Medical instrument comprising a wrist with a hybrid redirecting surface

Abstract

Certain aspects of the present disclosure are directed to medical instruments including a wrist having hybrid redirecting surfaces. Such medical instruments can include, for example, a shaft having a wrist positioned at a distal end. The wrist can include a proximal clevis connected to the shaft and a distal clevis pivotally connected to the proximal clevis. The wrist can also include static redirecting surfaces such as the faces of the clevis and dynamic redirecting surfaces such as pulleys. The instrument can include an end effector connected to the distal clevis. A plurality of pull wires can extend through the shaft and the wrist and engage and actuate the wrist and the end effector. A first pull wire segment of the plurality of pull wires can engage the static redirecting surfaces, and a second pull wire segment of the plurality of pull wires can engage the dynamic redirecting surfaces.

Description

[0001] Priority Application

[0002] This application claims priority to U.S. Provisional Application No. 62 / 866,205, filed June 25, 2019, which is incorporated by reference herein in its entirety and for all purposes. TECHNICAL FIELD

[0003] The systems and methods disclosed herein relate to medical instruments, and more particularly to medical instruments including a wrist having a hybrid redirecting surface. Medical instruments including a wrist having a hybrid redirecting surface can be implemented on a robotic medical system. BACKGROUND

[0004] Medical procedures, such as laparoscopic surgery, can involve accessing and visualizing an internal region of a patient. In a laparoscopy procedure, a medical instrument can be inserted into the internal region through a laparoscopic portal.

[0005] In certain procedures, a robotically-enabled medical system can be used to control the insertion and / or manipulation of a medical instrument and its end effector. The end effector can be connected to an elongated shaft of the medical instrument by a wrist that can be able to articulate. The robotically-enabled medical system can also include a robotic arm or other instrument positioning device. The robotically-enabled medical system can also include a controller for controlling the positioning of the medical instrument during a procedure. SUMMARY

[0006] The systems, methods, and devices of the disclosure each have several innovative aspects, no single one of which is solely responsible for the desirable attributes disclosed herein.

[0007] The present application relates to medical instruments having a novel wrist architecture that employs hybrid redirecting surfaces, where at least one redirecting surface is static and at least another redirecting surface is non-static.

[0008] In a first aspect, a medical instrument is disclosed. The medical instrument includes a shaft extending between a proximal end and a distal end, and a wrist positioned at the distal end of the shaft. The wrist includes a proximal clevis connected to the distal end of the shaft, a distal clevis pivotally connected to the proximal clevis, a static redirecting surface, and a dynamic redirecting surface. The medical instrument also includes an end effector connected to the distal clevis of the wrist, and a plurality of pull wires extending through the shaft and the wrist and engaged with the end effector. The plurality of pull wires are configured to actuate the wrist and the end effector. A first pull wire segment of the plurality of pull wires is engaged with the static redirecting surface. A second pull wire segment of the plurality of pull wires is engaged with the dynamic redirecting surface.

[0009] The medical instrument can optionally include one or more of the following features in any combination: (a) wherein the static redirecting surface comprises a stationary surface configured to direct the first pull wire segment from a first direction to a second direction by engagement with the static redirecting surface; (b) wherein the static redirecting surface is positioned between a proximal pulley configured to rotate in a first plane and a distal pulley configured to rotate in a second plane that is orthogonal to the first plane, and wherein the first pull wire segment engages the proximal pulley, the static redirecting surface, and the distal pulley; (c) wherein the proximal pulley is positioned at a proximal end of the distal fork and the distal pulley is positioned at a distal end of the distal fork; (d) wherein the dynamic redirecting surface comprises a surface of a redirecting pulley; (e) wherein the second pull wire segment engages a proximal pulley configured to rotate in a first plane on a first side of the medical instrument, the second pull wire segment engages a distal pulley on a second side of the medical instrument, the distal pulley is configured to rotate in a second plane that is orthogonal to the first plane, and the redirecting pulley is positioned between the proximal pulley and the distal pulley; (f) wherein the static redirecting surface and the dynamic redirecting surface are positioned on the distal fork of the wrist; (g) wherein the end effector comprises at least one jaw, actuation of the first pull wire segment causes the at least one jaw to open, and actuation of the second pull wire segment causes the at least one jaw to close; (h) wherein the wrist comprises an axle pivotally connecting the proximal fork to the distal fork, a first open pitch pulley mounted on the axle, a first close pitch pulley mounted on the axle, and wherein the axle extends through a first support leg of the distal fork, and wherein the first support leg of the distal fork is positioned between the first open pitch pulley and the first close pitch pulley; (i) wherein the wrist further comprises a second open pitch pulley mounted on the axle, a second close pitch pulley mounted on the axle, and wherein the axle extends through a second support leg of the distal fork, wherein the second support leg of the distal fork is positioned between the second open pitch pulley and the second close pitch pulley, and wherein the first open pitch pulley and the second open pitch pulley are positioned between the first support leg and the second support leg of the distal fork; (j) wherein the proximal fork comprises a first support leg and a second support leg, the axle extends through the first support leg and the second support leg of the proximal fork, and the first close pitch pulley and the second close pitch pulley, the first support leg and the second support leg of the distal fork, and the first open pitch pulley and the second open pitch pulley are positioned between the first support leg and the second support leg of the proximal fork; (k) a first redirecting pulley is positioned in the proximal fork and is configured to rotate about a first axis, and a second redirecting pulley is positioned in the proximal fork and is configured to rotate about a second axis, wherein the second axis is off-axis from the first axis; (l) wherein the end effector comprises a clamp of a bipolar energy instrument;and / or (m) wherein the plurality of pull wires includes n pull wires, and wherein actuation of one or more of the n pull wires facilitates control of n+1 degrees of freedom of the medical instrument.

[0010] In another aspect, a medical instrument is disclosed that includes a shaft extending between a proximal end and a distal end, and a wrist positioned at the distal end of the shaft. The wrist includes a proximal prong connected to the distal end of the shaft, a distal prong pivotally connected to the proximal prong by an axle, a first pulley rotatably mounted on the axle, and a second pulley rotatably mounted on the axle. The axle extends through a first support leg of the distal prong that is positioned between the first pulley and the second pulley, and an end effector is connected to the distal prong of the wrist, the end effector including at least one clamping member.

[0011] The medical instrument optionally includes one or more of the following features in any combination: (a) wherein the wrist further comprises a third pulley rotatably mounted on the axle and a fourth pulley rotatably mounted on the axle, wherein the axle extends through a second support leg of the distal prong head, the second support leg positioned between the third pulley and the fourth pulley; (b) wherein the second pulley and the third pulley are positioned between the first support leg and the second support leg of the distal prong head; (c) wherein the proximal prong head comprises a third support leg and a fourth support leg, the axle extends through the third support leg and the fourth support leg of the proximal prong head, and the first pulley, the second pulley, the third pulley, and the fourth pulley and the first support leg and the second support leg of the distal prong head are positioned between the third support leg and the fourth support leg of the proximal prong head; (d) a first pull wire segment, a second pull wire segment, a third pull wire segment, and a fourth pull wire segment contacting the first pulley, the second pulley, the third pulley, and the fourth pulley, respectively, and wherein the first pull wire segment and the fourth pull wire segment are associated with a closing motion of the end effector and the second pull wire segment and the third pull wire segment are associated with an opening motion of the end effector; (e) wherein the wrist further comprises a first static redirecting surface, a second static redirecting surface, a first dynamic redirecting surface, and a second dynamic redirecting surface; (f) wherein the first static redirecting surface comprises a stationary surface configured to redirect the second pull wire segment, the second static redirecting surface comprises a stationary surface configured to redirect the third pull wire segment, the first dynamic redirecting surface comprises a surface of a first redirecting pulley configured to redirect the first pull wire segment, and the second dynamic redirecting surface comprises a surface of a second redirecting pulley configured to redirect the fourth pull wire segment; (g) wherein the first static redirecting surface and the second static redirecting surface and the first dynamic redirecting surface and the second dynamic redirecting surface are positioned on the distal prong head of the wrist; (h) the first redirecting pulley is positioned in the proximal prong head and configured to rotate about a first axis, and the second redirecting pulley is positioned in the proximal prong head and configured to rotate about a second axis, wherein the second axis is non-coaxial with the first axis; and / or (i) wherein the first pull wire segment, the second pull wire segment, the third pull wire segment, and the fourth pull wire segment are configured to be actuated to control three degrees of freedom of the medical instrument.

[0012] In another aspect, a medical instrument is disclosed that includes a shaft extending between a proximal end and a distal end, and a wrist positioned at the distal end of the shaft. The wrist includes a proximal prong head connected to the distal end of the shaft, a distal prong head pivotally connected to the proximal prong head, a first redirecting pulley positioned in the proximal prong head and configured to rotate about a first axis, and a second redirecting pulley positioned in the proximal prong head and configured to rotate about a second axis, wherein the second axis is non-coaxial with the first axis. The instrument further includes an end effector connected to the distal prong head of the wrist.

[0013] The medical instrument can optionally include one or more of the following features in any combination: (a) the third redirecting pulley is positioned in the proximal prong head and is configured to rotate about a third axis, and the fourth redirecting pulley is positioned in the proximal prong head and is configured to rotate about a fourth axis; (b) wherein the first support wall of the proximal prong head is positioned between the first redirecting pulley and the second redirecting pulley, and the second support wall of the proximal prong head is positioned between the third redirecting pulley and the fourth redirecting pulley; (d) wherein the proximal prong head does not include a support wall between the second redirecting pulley and the third redirecting pulley; and wherein the second axis and the third axis are coaxial; (g) wherein the first axis and the fourth axis are non-coaxial; (f) a plurality of pull wires extending through the shaft and the wrist and engaged with the end effector, wherein the plurality of pull wires are configured to actuate the wrist and the end effector; (g) wherein the plurality of pull wires includes n pull wires, and wherein actuation of one or more of the n pull wires facilitates control of n+1 degrees of freedom of the medical instrument; (h) wherein the distal prong head includes: a static redirecting surface including a stationary surface configured to redirect a first pull wire segment extending through the wrist; and a dynamic redirecting surface including a surface of a distal redirecting pulley configured to redirect a second pull wire segment extending through the wrist; and / or (i) wherein actuation of the first pull wire segment causes an opening motion of the end effector, and actuation of the second pull wire segment causes a closing motion of the end effector. BRIEF DESCRIPTION OF DRAWINGS

[0014] The disclosed aspects will be described with respect to the following figures, which are provided to illustrate rather than limit the disclosed aspects, wherein like reference numerals indicate like elements throughout the several figures.

[0015] FIG. 1 Embodiments of a cart-based robotic system arranged for diagnostic and / or therapeutic bronchoscopy are shown.

[0016] FIG. 2 Further aspects of the robotic system of FIG. 1 are depicted.

[0017] FIG. 3 Embodiments of the robotic system of FIG. 1 arranged for ureteroscopy are shown.

[0018] FIG. 4 Embodiments of the robotic system of FIG. 1 arranged for vascular procedures are shown.

[0019] FIG. 5An embodiment of a table-based robotic system arranged for a bronchoscopy procedure is shown.

[0020] FIG. 6 An alternative view of the robotic system of FIG. 5 is provided.

[0021] FIG. 7 An exemplary system configured to stow a robotic arm is shown.

[0022] FIG. 8 An embodiment of a table-based robotic system configured for a ureteroscopy procedure is shown.

[0023] FIG. 9 An embodiment of a table-based robotic system configured for a laparoscopy procedure is shown.

[0024] FIG. 10 An embodiment of a table-based robotic system of FIGS. 5-9 with pitch or tilt adjustment is shown.

[0025] FIG. 11 A detailed illustration of the interface between the table and column of the table-based robotic system of FIGS. 5-10 is provided.

[0026] FIG. 12 An alternative embodiment of a table-based robotic system is shown.

[0027] FIG. 13 An end view of the table-based robotic system of FIG. 12 is shown.

[0028] FIG. 14 An end view of the table-based robotic system with a robotic arm attached thereto is shown.

[0029] FIG. 15 An exemplary instrument driver is shown.

[0030] FIG. 16 An exemplary medical instrument with a paired instrument driver is shown.

[0031] FIG. 17 An alternative design of an instrument driver and instrument is shown, in which the axis of the drive unit is parallel to the axis of the elongated shaft of the instrument.

[0032] FIG. 18 An instrument with an instrument-based insertion architecture is shown.

[0033] FIG. 19 An exemplary controller is shown.

[0034] FIG. 20A block diagram showing a positioning system that estimates the position of one or more elements of a robotic system, such as the position of an instrument, is depicted in accordance with an exemplary embodiment. FIGS. 1-10 FIGS. 16-18

[0035] FIG. 21 is a side view of an embodiment of a medical instrument including an end effector connected to a shaft of the medical instrument by a wrist.

[0036] FIG. 22 is a perspective view of an embodiment of an end effector and wrist of a medical instrument including a static redirecting surface located in the wrist.

[0037] FIGS. 23A-23E shows an embodiment of a medical instrument including a wrist having a hybrid redirecting surface.

[0038] FIG. 23A is a perspective view of a medical instrument.

[0039] FIG. 23B is a perspective view of a medical instrument with a distal prong shown transparent to reveal a static redirecting surface.

[0040] FIG. 23C is a first side view of a medical instrument.

[0041] FIG. 23D is a second side view of a medical instrument.

[0042] FIG. 23E is a top view of a proximal prong of a medical instrument.

[0043] FIG. 24 shows an embodiment of a distal pulley, jaw member, and pull wire of a medical instrument.

[0044] FIG. 25A shows an alternative embodiment of a distal prong including a hybrid redirecting surface.

[0045] FIG. 25B shows exemplary cable paths along the static redirecting surface and dynamic redirecting surfaces of the distal prong of FIG. 25A

[0046] shows an example of a distal prong including four dynamic redirecting surfaces. FIG. 26A

[0047] shows another view of the distal prong of FIG. 26B FIG. 26A DETAILED DESCRIPTION

[0048] ​​​​1. SUMMARY .

[0049] Aspects of the present disclosure can be integrated into a robotically-enabled medical system that is capable of performing a wide variety of medical procedures, including both minimally invasive procedures such as laparoscopy, as well as non-invasive procedures such as endoscopy. In endoscopy procedures, the system can be capable of performing bronchoscopy, ureteroscopy, gastroscopy, etc.

[0050] In addition to performing a wide variety of procedures, the system can provide additional benefits such as enhanced imaging and guidance to assist the physician. Additionally, the system can provide the physician the ability to perform procedures from an ergonomic position without the need for awkward arm movements and positions. Additionally, the system can provide the physician the ability to perform procedures with improved ease of use such that one or more of the instruments of the system can be controlled by a single user.

[0051] For illustrative purposes, various embodiments will be described below with reference to the accompanying drawings. It should be understood that numerous other implementations can be devised by those skilled in the art that will implement the disclosed concepts in a manner that can differ from the specific implementations disclosed. The title headings included herein are for reference only and are not intended to limit the scope of the concepts described. Such concepts can have applicability in a wide variety of contexts.

[0052] A. Robotic System - Cart .

[0053] A robotically-enabled medical system can be configured in a variety of ways, depending on the particular procedure. FIG. 1 An embodiment of a cart-based robotically-enabled system 10 arranged for diagnostic and / or therapeutic bronchoscopy is shown. During bronchoscopy, the system 10 can include a cart 11 having one or more robotic arms 12 to deliver a medical instrument such as a steerable endoscope 13 (which can be a procedure-specific bronchoscope for bronchoscopy) to a natural orifice entry point (i.e., the mouth of the patient positioned on a table in the present example) to deliver diagnostic and / or therapeutic tools. As shown, the cart 11 can be positioned proximate the upper torso of the patient in order to provide access to the entry point. Similarly, the robotic arms 12 can be actuated to position the bronchoscope relative to the entry point. The arrangement in FIG. 1 may also be utilized when performing a gastro-intestinal (GI) procedure with a gastroscope, a specialized endoscope for GI procedures. FIG. 2 An exemplary embodiment of a cart is depicted in greater detail.

[0054] With continued reference to FIG. 1Once the cart 11 is properly positioned, the robotic arms 12 can insert the steerable endoscope 13 into the patient robotically, manually, or a combination thereof. As shown, the steerable endoscope 13 can include at least two telescoping sections, such as an inner guide section and an outer sheath section, each coupled to a separate instrument driver from a set of instrument drivers 28, each coupled to a distal end of a separate robotic arm. This linear arrangement of instrument drivers 28, which facilitates coaxial alignment of the guide section with the sheath section, creates a“virtual rail” 29 that can be repositioned in space by manipulating one or more robotic arms 12 to different angles and / or orientations. The virtual rail described herein is depicted in the accompanying figures using dashed lines, and thus the dashed lines do not depict any physical structure of the system. Translation of the instrument drivers 28 along the virtual rail 29 telescopes the inner guide section relative to the outer sheath section, or advances or retracts the endoscope 13 from the patient. The angle of the virtual rail 29 can be adjusted, translated, and pivoted based on clinical application or physician preference. For example, in bronchoscopy, the angle and orientation of the virtual rail 29 as shown represents a compromise between providing the physician access to the endoscope 13 while minimizing friction caused by bending the endoscope 13 into the patient’s mouth.

[0055] After insertion, the endoscope 13 can be directed down the patient’s trachea and lungs using precise commands from the robotic system until reaching a target destination or surgical site. To enhance navigation through the patient’s lung network and / or to reach a desired target, the endoscope 13 can be manipulated to telescopically extend the inner guide section from the outer sheath section to obtain enhanced articulation and greater bend radius. Using separate instrument drivers 28 also allows the guide section and sheath section to be driven independently of one another.

[0056] For example, the endoscope 13 can be directed to deliver a biopsy needle to a target, such as a lesion or nodule within the patient’s lung. The needle can be deployed down a working channel that extends the length of the endoscope to obtain a tissue sample to be analyzed by a pathologist. Depending on the pathology results, additional tools can be deployed down the working channel of the endoscope for additional biopsies. After identifying that a nodule is malignant, the endoscope 13 can deliver tools through the endoscope to resect the potential cancerous tissue. In some cases, the diagnostic and therapeutic treatments can be delivered in separate procedures. In these cases, the endoscope 13 can also be used to deliver a fiducial to“mark” the location of the target nodule. In other cases, the diagnostic and therapeutic treatments can be delivered during the same procedure.

[0057] The system 10 can also include a movable tower 30 that can be connected to the cart 11 via support cables to provide control, electronic, fluid, optical, sensor, and / or electrical power support to the cart 11. Placing such functionality in the tower 30 allows for a smaller form factor cart 11 that can be more easily adjusted and / or repositioned by the operating physician and his / her staff. Additionally, dividing functionality between the cart / table and the support tower 30 reduces operating room clutter and facilitates improved clinical workflow. While the cart 11 can be positioned close to the patient, the tower 30 can be stowed in a remote location to not get in the way during the course of the procedure.

[0058] To support the robotic system described above, the tower 30 can include components of a computer-based control system that stores computer program instructions within, for example, a non-transitory computer-readable storage medium such as a permanent magnetic storage drive, a solid state drive, or the like. Execution of these instructions, whether occurring in the tower 30 or in the cart 11, can control the entire system or subsystems thereof. For example, when executed by a processor of the computer system, the instructions can cause components of the robotic system to actuate the relevant carriages and arm mounts, actuate the robotic arms, and control the medical instruments. For example, in response to receiving a control signal, a motor in a joint of the robotic arm can position the arm into a particular pose.

[0059] The tower 30 can also include pumps, flow meters, valve controllers, and / or fluid pathways in order to provide controlled irrigation and suction capabilities to systems that can be deployed through the endoscope 13. These components can also be controlled using the computer system of the tower 30. In some embodiments, irrigation and suction capabilities can be delivered directly to the endoscope 13 through separate cables.

[0060] The tower 30 can include a voltage and surge protector designed to provide filtered and protected power to the cart 11, avoiding the placement of power transformers and other auxiliary power components in the cart 11, resulting in a smaller, more movable cart 11.

[0061] The tower 30 can also include support equipment for sensors deployed throughout the robotic system 10. For example, the tower 30 can include optoelectronic equipment for detecting, receiving, and processing data received from optical sensors or cameras throughout the robotic system 10. In conjunction with the control system, such optoelectronic equipment can be used to generate real-time images for display in any number of control consoles deployed throughout the system, including display in the tower 30. Similarly, the tower 30 can also include electronic subsystems for receiving and processing signals received from deployed electromagnetic (EM) sensors. The tower 30 can also be used to house and position EM field generators for detection by EM sensors in or on medical instruments.

[0062] In addition to other consoles available in the rest of the system (e.g., a console mounted on top of a cart), tower 30 may also include console 31. Console 31 may include a user interface and display, such as a touchscreen, for physician operators. Consoles in system 10 are generally designed to provide both robot control and preoperative and real-time information for procedures, such as navigation and positioning information for endoscope 13. When console 31 is not the only console available to the physician, it may be used by a second operator (such as a nurse) to monitor the patient's health or vital signs and the operation of system 10, as well as to provide procedure-specific data, such as navigation and positioning information. In other embodiments, console 30 is housed in a separate body from tower 30.

[0063] Tower 30 can be connected to cart 11 and endoscope 13 via one or more cables or connectors (not shown). In some embodiments, support functions from tower 30 can be provided to cart 11 via a single cable, thereby simplifying the operating room and eliminating clutter. In other embodiments, specific functions can be coupled in separate wiring and connections. For example, while power can be provided to cart 11 via a single cable, support for controls, optics, fluid, and / or navigation can also be provided via separate cables.

[0064] FIG. 2 Provided from FIG. 1 The illustration shows a detailed depiction of an embodiment of a cart 11 in a cart-based robot-enabled system. The cart 11 typically includes an elongated support structure 14 (often referred to as a "post"), a cart base 15, and a console 16 at the top of the post 14. The post 14 may include one or more brackets, such as those for supporting one or more robotic arms 12. FIG. 2 The bracket 17 (or alternatively, "arm support") is deployed in three configurations. The bracket 17 may include a separately configurable arm mount that rotates along a vertical axis to adjust the base of the robotic arm 12 for better positioning relative to the patient. The bracket 17 also includes a bracket interface 19 that allows the bracket 17 to translate vertically along the post 14.

[0065] The bracket interface 19 is connected to the column 14 via a slot, such as slot 20, positioned on the opposite side of the column 14 to guide the vertical translation of the bracket 17. Slot 20 includes a vertical translation interface to position and hold the bracket 17 relative to the trolley base 15 at various vertical heights. The vertical translation of the bracket 17 allows the trolley 11 to adjust the reach of the robotic arm 12 to accommodate various table heights, patient sizes, and physician preferences. Similarly, separately configurable arm mounts on the bracket 17 allow the robotic arm base 21 of the robotic arm 12 to be angled in various configurations.

[0066] In some embodiments, the slot 20 can be supplemented with a slot cover that is flush and parallel with the slot surface to prevent dust and fluids from entering the interior cavity of the column 14 and the vertical translation interface as the carriage 17 is vertically translated. The slot cover can be deployed through a pair of spring spool positioned near the vertical top and bottom of the slot 20. The cover is coiled within the spool until deployed to extend and retract from its coiled state as the carriage 17 is vertically translated up and down. The spring loading of the spool provides the force to retract the cover into the spool as the carriage 17 is translated toward the spool while also maintaining a tight seal as the carriage 17 is translated away from the spool. The cover can be connected to the carriage 17 using, for example, a bracket in the carriage interface 19 to ensure proper extension and retraction of the cover as the carriage 17 is translated.

[0067] The column 14 can internally include mechanisms such as gears and motors designed to use a vertically aligned lead screw to mechanically translate the carriage 17 in response to control signals generated in response to user input (e.g., from the console 16).

[0068] The robotic arms 12 can generally include a robotic arm base 21 and an end effector 22 separated by a series of links 23 connected by a series of joints 24, each joint including an independent actuator, each actuator including an independently controllable motor. Each independently controllable joint represents an independent degree of freedom available to the robotic arm 12. Each of the robotic arms 12 can have seven joints and thus provide seven degrees of freedom. The plurality of joints results in a plurality of degrees of freedom, allowing for “redundant” degrees of freedom. Having redundant degrees of freedom allows the robotic arms 12 to position their respective end effectors 22 at a particular position, orientation, and trajectory in space using different link positions and joint angles. This allows the system to position and steer the medical instrument from a desired point in space while allowing the physician to move the arm joints to a clinically advantageous position away from the patient to create greater access while avoiding arm collisions.

[0069] The cart base 15 balances the weight of the column 14, the carriage 17, and the robotic arms 12 on the floor. Thus, the cart base 15 houses the heavier components such as electronics, motors, power supplies, and components that enable the cart 11 to move and / or be immobilized. For example, the cart base 15 includes rollable caster wheels 25 that allow the cart 11 to be easily moved around the room prior to a procedure. After reaching the appropriate position, the caster wheels 25 can be immobilized using a wheel lock to keep the cart 11 in the appropriate position during the procedure.

[0070] A console 16 positioned at the vertical end of the column 14 allows both a user interface for receiving user input and a display screen (or dual-purpose device such as, for example, a touchscreen 26) to provide the physician user with both pre-operative and intra-operative data. Potential pre-operative data on the touchscreen 26 can include pre-operative plans derived from pre-operative computed tomography (CT) scans, navigation and mapping data and / or records from a pre-operative patient interview. Intra-operative data on the display can include optical information provided from tools, sensors and coordinate information from sensors as well as important patient statistics such as respiration, heart rate and / or pulse. The console 16 can be positioned and tilted to allow the physician to access the console 16 from the side of the column 14 opposite the carriage 17. From this vantage, the physician can observe the console 16, the robotic arms 12 and the patient while operating the console 16 from behind the cart 11. As shown, the console 16 also includes a handle 27 to aid in maneuvering and stabilizing the cart 11.

[0071] FIG. 3 An embodiment of a robot-enabled system 10 arranged for a ureteroscopy is shown. In a ureteroscopy procedure, the cart 11 can be positioned to deliver a ureteroscope 32, a procedure-specific endoscope designed to traverse the urethra and ureter of a patient, to the lower abdominal region of a patient. In a ureteroscopy, it can be desirable for the ureteroscope 32 to be directly aligned with the urethra of the patient to reduce friction and force on sensitive anatomy in the region. As shown, the cart 11 can be aligned at the foot of the table to allow the robotic arms 12 to position the ureteroscope 32 for direct linear access to the urethra of the patient. The robotic arms 12 can insert the ureteroscope 32 directly into the lower abdomen of the patient through the urethra from the foot of the table along a virtual rail 33.

[0072] After insertion into the urethra, using similar control techniques as in bronchoscopy, the ureteroscope 32 can be navigated into the bladder, ureter and / or kidney for diagnostic and / or therapeutic applications. For example, the ureteroscope 32 can be directed into the ureter and kidney to break up an accumulated kidney stone using a laser or ultrasonic lithotripsy device deployed down the working channel of the ureteroscope 32. After lithotripsy is complete, the resulting stone fragments can be removed using a basket deployed down the ureteroscope 32.

[0073] FIG. 4Embodiments of a robot-enabled system 10 arranged similarly for a vascular procedure are shown. In a vascular procedure, the system 10 can be configured such that the cart 11 can deliver a medical instrument 34, such as a steerable catheter, to an access point in the femoral artery of a patient's leg. The femoral artery presents both a larger diameter for navigation and a relatively less circuitous and tortuous path to the patient's heart, which simplifies navigation. As in a ureteroscopy procedure, the cart 11 can be positioned toward the patient's leg and lower abdomen to allow the robot arm 12 to provide a virtual rail 35 that directly linearly accesses the femoral artery access point in the patient's thigh / hip region. After insertion into the artery, the medical instrument 34 can be steered and inserted by translating the instrument driver 28. Alternatively, the cart can be positioned around the patient's upper abdomen to reach alternative vascular access points, such as the carotid and brachial arteries near the shoulder and wrist.

[0074] B. Robotic System - Table .

[0075] Embodiments of the robot-enabled medical system can also incorporate a patient table. Incorporating a table reduces the amount of capital equipment within the operating room by removing the cart, which allows more access to the patient. FIG. 5 An embodiment of such a robot-enabled system arranged for a bronchoscopy procedure is shown. The system 36 includes a support structure or column 37 for supporting a platform 38 (shown as a "table" or "bed") on the floor. Much like the cart-based system, the end effector of the robot arm 39 of the system 36 includes an instrument driver 42 designed to manipulate an elongate medical instrument, such as a bronchoscope 40 in FIG. 5 In practice, a C-arm for providing fluoroscopic imaging can be positioned over the patient's upper abdominal region by placing the emitter and detector around the table 38.

[0076] FIG. 6An alternative view of the system 36 without the patient and medical instruments is provided for discussion purposes. As shown, the column 37 can include one or more carriages 43 shown as annular in the system 36 from which one or more robotic arms 39 can be based. The carriages 43 can translate along a vertical column interface 44 that extends along the length of the column 37 to provide different vantage points from which the robotic arms 39 can be positioned to reach the patient. The carriages 43 can rotate about the column 37 using a mechanical motor positioned within the column 37 to allow the robotic arms 39 to access multiple sides of the table 38, such as both sides of the patient. In embodiments with multiple carriages, the carriages can be individually positioned on the column and can translate and / or rotate independently of the other carriages. While the carriages 43 need not encircle the column 37 or even be circular, the annular shape as shown facilitates rotation of the carriages 43 about the column 37 while maintaining structural balance. Rotation and translation of the carriages 43 allows the system 36 to align medical instruments such as endoscopes and laparoscopes into different access points on the patient. In other embodiments (not shown), the system 36 can include a patient table or bed with adjustable arm supports in the form of bars or rails that extend alongside the patient table or bed. One or more robotic arms 39 (e.g., via a shoulder with an elbow joint) can be attached to the adjustable arm supports, which can be adjusted vertically. By providing vertical adjustment, the robotic arms 39 are advantageously able to be stored compactly underneath the patient table or bed and subsequently raised during a procedure.

[0077] The robotic arms 39 can be mounted on the carriages 43 through a set of arm mounts 45 that include a series of joints that can individually rotate and / or telescopically extend to provide additional configurability to the robotic arms 39. Additionally, the arm mounts 45 can be positioned on the carriages 43 so that when the carriages 43 are appropriately rotated, the arm mounts 45 can be positioned on the same side of the table 38 (as shown), on opposite sides of the table 38 (as shown), or on adjacent sides of the table 38 (not shown). FIG. 6 FIG. 9

[0078] The column 37 structurally provides support for the table 38 and provides a path for vertical translation of the carriages 43. Internally, the column 37 can be equipped with lead screws for guiding vertical translation of the carriages, as well as motors to mechanize translation of the carriages 43 based on the lead screws. The column 37 can also deliver power and control signals to the carriages 43 and robotic arms 39 mounted thereon.

[0079] The table base 46 has a footprint that is smaller than the footprint of the table 38, as shown in FIG. 1. The table base 46 can be positioned on a floor or other surface, and the table 38 can be positioned on top of the table base 46. The table base 46 can be used to provide structural support for the table 38 and can also be used to provide a path for vertical translation of the carriages 43. Internally, the table base 46 can be equipped with lead screws for guiding vertical translation of the carriages, as well as motors to mechanize translation of the carriages 43 based on the lead screws. The table base 46 can also deliver power and control signals to the carriages 43 and robotic arms 39 mounted thereon. FIG. 2 ​​The cart base 15 in the illustrated cart 11 similarly functions to house the heavier components to balance the table / bed 38, column 37, cradle 43, and robotic arm 39. The table base 46 can also incorporate rigid casters to provide stability during procedures. Casters deployed from the bottom of the table base 46 can extend in opposite directions along the two sides of the base 46 and retract when the system 36 needs to move.

[0080] Continuing FIG. 6 The system 36 can also include a tower (not shown) that divides the functions of the system 36 between the table and the tower to reduce the form factor and volume of the table. As in the previously disclosed embodiments, the tower can provide a variety of support functions to the table, such as processing, computing and control capabilities, power, fluids and / or optics, and sensor processing. The tower can also be movable to be positioned away from the patient, improving access for the physician and eliminating clutter in the operating room. Additionally, placing components in the tower allows for more storage space in the table base 46 for potential stowage of the robotic arm 39. The tower can also include a main controller or console that provides both a user interface for user input (such as a keyboard and / or pendant) and a display screen (or touchscreen) for preoperative and intraoperative information, such as real-time imaging, navigation, and tracking information. In some embodiments, the tower can also contain a holder for a gas canister to be used for gas injection.

[0081] In some embodiments, the table base can stow and store the robotic arm when not in use. FIG. 7 A system 47 is shown that stows the robotic arm in an embodiment of a table-based system. In the system 47, a cradle 48 can translate vertically into a base 49 to stow the robotic arm 50, arm mount 51, and cradle 48 within the base 49. A base cover 52 can translate and retract to open to deploy the cradle 48, arm mount 51, and robotic arm 50 about a column 53, and close to stow the cradle, arm mount, and robotic arm to protect them when not in use. The base cover 52 can seal with a film 54 along the edges of its opening to prevent dust and fluids from entering when closed.

[0082] FIG. 8Embodiments of a robot-enabled table-based system configured for a ureteroscopy procedure are shown. In a ureteroscopy, the table 38 can include a rotating portion 55 for positioning the patient at an offset angle from the column 37 and table base 46. The rotating portion 55 can rotate or pivot about a pivot point (e.g., located below the patient's head) in order to position the bottom portion of the rotating portion 55 away from the column 37. For example, the pivoting of the rotating portion 55 allows a C-arm (not shown) to be positioned over the patient's lower abdomen without competing for space with the column (not shown) below the table 38. By rotating the carriage 35 (not shown) about the column 37, the robot arms 39 can insert a ureteroscope 56 directly into the patient's groin area along a virtual rail 57 to reach the urethra. In a ureteroscopy, a stirrup 58 can also be secured to the rotating portion 55 of the table 38 to support the position of the patient's legs during the procedure and allow full access to the patient's groin area.

[0083] In a laparoscopy procedure, a minimally invasive instrument can be inserted into a patient's anatomy through a small incision in the patient's abdominal wall. In some embodiments, the minimally invasive instrument includes an elongate rigid member, such as a shaft, for accessing anatomical structures within the patient's body. After the patient's abdominal cavity is inflated, the instrument can be guided to perform a surgical or medical task, such as grasping, cutting, ablating, suturing, etc. In some embodiments, the instrument can include a scope, such as a laparoscope. FIG. 9 Embodiments of a robot-enabled table-based system configured for a laparoscopy procedure are shown. As shown, the carriage 43 of the system 36 can be rotated and vertically adjusted to position a pair of robot arms 39 on opposite sides of the table 38 so that instruments 59 can be positioned through minimal incisions on both sides of the patient to reach his / her abdominal cavity using the arm mounts 45. FIG. 9 As shown, the table 38 can be tilted to position the patient at an offset angle from the column 37 and table base 46. The rotating portion 55 of the table 38 can be rotated or pivoted about a pivot point (e.g., located below the patient's head) in order to position the bottom portion of the rotating portion 55 away from the column 37. For example, the pivoting of the rotating portion 55 allows a C-arm (not shown) to be positioned over the patient's lower abdomen without competing for space with the column (not shown) below the table 38. By rotating the carriage 35 (not shown) about the column 37, the robot arms 39 can insert a laparoscope 59 directly into the patient's abdominal cavity along a virtual rail 57 to reach anatomical structures within the patient's body.

[0084] To accommodate a laparoscopy procedure, the robot-enabled table system can also tilt the platform to a desired angle. FIG. 10 Embodiments of a robot-enabled medical system with pitch or tilt adjustment are shown. As shown, the system 36 can accommodate a tilt of the table 38 to position one portion of the table at a greater distance from the floor than another portion. Additionally, the arm mounts 45 can be rotated to match the tilt so that the robot arms 39 maintain the same planar relationship with the table 38. To accommodate steeper angles, the column 37 can also include a telescoping portion 60 that allows the vertical extension of the column 37 to prevent the table 38 from contacting the floor or colliding with the table base 46. FIG. 10 As shown, the table 38 can be tilted to position the patient at an offset angle from the column 37 and table base 46. The rotating portion 55 of the table 38 can be rotated or pivoted about a pivot point (e.g., located below the patient's head) in order to position the bottom portion of the rotating portion 55 away from the column 37. For example, the pivoting of the rotating portion 55 allows a C-arm (not shown) to be positioned over the patient's lower abdomen without competing for space with the column (not shown) below the table 38. By rotating the carriage 35 (not shown) about the column 37, the robot arms 39 can insert a laparoscope 59 directly into the patient's abdominal cavity along a virtual rail 57 to reach anatomical structures within the patient's body.

[0085] FIG. 11Detailed illustrations are provided of the interface between platform 38 and column 37. The pitch-rotation mechanism 61 can be configured to change the pitch angle of platform 38 relative to column 37 in multiple degrees of freedom. The pitch-rotation mechanism 61 can be implemented by positioning orthogonal axes 1 and 2 at the column interface, each axis being actuated by separate motors 3 and 4 in response to electrical pitch angle commands. Rotation along one screw 5 enables tilt adjustment along axis 1, while rotation along another screw 6 enables tilt adjustment along another axis 2. In some embodiments, ball joints can be used to change the pitch angle of platform 38 relative to column 37 in multiple degrees of freedom.

[0086] For example, pitch adjustment is particularly useful when attempting to position the table in a head-down, feet-up position (i.e., positioning the patient's lower abdomen higher than their upper abdomen above the floor) for lower abdominal surgery. The head-down, feet-up position allows the patient's internal organs to slide down to their upper abdomen by gravity, clearing the abdominal cavity to allow minimally invasive instruments to enter and perform lower abdominal surgical or medical procedures, such as laparoscopic prostatectomy.

[0087] FIG. 12 and FIG. 13 Isometric and end views of an alternative embodiment of a stage-based surgical robot system 100 are shown. The surgical robot system 100 includes one or more robotic arms (see, for example) that can be configured to support a stage 101 relative to it. FIG. 14 One or more adjustable arm supports 105 are provided. In the illustrated embodiment, a single adjustable arm support 105 is shown, but additional arm supports may be positioned on opposite sides of the platform 101. The adjustable arm support 105 may be configured such that it is movable relative to the platform 101 to adjust and / or change the orientation of the adjustable arm support 105 and / or any robotic arm attached to it relative to the platform 101. For example, the adjustable arm support 105 may be adjusted with one or more degrees of freedom relative to the platform 101. The adjustable arm support 105 provides high flexibility to the system 100, including the ability to easily retract one or more adjustable arm supports 105 and any robotic arms attached thereto under the platform 101. The adjustable arm support 105 may be raised from a retracted orientation to an orientation below the upper surface of the platform 101. In other embodiments, the adjustable arm support 105 can be raised from a retracted position to a position above the upper surface of the platform 101.

[0088] The adjustable arm support 105 provides several degrees of freedom, including lifting, lateral translation, and tilting. FIG. 12 and FIG. 13 In the exemplary embodiment, the arm support 105 is configured to have four degrees of freedom, which are in FIG. 12The first degree of freedom allows adjustment of the adjustable arm support 105 in the z-direction (“Z-lift”). For example, the adjustable arm support 105 can include a carriage 109 that is configured to move up or down along or relative to a column 102 of the support table 101. The second degree of freedom can allow the adjustable arm support 105 to tilt. For example, the adjustable arm support 105 can include a rotary joint that can allow the adjustable arm support 105 to align with the bed in a feet-up head-low position. The third degree of freedom can allow the adjustable arm support 105 to “pivot up,” which can be used to adjust the distance between a side of the table 101 and the adjustable arm support 105. The fourth degree of freedom can allow the adjustable arm support 105 to translate along the longitudinal length of the table.

[0089] FIG. 12 and FIG. 13 The surgical robotic system 100 in FIG. 13 is shown in

[0090] The adjustable arm support 105 can be mounted to the column 102. In other embodiments, the arm support 105 can be mounted to the table 101 or the base 103. The adjustable arm support 105 can include a carriage 109, a bar or rail connector 111, and a bar or rail 107. In some embodiments, one or more robotic arms mounted to the rail 107 can translate and move relative to one another.

[0091] The carriage 109 can be attached to the column 102 by a first joint 113 that allows the carriage 109 to move relative to the column 102 (e.g., such as up and down along a first or vertical axis 123). The first joint 113 can provide the adjustable arm support 105 with a first degree of freedom (“Z-lift”). The adjustable arm support 105 can include a second joint 115 that provides the adjustable arm support 105 with a second degree of freedom (tilt). The adjustable arm support 105 can include a third joint 117 that can provide the adjustable arm support 105 with a third degree of freedom (“pivot up”). An additional joint 119 (shown in FIG. 13 ) can be provided that mechanically constrains the third joint 117 to maintain the orientation of the rail 107 as the rail connector 111 rotates about the third axis 127. The adjustable arm support 105 can include a fourth joint 121 that can provide the adjustable arm support 105 with a fourth degree of freedom (translation) along a fourth axis 129.

[0092] FIG. 14An end view of a surgical robotic system 140A is shown having two adjustable arm supports 105A, 105B mounted on opposite sides of a table 101, according to one embodiment. A first robotic arm 142A is attached to a bar or rail 107A of the first adjustable arm support 105B. The first robotic arm 142A includes a base 144A attached to the rail 107A. A distal end of the first robotic arm 142A includes an instrument drive mechanism 146A that can attach to one or more robotic medical instruments or tools. Similarly, a second robotic arm 142B includes a base 144B attached to a rail 107B. A distal end of the second robotic arm 142B includes an instrument drive mechanism 146B. The instrument drive mechanism 146B can be configured to attach to one or more robotic medical instruments or tools.

[0093] In some embodiments, one or more of the robotic arms 142A, 142B include an arm having seven or more degrees of freedom. In some embodiments, one or more of the robotic arms 142A, 142B can include eight degrees of freedom, including an insertion axis (including 1 degree of freedom of insertion), a wrist (including 3 degrees of freedom of wrist pitch, yaw, and roll), an elbow (including 1 degree of freedom of elbow pitch), a shoulder (including 2 degrees of freedom of shoulder pitch and yaw), and a base 144A, 144B (including 1 degree of freedom of translation). In some embodiments, the insertion degree of freedom can be provided by the robotic arm 142A, 142B, while in other embodiments, the instrument itself provides insertion via an instrument-based insertion architecture.

[0094] C. Instrument Drivers and Interfaces .

[0095] The end effector of a robotic arm of the system can include (i) an instrument drive (alternatively referred to as an “instrument drive mechanism” or “instrument device manipulator”) incorporating electromechanical devices for actuating a medical instrument, and (ii) a removable or detachable medical instrument that can be free of any electromechanical components, such as motors. This dichotomy can be driven by the need to sterilize medical instruments used in medical procedures, and the inability to adequately sterilize expensive capital equipment due to the complex mechanical assemblies and sensitive electronics of the expensive capital equipment. Thus, the medical instrument can be designed to be detached, removed, and interchanged from the instrument drive (and thus from the system) for individual sterilization or disposal by the physician or the physician’s staff. In contrast, the instrument drive need not be changed or sterilized and can be draped for protection.

[0096] FIG. 15An example instrument driver is shown. An instrument driver 62 positioned at the distal end of a robotic arm includes one or more drive units 63 arranged with parallel axes to provide controlled torque to a medical instrument via drive shafts 64. Each drive unit 63 includes a separate drive shaft 64 for interacting with the instrument, a gearhead 65 for converting motor shaft rotation to a desired torque, a motor 66 for generating the drive torque, an encoder 67 to measure the speed of the motor shaft and provide feedback to control circuitry, and control circuitry 68 for receiving control signals and actuating the drive unit. Each drive unit 63 is independently controlled and motorized, and the instrument driver 62 can provide multiple (e.g., four as shown) independent drive outputs to a medical instrument. In operation, the control circuitry 68 will receive control signals, transmit motor signals to the motor 66, compare the resulting motor speed measured by the encoder 67 to a desired speed, and modulate the motor signal to generate the desired torque. FIG. 15 Four) independent drive outputs. In operation, the control circuitry 68 will receive control signals, transmit motor signals to the motor 66, compare the resulting motor speed measured by the encoder 67 to a desired speed, and modulate the motor signal to generate the desired torque.

[0097] For procedures requiring a sterile environment, the robotic system can incorporate a drive interface, such as a sterile adapter connected to a sterile drape, that sits between the instrument driver and the medical instrument. The primary purpose of the sterile adapter is to transfer angular motion from the drive shafts of the instrument driver to the drive inputs on the instrument while maintaining physical separation between the drive shafts and the drive inputs and thus maintaining sterility. Thus, an example sterile adapter can include a series of rotary inputs and rotary outputs designed to mate with the drive shafts of the instrument driver and the drive inputs on the instrument. A sterile drape composed of a thin, flexible material, such as clear or translucent plastic, connected to the sterile adapter is designed to cover capital equipment, such as the instrument driver, the robotic arm, and the cart (in a cart-based system) or table (in a table-based system). The use of the drape will allow the capital equipment to be positioned near the patient while still being located in an area that does not require sterilization (i.e., the non-sterile zone). On the other side of the sterile drape, the medical instrument can interface with the patient in an area that requires sterilization (i.e., the sterile zone).

[0098] D. Medical Instruments .

[0099] FIG. 16An example medical instrument with paired instrument drivers is shown. Like other instruments designed for use with robotic systems, the medical instrument 70 includes an elongated shaft 71 (or elongated body) and an instrument base 72. The instrument base 72, also referred to as an “instrument handle” due to its intended design for manual interaction by a physician, can generally include a rotatable drive input 73 (e.g., a socket, pulley, or spool) designed to mate with a drive output 74 of a drive interface on an instrument driver 75 extending through a distal end of a robotic arm 76. When physically connected, latched, and / or coupled, the mating drive input 73 of the instrument base 72 can share an axis of rotation with the drive output 74 in the instrument driver 75 to allow torque to be transferred from the drive output 74 to the drive input 73. In some embodiments, the drive output 74 can include splines designed to mate with a socket on the drive input 73.

[0100] The elongated shaft 71 is designed to be delivered through an anatomical opening or lumen (e.g., as in endoscopy) or through a minimally invasive incision (e.g., as in laparoscopy). The elongated shaft 71 can be flexible (e.g., with properties similar to an endoscope) or rigid (e.g., with properties similar to a laparoscope), or contain a customized combination of both flexible and rigid portions. When designed for laparoscopy, the distal end of a rigid elongated shaft can be connected to an end effector that extends from an articulating wrist formed by a forked head with at least one degree of freedom and a surgical tool or medical instrument (e.g., a grasper or scissors) that can be actuated based on forces from a tendon when the drive input is rotated in response to torque received from the drive output 74 of the instrument driver 75. When designed for endoscopy, the distal end of a flexible elongated shaft can include a steerable or controllable bending segment that is articulated and bent based on torque received from the drive output 74 of the instrument driver 75.

[0101] Tendons along the elongated shaft 71 transmit torque from the instrument driver 75 along the elongated shaft 71. These individual tendons (e.g., pull wires) can be individually anchored to individual drive inputs 73 within the instrument handle 72. From the handle 72, the tendons are guided down one or more pull lumens along the elongated shaft 71 and anchored at a distal portion of the elongated shaft 71, or in a wrist at the distal portion of the elongated shaft. During a surgical procedure, such as a laparoscopic, endoscopic, or hybrid procedure, these tendons can be coupled to a distally mounted end effector, such as a wrist, grasper, or scissors. Under such an arrangement, torque placed on the drive inputs 73 transmits tension to the tendons, causing the end effector to actuate in some manner. In some embodiments, during a surgical procedure, the tendons can cause a joint to rotate about an axis, causing the end effector to move in one direction or another. Alternatively, the tendons can connect to one or more jaws of a grasper at a distal end of the elongated shaft 71, where tension from the tendons causes the grasper to close.

[0102] In endoscopy, the tendons can be coupled to a bending or articulating segment positioned along the elongated shaft 71 (e.g., at the distal end) via adhesive, control rings, or other mechanical fixtures. When fixedly attached to the distal end of the bending segment, torque placed on the drive inputs 73 will be transmitted down the tendons, causing the softer bending segment (sometimes referred to as an articulatable segment or region) to bend or articulate. Along the unbending segment, it can be advantageous to have individual pull lumens spiraled or coiled that guide individual tendons along (or inside) the wall of the endoscope shaft to balance the radial forces caused by tension in the pull wires. The angle of the spirals and / or the spacing therebetween can be varied or designed for specific purposes, where tighter spirals exhibit less shaft compression under a load force, while lower amounts of spiraling cause greater shaft compression under a load force, but limit bending. In another instance, the pull lumens can be routed parallel to the longitudinal axis of the elongated shaft 71 to allow for controlled articulation in the desired bending or articulatable segment.

[0103] In endoscopy, the elongated shaft 71 houses a number of components to assist in the robotic procedure. The shaft 71 can include a working channel at the distal end of the shaft 71 for deployment of surgical tools (or medical instruments), irrigation, and / or suction of the surgical area. The shaft 71 can also house wires and / or optical fibers to transmit signals to / from an optical assembly at the distal tip, which can include an optical camera. The shaft 71 can also house optical fibers to carry light from a light source (e.g., light-emitting diode) located proximally to the distal end of the shaft 71.

[0104] At the distal end of instrument 70, the distal tip can also include openings for delivery of tools for diagnosis and / or treatment, working channels for irrigation and suction of the surgical site. The distal tip can also include a port for a camera, such as a fiberscope or digital camera, to capture images of the internal anatomical space. Relatedly, the distal tip can also include a port for a light source to illuminate the anatomical space when using the camera.

[0105] In FIG. 16 In the example of FIG. 8, the drive shaft axis and thus the drive input axis is orthogonal to the axis of the elongated shaft 71. However, this arrangement complicates the roll ability of the elongated shaft 71. Rolling the elongated shaft 71 along its axis while keeping the drive input 73 stationary causes undesirable tangling of the tendon as it extends out of the drive input 73 and into the pull cavity within the elongated shaft 71. The resulting tangling of the tendon can disrupt any control algorithm intended to predict the motion of the flexible elongated shaft 71 during an endoscopic procedure.

[0106] FIG. 17 An alternative design of an instrument driver and instrument is shown in which the axis of the drive units is parallel to the axis of the elongated shaft of the instrument. As shown, a circular instrument driver 80 includes four drive units whose drive outputs 81 are aligned in parallel at the end of a robotic arm 82. The drive units and their respective drive outputs 81 are housed in a rotating assembly 83 of the instrument driver 80 driven by one of the drive units within the assembly 83. In response to torque provided by the rotating drive unit, the rotating assembly 83 rotates along a circular bearing that connects the rotating assembly 83 to a non-rotating portion 84 of the instrument driver 80. Power and control signals can be transmitted from the non-rotating portion 84 of the instrument driver 80 to the rotating assembly 83 through electrical contact, which can be maintained through rotation of a brush slip ring connection (not shown). In other embodiments, the rotating assembly 83 can be responsive to a separate drive unit integrated into the non-rotatable portion 84 and thus not parallel to the other drive units. The rotating mechanism 83 allows the instrument driver 80 to allow the drive units and their respective drive outputs 81 to rotate as a single unit about an instrument driver axis 85.

[0107] Similar to the previously disclosed embodiments, the instrument 86 can include an elongated shaft portion 88 and an instrument base 87 (shown with a transparent outer skin for discussion purposes) that includes a plurality of drive inputs 89 (such as sockets, pulleys, and spools) configured to receive the drive outputs 81 in the instrument driver 80. Unlike the previously disclosed embodiments, the instrument shaft 88 extends from the center of the instrument base 87 whose axis is substantially parallel to the axis of the drive inputs 89, rather than orthogonal as in the design of FIG. 8. FIG. 16 ​

[0108] When coupled to the rotating assembly 83 of the instrument driver 80, the medical instrument 86, including the instrument base 87 and the instrument shaft 88, rotates about the instrument driver axis 85 in combination with the rotating assembly 83. Since the instrument shaft 88 is positioned at the center of the instrument base 87, the instrument shaft 88 is coaxial with the instrument driver axis 85 when attached. Thus, rotation of the rotating assembly 83 causes the instrument shaft 88 to rotate about its own longitudinal axis. Furthermore, as the instrument base 87 rotates with the instrument shaft 88, any tendons connected to the drive input 89 in the instrument base 87 do not tangle during rotation. Thus, the parallelism of the axes of the drive output 81, the drive input 89, and the instrument shaft 88 allows the shaft to rotate without tangling any control tendons.

[0109] FIG. 18 An instrument with an instrument-based insertion architecture is shown in accordance with some embodiments. The instrument 150 can be coupled to any of the instrument drivers described above. The instrument 150 includes an elongated shaft 152, an end effector 162 connected to the shaft 152, and a handle 170 coupled to the shaft 152. The elongated shaft 152 includes a tubular member having a proximal portion 154 and a distal portion 156. The elongated shaft 152 includes one or more channels or grooves 158 along its outer surface. The grooves 158 are configured to receive one or more wires or cables 180 therethrough. Thus, the one or more cables 180 extend along the outer surface of the elongated shaft 152. In other embodiments, the cables 180 can also pass through the elongated shaft 152. Manipulation of the one or more cables 180 (e.g., via an instrument driver) causes actuation of the end effector 162.

[0110] The instrument handle 170 (also referred to as an instrument base) can generally include an attachment interface 172 having one or more mechanical inputs 174, such as receptacles, pulleys, or spools, designed to reciprocally mate with one or more torque couplers on the attachment surface of the instrument driver. In some embodiments, the instrument 150 includes a series of pulleys or cables that enable the elongated shaft 152 to translate relative to the handle 170. In other words, the instrument 150 itself includes an instrument-based insertion architecture that accommodates insertion of the instrument, thereby minimizing reliance on a robotic arm to provide insertion of the instrument 150. In other embodiments, the robotic arm can be largely responsible for instrument insertion.

[0111] E. Controllers .

[0112] Any of the robotic systems described herein may include an input device or controller for manipulating a device attached to a robotic arm. In some embodiments, the controller may be coupled to the device (e.g., communicatively, electronically, electrically, wirelessly, and / or mechanically) such that manipulation of the controller, for example via master-slave control, causes corresponding manipulation of the device.

[0113] FIG. 19 This is a perspective view of an embodiment of controller 182. In this embodiment, controller 182 includes a hybrid controller that may have both impedance and admittance control. In other embodiments, controller 182 may utilize only impedance or passive control. In other embodiments, controller 182 may utilize only admittance control. By being a hybrid controller, controller 182 advantageously has lower perceived inertia during use.

[0114] In the illustrated embodiment, controller 182 is configured to allow manipulation of two medical devices and includes two handles 184. Each handle 184 is connected to a universal joint 186. Each universal joint 186 is connected to a positioning platform 188.

[0115] like FIG. 19 As shown, each positioning platform 188 includes a SCARA arm (selective compliance assembly arm) 198 connected to a post 194 via a prism joint 196. The prism joint 196 is configured to translate along the post 194 (e.g., along guide rail 197) to allow each handle 184 to translate in the z-direction, thus providing a first degree of freedom. The SCARA arm 198 is configured to allow the handles 184 to move in the xy-plane, thus providing two additional degrees of freedom.

[0116] In some embodiments, one or more load sensors are located within the controller. For example, in some embodiments, load sensors (not shown) are located within the body of each gimbal in gimbal 186. By providing load sensors, portions of controller 182 are capable of operating under admittance control, thereby advantageously reducing the sense inertia of the controller during use. In some embodiments, positioning platform 188 is configured for admittance control, while gimbal 186 is configured for impedance control. In other embodiments, gimbal 186 is configured for admittance control, while positioning platform 188 is configured for impedance control. Thus, for some embodiments, the translational or orientational degrees of freedom of positioning platform 188 may depend on admittance control, while the rotational degrees of freedom of gimbal 186 may depend on impedance control.

[0117] F. Navigation and Control .

[0118] Traditional endoscopy can involve the use of fluoroscopy (e.g., as can be delivered through a C-arm) and other forms of radiation-based imaging modalities to provide endoluminal guidance to the operating physician. In contrast, the robotic systems contemplated by the present disclosure can provide non-radiation-based navigation and localization means to reduce physician exposure to radiation and reduce the amount of equipment within the operating room. As used herein, the term“localization” can refer to determining and / or monitoring the position of an object in a reference coordinate system. Techniques such as preoperative mapping, computer vision, real-time EM tracking, and robotic command data can be used individually or in combination to achieve a radiation-free operating environment. In other cases where radiation-based imaging modalities are still used, preoperative mapping, computer vision, real-time EM tracking, and robotic command data can be used individually or in combination to improve the information obtained by radiation-based imaging modalities alone.

[0119] FIG. 20 is a block diagram illustrating a localization system 90 that estimates the position of one or more elements of a robotic system, such as the position of an instrument, in accordance with example embodiments. The localization system 90 can be a set of one or more computer devices configured to execute one or more instructions. The computer devices can be embodied by a processor (or processors) and computer-readable memory in one or more components discussed above. By way of example and not limitation, the computer devices can be located in the tower 30, FIG. 1 the cart 11, FIGS. 1-4 the bed, etc. FIGS. 5-14

[0120] As FIG. 20 illustrated, the localization system 90 can include a localization module 95 that processes input data 91-94 to generate position data 96 for the distal tip of a medical instrument. The position data 96 can be data or logic that represents the position and / or orientation of the distal end of the instrument relative to a reference frame. The reference frame can be a reference frame relative to patient anatomy or a known object, such as an EM field generator (see discussion below for EM field generators).

[0121] ​The various input data 91-94 are now described in more detail. Preoperative mapping can be accomplished by using a collection of low-dose CT scans. The preoperative CT scans are reconstructed into three-dimensional images that are visualized, for example, as "slices" of a cross-sectional map of the patient's internal anatomy. When analyzed in the aggregate, an image-based model of the anatomical lumens, spaces, and structures for the patient's anatomy, such as the patient's lung network, can be generated. Techniques such as centerline geometry can be determined and approximated from the CT images to form a three-dimensional volume of the patient's anatomy, referred to as model data 91 (also referred to as "preoperative model data" when generated using only preoperative CT scans). The use of centerline geometry is discussed in U.S. Patent Application 14 / 523,760, the contents of which are incorporated herein in their entirety. Network topology models can also be derived from the CT images and are particularly suitable for bronchoscopy.

[0122] In some embodiments, the instrument can be equipped with a camera to provide visual data (or image data) 92. The localization module 95 can process the visual data 92 to implement one or more vision-based (or image-based) location tracking modules or features. For example, the preoperative model data 91 can be used in conjunction with the visual data 92 to implement computer vision-based tracking of the medical instrument (e.g., an endoscope or an instrument advanced through a working channel of an endoscope). For example, using the preoperative model data 91, the robotic system can generate a library of expected endoscope images from the model based on the expected path of travel of the endoscope, each image linked to a location within the model. As the surgical procedure is performed, the robotic system can reference the library in order to compare real-time images captured at the camera (e.g., a camera at the distal end of the endoscope) to those in the image library to assist in localization.

[0123] Other computer vision-based tracking techniques use feature tracking to determine the motion of the camera, and thus the endoscope. Some features of the localization module 95 can identify circular geometries in the preoperative model data 91 that correspond to anatomical lumens and track changes in those geometries to determine which anatomical lumens are selected, as well as track the relative rotational and / or translational motion of the camera. The use of a topology map can further enhance the vision-based algorithms or techniques.

[0124] Optical flow (another computer vision-based technique) can analyze the displacement and translation of image pixels in a video sequence in the visual data 92 to infer camera motion. Examples of optical flow techniques can include motion detection, object segmentation calculations, brightness, motion compensated encoding, stereo disparity measurement, etc. Through multiple iterations of multi-frame comparisons, the motion and location of the camera (and thus the endoscope) can be determined.

[0125] The positioning module 95 can use real-time EM tracking to generate the real-time position of the endoscope in a global coordinate system that can be registered to the patient's anatomy represented by a preoperative model. In EM tracking, an EM sensor (or tracker), including one or more sensor coils embedded in one or more locations and orientations within the medical instrument (e.g., an endoscopic tool), measures changes in the EM field generated by one or more static EM field generators positioned at known locations. The positional information detected by the EM sensor is stored as EM data 93. The EM field generator (or transmitter) can be placed close to the patient to generate a low-intensity magnetic field detectable by the embedded sensor. The magnetic field induces a small current in the sensor coil of the EM sensor, which can be analyzed to determine the distance and angle between the EM sensor and the EM field generator. These distances and orientations can be "registered" to the patient's anatomy (e.g., a preoperative model) during surgery to determine the geometric transformations that align a single location in the coordinate system with its orientation in the preoperative model of the patient's anatomy. Once registered, an embedded EM tracker in one or more orientations of the medical device (e.g., the distal end of an endoscope) can provide real-time indication of the medical device’s progress through the patient’s anatomy.

[0126] Robot commands and kinematic data 94 can also be used by the positioning module 95 to provide orientation data 96 for the robotic system. Device pitch and yaw from joint movement commands can be determined during preoperative calibration. During surgical procedures, these calibration measurements can be combined with known insertion depth information to estimate the instrument's orientation. Alternatively, these calculations can be analyzed in conjunction with EM, vision, and / or topology modeling to estimate the medical device's orientation within the network.

[0127] like FIG. 20 As shown, the positioning module 95 can use multiple other input data. For example, although in FIG. 20 Although not shown, the device using shape sensing fibers can provide shape data, which the positioning module 95 can use to determine the position and shape of the device.

[0128] The localization module 95 can use the input data 91-94 in combination. In some cases, such combination can use a probabilistic method, where the localization module 95 assigns confidence weights to the location determined based on each of the input data 91-94. Therefore, in cases where the EM data may be unreliable (e.g., in the presence of EM interference), the confidence of the location determined by the EM data 93 may be reduced, and the localization module 95 may rely more heavily on the visual data 92 and / or robot commands and kinematic data 94.

[0129] As discussed above, the robotic systems discussed in this paper can be designed to combine one or more of the technologies mentioned above. The computer-based control system of a robotic system located in a tower, bed, and / or trolley can store computer program instructions in, for example, a non-transitory computer-readable storage medium (such as a permanent magnetic storage drive, a solid-state drive, etc.). When executed, these computer program instructions enable the system to receive and analyze sensor data and user commands, generate control signals for the entire system, and display navigation and positioning data, such as the instrument's orientation in a global coordinate system and anatomical diagrams.

[0130] 2. Medical Instruments Including Wrist with Hybrid Redirection Surface

[0131] The aforementioned robotic medical systems, as well as other robotic and / or non-robotic medical systems, may utilize medical devices including a wrist with a hybrid redirection surface, as described in this section. As mentioned above, the medical device may include an end effector positioned at the distal end of an elongated shaft. The end effector can be connected to the distal end of the elongated shaft via the wrist. The wrist may be articulate to allow control of the end effector. As mentioned above, the medical device may include one or more traction cables extending through the wrist to the end effector. The one or more traction cables may be actuated (e.g., pulled or tensioned) to articulate the wrist and end effector. As the one or more traction cables extend through the wrist, they may engage with one or more pulleys within the wrist.

[0132] FIG. 21 This is a side view of an embodiment of medical device 200. Medical device 200 may be similar to the medical device described above, for example, referring to... FIGS. 16-18 As shown, the medical device 200 includes an elongated shaft 202 and a handle 208. The elongated shaft 202 extends between a distal end 204 and a proximal end 206. In the illustrated embodiment, an end effector 212 configured as a gripper may be positioned at the distal end 204 of the elongated shaft 202. As shown, the end effector 212 may be connected to the distal end 204 of the elongated shaft 202 via a wrist 210. The wrist 210 may be configured to allow one or more degrees of freedom of the device 200. For example, the wrist 210 may be a two-degree-of-freedom wrist. For example, a two-degree-of-freedom wrist may allow the end effector 212 to pivot or rotate about a pitch axis and a yaw axis.

[0133] exist FIG. 21 In the illustrated embodiment, the instrument 200 includes a handle 208. The handle 208 may be configured to connect to an instrument drive mechanism, for example, as... FIG. 16 and FIG. 17As shown above, the device 200 may include one or more tendons, cables, or traction wires extending along an elongated shaft 202 between the end effector 212 and the handle 208 (e.g., through or on the elongated shaft). The handle 208 may include one or more drive inputs configured to engage a device drive mechanism (see [link to documentation]). FIG. 16 and FIG. 17 One or more drive outputs on the device 200 allow the device drive mechanism to actuate (e.g., tension or pull) a pull line. Actuating the pull line can cause movement of the wrist 210 and / or end effector 212 to allow remote manipulation and control of the end effector 212. For example, in some embodiments, actuation of the pull line can be configured to cause the jaws of the end effector 212 to open and close and / or allow the end effector 212 to rotate about a pitch axis and / or a yaw axis. As described above, the device drive mechanism can be positioned on the robot arm. In some embodiments, the robot arm can be controlled to position, roll, propel, and / or retract the device 200.

[0134] like FIG. 21 As shown, in some embodiments, the elongated shaft 202 extends through the handle 208. In such embodiments, the elongated shaft 202 may be configured to advance or retract relative to the handle 208. In some embodiments, the instrument actuation mechanism is configured to advance or retract the elongated shaft 202 relative to the handle 208. This allows the handle 208 to remain stationary, for example, when the elongated shaft 202 and the end effector 212 are advanced into the patient during the procedure. In some embodiments, the proximal end 206 of the elongated shaft 202 is attached to the handle 208 such that the elongated shaft 202 extends only between the end effector 212 and the handle 208.

[0135] According to one aspect of this disclosure, the redirection surface within the wrist 210 can be configured to change the direction of the pulley so as to guide the pulley between the pulleys. See below for reference. FIG. 22 To describe more comprehensively, some wrists may consist only of “static” redirection surfaces. As used herein, a “static” redirection surface refers to a non-moving or stationary surface formed on or within the wrist to redirect a contact traction wire. For example, a static redirection surface may be a static, stationary, or non-moving wall or channel formed on or within a fork-shaped head of the wrist, along which the traction wire slides as it is redirected.

[0136] In some embodiments, the medical devices described in this section include wrists with hybrid repositioning surfaces (e.g., such as...). FIGS. 23A-23EThe illustrated wrist 1000 includes at least one static redirecting surface and at least one "dynamic" redirecting surface. As used herein, a "dynamic" redirecting surface refers to a moving surface of the wrist that contacts a pull wire to redirect it. For example, a dynamic redirecting surface can be a surface of a rotating pulley of the wrist that redirects a pull wire. Examples of static surfaces and redirecting surfaces will be provided below to more fully illustrate these concepts.

[0137] In some cases, there can be advantages and disadvantages associated with both static redirecting surfaces and dynamic redirecting surfaces. For example, static redirecting surfaces can be considered mechanically simpler because they can include stationary or static surfaces. However, static redirecting surfaces can cause more wear on the pull wires. Because static redirecting surfaces remain stationary as they redirect the pull wires, the pull wires can slide across the static redirecting surfaces. The friction between the pull wires and the static redirecting surfaces can cause wear that can shorten the life of the pull wires. Dynamic redirecting surfaces can reduce or eliminate the wear issues that can be associated with static redirecting surfaces. This can be because dynamic redirecting surfaces rotate or otherwise move with the motion of the pull wires, reducing the friction between them. This can extend the life of the pull wires. However, in some cases, dynamic redirecting surfaces can be considered mechanically more complex. For example, dynamic redirecting surfaces can require additional components (as compared to static redirecting surfaces). Furthermore, it can be difficult to provide the additional components of dynamic redirecting surfaces in a small or compact form factor, which is often desirable for medical instruments associated with, for example, laparoscopic surgery.

[0138] The medical instruments described in this section that include a wrist with hybrid redirecting surfaces can include one or more static redirecting surfaces and one or more dynamic redirecting surfaces in a manner that can increase the advantages associated with each while minimizing the disadvantages. For example, in some embodiments, dynamic redirecting surfaces are implemented to redirect pull wire segments associated with closing motions (e.g., clamping motions) of an end effector, while static redirecting surfaces are implemented to redirect pull wire segments associated with opening motions (e.g., non-clamping motions) of the end effector. Because closing an end effector often requires greater force, tension, or load (or generally exerts more force in the closing direction), the pull wire segments associated with closing motions of the end effector can experience greater forces and be exposed to more wear. By using dynamic redirecting surfaces to redirect these pull wire segments, wear on the pull wires can be reduced, extending the life of the pull wires. Opening the end effector can require less force, so the pull wire segments associated with opening motions of the end effector can experience less force and less wear. Thus, it can be advantageous to use static redirecting for these pull wire segments because the use of these static redirecting surfaces can be less mechanically complex.

[0139] Furthermore, the medical devices described in this section that include wrists with hybrid redirection surfaces may include novel structural architectures that allow both static and dynamic redirection surfaces to be packaged in a minimal form factor suitable for laparoscopic or endoscopic medical devices, and may provide one or more additional advantages as further described below. Reference will now be made to... FIGS. 21-26B The features and advantages of the medical device of this application, including a wrist with a hybrid repositioning surface, are described in more detail below.

[0140] To help understand medical devices with wrists that include hybrid repositioning surfaces (such as, for example) FIGS. 23A-23E As shown in the image), first refer to FIG. 22 Describe a medical device having a wrist that consists only of a statically repositioned surface. FIG. 22 A perspective view of the distal end of a medical device 300, including a wrist portion having only a static repositioning surface, is shown.

[0141] As shown, the wrist 310 is positioned at the distal end 304 of the elongated shaft 302 of the medical device 300. The wrist 310 includes a proximal fork head 322 and a distal fork head 324. In the illustrated embodiment, the distal fork head 324 is shown as transparent to show features formed within it. The fork head 322 is connected to the distal end 304 of the elongated shaft 302. The distal fork head 324 is pivotally connected to the fork head 322. For example, a proximal axle 366 may extend through and connect to the distal fork head 322, such that the distal fork head 324 is rotatable relative to the proximal fork head 322 about the longitudinal axis of the proximal axle 366. This allows the wrist 310 to move or perform articulation in a first degree of freedom. The first degree of freedom may be pitch.

[0142] like FIG. 22 As shown, multiple pulleys 340 may also be mounted on the proximal axle 366 at the joint between the proximal fork head 322 and the distal fork head 324. In the illustrated embodiment, four proximal pulleys 340 are included. As will be described in more detail below, multiple pull cables (not shown) may engage with and be actuated to control the pitch of the medical device 300.

[0143] End effector 312 is connected to distal fork head 324. In the illustrated embodiment, end effector 312 includes a clamping member having a first jaw member 356 and a second jaw member 358. Other types of end effectors, such as grippers, cutters, scissors, etc., may also be used. In the illustrated embodiment, each of the jaw members 356, 358 is connected to one of the two distal pulleys 350 that is connected to the distal fork head 324. FIG. 24An exemplary jaw member is shown alone in FIG. 27. As shown, a distal wheel axle 367 can extend through the distal yoke 324, and a distal pulley 350 can be rotatably mounted on the distal wheel axle 367. The distal pulley 350 can thus rotate relative to the distal yoke 324 to allow the end effector 312 to rotate in a second degree of freedom. The second degree of freedom can be yaw. Additionally, a third degree of freedom can be provided if the distal pulley 350 is rotated in the opposite direction. The third degree of freedom can open and close the end effector 312. A plurality of pull wires (not shown) can be engaged with the distal pulley 350 and actuated to control the pitch of the medical instrument 300 and to open and close the end effector 312.

[0144] As FIG. 22 shown, the proximal wheel axle 366 and the distal wheel axle 367 can be oriented along axes that extend in different directions. In the illustrated embodiment, the proximal wheel axle 366 extends along a pitch axis and the distal wheel axle 367 extends along a yaw axis. The pitch axis and the yaw axis can be orthogonal to each other. Thus, the proximal pulley 340 and the distal pulley 350 rotate in different planes, which in the illustrated embodiment are orthogonal to each other. As a plurality of pull wires are engaged with both the proximal pulley 340 and the distal pulley 350, the plurality of pull wires needs to be reoriented between the proximal pulley 340 and the distal pulley 350. For example, the plurality of pull wires needs to be reoriented from the plane of the proximal pulley 340 to the plane of the distal pulley 350. To facilitate the reorientation of the pull wires, the distal yoke 324 includes a plurality of static reorientation surfaces 326 that are configured to reorient the plurality of pull wires. As shown, the static reorientation surfaces 326 include angled or curved surfaces formed in the distal yoke 324 for reorienting the plurality of pull wires. As a plurality of pull wire segments of the plurality of pull wires are actuated, the pull wire segments slide across the static reorientation surfaces 326 as they are reoriented.

[0145] The static reorientation surfaces 326 can be provided to change the direction of one or more pull wire segments of the plurality of pull wires. In FIG. 22 the medical instrument 300 of FIG. 27, the wrist 310 includes the distal yoke 324 with only static reorientation surfaces 326 in the form of one or more angled, curved, or sloped surfaces. While such static reorientation surfaces 326 can successfully reorient the pull wires, the sliding of the pull wire segments against the static reorientation surfaces 326 can cause external wear of the pull wires due to increased friction, thereby shortening the life of the pull wires. Additionally, the space available for the static reorientation surfaces 326 between the proximal pulley 340 and the distal pulley 350 can be limited.

[0146] FIG. 22 The medical instrument 300 shown in FIG. 27 can be considered an N+1 medical instrument because it uses four pull wire segments to achieve three degrees of freedom (pitch, yaw, and instrument actuation).

[0147] In comparison to the medical instrument 300 of FIG. 22 FIGS. 23A-23E A medical instrument 400 is shown having a wrist comprising a hybrid redirecting surface. That is, FIGS. 23A-23E The wrist of the medical instrument 400 comprises both static redirecting surfaces and dynamic redirecting surfaces. The use of a hybrid redirecting surface within the wrist can mitigate wear on the pull wires. While FIGS. 23A-23E An example is shown configured as a grasper instrument, but those skilled in the art will appreciate that the use of a hybrid redirecting surface is not limited to simply grasping instruments, but can be applied to many other instruments (e.g., cauterizing instruments, cutting instruments, suction and irrigation instruments, etc.).

[0148] As will be described below, the medical instrument 400 comprises both static redirecting surfaces and dynamic redirecting surfaces to achieve both the packaging benefits of static redirecting surfaces and the performance and longevity improvements of dynamic redirecting surfaces. As described above, during operation, the pull wire segments associated with the closed end effector can have substantially more load than the pull wire segments associated with the open end effector. Thus, the majority of the benefits of dynamic redirecting surfaces can be achieved by engaging the dynamic redirecting surfaces with the pull segments associated with the closed end effector. At the same time, static redirecting surfaces can be used to redirect the pull wire segments that experience less load and tension.

[0149] The structure of the medical instrument 400 will be described with reference to FIGS. 23A-23E . FIG. 23A is a perspective view of the medical instrument 400. FIG. 23B is another perspective view of the medical instrument 400 shown with the distal prong 424 shown as transparent in order to see certain internal features. FIG. 23C is a first side view of the medical instrument 400. FIG. 23D is a second side view of the medical instrument 400. FIG. 23E is a top view of the proximal prong 422 of the medical instrument 400.

[0150] As shown in FIG. 23A , in the illustrated embodiment, the medical instrument 400 comprises an elongated shaft 402 extending to a distal end 404. In FIG. 23A ​Only the distal end 404 of the elongated shaft 402 can be visible, but the elongated shaft 402 can be similar to the elongated shaft 202 of the medical instrument 200 described above. A wrist 410 is positioned at the distal end 404 of the elongated shaft 402. The wrist 410 is also connected to an end effector 412, which, as described above, is a grasper in the illustrated embodiment. As will be described in greater detail below, the wrist 410 can be configured to allow articulation with two degrees of freedom. In the example described below, the two degrees of freedom are pitch and yaw. Additionally, the end effector 412 can open and close to provide an additional degree of freedom for the medical instrument 400. The medical instrument 400 can be considered an N+1 medical instrument because it uses four pull wire segments to achieve three degrees of freedom (pitch, yaw, and instrument actuation).

[0151] In the illustrated embodiment, the wrist 410 includes a proximal clevis 422 and a distal clevis 424. The proximal clevis 422 can be attached to the distal end 404 of the elongated shaft 402. The distal clevis 424 can be pivotally connected to the proximal clevis 422. In the illustrated embodiment, the distal clevis 424 is pivotally attached to the proximal clevis 422 by an axle 466 that extends through the distal clevis 424 and the proximal clevis 422. The distal clevis 424 can rotate relative to the proximal clevis 422 about an axis of the axle 466. The rotation of the distal clevis 424 relative to the proximal clevis 422 about the axis of the axle 466 can provide one of the degrees of freedom of the wrist 410. For example, this degree of freedom can be pitch. Thus, the axle 466 can be considered a pitch axle, and the axis of the axle 466 can be considered a pitch axis of the wrist 410.

[0152] As FIG. 23C is most clearly seen, the proximal clevis 422 can include a first proximal clevis support leg 474 and a second proximal clevis support leg 476. The axle 466 can extend through the first proximal clevis support leg 474 and the second proximal clevis support leg 476 of the proximal clevis 422. Similarly, the distal clevis 424 can include a first distal clevis support leg 470 and a second distal clevis support leg 472. The axle 466 extends through the first distal clevis support leg 470 and the second distal clevis support leg 472 of the distal clevis 424. As will be described below, in some embodiments, the first proximal clevis support leg 474, the second proximal clevis support leg 476, the first distal clevis support leg 470, and the second distal clevis support leg 472 can be spaced apart in a manner that can provide a favorable architecture for a medical instrument with a wrist having a hybrid redirecting surface.

[0153] As FIGS. 23A-23D shown, the medical instrument 400 includes a plurality of proximal pulleys 440 and a plurality of distal pulleys 450 positioned in the wrist 410. As FIGS. 23A-23CAs most clearly seen, the proximal pulley 440 can be positioned on an axle 466 connecting the proximal fork head 422 and the distal fork head 424. As described above, the axle 466 can be a pitch axle, and therefore, the proximal pulley 440 can also be considered as a pitch pulley 440. In the illustrated embodiment, the proximal pulley 440 includes a first outer proximal pulley 442, a first inner proximal pulley 444, a second outer proximal pulley 446, and a second inner proximal pulley 448. The first outer proximal pulley 442, the first inner proximal pulley 444, the second outer proximal pulley 446, and the second inner proximal pulley 448 can each be positioned on the axle 466 such that they are rotatable about the axle 466. The proximal pulleys 440 each rotate in a pitch plane perpendicular to the axis of the axle 466.

[0154] like FIGS. 23A-23D As shown, the distal pulley 450 can be positioned on the axle 467. The axle 467 can extend through the distal fork head 424 as shown. The axis of the axle 467 can provide a second degree of freedom for the medical device 400. For example, this second degree of freedom can be yaw. Therefore, the axle 467 can be considered as a yaw axle and can provide a yaw axis for the wrist 410. In the illustrated embodiment, the distal pulley 450 includes a first distal pulley 452 and a second distal pulley 454 mounted on the axle 467. Each of the distal pulleys 450 can be configured to rotate in a yaw plane perpendicular to the axis of the axle 467.

[0155] The pitch wheel shaft 466 and the yaw wheel shaft 467 may be oriented at an angle relative to each other. In the illustrated embodiment, the pitch wheel shaft 466 and the yaw wheel shaft 467 are orthogonal. Therefore, the pitch plane and the yaw plane may also be orthogonal to each other.

[0156] The end effector 412 of the medical device 400 may be formed by a first jaw member 456 and a second jaw member 458. The first jaw member 456 may be connected to a first distal pulley 452, and the second jaw member 458 may be connected to a second distal pulley 454. The orientation of the end effector 412 can be controlled by rotating the first distal pulley 452 and the second distal pulley 454 in the same direction about axle 467. For example, the yaw of the end effector 412 can be adjusted by rotating both the first distal pulley 452 and the second distal pulley 454 in the same direction about axle 467. The end effector 412 can be actuated (e.g., opened or closed in the case of the illustrated gripper) by rotating the first distal pulley 452 and the second distal pulley 454 in opposite directions about axle 467. The actuation of the end effector 412 can be considered as a third degree of freedom of the medical device 400.

[0157] The medical device 400 may include multiple tension cables 430, which can be actuated (e.g., tensioned or pulled) to control three degrees of freedom (pitch, yaw, and actuation) of the medical device 400. FIGS. 23A-23D As shown, multiple tension lines 430 engage with a proximal pulley 440 and a distal pulley 450. In the illustrated embodiment, the multiple tension lines 430 include a first tension line segment 432, a second tension line segment 434, a third tension line segment 436, and a fourth tension line segment 438, which travel along various paths through the wrist 410.

[0158] For example, in the illustrated embodiment, a first pull wire segment 432 engages a first outer proximal pulley 442 and a first distal pulley 452. Actuation of the first pull wire segment 432 may be associated with closing the first jaw member 456. A second pull wire segment 434 may engage a first inner proximal pulley 444 and a second distal pulley 454. The second pull wire segment 434 may be associated with opening the second jaw member 458. A third pull wire segment 436 may engage a second outer proximal pulley 446 and a second distal pulley 454. The third pull wire segment 436 may be associated with closing the second jaw member 458. A fourth pull wire segment 438 may engage a second inner proximal pulley 448 and a first distal pulley 452. The fourth pull wire segment 438 may be associated with opening the first jaw member 456.

[0159] As shown, each of the first pull wire segment 432 and the fourth pull wire segment 438 can engage the first distal pulley 452, but engages on the opposite side. Similarly, each of the second pull wire segment 434 and the third pull wire segment 436 can engage the second distal pulley 454, but engages on the opposite side. In the illustrated embodiment, each proximal pulley in the proximal pulleys 440 is engaged by only one pull wire segment. On the same side of the wrist 410, the first pull wire segment 432 engages the first outer proximal pulley 442, and the fourth pull wire segment 438 engages the second inner proximal pulley 448. Similarly, on the same side of the wrist 410, the second pull wire segment 434 engages the first inner proximal pulley 444, and the third pull wire segment 436 engages the second outer proximal pulley 446. At the proximal pulley 440, the first pull line segment 432 and the fourth pull line segment 438 are positioned on the side of the wrist 410 opposite to the second pull line segment 434 and the third pull line segment 436.

[0160] like FIG. 23BMost clearly, the figure shows the distal fork head 424 as transparent, with multiple traction wires 430 redirected between the proximal pulley 440 and the distal pulley 450. To achieve this redirection, the wrist 410 of the device 400 includes a hybrid redirection surface. Specifically, in the illustrated embodiment, the wrist 410 includes a pair of static redirection surfaces and a pair of dynamic redirection surfaces positioned between the proximal pulley 440 and the distal pulley 450. FIG. 23B As shown, the pair of static redirection surfaces includes a first static redirection surface 426 and a second static redirection surface 433. The first static redirection surface 426 and the second static redirection surface 433 may each be an angled or curved surface formed in or on the distal fork head 424. An example is shown in... FIG. 23C The figure shows a static redirection surface 426. The pair of dynamic redirection surfaces includes a first dynamic redirection surface 428 and a second dynamic redirection surface 431. Each of the first dynamic redirection surface 428 and the second dynamic redirection surface 431 may include the surface of a redirection pulley (such as the first redirection pulley 429 and the second redirection pulley 435 shown in the figure).

[0161] Multiple pull wires 430 are redirected by static redirection surfaces 426, 433 and dynamic redirection surfaces 428, 431. In the illustrated embodiment, a first pull wire segment 432 engages a first dynamic redirection surface 428. A second pull wire segment 434 engages a first static redirection surface 426. A third pull wire segment 436 engages a second dynamic redirection surface 431. A fourth pull wire segment 438 engages a second static redirection surface 433.

[0162] Therefore, in this example, the first pull wire segment 432 and the third pull wire segment 436 associated with the closing end actuator 412 are redirected using the dynamic redirection surfaces 428 and 431 of the redirection pulleys 429 and 435, respectively. The second pull wire segment 434 and the fourth pull wire segment 438 associated with the opening end actuator 412 are redirected using the static redirection surfaces 426 and 433, respectively.

[0163] Medical device 400 also includes a shaft redirection pulley 480 positioned within the proximal fork head 422 and / or the elongated shaft 402. The shaft redirection pulley 480 is... FIG. 23E The figure most clearly shows is a top view of the proximal fork head 422. As shown, the shaft redirection pulley 480 includes a first outer shaft redirection pulley 482, a first inner shaft redirection pulley 484, a second outer shaft redirection pulley 486, and a second inner shaft redirection pulley 488. In the illustrated embodiment, the shaft redirection pulleys 480 are in an alternating position. That is, as... FIG. 23EAs shown, the first outer shaft redirect pulley 482 is positioned on a first axis 483 and the first inner shaft redirect pulley 484 is positioned on a second axis 485. The first axis 483 and the second axis 485 are non-coaxial (in the illustrated embodiment). The second inner shaft redirect pulley 488 is positioned on a third axis 489. In the illustrated embodiment, the third axis 489 is coaxial with the second axis 485. The second outer shaft redirect pulley 486 is positioned on a fourth axis 487. In the illustrated embodiment, the fourth axis 487 is non-coaxial with the first axis 483, the second axis 485, or the third axis 489. The proximal prong head 422 also includes a first proximal prong head support wall 492 and a second proximal prong head support wall 494. The first proximal prong head support wall 492 is positioned between the first inner shaft redirect pulley 482 and the first outer shaft redirect pulley 484. The second proximal prong head support wall 494 is positioned between the second inner shaft redirect pulley 486 and the second outer shaft redirect pulley 484. The first proximal prong head support leg 474 and the second proximal prong head support leg 476 are also shown in FIG. 23E

[0164] The structure of the medical instrument 400, which includes hybrid redirect surfaces, can provide several notable features and advantages over other types of medical instruments, such as medical instruments that include only static redirect surfaces (e.g., the medical instrument 100). FIG. 22 For example, for the illustrated embodiment of the medical instrument 400, which is shown as a grasper instrument, during operation, the pull wire segments associated with the closing end effector 412 (the first pull wire segment 432 and the third pull wire segment 436) can have a greater load than the pull wire segments used to open the end effector 412 (the second pull wire segment 434 and the fourth pull wire segment 438). Thus, it can be particularly advantageous for the pull wire segments used to close the end effector 412 to travel along the dynamic redirect surfaces 428, 431 in order to reduce the risk of pull wire wear, while the pull wire segments used to open the end effector 412 travel along the static redirect surfaces 426, 433, as shown. FIG. 23B Because the dynamic redirect surfaces 428, 431 move with the first pull wire segment 432 and the third pull wire segment 436 (as the redirect pulleys 429, 435 rotate), the friction between the dynamic redirect surfaces 428, 431 and the pull wire segments 432, 436 can be reduced as compared to the friction experienced between pull wire segments and static redirect surfaces. As previously mentioned, this can extend the life of the pull wires.

[0165] The structure of the medical instrument 400 can include several features that enable or facilitate the use of hybrid redirect surfaces within the distal prong head 424. First, the distal prong head support legs 470, 472 of the distal prong head 424 can be positioned between an inner proximal pulley and an outer proximal pulley. For example, as shown in FIG. 34, the first distal prong head support leg 470 is positioned between the inner proximal pulley 460 and the outer proximal pulley 462. The second distal prong head support leg 472 is also positioned between the inner proximal pulley 460 and the outer proximal pulley 462.​FIG. 23D As shown, the first distal prong support leg 470 is positioned between the first outer proximal pulley 442 and the first inner proximal pulley 444. Similarly, the second distal prong support leg 472 is positioned between the second outer proximal pulley 446 and the second inner proximal pulley 448. This arrangement or architecture provides a certain spacing distance between the static redirecting surfaces 426, 433 and the dynamic redirecting surfaces 428, 431 (e.g., redirecting pulleys 429, 435). This distance can provide a gap and sufficient space for mounting the redirecting pulleys 429, 435 and for the adjacent pull wire segments to pass through without interference. This is most clearly seen in FIG. 23D Because the first distal prong support leg 470 is positioned between the first outer proximal pulley 442 and the first inner proximal pulley 444, the third pull wire segment 446 has extra space to cross behind the first redirecting pulley 429. In addition, this configuration can allow the axle of the redirecting pulley 429 to be located on the outside of the distal prong support leg 470, such that it does not need to cut through the distal prong support leg 470 to accommodate the axle.

[0166] Second, the dynamic redirecting pulleys 429, 432 can be sized such that they can span to the distal pulley 450. This can enable larger redirecting pulleys 429, 432 to be fitted within the distal prong 424, which can extend the useful life of the pull wire segments that travel on them. Larger dynamic redirecting surfaces (e.g., redirecting pulleys) can generally result in better life performance. Thus, it is advantageous to include as large a redirecting pulley as possible within the limited space between the distal and proximal pulleys. This is shown in FIG. 23D The redirecting cable 439 is large enough such that the pull wire segment 432 spans from the first side 462 to the second side 464 (across the plane 460) to the first distal pulley 452 located on the opposite side of the pull wire segment 432 from where it engages the first outer proximal pulley 431. In some embodiments, in order to accommodate larger dynamic redirecting pulleys 429, the static redirecting surfaces 426 are designed to pass behind the pulleys 429 without crossing (see FIG. 23C ), which is enabled by the extra space provided by the distal prong support legs (discussed above).

[0167] Third, in the illustrated embodiment, the outer axle redirecting pulleys 482, 486 in the proximal prong 422 do not share a common axis with the inner axle redirecting pulleys 484, 488 in the proximal prong 422. It is noted that the axle redirecting pulleys 480 (see FIG. 23EAll of them provide dynamic redirection surfaces. This is possible because there may be more space within the proximal fork head 422 to accommodate the shaft redirection pulley 480. As mentioned above, a larger dynamic redirection surface (e.g., redirection pulley) generally results in better lifespan performance. In some cases, staggering the shaft redirection pulleys 480 allows for the use of larger pulleys. Furthermore, adding distal fork head support legs 470, 472 between the inner and outer proximal pulleys 440 pushes out the positions of corresponding shaft redirection pulleys 480 located in the shaft 402 of the medical device 400. With the outer shaft redirection pulleys 482, 486 pushed out, less space is available for assembling multiple (e.g., four) shaft redirection pulleys 480 along a common axis. While the size of one or more proximal redirection pulleys 480 can be reduced, this may reduce the beneficial effects on lifespan and performance. Therefore, in the illustrated embodiment, the proximal redirection pulley 480 is sized such that the cable is kept within the inner diameter of the instrument shaft 402, while the edges of the outer shaft redirection pulleys 482, 486 are located exactly within the outer diameter of the instrument shaft 402.

[0168] The three features described in the preceding paragraphs can be used with a hybrid repositioning surface to provide a favorable wrist structure. In some implementations, it is not necessary to include all three features.

[0169] FIG. 24 An embodiment of the first distal pulley 452 and the attached jaw member 456, as well as the first pull wire segment 432 and the fourth pull wire segment 438, is shown. FIG. 24 It also indicates a second distal pulley 454 having associated second pull wire segment 434 and third pull wire segment 436. As described above, the first pull wire segment 432 is associated with the opening jaw member 456, and the fourth pull wire segment 438 is associated with the closing jaw member 456. In some embodiments, the two pull wire segments 432, 438 may be part of the same pull wire, or each part of different pull wires sharing a crimping element at the jaw member 456.

[0170] FIG. 25A and FIG. 25B An alternative embodiment of the distal fork head 522, including a hybrid redirection surface, is shown. In this embodiment, the dynamic redirection surface 529 (configured as pulleys) is configured to redirect the pull line 530 along a path spanning from the distal pitch pulley 540 to the opposite side of the yaw pulley 550. In this embodiment, the proximal pitch pulleys 540 can be all centered and aligned, which allows for their larger size because they are all centered.

[0171] FIG. 26A and FIG. 26BA view of another embodiment of a distal prong head 622 is provided. In this embodiment, the static redirecting surface is replaced by a dynamic redirecting surface. Thus, the distal prong head 622 includes four redirecting pulleys 629. In this case, the instrument would not be considered to have a hybrid redirecting surface as it includes only one type of redirecting surface (dynamic).

[0172] 3. Implementation Systems and Terminology .

[0173] The specific implementations disclosed herein provide systems, methods, and apparatuses for medical instruments including a wrist having a hybrid redirecting surface.

[0174] It should be noted that as used herein the terms "couple," "coupling," "coupled," or other variations of the word couple can indicate either an indirect connection or a direct connection. For example, if a first component is "coupled" to a second component, then the first component can be either indirectly connected to the second component via another component or directly connected to the second component.

[0175] Phrases referencing specific computer-implemented processes / functions described herein can be stored as one or more instructions on a processor-readable or computer-readable medium. The term "computer-readable medium" refers to any available medium that can be accessed by a computer or processor. By way of example, and not limitation, such a medium can comprise random access memory (RAM), read-only memory (ROM), electrically erasable programmable read-only memory (EEPROM), flash memory, compact disc read-only memory (CD-ROM) or other optical disk storage, magnetic disk storage or other magnetic storage devices, or any other medium that can be used to store desired program code in the form of instructions or data structures and that can be accessed by a computer. It should be noted that a computer-readable medium can be tangible and non-transitory. The term "code" as used herein can refer to software, instructions, code or data that is executable by a computing device or processor.

[0176] The methods disclosed herein include one or more steps or actions for achieving the methods. The method steps and / or actions can be interchanged with one another without departing from the scope of the claims. In other words, unless a specific order of steps or actions is required for proper operation of the method being described, the order and / or use of specific steps and / or actions can be modified without departing from the scope of the claims.

[0177] As used herein, the term “plurality” denotes two or more. For example, a plurality of components indicates two or more components. The term “determining” encompasses a wide variety of actions and, therefore, “determining” can include calculating, computing, processing, deriving, investigating, looking up (e.g., looking up in a table, a database or another data structure), ascertaining and the like. Additionally, “determining” can include receiving (e.g., receiving information), accessing (e.g., accessing data in a memory) and the like. Additionally, “determining” can include resolving, selecting, choosing, establishing and the like.

[0178] The phrase “based on” is not meant to limit to “based only on” unless specifically indicated. In other words, the phrase “based on” describes both “based only on” and “based at least on.”

[0179] The foregoing detailed description of the implementations has been presented for purposes of illustration and description. Various modifications to the implementations can be apparent to those skilled in the art from this detailed description, and it is intended that the scope of the application be defined by the claims appended hereto. For example, it should be understood that the ordinary technician will be able to employ corresponding changes in structure detailed herein, such as equivalent means for performing the same functions, equivalent ways for going about the same acts, and equivalent ways for arriving at the same results. Therefore, the disclosed implementations are to be considered merely illustrative and the scope of the application is indicated by the appended claims, rather than the foregoing description, and all changes that come within the meaning of the claims are intended to be embraced therein.

Claims

1. A medical instrument comprising: (a) a shaft extending between a proximal end and a distal end; (b) a wrist positioned at the distal end of the shaft, the wrist comprising: (i) a proximal clevis connected to the distal end of the shaft and comprising a first proximal pulley configured to rotate in a first plane, (ii) a distal clevis pivotally connected to the proximal clevis and comprising a first distal pulley configured to rotate in a second plane, wherein the second plane is orthogonal to the first plane, (iii) a static redirecting surface, wherein the static redirecting surface is positioned between the first proximal pulley and the first distal pulley, (iv) a first redirecting pulley comprising a dynamic redirecting surface, (v) an axle pivotally connecting the proximal clevis to the distal clevis, wherein the first proximal pulley is mounted on the axle; and (vi) a second proximal pulley mounted on the axle; wherein the axle extends through a first support leg of the distal clevis, and wherein the first support leg of the distal clevis is positioned between the first proximal pulley and the second proximal pulley; (c) an end effector connected to the distal clevis of the wrist; and (d) a plurality of pull wires extending through the shaft and the wrist and into engagement with the end effector, wherein: (i) the plurality of pull wires are configured to actuate the wrist and the end effector, (ii) a first pull wire segment of the plurality of pull wires engages the static redirecting surface, and (iii) a second pull wire segment of the plurality of pull wires engages the dynamic redirecting surface, wherein the static redirecting surface receives the first pull wire segment thereon such that the first pull wire segment extends from the first proximal pulley, across the static redirecting surface, and to the first distal pulley to direct the first pull wire segment from the proximal clevis to the distal clevis.

2. The medical instrument of claim 1, wherein the static redirecting surface and the dynamic redirecting surface are located on the distal clevis of the wrist, wherein the distal clevis comprises a base, and wherein the static redirecting surface is positioned distally relative to the base of the distal clevis.

3. The medical instrument of claim 1, wherein the first pull wire segment engages the first proximal pulley, the static redirecting surface, and the first distal pulley.

4. The medical instrument of claim 1, wherein the first proximal pulley is positioned at a proximal end of the distal clevis and the first distal pulley is positioned at a distal end of the distal clevis.

5. The medical instrument of claim 1, wherein: the second proximal pulley is configured to rotate on a first side of the medical device; wherein the second pull wire segment engages a second distal pulley on a second side of the medical device, wherein the second distal pulley is oriented orthogonally relative to the second proximal and distal pulleys; and wherein the first redirecting pulley is positioned between the second proximal pulley and the second distal pulley.

6. The medical device of claim 1, wherein: the end effector comprises at least one jaw; wherein actuation of the first pull wire segment causes the at least one jaw to open; and wherein actuation of the second pull wire segment causes the at least one jaw to close.

7. The medical device of claim 1, wherein the wrist further comprises: (i) a third proximal pulley mounted on the axle; and (ii) a fourth proximal pulley mounted on the axle; wherein the axle extends through a second support leg of the distal clevis, wherein the second support leg of the distal clevis is positioned between the third proximal pulley and the fourth proximal pulley; and wherein the third proximal pulley and the fourth proximal pulley are positioned between the first support leg and the second support leg of the distal clevis.

8. The medical device of claim 7, wherein: wherein the proximal clevis comprises a third support leg and a fourth support leg; wherein the axle extends through the third support leg and the fourth support leg of the proximal clevis; and wherein the second proximal pulley and the fourth proximal pulley, the first support leg and the second support leg of the distal clevis, and the first proximal pulley and the third proximal pulley are positioned between the first support leg and the second support leg of the proximal clevis.

9. The medical device of claim 1, further comprising: (a) the first redirecting pulley is positioned in the distal clevis and is configured to rotate about a first axis; and (b) a second redirecting pulley positioned in the distal clevis and is configured to rotate about a second axis.

10. The medical device of claim 1, wherein the end effector comprises a clamp of a bipolar energy device.

11. The medical instrument of claim 1, wherein the plurality of pull wires includes n one or more of the plurality of pull wires, and wherein actuation of one or more of the n plurality of pull wires facilitates control of the medical instrument over n+1 one degree of freedom.

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