Remote center of motion control for surgical robots

Abstract

To control the remote center of motion (RCM) of a surgical robotic system, a search of possible configurations of the robotic manipulator is performed to find a configuration that provides the greatest overlap between a working area of a surgical instrument and a target anatomical structure. Forces at the RCM can be measured, such as using one or more sensors on a cannula or in an adapter that connects the robotic manipulator to the cannula. The measured forces are used to determine a change to the RCM to minimize the forces exerted on the patient at the RCM. From this change, the configuration of the robotic manipulator can be dynamically updated. Various aspects of this RCM control can be independent of one another or combined, such as to optimize the calibration of the working area to the target anatomical structure, to minimize the forces at the RCM, and / or to dynamically control the configuration of the robotic manipulator based on the working area calibration and the measurement of forces.

Description

BACKGROUND

[0001] The present embodiments relate to robotic systems for minimally invasive surgery (MIS). MIS can be performed with a robotic system that includes one or more robotic manipulators for manipulating surgical tools in accordance with commands from a remote operator. For example, the robotic manipulators can support various surgical instruments and devices at their distal ends, including dissecting knives, clamps, scissors, and imaging devices (e.g., endoscopes). Using the robotic system, a surgeon controls the robotic manipulators for remote operation during MIS.

[0002] Surgical instruments and devices are inserted into a patient via a cannula. By hardware or software design, the robotic manipulator has a remote center of motion (RCM) that is stationary with respect to the base of the robotic manipulator and thus stationary with respect to the patient. To avoid causing harm to the patient, the RCM is calibrated with the insertion point on the cannula. The robotic manipulator has a limited workspace that describes the volume of the patient that the surgical instrument tip can reach and operate within. With redundant robotic manipulators (e.g., more than 6 joints), there are several different configurations to dock the robotic manipulator to the cannula. As the configuration of the robotic arm changes in maintaining the RCM, the workspace also moves. Of these configurations, one configuration can be preferred over the others to ensure that most or all of the target anatomy is within the operable workspace. If the instrument does not reach the target anatomy as discovered after cannula placement, unnecessary trauma can be caused to the patient. The focus is to have the robotic manipulator in the proper configuration where the target anatomy is within reach of the surgical instrument in as short a time as possible and without extending the anesthesia time of the patient.

[0003] Once docked to the cannula, the robotic manipulator need not be in an "optimal" configuration to ensure that the target anatomy is within its working area. The "non-optimal" configuration of the robotic manipulator relative to the target anatomy can be due to the docking process. The target anatomy can also be redefined during the procedure. In these cases, the robotic manipulator can need to be reconfigured to align the working area with the target anatomy. This reconfiguration can be done by moving various joints of the manipulator around the fixed insertion port to coincide the working area with the target anatomy. Manual reconfiguration: (1) requires significant effort to visualize the shape and motion of the working area due to the movement of the arms, and (2) is physically taxing due to the multiple joints of the robotic manipulator that can need to be moved one by one. Since only complex mechanical structures can achieve the desired configuration, adjustments can need to be made multiple times, all of which take up valuable intraoperative time. Complex robotic systems with several degrees of freedom make it difficult to visualize the working area of the robot, especially to do so accurately through configuration. SUMMARY

[0004] By way of introduction, the preferred embodiments described below include methods, systems, instructions, and computer-readable media for RCM control of a surgical robotic system. In view of the RCM, possible configurations of the robotic manipulator are searched to find a configuration that can provide the greatest overlap between the working area of the surgical instrument and the target anatomy. Forces at the RCM can be measured, such as using one or more sensors on the cannula or in an adapter that connects the robotic manipulator to the cannula. The measured forces are used to determine a change to the RCM to minimize the forces exerted on the patient at the RCM. From this change, the configuration of the robotic manipulator can be dynamically updated. Various aspects of this RCM control can be independent of one another or combined, such as to optimize the alignment of the working area with the target anatomy, to minimize the forces at the RCM, and / or to dynamically control the configuration of the robotic manipulator based on the working area alignment and the force measurements.

[0005] A first aspect provides a method for RCM control of a surgical robotic system. An RCM is established for a robotic manipulator. An amount of overlap between a target anatomy and each of a plurality of working areas of a surgical instrument on the robotic manipulator is determined. The working areas correspond to different configurations of the robotic manipulator around the RCM. A configuration of the robotic manipulator having a greatest amount of overlap is selected. A joint of the robotic manipulator is moved to a new position corresponding to the selected configuration.

[0006] A second aspect provides a method for RCM control of a surgical robotic system. Force at the RCM is measured. The robotic manipulator configuration is adjusted to reduce the applied force at the RCM and maintain overlap between a working area of the surgical instrument and a target anatomical structure within the patient.

[0007] A third aspect provides a surgical robotic system for medical teleoperation. A surgical instrument is connected with a robotic manipulator. An adapter is connected with the robotic manipulator. The adapter is configured to connect with a cannula during teleoperation. One or more force sensors are on the adapter. A controller is configured to adjust the RCM of the robotic manipulator based on output from the force sensors.

[0008] The present invention is defined by the following claims, and nothing in this section shall be taken as a limitation on those claims. Any teaching that is described in relation to one class of claims can also apply to another class of claims. Other aspects and advantages of the present invention will become apparent upon consideration of the following detailed description and drawings. BRIEF DESCRIPTION OF DRAWINGS

[0009] The components and illustrations are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the present invention. Moreover, in the drawings, like reference numerals designate corresponding parts throughout the several views.

[0010] Figure 1 Illustration of a surgical room environment configured with a surgical robotic system according to one embodiment;

[0011] Figure 2 An exemplary surgical robotic arm and surgical tool are shown;

[0012] Figure 3 Flowchart for a method of remote center of motion control for a surgical robotic system according to one embodiment;

[0013] Figure 4A And Figure 4B An exemplary adapter and sensors for connection with a cannula are shown;

[0014] Figure 5 An exemplary working area calibrated with a target anatomical structure is shown;

[0015] Figure 6 An exemplary working area calibration is shown, while force sensing at the remote center of motion is shown; and

[0016] Figure 7 Block diagram for one embodiment of a surgical robotic system. DETAILED DESCRIPTION

[0017] An assisted arm maneuver is provided for repositioning the remote center of motion (RCM). The RCM can be safely, easily, and quickly repositioned or held constant to maximize the overlap volume between the target anatomy and the working volume of a robotic manipulator (e.g., a robotic arm) and surgical instruments. Possible robotic manipulator configurations are tested to identify the best level of overlap for a given RCM position. The robotic manipulator can be moved to conform to this calibration, the repositioning of the RCM, and / or teleoperation.

[0018] Measurement of cannula (e.g., cannula needle) forces (e.g., translational, pressure, and / or torque forces) can be used for adaptive RCM control. The RCM can be moved to accommodate patient motion, motion of the robotic manipulator, or another source of interfering forces on the patient tissue as the cannula is inserted (i.e., the RCM is at the entry point for the patient procedure). In one embodiment, the forces are measured using sensors on the cannula. In another embodiment, the forces exerted on the cannula are measured using sensors at the adapter contact points with the robotic manipulator. Information about the forces and stresses at the point of insertion of the cannula through the abdominal wall are provided by the measurements at the adapter, and the user or controller adjusts the position of the RCM accordingly and releases excess stress on the abdominal wall as needed.

[0019] Figure 1 and Figure 2 An example surgical robotic system is shown. The method for RCM control is discussed below in connection with this example system. Other surgical robotic systems and surgical or non-surgical robotic systems and robots can also use the method.

[0020] Figures 3 to 6 RCM control is involved, including calibration of the working volume to the target anatomy and / or sensing of forces on the adapter. Figure 7 A system for RCM control is involved.

[0021] Figure 1This is a schematic diagram of an exemplary operating room environment configured with a surgical robot system 100, which translates commands from a user into motion of a surgical robot manipulator 122 according to iterative inverse kinematics. The surgical robot system 100 includes a user console 110, a control tower 130, and a surgical robot 120 having one or more surgical robot manipulators 122 mounted on a surgical platform 124 (e.g., a table or bed), wherein surgical tools with end effectors are attached to the distal ends of the robot manipulators 122 for performing surgical procedures. Additional, different, or fewer components may also be provided, such as combining the control tower 130 with the console 110 or the surgical robot 120. The robot manipulator 122 is shown as tabletop mounted, but in other configurations, the robot manipulator 122 may be mounted on a trolley, ceiling, sidewall, or other suitable support surface.

[0022] Generally, a user (such as a surgeon or other operator) can sit at user console 110 to remotely operate the robotic manipulator 122 and / or surgical instruments (e.g., perform remote manipulation). User console 110 may be located in the same operating room as the robotic system 100, such as... Figure 1 As shown. In other environments, the user console 110 may be located in an adjacent or nearby room, or operated remotely from a remote location in a different building, city, or country. The user console 110 may include a seat 112, a pedal 114, one or more handheld user interface devices (UIDs) 116, and an open display 118 configured to display, for example, a view of a surgical site within a patient's body and a graphical user interface. As illustrated by the exemplary user console 110, a surgeon seated in the seat 112 and viewing the open display 118 can manipulate the pedal 114 and / or the handheld user interface device 116 to remotely and directly control the robotic arm 122 and / or surgical instruments mounted to the distal end of the arm 122. The user inputs commands to move the surgical manipulator 122 and / or the end effector. This user control determines changes in position, rate of movement, and rate of movement of the robotic manipulator 122. The rate and rate changes result in the expected dynamic torque force provided by the robotic manipulator 122. The surgeon, seated in chair 112, can view and interact with display 118 to input commands during surgery to move robotic manipulator 122 and / or surgical instruments under remote operation.

[0023] In some slightly different scenarios, the user can also operate the surgical robotic system 100 in an "over the bed" (OTB) mode, where the user is positioned at the side of the patient and simultaneously manipulates a robotically-driven tool / end effector attached to the patient (e.g., holding a handheld user interface device 116 in one hand) and a manual laparoscopic tool. For example, the user's left hand can manipulate a handheld user interface device 116 to control a robotic surgical component, while the user's right hand can manipulate a manual laparoscopic tool. Thus, in these different scenarios, the user can both perform a robotically-assisted MIS on the patient and manually perform a laparoscopic surgical procedure.

[0024] During an exemplary procedure or surgery, the patient is prepared and draped in a sterile manner to achieve anesthesia. Initial access to the surgical site can be performed manually with the robotic system 100 in a stowed or retracted configuration to facilitate access to the surgical site. Once access is complete, initial positioning and / or preparation of the robotic system can be performed. During the procedure, the surgeon at the user console 110 can utilize the pedals 114 and / or user interface devices 116 to manipulate various end effectors and / or imaging systems to perform the surgery by teleoperation. The aforementioned movements vary due to the particular surgeon, patient, and / or situation. Manual assistance can also be provided at the operating table by a person in a sterile gown who can perform tasks including, but not limited to, retracting tissue, or performing manual repositioning or tool changes involving one or more robotic manipulators 122. Some surgical tasks such as retraction, suturing, or other manipulations of tissue can alternatively be performed by one or more robotic manipulators 122 (e.g., third or fourth arms). Non-sterile personnel can also be present to assist the surgeon at the user console 110. When the procedure or surgery is complete, the robotic system 100 and / or user console 110 can be configured or set in a state that facilitates one or more post-operative procedures, including but not limited to cleaning and / or sterilization of the robotic system 100, and / or medical record input or printout, whether electronic or paper, via the user console 110.

[0025] In some aspects, communication between the surgical robot 120 and the user console 110 can be through a control tower 130, which can translate user inputs from the user console 110 into robot control commands and transmit the control commands to the surgical robot 120. The control tower 130 performs iterative inverse kinematics. The control tower 130 can also transmit status and feedback from the robot 120 back to the user console 110. Connections between the surgical robot 120, the user console 110, and the control tower 130 can be wired and / or wireless and can be proprietary and / or performed using any of a variety of data communication protocols. Any wired connections can optionally be built into the floor and / or walls or ceiling of the operating room. The surgical robot system 100 can provide video output to one or more displays, including displays within the operating room and remote displays accessed via the internet or other network. The video output or feed can also be encrypted to ensure privacy, and all or part of the video output can be saved to a server or electronic health record system.

[0026] Prior to starting a surgical procedure with the surgical robot system, a preoperative setup can be performed by the surgical team. During the preoperative setup, the main components of the surgical robot system (e.g., the table 124 and robot arms 122, the control tower 130, and the user console 110) are positioned in the operating room, already connected and powered on. The configuration of the table 124 and robot arms 122 can be fully retracted, with the arms 122 underneath the table 124, for storage and / or transport. The surgical team can extend the arms 122 from their retracted positions for draping. After draping, the arms 122 can be partially retracted until needed again. A number of routine laparoscopic steps can need to be performed, including cannula placement and insufflation. For example, each sleeve can be inserted into a small incision and through the body wall with the aid of a trocar. The sleeve and plug allow light to enter to make the tissue layers visible during insertion, minimizing the risk of damage when placed. Typically, an endoscope is placed first to provide a handheld camera view, facilitating placement of other cannulas. After insufflation, manual instruments can be inserted through the sleeves, if needed, to perform any laparoscopic steps by hand.

[0027] Next, the surgical team can position the robotic arms 122 above the patient and attach each arm 122 to its corresponding sleeve (e.g., cannula). The surgical robot system 100 is able to uniquely identify each tool (endoscope and surgical instrument) upon attachment and display the tool type and arm position on an open or immersive display 118 at the user console 110 and on a touchscreen display on the control tower 130. The corresponding tool function is enabled and activated using the master UID 116 and foot switch 114. The patient-side assistant can attach and detach tools as needed throughout the procedure. The surgeon, seated at the user console 110, can begin surgery remotely using tools controlled by two master UIDs 116 and foot switch 114. The system accurately translates the surgeon's hand, wrist, and finger movements into real-time movements of the surgical instruments via the master UID 116. Therefore, in direct remote operation, the system continuously monitors each surgical action of the surgeon and pauses instrument movement if the system cannot accurately reflect the surgeon's hand movements. During surgical procedures, when the endoscope is moved from one arm to the other, the system can adjust the master UID 116 for instrument calibration and continue to control the instrument's movement. The foot switch 114 can be used to activate various system modes, such as endoscope control and various instrument functions, including monopolar and bipolar ablation, without requiring the surgeon's hand to be removed from the master UID 116.

[0028] Figure 2 This is a schematic diagram illustrating an exemplary design of a robot manipulator, tool actuator, and connector for a robotic surgical tool, according to various aspects of the subject matter. Figure 2 As shown, the exemplary surgical robot manipulator 122 may include a plurality of connectors (e.g., connector 202) and a plurality of engagement modules (e.g., engagement 204, see also engagements J1 to J8) for actuating the plurality of connectors relative to each other. The engagement modules may include various engagement types, such as pitch engagements or roll engagements, which can substantially constrain the movement of adjacent connectors about certain axes relative to other axes. Figure 2A tool driver 210 attached to the distal end of the robot arm 122 is also shown in the example design. The tool driver 210 can include a cannula 214 coupled to its end to receive and guide a surgical instrument or end effector 220 (e.g., an endoscope, stapler, scalpel, scissors, clamp, retractor, etc.). The surgical instrument (or "tool") 220 includes an end effector 222 at its distal end. The multiple joint modules of the robot manipulator 122 can be actuated to position and orient the tool driver 210, which actuates the end effector 222 to perform a robotic surgical procedure. The end effector 222 is at the tool tip. In other embodiments, the tool tip is the tip of a needle or other object.

[0029] In Figure 2 In the example, joint JO is a table-mounted pivot joint and is located below the top of the surgical table. Joint JO is generally held stationary during a surgical procedure. Joints J1 through J5 form a structure or Cartesian robot arm and are generally held stationary during a procedure, so they do not contribute to motion during a surgical teleoperation. Joints J6 and J7 form a spherical arm that can be actively moved during a surgical procedure or teleoperation. Joint J8 converts the tool 220 (such as the end effector 222) to be part of the tool driver. Joint J8 can be actively moved during a surgical procedure. During a surgical procedure, joints J6 through J8 actively position the tool tip (i.e., the end effector 222) while maintaining the entry point of the patient's procedure at a fixed or steady position (i.e., the RCM) to avoid stressing the patient's skin. During setup, any of joints JO through J8 can be moved. During a surgical procedure, joints J6 through J8 can be moved according to safety limits in terms of hardware or position, velocity, acceleration, and / or torque forces. The surgical tool 220 can include zero, one, or more (e.g., three) joints, such as a joint for tool rotation plus any number of additional joints (e.g., a wrist for rotation about a longitudinal axis or other types of motion). Any degrees of freedom can be provided, such as three degrees from joints J6 through J8 and zero or one or more degrees of freedom from the surgical tool 220.

[0030] Figure 3A flowchart of one embodiment of a method for remote center of motion control for a surgical robotic system. A working area of an end effector 222 of a surgical instrument 220 is aligned with a target anatomy in view of a plurality of choices for positioning a robotic arm 122. The alignment can take into account a process for repositioning the RCM during teleoperation. The RCM can be repositioned based on sensing of forces, such as using sensors in an adapter of a robotic manipulator that are connected with a cannula 214.

[0031] Figure 3 The illustrated method is implemented by a control processor such as the control tower 130, a computer, a workstation, a server, or another processor. Any computer in the surgical robotic system 100 can be used. A user interface provides movement commands from a user that are received in act 300. The control processor (e.g., controller) establishes the RCM in act 310, determines the overlap in act 330, and selects the joint position in act 340. In act 320, a force sensor such as a torque force or pressure sensor senses the force. In act 350, the robotic arm 122 and / or the surgical tool 220 are moved by instructions or control from the control processor. Other devices can perform and / or be used for any of the acts described above.

[0032] The acts described above are performed in the order illustrated or in other orders. For example, act 300 is performed after any of the other acts described above. For another example, act 320 is performed before or after any of the acts described above.

[0033] Additional, different, or fewer acts can also be employed. For example, where calibration is performed prior to teleoperation, act 300 is not provided. For another example, where working area calibration is not taken into account for dynamic changes in the RCM (e.g., calibration is performed prior to teleoperation and / or patient movement), act 320 is not performed. For another example, where force sensing on the adapter is used to control the RCM without taking into account working area calibration, acts 330 and 340 are not provided. For another example, acts to initially position the surgical tool 220 on the patient, surgical planning acts, and / or acts to remove the surgical tool 220 from the patient can be provided.

[0034] In act 300, a control processor receives user commands to move a robotic manipulator 122 or a surgical tool 220 of the robotic manipulator 122 prior to or during teleoperation on a patient. The control processor receives the user input from the user console 110 such as the foot pedal 114 or user interface device 116 via a wireless or wired interface. In other embodiments, the user commands are received by loading from memory or transmission over a computer network.

[0035] In preparation for teleoperation, the user is seated at the surgeon's console 110. After the robotic manipulator 122 is positioned for teleoperation, one or more joints are locked in place with the RCM at the patient's skin or incision entry. For example, joints J0 through J5 (see Figure 2 ) are locked. The locking is performed by detents and / or by disabling the motors that actuate the joints. The joints remain locked during teleoperation. Any of the joints J0 through J5 can be unlocked and moved to adjust the RCM.

[0036] During teleoperation, the user inputs commands to move the robotic manipulator 122 and / or surgical tool 220. The commands are used to effect motion. Different commands can be provided for different movements. The commands can be for movement of the end effector 222. The commands can not be applicable to movement of a particular joint. The control processor converts the movement commands to control of the robotic manipulator 122 and / or the particular joint of the surgical tool 220.

[0037] In act 310, the control processor establishes the RCM for the robotic manipulator 122. In preparation for surgery, a bedside assistant inserts the cannula 214 through the patient's abdominal wall. The robotic manipulator 122 is docked to the cannula 214. The adapter of the robotic manipulator 122 is connected to the cannula 214. The docking is performed with care to avoid applying excessive force to the abdominal port. After docking with the robotic manipulator 122, the RCM is set at the point of insertion. The spatial relationship of the adapter in the robotic manipulator frame to the cannula 214 is known. The adapter, when connected to the cannula 214, the RCM is set at the point of insertion along the cannula 214 to the RCM.

[0038] The surgical robot 120 will perform operations while maintaining the RCM in a fixed position. In the absence of motion of the RCM, the robotic manipulator 122 continues to operate in coordination with the RCM in one position without risk of injury to the patient's tissue.

[0039] The RCM can move due to patient movement, robotic manipulator motion, and / or another teleoperation source. During operation, the abdominal position can change for various reasons. The operation can involve several stages in which the patient can be positioned or oriented in different ways by adjusting the height and tilt of the surgical table. Because the relative position of the abdominal opening can change, maintaining a fixed RCM position can introduce additional stress on the patient's abdomen and can cause unnecessary trauma or injury. The robotic manipulator 122 takes into account the displacement and motion of the RCM as it moves to avoid injury to the patient's tissue.

[0040] The RCM is established at a new position in the coordinate frame of the robotic manipulator 122. To avoid releasing and re-docking the robotic arm 122 at the cannula 214, the RCM is shifted or changed based on the force measured at the RCM (i.e., at the patient's insertion site). In act 320, the force (such as pressure or torque force) is measured at or for the RCM. The force is measured in any number of degrees of freedom, such as two degrees of freedom tangentially along the patient's plane at the insertion point, or six degrees of freedom measuring three translational forces and three rotational forces (or torque forces). The force at the RCM is sensed during the docking of the robotic manipulator 122 and surgical instrument 220 and / or during teleoperation. The sensing of the force can cause the robotic system 120 to issue a warning and assist in the adjustment of the RCM to minimize the stress or force on the patient's abdomen. The sensing of the force can be used for automatic adjustment of the RCM. The feedback from act 320 to act 310 indicates that the RCM is repositioned using the force.

[0041] In one embodiment, the force is sensed in act 320 using one or more sensors on the cannula 214. Figure 6 A force sensor 600 for sensing the force on the cannula 214 (e.g., cannula needle) on the patient's tissue is shown. Since the cannula 214 is connected to the robotic manipulator 122 after docking, the relative motion between the patient and the robotic manipulator 122 will cause a force on the cannula 214 through the patient's tissue. The presence of harmful forces at the insertion port can be checked by integrating the sensor 600 onto the cannula shaft to measure the force at the incision site.

[0042] The sensor 600 is a force gauge, such as a thin capacitive or resistive sensor. Because of its light and thin flexible construction, the sensor 600 can be wrapped around the cannula shaft. Once docked to the robotic manipulator 122, the electrical connection of the control processor to the sensor 600 is stabilized through the docking site (i.e., adapter) to activate the force sensor. Other connections, such as wireless or cable connections, can also be used. The readings of the sensor 600 provide a direct measurement (e.g., continuous real-time monitoring) of the magnitude and / or direction of the force at the tool insertion site. If the magnitude of the force sensed by the integrated sensor 600 exceeds a predetermined safety threshold (e.g., a force that can cause injury), the desired RCM motion is calculated to shift the RCM rather than keep the RCM stationary.

[0043] In another embodiment, the sensor 600 is in the adapter 420 of the robotic manipulator 122. Figure 4A and Figure 4BAn example is shown. The adapter 420 is configured to connect the robotic manipulator 122 to the cannula 214. For example, the adapter 420 is a female or concave connector that is shaped to enable a fixed orientation connection, such as a trapezoidal cuboid. Other wedge shapes can also be used. Alternatively, the adapter 420 is a male or convex connector that is wedge shaped. A snap fit engagement, a press fit engagement, a motorized lock, and / or a mechanical latch can be provided to lock the adapter 420 to the cannula 214 for docking.

[0044] In act 320, the force (e.g., lateral force and / or torque force) at the point of contact on the cannula adapter 420 of the robotic manipulator 122 is measured. Sensing at the adapter 420 can avoid difficulties in design and sterilization issues that come with placing the sensor 600 directly on the cannula 214.

[0045] The sensor 600 can be any type of sensor that correlates force to the abdomen. For example, a pressure sensor, a force sensor, a force sensor, or a proximity sensor can be used. The sensor 600 can be formed from multiple sensors, such as using multiple single degree of freedom sensors. The sensor senses force in one direction or one rotation. Different multiple degrees of freedom forces are measured by using different sensors at different locations within or on the adapter 420. For example, a pressure sensor is positioned on five surfaces in the adapter that correspond to the five surfaces that form the wedge shape described above. Each surface of the adapter 420 that comes into contact with the cannula 214 has a sensor when connected. Fewer or more sensors can be provided.

[0046] In the example of FIGS. 1-2, the pressure sensor is located inside the distal end cannula adapter 420. The sensor is placed on the robotic manipulator 122 and under the sterile drape to minimize the risk of contamination and potential damage to the sensor. When the robotic manipulator 122 is docked to the cannula 214 (see FIG. 3), the arrangement of the sensor covers all possible directions of pressure from stress on the abdominal wall. With the spatial relationship of the adapter 420 to the cannula 214 known, the force sensed at the adapter 420 can be geometrically related to the force at the insertion point (see FIG. 4). The measurements from the sensor are calibrated based on the type and geometry of the cannula 214 to eliminate the nominal pressure from the docking mechanism and relate the additional pressure reading to the force on the abdominal wall. Figure 4A Figure 4B In the example of FIGS. 1-2, the pressure sensor is located inside the distal end cannula adapter 420. The sensor is placed on the robotic manipulator 122 and under the sterile drape to minimize the risk of contamination and potential damage to the sensor. When the robotic manipulator 122 is docked to the cannula 214 (see FIG. 3), the arrangement of the sensor covers all possible directions of pressure from stress on the abdominal wall. With the spatial relationship of the adapter 420 to the cannula 214 known, the force sensed at the adapter 420 can be geometrically related to the force at the insertion point (see FIG. 4). The measurements from the sensor are calibrated based on the type and geometry of the cannula 214 to eliminate the nominal pressure from the docking mechanism and relate the additional pressure reading to the force on the abdominal wall. Figure 4A Figure 4B In the example of FIGS. 1-2, the pressure sensor is located inside the distal end cannula adapter 420. The sensor is placed on the robotic manipulator 122 and under the sterile drape to minimize the risk of contamination and potential damage to the sensor. When the robotic manipulator 122 is docked to the cannula 214 (see FIG. 3), the arrangement of the sensor covers all possible directions of pressure from stress on the abdominal wall. With the spatial relationship of the adapter 420 to the cannula 214 known, the force sensed at the adapter 420 can be geometrically related to the force at the insertion point (see FIG. 4). The measurements from the sensor are calibrated based on the type and geometry of the cannula 214 to eliminate the nominal pressure from the docking mechanism and relate the additional pressure reading to the force on the abdominal wall.

[0047] A graphical representation of the direction and magnitude of the force can be displayed to the user. Adjustments to the robotic manipulator 122 can be performed automatically, semi-automatically, or manually by the user to minimize the force on the abdomen. A warning can be issued to the user if the force exceeds a safety threshold.

[0048] ​​Referring again to Figure 3 In act 330, the control processor determines the amount of overlap between the target anatomy and each of a plurality of work areas of the surgical instrument 220 on the robotic manipulator 122. The robotic manipulator 122 and / or the surgical instrument 220 can be configured in a variety of possible ways (i.e., joint angle settings). For example, at the RCM, the joint J6 for a spherical rolling joint can be at a variety of positions discretely within any range and perform any number of steps within that range. At each possible position, a volume of a work area is provided to the end effector 222 or surgical instrument 220. The robotic manipulator 122 and surgical instrument 220 can be moved and operate within that particular work area volume. Each position of the joint J6 or other robotic configuration provides a work area at a different (e.g., different translational and / or rotational) relative position.

[0049] Based on the configuration of the robotic manipulator 122, the control processor calculates the accessible work area of the end effector 222. For example, the work area is a spherical area around the RCM point with a conical shaped cut-out inside that is inaccessible. Figure 5 and Figure 6 The work area is shown in shadowed spherical shape, including a conical area that is inaccessible to the end effector 222. If the origin of the J6 joint (spherical rolling) is translated by keeping the RCM fixed, the work area will rotate around its center. The conical area rotates to a different position relative to the patient. If the RCM moves, the work area will also be displaced in space.

[0050] For calibration of the work area, the target anatomy is determined in the coordinate system of the robotic manipulator 122. The surgeon manually or the imaging system automatically defines the boundaries of the target anatomy. Intraoperative or preoperative imaging can be used to segment the region of interest for teleoperation, such as identifying an organ, a lesion site, or a partial anatomical site. X-ray, computed tomography, ultrasound, or magnetic resonance imaging can also be used. In another embodiment, an endoscopic view and the surgeon's knowledge of human anatomy are used.

[0051] The coordinate system for imaging and the robotic surgical system 120 are aligned or registered by calibration, an imaging detector mounted in a known spatial position relative to the robotic manipulator 122 (e.g., by endoscopic imaging on the robotic manipulator 122) and / or by detecting a portion of the robotic manipulator 122 or surgical instrument 220 during imaging. The target anatomy can be located in the coordinate system of the robotic manipulator 122.

[0052] The overlap of the volume or other region of the target anatomy and the work region is optimized. Various work regions are possible corresponding to different positions of the robotic manipulator 122 about the RCM. Prior to or during teleoperation, after docking of the robotic manipulator 122, the optimal joint angles can be calculated to maximize the overlap volume of the work region of the surgical tool and the target organ / tissue while keeping the RCM point fixed (i.e., conditional optimization). In the example using joint J6, the possible work regions have different work region orientations (no translation) such that the unreachable zone (circular cone-shaped cutout in the work region) is always as far outside the target tissue / organ as possible.

[0053] The amount of overlap of these possible work regions (i.e., work regions oriented within the configuration range) and the target anatomy volume is determined. The volume, area, and / or distance that the work region and the target anatomy overlap in space is calculated. The amount of overlap can be different for different possible configurations, such as different orientations of the joint position within the discrete range for a spherical rolling joint. The work region can be translated and / or rotated while the RCM remains fixed due to the different possible configurations.

[0054] The orientations and / or positions of the different possible work regions are searched to find the maximum amount of overlap. The amount of overlap of each possible work region and the target anatomy is determined. After the robotic manipulator 122 is docked to the cannula 214, the control processor scans or searches the discrete neighborhood in these configurations (e.g., J6 (spherical rolling) joint positions) and calculates the overlap volume of the work region and the target anatomy corresponding to each configuration (e.g., movement of the J6 origin within the specified neighborhood). The configuration that provides the maximum overlap is selected as the "best configuration."

[0055] A nonlinear search can be used instead of searching all possible work regions. A nonlinear optimization method such as simulated annealing or a coarse-to-fine search can be used to speed up the search instead of a linear search. To quickly obtain the best pose, assuming that the initial manipulator configuration is close to optimal, the search can be done locally. This can result in the search indicating that the manipulator configuration needs to be "fine-tuned" instead of needing to be repositioned overall.

[0056] The determination of the configuration to maximize the overlap can be performed once the RCM is established (e.g., after docking). The determination can be performed prior to teleoperation. The determination process can be repeated. The determination process can be performed for each change in the RCM during teleoperation. The determination process can be performed as the target anatomy shifts, such as in a staged operation on different anatomies. Changes in the surgical tool 220 or any other reason that causes the target anatomy or work region to shift or change can trigger the determination process.

[0057] In act 340, the control processor selects a position of the robotic manipulator that has the largest amount of overlap. For the possible work area, the configuration is selected that provides the largest overlap with the target anatomy. Figure 5 An example is shown. The orientation of the work area on the left shows portions of the target anatomy that are outside the work area sphere, such as portions within the conical incision. The orientation of the work area on the right shows the work area sphere rotated so that no portion of the target anatomy is outside the work area (i.e., the conical incision no longer intersects the target anatomy after the rotation). The configuration of the robotic manipulator 122 (e.g., the angle of rotation of the joint J6) is selected to provide the largest overlap.

[0058] During teleoperation, this selection process is repeated. For each repetition, the same or a different configuration is selected. More or less maximum overlap can be provided due to the shift in position. A different configuration can provide more overlap than the configuration that provided the maximum overlap in the past due to the shift in position. A different work area of the possible work areas and a corresponding configuration are selected.

[0059] In act 350, the control processor moves the robotic manipulator 122 to the selected position or configuration. The control processor causes the robotic manipulator 122 and / or the surgical tool 220 to move. The output movement commands for the active joints during teleoperation cause the positions of the joints to change. The robotic manipulator 122 moves to achieve the selected configuration.

[0060] In one example using joint J6, the selection act 340 will provide a target x and y movement of the origin of joint J6 (spherical roll, sr) that provides the best pose (i.e., the largest overlap between the robot work area and the target anatomy): w x,sr , w y,sr . The robotic manipulator 122 moves to this best configuration (q 最佳 ) while keeping the force at the RCM (and thus the force experienced) at a safe level. A special case occurs if the robotic manipulator 122 is docked without pulling / pushing on the cannula 214 and if the patient remains still, in which case the force at the insertion port is small (thus safe) at the start and the RCM remains fixed at that position. In the case where there is residual force on the cannula 214 after docking and / or there is another source of force, the force experienced is released by updating (i.e., sliding) the position of the RCM and optimizing the overlap.

[0061] The joint position or configuration of the robotic manipulator 122 can be selected in act 340 based on more than just the overlap. The selection can be based on user commands in the teleoperation, RCM adjustments to reduce force, and / or the amount of overlap of the working region of the surgical instrument 220 with the region of interest of the patient (i.e., the target anatomy). The selection of the configuration takes various issues into account.

[0062] In one embodiment, the readings of the sensor 600 provide a direct measure of the magnitude and direction of the force at the tool insertion site for the RCM repositioning, with or without teleoperation commands, (e.g., continuous real-time monitoring values). If the sensed force magnitude exceeds a predetermined safety threshold (e.g., a force that can cause injury), the desired RCM motion is calculated based on the force magnitude, rather than keeping the RCM stationary. One example of this control is provided according to:

[0063]

[0064]

[0065] where is the sensed force vector described above, is the force vector threshold described above, is the change in RCM position vector, is a 3x3 rotation matrix from the robot base (world coordinate frame) to the joint J7 (spherical pitch) coordinate frame, and is a 3x3 rotation matrix from the joint J7 coordinate frame to the coordinate frame of the sensor. This rotation matrix can change dynamically according to the configuration of the robotic manipulator 122. is a fixed registration because once the robotic manipulator is docked, the orientation of the cannula 214 is fixed relative to the distal block attached to J7. K is a spring stiffness that defines the magnitude of the translation that can be commanded to the robot to reduce a given force. A larger value of K can result in a "less sensitive" system. A smaller value of K helps to create a sensitive system that can reduce the force to the set safety threshold level as quickly as possible. If the sensitive system is not adjusted properly, it can result in overshoot and thus cause instability in the robot motion.

[0066] Figure 6 An example of the working region calibration and shifting in the RCM for the selection of the robotic configuration of the robotic manipulator 220 for Figure 2 During teleoperation, there can be excessive force at the cannula 214, such as due to patient motion. To avoid causing injury, the force F detected on the cannula 214 (sensed via the embedded force sensor 600) is used to calculate a new RCM position ​to mitigate harmful stresses at the insertion port. Under this new RCM constraint, the optimal joint angles are recalculated to reorient the work area such that the target / tissue remains within the reachable work area to the greatest extent possible. The robotic manipulator 122 is moved by repositioning one or more joints according to the overlap and RCM, regardless of whether the operator moves the surgical instrument during teleoperation. If repositioning is done prior to teleoperation, the proximal end wrist (Jl l), the distal end wrist (JlO), and the tool rotation joint (J9) of the surgical instrument 220 are not used. During teleoperation, these joints (J9, JlO, and Jl l) only receive commands for manipulating the tool. For the spherical manipulator joints (J6, J7, J8), the calculated new joint commands for overlap and RCM positioning are added to the commands due to the surgeon's teleoperation, such that repositioning can continue even during teleoperation.

[0067] The new joint movements (e.g., repositioning the RCM, then possibly optimizing for overlap according to various configurations at the new RCM location) to satisfy the work area requirement (i.e., new movement of the spherical roll joint around the origin of the RCM point (w x,sr ,w y,sr ) and the force requirement at the insertion port (i.e., displacement of the RCM point to mitigate excessive force at the insertion port) can be calculated sequentially. Alternatively, the various motions described above can be utilized in one solution, such as given by:

[0068]

[0069]

[0070] where J represents the combined Jacobian, J + is the pseudo-inverse of this combined Jacobian, x, y, z are the spatial coordinates, tr is the tool roll (J9) joint origin, and sr is the spherical roll (J6) joint origin. The resulting is a 9x1 vector and contains new joint commands for joints J1 through J9 due to repositioning. Joints JlO and Jl l (proximal end wrist and distal end wrist on the surgical instrument 220) are not involved in this motion. When joints J6 through Jl l receive additional commands due to teleoperation , these two commands and are summed to satisfy (1) the work area requirement, (2) the force requirement at the insertion port, and (3) the teleoperation commands simultaneously. J1 through J5 are not involved in executing this teleoperation command, so they are not affected by the sum ​The resulting joint command vector for the entire robot (J1 to J11) is given as follows:

[0071]

[0072] Other commands or control functions can also be used. Other procedures for solving for three sources of motion and for positioning can also be used.

[0073] The configurations selected based on work area calibration, force sensing for RCM changes, and / or teleoperation can be performed once or can be repeated multiple times. When repeated (see feedback from action 350 to action 300), the robot manipulator 122 is gradually moved to the selected position and corresponding configuration.

[0074] Prior to initiating teleoperation, the robotic surgical system 120 guides the operator to present the robot manipulator 122 in the computed "best" pose for work area calibration according to the RCM to dock. Based on the computed joint movement The above guidance is performed quickly and easily.

[0075] The guidance can be performed in a variety of different ways. In haptic guidance via virtual fixtures, the virtual fixtures can be actively (pseudo-autonomous approach) or passively executed. In the actively executed approach, a virtual spring force is generated on top of the user applied force to pull the robot manipulator 122 towards the best pose. In this scheme, the manipulator 122 is automatically moved towards the best pose, but the user can always cancel or resist this motion by using the counter force. This allows the user to remain in the control loop to ensure safety. In the passively executed approach, the robot manipulator 122 is not automatically moved, but is moved based on the component of the user applied force or torque. The component of the user force or torque that is towards the best pose is amplified while the other components are damped. This can achieve a fully user- dominated motion, but provides haptic feedback to the user that feels resistive if they move away from the target pose and feels smooth if they move towards the best pose.

[0076] In another guidance, auditory feedback is used. The user is provided with audio suggestions to move each joint of the robot to the respective target position, such as "rotate joint 1 clockwise." If the target position is exceeded, the audio command switches to "rotate joint 1 counter-clockwise." At the same time, the remaining joints automatically align themselves to comply with the RCM constraints or force requirements.

[0077] In yet another guidance, visual feedback is used. Guidance is provided to the user through virtual cues to adjust the position of each joint individually. For example, if an adjustment is needed to which joint, an LED status light on that joint is displayed in red. The LED turns green once the joint reaches a position that achieves the calculated "best" overall pose. As another example, guidance is provided to the user through the use of an augmented reality display superimposing arrows on the view of the actual robot or user input controls.

[0078] After starting the teleoperation, the same or different guidance can be used to adjust the configuration and move the robot manipulator 122 based on RCM repositioning and / or work area calibration. Alternatively, the configuration is automatically performed based on work area calibration and / or RCM force reduction, regardless of whether the user has acknowledged starting the change.

[0079] In an example use case, before starting the teleoperation, after docking the manipulator, the RCM is repositioned or assisted in repositioning (e.g., simply translated) by repositioning assistance, such that any stress between the patient and the cannula 214 is released. Repositioning is also used to angularly adjust any one or more of the joints J1-J9 to rotate the work area (i.e., non-translational), such that the target anatomy is fully or mostly within the work area of the robot.

[0080] After starting the teleoperation, the work area requirements can still change, for example, due to complications arising during the surgical procedure, intraoperative discovery of anatomical variations, deformation or shift of organs, etc. Thus, the new target anatomy can be completely outside the boundaries of the optimized work area of the robot manipulator 122 or even more deviated from the area. If such changes in the required anatomical work area are sensible (e.g., in combination with joint angles and endoscope images can indicate where the surgeon is trying to reach and where the instrument joint reaches a limit, the surgeon is currently unable to reach the anatomy to operate on), the overall pose of the manipulator can be continuously or periodically reoriented, such that the target anatomy remains within the work area that the instruments 220 can reach. The reorientation can be triggered by the user, for example. The reorientation enables the teleoperation to continue without having to stop, reconsider the anatomy, work area, and manipulator arrangement, then manually guide the robot manipulator to a new pose and eventually continue the operation. This can avoid wasting surgical time.

[0081] During a surgical procedure, there can be movement of the tissue and the entire patient abdomen. This can induce additional pulling forces on the cannula 214 and cause trauma at the patient's insertion port. Exertion of forces on the patient, such as any sustained over-compression of tissue, can result in reduced perfusion of the tissue. Exertion of excessive forces on the tissue can impede blood flow in capillaries in the skin and also damage fascial vessels that are perforated upon entry into the skin. This reduced delivery of oxygen to the tissue can result in herniation of the incision site and complications in the wound healing process. Therefore, during operation, the presence of excessive forces at the incision site should be prevented or limited by readjusting the overall pose of the manipulator. Forces on the cannula 214 are sensed and used as a feedback mechanism in an assisted, automatic, or guided repositioning control mode to reconfigure the pose of the manipulator to maintain the forces at the cannula site at a tissue tolerable level throughout the surgical procedure.

[0082] Figure 7 Block diagram of one embodiment of a surgical robotic system for medical teleoperation. The system performs the method of Figure 3 or other methods. The RCM can be repositioned by any one or more (e.g., all) work area calibrations or force sensing.

[0083] The surgical robotic system includes one or more robotic manipulators 122 having corresponding surgical instruments 220 or other types of instruments connected with the robotic manipulators 122, a controller 702, and a memory 704. The user console 110 is represented or included as part of the surgical robotic system. Additional, different, or fewer components can be provided. For example, the robotic manipulators 122, surgical instruments 220, and / or user console 110 are not provided.

[0084] The robotic manipulators 122 each include one or more links and joints. The joints can be pitch joints or roll joints. Tool drivers and cannulas 214 for receiving and guiding surgical tools can be provided on each robotic manipulator 122. Different combinations of links and joints can define or form different portions of the robotic manipulators 122, such as different portions having different degrees or types of movement (e.g., translation and / or rotation). Any presently known or later developed robotic manipulators 122 having motors, sensors, links, joints, controllers, surgical instruments, and / or other structures can be used.

[0085] One or more robotic manipulators 122 are provided. For example, three or four robotic manipulators 122 are provided. The robotic manipulators 122 are mounted to a base of a table, such as a surgical table. Alternatively, a cart, floor, ceiling, or other base can be used. The robotic manipulators 122 include a cable or wireless transceiver for communicating with the controller 702 or middleware (e.g., control tower 130).

[0086] The robotic surgical instruments 220 are one or more graspers, retractors, scalpels, endoscopes, staplers, scissors, or other surgical devices for manipulating patient tissue. Manipulating tissue can be direct, such as making a cut or grasping. Manipulating tissue can also be indirect, such as pressing or contacting tissue with an endoscope to direct imaging or viewing of a portion of the patient’s body. Different or the same types of instruments 220 can be mounted to different robotic manipulators 122. For example, two robotic manipulators 122 can hold graspers, a third robotic manipulator 122 can hold a scalpel, and a fourth robotic manipulator 122 can hold an endoscope.

[0087] The robotic surgical instruments 220 are connected to a distal end of the robotic manipulators 122, but can be connected at other locations. The connection provides a driving force to operate the tools, such as closing graspers or scissors.

[0088] The robotic manipulators 122 include an adapter 420 connected configured to connect with the cannula 214 for interfacing and performing remote operations. The connection with the cannula 214 can position the surgical instruments 220 through the cannula 214 at an insertion point into the patient’s body. The insertion point is created as an RCM for the robotic manipulators 122 and the surgical instruments 220.

[0089] One or more sensors 600 on the cannula and / or on the adapter 420 monitor tissue stress for repositioning the RCM. For example, pressure sensors are located on different surfaces of the adapter 420. The different surfaces are surfaces that contact the connected cannula 214. The pressure sensors on the different surfaces of the recess or on the adapter 420 protrusions sense one or more degrees of freedom. In combination, a vector of multiple forces is sensed.

[0090] The user console 110 is a graphical user interface for a surgeon to interact with the surgical robotic system, such as the console including a processor for controlling the robotic manipulators 122. The user interface includes user inputs 708 and a display 118. The user inputs 708 and / or the display 118 are disposed at the user console 110 and / or the control tower 130, but can be at other locations.

[0091] User input 708 is a button, keyboard, rocker, joystick, trackball, voice recognition circuit, mouse, touchpad, touchscreen, slider, switch, UID 116, footswitch 114, or combination thereof, or any other input device for inputting to a surgical robot. Display 118 is a monitor, liquid crystal display (LCD), projector, plasma display, CRT, printer, or other now known or later developed device for outputting visual information. In alternative embodiments, display 118 is a head-mounted display. User input 708 can be one or more sensors for detecting eye movement and / or blinking. In still other embodiments, user input 708 is a microphone for inputting based on speech. A speaker can be provided for audio information output instead of or in addition to display 118.

[0092] Optional camera 706 is a digital camera for optically tracking user motion, such as when using UID 116 to control robot manipulator 122. In some embodiments, camera 706 can be a stereo camera and / or a depth camera. Camera 706 is positioned relative to the user and a target pattern or user console 110 for tracking human motion by tracking the target pattern or controlling robot manipulator 122 with user input 708.

[0093] Controller 702 is a controller that drives and / or models robot manipulator 122 and / or surgical instrument 220. Controller 702 is a general processor, central processing unit, control processor, graphics processor, graphics processor, digital signal processor, application-specific integrated circuit, field-programmable gate array, digital circuit, analog circuit, artificial intelligence processor, or combination thereof, or other now known or later developed device for controlling movement of robot manipulator 122 and / or surgical instrument 220. Controller 702 is a single device or multiple devices operating in series, in parallel, or individually. Controller 702 can be a main processor of a computer, such as the computer can be a laptop, server, workstation, or desktop computer, or can be a processor for handling some tasks in a larger system. Controller 702 is configured to implement instructions or perform actions based on hardware, software, firmware, or a combination thereof.

[0094] Controller 702 is configured to adjust the RCM of the robot manipulator based on output from sensor 600. The force at the insertion point measured by sensor 600 (e.g., multiple sensors on the adapter surface) is used to change the RCM to mitigate tissue stress.

[0095] The controller 702 is configured to determine an amount of overlap between the target anatomy and each of a plurality of working regions of the surgical instrument. Different working regions correspond to different positions of the robotic manipulator 122 about the RCM. For a given RCM, different working regions can be provided by the robotic manipulator 122 having different configurations, such as working regions having different orientations due to joint rotation. The controller 702 is configured to select a position of the robotic manipulator 122 (i.e., select a configuration) that results in a maximum amount of overlap between the working region and the target anatomy. The controller 702 is configured to move the robotic manipulator to the selected position, such as providing guidance to move the robotic manipulator 122 to the desired configuration. This guidance and corresponding movement can be provided prior to and / or during teleoperation, such as to reconfigure the robotic manipulator 122 in conjunction with (superimposed on) movement of the surgical instrument 220 to perform a surgical procedure on the patient to perform working region calibration.

[0096] The memory 704 or another memory is a non-transitory computer readable storage medium that stores data representing instructions that are executable by the programmed controller 702. Instructions for implementing the processes, methods, and / or techniques discussed herein can be provided on a computer readable storage medium or memory, such as a cache, buffer, RAM, removable media, hard disk, or other computer readable storage media. Computer readable storage media include various types of volatile and non-volatile storage media. The functions, acts or tasks illustrated in the figures or described herein are implemented with one or more sets of instructions stored in a computer readable storage medium or memory. The functions, acts or tasks are independent of the particular type of instructions set, storage media, processor or processing strategy. They can be performed by software, including microcode, firmware or hardware, including discrete logic or integrated circuitry, or a combination of the three. Similarly, the processing strategies can include multiple processor or multi-core processing, parallel processing, and the like.

[0097] In one embodiment, the instructions are stored on a removable media device for reading by a local or remote system. In other embodiments, the instructions are stored in a remote location for transmission over a computer network or through telephone lines. In still other embodiments, the instructions are stored within a given computer, CPU, GPU, or system.

[0098] While this application has been described with reference to various embodiments, it will be understood that various changes and modifications can be made without departing from the scope of the application. Accordingly, it is intended that the detailed description not be limiting, but rather serve as an example, and that the true spirit and scope of the application be defined by the following claims, including all equivalents.

Claims

1. A surgical robot system for remote medical operation, the surgical robot system comprising: A robot manipulator, the robot manipulator including one or more joints; Surgical instruments connected to the robotic manipulator; as well as The controller is configured to: Establish a remote motion center for the robot manipulator; Determine the amount of overlap between the target anatomical structure and each of the multiple working areas of the surgical instruments on the robotic manipulator, the working areas corresponding to different configurations of the robotic manipulator around the remote center of motion; Select the configuration of the robot manipulator that has the largest amount of overlap; as well as Move one or more of the joints of the robot manipulator onto the selected configuration.

2. The surgical robot system of claim 1, wherein the controller is configured to establish the remote center of motion by docking the robot manipulator with a cannula at the patient insertion site, the remote center of motion being the insertion site.

3. The surgical robot system of claim 1, wherein the controller is further configured to sense forces at the remote center of motion during remote manipulation via the robot manipulator and the surgical instruments; and wherein the controller is configured to establish the remote center of motion in response to changes based on the forces.

4. The surgical robot system of claim 3, further comprising sensors connected to the cannula of the robot manipulator.

5. The surgical robot system of claim 3, further comprising a force sensor in an adapter of the robot manipulator, the adapter being configured to connect the robot manipulator to a cannula.

6. The surgical robot system of claim 5, further comprising a plurality of single-degree-of-freedom sensors including the force sensor, the single-degree-of-freedom sensors being located on different surfaces of the adapter, the surfaces being in contact with the cannula when connected to the robot manipulator.

7. The surgical robot system of claim 3, wherein the controller is configured to determine during the remote operation, wherein the controller is configured to select during the remote operation, and wherein the controller is configured to move the one or more engagements of the robot manipulator to conform to the selected configuration and the remote center of motion established in response to the force.

8. The surgical robot system of claim 7, wherein the controller is configured to move the one or more joints to conform to a selected configuration, to conform to the remote center of motion established in response to the force, and to conform to the movement of the surgical instruments according to the operator during the remote operation.

9. The surgical robot system of claim 1, wherein the controller is configured to determine each working region corresponding to a range of discretized joint positions of the spherical rolling joint.

10. The surgical robot system of claim 1, wherein the controller is configured to determine the quantity as an overlapping volume, wherein the target anatomical structure is a segmented volume derived from medical imaging.

11. The surgical robot system of claim 1, wherein the controller is configured to search the plurality of working regions in a nonlinear search.

12. The surgical robot system of claim 1, wherein the controller is configured to repeat the determination and selection multiple times during the remote operation, wherein the selection for different repetitions in the repetitions is to select different work areas in the work area, and wherein the controller is configured to move the robot manipulator to the selected location through the repetitions.

13. A surgical robot system for remote medical operation, the surgical robot system comprising: A robot manipulator, the robot manipulator including one or more joints; Surgical instruments connected to the robotic manipulator; as well as The controller is configured to: Sensing the force at the remote motion center of the robot manipulator; as well as The position of the joint of the robot manipulator is adjusted to reduce the force at the remote motion center and to conform to the amount of overlap between the working area of ​​the surgical instrument and the region of interest in the patient.

14. The surgical robot system of claim 13, wherein the controller is configured to sense using a force sensor on a cannula connected to the robot manipulator.

15. The surgical robot system of claim 13, wherein the controller is configured to sense pressure with a plurality of pressure sensors on different surfaces of the adapter of the robot manipulator, the surfaces being in contact with the cannula.

16. The surgical robot system of claim 13, wherein the controller is configured to adjust by searching different possible working areas of the surgical instrument to find the maximum amount of overlap with the region of interest, the possible working areas corresponding to different possible engagement locations of the engagement, and selecting the possible working area having the maximum amount.

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