Robotic medical system with multiple medical devices

Abstract

A specific aspect relates to a robotic medical device system. Such a system may include a first and a second medical device. The first medical device may include a device base and an elongated shaft extending from the device base, and a robotic drive input. The first medical device may include a device inlet. The second medical device may include a device base and an elongated shaft extending through the device inlet. The second medical device may include a robotic drive input coupled to a rotating element within the second medical device. The robotic medical device system may include a robotic arm having a first and a second robotic drive output. The first robotic drive output may drive the robotic drive input of the first medical device, and the second robotic drive output may drive the robotic drive input of the second medical device.

Description

Technology Field

[0001] Cross-reference of related application(s)

[0002] This application claims the benefit of U.S. Provisional Application No. 62 / 887,569 filed August 15, 2019, which is incorporated herein by reference in its entirety.

[0003] Technology field

[0004] The systems and methods disclosed in this specification relate to medical instrument systems, and more specifically to medical instruments that can be controlled manually or by a robot. Background Technology

[0005] Medical procedures, such as endoscopy, may involve accessing and visualizing the medial side of a patient's anatomical structures for diagnostic and / or therapeutic purposes. For example, gastroenterology, urology, and bronchology involve medical procedures that allow a physician to examine the patient's lumen, such as the ureters, gastrointestinal tract, and airways (bronchi and bronchioles). During these procedures, a thin, flexible tubular instrument or device known as an endoscope is inserted into the patient through an opening (such as a natural orifice) and advanced toward a tissue site identified for subsequent diagnosis and / or treatment. The medical instrument may be controllable and articulable to facilitate navigation through the anatomical structures. Brief explanation of the drawing

[0006] The disclosed suns will be described below in this specification together with the accompanying drawings provided to illustrate the disclosed suns without limiting them, wherein similar names denote similar elements. FIG. 1 is a drawing illustrating an embodiment of a cart-based robotic system arranged for diagnostic and / or therapeutic bronchoscopy. FIG. 2 is a drawing illustrating an additional sun of the robot system of FIG. 1. FIG. 3 is a drawing illustrating an embodiment of the robotic system of FIG. 1 arranged for ureteroscopic surgery. FIG. 4 is a drawing illustrating an embodiment of the robotic system of FIG. 1 arranged for a vascular procedure. FIG. 5 is a drawing illustrating an embodiment of a table-based robotic system arranged for a bronchoscopy procedure. FIG. 6 is a drawing providing an alternative drawing of the robot system of FIG. 5. FIG. 7 is a drawing illustrating an exemplary system configured to stow robotic arm(s). FIG. 8 is a drawing illustrating an embodiment of a table-based robotic system configured for a ureteroscopic procedure. FIG. 9 is a drawing illustrating an embodiment of a table-based robotic system configured for a laparoscopic procedure. FIG. 10 is a drawing illustrating an embodiment of the table-based robot system of FIG. 5 to 9 having pitch or tilt control. FIG. 11 is a drawing providing a detailed example of an interface between a table and a column of the table-based robot system of FIGS. 5 to 10. FIG. 12 is a drawing illustrating an alternative embodiment of a table-based robot system. FIG. 13 is a drawing illustrating an end view of the table-based robot system of FIG. 12. FIG. 14 is a drawing illustrating an end view of a table-based robot system with a robot arm attached thereto. FIG. 15 is a drawing illustrating an exemplary instrument driver. FIG. 16 is a drawing illustrating an exemplary medical device having a paired instrument driver. FIG. 17 is a drawing illustrating an alternative design for a mechanism driver and mechanism in which the axis of the drive unit is parallel to the axis of the elongated shaft of the mechanism. FIG. 18 is a drawing illustrating a mechanism having a mechanism-based insertion architecture. FIG. 19 is a drawing illustrating an exemplary controller. FIG. 20 is a block diagram illustrating a localization system that estimates the position of one or more elements of a robot system of FIG. 1 to 10, such as the position of the mechanism of FIG. 16 to 18, according to an exemplary embodiment. FIGS. 21a through 21e are schematic drawings illustrating exemplary medical device systems. FIG. 22a is a drawing illustrating a bottom view of an exemplary endoscope according to one configuration. FIG. 22b is a drawing illustrating a perspective view of an exemplary medical device system that includes the functions of other medical devices within it according to one configuration. FIG. 23 is a drawing illustrating some of the internal components of an exemplary endoscope base. FIG. 24 is a drawing showing an upper perspective view of an exemplary pulley. FIG. 25 is a drawing illustrating an exemplary endoscope base of a medical instrument system (200) attached to one embodiment of a robotic instrument drive adapter. FIG. 26 is a drawing illustrating a bottom view of an exemplary medical device system according to one configuration. FIG. 27 is a plan view of an exemplary apparatus according to one embodiment. FIG. 28 is a drawing showing a bottom perspective view of the mechanism of FIG. 27 according to one embodiment. FIG. 29 is a cross-sectional view of the bottom surface of the apparatus of FIG. 28. FIGS. 30a and FIGS. 30b are perspective views of an exemplary robot mechanism drive adapter. FIG. 31 is a drawing illustrating an exemplary medical instrument system in which both the endoscope and the instrument are combined with a robotic instrument drive adapter. FIG. 32 is a drawing showing an enlarged view of a basket tool positioned on a circle. Specific details for implementing the invention

[0007] 1. Overview.

[0008] The aspects of the present disclosure may be integrated into a robotically-enabled medical system capable of performing various medical procedures, including both minimally invasive procedures such as laparoscopy and non-invasive procedures such as endoscopy. Among endoscopic procedures, the system may be capable of performing bronchoscopy, ureteroscopic surgery, gastroscopy, etc.

[0009] In addition to performing a wide range of procedures, the system can provide additional benefits to assist the physician, such as enhanced imaging and guidance. Furthermore, the system can provide the physician with the ability to perform procedures from an ergonomic position without the need for cumbersome arm movements and positions. Moreover, the system can provide the physician with the ability to perform procedures with improved ease of use, allowing one or more of the system's instruments to be controlled by a single user.

[0010] Various embodiments will be described below together with the drawings for illustrative purposes. It should be recognized that many other embodiments of the disclosed concept are possible and that various advantages can be achieved with the disclosed embodiments. Headings are included in this specification for reference and to assist in finding various sections. These headings are not intended to limit the scope of the concept described in relation thereto. Such concept may be applied throughout the entire specification.

[0011] A. Robot System - Cart.

[0012] Robotic medical systems can be configured in various ways depending on specific procedures. FIG. 1 illustrates one embodiment of a cart-based robotic system (10) arranged for diagnostic and / or therapeutic bronchoscopy. During bronchoscopy, the system (10) may include a cart (11) having one or more robotic arms (12) for delivering a medical instrument, such as a steerable endoscope (13), which may be a procedure-specific bronchoscope for bronchoscopy, to a natural opening access point (i.e., the patient's mouth positioned on a table in this example) for delivering the diagnostic and / or therapeutic tool. As illustrated, the cart (11) may be positioned close to the patient's upper body to provide access to the access point. Similarly, the robotic arms (12) may be actuated to position the bronchoscope relative to the access point. The arrangement of FIG. 1 may also be used when performing a gastrointestinal (GI) procedure with a gastroscopy, which is a specialized endoscope for gastrointestinal procedures. FIG. 2 illustrates an exemplary embodiment of a cart in more detail.

[0013] Referring again to FIG. 1, once the cart (11) is properly positioned, the robot arm (12) can insert the steerable endoscope (13) into the patient robotically, manually, or in combination thereof. As illustrated, the steerable endoscope (13) may include at least two telescoping parts, such as an inner leader part and an outer sheath part, each part being coupled to a separate telescoping driver from a set of telescoping drivers (28), each telescoping driver being coupled to the distal end of an individual robot arm. This linear arrangement of telescoping drivers (28), which facilitates aligning the leader part coaxially with the sheath part, creates a "virtual rail" (29) that can be repositioned in space by manipulating one or more robot arms (12) at different angles and / or positions. The virtual rail described herein is illustrated in the drawings using dashed lines, and thus the dashed lines do not illustrate any physical structure of the system. Translation of the instrument driver (28) along the virtual rail (29) moves the inner leader portion through the outer sheath portion or advances or retracts the endoscope (13) from the patient. The angle of the virtual rail (29) can be adjusted, translated, and pivoted based on clinical application or physician preference. For example, in bronchoscopy, the angle and position of the virtual rail (29) as illustrated represent a compromise between providing physician access to the endoscope (13) while minimizing friction caused by bending the endoscope (13) into the patient's mouth.

[0014] The endoscope (13) can be directed along the patient's trachea and lungs after insertion using precise commands from the robotic system until it reaches a target destination or surgical site. To improve navigation through the patient's lung network and / or to reach a desired target, the endoscope (13) can be operated to extend the inner leader portion through the outer sheath portion to obtain improved articulation and a larger bending radius. The use of separate instrument drivers (28) also allows the leader portion and the sheath portion to be driven independently of each other.

[0015] For example, the endoscope (13) can be directed to deliver a biopsy needle to a target, such as a lesion or nodule within the patient's lung. The needle can be deployed along a working channel extending along the length of the endoscope to obtain a tissue sample to be analyzed by a pathologist. Depending on the pathological results, additional tools may be deployed along the endoscope's working channel for additional biopsies. After the nodule is confirmed to be malignant, the endoscope (13) can deliver tools to the endoscope to excise potential cancerous tissue. In some cases, diagnostic and therapeutic treatments may be delivered as separate procedures. In those situations, the endoscope (13) may also be used to deliver a reference point to "mark" the location of the target nodule. In other cases, diagnostic and therapeutic treatments may be delivered during the same procedure.

[0016] The system (10) may also include a movable tower (30) which may be connected to the cart (11) via a support cable to provide support to the cart (11) for control units, electronics, fluid devices, optical systems, sensors, and / or power. Placing such functions within the tower (30) allows for a cart (11) of a smaller form factor that can be more easily adjusted and / or repositioned by the surgeon and their staff. Additionally, the separation of functions between the cart / table and the support tower (30) reduces clutter in the operating room and facilitates the improvement of clinical workflow. The cart (11) may be located near the patient, while the tower (30) may be loaded at a remote location so as not to interfere during the procedure.

[0017] To support the aforementioned robot system, the tower (30) may include component(s) of a computer-based control system that store computer program instructions in a non-transient computer-readable storage medium, such as a persistent magnetic storage drive or a solid state drive. The execution of these instructions can control the entire system or its sub-system(s), whether the execution occurs in the tower (30) or in the cart (11). For example, when executed by a processor of the computer system, the instructions can cause components of the robot system to operate the relevant carriage and arm mount, operate the robot arm, and control the medical instrument. For example, in response to receiving a control signal, a motor in the joint of the robot arm can position the arm to a predetermined position.

[0018] The tower (30) may also include a pump, a flow meter, a valve control unit, and / or a fluid access unit to provide controlled infusion and suction capabilities to a system that can be deployed through the endoscope (13). These components may also be controlled using the computer system of the tower (30). In some embodiments, the infusion and suction capabilities may be delivered directly to the endoscope (13) via separate cable(s).

[0019] The tower (30) includes a voltage and surge protector designed to provide filtered and protected power to the cart (11), thereby avoiding the placement of power transformers and other auxiliary power components within the cart (11), which can create a smaller and more mobile cart (11).

[0020] The tower (30) may also include support equipment for sensors deployed throughout the robot system (10). For example, the tower (30) may include optoelectronic equipment for detecting, receiving, and processing data received from optical sensors or cameras throughout the robot system (10). In combination with a control system, such optoelectronic equipment may be used to generate real-time images for display on any number of consoles deployed throughout the system, including within the tower (30). Similarly, the tower (30) may also include an electronic subsystem for receiving and processing signals received from deployed electromagnetic (EM) sensors. The tower (30) may also be used to house and position an EM field generator for detection by EM sensors within or on a medical device.

[0021] The tower (30) may also include a console (31) in addition to other consoles available in the rest of the system, such as a console mounted on top of a cart. The console (31) may include a user interface and a display screen, such as a touchscreen, for physician operators. The console within the system (10) is generally designed to provide both pre-operative and real-time information of the procedure, such as navigation and positioning information of the endoscope (13), as well as robot control. When the console (31) is not the only console available to the physician, it may be used by a second operator, such as a nurse, to monitor the patient's health or vitals and the operation of the system (10), as well as to provide procedure-specific data such as navigation and positioning information. In another embodiment, the console (30) is housed within a body separate from the tower (30).

[0022] The tower (30) may be connected to the cart (11) and endoscope (13) via one or more cables or connections (not shown). In some embodiments, support functions from the tower (30) may be provided to the cart (11) via a single cable to simplify and organize the operating room. In other embodiments, specific functions may be combined with separate cabling and connections. For example, power may be provided to the cart (11) via a single power cable, but support for the control unit, optical system, fluid device, and / or navigation may be provided via separate cables.

[0023] FIG. 2 provides a detailed example of one embodiment of a cart (11) from a cart-based robotic system illustrated in FIG. 1. The cart (11) generally comprises an elongated support structure (14) (commonly referred to as a “column”), a cart base (15), and a console (16) located on top of the column (14). The column (14) may include one or more carriages, such as a carriage (17) (alternatively an “arm support”), to support the deployment of one or more robotic arms (12) (three are shown in FIG. 2). The carriage (17) may include an individually configurable arm mount that rotates along a vertical axis to adjust the base of the robotic arm (12) for better positioning relative to the patient. The carriage (17) also includes a carriage interface (19) that allows the carriage (17) to translate vertically along the column (14).

[0024] The carriage interface (19) is connected to the column (14) through a slot (20) located on opposite sides of the column (14) to guide the vertical translation of the carriage (17). The slot (20) includes a vertical translation interface for positioning and maintaining the carriage (17) at various vertical heights relative to the cart base (15). The vertical translation of the carriage (17) allows the cart (11) to adjust the reach of the robot arm (12) to accommodate various table heights, patient sizes, and physician preferences. Similarly, an individually configurable arm mount on the carriage (17) allows the robot arm base (21) of the robot arm (12) to be tilted in various configurations.

[0025] In some embodiments, the slot (20) may be supplemented with a slot cover that is coplanar with and parallel to the slot surface to prevent dust and fluid from entering the vertical translation interface and the inner chamber of the column (14) as the carriage (17) translates vertically. The slot cover may be deployed via a pair of spring spools located near the vertical upper and lower portions of the slot (20). The cover is coiled within the spool until it is deployed to extend and retract from its coiled state as the carriage (17) translates vertically upward and downward. The spring-loading of the spool provides a force to retract the cover into the spool as the carriage (17) translates toward the spool, while also maintaining a tight seal as the carriage (17) translates away from the spool. The cover can be connected to the carriage (17) using, for example, a bracket within the carriage interface (19) to ensure proper extension and retraction of the cover as the carriage (17) translates.

[0026] The column (14) may include a mechanism such as a gear and a motor, which is internally designed to use a vertically aligned lead screw to translate the carriage (17) in a mechanized manner in response to a control signal generated in response to user input, such as input from a console (16).

[0027] A robot arm (12) may generally comprise a robot arm base (21) and an end effector (22) separated by a series of linkages (23) connected by a series of joints (24), each joint comprising an independent actuator, and each actuator comprising an independently controllable motor. Each independently controllable joint represents an independent degree of freedom available to the robot arm (12). Each of the robot arms (12) may have seven joints and thus provide seven degrees of freedom. Multiple joints create multiple degrees of freedom, allowing for "redundant" degrees of freedom. Having redundant degrees of freedom allows the robot arm (12) to position each of its end effectors (22) in a specific position, orientation, and trajectory in space using different linkage positions and joint angles. This allows the system to position and orient the medical device from a desired point in space, while simultaneously allowing the physician to move the arm joint to a clinically advantageous position away from the patient to create a superior approach while avoiding arm collisions.

[0028] The cart base (15) balances the weight of the column (14), carriage (17), and robot arm (12) on the floor. Thus, the cart base (15) accommodates heavier components such as electronics, motors, and power supplies, as well as components that enable movement and / or prevent the cart (11) from moving. For example, the cart base (15) includes a rollable wheel-shaped caster (25) that allows the cart (11) to move easily around the operating room before the procedure. Once it reaches the appropriate position, the caster (25) can be immobilized using a wheel lock to keep the cart (11) in place during the procedure.

[0029] Positioned at the vertical end of the column (14), the console (16) allows for both a user interface for receiving user input and a display screen (or a dual-purpose device such as a touchscreen (26)) for providing both preoperative data and intraoperative data to the physician user. Potential preoperative data on the touchscreen (26) may include preoperative planning, navigation and mapping data derived from preoperative computerized tomography (CT) scans, and / or records from preoperative patient interviews. Intraoperative data on the display may include optical information provided from tools, sensor and coordinate information from sensors, as well as vital patient statistics such as respiration, heart rate, and / or pulse. The console (16) may be positioned and tilted to allow the physician to access the console (16) from the side of the column (14) opposite the carriage (17). From this position, the doctor can observe the console (16), the robot arm (12), and the patient while operating the console (16) from behind the cart (11). As illustrated, the console (16) also includes a handle (27) to assist in operating and stabilizing the cart (11).

[0030] FIG. 3 illustrates an embodiment of a robotic system (10) arranged for ureteroscopic surgery. In a ureteroscopic procedure, a cart (11) may be positioned to deliver a ureteroscope (32), a procedure-specific endoscope designed to traverse the patient's urethra and ureter, to the patient's lower abdominal region. In ureteroscopic surgery, it may be desirable for the ureteroscope (32) to be directly aligned with the patient's urethra to reduce friction and force on sensitive anatomical structures within that region. As illustrated, the cart (11) may be aligned with the foot of a table to allow a robotic arm (12) to position the ureteroscope (32) for direct linear access to the patient's urethra. From the foot of the table, the robotic arm (12) may insert the ureteroscope (32) directly into the patient's lower abdomen through the urethra along a virtual rail (33).

[0031] After insertion into the urethra, the ureteroscope (32) can be navigated into the bladder, ureter, and / or kidney for diagnostic and / or therapeutic applications using control techniques similar to those in bronchoscopy. For example, the ureteroscope (32) can be directed into the ureter and kidney to break up kidney stone accumulations using a laser or ultrasonic lithotripsy device deployed along the working channel of the ureteroscope (32). After lithotripsy is completed, the resulting stone fragments can be removed using a basket deployed along the ureteroscope (32).

[0032] FIG. 4 illustrates an embodiment of a robotic system (10) arranged similarly for a vascular procedure. In a vascular procedure, the system (10) may be configured so that a cart (11) can deliver a medical device (34), such as a steerable catheter, to an access point within the femoral artery in the patient's leg. The femoral artery represents both a larger diameter for navigation and a relatively less detouring and meandering path to the patient's heart, which simplifies navigation. As in a ureteroscopy procedure, the cart (11) may be positioned toward the patient's leg and lower abdomen to allow a robotic arm (12) to provide a virtual rail (35) with a direct linear access to the femoral artery access point within the patient's thigh / buttock region. After insertion into the artery, the medical device (34) may be oriented and inserted by translating the device driver (28). Alternatively, the cart can be positioned around the patient's upper abdomen to reach alternative vascular access points, such as the carotid artery and brachial artery near the shoulder and wrist, for example.

[0033] B. Robot System - Table .

[0034] An embodiment of a robotic medical system may also incorporate a patient table. The integration of the table reduces the amount of capital equipment in the operating room by eliminating the cart, which allows for better access to the patient. FIG. 5 illustrates an embodiment of such a robotic system arranged for a bronchoscopy procedure. The system (36) includes a support structure or column (37) for supporting a platform (38) (indicated as "table" or "bed") on the floor. Much like a cart-based system, the end effector of the robotic arm (39) of the system (36) includes an instrument driver (42), which is designed to manipulate a slender medical instrument, such as the bronchoscope (40) of FIG. 5, through or along a virtual rail (41) formed from the linear alignment of the instrument driver (42). In fact, a C-arm for providing fluoroscopic imaging can be positioned over the upper abdominal region of the patient by placing an emitter and a detector around the table (38).

[0035] FIG. 6 provides an alternative drawing of a system (36) without a patient and medical device for the purpose of discussion. As illustrated, the column (37) may include one or more carriages (43) illustrated in a ring-shape within the system (36), and one or more robot arms (39) may be based thereon. The carriages (43) may translate along a vertical column interface (44) extending along the length of the column (37) to provide different advantageous points from which the robot arms (39) can be positioned to reach the patient. The carriage(s) (43) may rotate around the column (37) using mechanical motors located within the column (37) to allow the robot arms (39) to access multiple sides of the table (38), such as, for example, both sides of the patient. In an embodiment having multiple carriages, the carriages may be positioned individually on the column and may translate and / or rotate independently of the other carriages. Although the carriage (43) does not need to surround the column (37) or even be circular, a ring shape as illustrated facilitates the rotation of the carriage (43) around the column (37) while maintaining structural balance. The rotation and translation of the carriage (43) allow the system (36) to align medical instruments, such as endoscopes and laparoscopes, to different access points on the patient. In other embodiments (not illustrated), the system (36) may include a patient table or bed having an adjustable arm support in the form of a bar or rail extending to the side. One or more robotic arms (39) may be attached to the adjustable arm support (e.g., via a shoulder having an elbow joint) and may be vertically adjustable. By providing vertical adjustment, the robotic arms (39) can advantageously be compactly loaded under the patient table or bed and subsequently raised during the procedure.

[0036] The robot arm (39) may be mounted on the carriage (43) via a set of arm mounts (45) comprising a series of joints that can be individually rotated and / or extended in an insertable manner to provide additional configurability to the robot arm (39). Additionally, the arm mounts (45) may be positioned on the carriage (43) such that, when the carriage (43) is properly rotated, the arm mounts (45) can be positioned on the same side of the table (38) (as shown in FIG. 6), on opposite sides of the table (38) (as shown in FIG. 9), or on adjacent sides of the table (38) (not shown).

[0037] The column (37) structurally provides support for the table (38) and a path for the vertical translation of the carriage (43). Internally, the column (37) may be equipped with a lead screw to guide the vertical translation of the carriage and a motor to mechanize the translation of the carriage (43) based on the lead screw. The column (37) may also transmit power and control signals to the carriage (43) and the robot arm (39) mounted thereon.

[0038] The table base (46) functions similarly to the cart base (15) in the cart (11) shown in FIG. 2, accommodating heavier components to balance the table / bed (38), column (37), carriage (43), and robot arm (39). The table base (46) may also incorporate rigid casters to provide stability during the procedure. Deployed from the bottom of the table base (46), the casters may extend in opposite directions on both sides of the base (46) and may retract when the system (36) needs to be moved.

[0039] Referring further to FIG. 6, the system (36) may also include a tower (not shown), which divides the functions of the system (36) between the table and the tower to reduce the bulk and shape factor of the table. As in previously disclosed embodiments, the tower may provide various support functions to the table, such as processing, computing, and control capabilities, power, fluid devices, and / or optical and sensor processing. The tower may also be movable to be positioned away from the patient to improve physician access and keep the operating room tidy. Additionally, placing components within the tower allows for more storage space within the table base (46) for potential loading of the robotic arm (39). The tower may also include a master controller or console that provides both a display screen (or touchscreen) for pre-operative and intra-operative information, such as real-time imaging, navigation, and tracking information, as well as a user interface for user input, such as a keyboard and / or pendant. In some embodiments, the tower may also include a holder for a gas tank to be used for insufflation.

[0040] In some embodiments, the table base can store and hold a robot arm when not in use. FIG. 7 illustrates a system (47) for storing a robot arm in one embodiment of a table-based system. In the system (47), the carriage (48) can be translated vertically into the base (49) to store the robot arm (50), the arm mount (51), and the carriage (48) within the base (49). The base cover (52) can be translated and retracted to open so that the carriage (48), the arm mount (51), and the robot arm (50) can be deployed around the column (53), and can be closed to store and protect them when not in use. The base cover (52) can be sealed with a membrane (54) along the edge of its opening to prevent dust and fluid ingress when closed.

[0041] FIG. 8 illustrates an embodiment of a robotic table-based system configured for a ureteroscopic procedure. In a ureteroscopic procedure, the table (38) may include a swivel portion (55) for positioning the patient at an angle away from the column (37) and the table base (46). The swivel portion (55) may rotate or pivot around a pivot point (e.g., located below the patient's head) to position the lower portion of the swivel portion (55) away from the column (37). For example, pivoting of the swivel portion (55) allows the C-arm (not shown) to be positioned over the patient's lower abdomen without competing for space with the column (not shown) below the table (38). By rotating the carriage (35) (not shown) around the column (37), the robotic arm (39) can insert the ureteroscope (56) directly into the patient's groin area along the virtual rail (57) to reach the urethra. In the ureteroscopy, a stirrup (58) is also secured to the swivel portion (55) of the table (38) to support the position of the patient's leg during the procedure and allow clear access to the patient's groin area.

[0042] In a laparoscopic procedure, a minimally invasive instrument may be inserted into the patient's anatomical structure through small incision(s) within the patient's abdominal wall. In some embodiments, the minimally invasive instrument comprises a slender, rigid member, such as a shaft, used to access the anatomical structure within the patient. After the patient's abdominal cavity is distended, the instrument may be oriented to perform surgical or medical operations such as grasping, cutting, excision, suturing, etc. In some embodiments, the instrument may include a scope, such as a laparoscope. FIG. 9 illustrates one embodiment of a robotic table-based system configured for a laparoscopic procedure. As illustrated in FIG. 9, the carriage (43) of the system (36) can be rotated and vertically adjusted to position a pair of robotic arms (39) on opposite sides of the table (38), allowing the instrument (59) to be positioned using arm mounts (45) so that it passes through the minimal incisions on both sides of the patient and reaches his / her abdominal cavity.

[0043] To accommodate laparoscopic procedures, the robotic table system can also allow the platform to be tilted to a desired angle. FIG. 10 illustrates an embodiment of a robotic medical system having pitch or tilt control. As illustrated in FIG. 10, the system (36) can accommodate the tilt of the table (38) so that one part of the table is positioned at a greater distance from the floor than the other part. Additionally, the arm mount (45) can rotate to match the tilt so that the robotic arm (39) maintains a plane-like relationship with the table (38). To accommodate a steeper angle, the column (37) may also include an insertion portion (60) that allows the vertical extension of the column (37) to prevent the table (38) from touching the floor or colliding with the table base (46).

[0044] FIG. 11 provides a detailed example of an interface between a table (38) and a column (37). A pitch rotation mechanism (61) may be configured to change the pitch angle of the table (38) relative to the column (37) with multiple degrees of freedom. The pitch rotation mechanism (61) may be enabled by positioning orthogonal axes (1, 2) at the column-table interface, each axis being actuated by a separate motor (3, 4) in response to an electric pitch angle command. Rotation along one screw (5) will enable tilt adjustment along one axis (1), while rotation along another screw (6) will enable tilt adjustment along the other axis (2). In some embodiments, a ball joint may be used to change the pitch angle of the table (38) relative to the column (37) with multiple degrees of freedom.

[0045] For example, pitch adjustment is particularly useful when positioning the table in the Trendelenburg position for lower abdominal surgery—that is, when positioning the patient's lower abdomen higher than their upper abdomen from the floor. The Trendelenburg position allows the patient's internal organs to slide toward their upper abdomen due to gravity, thereby emptying the abdominal cavity to allow for the insertion of minimally invasive instruments to perform lower abdominal surgery or medical procedures, such as laparoscopic prostatectomy.

[0046] FIGS. 12 and FIGS. 13 illustrate isometric and end views of alternative embodiments of a table-based surgical robot system (100). The surgical robot system (100) includes one or more adjustable arm supports (105) that may be configured to support one or more robot arms (e.g., see FIG. 14) relative to a table (101). In the illustrated embodiment, a single adjustable arm support (105) is shown, but additional arm supports may be provided on opposite sides of the table (101). The adjustable arm support (105) may be configured to move relative to the table (101) to adjust and / or change the position of the adjustable arm support (105) and / or any robot arm mounted thereon relative to the table (101). For example, the adjustable arm support (105) may be adjusted relative to the table (101) by one or more degrees of freedom. The adjustable arm support (105) provides high versatility for the system (100), including the ability to easily load one or more adjustable arm supports (105) and any robot arm attached thereto under the table (101). The adjustable arm support (105) can be raised from a loaded position to a position below the upper surface of the table (101). In another embodiment, the adjustable arm support (105) can be raised from a loaded position to a position above the upper surface of the table (101).

[0047] The adjustable arm support (105) may provide several degrees of freedom, including lift, lateral translation, tilt, etc. In the exemplary embodiment of FIGS. 12 and 13, the arm support (105) is composed of four degrees of freedom, as illustrated by the arrow in FIGS. 12. The first degree of freedom allows adjustment ("Z-lift") of the adjustable arm support (105) in the z-direction. For example, the adjustable arm support (105) may include a carriage (109) configured to move upward or downward along or relative to a column (102) supporting the table (101). The second degree of freedom may allow the adjustable arm support (105) to tilt. For example, the adjustable arm support (105) may include a rotational joint that allows the adjustable arm support (105) to be aligned with the bed in a Trendelenburg position. The third degree of freedom may allow the adjustable arm support (105) to "pivot up," which can be used to adjust the distance between the side of the table (101) and the adjustable arm support (105). The fourth degree of freedom may allow translation of the adjustable arm support (105) along the longitudinal length of the table.

[0048] The surgical robot system (100) of FIGS. 12 and 13 may include a table supported by a column (102) mounted on a base (103). The base (103) and the column (102) support the table (101) against a support surface. A base axis (131) and a support axis (133) are shown in FIG. 13.

[0049] The adjustable arm support (105) may be mounted on a column (102). In another embodiment, the arm support (105) may be mounted on a table (101) or a base (103). The adjustable arm support (105) may include a carriage (109), a bar or rail connector (111), and a bar or rail (107). In some embodiments, one or more robot arms mounted on the rail (107) may translate and move relative to each other.

[0050] The carriage (109) may be attached to the column (102) by a first joint (113), which allows the carriage (109) to move relative to the column (102) (e.g., upward and downward along the first or vertical axis (123)). The first joint (113) may provide a first degree of freedom ("Z-lift") to the adjustable arm support (105). The adjustable arm support (105) may include a second joint (115) that provides a second degree of freedom (tilt) to the adjustable arm support (105). The adjustable arm support (105) may include a third joint (117) that provides a third degree of freedom ("upward pivot") to the adjustable arm support (105). An additional joint (119) (shown in FIG. 13) may be provided to mechanically restrain the third joint (117) to maintain the orientation of the rail (107) as the rail connector (111) rotates around the third axis (127). The adjustable arm support (105) may include a fourth joint (121) that can provide a fourth degree of freedom (translation) for the adjustable arm support (105) along the fourth axis (129).

[0051] FIG. 14 illustrates an end view of a surgical robot system (140A) having two adjustable arm supports (105A, 105B) mounted on opposite sides of a table (101). A first robot arm (142A) is attached to a bar or rail (107A) of the first adjustable arm support (105B). The first robot arm (142A) includes a base (144A) attached to the rail (107A). The distal end of the first robot arm (142A) includes a mechanism drive mechanism (146A) that can be attached to one or more robotic medical instruments or tools. Similarly, a second robot arm (142B) includes a base (144B) attached to the rail (107B). The distal end of the second robot arm (142B) includes a mechanism drive mechanism (146B). The mechanism drive mechanism (146B) may be configured to be attached to one or more robotic medical devices or tools.

[0052] In some embodiments, one or more of the robot arms (142A, 142B) comprise an arm having 7 or more degrees of freedom. In some embodiments, one or more of the robot arms (142A, 142B) may comprise 8 degrees of freedom, including an insertion axis (1 degree of freedom including insertion), a wrist (3 degrees of freedom including wrist pitch, yaw, and roll), an elbow (1 degree of freedom including elbow pitch), a shoulder (2 degrees of freedom including shoulder pitch and yaw), and a base (144A, 144B) (1 degree of freedom including translation). In some embodiments, the insertion degrees of freedom may be provided by the robot arms (142A, 142B), while in other embodiments, the mechanism itself provides insertion through a mechanism-based insertion architecture.

[0053] C. Mechanical driver and interface.

[0054] The end effector of the system's robotic arm may comprise (i) an instrument driver (alternatively referred to as an "instrument drive mechanism" or "instrument device manipulator") incorporating electromechanical means for operating a medical instrument, and (ii) a removable or detachable medical instrument that may not have any electromechanical components such as motors. This dichotomy may be driven by the need to sterilize medical instruments used in medical procedures, and the inability to adequately sterilize expensive capital equipment due to their complex mechanical assemblies and sensitive electronics. Therefore, medical instruments may be designed to be detached, removed, and exchanged from the instrument driver (and consequently the system) for individual sterilization or disposal by a physician or the physician's staff. In contrast, the instrument driver does not need to be altered or sterilized and may be draped for protection.

[0055] FIG. 15 illustrates an exemplary mechanism driver. Positioned at the distal end of a robot arm, the mechanism driver (62) comprises one or more drive units (63) arranged in parallel axes to provide controlled torque to a medical device via a drive shaft (64). Each drive unit (63) comprises an individual drive shaft (64) for interacting with the device, a gear head (65) for converting motor shaft rotation into a desired torque, a motor (66) for generating the drive torque, an encoder (67) for measuring the speed of the motor shaft and providing feedback to a control circuit, and a control circuit (68) for receiving a control signal and operating the drive unit. Because each drive unit (63) is independently controlled and powered, the mechanism driver (62) can provide a plurality (e.g., four, as illustrated in FIG. 15) of independent drive outputs to the medical device. When operating, the control circuit (68) will receive a control signal, transmit a motor signal to the motor (66), compare the generated motor speed measured by the encoder (67) with the desired speed, and modulate the motor signal to generate the desired torque.

[0056] For procedures requiring a sterile environment, the robotic system may incorporate a drive interface, such as a sterile adapter connected to a sterile drape, positioned between the instrument driver and the medical instrument. The primary purpose of the sterile adapter is to transmit angular motion from the drive shaft of the instrument driver to the drive input of the instrument, while maintaining physical separation between the drive shaft and the drive input and thereby preserving sterility. Accordingly, an exemplary sterile adapter may include a series of rotary inputs and outputs intended to align with the drive shaft of the instrument driver and the drive input on the instrument. Connected to the sterile adapter, the sterile drape, composed of a thin, flexible material such as clear or translucent plastic, is designed to cover capital equipment such as the instrument driver, the robotic arm, the cart (in a cart-based system), or the table (in a table-based system). The use of the drape will allow the capital equipment to be positioned close to the patient while remaining within an area that does not require sterilization (i.e., a non-sterile area). On the other side of the sterile drape, the medical instrument can interface with the patient in the area requiring sterilization (i.e., the sterile area).

[0057] D. Medical devices.

[0058] FIG. 16 illustrates an exemplary medical device having a paired instrument driver. Like other devices designed for use with a robotic system, the medical device (70) comprises an elongated shaft (71) (or elongated body) and an instrument base (72). The instrument base (72), also referred to as an "instrument handle" due to its intended design for manual interaction by a physician, may generally include a rotatable drive input (73), such as a receptacle, pulley, or spool, designed to be coupled with a drive output (74) extending through a drive interface on the instrument driver (75) at the distal end of the robot arm (76). When physically connected, latched, and / or coupled, the coupled drive input (73) of the instrument base (72) may share a rotational axis with the drive output (74) within the instrument driver (75), thereby allowing the transmission of torque from the drive output (74) to the drive input (73). In some embodiments, the drive output (74) may include a spline designed to match the receptacle on the drive input (73).

[0059] The slender shaft (71) is designed to be delivered through an anatomical opening or lumen, for example, in endoscopy, or through a minimally invasive incision, for example, in laparoscopy. The slender shaft (71) may be flexible (e.g., having characteristics similar to an endoscope) or rigid (e.g., having characteristics similar to a laparoscope), or may include a customized combination of both flexible and rigid parts. When designed for laparoscopy, the distal end of the rigid slender shaft may be connected to a surgical instrument or medical device, such as a gripper or scissors, which can be actuated based on force from a tendon as the drive input rotates in response to torque received from the drive output (74) of the instrument driver (75). When designed for endoscopy, the distal end of the flexible elongated shaft may include a steerable or controllable bending section that can be articulated and bent based on torque received from the drive output (74) of the instrument driver (75).

[0060] Torque from the instrument driver (75) is transmitted along the slender shaft (71) using tendons along the slender shaft (71). These individual tendons, such as pull wires, can be individually secured to individual drive inputs (73) within the instrument handle (72). From the handle (72), the tendons are directed along one or more pull lumens along the slender shaft (71) and secured to the distal portion of the slender shaft (71), or within a wrist located in the distal portion of the slender shaft. During surgical procedures such as laparoscopic, endoscopic, or hybrid procedures, these tendons can be coupled to distal end effectors, such as wrists, grippers, or scissors. Under such an arrangement, the torque applied to the drive inputs (73) will transmit tension to the tendons, thereby causing the end effectors to operate in a certain manner. In some embodiments, during the surgical procedure, the tendon may cause the joint to rotate about an axis, thereby causing the end effector to move in one direction or another. Alternatively, the tendon may be connected to one or more jaws of the gripper at the distal end of the elongated shaft (71), where tension from the tendon causes the gripper to close.

[0061] In endoscopy, the tendon may be coupled to a bending or articulating section positioned along the elongated shaft (71) (e.g., at the distal end) via an adhesive, a control ring, or other mechanical fastening. When fixedly attached to the distal end of the bending section, the torque applied to the drive input (73) is transmitted along the tendon, causing the softer bending section (sometimes referred to as the articulating section or region) to bend or articulate. Along the non-bending section, it may be advantageous to spiral or helical individual pull lumens that orient the individual tendon along (or inside) the wall of the endoscope shaft to balance the radial force generated from the tension of the pull wire. The angle of the spiraling and / or the spacing between them can be changed or manipulated for specific purposes, where a denser spiral indicates less shaft compression under load force, while a smaller amount of spiral results in greater shaft compression under load force but limits bending. At the other end of the spectrum, the pull lumen can be oriented parallel to the longitudinal axis of the slender shaft (71) to allow for desired bending or controlled articulation in the articulating section.

[0062] In endoscopy, the elongated shaft (71) accommodates a number of components to assist in a robotic procedure. The shaft (71) may include a working channel for deploying surgical tools (or medical instruments), irrigation, and / or aspiration to the surgical area at the distal end of the shaft (71). The shaft (71) may also accommodate wires and / or optical fibers for transmitting signals to and from an optical assembly at the distal tip, which may include an optical camera. The shaft (71) may also accommodate optical fibers for transmitting light from a proximal light source, such as a light-emitting diode, to the distal end of the shaft (71).

[0063] At the distal end of the instrument (70), the distal tip may also include an opening of a working channel for delivering a tool for diagnosis and / or treatment, irrigation, and aspiration to the surgical site. The distal tip may also include a port for a camera, such as a fibroscope or digital camera, for capturing an image of the internal anatomical space. In this regard, the distal tip may also include a port for a light source for illuminating the anatomical space when using the camera.

[0064] In the example of FIG. 16, the drive shaft axis, and accordingly the drive input axis, are orthogonal to the axis of the slender shaft (71). However, this arrangement complicates the rolling capability for the slender shaft (71). Rolling the slender shaft (71) along its axis while keeping the drive input (73) static causes undesirable entanglement of the tendons as the tendons extend from the drive input (73) and enter the pull lumen within the slender shaft (71). Such resulting entanglement of the tendons can interfere with any control algorithm intended to predict the movement of the flexible slender shaft (71) during an endoscopic procedure.

[0065] FIG. 17 illustrates an alternative design for a mechanism driver and mechanism in which the axis of the drive unit is parallel to the axis of the slender shaft of the mechanism. As illustrated, the circular mechanism driver (80) comprises four drive units whose drive outputs (81) are aligned parallel at the end of the robot arm (82). The drive units, and their respective drive outputs (81), are housed within a rotary assembly (83) of the mechanism driver (80), which is driven by one of the drive units within the assembly (83). In response to the torque provided by the rotary drive unit, the rotary assembly (83) rotates along a circular bearing connecting the rotary assembly (83) to the non-rotating part (84) of the mechanism driver (80). Power and control signals can be transmitted from the non-rotating part (84) of the mechanism driver (80) to the rotary assembly (83) through an electrical contact that can be maintained through rotation by a brushed slip ring connection (not illustrated). In another embodiment, the rotary assembly (83) is integrated within a non-rotatable part (84) so ​​as to respond to a separate drive unit that is not parallel to the other drive unit. The rotary mechanism (83) allows the mechanism driver (80) to rotate the drive unit and their respective drive outputs (81) as a single unit around the mechanism driver axis (85).

[0066] As with the previously disclosed embodiment, the mechanism (86) may include a mechanism base (87) (illustrated with a transparent outer skin for the purpose of discussion) comprising an elongated shaft portion (88) and a plurality of drive input portions (89), such as a receptacle, pulley, and spool, configured to accommodate a drive output portion (81) within the mechanism driver (80). Unlike the previously disclosed embodiment, the mechanism shaft (88) extends from the center of the mechanism base (87) in a manner that is substantially parallel to the axis of the drive input portion (89) rather than being orthogonal as in the design of FIG. 16.

[0067] When coupled to the rotary assembly (83) of the mechanism driver (80), the medical device (86), comprising the mechanism base (87) and the mechanism shaft (88), rotates around the mechanism driver axis (85) in combination with the rotary assembly (83). Since the mechanism shaft (88) is positioned at the center of the mechanism base (87), the mechanism shaft (88) is coaxial with the mechanism driver axis (85) when attached. Thus, the rotation of the rotary assembly (83) causes the mechanism shaft (88) to rotate around its own longitudinal axis. Furthermore, as the mechanism base (87) rotates together with the mechanism shaft (88), any tendon connected to the drive input (89) within the mechanism base (87) does not get tangled during rotation. Thus, the parallelism of the axes of the drive output (81), the drive input (89), and the mechanism shaft (88) allows for shaft rotation without tangling any control tendon.

[0068] FIG. 18 illustrates a mechanism having a mechanism-based insertion architecture according to some embodiments. The mechanism (150) may be coupled to any of the mechanism drivers discussed above. The mechanism (150) comprises an elongated shaft (152), an end effector (162) connected to the shaft (152), and a handle (170) coupled to the shaft (152). The elongated shaft (152) comprises a tubular member having a proximal portion (154) and a distal portion (156). The elongated shaft (152) comprises one or more channels or grooves (158) along its outer surface. The grooves (158) are configured to receive one or more wires or cables (180) through them. Thus, one or more cables (180) are routed along the outer surface of the elongated shaft (152). In other embodiments, the cables (180) may also be routed through the elongated shaft (152). The operation of one or more cables (180) (e.g., through a mechanism driver) triggers the operation of the end effector (162).

[0069] The mechanism handle (170), which may also be referred to as a mechanism support, may generally include an attachment interface (172) having one or more mechanical input parts (174), such as a receptacle, pulley, or spool, designed to be coupled with one or more torque couplers on the attachment surface of the mechanism driver.

[0070] In some embodiments, the mechanism (150) includes a series of pulleys or cables that enable the elongated shaft (152) to translate relative to the handle (170). In other words, the mechanism (150) itself includes a mechanism-based insertion architecture that accommodates the insertion of the mechanism, thereby minimizing dependence on a robot arm to provide the insertion of the mechanism (150). In other embodiments, the robot arm may primarily handle the insertion of the mechanism.

[0071] E. Controller.

[0072] Any of the robot systems described herein may include an input device or controller for operating a mechanism attached to a robot arm. In some embodiments, the controller may be coupled to the mechanism (e.g., communicably, electronically, electrically, wirelessly, and / or mechanically) such that the operation of the controller triggers a corresponding operation of the mechanism, for example, through master-slave control.

[0073] FIG. 19 is a perspective view of one embodiment of a controller (182). In this embodiment, the controller (182) includes a hybrid controller that can have both impedance and admittance control. In another embodiment, the controller (182) may use only impedance or passive control. In another embodiment, the controller (182) may use only admittance control. Because it is a hybrid controller, the controller (182) may advantageously have lower perceived inertia during use.

[0074] In the illustrated embodiment, the controller (182) is configured to allow operation of two medical devices and includes two handles (184). Each of the handles (184) is connected to a gimbal (186). Each gimbal (186) is connected to a positioning platform (188).

[0075] As illustrated in FIG. 19, each positioning platform (188) includes a SCARA arm (selective compliance assembly robot arm) (198) that is coupled to a column (194) by a prismatic joint (196). The prismatic joint (196) is configured to translate along the column (194) (e.g., along a rail (197)) to allow each of the handles (184) to translate in the z-direction to provide a first degree of freedom. The SCARA arm (198) is configured to allow movement of the handles (184) in the xy plane to provide a second additional degree of freedom.

[0076] In some embodiments, one or more load cells are located within the controller. For example, in some embodiments, a load cell (not shown) is located in the body of each gimbal (186). By providing a load cell, parts of the controller (182) can operate under admittance control, thereby advantageously reducing the perceived inertia of the controller during use. In some embodiments, the positioning platform (188) is configured for admittance control, while the gimbal (186) is configured for impedance control. In other embodiments, the gimbal (186) is configured for admittance control, while the positioning platform (188) is configured for impedance control. Thus, in some embodiments, the translational or positional degrees of freedom of the positioning platform (188) may depend on admittance control, while the rotational degrees of freedom of the gimbal (186) may depend on impedance control.

[0077] F. Navigation and Control.

[0078] Traditional endoscopy may provide in-tube guidance to the operating physician by involving the use of fluoroscopy and other forms of radiation-based imaging techniques (such as those that can be delivered via a C-arm, for example). In contrast, the robotic system considered by this disclosure provides non-radiation-based navigation and positioning means, which can reduce the physician's exposure to radiation and reduce the amount of equipment in the operating room. As used herein, the term "positioning" may refer to determining and / or monitoring the position of an object in a reference coordinate system. Techniques such as preoperative mapping, computer vision, real-time EM tracking, and robotic command data may be used individually or in combination to achieve a radiation-free surgical environment. In other cases where radiation-based imaging techniques are still used, preoperative mapping, computer vision, real-time EM tracking, and robotic command data may be used individually or in combination to enhance information obtained solely through radiation-based imaging techniques.

[0079] FIG. 20 is a block diagram illustrating a positioning system (90) for estimating the position of one or more elements of a robot system, such as the position of a mechanism, according to an exemplary embodiment. The positioning system (90) may be a set of one or more computer devices configured to execute one or more instructions. The computer devices may be implemented by a processor (or processors) and computer-readable memory within one or more components discussed above. As an example, but not a limitation, the computer devices may be located within the tower (30) shown in FIG. 1, the cart (11) shown in FIG. 1 through 4, the bed shown in FIG. 5 through 14, etc.

[0080] As illustrated in FIG. 20, the positioning system (90) may include a positioning module (95) that processes input data (91 to 94) to generate position data (96) for the distal tip of a medical instrument. The position data (96) may be data or logic representing the position and / or orientation of the distal end of the instrument relative to a frame of reference. The frame of reference may be a frame of reference for a patient's anatomical structure or a known object, such as an EM field generator (see discussion below for the EM field generator).

[0081] Now, various input data (91 to 94) are described in more detail. Preoperative mapping can be achieved through the use of a set of low-dose CT scans. Preoperative CT scans are reconstructed into three-dimensional images, which are visualized, for example, as "slices" of cross-sections of the patient's internal anatomical structures. When analyzed as a whole, an image-based model of the anatomical cavities, spaces, and structures of the patient's anatomical structures, such as the patient's lung network, can be generated. Techniques such as center-line geometry can be determined and approximated from the CT images to develop a three-dimensional volume of the patient's anatomical structures, referred to as model data (91) (also referred to as "preoperative model data" when generated using only preoperative CT scans). The use of center-line geometry is discussed in U.S. Patent Application No. 14 / 523,760, the contents of which are incorporated herein in their entirety. A network topological model can also be derived from CT images and is particularly suitable for bronchoscopy.

[0082] In some embodiments, the device may be equipped with a camera for providing vision data (or image data) (92). A positioning module (95) may process the vision data (92) to enable one or more vision-based (or image-based) positioning modules or features. For example, preoperative model data (91) may be used in conjunction with the vision data (92) to enable computer vision-based tracking of the medical device (e.g., advancing the endoscope or advancing the device through the endoscope's working channel). For example, using the preoperative model data (91), the robotic system may generate a library of predicted endoscope images from the model based on the predicted path of the endoscope, with each image linked to a specific location within the model. During surgery, this library may be referenced by the robotic system to assist in positioning by comparing real-time images captured from a camera (e.g., a camera at the distal end of the endoscope) with images in the image library.

[0083] Other computer vision-based tracking techniques use feature tracking to determine the movement of the camera and, consequently, the endoscope. Some features of the positioning module (95) can identify circular geometric structures within the preoperative model data (91) corresponding to the anatomical lumen and track changes in those geometric structures to determine which anatomical lumen has been selected, as well as the relative rotation and / or translational movement of the camera. The use of a topological map can further enhance the vision-based algorithm or technique.

[0084] Another computer vision-based technique, optical flow, can infer camera movement by analyzing the displacement and translation of image pixels in a video sequence within the vision data (92). Examples of optical flow techniques may include motion detection, object segmentation calculation, luminance, motion compensated encoding, stereo disparity measurement, etc. By comparing multiple frames over multiple iterations, the movement and position of the camera (and consequently the endoscope) can be determined.

[0085] The positioning module (95) may use real-time EM tracking to generate the real-time position of the endoscope in a global coordinate system that can be aligned with the anatomical structure of the patient represented by the preoperative model. In EM tracking, an EM sensor (or tracker) comprising one or more sensor coils embedded in one or more positions and orientations within a medical instrument (e.g., an endoscope tool) measures changes in the EM field generated by one or more static EM field generators located at known locations. The position information detected by the EM sensor is stored as EM data (93). The EM field generator (or transmitter) may be placed near the patient to generate a low-intensity magnetic field that the embedded sensor can detect. The magnetic field induces a small current in the sensor coil of the EM sensor, which can be analyzed to determine the distance and angle between the EM sensor and the EM field generator. These distances and orientations can be "aligned" to the patient's anatomical structure (e.g., preoperative model) during surgery to determine a geometric transformation that aligns a single location within the coordinate system with a location within a preoperative model of the patient's anatomical structure. Once aligned, an embedded EM tracker located at one or more locations on the medical device (e.g., the distal tip of an endoscope) can provide a real-time indication of the medical device's progression through the patient's anatomical structure.

[0086] Robot command and kinematics data (94) may also be used by a positioning module (95) to provide positioning data (96) for the robot system. The device pitch and yaw resulting from joint motion commands may be determined during preoperative calibration. During surgery, these calibration measurements may be used in combination with known insertion depth information to estimate the position of the instrument. Alternatively, these calculations may be analyzed in combination with EM, vision, and / or phase modeling to estimate the position of the medical instrument within the network.

[0087] As illustrated in FIG. 20, a number of different input data may be used by the positioning module (95). For example, although not illustrated in FIG. 20, a mechanism using a shape-sensing fiber may provide shape data that the positioning module (95) can use to determine the position and shape of the mechanism.

[0088] The positioning module (95) may use input data (91 to 94) as combination(s). In some cases, such combinations may use a probabilistic approach in which the positioning module (95) assigns a confidence weight to the position determined from each of the input data (91 to 94). Thus, if the EM data may not be reliable (as may be the case where there is EM interference), the confidence of the position determined by the EM data (93) may be reduced, and the positioning module (95) may rely more on the vision data (92) and / or robot command and kinematic data (94).

[0089] As discussed above, the robot system discussed in this specification may be designed to incorporate one or more combinations of the above techniques. A computer-based control system of a robot system based on a tower, bed and / or cart may store computer program instructions in a non-transient computer-readable storage medium, such as a permanent magnetic storage drive or a solid-state drive, for example, which, upon execution, enables the system to receive and analyze sensor data and user commands, generate control signals across the system, and display navigation and positioning data, such as the position of the mechanism in a global coordinate system, an anatomical map, etc.

[0090] 2. Manual and robot-controlled medical devices.

[0091] Embodiments of the present disclosure relate to devices, systems, and techniques for manual and robot-controllable medical devices. In some embodiments, manual and robot-controllable medical devices may be used with a robotic medical system such as that described above with reference to FIGS. 1 through 20. As discussed in detail below, manual and robot-controllable medical devices may be configured for manual control, robot control, or both. Such medical devices may also be considered as hybrid medical devices because they are configured for both manual and robot control. Examples of medical devices may include endoscopes, cameras (e.g., equipped with optical fibers), basketing tools, blade tools, laser tools (e.g., equipped with optical fibers), and / or other devices described herein.

[0092] In some embodiments, the medical device may be configured for endoscopic procedures. For example, the medical device may be configured for uroscopy, ureteroscopy, gastroscopy, bronchoscopy, or other endoscopic procedures. In some embodiments, the medical device may be configured for laparoscopic procedures or other types of medical procedures (e.g., open procedures).

[0093] A. Introduction of manual and robot-controlled medical devices.

[0094] In some embodiments, a manual and robot-controllable medical device may be operated in a first mode (manual mode) by a physician or other operator who physically handles and manually manipulates the medical device, and may also be operated in a second mode (robot mode) by a robotic medical system. When operated in manual mode, the physician may manually operate one or more manual drive inputs to control the medical device. When operated in robot mode, the medical device may be attached to a device drive mechanism located on the end of a robotic arm or other device positioning device. The device drive mechanism may include one or more robotic drive outputs that engage with one or more robotic drive inputs to control the medical device by robot. The physician may use a controller (e.g., as shown in FIG. 19) to control the robotic system.

[0095] The medical device may include an elongated shaft and a handle (or base of the device). The elongated shaft may be configured for insertion into the patient's anatomical structure during a medical procedure. In some embodiments, the elongated shaft is inserted into the patient's anatomical structure through a natural opening. In some embodiments, the elongated shaft is inserted into the patient's anatomical structure through an incision or other surgical opening. The elongated shaft may be flexible. The elongated shaft may be articulating and controllable. This may allow an operator, such as a physician, to control the articulation of the elongated shaft to navigate and steer the medical device through the patient's anatomical structure. Controlling the articulation of the elongated shaft may include deflecting or bending the articulating portion of the elongated shaft, and, in some embodiments, rolling or rotating the elongated shaft about the longitudinal axis of the shaft. In some embodiments, the articulating portion may be the distal portion of the elongated shaft. The articulating portion may be articulating with one or more degrees of freedom. The degrees of freedom may be linear or rotational, or may include joint movement along a plane. The operation of the slender shaft can be controlled at the mechanism base.

[0096] As described above (e.g., with reference to FIGS. 15 through 18), in some embodiments, the medical device may include one or more pull wires extending along (e.g., on or through) an elongated shaft. The pull wire may be attached to an actuation mechanism, such as a pulley and / or capstan, within the device handle. The actuation mechanism may then be connected to manual and robotic actuation inputs so that the actuation mechanism is actuated by the action of the manual and robotic actuation inputs to pull the pull wire and induce joint movement of the elongated shaft. In some embodiments, one or more of the manual actuation inputs and one or more of the robotic actuation inputs are each connected to the same actuation mechanism (e.g., a pulley, a capstan, and / or a pulley assembly) within the device handle, so that both the manual actuation input and the robotic actuation input may be used to actuate the same actuation mechanism. The manual actuation input may be separate from the robotic actuation input. For example, the manual drive input may be configured and positioned to be operable by hand, while the robotic drive input may be configured and positioned to engage with the robotic drive output so as to be operable by a robotic medical system. In some embodiments, the manual drive input remains exposed or accessible even when the mechanism handle is attached to the mechanism drive mechanism.

[0097] Medical devices configured for both robotic and / or manual control may provide one or more advantages in some embodiments. For example, in some embodiments, during the procedure, the medical device may first be manually inserted into the patient. A physician may first manually insert the medical device into the patient by physically handling it using a manual drive input to control the articulation of an elongated shaft to guide the medical device through the patient's anatomical structure. A medical device capable of providing the physician with the ability to perform manual insertion first may be faster and easier than robotic insertion in some cases. Manual insertion may, for example, provide the physician with fine feedback from the patient's internal anatomical structure. This may be the case, for example, in certain urological procedures, such as urological endoscopy, cystoscopy, ureteroscopy, or nephrology, and gastrointestinal endoscopy procedures. After initial manual insertion, the handle of the device may be attached to a device drive mechanism or a robotic medical system located on the end of a robotic arm or other device positioning device. When attached to a robotic medical system, the joint movement and control of the slender shaft of the medical device can subsequently be controlled by the robot. Robotic control can allow for precise and accurate control of the medical device at the treatment site. Since certain aspects of a medical procedure may be better suited to manual control and other aspects of a medical procedure may be best suited to robotic control, the hybrid medical device described herein can advantageously be used in either manual or robotic control modes as required depending on the specific situation or stage of the medical procedure. Such a medical device provides excellent flexibility to the physician and facilitates the performance of the medical procedure.

[0098] Additionally, some robotic medical systems may be limited in absolute insertion depth or stroke. It may be advantageous for a physician to manually insert an instrument (e.g., instrument head) to establish an approximate or rough position, while robotic features can provide finer adjustments to the instrument's position. Therefore, it may be advantageous to manually insert the medical instrument first so that the finite insertion depth or stroke of the robotic system can be advantageously utilized in the field of diagnosis or treatment. The medical instrument described herein may allow for manual placement of the instrument over long distances that would be cumbersome to perform with a robot. In some embodiments, manual control of the instrument may be used to provide initial gross positioning of the medical instrument. For example, manual control may be used to position the medical instrument at or near the treatment site within the patient's anatomical structure, and robotic control of the instrument may be used to provide fine position control during the procedure.

[0099] In some embodiments, a physician may manually control a medical device by operating a manual drive input before the medical device is attached to the device drive mechanism. In some embodiments, a physician may manually control a medical device by operating a manual drive input while the medical device is attached to the device drive mechanism.

[0100] As mentioned above, the medical device may include both manual and robotic drive inputs. In some embodiments, one of the manual drive inputs is configured to provide two-way deflection control for the slender shaft of the medical device. Two-way deflection control may allow deflection of the slender shaft in two directions. In some embodiments, the two directions may be opposite directions, such as upward and downward or left and right. This may also be referred to as two-way deflection control within a single plane, such as an upward-downward plane or a left-right plane. The terms of direction in this application (e.g., upward, downward, left, right, etc.) are used extensively to indicate different directions for the orientation of the medical device. Because the medical device may be frequently repositioned in a wide variety of orientations, the terms of direction should not be interpreted as limiting. For example, directions referred to as upward, downward, left, and right may vary depending on the orientation of the device. A manual drive input configured for 2-way deflection control may be, for example, a lever, a slider, a wheel, or other type of manually operable drive input. In some embodiments, operating the manual drive input in a first direction causes a deflection of the elongated shaft in the first direction (e.g., upward), and operating the manual drive input in a second direction causes a deflection of the elongated shaft in the second direction (e.g., downward).

[0101] The medical device may also include a manual drive input configured to allow roll control for an elongated shaft. This may be referred to as a manual roll input. For example, the medical device may include a manual drive input that allows the elongated shaft to rotate about the axis of the elongated shaft relative to the instrument handle. Such a manual drive input may be configured to allow roll of the elongated shaft relative to the instrument handle (in this case, the shaft is rotated about the longitudinal axis of the shaft). In some embodiments, manual roll control may allow rotation of the elongated shaft in both rotational directions of at least 90, at least 100, at least 110, at least 120, at least 130, at least 140, at least 150, at least 160, at least 170, at least 180, at least 190, at least 200, at least 210, at least 220, at least 230, at least 240, at least 250, at least 260, at least 270, at least 280, at least 290, at least 300, at least 310, at least 320, at least 330, at least 340, at least 350, at least 360 degrees, or more. In some embodiments, a manual drive input configured for roll control may be omitted, and the physician may physically roll the entire medical device (e.g., rolling the handle and the slender shaft together) to manually control the roll of the slender shaft.

[0102] Manual control of medical instruments using 2-way deflection and roll control can be arranged to be familiar and intuitive to many doctors who are accustomed to working with medical instruments configured solely for manual control.

[0103] In some embodiments, the medical device may include additional drive inputs configured to allow additional two-way deflection control. For example, the first manual drive input may allow two-way deflection control in the upward and downward directions, and the second manual drive input may allow two-way deflection control in the left and right directions. This will allow four-way deflection control for an elongated shaft using two manual drive inputs.

[0104] In some embodiments, the robot drive input is configured to allow 4-way deflection control. In some embodiments, the 4-way deflection control allows for joint movement of the slender shaft in four different directions. In some embodiments, the directions may be four orthogonal directions such as upward, downward, left, and right. In some embodiments, the robot drive input configured for 4-way deflection control may include two robot drive inputs. The two robot drive inputs may be configured to engage with two corresponding robot drive outputs on the mechanism drive mechanism. Each robot drive input may be rotatable in two opposite directions, e.g., clockwise and counterclockwise. Rotation of the first robot drive input of the two robot drive inputs in one direction (e.g., clockwise) may allow for joint movement in one of the four directions (e.g., upward). Rotation of the first robot drive input of the two robot drive inputs in opposite directions (e.g., counterclockwise) may allow joint movement in another of the four directions (e.g., downward). Rotation of the second robot drive input of the two robot drive inputs in one direction (e.g., clockwise) may allow joint movement in another of the four directions (e.g., right). Additionally, rotation of the second robot drive input of the two robot drive inputs in opposite directions (e.g., counterclockwise) may allow joint movement in another of the four directions (e.g., left). Thus, 4-direction deflection control can be achieved using two robot drive inputs. In some embodiments, the robot drive inputs are configured to provide deflection control in a different number of directions, such as 2-direction deflection control, 3-direction deflection control, etc.

[0105] The medical device may include additional robotic drive inputs configured to provide robotic roll control for the slender shaft of the medical device. For example, the medical device may include robotic drive inputs configured to engage with a corresponding robotic drive output on a device drive mechanism, allowing the slender shaft to rotate about the axis of the slender shaft relative to the device handle. Such robotic drive inputs may be configured to allow radial reorientation of the slender shaft relative to the device handle. In some embodiments, rotation of such robotic device drive inputs in a first direction (e.g., clockwise) causes clockwise rotation of the slender shaft, and rotation of such robotic device drive inputs in a second direction (e.g., counterclockwise) causes counterclockwise rotation of the slender shaft. In some embodiments, the robot roll control may allow rotation of the elongated shaft in both rotational directions of at least 90, at least 100, at least 110, at least 120, at least 130, at least 140, at least 150, at least 160, at least 170, at least 180, at least 190, at least 200, at least 210, at least 220, at least 230, at least 240, at least 250, at least 260, at least 270, at least 280, at least 290, at least 300, at least 310, at least 320, at least 330, at least 340, at least 350, at least 360 degrees, or more.

[0106] In some cases, robotically controlling medical instruments using 4-way deflection control and roll control can be familiar and intuitive to many doctors who are accustomed to working with robotic instruments configured solely for robotic control. For example, 4-way deflection control can be intuitive when operating the controller to control a medical instrument.

[0107] As mentioned above, in some embodiments, the medical device is configured for manual control allowing manual 2-way deflection control and roll control (roll control can be achieved manually by a manual drive input configured to roll an elongated shaft against the device handle or by physically rolling the entire medical device), and for robotic control allowing robotic 4-way deflection control and roll control. Other types of manual and robotic control are also possible. For example, the medical device may be configured for manual control allowing manual 4-way deflection control and roll control, and for robotic control allowing robotic 4-way deflection control and roll control. As another example, the medical device may be configured for manual control allowing manual 2-way deflection control and roll control, and for robotic control allowing robotic 2-way deflection control and roll control.

[0108] In some configurations, multiple units (e.g., two, three, four, etc.) may be combined together for easier use by a physician (e.g., they may be combined removablely). For example, an endoscope may be combined with another instrument. The other instrument may be any instrument described herein (e.g., a laser tool, a basketing tool, forceps, a blade, etc.). The other instrument may include an elongated shaft that is combined with the endoscope through the inlet of the endoscope. In some configurations, the inlet may allow the elongated shaft of the other instrument to enter the working channel of the endoscope. Thus, it may be possible to integrate the shaft of the other instrument into the working channel of the endoscope. In this way, the endoscope and the other instrument may be combined together within their working channels. In some embodiments, the base of the endoscope and the base of the other instrument may also be combined together. Such combination of the bases may be achieved through a combination mechanism (e.g., a clip, a snap, a magnet, a button, etc.).

[0109] In some embodiments, multiple mechanisms may be combined for use in fully manual operation, fully robotic operation, or a hybrid of manual and robotic operation. For example, multiple mechanisms may be combined so that they are held in a physician's hand as a unit (e.g., at their base and / or through an inlet, etc.). In some embodiments, the unit may be configured to be combined as a unit with a robotic mechanism drive system. One or both of the mechanisms may subsequently be separated, for example, from the robotic mechanism drive system and / or from other mechanisms of the multiple mechanisms. Thus, in some embodiments, excellent flexibility may be achieved for the mechanisms to be used manually (if applicable), robotically (if applicable), and as a hybrid (if applicable). One or more medical mechanisms may be controlled remotely. For example, the robotic function described herein may be handled remotely from the robotic mechanism drive system.

[0110] B. Exemplary embodiments of manual and robot-controlled medical devices.

[0111] Now, the above-mentioned and other features of manual and robot-controlled medical devices will be described with reference to the embodiments illustrated in FIGS. 21a through 31. These embodiments are provided by way of example and are intended to illustrate the principles of the present disclosure without limiting the present disclosure. Those skilled in the art will recognize that various modifications of the illustrated embodiments are possible when considering the present disclosure. Such modifications are intended to be within the scope of the present disclosure.

[0112] FIG. 21a illustrates a schematic diagram of an exemplary medical device system (100). A proximal direction (142) and a distal direction (144) are shown for reference. The medical device system (100) may include an endoscope (110), a device (120), and / or a distal drive unit (130). As illustrated, the device (120) may include a device base (121) and a device shaft (124). The endoscope (110) may include a device base (111) and a device shaft (132). The device shaft (124) may be coupled to the device base (121) at the distal end of the device base (121). The device shaft (124) may be inserted into a working channel (not shown) of the device shaft (132) through a device inlet (128). Accordingly, the mechanism (120) is sometimes referred to as a work channel mechanism in this specification, but the features described in this specification in relation to a work channel mechanism may be applied to other types of manual, robotic, and / or flexible mechanisms in other embodiments. The mechanism inlet (128) may support the mechanism shaft (124) to prevent unintended translation and / or rotation of the mechanism shaft (124) at the insertion point into the mechanism inlet (128), for example. The endoscope base (111) may be coupled to the mechanism base (121), for example, through a coupling mechanism.

[0113] A distal drive unit (130) may be used to control the movement of the endoscope shaft (132). For example, the distal drive unit (130) may translate the endoscope shaft (132) proximally and / or distally. The distal drive unit (130) may be controlled by a robot and / or remotely. The distal drive unit (130) may include, for example, a feed roller, a rack and pinion mechanism, a pincher, a gripper, or other mechanisms configured to drive the insertion or retraction of the endoscope shaft (130). Alternatively, the distal drive unit (130) may be replaced by a robot-controlled or steering sheath, or the distal drive unit (130) may be omitted.

[0114] FIG. 21b illustrates a schematic diagram of a medical device system (100) that may have features similar to the embodiment described above with reference to FIG. 21a, in which the device shaft (124) extends proximally from the proximal portion (136) of the device base (121). In some configurations, it may be advantageous to form a partial loop of the device shaft (124) by having the device shaft extend proximally (instead of distally) from the device base (121). For example, this configuration may allow for easier manual manipulation of the device shaft (124). In some configurations, a device actuator (138) may be included to manually and / or robotically translate the device shaft (124) longitudinally (e.g., proximal, distally). The device actuator (138) may be a linear actuator. The instrument actuator (138) may be fixedly coupled to the instrument shaft (124) to prevent sliding and / or rotation of the instrument shaft (124) where the instrument shaft (124) is coupled to the instrument actuator (138). Thus, the instrument actuator (138) can control the longitudinal position of the instrument shaft (124) and, accordingly, the distal portion of the instrument actuator (138) (e.g., the portion inserted into the patient). As illustrated, the instrument shaft (124) re-enters the instrument base (121) before entering the endoscope shaft (132) through the inlet (128). However, in some configurations, the instrument shaft (124) may be coupled directly to the instrument inlet (128) (e.g., without re-entering the instrument base (121)).

[0115] The partial loop formed by the mechanism shaft (124) can form a curvature having a radius. The radius can be changed in response to translation of the mechanism actuator (138). The radius may be approximately 1 mm, approximately 2 mm, approximately 3 mm, approximately 5 mm, approximately 8 mm, approximately 10 mm, approximately 12 mm, approximately 15 mm, approximately 20 mm, approximately 25 mm, approximately 30 mm, approximately 35 mm, approximately 40 mm, approximately 45 mm, approximately 50 mm, approximately 60 mm, approximately 70 mm, approximately 80 mm, approximately 90 mm, 100 mm, any distance between these, or within any range having an endpoint within these.

[0116] FIGS. 21c through 21e illustrate embodiments of an exemplary medical device system (100) including vertical and / or horizontal orientation with respect to a robotic device drive mechanism (150). As shown in FIG. 21c, an endoscope (110) may be positioned between the device (120) and the robotic device drive mechanism (150). As shown in FIG. 21d, in some embodiments, the device (120) may be positioned between the endoscope (110) and the robotic device drive mechanism (150). A robotic arm may be coupled to the robotic device drive mechanism (150). Some embodiments described herein include a robotic mechanism drive mechanism (150) that is directly coupled to both the instrument (120) and the endoscope (110) in a parallel configuration, as shown in FIG. 21e, for example, but the robotic mechanism drive mechanism (150) shown in FIG. 21c and FIG. 21d is directly coupled to either the endoscope (110) or the instrument (120) in a stacked configuration. In these examples, the direct coupling involves coupling via a sterile adapter, in which case the robotic drive output (154) is the driving output of the sterile adapter that can be mounted on the robotic capital equipment. The robotic mechanism drive mechanism (150) may include one or more robotic drive outputs (154) that can be coupled to a corresponding robotic drive input (not shown) of the endoscope base (111) and / or instrument base (121). In some embodiments such as that illustrated in FIG. 21c, the endoscope (110) may include a robot drive input that serves as a robot drive output that also serves as a corresponding robot drive input of the mechanism (120) (e.g., coupled to a drive output (154)). Additionally or alternatively, the mechanism (120) may include a robot drive input that serves as a robot drive output that serves as a corresponding robot drive input of the endoscope (110) (e.g., coupled to a drive output (154)), as in the embodiment illustrated in FIG. 21d.Accordingly, in some embodiments, a drive input for one medical device (e.g., endoscope (110)) may also include a drive output for a different medical device (e.g., device (120)). In this way, the device (120) may be indirectly controlled by the robot device drive mechanism (150) even when the device base (121) is not directly coupled to the robot device drive mechanism (150).

[0117] In some configurations, the robot mechanism drive mechanism (150) may be directly coupled to the mechanism (120) through a robot drive input that is directly coupled to a corresponding robot drive output, for example (e.g., via an endoscope (110)). For example, the robot drive input of the mechanism (120) may be an elongated drive input that is coupled to a corresponding robot drive output of the robot mechanism drive mechanism (150) (e.g., at least partially extended via the endoscope (110)). Additionally or alternatively, the robot mechanism drive mechanism (150) may include an extended (e.g., elongated) robot drive output that is at least partially extended via the endoscope (110) to be coupled to the robot drive input of the mechanism (120). Thus, various embodiments allow for direct coupling of the robot drive input / output between the robot mechanism drive mechanism (150) and the mechanism (120) even in the vertical configurations shown in FIG. 21c and FIG. 21d. Other variations are possible.

[0118] FIG. 22a illustrates a bottom view of an exemplary endoscope (210) according to one configuration that can be coupled to and used with a mechanism system (100) similar to the embodiment described above with reference to FIG. 21a and FIG. 21b. As illustrated, the endoscope (210) comprises an endoscope base (211) (or endoscope handle) and an elongated shaft (not shown). The elongated shaft may extend distally from an endoscope exit (242). The elongated shaft is configured to be inserted into a patient during a medical procedure. The elongated shaft may be configured to be articulating and controllable so that the elongated shaft can be navigated and steered through the patient's anatomical structure. For example, in some embodiments, the elongated shaft comprises a thin, flexible body configured to be inserted into and guided through a patient lumen, such as the urethra, ureter, gastrointestinal tract, esophagus, or airway of the lungs. As described above, a pull wire may be included in or on the slender shaft to control the articulation of the slender shaft. The slender shaft may extend between a distal end and a proximal end. The distal end may be configured to be inserted into the patient. The proximal end may be attached to the endoscope base (211) through the endoscope exit (242). The slender shaft may include a working channel (not illustrated) through which additional instruments or tools may pass for delivery to the distal end (205). The endoscope (210) may include a working channel entry port (not illustrated) configured to allow access to the working channel. The instrument shaft entry (228) may allow the instrument shaft (described later) to be inserted therein and coupled into the working channel entry port and into the working channel.

[0119] The endoscope base (211) is configured to allow both manual control and robotic control of the endoscope (210). For example, the endoscope base (211) is configured to be physically held and manually operated to provide manual control, and to be coupled to an instrument drive mechanism (see below) to provide robotic control. In some embodiments, a sterile adapter may be positioned between the endoscope base (211) and the instrument drive mechanism to maintain a sterile area during a medical procedure.

[0120] As illustrated, the endoscope base (211) includes a housing (212). As illustrated, the housing (212) may also be shaped to include a mechanism coupled thereto. The endoscope base (211) includes one or more endoscope receiving elements (276). The endoscope receiving elements (276) are configured to be coupled with a corresponding element of another mechanism (e.g., mechanism (220) described below). The housing (212) of the endoscope base (211) may be shaped to provide an ergonomic fit for the handle of the mechanism in the physician's hand and / or for the coupling of the other mechanism. For example, the shape of the housing (212) may allow the endoscope base (211) to be held more easily or comfortably during manual control. Alternatively or additionally, the shape of the housing (212) may provide (or not block) access to one or more unused robot drive outputs on the mechanism drive mechanism as described below. The endoscope base (211) may include a power access unit (214) for connecting to a power unit to supply power to one or more instruments of the medical instrument system (200). The power access unit (214) may be configured to provide an electrical and / or visual connection to the endoscope (210). In the illustrated embodiment, the power access unit (214) is illustrated as a strain relief for an umbilical cable leading to a connector in the tower.

[0121] The endoscope base (211) may include a device shaft inlet (228) that allows the insertion of a device (e.g., device (220) described below). The device shaft inlet (256) may include a device inlet actuator (229). The device inlet actuator (229) may allow manual control of the device shaft. In some embodiments, the device inlet actuator (229) may be tightened to improve the connection between the device shaft and the endoscope (210). The device inlet actuator (229) may include a Luer lock assembly. In some embodiments, the device inlet actuator (229) may prevent unintended slippage (e.g., translation, rotation) of the device shaft within the device shaft inlet (228). Additionally or alternatively, the device inlet actuator (229) may be configured to allow a doctor to manually rotate the device shaft.

[0122] The endoscope base (211) may include a manual actuator (236). In the illustrated embodiment, the manual actuator (236) is configured as a lever, but other mechanical structures such as a slider or a wheel are possible. As will be described in more detail below, the manual actuator (236) is configured to provide manual two-way deflection control for the endoscope (210). In the illustrated embodiment, the manual actuator (236) is configured to be operated back and forth or rotated. Moving the manual actuator (236) in the first direction may cause articulation of the elongated shaft in the first articulation direction, and moving the manual actuator (236) in the second direction (opposite to the first direction) may cause articulation of the elongated shaft in the second articulation direction. The first and second articulation directions may be substantially opposite (e.g., upward and downward), but this is not necessary in all embodiments.

[0123] The endoscope base (211) may also include a manual roll input controllable by the endoscope exit (242). Although not illustrated, the proximal end of the slender shaft of the endoscope (210) may be attached to the endoscope exit (242). In some embodiments, the slender shaft extends through the endoscope exit (242) and into the housing (212) of the endoscope (210). The endoscope exit (242) may be configured to allow the slender shaft to rotate relative to the endoscope base (211). As illustrated, the endoscope exit (242) may be a twister or a rotatable handle or grip that can rotate relative to the housing (212). For example, the endoscope exit (242) may rotate in clockwise and / or counterclockwise motion. In some embodiments, the endoscope exit (242) rotates in both clockwise and counterclockwise directions. The slender shaft can be rotatably fixed with respect to the endoscope exit (242) so that rotation of the endoscope exit (242) causes rotation of the slender shaft. The rotation of the slender shaft may be equivalent to and in the same direction as the corresponding movement of the endoscope exit (242), but this is not required in all embodiments. The elongated shaft may be allowed to rotate (e.g., rolling) in both rotational directions at least 90, at least 100, at least 110, at least 120, at least 130, at least 140, at least 150, at least 160, at least 170, at least 180, at least 190, at least 200, at least 210, at least 220, at least 230, at least 240, at least 250, at least 260, at least 270, at least 280, at least 290, at least 300, at least 310, at least 320, at least 330, at least 340, at least 350, or at least 360 degrees. Such rolling control is optional, and in a given embodiment, the rolling may be manually controlled, for example, by rotating the endoscope (210).

[0124] Referring again to FIG. 22a, the endoscope (210) includes a plurality of robotic endoscope drive inputs (262). In the illustrated embodiment, the endoscope (210) includes three robotic endoscope drive inputs (262), but in other embodiments, a different number of robotic endoscope drive inputs (262) may be used. The robotic endoscope drive inputs (262) are configured to engage with a corresponding robotic drive output on the mechanism when the endoscope base (211) is attached to the mechanism drive mechanism. An exemplary robotic drive output and mechanism drive mechanism are illustrated in FIG. 15 through 17 (as described above) and FIG. 25 and FIG. 30 (as described later). The robotic drive output of the mechanism drive mechanism engages with the robotic endoscope drive input (262) to transmit torque to the robotic endoscope drive input or to rotate the robotic endoscope drive input. In some embodiments, each of the robot endoscope drive inputs (262) is rotatable in both clockwise and counterclockwise directions. In the illustrated embodiment, the robot endoscope drive input (262) is configured as a grooved or keyed recess and is configured to engage with a robot drive output configured as a protruding spline. The robot drive output may be driven by a motor to rotate clockwise and counterclockwise. When the robot drive output engages with the robot endoscope drive input (262), the robot drive input transmits rotational motion to the robot endoscope drive input (262). In some embodiments, the robot drive output drives the robot endoscope drive input (262). In some embodiments, this arrangement may be reversed, or robot drive inputs and outputs of different types and configurations may be used.

[0125] An exemplary embodiment of the endoscope (210) is configured for at least four-way deflection control and four-way roll control. In this embodiment, two of the robot drive inputs (262) are configured for deflection control, and the other of the robot drive inputs (262) is configured for roll control. Each of the two robot drive inputs (262) configured for deflection control can allow two-way deflection control, so that four-way deflection control can be achieved together.

[0126] As will be described in more detail below, in some embodiments, the operation of the first robot drive input of one of the robot endoscope drive inputs (262) may be configured to induce joint movement of the elongated shaft identical to the operation of the manual drive input. For example, both the first robot drive input and the manual actuator (236) may be configured to induce joint movement of the elongated shaft in the upward and downward directions. This is because, as will be described below, both the first robot drive input and the manual actuator (236) may be connected to the same joint movement mechanism (e.g., a corresponding pulley) within the housing (212) of the endoscope base (211). In some embodiments, the two-way deflection control provided by the manual actuator (236) is identical to the two-way deflection control provided by the first robot drive input.

[0127] FIG. 22b illustrates a perspective view of an exemplary medical device system (200) that includes the functions of an endoscope and other medical instruments (e.g., basketing tools) within it according to one configuration. The medical device system (200) may include an endoscope base (211), an endoscope exit (242), an endoscope shaft (244), a manual actuator (236), a first device driving member (354), and a second device driving member (356). The first and second device driving members (354, 356) may include a rotating element such as a circular gear. In some embodiments, the first and second device driving members (354, 356) are coupled to corresponding first and second linear device actuators (360, 364). The first and second mechanism drive members (354, 356) and the first and second linear mechanism actuators (360, 364) share the function of the corresponding elements described below with reference to FIG. 29. The endoscope base (211) may include a rotary element (not shown) for articulated movement of the endoscope shaft (244) with a plurality of degrees of freedom. The rotary element may share the function of the pulley (310) described below with reference to FIG. 23. The first and second linear mechanism actuators (360, 364) may be manually disengaged from the corresponding first and second mechanism drive members (354, 356) in some embodiments. This may allow the first and second linear instrument actuators (360, 364) to be more easily coupled to the endoscope base (211) when necessary, and / or to be detached from the first and second linear instrument actuators (360, 364) for quick and easy manual operation. Thus, FIG. 22b illustrates some embodiments in which the functions of both the endoscope and other medical instruments are combined within a single endoscope base (211). The manual actuator (236) may share functions with the manual actuator (236) described in FIG. 23 below.

[0128] FIG. 23 illustrates some of the internal components of the endoscope base (211). A first side view of the endoscope base (211) with a portion of the housing (212) removed is shown to illustrate some of the internal components. As illustrated, two pulleys (or pulley assemblies), namely the first pulley (310a) and the second pulley (310b), are located within the housing (212). In this embodiment, the first pulley (310a) and the second pulley (310b) are each associated with two of the four articular directions of the elongated shaft. In some embodiments, each articular plane (e.g., upward-downward or left-right) may be linked to a single pulley assembly. For example, the upward and downward articular movements of the elongated shaft may be associated with the first pulley (310a), and the left and right articular movements of the elongated shaft may be associated with the second pulley (310b).

[0129] In the illustrated embodiment, the first pulley (310a) is rotatably mounted on the mechanism base and operatively coupled to the corresponding first robot drive input. The second pulley (310b) is rotatably mounted on the mechanism base and operatively coupled to the corresponding second robot drive input. Thus, rotation of the first robot drive input can induce a corresponding rotation of the first pulley (310a), and rotation of the second robot drive input can induce a corresponding rotation of the second pulley (310b). As mentioned above, rotation of the first pulley (310a) can induce articulated movement of the elongated shaft in the upward and downward directions, and rotation of the second pulley (310b) can induce articulated movement of the elongated shaft in the left and right directions. Thus, for some embodiments, robot 4-direction deflection control can be achieved with the first and second robot drive inputs and the first and second pulley assemblies (310a, 310b). Alternatively, four separate pulleys can be used with four corresponding robot drive inputs.

[0130] As mentioned above, the manual actuator (236) can also be rotatably mounted on the mechanism base and operatively coupled to the first pulley (310a), so that the manual actuator (236) can be used to rotate the first pulley (310a). Rotation of the first pulley (310a) can cause articulated movement of the elongated shaft in the upward and downward directions. Thus, in the illustrated embodiment, both the manual actuator (236) and the first robot drive input (227a) are each coupled to the first pulley (310a), so that both can cause articulated movement of the elongated shaft, for example, in the upward and downward directions. In the illustrated embodiment, the manual actuator (236) is configured as a lever fixedly attached to the first pulley (310a). For example, the end (237) of the manual actuator (236) can be attached to the shaft of the first pulley (310a). Accordingly, any movement of the manual actuator (236) can be directly transmitted to the first pulley (310a). Accordingly, the endoscope (210) is configured for manual 2-way deflection control (by the manual actuator (236)) and 4-way deflection control (by the first and second robot drive inputs).

[0131] In the illustrated embodiment, the second pulley (310b) is articulated only by the second robot drive input (227b). In some embodiments, a second manual actuator (not illustrated) may be coupled to the second pulley (310b) to further allow manual control of the elongated shaft, for example, in the left and right directions.

[0132] The robot shaft roll can be achieved by a first bevel gear (320) and a second bevel gear (330). The first bevel gear (320) can be attached to or otherwise operatively coupled to a third robot drive input so that rotation of the third robot drive input can cause rotation of the first bevel gear (320). The second bevel gear (330) can be attached to the proximal end of the elongated shaft of the endoscope (210) so that rotation of the second bevel gear (330) can cause rotation of the elongated shaft relative to the endoscope base (211). The first and second bevel gears (320, 330) can be engaged to transmit rotational movement of the third robot drive input to the elongated shaft of the endoscope (210). For example, as illustrated, a drive belt (324) may be used to operatively engage the first bevel gear (320) with a third robot drive input (not illustrated) at a distance. The third drive input may be located proximal to the first bevel gear (320). The third drive input may be positioned between the first and second robot drive inputs of the endoscope (210). Other methods and mechanisms for transmitting the rotational motion of the third robot drive input to the slender shaft of the endoscope (210) are also possible. In some embodiments, as the slender shaft rolls, internal components (such as coil pipes, pull wires, electric wires, and optical fibers) are allowed to twist, as they may be secured to both the proximal and distal ends of the slender shaft of the endoscope (210). The twisting of the internal components is achieved over most of the length of the slender shaft, thereby minimizing the resulting force / torque applied to the proximal and distal ends.

[0133] The endoscope (210) may also include an electronic controller (328). The electronic controller (328) may be coupled to power through a power access unit (214). The electronic controller (328) may be configured to provide electronic control for one or more elements placed inside the working channel of the elongated channel of the endoscope (210). For example, the endoscope (210) may include a camera, a light source, a microphone, other sensors, and / or other tools for use during medical procedures. The electronic controller (328) may provide power and / or signals for one or more of these tools. Additionally or alternatively, the electronic controller (328) may receive signals from one or more of these tools and transmit such information to a computer (not shown). For example, the electronic controller (328) may transmit video and / or audio signals to a remote display to assist a doctor during surgery.

[0134] The endoscope (210) may include one or more guide elements (332). The guide elements (332) may be positioned and sized to receive one or more pull wires therethrough and to facilitate their passage through the working channel of the elongated shaft of the endoscope (210). The guide elements (332) may advantageously reduce the damaging effect of friction on the pull wires as the pull wires articulate the elongated shaft. The guide elements (332) may guide the pull wires between the first and / or second pulley assemblies (310a, 310b) and the endoscope exit (242). A first level guide element (332) may be configured to guide the pull wire from the first pulley (310a), and a second level guide element (332) may be configured to guide the pull wire from the second pulley (310b). The first level and the second level may be spaced apart from each other (e.g., along an axis approximately parallel to the rotation axis of one or more of the first and / or second pulley assemblies (310a, 310b).

[0135] One or each of the pulleys (310a, 310b) may include a corresponding pulley ratchet (314a, 314b) and / or a pulley lock mechanism (318a, 318b), as shown in FIG. 23. For clarity, we will refer to the first pulley (310a), but the same function may be applied to the second pulley (310b). The pulley ratchet (314a, 314b) may be used, for example, to provide initial tension to the corresponding pulley (310a, 310b) during manufacturing. Thus, once the pull wire is properly tensioned by rotating the pulley ratchet (314a, 314b), the pulley lock mechanism (318a, 318b) prevents the pulley ratchet (314a, 314b) from rotating in the opposite direction.

[0136] An exemplary pulley (310) is illustrated in FIG. 24. Such a pulley (310) may be used for one or both of the pulleys (310a, 310b) discussed above. As illustrated, the pulley (310) comprises two pull wire spool elements (342). Each pull wire spool element may be configured to spool a corresponding pull wire in a direction opposite to that of the other. For example, while the first pull wire spool element may spool the pull wire clockwise, the second pull wire spool element may spool the corresponding pull wire counterclockwise. Thus, each pulley (310) may rotate in a first direction to cause one of the pull wires to be unspooled (e.g., extended) while causing the other of the pull wires to be spooled (e.g., retracted). In some embodiments, a manual actuator (e.g., manual actuator (236)) may be coupled to the pulley (310) so that movement (e.g., rotation) of the manual actuator causes rotation of the pulley (310). Additionally or alternatively, rotation of the pulley (310) (e.g., to a robot) may also cause movement of the manual actuator. The pulley ratchet (314) and the pulley lock mechanism (318) may work together to allow the pull wire of the pulley (310) to be tensioned before use. The pulley ratchet (314) may be used, for example, to provide initial tension to the pulley (310) during manufacturing. The pulley lock mechanism (318) prevents the pulley ratchet (314) from rotating in the opposite direction.

[0137] As mentioned above, the endoscope (210) may include a pull wire for articulated movement of the slender shaft. In some embodiments, one pull wire may be associated with each articulated direction of movement of the slender shaft. In some embodiments, the endoscope (210) may include four pull wires to enable four-directional deflection control. In such cases, for example, a first pull wire may be associated with upward deflection, a second pull wire may be associated with downward deflection, a third pull wire may be associated with rightward deflection, and a fourth pull wire may be associated with leftward deflection. The pull wire may extend between the first and second pulleys (310a, 310b) and the distal end of the slender shaft of the endoscope (210). At the distal end of the slender shaft, the pull wire may be connected thereto.

[0138] In the first and second pulleys (310a, 310b), each of the pull wires may be wound, wound, otherwise mounted, or connected thereto on one of the pulleys of the two pulley assemblies. For example, considering the pulley (310) of FIG. 24, the first pull wire (e.g., associated with upward deflection) may be wound within the first pull wire spool element, and the second pull wire (e.g., associated with downward deflection) may be wound within the second pull wire spool element. Opposite spooling of the two pull wires may allow the rotation of the pulley (310) to pull the first pull wire (e.g., to cause upward deflection) or the second pull wire (e.g., to cause downward deflection), depending on the direction in which the pulley (310) is rotated. The third and fourth pull wires may similarly be wound onto a second pulley (e.g., the second pulley (310b)) for left and right deflection control, for example. In some embodiments, a spring may additionally or alternatively be used to apply tension to one or more pull wires.

[0139] FIG. 25 illustrates a drawing of an endoscope base (211) of a medical instrument system (200) attached to one embodiment of a robotic instrument drive adapter (250). The medical instrument system (200) may include an elongated shaft (not shown). The robotic instrument drive adapter (250) may include a coupling surface to which the endoscope base (211) can be attached. In some embodiments, the robotic instrument drive adapter (250) may be configured as a sterile adapter. In some embodiments, a separate adapter (such as a sterile adapter) may be positioned between the endoscope base (211) and the robotic instrument drive adapter (250). The sterile adapter may provide a sterile boundary between the endoscope base (211) and the robotic instrument driver. The coupling surface may include a robotic drive output positioned thereon, such as an instrument drive output (272) (or an endoscope drive output (274) described later). One or more of the robot drive outputs may be engaged with the corresponding robot drive input of the endoscope base (211) and / or the mechanism base (221). The robot mechanism driver may include one or more motors for driving the robot drive outputs. The robot drive outputs may be configured as gears, protruding splines, etc. The robot mechanism drive adapter (250) may be configured to be attached to a robot arm or other mechanism positioning device, for example, as shown in FIGS. 16 and 17.

[0140] In some embodiments, when the endoscope base (211) is attached to the robot mechanism drive adapter (250), the manual actuator (236) and / or other actuator may be kept exposed and accessible. In some embodiments, the mechanism (200) may be configured such that the connection of the endoscope base (211) to the robot mechanism drive adapter (250) causes the manual actuator (236) to disengage.

[0141] The shape of the endoscope base (211) may expose one or more of the mechanism drive outputs (272). Thus, the exposed mechanism drive outputs (272) may be kept accessible to be connected to other tools (e.g., basketing tools, laser tools, etc.). In some embodiments, before connecting the endoscope base (211) to the robot mechanism drive adapter (250), a manual actuator (236) is operably connected to a pulley assembly (229) so that the manual actuator (236) can be actuated to induce joint movement of the mechanism (200) as described above. In some embodiments, after the endoscope base (211) is connected to the robot mechanism drive adapter (250), the manual actuator (236) is disengaged from the pulley assembly (229) so that the manual actuator (236) cannot be used to articulate the mechanism (200) while the endoscope base (211) is connected to the robot mechanism drive adapter (250).

[0142] In some embodiments, the connection of the endoscope base (211) to the robot mechanism drive adapter (250) causes the disengagement of the manual drive mechanism. The disengagement may be automatic. For example, inserting the mechanism drive output (272) of the robot mechanism drive adapter (250) into the corresponding input of the mechanism (e.g., the mechanism (220) discussed below) may cause the disengagement, for example, by disengaging the manual actuator (236) from the first pulley (310a). In some embodiments, the manual actuator (236) may be re-engaged when one or more mechanisms of the medical mechanism system (200) are removed from the robot mechanism drive adapter (250).

[0143] A predetermined drive output of the robot mechanism drive adapter (250) may provide tiered gearing. Such tiered gearing may allow for greater versatility in the compatibility of medical devices with the robot mechanism drive adapter (250). For example, each of the mechanism drive outputs (272) may include a first geared section (272a) and a second geared section (272b). The first geared section (272a) may be configured to engage with a specific tool element, while the second geared section (272b) may be configured to engage with a different tool element. The first geared section (272a) may have a gear for a radius larger than the radius of the second geared section (272b). Accordingly, for a given embodiment, the first gear-type section (272a) may be used to impart greater torque to the corresponding drive input (compared to the second gear-type section (272b)), while the second gear-type section (272b) may impart a relatively greater rotational speed to the corresponding drive input (compared to the first gear-type section (272a)). Even within the same mechanism, the first drive input of the mechanism may be configured for the gear radius of the first gear-type section (272a), while the second drive input may be configured for the second gear-type section (272b).

[0144] The robot mechanism drive adapter (250) may include a shoulder (248). The shoulder (248) may provide additional support for the endoscope (210) to promote a better fit of the coupling described herein and to reduce a loose fit. Additionally or alternatively, in some embodiments, the robot mechanism drive adapter (250) may include a corresponding shoulder for another mechanism. In some embodiments, the shoulder (248) is omitted.

[0145] FIG. 26 illustrates a bottom view of an exemplary medical device system (200) according to one configuration. As illustrated, the medical device system (200) includes an endoscope (210) and a device (220). The device (220) includes a device base (221) and an elongated shaft (224). The elongated shaft (224) may extend proximally from a proximal portion of the device base (221). However, in some embodiments, the elongated shaft (224) may extend distally from the device base (221). The elongated shaft (224) may be configured to be coupled into the device shaft inlet (228) of the endoscope (210). In this way, the elongated shaft (224) may be received into the working channel (not shown) of the elongated shaft of the endoscope (210).

[0146] The mechanism (220) may include one or more robotic mechanism drive inputs (264). One or more of the robotic mechanism drive inputs (264) may be configured to be coupled with a corresponding drive output (e.g., mechanism drive output (272)) of a robotic mechanism drive mechanism (e.g., robotic mechanism drive adapter (250)). An elongated shaft (224) is configured to be inserted into a patient during a medical procedure. The elongated shaft (224) may be configured to be articulated and / or controllable so that the elongated shaft can be navigated and steered through the patient's anatomical structure. Additionally or alternatively, the mechanism (220) may be configured to have additional functions. For example, a basketing tool may be configured to extend and retract to collect material (e.g., calcified calculi) within the patient. Such functions may be controlled by a robot by one or more of the robotic drive inputs.

[0147] In some configurations, the mechanism (220) may be manually controlled in addition to or alternative to robot control. As illustrated in FIG. 26, the mechanism (220) may include a first mechanism actuator (252) and a second mechanism actuator (254). The first mechanism actuator (252) may be configured to control a first degree of motion (e.g., proximal or distal movement). The second mechanism actuator (254) may be configured to control a second degree of motion (e.g., extension / retraction or opening / closing of the tool). Since the elongated shaft (224) may be coupled into the elongated shaft of the endoscope (210) (e.g., through the mechanism shaft inlet (228)), additional articulation of the elongated shaft (224) may be possible by directly controlling the elongated shaft of the endoscope (210) as described above. Accordingly, in some embodiments, the slender shaft (224) may be configured to be controlled with 5 degrees of freedom: left-right, up-down, rotation (e.g., roll), proximal-distal movement, and deployment-retraction (e.g., basket deployment). These degrees of freedom may be shared between the endoscope (210) and the instrument (220). However, because the endoscope (210) and the instrument (220) can be combined together as illustrated, the ergonomic shape of the medical instrument system (200) may allow a physician to easily control the slender shaft (224) as needed, both robotically and / or manually.

[0148] As described, in some embodiments, the slender shaft (224) may extend proximally from the proximal portion of the instrument (220). For example, the laser tool may advantageously include a fiber comprising a service loop. The "service loop" may include additional lengths of the slender and flexible shafts that provide degrees of freedom for translational and / or axial movement (e.g., extension, retraction) along the shaft axis of the flexible shaft. The service loop may include additional lengths of the slender shaft (224), for example, to allow for easier manual access and / or freedom of movement. The service loop does not necessarily have to form a circular or 360-degree loop, but may be any additional curved length of the flexible shaft. In some embodiments, the service loop may be formed by forming a loop of the flexible shaft with a wide radius outside the medical instrument base. The radius of the service loop may be formed near the proximal portion of the instrument base and / or proximally from the entrance of the endoscope base. In some embodiments, the service loop may be formed proximally from a proximal portion of the elongated shaft of the instrument, endoscope, or both. The service loop does not necessarily require a specific length. The service loop may also need to be extended to a minimum arc length. For example, the service loop may be extended to about 5 degrees, about 10 degrees, about 20 degrees, about 30 degrees, about 45 degrees, about 60 degrees, about 75 degrees, about 100 degrees, about 120 degrees, about 140 degrees, about 160 degrees, about 180 degrees, about 200 degrees, about 225 degrees, about 250 degrees, about 275 degrees, about 300 degrees, about 315 degrees, about 330 degrees, about 350 degrees, about 360 degrees, any number of angles between these, or any range having an endpoint within these.As mentioned above, the basket is extended and / or retracted by movement of the basket in a first direction relative to the sheath (e.g., relative advance of the basket) and / or by movement in the opposite direction relative to the sheath (e.g., relative retraction of the basket). In relation to the laser tool, the laser tool may include a laser fiber and a protective sheath. Other examples and tools are possible in the mechanism (220). The elongated shaft (224) may form a loop as described with reference to FIG. 21b and as described below.

[0149] FIG. 27 illustrates a plan view of an exemplary apparatus (220) according to one embodiment. The apparatus base (221) may include a first housing element (282) and a second housing element (284) in some embodiments. The first and second housing elements (282, 284) may be joined together to form a housing of the apparatus base (221). The second housing element (284) may include a coupling element for coupling with an endoscope (210). An apparatus button (218) may be operated to separate the apparatus (220) from the endoscope (210). Unless operated, the apparatus button (218) may be deflected to maintain the apparatus (220) coupled to the endoscope (210). The apparatus button (218) may be operated to separate the apparatus (220) from the endoscope (210). For example, in some embodiments, the user may slide the mechanism button (218) to disengage the mechanism (220) from the endoscope (210). In some embodiments, the mechanism button (218) may instead be placed on the endoscope (210) to allow the user to separate the endoscope (210) from the mechanism (220) through the endoscope (210).

[0150] FIG. 28 illustrates a bottom perspective view of the mechanism (220) of FIG. 27 according to one embodiment. The mechanism (220) may include a mechanism shaft coupler (256). The mechanism shaft coupler (256) may be fixedly coupled to the elongated shaft (224) to prevent relative rotation and / or translation of the elongated shaft (224). In some designs, the mechanism shaft coupler (256) includes an overmolded portion of the elongated mechanism (224). The mechanism shaft coupler (256) may be detached from the first mechanism actuator (252) to allow a physician to manually operate the elongated shaft (224) without controlling the mechanism base (221). Once use is finished, the physician may re-couple the mechanism shaft coupler (256) to the first mechanism actuator (252). The mechanism shaft coupler (256) may include an insert element received by a receiving element of the first mechanism actuator (252). Additionally or alternatively, the first mechanism actuator (252) may include an insert element received by a receiving element of the mechanism shaft coupler (256). The first mechanism actuator (252) may allow a physician to manually control the longitudinal position (e.g., proximal / distal) of the elongated shaft (224). The second mechanism actuator (254) may allow a physician to extend and / or retract the elongated shaft (224). Each of the first and second mechanism actuators (252, 254) is illustrated as a linear actuator. However, other types of actuators (e.g., wheels, levers, buttons, etc.) may be used.

[0151] FIG. 29 illustrates a cross-sectional view of the bottom surface of the mechanism (220) of FIG. 28. As illustrated, the mechanism (220) may include a first mechanism drive member (354) and a second mechanism drive member (356). The first and second mechanism drive members (354, 356) are coupled to a corresponding robot mechanism drive input (264) (illustrated in FIG. 28). The first and second mechanism drive members (354, 356) may be fixedly coupled to the corresponding robot mechanism drive input (264). The first and second mechanism drive members (354, 356) may be coupled to corresponding first and second mechanism actuators (252, 254). For example, as illustrated, the first mechanism drive member (354) is a circular gear and is coupled to a first linear mechanism actuator (360), which is illustrated as a linear gear. Other options are possible. Accordingly, as the first mechanism driving member (354) rotates, the first linear mechanism actuator (360) translates (e.g., in the longitudinal direction). As illustrated, the translation of the first linear mechanism actuator (360) also drives the first mechanism actuator (252). Additionally or alternatively, the first mechanism actuator (252) may be able to drive the translation of the first linear mechanism actuator (360), which subsequently drives the rotation of the first mechanism driving member (354).

[0152] The second mechanism drive member (356) is illustrated as being a key-type element. The second mechanism drive member (356) is coupled to the second linear mechanism actuator (364). As the second mechanism drive member (356) rotates, the second linear mechanism actuator (364) translates. In a given embodiment, this translation may cause the mechanism to unfold. As the second linear mechanism actuator (364) translates, the second mechanism actuator (254) may also translate, even when the second linear mechanism actuator (364) is driven by a robot. Additionally or alternatively, when the second linear mechanism actuator (364) is driven manually (e.g., via the second mechanism actuator (254)), this operation may drive the rotation of the second mechanism drive member (356). Manual and robotic operation may be used together or alone. In some designs, a portion of the elongated shaft (224) is terminated at the connection point with the second linear mechanism actuator (364) inside the mechanism base (221).

[0153] Although the first and second linear mechanism actuators (360, 364) have been discussed above as controlling a predetermined degree of freedom, other options are possible. For example, the first linear mechanism actuator (360) may be configured to control the translation of the elongated shaft (224), while the second linear mechanism actuator (364) may be configured to control the translation of a portion of the elongated shaft (224) (e.g., its outer sheath). Thus, the translation of the elongated shaft (224) (without unfolding) can be achieved through the simultaneous translation of both the first and second linear mechanism actuators (360, 364). Then, the unfolding or retraction of the elongated shaft (224) can be achieved by the corresponding advance or retraction of the elongated shaft (224) relative to the outer portion of the mechanism. It controls which of the first and second linear mechanism actuators (360, 364) can be reversed as desired. Thus, various control configurations can be achieved by changing which of the degrees of freedom is controlled by each of the first and second linear mechanism actuators (360, 364).

[0154] FIG. 30a illustrates a top perspective view of an exemplary robot mechanism drive adapter (250). The robot mechanism drive adapter (250) may include one or more mechanism drive outputs (272) and / or one or more endoscope drive outputs (274). As illustrated, the robot mechanism drive adapter (250) includes two mechanism drive outputs (272) for coupling with the mechanism (220) and an endoscope drive output (274) for coupling with the endoscope (210). The robot mechanism drive adapter (250) may include one or more drive mechanism coupling elements (292). As illustrated, the robot mechanism drive adapter (250) includes drive mechanism coupling elements (292). One or more drive mechanism coupling elements (292) may be configured to couple with one or more corresponding coupling elements (e.g., endoscope coupling elements (266)) of the mechanism (220) and / or endoscope (210). In some embodiments, the drive mechanism coupling element (292) is configured to be coupled to only one of the endoscope (210) or the mechanism (220), rather than both. However, in some embodiments, the robot mechanism drive adapter (250) includes a drive mechanism coupling element (292) configured to be coupled to both the endoscope (210) and the mechanism (220). Other configurations are possible. A shoulder (248) capable of promoting better coupling with the endoscope (210) is also illustrated. A release member (288) may be included within the robot mechanism drive adapter (250). The release member (288) may be pressed to allow, for example, the separation of the robot mechanism drive adapter (250) from the mechanism drive mechanism on the robot arm. In some embodiments, the release member (288) separates the endoscope coupling element (266) from the corresponding drive mechanism coupling element (292).

[0155] The robot mechanism drive adapter (250) may include an endoscope release actuator (290) configured to allow a user to detach the endoscope (210) from the robot mechanism drive adapter (250). In some embodiments, the endoscope release actuator (290) is coupled to a drive mechanism coupling element (292) such that when the endoscope release actuator (290) is pressed, the drive mechanism coupling element (292) undergoes a corresponding operation (e.g., pressing or translation). Thus, in some embodiments, a user can disengage the endoscope (210) from the robot mechanism drive adapter (250) by pressing the endoscope release actuator (290). The endoscope release actuator (290) may be deflected to a closed position. In some embodiments, an endoscope release actuator (290) may be placed on the endoscope (210) so that a user can detach the endoscope (210) from the robot mechanism drive adapter (250) via the endoscope (210). According to some embodiments, the latching method for the mechanism (220) and the endoscope (210) may provide improved usability and / or safety. In the illustrated embodiment, the release actuator (290) on the robot mechanism drive adapter (250) may not be operated until the work channel tool is first detached from the endoscope (210), thereby providing safety constraints. In other embodiments, the release actuator (290) may be operated while the work channel tool is still attached to the endoscope by providing a cutout or recess in the work channel tool that allows a user to access the release actuator (290) with their fingers, for example.

[0156] The robotic instrument drive adapter (250) may have an input and / or output (e.g., an adapter drive input (296) shown in FIG. 30b) for coupling to an instrument drive mechanism (e.g., an instrument driver (62) in FIG. 15, an instrument driver (75) in FIG. 16, and an instrument drive mechanism (146A, 146B) in FIG. 14). The robotic instrument drive adapter (250) may include or be connected to a sterile liner (e.g., a sterile drape) so that it can be used in a sterilization procedure. The robotic instrument drive adapter (250) may be referred to as a sterile adapter. The sterile liner may enhance a sterile environment during a specific procedure (e.g., surgery).

[0157] FIG. 30b illustrates a bottom perspective view of the robot mechanism drive adapter (250) illustrated in FIG. 30a. As mentioned above, the robot mechanism drive adapter (250) may include one or more adapter drive inputs (296) that drive a corresponding mechanism drive output (272) and / or an endoscope drive output (274). The adapter drive input (296) is configured to be coupled to a mechanism drive mechanism (e.g., the mechanism driver (62) of FIG. 15, the mechanism driver (75) of FIG. 16, and the mechanism drive mechanism (146A, 146B) of FIG. 14). The adapter drive input (296) may include a receiving element that is coupled to a protrusion of the corresponding drive output of the mechanism drive mechanism (not illustrated in FIG. 30b). In some embodiments, the adapter drive input (296) may include a protrusion that is coupled to a corresponding receiving element of the drive output of the mechanism drive mechanism. As described, the robot mechanism drive adapter (250) may include one or more release members (288) that can be operated (e.g., pressed or squeezed) by a user to separate the robot mechanism drive adapter (250) from the mechanism drive mechanism. One or more adapter coupling elements (286) of the robot mechanism drive adapter (250) may be coupled to the mechanism drive mechanism by, for example, a snap fit, a screw fit, or some other mechanical coupling arrangement. The operation of the release members (288) may separate the adapter coupling elements (286) from the mechanism drive mechanism.

[0158] FIG. 31 illustrates an exemplary medical device system (200) in which both an endoscope (210) and a device (220) are coupled to a robotic device drive adapter (250). One or both of the endoscope (210) and / or the device (220) may be detached from the robotic device drive adapter (250) (e.g., temporarily) for manual use.

[0159] Various medical devices may be controlled by a medical device (e.g., device (220)). For example, FIG. 32 shows an enlarged view of a basket head (175) positioned distally. The basket head (175) may be advanced within the device shaft (178) to capture a stone. The device shaft (178) may be the outer shaft of any aforementioned elongated device (e.g., elongated shaft (224)). Such advancement may be performed by manual contact with the basket tool through the aforementioned working channel, or through operable coupling with an insertion / retraction and / or actuation means, such as the aforementioned robot-based system. Such operation may involve activating the distal portion or distal end of the shaft, which in this example may involve extending or retracting the basket head (175) by deploying or withdrawing the basket head relative to the outer sheath or device shaft (178). Other medical devices may include a laser tool (not shown) which can be used to progressively destroy a stone through the controlled emission of laser-based energy into the stone. The laser tool may include a laser fiber having a proximal connecting element configured to interface with the instrument base (221) and a distal tip configured to emit laser-based energy to destroy an article such as a kidney stone. The stone may be attacked by the laser tip in a specific pattern to progressively break the stone into smaller pieces of subcritical geometry. For example, a "painting" pattern in which the laser tip addresses the stone at multiple points may be used.

[0160] 3. Implementation System and Terminology.

[0161] Some non-limiting examples of the system described in this specification are described below.

[0162] In the first example, the robotic medical instrument system comprises: a first medical instrument including an instrument base and an elongated shaft extending from the instrument base, wherein the instrument base includes a robotic drive input and a first rotary element coupled to the robotic drive input, and the robotic drive input of the first medical instrument is configured to articulate the distal end of the elongated shaft of the first medical instrument, and the first medical instrument further includes an instrument inlet communicating with a work channel extending through the first medical instrument; a second medical instrument including an elongated shaft configured to extend through the instrument base and the instrument inlet and partially within the elongated shaft of the first instrument, and the second medical instrument including a robotic drive input; and a robotic arm including first and second robotic drive outputs, wherein the first robotic drive output is configured to drive the robotic drive input of the first medical instrument and the second robotic drive output is configured to drive the robotic drive input of the second medical instrument.

[0163] In the second example, in the robot system of Example 1, the first rotating element includes a tensioning ratchet configured to allow initial tensioning of a pull wire coupled to the first rotating element.

[0164] In the third example, in the robot system of either Example 1 or Example 2, the slender shaft of the second medical device extends from the proximal part of the device base of the second medical device.

[0165] In the fourth example, in the robot system of Example 3, the second medical device includes a coupling element, the coupling element activably connects the elongated shaft of the second medical device to the robot drive input of the second medical device, and the robot drive input of the second medical device is activably connected to the elongated shaft of the second medical device at a point distal to the proximal part of the base of the device.

[0166] In the fifth example, in the robot system of Example 4, the second medical device further comprises a linear actuator coupled to a coupling element, and the linear actuator is configured to operate the elongated shaft of the second medical device in the longitudinal direction.

[0167] In the 6th example, in the robot system of any one of Examples 1 to 5, the second medical device includes a laser tool or a basketing tool.

[0168] In the seventh example, in the robot system of any one of the examples 1 to 6, the first actuator controls the longitudinal position of at least a portion of the slender shaft of the second medical device.

[0169] In the eighth example, in the robot system of Example 7, the second actuator controls the activation of the distal portion of the slender shaft of the second medical device.

[0170] In the ninth example, in the robot system of any one of Examples 1 to 8, the robot drive input of the second medical device is coupled to the sheath of the slender shaft of the second medical device.

[0171] In the 10th example, in the robot system of any one of Examples 1 to 9, the second medical device further includes a second robot drive input, and the second robot drive input is coupled to the inner part of the elongated shaft of the second medical device.

[0172] In the 11th example, in the robot system of any one of Examples 1 to 10, the slender shaft of the second medical device forms a service loop.

[0173] In the 12th example, in the robot system of Example 11, the service loop extends at least 45 degrees between the instrument inlet of the first medical instrument and the instrument base of the second medical instrument.

[0174] In the 13th example, the medical system comprises: an endoscope base having a first robot drive input and a first manual actuator, as an endoscope base having an elongated shaft extending therefrom; and a work channel mechanism having a second robot drive input and a second manual actuator, as a work channel mechanism having an elongated shaft configured to extend within the elongated shaft of the endoscope, wherein the first and second robot drive inputs are configured to be coupled to corresponding first and second robot drive outputs of a robot arm, and the first and second manual actuators are configured to be manually operated when the first and second robot drive inputs are separated from the first and second robot drive outputs of the robot arm.

[0175] In the 14th example, in the medical system of Example 13, the working channel apparatus comprises an apparatus base having a coupling element, and the coupling element is configured to allow a removable coupling of the apparatus base to an endoscope base.

[0176] In the 15th example, in the medical system of either Example 13 or Example 14, the endoscope further comprises a first rotary element configured to articulate the distal end of the elongated shaft of the endoscope with a first degree of freedom, and a first manual actuator configured to allow manual rotation of the first rotary element.

[0177] In Example 16, in any one of Examples 13 to 15, the working channel mechanism further comprises a mechanism base coupled to the slender shaft of the working channel mechanism, and the slender shaft of the working channel mechanism extends from a proximal portion of the mechanism base.

[0178] In Example 17, in any one of Examples 13 to 16, the work channel mechanism includes a coupling element that operatively connects the slender shaft of the work channel mechanism to a second robot drive input, and the second robot drive input of the work channel mechanism is operatively connected to the slender shaft of the work channel mechanism at a point distal to the proximal part of the mechanism base.

[0179] In the 18th example, in the medical system of Example 17, the working channel mechanism further comprises a linear actuator coupled to a coupling element, and the linear actuator is configured to operate the elongated shaft of the working channel mechanism in the longitudinal direction.

[0180] In Example 19, in the medical system of any one of Examples 13 to 18, the working channel mechanism includes a laser tool or a basketing tool.

[0181] In the 20th example, in the medical system of any one of Examples 13 to 19, the second robot drive input controls the longitudinal position of at least a portion of the elongated shaft of the work channel mechanism.

[0182] In Example 21, in any one of Examples 13 to 20, the second manual actuator controls the activation of the distal portion of the elongated shaft of the working channel mechanism.

[0183] In Example 22, in the medical system of any one of Examples 13 to 21, the second robot drive input is coupled to the sheath of the elongated shaft of the work channel mechanism.

[0184] In Example 23, in the medical system of any one of Examples 13 to 22, the elongated shaft of the instrument forms a service loop between the inlet of the endoscope and the instrument base of the working channel instrument.

[0185] In the 24th example, the medical device comprises a device base including a robot drive input and a linear actuator coupled to the robot drive input, wherein the robot drive input is configured to be coupled to a corresponding robot drive output of a robot arm; and an elongated shaft extending from a proximal portion of the device base, wherein the linear actuator is coupled to a portion of the elongated shaft at a point distal to the proximal portion of the device base.

[0186] In Example 25, in the robot system of Example 24, the linear actuator includes a linear gear configured to manipulate the longitudinal position of an elongated shaft.

[0187] In Example 26, in the medical device of either Example 24 or Example 25, the device further comprises a second robot drive input, and the second robot drive input is configured to actuate the distal end of the device.

[0188] In Example 27, the medical device of Example 26 further includes a manual actuator that further controls the operation of the distal end of the device.

[0189] In Example 28, in the medical device of either Example 26 or Example 27, the second robot drive input is configured to expand or contract the distal end of the device.

[0190] In Example 29, in any one of Examples 24 to 28, the medical device comprises a laser tool or a basketing tool.

[0191] In Example 30, in any one of Examples 24 to 29, the slender shaft forms a service loop extending from a proximal part of the base of the device to a point distal to the proximal part.

[0192] The embodiments disclosed herein provide systems, methods, and devices related to manual and robot-controllable medical devices. As discussed above, the medical device may be controlled by manual and robot drive inputs that allow the device to be used both manually and as a robot.

[0193] It should be noted that terms such as “combine,” “combining,” “combined,” or other variations of the word “combine” as used herein may indicate an indirect or direct connection. For example, where a first component is “combined” to a second component, the first component may be indirectly connected to the second component through another component or directly connected to the second component.

[0194] The specific computer-implemented processes and functions described herein by reference may be stored as one or more instructions on a processor-readable or computer-readable medium. The term “computer-readable medium” refers to any available medium that can be accessed by a computer or processor. By example, not by limitation, such media may include random access memory (RAM), read-only memory (ROM), electrically erasable programmable read-only memory (EEPROM), flash memory, compact disc read-only memory (CD-ROM) or other optical disc storage devices, magnetic disc storage devices or other magnetic storage devices, or any other medium that can be used to store desired program code in the form of instructions or data structures and can be accessed by a computer. It should be noted that computer-readable media may be tangible and non-transient. As used herein, the term “code” may refer to software, instructions, code, or data executable by a computing device or processor.

[0195] The method disclosed herein comprises one or more steps or actions for achieving the described method. Method steps and / or actions may be interchangeable without departing from the scope of the claims. In other words, unless a specific order of steps or actions is required for the proper operation of the described method, the order and / or use of specific steps and / or actions may be modified without departing from the scope of the claims.

[0196] As used herein, the term “plural” refers to two or more. For example, a plural component refers to two or more components. The term “determining” includes a wide variety of operations and may therefore include calculation, computing, processing, derivation, investigation, search (e.g., search in a table, database, or other data structure), verification, etc. Additionally, “determining” may include receiving (e.g., receiving information), accessing (e.g., accessing data in memory), etc. Additionally, “determining” may include interpretation, selection, selection, setting, etc.

[0197] The phrase "based on" does not mean "only based on" unless otherwise explicitly stated. In other words, the phrase "based on" describes both "only based on" and "at least based on".

[0198] The prior description of the disclosed embodiments is provided to enable those skilled in the art to manufacture or use the invention. Various modifications to these embodiments will be readily apparent to those skilled in the art, and the general principles defined herein may be applied to other embodiments without departing from the scope of the invention. For example, it will be recognized that those skilled in the art may employ a number of corresponding alternative and equivalent structural details, such as equivalent methods for fastening, mounting, joining, or engaging tool components, equivalent mechanisms for generating specific operating movements, and equivalent mechanisms for transmitting electrical energy. Accordingly, the invention is not intended to be limited to the embodiments shown herein, but is in the broadest scope consistent with the principles and novel features disclosed herein.

Claims

Claim 1 A robotic medical instrument system comprising: a first medical instrument including a first instrument base and a first elongate shaft extending from the first instrument base, wherein the first instrument base includes a first robotic drive input and a first rotary element coupled to the first robotic drive input, the first robotic drive input is configured to articulate the distal end of the first elongate shaft, and the first medical instrument further includes an instrument inlet communicating with a working channel extending through the first medical instrument; and a second medical instrument including a second instrument base and a second elongate shaft configured to partially extend within the first elongate shaft through the instrument inlet, and including a second robotic drive input. A robotic medical device system comprising a first and second robotic drive outputs, wherein the first robotic drive output is configured to drive the first robotic drive input and the second robotic drive output is configured to drive the second robotic drive input; wherein the first mechanism base and the second mechanism base are configured to be coupled to each other, and by coupling the first and second mechanism bases to the robotic device, the first robotic drive input is coupled to the first robotic drive output and the second robotic drive input is coupled to the second robotic drive output; wherein the first and second robotic drive inputs are configured to be controlled by the robotic device; and wherein the first mechanism base and the second mechanism base are configured to be detachably coupled together to form a unit comprising the first medical device and the second medical device. Claim 2 A robotic medical device system according to claim 1, wherein the first rotating element comprises a tensioning ratchet configured to allow initial tensioning of a pull wire coupled to the first rotating element. Claim 3 A robotic medical device system according to claim 1, wherein the second elongated shaft extends from the proximal portion of the second device base of the second medical device. Claim 4 A robotic medical device system according to paragraph 3, wherein the second medical device comprises a coupling element, the coupling element operably connects the second slender shaft to the second robot drive input, and the second robot drive input is operably connected to the second slender shaft at a point distal to the proximal portion of the second device base. Claim 5 A robotic medical device system according to claim 4, wherein the second medical device further comprises a linear actuator coupled to the coupling element, and the linear actuator is configured to operate the second elongated shaft in the longitudinal direction. Claim 6 A robotic medical device system according to claim 1, wherein the second medical device comprises a laser tool or a basketing tool. Claim 7 A robotic medical device system according to claim 1, wherein the first actuator controls the longitudinal position of at least a portion of the second elongated shaft. Claim 8 A robotic medical device system according to claim 7, wherein the second actuator controls the activation of the distal portion of the second elongated shaft. Claim 9 A robotic medical device system according to claim 1, wherein the second robot drive input is coupled to the sheath of the second elongated shaft. Claim 10 A robot medical device system according to claim 1, wherein the second robot drive input is coupled to the inner part of the second elongated shaft. Claim 11 A robotic medical device system according to claim 1, wherein the second elongated shaft forms a service loop. Claim 12 A robotic medical device system according to claim 11, wherein the service loop extends at least 45 degrees between the device inlet of the first medical device and the device base of the second medical device. Claim 13 delete Claim 14 delete Claim 15 delete Claim 16 delete Claim 17 delete Claim 18 delete Claim 19 delete Claim 20 delete Claim 21 delete Claim 22 delete Claim 23 delete Claim 24 delete Claim 25 delete Claim 26 delete Claim 27 delete Claim 28 delete Claim 29 delete Claim 30 delete

Images