System and method for controlling a surgical instrument

Abstract

The present application relates to systems and methods for controlling a surgical instrument. A teleoperational medical system includes an input device and a manipulator configured to couple to and move an instrument. The system also includes a control system including one or more processors. In response to a determination that the instrument is inserted into an instrument workspace in a direction corresponding to a field of view of the workspace, the control system is configured to map movement of the input device to movement of the instrument according to a first mapping. In response to a determination that the instrument is inserted into the instrument workspace in a direction that does not correspond to the field of view, the control system is configured to map movement of the input device to movement of the instrument according to a second mapping. The second mapping includes an inversion of the first mapping with respect to at least one direction of motion of the instrument.

Description

[0001] This application is a divisional application. The original application was filed on July 14, 2017, with application number 201780028494.6 and invention title "System and method for controlling surgical instruments".

[0002] Related applications

[0003] This patent application claims priority and filing date benefit to U.S. Provisional Patent Application 62 / 362,406, filed July 14, 2016, entitled “SYSTEMS AND METHODS FORCONTROLLING A SURGICAL INSTRUMENT,” which is incorporated herein by reference in its entirety. Technical Field

[0004] This disclosure relates to robotic systems and methods of use, including surgical systems and methods for minimally invasive remote surgical procedures, and systems and methods for controlling instruments for uterine manipulation. Background Technology

[0005] Minimally invasive medical techniques aim to reduce the amount of external tissue damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and harmful side effects. Minimally invasive telesurgical systems have been developed to increase surgeon flexibility and avoid some of the limitations of traditional minimally invasive techniques. In remote surgery, surgeons manipulate surgical instruments using some form of remote control (e.g., servo mechanisms), rather than directly holding and moving the instruments with their hands. In telesurgical systems, images of the surgical site are provided to the surgeon at a surgical workstation. While viewing two-dimensional or three-dimensional images of the surgical site on a monitor, the surgeon performs surgical procedures on the patient by manipulating a master control unit, which in turn controls the movement of servo-mechanically operated instruments.

[0006] In robot-assisted remote surgery, surgeons typically operate a master controller to control the movement of surgical instruments at the surgical site from a location remote from the patient (e.g., across the operating room, in a different room, or in a completely different building). The master controller usually includes one or more manual input devices, such as handheld wrist-mounted universal joints, joysticks, exoskeleton gloves, etc., operatively coupled to the surgical instruments, which are releasably coupled to patient-side "slave" surgical manipulators. The master's configuration and movement control the position, orientation, and articulation of the instruments at the surgical site via the patient-side "slave" surgical manipulators. Slaves are electromechanical components that include multiple arms, joints, connectors, servo motors, etc., connected together to support and control the surgical instruments. During surgical procedures, surgical instruments (including endoscopes) may be directly introduced into an open surgical site or, more generally, introduced into a body cavity via cannulation.

[0007] In minimally invasive surgical procedures, surgical instruments controlled by surgical manipulators can be introduced into the body cavity through a single surgical incision site on the patient's body or through multiple closely spaced incision sites. For some minimally invasive procedures, surgical instruments (especially surgical aids such as probes, tissue manipulators, and retractors) can also be introduced into the surgical workspace through more distant surgical incisions or natural orifices. Improved systems and methods are needed for the installation and control of these surgical instruments.

[0008] The instruments, systems, and methods described herein may be used for non-medical purposes, including industrial applications, general robotic uses, manipulation of non-tissue workpieces, and / or improvements in the beauty industry. Other non-surgical uses include for the removal of tissue from human or animal anatomy (without returning the human or animal anatomy) or human or animal cadavers. Summary of the Invention

[0009] The embodiments of the present invention are summarized by the appended claims.

[0010] In one embodiment, the remotely operated medical system includes an input device and a manipulator configured to couple with and move an instrument. The system also includes a control system comprising one or more processors. In response to determination that the instrument is inserted into an instrument workspace in an orientation corresponding to the field of view of the workspace, the control system is configured to map movement of the input device to movement of the instrument according to a first mapping. In response to determination that the instrument is inserted into the instrument workspace in an orientation not corresponding to the field of view, the control system is configured to map movement of the input device to movement of the instrument according to a second mapping. The second mapping includes an inversion of the first mapping with respect to at least one direction of movement of the instrument.

[0011] In another embodiment, the method includes generating a master control signal based on movement of a master controller in the master workspace, and determining the field-of-view orientation of an imaging device in the instrument workspace. The method further includes determining whether a slave device orientation of a slave device in the instrument workspace corresponds to or does not correspond to the field-of-view orientation. In response to the determination that the slave device orientation corresponds to the field-of-view orientation, the method includes mapping movement of the master controller to movement of the slave device according to a first mapping, and generating a slave device control signal for movement of the slave device in the instrument workspace based on the first mapping. In response to the determination that the slave device orientation does not correspond to the field-of-view orientation, the method includes mapping movement of the master controller to movement of the slave device according to a second mapping, and generating a slave device control signal for movement of the slave device in the instrument workspace based on the second mapping. The second mapping includes an inversion of the first mapping with respect to at least one direction of movement of the slave device.

[0012] In another embodiment, the remotely operated instrument system includes a master control input device in a master control workspace, an actuated instrument end effector in the instrument workspace, and an actuated tissue probe in the instrument workspace. A method of operating the remotely operated instrument system includes generating a set of master control signals in response to movement of the master control input device, and generating a first mapping in response to the set of master control signals. The first mapping maps movement of the master control input device to movement of the instrument end effector in the instrument workspace. In response to the set of master control signals, the method further includes generating a second mapping. The second mapping maps movement of the master control input device to movement of the actuated tissue probe in the instrument workspace. In response to the master control input device having a determination of control over the actuated instrument end effector, the method further includes generating a set of instrument control signals utilizing the first mapping. In response to the master control input device having a determination of control over the actuated tissue probe, the method includes generating a set of instrument control signals utilizing the second mapping. The second mapping includes an inversion of the first mapping with respect to at least one direction of movement of the actuated tissue probe. Attached Figure Description

[0013] The aspects of this disclosure are most fully understood by reading the following detailed description in conjunction with the accompanying drawings. It should be emphasized that, according to standard industry practice, the various features are not drawn to scale. In fact, the dimensions of the various features may be arbitrarily increased or decreased for clarity of explanation. Furthermore, reference numerals and / or letters may be repeated in various instances of this disclosure. Such repetition is for the purpose of simplicity and clarity and does not in itself indicate a relationship between the various embodiments and / or configurations discussed.

[0014] Figure 1 This is an illustrative description of a remote operating system according to embodiments of the present disclosure.

[0015] Figure 2This is a front elevation view of a patient-side trolley including three patient-side manipulators and an endoscope manipulator according to one embodiment of the present disclosure.

[0016] Figure 3 This is a front view of a surgeon's console in a remotely operated surgical system according to one embodiment of the present disclosure.

[0017] Figure 4 This is a perspective view of a patient-side manipulator arm with mounted surgical instruments according to one embodiment of the present disclosure.

[0018] Figure 5 This is an exploded schematic diagram of a uterine dissector, cannula, and surgical manipulator according to one embodiment of the present disclosure.

[0019] Figure 6 This is an exploded schematic diagram of a uterine dissector, cannula, and surgical manipulator according to a second embodiment of the present disclosure.

[0020] Figure 7 This is an exploded schematic diagram of a uterine dissector, cannula, and surgical manipulator according to a third embodiment of the present disclosure.

[0021] Figure 8 This is a side view of the tool fastener used with the curved cannula.

[0022] Figure 9 Is with Figure 8 A side view of a uterine dissector used with tools, fasteners, and curved cannulas.

[0023] Figure 10 This is a schematic diagram of a surgeon's console relative to a three-dimensional Cartesian coordinate reference system in the controller's workspace. The Cartesian coordinate reference frame shown in the figure has a Y-axis perpendicular to and extending from the page plane, indicated by a solid dot at the center of the reference frame symbol. This notation convention is used in all subsequent figures.

[0024] Figure 11 This is a schematic diagram of a surgical instrument (including an endoscope) relative to a surgical three-dimensional Cartesian coordinate reference system in the instrument workspace.

[0025] Figure 12 This is a view of a dissector placed inside a body cavity.

[0026] Figure 13 It is the process of controlling surgical instruments, such as dissectors, using inverted mapping technology.

[0027] Figure 14This is an endoscopic user view of the instrument workspace, in which the uterine dissector instrument (shown in dashed lines to indicate that it is obscured from the view) is in a first position relative to the tissue segment. In this view, the uterine dissector instrument is posterior to the tissue and cannot be directly visualized through the endoscope.

[0028] Figure 15 It is observed from the probe frame side. Figure 14 A view of the instrument workspace, with the uterine dissector instrument in the first position.

[0029] Figure 16 This is an endoscopic user view of the instrument workspace, where the uterine dissector instrument (shown in dashed lines) is in a second position relative to the tissue segment.

[0030] Figure 17 It is observed from the probe frame side. Figure 16 A view of the instrument workspace, with the uterine dissector instrument in the second position.

[0031] Figure 18 This is an endoscopic user view of the instrument workspace, in which the uterine dissector instrument (shown in dashed lines) is in the third position relative to the tissue segment.

[0032] Figure 19 It is observed from the probe frame side. Figure 18 A view of the instrument workspace, with the uterine dissector instrument in the third position.

[0033] Figure 20 This is an endoscopic user view of the instrument workspace, where the uterine dissector instrument (shown in dashed lines) is in the fourth position relative to the tissue segment.

[0034] Figure 21 It is observed from the probe frame side. Figure 20 A view of the instrument workspace, with the uterine dissector instrument in the fourth position.

[0035] Figure 22 This is a schematic diagram of a stand-alone slave manipulator with an installed uterine dissector instrument.

[0036] Figure 23 This is a schematic diagram of a bed-mounted slave controller with an installed uterine dissector instrument.

[0037] Figure 24 This is a side view of an auxiliary medical device according to an embodiment of the present disclosure.

[0038] Figure 25 yes Figure 24 Rear view of an auxiliary medical device.

[0039] Figure 26 yes Figure 24 Front view of an assistive medical device.

[0040] Figure 27 This is a side view of an auxiliary medical device according to another embodiment of the present disclosure.

[0041] Figure 28 yes Figure 27 Front view of an assistive medical device.

[0042] Figure 29 This is a schematic diagram of an auxiliary medical device having a connector assembly and a force transmission assembly according to one embodiment of the present disclosure.

[0043] Figure 30 This is a schematic diagram of an auxiliary medical device having a connector assembly and a force transmission assembly according to another embodiment of the present disclosure.

[0044] Figure 31 This is a schematic diagram of an auxiliary medical device having a connector assembly and a force transmission assembly according to another embodiment of the present disclosure.

[0045] Figure 32 Examples include assistive medical devices with passive lighting sources.

[0046] Figure 33 Examples include a colpotomizer cup with a passive lighting source.

[0047] Figure 34 Examples used in medical procedures Figure 33 Vaginal incision cup. Detailed Implementation

[0048] In the following detailed description of embodiments of the invention, numerous specific details are set forth to provide a thorough understanding of the disclosed embodiments. However, it will be apparent to those skilled in the art that embodiments of this disclosure may be practiced without these specific details. In other instances, well-known methods, procedures, components, and circuits have not been described in detail so as not to unnecessarily obscure aspects of embodiments of the invention.

[0049] Refer to the attached diagram. Figure 1The remote operating system is generally indicated by reference numeral 100. The remote-operated surgical system 100 includes a master console 102, also called a master console or surgeon's console, for inputting surgical procedures; and a slave manipulator 104, also called a patient-side manipulator (PSM), for remotely manipulating surgical instruments at the surgical site within the patient's body. The remote-operated surgical system 100 is used to perform minimally invasive remote-operated surgery. One example of a remote-operated surgical system that can be used to implement the systems and techniques described in this disclosure is a device manufactured by Intuitive Surgical, Inc. of Sunnyvale, California. Surgical system. In one implementation, the slave manipulator can be a stand-alone unit (see...). Figure 2 In an alternative implementation, the slave manipulator may be mounted to other equipment in the surgical arena, including, for example, an operating table (see...). Figure 23 In another alternative embodiment, the slave actuator may include freestanding and bed-mounted components.

[0050] The remote-operated surgical system 100 also includes an image capture system 106, which includes an image capture device (such as an endoscope) and associated image processing hardware and software. The remote-operated surgical system 100 also includes a control system 108, which is operatively connected to the sensors, motors, actuators, components of the master console 102, components of the slave manipulator 104, and the image capture system 106.

[0051] System 100 is used by a system operator (generally, a surgeon) performing minimally invasive surgical procedures on a patient. The system operator views images captured by image capture system 106 and presented on main console 102 for observation. In response to input commands from the surgeon, control system 108 implements servomechanical movement of surgical instruments coupled to remotely operated slave manipulators 104.

[0052] The control system 108 includes at least one processor, and generally multiple processors, for implementing control between the master controller 102, the slave controller 104, and the image capture system 106. The control system 108 also includes software programmed to implement instructions of some or all of the methods described herein. Although the control system 108... Figure 1The simplified schematic is shown as a single block, but the system may include multiple data processing loops (e.g., on the surgeon's console 102 and / or on the slave manipulator system 104), wherein at least some processing is optionally performed near the input device, some near the manipulator, etc. Any of a variety of centralized or distributed data processing architectures may be employed. Similarly, the programming code may execute as multiple separate programs or subroutines, or may be integrated into multiple other aspects of the remote operating system described herein. In one embodiment, the control system 108 may support wireless communication protocols such as Bluetooth, IrDA, HomeRF, IEEE 802.11, DECT, and Wireless Telemetry.

[0053] Figure 2 This is a front elevation view of a patient-side manipulator 104 according to one embodiment of a remotely operated surgical system 100. The patient-side manipulator 104 includes a base 120 situated on the floor, a support column 122 mounted on the base 120, and several arms supporting surgical instruments (including portions of an image capture system 106). Figure 2 As shown, arms 124a and 124b are instrument arms for supporting and moving surgical instruments used to manipulate tissues, and arm 126 is a camera arm for supporting and moving an endoscope. Figure 2 An optional third instrument arm 124c is also shown, which is supported on the back side of the support tower 122 and can be positioned as needed to the left or right of the patient-side manipulator to perform surgical procedures. Figure 2 Interchangeable surgical instruments 128a, 128b, and 128c are further shown—mounted on instrument arms 124a, 124b, and 124c, respectively—and an endoscope 130 is shown mounted on a camera arm 126. Those skilled in the art will understand that the arms supporting the instruments and camera can also be supported by a base platform (fixed or movable) mounted to a ceiling or wall, or in some cases to another piece of equipment (e.g., an operating table) in the operating room. Similarly, it will be understood that two or more separate bases can be used (e.g., one base supporting one arm). Surgical instruments 128a and 128b include end effectors 129a and 129b, respectively. (See also...) Figure 11 )

[0054] Figure 3This is a front elevation view of the main console 102 component according to one embodiment of a remotely operated surgical system 100. The main console 102 is equipped with multiple master tool manipulators (MTMs) 132a, 132b on the left and right sides, which are kinematic chains for controlling surgical tools, including endoscopes and various cannulas. MTM 132 may be simply referred to as the "master," and its associated arm 124 and surgical instruments 128 may be simply referred to as the "slave." The surgeon grasps the gripping components 134a, 134b on each MTM 132—generally with the thumb and forefinger—and can move the gripping components to various positions and orientations. Each MTM 132a, 132b will generally allow movement within the master workspace with multiple degrees of freedom, generally six degrees of freedom, three rotational degrees of freedom, and three translational degrees of freedom.

[0055] When the tool control mode is selected, each MTM 132 is coupled to control the corresponding instrument arm 124 of the patient-side manipulator 104. For example, the left MTM 132a may be coupled to control instrument arm 124a and instrument 128a, and the right MTM 132b may be coupled to control instrument arm 124b and instrument 128b. If the third instrument arm 124c is used during the surgical procedure and positioned on the left, the left MTM 132a can switch between controlling arm 124a and instrument 128a and controlling arm 124c and instrument 128c. Similarly, if the third instrument arm 124c is used during the surgical procedure and positioned on the right, the right MTM 132a can switch between controlling arm 124b and instrument 128b and controlling arm 124c and instrument 128c. In an alternative embodiment, the third instrument arm can be controlled by either the left or right MTM for surgical convenience. In some cases, the control allocation between the MTM 132a, 132b and the arm 124a / instrument 128a combination and the arm 124b / instrument 128b combination can also be interchanged. This can be achieved, for example, with the endoscope rotated 180 degrees, so that the instrument moving in the endoscopic field of view appears to be on the same side as the MTM being moved by the surgeon.

[0056] The surgeon's console 102 also includes a stereoscopic imaging display system 136. Left and right images captured by the stereoscopic endoscope 130 are output on corresponding left and right displays, which the surgeon perceives as three-dimensional images on the display system 136. In one configuration, the MTM 132 is positioned below the display system 136, such that images of surgical instruments displayed on the monitors appear to be co-located with the surgeon's hand below the monitors. This feature allows the surgeon to intuitively control various surgical instruments in the three-dimensional display as if directly looking at their hand. Therefore, the MTM servo control of the associated instrument arms and instruments is based on the endoscopic image reference frame.

[0057] If the MTM is switched to camera control mode, the endoscopic image reference frame (i.e., the "image frame" or "first instrument frame") is also used. For example, if camera control mode is selected, the surgeon can move the distal end of the endoscope by moving one or both MTMs (the portions of these two MTMs can be servo-mechanically coupled so that the two MTM portions appear to move together as a single unit). The surgeon can then visually move (e.g., pan, tilt, zoom) the displayed stereoscopic image (as if holding the image in their hand) by moving the MTMs.

[0058] The surgeon's console 102 is typically located in the same operating room as the patient-side manipulator 104, although its positioning places the surgeon operating the console outside the sterile area. One or more assistants typically assist the surgeon by working within the sterile surgical area (e.g., changing tools on the patient-side trolley, performing manual retraction, etc.). Therefore, the surgeon operates remotely from the sterile area, and thus the console can be located in a separate room or building from the operating room. In some implementations, two consoles 102 (co-located or remotely positioned) can be networked together, allowing two surgeons to simultaneously observe and control tools at the surgical site.

[0059] Figure 22 An example is shown with a slave manipulator 104 and a patient P positioned for surgery. In this embodiment, the slave manipulator 104 is freestanding, and the surgical instruments and uterine dissector are mounted to a freestanding base 120 and a support column 122. For clarity, some instrument arms and instruments are omitted.

[0060] Figure 4This is a perspective view of a portion of the control arm 124c with a mounted surgical instrument 128c. For clarity, sterile curtains and related mechanisms commonly used during surgery are omitted. The manipulator 140 includes a yaw servo actuator 142, a pitch servo actuator 144, and an insertion-withdrawal ("I / O") actuator 146. The surgical instrument 128c is shown mounted at an instrument spar 148 including a mounting carriage 149. An exemplary straight cannula 150 is shown mounted to a cannula mount 152. An axis 154 of the instrument 128c extends through the cannula 150. The manipulator 140 is mechanically constrained such that it moves the instrument 128c about a fixed remote motion center 156 (also referred to as "remote center 156") positioned along the instrument axis. Yaw actuator 142 provides yaw motion 158 about remote center 156, pitch actuator 144 provides pitch motion 160 about remote center 156, and I / O actuator 146 provides insertion and withdrawal motion 162 through remote center 156. Generally, remote center 156 is locked at the incision site in the patient's body wall during surgery and allows sufficient yaw and pitch motion to be used to perform the intended surgical task. Alternatively, the remote center may be located externally to allow a greater range of motion without contact with the patient. Those skilled in the art will understand that motion about the remote center can be constrained by the use of software or by physical constraints defined by mechanical components.

[0061] The mating force transmission discs in the mounting carriage 149 and the instrument force transmission assembly 164 couple the actuation force from the actuator in the manipulator 140 to move various components of the instrument 128c to position and orient the tissue probe 166 mounted distal to the curved axis 154. This actuation force can generally rotate the instrument axis 154 (thus providing another DOF through the remote center 156). Embodiments of the force transmission assembly are provided in U.S. Patent No. 6,331,191 (filed October 15, 1999; disclosure “Surgical Robotic Tools, Data Architecture, and Use”) and U.S. Patent No. 6,491,701 (filed January 12, 2001; disclosure “Mechanical Actuator Interface System for Robotic Surgical Tools”), both of which are incorporated herein by reference in their entirety. In an alternative embodiment, the instrument 128c may include a wrist-like component located distal to the axis, which provides additional yaw and pitch DOF. For example, tissue probe 166 may be, for example, a general tissue manipulator, tissue dissector, or tissue retractor. In an alternative embodiment, instrument 128c may include an imaging component.

[0062] Figure 5 Describes what can be installed to Figure 4 An exploded view of a two-piece surgical instrument 170 of the manipulator 140. In this embodiment, a straight cannula 150 is mounted to an instrument spar 148. The instrument 170 includes a force transmission assembly 172, a shaft 174, and a tissue probe 176. In this embodiment, the shaft 174 is a rigid rod with a curved portion 178. In alternative embodiments, the shaft may be hollow and / or flexible. The shaft 174 may be sterilizable and may include a back-loadable tissue probe or vaginal fornix delineator, such as a KOH cup manufactured by Cooper Surgical, Inc. of Trumbull, CT. The tissue probe 176 may be integrated with the shaft or may be removable and disposable. The instrument 170 is assembled by loading the shaft 174 through the distal end 180 of the cannula 150 and forming engagement with the force transmission assembly 172. With this configuration, any instrument insertion or removal action can be performed along the instrument axis associated with the spar 148. The curved nature of the axis gives the instrument versatility to manipulate tissues that are difficult to reach with straight instruments. In one embodiment, the tissue probe 176 may be the tip of a uterine dissector for intrauterine manipulation, but other instruments such as vaginal fornix delineators, retractors, actuated instruments, non-actuated instruments, or imaging devices may also be used in uterine procedures or surgical procedures in other anatomical locations.

[0063] Figure 6 Describes what can be installed to Figure 4 An exploded view of a two-piece surgical instrument 190 of the manipulator 140. In this embodiment, a curved cannula 192 is mounted to an instrument spar 148. The instrument 190 includes a force transmission assembly 194, a shaft 196, and a tissue probe 176. In this embodiment, the shaft 196 is a flexible rod. In one embodiment, the tissue probe 176 may be the distal end of a uterine dissector for intrauterine manipulation, but other instruments such as vaginal fornix delineators, retractors, actuated instruments, non-actuated instruments, or imaging devices may also be used for uterine procedures or surgical procedures in other anatomical locations. The tissue probe 176 may be integrated with the shaft, or it may be removable and disposable. The instrument 190 is assembled by loading the shaft 196 through the distal end 200 of the curved cannula 192 and forming engagement with the force transmission assembly 194. The flexible nature of the shaft allows it to bend for insertion through the curved cannula.

[0064] Figure 7 Describes what can be installed to Figure 4A schematic diagram of a one-piece surgical instrument 202 of the manipulator 140. In this embodiment, the instrument 202 includes a tissue probe 176, a curved shaft segment 204, and a straight shaft segment 203 that can be directly mounted to the spar 148 instead of a cannula. In this embodiment, the shaft 203 is a rigid rod with a rigid curved segment 204. In one embodiment, the tissue probe 176 may be the tip of a uterine dissector for intrauterine manipulation, but other instruments such as vaginal fornix delineators, retractors, actuated instruments, non-actuated instruments, or imaging devices may also be used for uterine procedures or surgical procedures in other anatomical locations. To accommodate actuated instruments, the shaft may be hollow and / or non-rigid. The tissue probe 176 may be integrated with the shaft or may be removable and disposable. Figure 4 The force transmission assembly 194 shows a “copy” force transmission assembly 205 attached to the spar 148. The instrument 202 is assembled by attaching the shaft 203 directly to the spar 148 instead of the cannula. The “copy” force transmission assembly can be installed during surgery to allow the system to identify the type of the attached instrument via an electronic identification mechanism built into the housing of the force transmission 205. The “copy” force transmission assembly can thus transmit a signal indicating that the tissue probe is ready for subsequent modes. Further description of the “copy” or “imitate” instrument is provided in U.S. Provisional Application 61 / 594,130 (filed February 2, 2012; disclosing “Systems and Methods for Controlling a Robotic Surgical System”), the entirety of which is incorporated herein by reference. In another alternative, the shaft 203 may include a stop feature to prevent random rotation relative to the spar 148. Alternatively, the shaft 203 may have the ability to rotate rotatably along its axis. Optionally, the force transmission component may include markers for determining the rotational position of the shaft 203 to assist in calculating the position of the tissue probe 176.

[0065] Figure 8 and 9 Another embodiment of the surgical instrument is disclosed. In this embodiment, a tissue probe can be attached to the distal end of a hollow shaft, which, as previously described, can be mounted to an I / O insertion spar. Specifically, Figure 8 A curved hollow shaft 210 and a distal fastener 212 are depicted, the distal fastener 212 being sized for insertion into the distal end 214 of the curved hollow shaft. The distal fastener 212 can be mechanically coupled to the curved cannula 210 via, for example, threaded coupling, snap coupling, friction coupling, or other known mechanical coupling. Suitable hollow shafts may include, for example, 5 or 8 mm hollow shafts. Larger or smaller hollow shafts may also be suitable within the patient's anatomical constraints. Figure 9 As shown, tissue probe 216 is mechanically coupled to distal fastener 212. Tissue probe 216 includes a distal opening 218 connected to tubing 220. Tubing 220 is used for flushing and aspirating the surgical site through tissue probe 216. In an alternative embodiment where I / O movement is not required, the tissue probe may be directly mounted to the cannula, which is mounted to the insertion spars (e.g., Figure 5 and 6 (The cannula shown).

[0066] In the above embodiments, the cannula and instrument shaft may be formed of a rigid material, such as stainless steel or a glass-epoxy composite. Alternatively, it may be formed of a flexible material, such as a high-modulus plastic, such as polyetheretherketone (PEEK), glass or carbon-filled PEEK, or a glass fiber-epoxy or carbon fiber-epoxy composite structure. The inner and outer diameters of the shaft or cannula, as well as the physical structure, are specifically chosen for each material selection to limit the magnitude of forces that can be applied to the body during use, or to allow the structure to bend sufficiently during use to follow a curved guide path within the instrument or cannula. Further information regarding the cannula and instrument shaft, including information regarding material composition and flexibility, is provided in detail in U.S. Patent Application No. 12 / 618,608 (filed November 13, 2009; disclosing “CurvedCannula Instrument”), the entirety of which is incorporated herein by reference.

[0067] Figure 10 The main console 102 is illustrated in the illustration. Figure 11 The schematic example illustrates the components of the slave controller 104 (including devices 130, 128a, 128b, 128c). Figure 10 As shown, the surgeon observes the instrument workspace 226 through a viewer on display system 136. The tissue probe 166, carried on instrument spar 148, performs positional and directional movements within the instrument workspace 226 in response to movement and motion inputs from the associated master controller in the master workspace 228 (also referred to as "master space 228"). As previously described, the instrument arm 124c can be controlled by either MTM 132a or MTM 132b. In this exemplary embodiment, the instrument arm 124c carrying the surgical instrument 128c, including the tissue probe 166, will be controlled by the left-side MTM 132a. Different master reference frames (X1, Y1, Z1) are associated with each MTM. It is understood that other reference frames may be confined within the master workspace. For example, viewer reference frames (X4, Y4, Z4) may be associated with the viewer on display system 136. Relationships between reference frames in the master workspace can be established through fixed motion relationships, through sensors, or other known relationships.

[0068] like Figure 11 As shown, during a surgical setup procedure, surgical instrument 128c is positioned within body cavity 230, and tissue probe 166 is positioned against the tissue wall 232 of body cavity 230. The body cavity can be any surgically created or naturally formed cavity. In one embodiment, for example, the body cavity is the patient's uterus, and the instrument is inserted into the uterus through the cervix and contacts the uterine wall. Between gynecological procedures, the tissue probe (which may be a uterine dissector) is used to elevate and move the uterine tissue wall so that it is properly positioned for entry of the surgical instrument-associated end effector. Figure 12 This is a view of the tissue probe 166 positioned against the tissue wall 232, viewed from inside the body cavity 230. This view, viewed from the proximal position of the tissue probe 166, will also be described as a “probe frame” or “second instrument frame” (X3, Y3, Z3) within the instrument workspace 226. The instrument frame may also be defined at other locations within the body cavity or at other locations along the axis of the instrument 128c.

[0069] During a surgical procedure, images of the end effectors 129a, 129b and the surrounding instrument workspace are captured by an endoscope 130 having a field of view 131. These images from the endoscope's perspective or field of view 131 are displayed on a display system 136, allowing the surgeon to see the responsive movement and motion of the end effectors 129a, 129b—as he or she controls such movement and motion via MTMs 132a, 132b, respectively.

[0070] The field of view 131 captured by endoscope 130 has an endoscopic reference frame (X2, Y2, Z2) within the instrument workspace 226. In this field of view, visualization of the tissue probe 166 is obscured by the tissue wall 232. However, the protrusion of the tissue wall 232 and the movement of the protrusion caused by movement of the tissue 166 on the opposite side of the tissue wall can be visualized in the field of view 131 of endoscope 130. Control system 108 is arranged such that the directional and positional movement of the MTM 132a via master manipulator 102 is mapped to the directional and positional movement of the tissue probe 166 observed in the image of the viewer on display system 136, as described in more detail below.

[0071] The probe frame, endoscope frame, reference frame for each end effector 129a, 129b, and any other reference frame defined within the instrument workspace 226 may have known relationships established by fixed motion connections or by sensors.

[0072] In the following description, the control system will be described with reference to MTM 132a and instrument arm 124c having surgical instruments 128c. Control between master and slave movement is achieved by comparing the master position and orientation in master workspace 228 with master Cartesian coordinate reference system with slave position and orientation in instrument workspace 226 with surgical Cartesian coordinate reference system. For ease of understanding and brevity, the term "Cartesian coordinate reference system" will be simply referred to as "frame" in the remainder of this specification. Thus, the control system 108 is used to compare the slave position and orientation within the endoscope frame with the master position and orientation in the master frame (and / or viewer frame), and actuates the slave to a position and / or orientation in the endoscope frame corresponding to the master position and / or orientation of the master frame (and / or viewer frame). As the MTM translates and rotates in three-dimensional space, the master reference frame translates and rotates accordingly. These master frame translations and rotations can be sensed and transformed (also referred to as “mapped”) to reference frames (including probe frames) in the instrument workspace to provide a control relationship between the MTM in the workspace and the coupled instruments and / or probes by utilizing known kinematic calculations. When the position and orientation of the master frame are changed, the frames of the coupled instruments are changed accordingly, such that the movement of the coupled instruments is controlled by the movement of the MTM.

[0073] As previously described, the control system 108 includes at least one (generally multiple) processors that, in response to a master control move input command, calculate the new corresponding position and direction of the slave control on a continuous basis determined by the processing cycle rate of the control system.

[0074] like Figure 10 As shown, the Z1 axis of the main control frame moves with the MTM 132a through the main control workspace. Naturally, the X1 and Y1 axes extend perpendicular to the Z1 axis. Also as... Figure 10 As shown, when the surgical site is viewed through the viewer of display system 136, the Z4 axis of the viewer frame in the main control workspace extends along (or parallel to) axis 242, indicating the surgeon's line of sight. Naturally, the X4 and Y4 axes extend perpendicular to the Z4 axis. Conveniently, the Y4 axis is selected to extend vertically relative to the viewer of display system 136, and the X4 axis is selected to extend horizontally relative to the viewer.

[0075] like Figure 11 As shown, the Z2 axis of the endoscope frame extends axially along (or parallel to) the observation axis 244 of the endoscope 130. Although in Figure 11The observation axis 244 is shown as coaxially aligned with the shaft axis of the endoscope 130, but it will be understood that the observation axis may be angled relative to it. Therefore, the endoscope can be in the form of a linear or angled endoscope. The X2 and Y2 axes lie in a plane perpendicular to the Z2 axis. Also... Figure 11 As shown, the Z3 axis of the probe frame extends axially along (or parallel to) the longitudinal axis of instrument 128c. The X3 and Y3 axes lie in a plane perpendicular to the Z3 axis.

[0076] Further information regarding the control system—including information regarding mapping the position and orientation of the master control in the master control workspace to the instruments in the instrument workspace—is provided in detail in U.S. Patent No. 6,424,885B1 (filed August 13, 1999; disclosing “Camera Referenced Control in a Minimally Invasive Surgical Apparatus”), the entirety of which is incorporated herein by reference. Generally, the surgical remote-operated mapping method involves moving the MTM in the master control workspace via articulated multiple master control connectors. Master control signals corresponding to the position, orientation, and speed of the MTM are transmitted to the control system. Generally, the control system generates corresponding slave motor signals to map the Cartesian position of the master control in the master control workspace to the Cartesian position of the end effector or tissue probe in the instrument workspace, according to a transformation. The control system may obtain this transformation in response to state variable signals provided by an image capture system, such that the image presentation of the end effector or tissue probe in the display system is substantially correlated with the MTM. Furthermore, using scaling and offset converters, the position and velocity in the master workspace are converted into the position and velocity in the instrument workspace. Further details of the conversion are provided in U.S. Patent No. 6,424,885, which is previously incorporated herein by reference. A surgical tissue probe or end effector is moved in the instrument workspace by hinged multiple slave joints in response to slave motor signals. In response to the movement of the master, the control system generates slave motor signals such that the image of the end effector or tissue probe displayed is substantially correlated with the MTM in the master workspace.

[0077] Since the surgeon has a distal end-on-view of the tissue probe 166 via the display system 136, a conventional master-to-slave mapping would require the MTM 132a to be twisted to an ergonomically inconvenient position and orientation, pointing in the opposite direction towards the surgeon. Therefore, a method of inverting the master-to-slave mapping along at least one coordinate would allow the surgeon to control the tissue probe 166 as if the instrument 128c were extending in the opposite direction from the tissue probe towards the surgeon. In other words, as will be described in detail below, movement of the MTM 132 is mapped to the tissue probe 166 in the opposite direction along at least one coordinate of the probe frame.

[0078] In conventional mapping techniques, movement of MTM 132a in the +X4 direction results in a corresponding movement of instrument 128a in the +X2 direction (including scaling and offset factors) within the instrument workspace of the endoscope frame. If the user wishes to relinquish control of instrument 128a and begin using MTM 132a to control instrument 128c, the user registers this instruction with control system 108 and transfers control of MTM 132a to instrument 128c.

[0079] Figure 13 An example of process 250 is provided for controlling surgical instrument 128c (such as a uterine dissector instrument) using inverted mapping technology. Before implementing the inverted mapping technology, the control system 108 is given information indicating that inverted mapping technology, rather than conventional mapping technology, is required. This information may be based, for example, on user input, sensor input, or other feedback identifying slave instruments or slave arms arranged in the configuration, such as an end-side view, where inverted mapping technology provides more comfortable manipulation for the user. As previously mentioned, the MTM 132 within the master control workspace 228 generally has six degrees of freedom, three rotational degrees of freedom and three translational degrees of freedom. Process 250 can be performed with all six degrees of freedom enabled. In an alternative implementation, the distal position of the tissue probe can be mapped, rather than the orientation of the probe. In other words, rotational / orientation mapping is rendered inoperable. More specifically, rotational degrees of freedom (yaw, pitch, and roll) can be released to create an interface that allows the surgeon to feel the MTM 132a dragging the tissue probe. Therefore, the tissue probe will appear to translate through a 3D coordinate system, but rotational capabilities will be disabled, with the MTM's rotation locked. Alternatively, master rotation can be allowed to float, where rotation is ignored during transformations of the tissue probe manipulation. In yet another alternative, translation is mapped with fewer than all rotational degrees of freedom. For example, MTM translation may be mapped along with rotation about the Z-axis, but not movement about the X and Y axes. Any errors between the master and probe regarding the disabled axes can be omitted from the display to avoid the need to remap the MTM.

[0080] In process 252, movement of the master control input device (i.e., MTM 132a) in the master control workspace 228 along a first direction is detected. In process 254, the movement of MTM 132a causes the generation of a master control signal. In process 256, the movement of MTM 132a in the master control workspace 228 is mapped to the tissue probe 166 in the instrument workspace. In process 258, a slave control signal is generated to move the tissue probe 166 in the instrument workspace along an inverted first direction. The inverted direction is opposite or reversed in magnitude along at least one axis of the Cartesian coordinate system. The movement, speed, and dimensional scale of the workspace can be controlled based on the tissue probe used. Restrictions on tissue (e.g., uterus) movement can be predetermined and set by the system or by visual cues from the surgeon.

[0081] As in Figure 14-21 The detailed examples provided further illustrate that the movement of the master control input device in the master control workspace can be mapped to the device in the device workspace based on the determination of the slave device's insertion direction. For example, if the slave device is inserted into the device workspace in a direction corresponding to the field of view, a field-of-view-related mapping can be used. Alternatively, if the slave device is inserted into the device workspace in a direction not corresponding to the field of view, a different mapping can be used, such as a mapping that includes an inversion of at least one direction of the slave device's movement.

[0082] Based on the geometric relationship between the observation axis of the imaging instrument and the slave instrument, determined through known motion relationships or sensor feedback, the insertion direction of the slave instrument can be considered "corresponding." The corresponding slave instrument direction can be any direction less than or equal to 90 degrees (or, in other embodiments, less than 90 degrees) relative to the observation axis (e.g., axis 244). Figure 11 In this context, instruments 128a and 128b can be considered inserted in corresponding directions based on their orientation relative to the observation axis 244. However, the orientation of the slave instrument can also be considered "non-corresponding" based on the geometric relationship between the observation axis of the imaging instrument and the slave instrument. A non-corresponding slave instrument orientation can be any orientation greater than 90 degrees (or, in other embodiments, not less than 90 degrees) relative to the observation axis. Figure 11 In this context, instrument 128c can be considered inserted in a non-corresponding direction because it has an insertion direction of approximately 180° relative to the observation angle 244 and does not extend between the observation angle 244 and the vertical plane of the distal end of the imaging instrument 130. Therefore, in Figure 11In this device, instruments 128a and 128b may have corresponding mappings along the observation axis 244 to the field of view, and instrument 128c may have an inverted mapping that includes at least one direction of movement of instrument 128c (e.g., the X3 direction). The inversion may be, for example, a reversal of the corresponding mapping or a 180° change in direction.

[0083] Now for reference Figure 14 The view through the instrument workspace 226 of endoscope 130 (i.e., the endoscope frame) allows the user to visualize segments of tissue wall 232, instrument 128a with end effector 129a, and instrument 128b with end effector 129b at the main console 102. While the tissue probe 166 in the workspace cannot be directly visualized due to the intervened tissue 232, the general location of its tip can be identified by protrusion, bulging, or other properties associated with the area of ​​tissue 232 that has been lifted by the tip. In one embodiment, an overlay image can be displayed to indicate the location of the tip. The overlay can be triggered when control is switched to the tissue probe. If an imaging probe is used, the tissue can be directly visualized, providing an internal view of the patient's anatomy. In this example frame, the +X2 direction is towards the right side of the page, the -X2 direction is towards the left side of the page, the +Y2 direction is towards the upper part of the page, the -Y2 direction is towards the lower part of the page, the +Z2 direction is away from the page, and the -Z2 direction is towards the page. In an alternative implementation, the surgeon may focus primarily on the amount of tissue stretch achieved via the probe and move the probe until the image in the endoscope frame indicates that the target tissue has been stretched to the surgeon's specific requirements.

[0084] For reference Figure 15 The probe frame of the instrument workspace 226, viewed from the opposite side of the tissue wall 232 (e.g., from the proximal end of instrument 128c, as seen from the cervix towards the uterus), has its X and Z axes inverted relative to the endoscope frame (X2, Y2, Z2). Specifically, in this example frame, the –X3 direction faces the left side of the page, the +X3 direction faces the right side of the page, the +Y3 direction faces the upper side of the page, the –Y3 direction faces the lower side of the page, the –Z3 direction is entering the page, and the +Z3 direction is exiting the page.

[0085] If the MTM 132a is coupled to move the tissue probe 166, and the surgeon wishes to... Figure 16 Moving tissue probe 166 toward the position shown towards end effector 129b will move MTM 132a along the +X4 direction (towards MTM 132b in master space 228). Due to the inverted position (non-corresponding direction) of instrument 128c, under the conventional non-inverted mapping scheme, the rightward movement of MTM 132a toward MTM 132b in master space 228 will result in... Figure 17 In the view, tissue probe 166 also moves to the right—along the +X3 direction, toward end effector 129a. To avoid this reversed result and to move tissue probe 166 toward the target end effector 129b, the mapping of MTM 132a is inverted. Therefore, as Figure 16 As shown, the movement of MTM 132a in the +X4 direction in the master control workspace 228 is inverted in the probe frame, causing the tissue probe 166 in the endoscope frame to move toward the end effector 129b in the -X3 direction (i.e., opposite to the +X3 direction).

[0086] More specifically, the control system 108 can be configured to determine whether the MTM 132a is communicatively coupled to a slave instrument such as instruments 128a, 128b, 130 (i.e., instruments other than tissue probe 166) in a corresponding direction, and if so, movement of the MTM 132a in the viewer frame is mapped to movement of the slave instrument in the endoscope frame according to a first mapping. The first mapping translates movement in a first direction (e.g., towards the right side of the viewer, +X4) in the viewer frame into movement in a first direction (e.g., towards the right side of the endoscope, +X2) in the endoscope frame. If the MTM 132a is communicatively coupled to a slave instrument (such as an inverted instrument 128c including tissue probe 166) in a non-corresponding direction, movement of the MTM 132a in the viewer frame is mapped to movement of the inverted instrument in the probe frame according to a second mapping. The second mapping translates a movement in a first direction (e.g., towards the right side of the viewer, +X4) in the viewer frame into a movement in an inverted first direction (e.g., towards the left side of the tissue probe, -X3, as viewed from a proximal position along the axis of instrument 128c). The inverted first direction (e.g., -X3) in the probe frame is opposite to the first direction (e.g., +X4) in both the viewer frame and the endoscope frame. In this embodiment, the movement of instrument 128c along the inverted first direction of the probe frame is in the same direction as the first direction of instrument 128a in the endoscope frame within the instrument workspace. In other words, in the instrument workspace 226, the first direction +X2 in the endoscope frame is the same as the inverted first direction -X3 in the probe frame.

[0087] For reference Figure 18 and 19 In another instance, it appears as follows Figure 14 and 15 The starting position of tissue probe 166. If the surgeon wishes to move tissue probe 166 upwards, he or she moves it along the +Y4 direction (in... Figure 10 In the master control space 228, move MTM 132a (away from page). In this example, a conventional mapping scheme can be used because the upward movement of MTM132a in the master control space 228 will result in... Figure 19 In the view, tissue probe 166 also moves upward—along the +Y3 direction. In other words, Figure 18 Endoscopic view and Figure 19 In the instrument view, the "upward" movement is the same. Therefore, when the MTM 132a moves along the +Y4 direction, the conventional mapping will cause the tissue probe 166 to move along the +Y2 and +Y3 directions.

[0088] More specifically, the control system 108 may be configured to determine whether the MTM 132a is communicatively coupled to a slave instrument such as instruments 128a, 128b, 130 (i.e., instruments other than tissue probe 166) in a corresponding direction, and if so, movement of the MTM 132a in the viewer frame is mapped to movement of a first slave instrument in the endoscope frame according to a first mapping. The first mapping translates movement in a first direction (e.g., upward toward the viewer, +Y4) in the viewer frame to movement in a first direction (e.g., upward toward the endoscope, +Y2) in the endoscope frame. If the MTM 132a is communicatively coupled to a slave instrument such as instrument 128c including tissue probe 166 in a non-corresponding direction, movement of the MTM 132a in the viewer frame is mapped to movement of a slave instrument in the probe frame according to a second mapping. The second conversion also converts movement in the first direction (e.g., upward towards the viewer, +Y4) in the viewer frame into movement in the first direction (e.g., upward towards the tissue probe, +Y3, as viewed from a proximal position along the axis of instrument 128c). The first direction (e.g., +Y3) in the probe frame is the same as the first direction (e.g., +Y4) in the viewer frame. In this embodiment, movement of instrument 128c along the first direction of the probe frame is in the same direction as the first direction of instrument 128a in the endoscope frame within the instrument workspace. In other words, in the instrument workspace 226, the first direction +Y2 in the endoscope frame is the same as the inverted first direction +Y3 in the probe frame.

[0089] For reference Figure 20 and 21 In another instance, it appears as follows Figure 14 and 15 The starting position of tissue probe 166. If MTM 132a is coupled to move tissue probe 166 and the surgeon wishes to move tissue probe 166 away from tissue wall 232, he or she will move MTM 132a along the –Z4 direction and away from it. Figure 10 The viewer in the display system 136 moves. Due to the inverted position (non-corresponding orientation) of the instrument 128c, under the conventional mapping scheme, the movement of the MTM 132a in the master control space 228 away from the surgeon along the –Z4 direction will result in Figure 21In the view, tissue probe 166 moves into the page—along the –Z3 direction, further into the tissue wall 232. To avoid such a reversed result and to allow tissue probe 166 to move away from the tissue wall 232 as needed, the mapping of MTM 132a is inverted. Therefore, as Figure 20 As shown, the movement of MTM 132a in the –Z4 direction in the master workspace 228 is reversed, causing the tissue probe 166 to move in the +Z3 direction (i.e., opposite to the –Z4 direction), away from the page and away from the tissue wall 232 (towards the cervix in the probe frame).

[0090] More specifically, the control system 108 may be configured to determine whether the MTM 132a is communicatively coupled to a slave instrument such as instruments 128a, 128b, 130 (i.e., instruments other than tissue probe 166) in a corresponding direction, and if so, movement of the MTM 132a in the viewer frame is mapped to movement of a first slave instrument in the endoscope frame according to a first mapping. The first mapping converts movement in a first direction (e.g., away from the viewer, -Z4) in the viewer frame into movement in a first direction (e.g., away from the endoscope, -Z2) in the endoscope frame. If the MTM 132a is communicatively coupled to a slave instrument (e.g., instrument 128c including tissue probe 166) in a non-corresponding direction, movement of the MTM 132a in the viewer frame is mapped to movement of a second slave instrument in the probe frame according to a second mapping. The second mapping converts movement in a first direction (e.g., away from the viewer, -Z4) within the viewer frame into movement in an inverted first direction (e.g., away from the tissue wall 232, +Z3, as observed from a proximal position along the axis of instrument 128c) within the probe frame. The inverted first direction (e.g., +Z3) in the probe frame is opposite to the first direction (e.g., -Z4) in both the viewer and endoscope frames. In this embodiment, movement of instrument 128c along the inverted first direction of the probe frame is in the same direction as the first direction of instrument 128a in the endoscope frame within the instrument workspace. In other words, within the instrument workspace 226, the first direction -Z2 in the endoscope frame is the same as the inverted first direction +Z3 in the probe frame.

[0091] While the provided examples describe linear movement along the X, Y, or Z axes, it will be understood that angular movement of the MTM 132a in the three-dimensional workspace 228 can also be mapped to the three-dimensional instrument workspace, such that the mapping is inverted about one or more of the coordinate axes and normal about one or more of the coordinate axes. For example, movement +X4, +Y4 in the viewer and endoscope frame can be mapped to correspond to movement –X3, +Y3 in the probe frame.

[0092] Figure 23The implementation example illustrates an optional slave controller system 300. System 300 includes separate remotely operated controller components 302 and 304. Both components 302 and 304 can be operated via a common master controller and control system. Alternatively, they can be operated via different master controllers, direct controllers, and / or control systems. Controller component 302 is substantially similar to... Figure 2 The described patient-side manipulator includes surgical instruments operated under master control. Manipulator component 304 is a separate servo-operated manipulator and includes a mountable instrument 306 with a tissue probe 308, similar to any of the embodiments described above. In this embodiment, manipulator component 304 is mounted to the bed rail 310 of the patient bed 312. Initial positioning of manipulator component 304 can be performed manually. For example, manipulator component 304 can be moved along the bed rail 310 and locked in place by a friction locking mechanism. After locking in place, manipulator component 304 can be placed under the control of the master manipulator and the central control system. With component 304 locked in place, the mountable instrument 306 with the tissue probe 308 can be operated as described with respect to the foregoing embodiments. In other alternative embodiments, the manipulator component can be mounted on either side of the patient bed or on another movable or fixed component of the operating table.

[0093] Figure 24-26 An example of an assistive medical device 400 according to another embodiment is shown, such as a uterine dissector. Regarding its use in conjunction with remote operation control, device 400 may be attached to... Figure 4 The instrument 400 has a spar 148. The instrument 400 has a proximal end 402 and a distal end 404. The proximal end includes a handle 406 for manual manipulation of the instrument when disconnected from the spar 148. The handle 406 has an ergonomic grip to allow the user to hold and manipulate the instrument when it is not under remote operating control. The instrument 400 further includes a mounting portion 408 sized and shaped to fit the cannula mount 152. The mounting portion 408 includes a recessed surface 410 that provides identification information indicating instrument features such as size and shape. In alternative embodiments, the identification information may be located on different parts of the instrument. In still other alternative embodiments, the identification information may be read at the spar 148 or otherwise sensed and communicate electronically from the instrument to the control system 108.

[0094] The device 400 further includes a fixed curved shaft portion 412 having an approximately 90° arc and a fixed radius of curvature. In this embodiment, the curved portion has an arc length. The curved portion 412 and other portions of the device 400 may be formed of a rigid material, including metals (e.g., stainless steel or titanium), polymers (e.g., polyetheretherketone (PEEK)), or ceramics. Suitable materials may be lightweight but have sufficient strength to resist significant bending or breakage when forces are applied to the device to manipulate tissues within the patient's anatomy. The curved portion 412 has a solid shaft, but in alternative embodiments it may be hollow to reduce weight or provide a channel for fluid flow or other medical instruments.

[0095] The distal end 404 of the device 400 includes a terminal fastener 414, and the curved shaft portion 412 includes channels, grooves, fasteners, and other fitting features 416. The fastener 414 and fitting features 416 are sized and shaped to fit a medical accessory 418. The medical accessory 418 includes a tissue probe 419. The tissue probe 419 may be rounded, flexible, expandable, and / or have other non-invasive terminal features that allow the probe to engage and apply force to tissue without tearing, scraping, or otherwise damaging the tissue. Various medical accessories suitable for the device 400 are available from Cooper Surgical, Inc. of Trumbull, CT, and may include those from... And uterine manipulator accessories from the Koh product line.

[0096] When attached to the instrument spar 148, the instrument 400 can be controlled to orbit along an axis A1 (perpendicular to) that does not intersect the instrument 400. Figure 24 The rotation center C1 is pivoted at the point of rotation (as per the page number). The instrument 400 may be constrained to a single rotational degree of freedom (e.g., pitch). Generally, the rotation center C1 is locked at the patient's orifice during surgery and allows sufficient pitch movement to perform the intended surgical manipulation. Alternatively, the rotation center may be located outside the body to allow a greater range of motion without contact with the patient. Those skilled in the art will understand that movement about the rotation center may be constrained by software applications or by physical constraints defined by mechanical components.

[0097] A positioning feature 420 is provided on the mounting portion 408 to indicate the direction of the instrument's curvature to the user when the curved portion of the instrument is located within the patient's anatomy and is therefore not visible to the user. The positioning feature 420 also serves to prevent the instrument 400 from rotating about an axis A2 extending through the mounting portion 408, thereby keeping the center of rotation C1 in a fixed position relative to the instrument spar 148. In this embodiment, the positioning feature 420 is a protrusion, but in alternative embodiments it may be a mark, a recess, or other indicative feature.

[0098] During the initial surgical setup procedure, instrument 400 is attached to cannulation fitting 152. As previously described, a "replica" force transmission assembly can be installed instead of the force transmission assembly. Figure 7 This allows the system to identify the type of medical device attached to the instrument spar. Medical accessory 418 is adapted to the curved shaft portion 412 and coupled to the distal end 404. The assembled instrument 400 is positioned within a body cavity, with a tissue probe 419 positioned against the tissue wall of the body cavity. The tissue probe may expand, for example, by utilizing fluid expansion. In an alternative embodiment, the instrument may first be positioned through a patient orifice and then coupled to a manipulator after the instrument is in place. As previously described, in various embodiments, the manipulator 140 may be attached to a patient bed, a movable support structure, or another fixed or movable component in the surgical area.

[0099] In this embodiment, the device 400 is along the X3 axis (perpendicular to...). Figure 24 The movement of the instrument 400 (page 404) is restricted, and because the rotational movement of the instrument 400 about the rotation center C1 is constrained, the movement of the instrument in the Y3 and Z3 directions is coupled. For example, at the distal end 404 of the instrument 400, moving forward about the rotation center C1 (page 404) Figure 24 When the distal end 404 pivots (i.e., pitch motion around axis A1) clockwise, the distal end 404 moves along the +Y3 and -Z3 directions. When the distal end 404 rotates in the opposite direction around the rotation center C1 (…), the distal end 404… Figure 24 When pivoting (counterclockwise), the distal end 404 moves along the –Y3 and +Z3 directions. The Y1 and Z1 directions of movement of the MTM 132a, which controls the movement of the tissue probe, can similarly be coupled. Alternatively, the Y1 and Z1 directions of movement of the MTM 132a, which controls the movement of the tissue probe, can be decoupled. When the movement of the MTM 132a is decoupled, the decoupled movement of the MTM 132a is mapped to an approximate MTM movement, while allowing coupled movement of the instrument.

[0100] As an example, if a surgeon wishes to move tissue probe 419 along the +Y3 direction, he or she will move it along the +Y1 direction (away from the +Y3 direction). Figure 10 The master control space 228 page) moves the MTM 132a. In this example, a conventional mapping scheme can be used because the upward movement of the MTM 132a in the master control space 228 will cause the tissue probe 419 to also move upward—along the +Y3 direction. In other words, the "upward" movement is the same in both the endoscopic view and the instrument view. Therefore, conventional mapping will cause the tissue probe 419 to move along the +Y3 direction when the MTM 132a moves along the +Y1 direction. If the surgeon wishes to move the tissue probe 419 away from the tissue wall 232 (page), Figure 11 If he or she will Figure 10MTM 132a moves along the -Z1 direction and away from the surgeon. Due to the inverted position of instrument 128c, under the conventional mapping scheme, the movement of MTM 132a away from the surgeon along the -Z1 direction in the master workspace 228 would cause tissue probe 419 to move further into the tissue wall along the -Z3 direction. To avoid this reverse result and to allow tissue probe 419 to move away from the tissue wall 232 as expected, the mapping of MTM 132a is inverted. Therefore, the movement of MTM 132a along the +Z1 direction in the master workspace 228 is inverted, causing tissue probe 166 to move away from the tissue wall 232 (towards the cervix in the probe frame) along the +Z3 direction.

[0101] Figure 27 and 28 An example of an assistive medical device 450, such as a uterine dissector, according to another embodiment is illustrated. Medical device 450 may be similar to device 400 in configuration and operation, and several distinguishing features will be described. Medical device 450 includes a proximal end 452, a distal end 454, and a curved shaft portion 456 extending between the proximal and distal ends. In this embodiment, a straight shaft portion 458 extends between the proximal end 452 and the curved shaft portion 456. When attached to device spar 148, device 450 is pivotable about a center of rotation C2. Compared to device 400, the straight shaft portion extends the center of rotation C2 away from spar 148. The selection of an instrument suitable for a particular procedure can be based on patient size and the distance between the tissue to be manipulated and the natural orifice or surgically created orifice through which the instrument is inserted.

[0102] Figure 29 This is a schematic diagram of an assistive medical device 460, which can be mounted in a configuration that provides additional degrees of freedom of movement for the tissue probe. Figure 4 The manipulator 140. In this embodiment, the instrument 460 has a proximal end 462, a distal end 464, a curved axis portion 466, and a straight axis portion 468. A tissue probe 469 is mounted to the distal end 464. An axis A3 extends through the straight axis portion 468. The instrument spar 148 of the manipulator 140 includes an instrument anchor 470. The instrument anchor 470 includes a channel sized to receive the straight axis portion 468 to couple the instrument 460 to the instrument spar 148. The instrument anchor 470 may be an accessory clamp, as described in more detail in U.S. Patent No. 8,182,469 (filed September 30, 2005; disclosing “Surgical Accessory Clamp and Method”), the entirety of which is incorporated herein by reference. The instrument anchor 470 can act as a bearing that allows the instrument 460 to make linear translations along axis A3 and rotational movements about axis A3, while constraining translational movements perpendicular to axis A3.

[0103] Force transmission assembly 472 (substantially similar to force transmission assembly 164 described above) couples actuation force from the actuator in manipulator 140 to move portions of instrument 460 to position and orient tissue probe 469 mounted distal to curved shaft 466. Connector 474 (e.g., a quick-disconnect mechanism) extends between the proximal and distal ends of instrument 460. In this embodiment, connector 474 is located between instrument anchor 470 and force transmission assembly 472. Optionally, connector 474 may extend between the proximal end of the instrument and the force transmission assembly. Connector 474 allows tissue probe 469 to rotate about axis A3 at the connector. Connector 474 may additionally or optionally allow tissue probe translation along axis A3 from the connector. Furthermore, connector 474 allows for quick replacement of the distal end of instrument 460 and tissue probe 469. For example, connector 474 allows removal of a non-sterile end effector or tissue probe from the sterile proximal portion of the instrument. Furthermore, connector 474 allows the instrument 460 and tissue probe 469 to be positioned within the patient's anatomy without obstruction from attached manipulators. For example, the instrument 460 and tissue probe 469 can be positioned and arranged within a patient's body cavity. After this initial setup activity is completed, an instrument spar 148 having a force transmission assembly 472 is introduced into the instrument 460. The straight shaft portion 468 is loaded into the instrument anchor 470—for example, through a distal opening of the instrument anchor or through an opening between pivoting clamp arms. The force transmission assembly 472 can then be operatively coupled to the straight shaft portion via connector 474. After the instrument 460 is connected to connector 474, the force transmission assembly 472 is operable to control the rotational movement of the tissue probe 469 about axis A3 and to control the translation of the tissue probe along axis A3. In one embodiment, to allow translation of the straight shaft portion 468 relative to connector 474, the straight shaft portion between the connector and the curved shaft portion may have a smaller diameter than the straight shaft portion between the connector and the force transmission assembly to allow telescopic movement. The instrument anchor 470 can be operated as a bearing for the rotational and translational motion of the straight portion of the support shaft.

[0104] Figure 30 This is a schematic diagram of an assistive medical device 480, which can be installed on... Figure 4 The manipulator 140 is configured to provide additional degrees of freedom of movement for the tissue probe. In this embodiment, the instrument 480 may be substantially similar to instrument 460 and... Figure 29The configurations, the differences of which will be described. In this embodiment, instrument 480 has a proximal end 482, a distal end 484, a curved axis portion 486, a straight axis portion 488, and a tissue probe 490. In this embodiment, a connector 492 (such as a quick-disconnect connector) engages between the distal end 484 and the instrument anchor 470. Connector 492 allows the tissue probe 490 and the curved portion 486 to rotate about an axis A4 at the connector. Connector 492 also allows the tissue probe to translate along axis A4 from the connector. Furthermore, connector 492 allows for quick replacement of the distal end 484 of the instrument and the tissue probe 490. Additionally, connector 492 allows the instrument 480 and the tissue probe 490 to be positioned within the patient's anatomy without obstruction from attached manipulators. In this embodiment, the components of instrument 480 are comparable to the components of instrument 460 ( Figure 29 This reduces complexity because the straight shaft portion can be attached to the connector without having to pass it through the instrument anchor. Since connector 492 is distal to the instrument anchor, it should be selected to withstand tissue probing forces without deformation. With the connector sufficiently secure, the straight shaft portion on either side of the connector can remain generally collinear and aligned with axis A4. For example, the connector may be able to withstand loads up to approximately 30 lbs.

[0105] Figure 31 This is a schematic diagram of an assistive medical device 500, which can be installed on... Figure 4 The manipulator 140 is configured to provide additional degrees of freedom of movement for the tissue probe. In this embodiment, the instrument 500 may be substantially similar to instrument 480 and... Figure 30 The configurations, the differences of which will be described. In this embodiment—rather than the quick-disconnect connector 474—the instrument 500 has a proximal end 502, a distal end 504, a curved axis portion 506, a straight axis portion 508, and a tissue probe 510. In this embodiment, the connector 512 (such as a multi-dimensional wrist connector) is located between the distal end 504 and the instrument anchor 470. Examples of various multi-dimensional wrist connectors are described in more detail in U.S. Patent No. 6,817,974 (filed June 28, 2002; disclosing “Surgical Tool Having Positively Positionable Tendon Actuated Multi-DiskWrist Joint”), the entirety of which is incorporated herein by reference. The connector 512 allows for multi-dimensional movement of the tissue probe 510 and the curved portion 506. Because the connector 512 is distal to the instrument anchor, the connector should be selected to withstand tissue probing forces without deformation. When the connector is sufficiently secure, the straight axis portion on either side of the connector remains generally collinear and aligned with axis A4. For example, the joint may be able to withstand a load of up to approximately 30 lbs.

[0106] Figure 32An example is an auxiliary medical device 550 including a passive light source. The medical device 550 can be, for example, a uterine dissector similar to any of the foregoing embodiments. Regarding its use with remote operation control, the device 550 can be attached to... Figure 4 The instrument spar 148. The instrument 550 includes a probe portion 552 coupled to the distal end of a shaft portion 554. The probe portion 552 and / or the shaft portion 554 may include one or more illumination reference marks 556. The illumination reference marks 556 may be passive illumination reference marks, which operate without connection to power mains or energy storage devices (such as batteries). Passive illumination reference marks receive incident light from a light source and emit light in response. In one alternative, the passive illumination reference mark may include a passive light-emitting diode (LED) system. The passive LED system may include a photosensor coupled to the LED. The photosensor receives excitation light and generates a current to illuminate the LED. In another alternative, the passive illumination reference mark may include an aperture, trench, recess, or other cavity or container for containing a fluorescent dye such as indocyanine green (ICG) dye. When the ICG dye is illuminated with light of an excitation wavelength (e.g., about 750 to 800 nm), it can be directly observed or imaged at longer observation wavelengths (e.g., beyond 800 nm).

[0107] Light received from an external source (such as light delivered to the surgical area via optical fiber) can directly illuminate the passive marker or by obscuring tissue. For example, reference Figure 11 If the passive marker is located on probe 166 within body cavity 230 (e.g., uterus), light emitted by endoscope 130 can penetrate the tissue wall to excite the passive marker on the probe. The excited passive marker emits light, which is visible to the user through the endoscope. Therefore, the position of the probe can be identified by the light from the passive marker penetrating the obstructing tissue. In an alternative embodiment, the excitation light may be supplied by a light source on the probe side or end effector side of the tissue wall. In an alternative embodiment, the marker may be an actively illuminated reference marker, including a battery or other power source that powers an LED or other light source.

[0108] Figures 33-34Another example of a medical device that can be fitted with passive illumination markers is illustrated. In this embodiment, the vaginal incision cup 560 includes passive illumination markers 562. When used for medical procedures such as hysterectomy, the vaginal incision cup 560 can be positioned at the base of the uterus 564. Light from an endoscope 566 or other light source can pass through the wall 568 of the uterus 564 to excite one or more of the markers 562. The light emitted from the excited markers 562 can then be visualized through the wall 568 by the endoscope 566. The excited markers 562 can thus act as guides for the medical device 570 to perform medical procedures such as ablation or incision. For example, if the markers 562 are arranged radially around the edge of the cup 560, the circular markings can act as guides for cutting tissue adjacent to the edge of the cup. Passive markers 574 can also be located on the uterine probe 572, including on the expandable portion of the probe. Such markings can help define the endometrium and fibroids to allow for a safer myomectomy procedure.

[0109] Passive markers (such as those described) can be used in a variety of medical procedures to identify devices, implants, target locations, or leave-behind guides or indicators—located where otherwise obscured tissue would prevent direct visualization by image capture systems, visualization systems, or the naked eye.

[0110] While the systems and methods described above can be used to elevate or retract tissue through natural or surgically created openings in a variety of surgical procedures, they are particularly useful for uterine manipulation. Uterine manipulation can be used in hysterectomy procedures or the treatment of endometriosis to provide constant, stable tension, enabling precise dissection. Remote control of uterine manipulation is also particularly useful when manual manipulation of a large uterus would lead to user fatigue. In addition to providing tissue tension, uterine manipulators can also be used to move the transaction place away from vital structures such as the ureters.

[0111] Remote uterine manipulation can also enhance the surgical autonomy of console surgeons. Surgeons can control the position entirely according to their own ideas without interacting with or waiting for a patient-side assistant. Furthermore, the patient-side assistant provides surgical assistance rather than manipulating the device. Remote uterine manipulation also avoids contamination of the patient-side assistant due to movement between the device arms.

[0112] Any reference to surgical instruments and methods is non-limiting, as the instruments and methods described herein can be used in animals, human cadavers, animal carcasses, parts of human or animal anatomy, non-surgical diagnostics, industrial systems, and robots or remote operating systems in general.

[0113] One or more elements of embodiments of the present invention can be implemented in software to execute on a processor of a computer system (such as control system 108). When implemented in software, the elements of embodiments of the present invention are essentially code segments that perform necessary tasks. Programs or code segments can be stored in a processor-readable storage medium or device, which can be downloaded via computer data signals carried on a carrier wave over a transmission medium or communication link. Processor-readable storage devices can include any medium capable of storing information (including optical media, semiconductor media, and magnetic media). Examples of processor-readable storage devices include electronic circuits; semiconductor devices, semiconductor storage devices, read-only memory (ROM), flash memory, erasable programmable read-only memory (EPROM); floppy disks, CD-ROMs, optical disks, hard disks, or other storage devices. Code segments can be downloaded via computer networks (such as the Internet, intranets, etc.).

[0114] Note that the process and display shown may not necessarily be associated with any specific computer or other device. Based on the teachings herein, various general-purpose systems can be used in conjunction with programs, or it may be convenient to demonstrate the construction of more specialized devices to perform the operations. The necessary structures for various such systems will be presented as elements in the claims. Furthermore, embodiments of the invention are not described with reference to any specific programming language. It will be understood that various programming languages ​​can be used to implement the teachings of the invention as described herein.

[0115] While certain exemplary embodiments of the invention have been described and illustrated in the accompanying drawings, it is to be understood that such embodiments are merely examples and not intended to limit the broad invention, and that embodiments of the invention are not limited to the specific constructions and arrangements shown and described, as various other modifications will be apparent to those skilled in the art.

Claims

1. A teleoperational system configured to support an instrument end effector in an instrument workspace or a tissue manipulator in the instrument workspace, the teleoperational system comprising: an input device in an input workspace; and a control system comprising one or more processors, wherein the control system is configured to: generate a set of control signals in response to movement of the input device, generate a set of instrument control signals using a first mapping in response to the set of control signals and in response to a determination that the input device has control of the instrument end effector, wherein the first mapping maps movement of the input device in the input workspace in a first direction to movement of the instrument end effector in a corresponding direction in an instrument reference frame in the first direction, and generate a set of instrument control signals using a second mapping in response to the set of control signals and in response to a determination that the input device has control of the tissue manipulator, wherein the second mapping maps movement of the input device in the input workspace to movement of the tissue manipulator in a tissue manipulator reference frame in a direction opposite the corresponding direction of the first direction.

2. The teleoperational system of claim 1, wherein the control system is further configured to generate the set of instrument control signals using the first mapping in response to a determination that the instrument end effector is inserted in the instrument workspace in a direction corresponding to a direction of a viewing axis of an imaging device in the instrument workspace.

3. The teleoperational system of claim 1, wherein the control system is further configured to generate the set of instrument control signals using the second mapping in response to a determination that the tissue manipulator is inserted in the instrument workspace in a direction that does not correspond to a direction of a viewing axis of an imaging device in the instrument workspace.

4. The teleoperational system of claim 1, wherein to generate the set of control signals, the control system is configured to: generate a plurality of control position signals and a plurality of control rotation signals from movement of the input device; deactivate at least one of the plurality of control rotation signals to create an active plurality of control rotation signals; and generate the set of instrument control signals for movement of the tissue manipulator in response to the plurality of control position signals and the active plurality of control rotation signals.

5. The teleoperational system of claim 4, wherein the control system is further configured to deactivate all of the plurality of control rotation signals.

6. The teleoperational system of claim 1, further comprising: a first manipulator configured to support the instrument end effector; and a second manipulator configured to support the tissue manipulator; wherein during use, the first manipulator and the second manipulator are configured to support the instrument end effector and the tissue manipulator on opposite sides of intervening tissue.

7. The teleoperational system of claim 1, further comprising: ​ ​ an imaging device; and a display system; wherein the control system is further configured to: display an image of a workspace of the instrument end effector on the display system, the image being captured by the imaging device, and display an image of a tip of the tissue manipulator on the displayed image of the workspace at a location corresponding to a position of the tip of the tissue manipulator within the workspace.

8. The teleoperational system of claim 1, wherein the control system is further configured to: in response to determining that the input device has control of the tissue manipulator, indicate a position of the tissue manipulator on the displayed image of the workspace of the instrument end effector.

9. The teleoperational system of any of claims 1 to 8 ， wherein: the tissue manipulator is coupled to a curved shaft; and rotate the tissue manipulator about a center of rotation positioned away from the curved shaft using the set of instrument control signals of the second mapping.

10. The teleoperational system of any of claims 1-8, wherein the control system is further configured to inflate the tissue manipulator with a fluid.

11. The teleoperational system of any of claims 1-8, wherein the tissue manipulator is a tissue probe.

12. A machine-readable medium comprising a plurality of machine-readable instructions which, when executed by one or more processors, are adapted to cause the one or more processors to perform a method of operating a teleoperational system comprising an input device in an input workspace and an instrument end effector in an instrument workspace or a tissue manipulator in the instrument workspace, the method comprising: in response to movement of the input device, generating a set of control signals; in response to the set of control signals, generating a first mapping, wherein the first mapping maps movement of the input device to movement of the instrument end effector in the instrument workspace; in response to the set of control signals, generating a second mapping, wherein the second mapping maps movement of the input device to movement of the tissue manipulator in the instrument workspace; in response to the set of control signals and in response to determining that the input device has control of the instrument end effector, generating a set of instrument control signals using the first mapping, wherein the first mapping maps movement of the input device in a first direction in the input workspace to movement of the instrument end effector in a corresponding direction in an instrument reference frame in the first direction; and in response to the set of control signals and in response to determining that the input device has control of the tissue manipulator, generating a set of instrument control signals using the second mapping, wherein the second mapping comprises an inversion of the first mapping with respect to at least one direction of motion of the tissue manipulator, wherein the second mapping maps movement of the input device in the input workspace to movement of the tissue manipulator in a tissue manipulator reference frame in a direction opposite the corresponding direction in the first direction.

13. The machine-readable medium of claim 12, wherein the method further comprises generating the set of instrument control signals using the first mapping in response to determining that the instrument end effector is inserted into the instrument workspace in a direction corresponding to a direction of a viewing axis of an imaging device in the instrument workspace.

14. The machine-readable medium of claim 12, wherein the method further comprises generating the set of instrument control signals using the second mapping in response to determining that the tissue manipulator is inserted into the instrument workspace in a direction that does not correspond to a direction of a viewing axis of an imaging device in the instrument workspace.

15. The machine-readable medium of claim 12, wherein generating the set of control signals comprises: generating a plurality of control position signals and a plurality of control rotation signals from movement of the input device; deactivating at least one of the plurality of control rotation signals to create an active plurality of control rotation signals; and generating the set of instrument control signals for movement of the tissue manipulator in response to the plurality of control position signals and the active plurality of control rotation signals.

16. The machine-readable medium of claim 12, wherein the method further comprises: displaying an image of a workspace of the instrument end effector on a display system, the image captured by an imaging device, and displaying an image of a tip of the tissue manipulator on the displayed image of the workspace at a location corresponding to a location of the tip of the tissue manipulator within the workspace.

17. The machine-readable medium of claim 12, wherein the method further comprises indicating a location of the tissue manipulator on the displayed image of a workspace of the instrument end effector in response to determining that the input device has control of the tissue manipulator.

18. A teleoperational system, the teleoperational system comprising: an input device in an input reference frame; a manipulator configured to support an instrument or a tissue manipulator; and a control system comprising one or more processors, wherein the control system is configured to: generate a set of control signals in response to movement of the input device; in response to determining that the instrument is controlled based on movement of the input device, map the set of control signals to a first movement of the instrument in an instrument reference frame using a first mapping and command the manipulator to move the instrument according to the first movement; and in response to determining that the tissue manipulator is controlled based on movement of the input device, map the set of control signals to a second movement of the tissue manipulator in a tissue manipulator reference frame using a second mapping and command the manipulator to move the tissue manipulator according to the second movement; wherein: the first mapping maps movement in a first input movement direction of the input device in the input reference frame to a first instrument movement direction in the instrument reference frame, the first instrument direction being a direction corresponding to the first input direction, ​ ​ ​ the second mapping maps motion along the first input direction to a first tissue manipulator motion direction in the tissue manipulator reference frame, the first tissue manipulator direction being opposite the first input direction, the instrument reference frame is not inverted relative to an imaging reference frame along at least the first instrument direction, and the tissue manipulator reference frame is inverted relative to the imaging reference frame along at least the first tissue manipulator direction.

19. The teleoperational system of claim 18, wherein the first tissue manipulator direction in the tissue manipulator reference frame is opposite the first input direction in the input reference frame.

20. The teleoperational system of claim 18 or 19, wherein motion of the tissue manipulator along the first tissue manipulator direction causes the tissue manipulator to move along the first instrument direction in the instrument reference frame.

21. A machine-readable medium comprising a plurality of machine-readable instructions adapted to cause one or more processors to perform a method of operating a teleoperational system comprising an input device in an input reference frame and a manipulator configured to support an instrument or a tissue manipulator, the method comprising: generating a set of control signals in response to movement of the input device; in response to determining that the instrument is to be controlled based on movement of the input device, mapping the set of control signals to a first movement of the instrument in an instrument reference frame using a first mapping and commanding the manipulator to move the instrument according to the first movement; and in response to determining that the tissue manipulator is to be controlled based on movement of the input device, mapping the set of control signals to a second movement of the tissue manipulator in a tissue manipulator reference frame using a second mapping and commanding the manipulator to move the tissue manipulator according to the second movement; wherein: the first mapping maps motion along a first input motion direction of the input device in the input reference frame to a first instrument motion direction in the instrument reference frame, the first instrument motion direction being a direction corresponding to the first input motion direction, the second mapping maps motion along the first input motion direction to a first tissue manipulator motion direction in the tissue manipulator reference frame, the first tissue manipulator motion direction being opposite the first input motion direction, the instrument reference frame is not inverted relative to an imaging reference frame along at least the first instrument motion direction, and the tissue manipulator reference frame is inverted relative to the imaging reference frame along at least the first tissue manipulator motion direction.

22. The machine-readable medium of claim 21, wherein the first tissue manipulator motion direction in the tissue manipulator reference frame is opposite the first input motion direction in the input reference frame.

23. The machine-readable medium of claim 21 or 22, wherein movement of the tissue manipulator in the first tissue manipulator movement direction causes the tissue manipulator to move in the first instrument movement direction in the instrument reference frame.

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