A computer-aided medical system and its control method

Abstract

This invention relates to a computer-aided medical system and its control method. The computer-aided medical system includes a flexible, elongated instrument. The flexible, elongated instrument includes multiple wires extending from a proximal end of the instrument to a distal end. Each of the multiple wires can be used to guide the distal end. The system also includes a control system coupled to the flexible, elongated instrument. The control system is configured to monitor movement of the flexible, elongated instrument along a longitudinal central axis and, based on this monitoring, determine the degree of movement of the flexible, elongated instrument along the longitudinal central axis in a first direction. The control system is also configured to change the stiffness of the flexible, elongated instrument by adjusting one or more forces applied to the distal end of the flexible, elongated instrument by the multiple wires, based on a stiffness profile relative to the degree of movement.

Description

[0001] This application is a divisional application of Chinese patent application 201780039384X (PCT / US2017 / 040214), entitled "A Computer-Aided Medical System and Control Method Thereof," filed on June 30, 2017, and entered the national phase on December 25, 2018.

[0002] Cross-references to related applications

[0003] This patent application claims priority and benefit on the filing date of U.S. Provisional Patent Application 62 / 357,555, filed July 1, 2016, entitled “SYSTEMS AND METHODS FORFLEXIBLE COMPUTER-ASSISTED INSTRUMENT CONTROL,” which is incorporated herein by reference in its entirety. Technical Field

[0004] This disclosure relates to systems and methods for computer-assisted medical surgery, and more specifically to systems and methods for controlling flexible, elongated instruments. Background Technology

[0005] Minimally invasive medical techniques aim to reduce the amount of tissue damaged during medical procedures, thereby reducing patient recovery time, discomfort, and harmful side effects. These techniques can be performed through natural openings in the patient's anatomy or through one or more surgical incisions. Through these natural openings or incisions, physicians can insert minimally invasive medical instruments (including surgical, diagnostic, therapeutic, or biopsy instruments) to reach the target tissue. To aid in reaching the target location, the positioning and movement of the medical instrument can be correlated with preoperative or intraoperative images of the patient's anatomy. Because image-guided instruments are image-correlated, they can navigate through natural passages or surgically created pathways in the anatomical system (e.g., intestines, kidneys, brain, heart, circulatory system, lungs, urethra, arteries, umbilical cord, etc.). Medical instruments need to be flexible enough to safely navigate within a tight bed of the anatomical pathway, while providing sufficient rigidity to ensure predictable performance orientation when deployed from the delivery catheter toward the target tissue. Summary of the Invention

[0006] Embodiments of the invention are best summarized by the claims appended to the specification. According to some embodiments, a computer-assisted medical system includes a flexible, elongated instrument. The flexible, elongated instrument includes multiple wires extending from a proximal end of the flexible, elongated instrument to a distal end of the flexible, elongated instrument. Each of the multiple wires can be used to guide the distal end. The system also includes a control system coupled to the flexible, elongated instrument. The control system is configured to monitor movement of the flexible, elongated instrument along a longitudinal central axis and, based on this monitoring, determine the degree of movement of the flexible, elongated instrument along the longitudinal central axis in a first direction. The control system is also configured to change the stiffness of the flexible, elongated instrument based on a stiffness profile relative to the degree of movement by adjusting one or more forces applied to the distal end of the flexible, elongated instrument by the multiple wires.

[0007] According to some embodiments, a method of controlling a medical device includes monitoring the movement of a command on a flexible, elongated instrument. The flexible, elongated instrument includes multiple wires extending from a proximal end of the flexible, elongated instrument to a distal end. Each of the multiple wires can be used to guide the distal end of the flexible, elongated instrument. The movement of the command is provided via an input device. The method also includes determining the degree of movement of the command on the flexible, elongated instrument based on the monitoring, and varying the stiffness of the flexible, elongated instrument based on a stiffness profile relative to the degree of movement by adjusting one or more forces applied to the distal end of the flexible, elongated instrument by each of the multiple wires.

[0008] According to some embodiments, a non-transitory machine-readable medium includes a plurality of machine-readable instructions, which, when executed by one or more processors associated with a flexible elongated device, are adapted to cause the one or more processors to perform a method. The method includes monitoring movement of the flexible elongated device. The flexible elongated device includes a plurality of wires extending from a proximal end of the flexible elongated device to a distal end of the flexible elongated device. Each of the plurality of wires can be used to guide the distal end of the flexible elongated device. The method also includes determining the degree of movement of the flexible elongated device based on the monitoring, and changing the stiffness of the flexible elongated device based on a stiffness profile relative to the degree of movement by adjusting one or more forces applied to the distal end of the flexible elongated device by each of the plurality of wires.

[0009] According to some embodiments, a computer-aided medical system includes a flexible, elongated instrument comprising multiple wires extending from a proximal end of the flexible, elongated instrument to a distal end. Each of the multiple wires can be used to guide the distal end. The system also includes a control system coupled to the flexible, elongated instrument. The control system is configured to monitor movement of the flexible, elongated instrument and determine an operating mode of the flexible, elongated instrument. The operating mode corresponds to one of a retraction mode, an insertion mode, and a parking mode. In response to determining that the operating mode is a retraction mode, the control system is configured to determine, based on monitoring, the degree of retraction of the flexible, elongated instrument, and based on the degree of retraction, to reduce the stiffness of the flexible, elongated instrument by adjusting one or more forces applied to the distal end of the flexible, elongated instrument by the multiple wires. In response to determining that the operating mode is an insertion mode, the control system is configured to determine, based on monitoring, the degree of insertion of the flexible, elongated instrument. The control system is also configured to increase the stiffness of the flexible, elongated instrument by adjusting one or more forces applied to the distal end of the flexible, elongated instrument by the multiple wires based on the degree of insertion. In response to the determination that the operating mode is the parking mode, the control system is configured to determine the degree of parking of the flexible slender instrument based on monitoring, and to increase or decrease the stiffness of the flexible slender instrument by adjusting one or more forces applied to the distal end of the flexible slender instrument by multiple wires based on the degree of parking. Attached Figure Description

[0010] Figure 1 This is an example of a remotely operated medical system.

[0011] Figure 2A This is an exemplary medical device system.

[0012] Figure 2B It is an exemplary distal end of a flexible, slender device.

[0013] Figure 3 This is an example actuator.

[0014] Figure 4A and Figure 4B A side view of the patient coordinate space is shown, which includes the medical device mounted on the insertion assembly.

[0015] Figure 5A and Figure 5B This is an exemplary stiffness profile of a flexible, slender device.

[0016] Figure 6 This is a flowchart illustrating an exemplary method for controlling a flexible body.

[0017] Figure 7 It shows in Figure 6 The stiffness multiplier curve related to the retraction distance is applied during an exemplary application of the method.

[0018] Figures 8-10 The submode stiffness profile is shown.

[0019] The embodiments and advantages of this disclosure can be best understood by referring to the following detailed description. It should be understood that the same reference numerals are used to identify the same elements shown in one or more figures, wherein the figures are for illustrative purposes and not for limiting the embodiments of this disclosure. Detailed Implementation

[0020] In the following description, specific details describing some embodiments according to this disclosure are set forth. Numerous specific details are set forth to provide a thorough understanding of the embodiments. However, it will be apparent to those skilled in the art that some embodiments may be practiced without some or all of these specific details. The specific embodiments disclosed herein are illustrative and not restrictive. Other elements may be implemented by those skilled in the art, although not specifically described herein, within the scope and spirit of this disclosure. Furthermore, to avoid unnecessary repetition, one or more features shown and described in connection with one embodiment may be incorporated into other embodiments, unless otherwise specifically described or if one or more features render the embodiment inoperable. In some cases, well-known methods, procedures, components, and circuits have not been described in detail to avoid unnecessarily obscuring aspects of the embodiments.

[0021] This disclosure describes various apparatuses and parts thereof based on their state in three-dimensional space. As used herein, the term "position" refers to the location of an object or part of an object in three-dimensional space (e.g., three translational degrees of freedom along Cartesian x, y, and z coordinates). As used herein, the term "orientation" refers to the rotational placement of an object or part of an object (three rotational degrees of freedom—e.g., roll, pitch, and yaw). As used herein, the term "pose" refers to the position of an object or part of an object in at least one translational degree of freedom and the orientation of the object or part of the object in at least one rotational degree of freedom (up to six degrees of freedom in total). As used herein, the term "shape" refers to a set of poses, positions, or orientations measured along an object. Components described as "connected" may be electrically or mechanically directly connected, or they may be indirectly connected via one or more intermediate components.

[0022] Long, flexible devices (such as catheters) have a small cross-section. These devices include one or more hollow openings along their length and are preferably designed to provide narrow passages for inserting medical devices and / or apparatus into a patient (e.g., airways in the lungs). The guide channel for the distal or distal end of the catheter facilitates easier control of catheter insertion.

[0023] One possible way to guide the tip of these conduits is by pushing and / or pulling a series of lines extending along a long, flexible device using actuators. Using these lines, operators and / or automation systems are able to pull and / or push more forcefully on one side of the tip relative to the other, causing the tip to bend in the desired direction relative to the rest of the device.

[0024] Besides guiding the tip, pushing and / or pulling the line more forcefully also affects how the tip's stiffness or rigidity becomes. This is usually not a problem when the tip's bend aligns with the channel it's inserted into, but it may not be when the tip is further inserted into the channel and / or retracted from the channel without aligning with the current channel. For example, the tip might be bent into a "hook" shape to be inserted along a curve in the channel, but when the tip retracts later, this "hook" prevents the tip from smoothly passing through straighter and / or differently curved sections of the channel. One way to account for the hook possibility is to reverse the guide used to insert the tip as it retracts later. Another approach is to reduce the tip's stiffness so that it can more easily adjust its shape according to the current channel when it retracts. The tip's stiffness can be adjusted by changing the amount of force applied by the line used to guide the tip. For example, to reduce stiffness, the amount of force applied to the line is reduced accordingly. The amount of force applied by the line can be controlled using a motor and / or actuator that can push and / or pull the line. Therefore, stiffness can be adjusted by changing the force and / or torque applied by the motor / actuator to control the push and / or pull of one or more wires in the conduit. Controlled reduction of stiffness can reduce the likelihood of the operator losing their way while controlling the movement of the conduit. Stiffness can be adjusted according to a predetermined plan or curve on how quickly the stiffness can be adjusted. For the stiffness of a conduit, the stiffness profile can have different behavioral zones; for example, the stiffness in one zone may decrease faster than in others.

[0025] During insertion, it may be desirable to increase stiffness to allow the catheter to be guided as it moves forward within the patient's access. Stiffness can be increased up to the catheter's maximum permissible stiffness.

[0026] When catheter movement is minimal, stiffness can be adjusted to a higher or lower level. When catheter movement is also minimal, stiffness can be increased to provide stability for instruments deployed through the catheter during surgery.

[0027] Figure 1 This is a simplified diagram of a remotely operated medical system 100 according to some embodiments. In some embodiments, the remotely operated medical system 100 may be suitable for, for example, surgical, diagnostic, therapeutic, or biopsy procedures. Figure 1As shown, medical system 100 typically includes a remote operation manipulator assembly 102 for operating medical devices 104 during various surgical procedures performed on patient P. The remote operation manipulator assembly 102 is mounted to or near the operating table T. The main assembly 106 allows the operator (e.g., such as...) to... Figure 1 The surgeon, clinician, or physician O shown observes the intervention site and controls the remote manipulator assembly 102.

[0028] The main component 106 may be located at the surgeon's console, which is typically in the same room as the operating table T, for example, next to the surgical table on which the patient P sits. However, it should be understood that the surgeon O may be in a different room or in a completely different building from the patient P. The main component 106 typically includes one or more control devices for controlling the remotely operated manipulator component 102. The control devices may include any number of various input devices, such as joysticks, trackballs, wheels, data gloves, triggers, hand-operated controllers, voice recognition devices, human motion or presence sensors, and / or similar motion devices that can be operated by the surgeon O to provide commands. To give the surgeon O a strong sense of direct control over the instrument 104, the control devices may have the same degrees of freedom as the associated medical instrument 104. In this way, the control devices provide the surgeon O with a sense of remote presentation or that the control devices are integrated with the medical instrument 104.

[0029] In some embodiments, the control device may have more or fewer degrees of freedom than the associated medical device 104, and still provide remote presentation to the physician O. In some embodiments, the control device may optionally move in six degrees of freedom and may also include a manual input device for actuating actuable handle (e.g., for closing a gripping forceps, applying a potential to an electrode, delivering medication, and / or similar actions).

[0030] The teleoperation manipulator assembly 102 supports the medical device 104 and may include a kinematic structure consisting of one or more non-servo-controlled links (e.g., one or more links that can be manually positioned and locked in place, often referred to as a setup structure) and a teleoperation manipulator. The teleoperation manipulator assembly 102 may optionally include multiple actuators or motors that drive inputs on the medical device 104 in response to commands from a control system (e.g., control system 112). The actuators may optionally include drive systems that, when coupled to the medical device 104, can advance the medical device 104 into a naturally or surgically created anatomical opening. Other drive systems may move the distal end of the medical device 104 with multiple degrees of freedom, which may include three linear degrees of motion (e.g., linear motion along the X, Y, Z Cartesian axes) and three rotational degrees of motion (e.g., rotation about the X, Y, Z Cartesian axes). Additionally, the actuator can be used to actuate the articulated end effector of medical device 104 for grasping tissue and / or similar actions in the forceps of a biopsy apparatus. Actuator position sensors, such as resolvers, encoders, potentiometers, and other mechanisms, can provide the medical system 100 with sensor data describing the rotation and orientation of the motor shaft. This position sensor data can be used to determine the motion of the object manipulated by the actuator.

[0031] The remote-operated medical system 100 may include a sensor system 108 having one or more subsystems for receiving information about the instruments of the remote-operated manipulator assembly 102. Such subsystems may include: a position / positioning sensor system, such as an electromagnetic (EM) sensor system; a shape sensor system for determining the position, orientation, rate, velocity, posture, and / or shape of the distal end and / or along one or more segments that may constitute a flexible body of the medical device 104; and / or a visualization system for capturing images from the distal end of the medical device 104.

[0032] The remote-operated medical system 100 also includes a display system 110 for displaying images or representations of the surgical site and medical device 104 generated by a subsystem of the sensor system 108. The display system 110 and the main component 106 can be oriented such that a physician O can control the medical device 104 and the main component 106 by means of remotely presented perception.

[0033] In some embodiments, the medical device 104 may have a visualization system (discussed in more detail below) that may include a viewing range component that records concurrent or real-time images of the surgical site and provides the images to an operator or physician via one or more displays of the medical system 100 (e.g., one or more displays of the display system 110). The concurrent images may be, for example, two-dimensional or three-dimensional images captured by an endoscope located within the surgical site. In some embodiments, the visualization system includes an endoscope component that may be integrally or detachably coupled to the medical device 104. However, in some embodiments, a separate endoscope attached to a separate manipulator assembly may be used with the medical device 104 to image the surgical site. In some examples, the endoscope may include one or more mechanisms for cleaning the one or more lenses of the endoscope when they are partially and / or completely obstructed by fluids and / or other materials encountered by the endoscope. In some examples, the one or more cleaning mechanisms may optionally include an air and / or other gas delivery system for emitting a stream of air and / or other gas to purge the one or more lenses clean. Examples of one or more cleaning mechanisms are discussed in more detail in International Publication No. WO / 2016 / 025465 (disclosing "Systems and methods for cleaning endoscopic instruments"), filed on August 11, 2016, which is incorporated herein by reference in its entirety. The visualization system can be implemented as hardware, firmware, software, or a combination thereof, which interacts with or is otherwise performed by one or more computer processors, which may include the processor of the control system 112.

[0034] Display system 110 can also display images of the surgical site and medical instruments captured by the visualization system. In some examples, remote-operated medical system 100 can configure controls for medical instrument 104 and main component 106 such that the relative positions of the medical instruments resemble the relative positions of the doctor O's eyes and hands. In this way, doctor O can manipulate medical instrument 104 and hand controls as if essentially viewing the workspace. Immersive means that the image presentation is a realistic perspective image simulating the viewpoint of a doctor physically manipulating medical instrument 104.

[0035] In some examples, the display system 110 can present images of the surgical site recorded preoperatively or intraoperatively using image data from imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermoforming, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, nanotube X-ray imaging, and / or similar techniques. The preoperative or intraoperative image data can be presented as two-dimensional, three-dimensional, or four-dimensional images (including, for example, time-based or velocity-based information) and / or as images of models created from preoperative or intraoperative image datasets.

[0036] In some embodiments, typically for the purpose of image-guided surgery, the display system 110 may display a virtual navigation image, wherein the actual location of the medical device 104 is registered with preoperative or concurrent images / models (i.e., dynamic reference). This can be done by presenting a virtual image of the internal surgical site to the physician O from the perspective of the medical device 104. In some examples, the perspective may be from the tip of the medical device 104. Images of the tip of the medical device 104 and / or other graphic or alphanumeric indicators may be overlaid on the virtual image to aid the physician O in controlling the medical device 104. In some examples, the medical device 104 may not be visible in the virtual image.

[0037] In some embodiments, display system 110 may display a virtual navigation image, wherein the actual location of medical device 104 is registered with preoperative or concurrent images to present a virtual image of medical device 104 within the surgical site to physician O from an external perspective. An image of a portion of medical device 104 or other graphic or alphanumeric indicators may be overlaid on the virtual image to assist physician O in controlling medical device 104. As described herein, a visual representation of data points may be presented to display system 110. For example, measured data points, moving data points, registered data points, and other data points described herein may be displayed visually on display system 110. Data points may be visually represented in the user interface as multiple dots or small circles on display system 110, or represented as a rendered model, such as a grid or line model created based on the set of data points. In some examples, data points may be color-coded according to the data they represent. In some embodiments, the visual representation may be refreshed in display system 110 after each processing operation has been performed to change the data points.

[0038] The remote-operated medical system 100 may also include a control system 112. The control system 112 includes at least one memory and at least one computer processor (not shown) for implementing control between the medical device 104, main component 106, sensor system 108, and display system 110. The control system 112 also includes programmed instructions (e.g., a non-transitory machine-readable medium storing the instructions) to implement some or all of the methods described according to various aspects of the disclosure herein, including instructions for providing information to the display system 110. While the control system 112... Figure 1 The system is shown as a single block in the simplified schematic, but it may include two or more data processing circuits, with some processing optionally performed on or near the remote operating manipulator component 102, other processing performed at the main component 106, and so on. The processor of the control system 112 can execute instructions, including instructions corresponding to the processes disclosed herein and described in more detail below. Any of a variety of centralized or distributed data processing architectures can be employed. Similarly, the programmed instructions can be implemented as multiple separate programs or subroutines, or they can be integrated into many other aspects of the remote operating system described herein. In one embodiment, the control system 112 supports wireless communication protocols such as Bluetooth, IrDA, HomeRF, IEEE 802.11, DECT, and wireless telemetry.

[0039] In some embodiments, the control system 112 may receive force and / or torque feedback from the medical device 104. In response to the feedback, the control system 112 may send a signal to the main component 106. In some examples, the control system 112 may send a signal instructing one or more actuators of the remote manipulation component 102 to move the medical device 104. The medical device 104 may extend to an internal surgical site within the patient P's body via an opening in the patient P's body. Any suitable conventional and / or specialized actuators may be used. In some examples, one or more actuators may be separate from or integrated with the remote manipulation component 102. In some embodiments, one or more actuators and the remote manipulation component 102 are provided as part of a remote manipulation trolley positioned near the patient P and the operating table T.

[0040] The control system 112 may optionally further include a virtual visualization system to provide navigational assistance to the physician O during image-guided surgery while controlling the medical device 104. Virtual navigation using the virtual visualization system may be based on a reference to a preoperative or intraoperative dataset of the acquired anatomical passage. The virtual visualization system processes images of the imaged surgical site using imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermoforming, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, nanotube X-ray imaging, etc. Software, which may be used in conjunction with manual input, is used to convert the recorded images into segmented two-dimensional or three-dimensional composite representations of parts or entire anatomical organs or regions. The image dataset is associated with the composite representation. The composite representation and the image dataset describe the various locations and shapes of the passage and their connectivity. Images used to generate the composite representation may be recorded preoperatively or intraoperatively during clinical surgery. In some embodiments, the virtual visualization system may use a standard representation (i.e., not patient-specific) or a mixture of standard representation and patient-specific data. Composite representations and any virtual images generated from composite representations can represent the static posture of deformable anatomical regions during one or more phases of motion (e.g., during the inspiratory / expiratory cycle of the lungs).

[0041] During virtual navigation surgery, sensor system 108 can be used to calculate the approximate positioning of medical device 104 relative to the anatomical structures of patient P. This positioning can be used to generate macroscopic (external) tracking images of the anatomical structures of patient P and virtual internal images of the anatomical structures of patient P. The system may implement one or more electromagnetic (EM) sensors, fiber optic sensors, and / or other sensors to register and display the recorded and displayed medical procedure with preoperatively recorded surgical images (e.g., known images from a virtual visualization system). For example, U.S. Patent Application No. 13 / 107,562, filed May 13, 2011 (disclosing a medical system providing dynamic registration of a model of anatomy for image-guided surgery) discloses such a system, which is incorporated herein by reference in its entirety. The remote-operated medical system 100 may also include optional operating and support systems (not shown), such as lighting systems, guidance control systems, irrigation systems, and / or aspiration systems. In some embodiments, the remote-operated medical system 100 may include more than one remote-operated manipulator component and / or more than one master component. The exact number of remote-controlled manipulator components will depend on the surgical procedure and space constraints within the operating room, as well as other factors. The master components 106 can be juxtaposed or located in different positions. Multiple master components allow more than one operator to control one or more remote-controlled manipulator components in various combinations.

[0042] Figure 2AThis is a simplified diagram of a medical device system 200 according to some embodiments. In some embodiments, the medical device system 200 can be used as a medical device 104 in an image-guided medical procedure performed using a remotely operated medical system 100. In some examples, the medical device system 200 can be used for non-remotely operated exploratory procedures or procedures involving conventionally manually operated medical instruments (such as endoscopy). Optionally, the medical device system 200 can be used to collect (i.e., measure) a set of data points corresponding to locations within an anatomical passageway of a patient (such as patient P).

[0043] The medical device system 200 includes an elongated device 202, such as a flexible catheter, coupled to a drive unit 204. The elongated device 202 includes a flexible body 216 having a proximal end 217 and a distal end 218 (or tip portion 218). In some embodiments, the flexible body 216 has an outer diameter of approximately 3 mm. Other flexible bodies may have larger or smaller outer diameters.

[0044] The medical device system 200 also includes a tracking system 230 for determining the position, orientation, rate, velocity, posture, and / or shape of the distal end 218 and / or one or more segments 224 along the flexible body 216 using one or more sensors and / or imaging devices, as described in further detail below. The entire length of the flexible body 216 between the distal end 218 and the proximal end 217 can be effectively divided into segments 224. The tracking system 230 is used if the medical device system 200 is aligned with the medical device 104 of the remotely operated medical system 100. The tracking system 230 is optionally implemented as hardware, firmware, software, or a combination thereof that interacts with or is otherwise executed by one or more computer processors, which may include Figure 1 The processor of the control system 112.

[0045] The tracking system 230 may optionally use a shape sensor 222 to track one or more of the distal end 218 and / or segments 224. The shape sensor 222 may optionally include an optical fiber aligned with the flexible body 216 (e.g., disposed within an internal channel (not shown) or mounted externally). In one embodiment, the diameter of the optical fiber is approximately 200 μm. In other embodiments, the size may be larger or smaller. The optical fiber of the shape sensor 222 forms an optical fiber bend sensor for determining the shape of the flexible body 216. In an alternative, an optical fiber including a fiber Bragg grating (FBG) is used to provide strain measurements in one or more dimensions of the structure. Various systems and methods for monitoring the shape and relative position of an optical fiber in three dimensions are described in U.S. Patent Application No. 11 / 180,389, filed July 13, 2005 (disclosing "Optical Fiber Position and Shape Sensing Apparatus and Related Methods Thereof"), U.S. Patent Application No. 12 / 047,056, filed July 16, 2004 (disclosing "Optical Fiber Shape and Relative Position Sensing"), and U.S. Patent No. 6,389,187, filed June 17, 1998 (disclosing "Optical Fiber Bending Sensor"), the disclosures of which are incorporated herein by reference in their entirety. In some embodiments, the sensor may employ other suitable strain sensing techniques, such as Rayleigh scattering, Raman scattering, Brillouin scattering, and fluorescence scattering. In some embodiments, the shape of the elongated device may be determined using other techniques. For example, the history of the distal end posture of the flexible body 216 may be used to reconstruct the shape of the flexible body 216 over time intervals. In some embodiments, the tracking system 230 may optionally and / or additionally track the distal end 218 using the position sensor system 220. The position sensor system 220 may use any suitable sensing technology or combination of sensing technologies, such as OFDR (Optical Frequency Domain Reflectometry) technology using fiber Bragg gratings, Rayleigh scattering, or some other suitable reflection method; position sensors implemented by EM (electromagnetic) technology; linear rotary encoder technology supported by capacitance, optics, resistance, or other technologies; and so on. As a specific example, the position sensor system 220 may include an electromagnetic (EM) sensor system or may be a component of an electromagnetic (EM) sensor system comprising one or more conductive coils capable of withstanding externally generated electromagnetic fields. Each coil of such an EM sensor system for implementing the position sensor system 220 then generates an induced electrical signal having characteristics dependent on the position and orientation of the coil relative to the externally generated electromagnetic field.In some embodiments, the position sensor system 220 can be configured and positioned to measure six degrees of freedom, such as three position coordinates X, Y, Z and three orientation angles of pitch, yaw, and roll of an indicator base point, or five degrees of freedom, such as three position coordinates X, Y, Z and two orientation angles of pitch and yaw of an indicator base point. Further description of the position sensor system is provided in U.S. Patent No. 6,380,732, filed August 11, 1999 (disclosing a "Six-DOF Tracking System with a Passive Transponder on the Tracked Object"), which is incorporated herein by reference in its entirety.

[0046] In some embodiments, the tracking system 230 may alternatively and / or additionally rely on historical posture, position, or orientation data stored for known points of the instrument system along cycles of alternating movement (e.g., breathing). This stored data can be used to form shape information about the flexible body 216. In some examples, a series of position sensors (not shown, such as electromagnetic (EM) sensors similar to those used in some embodiments of the position sensor system 220) may be positioned along the flexible body 216 and then used for shape sensing. In some examples, a history of data acquired during surgery from one or more of these sensors can be used to represent the shape of the elongated device 202, particularly if the anatomical passage is substantially static.

[0047] The flexible body 216 includes a channel 221, the size and shape of which are designed to receive a medical device 226. Figure 2BThis is a simplified diagram of a flexible body 216 having an extended medical device 226 according to some embodiments. In some embodiments, the medical device 226 can be used for procedures such as surgery, biopsy, ablation, illumination, irrigation, or aspiration. The medical device 226 can be deployed through channels 221 of the flexible body 216 and used at a targeted location within an anatomical structure. The medical device 226 may include, for example, an image capture probe, a biopsy instrument, laser ablation fibers, and / or other surgical, diagnostic, or therapeutic tools. Medical tools may include end effectors having a single working member, such as scalpels, blunt blades, optical fibers, electrodes, and / or the like. Other end effectors may include, for example, forceps, grasping forceps, scissors, applicators, and / or the like. Other end effectors may also include electrically activated end effectors, such as electrosurgical electrodes, transducers, sensors, and / or the like. In various embodiments, the medical device 226 is a biopsy instrument that can be used to remove sample tissue or cell samples from a targeted anatomical location. The medical device 226 may also be used in conjunction with an image capture probe also located within the flexible body 216. In various embodiments, the medical device 226 may be an image capture probe comprising a distal portion having a stereo or single-field-of-view camera at or near the distal end 218 of the flexible body 216, the stereo or single-field-of-view camera being used to capture images (including video images) processed by the visualization system 231 for display and / or to provide them to the tracking system 230 to support tracking of the distal end 218 and / or one or more segments 224. The image capture probe may include a cable coupled to the camera for transmitting the captured image data. In some examples, the image capture device may be a bundle of optical fibers coupled to the visualization system 231, such as a fiber optic endoscope. The image capture device may be monospectral or multispectral, for example capturing image data of one or more of the visible spectrum, infrared spectrum, and / or ultraviolet spectrum. Alternatively, the medical device 226 itself may be an image capture probe. The medical device 226 may be advanced from an opening in the channel 221 for surgical procedures and then retracted into the channel when the procedures are completed. The medical device 226 can be removed from the proximal end 217 of the flexible body 216 or from another optional device port (not shown) along the flexible body 216.

[0048] Medical device 226 may additionally accommodate a cable, linkage, or other actuation control (not shown) extending between its proximal and distal ends to controllably bend the distal end of medical device 226. Guided devices are described in detail in U.S. Patent No. 7,316,681, filed October 4, 2005 (disclosing "Articulated Surgical Instrument for Performing Minimally Invasive Surgery with Enhanced Flexibility and Sensitivity") and U.S. Patent No. 9,259,274, filed September 30, 2008 (disclosing "Passive Preload and Winch Actuator for Surgical Instruments"), both of which are incorporated herein by reference in their entirety.

[0049] The flexible body 216 may also accommodate cables, linkages, or other guiding controls (not shown) extending between the drive unit 204 and the distal end 218 to controllably bend the distal end 218, for example, as illustrated by the dashed line 219 drawn through the distal end 218. In some examples, at least four cables are used to provide independent “up-down” guidance to control the pitch of the distal end 218 and to provide “left-right” guidance to control the yaw of the distal end 281. Guideable elongated devices are described in detail in U.S. Patent Application No. 13 / 274,208, filed October 14, 2011 (disclosing a “catheter with a removable vision probe”), which is incorporated herein by reference in its entirety. In embodiments in which the medical device system 200 is actuated by a remotely operated component, the drive unit 204 may include a drive input that is removably coupled to and receives power from a drive element (e.g., an actuator) of the remotely operated component. In some embodiments, the medical device system 200 may include a gripping feature, a manual actuator, or other components for manually controlling the movement of the medical device system 200. In some examples, the actuator may be used to actuate an articulated end effector of the medical device 226, such as for gripping tissue in the forceps of a biopsy apparatus. One or more actuator position sensors, such as rotary transformers, encoders, potentiometers, and / or other mechanisms, may provide sensor data to the remotely operated components, including position and / or rotation information of the actuator and / or one or more wires 240. In some examples, this sensor data may be used to determine the movement of the distal end 218 and / or one or more end effectors manipulated by the actuator. In some examples, this sensor data may be used to calculate the force and / or torque applied by the wires 240. Actuators are discussed in more detail below.

[0050] The elongated device 202 may be steerable, or alternatively, the system may be non-steerable and lack an integrated mechanism for operator control of bending of the distal end 218. In some examples, the medical device may be defined within the wall of the flexible body 216 by one or more lumens that can be deployed and used at a target surgical location.

[0051] In some embodiments, the medical device system 200 may include flexible bronchial instruments, such as bronchoscopes or bronchial tubes, for the examination, diagnosis, biopsy, or treatment of the lungs. The medical device system 200 is also suitable for navigation and treatment of other tissues in any of a variety of anatomical systems, including the colon, intestine, kidneys and renal calyces, brain, heart, circulatory system including the vascular system, and / or similar systems, through a connection created naturally or surgically.

[0052] Information from tracking system 230 can be sent to navigation system 232, where it is combined with information from visualization system 231 and / or preoperatively acquired models to provide real-time location information to the physician or other operator. In some examples, the real-time location information can be displayed... Figure 1 The display system 110 is used for controlling the medical device system 200. In some examples, Figure 1 The control system 116 can utilize position information as feedback for positioning the medical device system 200. Various systems for registering and displaying surgical instruments with surgical images using fiber optic sensors are disclosed in U.S. Patent Application No. 13 / 107,562 (filed May 13, 2011, disclosing a medical system for image-guided surgery that provides a model of an anatomical structure for registration), which is incorporated herein by reference in its entirety.

[0053] In some examples, the medical device system 200 can Figure 1 The medical system is operated remotely within 100. In some embodiments, Figure 1 The remote control component 102 can be replaced by direct operator control. In some examples, direct operator control may include various handles and operator interfaces for handheld operation of the instrument.

[0054] In some embodiments, the control system 112 is configured to apply commands to the remotely operated manipulator assembly 102 and / or one or more actuators, the commands controlling the bending of the distal end 218 of the flexible body 216 using guide controls, which may include one or more gears, levers, pulleys, cables, lines, rods, belts, etc., and / or any combination of these methods. The guide controls are then used to transmit action along the axis of the surgical instrument from one or more inputs and actuate the distal end 218. In some examples, the commands include one or more instructions stored in memory. These instructions may be executed by a processor (e.g., the processor of the control system 112).

[0055] According to some embodiments, a flexible body 216 can be guided within some channels of the patient P. When the flexible body 216 contacts the wall of the channel, there is an external force pushing the flexible body 216 out of the channel, and vice versa. In some examples, one or more force and / or pressure sensors located on or inside the flexible body 216 can be used to determine the external force. The stiffness or rigidity of the flexible body 216 can optionally be controlled according to the magnitude of the thrust and / or tension applied to the line 240, so as to optionally adjust the ability of the flexible body to resist and / or reduce external forces that may cause the flexible body to bend. In some examples, the higher the magnitude of the force applied to the line 240, the higher the stiffness exhibited by the flexible body 216.

[0056] Figure 3 An exemplary actuator 400 is shown, such as an actuator included within a drive unit 204. In some examples, such as... Figure 3 As shown, actuator 400 is based on a rotational actuation method in which a rotating spindle 410 rotates to actuate controllable degrees of freedom (DOF). The rotating spindle 410 is coupled to a drive shaft 420, which may be a motor, servo system, active actuator, hydraulic actuator, pneumatic actuator, etc., and / or any combination of these methods (not shown). When torque is applied to the drive shaft 420 and the rotating spindle 410 rotates, the wire 430 attached to the rotating spindle 410 and / or the drive shaft 420 may be further wound around the rotating spindle 410 and / or the drive shaft 420, and / or unwound from the rotating spindle 410 and / or the drive shaft 420.

[0057] According to some embodiments, line 430 may correspond to any one of lines 240-242 and / or lines 310-340. In some examples, rotation of the spindle 410 and drive shaft 420, and the corresponding winding and / or unwinding of line 430, generates thrust and / or tension on line 430. In some examples, monitoring the rotation angle and / or rotational speed of the spindle 410 and / or drive shaft 420 may also provide an indication of how far line 430 is released and / or pulled. Thus, when actuator 400 is used in conjunction with line 240, the rotation angle and / or rotational speed of the spindle 410 and / or drive shaft 420 and / or the torque applied to drive shaft 420 by actuator 400 can provide useful feedback on the force applied to line 430, and thus provide useful feedback on the guidance that will be applied through line 430 at the distal end (e.g., distal end 218) of medical device system 200. The way the distal end 218 will bend may depend on the placement of line 430 relative to other lines that also contribute to the guidance.

[0058] In some embodiments, releasing or reducing the force in the wires of the catheter body can result in a corresponding decrease in the stiffness or rigidity of the catheter. Similarly, applying or increasing tension or thrust in the wires of the catheter body can result in an increase in the stiffness or rigidity of the catheter. This stiffness can be the physical stiffness or rigidity of the catheter body material. For example, the material of the catheter body becomes stiffer when multiple guide wires are pulled simultaneously. Alternatively, the stiffness or rigidity of the catheter can be a closed-loop stiffness or rigidity controlled by a control system. Closed-loop catheter control systems and methods are described, for example, in U.S. Patent Application No. 13 / 274,198, filed October 14, 2011 (disclosing "Catheter with Control Modes of Interchangeable Probes"), which is incorporated herein by reference in its entirety.

[0059] In some examples, drive shaft 420 may provide force and / or torque feedback information to medical device 104 and control system 112. In some examples, position sensors such as resolvers, encoders, potentiometers, and other mechanisms may provide data to remotely operated components regarding the rotation and / or orientation of drive shaft 420 and / or rotary spindle 410. In some examples, actuator 400 may be used in conjunction with line 240 in response to an external force acting on distal end 218 and measured by one or more force and / or pressure sensors. In some examples, the external force detected by one or more force and / or pressure sensors may optionally be compensated by actuating the corresponding line to direct the force toward or away from distal end 218.

[0060] Figure 4A and Figure 4B This is a simplified side view of a medical device mounted on an insertion assembly, according to some embodiments, in patient coordinate space. Figure 4A and Figure 4B As shown, the surgical environment 500 includes a patient P located on a platform 502. Patient P can be stationary in the surgical environment in the sense that the patient's overall movement is restricted by sedation, restraint, and / or other means. Circulatory anatomical movements, including the patient P's breathing and cardiac movements, can continue unless the patient is instructed to maintain his or her breathing to temporarily suspend respiratory movements. Therefore, in some embodiments, data can be collected at specific stages of breathing and labeled and identified with that stage. In some embodiments, the stage at which data was collected can be inferred from the physiological information collected from patient P. Within the surgical environment 500, a point collection device 504 is coupled to an instrument holder 506. In some embodiments, the point collection device 504 may use EM sensors, shape sensors, and / or other sensor modalities. When measurement points are collected from within the patient P's passage, these points are stored in a data storage device (e.g., a memory). This set of measurement points can be stored in a database that includes at least some, but may include all, measurement points obtained during or just before the procedure. When stored in memory, each point can be represented by data including the point's coordinates, timestamp, and / or relative sensor position or a single sensor ID (when the positions of several points are determined simultaneously using multiple sensors distributed along the length of the point collection device 504).

[0061] Instrument holder 506 is mounted to insertion stage 508 fixed within surgical environment 500. Alternatively, insertion stage 508 may be movable, but may also have a known location within surgical environment 500 (e.g., via tracking sensors or other tracking devices). Instrument holder 506 may be a component of a remote manipulator assembly (e.g., remote manipulator assembly 102) coupled to point-collecting instrument 504 to control insertion motion (i.e., movement along axis A) and optionally control movement of the distal end 518 of flexible elongated instrument 510 in multiple directions (including yaw, pitch, and roll). In some examples, flexible elongated instrument 510 corresponds to instrument system 200 and / or flexible body 300. Instrument holder 506 or insertion stage 508 may include actuators (not shown), such as servo motors, for controlling movement of instrument holder 506 along insertion stage 508.

[0062] An elongated instrument 510 is coupled to an instrument body 512. The instrument body 512 is coupled and secured relative to an instrument holder 506. In some examples, a fiber optic shape sensor 514 is fixed at a proximal point 516 on the instrument body 512. In some embodiments, the proximal point 516 of the fiber optic shape sensor 514 may be movable along the instrument body 512, and the location of the proximal point 516 may be known (e.g., by a tracking sensor or other tracking device). The shape sensor 514 measures the shape from the proximal point 516 to another point (such as the distal end 518 of the elongated instrument 510). In some examples, a point collection device 504 may be similar to the medical device system 200.

[0063] As the position measuring device 520 moves on the insertion stage 508 along the retraction and / or insertion axis A (e.g., along the longitudinal central axis of the instrument body), the position measuring device 520 provides information about the position of the instrument body 512. The position measuring device 520 may include a rotary transformer, encoder, potentiometer, and other sensors that determine the rotation and orientation of a drive shaft that controls the movement of the instrument carriage 506 and thus the movement of the instrument body 512. In some embodiments, the insertion stage 508 is linear. In some examples, the insertion stage 508 may be curved or have a combination of curved and linear portions.

[0064] Figure 4AThe device body 512 and device holder 506 are shown in a retracted position along the insertion stage 508. In this retracted position, the proximal point 516 is located at position L0 on axis A. In this position along the insertion stage 508, the A component of the positioning of the proximal point 516 can be set to zero and / or another reference value to provide a reference for describing the position of the device holder 506 on the insertion stage 508, and thus the position of the proximal point 516 on the insertion stage 508. Due to this retracted position of the device body 512 and device holder 506, the distal end 518 of the elongated device 510 can be positioned precisely within the access port of the patient P. Also in this position, the position measuring device can be set to zero and / or another reference value (e.g., I = 0). Figure 4B In this position, the instrument body 512 and instrument holder 506 have been advanced along the linear track of the insertion stage 508, and the distal end 518 of the flexible, elongated instrument 510 has been advanced into the patient P. At this advanced position, the proximal point 516 is located at position L1 on the A-axis. In some examples, encoder and / or position data from one or more actuators controlling the movement of the instrument holder 506 along the insertion stage 508 and / or one or more position sensors associated with the instrument holder 506 and / or the insertion stage 508 are used to determine the position L1 of the proximal point 516 relative to position L0. A In some examples, position L1 can also serve as an indicator of the distance or depth of insertion of the distal end 518 of the elongated instrument 510 into the anatomical structure of the patient P. In alternative examples, the flexible elongated instrument 510 can be advanced to a position where the proximal point 516 is located beyond L1.

[0065] The flexible, elongated instrument 510 can be advanced from position L0, advanced or retracted from any position between L0 and advancement position L1, or advanced or retracted from any position beyond L1. During retraction, it may be desirable for the distal end 518 to have reduced stiffness in order to reduce the risk of injury to the patient P and / or damage to the flexible, elongated instrument 510. Stiffness in the flexible instrument during retraction may cause forces exerted by the distal end 518 on the channel wall, resulting in abrasions. To prevent damage to the anatomical channel, the stiffness of the distal end 518 can be reduced during retraction, thereby reducing any contact with the channel wall and the resulting forces from that contact. In some procedures, retraction occurs with minor positional adjustments or small, rapid reciprocating movements. In such procedures, sudden and complete relaxation of the flexible instrument during retraction may be undesirable, as complete relaxation may alter the orientation (i.e., pointing direction) of the distal end of the instrument. Therefore, in some embodiments, it may be more appropriate to gradually adjust the stiffness of the flexible instrument based on the time elapsed or the distance traveled during the movement mode. This allows for minute retraction movements and subsequent insertion movements without altering the orientation of the distal end of the instrument. In such an embodiment, according to... Figure 5A and Figure 5B Using the aforementioned stiffness profile to control the increase or decrease of stiffness in a flexible, slender instrument may be advantageous. Alternatively, stiffness adjustment can have a stepped curve, wherein no stiffness adjustment is performed for a period of time until a threshold time, distance, or rate is reached, and then complete relaxation occurs after the threshold is reached.

[0066] In some embodiments, the flexible elongated instrument 510 may be positioned within a channel of the patient P's anatomical structure, preventing insertion or retraction. When positioned, it may be desirable to increase stiffness or place the elongated instrument in a "locked" mode to provide stability for instruments deployed via the flexible elongated instrument 510 during surgery. Alternatively, it may be desirable to maintain relatively constant stiffness, reduce stiffness to minimize any contact with the channel wall and the forces generated by such contact, or, as with retraction or insertion, to control the stiffness of the flexible elongated instrument 510 according to a stiffness profile.

[0067] Figure 5A and Figure 5B These are exemplary stiffness profiles 600 and 650 for flexible elongated instruments (e.g., flexible body 216 and / or flexible elongated instrument 510). Stiffness profiles 600 and 650 are graphical representations of possible variations in stiffness or rigidity, illustrated by curves 610 and 660, respectively. Curves 610 and 660 illustrate how the stiffness, represented by k, can be adjusted according to a parameter S representing a range of movement modes (such as insertion, retraction, or parking). In some examples, the control system 112 is configured to apply one or more stiffness profiles 600 and / or 650 to the flexible elongated instrument during surgery.

[0068] According to some embodiments, S may represent a distance or a change in distance, such as a change in the insertion depth or retraction distance of the flexible elongated instrument, or a change in the distance traveled by the flexible elongated instrument through the patient passage as a percentage of the maximum insertion depth value. According to other embodiments, S may represent other variables that can be used to characterize the degree of retraction, insertion, and / or parking of the flexible elongated instrument. For example, S may represent the elapsed insertion time, the elapsed retraction time, the elapsed parking time, the change in insertion depth, the retraction distance, speed, rate, etc., and / or any combination thereof. Alternatively, S may represent the time elapsed since the start of insertion, retraction, or parking.

[0069] During instrument movement (e.g., retraction, insertion, or parking), the stiffness value k can range between an initial value (e.g., k1, k3) and a final value (e.g., k2, k4). In some examples, the lowest stiffness value (e.g., k2, k3) may correspond to a desired nominal value, such as zero or a small but non-zero stiffness. The operator can select the desired nominal stiffness value based on the size of one or more actuators of the actuated flexible elongated instrument, based on the ability of the flexible elongated instrument to bend in response to anatomical movements, based on the ongoing surgery, and / or any combination of these methods.

[0070] like Figure 5A and Figure 5B As shown, stiffness profiles 600 and 650 can be organized in different behavioral regions of the stiffness of flexible, slender instruments, as illustrated by curves 610 and 660. For example, Figure 5A Including zones 620, 630, and 640 and Figure 5B This includes zones 670, 680, and 690. Each zone can represent the elapsed S-cycle, such as different distances traveled or different time periods, and curves 610 and 660 can represent different rates of change of the stiffness value k in different zones. Some zones, such as 620, 640, 670, and 690, can serve as transition zones, where the stiffness value k remains relatively constant as S increases, allowing the stiffness profile to transition smoothly at the beginning and end of motion modes such as retraction, insertion, or parking. In other zones, such as 630 and 680, the rate of change of the stiffness value k is greater. In these examples, the zone with the maximum rate of change of stiffness occurs near the middle of the motion mode, but in other examples, the zone with the maximum rate of change of stiffness may occur at other times in the motion mode. In some examples, stiffness profiles 600 and / or 650 may optionally include additional zones (not shown) with corresponding stiffness functions. In some examples, the stiffness profile may be characterized by a combination of stiffness profiles 600 and 650. In some embodiments, stiffness profiles 600 and / or 650 may optionally include any combination and / or any combination of linear, nonlinear, exponential, logarithmic, step, piecewise, hyperbolic, parabolic, periodic / trigonometric, inverse hyperbolic, polynomial, modular, other monotonic functions, etc. In some examples, the stiffness profile may also include hysteresis or memory characteristics, where stiffness adjustment in one direction S (e.g., when moving from a small value to a large value) differs from adjustment in the opposite direction of S. Typically, the stiffness adjustment curve may depend linearly or nonlinearly on variables other than S, such as the derivative of S, the integral of S, or any combination thereof, or on other additional variables.

[0071] Stiffness profiles 600 and / or 650 can be used to adjust the forces applied by one or more actuators to one or more wires (such as any wires 240, 430 used for guiding the distal end of a flexible elongated instrument). For example, stiffness profiles 600 and / or 650 can be used to adjust the forces and / or torques applied by one or more actuators to control the pushing and / or pulling of one or more of the one or more wires within the flexible elongated instrument. When adjusting the forces and / or torques applied by one or more actuators, stiffness profiles 600 and / or 650 can implement scaling factors and / or torque multipliers for scaling the forces and / or torques applied by one or more actuators. In some examples, the scaling factor or torque multiplier can range from 1.0 or close to 1.0 for k1 to a nominal, possibly non-zero value for k2. In some examples, the scaling factor or torque multiplier can range from a nominal, possibly non-zero value for k3 to 1.0 or close to 1.0 for k4. In some examples, the stiffness profiles 600 and / or 650 may represent a function dependent on additional factors such as the external force applied to the flexible elongated instrument, the shape of the flexible elongated instrument, the sensitivity of the anatomical structure forming the channel, the curvature of the anatomical structure, one or more operator preferences, and / or any combination of these factors. In some examples, stiffness may correspond to the set of individual forces on each line, for example, by averaging, weighted summing, and / or similar methods and / or any combination of these methods.

[0072] See Figure 5A This illustrates an example of the stiffness profile during the retraction mode of an elongated flexible device. By applying stiffness profile 600 during the retraction mode, the stiffness of the flexible elongated instrument is reduced, and thus any contact forces from the flexible elongated instrument applied to anatomical tissues (e.g., channel walls) can be reduced. Furthermore, controlled reduction of stiffness is particularly suitable when the instrument is being adjusted, moved in reciprocating motions, or otherwise retracted a relatively small distance before parking or transitioning to insertion.

[0073] Typically, an instrument with an applied stiffness profile 600 will experience a slight decrease in stiffness in zone 620, a greater decrease in stiffness in zone 630, and a relatively stable relaxation state in zone 640. More specifically, in the first zone 620, as S increases and retraction begins to occur, the stiffness remains approximately at or slightly below the initial stiffness k1. In the second zone 630, starting from S1, as S further increases, the stiffness decreases at a faster rate than in the first zone 620, and additional retraction occurs, increasing the likelihood of contact between the distal end of the flexible, slender instrument and the channel wall. The faster rate of stiffness reduction causes the instrument to lose rigidity more quickly and thus reduces the potential injury that a rigid instrument might cause to the patient. In the third zone 640, starting from S2, as the retraction distance continues to increase, the stiffness gradually decreases to a near-constant desired final value k2.

[0074] See Figure 5B This illustrates an example of the stiffness profile during the insertion mode of an elongated flexible device. In this example, S can represent the distance or time period traveled during the insertion mode. Figure 5B In the example, stiffness profile 650 is a mirror image of stiffness profile 600 and can optionally be used to increase stiffness during insertion and / or parking of a flexible, elongated instrument to allow for distal-end control during advancement of the flexible, elongated instrument and / or when it is held stable within the channel. Typically, an instrument with the applied stiffness profile 650 will experience a slight increase in stiffness in zone 670, a larger increase in stiffness in zone 680, and a relatively stable stiffness state in zone 690. More specifically, in the first zone 670, at the start of insertion and / or parking, the stiffness is maintained approximately at or slightly above the initial stiffness k3 as S increases. In the second zone 680, as S further increases, the stiffness increases at a faster rate than in the first zone 670. Figure 5B In the second zone 680, as S increases further, the stiffness increases at a faster rate. In the third zone 690, as S continues to increase, the stiffness gradually decreases to a near-constant desired final value k4. In some examples, k4 may correspond to the desired maximum stiffness. The desired maximum stiffness can be a maximum stiffness selected by the operator based on the size of one or more actuators actuating the flexible, slender instrument, based on the ongoing surgery, safety limits, and / or similar methods and / or any combination of these methods.

[0075] In some embodiments, when the flexible device enters a parking mode, a stiffness profile similar to stiffness profile 600 or stiffness profile 650 may be applied. For example, if the flexible device enters a parking mode from a retracted mode, the flexible device may stiffen in the parking mode. When some stiffness profile is applied during the parking mode, the stiffness can increase or decrease more quickly because the flexible device does not move.

[0076] In some embodiments, the first region 620 / 670 and / or the third region 640 / 690 are optional. The stiffness profile 600 / 650 may have a different shape and / or region than that shown in curves 610 / 660. As shown, the stiffness profile 600 / 650 is a smooth function such that it is at least continuously differentiable within its regions, or the stiffness profile 600 / 650 may be a continuous function passing through regions 620 / 670-640 / 690. Alternatively, the stiffness profile 600 / 650 is not continuously differentiable at the start and / or end points between one or more regions 620 / 670-640 / 690. In some examples, the stiffness profile 600 / 650 is constant at the initial value k1 in the first region 620 / 670. At zone 63 / 6800 in the second region, starting from S1, the stiffness may decrease linearly as S increases until the third region 640 / 690 at S2. The stiffness profile 600 / 650 may optionally include a series of steps, starting with an initial value k1 at zone 620 / 670 and gradually decreasing or increasing at zone 630 / 680 in the second region to a desired final value k2. In some examples, the shape of curve 610 / 660 represents a logistic function. In some examples, the stiffness profile 600 / 650 is a monotonically decreasing or increasing function to ensure that the stiffness decreases, increases, and / or remains unchanged throughout the movement of the flexible, slender instrument.

[0077] While systems and methods for airway communication for the lungs have been described in this disclosure, they are also suitable for navigating and treating other tissues through naturally or surgically created airways in any of the various anatomical systems, including the intestines, kidneys, brain, heart, circulatory system, urethra, arteries, umbilical cord, and / or similar systems.

[0078] Figure 6 This is a flowchart illustrating an exemplary method 700 for controlling a flexible body (such as flexible body 216 and / or flexible elongated device 510). Method 700 in... Figure 6 The diagram shows a set of operations or processes 702-710. Not all of the shown processes 702-710 can be performed in all embodiments of method 700. Additionally, Figure 6One or more processes not explicitly shown may be included before, after, between, or as part of processes 702-710. In some embodiments, one or more of processes 702-710 may be implemented at least in part in the form of executable code stored on a non-transitory, tangible computer-readable medium, which, when run by one or more processors (e.g., the processor of control system 112), causes one or more processors to execute one or more of processes 702-710. In some examples, the method may begin when the flexible body is introduced into the channel. In some examples, the anatomical channel may include the intestine, kidney, brain, heart, circulatory system, lung, urethra, artery, umbilical cord, and / or similar systems.

[0079] During process 702, movement of the flexible body is monitored. Movement of the flexible body can be measured by a sensor system (such as sensor system 108). The position of the flexible body can be determined using one or more sensors (such as position sensor system 220, shape sensor 222, or position measuring device 520). This position can correspond to the insertion depth, such as the position of the instrument body 512 along axis A. Monitoring can occur continuously, periodically, and / or at set markers. In some examples, process 702 can be performed concurrently with other steps in method 700. Alternatively, movement can be determined based on the motion of commands from input devices (such as those described with reference to main component 106). In some examples, detection of input devices associated with insertion or retraction can be used to determine movement. In many more examples, a user can provide input by pressing a button or tapping a button on a touchscreen to indicate a desired change of orientation.

[0080] Monitoring the movement of the flexible body may include recording state attributes of the flexible body, such as current position, current time, and / or current control configuration (e.g., current stiffness caused by closed-loop guideline control). Alternatively, monitoring the movement of the flexible body may include recording input values ​​of an input device, such as measurements of magnitude, rate, or velocity input by the operator at the control device, the time the input device has been actuated in one direction, pressure applied to the input device, loss of contact between the operator's hand and the input device, etc. Recording the current position may include measuring the insertion depth, such as the position of the instrument body 512 along axis A. Recording the current stiffness may include measuring one or more forces applied by one or more actuators to one or more lines (such as any of lines 240-242, 310-340, and / or 430) of a guide used to control the distal end (such as distal end 218) of the flexible body. The stiffness may correspond to a set of individual forces on each line, for example, by averaging, weighted summing, etc. Measuring stiffness may also include taking into account external forces applied to the flexible body, which can be measured by one or more force and / or pressure sensors (such as one or more strain gauges). In some examples, measuring stiffness may also include taking into account the measured shape, moment of inertia, Young's modulus, length of the bending portion at the distal end, and / or any combination of these methods. Measuring stiffness may include measuring motor current or applied actuator torque (such as torque applied by an actuator to drive shaft 420) to control the forces applied to one or more wires. In some examples, a stiffness profile from a previous mode may be used to determine the current stiffness based on movement monitored during process 702.

[0081] During process 704, the operating mode of the flexible body is determined. This mode may correspond to one of retraction, insertion, and parking modes. The mode may be determined based on movement monitored during process 702. In some examples, mode determination may be based on elapsed time, velocity, distance traveled by the flexible body, and / or any combination thereof. The distance traveled may be equal to the displacement between the current position and the insertion depth recorded during process 702. The current position may correspond to the insertion depth of the flexible body. The elapsed time may be equal to the difference between the current time and the time recorded during process 702. Velocity may be calculated by a sensor using numerical differentiation, dividing the distance traveled by the elapsed time, and / or exponential smoothing of velocity sample values, low-pass filtering, and / or any combination of these methods. Numerical differentiation may include backward difference approximation, etc. In some examples, mode determination may be based on the input quantity value of the input device determined by measurements of the magnitude, rate, or speed of operator input at the control device, the time the input device has been actuated in one direction, the pressure placed on the input device, loss of contact between the operator's hand and the input device, and / or similar factors.

[0082] The movement mode can be defined as an insertion mode when the speed of the flexible body exceeds a threshold in the insertion direction or when the input device is actuated at a speed exceeding the threshold in the insertion direction. Additionally or alternatively, the mode can be defined as an insertion mode when the speed of the flexible body or the speed at which the input device is actuated exceeds the threshold in the insertion direction for a threshold time. In some examples, the threshold time is between 1 and 10 seconds. In some examples, the threshold speed in the insertion direction is between 0.1 and 5 millimeters per second. In some examples, the flexible body is considered to be in insertion mode until its speed in the retraction direction exceeds the threshold. In some examples, the actuation of the input device is considered to be in insertion mode until the actuation speed of the input device in the retraction direction exceeds the threshold.

[0083] The mode can be identified as a retraction mode when the speed of the flexible body in the retraction direction exceeds a threshold or when the input device is actuated in the retraction direction at a speed exceeding a threshold. Additionally or alternatively, the mode can be identified as a retraction mode when the speed of the flexible body or the speed at which the input device is actuated in the retraction direction exceeds a threshold for a threshold time. In some examples, the threshold time is between 1 and 10 seconds. In some examples, the threshold speed in the retraction direction is between 0.1 and 5 millimeters per second. In some examples, the flexible body is considered to be in a retraction mode until its speed in the insertion direction exceeds a threshold. In some examples, the actuation of the input device is considered to be in an insertion mode until the actuation speed of the input device in the retraction direction exceeds a threshold. In some examples, the mode can be identified as a retraction mode when the retraction distance traveled since the last forward movement exceeds a threshold (such as 5 or 10 mm). In some examples, the mode can be identified as a retraction mode when the flexible body retracts a distance since the last forward movement exceeding a threshold (such as 5 or 10 mm) via user input command.

[0084] A parking mode can be identified when the speed of the flexible body drops below a threshold or when the input device is actuated at a speed below the threshold. Additionally or alternatively, a parking mode can be identified when the speed of the flexible body or the speed at which the input device is actuated is below the threshold for a threshold time. In some examples, the threshold time is between 1 and 10 seconds. In some examples, the threshold speed is between 0.1 and 5 millimeters per second. In some examples, conditions associated with the threshold speed and / or threshold time prior to identifying a change in mode may include disturbances, sensed noise, circulatory anatomical movements (such as breathing and cardiac movements), movement within the anatomical structure, and / or other movements caused by environmental displacement and / or combinations thereof. In some examples, a parking mode can be identified due to the operator losing contact with the input device.

[0085] During process 706, the degree of movement (including lack of movement) in the operating mode is determined. The degree of retraction movement, insertion movement, or parking / stability is measured using commands from the input device or sensors similar to those discussed with respect to process 702. The degree of movement may include measuring elapsed time, distance traveled, etc., and / or any combination thereof. The distance traveled may be equal to the displacement between the current insertion depth of the flexible body and the insertion depth recorded during process 702, or the displacement between the current input device position and the previous input device position. The elapsed time may be equal to the difference between the current time and the time recorded during process 702.

[0086] During process 708, the stiffness of the flexible body is adjusted based on the degree of movement. The stiffness can be adjusted by controlling the force applied by one or more actuators to one or more guide wires used to control the distal end of the flexible body. Each wire may have a force regulated by its own force curve, which substantially resembles the stiffness profile. The stiffness can be modified by adjusting the force and / or torque applied by one or more actuators to control the pushing and / or pulling of one or more wires in the flexible body. In some examples, the actual force or torque applied by the actuators is adjusted. In some examples, the maximum force and / or torque limits are set on a controller that controls each of the one or more actuators.

[0087] During retraction mode, the stiffness of the flexible body can be reduced according to a stiffness profile (such as stiffness profile 600). K1 can be set to the stiffness recorded during process 702 and reduced until the stiffness reaches a final stiffness value (such as k2 from stiffness profile 600). The final stiffness can be set to a nominal, possibly non-zero, value to maintain at least some control over bending in the distal end of the flexible body, instruments deployed at the distal end of the flexible body, etc. During insertion mode, the stiffness of the flexible body can be increased according to a stiffness profile (such as stiffness profile 650). k3 can be set to the stiffness recorded during process 702 and increased until the stiffness reaches a final stiffness (such as k4 from stiffness profile). During parking mode, the final stiffness can provide sufficient rigidity to the flexible body to guide the advancing flexible body and control the orientation of the medical instrument deployed from the flexible body. Alternatively, during parking mode, stiffness can be increased in locking mode so that the flexible body can be properly articulated or used as an effective fixation platform.

[0088] During process 708, stiffness can be adjusted based on additional factors such as one or more external forces applied to the flexible body, the shape of the flexible body, the sensitivity of the anatomical structure forming the channel, the curvature of the anatomical structure, one or more operator preferences, and / or any combination of these methods.

[0089] During process 710, it is determined whether a change in movement mode has occurred. For example, it may be determined that the movement mode has changed from insertion mode to retraction or parking mode, or vice versa. The mode change may be determined based on elapsed time, speed, distance traveled, and / or any combination thereof. In some examples, the mode change is determined based on a change in the direction of movement of the flexible body. In some examples, the mode change is determined when the speed of the flexible body exceeds a threshold in a direction opposite to a previously determined movement mode. Conditions associated with the threshold speed and / or threshold time before determining the mode change may need to consider disturbances, sensed noise, cyclic anatomical movements (such as respiratory and cardiac movements), movements within the anatomical structure, and / or other movements caused by environmental displacement and / or combinations thereof. In some embodiments, the parking mode is optional, wherein the operating modes are limited to retraction and insertion modes.

[0090] If the pattern is determined to have changed in process 710, the method can be repeated starting from process 704. If the pattern has not changed, the method can be repeated starting from process 706.

[0091] As stated above and further emphasized here, Figure 6 This is an example of an undue limitation of the scope of the claims. Those skilled in the art will recognize many variations, substitutions, and modifications. In some embodiments, during the transition from the first mode to the second mode, the stiffness profile of the first mode may continue as if the mode had not changed. In some examples, during the transition from the insertion mode to the parking mode, the stiffness may continue to increase according to the stiffness profile of the insertion mode as if insertion continued without interruption. In some examples, during the transition from the parking mode to the insertion mode, the stiffness may continue to increase according to the stiffness profile of the parking mode as if parking continued without interruption. In some examples, during the transition from the retraction mode to the parking mode, the stiffness may continue to decrease according to the stiffness profile of the retraction mode as if retraction continued without interruption. In some examples, during the transition from the parking mode to the retraction mode, the stiffness may continue to decrease according to the stiffness profile of the parking mode as if parking continued without interruption.

[0092] In some embodiments, one or more of the processes 702-710 of method 700 may be implemented at least in part as executable code stored on a non-transitory, tangible machine-readable medium, which, when run by one or more processors (e.g., control system 112), causes one or more processors to execute one or more of processes 702-710. Additionally, one or more elements of the embodiments and examples may be implemented in software to execute on one or more processors. When implemented in software, the elements of the embodiments are essentially code segments that perform necessary tasks. Programs or code segments may be stored in non-transitory processor-readable storage media or devices, including any medium capable of storing information including optical, semiconductor, and magnetic media. Examples of non-transitory processor-readable storage devices include electronic circuits, semiconductor devices, semiconductor memory 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 may be downloaded via computer networks such as the Internet, intranets, etc. As described herein, operations such as entering, detecting, starting, registering, displaying, receiving, generating, determining, moving data points, segmenting, and matching can be performed at least in part by the control system 112 or one or more of its processors.

[0093] The previously described stiffness profiles 600 and / or 650 may implement scaling factors and / or torque multipliers to scale the forces and / or torques applied by one or more actuators. Figure 7 The stiffness multiplier curve 800 is shown during an exemplary application of the retraction method at retraction distances 802 and 804. In some examples, the multiplier m may represent a scaling factor and / or torque multiplier used to scale the forces and / or torques applied by one or more actuators during process 708 to adjust the stiffness of the flexible elongated instrument. The stiffness multiplier curve 800 is a graphical representation of the possible variations in the multiplier m, shown by curve 810 according to the retraction distance (denoted by d). Time t0-t7 shows the retraction distances d0-d 最终 The relationship between the multiplier m and time. In some examples, the multiplier m can range from a value m1 of 1.0 or close to 1.0 for the relative stiffness of the flexible device to a value m2 of zero or close to zero for the relative relaxation of the flexible device. In some examples, torque is the multiplier and the maximum torque τ that can be applied by the actuator. max The function is shown in Equation 1. In some examples, the torque determined by Equation 1 can be applied by the corresponding controller as the actual torque applied by the individual actuators or as the maximum torque limit applied to the individual actuators.

[0094] τ=τ max ×m(d,t) (1)

[0095] In some examples, when scaling forces, τ and τ max Correspondingly by f and f max Instead, it sets the actual force or maximum force limit.

[0096] exist Figure 7 In the initial position d0, the flexible instrument is inserted into the anatomical channel and placed in a parking mode, where the multiplier is set at m1. In one example, the flexible instrument may be inserted 100 mm into the anatomical channel during parking. The flexible instrument then enters a retraction mode. In the initial phase of the retraction mode, the flexible instrument moves from the initial position d0 and a retraction distance d1, while the multiplier remains constant or approximately constant at or near the value m1. In one example, the degree of retraction of the flexible instrument between d0 and d1 may be approximately 5 mm. The distance between d0 and d1 may be traversed over a time interval between t0 and t1. After the flexible instrument retracts a distance d1, the multiplier m begins to decrease. Over the retraction distance between d1 and d2, the multiplier m decreases from the value m1 (e.g., relative stiffness) to the value m2 (e.g., relative relaxation). The distance between d1 and d2 may be traversed over a time interval between t1 and t2. In this example, the degree of retraction of the flexible instrument between d1 and d2 may be approximately 10 mm. As the flexible instrument continues to retract from distance d2 back to d3, the multiplier remains at m2. In one example, the flexible instrument can retract approximately 35mm between d2 and d3. The distance between d2 and d3 can be traversed over the time interval between t2 and t3.

[0097] At a distance d3, the flexible instrument exits the retracted mode and enters the parking mode. In the parking mode, the flexible instrument remains at a distance d3 for a period of time between t3 and t4. In this example, while in the parking mode, the multiplier increases to m1 (e.g., relative stiffness). This transition from the multiplier m2 to m1 can occur abruptly over a short period of time, or it can follow a more gradual transition curve based on the elapsed time.

[0098] At time t4, the flexible instrument exits the parking mode and re-enters the retraction mode. In the initial phase of the second retraction mode, the flexible instrument moves from the parking distance d3 to the retraction distance d4, while the multiplier remains constant or approximately constant at or near the value m1. In this example, the flexible instrument may retract approximately 5 mm between d3 and d4. The distance between d3 and d4 can be traversed over the time interval between t4 and t5. After the flexible instrument has retracted a distance d4, the multiplier m begins to decrease. At the retraction distance between d4 and d5, the multiplier m again decreases from a value m1 (e.g., relative stiffness) to a value m2 (e.g., relative relaxation). The distance between d4 and d5 can be traversed over the time interval between t5 and t6. In one example, the flexible instrument may retract approximately 10 mm between d4 and d5. As the flexible instrument continues to retract from distance d5 to d6, where the flexible instrument is fully retracted from the patient's anatomy... 最终 The multiplier remains at m2. In one example, the flexible instrument can retract approximately 35 mm between d2 and d3. d5 and d 最终 The distance between them can be traversed within the time interval between t6 and t7.

[0099] In drive motion modes such as insertion or retraction, various sub-modes of the control system can be selected to change the stiffness of the flexible body based on a specific stiffness profile of the sub-mode.

[0100] An example of a sub-mode that drives the movement mode is a fully passive sub-mode. A fully passive sub-mode can be selected by the operator using, for example, a recognition input from a control device at the main component 106 (such as a double-click or multiple-click of a “passive” button located on the control device), a voice command, or an anatomical gesture command. Figure 8 A stiffness profile 900 that can be used in a fully passive sub-mode is shown. According to stiffness profile 900, the stiffness of the flexible body decreases as the actuator torque decreases from the operating torque 905 to an approximately zero torque during the time interval between the operator input time (t = 0) and the predetermined time (t = t2). In this embodiment, stiffness profile 900 is linear, but in alternative embodiments, the stiffness profile in the fully passive sub-mode can be non-linear. The fully passive sub-mode can be adapted for use upon completion of the procedure, where the operator uses the main assembly to retract the flexible body from the patient's anatomy. Alternatively, the fully passive sub-mode may be suitable when the flexible catheter is positioned within a sharp bend in the anatomical channel, and the operator wishes to reduce the stiffness in the flexible catheter (and thus the anatomical channel), for example, to allow the biopsy needle to pass through. The control system can remain in the fully passive sub-mode until the operator selects a different mode or until another predetermined condition occurs.

[0101] Another example of a sub-mode that drives the movement mode is the slow passive sub-mode. The slow passive sub-mode can be selected by the operator using, for example, recognition input to the control device at the main component 106 (such as pressing and holding the “passive” button located on the control device during the time period of the slow passive sub-mode), voice commands, or anatomical gesture commands. Figure 8 A stiffness profile 910 that can be used in the slow passive sub-mode is shown. According to stiffness profile 910, the stiffness of the flexible body decreases as the actuator torque decreases from the operating torque 905 to an approximately zero torque during the time interval between the operator input time (t = 0) and the predetermined time (t = t3). Compared to the fully passive stiffness profile 910, the slow passive stiffness profile decreases the torque at a slower rate. In this embodiment, stiffness profile 910 is linear, but in alternative embodiments, the stiffness profile in the fully passive sub-mode can be non-linear. Figure 9 This nonlinear curve 950 is illustrated. According to the stiffness profile 950, the stiffness of the flexible body decreases as the actuator torque rapidly decreases between the initial intervals (t0-t1). The actuator torque is relatively stable between intervals (t1-t2) and rapidly decreases to near-zero torque within the interval (t2-t3). The slow passive sub-mode is suitable when the operator makes fine adjustments to the position of the flexible body within the patient's anatomy, where the short incremental distance of movement of the flexible body is too small to effectively reduce the actuator torque under normal driving motion modes (such as insertion or retraction). At time t2, after sufficient time, the operator may intend to withdraw the flexible body from the patient's anatomy or make a significant withdrawal movement. Therefore, the decrease in torque is rapid from t2 to t3. The control system can remain in the slow passive sub-mode until, for example, the operator releases the passive button. When the passive button is released, the control system can return to the previous operating mode by ramping the torque up to the previous torque level or operating torque level using a linear or nonlinear ramp curve.

[0102] Another example of a sub-mode of the drive movement mode is the clutch insertion sub-mode. The clutch insertion sub-mode can be selected by the operator using, for example, a recognition input to the clutch input located on a bracket on the manipulator assembly 102 (e.g., the operator can press and hold the clutch input button or double-click or multi-click the clutch input button) or another component of system 100. Alternatively, another type of user input includes voice commands or anatomical gesture commands. Figure 8A stiffness profile 920 for use in the insertion clutch sub-mode is shown. According to stiffness profile 920, the stiffness of the flexible body decreases immediately or within a relatively short time period at the moment of operator input (t = t1) as the actuator torque decreases from the operating torque to approximately zero torque. In this embodiment, stiffness profile 920 is linear, but in alternative embodiments, the stiffness profile in the insertion clutch sub-mode can be non-linear over a relatively short time period. In this sub-mode, the main assembly 106 may not accept user commands to control the manipulator or attached instrument, and the actuator providing motion along the insertion path may be disabled. The insertion clutch sub-mode can be suitable for use when the operator wants to quickly remove the flexible body from the patient's anatomy in an emergency or for other clinical purposes. In the insertion clutch sub-mode, the operator can manually retract the flexible body by moving the manipulator assembly 102 coupled to instrument 104 during the insertion phase. The control system can remain in the insertion clutch sub-mode until the operator releases the clutch input button or another release condition is met.

[0103] Another example of a sub-mode that drives the movement mode is the automatic-passive sub-mode. The automatic-passive sub-mode can be selected by the operator using recognition input from a control device at the main component 106 (e.g., a click of a “passive” button on the control device), voice commands, or anatomical gesture commands. Figure 10A stiffness profile 960, which can be used in the automatic passive sub-mode, is shown. According to stiffness profile 960, the stiffness of the flexible body decreases as the actuator torque decreases from the operating torque 905 to a torque approximately zero based on the input magnitude. The input magnitude can be a measurement of the magnitude or rate of operator input at the control device of the main assembly 106, which relates to a measurement of the desired distance the flexible body is commanded to move. For example, if the control device is a roller on the main assembly 106, a small retraction on the roller is considered a small input magnitude in the automatic passive sub-mode related to a short commanded movement distance, and a large retraction on the roller is considered a large input magnitude in the automatic passive sub-mode related to a large commanded movement distance. Using stiffness profile 960, a small input magnitude keeps the flexible body under active control at the operating torque 905. This allows the operator to perform fine adjustments of position without losing orientation at the distal end of the flexible body. Using stiffness profile 960, a large input magnitude causes the actuator torque to decrease from the operating torque to a torque approximately zero. This allows the operator to move the flexible body a considerable distance or remove it from the patient's anatomy with little or no stiffness. In this embodiment, the stiffness profile 960 is linear, but in alternative embodiments, the stiffness profile in the automatic passive sub-mode can be non-linear. The control system can remain in the automatic passive sub-mode during a specific movement mode (e.g., retraction), but when the operator changes the movement mode (e.g., returning to active insertion), the control system switches out of the automatic passive sub-mode and the actuator torque gradually or according to a configurable linear or non-linear transition curve returns to the operating torque 905. Alternatively, exiting the automatic passive sub-mode can be accomplished via another type of user input (such as a switch).

[0104] Note that the processes and displays presented may not inherently relate to any particular computer or other device. The necessary structures for such systems will appear as elements in the claims. Furthermore, embodiments are described without reference to any particular programming language. It should be understood that various programming languages ​​can be used to implement the teachings of the invention as described herein.

[0105] While certain exemplary embodiments of the invention have been described and illustrated in the accompanying drawings, it should be understood that these embodiments are merely illustrative and not limiting, and that the embodiments of the invention are not limited to the specific structures and arrangements shown and described herein, as various other modifications will be apparent to those skilled in the art.

Claims

1. A medical system comprising: A flexible, elongated device comprising multiple wires capable of controlling the guidance of the flexible, elongated device; and The control system is configured as follows: Monitor the movement of the flexible, slender instrument; The degree of motion of the flexible, slender device is determined based on the monitoring. Based on the monitoring, the operating mode of the flexible elongated device is determined from multiple operating modes, including a retraction mode, an insertion mode, and a parking mode; and In response to the change in operating mode, the stiffness of the flexible elongated instrument is altered by adjusting one or more forces applied to the distal end of the flexible elongated instrument by the plurality of wires, based on the rate of change of stiffness of the degree of motion.

2. The medical system according to claim 1, wherein: The rate of change of stiffness is nonlinear with respect to the degree of motion; and The degree of movement is at least one of the speed of movement, the elapsed time of movement, or the distance traveled.

3. The medical system according to claim 1, wherein, The control system is configured to determine the operating mode as the retraction mode based on the speed of movement exceeding a threshold in the retraction direction, and to determine the operating mode as the insertion mode based on the speed of movement exceeding the threshold in the insertion direction.

4. The medical system according to claim 3, wherein, The degree of motion includes the time elapsed during the movement.

5. The medical system according to claim 3, wherein, The degree of movement includes the distance traveled.

6. The medical system according to claim 1, wherein, The control system is configured to determine the operating mode as the retraction mode based on the fact that the retraction distance traveled since the last forward movement exceeds a threshold.

7. The medical system according to claim 6, wherein, The degree of motion includes the time elapsed during the movement.

8. The medical system according to claim 6, wherein, The degree of movement includes the distance traveled.

9. The medical system according to claim 1, wherein, The control system is configured to reduce the stiffness of the flexible, slender instrument in response to a change in the operating mode to the retraction mode.

10. The medical system according to claim 1, wherein, The control system is configured to increase the stiffness of the flexible, elongated instrument in response to a change in the operating mode to either the insertion mode or the parking mode.

11. The medical system according to claim 1, wherein, The control system is configured to determine a change in the operating mode based on the speed of the movement exceeding a threshold in a direction opposite to a previously determined motion pattern.

12. The medical system according to claim 1, wherein, The control system is configured to determine the change in operating mode based on the change in the direction of movement.

13. The medical system according to claim 1, wherein, The control system is configured to change the stiffness of the flexible elongated device in the parking mode at a higher rate of stiffness change than in the insertion mode or the retraction mode.

14. The medical system according to claim 1, wherein, The control system is configured as follows: Determine whether the speed of the movement in the retraction direction exceeds a first threshold; and In response to the speed exceeding the first threshold, the stiffness of the flexible elongated device is reduced based on the elapsed time of the movement.

15. A non-transitory machine-readable medium comprising machine-readable instructions, which, when executed by one or more processors of a control system, cause the one or more processors to perform: Monitoring the movement of a flexible, elongated instrument, the flexible, elongated instrument comprising multiple lines capable of controlling the guidance of the flexible, elongated instrument; The degree of motion of the flexible, slender device is determined based on the monitoring. Based on the monitoring, the operating mode of the flexible elongated device is determined from multiple operating modes, including a retraction mode, an insertion mode, and a parking mode; and In response to a change in operating mode, the stiffness of the flexible elongated instrument is altered by adjusting one or more forces applied to the distal end of the flexible elongated instrument by the multiple wires, based on the rate of change of stiffness of the degree of motion.

16. The non-transitory machine-readable medium according to claim 15, wherein: The rate of change of stiffness is nonlinear with respect to the degree of motion; and The degree of movement is at least one of the speed of movement, the elapsed time of movement, or the distance traveled.

17. The non-transitory machine-readable medium according to claim 15, wherein, The operation mode is determined to be the retraction mode based on the speed of movement exceeding a threshold in the retraction direction, and the operation mode is determined to be the insertion mode based on the speed of movement exceeding the threshold in the insertion direction.

18. The non-transitory machine-readable medium of claim 15, wherein the operating mode is determined as the retraction mode based on the retraction distance traveled since the last forward movement exceeding a threshold.

19. The non-transitory machine-readable medium of claim 15, further comprising, when executed by the one or more processors of the control system, causing the one or more processors to perform the following operations: Determine whether the speed of the movement in the retraction direction exceeds a first threshold; and In response to the speed exceeding the first threshold, the stiffness of the flexible elongated device is reduced based on the elapsed time of the movement.

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