Guide device for conveying elongated equipment and method of use

Abstract

The present invention relates to a guide device and a method of use for conveying a slender device. A variable length support assembly includes a first end, a second end, a plurality of support member pairs, and a plurality of eyelets configured to receive a slender flexible instrument. Each support member pair includes a first support member connected to a second support member, and each of the plurality of eyelets is movably connected to at least one pair of the plurality of support member pairs along a longitudinal center axis between the first end and the second end. The variable length support assembly is configured to selectively switch from a compressed structure to an expanded structure along the longitudinal center axis, and when the slender flexible instrument is advanced along the longitudinal center axis, the plurality of eyelets are suitable for supporting the slender flexible instrument. Each of the plurality of eyelets includes a tapered alignment member, the tapered alignment member being configured to contact the tapered alignment member of an adjacent eyelet to align the plurality of eyelets along the longitudinal axis when the variable length assembly switches from the expanded structure to the compressed structure.

Description

[0001] This application is a divisional application. The application date of the original application is July 7, 2017, the application number is "201780045618.1", and the name of the invention is "Guiding device and use method for conveying slender equipment".

[0002] CROSS-REFERENCE TO RELATED APPLICATIONS

[0003] This patent application claims priority to and the benefit of the filing date of U.S. Provisional Patent Application No. 62 / 359,957, filed on July 8, 2016, entitled “GUIDE APPARATUS FOR DELIVERY OF AN ELONGATE DEVICE AND METHODS OF USE,” which is incorporated herein by reference in its entirety. Technical Field

[0004] The present disclosure relates to systems and methods for navigating patient anatomy for minimally invasive surgery, and more particularly to apparatus and methods for guiding and supporting delivery of elongated devices, such as flexible interventional instruments and / or steerable interventional instruments, into patient anatomy. Background Art

[0005] Minimally invasive medical technology is intended to reduce the amount of tissue damaged during interventional surgery, thereby reducing the patient's recovery time, discomfort and harmful side effects. This minimally invasive technology can be performed through the natural orifice in the patient's anatomical structure or through one or more surgical incisions. Through these natural orifices or incisions, clinicians can insert interventional instruments (including surgery, diagnosis, treatment or biopsy instruments) to reach the target tissue location. Doctors can insert minimally invasive medical instruments (including surgery, diagnosis, treatment or biopsy instruments) through these natural orifices or incisions to reach the target tissue location. One such minimally invasive technology is to use a flexible and / or directional elongated device (for example, a flexible catheter) that can be inserted into an anatomical channel and directed to the region of interest in the patient's anatomical structure. In order to reach the target tissue location, the minimally invasive interventional instrument can navigate the natural channel or surgically created channel in the anatomical system (for example, lungs, colon, intestines, kidneys, heart, circulatory system or similar systems). Controlling this elongated device by medical staff involves the management of several degrees of freedom, including at least the management of the insertion and retraction of the elongated device and the guidance of the device. In addition, different operating modes can also be supported.

[0006] Remotely operated interventional systems can be used to insert flexible interventional instruments into a patient's anatomy. Several interventional instruments are made of flexible materials that allow for maneuverability through the patient's body. In existing systems, at least a portion of the interventional instrument extending between the patient and the remotely operated manipulator is unsupported, and the flexible properties of the instrument can cause it to bend, twist, or bend in an undesirable manner at a point outside the patient's body when force is applied to insert the instrument into the patient's anatomy. Deformation of the instrument can damage internal components such as fiber optic shape sensors or endoscopic devices. Improved systems and methods are needed to guide and support interventional instruments when they are inserted into the patient's anatomy to prevent deformation of the instrument. Summary of the invention

[0007] Embodiments of the invention are outlined by the claims appended to the description.

[0008] According to some embodiments, a device for guiding an elongated flexible instrument includes a variable length support assembly. The variable length support assembly includes a first end, a second end, a plurality of support member pairs, and a plurality of eyelets configured to receive the elongated flexible instrument. Each support member pair includes a first support member connected to a second support member, and each of the plurality of eyelets is movably connected to at least one pair of the plurality of support member pairs along a longitudinal center axis between the first end and the second end. The variable length support assembly is configured to selectively switch from a compressed configuration to an expanded configuration along the longitudinal center axis, and when the elongated flexible instrument is advanced along the longitudinal center axis, the plurality of eyelets are suitable for supporting the elongated flexible instrument. Each of the plurality of eyelets includes a tapered alignment member, the tapered alignment member being configured to contact the tapered alignment member of an adjacent eyelet to align the plurality of eyelets along the longitudinal axis when the variable length assembly switches from the expanded configuration to the compressed configuration.

[0009] According to some embodiments, a device for guiding an elongated flexible instrument includes a variable length support assembly. The variable length support assembly includes a first end, a second end, a plurality of support member pairs, and a plurality of eyelets configured to receive the elongated flexible instrument. Each support member pair includes a first support member connected to a second support member, and each of the plurality of eyelets is movably connected to at least one pair of the plurality of support member pairs along a longitudinal center axis between the first end and the second end. The device also includes a proximal connector at the first end of the variable length support assembly. The proximal connector is configured to connect the variable length support assembly to an instrument interface portion, and a proximal arm synchronization assembly stabilizes the connection between the proximal connector and the variable length support assembly. The variable length support assembly is configured to selectively convert from a compressed structure to an expanded structure along the longitudinal center axis. When the elongated flexible instrument is advanced along the longitudinal center axis, the plurality of eyelets are suitable for supporting the elongated flexible instrument.

[0010] It should be understood that the above general description and the following specific embodiments are exemplary and explanatory in nature, and are intended to provide an understanding of the present disclosure without limiting the scope of the present disclosure. To this end, according to the following specific embodiments, other aspects, features and advantages of the present disclosure will be apparent to those skilled in the art. BRIEF DESCRIPTION OF THE DRAWINGS

[0011] Various aspects of the present disclosure are best understood in light of the following detailed description when read in conjunction with the accompanying drawings. It should be emphasized that, in accordance with standard industry practice, various features are not drawn to scale. In fact, the dimensions of various features may be increased or decreased arbitrarily for clarity of discussion. In addition, the present disclosure may repeat reference numerals and / or letters in various examples. This repetition is for simplicity and clarity purposes and does not in itself represent a relationship between the various embodiments and / or configurations discussed.

[0012] Figure 1 is a simplified diagram of a teleoperated medical system according to some embodiments of the present disclosure.

[0013] Figure 2A is a simplified diagram of a medical device system according to some embodiments of the present disclosure.

[0014] Figure 2B is a simplified diagram of a medical device with an extended medical tool according to some embodiments of the present disclosure.

[0015] Figure 3 is a simplified illustration of a side view of a teleoperated manipulator assembly, an elongated instrument, and an instrument guide according to some embodiments of the present invention.

[0016] Figure 4 A side view of instrument guide 400 is shown in a compressed configuration.

[0017] Figure 5 Shows Figure 4 Front view of the instrument guide shown in .

[0018] Figure 6 Shows Figure 4 A side view of an instrument guide device in a deployed configuration is shown in FIG.

[0019] Figure 7 Shows Figure 4 A top view of the instrument guide device in the deployed configuration is shown in FIG.

[0020] Figure 8 Shows Figure 4 Bottom view of the instrument guide device in the deployed configuration shown in .

[0021] Fig. 9 Shows Figure 4 A perspective view of an instrument guide device in a deployed configuration is shown in FIG.

[0022] Figures 10A-10E Shows Figure 4 The proximal portion of the variable length support assembly shown in FIG. Figures 10A-10D A perspective view of an exemplary arm synchronization assembly coupled to a variable length support assembly is shown, and Fig. 10E A top view of an exemplary arm synchronization assembly is shown according to one embodiment of the present disclosure.

[0023] Fig.11A A perspective view of a central portion of a variable length support assembly is shown according to one embodiment of the present disclosure.

[0024] Figures 11B-11D A perspective view of a central portion of an exemplary variable length support assembly according to another embodiment of the present disclosure is shown. Fig. 11B A close-up perspective view of an exemplary support member connected by a living hinge in a deployed configuration is shown according to one embodiment of the present disclosure. Fig. 11C A perspective view of a variable length support assembly in a deployed configuration is shown according to one embodiment of the present disclosure. Fig.11D A perspective view of a variable length support assembly in a compressed configuration is shown according to one embodiment of the present disclosure.

[0025] Fig.12 A perspective view of an exemplary first support member and an exemplary eyelet is shown according to one embodiment of the present disclosure.

[0026] Fig.13 A perspective view of an exemplary second support member according to one embodiment of the present disclosure is shown.

[0027] Fig.14 Shows Fig.12 A perspective view of an eyelet shown in FIG. 1 and an exemplary pin according to one embodiment of the present disclosure.

[0028] Figure 15-16B A portion of an exemplary instrument guide including an exemplary alignment member according to one embodiment of the present disclosure is shown. Specifically, Fig.15 Perspective views of exemplary eyelets, exemplary pins, and exemplary alignment members are shown. Fig.16A The invention shows a first support member and a second support member coupled to the first support member in the deployed configuration. Fig.15 A top cross-sectional view of the eyelet and alignment member shown in FIG. Fig. 16B The invention shows a first and second support member coupled to a compressed configuration. Fig.15 A top cross-sectional view of the eyelet and alignment member shown in FIG.

[0029] Figure 17-18B 1 shows a portion of an exemplary instrument guide device including an exemplary alignment member according to another embodiment of the present disclosure. Specifically, Fig.17 A perspective view of an exemplary eyelet and an exemplary alignment member is shown. Fig.18A The invention shows a first support member and a second support member coupled to the first support member in the deployed configuration. Fig.17 A top view of the eyelet and alignment features shown in FIG. Fig.18B The invention shows a first and second support member coupled to a compressed configuration. Fig.17 A top view of the eyelet and alignment features shown in FIG.

[0030] Figures 19A-19C A perspective view of an exemplary eyelet and an exemplary alignment member according to one embodiment of the present disclosure is shown.

[0031] Figures 20A-20D An embodiment according to the present disclosure includes Figures 19A-19C A perspective view of an exemplary variable length support assembly showing an eyelet and alignment member as shown in FIG.

[0032] Fig.21 A perspective view of an exemplary eyelet is shown according to one embodiment of the present disclosure.

[0033] Figures 22A-22C An embodiment according to the present disclosure includes Fig.21 A perspective view of an exemplary variable length support assembly for an eyelet shown in FIG.

[0034] Fig.23 A perspective view of an exemplary eyelet is shown according to one embodiment of the present disclosure.

[0035] Figures 24A-24C An embodiment according to the present disclosure includes Fig.21 A perspective view of an exemplary variable length support assembly for an eyelet shown in FIG.

[0036] Figures 25A-25C A perspective view of an example variable length support assembly coupled to an example arm synchronization assembly is shown according to one embodiment of the present disclosure. Fig.25A The length of the variable length support assembly is shown. Fig.25B An exemplary proximal arm synchronization assembly coupled to a variable length support assembly is shown, and Fig.25C An exemplary distal arm synchronization assembly is shown according to one embodiment of the present disclosure.

[0037] Figures 26A-26BA perspective view of an exemplary instrument guide according to another embodiment of the present disclosure is shown.

[0038] Fig.27A A set of gears in a proximal arm synchronization assembly is shown according to one embodiment of the present disclosure.

[0039] Fig.27B A set of gears in a proximal arm synchronization assembly according to another embodiment of the present disclosure is shown.

[0040] Fig.28 A cross-sectional view of a variable length support assembly is shown in a collapsed state.

[0041] Fig.29A and Fig.29B A perspective view and a top view are respectively shown of an eyelet according to one embodiment of the present disclosure.

[0042] Fig. 30A and Fig. 30B A perspective view and a top view are respectively shown of an eyelet according to another embodiment of the present disclosure.

[0043] Fig.31A An assembly fixture for assembling the instrument guide is shown.

[0044] Fig.31B A single support member 2520 is shown in an exploded configuration.

[0045] By referring to the following detailed description, the embodiments of the present disclosure and its advantages can be best understood. It should be understood that the same reference numerals are used to identify the same elements shown in one or more of the accompanying drawings, wherein what is shown in these figures is for the purpose of illustrating the embodiments of the present disclosure rather than for limiting the embodiments of the present disclosure. DETAILED DESCRIPTION

[0046] In the following description, the specific details of describing some embodiments according to the present disclosure are set forth. Many specific details are set forth in order to provide a thorough understanding of the embodiments. However, it is apparent to those skilled in the art that some embodiments may be practiced without some or all of these specific details. The specific embodiments disclosed herein are illustrative and not restrictive. Those skilled in the art may implement other elements, although not specifically described here, within the scope and spirit of the present disclosure. In addition, in order to avoid unnecessary repetition, one or more features shown and described in conjunction with one embodiment may be incorporated into other embodiments, unless otherwise specifically described or if one or more features make the embodiments inoperative.

[0047] In certain instances, well-known methods, procedures, components, and circuits have not been described in detail so as not to unnecessarily obscure aspects of the embodiments.

[0048] The present disclosure describes various apparatuses and parts of apparatuses according to their states in three-dimensional space. As used herein, the term "position" refers to the positioning of an object or a part of an object in three-dimensional space (e.g., three translational degrees of freedom along Cartesian x, y, and z coordinates). As used herein, the term "orientation" refers to the rotational placement of an object or a part of an object (three degrees of rotational freedom-e.g., roll, pitch, and yaw). As used herein, the term "posture" refers to the position of an object or a part of an object in at least one translational degree of freedom and the orientation of the object or a part of the object in at least one rotational degree of freedom (up to six degrees of freedom). As used herein, the term "shape" refers to a set of postures, positions, or orientations measured along an object.

[0049] Figure 1 is a simplified diagram of a teleoperated medical system 100 according to some embodiments. In some embodiments, the teleoperated medical system 100 may be suitable for use in, for example, surgical, diagnostic, therapeutic, or biopsy procedures. Figure 1 As shown, medical system 100 generally includes a teleoperated manipulator assembly 102 for operating medical instruments 104 when performing various surgeries on a patient P. Teleoperated manipulator assembly 102 is mounted to or near an operating table T. An operator input system 106 (sometimes referred to as a master assembly 106) allows an operator (e.g., a surgeon, a clinician, or a physician) to input the medical instruments 104 to the patient P. Figure 1 The doctor (2) shown observes the intervention site and controls the remotely operated manipulator assembly 102.

[0050] The main assembly 106 can be located at the doctor's console, which is typically located in the same room as the operating table T, such as next to the surgical table on which the patient P is located. However, it should be understood that the doctor O can be located in a different room from the patient P or in a completely different building. The main assembly 106 typically includes one or more control devices for controlling the remotely operated manipulator assembly 102. The control device can include any number of various input devices, such as a joystick, a tracking ball, a data glove, a trigger gun, a hand-operated controller, a voice recognition device, a human motion or presence sensor, and / or the like. In order to give the doctor O a strong sense of direct control of the instrument 104, the control device can have the same degrees of freedom as the associated medical device 104. In this way, the control device provides the doctor O with a remote presentation or perception that the control device and the medical device 104 are integrated.

[0051] In some embodiments, the control device may have more or fewer degrees of freedom than the associated medical instrument 104 and still provide telepresence to the physician O. In some embodiments, the control device may optionally be movable with six degrees of freedom and may also include a manual input device for actuating an actuatable handle of the instrument (e.g., for closing grasping jaws, applying potentials to electrodes, providing medication, and / or the like).

[0052] Figure 1 is a simplified diagram of a teleoperated medical system 100 according to some embodiments. In some embodiments, the teleoperated medical system 100 may be suitable for use in, for example, surgical, diagnostic, therapeutic, or biopsy procedures. Figure 1 As shown, the teleoperation system 100 generally includes a teleoperation manipulator assembly 102 for operating a medical instrument 104 when performing various surgeries on a patient P. The assembly 102 is mounted to or near an operating table O. A main assembly 106 allows an operator (e.g., a surgeon, a clinician, or a physician) to Figure 1 The doctor (2) shown observes the intervention site and controls the remotely operated manipulator assembly 102.

[0053] The main assembly 106 (or main surgeon control input assembly 106) can be located at the surgeon's console, which is typically located in the same room as the operating table O, such as next to the surgical table on which the patient P is placed. However, it should be understood that the doctor O can be located in a different room from the patient P or in a completely different building. The main assembly 106 typically includes one or more control devices for controlling the manipulator assembly 102. The control device can include any number of various input devices, such as joysticks, tracking balls, data gloves, trigger guns, hand-operated controllers, voice recognition devices, human motion or presence sensors, etc. In order to give the doctor O a strong sense of direct control of the instrument 104, the control device can have the same degrees of freedom as the associated medical instrument 104. In this way, the control device provides the doctor O with a remote presentation or perception that the control device and the medical instrument 104 are integrated.

[0054] In some embodiments, the control device may have more or fewer degrees of freedom than the associated medical instrument 104 and still provide telepresence to the physician O. In some embodiments, the control device moves with six degrees of freedom and may also include a manual input device for actuating an actuatable handle of the instrument (e.g., for closing grasping jaws, applying potentials to electrodes, providing medication, etc.).

[0055] The teleoperation assembly 102 supports the medical device system 104 and may include a kinematic structure consisting of one or more non-servo controlled links (e.g., one or more links that can be manually positioned and locked in place, which are generally referred to as a set-up structure) and a teleoperation manipulator. The teleoperation assembly 102 includes a plurality of actuators or motors that drive inputs on the medical device system 104 in response to commands from a control system (e.g., control system 112). The motor includes a drive system that, when coupled to the medical device system 104, can advance the medical device into a naturally created or surgically created anatomical orifice. Other motorized drive systems can move the distal end of the medical device with multiple degrees of freedom, which can include three linear motion (e.g., linear motion along the X, Y, Z Cartesian axes) degrees of freedom and three rotational motion (e.g., rotation around the X, Y, Z Cartesian axes) degrees of freedom. In addition, the motor can be used to actuate an articulated end effector of the instrument for grasping tissue in the jaws of a biopsy device or the like. Motor position sensors such as resolvers, encoders, potentiometers, and other mechanisms can provide sensor data describing the rotation and orientation of the motor shaft to the remote operating assembly. This position sensor data can be used to determine the motion of an object manipulated by the motor.

[0056] The teleoperated medical system 100 also includes a sensor system 108 having one or more subsystems for receiving information about the instrument of the teleoperated assembly. Such subsystems may include: a position / location sensor system (such as an electromagnetic (EM) sensor system); a shape sensor system for determining the position, orientation, velocity, speed, posture and / or shape of the catheter tip and / or one or more segments along the flexible body of the instrument system 104; and / or a visualization system for capturing images from the distal end of the catheter system.

[0057] Visualization systems (e.g. Figure 2AThe visualization system 231) may include a viewing scope component that records concurrent or real-time images of the surgical site and provides the images to the clinician or surgeon S. The concurrent images may be, for example, two-dimensional or three-dimensional images captured by an endoscope located within the surgical site. In the present embodiment, the visualization system includes an endoscope component that can be integrally or removably coupled to the medical device 104. However, in alternative embodiments, a separate endoscope attached to a separate manipulator assembly may be used with the medical device to image the surgical site. The visualization system may be implemented as hardware, firmware, software, or a combination thereof that interacts with or is otherwise executed by one or more computer processors, which may include a processor of the control system 112 (described below). The processor of the control system 112 may execute instructions, including instructions corresponding to the processes disclosed herein.

[0058] The teleoperated medical system 100 also includes a display system 110 for displaying images or representations of the surgical site and (one or more) medical instrument systems 104 generated by the subsystems of the sensor system 108. The display system 110 and the operator input system 106 can be oriented so that the doctor O can control the medical instrument system 104 and the operator input system 106 with the help of the telepresented perception.

[0059] The display system 110 can also display images of the surgical site and medical instruments captured by the visualization system. The display system 110 and control device can be oriented so that the relative positions of the imaging device and medical instruments in the scope assembly are similar to the relative positions of the surgeon's eyes and hands, so the operator can manipulate the medical instruments 104 and hand controls as if viewing the workspace essentially immersively. Immersive means that the presentation of the image is a true perspective image that simulates the perspective of the operator who is physically manipulating the instrument 104.

[0060] Alternatively or additionally, the display system 110 may present an image of the surgical site recorded preoperatively or intraoperatively using image data from an imaging technique such as computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermography, ultrasound, optical coherence tomography (OCT), thermography, impedance imaging, laser imaging, or nanotube x-ray imaging. The preoperative or intraoperative image data may be presented as a two-dimensional, three-dimensional, or four-dimensional (including, for example, time-based or velocity-based information) image or as an image from a model created from the preoperative or intraoperative image data set.

[0061] In some embodiments, typically for the purpose of imaging-guided surgery, the display system 110 may display a virtual navigation image in which the actual position of the medical instrument 104 is registered (i.e., dynamically referenced) with a preoperative or concurrent image / model to present a virtual image of the internal surgical site to the surgeon O from the perspective of the position of the tip of the instrument 104. In some examples, the perspective may be from the tip of the medical instrument 104. An image of the tip of the instrument 104 or other graphical or alphanumeric indicators may be superimposed on the virtual image to assist the surgeon O in controlling the medical instrument. Alternatively, the instrument 104 may not be visible in the virtual image.

[0062] In other embodiments, the display system 110 can display a virtual navigation image in which the actual positioning of the medical instrument is registered with the preoperative or concurrent image to present a virtual image of the medical instrument within the surgical site to the doctor O from an external perspective. An image of a portion of the medical instrument or other graphic or alphanumeric indicator can be superimposed on the virtual image to assist the doctor O in controlling the instrument 104. As described herein, a visual representation of the data points can be presented to the display system 110. For example, measured data points, moved data points, registered data points, and other data points described herein can be displayed on the display system 110 in a visual representation. The data points can be visually represented in the user interface by a plurality of points or dots on the display, or represented as a rendered model, such as a grid or line model created based on the set of data points. In some examples, the data points can be color-coded according to the data they represent. In some embodiments, the visual representation can be refreshed in the display system 110 after each processing operation has been implemented to change the data point.

[0063] The remotely operated medical system 100 also includes a control system 112. The control system 112 includes at least one memory and at least one computer processor (not shown), and typically includes multiple processors, for implementing control between the medical device system 104, the operator input system 106, the sensor system 108, and the display system 110. The control system 112 also includes programmed instructions (e.g., a non-transitory machine-readable medium storing instructions) to implement some or all of the methods described according to the various aspects disclosed herein, and the programmed instructions include instructions for providing pathology information to the display system 110. Although the control system 112 is Figure 1102 is shown as a single box in the simplified schematic diagram of , but the system may include two or more data processing circuits, with a portion of the processing optionally performed on or near the remote operation component 102, another portion of the processing performed at the operator input system 106, another portion of the processing performed at the main component 106, and so on. The processor of the control system 112 can execute instructions, including instructions corresponding to the processes disclosed herein and described in more detail below. Any of a variety of centralized or distributed data processing architectures can be employed. Similarly, the programmed instructions can be implemented as multiple separate programs or subroutines, or they can be integrated into multiple other aspects of the remote operation system described herein. In one embodiment, the control system 112 supports wireless communication protocols such as Bluetooth, IrDA, HomeRF, IEEE 802.11, DECT, and wireless telemetry.

[0064] In some embodiments, the control system 112 may receive force and / or torque feedback from the medical device 104. In response to the feedback, the control system 112 may send a signal to the main assembly 106. In some examples, the control system 112 may send a signal instructing one or more actuators of the teleoperated manipulator assembly 102 to move the medical device 104. The medical device 104 may extend to an internal surgical site within the body of the patient P via an opening in the body of the patient P. Any suitable conventional and / or specialized actuator may be used. In some examples, the one or more actuators may be separated or integrated with the teleoperated manipulator assembly 102. In some embodiments, the one or more actuators and the teleoperated manipulator assembly 102 are provided as part of a teleoperated cart positioned near the patient P and the operating table T.

[0065] The control system 112 may further include a virtual visualization system to provide navigation assistance to the doctor O when controlling (one or more) medical device systems 104 during image-guided surgery. Virtual navigation using a virtual visualization system is based on reference to a preoperative or intraoperative data set obtained for an anatomical channel. The virtual visualization system uses imaging techniques (e.g., computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermography, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, nanotube X-ray imaging, etc.) to process images of the imaged surgical site. Software that can be used in conjunction with manual input is used to convert the recorded image into a segmented two-dimensional or three-dimensional composite representation of a portion or entire anatomical organ or anatomical region. The image data set is associated with the composite representation. The composite representation and the image data set describe various positioning and shapes of the channel and its connectivity. The image used to generate the composite representation can be recorded preoperatively or intraoperatively during clinical surgery. In some embodiments, the virtual visualization system can use a standard representation (i.e., not patient-specific) or a mixture of a standard representation and patient-specific data. The composite representation and any virtual images generated by the composite representation may represent the static pose of the deformable anatomical region during one or more phases of motion (eg, during the inspiration / expiration cycle of the lungs).

[0066] During a virtual navigation surgery, the sensor system 108 can be used to calculate the approximate positioning of the instrument relative to the anatomical structure of the patient P. This positioning can be used to generate macroscopic (external) tracking images of the anatomical structure of the patient P and virtual internal images of the anatomical structure of the patient P. The system can implement one or more electromagnetic (EM) sensors, fiber optic sensors, and / or other sensors to register and display the medical practice with preoperatively recorded surgical images (such as those from a virtual visualization system). For example, U.S. Patent Application No. 13 / 107,562 (filed on May 13, 2011) (disclosing "Medical System Providing Dynamic Registration of a Model of an Anatomic Structure for Image-Guided Surgery") discloses such a system, which application is incorporated herein by reference in its entirety.

[0067] The teleoperation medical system 100 may also include optional operating and support systems (not shown), such as lighting systems, guidance control systems, flushing systems, and / or suction systems. In some embodiments, the teleoperation system may include more than one teleoperation assembly and / or more than one main assembly. The exact number of manipulator assemblies will depend on the surgical procedure and space constraints and other factors in the operating room. Main assemblies 106 may be juxtaposed or they may be located in different locations. Multiple main assemblies allow more than one operator to control one or more teleoperation manipulator assemblies in various combinations.

[0068] Figure 2A is a simplified diagram of a medical device system 200 according to some embodiments. In some embodiments, the medical device system 200 can be used as a medical device 104 in an image-guided medical procedure performed using a teleoperated medical system 100. In some examples, the medical device system 200 can be used for non-teleoperated exploratory procedures or procedures involving traditional manually operated medical devices (such as endoscopy). Optionally, the medical device system 200 can be used to collect (i.e., measure) a set of data points corresponding to locations within an anatomical passage of a patient (such as patient P).

[0069] The instrument system 200 includes an elongated device 202 (such as a catheter system) coupled to a drive unit 204. The elongated device 202 includes an elongated flexible body 216 having a proximal end 217 and a distal end 218 (or a tip portion 218). In one embodiment, the flexible body 216 has an outer diameter of approximately 3 mm. Other flexible body outer diameters may be larger or smaller.

[0070] The medical device system 200 also includes a tracking system 230 for determining the position, orientation, velocity, speed, posture, and / or shape of the distal end 218 and / or one or more segments 224 along the flexible body 216 using one or more sensors and / or imaging devices as described in further detail below. The entire length of the flexible body 216 between the distal end 218 and the proximal end 217 can be effectively divided into the segments 224. If the medical device system 200 is consistent with the medical device 104 of the teleoperated medical system 100, the tracking system 230. The tracking system 230 can optionally be implemented as hardware, firmware, software, or a combination thereof that interacts with or is otherwise executed by one or more computer processors, which can include Figure 1 A processor of the control system 112 in the system.

[0071] Tracking system 230 may optionally track distal end 218 and / or one or more of segments 224 using shape sensor 222. Shape sensor 222 may optionally include an optical fiber aligned with flexible body 216 (e.g., disposed within an internal channel (not shown) or mounted externally). In one embodiment, the optical fiber has a diameter of approximately 200 μm. In other embodiments, the dimensions may be larger or smaller. The optical fiber of shape sensor 222 forms an optical fiber bend sensor for determining the shape of flexible body 216. In an alternative, an optical fiber including a fiber Bragg grating (FBG) is used to provide strain measurements in the structure in one or more dimensions. Various systems and methods for monitoring the shape and relative position of an optical fiber in three dimensions are described in U.S. Patent Application No. 11 / 180,389 (filed on July 13, 2005) (disclosing "Fiber optic position and shape sensing device and method relating thereto") and U.S. Patent Application No. 12 / 047,056 (filed on July 16, 2004) (disclosing "Fiber-optic shape and relative position sensing") and U.S. Patent No. 6,389,187 (filed on June 17, 1998) (disclosing "Optical Fiber Bend Sensor"), the disclosures of which are incorporated herein by reference in their entirety. The sensors in some embodiments may employ other suitable strain sensing techniques, such as Rayleigh scattering, Raman scattering, Brillouin scattering, and fluorescence scattering. In some embodiments, the shape of the elongated device may be determined using other techniques. For example, the history of the distal end posture of the flexible body 216 can be used to reconstruct the shape of the flexible body 216 over a time interval. In some embodiments, the tracking system 230 can optionally and / or additionally track the distal end 218 using a position sensor system 220. The position sensor system 220 can use any suitable sensing technology or combination of sensing technologies, such as: OFDR (Optical Frequency Domain Reflectometry) technology such as using fiber Bragg gratings, Rayleigh scattering, or some other applicable reflection method; position sensors implemented by EM (electromagnetic) technology; linear rotary encoder technology supported by capacitive, optical, resistive or other technologies; etc. As a specific example, the position sensor system 220 can include an EM sensor system or can be a component of an EM sensor system, wherein the position sensor system 220 includes one or more conductive coils that can be subjected to an externally generated electromagnetic field.Each coil of such an EM sensor system used to implement the position sensor system 220 then generates an induced electrical signal having characteristics that depend on the position and orientation of the coil relative to the externally generated electromagnetic field. In some embodiments, the position sensor system 220 can be constructed and positioned to measure six degrees of freedom, for example, three position coordinates X, Y, Z and three orientation angles of pitch, yaw and roll indicating a base point, or five degrees of freedom, for example, three position coordinates X, Y, Z and two orientation angles of pitch and yaw indicating a base point. A further description of the position sensor system is provided in U.S. Patent No. 6,380,732 (filed on August 11, 1999) (disclosing "Six-Degree of Freedom Tracking System Having a Passive Transponder on the Object Being Tracked"), which is incorporated herein by reference in its entirety.

[0072] In some embodiments, tracking system 230 may alternatively and / or additionally rely on historical posture, position, or orientation data stored for known points of the instrument system along a cycle of alternating motion (e.g., breathing). This stored data may be used to form shape information about flexible body 216. In some examples, a series of position sensors (not shown) (such as electromagnetic (EM) sensors similar to those used in some embodiments of position sensor system 220) may be positioned along flexible body 216 and then used for shape sensing. In some examples, a history of data collected during surgery from one or more of these sensors may be used to represent the shape of elongated device 202, particularly if the anatomical passage is generally static.

[0073] Flexible body 216 includes a channel 221 sized and shaped to receive a medical device 226 . Figure 2B2 is a simplified diagram of a flexible body 216 with an extended medical device 226 according to some embodiments. In some embodiments, the medical device 226 can be used for procedures such as surgery, biopsy, ablation, illumination, irrigation, or suction. The medical device 226 can be deployed through the channel 221 of the flexible body 216 and used at a target location within the anatomical structure. The medical device 226 may include, for example, an image capture probe, a biopsy instrument, a laser ablation fiber, and / or other surgical, diagnostic, or therapeutic tools. The medical tool may include an end effector with a single working member, such as a scalpel, a blunt blade, an optical fiber, an electrode, and / or the like. Other end effectors may include, for example, forceps, graspers, scissors, clip appliers, and / or the like. Other end effectors may also include electrically activated end effectors, such as electrosurgical electrodes, converters, sensors, and / or the like. In various embodiments, the medical device 226 is a biopsy instrument, which can be used to remove sample tissue or cell sampling from a target anatomical location. The medical device 226 may also be used with an image capture probe that is also within the flexible body 216. In various embodiments, the medical device 226 can be an image capture probe that includes a distal portion having a stereoscopic or monoscopic camera at or near the distal end 218 of the flexible body 216, the stereoscopic or monoscopic camera being used to capture images (including video images) processed by the visualization system 231 for display and / or to provide it to the tracking system 230 to support tracking of the distal end 218 and / or one or more segments 224. The image capture probe can include a cable coupled to the camera for transmitting the captured image data. In some examples, the image capture instrument can be a fiber optic bundle coupled to the visualization system 231, such as a fiberscope. The image capture instrument can be single-spectrum or multi-spectrum, for example, capturing image data in one or more of the visible spectrum, infrared spectrum, and / or ultraviolet spectrum. Alternatively, the medical device 226 itself can be an image capture probe. The medical device 226 can be advanced from the opening of the channel 221 to perform surgery, and then retracted into the channel when the surgery is completed. The medical device 226 may be removed from the proximal end 217 of the flexible body 216 or from another optional instrument port (not shown) along the flexible body 216 .

[0074] The medical device 226 may additionally house a cable, linkage, or other actuation control (not shown) extending between its proximal and distal ends to controllably bend the distal end of the medical device 226. Steerable instruments are described in detail in U.S. Patent No. 7,316,681 (filed on October 4, 2005) (disclosing "Articulated Surgical Instrument for Performing Minimally Invasive Surgery with Enhanced Dexterity and Sensitivity") and U.S. Patent Application No. 12 / 286,644 (filed on September 30, 2008) (disclosing "Passive Preload and Capstan Drive for Surgical Instruments"), which are incorporated herein by reference in their entirety.

[0075] The flexible body 216 may also house cables, linkages, or other guidance controls (not shown) extending between the drive unit 204 and the distal end 218 to controllably bend the distal end 218, for example, as shown by a dashed line depiction 219 of the distal end 218. In some examples, at least four cables are used to provide independent "up and down" guidance to control the pitch of the distal end 218 and to provide "side to side" guidance to control the yaw of the distal end 281. Steerable elongated devices are described in detail in U.S. Patent Application No. 13 / 274,208 (filed on October 14, 2011) (disclosing "Catheter with Removable Vision Probe"), which is incorporated herein by reference in its entirety. In embodiments where the medical device system 200 is actuated by a remotely operated assembly, the drive unit 204 may include a drive input that is removably coupled to and receives power from a drive element (e.g., an actuator) of the remotely operated assembly. In some embodiments, the medical device system 200 may include gripping features, manual actuators, or other components for manually controlling the movement of the medical device system 200. The elongated device 202 may be steerable, or, alternatively, the system may be non-steerable, lacking an integrated mechanism for operator-controlled bending of the distal end 218. In some examples, a medical device may be defined in the wall of the flexible body 216 through which one or more lumens may be deployed and used at a target surgical location.

[0076] In some embodiments, the medical device system 200 may include a flexible bronchial instrument, such as a bronchoscope or bronchial catheter, for inspection, diagnosis, biopsy, or treatment of the lung. The medical device system 200 is also suitable for navigation and treatment of other tissues in any of a variety of anatomical systems, including the colon, intestines, kidneys and calyces, brain, heart, circulatory system including vasculature, and / or the like, through natural or surgically created connecting passages.

[0077] Information from tracking system 230 can be sent to navigation system 232 where it is combined with information from visualization system 231 and / or preoperatively acquired models to provide real-time position information to a physician or other operator. In some examples, the real-time position information can be displayed on a Figure 1 The display system 110 is used for controlling the medical device system 200. In some examples, Figure 1 The control system 116 can utilize the position information as feedback for positioning the medical instrument system 200. Various systems for using fiber optic sensors to register and display surgical instruments with surgical images are provided in U.S. Patent Application No. 13 / 107,562 (filed on May 13, 2011) (disclosing "Medical System Providing Dynamic Registration of a Model of an Anatomic Structure for Image-Guided Surgery"), which is incorporated herein by reference in its entirety.

[0078] In some examples, the medical device system 200 may be Figure 1 In some embodiments, Figure 1 The teleoperated manipulator assembly 102 may be replaced by direct operator control. In some examples, direct operator control may include various handles and operator interfaces for handheld operation of the instrument.

[0079] When a catheter (or other elongated flexible medical device) is inserted into a patient's anatomical structure using a remotely operated assembly, the length of the catheter outside the patient's body should be supported when it is pushed into the patient's body. Otherwise, when the catheter is pushed from the proximal end and encounters friction in the patient's anatomical structure at the distal end, the catheter will warp or bend. In order to prevent such deformation of the catheter, when the instrument guide device enters the patient's anatomical structure along the insertion axis, the instrument guide device can be used to provide support to the catheter at regular intervals. Before the catheter is introduced into the patient's anatomical structure, the catheter can pass through the channel or eyelet of the instrument guide device. In the embodiments described herein, the instrument guide device can be converted between a compressed structure and an expanded structure. In the embodiments described herein, the guide device includes an alignment element that enables the eyelet of the guide device to self-align along the insertion axis before the catheter is introduced into the guide device. Typically, the catheter is introduced into the guide device while the device is in a compressed structure. After the distal portion of the catheter passes through the eyelet of the guide device, the guide device can be expanded around the remaining portion of the catheter. When the catheter is advanced into the patient's anatomical structure and the exposed length of the catheter is reduced, the instrument guide device returns to a compressed structure. As the catheter enters the patient's anatomy, the guide compresses and the alignment member guides the eyelet to realign with the insertion axis. In some embodiments, the instrument guide devices described herein include features that increase the stiffness and stability of the device in the deployed configuration. Thus, the embodiments described herein effectively provide stable support for the catheter as it is introduced, traversed through, and removed from the patient's anatomy.

[0080] Figure 3The instrument interface portion 300 and instrument guide 302 of a teleoperated manipulator assembly (e.g., teleoperated manipulator assembly 102) according to an embodiment of the present invention are schematically shown. The instrument interface portion 300 includes a drive input 304 that can provide a mechanical connection between the instrument end effector and the flexible body guide mechanism to a drive motor mounted to the teleoperated manipulator. For example, a pair of drive inputs can control the pitch motion of the distal end of the instrument flexible body, wherein one adapter of the pair of drive inputs controls motion in an upward direction and the other adapter of the pair of drive inputs controls motion in an opposite downward direction. Other pairs of drive inputs can provide opposite motions of other degrees of freedom for the flexible body and / or end effector. In some embodiments, the drive input 304 can be coupled to or positioned within an instrument control unit 305 that controls the positioning of an elongated instrument (e.g., a catheter 310). For example, instruments that interface with a remote operation or robotic manipulator are described in U.S. Patent No. 6,331,181 filed on October 15, 1999 (disclosing "Surgical Robotic Tools, Data Architecture, And Use") and U.S. Patent No. 6,491,701 filed on January 12, 2001 (disclosing "Mechanical Actuator Interface System For Robotic Surgical Tools"), all of which are incorporated herein by reference in their entirety. The instrument interface portion 300 can also control instrument insertion by moving linearly along the insertion axis A.

[0081] During use, catheter 310 is positioned within instrument guide 302, and instrument guide 302 is used to minimize buckling of catheter 310 as catheter 310 is advanced toward, retained within, and retracted from a patient's anatomy. Instrument guide 302 has a proximal end 312 and a distal end 314. In some embodiments, proximal end 312 of instrument guide 302 is removably coupled to mounting plate 316 of instrument interface portion 300. Mounting plate 316 may be movable relative to proximal end 318 and distal end 320 of instrument interface portion 300 (e.g., along insertion axis A). Proximal end 318 and distal end 320 may or may not be disposed at the physical ends of instrument interface portion 300. For example, in the illustrated embodiment, proximal end 318 and distal end 320 include motion stops disposed away from the actual ends of instrument interface portion 300, which are shaped and configured to stop axial translation of mounting plate 316. During use, the distal end 314 of the instrument guide 302 can be removably coupled to an anchor 317 within the surgical field. The anchor 317 can be positioned on the instrument interface portion 300 (e.g., on a flexible instrument manipulator or FIM), on a surgical table, on a surgical frame, or on a patient anatomy. In one example, the anchor 317 can include a mouth guard that is gripped by the patient's teeth. The instrument guide 302 provides longitudinal support along the length of the catheter 310 located within the instrument guide 302 to minimize buckling of the exposed length of the catheter 310 as the catheter 310 is advanced into the patient's body P.

[0082] Figure 4-9 Various views of an exemplary instrument guide device 400 according to one embodiment of the present disclosure are shown. Specifically, Figure 4 A side view of instrument guide 400 is shown in a compressed configuration. Figure 5 A front view of instrument guide 400 is shown. Figure 6 A side view of instrument guide 400 is shown in a deployed configuration. Figure 7 A top view of instrument guide 400 is shown in a deployed configuration.

[0083] Figure 8 A bottom view of instrument guide 400 is shown in a deployed configuration. Fig. 9 A perspective view of instrument guide 400 is shown in a deployed configuration.

[0084] The instrument guide device 400 is Figure 3 Unless otherwise noted or apparent from the description, the design, function, and use of this specific embodiment are similar to those of the referenced Figure 3The same as described above for the instrument guide device 302 shown in the figure. In the illustrated embodiment, the instrument guide device 400 includes a proximal coupling 405, a variable length support assembly 410 extending from a first end 412 to a distal end 414, a distal coupling 415 at the distal end 414, and a retaining assembly 420 such as a latch mechanism. In use, the catheter 310 can be threaded through a proximal hole 422 on the proximal coupling 405 (at Fig. 10A ), through the variable length support assembly 410 and through the distal hole 425 ( Figure 5 ). Proximal hole 422 may also be referred to as lumen 422. Initially, in some cases, after catheter 310 is distally passed through variable length support assembly 410, instrument guide 400 may be moved from Figure 4 The compression structure shown in Figure 6-9 After the catheter 310 passes through the variable length support assembly 410 and enters the patient, the instrument guide 400 can be moved from the catheter 310 to the patient's body as the catheter 310 is advanced distally along the insertion axis A. Figure 6-9 The expanded or extended configuration shown in Figure 4 Instrument guide 400 and variable length support assembly 410 extend when catheter 310 is withdrawn from the patient, and a longer length of catheter 310 is exposed outside the patient (ie, the exposed length of catheter 310 that requires support).

[0085] The proximal coupling 405 is connected to the proximal side of the housing 405 by fastening elements 430a and 430b ( Figure 7 305) to removably couple the first end 412 of the variable length support assembly 410 to the instrument interface portion 300 and / or the instrument control unit 305. In the illustrated embodiment, the fastening elements 430a, 430b include shoulder screws or shoulder bolts that are shaped and sized to engage with the instrument interface portion 300 (e.g., on the mounting plate 316) and / or Figure 3 The corresponding threaded holes in the instrument control unit 305 shown in FIG. Figure 8 As shown, the proximal coupling 405 includes threaded holes 435a, 435b, which are shaped and sized to receive fastening elements 430a, 430b, respectively. After aligning the threaded holes 435a, 435b with corresponding threaded holes in the instrument interface portion 300 and / or the instrument control unit 305, the fastening elements 430a, 430b can be inserted through the threaded holes 435a, 435b, respectively, and tightened to securely attach the instrument guide device 400 to the mounting plate 316 (or Figure 3Other embodiments may include any of a variety of fastening elements capable of securely and removably coupling proximal coupler 405 of instrument guide 400 to a teleoperated manipulator assembly, including but not limited to snap-fit ​​engagements, friction engagements, hook fasteners, pins, carriage bolts, and mating screws. Proximal coupler 405 includes lumen 422 ( Fig. 9 and Fig. 10A ), which is sized and shaped to receive catheter 310 (or other elongated member) into instrument guide 400. In some embodiments, lumen 422 is linearly aligned along insertion axis A with distal aperture 425 in distal coupler 415.

[0086] like Figure 4 As shown, when the instrument guide device 400 is collapsed, the retention assembly 420 can be used to selectively retain the variable length support assembly 410 in a compressed configuration. In the illustrated embodiment, the retention assembly 420 includes a hinge mechanism that includes a proximal segment 440 and a distal segment 445. The proximal segment 440 is hingedly connected to the proximal coupler 405 at one end and is hingedly connected to the distal segment 445 at the opposite end. The distal segment 445 includes a distal fastener 448 that is shaped and sized to selectively engage an attachment element 450 disposed on the distal coupler 415. In the illustrated embodiment, as shown in FIG. Figure 4 and Figure 5 As shown, distal fastener 448 is shaped as a serrated hook that is sized to selectively latch onto attachment element 450, which is shaped as a rod. Specifically, attachment element 450 is configured to snap into a corresponding recess 455 on distal fastener 448. In other embodiments, distal fastener 448 and attachment element 450 are shaped and sized to be any of a variety of removably mating fastening elements, including but not limited to other snap-fit ​​engagements, hook fasteners, threaded engagements, and friction engagements. In some cases, retaining assembly 420 can be used to temporarily lock while instrument guide 400 is being transported or attached to teleoperated manipulator assembly 102, or while catheter 310 is initially being passed through instrument guide 400. Figure 4 Variable length support assembly 410 is shown in a compressed configuration. When distal fastener 448 is removed from attachment element 450, distal segment 445 can be folded toward proximal segment 440, and both segments 445, 440 can be lifted from variable length support assembly 410 and folded in the direction of arrow A1. After distal fastener 448 is removed from attachment element 450, variable length support assembly 410 can be extended to an expanded configuration, such as Figure 6-9 shown.

[0087] In addition to cooperating with the retaining assembly 420 to keep the instrument guide 400 in a compressed configuration, the distal coupler 415 can also be used to removably couple the instrument guide 400 to a patient or another device (e.g., a stabilizer mounted to the patient or an operating table) to stabilize the distal end of the instrument guide when the catheter 310 passes through the variable length support assembly 410. For example, in some embodiments, the attachment element 450 of the distal coupler 415 can be connected to the stabilizer in the surgical field, such as, as a non-limiting example, a hook or a tether. During use, the stabilizer can be connected to the patient's body and / or the operating table. In some cases, the stabilizer may include an introducer sheath at the insertion site that is configured to receive the catheter 310. The instrument guide 400 provides support at discrete intervals along the length of the catheter 310 between the stabilizer and the proximal coupler 405. Typically, the distal coupler 415 is stationary relative to the patient.

[0088] When the proximal coupling 405 moves proximally along the insertion axis A in the direction of arrow A1, the variable length support assembly 410 can be moved from Figure 4 The compressed structure shown in Figure 6-9 In some cases, the movement of the catheter 310 into and out of the patient's anatomy is coupled to the movement of the proximal coupler 405. In some cases, when the catheter 310 is initially advanced distally along the insertion axis A and into the patient's anatomy, the proximal coupler 405 moves in unison with the catheter 310 in the direction of arrow A2. Similarly, in some cases, when the catheter 310 is removed from the patient's anatomy, the proximal coupler 405 moves in unison with the catheter 310 along the insertion axis A in the direction of arrow A1. Figure 3 When the instrument interface portion 300 and / or the instrument control unit 305 shown in FIG. 3 further advances the catheter 310 into the patient's anatomy to thereby linearly displace the variable length support assembly 410 along the axis A in the direction of arrow A2, the variable length support assembly 410 can collapse or fold back into the compressed configuration. When the catheter 310 is fully inserted into the patient's body, the variable length support assembly 410 is in a position such as Figure 4 When the catheter 310 is only partially inserted into the patient's body, the variable length support assembly 410 is partially extended, as shown in FIG. Figure 6-9 When the catheter 310 is completely withdrawn from the patient or at least retracted (eg, into a delivery device) without being in direct contact with the patient's anatomy, the variable length support assembly 410 is fully extended.

[0089] like Figure 4As shown, the variable length support assembly 410 is disposed between the proximal coupling 405 and the distal coupling 415. Figure 6-9 As shown, the variable length support assembly 410 includes a plurality of pairs of corresponding support members 460, 465 that are connected to each other to form an expandable support structure. A first support member 460 is coupled to a second support member 465 to form a support frame of pairs of support members 460, 465 assembled in an expandable scissor-like configuration. Figure 7 As shown, when instrument guide device 400 is in the deployed configuration, first support member 460 is staggered with second support member 465 along central axis CA to form variable length support assembly 410. First support member 460 extends through second support member 465 and generally bisects second support member 465 to form a crisscross, deployable, variable length support assembly 410.

[0090] Figures 10A-10D A perspective view of a proximal portion of a variable length support assembly 410 and a proximal coupler 405 is shown in accordance with one embodiment of the present disclosure. Fig. 10E A top view of a proximal portion of a variable length support assembly 410 is shown in accordance with one embodiment of the present disclosure. Fig.11A 4 shows a perspective view of a central portion of a variable length support assembly 410 according to one embodiment of the present disclosure. Figure 7 , 8 As shown in FIGS. 11A and 11A , the variable length support assembly 410 includes two proximal arms 470 a , 470 b , two distal arms 472 a , 472 b , and a repeating array having three major components: a first support member 460 , a second support member 465 , and an eyelet 475 . Fig.12 A perspective view of a first support member 460 and an eyelet 475 is shown in accordance with one embodiment of the present disclosure. Fig.13 A perspective view of a second support member 465 is shown according to one embodiment of the present disclosure. Fig.14 A perspective view of an eyelet 475 is shown according to one embodiment of the present disclosure.

[0091] like Fig.14As shown, each eyelet 475 includes a generally hollow cylindrical or annular ring. In other embodiments, the eyelet 475 may include any of a variety of channels having various sizes and shapes. For example, some embodiments may include rectangular or oval eyelets. The eyelet 475 is configured to receive a pin or other fixing element in a receiving hole 476a, 476b, which is located on the opposite side of the outer surface 477 of the eyelet 475. In use, the eyelet 475 is configured to receive an elongated instrument, such as, but not limited to, a catheter 310, a sheath, a guide wire, or any combination thereof. In the illustrated embodiment, the size and shape of the eyelet 475 is set to allow the catheter 310 to pass easily. As shown in FIG. Fig.14 As shown, the eyelet 475 includes an inner cavity 478 having a diameter D1, and the diameter D1 is sized to accommodate the catheter 310. The diameter D1 can be in the range of 2 mm to 12 mm. In some embodiments, the diameter D1 is 5 mm. Other diameters are contemplated. Fig.12 As shown, the first support member 460 includes a central opening 480 having a diameter D2, and the diameter D2 is sized to accommodate a single eyelet 475. The diameter D2 can be in the range of 4 mm to 24 mm. In some embodiments, the diameter D2 is 10 mm. Other diameters are contemplated. The eyelet 475 has a thickness T1, and the central opening 480 of the first support member 460 has a central thickness T2 and an outer thickness T3. In the illustrated embodiment, the thickness T1 of the eyelet 475 is approximately the same as the central thickness T2. In other embodiments, the thickness T1 can be greater than or less than the central thickness T2. The thickness T1 can be in the range of 2 mm to 18 mm. In some embodiments, the thickness T1 is 6 mm. The central thickness T2 can be in the range of 2 mm to 12 mm. In some embodiments, the central thickness T2 is 5 mm. The outer thickness T3 can be in the range of 2 mm to 12 mm. In some embodiments, the outer thickness T3 is 5 mm. Other thicknesses are contemplated.

[0092] In the illustrated embodiment, both the first support member 460 and the second support member 465 have a generally rectangular profile. However, other shapes are also contemplated for the support members, including but not limited to square, rectangular, diamond, and oval shapes. Specifically, the first support member 460 is shaped as a rectangular plate having a central opening 480. The first support member 460 includes two recesses 484a, 484b located on the sides of the central opening 480 of the first support member 460. As shown in FIG. Fig.12 As shown, the first support member 460 includes a height H1. The height H1 can be in the range of 6 mm to 54 mm. In some embodiments, the height H1 is 18 mm. Other heights are contemplated. Other heights are contemplated. Fig.13As shown, the second support member 465 includes an upper rod 481, a lower rod 482 and two walls 483a, 483b. The walls 483a, 483b have an outer thickness T4. In the illustrated embodiment, the outer thickness T4 is approximately the same as the outer thickness T3 of the first support member 460. In other embodiments, the thickness T4 may be greater than or less than the thickness T3. The outer thickness T4 may be in the range of 2 mm to 12 mm. In some embodiments, the outer thickness T4 is 18 mm. Other thicknesses are contemplated. The walls 483a, 483b of the second support member 465 include recesses 486a, 486b, respectively. In the illustrated embodiment, the recesses 486a, 486b include semi-elliptical cutouts in the walls 483a, 483b. As shown in FIG. Fig.13 As shown, the space between the upper rod 481 and the lower rod 482 of the second support member 465 includes a height H2. The height H2 can be in the range of 6 mm to 54 mm. In some embodiments, the height H2 is 18 mm. Other heights are contemplated. The second support member 465 includes a height H3. The height H3 can be in the range of 10 mm to 80 mm. In some embodiments, the height H3 is 30 mm. Other heights are contemplated.

[0093] like Fig. 10A and Fig.11A As shown, each first support member 460 intersects with a corresponding second support member 465 through a central window 487 extending through the second support member 465. The first support member 460 is coupled to the intersecting second support member 465 at a central hinge 493 aligned with a vertical axis VA that bisects the centroid of the eyelet 475. Fig.12 and Fig.13As shown, the central hinge includes a first pin 485a and a second pin 485b, which are inserted into the top and bottom of the eyelet 475 respectively through the first support member 460 and the second support member 465 along the vertical axis VA. The eyelet 475 is movably or rotatably coupled to the first support member 460 and the second support member 465 at the central hinge 493 by the first pin 485a and the second pin 485b. In the illustrated embodiment, the central hinge 493 includes a pin joint having a first pin 485a and a second pin 485b, which extend through channels in the first support member 460 and the second support member 465 to receiving holes 476a, 476b in the eyelet 475. For example, in the illustrated embodiment, the first pin 485a extends through the channels 490a, 490b in the first support member 460 and the second support member 465, respectively, and the second pin 485b extends through the channels 495a, 495b in the first support member 460 and the second support member 465, respectively. Thus, the eyelet 475 is coupled to both the first support member 460 and the second support member 465 via the first pin 485a and the second pin 485b, and can pivot 360 degrees about the vertical axis VA within the central opening 480 of the first support member 460.

[0094] Return to Fig. 10A , Fig. 10B and Fig.11A , adjacent support members 460, 465 are hingedly coupled to each other at their ends at the external hinge 486. In some embodiments, as shown in FIG. 11, the external hinge 486 comprises a pin joint having a pin, bolt, or screw extending through peripheral attachment holes 498, 499 in the first support member 460 and the second support member 465, respectively. In other embodiments, as shown in FIG. Figures 11B-11D As shown, the external hinge may comprise a living hinge or a thin flexible hinge that is a continuation of the support member itself. Figures 11B-11D A perspective view of a central portion of an exemplary variable length support assembly according to another embodiment of the present disclosure is shown. Fig. 11B A close-up perspective view of an exemplary support member connected by a living hinge in a deployed configuration is shown according to one embodiment of the present disclosure. Fig. 11C A perspective view of a variable length support assembly in a deployed configuration is shown according to one embodiment of the present disclosure. Fig.11D A perspective view of a variable length support assembly in a compressed configuration is shown according to one embodiment of the present disclosure.

[0095] Specifically, Figures 11B-11DAn exemplary variable length support assembly 410' is shown including an outer hinge 486' that includes a living hinge or a thin flexible hinge made of the same material as the two support members 460', 465'. The variable length support assembly 410' is substantially similar to the variable length support assembly 410, except for the living hinge described herein. For example, the outer hinge 486' can be made of partially oriented polypropylene, polyethylene, or ultra high molecular weight polyethylene. In such an embodiment, the outer hinge 486' can be a section of the wall connecting the support members 460', 465' that is thinner than the outer thickness T3 of the first support member 460' and the outer thickness T4 of the second support member 465' (e.g., Fig.12 and Fig.13 493'), thereby allowing flexing along the line of the outer hinge 486' with sufficient bending and motion constraint range. In the illustrated embodiment, when the variable length support assembly 410' is in the expanded state, the outer hinge 486' has an arcuate or semicircular cross-sectional profile. Such a living hinge has minimal friction and low wear, and low cost and ease of manufacture may be advantageous. In other embodiments, the support members 460, 465 can be manufactured as mating halves so that the staggered relative support members can be assembled from multiple pairs of identical molded parts or two complementary molded parts. For example, in some embodiments, the support members 460', 465' can be manufactured as a mating pair of a first support member 460' and a second support member 465' connected at a central hinge 493'. In other embodiments, the support members 460', 465' can be manufactured as two separate chains of a first support member 460' and a second support member 465' connected at an outer hinge 486'.

[0096] return Figure 4 , when the variable length support assembly 410 is collapsed in the compressed configuration, the support members 460, 465 are positioned adjacent to each other. Figure 6-11A As shown, when the variable length support assembly 410 is unfolded in the unfolded configuration, the support members 460, 465 are spaced apart from each other in a scissor-like configuration. More specifically, the support members 460, 465 pivot relative to each other at the central hinge 493 and the outer hinge 486, thereby forcing the eyelets 475 to separate from each other at regular intervals.

[0097] Refer to above Fig. 10A and Fig.11A In the illustrated embodiment described, in particular, when the catheter 310 passes through the eyelet 475 (e.g., when the catheter 310 passes through the eyelet 475 Figure 4), eyelets 475 are aligned along insertion axis A. However, in this embodiment, when variable length support assembly 410 is returned to the compressed configuration (e.g., without catheter 310 passing through eyelets 475 and maintaining their alignment), all eyelets 475 may be misaligned. For example, one or more eyelets 475 may be rotated along vertical axis VA such that a catheter may encounter resistance when subsequently advanced into variable length support assembly 410. In such an embodiment, the user may need to manually realign each eyelet 475 or manipulate catheter 310 to nudge eyelets 475 into proper alignment prior to advancing catheter 310.

[0098] In other embodiments, instrument guide 400 includes an alignment feature that ensures that eyelets 475 are automatically aligned to form a passage for catheter 310 without the need to manually readjust individual eyelets 475. For example, Figure 15-18B Two embodiments of variable length support assemblies are described that include different types of alignment members that facilitate self-alignment of the eyelets.

[0099] Fig.15 4 shows a portion of a variable length support assembly 500 that may be included in an instrument guide 400. Specifically, Fig.15 An exemplary eyelet 505 is shown having alignment members 510a, 510b extending laterally from an outer wall 515. The eyelet 505 is substantially similar to the eyelet 505 described above with reference to FIG. Fig.14 The eyelet 475 described above is shown in Figure 1, except for the differences described herein. The eyelet 505 is configured to receive the pins 485a, 485b in the receiving holes 506a, 506b, respectively, which are located on opposite sides of the eyelet 505. Each alignment member 510a, 510b includes an elongated rod 520a, 520b, respectively, which can have a circular, rectangular or other prismatic or conical shape, which can optionally also terminate in a protrusion 525a, 525b. In the illustrated embodiment, the protrusions 525a, 525b are shaped as spheres, but other embodiments can have protrusions of different shapes, such as but not limited to cubes, tabs, or cones. In other embodiments, the alignment members 510a, 510b can be completely devoid of protrusions 525a, 525b. The alignment members 510a, 510b are fixed to opposite sides of the eyelet 505 in a horizontal orientation (i.e., on a horizontal axis HA perpendicular to the vertical axis VA).

[0100] Figures 16A-16B Portions of variable length support assembly 501 that may be included in instrument guide 400 are shown. Fig.16A and Fig. 16BA top view of first support member 530, second support member 535, eyelet 505, and alignment members 510a, 510b is shown.First support member 530 and second support member 535 are substantially similar to first support member 460 and second support member 465, respectively, described above, except for the differences described herein. Fig.16A 5 shows a top view of the first support member 530 and the second support member 535 in the deployed configuration, and Fig. 16BA top view of a first support member 530 and a second support member 535 in a compressed configuration is shown. The first support member 530 includes a first depression 540a and a first groove 541a on a first wall 545 and a second depression 540b and a second groove 541b on a second wall 550. The inner wall including the first wall 545 is on the opposite side of the first support member 530 compared to the second wall 550. The second support member 535 includes a third depression 555a and a third groove 556a on a first wall 560 and a second depression 555b and a fourth groove 556b on a second wall 565. The inner wall including the first wall 560 is on the opposite side of the second support member 535 compared to the second wall 565. The grooves 541a, 541b, 556a and 556b are shaped and sized to complement the shapes of the elongated rods 520a, 520b, respectively. The shapes and sizes of the recesses 540a, 540b, 555a and 555b are set to complement the shapes of the protrusions 525a, 525b. For example, in the illustrated embodiment, the recesses 540a, 540b, 555a and 555b have a hemispherical shape corresponding to the spherical shape of the protrusions 525a, 525b. In other embodiments, the recesses 540a, 540b, 555a and 555b may have a conical shape to help guide the protrusions 525a, 525b to the mating position. When the variable length support assembly 501 is in a compressed configuration, the first support member 530 and the second support member 535 pivot above the central hinge 493 so that the protrusions 525a, 525b can be inserted between the first support member 530 and the second support member 535. Specifically, the protrusion 525a is located in the recesses 540a and 555a of the first support member 530 and the second support member 535, respectively. The protrusion 525b is located in the recesses 540b and 555b of the first support member 530 and the second support member 535, respectively. In some embodiments, the walls of the first support member 530 and the second support member 535 include grooves or elongated depressions (not shown) configured to receive the elongated rods 520a, 520b inserted therebetween. When the alignment elongated rods 520a, 520b are inserted between the walls of the support members 530 and 535 into the grooves or elongated depressions in the walls of the support members 530 and 535, or when the protrusions 525a, 525b are fixed in the recesses 540a, 540b, 555a and 555b, the eyelet 505 is forced to align with other eyelets in the variable length support assembly (i.e., with the insertion axis A shown in FIG. 4).

[0101] Figure 17-18B Portions of an exemplary variable length support assembly 690 that may be included in instrument guide 400 are shown. Specifically, Fig.17An exemplary eyelet 605 is shown having alignment members 611a, 611b extending laterally from an outer wall 615. Eyelet 605 is substantially similar to eyelet 475 described above, except for the differences described herein. Fig.18A and Fig.18B A top view of first support member 630, second support member 635, eyelet 605, and alignment members 611a, 611b is shown. First support member 630 and second support member 635 are substantially similar to first support member 460 and second support member 465, respectively, described above, except for the differences described herein. Fig.18A 630 and the second support member 635 in a deployed configuration, and Fig.18B A top view of a first support member 630 and a second support member 635 in a partially compressed configuration is shown. Alignment members 611a, 611b are fixed to opposite sides of the eyelet 605 in a horizontal orientation (i.e., on a horizontal axis HA perpendicular to the vertical axis VA). Each alignment member 611a, 611b includes an elongated rod 620a, 620b, respectively, extending from the eyelet 605 and telescopically coupled with an additional linkage that connects the elongated rod 620a, 620b to the support members 630, 635. Specifically, the first elongated rod 620a is coupled to a first forked linkage 625a, and the second elongated rod 620b is coupled to a second forked linkage 625b. The forked linkages 625a, 625b are three-pronged tine linkages. The first forked linkage 625a includes three links, each connected to the elongated rod 620a: a central link 626a that telescopes over the elongated rod 620a, a first peripheral link 627a that connects the central link 626a and the elongated rod 620a to the first support member 630, and a second peripheral link 628a that connects the central link 626a and the elongated rod 620a to the second support member 635. The second forked linkage 625b includes three links, each connected to the elongated rod 620b: a central link 626b that telescopes over the elongated rod 620b, a first peripheral link 627b that connects the central link 626b and the elongated rod 620b to the first support member 630, and a second peripheral link 628b that connects the central link 626b and the elongated rod 620b to the second support member 635. Other embodiments may have differently shaped linkages that are shaped and configured to hingedly connect the elongated rods 620a, 620b to the support members 630, 635 such that the eyelets 605 self-align when creating a passageway for the conduit 310.

[0102] When instrument guide 400 is switched to the compressed configuration, as shown Fig.18BAs shown, the first support member 630 and the second support member 635 are pivoted above the central hinge 493 so that the forked linkages 625a and 625b can be interposed therebetween. Specifically, the first forked linkage 625a and the second forked linkage 625b are telescopically slid away from the elongated rods 620a and 620b, respectively, thereby extending the alignment members 611a and 611b and allowing the linkages 625a and 625b to fold flat between the support members 630 and 635. In this embodiment, the alignment members 611a and 611b continuously guide the eyelet 605 and the eyelet 605 to be aligned with the eyelet 605. Figure 4 The insertion axis A shown in is constantly aligned, and so are all other eyelets in the variable length support assembly having similar alignment features. In some embodiments, the linkages 625a, 625b include living hinges and act as pivots rather than conventional linkages.

[0103] In another embodiment, Figures 19A-20D As shown, the alignment member may include a torsion spring. Figures 19A-19C show an exemplary eyelet 705 having alignment members 710a, 710b extending from an outer wall 715. Eyelet 705 is substantially similar to eyelet 475 described above, except for the differences depicted and described herein. Specifically, alignment members 710a, 710b include torsion springs extending from attachment features 722a, 722b, respectively. The torsion springs comprising alignment members 710a, 710b include coil portions 724a, 724b, tine portions 726a, 726b, and tail portions 728a, 728b, respectively. The coil portions 724a, 724b of the torsion springs comprising alignment members 710a, 710b are wound around attachment features 722a, 722b, respectively. The tine portions 726a, 726b and tail portions 728a, 728b are continuous extensions from either end of the coil portions 724a, 724b of the alignment members 710a, 710b, respectively. The tail portions 728a, 728b are anchored within the eyelet 705.

[0104] Figures 20A-20D A perspective view of an exemplary variable length support assembly 720 including an eyelet 705 is shown according to one embodiment of the present disclosure. Figures 20A-20DAs shown, the alignment members 710a, 710b are shaped and configured to exert equal forces between the eyelet 705 and the first and second support members 730, 735 located on opposite sides of the eyelet 705 when the variable length support assembly 720 is extended and compressed. The tine portions 726a, 726b are sized and shaped to interact with the first and second support members 730, 735 of the variable length support assembly 720. In the illustrated embodiment, the tine portions 726a, 726b include substantially straight elongated rods that are shaped and sized to exert a biasing force on the first and second support members 730, 735 to maintain the eyelet 705 aligned with other eyelets 705 along the central axis CA extending through the variable length support assembly 720.

[0105] In yet another embodiment, Fig.21 and Figures 22A-22C As shown, the alignment member may include a spring bend. Fig.21 An exemplary eyelet 805 is shown having alignment members 810a, 810b extending from an outer wall 815. Eyelet 805 is substantially similar to eyelet 475 described above, except for the differences described herein. In the illustrated embodiment, alignment members 810a, 810b include spring bends extending laterally from opposite sides of eyelet 805.

[0106] Figures 22A-22C A perspective view of an exemplary variable length support assembly 820 including an eyelet 805 is shown according to one embodiment of the present disclosure. The alignment members 801a, 801b are shaped, sized, and positioned to continuously support the faces of the first support member 830 and the second support member 835 throughout the full range of opening and closing between the first support member 830 and the second support member 835 when the variable length support assembly 820 is extended and compressed. Figures 22A-22C As shown, the alignment members 810a, 810b are shaped and configured to apply biasing forces to the first support member 830 and the second support member 835, respectively, located on opposite sides of the eyelet 805 when the variable length support assembly 820 is extended and compressed. The distal tips 826a, 826b of the alignment members 810a, 810b are sized and shaped to interact with the first support member 830 and the second support member 835, respectively, of the variable length support assembly 820. In the illustrated embodiment, the alignment members 810a, 810b include curved elongated rods or arms that are shaped and sized to apply biasing forces to the first support member 830 and the second support member 835 to maintain the eyelet 805 aligned with other eyelets 805 along the central axis CA extending through the variable length support assembly 820.

[0107] In another embodiment, Fig.23 and Figures 24A-24C As shown, the alignment member may include a magnet. While the magnet may provide alignment of the eyelet along the insertion axis, the magnet may also be used to maintain the variable length support assembly 920 in a compressed configuration to stow, replace or supplement a latch mechanism such as the retention assembly 420. Fig.23 An exemplary eyelet 905 is shown having alignment members 910a, 910b coupled to an outer wall 915. Eyelet 905 is substantially similar to eyelet 475 described above, except for the differences described herein. In the illustrated embodiment, alignment members 910a, 910b include magnetic poles having a magnetic pole axis that is aligned with a longitudinal axis LA of an inner cavity 925 in each eyelet 905. In the illustrated embodiment, alignment members 910a, 910b include cylindrical magnets located within outer wall 915. Alignment members 910a, 910b are positioned approximately 180 degrees apart from each other and aligned along a horizontal axis HA that extends through the center of the inner cavity 925. In other embodiments, magnetic alignment members 910a, 910b may be positioned in different arrangements relative to the inner cavity and each other. For example, the magnet may include a ring disposed concentrically around the inner cavity 920. The eyelet 905 may include a first annular magnet located on a distal surface of the eyelet 905 and a second annular magnet located on a proximal surface of the eyelet 905, thereby allowing adjacent eyelets 905 within the variable length support assembly 920 to mate and magnetically attract when the variable length support assembly is in a compressed configuration.

[0108] Figures 24A-24C A perspective view of an exemplary variable length support assembly 920 including an eyelet 905 is shown according to one embodiment of the present disclosure. The alignment members 910a, 901b are shaped, sized, and positioned to maintain the eyelet 905 continuously aligned along a central axis CA extending through the lumen 925 over the full range of extension and compression of the variable length support assembly 920. Figures 24A-24C As shown, the alignment members 910a, 910b are arranged so that when the variable length support assembly 920 is extended and compressed, the magnetic attraction between the alignment members of adjacent eyelets 905 maintains the alignment of the eyelets 905. In the illustrated embodiment, the magnetic attraction between the alignment members 910a, 910b of adjacent eyelets 905 is used to maintain the adjacent eyelets 905 aligned with each other, and therefore aligned with other eyelets 905 arranged in series along the central axis CA extending through the variable length support assembly 920.

[0109] The alignment members 910a, 910b on opposite sides of the eyelet 905 can be positioned within the eyelet 905 to have opposite polarities. In other words, the alignment members 910a of adjacent eyelets 905 can have opposite polarities, and the alignment members 910b of adjacent eyelets 905 can have opposite polarities. Therefore, the facing walls of adjacent eyelets 905 in the variable length support assembly 920 can have opposite polarities, thereby aligning the eyelets 905. Specifically, when the variable length support assembly 920 is retracted toward the fully closed configuration, the alternating polarities will force the eyelets to align along the central axis CA (and the insertion axis A). This ensures that whenever the variable length support assembly 920 is retracted without a flexible instrument being inserted through the eyelet 905, the eyelet 905 will align itself when the variable length support assembly 920 reaches its fully retracted configuration, thereby preventing misaligned eyelets 905 from interfering with the full retraction of the variable length support assembly 920. Such magnetic alignment features 910a, 910b may also eliminate the need for mechanical latches (such as those described above to retain assembly 420) to hold assembly 920 closed when assembly 920 is not attached at both ends to a flexible instrument manipulator system (ie, instrument interface portion 300).

[0110] As mentioned above, the variable length support assembly can be Figure 3 The catheter 310 shown in FIG. 1 enters or exits the patient's anatomical structure P ( Figure 1 ) along its varying exterior (i.e., outside the patient's anatomical structure P) length when the variable length support assembly is in a compressed configuration. The alignment member forces the eyelets to self-align along a common axis (e.g., an insertion axis). As the catheter 310 passes through the support assembly, the catheter 310 is automatically aligned along the insertion axis and is prevented from warping by being supported at regular intervals at each eyelet. With the support member in an expanded configuration, the support assembly minimizes bending or warping of the catheter 310 as the distal end of the catheter is advanced into the patient's anatomical structure P. Any significant bending or warping of the catheter 502 may damage the optical fiber used for shape sensing or endoscopy, or damage the catheter itself. Moreover, bending or warping may make advancing the catheter unintuitive because the user will not observe any distal tip movement even if the user is advancing the proximal end of the catheter.

[0111] Figures 10A-10E Shows Figure 4 The proximal portion of the variable length support assembly shown in FIG. Figures 10A-10D A perspective view of an exemplary proximal arm synchronization assembly 600 is shown, and Fig. 10E4 shows a top view of a proximal arm synchronization assembly 600 according to one embodiment of the present disclosure. The proximal arm synchronization assembly 600 is connected to the proximal coupling 405 and is used to constrain the movement of the variable length support assembly 410. Specifically, the proximal arm synchronization assembly 600 ensures that the variable length support assembly 410 is aligned with the central axis CA ( Figure 7-9 ) is extended and retracted in alignment, with the central axis CA extending through the proximal connector 405 and the eyelet 475.

[0112] In the illustrated embodiment, the proximal arm synchronization assembly 600 includes at least two spools 605a and 605b. Spools 605a, 605b are respectively connected to proximal arms 470a, 470b. In some embodiments, spools 605a, 605b are respectively the integral features of proximal arms 470a, 470b. Each spool 605a, 605b may include two separate spools (i.e., upper spool and lower spool), and the two separate spools are respectively independently connected to upper cable 610a and lower cable 610b. For simplicity, each group of upper spools and lower spools are referred to as two single spools 605a, 605b in this article. It is understood that the upper spool and the lower spool can work independently of each other, and can be wound in opposite directions to synchronize the motion of proximal arms 470a, 470b and support members 460, 465. The cables 610a, 610b are wound around the spools 605a, 605b in opposing S-shaped configurations to (1) synchronize the proximal arms 470a, 470b, (2) actuate the first support member 460 and the second support member 465 of the variable length support assembly 410 equally relative to each other, and (3) stabilize and secure the connection between the proximal connector 405 and the variable length support assembly 410 to prevent sagging of the variable length support assembly 410 if a user releases the distal connector 415 from the anchor (such as a distal connector) while a catheter is passing through the variable length support assembly 410. Figure 3 Specifically, the cable 610a is wound around the upper portions 612a, 612b of the bobbins 605a, 605b, respectively, and the cable 610b is wound around the lower portions 614b, 614b of the bobbins 605a, 605b, respectively. The bobbin 605b includes at least one tensioning element 608 coupled to one end of the cable 610a. In the illustrated embodiment, as shown in FIG. Fig. 10BAs shown, the tensioning element 608 can rotate around a vertical axis VA extending through the center of the spool 605b in the directions indicated by arrows A3 and A4. The rotation of the tensioning element 608 is used to increase or decrease the tension in the cable 610a. For example, in the illustrated example, the rotation of the tensioning element 608 in the direction of arrow A3 is used to reduce the tension on the cable 610a, and the rotation of the tensioning element 608 in the direction of arrow A4 (i.e., the opposite direction) is used to increase the tension on the cable 610a. The tensioning element 608 includes an engagement feature 609 that facilitates the rotation of the tensioning element 608. In the illustrated embodiment, the engagement feature 609 is a recess on the tensioning element 608. The engagement feature 609 can be selectively connected to a tool that is configured to rotate the tensioning element 608 or otherwise adjust the tensioning element 608.

[0113] Because the upper cable 610a and the lower cable 610b are wound in opposite directions, the tension in these cables 610a, 610b prevents unequal movement of the proximal arms 470a, 470b in respective opposite directions, thereby ensuring that the proximal arms 470a, 470b always open and close while maintaining equal but opposite angles relative to the central axis CA of the variable length support assembly 410. Increasing the tension on the cable 610a serves to increasingly constrain the movement of the support member. Thus, the cables 610a, 610b of the proximal arm synchronization assembly 600 effectively constrain the support members 460, 465 of the variable length support assembly 410 to move along the central axis CA.

[0114] In other embodiments, Figures 25A-25C As shown, a gear set with an equal number of teeth can replace the spools 605a, 605b and provide the same constraints on the movement of the proximal arms 470a, 470b. Specifically, Figures 25A-25C A perspective view of an exemplary variable length support assembly 950 coupled to a proximal arm synchronization assembly 955 and a distal arm synchronization assembly 960 is shown in accordance with one embodiment of the present disclosure. Fig.25A The length of the variable length support assembly 950 is shown. Fig.25B A proximal arm synchronization assembly 955 is shown coupled to the variable length support assembly 950, and Fig.25CA distal arm synchronization assembly 960 is shown according to one embodiment of the present disclosure. In the illustrated embodiment, the variable length support assembly 950 includes a plurality of first support members 962 coupled to a second support member 964. A proximal arm synchronization assembly 955 is coupled to the proximal coupler 405 and is used to constrain the movement of the variable length support assembly 950. Specifically, the proximal arm synchronization assembly 955 ensures that the variable length support assembly 950 is extended and retracted in alignment with the central axis CA extending through the proximal coupler 405, the eyelet 475, and the distal coupler 415.

[0115] In the illustrated embodiment, the proximal arm synchronization assembly 955 includes four gear elements 965a, 965b, 965c and 965d. Gears 965a and 965c include one side of the proximal arm synchronization assembly 955, while gears 965b and 965d include the other side of the proximal arm synchronization assembly 955. Gears 965a and 965c of the proximal arm synchronization assembly 955 are coupled to the proximal arm 470a, while gears 965b and 965d of the proximal arm synchronization assembly 955 are coupled to the proximal arm 470b. In some embodiments, the gears 965a-d are integral features of the proximal arms 470a, 470b. It will be appreciated that the upper gears 965a, 965b and the lower gears 965c, 965d rotate in opposite directions to synchronize the movement of the proximal arms 470a, 470b and the support members 962, 964. Gears 965a-d operate to (1) synchronize the proximal arms 470a, 470b, (2) actuate the first support member 962 and the second support member 964 of the variable length support assembly 950 equally relative to each other, and (3) stabilize and secure the connection between the proximal coupler 405 and the variable length support assembly 950. Rotation of the gears 965a-d serves to constrain the motion of the proximal arms 470a, 470b to move through equal and opposite angles.

[0116] The distal arm synchronization assembly 960 is substantially similar in structure and function to the proximal arm synchronization assembly 955, and includes four gear elements 970a, 970b, 970c, and 970d. Gears 970a and 970c comprise one side of the distal arm synchronization assembly 960, while gears 970b and 970d comprise the other side of the distal arm synchronization assembly 960. Gears 970a and 970c of the distal arm synchronization assembly 960 are coupled to the distal arm 472a, while gears 970b and 970d of the distal arm synchronization assembly 960 are coupled to the distal arm 472b. In some embodiments, the gears 970a-d are an integral feature of the distal arms 472a, 472b.

[0117] While a single set of gears can provide restraint to motion in two opposing lateral directions, it should be noted that multiple sets of gears can share the load, thereby allowing the arm synchronization assembly to withstand higher side loads than a single set of gears.

[0118] Figure 26A-2B A perspective view of an exemplary instrument guide device 1000 according to another embodiment of the present disclosure is shown. Instrument guide device 1000 may include variable length support assembly 1010 and an arm synchronization assembly, which may include proximal arm synchronization assembly 1020 and distal arm synchronization assembly 1030. Instrument guide device 1000, variable length support assembly 1010, proximal arm synchronization assembly 1020, and distal arm synchronization assembly 1030 may be substantially similar to imaging guide device 400, variable length support assembly 410, proximal arm synchronization assembly 955, and distal arm synchronization assembly 960, respectively, except for the differences described herein. FIG. 26A shows instrument guide device 1000 from a top perspective view, while FIG. 26A shows instrument guide device 1000 from a top perspective view. Fig.26B Instrument guide 1000 is shown from a bottom perspective.

[0119] The proximal arm synchronization assembly 1020 may include a first gear pair 1025a / 1025b and a second gear pair 1025c / 1025d located at the proximal end of the variable length support assembly 1010. The gears 1025a-1025d may be substantially similar in structure and function to the gears 965a-965d, except for the differences described herein. In the illustrated embodiment, the gears 1025a-1025d require less than 360 degrees of rotation to provide tooth engagement during full extension and collapse of the variable length support assembly 1010. Therefore, the gears 1025b and 1025d may be formed as circular gears having teeth on a partial circumference, such as Fig.26A , Fig.26B and Fig.27A Gears 1025a and 1025c may also include partial circumferential teeth, however, Fig.26A , Fig.26B and Fig.27A As shown, gears 1025a and 1025c can each be shaped as a wedge rather than a circular gear. Fig.27B In the alternative embodiment shown in , the two gears can be shaped as wedges with curved surfaces for part-circumferential teeth. In yet another embodiment (not shown), the two gears can be shaped as circular gears with part-circumferential teeth.

[0120] In some embodiments, the gears may present a potential pinch point for the operator, thus raising safety concerns. Fig.27AAs shown, gear 1025a may include guard 1035a that provides protection against pinch points between meshing teeth in gear pair 1025a / 1025b. A single guard 1035a extending over gear pair 1025a / 1025b allows for free rotational movement of the guard during expansion and compression of variable length support assembly 1010. Fig.27B In the illustrated alternative embodiment, gear 1025a' may be identical to gear 1025a but oriented in a mirrored manner, thereby allowing guard 1035a' to rotate in a different plane than guard 1035a, thereby avoiding interference between the guards. Gear pair 1025c / 1025d may be substantially similar in structure and function to gear pair 1025a / 1025b. Referring back to FIGS. 26A and 26B, Fig.26B , a housing 3000 may be provided, which will be described in further detail below. In an alternative embodiment (not shown), the housing may extend to cover the gear pairs 1025a / 1025b and 1025c / 1025d, replacing the guards 1035a and 1035c and providing protection against potential pinch points.

[0121] The distal arm synchronization assembly 1030 is substantially similar in structure and function to the proximal arm synchronization assembly 1020. It should be understood that the distal synchronization arm 1030 and the proximal arm synchronization assembly 1020 may also include components substantially similar to those described with respect to the synchronization arm assembly 600 including the spools 605a and 605b and / or the gear elements 965a, 965b, 965c, and 965d. The proximal arm synchronization assembly 1020 and the distal arm synchronization assembly 1030 may use any combination of spools and gear assemblies, including any variation of the gear embodiments described herein.

[0122] Fig.28A cross-sectional view of a variable length support assembly 1010 in a collapsed state is shown, wherein an eyelet 1040 is rotatably coupled to the support member 2010 using a pin 2020. The eyelet 1040 is substantially similar to the eyelet 475 and the eyelet 905 disclosed above, except for the differences described herein. In the illustrated embodiment shown in FIG. 29A , the eyelet 1040 includes a body 1042 including a distal surface 1045 of a rectangular shape, a corresponding proximal surface 1055, and a lumen 1065 extending therebetween. The lumen 1065 may include chamfered edges that terminate at the surfaces 1045, 1055 to allow for easy passage of an instrument such as a catheter 310, as described above for the eyelets 705, 805, and 905. It should be understood that while eyelet 475, eyelet 505, and eyelet 605 are not shown as having chamfered lumens, each eyelet may include a chamfer to facilitate passage of conduit 310. Body 1042 also includes an upper surface 1043a and a bottom surface 1043b.

[0123] like Fig.29A and Fig.29B As shown, the eyelet 1040 may also include alignment members 1075a-1075d. In this embodiment, the alignment members 1075a-1075d are protrusions extending laterally away from the body 1042. The edge of each alignment member 1075a-1075d can be curved away from the distal surface 1045 and away from the proximal surface 1045 toward the lateral tip 1076a-1076d, thereby forming a tapered profile. Fig.29AIn an embodiment, the tips 1076a-1076d are rounded and symmetrical about the rotation axis R passing through the body 1042. In some embodiments, the ratio of the radius of curvature of the tip 1076a to the arc length of the curved surface of the alignment member 1075a can be in the range of 0.0250-0.500. In one embodiment, for example, the radius of curvature of the tip 1076a can be 0.200 mm, and the arc length of the curved surface of the alignment member 1075a can be approximately 5.100 mm. The tips 1076a-1076d can be continuously curved, or can have a non-curved length defined by a surface having a radius of curvature. The outer edges of the alignment members 1075a-1075d can be curved away from the upper surface 1043a or the bottom surface 1043b toward the tips 1076a-1076d. When the variable length assembly 1010 is in an expanded or uncollapsed configuration without the elongated flexible member extending through the eyelet 1040, the eyelet can rotate freely (e.g., between 0° and 360°). When the support assembly 1010 is collapsed, the shape of the alignment members 1075a-1075d allows for self-alignment with adjacent eyelets 1040, which results in an aligned stack of adjacent eyelets 1040 such that the distal surface 1045 of one eyelet 1040 faces the proximal surface 1055 of an adjacent eyelet 1040. When adjacent eyelet alignment members contact each other as the assembly collapses, the curved edges and tapered profiles of the alignment members bias the series of eyelets 1040 toward alignment along a longitudinal axis passing through the lumen 1065. Once the alignment members 1075a-1075d of adjacent eyelets 1040 contact each other, the shape of the alignment members urges the eyelets 1040 into a stacked configuration such that the lumen 1065 of each eyelet 1040 is aligned. Fig.29B As can be seen in the top perspective view in FIG. 1 , the upper surface 1043a of the aperture 1040 can include a rectangular profile with the alignment members 1075a and 1075c extending away from the upper surface 1043a toward a pointed oval end.

[0124] Fig. 30A and Fig. 30B An alternative embodiment of eyelet 1050 is shown having tapered alignment members 2005a-2005d. Alignment member 2005a curves from distal surface 1085 toward proximal surface 1095 to form lateral tip 2006a, while alignment member 2005c curves from proximal surface 1095 toward distal surface 1085 to form lateral tip 2006c. Fig. 30B A top view of the eyelet 1050 is shown in FIG. Fig. 30BThe curved shape of the tapered alignment members 2005a-2005d is shown to include a curved parallelogram top profile having tips 2006a and 2006c. In some embodiments, the curved lateral surfaces of the parallelogram can be formed by a major curve, and the tips can be formed with minor curves. The ratio of the radius of curvature of the minor curve to the radius of curvature of the major curve can be approximately 0.050-0.100. In one embodiment, for example, the minor curve forming the tip can have a radius of curvature of approximately 0.600 mm, while the major curve forming the lateral curved surface of the parallelogram can be approximately 8.0 mm. Fig. 30A and Fig. 30B In an embodiment, the tips 2006a and 2006c are rounded and the alignment member and the tips are asymmetrical about an axis of rotation R passing through the aperture 1050.

[0125] The shape of eyelets 1040 and 1050 can allow for more reliable self-alignment than other shapes. Depending on the initial misalignment, the non-curved alignment members may collapse relative to each other into an orthogonal misaligned position. For example, if a square or rectangular eyelet is misaligned by 90 degrees (i.e., rotated 90 degrees around the longitudinal axis of a pin such as pin 2020), the misaligned eyelet will remain in an orthogonal misaligned configuration when the instrument guide collapses. An elliptical profile can help avoid 90 degree misalignment, but may still be prone to locking in an orthogonal misaligned configuration. The shape of eyelets 1040 and 1050 includes curved edges that converge to a bend point that helps avoid locking in any initial misaligned configuration.

[0126] Return to reference Fig.26A and Fig.26B, housing 3000 may provide a housing for electronics (e.g., a printed circuit board (PCB) and sensors associated with instrument guide device 1000) and / or mechanical fasteners (including latches, mounting screws, magnetic connectors, etc.) for securing instrument guide device 1000 to a component within teleoperated medical system 100 (such as teleoperated manipulator assembly 102). In one example, instrument guide device PCB 3020 may be provided with electrical pads 3025 configured to mate with corresponding pogo pins on a system PCB (not shown) provided on teleoperated manipulator assembly 102. A controller within teleoperated medical system 100 may monitor and count the frequency with which the pogo pins are connected and disconnected from the system PCB in order to determine the number of times variable length support assembly 1010 is installed to teleoperated manipulator assembly 102. In an alternative embodiment, the PCB may be replaced with a presence sensor that indicates installation and / or removal of instrument guide device 1000. In some embodiments, if instrument guide device 1000 has a finite number of life cycles, the presence sensor may be a life cycle indicator. The controller can save the number of connections of instrument guide device 1000 and provide an indication to the user when a new instrument guide device 1000 must be used for the next medical procedure. In one example, the support assembly PCB can include identification information, and the controller can record the number of uses of instrument guide device 1000 associated with a specific identification part number representing the specific instrument guide device 1000. Housing 3000 can also include a coupling mechanism for detachably coupling one end of instrument guide device 1000 to remotely operated manipulator assembly 102 (not shown). Fig.26A and Fig.26B In the illustrated embodiment of the housing 3000, the housing may include a pair of latches 3015 that may be actuated by buttons 3010 positioned on an outer surface of the housing 3000. The buttons may be depressed to compress the latches to engage with corresponding attachment elements (not shown) on the teleoperated manipulator assembly 102. In alternative embodiments, the coupling mechanism may include any type of fastening element, such as a snap-fit ​​engagement, a friction engagement, a hook fastener, a pin, a magnetic fastener, a bolt (such as a carriage bolt), a screw (such as a mating screw, a thumb screw), and / or the like.

[0127] like Fig.26A and Fig.26BAs shown, a distal coupling 2050 may also be provided to removably couple the distal end of the instrument guide device 1000 to a portion of the teleoperated manipulator assembly 102, such as a support arm included in the teleoperated manipulator assembly 102 (not shown). The distal coupling 2050 may include a C-shaped clamp made of a flexible material that can be bent open by pressure to fit onto the support arm and return to its original shape to lock onto the support arm. The support arm may include a slot (not shown) that can cooperate with a protrusion 2055 on the distal coupling 2050.

[0128] In alternative embodiments, housing 3000 may be included only on the distal end of instrument guide device 1000 or on both the distal and proximal ends of instrument guide device 1000. Fig.26A The illustrated coupling may be included at the distal end and / or the proximal end of instrument guide 1000. Fig.26A and Fig.26B While shown with respect to instrument guide 1000 , it should be understood that housing 3000 , electronics, mechanical fasteners, and a controller for counting variable length support assembly life cycles may be implemented in any embodiment of an instrument guide including, but not limited to, instrument guide 400 .

[0129] Assembly of the instrument guide may require a complex and time consuming assembly process. Fig.31A An example of an assembly jig 3500 for assembling instrument guide device 2500 is shown, which can facilitate the assembly process by providing a retaining structure that allows instrument guide device 2500 to be assembled in separate subassembly layers. By providing the separate sub-layers in a modular manner, the number of parts can be reduced, thereby reducing costs and assembly time. Fig.31A Instrument guide device 2500 is shown fully assembled within assembly fixture 3500. Instrument guide device 2500 may include proximal coupler 2505, distal coupler 2515, and variable length support assembly 2510 including support member 2520 and eyelet 2530. Fig.31B As shown, each support member 2520 may include a lower support member 2525, an upper support member 2545, and an inner support member 2535. Although assembly jig 3500 is shown with instrument guide 2500, it should be understood that assembly jig 3500 may be used in a similar manner as assembly jigs with instrument guides 400, 960, and 1000 described herein, which are similar in structure and function to instrument guide 2500.

[0130] Fig.31BA single support member 2520 is shown in an exploded configuration for illustration. During assembly of the instrument guide device 2500, a first subassembly layer may include a lower support member 2525 that may fit into a slot 3510 within an assembly fixture 3500 that provides a stable support structure that allows the instrument guide device 2500 to be assembled in separate subassembly layers. A second subassembly layer includes an eyelet 2530, an inner support member 2535, a pin 2550 for rotatably coupling the eyelet 2530 to the inner support member 2535 and the lower support member 2525, and a pin 2540 for coupling the lower support member 2525 to the inner support member 2535. The distal coupler 2515 and the proximal coupler 2505 may then be assembled at the end of the variable length support assembly 2500. A third subassembly layer may include an upper support member 2545 that may snap into the lower support member using a mechanical snap retainer. The assembly process allows for a simple assembly method without the use of adhesives, screws and other fasteners that require the use of tools.

[0131] The systems and methods of the present disclosure are applicable to connecting bronchial passages of the lungs and are applicable to navigating and treating other tissues through natural or surgically created connecting passages in any of a variety of anatomical systems, including the colon, intestines, kidneys, brain, heart, circulatory system, reproductive system, or the like. The methods and embodiments of the present disclosure are also applicable to non-invasive applications.

[0132] One or more elements of the embodiments of the present invention may be implemented in software to be executed on a processor of a computer system such as the control system 112. When implemented in software, the elements of the embodiments of the present invention are essentially code segments to perform the necessary tasks. The program or code segment may be stored in a processor-readable storage medium or device, and the program or code segment may be downloaded via a computer data signal contained in a carrier wave on a transmission medium or communication link. The processor-readable storage device may include any medium that can store information, including optical media, semiconductor media, and magnetic media. Examples of processor-readable storage devices include: electronic circuits; semiconductor devices, semiconductor memory devices, read-only memories (ROMs), flash memories, erasable programmable read-only memories (EPROMs); floppy disks, CD-ROMs, optical disks, hard disks, or other storage devices. The code segments may be downloaded via a computer network such as the Internet, an intranet, or the like.

[0133] Note that the processes and displays presented may not be inherently related to any particular computer or other device. The structures required for various such systems will appear as elements in the claims. In addition, the embodiments are described without reference to any particular programming language. It should be appreciated that various programming languages ​​can be used to implement the teachings of the present invention as described herein.

[0134] Although certain exemplary embodiments of the present invention have been described and shown in the accompanying drawings, it should be understood that these embodiments are merely illustrative of the broad invention and not restrictive, and that the embodiments of the present invention are not limited to the specific construction and arrangements shown and described, since various other modifications may occur to those skilled in the art.

Claims

1. A device for guiding an elongated flexible instrument, the device comprising: A variable length support assembly comprising: First end; a second end, wherein a longitudinal center axis extends between the first end and the second end; a plurality of support member pairs, the plurality of support member pairs including a first support member pair including a first support member connected to a second support member, wherein the first support member intersects the second support member and is connected to the second support member by a central hinge disposed along the longitudinal center axis; a plurality of eyelets configured to receive the elongated flexible instrument, a first eyelet of the plurality of eyelets being movably coupled to the first pair of support members at the central hinge; and a plurality of alignment members configured to align the plurality of eyelets along the longitudinal center axis, wherein a first alignment member of the plurality of alignment members has a proximal end and a distal end and is fixed about the first eyelet at the proximal end, wherein the variable length support assembly is configured to selectively transition from a compressed configuration to an expanded configuration along the longitudinal center axis, and wherein the plurality of eyelets are adapted to support the elongated flexible instrument as the elongated flexible instrument is advanced along the longitudinal center axis.

2. The device of claim 1, wherein the central hinge comprises a pin joint.

3. The device of claim 1, wherein the first eyelet is rotatably coupled to the first support member and the second support member via the central hinge.

4. The device of claim 1, wherein the first eyelet is positioned within the first support member and is rotatable about a vertical axis extending through the central hinge.

5. The device of claim 4, wherein the support members of each of the pair of support members pivot relative to each other, thereby forcing the plurality of eyelets to separate at regular intervals.

6. The device of claim 1, wherein adjacent pairs of support members are connected to each other by external hinges.

7. The device of claim 6, wherein the outer hinge comprises a pin joint.

8. The device of claim 6, wherein the external hinge comprises a living hinge extending between adjacent support members.

9. The device of claim 1 further comprising a proximal coupler at the first end of the variable length support assembly, the proximal coupler being configured to couple the variable length support assembly to an instrument interface portion.

10. The device of claim 9, wherein the proximal coupler includes a proximal aperture sized to receive the elongated flexible instrument, wherein the proximal aperture is aligned with the plurality of eyelets along the longitudinal center axis.

11. The device according to claim 9 further includes a proximal arm synchronization assembly connected to the proximal connector and the variable length support assembly, and the proximal arm synchronization assembly is configured to increase the stability of the connection between the proximal connector and the variable length support assembly.

12. The device of claim 11, wherein the proximal arm synchronization assembly is configured to cause the first support member and the second support member to be actuated equally relative to the longitudinal center axis and relative to each other.

13. The device of claim 12, wherein the proximal arm synchronization assembly constrains the variable length support assembly such that the pair of support members maintain equal and opposite angles relative to the longitudinal center axis when the variable length support assembly is extended and retracted.

14. The device of claim 11, the proximal arm synchronization assembly comprising a pair of spools and a set of cables wound around the pair of spools in opposite S-shapes.

15. The device of claim 11, the proximal arm synchronization assembly comprising a pair of gears.

16. The device of claim 9, further comprising a latch mechanism coupled to the proximal coupler, the latch mechanism configured to selectively retain the variable length support assembly in the compressed configuration.

17. The device of claim 16, further comprising an attachment element at a distal end of the variable length support assembly, wherein the latch mechanism selectively engages the attachment element to retain the variable length support assembly in the compressed configuration.

18. The apparatus of claim 1, further comprising a distal coupler at the second end of the variable length support assembly, the distal coupler configured to couple the variable length support assembly to an anchor in a surgical field.

19. The device of claim 1, wherein the first alignment member comprises an elongated rod extending laterally from the first eyelet.

20. The device of claim 19, wherein the first support member and the second support member include recesses having a shape corresponding to the slender rod, wherein the slender rod is clamped between the recesses of the first support member and the second support member when the variable length support assembly assumes the compressed structure.

21. The device of claim 19, wherein the first alignment member terminates in a protrusion.

22. The device of claim 21, wherein the first support member and the second support member include recesses having a shape corresponding to the protrusion, wherein the protrusion is clamped between the recesses of the first support member and the second support member when the variable length support assembly assumes the compressed structure.

23. The device of claim 19, wherein the first alignment member comprises a fork-like linkage extending between the first eyelet and the first and second support members.

24. The device of claim 23, wherein the fork-like linkage comprises the elongated rod and a three-pronged tine linkage telescopically connected to the elongated rod.

25. The device of claim 24, wherein the three-pronged tine linkage includes peripheral tines coupled to the first and second support members.

26. The device of claim 1, wherein the first alignment member comprises a torsion spring extending between the first eyelet and the first and second support members.

27. The device of claim 1, wherein the first alignment member comprises a spring bend extending between the first eyelet and the first and second support members.

28. The device of claim 1, wherein two alignment members of the plurality of alignment members are secured to each eyelet of the plurality of eyelets.

29. A device for guiding an elongated flexible instrument, the device comprising: A variable length support assembly comprising: First end; a second end, wherein a longitudinal center axis extends between the first end and the second end; a plurality of support member pairs, the plurality of support member pairs including a first support member pair including a first support member connected to a second support member, wherein the first support member intersects the second support member and is connected to the second support member by a central hinge disposed along the longitudinal center axis; a plurality of eyelets configured to receive the elongated flexible instrument, a first eyelet of the plurality of eyelets being movably coupled to the first pair of support members at the central hinge; and a plurality of alignment members configured to align the plurality of eyelets along the longitudinal center axis, wherein a first alignment member of the plurality of alignment members comprises a magnet; wherein the variable length support assembly is configured to selectively transition from a compressed configuration to an expanded configuration along the longitudinal center axis, and wherein the plurality of eyelets are adapted to support the elongated flexible instrument as the elongated flexible instrument is advanced along the longitudinal center axis.

30. The apparatus of claim 29, wherein a second alignment member of the plurality of alignment members comprises a second magnet, and wherein the magnet is coupled to the first eyelet and the second magnet is coupled to a second eyelet, the second eyelet being adjacent to the first eyelet.

31. The device of claim 30, wherein the magnet and the second magnet are arranged so that a portion of the magnet facing the second magnet has an opposite polarity to a portion of the second magnet facing the magnet.

32. The device of claim 29, wherein the first alignment member comprises a pair of magnets coupled to a set of adjacent apertures.

33. The apparatus of claim 29, wherein the plurality of alignment members comprise a plurality of magnets, and wherein when the variable length support assembly is in the compressed structure, the plurality of magnets attract to maintain the variable length support assembly in the compressed structure.

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