument device manipulator 602, for example, using corresponding engagement structure. Similarly, the input from the handpiece 600 may extend through the housing 611 for mechanically coupling to the conversion device 610, for example, using corresponding engagement structure.

[0096] In either case, one or more of the outputs or inputs may pass through the housing 611 to provide coupling between the instrument device manipulator 602, the conversion device 610, and / or the handpiece 600. In some cases, the instrument device manipulator 602 includes one or more outputs, which may extend through the housing. The conversion device may include one or more inputs that extend through the housing and / or one or more outputs that may extend through the housing. Similarly, the handpiece 600 may include one or more inputs that extend through the housing of the conversion device 610.

[0097] The handpiece 600 may include any suitable treatment probe 616, such as a water jet 618, and may be coupled to the instrument device manipulator 602 using an attachment device, which may include a reusable conversion device 610. The reusable conversion device 610 may provide advantages because mechanical and electrical precision can be built into the device with minimal impact on the cost of a single procedure. The handpiece 600 may be removably coupled to the conversion device 610, which may be removably coupled to the instrument device manipulator 602. The removably coupled portion facilitates interchangeability of similar devices, giving surgeons the ability to quickly and easily change between different types of instruments in response to medical needs. The handpiece 600 may include a position encoder 620 configured to transmit a signal associated with the position of the treatment probe 616. The signal may correspond to the rotational angle, position, orientation, translation, or a combination of the treatment probe 616. Additional encoders 620 may be provided to transmit signals associated with the position or orientation of other instruments such as imaging probes, endoscopes, catheters, lasers, microwaves, etc. Similarly, one or more encoders may be provided in conjunction with the instrument device manipulator 602 to determine the position and orientation of the instrument device manipulator 602.

[0098] The translation device 610 may comprise a connector configured to couple to the instrument device manipulator 602 and lock the translation device 610 in place relative to the instrument device manipulator 602. The instrument device manipulator 602 may comprise a coupling structure disposed at the distal end of the arm and configured to securely receive the connector of the translation device 610. Similarly, additional coupling structure may be provided between the translation device 610 and the handpiece 600. Once the handpiece 600 and the instrument device manipulator 602 are coupled together by the translation device 610, movement of the handpiece 600 may be controlled by moving the instrument device manipulator 602 (e.g., by articulating one or more joints of the instrument device manipulator 602 or by actuating one or more motors of the instrument device manipulator 602, under computer control or manual control).

[0099] In some embodiments, the handpiece 600 is coupled to the conversion device 610 by a quick release mechanism such that the connection between the handpiece 600 and the conversion device 610 can be quickly disconnected to prevent injury to the patient if the instrument device manipulator 602 loses position or otherwise fails to operate properly. The quick release mechanism may also facilitate quick change of handpiece 600 and instrument during a procedure when it is desirable to attach an alternate instrument to the instrument device manipulator 602 using the conversion device 610.

[0100] Similarly, the translation device 610 may be coupled to the instrument device manipulator 602 through a similar mechanism that may provide a quick release. The coupling of the handpiece 600 to the translation device 610 and the translation device 610 to the instrument device manipulator 602 may be by similar connecting structures or by different structures. For example, the handpiece 600 may be coupled to the translation device 610 by a magnetic coupling, while the translation device 610 may be coupled to the instrument device manipulator 602 by a mechanical locking structure. Other coupling structures may include a slot with a magnet disposed therein, and a cooperating ferromagnetic fastener may be configured to fit within the slot. The coupling may be provided by a latching mechanism to selectively engage and disengage from the cooperating coupling member. Additionally, the coupling structure may include a rotating knob, a lever, cooperating bosses and pockets, a hook, a latch, a pin, or some other suitable type of connector to releasably secure the handpiece 600 to the conversion device 610 and the conversion device 610 to the instrument device manipulator 602.

[0101] As shown, the instrument device manipulator 602 may have two motors 612. The right-angle translation device linkage 622 shown in FIG. 6B may be geometrically preferable in some cases for the arrangement of the linkages of the arms supporting the instrument device manipulator 602. The first motor 612 has an output shaft carrying a linkage, such as a bevel gear, worm gear, helical gear, or some other configuration. The first motor 612 is coupled to a cooperating linkage of the translation device 610. The translation device 610 is in turn coupled to an instrument, such as a water jet 618, to provide rotational motion for the instrument. In some embodiments, the instrument comprises a distal end, a proximal end, and a lumen extending between the distal and proximal ends. The distal end may carry an energy source, such as a nozzle, and the proximal end may be coupled to a high-pressure fluid source. In some cases, the instrument is maintained in a generally straight line as it is carried by the translation device 610. In some cases, the instrument fits into a groove formed on the exterior of conversion device 610, facilitating rapid insertion and removal of the instrument using conversion device 610. The instrument may be retained by a retaining structure carried by conversion device 610, such as a clip, lever, or some other suitable structure.

[0102] The second motor 614 of the instrument device manipulator 602 has an output shaft carrying a linkage, which may be a bevel gear 622, a worm drive, a helical gear, or some other suitable gear. The second motor 614 is coupled to a cooperating gear of a translation device 610. The translation device 610 is in turn coupled to an instrument, such as a water jet 618, and used to provide translational linear motion for the instrument. In some cases, the translation device 610 comprises a step-up translation device 610, in which case the rotational output of the translation device 610 is faster than the rotational input of the translation device 610. This may be accomplished, for example, by a driven gear 624 having a smaller pitch circle than the drive gear 626. In some embodiments, the driven gear 624 has a fewer number of gear teeth compared to the drive gear 626. Alternatively, the converter 610 may be a step-down converter 610, in which case the driven gear 624 has a larger pitch circle than the meshed driving gear 626. In such a case, the driven gear 624 may have more teeth than the driving gear 626, causing it to rotate at a slower speed than the driving gear 624.

[0103] In some embodiments, the first motor 612 and the second motor 614 of the tool device manipulator 602 are coupled to a single input of the conversion device 610. For example, two or more motors of the tool device manipulator 602 may be coupled together in the conversion device 610 and combine their power into a single output shaft. Additionally, the conversion device 610 may incorporate two or more motors and a conversion device or other leverage to reduce the input from the two or more motors to provide a greater combined torque on the output shaft, or to multiply the input from the two or more motors to provide a higher speed. A step-down conversion device 610 may be useful when torque is preferred over speed, such as for applying a crimping force. A step-up conversion device 610 may be useful when speed is preferred over torque, such as for ultrasonic motion, burr cutting, frictional heating, or other suitable high-speed processes.

[0104] The translation device 610 may comprise a right-angle translation device 610, in which the output shaft of the instrument device manipulator 602 motor is orthogonal (or nearly orthogonal) to the input shaft of the handpiece 600. For convenience in describing various configurations, the handpiece 600 has a longitudinal axis, and the treatment probe 616 (e.g., water jet) extends parallel to the longitudinal axis of the handpiece 600, also referred to as the Z-direction. The XY plane is orthogonal to the Z-direction. In some embodiments, the water jet is translated in the Z-direction by a second motor, also referred to as a Z-drive 630, and rotated about its longitudinal axis by a rotational motor (“R-drive”) 632. The treatment probe 616 translates longitudinally and / or rotatably oscillates under command by a computing device. The computing device sends signals to the instrument device manipulator 602 to operate one or more motors 612, which are coupled to the instrument of the handpiece 600 by a linkage. The handpiece 600 has one or more encoders 620 that transmit signals, such as the location, position, orientation, translation, or some other signal, back to the computing device that indicates a parameter of the handpiece 600 or one or more instruments of the handpiece 600.

[0105] The handpiece 600 may be coupled to the translation device 610 to mechanically couple the R-drive 632 and Z-drive 630 to an instrument of the handpiece 600. For example, the translation device 610 may include a coupler 634, such as a hex shaft coupler, that receives a corresponding shaped structure on the handpiece 600 so that the instrument of the handpiece 600 is drivingly engaged with the translation device 610 when the handpiece 600 is coupled to the translation device 610. Other couplers are also contemplated, including, but not limited to, round couplers with flats, round couplers with keyhole slots, square or rectangular couplers, spline couplers, pentagonal couplers, and the like. Thus, the motor of the instrument device manipulator 602 is coupled to the translation device 610, which transfers the motion of the instrument device manipulator 602 motor to the instrument of the handpiece 600. Once coupled, activation of the instrument device manipulator 602 motors results in R-drive or Z-drive movement of the instrument in the handpiece 600.

[0106] In some embodiments, input from the instrument device manipulator 602 may provide articulation of one or more instruments of the handpiece 600. For example, instruments such as probes, scopes, or other devices may be flexible, compartmentalized, articulated, or have other methods that allow for articulation of the instrument. Input from the instrument device manipulator 602 may be used to articulate the instrument, such as by manipulating wires, for example, by tensioning, twisting, compressing, or some other applied force. The instruments of the handpiece 600 may be rotated, translated, articulated, or a combination of movements in response to forces applied from the instrument device manipulator 602.

[0107] The electrical system interface device 636 may be carried by the translation device 610 and may transmit, condition, or interpret electrical signals between the instrument of the device manipulator 602 and the handpiece 600. The electrical system interface device 636 may include one or more electrical connectors and may electrically couple to the handpiece 600 and the instrument device manipulator 602 when the handpiece 600 is coupled to the instrument device manipulator 602 by the translation device 610. The electrical system interface device 636 may transmit power and / or commands to the handpiece 600 from a computing system or the like, and may transmit signals from the handpiece 600 to the instrument device manipulator 602, such as signals associated with force, imaging, volume, position, direction, orientation, temperature, or some other parameter. It may also provide signal processing between the handpiece 600 and the instrument device manipulator 602, and signal passing to and from the system 400. In some embodiments, the handpiece 600 includes one or more encoders 620 for transmitting signals associated with parameters of the handpiece 600 to a computing system.

[0108] An imaging device, such as a cystoscope 642 , an ultrasound probe, or other type of imaging device, may be carried by the handpiece 600 and manually positioned by the manual position control device 640 .

[0109] FIG. 6C illustrates a system for coupling a handpiece 600 to an instrument device manipulator 602 via a right-angle shaft translation device 610. As shown, the translation device 610 may utilize two R-drive motors 612, 702 for rotational motion, such as to rotatably drive an instrument (e.g., a water jet) about its longitudinal axis. The handpiece 600 may be substantially as described anywhere herein, and the instrument device manipulator 602 may similarly be substantially as described herein, such as in connection with FIGS. 2-6B. The instrument device manipulator 602 may have three or more motors mechanically coupled to the translation device 610. For example, the translation device 610 may receive input from two motors 612, 702 and translate the input into rotational motion of an instrument, such as a treatment probe 616, e.g., a water jet. A third motor of the instrument device manipulator 602 may provide input to a translation device 610, coupled to the handpiece 600, to provide linear motion in the Z-direction, as shown. In the illustrated embodiment, the imaging device (e.g., a cystoscope) may be manually driven rotationally, in the Z-direction, or in some other direction.

[0110] FIG. 7A illustrates a system for coupling a handpiece 600 to an instrument device manipulator 602 by a parallel shaft translation device 610. The parallel shaft translation device 610 connection shown in FIG. 7A may be geometrically preferable in some cases with respect to the arrangement of the connections of the arms supporting the instrument device manipulator 602. The handpiece 600 may be substantially as described anywhere herein, and the instrument device manipulator 602 may likewise be substantially as described herein, such as with reference to FIGS. 2-6 . The instrument device manipulator 602 may have two motors 612, 614 mechanically coupled to the translation device 610, as described herein. The translation device 610, in turn, can be mechanically coupled to the handpiece 600 and any instrument associated with the handpiece 600.

[0111] In some embodiments, the single instrument device manipulator 602 has two or more motors. A first motor 612 is coupled to the handpiece 600 through a translation device 610 and provides an R-drive 632 for an instrument, such as a water jet 618. A second motor 614 is coupled to the handpiece 600 through a translation device 610 and provides a Z-drive 630 for an instrument, such as a water jet. The translation device 610 receives an input shaft from the instrument device manipulator 602 and includes an output shaft that provides driving engagement to the instrument of the handpiece 600. The translation device 610 may include a parallel translation device 610, in which case the input shaft 704 and output shaft 706 are generally parallel. The input shaft 704 can be coupled to the output shaft 706 through any suitable structure, such as cooperating gears, belts, links, chains, or some other linkage that couples the input shaft to the output shaft 706.

[0112] The conversion device 610 may include an electrical system interface device 636 that provides electrical communication between the instrument device manipulator 602 and the handpiece 600, as described herein. The electrical system interface device 636 may include one or more electrical couplers that enable electrical communication between the instrument device manipulator 602 and the handpiece 600, such as for delivering power and unidirectional or bidirectional electrical signals. It may also provide signal processing between the handpiece 600 and the instrument device manipulator 602 and signal passing to and from the system 400.

[0113] The handpiece 600 may include any of several instruments, such as a water jet 618, as shown. A first motor 612 of the instrument device manipulator 602 may be coupled to an R-drive 632 to provide the water jet, and a second motor 614 of the instrument device manipulator 602 may be coupled to a Z-drive 630 to provide the water jet. Although a water jet is used throughout as the instrument of the exemplary handpiece 600 operated by a motor associated with the instrument device manipulator 602, it should be understood that many other types of instruments (e.g., laser, microwave, transducer, etc.) may likewise be operated in the same or similar manner, and the discussion of a water jet in conjunction with the embodiments described herein should not be limiting.

[0114] An imaging device may be associated with handpiece 600 and may be positioned by manual position control device 640. Manual position control device 640 may be any suitable device, but in some embodiments comprises a knob, wheel, handle, cam, gear, or some other structure that allows for selective positioning and locking of the imaging device relative to handpiece 600.

[0115] FIG. 7B illustrates a system for coupling a handpiece 600 to an instrument device manipulator 602 by a parallel shaft translation device 610. The parallel shaft translation device 610 connection shown in FIG. 7B may be geometrically preferable in some cases for the arrangement of the connections of the arms supporting the instrument device manipulator 602. The handpiece 600 may be substantially as described anywhere herein, and the instrument device manipulator 602 may similarly be substantially as described herein, such as with reference to FIGS. 2-6C. The instrument device manipulator 602 may have three motors mechanically coupled to the translation device 610, as described herein. The translation device 610, in turn, may be mechanically coupled to the handpiece 600 and any instrument associated with the handpiece 600.

[0116] As an example, two motors of the instrument device manipulator 602 may be coupled to the handpiece 600 to provide rotational movement of the instrument of the handpiece 600. The two motors may operate in opposite directions to selectively drive the instrument in two rotational directions. A third motor 702 may drive the handpiece 600 or the instrument of the handpiece 600 in the Z-direction. The motors may be engaged with the translation device 610 through any suitable mechanism, as described elsewhere herein, and output from the motors of the instrument device manipulator 602 can be transmitted to the handpiece 600, one or more instruments of the handpiece 600, or other devices useful in a medical procedure.

[0117] 8 illustrates a system for coupling a handpiece 600 to an instrument device manipulator 602 by a right-angle shaft translation device 610 with a motorized imaging probe 806. The handpiece 600 and instrument device manipulator 602 may be substantially as described elsewhere herein, such as with reference to Figures 2-6C, among others. The instrument device manipulator 602 may include three or more motors operably coupled to the translation device 610. The translation device 610 may include a right-angle shaft translation device 610 and corresponding gears may change the orientation of the output shaft relative to the input shaft.

[0118] In some embodiments, the translation device 610 includes a gear with internal teeth that receive the external teeth of the motor gear. In other words, the translation device 610 gear may surround the motor gear as the translation device 610 is coupled to the instrument device manipulator 602. The translation device 610 gear may then mate with another gear to facilitate right-angle shaft translation device 610 configuration.

[0119] A second motor 614 of the instrument device manipulator 602 may couple to a second linkage of the translation apparatus 610 and provide Z-drive for one or more instruments of the handpiece 600. A third motor 802 of the instrument device manipulator 602 may couple to a third linkage 804 of the translation apparatus 610 and provide Z-drive for the imaging device 806. The imaging device 806 may be driven by any suitable mechanism that converts rotational motion of the motor 802 into linear motion of the imaging device 806, such as a rack and pinion, a belt drive, a chain drive, a worm drive, or some other mechanism.

[0120] 8 shows the output of the instrument device manipulator 602 passing through the housing 611 of the translation device 610 and coupling to the translation device within the housing, it should be understood that the input of the translation device may extend through the housing to operably couple to the instrument device manipulator 602. Furthermore, in some embodiments, the surface of the housing may include a receptacle to capture a protrusion from the instrument device manipulator 602. In some embodiments, the instrument device manipulator includes an engagement structure, such as a gear, key, hex, or star shape, that is received within a similarly shaped engagement structure of the translation device. As an example, a gear, key, hex, star, or some other shaped shaft may protrude from the instrument device manipulator 602 and engage with a correspondingly shaped receptacle within the housing or within a surface of the housing.

[0121] FIG. 9 illustrates a system for coupling a handpiece 600 to an instrument device manipulator 602 by a parallel shaft translation apparatus 610 with a motorized imaging device 806. The handpiece 600 and instrument device manipulator 602 may be substantially as described elsewhere herein, such as in connection with FIGS. 2-6C, among others. The embodiment of FIG. 9 may also be substantially similar to that of FIG. 8. However, FIG. 9 shows a parallel shaft translation apparatus 610 as opposed to the right-angle shaft translation apparatus 610 of FIG. 8. The parallel shaft translation apparatus 610 may be as described elsewhere herein and may use any combination of linkages or other suitable structures to transfer power from the instrument device manipulator 602 motor to the instrument of the handpiece 600.

[0122] According to some embodiments, a pressure regulation valve 902 may be provided to control, vary, or adjust the pressure of the water jets 618. In some cases, the pressure regulation valve 902 comprises a throttle valve, a pressure relief valve, or some other suitable mechanism for varying the pressure of water delivered to the water jets 618. The pressure of the water jets 618 may be controlled in response to the angle of the water jets 618. For example, as the water jets 618 are rotated, the water pressure may be higher at some predetermined angular orientations and lower at other predetermined orientations. The tissue treatment profile may indicate the cutting profile of the tissue to be treated, and in some cases, the cutting depth varies along the tissue treatment profile. In these cases, the pressure of the water jets 618 may be varied to affect the tissue treatment profile. In other words, the water pressure may be dynamically varied along the cutting profile to achieve the desired cutting profile.

[0123] In some cases, at a certain rotational orientation relative to the water jet 618, the cutting profile may resemble an ellipse or partial ellipse. The pressure of the water jet 618 may be dynamically controlled to achieve this cutting profile. The pressure of the water jet may be dynamically controlled in any suitable manner, in some cases controlled by one or more valves 902 (e.g., throttle valves, pressure relief valves, pressure control valves), and in other cases the pressure may be controlled by a pump that is driven to achieve variable water pressure that, in combination with the water jet being moved according to the treatment plan, achieves the cutting profile. The water pressure may therefore be rapidly varied as the water jet instrument translates, rotates, and / or oscillates.

[0124] FIG. 10 illustrates a system for coupling a handpiece 600 to an instrument device manipulator 602 via a right-angle shaft translation device 610 that provides two rotary motors for coupling to a surgical instrument. The handpiece 600 and instrument device manipulator 602 may be substantially as described elsewhere herein, such as with reference to FIGS. 2-6C, among others. The instrument device manipulator 602 may include three or more motors that drivingly engage the translation device 610 once the translation device 610 is coupled to the instrument device manipulator 602. Two motors 614, 702 may be used as R-drive motors, with each R-drive motor operating in one rotational direction and two motors operating in opposing rotational directions. The use of two opposing motors facilitates rapid reversal of rotational direction, which can lead to more precise positioning of the water jet and faster tissue resection. The use of two motors may also facilitate improved service life of the device by reducing the duty cycle on the individual motors, thus allowing the internal wiring of each motor to operate at a lower temperature.

[0125] A clutch 1002 may be disposed on the translator shaft to selectively couple to and decouple from one or more of the R-drive motors 614, 702. A second clutch 1004 may optionally be provided, with each clutch configured to selectively couple to and decouple from an associated R-drive motor 614, 702. One or more clutches may be electrically actuated alternately to couple to and decouple from the R-drive motor such that only one Z-drive motor is coupled to the treatment probe 616 at any one time.

[0126] In some cases, a rotational inertia flywheel 1006 may be carried by the R-drive motor output shaft. The rotational inertia flywheel 1006 may be used to increase the rotational inertia of the R-drive motor so that the rotational inertia of the R-drive motor is substantially higher than the rotational inertia of the rotating treatment probe 616 (e.g., water jet). In some embodiments, the R-drive motor spins in only one direction to rapidly change the rotational direction of the treatment probe 616, and the increased rotational inertia of the R-drive motor provides for rapid reversal of the rotational direction of the treatment probe 616. In some cases, the R-drive motor is configured to rotate the treatment probe 616 at a rate of up to 10 revolutions per second (rps) (3,600° / sec). In some embodiments, the treatment probe 616 may rotate through an arc of about 5° to about 235°, and may be configured to rotate through an arc of 15°, 30°, 45°, 60°, 90°, 120°, or 225°, or any arc as determined by the patient's anatomy and the treatment plan established by the surgeon. In some cases where the treatment arc is 60°, the treatment probe 616 may change direction approximately 12 times per second. This can create significant torsional stresses on the treatment probe 616 shaft. In some embodiments, one or more torsional impact springs 1008 are provided to absorb at least a portion of the torsional stresses caused by rapid direction changes.

[0127] The conversion device 610 may carry an electrical system interface device 636, as described herein, to carry signals that operate one or more clutches to engage and disengage the R-drive motor according to a treatment plan. In some cases, the treatment plan defines a volume of ablation, and the water jet 618 is rotatably driven in a sweeping arc according to the treatment plan to remove the appropriate volume of tissue. The electrical system interface device 636 may carry signals from a computer or the like that issues instructions according to the treatment plan to control the rotational speed and clutch timing of the R-drive motors 612, 702 to provide treatment to the desired volume of tissue.

[0128] The Z-drive motor 614 may position the handpiece 600 in the Z-direction according to a treatment plan. By operating the two R-drive motors and the Z-drive motor in conjunction, the water jet may be configured to oscillate and translate at a desired rate to treat a predetermined volume of tissue. In some cases, the Z-drive provides high-speed motion in the Z-direction. For example, the Z-drive 630 may move the water jet 618 at a rate of 30 cm / sec, which corresponds to a jet rotation of 720° / sec at a predetermined cutting depth. In some embodiments, one or more optical encoders 620 are used to sense the rotational travel limits of the water jet and send a signal to reverse the rotational direction of the water jet 618.

[0129] FIG. 11 illustrates a system for coupling a handpiece 600 to an instrument device manipulator 602 by a parallel shaft translation device 610 that provides two rotary motors coupled to a surgical instrument. The handpiece 600 and instrument device manipulator 602 may be substantially as described elsewhere herein, such as with reference to FIGS. 2-6, among others. The illustrated embodiment of the translation device 610 may be substantially similar to the embodiment illustrated in FIG. 10. However, a parallel shaft translation device 610 is shown, as opposed to the right-angle translation device 610 of FIG. 10.

[0130] 12 illustrates a system for coupling a handpiece 600 to an instrument device manipulator 602 by a right-angle shaft translation device 610, which provides two rotary motors coupled to a surgical instrument and a motorized imaging probe 806. The handpiece 600 and instrument device manipulator 602 may be substantially as described elsewhere herein, such as with reference to, inter alia, FIGS. 2-6C. The illustrated embodiment may be similar to the embodiment of FIG. 10, with the addition of a fourth Z-drive motor 1202 coupled to an imaging device 806 (e.g., a cystoscope) and allowing computer control of the position of the imaging device 806 in the Z-direction.

[0131] 13 illustrates a system for coupling a handpiece 600 to an instrument device manipulator 602 by a parallel shaft translation device 610 providing two rotary motors coupled to a surgical instrument (e.g., a treatment probe 616) with a motorized imaging probe 806. The handpiece 600 and instrument device manipulator 602 may be substantially as described elsewhere herein, such as with reference to Figures 2-6C, among others. The illustrated embodiment may be similar to that of Figure 12, with the substitution of a parallel shaft translation device 610 for the right-angle shaft translation device 610.

[0132] FIG. 14 illustrates a system for coupling a handpiece 600 to an instrument motor driver 1402 that provides two rotary motors. In some embodiments, the handpiece 600 is coupled to the instrument motor driver 1402 by a conversion device 610. The instrument motor driver 1402 may be coupled to an instrument device manipulator 602. The handpiece 600 and the instrument device manipulator 602 may be substantially as described elsewhere herein, such as with reference to FIGS. 2-6C, among others. In some cases, the instrument device manipulator 602 may not possess a motor that may be coupled to operate the instrument of the handpiece 600. Thus, in some embodiments, the handpiece 600 is coupled to the conversion device 610, which is in turn coupled to the instrument motor driver. The instrument motor driver 1402 may have two or more motors, such as three, four, five, six, seven, eight, or more motors. The tool motor driver 1402 may be coupled to the translation device 610 by any suitable structure, similar to how the translation device 610 may be coupled to the tool device manipulator 602, as described elsewhere herein.

[0133] As shown, the instrument motor driver 1420 includes two R-drive motors 1404, 1406 that can be operated in opposite directions. One or more clutches 1002, 1004 may be selectively engaged and disengaged to allow each R-drive motor to sequentially engage with the handpiece 600 and rotate the treatment probe 616 in both rotational directions. Another motor of the instrument motor driver 1402 may be coupled to the handpiece 600 and provide Z-direction linear motion. The other motor of the instrument motor driver may be used for other tasks, such as Z-direction translation of the imaging probe, XY linear movement of the handpiece 600, or some other purpose.

[0134] The conversion device 610 may include one or more torsional impact springs 1008 to reduce torsional stresses that would otherwise be imparted to the treatment probe 616 from oscillating back and forth in response to R-drive motor engagement and disengagement therefrom.

[0135] In some cases, the instrument motor driver 1402 is configured to rotationally drive the treatment probe 616, and the motor instrument associated with the device manipulator 602 (e.g., a robotic arm) is used to manipulate the handpiece 600 and its instrument in the X, Y, and Z directions. In some cases, the instrument motor driver 1402 comprises one or more R-drive motors 1404, 1406 for rotating the treatment probe 616, while the instrument device manipulator 602 includes one or more motors for driving the treatment probe 616 in the Z-direction and, optionally, other handpiece 600 instruments in the X, Y, and / or Z directions.

[0136] 15 illustrates a system for coupling a handpiece 600 to an instrument motor driver 1402 that provides two rotary motors 1404, 1406 that provide high speed motor direction switching. The illustrated instrument motor driver 1402 and handpiece 600 may be substantially similar to other embodiments described herein.

[0137] The instrument motor driver 1402 may be coupled to the instrument device manipulator 602, as described above. A conversion device 610 is coupled to the handpiece 600 and the instrument motor driver 1402 and converts rotational motion from the instrument motor driver 1402 into linear and / or rotational movement of the handpiece 600 or the instrument of the handpiece 600. The conversion device 610 may include a linkage 606 for operably coupling the output shaft of a motor associated with the instrument motor driver 1402 to the instrument of the handpiece 600. In some cases, the linkage 606 comprises gears, a chain, a belt, or some other linkage 606. The instrument motor driver 1402 may have two motors configured to drive the treatment probe 616 in one rotational direction, and the two R-drive motors may rotate in opposite directions. Each R-drive motor may vary between drive cycles and be driven in the opposite direction to the other R-drive motor. The operation of the two R-drive motors may be timed so that one motor is driving while the other motor is idle. To change direction, the two motors switch states. In this manner, only one motor actively drives the treatment probe 616 at a time. As the R-drive motors are driven sequentially, the treatment probe 616 oscillates about its longitudinal axis in response to being driven in opposite directions by the motors in turn. The motors may be controlled by a computing device and driven to oscillate the treatment probe 616 according to a treatment plan.

[0138] 15 further illustrates a timing diagram of the R-drive motors 1404, 1406 as they are driven in sequence. One or more electronic modulators may be involved in sequentially driving the two R-drive motors. For example, the first motor 1404 may be driven in cycles of active drive 1502 and idle 1504. Similarly, the second motor 1406 may also be driven in cycles of active drive 1506 and idle 1508. The first motor 1404 and the second motor 1406 may be driven 180 degrees out of phase, such that when the first motor 1404 is actively driving 1502, the second motor is in the idle phase 1506. Similarly, when the second motor is actively driving 1508, the first motor may be in the idle phase 1504.

[0139] In practice, it has been observed that there is a large amount of back electromotive force (EMF) generated when rapidly driving a motor and reversing its direction. The generated back EMF acts against the applied voltage that is causing the motor to spin, reducing the current flowing through the motor's coils. By sequentially turning off the motor, the back EMF is largely isolated as the motor is allowed to idle, thus increasing the efficiency of the system.

[0140] In some embodiments, the motors may be selectively coupled to the treatment probe 616 by the conversion device 610; in some embodiments, as one R-drive motor is engaged with the treatment probe 616, the other motor is idle or otherwise disengaged so as not to drive the treatment probe 616. The R-drive motors may sequentially engage and disengage from the treatment probe 616 such that the treatment probe 616 oscillates in the R-direction according to the treatment plan. Oscillation may be implemented, for example, by including gear teeth around only a portion of the drive gear of the R-drive motor. For example, the drive gear of each R-drive motor may include gear teeth around a discrete portion of its circular pitch. As an example, the drive gear may include 30° of teeth followed by a 30° land, followed by a 30° of teeth followed by a 30° land. The gears may be arranged so that only one gear at a time drives the treatment probe 616, causing the probe to oscillate in the R-direction.

[0141] FIG. 16 illustrates a system for coupling a handpiece 600 to an instrument device manipulator 602 by a parallel-shaft translation device 610 providing two rotational motors. The handpiece 600 and instrument device manipulator 602 may be substantially as described elsewhere herein, such as with reference to FIGS. 2-6C, among others. As shown, two R-drive motors 612, 702 of the instrument device manipulator 602 are coupled to the translation device 610 to provide oscillatory rotation to a treatment probe 616 (e.g., a water jet). The R-drive motor may optionally include a flywheel 1006 to increase the rotational inertia of the R-drive motor. The translation device 610 may include one or more torsional springs 1008 to reduce torsional stress on the treatment probe 616 as it oscillates. A Z-drive motor 614 is coupled to the treatment probe 616 and may linearly translate the treatment probe 616 according to a treatment plan.

[0142] A stationary structure 1602 couples the handpiece 600 to the translation apparatus 610 and may also provide support for an imaging probe 806, such as a cystoscope, a TRUS probe, or some other device. The imaging probe 806 may be manually positioned in the Z-direction or may be driven by a motor associated with the instrument device manipulator 602. An electrical system interface device 636 may be provided, which may be substantially as described anywhere herein, for providing electrical communication to and from the handpiece 600.

[0143] 17 illustrates a system for coupling a handpiece 600 with two instrument device manipulators 602 and a driven imaging probe 616. The handpiece 600 and instrument device manipulators 602, 1704 may be substantially as described elsewhere herein, such as with reference to Figures 2-6C, among others. A first translation device 610 may be coupled to the first instrument device manipulator 602 and the handpiece 600. The first translation device 610 may provide R-drive for the handpiece 600 instrument and / or Z-drive for the handpiece 600 instrument.

[0144] A second translation device 1702 may be coupled to a second instrument device manipulator 1704 and the handpiece 600. The second translation device 1702 may enable a motor associated with the second instrument device manipulator 1704 to provide motion to the instrument of the handpiece 600. As shown, the second instrument device manipulator 1704 provides rotational input from a motor 1706, which is converted by the second translation device 1702 into linear translation to provide Z-drive for the imaging probe 806. With this type of arrangement, two instrument device manipulators can be coupled to a single handpiece 600 to operate various instruments associated with the handpiece 600. In some cases, the instrument device manipulator 602 may not include enough motors to actuate the instruments of all the handpieces 600, in which case two or more instrument device manipulators 602 may cooperate to operate the instruments of the handpieces 600, such as by providing X, Y, and Z positioning of the handpiece 600 and R-drive and Z-drive to one or more instruments of the handpieces 600. An electrical system interface device 636 may electrically couple one or more instrument device manipulators 602 and the handpieces 600, such as to provide power and communication capabilities. The first and second translation devices 610, 1702 may comprise right-angle shaft translation devices, parallel shaft translation devices, or a combination of right-angle and parallel shaft translation devices.

[0145] Figure 18 illustrates a system for coupling a handpiece 600 and two instrument device manipulators 602, 1704, with a right-angle shaft translation apparatus 610 and an imaging probe 806 (e.g., a cystoscope) actuated by one instrument device manipulator 602. The embodiment illustrated in Figure 18 may be substantially similar to that illustrated in Figure 17, except that Figure 18 may include an imaging probe 806 fixed to the instrument device manipulator 1704, the position of which may be directly related to the position of the instrument device manipulator 1704.

[0146] 19 illustrates a system for coupling a handpiece 600 and two instrument device manipulators 602, 1704, with a right-angle translation device 610 coupled to one instrument device manipulator 602 for controlling the handpiece 600 and a second instrument device manipulator 1704 for controlling a second treatment probe 1710. The handpiece 600 and instrument device manipulators 602, 1704 may be substantially as described elsewhere herein, such as with reference to Figures 2-6C, among others. The first instrument device manipulator 602 may have any number of motors for actuating the instrument of the handpiece 600. As shown, three motors are coupled to the handpiece 600 by the first translation device 610. The first conversion device 610 provides a first motor 612 for providing an R-drive to the treatment probe 616, a second motor 614 for providing a Z-drive to the treatment probe 616, and a third motor 712 for providing a Z-drive to the imaging probe 806.

[0147] The second instrument device manipulator 1704 may be coupled to a second translation device 1702 that engages with the handpiece 600. The second instrument device manipulator 1704 may include a first motor 1902 that provides R-drive for the second treatment probe 1710 of the handpiece 600 and a second motor 1706 that provides Z-drive for the second treatment probe 1710. The second treatment probe 1710 may be used for any purpose, such as imaging, delivery of energy (e.g., fluid energy, light energy, microwave energy, thermal energy), delivery of drugs or radiation, or some other purpose. As described above, the electrical system interface device 636 can provide power and communication with the handpiece 600.

[0148] While the illustrated embodiment appears to show two instrument device manipulators 602, 1704 adjacent to one another, it should be understood that the two instrument device manipulators 602, 1704 can be positioned at any orientation relative to one another. For example, the two instrument device manipulators 602, 1704 may be adjacent to one another, opposite one another, perpendicular to one another, or at some other orientation for engaging the conversion device and coupling to the handpiece 600. Similarly, the conversion device may be configured with any suitable configuration, such as a right-angle shaft conversion device, a parallel shaft conversion device, a direct drive conversion device, or some other configuration. Any of the described embodiments may incorporate a right-angle shaft conversion device, a parallel shaft conversion device, a direct drive conversion device, a combination of conversion device types, or some other configuration.

[0149] 20 illustrates a system for coupling a handpiece 600 and two instrument device manipulators 602, 1704, where one instrument device manipulator 602 is coupled to the handpiece 600 using a right-angle translator 610 and another instrument device manipulator 1704 is coupled to an imaging probe 806. The handpiece 600 and instrument device manipulators 602 may be substantially as described elsewhere herein, such as with reference to Figures 2-6, among others. As shown, the first instrument device manipulator 602 may be coupled to the handpiece 600 by a translator 610, such as the right-angle translator 610, and may include one or two R-drive motors, a Z-drive motor coupled to the treatment probe 616, and a Z-drive motor coupled to the imaging probe 806.

[0150] The second instrument device manipulator 602 may be coupled to an imaging probe 2002, such as a TRUS probe. The TRUS probe 2002 may be directly coupled to the instrument device manipulator 1704 or may be coupled to a translation apparatus and driven in the Z-direction by a Z-drive motor of the second instrument device manipulator 1704. Similarly, the TRUS probe 2002 may be rotatably driven and may also pivot in the X or Y directions about an axis. The TRUS probe 2002 may have a protective sheath 2004 centered about its exterior, which may be coupled to the second instrument device manipulator 1704.

[0151] 21 illustrates a system for coupling a handpiece 600 to an instrument device manipulator 602 and an imaging probe 806 to another instrument device manipulator 1704 by a right-angle translation device 610. The handpiece 600 and instrument device manipulators 602, 1704 may be substantially as described elsewhere herein, such as with reference to Figures 2-6C, among others. A first instrument device manipulator 602 may be coupled to the translation device 610, which is in turn coupled to the handpiece 600. The first instrument device manipulator 602 may include three or more motors for actuating the instrument of the handpiece 600. For example, a first R-drive motor 612 actuates rotation of the treatment probe 616 of the handpiece 600, a second Z-drive motor 702 actuates linear translation of the treatment probe 616, and a third motor 614 actuates linear translation of the imaging probe 806 of the handpiece 600.

[0152] The second instrument device manipulator 1704 is coupled to the second translation apparatus 1702 and may include one or more motors. In some embodiments, the second instrument device manipulator 1704 comprises a first motor 1902 for providing rotation of the second imaging probe 2002 (e.g., a TRUS probe) and a second motor 1706 for providing linear translation of the second imaging probe 2002. In some embodiments, the position and orientation of the second imaging probe 2002 may be provided by direct coupling to the second instrument device manipulator 1704, and the position of the second instrument device manipulator 1704 may determine the orientation and position of the second imaging probe 2002. As described above, the electrical system interface device 636 can provide electrical communication with the handpiece 600 and, optionally, the second imaging probe 2002. A fixation element 2102 may secure the handpiece relative to the first translation apparatus 610. This structure allows the handpiece to be spaced apart from, yet still be coupled to, the conversion device 610. The fixation element 2102 may be a rigid structure and provide a secure attachment between the handpiece 600 and the conversion device 610.

[0153] A second fixation element 2104 may couple the protective sheath 2004 to the second translation apparatus 1702, the second instrument device manipulator 104, or both. In some embodiments, the second fixation element provides a fixed and secure coupling between the sheath 2004 and the second translation apparatus 1702.

[0154] FIG. 22 illustrates the coupling of three instrument device manipulators 602 to a handpiece 600 and an imaging probe 806. The handpiece 600 and instrument device manipulator 602 may be substantially as described elsewhere herein, such as with reference to FIGS. 2-6C, among others. In the illustrated embodiment, a first instrument device manipulator 602 is coupled to the handpiece 600 by a first translation device 610. The first instrument device manipulator 602 may include one or more motors that provide rotational drive to the treatment probe 616. The treatment probe 616 may be in a fixed linear position relative to the handpiece 600, and the Z-position of the treatment probe 616 may be operated by positioning the first instrument device manipulator 602. A second instrument device manipulator 1704 may be coupled to a second translation device 1702. The second translation device 1702 may provide linear translation of the imaging probe 806. The second instrument device manipulator 1704 may additionally support probe functions, such as suction, irrigation, and other plumbing connections, fittings, manifolds, hoses, etc., allowing the second instrument device manipulator 1704 to support instruments provided for these purposes.

[0155] A third instrument device manipulator 2202 may be coupled to a third translation apparatus 2204, which in turn is coupled to the second imaging probe 2002, the second treatment probe 1710, or some other probe. The third instrument device manipulator 2202 may provide translation and / or rotation of the second imaging probe 2002 or the second treatment probe 1710.

[0156] The first, second, and third instrument device manipulators may cooperate to position and actuate the handpiece 600 and its associated instrument.

[0157] According to some embodiments, a handpiece 600, which may comprise any of several suitable instruments for a wide range of patient procedures, may be coupled to any of several different instrument device manipulators 602 using a translation device 610. The motors of the instrument device manipulator 602 may be configured in any arrangement, pattern, spacing, and number of motors. The translation device 610 may be manufactured, sold, and implemented as a separate component and configured to couple to the instrument device manipulator 602, receiving as input rotational motion from one or more motors associated with the instrument device manipulator 602. The translation device 610, in turn, is coupled to the handpiece 600, engages one or more instruments associated with the handpiece 600, and provides rotational motion, translational motion, or both to the one or more instruments associated with the handpiece 600. In some cases, the translation device 610 provides translational motion by translating the entire handpiece 600. In some cases, the instrument device manipulator 602 provides translation of the handpiece 600 by repositioning the instrument device manipulator 602 .

[0158] The conversion device 610 thus acts as an intermediary between any of a variety of instrument device manipulators 602 and any of a variety of handpieces 600. The handpiece 600 does not need to be specifically designed and manufactured to couple to a particular instrument device manipulator 602, as has been the case with past systems and methods. As a result, the handpiece 600 and its associated instrument can be designed and manufactured independent of the particular instrument device manipulator 602 to which it will be subsequently coupled in use.

[0159] Additionally, the conversion device 610 can be reusable for multiple procedures. In some embodiments, the handpiece 600, as described herein, may be considered a consumable item and may be disposed of after each use. In some embodiments, the conversion device 610 is integrated with or coupled to a motor pack that provides actuation to the implements of the handpiece 600, such as for rotation and translation. The conversion device 610 may include one or more encoders to transmit signals associated with the implements to a computing device.

[0160] As described herein, the computing devices and systems described and / or illustrated herein broadly represent any type or form of computing device or system capable of executing computer-readable instructions such as those contained within the modules described herein. In their most basic configurations, these computing devices may each include at least one memory device and at least one physical processor.

[0161] The terms "memory" or "memory device" as used herein generally refer to any type or form of volatile or non-volatile storage device or medium capable of storing data and / or computer-readable instructions. In one example, a memory device may store, load, and / or maintain one or more of the modules described herein. Examples of memory devices include, but are not limited to, random access memory (RAM), read-only memory (ROM), flash memory, hard disk drives (HDDs), solid-state drives (SSDs), optical disk drives, caches, variations or combinations of one or more thereof, or any other suitable storage memory.

[0162] Additionally, the terms “processor” or “physical processor” as used herein generally refer to any type or form of hardware-implemented processing unit capable of interpreting and / or executing computer-readable instructions. In one embodiment, a physical processor may access and / or modify one or more modules stored within a memory device described above. Examples of physical processors include, but are not limited to, a microprocessor, a microcontroller, a central processing unit (CPU), a graphics processing unit (GPU), a tensor processing unit (TPU), a field programmable gate array (FPGA) implementing a soft-core processor, an application-specific integrated circuit (ASIC), a portion of one or more of them, a variation or combination of one or more of them, or any other suitable physical processor. A processor may also comprise a distributed processor system, e.g., parallel-running processors, or a remote processor such as a server, and combinations thereof.

[0163] Although illustrated as separate elements, the method steps described and / or illustrated herein may represent parts of a single application. Additionally, in some embodiments, one or more of these steps may represent or correspond to one or more software applications or programs that, when executed by a computing device, may cause the computing device to perform one or more tasks, such as method steps.

[0164] Additionally, one or more of the devices described herein may transform data, physical devices, and / or representations of physical devices from one form to another. Additionally or alternatively, one or more of the modules listed herein may transform a processor, volatile memory, non-volatile memory, and / or any other portion of a physical computing device from one form of computing device to another form of computing device by executing on the computing device, storing data on the computing device, and / or otherwise interacting with the computing device.

[0165] The term "computer-readable medium" as used herein generally refers to any form of device, carrier, or medium capable of storing or carrying computer-readable instructions. Examples of computer-readable media include, but are not limited to, transmission-type media such as carrier waves, and non-transitory-type media such as magnetic storage media (e.g., hard disk drives, tape drives, and floppy disks), optical storage media (e.g., compact discs (CDs), digital video discs (DVDs), and BLU-RAY discs), electronic storage media (e.g., solid-state drives and flash media), and other distribution systems.

[0166] Those skilled in the art will recognize that any process or method disclosed herein can be modified in many ways. The process parameters and sequence of steps described and / or illustrated herein are given as examples only and can be varied as desired. For example, although the steps illustrated and / or described herein may be shown or discussed in a particular order, these steps do not necessarily have to be performed in the order shown or discussed.

[0167] The various exemplary methods described and / or illustrated herein may also omit one or more of the steps described or illustrated herein, or may comprise additional steps in addition to those disclosed. Furthermore, the steps of any method as disclosed herein can be combined with one or more steps of any of any other methods as disclosed herein.

[0168] A processor as described herein can be configured to perform one or more steps of any of the methods disclosed herein. Alternatively, or in combination, a processor can be configured to combine one or more steps of one or more methods as disclosed herein.

[0169] Unless otherwise stated, the terms "connected to" and "coupled to" (and their derivatives) as used in this specification and claims shall be interpreted as allowing both direct and indirect (i.e., via other elements or components) connections. Additionally, the terms "a" or "an" as used in this specification and claims shall be interpreted as meaning "at least one of." Finally, for ease of use, the terms "including" and "having" (and their derivatives) as used in this specification and claims shall be synonymous with and have the same meaning as the word "comprising."

[0170] A processor as disclosed herein may be configured with instructions to perform any one or more steps of any method as disclosed herein.

[0171] It should be understood that the terms "first," "second," "third," etc. may be used herein to describe various layers, elements, components, regions, or sections without reference to any particular order or sequence of events. These terms are merely used to distinguish one layer, element, component, region, or section from another layer, element, component, region, or section. A first layer, element, component, region, or section as described herein could be referred to as a second layer, element, component, region, or section without departing from the teachings of the present disclosure.

[0172] As used herein, the term "or" is used inclusively to refer to items as alternatives and in combination.

[0173] As used herein, letters such as numbers refer to similar elements.

[0174] While reference is made to "right-angle" in "right-angle" shaft conversion devices, etc., it should be understood that the term "right-angle" is used to describe elements that extend at approximately right angles to one another, e.g., within about 10 degrees of perpendicular to one another.

[0175] While referring to "parallel" such as a "parallel" shaft conversion device, it should be understood that the term "parallel" is used to describe elements that extend generally parallel to one another, e.g., within about 10 degrees of parallelism with one another.

[0176] This disclosure includes the following numbered appendices:

[0177] Appendix 1. A system for treating or imaging a patient, comprising: a probe sized for insertion into the patient; a translation device configured to couple to the probe; and an instrument device manipulator configured to operably couple to the translation device, the instrument device manipulator comprising one or more motors configured to engage with the translation device, the translation device configured to receive input from the one or more motors and further configured to transmit input from the one or more motors to the probe to rotate, translate, articulate, or a combination of the probe.

[0178] Clause 2. The system of clause 1, wherein the probe is a treatment probe and further comprises an imaging probe sized for insertion into a patient.

[0179] Clause 3. The system of clause 2, wherein the imaging probe is a cystoscope.

[0180] Clause 4. The system of clause 2, wherein the imaging probe is a TRUS probe.

[0181] Clause 5. The system of Clause 2, wherein the treatment probe is configured for tissue sample collection.

[0182] Appendix 6. The system of Appendix 2, wherein the conversion device is configured to receive input from one or more motors to rotate, translate, articulate, or a combination of the treatment probe.

[0183] Clause 7. The system of Clause 6, wherein the conversion device is configured to receive inputs from two or more motors and add the inputs from the two or more motors to an output of the conversion device.

[0184] Appendix 8. The system of Appendix 1, wherein the conversion device is configured to provide electrical communication between the instrument device manipulator and the treatment probe.

[0185] Clause 9. The system of Clause 8, wherein the electrical communication comprises an encoder signal from the treatment probe associated with one or more of a position, a translation, and a rotation of the treatment probe.

[0186] Clause 10. The system of Clause 8, wherein the electrical communication includes delivering power to the treatment probe.

[0187] Clause 11. The system of clause 1, wherein the conversion device comprises a drive gear on the drive shaft and a driven gear on the driven shaft, the drive shaft and the driven shaft being substantially perpendicular to one another.

[0188] Clause 12. The system of Clause 11, wherein the drive gear and the driven gear comprise bevel gears.

[0189] Clause 13. The system of Clause 11, wherein the drive gear and the driven gear comprise spiroid gears.

[0190] Clause 14. The system of clause 11, wherein the drive gear and the driven gear comprise worm gears.

[0191] Appendix 15. The system of Appendix 1, wherein the conversion device comprises a drive gear or drive pulley on the drive shaft and a driven gear or driven pulley on the driven shaft, the drive shaft and the driven shaft being generally parallel to one another.

[0192] Clause 16. The system of clause 15, wherein the drive gear and the driven gear comprise spur gears.

[0193] Clause 17. The system of clause 15, wherein the drive gear and the driven gear comprise helical gears.

[0194] Clause 18. The system of clause 15, wherein the drive pulley and the driven pulley comprise timing pulleys connected by a timing belt.

[0195] Clause 19. The system of clause 15, wherein the drive pulley and the driven pulley comprise timing sprockets connected by a timing chain.

[0196] Clause 20. The system of clause 1, wherein the probe further comprises a coupling portion for releasably coupling the probe to the conversion device.

[0197] Clause 21. The system of clause 20, wherein the coupling is a quick release coupling.

[0198] Clause 22. The system of clause 20, wherein the coupling provides a locking engagement.

[0199] Appendix 23. The system of Appendix 1, wherein the conversion device further comprises a coupling portion for releasably coupling the conversion device to the instrument device manipulator.

[0200] Clause 24. The system of Clause 23, wherein the coupling comprises a quick release coupling.

[0201] Appendix 25. The system of Appendix 1, further comprising one or more force sensors operably coupled to the probe and the one or more computing devices to detect compression of the patient's tissue using the probe.

[0202] Clause 26. The system of clause 25, wherein the one or more force sensors are operably coupled to the instrument device manipulator.

[0203] Addendum 27. The system of Addendum 1, wherein the conversion device is configured to receive input from one motor of the instrument device manipulator and cause rotational movement of the probe.

[0204] Addendum 28. The system of Addendum 1, wherein the conversion device is configured to receive input from two or more motors of the instrument device manipulator to cause rotational movement of the probe.

[0205] Clause 29. The system of clause 28, wherein the two motors rotate at the same speed but in opposite directions.

[0206] Clause 30. The system of clause 29, wherein the conversion device selectively engages outputs from the two motors to the probe.

[0207] Clause 31. The system of clause 30, wherein the conversion device selectively engages the outputs from the two motors in sequence with the probe.

[0208] Clause 32. The system of clause 31, wherein the conversion device is configured to selectively engage one of the two motors with the probe at a time.

[0209] Clause 33. The system of Clause 30, wherein the conversion device further comprises a clutch configured to selectively engage the outputs from the two motors to the probe.

[0210] Clause 34. The system of clause 33, wherein the clutch is an electric power operated clutch.

[0211] Addendum 35. The system of Addendum 30, wherein the conversion device further comprises a torsional impact spring configured to absorb at least a portion of the torsional stress as the probe is rotated.

[0212] Clause 36. The system of clause 30, wherein a first motor of the two motors includes a first rotary inertia flywheel carried by a first output shaft.

[0213] Clause 37. The system of clause 36, wherein the second of the two motors includes a second rotary inertia flywheel carried by the second output shaft.

[0214] Clause 38. The system of clause 1, wherein the conversion device is a step-down conversion device.

[0215] Addendum 39. The system of Addendum 1, wherein the conversion device is an increasing conversion device.

[0216] Clause 40. The system of clause 1, wherein the conversion device is configured to rotate the probe at a rate of up to 10 revolutions per second.

[0217] Clause 41. The system of clause 1, wherein the conversion apparatus further comprises a rotational / linear conversion device.

[0218] Clause 42. The system of clause 41, wherein the rotary / linear conversion device comprises a rack and pinion system.

[0219] Clause 43. The system of clause 41, wherein the rotary / linear conversion device comprises a belt drive.

[0220] Clause 44. The system of clause 41, wherein the rotary / linear conversion device comprises a chain drive.

[0221] Clause 45. The system of clause 41, wherein the rotary / linear conversion device comprises a lead screw.

[0222] Clause 46. The system of clause 41, wherein the rotary / linear conversion device comprises a ball screw.

[0223] Clause 47. The system of clause 41, wherein the rotary / linear conversion device comprises a roller screw.

[0224] Clause 48. The system of clause 1, further comprising an imaging probe.

[0225] Clause 49. The system of clause 48, wherein the conversion device is configured to receive input from one of the one or more motors to linearly translate the imaging probe.

[0226] Appendix 50. The system of Appendix 1, wherein the instrument device manipulator is a first instrument device manipulator and further comprises a second instrument device manipulator.

[0227] Addendum 51. The system of Addendum 50, wherein the first instrument device manipulator is configured to provide movement of the probe and the second instrument device manipulator is configured to provide movement of the imaging probe.

[0228] Clause 52. The system of clause 51, wherein the probe and imaging probe are carried by a handpiece.

[0229] Addendum 53. The system of Addendum 52, wherein the first instrument device manipulator is coupled to the handpiece by a first conversion device.

[0230] Clause 54. The system of clause 53, wherein the second instrument device manipulator is coupled to the handpiece by a second conversion device.

[0231] Clause 55. The system of clause 42, wherein one or more of the first conversion device and the second conversion device is a right-angle shaft conversion device.

[0232] Clause 56. The system of clause 42, wherein one or more of the first conversion device and the second conversion device are parallel shaft conversion devices.

[0233] Addendum 57. The system of Addendum 1, wherein the conversion device is operably coupled to the probe by a shaft coupler.

[0234] Addendum 58. The system of Addendum 1, wherein the probe is configured to be coupled to the translation device before the translation device is coupled to the instrument device manipulator.

[0235] Appendix 59. The system of Appendix 1, wherein the probe is configured to be coupled to the conversion device after inserting the probe into the patient.

[0236] Appendix 60. The system of Appendix 1, wherein the probe is positionable in the X direction, the Y direction, the Z direction, or a combination by the instrument device manipulator.

[0237] Addendum 61. The system of Addendum 60, wherein the probe is positionable by an instrument device manipulator based, at least in part, on instructions from a computing device.

[0238] Addendum 62. The system of Addendum 60, wherein the probe is positionable by an instrument device manipulator based, at least in part, on manual manipulation.

[0239] Addendum 63. The system of Addendum 62, wherein the instrument device manipulator is manually adjustable to adjust the probe in one or more of at least one rotational axis or at least one translational axis.

[0240] Addendum 64. The system of Addendum 1, wherein the conversion device further comprises an electrical connector configured to electrically couple the conversion device to the instrument device manipulator.

[0241] Addendum 65. The system of Addendum 64, wherein the electrical connector is a first electrical connector and the conversion device further comprises a second electrical connector configured to electrically couple the conversion device to the probe.

[0242] Clause 66. The system of clause 65, wherein the conversion device is configured to electrically couple the instrument device manipulator and the probe.

[0243] Addendum 67. The system of Addendum 1, wherein the probe is a water jet and further comprises a pressure regulator configured to dynamically vary the water pressure on the water jet.

[0244] Addendum 68. A conversion device configured to couple a probe to an instrument device manipulator, the conversion device comprising: a first coupler for selectively engaging with the instrument device manipulator; a second coupler for selectively engaging with the probe; a first linkage configured to engage with the instrument device manipulator and receive motion input from the instrument device manipulator; and a second linkage configured to operably couple with the probe, wherein the conversion device is configured to transfer the motion input received from the instrument device manipulator to the probe.

[0245] Clause 69. The conversion device of clause 68, wherein the probe is a treatment probe and further comprises an imaging probe coupled to the conversion device.

[0246] Addendum 70. The conversion device of Addendum 69, wherein the motion input is a rotational input, and the conversion device is configured to receive the rotational input from the instrument device manipulator and rotate, translate, articulate, or a combination of the treatment probe.

[0247] Addendum 71. The conversion device of Addendum 68, wherein the conversion device is configured to provide electrical communication between the instrument device manipulator and the probe.

[0248] Clause 72. The conversion device of clause 68, further comprising an electrical connector for establishing electrical communication with the instrument device manipulator when the conversion device is coupled to the instrument device manipulator.

[0249] Clause 73. The conversion device of clause 72, further comprising an electrical signal processor for processing the position-encoding signal and providing an improved position measurement of the probe.

[0250] Clause 74. The conversion device of clause 72, further comprising an electrical signal processor for processing camera signals from an imaging system arrayed alongside the probe.

[0251] Clause 75. The conversion device of clause 72, further comprising an electrical signal processor for processing the position-encoding signal and providing an improved position measurement of the second treatment probe.

[0252] Clause 76. The conversion device of clause 68, wherein the conversion device comprises a driven gear on the driven shaft, the driven gear being in meshing contact with a drive gear on the drive shaft of the instrument device manipulator.

[0253] Clause 77. The conversion device of clause 76, wherein the drive shaft and the driven shaft are positioned approximately perpendicular to each other.

[0254] Clause 78. The conversion device of clause 76, wherein the drive shaft and the driven shaft are substantially parallel to one another.

[0255] Addendum 79. The conversion apparatus of Addendum 76, wherein the drive gear of the instrument device manipulator provides rotational movement of the probe and the driven gear provides linear translation.

[0256] Addendum 80. The conversion apparatus of Addendum 76, wherein the drive gear of the instrument device manipulator provides the rotational motion of the probe and the driven gear provides the rotational motion.

[0257] Addendum 81. The transformation apparatus of Addendum 76, wherein the drive gear of the instrument device manipulator provides rotational motion of the probe and the driven gear provides linear translation.

[0258] Clause 82. The transition device of clause 68, wherein the first coupler is a quick-release coupler.

[0259] Addendum 83. The conversion device of Addendum 68, wherein the conversion device receives input from two motors of the instrument device manipulator, the two motors configured to rotate in opposite directions.

[0260] Clause 84. The conversion device of clause 83, wherein the conversion device transmits input from the two motors of the instrument device manipulator to the probe, causing the probe to oscillate a predetermined number of degrees about the longitudinal axis of the probe.

[0261] Clause 85. The conversion device of clause 84, wherein the conversion device is configured to selectively engage and disengage the two motors and the probe therefrom.

[0262] Clause 86. The conversion device of clause 85, further comprising a clutch mechanism, the clutch mechanism operable to selectively engage and disengage the two motors and the probe therefrom.

[0263] Addendum 87. The conversion device of Addendum 86, wherein the clutch mechanism is electrically actuable.

[0264] Addendum 88. The conversion device of Addendum 84, wherein the conversion device transmits inputs from the two motors of the instrument device manipulator to the probe in response to instructions from the computing device.

[0265] Addendum 89. The conversion device of Addendum 68, wherein the probe is an imaging probe, and the conversion device is configured to convert motion input received from the instrument device manipulator into linear motion of the imaging probe.

[0266] Addendum 90. The conversion device of Addendum 68, wherein the conversion device is configured to receive two or more inputs from the instrument device manipulator.

[0267] Clause 91. The conversion device of Clause 90, wherein the conversion device is configured to receive two or more inputs and combine the two or more inputs into a single output.

[0268] Clause 92. The conversion device of clause 90, wherein the conversion device is configured to receive five or more inputs from the instrument device manipulator.

[0269] Addendum 93. The transformation apparatus of any one of Addendums 74 and 75, wherein the input from the instrument device manipulator comprises a rotational input.

[0270] Addendum 94. The conversion device of Addendum 93, wherein each of the rotational inputs comprises a gear coupled to a motor.

[0271] Addendum 95. A conversion device comprising: a first coupling portion configured to operably couple to a probe; a second coupling portion configured to operably couple to an instrument device manipulator; and an electrical system interface configured to provide electrical communication between the probe and the instrument device manipulator.

[0272] Clause 96. The conversion device of clause 95, wherein the conversion device is configured to convert input motion from the instrument device manipulator into motion of the probe.

[0273] Addendum 97. The conversion device of Addendum 96, wherein the input motion is rotational motion and the motion of the probe is rotational motion.

[0274] Addendum 98. The conversion device of Addendum 96, wherein the input motion is rotational motion and the motion of the probe is linear motion.

[0275] Addendum 99. A system for treating or imaging a patient, comprising: a probe sized for insertion into the patient; and an instrument device manipulator configured to operably couple to the probe, the instrument device manipulator comprising one or more motors configured to engage the probe, the probe configured to receive input from the one or more motors and further configured to transmit rotational input from the one or more motors to the probe to rotate, translate, articulate, or a combination thereof.

[0276] Clause 100. The system of clause 99, further comprising a conversion device coupled between the probe and the instrument device manipulator, the conversion device configured to transmit the output of the one or more motors to the probe.

[0277] Addendum 101. The system of any one of the preceding appendices, wherein the probe is configured to provide energy for hemostasis of the treated tissue.

[0278] Addendum 102. The system of Addendum 101, wherein the energy for hemostasis is applied without simultaneous image guidance.

[0279] Clause 103. The system of any one of the preceding clauses, wherein the probe is configured to treat or remove kidney stones.

[0280] Clause 104. The system of any one of the preceding clauses, wherein the probe is configured to treat or remove cancer.

[0281] Clause 105. The system of any one of the preceding clauses, wherein the conversion device is at least partially enclosed within a housing.

[0282] Addendum 106. The system of Addendum 105, wherein the housing includes one or more openings allowing one or more inputs and / or one or more outputs to extend therethrough to operably couple the conversion device to another component.

[0283] Addendum 107. The system of Addendum 105, wherein the conversion device is configured to be decoupled from the instrument device manipulator and the probe in a freestanding configuration of the conversion device, and the housing at least partially encloses the conversion device.

[0284] The embodiments of the present disclosure are shown and described herein and are provided by way of example only. Those skilled in the art will recognize numerous adaptations, modifications, variations, and substitutions without departing from the scope of the present disclosure. Several alternatives and combinations of the embodiments disclosed herein may be utilized without departing from the scope of the present disclosure and the invention(s) disclosed herein. Accordingly, the scope of the invention(s) of the present disclosure shall be defined solely by the scope of the appended claims and their equivalents.

Claims

[Claim 1] The invention described in this specification.

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