Insertion of reducing bushing

Abstract

The present disclosure relates to a cannula reducer that can include a sleeve having a proximal end and a distal end. The sleeve can be configured to be inserted into a cannula. The sleeve can have an internal passage configured to receive a surgical instrument. The proximal end of the sleeve is configured to be attached to the surgical instrument.

Description

Technical Field

[0001] The systems and methods disclosed herein relate to medical devices, and more specifically to intubation reducers. Background Technology

[0002] Minimally invasive procedures allow access to target sites within a patient with minimal trauma. For example, laparoscopic surgery allows access to a patient's body cavity through a small incision in the abdomen. Cannulation creates a surgical passageway, allowing elongated medical instruments to enter internal anatomical locations to perform procedural functions such as manipulating or visualizing tissues within the patient. During surgery, cannulation supports and maintains the coaxial alignment of the instrument with the cannula. In some applications, the cannula is sized or configured to support and / or align instruments of a specific diameter. Attached Figure Description

[0003] The disclosed aspects will be described below in conjunction with the accompanying drawings, which are provided to illustrate and not limit the disclosed aspects, wherein similar reference numerals denote similar elements.

[0004] Figure 1 An implementation scheme of a cart-based robotic system deployed for the diagnosis and / or treatment of bronchoscopy procedures is shown.

[0005] Figure 2 Depicting Figure 1 Another aspect of robotic systems.

[0006] Figure 3 The setup for ureteroscopy is shown. Figure 1 The implementation plan for the robot system.

[0007] Figure 4 The diagram shows the arrangement used for vascular procedures. Figure 1 The implementation plan for the robot system.

[0008] Figure 5 An implementation of a table-based robotic system deployed for bronchoscopy procedures is shown.

[0009] Figure 6 Provided Figure 5 An alternative view of the robot system.

[0010] Figure 7 An exemplary system configured to retract a robotic arm is shown.

[0011] Figure 8 An implementation scheme of a table-based robotic system constructed for ureteroscopy procedures is shown.

[0012] Figure 9An implementation scheme of a stage-based robotic system constructed for laparoscopic procedures is shown.

[0013] Figure 10 It shows Figures 5 to 9 An implementation scheme for a platform-based robot system with pitch and tilt adjustment.

[0014] Figure 11 Provided Figures 5 to 10 A detailed diagram of the interface between the platform and the column of the platform-based robotic system.

[0015] Figure 12 An alternative implementation of a stage-based robotic system is shown.

[0016] Figure 13 It shows Figure 12 An end view of a platform-based robotic system.

[0017] Figure 14 An end view of a stage-based robotic system with a robotic arm attached thereto, according to some embodiments, is shown.

[0018] Figure 15 An exemplary device driver is shown.

[0019] Figure 16 An exemplary surgical instrument with paired instrument actuators is shown.

[0020] Figure 17 Alternative designs of instrument actuators and instruments according to some embodiments are shown, wherein the axis of the actuator is parallel to the axis of the slender axis of the instrument.

[0021] Figure 18 An instrument with an instrument-based insertion architecture according to some embodiments is shown.

[0022] Figure 19 An example controller is shown.

[0023] Figure 20 A block diagram illustrating estimates is depicted according to some implementation schemes. Figures 1 to 10 The location of one or more components of a robotic system (such as...) Figures 16 to 18 A positioning system for the location of instruments.

[0024] Figure 21 An exemplary docking arrangement of components of a robot system according to some implementation schemes is shown.

[0025] Figure 22 The following are illustrated according to some implementation schemes. Figure 21 A cross-sectional view of the docking arrangement.

[0026] Figure 23 The following are illustrated according to some implementation schemes. Figure 21 An exploded view of the docking arrangement.

[0027] Figure 24 The illustration shows an intubation reducer and surgical instruments according to some implementation schemes.

[0028] Figure 25 The following are illustrated according to some implementation schemes. Figure 24 The cannula and surgical instruments are used as assembly units.

[0029] Figure 26 The diagram illustrates the docking of cannula reducers and surgical instruments with a robotic system according to some implementation schemes.

[0030] Figure 27 A latching mechanism for a cannula reducer according to some embodiments is shown.

[0031] Figure 28 The following are illustrated according to some implementation schemes. Figure 27 A cross-sectional view of the latching mechanism.

[0032] Figure 29 The distal end of a cannulation reducer according to some embodiments is shown.

[0033] Figure 30 The distal end of a cannula reducer within a cannula is shown according to some embodiments.

[0034] Figures 31 to 33 An exemplary latching mechanism for inserting a reducer is shown according to some embodiments.

[0035] Figure 34 shows an exploded view of an exemplary cannula reducer and surgical instruments according to some implementation schemes.

[0036] Figure 35 shows the cannula and surgical instruments of Figure 34 as assembly units.

[0037] Figure 36 shows an exploded view of an exemplary cannula and surgical instruments according to some implementation schemes.

[0038] Figure 37 shows the cannula and surgical instruments of Figure 36 as part of the assembly unit.

[0039] Figure 38 shows the cannula reducer and surgical instruments of Figure 36 as assembly units.

[0040] Figure 39 shows an exploded view of an exemplary cannula and surgical instruments according to some implementation schemes.

[0041] Figure 40 shows the cannula and surgical instruments of Figure 39 as part of the assembly unit.

[0042] Figure 41 shows the cannula and surgical instruments of Figure 39 as assembly units.

[0043] Figure 42 An exploded view of a docking arrangement with an exemplary cannula reducer and insert is shown according to some embodiments.

[0044] Figure 43 It shows the assembly unit. Figure 42 The cannula reducer and insert.

[0045] Figure 44 shows an exploded view of an exemplary cannula reducer and insert according to some embodiments.

[0046] Figure 45 shows the cannula reducer and insert of Figure 44 as an assembly unit.

[0047] Figure 46 shows an exploded view of an exemplary cannula reducer and insert according to some embodiments.

[0048] Figure 47 shows the cannula reducer and insert of Figure 46 as an assembly unit.

[0049] Figure 48 and Figure 49 A flowchart is shown illustrating a method for using a cannula reducer according to some implementation schemes. Detailed Implementation

[0050] 1. Overview .

[0051] The aspects of this disclosure can be integrated into robot-enabled medical systems capable of performing a variety of medical procedures, including minimally invasive procedures such as laparoscopy and non-invasive procedures such as endoscopy. In endoscopic procedures, the system may be able to perform bronchoscopy, ureteroscopy, gastroscopy, etc.

[0052] In addition to executing a wide range of procedures, the system can provide additional benefits such as enhanced imaging and guidance to assist physicians. Furthermore, the system allows physicians to execute procedures from an ergonomic orientation, eliminating the need for awkward arm movements and postures. Additionally, the system provides physicians with improved ease of use, enabling one or more of the system's instruments to be controlled by a single user.

[0053] For illustrative purposes, various embodiments will be described below in conjunction with the accompanying drawings. It should be understood that many other specific embodiments of the disclosed concepts are possible, and various advantages can be achieved using the disclosed specific embodiments. Titles are included herein for reference and to aid in locating the various sections. These titled sections are not intended to limit the scope of the concepts referred to therein. Such concepts are applicable throughout the specification.

[0054] A. Robotic System – Trolley .

[0055] Robot-enabled medical systems can be configured in a variety of ways, depending on specific procedures. Figure 1 An embodiment of a cart-based robot-enabled system 10 arranged for diagnostic and / or therapeutic bronchoscopy procedures is illustrated. During bronchoscopy, system 10 may include a cart 11 having one or more robotic arms 12 to deliver medical instruments, such as a manipulable endoscope 13 (which may be a procedure-specific bronchoscope for bronchoscopy), to a natural orifice entry point (i.e., in this example, the patient's mouth positioned on the table) to deliver diagnostic and / or therapeutic tools. As shown, cart 11 may be positioned near the patient's upper torso to provide access to the entry point. Similarly, robotic arms 12 may be actuated to position the bronchoscope relative to the entry point. When performing GI procedures using a gastroscopy (a procedure-specific endoscope for gastrointestinal (GI) procedures), the same approach may be used. Figure 1 The layout within. Figure 2 An exemplary implementation of the cart is described in more detail.

[0056] Continue to refer to Figure 1Once the trolley 11 is correctly positioned, the robotic arm 12 can robotically, manually, or in combination thereof insert the steerable endoscope 13 into the patient. As shown, the steerable endoscope 13 may include at least two telescopic portions, such as an inner guide portion and an outer sheath portion, each portion being coupled to a separate instrument actuator from a set of instrument actuators 28, each instrument actuator being coupled to the distal end of a separate robotic arm. This linear arrangement of the instrument actuators 28, which facilitates coaxial alignment of the guide portion and the sheath portion, creates a “virtual track” 29, which can be repositioned in space by manipulating one or more robotic arms 12 to different angles and / or positions. The virtual track described herein is depicted using dashed lines in the accompanying drawings, and therefore the dashed lines do not depict any physical structure of the system. Translation of the instrument actuators 28 along the virtual track 29 causes the inner guide portion to extend or retract relative to the outer sheath portion, or to advance or retract the endoscope 13 from the patient. The angle of the virtual track 29 can be adjusted, translated, and pivoted based on clinical application or physician preference. For example, in bronchoscopy, the angle and position of the virtual track 29 shown in the figure represent a trade-off between providing the physician with access to the endoscope 13 and minimizing friction caused by the endoscope 13 bending into the patient's mouth.

[0057] After insertion, endoscope 13 can be guided downwards through the patient's trachea and lungs using precise commands from the robotic system until the target destination or surgical site is reached. To enhance navigation through the patient's lung network and / or reach the desired target, endoscope 13 can be manipulated to telescopically extend the inner guide portion from the outer sheath portion to achieve enhanced joint movement and a larger radius of flexion. The use of separate instrument actuators 28 also allows the guide portion and sheath portion to be driven independently of each other.

[0058] For example, endoscope 13 can be guided to deliver a biopsy needle to a target, such as a lesion or nodule in a patient's lung. The needle can be deployed downwards along the working channel, which extends the length of the endoscope to obtain a tissue sample to be analyzed by a pathologist. Depending on the pathological findings, additional tools can be deployed downwards along the working channel of the endoscope for additional biopsies. After the nodule is identified as malignant, endoscope 13 can be used to deliver endoscopic tools to remove the potential cancerous tissue. In some cases, diagnostic and therapeutic procedures can be delivered in a separate procedure. In these cases, endoscope 13 can also be used to deliver a reference point to "mark" the location of the target nodule. In other cases, diagnostic and therapeutic procedures can be delivered during the same procedure.

[0059] System 10 may also include a movable tower 30, which can be connected to the trolley 11 via support cables to provide control, electronic, fluid, optical, sensor, and / or electrical support to the trolley 11. Placing such functionality within the tower 30 allows for a smaller form factor trolley 11 that can be more easily adjusted and / or repositioned by the operating physician and his / her staff. Additionally, the division between the trolley / table and the support tower 30 reduces operating room clutter and facilitates improved clinical workflow. While the trolley 11 can be positioned close to the patient, the tower 30 can be retracted in a remote location to avoid obstructing the path during procedures.

[0060] To support the aforementioned robotic system, tower 30 may include components of a computer-based control system that stores computer program instructions in a non-transitory computer-readable storage medium such as a permanent magnet memory drive, a solid-state drive, etc. Whether execution occurs within tower 30 or cart 11, the execution of these instructions can control the entire system or its subsystems. For example, when executed by the processor of the computer system, the instructions can cause components of the robotic system to actuate relevant brackets and arm mounts, actuate the robotic arm, and control medical devices. For instance, in response to receiving a control signal, a motor in the joint of the robotic arm can position the arm into a specific posture.

[0061] Tower 30 may also include pumps, flow meters, valve controllers, and / or fluid passages to provide controlled flushing and suction capabilities to a system that can be deployed via endoscope 13. These components may also be controlled using a computer system of tower 30. In some embodiments, flushing and suction capabilities may be delivered directly to endoscope 13 via a separate cable.

[0062] Tower 30 may include voltage and surge protectors designed to provide filtered and protected power to trolley 11, thereby avoiding the need to place power transformers and other auxiliary power components in trolley 11, resulting in a smaller and more portable trolley 11.

[0063] Tower 30 may also include support devices for sensors deployed throughout the robotic system 10. For example, tower 30 may include optoelectronic devices for detecting, receiving, and processing data received from optical sensors or cameras throughout the robotic system 10. In conjunction with a control system, such optoelectronic devices can be used to generate real-time images for display in any number of consoles deployed throughout the system (including displays within tower 30). Similarly, tower 30 may also include electronic subsystems for receiving and processing signals received from deployed electromagnetic (EM) sensors. Tower 30 may also be used to house and position EM field generators for detection by EM sensors within or on top of medical devices.

[0064] In addition to other consoles available in the rest of the system (e.g., a console mounted on top of a cart), tower 30 may also include console 31. Console 31 may include a user interface and display, such as a touchscreen, for physician operators. Consoles in system 10 are generally designed to provide both robot control and preoperative and real-time information for procedures, such as navigation and positioning information for endoscope 13. When console 31 is not the only console available to the physician, it may be used by a second operator (such as a nurse) to monitor the patient's health or vital signs and system operation, as well as to provide procedure-specific data, such as navigation and positioning information. In other embodiments, console 30 is housed in a separate body from tower 30.

[0065] Tower 30 can be connected to cart 11 and endoscope 13 via one or more cables or connectors (not shown). In some embodiments, support functions from tower 30 can be provided to cart 11 via a single cable, thereby simplifying the operating room and eliminating clutter. In other embodiments, specific functions can be coupled in separate wiring and connections. For example, while power to the cart can be provided via a single cable, support for control, optics, fluid, and / or navigation can also be provided via separate cables.

[0066] Figure 2 Provided from Figure 1 The illustration shows a detailed implementation of a cart-based robot-enabled system. The cart 11 typically includes an elongated support structure 14 (often referred to as a "post"), a cart base 15, and a console 16 at the top of the post 14. The post 14 may include one or more brackets, such as those for supporting one or more robotic arms 12. Figure 2 The bracket 17 (or alternatively, "arm support") is deployed in three configurations. The bracket 17 may include a separately configurable arm mount that rotates along a vertical axis to adjust the base of the robotic arm 12 for better positioning relative to the patient. The bracket 17 also includes a bracket interface 19 that allows the bracket 17 to translate vertically along the post 14.

[0067] The bracket interface 19 is connected to the column 14 via slots such as slots 20, which are positioned on opposite sides of the column 14 to guide the vertical translation of the bracket 17. Slots 20 contain vertical translation interfaces to position and hold the bracket relative to the trolley base 15 at various vertical heights. The vertical translation of the bracket 17 allows the trolley 11 to adjust the reach of the robotic arm 12 to accommodate various table heights, patient sizes, and physician preferences. Similarly, separately configurable arm mounts on the bracket 17 allow the robotic arm base 21 of the robotic arm 12 to be angled in various configurations.

[0068] In some embodiments, slot 20 may be supplemented with a slot cover flush and parallel to the slot surface to prevent dust and fluid from entering the internal cavity of column 14 and the vertical translation interface during the vertical translation of bracket 17. The slot cover can be deployed via a pair of spring reels positioned near the vertical top and bottom of slot 20. The cover is coiled within the reels until deployed, extending and retracting from its coiled state as bracket 17 translates vertically up and down. The spring load of the reels provides the force to retract the cover into the reels as bracket 17 translates toward the reels, while maintaining a tight seal as bracket 17 translates away from the reels. The cover can be attached to bracket 17 using, for example, a bracket in bracket interface 19, to ensure proper extension and retraction of the cover during the translation of bracket 17.

[0069] The column 14 may internally include mechanisms such as gears and motors, which are designed to mechanically translate the bracket 17 using vertically aligned lead screws in response to control signals generated in response to user input (e.g., input from the console 16).

[0070] A robotic arm 12 typically includes a robotic arm base 21 and an end effector 22 separated by a series of links 23 connected by a series of joints 24, each joint including an independent actuator, and each actuator including an independently controllable motor. Each independently controllable joint represents an independent degree of freedom available to the robotic arm. Each of the arms 12 has seven joints and thus provides seven degrees of freedom. Multiple joints result in multiple degrees of freedom, thus allowing for “redundant” degrees of freedom. Redundant degrees of freedom allow the robotic arm 12 to position its corresponding end effector 22 in a specific orientation, orientation, and trajectory in space using different link orientations and joint angles. This allows the system to locate and guide medical devices from desired points in space, while allowing physicians to move the arm joints to a clinically advantageous orientation away from the patient to achieve greater proximity while avoiding arm collisions.

[0071] The trolley base 15 balances the weight of the column 14, bracket 17, and arm 12 on the floor. Therefore, the trolley base 15 houses heavier components such as electronics, motors, power supplies, and components that enable the trolley to move and / or be stationary. For example, the trolley base 15 includes rollable wheel-shaped casters 25 that allow the trolley to move easily around the room before the procedure. Once in the correct position, the casters 25 can be secured using wheel locks to hold the trolley 11 in the correct position during the procedure.

[0072] The console 16, positioned at the vertical end of column 14, allows both a user interface for receiving user input and a display screen (or dual-purpose device, such as, for example, touchscreen 26) to provide both preoperative and intraoperative data to the physician user. Potential preoperative data on touchscreen 26 may include preoperative planning, navigation, and mapping data derived from preoperative computed tomography (CT) scans and / or records from preoperative patient interviews. Intraoperative data on the display screen may include optical information from tools and sensors, coordinate information from sensors, and important patient statistics such as respiration, heart rate, and / or pulse. The console 16 can be positioned and tilted to allow the physician to access it from the side of column 14 opposite to bracket 17. From this orientation, the physician can operate the console 16 from behind cart 11 while observing the console 16, robotic arm 12, and patient. As shown, the console 16 also includes a handle 27 for assisting in manipulation and stabilizing cart 11.

[0073] Figure 3 An embodiment of a robot-enabled system 10 arranged for ureteroscopy is shown. In a ureteroscopy procedure, a trolley 11 is positioned to deliver a ureteroscope 32 (a procedure-specific endoscope designed to traverse the patient's urethra and ureter) to the patient's lower abdominal region. During ureteroscopy, it is desirable to align the ureteroscope 32 directly with the patient's urethra to reduce friction and force on sensitive anatomical structures in that region. As shown, the trolley 11 can be aligned at the foot of the table to allow the robotic arm 12 to position the ureteroscope 32 for direct linear access into the patient's urethra. The robotic arm 12 can insert the ureteroscope 32 directly into the patient's lower abdomen through the urethra from the foot of the table along a virtual track 33.

[0074] After insertion into the urethra, using control techniques similar to those used in bronchoscopy, the ureteroscope 32 can be navigated to the bladder, ureter, and / or kidney for diagnostic and / or therapeutic applications. For example, the ureteroscope 32 can be guided into the ureter and kidney to break up accumulated kidney stones using a laser or ultrasonic lithotripsy device deployed downwards along the working channel of the ureteroscope 32. After lithotripsy is complete, the resulting stone fragments can be removed using a basket deployed downwards along the ureteroscope 32.

[0075] Figure 4A similar implementation of a robot-enabled system for vascular procedures is shown. In vascular procedures, system 10 can be configured such that a trolley 11 delivers a medical device 34 (such as a manipulable catheter) to an entry point in the femoral artery in the patient's leg. The femoral artery presents both a relatively large diameter for navigation and a relatively less circuitous and tortuous path to the patient's heart, which simplifies navigation. As in ureteroscopy procedures, trolley 11 can be positioned toward the patient's leg and lower abdomen to allow robotic arm 12 to provide a virtual track 35 for direct linear access to the femoral artery entry point in the patient's thigh / hip region. After insertion into the artery, the medical device 34 can be guided and inserted via translational device actuator 28. Alternatively, the trolley can be positioned around the patient's upper abdomen to reach alternative vascular entry points, such as the carotid and brachial arteries near the shoulder and wrist.

[0076] B. Robot System – Unit .

[0077] Implementations of robot-enabled medical systems can also incorporate patient tables. By removing the trolley, incorporating the table reduces the number of major pieces of equipment in the operating room, allowing for better patient access. Figure 5 An embodiment of such a robot-enabled system arranged for a bronchoscopy procedure is shown. System 36 includes a support structure or column 37 for supporting a platform 38 (shown as a “table” or “bed”) on a floor. Much like a trolley-based system, the end effector of the robotic arm 39 of system 36 includes an instrument actuator 42, which is designed to manipulate elongated medical instruments, such as… Figure 5 The bronchoscope 40 is used in the bronchoscopy. In practice, the C-arm used to provide fluorescence imaging can be positioned above the patient's upper abdominal region by placing the transmitter and detector around the stage 38.

[0078] Figure 6An alternative view of system 36 without a patient and medical devices is provided for discussion purposes. As shown, column 37 may include one or more brackets 43, shown as annular in system 36, upon which one or more robotic arms 39 may be based. The brackets 43 may translate along a vertical column interface 44 extending along the length of column 37 to provide different vantage points from which the robotic arms 39 may be positioned to reach the patient. The brackets 43 may be rotated about column 37 using mechanical motors positioned within column 37 to allow the robotic arms 39 to access multiple sides of table 38, such as both sides of the patient. In embodiments with multiple brackets, the brackets may be individually positioned on the column and may translate and / or rotate independently of other brackets. While the brackets 43 need not be circular or even encircling column 37, the annular shape shown facilitates rotation of the brackets 43 about column 37 while maintaining structural balance. Rotation and translation of the brackets 43 allow the system to align medical devices such as endoscopes and laparoscopes to different access points on the patient. In other embodiments (not shown), system 36 may include a patient examination table or bed with an adjustable arm support, which takes the form of a rod or rail extending beside the patient examination table or bed. One or more robotic arms 39 (e.g., via a shoulder with an elbow joint) may be attached to the adjustable arm support, which can be vertically adjusted. By providing vertical adjustment, the robotic arms 39 are advantageously able to be compactly retracted under the patient examination table or bed and subsequently raised during the procedure.

[0079] Arm 39 can be mounted on a bracket via a set of arm mounts 45 comprising a series of joints that can be individually rotated and / or telescopically extended to provide additional constructability to the robotic arm 39. Additionally, the arm mounts 45 can be positioned on the bracket 43 such that, when the bracket 43 is properly rotated, the arm mounts 45 are positioned on the same side of the platform 38 (e.g., ...). Figure 6 As shown), on the opposite side of platform 38 (as shown) Figure 9 (as shown) or on the adjacent side of platform 38 (not shown).

[0080] Column 37 structurally supports platform 38 and provides a path for the vertical translation of the bracket. Internally, column 37 may be equipped with a lead screw for guiding the vertical translation of the bracket, and a motor for mechanizing the translation of the bracket based on the lead screw. Column 37 may also transmit power and control signals to bracket 43 and robotic arm 39 mounted thereon.

[0081] Platform base 46 has with Figure 2The trolley base 15 in the illustrated trolley 11 serves a similar function, accommodating heavier components to balance the table / bed 38, column 37, bracket 43, and robot arm 39. The table base 46 may also incorporate rigid casters to provide stability during operation. Casters, deployed from the bottom of the table base 46 on either side, can extend in opposite directions and retract when the system 36 needs to be moved.

[0082] continue Figure 6 System 36 may also include a tower (not shown) that divides the functionality of system 36 between the table and the tower to reduce the form factor and volume of the table. As in previously disclosed embodiments, the tower may provide the table with various support functions such as processing, computing and control capabilities, electrical, fluid and / or optical, and sensor processing. The tower may also be movable to be positioned away from the patient, thereby improving physician access and eliminating clutter in the operating room. Additionally, placing components in the tower allows for more storage space in the base of the table for potential retraction of the robotic arm. The tower may also include a main controller or console that provides a user interface such as a keyboard and / or the tower for user input, and a display screen (or touchscreen) for preoperative and intraoperative information such as real-time imaging, navigation, and tracking information. In some embodiments, the tower may also include a holder for gas cylinders to be used for inflatation.

[0083] In some implementations, the base can be retracted and stored when not in use. Figure 7 A system 47 for retracting a robotic arm is illustrated in an embodiment of a platform-based system. In system 47, a bracket 48 can be vertically translated into a base 49 to retract the robotic arm 50, arm mount 51, and bracket 48 within the base 49. A base cover 52 can be translated and retracted to open to deploy the bracket 48, arm mount 51, and arm 50 around a post 53, and to close to retract the bracket, arm mount, and arm for protection when not in use. The base cover 52 can be sealed along the edge of its opening using a membrane 54 to prevent dust and fluid from entering when closed.

[0084] Figure 8An embodiment of a robot-enabled table-based system configured for a ureteroscopy procedure is illustrated. During ureteroscopy, table 38 may include a rotating portion 55 for positioning the patient at an angle to column 37 and table base 46. The rotating portion 55 may rotate or pivot about a pivot point (e.g., below the patient's head) to position the lower portion of the rotating portion 55 away from column 37. For example, pivoting of the rotating portion 55 allows a C-arm (not shown) to be positioned above the patient's lower abdomen without competing for space with the column (not shown) below table 38. By rotating a bracket (not shown) about column 37, robotic arm 39 can insert a ureteroscope 56 directly into the patient's groin region along a virtual track 57 to reach the urethra. During ureteroscopy, stirrups 58 may also be fixed to the rotating portion 55 of table 38 to support the orientation of the patient's legs during the procedure and allow full access to the patient's groin region.

[0085] In laparoscopic procedures, minimally invasive instruments are inserted into the patient's anatomical structures through one or more small incisions in the abdominal wall. In some embodiments, the minimally invasive instruments include elongated rigid components, such as axes, for accessing the anatomical structures within the patient. After the patient's abdominal cavity is inflated, the instruments can be guided to perform surgical or medical tasks, such as grasping, cutting, ablation, suturing, etc. In some embodiments, the instruments may include endoscopes, such as laparoscopes. Figure 9 An implementation of a table-based, robot-enabled system configured for laparoscopic procedures is shown. Figure 9 As shown, the bracket 43 of system 36 can be rotated and vertically adjusted to position the pair of robotic arms 39 on opposite sides of table 38, so that the instrument 59 can be positioned through the smallest incision on both sides of the patient to reach his / her abdominal cavity using arm mount 45.

[0086] To accommodate laparoscopic procedures, the robot-enabled platform system can also tilt the platform to the desired angle. Figure 10 An implementation scheme for a robot-enabled medical system with pitch or tilt adjustment is shown. For example... Figure 10 As shown, system 36 can adapt to the tilt of platform 38 to position one part of the platform at a greater distance from the base plate than the other part. Additionally, arm mount 45 is rotatable to match the tilt, ensuring that arm 39 maintains the same planar relationship with platform 38. To accommodate steeper angles, column 37 may also include a telescopic portion 60 that allows vertical extension of column 37 to prevent platform 38 from contacting the floor or colliding with base 46.

[0087] Figure 11Detailed illustrations are provided of the interface between platform 38 and column 37. The pitch-rotation mechanism 61 can be configured to change the pitch angle of platform 38 relative to column 37 in multiple degrees of freedom. The pitch-rotation mechanism 61 can be implemented by positioning orthogonal axes 1, 2 at the column interface, each axis being actuated by separate motors 3, 4 in response to electrical pitch angle commands. Rotation along one screw 5 enables tilt adjustment along axis 1, while rotation along another screw 6 enables tilt adjustment along another axis 2. In some embodiments, ball joints can be used to change the pitch angle of platform 38 relative to column 37 in multiple degrees of freedom.

[0088] For example, pitch adjustment is particularly useful when attempting to position the table in the Trendrenburg position (i.e., positioning the patient's lower abdomen higher than the floor) for lower abdominal surgery. The head-down, feet-up position causes the patient's internal organs to slide down to his / her upper abdomen by gravity, clearing the abdominal cavity to allow minimally invasive instruments to enter and perform lower abdominal surgical or medical procedures, such as laparoscopic prostatectomy.

[0089] Figure 12 and Figure 13 Isometric and end views of an alternative embodiment of a stage-based surgical robot system 100 are shown. The surgical robot system 100 includes components that can be configured to support one or more robotic arms relative to a stage 101 (see, for example...). Figure 14 One or more adjustable arm supports 105 are provided. In the illustrated embodiment, a single adjustable arm support 105 is shown, but additional arm supports may be positioned on opposite sides of the platform 101. The adjustable arm support 105 may be configured to be movable relative to the platform 101 to adjust and / or change the position of the adjustable arm support 105 and / or any robotic arm attached to the adjustable arm support relative to the platform 101. For example, the adjustable arm support 105 may be adjusted with one or more degrees of freedom relative to the platform 101. The adjustable arm support 105 provides high flexibility to the system 100, including the ability to easily retract one or more adjustable arm supports 105 and any robotic arm attached to the one or more adjustable arm supports under the platform 101. The adjustable arm support 105 may be raised from a retracted position to a position below the upper surface of the platform 101. In other embodiments, the adjustable arm support 105 may be raised from a retracted position to a position above the upper surface of the platform 101.

[0090] The adjustable arm support 105 provides several degrees of freedom, including lifting, lateral translation, and tilting. Figure 12 and Figure 13 In an exemplary embodiment, the arm support 105 is configured to have four degrees of freedom, which are in Figure 12The arrows indicate the first degree of freedom, which allows adjustment of the adjustable arm support 105 in the z-direction (“Z-lift”). For example, the adjustable arm support 105 may include a bracket 109 configured to move up or down along or relative to the column 102 of the support platform 101. The second degree of freedom allows the adjustable arm support 105 to tilt. For example, the adjustable arm support 105 may include a rotary joint that allows the adjustable arm support 105 to be aligned with the bed in a head-down, feet-up position. The third degree of freedom allows the adjustable arm support 105 to “pivot upwards”, which can be used to adjust the distance between one side of the platform 101 and the adjustable arm support 105. The fourth degree of freedom allows the adjustable arm support 105 to translate along the longitudinal length of the platform.

[0091] Figure 12 and Figure 13 The surgical robot system 100 may include a platform supported by a column 102 mounted to a base 103. The base 103 and the column 102 support the platform 101 relative to a support surface. A floor axis 131 and a support axis 133 are... Figure 13 As shown in the image.

[0092] The adjustable arm support 105 can be mounted to the column 102. In other embodiments, the arm support 105 can be mounted to the platform 101 or the base 103. The adjustable arm support 105 may include a bracket 109, a rod or rail connector 111, and a rod or rail 107. In some embodiments, one or more robotic arms mounted to the rail 107 can translate and move relative to each other.

[0093] The bracket 109 can be attached to the post 102 via a first joint 113, which allows the bracket 109 to move relative to the post 102 (e.g., such as moving up or down along a first axis or vertical axis 123). The first joint 113 can provide a first degree of freedom (“Z-lift”) to the adjustable arm support 105. The adjustable arm support 105 may include a second joint 115, which provides a second degree of freedom (tilt) to the adjustable arm support 105. The adjustable arm support 105 may include a third joint 117, which provides a third degree of freedom (“upward pivot”) to the adjustable arm support 105. An additional joint 119 may be provided (in... Figure 13 (As shown in the diagram), the additional joint mechanically constrains the third joint 117 to maintain the orientation of the guide rail 107 as the guide rail connector 111 rotates about the third axis 127. The adjustable arm support 105 may include a fourth joint 121 that can provide a fourth degree of freedom (translation) for the adjustable arm support 105 along the fourth axis 129.

[0094] Figure 14An end view of a surgical robot system 140A according to one embodiment, having two adjustable arm supports 105A, 105B mounted on opposite sides of a stage 101, is shown. A first robotic arm 142A is attached to a rod or rail 107A of the first adjustable arm support 105B. The first robotic arm 142A includes a base 144A attached to the rail 107A. The distal end of the first robotic arm 142A includes an instrument drive mechanism 146A for attachment to one or more robotic medical instruments or tools. Similarly, a second robotic arm 142B includes a base 144B attached to the rail 107B. The distal end of the second robotic arm 142B includes an instrument drive mechanism 146B. The instrument drive mechanism 146B may be configured to attach to one or more robotic medical instruments or tools.

[0095] In some embodiments, one or more of the robotic arms 142A and 142B include an arm with seven or more degrees of freedom. In some embodiments, one or more of the robotic arms 142A and 142B may include eight degrees of freedom, including an insertion axis (including one degree of freedom for insertion), a wrist (including three degrees of freedom for wrist pitch, yaw, and roll), an elbow (including one degree of freedom for elbow pitch), a shoulder (including two degrees of freedom for shoulder pitch and yaw), and a base 144A and 144B (including one degree of freedom for translation). In some embodiments, the insertion degree of freedom may be provided by the robotic arms 142A and 142B, while in other embodiments, the instrument itself provides insertion via an instrument-based insertion architecture.

[0096] C. Instrument drivers and interfaces .

[0097] The end effector of the system's robotic arm includes: (i) an instrument actuator (alternatively referred to as an "instrument drive mechanism" or "instrument device manipulator") incorporating electromechanical devices for actuating the medical device; and (ii) a removable or detachable medical device that may not contain any electromechanical components, such as motors. This dichotomy may be driven by the need to sterilize medical devices used in medical procedures, and the inability to adequately sterilize expensive capital equipment due to its complex mechanical components and sensitive electronics. Therefore, the medical device can be designed to be detached, removed, and interchanged from the instrument actuator (and thus from the system) for individual sterilization or disposal by a physician or physician staff. In contrast, the instrument actuator does not need to be altered or sterilized and can be covered for protection.

[0098] Figure 15An example instrument actuator is shown. The instrument actuator 62, positioned at the distal end of a robotic arm, includes one or more drive units 63 arranged parallel to the axis to provide controlled torque to a medical device via a drive shaft 64. Each drive unit 63 includes a separate drive shaft 64 for interacting with the device, a gear head 65 for converting motor shaft rotation into desired torque, a motor 66 for generating drive torque, an encoder 67 for measuring the speed of the motor shaft and providing feedback to control circuitry, and control circuitry 68 for receiving control signals and actuating the drive unit. Each drive unit 63 is independently controlled and motorized, and the instrument actuator 62 can provide multiple (e.g., ...) to the medical device. Figure 15 Four independent drive outputs are shown. In operation, the control circuit 68 receives control signals, transmits motor signals to the motor 66, compares the motor speed measured by the encoder 67 with the desired speed, and modulates the motor signals to generate the desired torque.

[0099] For procedures requiring a sterile environment, the robotic system can incorporate a drive interface, such as a sterile adapter connected to a sterile cover, positioned between the instrument actuator and the medical device. The primary purpose of the sterile adapter is to transmit angular motion from the drive shaft of the instrument actuator to the drive input of the device, while maintaining physical separation between the drive shaft and the drive input, and thus maintaining sterility. Therefore, an exemplary sterile adapter may include a series of rotary inputs and rotary outputs designed to mate with the drive shaft of the instrument actuator and the drive input on the device. The sterile cover, composed of a thin, flexible material (such as transparent or translucent plastic), is connected to the sterile adapter and designed to cover the main equipment, such as the instrument actuator, robotic arm, and trolley (in trolley-based systems) or table (in table-based systems). The use of the cover allows the medical device to be positioned near the patient while still within an area that does not require sterilization (i.e., a non-sterile area). On the other side of the sterile cover, the medical device can dock with the patient in an area that requires sterilization (i.e., a sterile area).

[0100] D. Medical devices .

[0101] Figure 16An example medical device with paired instrument actuators is shown. Similar to other devices designed for use with robotic systems, the medical device 70 includes an elongated shaft 71 (or elongated body) and an instrument base 72. The instrument base 72, also referred to as the “instrument handle” due to its intended design for manual interaction by a physician, typically includes a rotatable drive input 73 (e.g., a socket, pulley, or reel) designed to mate with a drive output 74 on a drive interface extending through the distal end of the robotic arm 76. When physically connected, latched, and / or coupled, the mating drive input 73 of the instrument base 72 can share a rotational axis with the drive output 74 in the instrument driver 75 to allow torque to be transmitted from the drive output 74 to the drive input 73. In some embodiments, the drive output 74 may include splines designed to mate with sockets on the drive input 73.

[0102] The elongated shaft 71 is designed to be delivered through an anatomical opening or cavity (e.g., as in endoscopy) or through a minimally invasive incision (e.g., as in laparoscopy). The elongated shaft 71 can be flexible (e.g., having endoscope-like properties) or rigid (e.g., having laparoscopy-like properties), or a customized combination of both flexible and rigid portions. When designed for laparoscopy, the distal end of the rigid elongated shaft can be connected to an end effector extending from a connector wrist formed by a connecting fork having at least one degree of freedom and a surgical tool or medical instrument (such as, for example, a gripper or scissors), which can be actuated based on forces from a tendon when the drive input rotates in response to torque received from the drive output 74 of the instrument actuator 75. When designed for endoscopy, the distal end of the flexible elongated shaft can include a manipulable or controllable bending segment that articulates and bends based on torque received from the drive output 74 of the instrument actuator 75.

[0103] Torque from the instrument actuator 75 is transmitted downwards along shaft 71 to the elongated shaft 71 via tendons. These individual tendons (such as traction cables) may be individually anchored to various drive inputs 73 within the instrument handle 72. From the handle 72, the tendons are guided downwards along one or more traction chambers of the elongated shaft 71 and anchored at the distal portion of the elongated shaft 71, or at the wrist at the distal portion of the elongated shaft. During surgical procedures such as laparoscopy, endoscopy, or hybrid procedures, these tendons may be coupled to distally mounted end effectors, such as wrists, grippers, or scissors. In such an arrangement, torque applied to the drive inputs 73 transmits tension to the tendons, thereby actuating the end effector in a certain way. In some embodiments, during surgical procedures, the tendons may cause the connector to rotate about the axis, thereby causing the end effector to move in one direction or the other. Alternatively, the tendons may be coupled to one or more jaws of a gripper at the distal end of the elongated shaft 71, wherein tension from the tendons causes the gripper to close.

[0104] During endoscopy, tendons can be attached via adhesives, control rings, or other mechanical fasteners to flexural or articulated segments positioned along an elongated axis 71 (e.g., at the distal end). When securely attached to the distal end of a flexural segment, torque applied to the drive input 73 is transmitted down the tendon, causing the softer flexural segment (sometimes referred to as an articulated segment or region) to flex or articulate. Along non-flexural segments, it can be advantageous to helve or coil individual traction cavities that guide individual tendons along the wall (or inside) of the endoscope axis to balance radial forces caused by tension in the traction lines. For specific purposes, the angle of the helices and / or the spacing between them can be varied or designed, with tighter helices exhibiting less axial compression under load, while lower helical amounts cause greater axial compression under load but also exhibit restricted flexion. Alternatively, traction cavities can be guided parallel to the longitudinal axis 71 to allow controlled articulation within the desired flexural or articulated segment.

[0105] In endoscopic procedures, the elongated shaft 71 houses multiple components to assist in robotic procedures. The shaft may include a working channel for deploying surgical instruments (or medical devices), irrigation components, and / or suction components to an operating area at the distal end of the shaft 71. The shaft 71 may also house wires and / or optical fibers to transmit signals to / from optical components at the distal end, which may include an optical camera. The shaft 71 may also house optical fibers to carry light from a proximal light source (such as a light-emitting diode) to the distal end of the shaft.

[0106] At the distal end of the instrument 70, the distal end may also include an opening for delivering tools for diagnostic and / or treatment, irrigation, and aspiration to the surgical site. The distal end may also include a port for a camera (such as a fiberscope or digital camera) to capture images of the internal anatomical space. Relatedly, the distal end may also include a port for a light source used to illuminate the anatomical space when the camera is used.

[0107] exist Figure 16 In the example, the axis of the drive shaft, and therefore the axis of the drive input, is orthogonal to the axis of the elongated shaft. However, this arrangement complicates the rolling capability of the elongated shaft 71. Rolling the elongated shaft along its axis while keeping the drive input 73 stationary can cause undesirable tangling of the tendon as it extends from the drive input 73 and enters the traction cavity within the elongated shaft 71. Such tangling of the tendon can disrupt any control algorithm designed to predict the movement of the flexible elongated shaft during endoscopic procedures.

[0108] Figure 17 An alternative design of the instrument actuator and instrument is shown, wherein the axis of the drive unit is parallel to the axis of the slender axis of the instrument. As shown, the circular instrument actuator 80 includes four drive units whose drive outputs 81 are aligned parallel to each other at the end of the robot arm 82. The drive units and their respective drive outputs 81 are housed in a rotating assembly 83 of the instrument actuator 80, driven by one of the drive units within assembly 83. In response to torque provided by the rotating drive unit, the rotating assembly 83 rotates along a circular bearing that connects the rotating assembly 83 to the non-rotating portion 84 of the instrument actuator. Electrical and control signals can be transmitted from the non-rotating portion 84 of the instrument actuator 80 to the rotating assembly 83 via electrical contacts, which can be maintained by rotation of a brush slip ring connection (not shown). In other embodiments, the rotating assembly 83 may be responsive to a separate drive unit integrated into the non-rotating portion 84 and therefore not parallel to the other drive units. The rotation mechanism 83 allows the instrument actuator 80 to allow the drive units and their respective drive outputs 81 to rotate as a single unit about the instrument actuator axis 85.

[0109] Similar to previously disclosed embodiments, the instrument 86 may include an elongated shaft portion 88 and an instrument base 87 (shown as having a transparent outer surface for discussion purposes), the instrument base including a plurality of drive inputs 89 (such as sockets, pulleys, and reels) configured to receive drive outputs 81 in the instrument driver 80. Unlike previously disclosed embodiments, the instrument shaft 88 extends from the center of the instrument base 87, and the axis of the instrument base is substantially parallel to the axes of the drive inputs 89, rather than... Figure 16 It is orthogonal as in the design.

[0110] When coupled to the rotating assembly 83 of the instrument driver 80, the medical instrument 86, including the instrument base 87 and the instrument shaft 88, rotates in combination with the rotating assembly 83 about the instrument driver axis 85. Since the instrument shaft 88 is positioned at the center of the instrument base 87, it is coaxial with the instrument driver axis 85 when attached. Therefore, rotation of the rotating assembly 83 causes the instrument shaft 88 to rotate about its own longitudinal axis. Furthermore, as the instrument base 87 rotates together with the instrument shaft 88, any tendons connected to the drive input portion 89 in the instrument base 87 do not become entangled during rotation. Therefore, the parallelism of the axes of the drive output portion 81, the drive input portion 89, and the instrument shaft 88 allows the shaft to rotate without causing any control tendons to become entangled.

[0111] Figure 18 An instrument with an instrument-based insertion architecture according to some embodiments is shown. Instrument 150 is connectable to any of the instrument actuators described above. Instrument 150 includes an elongated shaft 152, an end effector 162 connected to the shaft 152, and a shank 170 connected to the shaft 152. The elongated shaft 152 includes a tubular member having a proximal portion 154 and a distal portion 156. The elongated shaft 152 includes one or more channels or grooves 158 along its outer surface. The grooves 158 are configured to receive one or more wires or cables 180 passing through the grooves. Thus, one or more cables 180 extend along the outer surface of the elongated shaft 152. In other embodiments, the cables 180 may also pass through the elongated shaft 152. Manipulation of the one or more cables 180 (e.g., via an instrument actuator) actuates the end effector 162.

[0112] The instrument handle 170 (also referred to as the instrument base) typically includes an attachment interface 172 having one or more mechanical inputs 174, such as jacks, pulleys, or spools, which are designed to reciprocately engage with one or more torque couplers on the attachment surface of the instrument actuator.

[0113] In some embodiments, the instrument 150 includes a series of pulleys or cables that enable the elongated shaft 152 to translate relative to the handle 170. In other words, the instrument 150 itself includes an instrument-based insertion architecture that adapts to the insertion of the instrument, thereby minimizing reliance on a robotic arm to provide the insertion of the instrument 150. In other embodiments, the robotic arm may be largely responsible for the instrument insertion.

[0114] E. Controller .

[0115] Any of the robotic systems described herein may include input devices or controllers for manipulating instruments attached to a robotic arm. In some embodiments, the controller may be coupled to the instrument (e.g., communicatively, electronically, electrically, wirelessly, and / or mechanically) such that manipulation of the controller, for example via master-slave control, causes corresponding manipulation of the instrument.

[0116] Figure 19 This is a perspective view of an embodiment of controller 182. In this embodiment, controller 182 includes a hybrid controller that may have both impedance and admittance control. In other embodiments, controller 182 may utilize only impedance or passive control. In other embodiments, controller 182 may utilize only admittance control. By being a hybrid controller, controller 182 advantageously has lower perceived inertia during use.

[0117] In the illustrated embodiment, the controller 182 is configured to allow manipulation of two medical devices and includes two handles 184. Each of the handles 184 is connected to a gimbal 186. Each gimbal 186 is connected to a positioning platform 188.

[0118] like Figure 19 As shown, each positioning platform 188 includes a SCARA arm (selective compliant assembly robot arm) 198 connected to a post 194 via a prism joint 196. The prism joint 196 is configured to translate along the post 194 (e.g., along track 197) to allow each of the handles 184 to translate in the z-direction, thus providing a first degree of freedom. The SCARA arm 198 is configured to allow the handles 184 to move in the xy-plane, thus providing two additional degrees of freedom.

[0119] In some embodiments, one or more load sensors are located within the controller. For example, in some embodiments, load sensors (not shown) are located within the body of each of the gimbals 186. By providing load sensors, portions of the controller 182 are capable of operating under admittance control, thereby advantageously reducing the sense inertia of the controller during use. In some embodiments, the positioning platform 188 is configured for admittance control, while the gimbal 186 is configured for impedance control. In other embodiments, the gimbal 186 is configured for admittance control, while the positioning platform 188 is configured for impedance control. Thus, for some embodiments, the translational or positional degrees of freedom of the positioning platform 188 may depend on admittance control, while the rotational degrees of freedom of the gimbal 186 may depend on impedance control.

[0120] F. Navigation and Control .

[0121] Traditional endoscopy can involve the use of fluoroscopy (e.g., via C-arm delivery) and other forms of radiation-based imaging modalities to provide intracavitary guidance to the operating physician. In contrast, the robotic system envisioned in this disclosure can provide radiation-free navigation and positioning, reducing physician radiation exposure and the amount of equipment required in the operating room. As used herein, the term "positioning" can refer to determining and / or monitoring the orientation of an object in a reference coordinate system. Techniques such as preoperative mapping, computer vision, real-time EM tracking, and robot command data can be used individually or in combination to achieve a radiation-free operating environment. In other cases where radiation-based imaging modalities are still used, preoperative mapping, computer vision, real-time EM tracking, and robot command data can be used individually or in combination to improve upon information obtained solely through radiation-based imaging modalities.

[0122] Figure 20 This is a block diagram illustrating a positioning system 90 for estimating the position of one or more components of a robotic system (such as the position of a machine) according to an exemplary embodiment. The positioning system 90 may be a group of one or more computer devices configured to execute one or more instructions. The computer devices may be embodied by a processor (or multiple processors) and computer-readable storage among the components discussed above. By way of example and not limitation, the computer devices may be located in... Figure 1 Tower 30 shown Figures 1 to 4 The trolley shown Figures 5 to 14 The bed, etc. shown.

[0123] like Figure 20 As shown, the positioning system 90 may include a positioning module 95 that processes input data 91-94 to generate position data 96 for the distal end of a medical device. The position data 96 may be data or logic representing the position and / or orientation of the distal end of the device relative to a reference frame. The reference frame may be relative to a patient's anatomy or a known object (such as an EM field generator) (see the discussion of EM field generators below).

[0124] The various input data are now described in more detail 91-94. Preoperative mapping can be accomplished using a collection of low-dose CT scans. The preoperative CT scans are reconstructed into three-dimensional images, which are visualized, for example, as “slices” of cross-sectional views of the patient’s internal anatomy. When analyzed in whole, image-based models of the anatomical cavities, spaces, and structures of the patient’s anatomical structures, such as the patient’s lung network, can be generated. Techniques such as centerline geometry can be determined and approximated from CT images to form a three-dimensional volume of the patient’s anatomy, which is referred to as model data 91 (also referred to as “preoperative model data” when generated using only preoperative CT scans). The use of centerline geometry is discussed in U.S. Patent Application 14 / 523,760, the contents of which are incorporated herein by reference in their entirety. Network topology models can also be derived from CT images and are particularly well-suited for bronchoscopy.

[0125] In some implementations, the device may be equipped with a camera to provide visual data 92. The positioning module 95 can process the visual data to enable one or more vision-based position tracking methods. For example, preoperative model data can be used in conjunction with visual data 92 to enable computer vision-based tracking of a medical device (e.g., an endoscope or an instrument propelled through the working channel of an endoscope). For example, using preoperative model data 91, the robotic system can generate a library of expected endoscope images based on the model, with each image linked to a location within the model, based on the expected path of the endoscope's movement. In operation, the robotic system can refer to this library to compare real-time images captured at a camera (e.g., a camera at the distal end of the endoscope) with those images in the image library to aid in positioning.

[0126] Other computer vision-based tracking techniques use feature tracking to determine camera motion, and thus, endoscope motion. Some features of the localization module 95 can identify circular geometries corresponding to anatomical cavities in the preoperative model data 91 and track changes in those geometries to determine which anatomical cavity has been selected, as well as track the relative rotation and / or translational motion of the camera. The use of a topology map can further enhance vision-based algorithms or techniques.

[0127] Optical flow (another computer vision-based technique) can analyze the displacement and translation of image pixels in a video sequence within visual data 92 to infer camera motion. Examples of optical flow techniques can include motion detection, object segmentation computation, brightness, motion compensation coding, stereo parallax measurement, and more. Through multiple iterations and comparisons of multiple frames, the motion and position of the camera (and therefore the endoscope) can be determined.

[0128] The positioning module 95 can use real-time EM tracking to generate the real-time position of the endoscope in a global coordinate system that can be registered to the patient's anatomy represented by a preoperative model. In EM tracking, an EM sensor (or tracker), including one or more sensor coils embedded in one or more locations and orientations within the medical instrument (e.g., an endoscopic tool), measures changes in the EM field generated by one or more static EM field generators positioned at known locations. The positional information detected by the EM sensor is stored as EM data 93. The EM field generator (or transmitter) can be placed close to the patient to generate a low-intensity magnetic field detectable by the embedded sensor. The magnetic field induces a small current in the sensor coil of the EM sensor, which can be analyzed to determine the distance and angle between the EM sensor and the EM field generator. These distances and orientations can be "registered" to the patient's anatomy (e.g., a preoperative model) during surgery to determine the geometric transformations that align a single location in the coordinate system with its orientation in the preoperative model of the patient's anatomy. Once registered, an embedded EM tracker in one or more orientations of the medical device (e.g., the distal end of an endoscope) can provide real-time indication of the medical device’s progress through the patient’s anatomy.

[0129] Robot commands and kinematic data 94 can also be used by the positioning module 95 to provide orientation data 96 for the robotic system. Device pitch and yaw, derived from joint movement commands, can be determined during preoperative calibration. During surgery, these calibration measurements can be combined with known insertion depth information to estimate the instrument's orientation. Alternatively, these calculations can be analyzed in conjunction with EM, vision, and / or topology modeling to estimate the medical device's orientation within the network.

[0130] like Figure 20 As shown, the positioning module 95 can use a variety of other input data. For example, although Figure 20 Not shown, but the device utilizing shape sensing fibers can provide shape data, which the positioning module 95 can use to determine the position and shape of the device.

[0131] The localization module 95 can use the input data 91-94 in combination. In some cases, such combination can use a probabilistic method, where the localization module 95 assigns confidence weights to the position determined based on each of the input data 91-94. Therefore, in cases where the EM data may be unreliable (e.g., in the presence of EM interference), the confidence of the position determined by the EM data 93 may be reduced, and the localization module 95 may rely more heavily on the visual data 92 and / or robot commands and kinematic data 94.

[0132] As discussed above, the robotic systems discussed in this paper can be designed to combine one or more of the above technologies. Computer-based control systems of robotic systems located in towers, beds, and / or trolleys can store computer program instructions in, for example, non-transitory computer-readable storage media (such as permanent magnetic storage drives, solid-state drives, etc.). Upon execution, these computer program instructions enable the system to: receive and analyze sensor data and user commands; generate control signals for the entire system; and display navigation and positioning data, such as the instrument's orientation in a global coordinate system, anatomical diagrams, etc.

[0133] 2. Insertion reducing tube .

[0134] Some embodiments disclosed herein provide a cannula reducer that can be used to support and align surgical instruments within a cannula. The reducer can be coupled as a component to the surgical instrument and inserted into the cannula. Furthermore, the reducer can also, or alternatively, be coupled distally to a sealing layer within the cannula. Among various advantages, such features allow clinicians to leave the cannula in place when switching between instruments of different sizes, thereby reducing patient trauma, reducing operative time, and reducing some of the risks and other challenges associated with the additional work required using existing systems and methods. Such features can also, or alternatively, alleviate the need for auxiliary sealing mechanisms within the reducer, thereby reducing the cost or complexity associated with the reducer device.

[0135] For example, Figures 21 to 23 Depicting the use of a reducing tube 310 for insertion (in) Figure 23 An exemplary robotic system 200 is used in conjunction with (as shown in the diagram). According to some embodiments, a cannula reducer 310 can be used to support and align a surgical instrument 230 within a cannula 210. According to some embodiments described herein, the cannula reducer 310 can be configured to allow the inner diameter of the cannula shaft 212 to be adapted for supporting and coaxially aligning the surgical instrument 230, the surgical instrument being configured or sized for use with a cannula having a smaller inner diameter. The cannula reducer 310 can be used to adapt the cannula 210 and / or the surgical instrument 230 to be configured for use with the system 200 described herein.

[0136] In some embodiments, the reducing cannula 310 may be attached to the surgical instrument 230, thereby allowing the reducing cannula 310 and the surgical instrument 230 to be inserted into the cannula 210 as an assembly unit. Furthermore, in some embodiments, the reducing cannula 310 may be attached distally to all or part of the sealing unit 240, thereby allowing the sealing unit 240 to directly seal the surgical instrument 230.

[0137] Figure 23An exploded view of a robotic system 200 is shown. In the depicted example, the robotic system 200 includes a manipulator 220 configured to manipulate a cannula 210 and a surgical instrument 230 inserted through the cannula 210. The manipulator 220 may be coupled to the distal end of a robotic arm and may be configured according to any of the manipulators or instrument actuators described herein (e.g., 28, 62, 75, 80). The surgical instrument 230 may include an elongated instrument shaft 236 and may be configured according to any of the surgical instruments described herein (e.g., 34, 70, 88, 150).

[0138] Manipulator 220 may be configured to engage with medical devices, such as cannulas 210 and / or surgical instruments 230, such that manipulator 220 can control the movement of these devices. In the depicted example, manipulator 220 includes: an instrument docking member 224 configured to attach to the base 232 of surgical instrument 230; and a cannulas docking member 226 configured to attach to the funnel portion 214 of cannulas 210. In the illustrated embodiment, instrument docking member 224 is positioned on a first side of manipulator 220, and cannulas docking member 226 is positioned on a second side of manipulator 220. Manipulator 220 also includes a channel 222 to receive the shaft 236 of surgical instrument 230 and allow the shaft 236 of surgical instrument 230 to extend through manipulator 220. Both docking members 224 and 226 facilitate docking and disengagement of the respective devices when the devices are in a docking configuration, while securing the device to the body of manipulator 220. In use, the cannula 210 is inserted into the patient at the intended access opening. The manipulator 220 can then be moved to the position of the cannula 210, and the cannula docking member 226 can be attached to the cannula 210 via a latching mechanism within the cannula docking member 226. The instrument 230 can then be inserted through the cannula 210 and attached to the instrument docking member 224. In the docking configuration, the instrument 230 and the cannula 210 are coaxially aligned along the insertion axis, such that the shaft 236 extends through the channel 222 and the cannula 210. In some embodiments, the manipulator 220 may include one or more actuators to actuate or manipulate the instrument shaft 236 and / or end effector 237 of the surgical instrument 230. For example, the manipulator 220 may operate an actuation mechanism 244 at the instrument base to control the instrument shaft 236 and / or the end effector 237 in one or more degrees of freedom.

[0139] Although Figure 22A single manipulator is depicted that engages with both instrument 230 and cannula 210, but it is possible to employ multiple robotic manipulators or arms, such that the movement of cannula 210 and instrument 230 is controlled by individual robotic manipulators or arms. Furthermore, manipulator 220 may be configured to be directly attached to instrument 230 and cannula 210, or manipulator 220 may be configured to be able to be attached to instrument 230 and cannula 210 through an intermediate sterile barrier.

[0140] In the depicted example, cannula 210 can displace or dissect soft tissue to allow insertion of cannula 210 into a patient's body cavity to provide access to a surgical site. Optionally, during initial insertion, an occluder can be inserted through cannula 210 to provide an expanding or blunt tip that facilitates insertion of cannula 210 through an incision or other opening in the patient. According to some embodiments, cannula 210 is configured to provide access to a surgical site within the patient's abdomen for laparoscopic procedures. Alternatively or additionally, cannula 210 may be configured to provide access to sites for urological, endoscopic, percutaneous, orthopedic, and / or other medical or minimally invasive procedures, wherein surgical instruments are introduced to the site via cannula 210. In some applications, cannula 210 provides access to a surgical site for a robotic procedure performed by the robotic system described herein. Alternatively or additionally, cannula 210 may be configured for manual procedures.

[0141] In the depicted example, the proximal portion of the cannula 210 is configured as a funnel portion 214, which has a diameter generally larger than that of the cannula shaft 212. The funnel portion 214 may transition to the smaller diameter cannula shaft 212 to facilitate insertion of a tool from an opening at the proximal end of the cannula 210. Optionally, the funnel portion 214 of the cannula 210 may be used as a handle by a clinician or other user to advance the cannula 210 or otherwise apply force to the cannula 210. In some embodiments, the funnel portion 214 may form an attachment point that can be engaged by a robotic manipulator to manipulate the movement of the cannula 210. In some embodiments, the funnel portion 214 includes a sealing unit 240 that may be fixed to the funnel portion or configured as a removable sealing cartridge. The sealing unit 240 helps to seal fluids, such as injected gas or liquid, within the patient's body cavity. A fluid port (such as a stop valve or Luer connector) may be located at the funnel portion 214 of the cannula 210 to provide a connection point through which fluid can flow through the cannula 260 and into or out of the patient.

[0142] As shown in the figure, the cannula shaft 212 is configured as a tubular portion extending distally from the funnel portion 214. The lumen 213 of the cannula shaft 212 provides a channel through which the shaft of an instrument can extend to access the surgical site. The lumen 213 provides a working passage or channel through which tools can be inserted, manipulated, and / or removed along the longitudinal axis of the cannula. Optionally, the movement of the cannula 210 and the tools can be manipulated or controlled by the robotic system described herein. In the illustrated embodiment, the cannula shaft 212 is configured as a straight tube terminating at an inclined distal end, but the cannula 210 and the cannula shaft 212 can have various configurations. For example, the cannula shaft 212 can be arcuate, curved, or angled, or the distal end of the cannula shaft 212 can be flat or have other geometries.

[0143] As described herein, the cannula 210 can be used with the surgical instrument 230 and is configured to provide access to a patient's body cavity, even if the inner diameter of the cannula shaft 212 is larger than the outer diameter of the instrument shaft 236. In some embodiments, the lumen 213 of the cannula shaft 212 can support and coaxially align the shaft 236 of the surgical instrument 230 within the cannula shaft 212. In some applications, the size or configuration of the cannula 210 is set to support and / or align a surgical instrument 230 of a certain size or diameter. For example, the size or configuration of the cannula 210 may be set to support and / or align a surgical instrument 230 having a shaft 236 with a nominal diameter of 12 mm.

[0144] In some laparoscopic procedures, clinicians can utilize cannulas constructed to work with 12mm diameter surgical instruments, which have an 8mm diameter axis, to provide flexibility in instrument access and minimize the number of incisions required for unique cannulation. However, in some applications, such as robot-assisted laparoscopic procedures, the additional clearance between the working channels of the 8mm diameter instrument and the 12mm diameter cannula allows for misalignment between the instrument's centerline and the cannula's centerline, which can reduce the positional accuracy of the instrument's working end. In some applications, the robotic surgical system may not be able to compensate for this reduction in positional accuracy.

[0145] Advantageously, when the inner diameter of the cannula is too large or is intended for use with instruments having a larger outer profile or outer diameter, a cannula reducer can be used to reduce the inner profile or inner diameter in which the instrument will be mounted, thereby allowing the instrument's axis to be supported and aligned with the cannula intended for larger surgical instruments. In some applications, certain conventional reducers may be incompatible with the mating arrangement of the cannula 210, surgical instrument 230, and / or manipulator 220 described herein. Furthermore, certain conventional reducers may be coupled to or attached to the cannula, requiring the surgical instrument to be removed from the cannula in a separate step to introduce or remove the reducer. Additionally, certain conventional reducers may pass through the sealing unit, reducing the effectiveness of the sealing unit and requiring auxiliary sealing mechanisms or sealing surfaces to maintain inflation.

[0146] Therefore, as described above, according to at least one embodiment disclosed herein, it is recognized that it may be desirable to provide a cannula reducer adapted to the inner diameter of the cannula while being compatible with docking arrangements of the cannula, surgical instruments, and / or manipulators. Furthermore, according to at least one embodiment disclosed herein, it is recognized that it may be desirable to provide a cannula reducer that can be attached to a surgical instrument, thereby allowing the reducer and surgical instrument to be manipulated and / or inserted into the cannula as assembly units. Additionally, according to at least one embodiment disclosed herein, it is recognized that it may be desirable to provide a cannula reducer that can be attached distally to a sealing layer, thereby allowing the sealing layer to directly seal the surgical instrument. The various embodiments disclosed herein allow clinicians to achieve these and other advantageous results, as discussed herein.

[0147] Figure 24 and Figure 25 The intubation reducer 310 and surgical instruments 230 are depicted. Figure 26 The illustration depicts a cannula reducer 310 and a surgical instrument 230 mating within a surgical system. In the illustrated example, the cannula reducer 310 may be attached to the surgical instrument 230 to adapt the surgical instrument 230 for secure fitting and / or alignment within the cannula 210 intended for use with a larger surgical instrument.

[0148] As shown in the figure, the reducing tube 310 has a reducing sleeve or body 320, which is typically shaped to securely fit and / or align within the cannula 210. In some embodiments, the reducing body 320 has a generally tubular or cylindrical shape. Optionally, the reducing body 320 may be keyed, splined, bent, arc-shaped, etc., to fit within the cannula 210.

[0149] In the depicted example, the reducer body 320 has an outer diameter configured to securely fit and / or align within the cannula 210. In the depicted example, the size or configuration of the outer diameter of the reducer body 320 can be set to be supported or aligned by the cannula lumen 213. For example, the outer diameter of the reducer body 320 may have a nominal diameter of 12 mm to be supported and / or aligned within a cannula configured for use with surgical instruments of 12 mm diameter. The outer diameter of the reducer body 320 can be any suitable size corresponding to the desired working passage or lumen diameter of the cannula, thereby allowing the reducer 310 to be fully supported and / or aligned within the cannula. In the depicted example, the outer diameter of the reducer body 320 is larger than the outer diameter of the instrument shaft 236.

[0150] As shown, the reducer body 320 may have a hollow or tubular structure defining a reducer channel 321 to receive the instrument shaft 236 of the surgical instrument 230. In the depicted example, the reducer channel 321 is a hollow portion of the reducer body 320 that defines an extension through the interior of the reducer body 320 and is generally shaped to receive, assemble, and align the instrument shaft 236 of the surgical instrument 230. The reducer channel 321 may have a generally circular cross-sectional shape. Optionally, the reducer channel 321 may be keyed, curved, arc-shaped, etc., to mate with the instrument shaft 236. The instrument shaft 236 can be inserted into the reducer channel 321 through the proximal end 340 of the cannulation reducer 310.

[0151] In the depicted example, the inner diameter or configuration of the reducer channel 321 is set to support and / or axially align the instrument shaft 236. For example, the inner diameter of the reducer channel 321 may be configured to receive an instrument shaft 236 with a nominal diameter of 8 mm. The inner diameter of the reducer channel 321 can be any suitable size to provide a working passage corresponding to the nominal diameter of the desired surgical instrument 230, which allows the instrument shaft 236 to be fully supported and / or aligned within the cannula reducer 310. Advantageously, the surgical instrument 230 can be supported and / or aligned within the cannula 210 by supporting and / or aligning the surgical instrument 230 within the cannula reducer 310 and by supporting and / or aligning the cannula reducer 310 within the cannula 210, even in applications where the cannula 210 is intended for use with surgical instruments having a larger nominal diameter (e.g., an 8 mm diameter surgical instrument with a 12 mm diameter cannula).

[0152] As shown in the figure, the cannula reducer 310 and the surgical instrument 230 can be attached together as an assembly unit 300. Advantageously, the cannula reducer 310 and the surgical instrument 230 can be inserted, connected, or docked together with the manipulator 220 and / or inserted into the cannula 210 as an assembly unit 300. Furthermore, because the cannula reducer 310 can be attached to the surgical instrument 230, the surgical instrument 230 and the cannula reducer 310 can be removed as an assembly unit 300, thereby facilitating quick replacement of the surgical instrument 230 from the cannula 210 and / or the manipulator 220. When removing the assembly unit 300 from the cannula 210 and / or the manipulator 220, the cannula reducer 310 can be removed from the surgical instrument 230.

[0153] As shown, the proximal end 340 of the reducing cannula 310 can be attached to or attached to the surgical instrument 230. For example, the proximal end 340 of the reducing cannula 310 can be attached to various features of the surgical instrument 230 that are positioned about the instrument axis along its length 236. In the illustrated example, the proximal end 340 of the reducing cannula 310 can be attached to various features on the outer portion of the surgical instrument 230.

[0154] In some embodiments, the proximal end 340 is coupled to or attached to the base portion 232 of the surgical instrument 230. The housing of the base portion 232 may accommodate an actuation or drive mechanism for actuating the instrument shaft 236 and / or end effector 237 of the surgical instrument 230, and may extend over a portion of the instrument shaft 236. In the depicted example, the base portion 232 includes a proximal housing portion and a distal housing portion, the proximal housing portion defining a body and handle for supporting the actuation mechanism of the instrument, and the distal housing portion defining an instrument sleeve 234 extending from the body over a portion of the instrument shaft 236. In the depicted example, the proximal end 340 of the cannula reducer 310 is attached to the distal end of the instrument sleeve 234. Optionally, the base portion 232 and / or the instrument sleeve 234 may allow the surgical instrument 230 to be aligned within the cannula and / or relative to the cannula reducer.

[0155] Figure 26 A cross-sectional view of the surgical instrument 230, manipulator 220, cannula 210, and reducer 310 in a docking configuration is shown. Figure 26An actuation mechanism 244 of the instrument is also depicted, which can be operated by manipulator 220 to actuate portions of the instrument 230. Actuation mechanism 244 may include internal components of various parts, such as one or more pulleys, reels, and / or gears, which can be operated by manipulator 220 to actuate one or more degrees of freedom of the instrument shaft 236. In some embodiments, actuation mechanism 244 may be operated to drive movement of a portion of the instrument shaft 236 relative to the instrument base 232, such that when actuation mechanism 244 is operated, instrument shaft 236 moves relative to cannula 210, instrument sleeve 234, and attached reducer 310. For example, operation of actuation mechanism 244 may be configured to drive axial movement of instrument shaft 236 relative to instrument base 232, such that instrument shaft 236 is advanced or retracted through instrument sleeve 234 and through reducer 310. Therefore, when the instrument shaft 236 is manipulated and moved through the cannula 210, the reducer 310 and the instrument base 232 to perform a medical procedure, the reducer 310 attached to the surgical instrument 230 can remain in place within the cannula 210 and relative to the instrument base 232.

[0156] like Figure 26As shown, the size of the reducing cannula 310 and / or surgical instrument 230 can be set or otherwise configured such that when the reducing cannula 310 and surgical instrument 230 are inserted into or docked with the cannula 210, the proximal end 340 of the reducing cannula 310 can be positioned away from the sealing layer disposed within the sealing unit 240. Here, the length of the instrument sleeve 234 and the spacing between the instrument docking member 224 and the cannula docking member 226 of the manipulator 220 are such that when both the instrument 230 and the cannula 210 are docked with the manipulator 220, the distal end of the instrument sleeve 234 extends into the funnel portion 214 of the cannula 210, beyond the proximal sealing layer 248 positioned within the cannula 210. The proximal sealing layer 248 defines a sealing plane such that when the proximal end of the reducer 310 is attached to the distal end of the instrument sleeve 234, the proximal end of the reducer 310 and the attachment point between the reducer 310 and the instrument sleeve 234 are located away from the sealing plane. Optionally, the proximal end 340 of the cannula reducer 310 may be positioned in a mating configuration away from both the distal sealing layer 249 and the proximal sealing layer 248 within the sealing unit 240. In some embodiments, the proximal end 340 of the cannula reducer 310 may be positioned in a mating configuration between the distal end seal layer 249 and the proximal sealing layer 248 within the sealing unit 240. In such embodiments, the proximal sealing layer 248 may provide a seal on the instrument 230 when the instrument 230 is present in the cannula 210, while the distal sealing layer 249 may provide a seal when no instrument is present in the cannula 210. Advantageously, by positioning the proximal end 340 of the cannula reducer 310 away from the sealing layer within the sealing unit 240, the use of the cannula reducer 310 does not affect the engagement or sealing of the sealing layer against the surgical instrument 230, and thus allows the sealing unit 240 to remain inflated.

[0157] Optionally, the size of the reducing tube 310 and / or the surgical instrument 230 may be set or otherwise configured such that when the reducing tube 310 and the surgical instrument 230 are inserted into or mated with the cannula 210, the proximal end 340 of the reducing tube 310 may be positioned near the sealing unit 240 or a sealing layer disposed within the sealing unit 240. For example, the reducing tube 310 may be configured to attach to other portions of the surgical instrument 230, such as the main body portion of the instrument base housing, or to a position near the sealing layer along the instrument sleeve 234. In another example, when the instrument is inserted into the cannula, the distal end of the instrument sleeve 234 may terminate near the sealing layer.

[0158] In the depicted example, the size of the reducing cannula 310 and / or the surgical instrument 230 may be set or otherwise configured such that when the reducing cannula 310 and the surgical instrument 230 are engaged as assembly unit 300, the distal end 330 of the reducing cannula may be positioned close to the end effector 237 of the surgical instrument 230. Furthermore, the size of the reducing cannula 310 and / or the surgical instrument 230 may be set or otherwise configured such that when the reducing cannula 310 and the surgical instrument 230 are inserted into or docked with the cannula 210, the distal end 330 of the reducing cannula 310 may be positioned close to the distal end 217 of the cannula 210.

[0159] As used herein, the terms “proximal end” and / or “distal end” may refer to the end point of a body or component, and the portion adjacent to, near or otherwise close to the end point of a body or component.

[0160] For example, distal end 330 and / or proximal end 340 may refer to the end point of reducer body 320, and the portion of reducer body 320 adjacent to, near, or otherwise close to the end point of reducer body 320. Thus, the term proximal end 340 may include the portion of reducer body 320 adjacent to or near the proximal end point of reducer body 320, and the term distal end 330 may include the portion of reducer body 320 adjacent to or near the distal end point of reducer body 320.

[0161] Cannula reducers can be releasably engaged to surgical instruments using various types of attachment mechanisms, such as mechanical latches, magnetic latches, or threaded connections. Figure 27 and Figure 28 An example of a latching mechanism is depicted, which can be used to releasably attach, engage, or latch the cannula reducer 310 to the surgical instrument 230 to secure the cannula reducer 310 to the surgical instrument 230. As described herein, the cannula reducer 310 can be latched to the base portion 232 and / or the instrument sleeve 234 of the surgical instrument 230. In the depicted example, the cannula reducer 310 can be latched to a feature or port of the surgical instrument 230.

[0162] As shown, the latching mechanism may include one or more latching members 342 that may engage with a feature or lip 235 extending from the surface of the instrument sleeve 234. In some embodiments, the lip 235 may extend or protrude from a distal portion of the surgical instrument 230 or any other suitable portion. In the depicted example, the latching member 342 may include a groove, recess, or other complementary feature that receives a portion of the lip 235. Engagement of the latching member 342 with the lip 235 may restrict or prevent axial movement of the cannula reducer 310 relative to a portion of the surgical instrument 230. In some embodiments, engagement of the latching member 342 with the lip 235 may allow rotation of the cannula reducer 310 relative to a portion of the surgical instrument 230.

[0163] In the depicted example, the latching member 342 is movable to engage and disengage with the lip 235. For example, the latching member 342 may move radially inward to engage with the lip 235 and retain the cannula reducer 310 relative to the surgical instrument 230. The latching member 342 may be biased inward to engage the lip 235. The latching member 342 may move radially outward to disengage from the lip 235 and release the cannula reducer 310 from the surgical instrument 230.

[0164] As shown, the latching member 342 is movable or pivotable relative to the reducer body 320 to allow the latching member 342 to engage or disengage from the lip 235. The latching member 342 is coupled to the reducer body 320 via one or more hinge portions 346, which allow the latching member 342 to move relative to the reducer body 320. The hinge portions 346 can be biased to cause the latching member 342 to engage with the lip 235.

[0165] In the depicted example, the hinge portion 346 may be a movable hinge or a flexural portion that deflects or deforms to allow movement of the latching member 342. In some embodiments, the latching member 342 and the hinge portion 346 may be formed integrally or monolithically with the reducer body 320, thereby reducing the complexity of the cannulation reducer 310. Optionally, the hinge portion 346 may have a different thickness, construction, or material composition relative to the reducer body 320 to allow the latching member 342 to move in a desired manner. In some embodiments, the latching member 342 may be a separate portion attached to the reducer body 320.

[0166] Optionally, the latching member 342 can be actuated by pressing one or more release buttons 344. The release button 344 provides an actuating portion that can be coupled to the latching member 342 to allow the latching member 342 to move in response to actuation of the release button 344. For example, a clinician can press the release button 344 to disengage the latching member 342 from the lip 235. The release button 344 may have a groove or other features to allow the clinician to actuate the release button 344.

[0167] In some embodiments, the release button 344 and the latching member 342 are rotatable about a common pivot point (such as the hinge portion 346). Thus, when the release button 344 is pressed radially inward, the latching member 342 can move radially outward to disengage the latching member 342 from the lip 235. Similarly, when the latching member 342 moves radially inward to engage the lip 235, the release button 344 can move radially outward. Similar to the latching member 342, the release button 344 can be integrally or integrally formed with the reducer body 320, thereby reducing the complexity of the cannulation reducer 310.

[0168] refer to Figure 29 and Figure 30 In some embodiments, the distal end 330 of the reducing tube 310 may include one or more ribs 332 to create a flow path allowing injected gas to pass between the reducing tube 310 and the lumen 213 of the cannula 210. As shown, the ribs 332 may extend radially from a surface located at the distal end 330 of the reducing tube body 320. In some embodiments, the ribs 332 may be configured to extend to contact the inner surface of the lumen 213 of the cannula. The ribs 332 may be circumferentially spaced. Optionally, the ribs 332 may be equidistantly spaced. The reducing tube 310 may include any suitable number of ribs 332, including but not limited to two, four, six, or eight ribs. The ribs 332 may have any suitable shape or cross-sectional profile. In some embodiments, the ribs 332 may be defined as grooves or cutouts in the reducing tube body 320.

[0169] As shown in the figure, the spacing between the ribs 332 defines a radial gap 334, which allows fluid to flow between the outer surface of the reducer body 320 and the inner surface of the cannula lumen 213. In addition to allowing fluid flow, the ribs 332 also provide structural support for the cannula 210.

[0170] refer to Figure 31The reducing cannula 410 may include one or more latching members 442, which may engage via a window 235' defined in the surface of the instrument sleeve 234 to form an assembly unit 400. In some embodiments, the window 235' may be defined in a distal portion of the surgical instrument 230 or any other suitable portion. In the depicted example, the latching member 442 may include a radially projecting portion extending through and / or engaging with an edge of the window 235'. Engagement of the latching member 442 with the window 235' may restrict or prevent axial and / or rotational movement of the reducing cannula 410 relative to the surgical instrument 230.

[0171] In the depicted example, latching member 442 is movable to engage and disengage from window 235'. For example, latching member 442 is radially outward to extend through window 235' and retain cannula reducer 410 relative to surgical instrument 230. Latching member 442 can be outwardly biased to engage window 235'. Latching member 442 is radially inward to disengage from window 235' and release cannula reducer 410 from surgical instrument 230.

[0172] As shown, the latching member 442 is movable or pivotable relative to the reducer body 420 to allow the latching member 442 to engage or disengage from the window 235'. The latching member 442 is coupled to the reducer body 420 via one or more hinge portions 446, which allow the latching member 442 to move relative to the reducer body 420. The hinge portions 446 can be biased to cause the latching member 442 to engage with the window 235'.

[0173] As described herein, the hinge portion 446 may be a movable hinge or a flexural portion that deflects or deforms to allow movement of the latch member 442. Optionally, the latch member 442 itself provides a release button that can be actuated by directly pressing the latch member 442. For example, a clinician may press the latch member 442 to disengage the latch member 442 from the window 235'. The latch member 442 may have a groove or other features to allow a clinician to actuate the latch member 442.

[0174] refer to Figure 32The cannula reducer 510 may include a latching mechanism having opposing latching fingers arranged to releasably latch onto the insertion port of the surgical instrument 230, thereby forming the assembly unit 500. As shown, the cannula reducer 510 may include one or more latching members 542 configured as latching fingers that are movable outwardly relative to each other along the circumference of the cannula reducer 510 to engage the edge of a window 235' defined in the surface of the instrument sleeve 234. In some embodiments, the window 235' may be defined in a distal portion of the surgical instrument 230 or any other suitable portion. In the depicted example, the latching fingers may include hook-like portions extending through and / or engaging with the edge of the window 235'. Engagement of the latching fingers with the window 235' may restrict or prevent axial and / or rotational movement of the cannula reducer 510 relative to a portion of the surgical instrument 230.

[0175] In the depicted example, the latching fingers are movable to engage and disengage with window 235'. For example, the latching fingers may move outward relative to each other to engage the edge of window 235' and retain the cannula 510 relative to surgical instrument 230. The latching fingers may bias outward relative to each other to engage the edge of window 235'. The latching fingers may provide release buttons that move inward toward each other to disengage window 235' and release the cannula 510 from surgical instrument 230.

[0176] As shown, the latching fingers are movable or pivotable relative to each other and the reducer body 520 to allow the latching fingers to engage or disengage from window 235'. The latching fingers are coupled to the reducer body 520 via one or more hinge portions 546, which allow the latching fingers to move relative to each other and the reducer body 520. The hinge portions 546 can be biased to cause the latching fingers to move outward relative to each other to engage with window 235'.

[0177] As described herein, the hinge portion 546 may be a movable hinge or a flexural portion that deflects or deforms to allow movement of the latch finger. Optionally, the latch finger may provide a release button that is actuated by pressing the proximal end 530 of the reducer body 520. For example, a clinician may press the proximal end 530 of the reducer body 520 to disengage the latch finger from the window 235'.

[0178] refer to Figure 33The reducing cannula 610 may include a latching mechanism having opposing latching fingers arranged to releasably latch onto a protruding feature of the surgical instrument 230, thereby forming an assembly unit 600. As shown, the reducing cannula 610 may include one or more latching members 642 configured as latching fingers that engage an edge of a protrusion 235” extending from the distal end of the instrument sleeve 234. Here, the latching member 642 can be disengaged from the instrument 230 by pulling the reducing cannula body 620 away from the instrument 230 with sufficient force without actuating a release button. In the depicted example, the latching fingers may include hook-shaped portions having a mating profile that engages with the edge of the protrusion 235”. The engagement of the latching fingers with the protrusion 235” restricts or prevents axial and / or rotational movement of the reducing cannula 610 relative to a portion of the surgical instrument 230 (e.g., the sleeve 234).

[0179] In the depicted example, the latching fingers are movable to engage and disengage with the protrusion 235”. For example, the latching fingers may move inward relative to each other to engage the edge of the protrusion 235” and retain the cannula 610 relative to the surgical instrument 230. The latching fingers may be biased inward to engage the edge of the protrusion 235”. The latching fingers may move outward away from each other to disengage the protrusion 235” and release the cannula 610 from the surgical instrument 230.

[0180] As shown, the latching fingers are movable or pivotable relative to each other and the reducer body 620 to allow the latching fingers to engage or disengage from the protrusion 235". The latching fingers are coupled to the reducer body 620 via one or more hinge portions 646, which allow the latching fingers to move relative to each other and the reducer body 620. The hinge portions 646 can be biased to cause the latching fingers to move inward relative to each other to engage with the protrusion 235".

[0181] As described herein, the hinge portion 646 may be a movable hinge or a flexural portion that deflects or deforms to allow movement of the latching finger. Optionally, the latching finger can be deflected by inserting or removing the protrusion 235” from the latching finger. Thus, the latching finger can hold the surgical instrument 230 with a predetermined force and allow the cannula reducer 610 to be released from the surgical instrument 230 if the predetermined force is exceeded.

[0182] In some implementations, the cannula reducer can be laterally attached to the surgical instrument before being inserted into the cannula. Laterally attached cannula reducers allow clinicians to securely attach the reducer to the surgical instrument without the risk of injury or damage to the surgical instrument due to avoiding contact with the end effector or other parts of the surgical instrument.

[0183] Referring, for example, to Figures 34 and 35, the reducing tube 710 may be laterally attached to the surgical instrument 230 to adapt the surgical instrument 230 for secure fitting and / or alignment within a cannula intended for use with a larger surgical instrument. As shown, the reducing tube 710 has a reducing tube body 720 having a proximal end 740, an intermediate portion 722, and a distal end 730, the distal end typically shaped for secure fitting and / or alignment within the cannula. In some embodiments, the proximal end 740, the intermediate portion 722, and the distal end 730 are configured to partially contact the lumen of the cannula.

[0184] As shown, the proximal end 740 and the intermediate portion 722 may each and cooperatively define a lateral channel 721 to receive the instrument shaft 236 of the surgical instrument 230. In the depicted example, the lateral channel 721 may generally be shaped to receive, assemble, and align the instrument shaft 236 of the surgical instrument 230. The lateral channel 721 may have a generally C-shaped cross-sectional shape, wherein a channel opening extends between the proximal end 740 and the distal end 730 to receive the instrument shaft 236. The instrument shaft 236 may be laterally inserted into the lateral channel 721 through the channel opening extending between the proximal end 740 and the distal end 730. In some embodiments, the distal end 730 may form a closed loop, and the instrument shaft 236 of the surgical instrument 230 may retract during insertion to avoid contact with the distal end 730 during lateral attachment.

[0185] In the depicted example, the internal dimensions or configuration of the lateral channel 721 are set to support and / or axially align the instrument shaft 236. As described herein, the cannula reducer 710 and the surgical instrument 230 may be attached together as an assembly unit 700.

[0186] As shown, the proximal end 740 of the reducing catheter 710 can be coupled to or attached to the surgical instrument 230. In the illustrated example, the reducing catheter 710 can be releasably attached, engaged, or latched to the surgical instrument 230 to secure the reducing catheter 710 to the surgical instrument 230.

[0187] As shown, the proximal end 740 may engage with a feature or window 235' defined in the surface of the instrument sleeve 234. In some embodiments, the window 235' is a keyed slot defined in the distal portion of the instrument sleeve 234 or any other suitable portion of the surgical instrument 230. In the depicted example, the proximal end 740 defines a circumferential extension that may extend through and / or engage with the edge of the window 235'. Engagement of the proximal end 740 with the window 235' may restrict or prevent axial movement of the cannula reducer 710 relative to the surgical instrument 230.

[0188] In the depicted example, the proximal end 740 is movable to engage and disengage from the window 235'. For example, the proximal end 740 may engage, deform, or have an interference fit with the window 235' to retain the cannula 710 relative to the surgical instrument 230. The proximal end 740 may deform to disengage from the window 235' and release the cannula 710 from the surgical instrument 230.

[0189] Referring to Figures 36 to 38, the cannula reducer 810 may be laterally attached to the surgical instrument 230 so that the surgical instrument 230 is suitable for secure fitting and / or alignment within the cannula intended for use with a larger surgical instrument.

[0190] As shown in the figure, the reducing tube 810 has a reducing sleeve or body 820 with a proximal end 840 and a distal end 830, typically shaped to securely fit and / or align within the cannula. In some embodiments, the reducing body 820 has a generally tubular or cylindrical shape. Optionally, the reducing body 820 may be keyed, splined, bent, arc-shaped, etc., for fitting within the cannula.

[0191] In the depicted example, the reducer body 820 has an outer diameter configured to securely fit and / or align within the cannula. In the depicted example, the size or configuration of the outer diameter of the reducer body 820 can be set to be supported or aligned by the cannula lumen.

[0192] As shown, the reducer body 820 may define a lateral channel 821 to receive the instrument shaft 236 of the surgical instrument 230. In the depicted example, the lateral channel 821 may generally be shaped to receive, assemble, and align the instrument shaft 236 of the surgical instrument 230. The lateral channel 821 may have a generally "C"-shaped cross-sectional shape, wherein a channel opening extends between a proximal end 840 and a distal end 830 to receive the instrument shaft 236. The instrument shaft 236 may be laterally inserted into the lateral channel 821 through the channel opening extending between the proximal end 840 and the distal end 830. As shown, the proximal end 840 may engage with a feature or window 235' defined in the surface of the instrument sleeve 234. Here, the lateral attachment sequence involves axially moving the reducer 810 to engage the surgical instrument after the instrument shaft has been laterally loaded into the channel of the reducer 810.

[0193] Referring to Figures 39 through 41, the reducing cannula 910 may include a latching mechanism that engages with a lip 235 extending from the surgical instrument 230. As shown, the reducing cannula 910 may include a proximal end 940 configured to engage with the lip 235 defined on a distal end of the instrument sleeve 234. In the depicted example, the proximal end 940 defines a circumferential extension that may extend over, around, or otherwise engage with the lip 235. Engagement of the proximal end 940 with the lip 235 may restrict or prevent axial movement of the reducing cannula 910 relative to a portion of the surgical instrument 230.

[0194] In the depicted example, the proximal end 940 is movable to engage and disengage from the lip 235. For example, the proximal end 940 may engage, deform, or otherwise elastically engage with the lip 235 to retain the cannula 910 relative to the surgical instrument 230. The proximal end 940 may deform to disengage from the lip 235 and release the cannula 910 from the surgical instrument 230.

[0195] In some implementations, the reducing catheter can be inserted, coupled, or docked together with the manipulator and / or inserted separately from the surgical instruments into the cannula. Furthermore, the reducing catheter can be positioned within the cannula by an insert releasably attached to the reducing catheter.

[0196] For example, refer to Figure 42 and Figure 43 The reducing cannula 1010 can be introduced into the manipulator 220 and / or the cannula 210 using the inserter 1060. The inserter 1060 can be configured to load the reducing cannula 1010 into the cannula 210 through a channel of the manipulator 220 after the manipulator is engaged with the cannula 210. During insertion, the proximal end 1040 of the reducing cannula 1010 can be engaged with or attached to the inserter 1060. For example, the proximal end 1040 of the reducing cannula 1010 can be attached, engaged, or latched to an engagement feature 1062 of the inserter 1060. In the depicted example, the proximal end 1040 may include a groove, recess, or other complementary feature to engage with the engagement feature 1062. Engagement of the proximal end 1040 with the engagement feature 1062 allows the reducing cannula 1010 to be axially advanced by the inserter 1060 into the manipulator 220 and the cannula 210.

[0197] In some embodiments, engagement feature 1062 is movable to engage and disengage with the proximal end 1040 of the cannula reducer 1010. For example, engagement feature 1062 may expand radially outward to engage with the proximal end 1040 of the cannula reducer 1010 and retain the cannula reducer 1010 relative to the insert 1060 to allow the cannula reducer 1010 to be positioned by the insert 1060 as assembly unit 1000.

[0198] Engaging feature 1062 is radially retractable inward to disengage from proximal end 1040 to release cannula reducer 1010 from insert 1060, thereby allowing cannula reducer 1010 to be installed within cannula 210. Optionally, movement of engaging feature 1062 can be controlled by pressing release button 1070. For example, by actuating release button 1070, cannula reducer 1010 be released from insert 1060 and installed within cannula 210.

[0199] Referring to Figures 44 and 45, the reducing cannula 1110 may include a latching feature 1142 that releasably engages with the insert 1160. During insertion, the latching feature 1142 may engage with a mating feature 1165 defined in the surface of the insert 1160. In the depicted example, the latching feature 1142 may include axially and circumferentially extending hook-shaped portions that engage with the mating feature 1165. Engagement of the latching feature 1142 prevents axial and / or rotational movement of the reducing cannula 1110 relative to the insert 1160 during insertion.

[0200] In the depicted example, latching feature 1142 and / or mating feature 1165 may be movable, deflected, or deformed to engage and disengage the cannula reducer 1110 from the insert 1160. For example, mating feature 1165 may be circumferentially inwardly moved to engage latching feature 1142 and hold the cannula reducer 1110 together with the insert 1160 as assembly unit 1100 during insertion. Matting feature 1165 may be circumferentially outwardly moved to disengage latching feature 1145 from the insert 1060, thereby releasing the cannula reducer 1110 and positioning it within the cannula. In some embodiments, engaging feature 1162 may be distally pushed or advanced relative to the insert 1160 to release latching feature 1142 from mating feature 1165 and release and position the cannula reducer 1110. Optionally, movement of engaging feature 1162 may be controlled by pressing release button 1170.

[0201] Referring to Figures 46 and 47, the reducing cannula 1210 may include a lip 1242 that can releasably engage with an engagement feature 1262 of the insert 1260. During insertion, the engagement feature 1262 of the insert 1260 can engage with the lip 1242 on a surface defined at the distal end 1240 of the reducing cannula 1210. In the depicted example, the engagement feature 1262 may include a circumferential extension that may extend over, around, or otherwise engage with the lip 1242. Engagement of the engagement feature 1262 with the lip 1242 prevents axial movement of the reducing cannula 1210 relative to the insert 1260 during insertion of the reducing cannula 1210.

[0202] In the depicted example, engagement feature 1262 is movable, deflectable, or deformable to engage and disengage the cannula reducer 1210 from the insert 1260. For example, engagement feature 1262 engages, deforms, or otherwise resiliently engages with lip 1242 and holds the cannula reducer 1210 to the insert 1260 as assembly unit 1200 during insertion. Engagement feature 1262 is deformable to disengage lip 1242 from the insert 1260, thereby releasing and positioning the cannula reducer 1210. In some embodiments, engagement feature 1262 may push or advance the cannula reducer 1210 distally relative to the insert 1260, thereby releasing engagement feature 1262 from lip 1242 and releasing and positioning the cannula reducer 1210. Optionally, movement of engagement feature 1262 can be controlled by pressing release button 1270.

[0203] refer to Figure 48 This document describes method 1300 using an endotracheal cannula of varying diameter. In step 1302, the cannula is fitted onto the patient. The cannula can be inserted into the patient at the intended access opening. The cannula may displace or dissect soft tissue to allow insertion into the patient's body cavity to provide access to the surgical site. Optionally, during initial insertion, an occluder may be inserted through the cannula to provide an expanding or blunt tip that facilitates insertion of the cannula through an incision or other opening in the patient.

[0204] In step 1304, the robotic arm and / or manipulator is moved to the cannula location. The manipulator may dock or otherwise attach to the cannula.

[0205] In step 1306, as described herein, an endotracheal reducer may be attached to a surgical instrument smaller than the surgical instrument intended for implantation in a patient. The endotracheal reducer and the surgical instrument may be attached together to form an assembly unit. In some embodiments, the proximal end of the endotracheal reducer may be coupled to or attached to the surgical instrument. For example, the proximal end of the endotracheal reducer may be attached to various features of the surgical instrument extending along the length of the instrument axis. In the depicted example, the proximal end of the endotracheal reducer may be attached to various features on the outer portion of the surgical instrument.

[0206] In step 1308, the assembly unit may be inserted, connected, or docked together with the manipulator and / or inserted into the cannula. In the docked configuration, the instruments, reducers, and cannula are coaxially aligned along the insertion axis, allowing the instrument axis to extend through the cannula. The lumen of the cannula axis supports and coaxially aligns the cannula reducer, and subsequently supports and coaxially aligns the axis of the surgical instruments within the cannula axis.

[0207] In some embodiments, the cannula reducer and / or surgical instrument may be configured such that when the cannula reducer and surgical instrument are inserted into or docked with the cannula, the proximal end of the cannula reducer may be positioned away from the sealing layer disposed within the sealing unit.

[0208] refer to Figure 49 This document describes method 1400 for using an endotracheal cannula and changing surgical instruments. As described in step 1308, in step 1402, the endotracheal cannula and surgical instruments may be inserted, connected, or docked together with a manipulator and / or inserted into the cannula. In step 1404, a surgical task or procedure using the surgical instruments is performed. The surgical task or procedure may include laparoscopic, urological, endoscopic, percutaneous, orthopedic, and / or other medical or minimally invasive procedures in which surgical instruments are introduced to the site via a cannula.

[0209] After the surgical task or procedure is completed, in step 1406, the surgical instruments and the cannula reducer can be removed as an assembly unit. Advantageously, by removing the cannula reducer and surgical instruments as a unit, the surgical instruments can be quickly inserted and removed from the cannula. Optionally, the cannula reducer can be removed from the surgical instruments when the assembly unit is removed from the cannula and / or manipulator.

[0210] After removing the first surgical instrument and the cannula, in step 1408, a second surgical instrument may be introduced into the cannula for subsequent surgical tasks or procedures. The second surgical instrument may be inserted with or without the cannula.

[0211] Although various embodiments are described herein with reference to cannulation, the reducers described herein can be applied to other medical devices. For example, any reducer disclosed herein can be applied to medical devices other than cannulation or surgical instruments, including, for example, other access devices.

[0212] 3. Implementation system and terminology.

[0213] It should be noted that, as used herein, the terms “couple,” “coupling,” “coupled,” or other variations thereof may indicate an indirect or direct connection. For example, if a first component is “coupled” to a second component, the first component may be indirectly connected to the second component or directly connected to the second component via another component.

[0214] The methods disclosed herein include one or more steps or actions for implementing the methods. The method steps and / or actions may be interchanged without departing from the scope of the claims. In other words, the order and / or use of specific steps and / or actions may be modified without departing from the scope of the claims unless proper operation of the described method requires a specific order of steps or actions.

[0215] As used herein, the term "multiple" means two or more. For example, multiple components indicates two or more components. The term "determine" encompasses a variety of actions, and therefore, "determine" can include calculation, operation, processing, derivation, investigation, lookup (e.g., searching in a table, database, or another data structure), ascertainment, etc. Additionally, "determine" can include receiving (e.g., receiving information), accessing (e.g., accessing data in memory), etc. Furthermore, "determine" can include parsing, selecting, picking, building, etc.

[0216] Unless otherwise explicitly stated, the phrase “based on” does not mean “based on only”. In other words, the phrase “based on” describes both “based on only” and “based on at least”.

[0217] The foregoing description of the disclosed specific embodiments is provided to enable any person skilled in the art to make or use the invention. Various modifications to these specific embodiments will be readily apparent to those skilled in the art, and the general principles defined herein may be applied to other specific embodiments without departing from the scope of the invention. For example, it should be understood that those skilled in the art will be able to employ numerous corresponding alternatives and equivalent structural details, such as equivalent means of fastening, mounting, connecting, or engaging tool components, equivalent mechanisms for generating specific actuating movements, and equivalent mechanisms for delivering electrical energy. Therefore, the invention is not intended to be limited to the specific embodiments shown herein, but is endowed with the broadest scope consistent with the principles and novel features disclosed herein.

Claims

1. A cannula reducer, the cannula reducer comprising: A sleeve having a proximal end and a distal end, the sleeve being configured to be inserted into a cannula and having an internal channel configured to receive a surgical instrument, wherein the proximal end of the sleeve is configured to be attached to the surgical instrument. The distal end of the sleeve includes one or more radial extensions and one or more radial gaps, the one or more radial extensions being configured to engage with the inner surface of the cannula, and the one or more radial gaps being angularly offset from the one or more radial extensions and configured to allow fluid to flow between the outer surface of the sleeve and the inner surface of the cannula.

2. The reducing tube according to claim 1, wherein, The proximal end of the sleeve is configured to be attached to the surgical instrument along its axis.

3. The reducing tube according to claim 1, wherein, In the docking configuration where the sleeve and the surgical instrument are connected to the cannula, the proximal end of the sleeve is configured to attach to the surgical instrument at a location away from the sealing layer connected to the cannula.

4. The reducing tube according to claim 1, wherein, The proximal end of the sleeve includes a latching member configured to engage with the housing of the surgical instrument.

5. The reducing tube according to claim 4, wherein, The latching member is connected to the sleeve via a flexural portion.

6. The reducing tube according to claim 4, wherein, The latching member is integrally formed with the sleeve.

7. The reducing tube according to claim 4, wherein, The sleeve also includes an actuating portion coupled to the latching member, wherein movement of the actuating portion causes the latching member to move and disengages the sleeve from the surgical instrument.

8. The reducing tube according to claim 1, wherein, The sleeve includes a tubular body extending from the proximal end to the distal end, and the internal channel is an inner cavity extending through the tubular body.

9. The reducing tube according to claim 1, wherein, The sleeve includes a lateral channel extending along a portion of the sleeve between the proximal end and the distal end, wherein the size of the lateral channel is configured to allow the axis of the surgical instrument to pass through during the lateral attachment of the sleeve to the surgical instrument.

10. A surgical system, the surgical system comprising: Intubation; Surgical instruments, the surgical instruments comprising: Base, the base being configured to be mounted to a robotic arm; and A shaft extending through the base and configured to extend through the cannula; and A reducing sleeve, the reducing sleeve being configured to attach to the base of the surgical instrument to allow the surgical instrument and the reducing sleeve to be inserted into the cannula as an assembly unit; The distal end of the sleeve includes one or more radial extensions and one or more radial gaps, the one or more radial extensions being configured to engage with the inner surface of the cannula, and the one or more radial gaps being angularly offset from the one or more radial extensions and configured to allow fluid to flow between the outer surface of the sleeve and the inner surface of the cannula.

11. The surgical system of claim 10, wherein, The proximal end of the reducing sleeve is attached to the surgical instrument.

12. The surgical system of claim 10, wherein, The shaft of the surgical instrument is configured to advance or retract relative to the reducing sleeve and the base of the surgical instrument.

13. The surgical system of claim 10, wherein, The base of the surgical instrument includes an instrument sleeve, the shaft of the surgical instrument extends through the instrument sleeve, and the reducing sleeve is configured to attach to the instrument sleeve.

14. The surgical system of claim 13, wherein, The instrument sleeve is configured to receive the reducer sleeve.

15. The surgical system according to claim 13, wherein, The shaft of the surgical instrument is configured to advance or retract relative to the reducer sleeve and the instrument sleeve.

16. The surgical system of claim 13, wherein, The instrument sleeve is defined by an engagement feature that allows it to engage with the reducer sleeve.

17. The surgical system of claim 16, wherein, The engagement feature includes a lip extending radially from the surface of the instrument sleeve, and the reducing sleeve is configured to engage the lip.

18. The surgical system of claim 10, wherein, The robotic arm includes a robotic manipulator having a first end configured to attach to the cannula, a second end configured to attach to the base of the surgical instrument, and at least one actuator configured to actuate the surgical instrument. The robotic arm also includes at least one actuator configured to move the robotic manipulator relative to the patient.

19. A method comprising: Attach the cannula reducer sleeve to the surgical instruments; as well as After attaching the cannula reducer sleeve to the surgical instrument, the cannula reducer sleeve and the surgical instrument are inserted into the cannula. The distal end of the sleeve includes one or more radial extensions and one or more radial gaps, the one or more radial extensions being configured to engage with the inner surface of the cannula, and the one or more radial gaps being angularly offset from the one or more radial extensions and configured to allow fluid to flow between the outer surface of the sleeve and the inner surface of the cannula.

20. The method of claim 19, further comprising attaching the proximal end of the cannula reducer sleeve to the surgical instrument along the axis of the surgical instrument.

21. The method according to claim 19, wherein, After the cannula reducer sleeve and the surgical instruments are inserted into the cannula, the cannula reducer sleeve is moved away from the sealing layer connected to the cannula.

22. The method of claim 19, further comprising axially inserting the surgical instrument into the cannula reducer sleeve via the proximal end.

23. The method of claim 19, further comprising laterally inserting the surgical instrument into the reducing sleeve via a lateral channel extending along a portion of the reducing sleeve between a proximal end and a distal end.

24. The method according to claim 19, further comprising: The cannula reducer sleeve and the surgical instruments are removed from the cannula as an assembly unit. as well as A second surgical instrument is inserted into the cannula.

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