Instrument with counter-rotation mechanism

Abstract

The present application relates to instruments having a counter-pivot mechanism. The instrument includes an elongated shaft, a counter-pivot mechanism, and a control cable. A first joint of the counter-pivot mechanism has a first link coupled to the elongated shaft, and a second joint has a second link disposed distal to the first joint. An elongated tube is disposed between the first and second joints. A restraining cable extends linearly between the first and second joints within a first groove formed in an outer surface of the elongated tube. The control cable spirally wraps around the elongated tube within a second groove formed in the outer surface. The joints are coupled by the restraining cable such that when the counter-pivot mechanism is manipulated by the control cable, the first joint pivots in a first direction and the second joint pivots in an opposite second direction to maintain the first and second links in a parallel orientation.

Description

[0001] Cross-reference applications

[0002] This application claims priority and benefit to U.S. Provisional Application No. 63 / 327,472, entitled “Instrument With a Counter-Pivoting Mechanism,” filed April 5, 2022, which is incorporated herein by reference in its entirety. Technical Field

[0003] This disclosure relates to systems and methods for performing medical or non-medical procedures, and more specifically to tools having a counter-pivoting mechanism. Background Technology

[0004] Minimally invasive medical techniques aim to reduce the amount of tissue damaged during medical procedures, thereby reducing patient recovery time, discomfort, and harmful side effects. These techniques can be performed through natural openings in the patient's anatomy or through one or more surgical incisions. The operator can insert minimally invasive medical instruments through these natural openings or incisions to reach the target tissue location. Minimally invasive medical instruments include devices such as therapeutic instruments, diagnostic instruments, biopsy instruments, and surgical instruments. These instruments can be inserted into anatomical channels and navigated to regions of interest within the patient's anatomy.

[0005] Some medical devices include parallel motion mechanisms to translate a portion of the device while maintaining the orientation of that portion. Existing parallel motion mechanism constructions include two coaxial tubes with cables routed between the inner and outer tubes, as described in U.S. Patent No. 7,942,868 (filed June 13, 2007) (disclosing “Surgical Instrument with Parallel Motion Mechanism”), which is incorporated herein by reference in its entirety. This design has characteristics that may be undesirable in certain procedures.

[0006] Devices with improved anti-pivot mechanisms are needed to enhance medical and non-medical procedures. Summary of the Invention

[0007] Consistent with some examples, an apparatus may include an elongated shaft, an anti-pivot mechanism, and a plurality of control cables extending through the elongated shaft and configured to control manipulation of the anti-pivot mechanism. The elongated shaft may have a proximal portion and a distal portion. The anti-pivot mechanism may include: a first joint coupled to the distal portion of the elongated shaft, the first joint including a first link; and a second joint disposed distal to the first joint, the second joint including a second link. The anti-pivot mechanism may also include an elongated tube disposed between the first and second joints and having a central cavity extending along a longitudinal axis of the elongated tube. The plurality of constraint cables may extend linearly between the first and second joints within a plurality of first grooves formed in the outer peripheral surface of the wall of the elongated tube. The plurality of control cables may be helically wound around at least a portion of the elongated tube within a plurality of second grooves formed in the outer peripheral surface of the wall of the elongated tube. The first and second joints can be connected by multiple constraint cables such that when the anti-pivot mechanism is operated by multiple control cables, the first joint pivots along a first direction, and the second joint pivots along a second direction opposite to the first direction, while the first and second joints are maintained in a parallel orientation.

[0008] In some examples, each of the multiple control cables may be attached to a second joint. An apparatus may also include a third joint connected to a first joint and a fourth joint connected to the second joint. The first and second joints may be configured to pivot in the pitch direction, while the third and fourth joints may be configured to pivot in the yaw direction. The multiple control cables may include a set of pitch control cables and a set of yaw control cables.

[0009] In some examples, each of the plurality of control cables may exit the wall of the elongated tube at a position approximately 180° circumferentially offset from the position where each respective control cable enters the wall of the elongated tube. In some examples, a plurality of second grooves may be formed in the wall deeper than a plurality of first grooves such that a plurality of constraint cables are arranged radially outward from the plurality of control cables within the elongated tube, or a plurality of first grooves may be formed in the wall deeper than a plurality of second grooves such that a plurality of constraint cables are arranged radially inward from the plurality of control cables within the elongated tube.

[0010] In some examples, the outer diameter of the slender tube can be less than about 5 mm. The maximum width of the central cavity can be greater than about 2.8 mm. At this point, the ratio of the cross-sectional area of ​​the central cavity to the cross-sectional area of ​​the slender tube can be greater than 1:2.

[0011] In some examples, an apparatus may include an end effector disposed distal to a counter-pivot mechanism. The end effector may optionally include an elbow joint. Multiple elbow control cables may extend through the central cavity of an elongated tube and be secured to the elbow joint. The multiple elbow control cables may be disposed within multiple coils extending through the central cavity of the elongated tube. The end effector may include a gripper, and the multiple elbow control cables may include at least four cables configured to control the pitch, yaw, and gripping of the end effector. The end effector may include an electrocautery blade or ablation tool, and wires may extend through the central cavity of the elongated tube.

[0012] In some examples, a device may include a shape sensor that extends through the first and second joints.

[0013] Consistent with some examples, an apparatus may include an elongated shaft having a proximal portion and a distal portion, an anti-pivot mechanism, and a plurality of control cables extending through the elongated shaft and configured to control the manipulation of the anti-pivot mechanism. The anti-pivot mechanism may include: a first joint coupled to the distal portion of the elongated shaft, the first joint including a first coupling; a second joint disposed distal to the first joint, the second joint including a second coupling; an elongated tube disposed between the first and second joints and having a central cavity extending along a longitudinal axis of the elongated tube; and a plurality of constraint cables extending between the first and second joints within a plurality of channels formed in the wall of the elongated tube. The plurality of control cables may be helically wound around at least a portion of the elongated tube within a plurality of grooves formed in the outer circumferential surface of the wall of the elongated tube. The first and second joints may be coupled by the plurality of constraint cables such that when the anti-pivot mechanism is manipulated by the plurality of control cables, the first joint pivots in a first direction, and the second joint pivots accordingly in a second direction opposite to the first direction, while the first and second couplings are maintained in a parallel orientation.

[0014] In some examples, the multiple channels may include linear cavities extending through the wall of the elongated tube. In some examples, the multiple channels may extend within a central cavity. In some examples, the multiple channels may include grooves formed in the inner surface of the wall of the elongated tube.

[0015] Consistent with some examples, a method of controlling an apparatus may include manipulating at least one of a plurality of control cables extending through an elongated shaft of the apparatus, the apparatus having a proximal portion, a distal portion, and a counter-pivot mechanism. The counter-pivot mechanism may include: a first joint coupled to the distal portion of the elongated shaft, the first joint including a first coupling; a second joint disposed distal to the first joint, the second joint including a second coupling; an elongated tube disposed between the first and second joints and having a central cavity extending along a longitudinal axis of the elongated tube; and a plurality of constraint cables extending linearly between the first and second joints within a plurality of first grooves formed in the outer circumferential surface of the wall of the elongated tube. At least one control cable may extend through at least one of a plurality of helically wound second grooves formed in the outer circumferential surface of the wall of the elongated tube. Manipulating at least one control cable may pivot the first joint in a first direction and the second joint in a second direction opposite to the first direction, while the first and second couplings are maintained in a parallel orientation by the plurality of constraint cables.

[0016] Other examples include corresponding computer systems, devices, and computer programs stored on one or more computer storage devices, each configured to perform the actions of any of the methods described herein.

[0017] It should be understood that both the foregoing general description and the following detailed description are exemplary and explanatory in nature and are intended to provide an understanding of the disclosure without limiting its scope. In this regard, further aspects, features, and advantages of the disclosure will be apparent to those skilled in the art from the following detailed description. Attached Figure Description

[0018] When read in conjunction with the accompanying drawings, various aspects of this disclosure will be best understood through the following detailed description. It should be emphasized that, in accordance with standard industry practice, the various features are not drawn to scale. In fact, the dimensions of the various features may be increased or decreased arbitrarily for clarity of discussion. Furthermore, reference numerals and / or letters may be repeated in various examples of this disclosure. This repetition is for simplicity and clarity and does not in itself indicate a relationship between the various embodiments and / or configurations discussed.

[0019] Figure 1 It is a diagram of a remote operating system based on this disclosure.

[0020] Figure 2A An instrument system employing aspects of this disclosure is shown.

[0021] Figure 2B An example of a device with extensions according to this disclosure is shown. Figure 2A The distal part of the instrument system.

[0022] Figure 2C It shows Figure 2A The distal end of a flexible, steerable device in a medical device system.

[0023] Figure 2D The distal portion of the instrument system employing the aspects of this disclosure is shown.

[0024] Figure 3 The distal portion of the device according to this disclosure is shown.

[0025] Figure 4 An elongated tube of the anti-pivot mechanism according to this disclosure is shown.

[0026] Figure 5A Multiple anti-pivot mechanism joints formed by links according to this disclosure are shown.

[0027] Figure 5B As shown Figure 5A The connecting section is shown.

[0028] Figure 6 An adapter for connecting a reverse pivoting mechanism to an elongated shaft of an instrument, according to the present disclosure, is shown.

[0029] Figures 7A-7B An anchoring joint of the anti-pivot mechanism according to this disclosure is shown.

[0030] Figures 8A-8B The anti-pivot mechanisms according to this disclosure are shown in straight and curved configurations, respectively.

[0031] Figure 9 A cross-section through the distal portion of the device according to this disclosure is shown.

[0032] Figure 10 The distal end of the anti-pivot mechanism with the joint removed is shown according to this disclosure.

[0033] Figure 11 The proximal end of the anti-pivot mechanism with the joint removed is shown according to this disclosure.

[0034] Figure 12 A cross-section through the distal portion of the device according to this disclosure is shown.

[0035] Figures 13A-13B It shows the through Figure 9 Cross-section of the anti-pivot mechanism.

[0036] Figures 14-16 A cross-section through an example of an anti-pivoting mechanism according to this disclosure is shown.

[0037] Examples and advantages of this disclosure will be best understood by referring to the following detailed description. It should be understood that the same reference numerals are used to identify one or more of the same elements shown in the figures, wherein the illustrations are for illustrative purposes and not for limitation. Detailed Implementation

[0038] Numerous specific details are set forth in the following detailed description of various aspects of the invention in order to provide a thorough understanding of the disclosed embodiments. However, it will be apparent to those skilled in the art that embodiments of this disclosure can be practiced without these specific details. In other instances, well-known methods, procedures, components, and circuits have not been described in detail so as not to unnecessarily obscure various aspects of the embodiments of the invention. Furthermore, to avoid unnecessary descriptive repetition, one or more components or actions described according to one illustrative embodiment may be used or omitted where applicable in other illustrative embodiments. For the sake of brevity, many iterations of these combinations will not be described separately. For simplicity, in some instances, the same reference numerals are used in all the drawings to refer to the same or similar parts.

[0039] A counter-pivot mechanism can be positioned between the end effector and the elongated shaft of the instrument. The counter-pivot mechanism can be designed to maintain a parallel arrangement between the proximal and distal couplings on either side of the counter-pivot mechanism during bending of the instrument at the counter-pivot mechanism. This allows for translation of the end effector and / or toggle while maintaining the orientation of the end effector and / or toggle relative to a portion of the elongated shaft.

[0040] This disclosure relates to a counter-pivot mechanism for instruments, having a design that facilitates use in remotely operated or robot-assisted surgical platforms by reducing the outer diameter of the counter-pivot mechanism and / or increasing the inner diameter of the central cavity or working channel. This can be achieved, for example, by arranging the control elements and / or constraint cables for the counter-pivot mechanism in grooves or channels formed in the wall of the counter-pivot mechanism.

[0041] Refer to the attached diagram. Figure 1 A remote operating system used for, for example, surgical procedures, diagnosis, treatment, biopsy, or non-medical procedures (collectively referred to herein as "surgical") is generally indicated by figure number 100. Figure 1As shown, the remote operating system 100 generally includes a remote operation manipulator component 102 for operating the medical device system 104 while performing various procedures—such as performing medical procedures on patient P. The medical device system 104 may include one or more steerable instruments and / or one or more passive instruments. One or more instruments of the medical device system 104 may be configured to be positioned within the working channels or cavities of one or more other instruments of the medical device system 104. In some examples, one or more surgical instruments or tools may be positioned within one or more working channels of instruments such as catheters or endoscopes of the medical device system 104. The manipulator component 102 is mounted to or near a patient support table T, which may be located in an operating room or other medical environment. An operator input system 106 allows an operator (e.g., a clinician, surgeon, or other personnel) S to observe the intervention site and control the manipulator component 102. Figure 1 The diagram illustrates a single manipulator assembly 102, a medical device system 104, and an operator input system 106. However, it should be understood that various remotely operated systems may have multiple manipulator assemblies, medical device systems (each comprising one or more medical devices), operator input systems, or combinations thereof.

[0042] Operator input system 106 may be located at the user control system, typically in the same room as the patient support table T. However, it should be understood that the operator S may be located in a different room or a completely different building, or geographically distant from the patient P. Operator input system 106 generally includes one or more control devices for controlling manipulator assembly 102. Control devices may include any number of various input devices or sensors, such as joysticks, trackballs, data gloves, trigger guns, manual operation controllers, eye-tracking devices, voice recognition devices, body motion or presence sensors, or similar devices. In some embodiments, the control device will be provided with the same degrees of freedom as one or more associated medical device systems (such as medical device system 104), thereby providing telepresence to the operator, or the control device and the medical device system will be integrated to give the operator a sufficiently strong perception of direct control over the medical device system. In other embodiments, the control device may have more or fewer or different degrees of freedom compared to one or more associated medical device systems (such as medical device system 104), and still provide telepresence to the operator. In some embodiments, the control device is a manual input device that moves in six degrees of freedom and may also include an actuable handle for actuating instruments (e.g., for closing a gripper, applying a potential to an electrode, delivering a therapeutic drug, etc.).

[0043] The teleoperated manipulator assembly 102 supports the medical device system 104 and may include one or more non-servo-controlled links (e.g., one or more links that can be manually or robotically positioned and locked in place, commonly referred to as a setup structure) and the kinematic structure of the teleoperated manipulator. The teleoperated manipulator assembly 102 includes multiple actuators or motors that drive inputs on one or more instruments of the medical device system 104 in response to commands from a control system (e.g., control system 112). The motors include drive systems that, when coupled to the medical device system 104, advance one or more instruments of the medical device system 104 into naturally formed or surgically formed anatomical openings. Other motorized drive systems may enable the distal ends of one or more instruments of the medical device system 104 to move with multiple degrees of freedom, including three translational degrees of freedom (e.g., translational motion along the X, Y, and Z Cartesian axes) and three rotational degrees of freedom (e.g., rotation about the X, Y, and Z Cartesian axes). Additionally, motors can be used in articulated end effectors of actuating instruments to grip tissue in the jaws of a biopsy apparatus or similar tool. Motor position or velocity sensors, such as solvers, encoders, potentiometers, and other mechanisms, can provide sensor data to remotely operated components to describe the rotation and orientation of the motor shaft. This position sensor data can be used to determine the motion of the object manipulated by the motor.

[0044] The remote operating system 100 also includes a sensor system 108 having one or more subsystems for receiving information about sub-components of the remote operating system 100 (including the instrument of the remote manipulator assembly 102). Such subsystems may include at least one of the following: an orientation / position sensor system (e.g., an electromagnetic (EM) sensor system); a shape sensor system for determining the orientation, orientation, velocity, rate, posture, and / or shape of at least a portion of the instrument of a medical device system 104, such as a flexible, steerable body or a rigid instrument body with or without joints; a visualization system for capturing images from the distal end of the instrument; other sensor systems based on various sensor technologies; or combinations thereof.

[0045] In some examples, visualization systems (e.g., Figure 2AThe visualization system 231 may include an endoscope assembly that records concurrent or real-time images of the surgical site and provides the images to an operator (e.g., a clinician, surgeon, or other person). The concurrent images may be, for example, two-dimensional or three-dimensional images captured by an endoscope positioned within the surgical site. In this embodiment, the visualization system includes an endoscope component that may be integrally or removably coupled to one or more instruments of the medical device system 104. However, in an alternative embodiment, a separate endoscope attached to a separate manipulator assembly may be used in conjunction with the medical device system 104 to image the surgical site. The visualization system may be implemented as hardware, firmware, software, or a combination thereof that interacts with or is otherwise executed by one or more computer processors, which may include the processor of the control system 112 (described below). The processor of the control system 112 may execute instructions including instructions corresponding to the processes disclosed herein.

[0046] The remote operating system 100 also includes a display system 110 for displaying images or representations of the surgical site and / or medical device systems (one or more) 104 generated by a subsystem of the sensor system 108. The display system 110 and the operator input system 106 can be oriented such that an operator can use the remotely presented perception to control the medical device system 104 and the operator input system 106.

[0047] Display system 110 can also display images of the surgical site and medical instruments (e.g., instruments of medical device system 104) captured by the visualization system. Display system 110 and control devices can be oriented such that the relative orientation of the imaging devices within the endoscope assembly and medical instruments approximates the relative orientation of an operator's eyes and hands, allowing the operator to manipulate medical device system 104 and hand controls as if observing the workspace in a substantially real-world setting. "Substantially-world" refers to the presentation of a true perspective image that simulates the viewpoint of a physician physically manipulating medical device system 104.

[0048] Optionally or additionally, the display system 110 may present images of the surgical site and / or virtual navigation images recorded preoperatively or intraoperatively. Further details suitable for displaying such information are provided in International Patent Publication No. WO2018 / 132386 (filed January 9, 2018) (disclosing “Systems and Methods for Using a Robotic Medical System”) and U.S. Patent Application Publication No. 2012 / 0289777 (filed May 13, 2011) (disclosing “Medical System Providing Dynamic Registration of a Model of an Anatomic Structure for Image-Guided Surgery”), which are incorporated herein by reference in their entirety.

[0049] The remote operating system 100 also includes a control system 112. The control system 112 includes at least one memory and at least one computer processor (not shown), and in some embodiments, generally multiple processors, for implementing control between the medical device system 104, the operator input system 106, the sensor system 108, and the display system 110. The control system 112 also includes programmed instructions stored on a non-transitory processor-readable storage medium (e.g., a computer-readable medium storing instructions) to implement some or all of the methods described according to various aspects of the disclosure herein, including instructions for providing information to the display system 110. Although the control system 112... Figure 1 Shown as a single block in the simplified schematic, the control system 112 may include two or more data processing circuits, wherein a portion of the processing is optionally executed on or near the remote operating manipulator component 102, another portion of the processing is executed at the operator input system 106, and so on. Any of a wide variety of centralized or distributed data processing architectures may be employed. Similarly, the programmed instructions may be implemented as multiple separate programs or subroutines, or they may be integrated into multiple other aspects of the remote operating system described herein. In one embodiment, the control system 112 supports one or more wired or wireless communication protocols. Examples of wireless communication protocols include Bluetooth, IrDA, HomeRF, IEEE 802.11, DECT, and wireless telemetry.

[0050] In some embodiments, the control system 112 may include one or more servo controllers that receive force and / or torque feedback from one or more medical devices (such as the medical devices of medical device system 104). In response to this feedback, the servo controllers transmit signals to the operator input system 106. The servo controllers (one or more) may also transmit signals instructing the remote manipulator assembly 102 to move the medical device, which extends into the body through an opening in the patient's body to an internal surgical or treatment site. Any suitable conventional or dedicated servo controller may be used. The servo controller may be separate from or integrated with the remote manipulator assembly 102. In some embodiments, the servo controller and the remote manipulator assembly 102 are provided as part of a remotely operated arm trolley configured to be positioned adjacent to the patient's body during a surgical procedure.

[0051] The remote operating system 100 may also include optional operating and support systems (not shown) such as lighting systems, steering control systems, flushing systems, suction systems, cauterization or energy application systems, other systems, or combinations thereof. In alternative embodiments, the remote operating system 100 may include more than one remote manipulator assembly 102 and / or more than one operator input system 106. The exact number of remote manipulator assemblies will depend on factors such as the surgical procedure and space constraints within the operating room. Operator input systems may be juxtaposed, or they may be located in separate geographically proximate or distant locations. Multiple operator input systems allow more than one operator to control one or more manipulator assemblies in various combinations.

[0052] Figure 2A A medical device system 200 according to various aspects of this disclosure is illustrated, which can be used as a medical device system 104 or in a medical device system 104 in an image-guided medical procedure executed using a remote operating system 100. Optionally, the medical device system 200 can be used in non-remotely operated exploratory procedures or procedures involving medical devices that require routine manual operation, such as endoscopy.

[0053] The instrument system 200 includes a flexible, steerable body 202 coupled to a housing 204. The flexible, steerable body 202 has a proximal end 217 and a distal or tip portion 218. In various embodiments, the flexible, steerable body 202 has dimensions and shapes that reach a target anatomy, such as a diameter, for example, from 4 mm to 25 mm. Other flexible, steerable body outer diameters may be larger or smaller. The instrument system 200 may optionally include one or more shape sensors 222 for determining the orientation, direction, velocity, rate, posture, shape, or other physical characteristics of the flexible, steerable body tip at the distal end 218 of at least a portion of one or more segments 224 of an instrument (e.g., instrument 226, described further in detail below) that can be positioned within a cavity or channel 221 of the flexible, steerable body 202. The entire length of the flexible, steerable body 202 between the distal end 218 and the proximal end 217 can be effectively divided into segments 224. If the device system 200 is a medical device system of a remote operating system 100, such as medical device system 104, then the shape sensor 222 may be a component of the sensor system 108. If the device system 200 is manually operated or otherwise used for a non-remote operation procedure, the shape sensor 222 may be coupled to the tracking system 230, which queries the shape sensor 222 and processes the received shape data. In some embodiments, the flexible steerable body 202 may optionally include one or more shape sensors 222. Additionally or optionally, the device 226 coupled to or positioned within the cavity 221 of the flexible steerable body 202 may optionally include the shape sensor 222.

[0054] The medical device system 200 (e.g., steerable body 202 and / or device 226) may optionally include one or more orientation sensor systems 220 and / or shape sensors 222, which may be provided within the flexible steerable body 202 or device 226 or mounted on the exterior of the flexible steerable body 202 or device 226. U.S. Patent Application No. 11 / 180,389 (filed July 13, 2005) discloses "Fiber optic position and shape sensing device and methodrelating thereto"; U.S. Patent Application No. 12 / 047,056 (filed July 16, 2004) discloses "Fiber-optic shape and relative position sensing"; and U.S. Patent No. 6,389,187 (filed June 17, 1998) discloses "Optical Fibre Bend Sensor"; U.S. Patent Application No. 13 / 107,562 (filed May 13, 2011) discloses "Medical System Providing Dynamic Registration of a Model of an Anatomic Structure for Image-Guided Surgery"; and U.S. Patent No. 6,380,732 (filed August 11, 1999) discloses "Six-Degree of Freedom Tracking System Having a PassiveTransponder on the Object Being" Various systems and methods for monitoring the shape and relative orientation of an instrument are described in U.S. Provisional Patent Application 63 / 240471 (filed September 3, 2021) (disclosing "Ultrasound Elongate Instrument Systems and Methods"), all of which are incorporated herein by reference in their entirety. Tracking system 230 may include one or more orientation sensor systems 220 and one or more shape sensors 222 for determining the orientation, direction, velocity, posture, and / or shape of the instrument. Tracking system 230 may be implemented as hardware, firmware, software, or a combination thereof that interacts with or is otherwise executed by one or more computer processors, which may include the processor of control system 112.

[0055] The flexible, steerable body 202 includes one or more cavities 221, which are sized and shaped to receive one or more medical instruments 226. Medical instruments may include, for example, image-capturing devices (e.g., endoscopes, such as monoscopic or stereoscopic endoscopes), electrosurgical devices, biopsy instruments, laser ablation fibers, or other surgical, diagnostic, or therapeutic tools. Medical instruments may include end effectors having one or more working components such as scalpels, blunt blades, optical fibers, or electrodes. Other end effectors may include, for example, forceps, grippers, scissors, applicators, etc. Examples of electrically activated end effectors include electrosurgical electrodes, transducers, sensors, etc. One or more cavities 221 may have a diameter, for example, from approximately 3 mm to 20 mm. In one example, cavity 221b, configured to receive an instrument of approximately 5 mm, may have a diameter of approximately 6 mm. Cavity 221a may have a larger diameter to receive larger instruments, such as image-capturing devices. For example, as... Figure 2C As shown, the flexible, steerable body 202 may include a cavity 221a sized to receive a larger instrument, such as an image capture device, and two cavities 221b each sized to receive a flexible instrument 226. However, other embodiments may include more or fewer cavities 221a and / or 221b (e.g., one, two, three, four, or more cavities 221a, 221b). Cavities 221a, 221b may have different dimensions relative to each other, or two or more of cavities 221a, 221b may have the same dimensions. In some embodiments, the larger cavity 221a may be positioned below the smaller cavity 221b, such as... Figure 2C As shown, either the larger cavity 221a may be positioned above the smaller cavity 221b, or the larger cavity 221a may be positioned along a common horizontal plane with one or more of the smaller cavities 221b.

[0056] In various embodiments, one or more of the medical devices 226 may be or include an image capturing device comprising a distal portion having a stereo or single-view camera, the distal portion being processed by the visualization system 231 for display. The image capturing device may include a cable coupled to the camera for transmitting captured image data. Alternatively, the image capturing device may be an optical fiber bundle coupled to the visualization system, such as a fiber optic endoscope. The image capturing device may be monospectral or multispectral, for example, capturing image data in one or more of the visible spectrum, infrared spectrum, or ultraviolet spectrum.

[0057] In some embodiments, the flexible, steerable body 202 may include an image capture device 235, such as a stereo camera, positioned at or near the distal end 218, such as... Figure 2DAs shown, this is for capturing images (including video images). Multiple cavities 221 extending through the flexible, steerable body 202 provide entry points for multiple instruments 226 into the surgical site within the field of view of the image capturing device. For example, as... Figure 2D As shown, the flexible, steerable body 202 may include an image capturing device 235 and two cavities 221, each receiving a flexible instrument 226. However, other embodiments may include more or fewer cavities 221 (e.g., one, two, three, four, or more cavities). The cavities 221 may have different dimensions relative to each other, or two or more of the cavities 221 may have the same dimensions. In some embodiments, the image capturing device 235 may be positioned below the cavity 221, or the image capturing device 235 may be positioned above the cavity 221, or the image capturing device 235 may be positioned along a common horizontal plane with one or more of the cavities 221.

[0058] Medical device 226 may be accommodated between the proximal and distal ends of the device, including a cable, linkage, or other actuation control (not shown) extending to controllably bend the distal end of the device. Steering devices are described in detail in U.S. Patent No. 7,316,681 (filed October 4, 2005) (disclosing “Articulated Surgical Instrument for Performing Minimally Invasive Surgery with Enhanced Dexterity and Sensitivity”) and U.S. Patent Application No. 12 / 286,644 (filed September 30, 2008) (disclosing “Passive Preload and Capstan Drive for Surgical Instruments”), which are incorporated herein by reference in their entirety.

[0059] The flexible, steerable body 202 may also accommodate cables, linkages, or other steering controls (not shown) extending between the housing 204 and the distal end 218 to controllably bend the distal end 218—for example, as depicted by the dashed line 219 at the distal end of the flexible, steerable body 202. Flexible, steerable bodies, such as catheters, are described in detail in U.S. Patent Application No. 13 / 274,208 (filed October 14, 2011) (disclosing “Catheter with Removable Vision Probe”), which is incorporated herein by reference in its entirety. In embodiments where the instrument system 200 is actuated by a remotely operated component such as the remotely operated manipulator assembly 102, the housing 204 may include a drive input that is removably coupled to and receives power from a motorized drive element of the remotely operated component. In embodiments where the instrument system 200 is wholly or partially manually operated, the housing 204 may include clamping features, manual actuators, or other components for manually controlling the movement of the instrument system 200. The instrument system 200 may be steerable, or alternatively, the system may be non-steerable and lack an integrated mechanism for operator control of instrument bending. Additionally or alternatively, one or more cavities are defined within the walls of a flexible, steerable body 202 through which a medical instrument can be deployed and used at a target surgical site.

[0060] In various embodiments, the medical device system 200 may include a flexible instrument adapted to navigate and treat tissues in any anatomical system of various anatomical systems via naturally or surgically formed connection channels, including the colon, intestine, kidney, brain, heart, circulatory system, pulmonary system, stomach, other gastrointestinal channels, etc.

[0061] exist Figure 2A In one embodiment, the instrument system 200 is remotely operated within a remote operating system 100. In an alternative embodiment, the remote-operated manipulator assembly 102 may be replaced by direct operator control. In the direct operation alternative, various handles and operator interfaces may be included for handheld operation of the instrument.

[0062] As in Figure 2BAs shown in more detail, medical devices (such as medical device 226) for procedures such as surgery, biopsy, ablation, illumination, irrigation, or aspiration can be deployed through one or more cavities of the flexible steerable body 202 and used at a target location within the anatomy. Medical device 226 can be used in conjunction with an image-capturing device (e.g., an endoscope) also located within the flexible steerable body 202. Optionally, medical device 226 itself can be an image-capturing device. Medical device 226 can be advanced from an opening in cavity 221 to perform a procedure and then retracted into the cavity when the procedure is complete. In some embodiments, optionally, medical device 226 can be removed from the proximal end 217 of the flexible steerable body 202 or from another optional instrument port (not shown) along the flexible steerable body.

[0063] Figure 3 The distal portion of the device 300 is shown; the device 300 may be as follows: Figure 2B and Figure 2D The example of medical device 226 shown has a reverse pivoting mechanism 306. The various components of the reverse pivoting mechanism 306 will be described below. Figures 4-7B This will be discussed. It should be understood that the instrument 300 may extend from a guiding device such as a flexible, steerable body 202, and may be used independently without a guiding device, or may itself be a guiding device for guiding the tool to a target site. Although described in the context of medical devices used in remotely operated systems, it should be understood that the disclosure herein takes into account the use of anti-pivot mechanisms in non-medical devices (e.g., mechanical repair or manufacturing applications) and non-remotely operated (e.g., handheld) devices.

[0064] The instrument 300 may include an elongated shaft 302, an end effector 304, and a counterpivot mechanism 306 disposed between the elongated shaft and the end effector. An adapter 308 may secure the counterpivot mechanism 306 to the elongated shaft 302; however, it should be understood that in other examples, the counterpivot mechanism 306 may include a portion of the elongated shaft, making the adapter 308 optional. An elbow assembly 310—which may include multiple joints such as a proximal joint 305a and a distal joint 305b—may be disposed between the counterpivot mechanism 306 and the end effector 304. Although shown in the illustrated example as a gripper with two jaws, the end effector 304 may be any suitable tool, including but not limited to ablation tools, biopsy tools, image capture devices, therapeutic tools, etc. Although not shown to avoid obscuring the features described herein, a flexible outer sheath or braid may extend over some or all of the elongated shaft 302, adapter 308, counterpivot mechanism 306, elbow assembly 310, and / or end effector 304. The flexible outer sheath prevents fluids, tissues, or other debris from entering the device 300.

[0065] The anti-pivot mechanism 306 provides anti-pivot movement between components located at opposite ends of the mechanism 306. Specifically, one or more other joints in the second portion of the anti-pivot mechanism 306 bend in a second direction opposite to the first direction, or otherwise differently, causing one or more joints in the first portion of the anti-pivot mechanism 306 to pivot in the first direction. In some embodiments, the anti-pivot mechanism 306 allows the distal portion of the device 300 to bend or pivot without changing the orientation of the distal portion of the device relative to the proximal portion of the device. That is, the anti-pivot mechanism 306 is configured to maintain the device 300 in an orientation parallel to the device in an orientation parallel to the proximal portion of the anti-pivot mechanism (e.g., the end effector 304 and / or the toggle assembly 310) during bending of the anti-pivot mechanism, so as to translate the distal portion relative to the proximal portion without changing the orientation. The anti-pivot mechanism 306 allows multiple instruments (such as instrument 300) to extend and open from the distal end of the guide device (such as the flexible steerable body 202), for example... Figure 2D As shown, this provides increased workspace between instruments to ensure uninterrupted range of motion and a wider range of approach angles to the target tissue. When the end effector opens, the orientation of the elbow joint is maintained in alignment with the axis via a counter-pivot mechanism, allowing the elbow joint to maintain its range of motion without compensating for directional changes that might otherwise occur due to instrument opening. In the example shown, the distal portion of the instrument can be the proximal connector 305a of the elbow assembly 310, while the proximal portion can be the adapter 308, such that when the counter-pivot mechanism 306 bends, the proximal connector 305a of the elbow assembly 310 is maintained in a parallel, or otherwise constant, orientation relative to the adapter 308. However, it should be understood that the counter-pivot mechanism 306 can be configured to maintain a constant orientation between other portions or components of the instrument disposed on the opposite side of the counter-pivot mechanism. Furthermore, in some embodiments, the anti-pivot mechanism 306 can provide an anti-pivot motion, whereby the device 300 pivots in a direction opposite to that of the proximal portion of the anti-pivot mechanism 306 without maintaining a parallel or constant orientation. For example, the anti-pivot motion can deviate from the parallel orientation, causing a certain amount of orientational change in the distal portion relative to the proximal portion.

[0066] The illustrated anti-pivot mechanism 306 may include an elongated tube 314 (through which control cable 356 and constraint cable 358 extend) and a proximal joint assembly 312 and a distal joint assembly 313 formed by joints at either end of the elongated tube. Channels or recesses 316, 318 formed in the elongated tube may receive cables 356, 358. Control cable 356 is actuated to hinge joint assemblies 312, 313, thereby causing elbow assembly 310 and / or end effector 304 to translate relative to elongated axis 302 in a desired direction. Constraint cable 358 causes relative pivoting movement of joint assemblies 312, 313 to maintain orientation of elbow assembly 310 and / or end effector 304 during such translation caused by control cable 356. As further described below, the grooves 316, 318 where the cables are arranged can be formed in the outer peripheral surface of the elongated tube 314, which can facilitate the assembly and manufacture of the device.

[0067] Figure 5A and 8A - Figure 8B Further illustrations are provided of the arrangement of the joints in the proximal joint assembly 312 and the distal joint assembly 313. As discussed further below, the constraint cable 358 may extend axially through the length of the anti-pivot mechanism 306 in a first plurality of channels or grooves 316 formed in the elongated tube 314 (e.g., in a configuration aligned with or parallel to the longitudinal axis of the elongated tube 314). The constraint cable 358 may terminate proximally at the adapter 308 and distally at an anchoring joint 342 disposed distally on the joint 313. In some examples, the anchoring joint 342 may be omitted, and the constraint cable 358 may terminate distally at the most distal joint of the distal joint assembly 313. Because the constraint cables 358 have a fixed length and are fixedly secured at the distal and proximal ends of the anti-pivot mechanism 306, the opposing pairs of constraint cables 358 maintain parallel movement of the anti-pivot mechanism when the mechanism is actuated by the control cable 356. However, in other embodiments, the constraint cable 358 provides a reverse pivoting motion that deviates from the parallel orientation.

[0068] Control cable 356 may extend from the proximal portion of the elongated shaft through a coil (not shown) extending within the elongated shaft 302. The coil may terminate before the anti-pivot mechanism 306, for example, at the nearest-side connector 307a of the anti-pivot mechanism. Figure 5AThe cable terminates at or near adapter 308. Optionally, in some embodiments, when the cable disposed within the respective coil is pulled, the coil can be used to receive axial compressive loads, thereby isolating movement caused by pulling the cable to components distal to the coil, while preventing bending along the length of the coil, for example, in the flexible elongated shaft 302. The coil may be similar to those described in U.S. Patent Publication No. US 2016 / 0067450 (filed September 3, 2015) (disclosing “Flexible Instrument with Nested Conduits”), which is incorporated herein by reference in its entirety. In other examples, the elongated shaft 302 may be rigid, and therefore the coil may be omitted, as the rigidity of the elongated shaft 302 itself prevents bending and isolates movement to components distal to the elongated shaft 302.

[0069] The control cable 356 may extend axially distally and continue through the anti-pivot mechanism 306 in a second plurality of grooves or channels 318 formed in the elongated tube 314. The channels 318 may be helically positioned within the elongated tube 314 such that the control cable 356 may be helically wound within the channels 318 of the elongated tube 314. For example, see reference... Figure 3 The control cable 356, which enters the elongated tube 314 on the left proximal end, exits the elongated tube on the right distal end, approximately 180° (e.g., 150-210°) radially from where it enters. The control cable 356 may terminate at and be secured to the distal portion or distal side of the anti-pivot mechanism 306. In the illustrated example, the control cable 356 may terminate at the anchoring joint 342 distal to the distal joint 312. In some examples, crimps or sleeves may be attached to the end of the control cable to anchor it in a manner similar to a restraint cable.

[0070] Generally, the length (or proximal and distal boundaries) of the anti-pivot mechanism 306 can be defined by an anchor point at which the end of the restraint cable 358 is secured or attached to the device 300. In the example shown, the anti-pivot mechanism 306 may begin proximally to the nearest joint 307a of the proximal joint assembly 312, near the adapter 308, and may terminate distally to the distal joint 315d of the distal joint assembly 313, near the elbow assembly 310 (see [link to original text]). Figure 8A Furthermore, although it is shown that there are two proximal joints 309a, 309b and two distal joints 311a, 311b ( Figure 8AHowever, the anti-pivot mechanism 306 may include any number of joints at each end of the elongated tube 314. By utilizing two proximal joints 309 and two distal joints 311 (each of which may include two couplings 307, 315 or may share a common coupling) at each end of the anti-pivot mechanism 306, the two joints at each end can be configured to pivot in an orthogonal direction to provide movement in both the pitch and yaw directions. In some examples, the adapter 308, anchor coupling 342, and / or toggle assembly 310 may be considered part of the anti-pivot mechanism 306.

[0071] Figure 4 It shows in Figure 3 An example of an elongated tube 314 used in the anti-pivot mechanism 306. The elongated tube 314 includes a wall 317 formed around a central cavity 320 extending along the longitudinal axis 361 of the elongated tube. The outer diameter D1 of the elongated tube 314 can be approximately 2 mm to 20 mm. In one example, the outer diameter of the elongated tube 314 is approximately 5 mm, such as 4 mm or 6 mm. The central cavity 320 shown has a substantially square cross-section, but can be circular or any other suitable shape. The central cavity 320 can have a width or diameter W1 of approximately 1 mm to 10 mm. In one example, for an elongated tube 314 with an outer diameter of approximately 5 mm, the maximum dimension W1 across the central cavity 320 can be approximately 2.8 mm, such as 2.5 mm or 3.0 mm.

[0072] On the outer peripheral surface of the elongated tube 314, a plurality of first grooves 316 and a plurality of second grooves 318 are formed. The first grooves 316 are configured to receive a plurality of constraint cables 358, while the second grooves 318 are configured to receive a plurality of control cables 356. The first grooves 316 are substantially linear along the length of the elongated tube 314 (e.g., the first grooves 316 extend along or parallel to the longitudinal axis 361 of the elongated tube 314). The second grooves 318 are spirally or helically wound around the elongated tube. The second grooves 318 are formed deeper in the wall than the first grooves 316. In this way, when the constraint cables 358 are arranged radially outward from the control cables 356 relative to the longitudinal axis 361, the constraint cables 358 can pass over the control cables 356, for example... Figures 13A-13BAs shown. This arrangement allows the restraint cable 358 to exert a radially inward force to help retain the control cable 356 in its respective second groove 318. It should be understood that in other examples, the first groove 316 may be formed deeper in the wall of the elongated tube 314, while the second groove 318 may be formed shallower, such that the control cable 356 is positioned radially outward from the restraint cable 358. In some examples, the first groove 316 for receiving the restraint cable 358 may also be helically wound around the elongated tube 314 in the same or opposite orientation as the second groove 318, or both the first groove 316 and the second groove 318 may extend substantially linearly along the elongated tube 314. In some examples, the control cable 356 may be wound around the outside of the tube 314 (e.g., in a straight or helical groove 318), while the restraint cable 358 may be wired through the central cavity 320 or through other cavities in the wall of the tube 314. In some examples, four first grooves 316 and four second grooves 318 are formed in the elongated tube 314. The first grooves 316 may be circumferentially spaced at 90° intervals. The second grooves may also be circumferentially spaced at 90° intervals. At the distal and proximal ends of the elongated tube 314, each first groove 316 may be positioned between two adjacent second grooves 318. In some examples, more or fewer than four first and / or second grooves may be used. In some examples, three control cables 356 and three second grooves 318 may be used, each circumferentially spaced at approximately 120° intervals. In some examples, three constraint cables 358 and three first grooves 316 may be used. The first and / or second grooves may be equidistantly spaced around the circumference of the elongated tube 314, or they may be unevenly spaced.

[0073] exist Figure 4 In the example shown, the length of the elongated tube 314 and the pitch angles of the plurality of second grooves 318 are such that each second groove 318 terminates at a radial orientation at the distal end of the elongated tube, approximately 180° from the corresponding radial orientation at the proximal end of the elongated tube. However, the elongated tube 314 may be shorter or longer, and the pitch angles of the second grooves 318 may be steeper or shallower, depending on the preferred characteristics of the specific design application. In this respect, the second grooves 318 may wind along the length of the elongated tube 314 at angles less than or greater than 180°, for example, 90° or less, or 360° or greater.

[0074] like Figure 4 As shown, one end face of the elongated tube 314 includes a plurality of protrusions 322, while the opposite end face includes a plurality of recesses 324 extending therefrom. The protrusions 322 and recesses 324 can be configured to engage with corresponding protrusions 322 and recesses 324 on adjacent components of the elongated tube 314, for example, as... Figures 5A-5B The distal or proximal pivot joint 326 is shown. The engagement of the corresponding pair of protrusions 322 and recesses 324 resists translation and rotation of adjacent components.

[0075] Actuation (e.g., pulling or pushing) of control cable 356 causes bending of anti-pivot mechanism 306 and corresponding translation of components on the distal side of anti-pivot mechanism (i.e., end effector 304 and toggle assembly 310), while constraint cable 358 keeps coupling pairs 307a, 315d in parallel arrangement during such translation.

[0076] Compared to parallel motion mechanisms that include two coaxial tubes with cables running between an inner and outer tube, the design of the anti-pivot mechanism 306 offers several desirable features. For example, the anti-pivot mechanism 306 eliminates one of the two tubes in a parallel motion mechanism, allowing the outer diameter of the anti-pivot mechanism to be reduced from 6 mm or more to less than 5 mm, while also allowing for an increase in the inner diameter or cross-sectional area of ​​the central cavity 320, thus providing a larger inner diameter to outer diameter (or central cavity cross-sectional area to total cross-sectional area) ratio. The increased area of ​​the central cavity 320 allows the toggle and / or end effector cables to be routed through a coil within the central cavity 320, which helps to isolate the effects of toggle actuation loads on the alignment or orientation of the anti-pivot mechanism 306. The central cavity 320 may additionally accommodate wires (e.g., powering electrocautery tools), shape sensors, clamping controls (push-pull or pull-pull), and / or additional coils accommodating these components. In some examples, the compact arrangement of multiple components extending through the central cavity 320, such as wires, shape sensors, clamping controls, etc., can resemble a coil to isolate the actuating load from the elbow and / or end effector cables without using a coil. For example, during upper or lower gastrointestinal procedures, the reduced outer diameter of the elongated tube 314 can improve the applicability of the instrument 300 for intraluminal use in tight anatomical spaces, where it can be inserted through the working channel of a flexible, steerable body.

[0077] Furthermore, the proposed design simplifies the manufacture and assembly of the anti-pivot mechanism 306. For example, wiring controls and / or cable restraints within the outer surface of the wall of the elongated tube 314 eliminates the need for a separate internal tube. Compared to existing devices, these cables can be quickly inserted radially from the outside of the elongated tube into the recesses 316, 318, eliminating the difficult task of longitudinally feeding the cables through narrow openings in the anti-pivot mechanism. The ability to externally inspect the cable wiring after installation also allows for visual confirmation that the cable wiring is appropriate and that no incorrect crossings have occurred.

[0078] Figure 5AAn example of a proximal joint assembly 312 including a pair of joints 309a, 309b is shown. The first joint 309a includes a first joint 307a and a second joint 307b. The second joint 309b includes a third joint 307c and a fourth joint 307d. The first joint 307a and the third joint 307c may be identical or may each have unique features. Similarly, the second joint 307b and the fourth joint 307d may be identical or may each have unique features. In some examples, the first joint 309a and the second joint 309b may each include a common central joint, instead of having two discrete pairs of joints.

[0079] Each of the first joints 307a and the third joint 307c includes a first mating feature 319a, while each of the second joints 307b and the fourth joint 307d includes a corresponding second mating feature 319b, such that each joint pivots about a rotational axis extending through the first and second mating features. The various mating features are arranged as described in U.S. Patent No. 6,817,974 (filed June 28, 2002) (disclosing “Surgical Tool Having Positively Positionable Tendon-Actuated Multi-Disk Wrist Joint”), which is incorporated herein by reference in its entirety. Joints 307 can be secured together by any suitable first and second mating features 319a, 319b, such as a pair of grooves and corresponding protrusions as shown, by a hinge pin extending along the rotational axis, by radial segments of interlaced gear teeth, or by any other suitable securing mechanism. Figure 5A The arrangement shown implies that the axis of rotation of the first joint 309a is orthogonal to the axis of rotation of the second joint 309b. In this respect, the two joints 309a and 309b facilitate pivotal movement of the device 300 in both the yaw and pitch directions, and any combination thereof. The distal joint assembly 313 can be coupled with… Figure 5A The proximal joint assembly 312 shown is identical, but may also have unique features. For example, the anti-pivot mechanism 306 may have more proximal joints 309 than the distal joints 311, or it may have more distal joints 311 than the proximal joints 309. The distal connector 315 of the distal joint assembly 313 may have different mating features than the proximal connector 307 of the proximal joint assembly 312.

[0080] Figure 5BAn example of a first joint 307a is shown, having a central cavity 328, multiple control cable cavities 330, and multiple constraint cable cavities 332. A first mating feature 319a includes a pair of protrusions configured to pivotally engage corresponding recesses on adjacent joints 307. Multiple recesses 324 are provided for mating engagement with protrusions 322 of adjacent joints 307, adapters 308, or elongated tubes 314. Other joints 307 of the proximal articulation assembly 312 and joints 315 of the distal articulation assembly 313 may have similar or related features.

[0081] Figure 6 Another example of adapter 308 is shown, which can be similar to Figure 3 The adapter 308 is shown. A flange 336 at the proximal end of the adapter 308 can be sized to receive and engage the distal end of the elongated shaft 302 via any suitable mechanism (fastener, adhesive, etc.). The distal portion of the adapter 308 includes a plurality of anchor recesses 340, each configured to receive a proximal anchor 352 for a corresponding constraint cable. A plurality of control cable cavities 338 extend between adjacent anchor recesses 340. A control cable 356 extends through a coil in the elongated shaft 302 of the device 300, the coil terminating within the adapter 308. The control cable 356 then extends through the control cable cavities 338 and into the proximal joint assembly 312 of the anti-pivot mechanism 306. The distal end face of the adapter 308 includes a plurality of protrusions 322 configured to engage corresponding recesses of adjacent joints, such as the first joint 307a. Alternatively, adapter 308 may include a recess configured to engage a corresponding protrusion on adjacent side connector 307. In some examples, adapter 308 may be soldered to adjacent side connector 307.

[0082] Figures 7A-7B The proximal and distal sides of the anchoring joint 342 are shown respectively. The anchoring joint 342 is configured to be positioned between the distal joint assembly 313 and the elbow assembly 310, as shown. Figure 3As shown. Similar to adapter 308, couplings 307, 315, and elongated tube 314, anchor coupling 342 also includes a central cavity 344 aligned with central cavities 320, 328, and 334 in the anti-pivot mechanism 306 to accommodate pull cables, control cables, and other mechanisms extending from the elongated shaft 302 to the toggle assembly 310 and / or end effector 304. Anchor coupling 342 includes a plurality of supports 346 extending into the central cavity 344. The supports 346 may act as wedges or pillars for anchoring the control cable 356. In some examples, a pair of control cables 356 may comprise a single cable extending from the proximal end of the elongated shaft 302 to the anchor joint 342, looped around one of the support members 346 and / or other features of the anchor joint 342, and then extending back through the elongated shaft 302. With the central portion of the cable secured to the anchor joint 342, this single cable can function as two separate control cables 356. In the illustrated example, the support member 346 includes a curved surface configured to accommodate a correspondingly shaped outer surface of the coil through which the end effector and / or toggle assembly control cables extend. While it will be understood that the support 346 may be omitted in some examples because the control cable 356 may be anchored in another way (e.g., a coil), when included, they help to hold the coil in their respective corners of the central cavity 344 (and central cavities 320, 328 and 334), thus leaving an opening in the center of the central cavity 344 that can accommodate wires, end effector push rods or pull rods, tools (e.g., biopsy needles), etc.

[0083] The proximal side of the anchoring joint 342 includes a plurality of anchoring recesses 350 configured to receive a distal anchoring member 354 (e.g., a coil or sleeve) of a corresponding constraint cable 358. A plurality of control cable cavities 348 extend through the anchoring joint 342 such that a control cable 356 passes through the control cable cavity 348 and is secured to the anchoring joint. It should be understood that in other examples, the control cable 356 and / or the constraint cable 358 may terminate on the distal or proximal side of the anchoring joint 342 and may be anchored in any suitable manner. In some examples, the anchoring joint 342 may be omitted, and the control cable 356 and the constraint cable 358 may be anchored to a joint of another component, such as the distal joint assembly 313, or to an end effector component, such as the proximal elbow joint.

[0084] Figures 8A-8B A top view of the bending of the anti-pivot mechanism 306 according to some embodiments is shown. Figure 8A In this configuration, the anti-pivot mechanism 306 is in a neutral or upright position, wherein all joints 309a-b and 311a-b are linearly aligned with the longitudinal axis 361 of the elongated tube 314. Figure 8B In this configuration, control cable 356 has been actuated (e.g., by an actuator of remotely operated manipulator assembly 102) to bend joint 311a to the left in a first direction (e.g., yaw direction). This pivoting movement induces tension in the restraint cable, which is not directly controlled by the actuator. The tension in the restraint cable applies a reciprocating actuation force to joint 309b, causing it to bend to the right by an equal amount in a direction opposite to the first direction, thereby maintaining the parallel orientation between proximal joint 307a and distal joint 315d. For this purpose, anchor joint 342 and other components distal to it remain in the same orientation relative to adapter 308 and / or elongated shaft 302 as before the actuation of anti-pivot mechanism 306. That is, in the absence of any individual actuation of toggle assembly 310 or end effector 304, components of toggle assembly 310 and end effector 304 will bend to the left when anti-pivot mechanism 306 is actuated (e.g., from...). Figure 8A Configuration-induced motion Figure 8B The configuration of the two axes (302 and 302) maintains the same orientation relative to the far end of the slender axis 302, but their relative orientation will change (i.e., translate).

[0085] Because the control cable 356 is spirally wound around the elongated tube at approximately 180°, the control cables extending along the right side of joints 307a-d are the same control cables extending along the left side of joints 315a-d. To this end, one control cable is configured to pass through the right side of joint 309b, spirally wound around the elongated tube 314, and exit the elongated tube 314 on the left side of joint 311a. This reduces the actuation force required to actuate the anti-pivot mechanism 306 or can double the applied force—compared to a design where the control cable extends substantially straight through the anti-pivot mechanism without spiral winding. The spiral winding of the control cable 356 also increases the stiffness of the joints in the anti-pivot mechanism 306.

[0086] exist Figure 8BIn the example shown, control cable 356 has been actuated in such a manner that joints 309a and 311b remain in their neutral orientation. However, it should be understood that joints 309a and 311b may be actuated in the pitch direction, while non-joints 309b and 311a may be actuated in the yaw direction, or all joints 309a-b and 311a-b may be actuated simultaneously to provide pitch and yaw movement while maintaining the parallel alignment of anchor joint 342 and adapter 308. In the example shown, inner joints 309b and 311a have parallel axes of rotation, while outer joints 309a and 311b have parallel axes of rotation, such that the inner joints are mirror images of each other, and the outer joints are mirror images of each other. It will be understood that in some examples, the joints may be arranged in a variety of alternative configurations. For example, the proximal joint 309a of the proximal joint assembly may be arranged parallel to the proximal joint 311a of the distal joint assembly, while the distal joint 309b of the proximal joint assembly may be arranged parallel to the distal joint 311b of the distal joint assembly.

[0087] Multiple control cables 356 can be simultaneously actuated to induce the desired movement of the anti-pivot mechanism 306. For example, in an example where the control cables 356 are arranged in pairs of opposing cables (e.g., spaced 180° apart), the first control cable can be pulled (e.g., its length decreased), while the opposing second control cable is released at substantially the same rate (e.g., its length increased), creating cable length conservation. In some examples, each control cable can be actuated by a separate actuator. In some examples, opposing control cables can be actuated by a single actuator, wherein the proximal end of each control cable is wound around a capstan in the opposing direction, the capstan being configured to be rotated by the actuator. Cable length conservation helps maintain the desired tension in the control cables to prevent derailment of slack cables and / or excessive tension in the cables that could damage the cables or other components.

[0088] Figure 9 A cross-section taken along the longitudinal axis 361 of the elongated tube 314 of the anti-pivot mechanism 306 is shown. As described above, a plurality of toggle and / or end-actuator control elements (e.g., cables) may extend through the central cavity 320 of the anti-pivot mechanism 306. Optionally, as further described above, a coil 360 may additionally extend through the central cavity 320 of the anti-pivot mechanism 306. The coil 360 may surround or house the toggle and / or end-actuator control cables 362 while isolating the axial loads caused by the actuation of the toggle and / or control cables 362 from the anti-pivot mechanism 306 to prevent the anti-pivot mechanism 306 from bending in response to the actuation force on the toggle control cables 362. Conversely, when the anti-pivot mechanism 306 is actuated, the coil 360 also prevents the anti-pivot mechanism 306 from applying forces on the toggle control cables 362 that would otherwise tend to manipulate the toggle.

[0089] Figures 10-11 The distal and proximal ends of the anti-pivot mechanism 306 are shown respectively, with couplings 307 and 315 removed to avoid obscuring other features. Figure 10 At the distal end shown, as mentioned above... Figures 7A-7B The distal anchor 354 of the restraint cable 358 may be received in an anchor recess on the proximal side of the anchor joint 342. In some examples, the distal anchor 354 may be secured to the anchor joint 342 and / or the distal joint 315d, while in other examples, the distal anchor 354 may be secured only to the restraint cable 358 itself to prevent the distal end of the restraint cable from being withdrawn through the restraint cable cavity 332 in the distal joint 315d. The control cable 356 may pass through the control cable cavity 348 in the anchor joint 342 and is anchored distally thereto. In some examples, the control cable 356 is tied around a component of the anchor joint 342, such as a support 346. In some examples, each of the control cables 356 is secured to an anchor on the proximal or distal side of the anchor joint 342, similar to the distal anchor 354, wherein the anchor recess (e.g., Figure 7A Anchor recess 350) accommodates the anchor. In some examples, anchor joint 342 may be omitted, and the distal anchor 354 on the constraint cable 358 and similar anchors on the control cable 356 may abut against the distal joint of the distal joint assembly (e.g., Figure 8A The distal anchorage of the distal connector 315d in the middle is located distally. In some examples, the distal anchorage 354 on the constraint cable 358 and a similar anchorage on the control cable 356 can be received in the anchorage recess (similar to the anchorage recess). Figure 6 The anchoring recess 340 in the adapter 308 shown is formed in the proximal end of the elbow component (e.g., proximal elbow joint 305a) or the device 300 disposed on the distal side of other components of the anti-pivot mechanism 306.

[0090] At the proximal end of the anti-pivot mechanism 306, such as Figure 11 As shown, the proximal anchor 352 of the restraint cable 358 can be received in the anchor recess in the adapter 308. In some examples, the proximal anchor 352 can be secured to the adapter 308 and / or the proximal connector 307a, while in other examples, the proximal anchor 352 can be secured only to the restraint cable 358 itself and can be adjacent to the proximal connector 307a to prevent the proximal end of the restraint cable from being withdrawn through the restraint cable cavity 332 in the proximal connector 307a. The control cable 356 passes through the control cable cavity in the adapter 308. Figure 6 The cavity 338 extends through the slender shaft 302.

[0091] In the example shown, the control cable cavities in the anchor joint 342 and adapter 308 are aligned with the second groove 318 on the elongated tube 314, such that the control cable extends linearly from the adapter 308 through the proximal joint assembly 312 to the elongated tube 314, and linearly from the elongated tube 314 through the distal joint assembly 313 to the anchor joint 342, while the control cable is spirally wound through the elongated tube 314. In contrast, the constraint cable 358 is positioned radially inward at the anchor joint 342 and adapter 308—compared to their orientation in the first groove 316 on the elongated tube 314. This allows for [further details regarding the arrangement of joints 307 and 315]. Figure 10 and Figure 11 As can be seen, the constraint cables 358 are slightly bent at both the proximal and distal ends of the elongated tube 314. This arrangement allows the constraint cables 358 to be radially inwardly biased within the elongated tube 314, which helps to retain the control cables 356 in their respective recesses.

[0092] It will be understood that in other examples, control cable 356 and / or constraint cable 358 may be positioned radially inward or radially outward in one or more components of anti-pivot mechanism 306 (e.g., elongated tube 314, in joint assemblies 312, 313, in adapter 308 and / or in anchoring joint 342) as shown in the examples illustrated.

[0093] Figure 12 A cross-section of the anti-pivot mechanism 306 along its longitudinal axis is shown, wherein the toggle control cables 362 and their respective coils 360 are removed from the central cavities 320, 328, 334, 344 of the various components to avoid obscuring other features. Although the coils for the toggle control cables 362 are not shown, two of the four coils 360 for the control cables 356 are shown extending along the length of the elongated axis 302 and terminating in the adapter 308. The control cables 356 extend from the distal ends of the coils 360 through the control cable cavity 338 of the adapter 308. Although the example shown and its description involve four control cables 356 and four constraint cables 358, it should be understood that any suitable number of control cables 356 or constraint cables 358 may be used.

[0094] Figure 13A and Figure 13BA cross-section of the elongated tube 314 is shown, taken in planes transverse to the longitudinal axis and spaced apart along the length of the elongated tube 314. It can be seen that four toggle control cables 362 and their respective coils 360 extend through the central cavity 320. Consideration is given to the fact that the coils 360 for the toggle control cables 362 can be removed, thereby allowing the outer diameter of the central cavity 320, and consequently the elongated tube 314, to be manufactured smaller. Providing four toggle control cables 362, as shown, allows for multiple degrees of freedom in controlling the toggle assembly 310 and the end effector 304. For example, in... Figure 3 In the case of the gripper shown, the four toggle control cables 362 allow control in three degrees of freedom, including jaw pitch, yaw, and opening / closing.

[0095] exist Figure 13A At the cross-section shown, multiple first grooves 316 and multiple second grooves 318 circumferentially overlap, causing the constraint cable 358 to cross the control cable 356. Figure 13B At the cross-section shown, multiple first grooves 316 are circumferentially offset from multiple second grooves 318. It will be understood that... Figure 13A and Figure 13B This difference arises because the first groove 316 is substantially linear along the elongated tube 314, while the second groove 318 spirally wraps around the elongated tube 314, for example... Figure 4 As shown.

[0096] Although Figures 13A-13B Not shown, but it is conceivable that shape sensors, such as fiber optic shape sensors, could extend through the anti-pivot mechanism 306 to measure the bending angles of joints 309, 311, elbow assembly 310, and / or end effector 304. Such shape sensors could pass through the central cavity of each component of the anti-pivot mechanism 306 (e.g., the central cavity 320 of the elongated tube 314) or through cavity wiring formed within the walls of each component, similar to control cable wiring.

[0097] In addition to or as an alternative to the elbow control cable 362, one or more wires may be routed through the central cavity to power the end effector as needed, such as an ablation tool or imaging device. Similarly, one or more control levers for pushing or pulling to actuate the end effector, such as a gripper, may be routed through the central cavity.

[0098] Figures 14-16 Cross-sectional views of various alternative arrangements of the elongated tube 314 of the anti-pivot mechanism 306 are shown. Figure 14 In, with Figure 13BIn contrast, the plurality of first grooves 316 are replaced by a plurality of channels in the form of a constraint cable cavity 370 formed in the wall of the elongated tube 314, such that the constraint cable 358 extends through the constraint cable cavity 370. Figure 15 In this configuration, the plurality of first recesses 316 are replaced by a plurality of channels including a constraint cable conduit 372, which may include or resemble a coil, such that the constraint cable 358 extends through the constraint cable conduit 372 within the central cavity 320. Optionally, the constraint cable conduit 372 may be omitted. Figure 16 In this configuration, multiple first grooves 316 are replaced by multiple channels, including a constraint cable groove 374, which is formed on the inner surface of an elongated tube 314 within the central cavity 320, such that the constraint cable 358 extends within the constraint cable groove 374. (As mentioned above...) Figures 10-11 As discussed, compared to the position of the constraint cable 358 within the joint assemblies 312, 313, the constraint cable 358 can be positioned radially inward within the constraint cable groove 374. To this end, the constraint cable 358 can be biased outward within the elongated tube 314, which helps to retain the constraint cable 358 within the constraint cable groove 374.

[0099] In some examples, a method of manufacturing a reverse pivoting mechanism 306 or an apparatus 300 having a reverse pivoting mechanism may include forming an elongated tube 314. The elongated tube may be constructed from any suitable material (one or more) that provides sufficient rigidity to resist bending, including but not limited to ceramics, plastics, thermoplastics, polyvinyl chloride (PVC), polyamide-imide (PAI), polyetheretherketone (PEEK), polyethylene terephthalate (PET), polycarbonate, acrylic acid, steel, stainless steel, titanium, aluminum, cobalt, nickel, molybdenum, chromium, metal alloys, etc. The elongated tube may be constructed using one or more of a variety of manufacturing methods, including but not limited to injection molding, casting, subtractive manufacturing methods such as machining, and / or additive manufacturing methods such as fused deposition modeling, powder bed sintering, etc.

[0100] In some examples, the elongated tube 314 is formed from a cylindrical blank workpiece of stock material. The stock material can be a round tube or a solid rod. If desired, the central cavity 320 can be formed, for example, by machining along the longitudinal axis of the blank. One or more sets of grooves and / or channels can be formed, for example, by machining or milling, through the wall of the workpiece, into the outer surface of the workpiece, or into the inner surface of the workpiece defining the central cavity. In one example, two sets of grooves are formed in the outer surface of the workpiece. The first set of grooves 316 is formed linearly along the length of the tube parallel to the longitudinal axis, while the second set of grooves 318 is formed helically around the workpiece using, for example, a 4-axis CNC milling machine. The second set of grooves can be milled deeper into the workpiece than the first set of grooves, and vice versa.

[0101] In some examples, additive manufacturing is used to form an elongated tube 314 from powder material. In one example, a laser beam or electron beam can be controlled to melt a continuous layer region of powder material in a powder bed. In another example, a polymer can be used to fuse the layers of powder material together. The workpiece is then heated, for example in a furnace, to melt the polymer from the workpiece and sinter the remaining powder together. Additive manufacturing may be preferred in examples where machining may be difficult, such as in those where the channel for receiving cables is formed as a cavity extending axially or helically within the wall of the elongated tube, or as a groove extending along the inner surface of the central cavity of the elongated tube.

[0102] In some examples, a combination of subtractive and additive manufacturing methods can be used to form the slender tube 314.

[0103] The joint 307 can also be constructed using any suitable subtractive or additive manufacturing method (one or more). The joint 309 can be constructed by mating a first mating feature 319a and a corresponding second mating feature 319b of the joint pair. The joints can then be assembled together to form a proximal joint assembly 312 and a distal joint assembly 313 by engaging a plurality of protrusions 322 on adjacent joints with corresponding a plurality of recesses 324. Adhesives can be used to secure adjacent joints together.

[0104] The joint assemblies 312 and 313 can be secured to the elongated tube 314 via a snap-fit ​​and / or adhesive between corresponding mating protrusions 322 and recesses 324. If present, the anchoring joint 342 can be secured to the distal end of the distal joint assembly 313 in a similar manner. Similarly, the distal joint assembly 313 or the anchoring joint 342 (if present) can be secured to the elbow assembly 310 (if present) or the end effector 304, while the proximal joint assembly 312 can be secured to the elongated shaft 302 or the adapter 308.

[0105] A method of manufacturing a reverse pivoting mechanism 306 or an apparatus 300 having a reverse pivoting mechanism may further include wiring a set of constraint cables 358 through a first set of grooves or channels in an elongated tube 314, and wiring a set of control cables 356 through a second set of grooves or channels in the elongated tube. In an example where both constraint cables and control cables are disposed in sets of grooves formed in the outer surface of the elongated tube, and one set of grooves is deeper than the other, the cable corresponding to the deeper groove (e.g., the control cable) may be inserted first, followed by the cable corresponding to the shallower groove (e.g., the constraint cable). Compared to having each cable pass longitudinally through a channel in the elongated tube, such an example improves efficiency and reduces overall assembly time by allowing the cables to be inserted radially into the elongated tube in a direction transverse to the longitudinal axis.

[0106] Control cables 356 and restraint cables 358 can be routed through various components of the device 300 at any suitable step in the assembly process. In one example, control cables 356 and restraint cables 358 may first be routed through an elongated tube 314, and proximal articulation assembly 312 and distal articulation assembly 313 (or each of their individual joints) may slide on the respective ends of the control and restraint cables, with the cables passing through corresponding cavities in each joint 307. A proximal anchor 352 may be secured to the proximal end of restraint cable 358, while a distal anchor 354 may be secured to the distal end of restraint cable 358. The distal end of control cable 356 may be secured to the distal end of anti-pivot mechanism 306 (e.g., at anchor joint 342). The proximal end of control cable 356 may then be fed into elongated shaft 302 before anti-pivot mechanism 306 is secured to elongated shaft 302. In another example, after the elongated tube 314 is assembled to the proximal joint assembly 312 and the distal joint assembly 313 and before the anti-pivot mechanism 306 is secured to the elongated shaft 302, the control cable 356 and the restraint cable 358 are fed through the anti-pivot mechanism 306. In another example, the restraint cable 358 is routed through the anti-pivot mechanism 306 and secured thereto using the proximal anchor 352 and the distal anchor 354, then the anti-pivot mechanism 306 is secured to the elongated shaft 302, and then the control cable is routed through the anti-pivot mechanism 306 and secured to its distal end (e.g., at the distal end of the anchor joint 342).

[0107] When the toggle assembly 310 and / or end effector 304 are secured to the anti-pivot mechanism 306, the remote control mechanisms—including toggle assembly control cables, end effector control cables, or other end effector devices such as wires for electrotherapy, ablation, imaging, etc., each optionally housed in a coil—can be wired through the central cavities 320, 328, and 334. This can occur before or after the anti-pivot mechanism 306 is secured to the elongated shaft 302.

[0108] In the description, specific details describing some examples have been set forth. Numerous specific details have been set forth to provide a thorough understanding of the examples. However, it will be apparent to those skilled in the art that some examples can be practiced without some or all of these specific details. The specific examples disclosed herein are intended to be illustrative and not restrictive. Those skilled in the art will recognize that other elements, though not specifically described herein, are also within the scope and spirit of this disclosure.

[0109] Elements described in detail with reference to an example, instance, embodiment, or application may optionally be included in other examples, embodiments, or applications that are not specifically shown or described therein. For example, if an element is described in detail with reference to an example but not with reference to a second example, that element may still be required to be included in the second example. Therefore, to avoid unnecessary repetition in the foregoing description, one or more elements shown and described in conjunction with an example, embodiment, or application may be incorporated into other examples, embodiments, or applications unless specifically described otherwise, unless the one or more elements would render the example or embodiment inoperable, or unless the two or more elements provide conflicting functionality. Similarly, it should be understood that any particular element, including system components or method processes, is optional and should not be considered an essential feature of this disclosure unless expressly stated otherwise.

[0110] As would normally occur to those skilled in the art related to this disclosure, any changes and further modifications to the apparatus, instruments, and methods described herein, as well as any further application of the principles of this disclosure, are fully anticipated. In particular, it is fully anticipated that features, components, and / or steps described with respect to one example may be combined with features, components, and / or steps described with respect to other examples of this disclosure. Furthermore, the dimensions provided herein are for specific examples, and it is anticipated that the concepts of this disclosure may be implemented using different sizes, dimensions, and / or ratios.

[0111] While this document provides examples within the context of medical procedures, any references to medical or surgical instruments and methods are non-limiting. For example, the instruments, systems, and methods described herein can be used for non-medical purposes, including industrial applications, general robotic applications, and sensing or manipulating non-tissue artifacts. Other example applications include cosmetic improvements, imaging of human or animal anatomy, collecting data from human or animal anatomy, and training medical or non-medical personnel. Further example applications include procedures on tissue removed from human or animal anatomy (without returning the anatomy) and procedures performed on human or animal cadavers. Furthermore, these techniques can also be used in surgical or non-surgical medical treatments or diagnostic procedures.

[0112] The methods described herein are shown as a set of operations or procedures. Not all procedures shown are executable in all examples of the methods. Additionally, one or more procedures not explicitly shown or described may be included before, after, between, or as part of an example procedure. In some examples, one or more procedures may be executed by a control system (e.g., control system 112), or may be implemented at least in part in the form of executable code stored on a non-transitory, tangible, machine-readable medium, which, when run by one or more processors (e.g., the processor of control system 112), causes one or more processors to perform one or more procedures.

[0113] One or more elements in the examples of this disclosure can be implemented in software to execute on a processor of a computer system, such as a control processing system. When implemented in software, the elements in the examples of this disclosure are essentially code segments that perform the desired tasks. Programs or code segments can be stored in processor-readable storage media or devices that may have been downloaded via computer data signals embodied as carrier waves over a transmission medium or communication link. Processor-readable storage devices can include any medium capable of storing information, including optical, semiconductor, and magnetic media. Examples of processor-readable storage devices include electronic circuits; semiconductor devices, semiconductor storage devices, read-only memory (ROM), flash memory, erasable programmable read-only memory (EPROM); floppy disks, CD-ROMs, optical disks, hard disks, or other storage devices. Code segments can be downloaded via computer networks such as the Internet, intranets, etc. Any of a wide variety of centralized or distributed data processing architectures can be employed. Programmed instructions can be implemented as multiple individual programs or subroutines, or they can be integrated into multiple other aspects of the system described herein. In one example, the control system supports wireless communication protocols such as Bluetooth, IrDA, HomeRF, IEEE 802.11, DECT, and wireless telemetry.

[0114] Please note that the processes and displays presented may not inherently relate to any particular computer or other device. Various general-purpose systems can be used in conjunction with the teachings and procedures herein, or it may prove convenient to construct more specialized devices to perform the described operations. The necessary structures for various such systems will appear as elements in the claims. Furthermore, examples of this disclosure are described without reference to any particular programming language. It will be understood that the teachings of this disclosure can be implemented using various programming languages.

[0115] This disclosure describes the states of various instruments, parts of instruments, and anatomical structures in three-dimensional space. As used herein, the term "orientation" refers to the position of an object or part of an object in three-dimensional space (e.g., three translational degrees of freedom along Cartesian x, y, and z coordinates). As used herein, the term "orientation" refers to the rotational placement of an object or part of an object (three rotational degrees of freedom—e.g., roll, pitch, and yaw). The "pitch" and "yaw" directions are not necessarily limited to vertical and horizontal movements, respectively, but can be any directions orthogonal to each other. As used herein, the term "pose" refers to the orientation of an object or part of an object in at least one translational degree of freedom and the orientation of the object or part of an object in at least one rotational degree of freedom (up to six degrees of freedom in total). As used herein, the term "shape" refers to a set of poses, orientations, or orientations measured along the length of an object.

[0116] While certain exemplary examples of this disclosure have been described and illustrated in the accompanying drawings, it should be understood that these examples are merely illustrative and not intended to limit the broad scope of the disclosure herein, and that the examples of this disclosure should not be limited to the specific constructions and arrangements shown and described, as various other modifications will be apparent to those skilled in the art.

Claims

1. An apparatus having a reverse pivoting mechanism, comprising: An elongated shaft having a proximal portion and a distal portion; Anti-pivot mechanism, the anti-pivot mechanism comprising: A first joint connected to the distal portion of the elongated shaft, the first joint including a first connector; A second joint is disposed distal to the first joint, the second joint including a second connector; A slender tube disposed between the first joint and the second joint and having a central cavity extending along the longitudinal axis of the slender tube; and A plurality of constraint cables extend within a plurality of first grooves formed in the outer peripheral surface of the wall of the elongated tube between the first and second joints; and A plurality of control cables extend through the elongated shaft and are configured to control the operation of the anti-pivot mechanism, wherein the plurality of control cables are helically wound around at least a portion of the elongated tube within a plurality of second grooves formed in the outer circumferential surface of the wall of the elongated tube. The first joint and the second joint are connected by the plurality of constraint cables, such that when the anti-pivot mechanism is operated by the plurality of control cables, the first joint pivots along a first direction, and the second joint pivots along a second direction opposite to the first direction, while the first joint and the second joint are maintained in a parallel orientation.

2. The device of claim 1, wherein each of the plurality of control cables is secured to the second joint.

3. The device according to claim 1, further comprising: A third joint, which is connected to the first joint; and A fourth joint, which is connected to the second joint, wherein the first and second joints are configured to pivot in the pitch direction, and wherein the third and fourth joints are configured to pivot in the yaw direction.

4. The apparatus of claim 1, wherein each of the plurality of control cables exits the wall of the elongated tube at a position approximately 180° circumferentially offset from the longitudinal axis of the position where each respective control cable enters the wall of the elongated tube.

5. The device according to any one of claims 1-4, wherein the plurality of second grooves are formed deeper in the wall than the plurality of first grooves, such that the plurality of constraint cables are arranged radially outward from the plurality of control cables within the elongated tube.

6. The device according to any one of claims 1-4, wherein the plurality of first grooves are formed deeper in the wall than the plurality of second grooves, such that the plurality of constraint cables are arranged radially inward from the plurality of control cables within the elongated tube.

7. The device according to claim 1, wherein the ratio of the cross-sectional area of ​​the central cavity to the cross-sectional area of ​​the elongated tube is greater than 1:

2.

8. The apparatus of claim 1 further includes an end effector disposed distal to the anti-pivot mechanism.

9. The device of claim 8, wherein the end effector includes an elbow joint, and a plurality of elbow control cables extend through the central cavity of the elongated tube and are secured to the elbow joint.

10. The device of claim 9, wherein the plurality of elbow control cables are disposed within a plurality of coils extending through the central cavity of the elongated tube.

11. The device of claim 8, wherein the end effector comprises an electrocautery knife or ablation tool, and a wire extends through the central cavity of the elongated tube.

12. The device according to any one of claims 1-4, further comprising a shape sensor extending through the first joint and the second joint.

13. The device of claim 8, wherein the end effector includes a gripper, and a plurality of gripping control cables extend through the central cavity of the elongated tube and are secured to the gripper.

14. A method for controlling an apparatus having a reverse pivoting mechanism, comprising: A control cable is manipulated from at least one of a plurality of control cables extending through an elongated shaft of the device, the device having a proximal portion, a distal portion, and an anti-pivot mechanism, the anti-pivot mechanism comprising: A first joint connected to the distal portion of the elongated shaft, the first joint including a first connector; A second joint is disposed distal to the first joint, the second joint including a second connector; A slender tube disposed between the first joint and the second joint and having a central cavity extending along the longitudinal axis of the slender tube; and Multiple constraint cables extend linearly within multiple first grooves formed in the outer peripheral surface of the wall of the elongated tube between the first joint and the second joint, wherein at least one control cable extends through at least one of multiple spirally wound second grooves formed in the outer peripheral surface of the wall of the elongated tube. The first joint is pivoted along a first direction and the second joint is pivoted along a second direction opposite to the first direction by manipulating the at least one control cable, while the first joint and the second joint are maintained in a parallel orientation by the plurality of constraint cables.

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