Artificial intelligence for robotic surgery

Abstract

The present disclosure generally relates to artificial intelligence for robotic surgery. An apparatus for robotic surgery includes a processor configured with instructions to receive patient data from a treated patient, receive surgical robotic data for each of a plurality of treated patients, and output a treatment plan for the patient to be treated in response to the patient data and the surgical robotic data. The method has the advantage of adapting to individual variability and surgical system parameters among patients in order to provide improved treatment outcomes.

Description

[0001] This application is a divisional application of the application with international application number PCT / US2019 / 038574, international application date June 21, 2019, entry into the Chinese national phase date February 20, 2021, national application number 201980054839.4, and invention name “Artificial Intelligence for Robotic Surgery”.

[0002] Cross-references

[0003] This application claims the benefit of U.S. Provisional Application No. 62 / 688,349, filed on June 21, 2018, entitled “ARTIFICIAL INTELLIGENCE FOR SURGICAL ROBOTIC SURGERY,” the entire disclosure of which is incorporated by reference.

[0004] The subject matter of this application is related to PCT / US2015 / 048695, entitled “PHYSICIAN CONTROLLED TISSUE RESECTION INTEGRATED WITH TREATMENT MAPPING OF Target Organ Images”, filed on September 4, 2015; PCT / US2015 / 048687, entitled “GENE ANALYSIS AND GENERATION OF STEMCELL METHODS AND APPARATUS”, filed on September 4, 2015; PCT / US2015 / 038605, entitled “FLUID JET TISSUE RESECTION AND COLD COAGULATION (AQUABLATION) METHODS AND APPARATUS”, filed on June 30, 2015; and PCT / US2015 / 038606, entitled “FLUID JET TISSUE RESECTION AND COLD COAGULATION (AQUABLATION) METHODS AND APPARATUS”, filed on June 24, 2015. and PCT / US2014 / 054412, filed on September 5, 2014, entitled “AUTOMATED IMAGE-GUIDED TISSUE RESECTION AND TREATMENT”; these applications are hereby incorporated by reference in their entireties. background

[0006] Surgical robotics has led to new surgical procedures and improvements to existing surgical procedures. However, existing methods and devices for robotic surgery may be less than ideal in at least some aspects. For example, existing methods may not ideally address individual variability, such as tissue ablation rates and healing. In addition, additional factors (such as surgical preparation time and treatment time) may be related to outcomes and may not be ideally addressed with existing methods and devices.

[0007] At least some existing surgical procedures may not be ideally suited to tailor surgical procedures to the specific requirements of individual patients. For example, for prostate surgery (e.g., benign prostatic hyperplasia (BPH)), there may be a trade-off between surgical effectiveness and possible side effects. Prostate surgery may involve cutting or ablating BPH tissue near delicate tissue structures (e.g., caruncle of spermatozoa), which is often critical to male sexual function. Work related to the present disclosure suggests that it may be helpful to determine the location and amount of BPH tissue to be removed with respect to patient-specific preferences.

[0008] In light of the foregoing, improved methods and devices for surgical procedures would be helpful. Ideally, such methods and devices would improve upon at least some of the shortcomings of existing procedures.

[0009] Overview

[0010] In a first aspect, an apparatus for robotic surgery includes a processor configured with instructions to receive patient data from a patient to be treated, receive surgical robot data for each of a plurality of patients to be treated, and output a treatment plan for the patient to be treated in response to the patient data and the surgical robot data. This approach has the advantage of adapting to surgical system parameters and individual differences in patients, thereby providing improved treatment outcomes.

[0011] Incorporated by Reference

[0012] All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference. BRIEF DESCRIPTION OF THE DRAWINGS

[0014] The novel features of the present invention are particularly set forth in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by referring to the following detailed description and the accompanying drawings, which set forth illustrative embodiments in which the principles of the present invention are utilized, in which:

[0015] Figure 1 is a schematic diagram of an apparatus suitable for performing intraurethral prostate tissue debulking according to some embodiments;

[0016] Figures 2A-2D Pictured Figure 1 The use of devices to perform prostate tissue debulking;

[0017] Figure 3A and Figure 3B A system for treating a patient according to some embodiments is shown;

[0018] Figure 4A illustrates pressure regulation to a surgical site at substantially constant pressure and variable flow according to some embodiments;

[0019] Figure 4B illustrates flow regulation at a surgical site using a pump that provides a substantially fixed fluid flow rate and a substantially constant pressure according to some embodiments;

[0020] Figure 5A illustrates organs suitable for merging according to many embodiments;

[0021] Figure 5B Treatment with a device according to many embodiments is shown. Figure 5A of the prostate;

[0022] Fig. 6A shows an ablation flame visible to the human eye according to some embodiments;

[0023] Figure 6B It shows that Fig. 6A High-speed image of the ablation flame shown;

[0024] Figure 7 shows multiple shedding pulses and scanning of ablative jets to provide smooth and controlled tissue erosion at multiple overlapping locations in accordance with some embodiments;

[0025] Fig. 8A shows an attachment device according to some embodiments;

[0026] Figure 8B Components of the attachment device are shown;

[0027] Figure 8C showing components of an attachment device having a coupler in a partially retracted position and an elongated carrier including an energy source, the elongated carrier extending through the coupler toward a distal end of the elongated support;

[0028] Fig.8D showing a distal portion of an elongated holder and an elongated tube with a coupler mounted thereon;

[0029] Figures 8E1-8E4 shows a coupler according to some embodiments;

[0030] Fig.8F shows a bottom side view of a bracket according to some embodiments;

[0031] Figure 8G shows an end view of a bracket according to some embodiments;

[0032] Figure 8H shows an isolated endoscope according to some embodiments;

[0033] Figure 8I1 shows a side view of an endoscope according to some embodiments;

[0034] Figure 8I2 As shown in Figure 8I1 A side view along section AA in FIG.

[0035] Figure 8I3 Shows Figure 8I1 Cross-section BB of the endoscope;

[0036] Figure 8I4 As shown in Figure 8I1 Top view of the endoscope in;

[0037] Figure 8I5 As shown in Figure 8I1 The distal end of the endoscope in;

[0038] Figure 8J A housing of a bracket as described herein is shown;

[0039] Figure 8K shows an end view of an attachment device as described herein;

[0040] Figure 8L showing components of an arm configured to be coupled to an attachment device;

[0041] Figure 8M shows a view of the upper side of an attachment device according to some embodiments;

[0042] Figure 8N Components of an arm according to some embodiments are shown;

[0043] Figure 8O1 and Figure 8O2 Shows Figure 8N The internal structure of the arm component shown;

[0044] Figure 8P shows a linkage arrangement of an attachment device according to some embodiments;

[0045] Figure 8Q An encoder mounted on the proximal end of the carrier is shown;

[0046] Figure 8R1 An encoder according to some embodiments is shown;

[0047] Figure 8R2 A table showing coordinate references for different transitions measured with multiple photodetectors is shown;

[0048] Figure 8S showing a suction port on the distal end of a holder according to some embodiments;

[0049] Figure 8T shows a console according to some embodiments;

[0050] Fig.9A and Fig. 9B side and top views, respectively, showing alignment of a treatment probe axis with a sagittal plane of an imaging probe according to some embodiments;

[0051] Fig. 9C and Fig.9D 10 respectively show a side view and a top view of a treatment probe across a sagittal image plane field of view according to some embodiments;

[0052] Figures 10A-10T shows a treatment screen of a device according to some embodiments;

[0053] Fig.11 A method of treating a patient according to some embodiments is shown;

[0054] Fig.12 shows the maximum tissue penetration depth of the cut and the flow rate through the nozzle according to some embodiments;

[0055] Fig.13 shows the selective removal of a potato with a porcine blood vessel located over an incision in the potato as a model for selective removal of tissue according to some embodiments; and

[0056] Fig.14 illustrates a potato being treated using a predetermined treatment profile and treatment table based on user input according to some embodiments;

[0057] Fig.15 A method of treating a patient using artificial intelligence or machine learning according to some embodiments is shown;

[0058] Fig.16 shows a processor system according to some embodiments;

[0059] Figures 17A to 17C showing a user interface screen of an apparatus according to some embodiments;

[0060] Fig.18 showing a user interface screen of an apparatus according to some embodiments;

[0061] Figures 19A to 19D shows a representation of treatment of a patient according to some embodiments;

[0062] Fig. 20 A method of treating a patient according to some embodiments is shown;

[0063] Fig.21 illustrates an example convolutional neural network according to some embodiments; and

[0064] Fig. 22 Methods of training and using classifiers according to some embodiments are shown. Detailed Description

[0066] The method and apparatus disclosed herein are very suitable for combination with many types of surgery (e.g., prostate surgery and related methods and apparatus). The method and apparatus disclosed herein can be used to determine suitable treatment parameters and are suitable for combination with equipment using energy (e.g., mechanical energy, radiotherapy, water jet therapy, radiotherapy, laser ablation, and combinations thereof) for treating the prostate. The method and apparatus disclosed herein can be used with surgical robot systems having therapeutic image guidance, multidimensional imaging, autonomous robots, and ablation (e.g., no hot water jet ablation). The method and apparatus disclosed herein can be used to improve many types of surgical robot surgeries, such as articulated robot systems, rotation and swing axis systems, and systems including joints that can mimic human motion in response to user input. These systems can rely on image guidance, wherein surgical parameters are input into the system before treatment. The system can be established by the operator before surgery.

[0067] The systems and methods disclosed herein include multiple sensors, each of which is capable of measuring recorded states of robotic system components before, during, and after surgery, which can be used for analysis to improve surgical procedures and outcomes. For example, a surgical robotic system can include multiple parameters related to the state of the system and associated components, such as the angle of the axis, the longitudinal positioning of the axis, data related to the energy (e.g., pressure or irradiance) used to ablate tissue, real-time ultrasound imaging, and real-time endoscopic imaging (e.g., cystoscopic imaging). Data during treatment can be recorded in real time and used to generate multiple data frames corresponding to the state of the surgical robotic system throughout the treatment. The data frames can correspond to fixed time intervals between frames, such as one second, so as to provide input data suitable for processing with machine learning or artificial intelligence as described herein.

[0068] Although embodiments of the present disclosure are particularly directed to the treatment of the prostate, certain aspects of the present disclosure may also be used to treat and improve other organs and tissues, such as the brain, heart, lungs, intestines, eyes, skin, kidneys, liver, pancreas, stomach, uterus, ovaries, testicles, bladder, ears, nose, mouth, soft tissues (e.g., bone marrow), adipose tissue, muscle, glandular and mucosal tissues, spinal cord and nerve tissues, cartilage, hard biological tissues (e.g., teeth, bones), and body cavities and passages (e.g., sinuses, ureters, colon, esophagus, lung passages, blood vessels, and throat). The devices disclosed herein may be inserted through an existing body cavity, or through an opening created in body tissue.

[0069] Work related to the embodiments suggests that input patient data (e.g., demographic data and image data of the organ to be treated (e.g., the prostate) may be correlated with the results (e.g., cut cross-sections of tissue removed). Biopsy data (if available) may also be helpful in determining appropriate adjustments to the planned surgical treatment.

[0070] The input data can be generated and recorded from many types of surgical systems. The methods and apparatus disclosed herein are well suited for use in combination with many applications related to surgical robotics and can be combined with the hardware, processors, and software of many existing systems such as described in the following patents: PCT / US2015 / 048695, entitled “PHYSICIAN CONTROLLED TISSUE RESECTION INTEGRATED WITH TREATMENT MAPPING OF TARGET ORGAN IMAGES”, filed on September 4, 2015; PCT / US2015 / 048687, entitled “GENE ANALYSIS AND GENERATION OF STEM CELL METHODS AND APPARATUS”, filed on June 30, 2015; and PCT / US2015 / 048689, entitled “FLUID JET TISSUE RESECTION AND COLD COAGULATION (AQUABLATION) METHODS”, filed on June 30, 2015. and APPARATUS”; PCT / US2015 / 037521, filed on June 24, 2015, entitled “TISSUESAMPLING ANDCANCER TREATMENT METHODS AND APPARATUS”; and PCT / US2014 / 054412, filed on September 5, 2014, entitled “AUTOMATED IMAGE-GUIDED TISSUE RESECTION AND TREATMENT”; the entire disclosures of these applications are pre-incorporated by reference. Many of the components of the AQUABEAM SYSTEM commercially available from Procept BioRobotics are well suited for combination according to the embodiments disclosed herein.

[0071] Embodiments disclosed herein can be combined in many ways to provide improved treatment to patients. Although reference is made to some components in some figures and other components in other figures, it is contemplated that each of these components can be combined with any one or more of the other components to provide improved treatment to patients.

[0072] As used herein, the terms "proximal" and "distal" in the context of the device refer to the proximal and distal sides as referenced from the device outside the patient, such that proximal may refer to components outside the patient and distal may refer to components inside the patient.

[0073] As used herein, similar words and characters refer to similar structures.

[0074] As used herein, the terms "carrier probe" and "treatment probe" are used interchangeably.

[0075] As used herein, the terms "ablation" and "resection" are used interchangeably.

[0076] As used herein, "based on" and "responsive to" are used interchangeably.

[0077] As used herein, the terms "cutting profile" and "resection profile" are used interchangeably.

[0078] Figures 1 to 2D The subject matter and corresponding text of the present invention are incorporated by reference as described in the following applications: U.S. application serial number 12 / 700,568, filed on February 4, 2010, entitled “MULTI FLUID TISSUE RESECTION METHODS AND DEVICES,” published as US20110184391; and PCT application PCT / US2011 / 023781, filed on February 4, 2011, entitled “MULTI FLUID TISSUE RESECTION METHODS AND DEVICES,” published on November 8, 2011 as WO2011097505; the entire disclosures of these applications are pre-incorporated herein by reference.

[0079] The methods and devices disclosed herein are well suited for combination with a number of commercially available surgical systems and procedures, and may include those commercially available from Procept BioRobotics Inc. CORPORATION for One or more components of a surgical system for treatment. In some embodiments disclosed herein, a water jet immersed in saline is used to remove tissue and is referred to herein as "aqua-ablation."

[0080] refer to Figure 1, an exemplary prostate tissue debulking device 10 constructed according to the principles of the present invention includes a catheter assembly that generally includes a shaft 12 having a distal end 14 and a proximal end 16. The shaft 12 is generally a polymer extrusion that includes one, two, three, four or more axial lumens extending from a hub 18 at the proximal end 16 to a position near the distal end 14. The shaft 12 generally has a length in the range of from 15 cm to 25 cm and a diameter in the range of from 1 mm to 10 mm, generally from 2 mm to 6 mm. The shaft will have sufficient column strength so that it can be introduced upward through the male urethra, as described in more detail below.

[0081] The shaft includes an energy source located in the energy delivery region 20, wherein the energy source can be any of a number of specific components as discussed in more detail below. Distal to the energy delivery region, an expandable anchoring balloon 24 is located at or very near the distal end 14 of the shaft. The balloon is connected to a balloon expansion source 26 connected through the hub 18 through one of the axial lumens. In addition to the energy source 22 and the balloon expansion source 26, the hub optionally also includes connections for an infusion / irrigation source 28, a suction (vacuum) source 30, and / or an insufflation (pressurized CO2 or other gas) source 32. In an exemplary embodiment, the infusion or irrigation source 28 can be connected to one or more delivery ports 34 proximal to the balloon anchor 24 and distal to the energy delivery region 20 through an axial lumen (not shown). The suction source 30 can be connected to a second port or opening 36 located generally proximal to the energy delivery region 20, while the insufflation source 32 can be connected to an additional port 38 also located generally proximal to the energy delivery region. It will be appreciated that the location of ports 34, 36 and 38 is not critical, although certain positioning may result in particular advantages described herein, and that the lumen and delivery device may be provided by additional catheters, tubes and the like (e.g., including coaxial sleeves, sheaths and the like that may be located on shaft 12).

[0082] Although the present embodiments are described with reference to the human prostate, it should be understood that they are generally applicable to treating mammalian prostates. Figures 2A-2D , the prostate tissue debulking device 10 is introduced through the male urethra U into an area within the prostate P immediately distal to the bladder B. Figure 2A Once the catheter 10 is positioned so that the anchoring balloon 24 is just located at the bladder neck BN ( Figure 2B ), the balloon can be expanded to preferably occupy substantially the entire interior of the bladder, such as Figure 2CAs shown. Once the anchoring balloon 24 is inflated, the positioning of the prostate tissue debulking device 10 will be fixed and stabilized within the urethra U, so that the energy delivery area 20 is positioned within the prostate P. It will be appreciated that the correct positioning of the energy delivery area 20 depends solely on the expansion of the anchoring balloon 24 within the bladder. When the prostate is located immediately proximal to the bladder neck BN, the delivery area can be appropriately positioned by spacing the distal end of the energy delivery area very close to the proximal end of the balloon, typically within a range from 0 mm to 5 mm, preferably from 1 mm to 3 mm. After the anchoring balloon 24 is inflated, energy can be delivered into the prostate for debulking, as shown by the arrows in Figure 2. Once the energy has been delivered for a period of time and over the desired surface area, the energy area can be stopped and the prostate will be debulked to relieve pressure on the urethra, as shown in Figure 2. Figure 2D At that time, the irrigation fluid can be delivered through port 34 and drawn into port 36, as shown. Figure 2D Optionally, after treatment, the area may be cauterized using a cautery balloon and / or stent, which may be placed using a modified or separate catheter device.

[0083] Figure 3A and Figure 3B A system for treating a patient according to an embodiment is shown. System 400 includes a treatment probe 450 and may optionally include an imaging probe 460. Treatment probe 450 is coupled to console 420 and linkage 430. Imaging probe 460 is coupled to imaging console 490. Treatment probe 450 and imaging probe 460 of a patient may be coupled to a common base 440. The patient is supported by a patient support 449. Treatment probe 450 is coupled to base 440 using arm 442. Imaging probe 460 is coupled to base 440 using arm 444.

[0084] The patient is placed on the patient support 449 so that the treatment probe 450 and the ultrasound probe 460 can be inserted into the patient's body. The patient can be placed in one or more of many positionings (e.g., prone, supine, upright or tilted). In many embodiments, the patient is placed in lithotomy position, and for example, stapes can be used. In many embodiments, the treatment probe 450 is inserted into the patient's body in a first direction on the first side of the patient, and the imaging probe is inserted into the patient's body in a second direction on the second side of the patient. For example, the treatment probe can be inserted into the patient's urethra from the front side of the patient, and the imaging probe can be inserted into the patient's intestines from the rear side of the patient through the rectum. The treatment probe and the imaging probe can be placed in the patient's body, wherein one or more of urethral tissue, urethral wall tissue, prostate tissue, intestinal tissue or intestinal wall tissue extend therebetween.

[0085] Treatment probe 450 and imaging probe 460 can be inserted into the patient in one or more of many ways. During insertion, each arm can include a substantially unlocked configuration so that the probe can be ideally rotated and translated to insert the probe into the patient. When the probe is inserted into the desired position, the arm can be locked. In the locked configuration, the probe can be oriented relative to each other in one or more of many ways (e.g., parallel, skewed, horizontal, tilted, or non-parallel). In order to map the image data of the imaging probe to the treatment probe coordinate reference, it may be helpful to determine the orientation of the probe using an angle sensor as described herein. Mapping tissue image data to the treatment probe coordinate reference space can allow an operator (e.g., a doctor) to accurately aim and treat the tissue identified for treatment.

[0086] In many embodiments, the treatment probe 450 is coupled to the imaging probe 460. In order to align the treatment probe 450 based on the image from the imaging probe 460. The coupling can be achieved with a common base 440, as shown. Optionally or in combination, the treatment probe and / or the imaging probe can include magnets to keep the probe aligned through the patient's tissue. In many embodiments, the arm 442 is a movable and lockable arm so that the treatment probe 450 can be located at a desired position in the patient's body. When the probe 450 is located at the desired position of the patient, the arm 442 can be locked with an arm lock 427. The imaging probe can be coupled to the base 440 with an arm 444, which can be used to adjust the alignment of the imaging probe when the treatment probe is locked in place. The arm 444 can include a lockable and movable probe, for example, under the control of the imaging system or the console and the user interface. The movable arm 444 can be micro-actuated so that the imaging probe 440 can be adjusted with a small movement of, for example, about 1 mm relative to the treatment probe 450.

[0087] In many embodiments, the treatment probe 450 and the imaging probe 460 are coupled to angle sensors so that treatment can be controlled based on the alignment of the imaging probe 460 and the treatment probe 450. Angle sensor 495 is coupled to the treatment probe 450 with a support 438. Angle sensor 497 is coupled to the imaging probe 460. The angle sensor may include one or more of many types of angle sensors. For example, the angle sensor may include a goniometer, an accelerometer, and a combination thereof. In many embodiments, the angle sensor 495 includes a three-dimensional accelerometer to determine the orientation of the treatment probe 450 in three dimensions. In many embodiments, the angle sensor 497 includes a three-dimensional accelerometer to determine the orientation of the imaging probe 460 in three dimensions. Alternatively or in combination, the angle sensor 495 may include a goniometer to determine the angle of the treatment probe 450 along the elongate axis of the treatment probe. The angle sensor 497 may include a goniometer to determine the angle of the imaging probe 460 along the elongate axis of the imaging probe 460. The angle sensor 495 is coupled to the controller 424. An angle sensor 497 of the imaging probe is coupled to the processor 492 of the imaging system 490. Optionally, the angle sensor 497 may be coupled to the controller 424, and also in combination.

[0088] The console 420 includes a display 425 coupled to a processor system in a component for controlling a treatment probe 450. The console 420 includes a processor 423 having a memory 421. A communication circuit 422 is coupled to the processor 423 and the controller 422. The communication circuit 422 is coupled to an imaging system 490. The console 420 includes a component of an endoscope 35 coupled to an anchor 24. An infusion and flushing control 28 is coupled to the probe 450 to control infusion and flushing. An aspiration control 30 is coupled to the probe 450 to control aspiration. The endoscope 426 can be a component of the console 420 and an endoscope that can be inserted with the probe 450 to treat a patient. An arm lock 427 of the console 420 is coupled to the arm 422 to lock the arm 422 or allow the arm 422 to be freely movable to insert the probe 450 into the patient.

[0089] The console 420 may include a pump 419 coupled to a carrier and a nozzle as described herein.

[0090] The processor, controller, and control electronics and circuitry may include one or more of a number of suitable components, such as one or more processors, one or more field programmable gate arrays (FPGAs), and one or more memory storage devices. In many embodiments, the control electronics control a control panel of a graphical user interface (hereinafter "GUI") to prescribe a preoperative plan according to user-specified treatment parameters, as well as provide user control over the surgical procedure.

[0091] Treatment probe 450 includes anchor 24. Anchor 24 anchors the distal end of probe 450 while energy is delivered to energy delivery region 20 using probe 450. Probe 450 may include nozzle 200 as described herein. Probe 450 is coupled to arm 422 with linkage 430.

[0092] The linkage 430 includes components that move the energy delivery region 20 to a desired target location of the patient, for example, based on an image of the patient. The linkage 430 includes a first portion 432 and a second portion 434 and a third portion 436. The first portion 432 includes a substantially fixed anchor portion. The substantially fixed anchor portion 432 is fixed to a support 438. The support 438 may include a reference frame for the linkage 430. The support 438 may include a rigid chassis or frame or housing to rigidly and securely couple the arm 442 to the treatment probe 450. The first portion 432 remains substantially fixed while the second portion 434 and the third portion 436 move to direct energy from the probe 450 to the patient. The first portion 432 is fixed to a substantially constant distance 437 from the anchor 24. The substantially fixed distance 437 between the anchor 24 and the fixed first portion 432 of the linkage allows the treatment to be accurately placed. The first portion 424 may include a linear actuator to accurately position the high pressure nozzle in the treatment area 20 at a desired axial location along the long axis of the probe 450 .

[0093] The long axis of the probe 450 generally extends between the proximal portion of the probe 450 near the linkage 430 to the distal end having the anchor 24 attached thereto. The third portion 436 controls the angle of rotation about the long axis. During treatment of a patient, the distance 439 between the treatment area 20 and the fixed portion of the linkage varies relative to the anchor 24. The distance 439 is adjusted in response to computer control to set a target position along the long axis of the treatment probe with reference to the anchor 24. The first portion of the linkage remains fixed while the second portion 434 adjusts the positioning of the treatment area along the axis. The third portion of the linkage 436 adjusts the angle about the axis in response to the controller 424 so that the distance along the axis at the angle of treatment can be very accurately controlled with reference to the anchor 24. The probe 450 can include a rigid member, such as a spine extending between the support 438 and the anchor 24 so that the distance from the linkage 430 to the anchor 24 remains substantially constant during treatment. The treatment probe 450 is coupled to the treatment component as described herein to allow treatment with one or more forms of energy (e.g., mechanical energy from a jet, electrical energy from an electrode, or light energy from a light source such as a laser source). The light source may include infrared light, visible light, or ultraviolet light. The energy delivery region 20 may be moved under the control of the linkage 430 so as to deliver the desired form of energy to the target tissue of the patient.

[0094] The imaging system 490 includes a memory 493, a communication circuit 494, and a processor 492. The processor 492 in a corresponding circuit is coupled to the imaging probe 460. The arm controller 491 is coupled to the arm 444 to precisely position the imaging probe 460.

[0095] Figure 4A Pressure regulation of a surgical site with substantially constant pressure and variable flow is shown. A saline bag is placed at a height to provide substantially constant pressure regulation. The saline bag can be placed at a height corresponding to approximately 50 to 100 mm of mercury (hereinafter "mmHg"). The saline bag is coupled to an irrigation port as described herein. A collection bag is coupled to one or more of an irrigation port, a suction port, or a suction port as described herein. The collection bag collects tissue removed by the water jet ablation probe 450 as described herein.

[0096] Figure 4B Fluid flow regulation at a surgical site is shown using a pump that provides a substantially fixed fluid flow. The pump removes fluid from the surgical site at a substantially fixed flow rate. For example, the pump may include a peristaltic pump. The pump is configured to remove fluid at a rate substantially the same as or greater than the water ablation jet saline flow rate so as to suppress pressure buildup at the surgical site. For example, the peristaltic pump may be coupled to a suction port of a manifold including tissue removal port 456C as described herein. Providing a pump having a flow rate that is at least the flow rate of the tissue ablation jet provides improved suction because ablated tissue that may otherwise clog the tissue removal opening and the channel may be subjected to a greater amount of pressure while the pump maintains a substantially fixed flow rate to remove material that would otherwise clog the channel.

[0097] The irrigation flow from the saline bag can be kept open to provide at least two functions: 1) maintain pressure based on the height of the saline bag; and 2) provide a safety check valve in the event that the peristaltic pump is not functioning properly as one can visually see that the fluid entering the bag is pink.

[0098] In an alternative embodiment, the flow rate of the pump includes a variable rate to provide a substantially constant pressure in the patient near the surgical site. Active sensing of the pressure of the treated organ and the variable flow rate of the pump can include a closed-loop pressure regulation system. The pump can be coupled to a sensor, such as a pressure sensor, and the flow rate is changed to maintain a substantially constant pressure. The pressure sensor can be located in one or more of many locations, such as on the treatment probe, in the suction channel of the probe, in a recess on the outer surface of the probe, on the inner surface of the probe coupled to the surgical site, or near the inlet of the pump on the console.

[0099] Figure 5AAn organ suitable for merging according to an embodiment is shown. The organ may include one or more of the many organs as described herein, such as a prostate. In many embodiments, the organ includes, for example, a capsule and tissue contained within the capsule and capsule vessels and nerves located on the outside of the capsule. In many embodiments, the organ includes a prostate. The prostate may include hyperplasia, such as benign prostatic hyperplasia or cancer and a combination thereof. In many embodiments, the hyperplastic tissue may include tissue located in the patient's body, wherein the cancer may not be detected. In many embodiments, capsule vessels and nerves extend along the outer surface of the prostate. In many embodiments, the hyperplastic tissue may be located above the prostate. In many embodiments, the hyperplastic tissue may include tissue of unknown specificity as to whether the tissue includes cancerous tissue or benign tissue.

[0100] Figure 5B Treatment with a device according to an embodiment is shown Figure 5A In many embodiments, tissue of the prostate is removed according to a tissue removal profile. For example, the tissue removal profile can consist of a predetermined tissue removal profile based on image-guided tissue removal as described herein. Alternatively, the tissue removal profile can consist of a removal profile of tissue removed using a handheld tissue removal device. In many embodiments, tissue of an organ (e.g., a prostate) is removed into a capsule, for example, to reduce a distance from the tissue removable profile to the outside of the capsule.

[0101] The device for tissue removal can include a nozzle configured to deliver a fluid stream, wherein the fluid stream can include one or more of a liquid or a gas. For example, the liquid fluid stream can include one or more of water or saline. The liquid fluid stream can be configured to leave the nozzle in the form of a liquid ablation jet, produce cavitation in the prostate tissue and separate the tissue into multiple fragments. The liquid fluid stream can be released into the liquid in which the nozzle is immersed so as to provide cavitation using a shedding pulse as described herein. The liquid in which the nozzle is immersed can include, for example, one or more of water or saline.

[0102] Fig. 6A An ablation flame visible to the human eye is shown according to an embodiment.

[0103] Figure 6B As shown in Fig. 6A High-speed image of the ablation flame in the . The image was taken at a speed of approximately 1 / 400 second.

[0104] Fig. 6A and Figure 6BThe data from the embodiment show that the ablation flame includes multiple white clouds generated by the ablation flow when released from the nozzle. Work related to the embodiment shows that the cavitation cloud can be shed from the jet at a characteristic shedding frequency. The length 992 of each cloud is related to the shedding frequency and speed of the cloud. The relatively cool ablation flame of the jet includes a length 990 corresponding to the cutting length of the jet, which can be adjusted to cut tissue to a controlled depth as described herein. In many embodiments, the nozzle of the jet is as shown in FIG. Figure 6B The non-cutting configuration shown is placed at least about one quarter of the length 992 of the shedding cloud to allow the shedding cloud to form substantially before the cloud strikes the tissue. This divergence of the shedding cloud to a larger cross-sectional size can also provide improved tissue removal as the cloud can be distributed to a larger area of ​​the tissue, and provide improved overlap among the pulses of the jets.

[0105] In addition to the impact pressure of the jet, the highly turbulent and erosive areas corresponding to the white cloud of the image substantially contribute to the ablation of the tissue as described herein. The white cloud includes multiple cavitation areas. When pressurized water is injected into the water, small cavitations are generated in the low-pressure area in the shear layer near the nozzle outlet. Small cavitations may include cavitation vortices. The cavitation vortices merge with each other to form large discrete cavitation structures that appear as cavitation clouds in high-speed images. When interacting with tissue, these cavitation clouds provide effective ablation. Without being limited by any particular theory, it is believed that the cavitation cloud that impacts the tissue combines with the high-speed fluid that limits the cavitation that impacts the tissue to cause a large amount of erosion of the tissue associated with cavitation.

[0106] The nozzles and pressures as described herein can be configured to provide a pulsatile cloud by one of ordinary skill in the art based on the teachings provided herein, for example, with control of the angle of the nozzle. In many embodiments, the nozzle of the fluid delivery element includes a cavitating jet to improve ablation of tissue.

[0107] The nozzles and pressure of the fluid delivery element may be arranged to provide an abscission frequency suitable for removal of tissue.

[0108] In many embodiments, the "white cloud" of the "flame" includes a region of "entrainment" where surrounding water is drawn or "entrained" into the jet. Work related to the embodiments has shown that entrainment of fluid can be related to shedding frequency.

[0109] According to an embodiment, the shedding frequency and size of the cloud shed from the jet may be used to provide tissue ablation.The shedding frequency may be combined with the angular scan rate of the probe about the longitudinal axis to provide an overlap of locations where each cloud interacts with tissue.

[0110] Figure 7Multiple shedding pulses 995 and scanning of the ablative jet according to an embodiment are shown to provide smooth and controlled tissue erosion at multiple overlapping locations 997. When a pump is used, the shedding frequency can be significantly faster than the pump frequency so that multiple shedding clouds are provided for each pulse of the pulsating pump. The scanning rate of the probe can be related to the shedding frequency to provide improved tissue removal, for example, with shedding clouds configured to provide overlapping pulses.

[0111] In many embodiments, the system includes a pump having a frequency less than the frequency of the shedding pulses so as to provide multiple shedding pulses for each pulse of the pump. The pump can have a pulse rate of at least about 50 Hz, such as in the range of about 50 Hz to about 200 Hz, and the shedding pulses include a frequency of at least about 500 Hz, such as in the range of from about 1 kHz to about 10 kHz.

[0112] Although the pulsing of a pump is shown, a similar sweep of a pulsed cloud can be provided with a continuous flow pump.

[0113] While the nozzle can be configured in one or more of many ways, in many embodiments, the nozzle includes a Strouhal number (hereinafter "St") in a range from about 0.02 to about 0.3, for example in a range from about 0.10 to about 0.25, and in many embodiments in a range from about 0.14 to about 0.2.

[0114] In many embodiments, the Strouhal number is defined by:

[0115] St=(Fshed)*(W) / U

[0116] Wherein, Fshed is the shedding frequency, W is the width of the cavitation jet, and U is the velocity of the jet at the exit. One of ordinary skill in the art may modify the nozzle as described herein to obtain a shedding frequency suitable for combination according to the embodiments described herein, and experiments may be conducted to determine cloud length and shedding frequency suitable for tissue removal.

[0117] Nozzle configurations that provide multiple shedding clouds are suitable for use with one or more probes as described herein.

[0118] Fig. 8AAn attachment device 800 according to an embodiment is shown. The attachment device is configured to be attached to an arm as described herein. The attachment device includes one or more components of a surgical system to treat a patient as described herein. In many embodiments, the attachment device includes a handpiece 802 for enabling a surgeon to manipulate the attachment device with the arm in an unlocked position so as to insert a distal end of the attachment device into the patient. In many embodiments, the attachment device includes a linkage 804, which includes a rotatable body configured to receive torque from the arm during rotation, as described herein.

[0119] The attachment device comprises a plurality of parts that are manufactured to size and installed in the surgical access site (e.g., urethra) of the patient. For example, the attachment device may comprise an elongated support 806, an elongated tube 808, and a coupling 814 as described herein. The elongated support 806 comprises a rigid support configured to be inserted into the patient's body. The elongated support may comprise a circular distal end to facilitate insertion into the patient's body along the access path so that the expansion path allows and facilitates the insertion of the coupling. The elongated support may comprise a plurality of suction channels positioned to remove the excised tissue from the surgical site. The elongated support may comprise a plurality of channels extending from the suction port 828 to the opening on the distal end of the elongated support.

[0120] The elongated tube 808 may include a telescoping tube including a first distal portion 810 and a second proximal portion 812. The second portion may be sized larger than the first portion to receive the first portion and allow for sliding movement of the tube. A coupler 814 on the distal end of the distal portion of the tube may be connected to an endoscope. The endoscope connected to the coupler may move proximally and distally, and the elongated tube may shorten and decrease in length as the coupler moves proximally and distally with the distal tip 818 of the endoscope.

[0121] The coupler 814 may include an inclined distal surface 820 or at least one surface shaped to facilitate insertion of the coupler into the patient. When the attachment device is inserted into the patient, the coupler may be placed adjacent to the distal end of the elongated support. The endoscope tip 818 may be coupled to the coupler with the structure of the coupler. For example, the coupler may include an engagement structure shaped to receive a corresponding engagement structure on the endoscope tip so that the coupler cooperates with the endoscope tip and is effectively keyed and locked to the endoscope tip. Proximal and distal movement of the endoscope may move the coupler proximally and distally with a corresponding decrease or increase in the length of the elongated tube.

[0122] The attachment device may include a hub 822 including an irrigation port 824 and a suction port 826. The irrigation port may be coupled to the internal passage of the elongated tube to direct a fluid, such as saline, to an irrigation opening 816 located on the distal end of the elongated tube. The irrigation opening may provide fluid, such as saline, to the surgical site. Alternatively, fluid, such as gas, may be provided to the surgical site using insufflation. The suction port on the hub may be connected to an opening on the elongated support with the passage extending axially along the elongated support.

[0123] The elongated tube 808 of the endoscope includes a first distal portion 810 of the tube and a second proximal portion 812 of the elongated telescoping tube. The second proximal portion is sized larger than the first distal portion to slidably receive the first distal portion to allow the coupler to move proximally and distally with the endoscope.

[0124] The attachment device includes multiple structures that allow a user (e.g., a doctor) to adjust the endoscope independently of other components of the device. In many embodiments, the endoscope is coupled to an endoscope bracket 828. The endoscope bracket can be advanced and retracted to move the distal end of the endoscope connected to the connector proximally and distally. The attachment device may include a rack 830 coupled to a pinion that allows the endoscope bracket to move proximally and distally with the rotation of a knob 832 on the endoscope bracket. The attachment device may include a track 834 to engage the endoscope bracket so that the endoscope bracket can slide along the track, for example, with the rotation of the knob. In many embodiments, the attachment device includes a connection of a high voltage cable 836 to a carrier that carries a source of therapeutic energy under the control of a linkage.

[0125] Figure 8B Components of an attachment device 800 are shown. The endoscope can include a rigid distal portion 838 and a flexible proximal portion 840. The rigid portion of the endoscope can extend from the endoscope bracket 828 to the distal tip of the endoscope. The rigid portion of the endoscope can extend through a seal 842 to seal and contain fluids from the surgical site. The rigid portion of the endoscope can be coupled to the bracket using an engagement structure on the proximal portion of the endoscope. The rigid portion of the endoscope can also be coupled to the coupler using a distal engagement structure located near the tip of the endoscope. The rigid portion of the endoscope extending between the bracket and the coupler provides proximal and distal movement of the distal portion of the coupler and the telescoping tube.

[0126] In many embodiments, a flexible high pressure saline tube 836 extends to the attachment device to provide pressurized fluid from an external pump.

[0127] In many embodiments, the attachment device is configured to allow a user to remove a component of the device, such as an endoscope. For example, a bracket release 844 can be provided on the proximal end of the attachment device, allowing the user to slide the bracket proximally off the track to remove the endoscope from the surgical site.

[0128] Figure 8C Components of an attachment device 800 are shown with a coupler 814 in a partially retracted position and an elongated carrier 846 including an energy source 848 extending through the coupler toward the distal end of an elongated support 806. In many embodiments, the endoscope tip can be at least partially retracted to view a treatment probe 846 in the support. The elongated carrier including the treatment probe can have an energy source located thereon to direct energy to a treatment site. The distal portion of the elongated tube 808 can be retracted into the proximal portion of the elongated tube to allow the coupler with the endoscope tip attached thereto to view the treatment site. For example, the coupler can be retracted proximally with rotation of the knob to the proximal position.

[0129] The elongated support 806 can be connected to the elongated tube 808 in one or more of many ways to increase rigidity. For example, the elongated support can be welded to the proximal portion of the elongated tube at multiple locations 850 to increase rigidity to the combination of the elongated support and the elongated tube.

[0130] The welded portion of the elongated tube may be maintained in a fixed position relative to the elongated holder as the distal portion of the elongated tube slides relative to the proximal fixed portion of the tube.

[0131] Fig.8D The elongated support 806 and the distal portion of the elongated tube 808 are shown, and the elongated tube 808 has a coupler 814 mounted thereon. The elongated support can include a decompression tip, such as a rounded distal tip 852, to facilitate insertion along a surgical access path (e.g., through the urethra). The inclined distal surface 820 of the coupler can facilitate insertion and push tissue away from the elongated support. In many embodiments, the elongated support includes a recess that is sized to receive a portion of the coupler so that the distal-most tip of the coupler fits within the recess behind the decompression distal tip. The decompression distal tip can define an access path for the attachment device to enter the patient's body, and the inclined distal surface of the coupler can follow the decompression tip, and the tip of the coupler can follow the path of the decompression tip. This combination of the decompression tip and the inclined distal surface can facilitate insertion.

[0132] The elongated tube 808 including a plurality of openings 816 can move with the coupling 814. The coupling that receives the distal tip of the endoscope can be configured in one or more of many ways to receive the endoscope tip, for example, with a protrusion received on the endoscope and locked to a channel or slot of the endoscope. The distal portion of the elongated telescopic tube can include an opening 854 to receive a fastener from the coupling. The fastener extending from the coupling through the opening of the tube can effectively lock the coupling to the distal end of the tube. The distal end 810 of the tube may include a plurality of irrigation openings 816. The plurality of irrigation openings can move with the endoscope tip to clean and facilitate observation with the endoscope tip. The movement of the irrigation openings generally directs fluid toward the surgical site so that the fluid can be directed. For example, when the treatment probe tip is immersed in liquid, the irrigation openings that move with the endoscope tip have the advantages of cleaning the tip and providing fluid to increase visibility.

[0133] Figures 8E1 to 8E4 A coupler 814 is shown according to an embodiment. Figure 8E1 A cross-sectional end view is shown. Figure 8E2 A cross-sectional side view is shown. Figure 8E3 shows a side view, and Figure 8E4 An end view is shown. The coupler includes a carrier channel 856 to receive a therapeutic probe on the carrier, as described herein. The carrier channel is sized to allow the carrier including the therapeutic probe to slide proximally, distally, and rotationally without interference from the coupler. The carrier channel may include guides that facilitate alignment and placement and stabilize the position of the distal end of the carrier including the energy source. The coupler includes an endoscope channel 858 sized to receive an endoscope. The endoscope channel may be configured to receive an endoscope and an engagement structure of the endoscope and lock the engagement structure of the endoscope to the coupler.

[0134] use Figure 8E2 The side view shown shows the field of view 860 of the endoscope. The field of view of the endoscope can be the field of view of a commercially available endoscope, such as a 70° field of view. The endoscope can view the surgical site, the elongated support, and the therapeutic probe of the carrier from within the endoscope channel. In many embodiments, the inclined surface 820 of the distal end of the coupler is inclined at an angle so as to define the field of view along an upper portion of the field of view of the endoscope.

[0135] like Figure 8E3 As shown, the coupler 814 may include a slot 862 to receive a protrusion on the endoscope. For example, the slot may be sized to allow the protrusion to enter the slot as the endoscope is rotated. Although a slot is shown, the engagement structure of the coupler that receives the engagement structure on the distal end of the rigid portion of the endoscope may be configured in one or more of many ways (e.g., using a locking structure, a threaded structure, a hub, and threads).

[0136] For example, the endoscope tip may include a leaf spring or similar structure configured to snap into a corresponding capture edge or lip disposed along at least a portion of the inner periphery of the coupler. Using such a mechanism, a user can lock the endoscope tip to the coupler by simply pushing the endoscope tip into the coupler until the leaf spring engages the capture edge. To allow the endoscope tip to be separated from the coupler, a portion of the inner periphery of the coupler may include a beveled edge configured to allow the leaf spring to slide out. To separate the endoscope tip from the coupler, the user can rotate the endoscope until the leaf spring is aligned with the beveled edge and then pull the endoscope out.

[0137] exist Figure 8E3 Also shown is a protrusion 855 extending through the tube.

[0138] Figure 8E4 Approximate dimensions of the treatment probe carrier 846 and the endoscope 866 are shown in dashed lines in the carrier channel 856 and the endoscope channel 858, respectively. The carrier channel and the endoscope channel can be sized and spaced to provide a gap 868 between the carrier and the endoscope. In many embodiments, the rigid distal tip of the endoscope includes a protrusion 864 as described herein. The protrusion can extend a radial distance from the rigid distal portion to fit into the slot 862 and engage the coupler. In many embodiments, the protrusion is sized to extend a distance greater than the gap so as to lock the coupler to the endoscope when the carrier probe including the energy source extends through the carrier channel. For example, this configuration can facilitate assembly and disassembly of the coupler to and from the endoscope when the carrier is removed, and provide locking of the coupler when the carrier is inserted into the coupler.

[0139] Fig.8F A bottom side view of a bracket 828 according to an embodiment is shown. The bottom side view shows a flexible portion 840 of the endoscope and a rigid portion 838 of the endoscope coupled to a proximal engagement structure 870 of the endoscope. The proximal engagement structure of the endoscope fits within an engagement structure 872 of the bracket so that proximal and distal movement of the bracket moves the rigid portion of the endoscope in the engagement structure. The bottom side view of the bracket shows a pinion 874 that rotates with the knob 832. The pinion engages with the rack as described herein. Also shown in the bottom side view are slots 876 on each side of the bracket that receive tracks for attachment devices as described herein. The engagement structure 872 of the bracket may include a plurality of protrusions. For example, a plurality of protrusions may extend on the proximal side of the bracket and on the distal side of the bracket to move the endoscope proximally and distally.

[0140] Figure 8GAn end view of a bracket 828 is shown according to an embodiment. The bracket includes a plurality of slots 876 sized to receive rails of an attachment device. The bracket also includes a channel 878 sized to receive an endoscope.

[0141] Fig.8F and 8G The bracket shown in can be configured to have a low profile to facilitate user manipulation of the attached device. For example, the bracket can be configured to have a housing with a relatively short height, and the knob can be shaped and formed to have a relatively small diameter and a long length (e.g., to facilitate gripping of the knob by the user).

[0142] Figure 8H A stand-alone endoscope 866 is shown in accordance with an embodiment. The endoscope includes an eyepiece 880 that allows a user (e.g., a surgeon) to view a surgical site at a distal end of the endoscope, wherein the eyepiece is located on a proximal end of the endoscope. The endoscope includes an illumination port 882 that allows a camera (e.g., a high definition camera) to be coupled to the endoscope. The endoscope includes a proximal flexible portion 840 as described herein. The endoscope includes a proximal engagement structure 870. The proximal engagement structure is located between the flexible proximal portion 838 of the endoscope and the rigid distal portion 840 of the endoscope. The endoscope includes a distal engagement structure 884 as described herein.

[0143] Figure 8I1 A side view of endoscope 866 is shown. Figure 8I2 Shown along as in Figure 8I1 Side view of section AA in FIG. Figure 8I3 Shows Figure 8I1 Section BB of an endoscope, wherein section BB includes a structure similar to the structure shown in section AA. Figure 8I4 As shown in Figure 8I1 Top view of the endoscope in the. Figure 8I5 As shown in Figures 8I1-8I4 The endoscope includes an eyepiece 880, an illumination port 882, a flexible portion 840, a proximal engagement structure 870, a rigid distal portion 838, and a distal end 818 of the endoscope, as described herein. Figure 8I2 and Figure 8I3 Cross-sectional views of an endoscope and structures that provide fixed alignment of the endoscope relative to an engagement structure are shown. For example, the flat surfaces shown along sections AA and BB correspond to the largest dimension across the proximal engagement structure. When the endoscope is used, having the proximal engagement structure in fixed alignment with the endoscope can facilitate alignment and ensure an accurate reference frame. Figure 8I4 The distal engagement structure 884 along section G is shown in a top view. Figure 8I5Detail G in FIG. 8 shows the distal engagement structure 884 as a protrusion 864 extending from the distal end.

[0144] In many embodiments, the proximal engagement structure includes a reference structure, such as a maximum dimension that defines the orientation of the endoscope relative to the attachment device. The maximum dimension across the proximal engagement structure informs the user or other person assembling the device of the reference frame of the endoscope relative to the attachment device as described herein. The attachment device can include a reference frame for treatment and surgery as described herein. For example, angular rotation of the treatment probe around the portal can be made relative to the attachment device and components of the attachment device (e.g., encoders), as described herein.

[0145] Figure 8J A housing 886 of a bracket as described herein is shown. For example, the housing of the bracket may include a single part of injection molded plastic. The single part may be provided in duplicate, such as a pair of parts of a single part, to allow assembly of the bracket housing. For example, reference Figure 8J , a second housing may be provided having the same shape as the first part 888 of the housing so that the two parts snap together on the knob and shaft and pinion as described herein to define a bracket.

[0146] Figure 8K An end view of an attachment device 800 as described herein is shown. The attachment device includes a plurality of rotatable connectors, such as a first rotatable connector 890 and a second rotatable connector 892. The first rotatable connector determines the axial position of the energy source to treat the patient. The second rotatable connector determines the angular position of the energy source relative to the axis. For example, the energy source may include a gem mounted on a hypo tube, wherein the axial position of the gem is determined with the first rotatable connector, and the angle of the gem relative to the axis is determined relative to the second rotatable connector. The first and second rotatable connectors can be used to control both the rotation and axial position of the energy source, as described herein. An attachment device including a handpiece may include an electrical connector 894. The electrical connector may be connected to an electrical connector on an arm. The electrical connector may be used to transmit signals to and from the attachment device. The signal transmitted with the electrical connector may include an electrical signal from an encoder to a controller away from the attachment device. The attachment device may include a printed circuit board 896 having an electrical connector arranged thereon to connect the attachment device to the arm. The electrical connector may include a standard connector known in the industry. The printed circuit board may include a circuit system 898 of the handpiece. The circuit system may include, for example, a processor in non-volatile memory configured to record aspects of the treatment, such as a treatment table and machine parameters such as flow rates and pressures as described herein. High pressure saline tube 836 may include a flexible tube extending into the proximal end of the handpiece.

[0147] Figure 8LComponents of an arm 900 configured to couple to an attachment device 800 are shown. The arm may include a locking mechanical connector 902 configured to couple to the attachment device and lock the attachment device in place. The arm may include a plurality of rotatable connectors 904 configured to engage a rotatable connector of the attachment device. The arm may include an electrical connector 906 configured to connect to the attachment device. Although an electrical connector is shown, other connectors, such as fiber optic or optical connectors, may also be used. The arm may also include a contact sensor 908 that senses contact of the attachment device with the arm.

[0148] The circuit system of the arm and the attachment device can be configured in one or more of many ways to facilitate the connection of the attachment device to the arm. Optionally or in combination, the attachment device can be configured to include a consumable device, such as a disposable device. In many embodiments, the contact sensor is coupled to a circuit system configured to rotate the rotatable connector on the arm in response to the contact sensor engaging the attachment device. When the contact sensor engages the attachment device, the rotatable connector rotates back and forth throughout the predetermined range of motion to allow the rotatable connector on the arm to be matched with the rotatable connector on the attachment device. In many embodiments, the rotatable connector on the arm includes a plurality of hexagonal sockets, and the attachment device includes a plurality of hexagonal cross-section protrusions to engage the socket of the arm. Optionally, the socket and the protrusion can be reversed so that the socket is set on the attachment device and the protrusion is set on the arm or a combination thereof. Once the rotatable connector engages the rotatable connector of the attachment device, the circuit system in the arm can detect movement using a sensor located on the attachment device, and stop the rotation of the rotatable connector when the coupling of the arm to the attachment device is completed.

[0149] Figure 8M A view of the upper side of an attachment device 800 according to an embodiment is shown. For example, the upper side of the attachment device can be positioned relative to a side having a rack and pinion. The attachment device can include a measurement scale 801 and an indicator 803 (e.g., LED) to indicate the position of the energy source on a carrier probe including a treatment probe. In many embodiments, the indicator is mounted on an internal linkage that moves axially to treat a patient. This LED indicator on the probe can inform the user of the position of the treatment probe. The measurement scale can include one or more of many units, and typically includes a one-to-one scale with the motion of the probe tip. For example, the measurement scale can be in units of, for example, centimeters, millimeters, or other length units.

[0150] Figure 8NComponents of an arm 900 according to an embodiment are shown. The components of the arm may include an attachable component of the arm, which includes a user input device 910. The user input device may include a first input end 912 to increase the intensity of the energy source and a second input end 914 to decrease the intensity of the energy source. For example, when the energy source includes a liquid flow, the increase in the intensity of the energy source may include an increased flow rate of the energy source and / or an increased pressure of the energy source. For example, the reduced intensity of the energy source may include a reduced flow rate or a reduced pressure of the energy source, and a combination thereof.

[0151] Figure 8O2 and Figure 8O1 Shows Figure 8N The internal structure of the arm component is shown. Figure 8O1 Circuitry 916 of the lower portion of the component is shown. The circuitry can be coupled to connector 906, which is coupled to an attachment device. The circuitry can include circuitry as described herein, and can, for example, include one or more of many known circuit components, such as a processor, a memory (e.g., a random access memory), and a gate array (e.g., a field programmable gate array). The circuitry can include one or more of many known components for controlling a motor. Figure 8O2 The motor 918 of the arm according to an embodiment is shown. The motor may include known motor components capable of driving surgical instruments. The motor may include a shaft extending to a protrusion of a rotatable connector as described herein. When the attachment device is connected to the arm, the motor may engage the attachment device.

[0152] like Figure 8O1 The circuit system coupled to the connector shown can be used to control the motor to position the energy source at a desired axial position and rotation angle around the axis. The circuit system can include one or more instructions to transmit a signal to an encoder located on the attachment device to measure the angular position of the probe rotating around the axis. The rotation of the energy source around the axis can be fed back to the circuit system, and the circuit system can drive the energy source to multiple positions according to the instructions of the treatment table as described herein. By positioning the circuit system and motor at a reusable location on the arm, the cost and complexity of the attachment device including the head can be significantly reduced.

[0153] Figure 8P A linkage 804 of an attachment device 800 is shown according to an embodiment. Figure 8PThe linkage shown in may include one or more components configured to direct the energy source to a desired position and angle on the distal end of a carrier 846 including a treatment probe. A carrier carrying the energy source near the distal end is coupled to the linkage to control the positioning and angle of the energy source on the end of the carrier. The carrier may include, for example, a hypotube, and the energy source may include one or more of the many energy sources described herein. For example, the energy source may include a nozzle formed with a material containing gemstones. The gemstones on the hypotube may receive high-pressure fluid from the cable 836. The carrier is connected to a flexible conduit that receives energy along a flexible high-pressure tube with a medium (e.g., high-pressure saline). The carrier is connected to the linkage so that the carrier translates and rotates in response to commands from the circuit system.

[0154] The linkage includes a first rotating connector 890 that controls the Z-axis positioning along the long axis of the carrier and a second rotatable connector 892 that controls the angle of the energy source relative to the long axis. The first rotatable connector 890 is rotatably connected to a plurality of threads 889. As shown by arrows 891, the rotation of the threads can drive the linkage proximally and distally. The threads, when rotated, can cause the carrier 846 to move proximally and distally as shown. When the carrier moves proximally and distally, the second rotatable connector 892 can slide along an elongated structure (e.g., a hexagonal structure) 895. The sliding of the carrier in the axial direction can be provided for a range of treatments, such as up to about 7 mm. The second rotatable connector 892 can be rotated to cause the rotation of the carrier. For example, the rotation of the second rotatable connector can cause the angular rotation of the carrier, as shown by the rotation arrow 893. The rotation of the second rotatable connector can rotate the gear 805 of the linkage coupled to the carrier 846. The gear of the linkage can be concentric with the carrier to cause the rotation of the carrier around the long axis of the carrier. The second rotatable connector may include a second gear concentric with the rotatable connector to cause rotation of a gear concentric with the carrier. The linkage may include an idler gear, for example between the first gear and the second gear, to cause angular rotation of the energy source relative to the long axis of the carrier.

[0155] Figure 8QAn encoder 807 mounted on the proximal end of a carrier 846 is shown. The encoder on the proximal end of the carrier can allow accurate rotational positioning of the angle of the energy source. In response to the signal measured from the encoder, the carrier can be rotated to the target position. The encoder on the proximal end of the carrier can include one or more of many known encoders. In many embodiments, the encoder includes a Gray encoder configured to provide orthogonal measurement. The encoder can be arranged on the surface of a carrier having an annular structure extending from the carrier, for example, so as to provide an accurate surface for fixing the encoder. In addition, the photodetector 809 can be arranged in a line extending in the direction of the carrier probe axis. This can facilitate the measurement of the angle of the energy source and can allow the detector to be located on the plane of the printed circuit board. The encoder can extend on the surface of the carrier probe, and the carrier probe can include a removable carrier treatment probe. As described herein, the removable carrier treatment probe can extend into the seal. In many embodiments, the encoder includes an alignment structure that can be aligned with the energy source carried on the distal tip of the probe to ensure accurate alignment during manufacturing. For example, the encoder can include multiple edge transitions, each of which extends in the axial direction. One or more edges can be preconfigured to align with the angle of the energy source extending from the long axis of the probe. For example, the energy source can extend from the axis in a radial direction at the same angle as the edge extends radially from the probe, or be positioned along an angle extending radially from the probe.

[0156] Figure 8R1 An encoder 807 is shown according to an embodiment. As shown with the encoder, each edge 811 corresponds to an angular reference relative to the probe. For example, a zero degree reference 813 is shown. The zero degree reference is aligned with an energy source extending from the distal end of the carrier.

[0157] Figure 8R2 Table 815 showing coordinate references for different transitions measured with multiple photodetectors is shown. These locations can give the absolute location of the probe within a certain range. The circuit system described herein can be configured to Figure 8R2 The interpolation can be performed in one or more of many ways. For example, the motor can include a stepper motor to provide interpolation. Alternatively, the motor can include an encoder within the motor that can be used to provide interpolation.

[0158] The white area of ​​table 815 corresponds to the steel tube portion of the encoder, while the black area corresponds to the black plastic tube portion of the encoder. The steel tube and the black plastic tube can form a plurality of rows distributed along the longitudinal axis of the encoder, each row extending around the periphery of the encoder. Each row can be aligned with a photodetector. For each photodetector A (far side), B, C and D (near side), the rotational positioning of the encoder corresponding to the white area can correspond to a "on" or "1" binary code, while the rotational positioning of the encoder corresponding to the black area can correspond to a "off" or "0" binary code.

[0159] exist Figure 8Q , Figure 8R1 and Figure 8R2 The encoder and photodetector configurations in are provided as examples only, and many other configurations are possible. For example, while Figure 8Q , Figure 8R1 and Figure 8R2 An encoder comprising 4 rows is shown, each row aligned with one of the 4 photodetectors, but the encoder may have any number of rows aligned with any number of photodetectors in any suitable configuration. The encoder may include one or more additional rows and additional photodetectors aligned with each additional encoder row to increase the resolution of the encoder and thereby provide a more finely adjustable position adjustment of the motor and thus the carrier.

[0160] Figure 8S A suction port 817 on the distal end 819 of a support 806 is shown according to an embodiment. The distal end of the support includes a plurality of ports 817 to aspirate material from the surgical site. The plurality of ports can be sized to receive tissue removed by an energy source 848. The ports can be positioned at predetermined locations to provide visual guidance to the user. For example, the suction ports can be positioned at one centimeter intervals so that the user can easily determine the size and position of the tissue at the target site. For example, the user can also assess the accuracy and verify the accuracy of the probe during use. The support can include, for example, a plurality of ports in a number from 2 to about 10. The plurality of ports can be located on the underside of the support facing the carrier 846. The concave shape of the support can improve alignment and provide space to accommodate the probe. The suction port on the distal end of the support can be fluidly coupled to the suction port on the proximal end of the support near the hub with, for example, a channel extending from the port to the plurality of ports ( Fig. 8A826 in). During treatment, the carrier of the energy source can slide toward the distal end of the support. The port can provide a reference structure to determine the position of the carrier relative to the energy source and can be helpful in facilitating alignment during treatment. For example, multiple ports on the distal end of the support can be seen with ultrasound and can be seen with an endoscope with a field of view as described herein. The multiple ports can be located between the spherical portion on the distal end and the fixed portion of the tube. As described herein, the carrier probe can be advanced to the distal end of the support and retracted. As described herein, Figure 8S As shown, the carrier of the energy source is shown in a retracted position. The coupling structure 814 is also shown as retracted, coupling the endoscope to the elongated tube 808. The proximal portion 812 of the tube is shown, and the distal portion 810 of the tube is received therein so that a portion of the irrigation port 824 is covered with the proximal portion of the tube. The coupling 814 as described herein can be used to advance the elongated tube and the endoscope as described herein. For example, the carrier including the energy source can be moved independently of the endoscope and the coupling in the tube. In at least some embodiments, this independent movement is helpful for treatment. Alternatively or in combination, the coupling can be located on the energy source to act as a shield for the user of the system from the energy source. For example, when the system is initially established, the coupling can slide on the energy source to block the energy source. In many embodiments, the coupling includes sufficient mechanical strength to withstand the energy source, and the energy source is configured to remove tissue and not destroy the coupling when the coupling is located above the energy source.

[0161] Figure 8T A console 920 according to an embodiment is shown. The console includes multiple inputs and multiple outputs of a user interface that allows a user to program the system for treatment. The console includes an angle input 922 that increases the angle and a second angle input 924 that decreases the angle. The console includes a prime input 926 to prime the pump. The console includes a mode input 928 to set the mode. The console includes an inhalation input 930 to inhale. The console includes outputs such as a docking configuration 932, an arm state 934, and a fault state 936. Power can be increased or decreased to the energy source as shown by a plus sign 938 and a minus sign 940. Foot pedals 942 and manual controls 944 are shown as inputs. The foot pedals can include standard commercially available foot pedals, and the manual controls can include positive and negative controls on the arms as described herein. The high pressure tube can be attached to a channel or connector 946 coupled to the high pressure pump.

[0162] Fig.9A and Fig. 9B Side and top views, respectively, show the alignment of the treatment probe axis with the sagittal plane of the imaging probe. Fig.9AThe therapeutic probe 450 is shown tilted relative to the imaging probe 460. The imaging probe includes a long axis 461 that provides a reference for the image. In many embodiments, the imaging probe includes a long axis. The imaging probe can include an ultrasound probe having a long axis that at least partially defines a sagittal image plane 950. In many embodiments, the imaging probe includes a sagittal image field of view, and when the therapeutic probe is within the field of view of the sagittal image, the therapeutic probe 450 is substantially aligned with the sagittal plane of the imaging probe.

[0163] Although reference is made herein to a transrectal ultrasound (TRUS) imaging probe, the imaging probe may include, for example, one or more of a number of known probes, such as a non-TRUS probe, an ultrasound probe, a magnetic resonance probe, and an endoscope or fluoroscope.

[0164] The user can use the image of the treatment probe obtained with the imaging probe to align the treatment probe with the imaging probe. In axial mode, when the imaging probe is not adequately aligned with the treatment probe, the treatment probe may appear distorted. The distortion of the treatment probe may depend on the cross-sectional shape of the treatment probe. For example, a disc-shaped cross-sectional profile may appear as a distorted crescent in axial mode. In sagittal imaging mode, only the portion of the elongated probe extending through the sagittal field of view will appear in the image. The user can be prompted to align the probe until adequate alignment is obtained, such as to observe the treatment probe with suppressed distortion of the treatment probe in axial mode and to observe the elongated treatment probe over a considerable axial distance (e.g., 5 cm) of the probe in the sagittal image.

[0165] In many embodiments, such as Fig. 9B As shown, the long axis 451 of the elongated treatment probe 450 is substantially aligned with the sagittal image plane 950 when a substantial portion of the elongated treatment probe is visible in the sagittal image (eg, 5 mm).

[0166] Fig. 9C and Fig.9D A side view and a top view of the treatment probe 450 are shown, respectively, across the field of view of the sagittal image plane 950. For example, the user may be prompted to improve the alignment to something like Fig.9A and Fig. 9B Configuration.

[0167] There may be residual alignment errors that are corrected with software instructions of the processor in response to an image of the treatment probe measured with the imaging probe. In many embodiments, the long axis of the treatment probe may appear to be rotated in the image. The system software may be configured to measure the rotation and rotate the image. For example, a user may be trained to see a sagittal image in which the axis of the imaging probe is used as a reference. However, to plan treatment, the user may better visualize the treatment, for example, when the long axis of the treatment probe appears horizontally or vertically on the user's screen. In many embodiments, the software measures the rotation angle of the treatment probe in an image (e.g., a TRUS image) and rotates the image in response to the rotation of the treatment probe. For example, the system software may measure an angle of one degree of rotation and rotate the image accordingly so that the rotation angle appears to be zero degrees to the user.

[0168] Figures 10A-10T A treatment screen of a device according to an embodiment is shown.

[0169] Fig. 10A A priming verification screen is shown according to an embodiment. The priming verification screen includes a user input for the user to press a continue button when priming is complete. Priming is performed to prime the pump. It can be used to provide an energy source, such as a fluid flow. Although reference is made to a pump, the energy source can include another energy source or an alternative energy source, such as an electrical energy source. When priming is complete, the user presses continue.

[0170] Fig. 10B 1 shows a waiting for docking screen according to an embodiment. Fig. 10B , the user is prompted to dock the system. As described herein, the system can be docked by placing the accessory on the arm. Once the accessory is docked to the arm, the system automatically proceeds to the next step.

[0171] In many embodiments, during the docking step, a rotational coupling of the arm is provided to align the coupling of the arm with an attachment comprising a handpiece as described herein.

[0172] Fig. 10C A prompt is shown for the user to confirm that the ultrasound is in the transverse view. This screen may provide an ultrasound image in the transverse view to orient and confirm that the ultrasound probe is in the correct transverse view for the user. Once the user looks at the ultrasound system and confirms that the ultrasound is in the transverse view, the screen of the user interface provides a continue button for the user to provide input. When the input continues, the user will be prompted to proceed to the next screen.

[0173] Fig. 10DAn angle selection input screen is shown. The angle selection input screen allows the user to select a treatment angle. The input screen includes a plurality of icons; a first icon displays an increased angle, and a second icon displays a decreased angle. The user uses an input device (e.g., a cursor and a mouse) to click on the appropriate icon to increase the angle. For example, if the user wishes to increase the angle, the user clicks on an icon including an outwardly extending arrow to increase the treatment angle. Once the treatment angle is selected, the user can enter confirmation by pressing a confirmation button. Selecting an angle in a lateral view allows the user to adjust the treatment angle according to the patient's anatomy. For example, the treatment angle can be in a range from about 1 degree to 180 degrees. In many embodiments, the angle range is in a range from about 10 degrees to about 170 degrees.

[0174] Fig. 10E Angles selected according to embodiments are shown. Fig. 10E In the example, a selection angle of 80 degrees is shown. Once the user has selected the desired angle, the user can press a confirmation button to move to the next user input screen.

[0175] Fig.10F A prompt is shown for the user to change the ultrasound to a sagittal view. Upon changing the ultrasound to a sagittal view, the user may press a continue button with an input device (e.g., a mouse or a touch screen display). The input displayed to the user may display an icon showing a sagittal ultrasound view to orient the user relative to the sagittal view.

[0176] Figure 10G A probe scale user input screen is shown. The probe scale user input screen may be used to set the scale of the probe relative to the ultrasound image. The probe may be seen in the upper right corner of the sagittal image. A crosshair may be placed on the movable marker to identify the probe. In many embodiments, the user is prompted to identify the probe tip by placing the crosshair on the probe tip. When the user places the crosshair on the probe tip, the instrument receives a command from the input that the probe tip has been identified.

[0177] When the probe tip is identified, the instrument advances the carrier probe to a distal position.

[0178] Fig. 10H The carrier probe tip is shown advanced to the distal position. The carrier probe tip can be seen with markings identifying the end of the carrier probe. The user may be prompted to identify the carrier probe tip in the second configuration. Fig. 10H As shown, the first position of the carrier probe tip is a proximal position as shown by a marking, and the second position of the carrier probe tip is a distal position as shown by a second marking.

[0179] While the carrier may be configured in one or more of a number of ways to perform calibration and image-guided definition of treatment as described herein, in many embodiments, a probe including a holder as described herein is used.

[0180] Reference again Figure 10G , the probe tip can be seen in a proximal position with the elongated support extending distally a substantial difference. Fig. 10H As can be seen in the Figure 1 , the probe tip extends a considerable distance, being closer to the distal end of the elongated support as described herein.

[0181] When the user is satisfied with the marking, the user can press Accept Input to accept the marking. If the user is not satisfied with the marking displayed in the image, the user can press the Clear button to repeat the step and identify the correct marking on the probe at the first and second positions.

[0182] like Fig.10I As shown, the calibration of the probe is repeated. The user input screen displays a probe scale icon for identifying the scale on the probe, and the user again places crosshairs on the probe to mark the start and end positioning. According to some embodiments, a total of three comparisons may be required. When setting the probe scale multiple times is successfully completed, the scale can be calculated.

[0183] Fig.10J A user input screen is shown where the user is informed that the scale has been calculated. The user is then prompted to press the Continue button to advance to the next screen.

[0184] Figure 10K A screen displayed on a display is shown to confirm the scale. The radical symbol can be displayed as an overlay on the ultrasound image with a scale determined by the calibration. For example, Figure 10K As shown, the scale can extend a distance of 70 mm. The scale and the marks used can also be displayed with radical symbols displayed on the display. For example, a proximal mark and a distal mark can be displayed on the display. When the distance between the proximal position and the distal position includes approximately 60 mm, the display can display marks at, for example, the zero position and the 60 mm position. The radical symbol displayed on the ultrasound image is presented to the user, and the user has the opportunity to accept or reset the scale. If the user chooses to reset the scale, the user is prompted to set the scale again. If the user accepts and confirms the scale, the user is allowed to proceed to the next screen.

[0185] Fig.10LA screen showing a calibration cut is shown according to an embodiment. The calibration cut may be performed to verify accurate calibration of the system with an initial treatment before completing the treatment. The display screen prompts the user with instructions. The user is prompted to perform the calibration cut. The user may be told to press and hold the foot switch to advance the cut, and to lift the foot switch to pause or complete the treatment. Fig.10L , showing a radical symbol overlaid with a treatment probe. The treatment carrier probe including a nozzle can initially be aligned at a zero reference, for example, above a spermatic collateral as described herein. A jet can be released from the nozzle, and the jet can be visualized with ultrasound or other imaging modalities (e.g., endoscope) as described herein.

[0186] Figure 10M A calibration cut progression is shown according to an embodiment. Figure 10M An image of the real-time calibration cut is shown on the screen. The probe automatically advances and the user is instructed to lift the foot switch to pause or complete treatment and the display window indicates the probe advances. The probe may be advanced according to the treatment profile programmed into the device as described herein. For example, reference Figure 10M , the incision may be displayed as extending approximately halfway through the entire treatment, although the actual image displayed to the user in real time may be provided relative to the scale. Figure 10M The image of an organ being resected (eg, a prostate) shown may help the user determine that the system is accurately set up to complete treatment of tissue that is initially less susceptible to variability in treatment.

[0187] Fig.10N A calibration cut near the distal end of the incision is shown. As shown on the ultrasound image, the jet including the cold flame advances to a position approximately 60 mm from the zero reference point. As shown in the real-time image, tissue is substantially excised with the targeted calibration cut. This screen provides the user with input to confirm the treatment, and the user can indicate that the calibration cut is complete by pressing a confirmation button. The user is prompted to restart or complete the calibration cut. When the user confirms that the calibration cut is complete, the user is then provided with the next input screen.

[0188] Fig.10OA determine depth of cut user interface screen according to an embodiment is shown. A determine depth of cut input of the user interface displayed on the display allows the user to set the depth of cut. Because scaling of the ultrasound image to the treatment probe was previously performed, the pixel coordinate reference of the image can be used to set additional references, such as the coordinate reference of the treatment profile. The user is prompted with multiple lines to indicate the depth of cut. The first icon displays vertical arrows, with the first vertical arrow pointing up and the second vertical arrow pointing down, and the user is allowed to slide the image overlay onto the cutting profile to allow the user to approximately estimate the calibration depth of cut. Another input screen that allows the user to further adjust the calibration cutting measurement can also be provided to the user. Once the user confirms the depth of cut, the user is prompted to proceed to the next user input screen. In many embodiments, the system includes multiple thresholds to determine whether the calibration depth of cut is within the appropriate machine boundaries. For example, a cut that is too shallow may prompt a warning to the user, and a cut that is too deep may prompt a similar warning to the user.

[0189] The user interface screen may include several values ​​available to the user. For example, pressure and time may be displayed to the user along with a target angle. The user may also be displayed surgical steps to complete the procedure, such as setup steps, such as an irrigation pump and docking as described herein. For example, a plan may include angles and scales, and a cut may include calibration cuts and profiles, and a treatment may include a treatment profile.

[0190] Figure 10P An adjustable cross section according to an embodiment is shown. Figure 10P The treatment profile is shown shaped according to the user's anatomy. With the ultrasound image of the prostate or other organs displayed to the user, the user can select multiple locations to adjust the treatment. For example, Figure 10P As shown, the organ being treated may include an enlarged prostate. For example, the enlarged prostate may extend beyond the bladder neck or into the bladder neck, as indicated by number 9. The narrow limit of the bladder neck shown in FIG8 can be adjusted according to the user's anatomical structure and measurement profile. And FIG10 can show the anatomical structure of the prostate, for example, near the capsule, and the user can adjust the cutting profile accordingly. The user is allowed to adjust and confirm the contour. The user is provided with an adjustment and confirmation contour menu and instructions. The user is informed to adjust the contour boundaries and confirm to proceed. When the user confirms the treatment profile displayed on the ultrasound image, the user presses the continue button to proceed.

[0191] Figure 10QThe start treatment screen is shown. The start treatment screen allows the user to start treatment. The user is instructed to press start to start treatment, and the user is instructed to press and hold the foot switch to advance the cut. Lifting the foot switch can pause the treatment. Optionally, the user can complete the treatment. The user is displayed a cutting profile that is matched based on the profile provided by the user. The target cutting profile may include an approximation of the expected profile provided by the user. Although the cutting profile of the flame can be configured in many ways, in many embodiments the power of the jet can be increased so that the distance of the white flame and cavitation as described herein can be extended to the desired target distance.

[0192] Work related to the embodiment indicates that the flow rate of the jet can provide a radial cutting distance, which can be substantially linearly related to the flow rate of the fluid entering the jet. In many embodiments, the surgical site is irrigated with saline, and a fluid stream including saline is released at high pressure to form multiple shedding pulses as described herein. Because the distance of the white cold flame is substantially related to the cutting distance, the user can be provided with visual input about the cutting depth profile. When the cutting depth profile changes, the flow rate of the fluid from the jet can be changed to correspond to the cutting depth profile.

[0193] Figure 10Q The cutting depth profile including steps shown in can correspond to the steps of changing flow rate. For example, the flow rate can be set with any integer value from 0 to 10, and the calibration incision can be performed with a flow rate of 3 on an arbitrary scale. For example, based on the user's anatomical structure and cutting profile, the system software can determine that a flow rate of 9 is suitable for the deepest incision, and a flow rate of 8 can be performed near the bladder neck. Near the proximal and distal ends of the incision, the flow rate can, for example, increase from a value of about 3 near the distal end of the incision to a value of about 8 corresponding to tissue in the bladder neck. And the flow rate can be reduced to, for example, about 3. When the treatment probe including the jet is pulled proximally, the power of the pump can be reduced corresponding to the cutting profile. For example, the flow rate of the pump in arbitrary units can be reduced from about 8 to a value of about 3 near the proximal end of the incision.

[0194] Figure 10R The treatment is shown with the treatment nozzle carried on the probe pulled proximally. Figure 10RAs shown in other figures, the proximal pulling of the energy source on the carrier probe can reset the tissue. The treatment probe continues to be pulled proximally with the rotation and swinging of the probe tip until a predetermined volume of tissue is removed. This removal of a predetermined volume of tissue according to the cutting profile can provide very accurate tissue removal. In many embodiments, the fine structures of the prostate, such as capsules and nerves, can be avoided. In many embodiments, the screen seen by the user may include additional screens that may be helpful. For example, a treatment guide window can be provided, which displays the positioning of the energy source on the carrier relative to the treatment axis. The long axis of the treatment can extend from about 0 to 6 mm based on, for example, a program. When the energy source is pulled proximally, an indicator can be displayed on the screen, which displays the current position of the treatment. In many embodiments, the indicator displayed on the screen can and should correspond to the indicator on the handpiece as described herein. This redundant information allows the user to verify whether the instrument is operating correctly.

[0195] As described and shown herein, a series of steps can be displayed to the user on the screen, for example, on the right hand side to be completed. For example, the current step can be displayed to the user as a treatment, and several previous steps can also be displayed to the user. The previous steps can include setup steps, such as perfusion and docking as described herein. The previous steps can include planning, such as setting angles and scales as described herein. And the previous steps can include defining cutting profiles or parameters related to cutting, such as calibration and definition of cutting profiles.

[0196] Fig. 10S The treatment complete screen is shown. Upon completion of a pre-programmed treatment, the user is presented with the treatment complete screen and has the option to return to adjust the section and perform additional resection of tissue or enter done and move to the next screen.

[0197] Figure 10T An export data screen is shown. The user is prompted to export the data. The processor may include instructions to export the surgical data to non-volatile memory.

[0198] The treatment can be stored in one or more of many ways. For example, the treatment can be stored on a non-volatile memory (e.g., a flash drive). Alternatively or in combination, an attachment device as described herein can include a non-volatile memory to store the treatment. The stored treatment parameters can include measured sensed parameters, such as the pressure of the treatment, the flow rate of the treatment, and the position of the probe during the treatment. The stored treatment parameters can also include, for example, a treatment table. And the treatment table can provide useful information. For example, when compared with the measured position of the probe during the treatment to verify that the treatment has been performed according to the treatment table. When the user presses the next screen, the user is prompted to move on to the next stage.

[0199] FIG. 10A to FIG. 10T The user interface screens of are shown as an example of a series of screens according to an embodiment. Based on the teachings provided herein, one of ordinary skill in the art will recognize many variations. For example, some screens may be removed. Other screens may be added. Some screens may be combined. Some screens may include sub-screens. In addition, the screens may be presented in a different order.

[0200] In many embodiments, other alignment screens may be provided. For example, a user may be requested to identify an axis of the treatment probe in order to identify a reference axis for the treatment. A user may be requested to identify a marking of the treatment probe, for example, in order to determine that the treatment probe axis displayed on the image is aligned with the translation of the mapped treatment displayed on the screen.

[0201] Fig.11 A method 1100 of treating a patient is shown, in accordance with many embodiments.

[0202] Step 1102, providing an imaging probe having an imaging probe axis.

[0203] Step 1104, provide a treatment probe having a treatment probe shaft.

[0204] In step 1106, the imaging probe axis is aligned with the treatment probe axis.

[0205] Step 1110, verify the alignment of the treatment probe axis along the sagittal plane of the imaging probe.

[0206] Step 1112, correct the residual error.

[0207] Step 1114, measuring the angle of the treatment probe axis relative to the imaging probe having the imaging probe.

[0208] Step 1116, rotating the image of the patient with the probe inserted therein in response to the angle.

[0209] At step 1152, the user interface may ask the user whether priming of the treatment probe has been completed.

[0210] At step 1154, the user interface may wait for the treatment probe to be docked with a computer operating the user interface.

[0211] The user interface may confirm with the user that the ultrasound imaging device is imaging the subject in a transverse view, step 1156. After such confirmation, the main menu screen of the user interface may be displayed.

[0212] At step 1158, the user interface may allow the user to select a target angle for the treatment probe when performing a cutting procedure. The target angle may vary between 0 and 180 degrees.

[0213] In step 1160 , the user interface may confirm the selected cutting angle with the user.

[0214] At step 1162 , the user interface may confirm with the user that the ultrasound imaging device is imaging the subject in a sagittal view.

[0215] At step 1164, the user interface may facilitate calibration or calibration of the therapeutic probe by requesting the user to identify the start and end positions of the probe tip as the probe tip advances from the retracted position as shown in the ultrasound image. The start and end positions may be identified by placing start and end markers, respectively, on the image display portion of the user interface.

[0216] At step 1166 , the user interface may confirm with the user that the start and end positioning of the probe tip marker is acceptable.

[0217] Step 1168, the user interface can repeat the identification and acceptance of the start and end positioning of the probe tip. In many embodiments, these steps (e.g., steps 1166 and 1168) are repeated three times to verify the calibration of the probe tip.

[0218] At step 1170 , the user interface may confirm the calibration or calibration of the probe tip with the user.

[0219] At step 1172, the probe tip may perform a calibration cut. The user interface may provide instructions for activating the probe tip to perform the calibration cut. Alternatively or in combination, the user interface may provide a menu or submenu to operate the treatment probe to perform the calibration cut. When the calibration cut is performed, a display portion of the user interface may display a sagittal view of the target tissue. The treatment probe may be paused and unpaused during the cutting process.

[0220] At step 1174, the user interface may confirm with the user that the calibration cut has been completed.

[0221] The user interface may allow the user to determine and confirm the cutting depth of the calibration cut, step 1176. The user interface may provide markers for the user to drag and place at the cutting location and probe location to confirm the cutting depth.

[0222] Step 1178, the user interface may allow the user to adjust and then confirm the contour boundary of the final cut. The user interface may provide one or more markers for the user to drag and place at the desired contour boundary points to modify the contour boundary as needed.

[0223] At step 1180, the treatment probe tip may perform a final cut. The user interface may provide instructions for activating the probe tip to perform the final cut. Alternatively or in combination, the user interface may provide a menu or submenu to operate the treatment probe to perform the final cut. A display portion of the user interface may display a sagittal view of the target tissue as the final cut is performed. The treatment probe may be paused and unpaused during the cutting process.

[0224] At step 1182, the treatment may be completed and the user interface may provide options, for example, to repeat and / or modify the treatment and / or export the history, parameters, and other information of the treatment performed to a storage medium (e.g., a USB drive, a local data storage device, or a cloud-based storage device).

[0225] The steps of method 1100 may be Figures 10A-10T screen combination.

[0226] Although the above steps illustrate a method 1100 of operating a treatment probe according to many embodiments, one of ordinary skill in the art will recognize many variations based on the teachings described herein. The steps may be completed in a different order. Steps may be added or omitted. Some steps may include sub-steps. Many steps may be repeated as often as is beneficial for treatment.

[0227] For example, steps associated with the performance of the calibration cut (e.g., corresponding to Figure 10L-10O , and / or steps 1172-1176 of method 1100). If there is sufficient data on system performance to provide an accurate correlation between system power and resulting penetration depth of the cut, then the calibration step may not be necessary and the system can be configured to proceed directly to the treatment cut.

[0228] One or more steps of method 1100 may be performed using a circuit system as described herein (e.g., one or more of a processor or logic circuit of a system described herein). The circuit system may be programmed to provide one or more steps of method 1100, and the program may include program instructions stored on a computer readable memory or programmed steps of a logic circuit such as a programmable array logic or a field programmable gate array, for example. Fig.11 Methods according to embodiments are shown. Based on the teachings disclosed herein, those skilled in the art will recognize many variations and adaptations. For example, steps of the method may be deleted. Additional steps may be provided. Some steps may include sub-steps. Some steps may be repeated. The order of the steps may be changed.

[0229] A processor as described herein may be configured to perform Fig.11One or more steps of the method of and providing one or more user interface screens as described herein. In many embodiments, the processor is configured to perform at least a portion of the one or more steps in response to user input displayed on the display, and the processor may include instructions to generate and display the user interface screens as described herein.

[0230] The processor may further be configured to record in this document about Figures 10A-10T and Fig.11 Each performed step of the method described can be recorded. A separate usage log can be maintained for each user or operator of the system, wherein all operator inputs provided during each step of the method can be recorded. The operator log can be configured so that the operator cannot modify it (e.g., recorded as a read-only file, stored in a restricted access database, backed up to a remote server, etc.). The record of all operator inputs and performed steps can provide enhanced operator accountability and provide useful reference data for system improvement and / or troubleshooting.

[0231] experiment

[0232] Fig.12 The maximum tissue penetration depth of the cut and the flow rate through the nozzle according to the embodiment are shown. The maximum penetration depth substantially corresponds to the length of the cavitation bubble of the jet comprising the "cold" water ablation flame. The maximum tissue penetration depth of the ablation directly corresponds to the flow rate, and in many embodiments is linearly related to the flow rate.

[0233] Fig.12 The illustration of shows a cut potato as a model of prostate BPH according to an embodiment. The maximum penetration depth of the potato corresponds closely to the maximum cutting depth of the BPH. The potato is shown cut with a nozzle and a rotating probe at 10 different flow settings corresponding to rates ranging from about 50 ml / min to about 250 ml / min, as described herein. The maximum penetration depth ranges from about 4 mm at 50 ml / min to about 20 mm at 250 ml / min.

[0234] In many embodiments, for properly configured nozzles as described herein, cavitation cloud growth and length include functions of flow rate, which is proportional to injection pressure and vice versa. As pressure increases, the maximum erosion radius increases linearly, which is shown as Fig.12 Maximum penetration depth.

[0235] High-speed cavitation jets can be produced by using a known high-pressure pump to force water to flow through the nozzle in a continuous or pulsating flow. Although the flow type is produced by the pump, the cavitation phenomenon is pulsating due to the unstable nature of the steam chamber, and the cavity formation is also pulsating even in the continuous jet as described herein. Without being limited to a specific theory, it is believed that the water jets of pulsating flow and continuous flow will all cause equal amounts of material erosion within a given amount of time. In many embodiments, the nozzle geometry is configured to provide fluid dynamics and cavitation processes as described herein. In many embodiments, the nozzle is configured to suppress the tight contraction at the water jet outlet, which can be related to the cavitation that can occur inside the nozzle itself. In many embodiments, the sharp corners separate the water from the wall and converge toward the centerline of the nozzle, further contracting the water jet path while significantly reducing the friction effect caused by the nozzle wall. This results in increased speed together with corresponding pressure drop and steam chamber formation. Steam chamber formation will affect the overall fluid dynamics because their final collapse causes turbulence and can affect the depth of erosion. One of ordinary skill in the art may experiment to determine appropriate nozzle geometry and flow rates to provide tissue removal as described herein without undue experimentation.

[0236] Water Melting

[0237] Underwater water jet cutting as described herein has the ability to utilize cavitation phenomena to treat patients with benign prostatic hyperplasia (BPH). The jet removes the excess soft tissue growth seen in BPH through pressure pulses and microjets caused by collapsed steam cavities. The water jet direction can be manipulated by changing the position and orientation of the nozzle of the device, for example by translating the nozzle in the front-to-back direction or by rotating the nozzle up to 180 degrees.

[0238] Because steam cavity formation and its erosion intensity are functions of both injection pressure and fluid dynamics, the depth of the material can be controlled by configuring the pressure and nozzle geometry. Larger injection pressure will result in faster exit velocity. As discussed in this article, nozzle geometry can further increase velocity according to contraction, and will affect the degree of pressure drop when the water jet leaves through the Venturi effect. These factors can result in a longer distance that the cavitation cloud can grow and travel before collapsing and releasing the pressure pulse and microjet. The nozzle geometry and pressure settings of the water ablation system are optimized to give the user precise control and ensure that the cavitation jet only removes the desired benign tissue growth.

[0239] According to an embodiment, the images provided herein show how tissue erosion depth is a function of pressure. These images show smaller cavitation cloud lengths and corresponding tissue resection depths for lower injection pressures compared to other images.

[0240] In many embodiments, water ablation as described herein is capable of removing excess tissue growth, such as BPH, with inhibited removal and damage to arteries and veins. The pressure pulses and microjets caused by cavitation exceed the threshold energy required to erode soft tissue growth and may cause minimal damage to other structures (such as blood vessels, which have much higher threshold energies). Repetitive and focused pressure pulses and microjets may cause fatigue stress on the vasculature and lead to bleeding, but the water ablation system algorithms and treatment instructions as described herein are configured to inhibit such damage.

[0241] In many embodiments, the generation of harmful emboli is inhibited. For example, vapor cavity formation can benefit from the tiny nuclei of air that are already present in the bloodstream. Cavitation can result in the growth of the nucleus without any additional air being introduced into the system. Furthermore, once the local jet pressure exceeds the vapor pressure, the cavity collapses so that the air pockets can be reduced back to their original core size. In many embodiments, emboli formation is inhibited because cavitation relies on and can be limited to the trace amounts of air inherent in the saline solution surrounding the urethra, and the vapor cavity dissipates quickly when the jet pressure begins to rise.

[0242] Hydroablation as described herein exploits this phenomenon. The naturally self-limiting erosion radius and the unique ability to precisely ablate tissue with low damage threshold energies while minimizing damage to nearby structures with larger dense cell structures (e.g., arteries) make hydroablation as described herein a useful surgical tool for treating BPH. Combined with the near-isothermal nature of cavitation as described herein, it can mitigate collateral damage and provide improved healing and improved safety features.

[0243] Fig.13 Selective removal of a potato with a porcine blood vessel located above the incision of the potato is shown as a model for selective removal of tissue. The porcine blood vessel is placed on the potato prior to the incision so that the porcine blood vessel is exposed to a water jet with cavitation in order to remove the potato. A model of hydroablation resection of soft potato tissue that is a close representation of the benign tissue growth seen in BPH without causing severe damage to the porcine blood vessel.

[0244] Fig.14 Shown are potatoes being treated using a predetermined treatment profile and treatment table based on user input.

[0245] Artificial Intelligence and Machine Learning

[0246] The present disclosure provides several examples of patient and surgical robot data and machine learning that can be used to train machine learning algorithms, and any type of patient data and surgical robot data as described herein can be used. For example, tissue ablation parameters, such as pressure and nozzle type, can be used in conjunction with the type of tissue to be ablated (e.g., cystic tissue or BPH or cancerous tissue). Additional parameters include treatment plan profiles, such as the radius, angle, and longitudinal positioning of the cutting profile. This can be combined with real-time imaging from imaging devices (e.g., ultrasound probes, TRUS probes, endoscopes, cytoscopes, and optical images). Images can include images of tissue structures (e.g., urethra, bladder neck, and spermatozoa). Images can include a portion of surgical instruments (e.g., rotating and swinging probes as described herein). Images can be processed with image segmentation, for example, to determine the position of tissue structures and surgical instruments. Artificial intelligence software instructions can be configured to automatically identify tissue structures and surgical instruments and determine the relative position of each. For example, data can be vectorized and input into a machine learning classifier.

[0247] The imaged tissue structures may include, for example, reference Figure 5B Any tissue structure described herein, and may include, for example, bladder, cystic vessels, cysts, nerves, BPH, and cystic tissue.

[0248] Sensor data, positioning data and recorded treatment positioning may include, for example, reference Figure 3A and FIG. 10A to FIG. 10R Any of the sensor data, positioning data, and recorded treatment positioning described herein may include components and sensors and elements of the apparatus. The recorded data may include, for example, data of an energy source, pump, infusion / irrigation, insufflation, endoscope, balloon inflation, suction, light source, arm lock, arm controller, linkage, each angle sensor, patient support, or base.

[0249] Treatment data may include, for example, reference FIG. 8A to FIG. 8T The apparatus may include a plurality of configurations, such as a position of the probe relative to a plurality of structures that allow a user (e.g., a physician) to adjust the endoscope independently of other components of the apparatus. In many embodiments, the endoscope is coupled to an endoscope carriage or linkage as described herein, wherein the sensor is configured to determine the position of the endoscope on the carriage during setup. The endoscope carriage may be advanced and retracted to move the distal end of the endoscope connected to the coupling proximally and distally, and these positions are recorded during setup.

[0250] Treatment data may include, for example, reference FIG. 10A to FIG. 10S Any data and images of planned treatment as described herein. Treatment data may include target angle, planned cut tissue profile, pressure, and other parameters as described herein.

[0251] Treatment data may include, for example, reference FIG. 9A to FIG. 9B and FIG. 10A to FIG. 10S Setup data related to the alignment of the surgical treatment probe with the imaging probe. For example, the alignment of the treatment probe axis as described herein with the sagittal plane of the imaging probe can be recorded and used as input. The inclination of the long axis of the treatment probe relative to the long axis of the imaging probe as described herein can be used as input. The recorded image can include an image from the imaging probe, which includes a sagittal image field of view, wherein, for example, when the treatment probe is within the field of view of the sagittal image, the treatment probe as described herein is substantially aligned with the sagittal plane of the imaging probe. For example, the setup data can include perfusion data, docking data, angle data, scale data, calibration data, cutting profile data, corresponding times of one or more of these data, and planned treatment times.

[0252] As described herein, artificial intelligence or machine learning can be used to modify the planning data. For example, as described herein, the planned and modified tissue removal profiles can be displayed on a display, overlaid on the tissue image.

[0253] Fig.15 A method 1500 for treating a patient using artificial intelligence or machine learning according to some embodiments is shown. While the method can be performed in many ways, in some embodiments, patient data for each of a plurality of treated patients is received. The data for each of a plurality of treated patients includes one or more of patient demographics, a cut profile of tissue to be removed, an actual profile of tissue to be removed, a target volume of tissue to be removed, an actual volume of tissue removed, or a ratio of the amount of tissue targeted for removal to the amount removed. Surgical robot data for each of a plurality of treated patients is received. The surgical robot data includes a plurality of treatment parameters recorded during treatment, treatment time, setup time, imaging time, time of treatment probe movement, a plurality of positions and orientations of the treatment probe, a plurality of images of tissue, a plurality of images of tissue (each image including the treatment probe), or the intensity of an energy source for removing tissue. A treatment plan for the patient to be treated is output in response to the patient data and the surgical robot data.

[0254] At step 1505, patient demographic data is recorded for each of the plurality of treated patients. The patient demographic data for each of the plurality of patients and the patient to be treated includes one or more of patient age, weight, gender, or body mass index.

[0255] At step 1510, a treatment plan is recorded for each of a plurality of treated patients. The treatment plan may include any treatment plan as described herein.

[0256] At step 1515, setup data is recorded from the surgical robot for each of the plurality of treated patients. The setup data may include any setup data as described herein.

[0257] At step 1520, each of the plurality of patients is treated according to the treatment plan. The patient may be treated using any one or more of the surgical method steps as described herein.

[0258] At step 1523, data is recorded for each of the plurality of treated patients during treatment. The recorded data may include images of each of the plurality of patients. The recorded data may include a continuous image of any image as described herein, such as a movie.

[0259] The plurality of treatment parameters recorded during treatment include a measured treatment time, a measured setup time, a measured imaging time, a measured time of treatment probe movement, a measured intensity of an energy source that removes tissue, a plurality of recorded positions of the treatment probe, a plurality of recorded images of tissue during treatment, a plurality of recorded orientations of the treatment probe, a plurality of tissue images corresponding to each of the plurality of recorded positions and orientations. The plurality of treatment parameters recorded during treatment include a plurality of sequentially arranged frames of data, including each of the plurality of sequentially arranged frames of data of an image of tissue, an image of the treatment probe positioned relative to the treated tissue, a position of the treatment probe, an orientation of the treatment probe, or an energy of the treatment probe, and optionally wherein each of the plurality of sequentially arranged frames of data corresponds to a substantially fixed time interval between each of the plurality of frames.

[0260] At step 1525, sensor data and treatment data of the robotic component are recorded, wherein the data corresponds to each of the plurality of images for each of the plurality of treated patients. The intensity of the energy source includes water jet intensity, light beam intensity, radio frequency energy intensity, ionizing radiation intensity, stereotactic radiation intensity, or ultrasound energy intensity.

[0261] At step 1530, data frames are generated from the plurality of images and sensor data and the treatment data for each of the plurality of treated patients. The data frames may include image frames corresponding to fixed intervals (e.g., one second between frames). Alternatively or in combination, vectorized data may be generated from the image frames.

[0262] At step 1535, pre-treatment data is received, wherein the pre-treatment data corresponds to an outcome parameter for each of a plurality of treated patients.

[0263] At step 1540, post-treatment data is received, wherein the post-treatment data corresponds to an outcome parameter for each of a plurality of treated patients.

[0264] At step 1545, surgical robotic data is received for each of a plurality of treated patients.

[0265] At step 1550, artificial intelligence processor instructions or machine learning classifiers are trained in response to the received treated patient and surgical treatment data. Artificial intelligence processor instructions may include one or more of machine learning, search and mathematical optimization, artificial neural networks, statistics, probability, support vector machine learning, clustering of data sets, image classification, image segmentation. Machine learning processor instructions may include one or more of decision tree learning, association rule learning, artificial neural networks, deep learning, inductive logic programming, support vector machines, clustering, Bayesian networks, reinforcement learning, representation learning, similarity and metric learning, sparse dictionary learning, genetic algorithms, rule-based machine learning or learning classifier systems.

[0266] At step 1555, the trained artificial intelligence or trained machine learning classifier is validated.

[0267] At step 1560, the data of the patient to be treated is input into a trained artificial intelligence or a trained machine learning classifier.

[0268] At step 1565, a treatment plan for the patient to be treated is determined.

[0269] At step 1570, the treatment plan for the patient to be treated is input into a trained artificial intelligence or machine learning classifier.

[0270] At step 1575, the treatment plan is modified in response to the trained artificial intelligence or machine learning classifier. Adjustments to the treatment plan for the patient to be treated may include adjustments to one or more of a cutting profile of tissue to be removed, an actual profile of tissue to be removed, a target volume of tissue to be removed, an actual volume of tissue to be removed, a treatment time, a setup time, an imaging time, a time for movement of the treatment probe, an intensity of an energy source to remove tissue, or a ratio of the amount of tissue targeted for removal to the amount removed. The cutting profile may include a plurality of positions including a plurality of angular coordinates about a treatment axis, a plurality of corresponding axial coordinates along the axis, and a plurality of radial distances from the axis. Adjustments to the cutting profile may include adjustments to a plurality of angular coordinates about a treatment axis, a plurality of corresponding axial coordinates along the axis, or a plurality of radial distances from the axis.

[0271] At step 1580, the modified treatment plan is output and received as input into a processor of the surgical robotic system.

[0272] At step 1585, the initial cutting profile and the modified cutting profile are displayed on the image of the tissue to be treated. For example, the initial cutting profile is overlaid on the image of the tissue to be resected on the display, and the adjusted cutting profile is displayed on the image of the tissue to be treated.

[0273] At step 1590, the patient is treated with the modified treatment plan.

[0274] At step 1595, data from the patient treated with the modified treatment plan is recorded.

[0275] At step 1597, the trained artificial intelligence or trained machine learning classifier is updated in response to the patient being treated with the modified treatment plan.

[0276] One or more steps of method 1500 may be performed using circuitry or processor instructions as described herein, such as one or more processors or logic circuits of the systems described herein. The circuitry may be programmed to provide one or more steps of method 1500, and the program may include program instructions stored on a computer-readable memory or programmed steps of logic circuits such as having programmable array logic or field programmable gate arrays.

[0277] Fig.15 Methods according to embodiments are shown. Based on the teachings disclosed herein, those skilled in the art will recognize many variations and adaptations. For example, steps of the method may be deleted. Additional steps may be provided. Some steps may include sub-steps. Some steps may be repeated. The order of the steps may be changed.

[0278] Digital processing equipment

[0279] In some embodiments, the platforms, systems, media, and methods described herein include a digital processing device or its use. In other embodiments, the digital processing device includes one or more hardware central processing units (CPUs) or general purpose graphics processing units (GPGPUs) that perform the functions of the device. In some other embodiments, the digital processing device also includes an operating system configured to execute executable instructions. In some embodiments, the digital processing device is optionally connected to a computer network. In other embodiments, the digital processing device is optionally connected to the Internet so that it accesses the World Wide Web. In some other embodiments, the digital processing device is optionally connected to a cloud computing infrastructure. In other embodiments, the digital processing device is optionally connected to an intranet. In other embodiments, the digital processing device is optionally connected to a data storage device.

[0280] According to the description herein, suitable digital processing devices include server computers, desktop computers, laptop computers, notebook computers, small notebook computers, netbook computers, netpad computers, set-top computers, streaming media devices, handheld computers, Internet appliances, mobile smart phones, tablet computers, personal digital assistants, video game consoles and vehicles as non-limiting examples. Those skilled in the art will recognize that many smart phones are suitable for use in the system described herein. Those skilled in the art will also recognize that selected televisions, video players and digital music players with optional computer network connections are suitable for use in the system described herein. Suitable tablet computers include tablet computers with booklets, tablets and convertible configurations known to those skilled in the art.

[0281] In some embodiments, the digital processing device includes an operating system configured to execute executable instructions. For example, an operating system is software, including programs and data, that manages the hardware of the device and provides services for the execution of applications. Those skilled in the art will recognize that suitable server operating systems include, as non-limiting examples, FreeBSD, OpenBSD, Linux, Mac OS X Windows and Those skilled in the art will recognize that suitable personal computer operating systems include, by way of non-limiting example, Mac OS and UNIX-type operating systems, such as In some embodiments, the operating system is provided by cloud computing. Those skilled in the art will also recognize that suitable mobile smartphone operating systems include, by way of non-limiting example, OS, Research In BlackBerry Windows Windows OS, Windows OS, and Those skilled in the art will also recognize that suitable streaming device operating systems include, by way of non-limiting example, Apple Google Google Amazon and Those skilled in the art will also recognize that suitable video game console operating systems include, by way of non-limiting example, Xbox Microsoft Xbox One, Wii and

[0282] In some embodiments, the device includes a storage and / or memory device. A storage and / or memory device is one or more physical devices for storing data or programs on a temporary or permanent basis. In some embodiments, the device is a volatile memory and requires power to maintain the stored information. In some embodiments, the device is a non-volatile memory and retains the stored information when the digital processing device is not powered. In other embodiments, the non-volatile memory includes flash memory. In some embodiments, the non-volatile memory includes a dynamic random access memory (DRAM). In some embodiments, the non-volatile memory includes a ferroelectric random access memory (FRAM). In some embodiments, the non-volatile memory includes a phase change random access memory (PRAM). In other embodiments, the device is a storage device, which includes, as non-limiting examples, a CD-ROM, a DVD, a flash memory device, a disk drive, a tape drive, an optical drive, and a storage device based on cloud computing. In other embodiments, the storage and / or memory device is a combination of those devices disclosed herein, for example.

[0283] In some embodiments, the digital processing device includes a display that sends visual information to a user. In some embodiments, the display is a cathode ray tube (CRT). In some embodiments, the display is a liquid crystal display (LCD). In other embodiments, the display is a thin film transistor liquid crystal display (TFT-LCD). In some embodiments, the display is an organic light emitting diode (OLED) display. In various other embodiments, the OLED display is a passive matrix OLED (PMOLED) or an active matrix OLED (AMOLED) display. In some embodiments, the display is a plasma display. In other embodiments, the display is a video projector. In yet other embodiments, the display is a combination of devices such as those disclosed herein.

[0284] In some embodiments, the digital processing device includes an input device that receives information from a user. In some embodiments, the input device is a keyboard. In some embodiments, the input device is a pointing device, which includes, as non-limiting examples, a mouse, a trackball, a touchpad, a joystick, a game controller, or a stylus. In some embodiments, the input device is a touch screen or a multi-touch screen. In other embodiments, the input device is a microphone that captures voice or other sound input. In other embodiments, the input device is a video camera or other sensor that captures motion or visual input. In other embodiments, the input device is a Kinect, Leap Motion, or the like. In yet other embodiments, the input device is a combination of those devices disclosed herein, for example.

[0285] refer to Fig.16 In certain embodiments, the exemplary digital processing device 1601 is programmed or otherwise configured to use artificial intelligence or machine learning to establish, plan or perform surgical robotic surgery. The device 1601 can adjust various aspects of machine learning and artificial intelligence of the present disclosure, such as determining a cutting profile in response to data of a patient to be treated and data from previously treated patients and previous surgical procedures, as described herein. In this embodiment, the digital processing device 1601 includes a central processing unit (CPU, also "processor" and "computer processor" herein) 1605, which can be a single-core or multi-core processor or multiple processors for parallel processing. The digital processing device 1601 also includes a memory or memory location 1610 (e.g., random access memory, read-only memory, flash memory), an electronic storage unit 1615 (e.g., a hard disk), a communication interface 1620 (e.g., a network adapter) for communicating with one or more other systems, and peripheral devices 1625 (e.g., cache, other memory, data storage device, and / or electronic display adapter). Memory 1610, storage unit 1615, interface 1620 and peripheral device 1625 communicate with CPU 1605 through communication bus (solid line) (e.g., motherboard). Storage unit 1615 may be a data storage unit (or data repository) for storing data. Digital processing device 1601 may be operatively coupled to computer network ("network") 1630 by means of communication interface 1620. Network 1630 may be the Internet, the internet and / or an extranet, or an intranet and / or an extranet communicating with the internet. In some cases, network 1630 is a telecommunications and / or data network. Network 1630 may include one or more computer servers that may implement distributed computing (e.g., cloud computing). In some cases, with the aid of device 1601, network 1630 may implement a peer-to-peer network that enables devices coupled to device 1601 to function as clients or servers.

[0286] Continue to refer Fig.16 , CPU 1605 can execute a series of machine-readable instructions that can be embodied in a program or software. Instructions can be stored in a memory location (e.g., memory 1610). Instructions can be directed to CPU 1605, which can then program or otherwise configure CPU 1605 to implement the method of the present disclosure. Examples of operations performed by CPU 1605 can include fetching, decoding, executing, and writing back. CPU 1605 can be part of a circuit (e.g., an integrated circuit). One or more other components of device 1601 can be included in the circuit. In some cases, the circuit is an application specific integrated circuit (ASIC) or a field programmable gate array (FPGA).

[0287] Continue to refer Fig.16 , storage unit 1615 can store files, such as drivers, libraries, and saved programs. Storage unit 1615 can store user data, such as user preferences and user programs. In some cases, digital processing device 1601 may include one or more additional data storage units externally (located on a remote server), which communicates via an intranet or the Internet.

[0288] Continue to refer Fig.16 , the digital processing device 1601 can communicate with one or more remote computer systems via the network 1630. For example, the device 1601 can communicate with a remote computer system of a user. Examples of remote computer systems include personal computers (e.g., portable PCs), tablet or tablet PCs (e.g., iPad, Galaxy Tab), phones, smartphones (such as iPhone, Android-enabled devices, ) or a personal digital assistant.

[0289] The methods as described herein may be implemented by machine (e.g., computer processor) executable code stored on an electronic storage location of the digital processing device 1601 (e.g., on the memory 1610 or electronic storage unit 1615). The machine executable code or machine readable code may be provided in the form of software. During use, the code may be executed by the processor 1605. In some cases, the code may be retrieved from the storage unit 1615 and stored on the memory 1610 for easy access by the processor 1605. In some cases, the electronic storage unit 1615 may be excluded, and the machine executable instructions are stored on the memory 1610.

[0290] Non-transitory computer readable storage medium

[0291] In some embodiments, the platforms, systems, media, and methods disclosed herein include one or more non-transitory computer-readable storage media encoded with a program, and the program includes instructions executable by an operating system of an optionally networked digital processing device. In other embodiments, the computer-readable storage medium is a tangible component of the digital processing device. In some other embodiments, the computer-readable storage medium is optionally removable from the digital processing device. In some embodiments, as non-limiting examples, the computer-readable storage medium includes a CD-ROM, a DVD, a flash memory device, a solid-state memory, a disk drive, a tape drive, an optical drive, a cloud computing system and service, etc. In some cases, the program and instructions are permanently, substantially permanently, semi-permanently, or non-temporarily encoded on the medium.

[0292] Computer Programs

[0293] In some embodiments, the platforms, systems, media, and methods disclosed herein include at least one computer program or its use. The computer program includes a series of instructions executable in the CPU of a digital processing device and written to perform a specified task. Computer-readable instructions can be implemented as program modules that perform specific tasks or implement specific abstract data types, such as functions, objects, application programming interfaces (APIs), data structures, etc. Based on the disclosure provided herein, those skilled in the art will recognize that computer programs can be written in various versions of various languages.

[0294] The functions of the computer readable instructions can be combined or distributed in various environments as needed. In some embodiments, the computer program includes an instruction sequence. In some embodiments, the computer program includes multiple instruction sequences. In some embodiments, the computer program is provided from one location. In other embodiments, the computer program is provided from multiple locations. In various embodiments, the computer program includes one or more software modules. In various embodiments, the computer program partially or entirely includes one or more web applications, one or more mobile applications, one or more stand-alone applications, one or more web browser plug-ins, extensions, add-ons or attachments or a combination thereof.

[0295] Web Application

[0296] In some embodiments, the computer program includes a web application. Based on the disclosure provided herein, those skilled in the art will recognize that in various embodiments, the web application utilizes one or more software frameworks and one or more database systems. In some embodiments, in the software framework (e.g., .NET or Ruby on Rails (RoR)). In some embodiments, the web application utilizes one or more database systems, which include, as non-limiting examples, relational, non-relational, object-oriented, associative, and SML database systems. In other embodiments, suitable relational database systems include, as non-limiting examples, SQL Server, mySQL TM and Those skilled in the art will also recognize that in various embodiments, a web application is written in one or more versions of one or more languages. A web application may be written in one or more markup languages, presentation definition languages, client-side scripting languages, server-side coding languages, database query languages, or combinations thereof. In some embodiments, a web application is written in a markup language such as Hypertext Markup Language (HTML), Extensible Hypertext Markup Language (XHTML), or Extensible Markup Language (XML) to some extent. In some embodiments, a web application is written in a presentation definition language such as Cascading Style Sheets (CSS) to some extent. In some embodiments, a web application is written in a client-side scripting language such as Asynchronous Javascript and XML (AJAX), Actionscript, Javascript, or ) to write web applications. In some embodiments, server-side coding languages ​​(e.g., Active Server Pages (ASP), Perl, Java TM , JavaServer Pages (JSP), Hypertext Preprocessor (PHP), Python TM , Ruby, Tcl, Smalltalk, In some embodiments, web applications are written in a database query language (e.g., Structured Query Language (SQL)) to some extent. In some embodiments, web applications integrate enterprise server products, such as Lotus In some embodiments, the web application includes a media player element. In various other embodiments, the media player element utilizes one or more of a number of suitable multimedia technologies, which include, as non-limiting examples, HTML 5, Java TM and

[0297] Mobile Apps

[0298] In some embodiments, the computer program includes a mobile application provided to the mobile digital processing device. In some embodiments, the mobile application is provided to the mobile digital processing device at the time it is manufactured. In other embodiments, the mobile application is provided to the mobile digital processing device via a computer network described herein.

[0299] In view of the disclosure provided herein, mobile applications are created using hardware, languages, and development environments known in the art by techniques known to those skilled in the art. Those skilled in the art will recognize that mobile applications are written in several languages. Suitable programming languages ​​include, by way of non-limiting example, C, C++, C#, Objective-C, Java, and the like. TM ,Javascript,Pascal,Object Pascal,Python TM , Ruby, VB.NET, WML and XHTML / HTML with or without CSS or a combination thereof.

[0300] Suitable mobile application development environments are available from several sources. As non-limiting examples, commercially available development environments include AirplaySDK, alcheMo, Celsius, Bedrock, Flash Lite, .NET Compact Framework, Rhomobile, and WorkLight mobile platforms. Other development environments are freely available, including, as non-limiting examples, Lazarus, MobiFlex, MoSync, and Phonegap. In addition, mobile device manufacturers distribute software development kits, which include, as non-limiting examples, the iPhone and iPad (iOS) SDK, the Android TM SDK, SDK, BREW SDK, OSSDK, Symbian SDK, webOSSDK and Mobile SDK.

[0301] Those skilled in the art will recognize that several commercial forums are available for the distribution of mobile applications, including, by way of non-limiting example, App Store, Play, Chrome WebStore, App World, App Store for Palm devices, App Catalog for webOS, Marketplace, for Ovi Store on your device, Apps and DSi Shop.

[0302] Standalone Application

[0303] In some embodiments, the computer program comprises a stand-alone application, which is a program that runs as an independent computer process rather than an add-on to an existing process (e.g., not a plug-in). Those skilled in the art will recognize that stand-alone applications are often compiled. A compiler is a computer program that converts source code written in a programming language into binary object code (e.g., assembly language or machine code). Suitable compiled programming languages ​​include, by way of non-limiting examples, C, C++, Objective-C, COBOL, Delphi, Eiffel, Java, and the like. TM , Lisp, Python TM , Visual Basic and VB.NET or a combination thereof. Compilation is often performed at least in part to create an executable program. In some embodiments, the computer program includes one or more executable compiled applications.

[0304] Web Browser Plug-ins

[0305] In some embodiments, a computer program includes a web browser plug-in (e.g., extension, etc.). In computing, a plug-in is one or more software components that add specific functionality to a larger software application. The maker of the software application supports plug-ins to enable third-party developers to create capabilities that extend the application, to support easy addition of new functionality, and to reduce the size of the application. When supported, plug-ins enable the functionality of customized software applications. For example, plug-ins are commonly used in web browsers to play videos, generate interactivity, scan for viruses, and display specific file types. Those skilled in the art will be familiar with several web browser plug-ins, including Player, and In certain embodiments, the toolbar includes one or more web browser extensions, plug-ins or add-ons. In certain embodiments, the toolbar includes one or more browsing bars, tool belts or desktop belts.

[0306] In view of the disclosure provided herein, one skilled in the art will recognize that several plug-in frameworks are available that enable development of plug-ins in various programming languages, including, as non-limiting examples, C++, Delphi, Java, and the like. TM , PHP, Python TM and VB.NET or a combination thereof.

[0307] A web browser (also known as an Internet browser) is a software application designed for use with a network-connected digital processing device for retrieving, presenting, and traversing information resources on the World Wide Web. Suitable web browsers include, by way of non-limiting example, Internet Chrome, Opera and KDE Konqueror. In some embodiments, the web browser is a mobile web browser. Mobile web browsers (also known as micro-browsers, mini-browsers, and wireless browsers) are designed for use on mobile digital processing devices, including, by way of non-limiting examples, handheld computers, tablet computers, netbook computers, small notebook computers, smart phones, music players, personal digital assistants (PDAs), and handheld video game systems. Suitable mobile web browsers include, by way of non-limiting examples, Browser, RIM Browser, Blazer, Browsers, for mobile devices Internet Mobile, BasicWeb, Browser, Opera Mobile and PSP TM Browser.

[0308] Software Modules

[0309] In some embodiments, the platform, system, medium and method disclosed herein include software, server and / or database module or its use. In view of the disclosure provided herein, the software module is created by the technology known to those skilled in the art using machines, software and languages ​​known in the art. The software module disclosed herein is implemented in many ways. In various embodiments, the software module includes a file, a code segment, a programming object, a programming structure or a combination thereof. In various other embodiments, the software module includes multiple files, multiple code segments, multiple programming objects, multiple programming structures or a combination thereof. In various embodiments, one or more software modules include web applications, mobile applications and standalone applications as non-limiting examples. In some embodiments, the software module is in a computer program or application. In other embodiments, the software module is in more than one computer program or application. In some embodiments, the software module is hosted on a machine. In other embodiments, the software module is hosted on more than one machine. In other embodiments, the software module is hosted on a cloud computing platform. In some embodiments, the software module is hosted on one or more machines in a location. In other embodiments, the software module is hosted on one or more machines in more than one location.

[0310] database

[0311] In some embodiments, the platform, system, medium and method disclosed herein include one or more databases or their use. In view of the disclosure provided herein, those skilled in the art will recognize that many databases are suitable for the storage and retrieval of patient information and surgical information as described herein. In various embodiments, as non-limiting examples, suitable databases include relational databases, non-relational databases, object-oriented databases, object databases, entity-relationship model databases, associated databases and XML databases. Other non-limiting examples include SQL, PostgreSQL, MySQL, Oracle, DB2 and Sybase. In some embodiments, the database is based on the Internet. In other embodiments, the database is based on web. In some other embodiments, the database is based on cloud computing.

[0312] The patient data for each patient can be stored in a database as described herein and used as input to train a classifier. The patient data can include several fields and images for each patient and can include a library of treatments. As described herein, the patient data can include values ​​for safety and efficacy parameters for each patient.

[0313] Exemplary artificial intelligence, classifiers, neural networks, and associated input and user interfaces

[0314] The efficacy and persistence of patient treatment can be measured in many ways. The persistence of treatment can correspond to the stability of efficacy parameters over time. For example, the persistence parameter can correspond to the patency of the urethra and urine flow rate of the postoperative patient over time. Although many metrics of patient efficacy can be used, in some embodiments, the International Prostate Symptom Score ("I-PSS") is used to determine the efficacy of surgery. Questionnaires and results for training algorithms as described herein can be provided to patients before and after treatment. The I-PSS score has 7 questions, each with a graded answer on a scale of 1 to 5. These graded answers can be used as input to train the algorithm. Questions include incomplete emptying, frequency, intermittent, urgency, weak stream, straining, and nocturia. "Incomplete emptying" refers to the feeling that the bladder is not emptying. "Frequency" refers to how often the subject urinates less than once every two hours. "Intermittent" refers to how often the subject stops urinating during urination and starts urinating again a few times. "Urgency" refers to how often the subject finds it difficult to postpone urination. "Weak stream" refers to how often the subject has a weak urine stream. "Straining" refers to how often a subject has to strain to initiate urination. Nocturia refers to how many times a subject gets up to urinate at night. The total of these values ​​can be added together to determine an overall score: 1-7: mild; 8-19: moderate; and 20-35: severe. This total can be used as an input to an algorithm (e.g., a classifier or neural network) as described herein.

[0315] Other tests may be used, such as the American Urological Association ("AUA") Symptom Index.

[0316] Another input to the algorithm can be a patient outcome related to sexual function after prostate surgery, such as the International Index of Erectile Function Brief Questionnaire ("IIEF-5"). The IIEF-5 has five questions related to sexual function, and the answers range from values ​​of 1 to 5, where 1 is very low and 5 is very high. Questions are directed to confidence, firmness, stability, and the subject's satisfaction with erection. The IIEF-5 scores can be combined to provide a total score. Individual values ​​and / or total scores can be used as input to the algorithm as described herein to train one or more classifiers or neural networks.

[0317] Additional parameters that may be used include one or more of return to work time, urine flow data, catheter insertion time, catheter tension, Foley catheter tension, or catheter tensioning device methods. In urological surgery (e.g., prostate) surgery, it may be helpful to place a catheter (e.g., a Foley catheter) in a patient to maintain urine flow. Work related to the present disclosure suggests that tightening a catheter placed in a patient's urethra can reduce bleeding and maintain catheter placement. Because catheter insertion may be slightly uncomfortable for the patient, it may be helpful to reduce catheter insertion time while maintaining urethral patency and reducing bleeding. Because multiple types of catheter tensioning can be used, it may be helpful to receive the type of catheter tensioning used as input. Examples of catheter tensioning include weights, springs, straps, and other methods that can be used to tighten a catheter.

[0318] The input patient data may include one or more biomechanical parameters of the tissue from the patient, such as one or more of tissue strain, tissue elasticity, tissue tensile strength, tissue elongation, tissue modulus, or tissue homogeneity. These measurements may be performed for each patient and used as input. For example, an ultrasound probe may be used to measure these parameters, and these parameters may include components of the ultrasound probe. For example, the ultrasound probe may be configured to measure tissue using one or more of low-frequency vibration, step length, hand-drawn lines, physiological displacement, radiation force (e.g., displacement, pulse, shear wave, and acoustic emission), or pulse echo or Doppler ultrasound. The ultrasound probe that measures tissue parameters may include components of a TRUS probe as described herein.

[0319] Alternatively or in combination, these biomechanical tissue parameters can be determined with a measurement tool and provided as input to physical palpation. In some embodiments, these values ​​can be determined using a lookup table. For example, demographic parameters (e.g., the patient's age) and tissue biomechanical parameters for each patient can be input into a classifier and used to generate a lookup table of tissue parameters in response to patient demographic data.

[0320] Patient images used as input may include, for example, one or more of tissue edge identification, tissue plane identification, tissue differentiation detection, fluoroscopy, CT scan imaging, magnetic resonance imaging, radioactive detection, or radiopaque imaging. In some embodiments, the image includes a fluorescent image of the patient's tissue. The fluorescent image may include an image of tissue labeled with a fluorescent antibody that is configured to bind to cancerous tissue so as to, for example, identify cancerous tissue in the image.

[0321] The input patient data may include identification of cancerous tissue in one or more images of the patient.

[0322] In some embodiments, the processor is configured with instructions for the user to select one or more parameters for determining one or more of a safety parameter value, an efficacy parameter value, or a suggested tissue resection profile. For example, if a physician believes that a particular demographic parameter or another parameter is not helpful in planning treatment or predicting outcomes, it may be helpful to accommodate specific preferences based on user experience.

[0323] In some embodiments, the processor is configured with instructions for a user to plan a surgery on a first display remote from the surgical system, store parameters for the planned surgery, and provide the parameters to the processor operatively coupled to the display of the surgical system. This may be helpful for a user to pre-plan a surgery. For example, a surgeon may pre-plan a patient treatment at a location remote from the surgical site and have the parameters of the planned treatment loaded onto the surgical system to reduce preparation time at the surgical site.

[0324] In some embodiments, guidance is provided to the user in response to the patient data. The user can select visualization or pre-planning reports based on different approaches to different recommended treatment plans, either individually or in groups, based on artificial intelligence "AI" approaches. The user can consider the merits of different algorithms in predicting outcomes, such as risk, recovery, sustainability, length of surgery, specific patient characteristics, or physician characteristics.

[0325] In some embodiments, for example, a user selects data to be used with a selected algorithm. For example, this can allow a user to consider outcome likelihoods, odds, and risks for different scenarios and in their desired relationship to risk.

[0326] Although the rotation and translation of the treatment probe are mentioned, the methods, devices and artificial intelligence programs disclosed herein are very suitable for combination with many types of robotic surgery. The robotic system may include a processor operatively coupled to a linkage device (e.g., a robotic arm). For example, the surgical system may include a robotic arm, such as a 5 to 7 degree of freedom robotic arm with an end effector. The robotic arm may include a joint state that can be recorded together with an image of the surgery. The end effector may include an energy source as described herein to remove tissue to a tissue resection profile. The end effector may be present in an image stored as described herein. One or more of the image, linkage state, resection profile, or patient data (e.g., demographic data) may be recorded in a database, which includes a library of patient surgeries as described herein, and the database is used for training a classifier as described herein. The trained classifier may receive data from an individual patient as input and an output of a classifier for determining treatment parameters. Treatment of an individual patient may be planned with a user interface as described herein.

[0327] Treatment parameters and safety and efficacy data can be used as reference, for example Fig.15 Training one or more classifiers or neural networks as described herein. Once trained, the classifiers and / or neural networks can be used to provide information on a display to help a robotic system user (e.g., a surgeon) determine an appropriate tissue resection or cutting profile.

[0328] For example, the information displayed on the display may include safety parameters and efficacy parameters. The system user may adjust the tissue resection profile to provide an appropriate balance between the safety parameters and the efficacy parameters. The safety parameters may include the likelihood of erectile dysfunction, such as a predicted IIE-5 score at a time after surgery (e.g., one year after surgery). The efficacy parameters may include the likelihood of retreatment at a future time (e.g., in the next 5 years). The efficacy parameters may include a predicted I-PSS score at a future time, such as a predicted I-PSS score in the next five years.

[0329] Displaying these sections with associated parameters may be helpful for the doctor to plan treatment according to a treatment plan acceptable to the patient. For example, some patients may object to retreatment and be willing to accept a certain sexual dysfunction. Alternatively, some patients may object to sexual dysfunction and be more willing to accept retreatment.

[0330] In some embodiments, as part of the treatment plan, the doctor can present the target safety and efficacy parameters to the patient on the display of the computer, and the patient can digitally sign and accept these parameters. For example, the display can be displayed to the patient at the predicted I-PSS score at 5 years, and displayed to the user at the predicted IIEF-5 score at 1 year, and the user can digitally sign and accept these parameters. The target parameters can be displayed on the display together with the image of the prostate and the patient's digital signature. The data can be stored on the processor as described herein, and provided to the doctor as part of the treatment plan process on the display as described herein. The data can also be stored as part of the patient's record (e.g., as an electronic medical record ("EMR")).

[0331] refer to Fig.17A , shows a sample user interface 1700 that can be used with the devices and methods described herein. The user interface 1700 may include two main areas, such as an instruction area 1702 and a control area 1704. Of course, the layout of the user interface 1700 shown is exemplary, and any suitable layout or arrangement of information and control inputs may be utilized without departing from the scope hereof.

[0332] In the instruction area 1702, the user of the system may be reminded and / or prompted about the next surgical step in a series of steps. For example, as shown, the instruction area 1702 indicates that the imaging device (e.g., a TRUS probe) is scanning the prostate in the scan window 1706. The scan window 1706 may display the area of ​​the anatomical structure that is being scanned or should be scanned for the current surgical step, as will be described below. The view provided is a lateral view of the prostate.

[0333] The anatomical structure selection window 1708 provides the user with the ability to select a portion of the anatomical structure for which a working section is to be established. As shown, the user selects "prostate" as the portion of the anatomical structure for which a working section is to be set.

[0334] Safety and efficacy parameter window 1750 shows the value of one or more safety or efficacy parameters for the subject as described herein in response to the resection profile and ultrasound image. For example, efficacy value X may include one or more of the target efficacy value or efficacy values ​​determined in response to the resection profile and structure of the image. For example, window 1750 may display the target efficacy value determined for the patient in consultation with the patient and the predicted efficacy value generated in response to the resection profile and image. Window 1750 may display the target safety value determined for the patient in consultation with the patient and the predicted safety value generated in response to the resection profile and image. These values ​​may be determined in real time in response to the resection profile and the structure of the ultrasound image displayed on the display. Safety parameters may include value X, and efficacy parameters may include value Y. When the user adjusts the resection profile, the values ​​of X and Y displayed on the display may change. The processor may be configured with instructions for generating an initial resection profile in response to the ultrasound image and the target safety and efficacy values ​​previously agreed upon by the patient and the doctor. The initial resection profile may be provided on the display and adjusted by the user.

[0335] When the portion of the anatomical structure is selected, an image corresponding to the selected portion of the anatomical structure can be displayed. For example, a real-time image captured by an in-situ imaging system can be displayed. In some instances, a TRUS probe will be placed near the patient's prostate and will provide real-time imaging of the region. In the control area 1704 of the user interface 1700, the user will be able to specify the area to be treated. The system is programmed with default values, which help the user select a suitable treatment plan. For example, in the case where the user has selected the prostate, as shown, the control window 1704 initially displays an arc 1710 with an angle 1712 and a radius 1714. The arc 1710 defines a tissue resection profile, wherein the treatment area within the arc 1710 is treated, and the area outside the arc 1710 is excluded from treatment. Arc control handles 1716a, 1716b are provided and allow the user to control each leg of the arc 1710 to adjust the angle 1712. The display shows the selected angle 1712 and can be used to accurately adjust the angle 1712 to define a suitable treatment area. The resection profile displayed on the display may initially include a profile determined in response to desired safety and efficacy values. The vertex 1718 of the arc 1710 shows the placement of the treatment probe. In some cases, the treatment probe provides energy delivery to treat the affected area. In some cases, the treatment probe is rotated about its longitudinal axis to direct the treatment energy as described herein. Therefore, the treatment area will resemble the arc 1710 with a radius 1714 commensurate with the energy intensity. When the arc control handles 1716A, 1716B are adjusted to define the tissue resection profile and treatment area, these settings are stored for later use during surgery and control the degree of rotation of the treatment probe using energy delivery during resection.

[0336] The user interface 1700 may include a user input 1760 for a user to select parameters of a model for determining values ​​of one or more safety and efficacy parameters as disclosed herein. This selection of parameters may allow the user to select parameters that may be more helpful than other parameters, and remove parameters that may be less helpful than other parameters for a particular patient. For example, if the user believes that a parameter (e.g., age) is not very helpful in predicting an outcome, the user may deselect the parameter as an input to a classifier model for predicting an outcome. Alternatively, if the user believes that age is a helpful parameter, the user may select age as a parameter to be used as an input to a classifier model.

[0337] The user interface 1700 may include a user input 1770 for the user to select data to be displayed on the display. The data displayed on the display may include, for example, visualization data. In some embodiments, the user may select whether to display the suggested treatment profile overlaid with the patient's planned treatment profile on the display after the user adjustment. This may be helpful for the user to determine how far the patient's planned treatment profile deviates from the profile suggested by the algorithm. The user may select additional types of visualization data to be displayed on the display. For example, the user may select a planned trajectory for an energy source for treatment.

[0338] refer to Fig. 17B , the user interface 1700 shows that different parts of the anatomy are selected in the anatomy selection window 1708 within the instruction area 1702. As shown, the middle lobe is selected as the treatment region within the anatomy selection window 1708, and the control area 1704 is updated to display the imaging associated with the middle lobe anatomy. As before, the control area 1704 overlays a display of a resection profile defined by a treatment boundary including an arc 1710. The arc 1710 is customizable by the user and in some instances by specifying a radius 1714 to manipulate the arc control handles 1716A, B. The arc 1710 defines the resection profile and treatment region, and different resection profiles and treatment regions can be provided for different anatomical regions. For example, as shown, the instruction area 1702 allows the user to select between the prostate, bladder neck, and middle lobe within the anatomy selection window 1708. Window 1750 can display the safety parameter X and the efficacy parameter Y, and these values ​​can change in real time as the user adjusts the resection profile.

[0339] Similar to the prostate setting, when the mid-lobe anatomy is selected, an image of the treatment region, e.g., by a TRUS probe appropriately positioned to image the anatomical feature of interest, is displayed in the control area 1704, and the user is able to designate a treatment region for that anatomical feature. The multiple resection sections and corresponding treatment regions established by the user can be fed into a computer, which can save the treatment plan for execution by a surgeon (whether human or robotic).

[0340] refer to Fig. 17C, user interface 1700 is shown. As shown, in the anatomy selection window 1708, the prostate is selected and the control area 1704 displays real-time imaging data of the selected anatomy. The anatomy selection window 1708 is further updated to select an option labeled "Adjust Veru Protection Zone" 1720. This refers to a treatment plan designed to protect the verru ("veru") from aggressive resection. The veru protection zone can be configured in many ways and can, for example, include a butterfly cutting profile. Although a veru protection zone is mentioned, the protection zone can, for example, include one or more protection zones to protect delicate tissue structures, such as a tumor or the retina of an eye.

[0341] As shown, once the "Adjust Veru Protection Area" 1720 radio button is selected, a new overlay appears on the control area 1704 and defines a veru arc 1722 that is a portion of the arc 1710. The veru arc 1722 shares the vertex 1718 and may share the length of the radius 1714 with the arc 1710.

[0342] Veru arc 1722 includes a treatment profile that defines an area associated with a veru protection zone 1724. In prostate surgery, as described herein, there is a risk / reward trade-off between the efficacy of surgery and male sexual function. The aggressiveness of prostatectomy treatment is related to the proximity to the veru. If tissue is removed closer to the veru, the efficacy of prostate treatment for benign prostatic hyperplasia can be increased. However, the risk of male sexual dysfunction can also be increased. Providing a window 1750 of safety and efficacy parameters may be helpful to the user to adjust the patient's treatment profile to correspond to the target safety and efficacy metrics.

[0343] The colliculus is an anatomical landmark near the entrance of the ejaculatory duct into the urethra and may also be referred to as the colliculus. The structure of the colliculus consists of striated muscle fibers of the external sphincter interlaced with smooth muscle tissue from the urethral wall. Some of the embodiments described herein allow for targeted specific treatment of prostate tissue in close proximity to the colliculus. Figures 17A-17C In the illustrated embodiment, the user can specify resection profiles and treatment plans for various regions of the prostate. For example, a treatment plan is created that includes unique treatments for the prostate, bladder neck and middle lobe, and a unique plan for the spermatozoon region.

[0344] The user can adjust the resection profile in response to safety and efficacy parameters displayed on the display.

[0345] Although FIG. 17A to FIG. 17CReferring to a display coupled to a surgical system, but in some embodiments similar images and user input can be used for remote treatment planning and pre-planning in a remote location away from the surgical instrument (e.g., in another room or building). The processor can be configured with instructions for the user to plan treatment, and these parameters can be stored and loaded onto the processor of the surgical system. For example, a diagnostic image of the patient can be generated prior to treatment (e.g., in an imaging laboratory). The image can be displayed to the user on a display on a mobile device, and the treatment profile and other aspects of the treatment can be adjusted. Once accepted, the treatment parameters (e.g., resection profile) can be loaded onto the surgical instrument.

[0346] refer to Fig.18 , sagittal user interface 1800 shows a sagittal view of the treatment area, with anatomically distal organs on the left side of the figure. The user interface may include a lateral interface 1700 and a sagittal interface 1800 to plan treatment profiles in three dimensions for 3D volume tissue removal. This screen displays information from the treatment plan that has been entered, such as the rotation angle of the treatment probe 1802 (which is 135 degrees in this example) and the resection depth 1804 (which is 24.3 mm in the example shown).

[0347] The user interface 1800 allows further refinement of the treatment plan by manipulating the treatment profile 1806. The treatment profile 1806 generally follows an anatomical curve fit 1808 of the region of interest. In some cases, the system may detect anatomical features, such as by one or more algorithms (e.g., image analysis, feature recognition, edge detection, or some other algorithm or combination of algorithms) performed on ultrasound imaging to detect recommended boundaries of anatomical features and / or recommended boundaries of resection profiles and treatment regions.

[0348] The system can present an overlay of information on the ultrasound imaging information, which information may include anatomical parts of the organ, instructions, resection profiles, and other information. In the user interface 1800 shown, the overlay identifies regions corresponding to the middle lobe region 1810, the bladder neck region 1812, and the middle prostate region 1814. Each of these identified regions may have a different treatment plan associated with it. For example, the middle lobe region 1810 may have a specified resection angle, resection depth, and translation distance for tissue resection, which may be different from the treatment plan specific to the bladder neck region 1812, which may also be different from the treatment plan for the middle prostate region 1814.

[0349] The processor can be configured to not only identify various anatomical regions, but also store information about the recommended and selected treatment plans for each region. For example, information from previous surgeries can be stored in a database that corresponds to one or more treatment plans for a single organ or a portion of a single organ. This information from previous surgeries can be used to train a classifier or neural network as described herein. The trained classifier or neural network can generate a suitable recommended treatment plan including multiple tissue resection sections. This recommended resection section can be generated and presented on the display together with the predicted safety value X and predicted safety value Y in window 1750. When a treatment plan including multiple cutting sections is modified by a user, the processor can receive the modified treatment plan, cutting section, and ultrasound image, and the trained classifier or neural network can be used to generate updated safety and efficacy parameters displayed on display 1750. The trained classifier or neural network can also receive patient information (e.g., age, height, weight, symptoms, and other information as described herein when determining the values ​​of safety and efficacy parameters and when generating a treatment plan) as input.

[0350] The user interface 1800 may include controls that allow the user to adjust the treatment plan. For example, a treatment start control 1816, a treatment end control 1818, and a veru zone start control 1820. Any of these controls can be manipulated by the user to modify the resection profile of the treatment plan. For example, the user can move one or more controls to modify the resection profile, for example, by modifying the resection depth, the position of the resection start control 1816, or the position of the veru start zone control 1820. The changes made by the user at the user interface 1800 are stored in the memory of the associated computing system for later execution during surgery. In some cases, the surgery is performed by a robotic device performing the surgery according to the resection boundary limits.

[0351] The user interface 1800 also has informational and / or educational components, such as a surgical walk-through area 1822 that provides guidance to the user of the system. For example, as shown, the surgical walk-through area 1822 includes a list of surgical setup steps for the user to perform, such as positioning the handpiece 1824, positioning the TRUS probe 1826, and aligning the handpiece and TRUS probe 1826.

[0352] The surgical walk-through area also includes the creation and / or modification of the treatment plan, for example by providing the user with the opportunity to input and / or modify the resection angle 1830, the registration of the treatment probe 1832, and the cutting profile 1834. Fig.18As shown, the setup steps are completed for the procedure, as indicated by the check marks next to the handpiece 1824, TRUS 1826, alignment 1828, angle 1830, and registration 1832. At the current stage in the example shown, the user still needs to complete the adjustment of the profile 1834. When the setup steps and planning steps are completed in the user interface 1800, the user can indicate that the procedure is ready to begin by selecting the treatment icon 1836, at which point the system can autonomously begin the procedure according to the treatment plan.

[0353] In some cases, the treatment plan is stored in a database along with other treatment plans and may include data about the patient and the treatment plan, such as patient age, weight, height, symptoms, duration of symptoms, diagnosis, past treatment history, treatment efficacy, medication history, and the like. Past treatment plans may include data such as angles and resection profiles for multiple historical treatments for multiple patients and be stored as historical treatment plan data.

[0354] The historical treatment plan data may be analyzed as described herein by one or more suitable algorithms (e.g., one or more of an artificial intelligence algorithm, supervised machine learning, unsupervised machine learning, a neural network, or a convolutional neural network). In some cases, the historical treatment plan data is analyzed by one or more machine learning algorithms and may be used to train a classifier. For example, a neural network may analyze historical treatment data to provide a recommended treatment plan for one or more current patients. For example, based on historical treatment data, a neural network may be used to build, train, and deploy a machine learning model including preparing and labeling historical treatment data, selecting an algorithm, training the model, validating the model, adjusting and optimizing the model, deploying the model, making predictions about future treatment plans, and providing treatment plans for current or future patients.

[0355] In some instances, a convolutional neural network can be implemented to analyze visual data, such as ultrasound imaging from a TRUS probe, and provide feedback to feed into a machine learning model. Visual data analysis can include identifying anatomical features along with associated location, size, shape, health, and other information.

[0356] A processor as described herein may be configured as described, for example, with reference to FIG. 17A to FIG. 18 Instructions for providing user interfaces, images, and windows as described herein.

[0357] refer to Fig.19A , showing a resection procedure. As shown, the treatment probe 1902 is inserted through the urethra into the distal portion of the treatment area. Figures 19A-19D When used in the examples shown in the drawings, the terms "proximal" and "distal" are from the perspective of the treatment probe. Thus, the distal end of the treatment probe is the portion of the probe that is inserted farthest into the patient's body.

[0358] The treatment probe 1902 includes an inlet 1904 and an energy treatment probe 1906. Figures 19A-19D As is clear, the treatment area 1908 is shown by the dotted line. As shown in the illustration, the resection procedure has begun and the energy treatment probe 1906 is moved proximally from one end of the treatment area and tissue is ablated from the distal portion of the treatment area 1908. The suction port actively aspirates fluid and ablated tissue during the procedure and may include components of a fluid management system. As described above, the energy treatment probe rotates through the angle and translates along the length specified in the user interface 1800. In addition, the depth of resection is also controlled based on user input within the user interface 1800.

[0359] refer to Fig.19B , it can be seen that the energy treatment probe 1906 is moved further proximally to ablate a larger volume of tissue. During the translational motion of the energy treatment probe 1906, the intensity of the ablation energy varies according to the treatment plan so that the ablation closely follows the treatment area boundary 1908.

[0360] Reference now Fig.19C , the energy treatment probe 1906 is moved to a position generally aligned with the proximal edge of the treatment area 1908. It can be seen that the ablation energy 1910 is coming from the energy treatment probe 1906 at a relatively low intensity. In the treatment plan shown, it can be seen that tissue is retained in the area of ​​the verruca 1912. When the user establishes the verru protection zone 1724, such as Fig. 17C As shown, a treatment plan is created that protects the area from erosive resection. In some instances, tissue within the veru protection zone 1724 is ablated separately from surrounding tissue. As shown, tissue next to the veru 1912 has been ablated, but tissue directly above the veru has not yet been ablated. Resection according to the treatment plan (in which the veru protection zone 1724 has been established) will leave a tissue wedge 1914 above the veru 1912. The tissue wedge 1914 can be ablated according to a unique treatment plan that can, for example, gently ablate tissue by using multiple scans in translation and rotation directions using relatively low energy intensities from the energy treatment probe 1906 to ablate the tissue wedge 1914.

[0361] In some cases, tissue on one side of tissue wedge 1914 is ablated first, and tissue on the other side of tissue wedge 1914 is then ablated, and tissue wedge 1914 is ablated last to protect the verumontanum from erosive resection.

[0362] refer to Fig.19D, the energy treatment probe 1906 continues to move proximally and is removing a wedge of tissue 1914 above the caruncle of the spermatic cord. Although the figure shows that the wedge of tissue 1914 is being ablated in a single translational pass of the energy treatment probe 1906, it should be understood that the energy treatment probe 1906 may make multiple translational passes and / or multiple rotational scans in order to adequately remove the wedge of tissue 1914. The suction port 1904 may include multiple ports or channels through which material is removed from the treatment site.

[0363] Fig. 20 A method 2000 of resecting tissue is shown.

[0364] At step 2002, a target value for a patient efficacy parameter is received.

[0365] At step 2004, a target value for a patient safety parameter is received.

[0366] At step 2006, values ​​of demographic parameters of the patient are received.

[0367] At step 2008, a tissue resection profile is generated. This process may be automated, or may be created or modified by user input (e.g., by modifying the cutting profile of the treatment area). In some embodiments, the resection profile is generated in response to the values ​​of target safety and efficacy parameters.

[0368] At step 2010, an image of an organ to be resected is received.

[0369] At step 2012, the fine tissue structure of the image of the organ is identified from the image. This can be based on image feature recognition by applying a convolutional neural network that employs any of many suitable image analysis algorithms, such as edge detection, feature recognition, segmentation, 3D model reconstruction, etc.

[0370] At step 2014, the tissue resection profile is compared to the fine tissue structure of the image.

[0371] At step 2016, values ​​for safety parameters and efficacy parameters are generated using one or more neural networks or classifiers trained on a database, as described herein. These values ​​can be generated using a trained convolutional neural network application that classifies image features (e.g., using ultrasound imaging).

[0372] At step 2018, the target value and the generated value are displayed.

[0373] At step 2020, one or more resection regions are adjusted. This may include determining different treatment regions for a single organ, such as determining separate treatment regions for the bladder neck, middle lobe, and mid-prostate. Determining different treatment regions facilitates creating separate treatment plans for each treatment region.

[0374] At step 2022, the resection angle is adjusted. The treatment angle is as described above. Figures 17A-17C Described herein, and may be based on an overlay of real-time imaging of the area to be treated.

[0375] At step 2024, the resection profile is adjusted. This may be done by a user in response to the target value and the generated value displayed on the display. The resection profile may be adjusted for each of the one or more treatment regions.

[0376] At step 2026, the fine tissue structure protection zone is adjusted. For example, the fine tissue structure protection zone may include a veru protection zone.

[0377] At step 2028, updated values ​​for safety and efficacy parameters are generated and displayed to the user.

[0378] At step 2030, tissue away from the protected area is resected, for example. The energy therapy probe can translate along its longitudinal axis and can additionally rotate about its longitudinal axis. The energy therapy probe can be moved over tissue within the treatment area in a single pass to ablate tissue according to the treatment plan, or multiple passes can be made to ablate tissue according to the treatment plan.

[0379] At step 2032, tissue adjacent to the delicate tissue structure is resected on a first side of the protected area.

[0380] At step 2034, tissue on a second side of the delicate tissue structure protection zone is resected, which may leave a wedge of unresected tissue over delicate tissue structures, such as delicate tissue structures of the caruncle of spermatophore. The tissue may be resected by an energy therapy probe that provides ablative energy to the tissue.

[0381] At step 2036, the treatment data is stored and the treatment database is updated as described herein. One or more classifiers or neural networks may also be updated as described herein.

[0382] although Fig. 20 A method 2000 of resecting tissue of an organ (e.g., prostate tissue) according to some embodiments is shown, but many variations and adaptations may be made, as will be readily appreciated by those of ordinary skill in the art. For example, some steps may be repeated, some steps omitted, and steps may be performed in a different order. In addition, other types of tissue described herein may be treated.

[0383] One or more steps of method 2000 may be combined with method 1500. For example, a classifier or neural network may be trained with a database of patient treatments. Once the classifier or neural network is trained, the trained classifier or neural network may be used to determine safety and efficacy parameters for the patient being treated in response to demographic data, ultrasound images, and as described with reference to method 2000.

[0384] The method 1500 may be used to train a neural network as described herein, alternatively or in conjunction with a classifier, as described herein.

[0385] A processor as described herein may be configured to perform one or more steps of the methods disclosed herein, such as steps of method 1500 and method 2000 .

[0386] refer to Fig.21 , an example of a two-dimensional convolutional neural network 2100 is shown. Initially, a data set 2102 is provided, which may include images from historical treatment data of previous patients and surgeries. A convolution operation 2104 produces data in a second data set 2106, which in turn causes a pooling layer 2108 to be applied to produce a pooled layer 2110 of sub-sample data to further compress the spatial size of the representation. The sub-sample data may be convolved 2112 to produce a third data set 2114, which may further cause a pooling layer to be applied 2116 to provide sub-sample data 2118. The sub-sample data 2118 may pass through a first fully connected layer 2120 and a second fully connected layer 2122 to generate a classification matrix output 2124. One or more filters may be applied at each convolution layer to provide different types of feature extraction. After the model is defined, it may be compiled and the accuracy of feature recognition may be used as a performance metric. The model may be trained over time, for example, by using historical surgical data as training data, and validated according to the model's predictions, and validated over time until the model's predictions converge with the real data.

[0387] Fig. 22 A method 2200 of training and using an artificial intelligence or machine learning classifier according to some embodiments is shown. While the method can be performed in many ways, in some embodiments, the classifier is trained to recognize anatomical landmarks and multiple resection profiles associated with the anatomical landmarks. The method includes comparing resection profiles of past patients with anatomical landmarks and patient data (e.g., outcome data and demographic data) as described herein. The resection profiles can include actual resection profiles from the past, which are overlaid on images from treatments or generated and suggested based on machine learning algorithms, weights of data points, patient data, and other input types.

[0388] The data set is generated and can be stored in a database including historical information, which may include a library of actual historical data. As described herein, the library of patient data may be stored in a database keyed by a unique patient identifier for each patient and the associated data of each patient. The database may include a relational database keyed by a unique patient identifier. The historical data stored for each patient may include robotic data from surgery, images from surgery, preoperative questionnaire data, postoperative questionnaire data, retreatment data, and sexual function data for each patient in the database. The database may include data from any suitable number of patients (e.g., at least 100 patients, and at least 1000 patients, and at least 10,000 patients and from 10,000 to 1,000,000 patients in some embodiments). Based on data input, as described herein, the method utilizes an appropriate model to generate prediction result data for training a classifier. The classifier is validated with data, which may be trained by iteration. Then, the validated classifier is used to receive input from an actual patient and output useful information, such as a suggested resection profile, in response to the value of the target safety and efficacy parameters, as described herein. The input data may include an image of the patient and target safety and efficacy parameters and other patient data, as described herein. Alternatively or in combination, the input data may include target tissue resection profiles and predicted values ​​of safety and efficacy parameters, as described herein. In some embodiments, the patient data includes one or more of tensile strength, modulus, elasticity, vascularity, biomarker data, medication history, or genetic data for each patient.

[0389] At step 2202, a classifier is trained on multiple anatomical landmarks from multiple images. This can be performed by one or more image analysis algorithms that allow a classifier (e.g., a convolutional neural network) to determine anatomical features displayed with the image data. Although the classifier can be trained in many ways, in some embodiments a trained professional (e.g., a radiologist or surgeon) identifies the landmarks and utilizes a user interface (e.g., a touch pad) to input the location and type of the anatomical landmark. For example, the anatomical landmark can include one or more fine tissue structures, such as a colliculus, a retina of an eye, or a tumor, as described herein. For example, this training can be completed for several images from a library of treatments.

[0390] At step 2204, a classifier is trained on a plurality of resection profiles. The resection profiles may include a target resection profile overlaid on an image as described herein, wherein the image is stored in a database. Alternatively or in combination, a classifier may be trained with user input to identify a resection profile from an image (e.g., an ultrasound image) as described herein. For example, a treating professional may identify a location and profile of a resection by a user inputting the location of an image with an input device (e.g., a touch pad), and the user may draw a line of a resection profile with the input device to train the classifier.

[0391] At step 2206, the resection profile is compared to an anatomical landmark. For example, the distance between the resection profile and the anatomical landmark can be compared. The anatomical landmark can include one or more fine tissue structures as described herein and the distance between the resection profile and the anatomical landmark compared for each of the plurality of patients. In some cases, the resection profile includes one or more protection zones to protect sensitive tissue structures as described herein. The distance from the protection zone to the fine tissue structure is compared for each of the plurality of patients.

[0392] At step 2208, the method generates a data set between the location of the anatomical structure and the resection profile of the anatomical structure. This can be based on actual historical data indicating the efficacy of treatment based on the resection profile.

[0393] At step 2210, patient demographic data is received. Patient demographic data may include any of a variety of data types presenting information about the patient, as described herein. As non-limiting examples, demographic data may include information related to age, weight, body mass index, medication history, surgical history, flow, sexual function, geography, ethnicity, symptoms, diet, family structure, and the like.

[0394] At step 2212, predicted outcome data is generated and used to train the classifier. For example, the method can generate predicted outcome data that can be compared against actual historical data. In the event that there are identified gaps between the predicted outcome data and the actual outcome data from the historical data, the classifier can be modified and training can be iterated until the predicted outcome data matches the actual historical data within a threshold amount.

[0395] At step 2214, the trained classifier is validated. As described, this can be an iterative process of comparing the predicted data against the actual data, and the classifier can be modified until the predicted data converges towards the actual data.

[0396] At step 2216, data from an individual patient is received. This may include any of the demographic data described along with other data types that provide sufficient information to the classifier to generate a resection profile.

[0397] Safety parameters and efficacy parameters are generated for the individual patient at step 2218. These may be based on user input, or may be automatically generated based on likely or desired outcomes.

[0398] At step 2220, a recommended resection profile is determined for the individual patient. In other words, based on the input data, the trained classifier generates and outputs a recommended resection profile for the individual patient. The resection profile can be modified as described herein to reduce the amount of resection or ablation erosion in the protection zone or other zones, as described herein. Alternatively, the resection profile can be modified to increase the aggressiveness of tissue resection.

[0399] The proposed resection profiles, actual resection profiles, and actual surgical results can be stored in a database and used to improve classifiers and other machine learning algorithms. The surgical parameters can be recorded for each surgery and can include any parameters as described herein, such as measured treatment time, measured setup time, measured imaging time, measured time of movement of the treatment probe, measured intensity of the energy source that removes tissue, multiple recorded positions of the treatment probe, multiple recorded images of tissue during treatment, multiple recorded orientations of the treatment probe, or one or more of multiple tissue images corresponding to each of multiple recorded positions and orientations. The multiple treatment parameters recorded during treatment can include multiple sequentially arranged data frames, each of the multiple sequentially arranged data frames including an image of tissue, an image of the treatment probe positioned relative to the tissue being treated, the position of the treatment probe, the orientation of the treatment probe, or the energy of the treatment probe, and optionally, each of the multiple sequentially arranged data frames corresponds to a substantially fixed time interval between each of the multiple frames. As described herein, for each of the multiple patients stored in the database, the value of each of these parameters can be stored in a library of treatments.

[0400] The described artificial intelligence and machine learning systems may include a processor having instructions configured to perform one or more of artificial intelligence, search and mathematical optimization, artificial neural networks, statistics, probability, support vector machine learning, clustering of data sets, image classification, image segmentation. The instructions may include one or more of decision tree learning, association rule learning, artificial neural networks, deep learning, inductive logic programming, support vector machines, clustering, Bayesian networks, reinforcement learning, representation learning, similarity and metric learning, sparse dictionary learning, genetic algorithms, rule-based machine learning, or learning classifier systems.

[0401] One or more steps of method 2200 may be performed with a processor as described herein. One or more steps of method 2200 may be performed with circuitry or processor instructions as described herein (e.g., one or more processors or logic circuits of the systems described herein). The circuitry may be programmed to provide one or more steps of method 2200, and the program may include program instructions stored on a computer readable memory or programmed steps of a logic circuit such as a programmable array logic or a field programmable gate array.

[0402] Fig. 22 Methods according to some embodiments are shown. Based on the teachings disclosed herein, those of ordinary skill in the art will recognize many variations and adaptations. For example, some steps of the method may be removed. Additional steps may be provided. Some steps may include sub-steps. Some steps may be repeated. The order of the steps may be changed.

[0403] A convolutional neural network may be used to classify the image data, and this or an alternative machine learning algorithm may be applied to result in the generation of a recommended treatment profile. The machine learning neural network model may be trained over time by utilizing historical treatment data and modification of the recommended treatment plan output from the model. The result is the generation of a recommended treatment plan that improves over time based on continued training of the machine learning model.

[0404] The energy source may include one or more of mechanical energy, water jet, electromagnetic energy, laser energy, radio frequency (RF) energy, radiation therapy (RT) energy or ultrasonic energy, steam, water vapor, heated water vapor, or any other type of suitable energy source for ablating, resecting or removing tissue, and combinations thereof.

[0405] The description includes the following numbered clauses, which are part of this disclosure.

[0406] Clause 1. An apparatus for use in robotic surgery, the apparatus comprising:

[0407] A processor configured with instructions to:

[0408] receiving patient data for each of a plurality of treated patients, the data for each of the plurality of treated patients comprising one or more of patient demographics, a cut profile of tissue to be removed, an actual profile of tissue to be removed, a target volume of tissue to be removed, an actual volume of tissue to be removed, or a ratio of an amount of tissue targeted for removal to an amount removed,

[0409] receiving surgical robotic data for each of a plurality of treated patients, the surgical robotic data comprising a plurality of treatment parameters recorded during treatment, treatment time, setup time, imaging time, time of treatment probe movement, a plurality of positions and orientations of the treatment probe, a plurality of images of tissue, each of the plurality of images of tissue including the treatment probe, or an intensity of an energy source that removed tissue; and

[0410] A treatment plan for the patient to be treated is output in response to the patient data and the surgical robot data.

[0411] Clause 2. The apparatus of clause 1, wherein the instructions further comprise:

[0412] Receiving an adjustment to a treatment plan for the patient to be treated, wherein the adjustment to the treatment plan for the patient to be treated comprises adjusting one or more of a cutting profile of tissue to be removed, an actual profile of tissue to be removed, a target volume of tissue to be removed, an actual volume of tissue to be removed, a treatment time, a setup time, an imaging time, a time of movement of a treatment probe, an intensity of an energy source for removing tissue, or a ratio of an amount of tissue targeted for removal to an amount removed.

[0413] Item 3. The device of Item 2, wherein the cutting profile comprises a plurality of positions, the plurality of positions comprising a plurality of angular coordinates around the treatment axis, a plurality of corresponding axial coordinates along the axis, and a plurality of radial distances from the axis, and wherein adjustment of the cutting profile comprises adjustment of the plurality of angular coordinates around the treatment axis, the plurality of corresponding axial coordinates along the axis, or the plurality of radial distances from the axis.

[0414] Clause 4. The apparatus of clause 1, wherein the processor is configured with instructions to display on the display the initial cutting profile overlaid on the image of the tissue to be resected and to display the adjusted cutting profile over the image of the tissue to be treated.

[0415] Clause 5. The device of clause 1, wherein the plurality of treatment parameters recorded during treatment include a measured treatment time, a measured setup time, a measured imaging time, a measured time of movement of the treatment probe, a measured intensity of an energy source that removes tissue, a plurality of recorded positions of the treatment probe, a plurality of recorded images of tissue during treatment, a plurality of recorded orientations of the treatment probe, and a plurality of tissue images corresponding to each of the plurality of recorded positions and orientations.

[0416] Item 6. The device of Item 5, wherein the plurality of treatment parameters recorded during treatment comprises a plurality of sequentially arranged data frames, each of the plurality of sequentially arranged data frames comprising an image of tissue, an image of a treatment probe positioned relative to tissue being treated, the positioning of the treatment probe, the orientation of the treatment probe, or the energy of the treatment probe, and optionally wherein each of the plurality of sequentially arranged data frames corresponds to a substantially fixed time interval between each of the plurality of frames.

[0417] Clause 7. The apparatus of any of the preceding clauses, wherein the patient demographics for each of the plurality of patients and the patient to be treated include one or more of patient age, weight, gender, body mass index, race, geography, diet, or family structure.

[0418] Item 8. The device of Item 1, wherein the intensity of the energy source comprises a water jet intensity, a light beam intensity, a radio frequency energy intensity, an ionizing radiation intensity, a stereotactic radiation intensity, or an ultrasound energy intensity.

[0419] Clause 9. The apparatus of clause 1, wherein a treatment plan for a patient to be treated in response to the patient data and the surgical robot data is determined using processor instructions including one or more of artificial intelligence or machine learning.

[0420] Clause 10. The apparatus of clause 9, wherein the treatment plan is determined using artificial intelligence processor instructions, and wherein the artificial intelligence processor instructions include one or more of machine learning, search and mathematical optimization, artificial neural networks, statistics, probability, support vector machine learning, clustering of data sets, image classification, or image segmentation.

[0421] Clause 11. The apparatus of clause 9, wherein the treatment plan is determined using machine learning processor instructions, and wherein the machine learning processor instructions include one or more of decision tree learning, association rule learning, artificial neural networks, deep learning, inductive logic programming, support vector machines, clustering, Bayesian networks, reinforcement learning, representation learning, similarity and metric learning, sparse dictionary learning, genetic algorithms, rule-based machine learning, or a learning classifier system.

[0422] Clause 12. The apparatus of clause 11, wherein the instructions further cause the processor to receive human-computer interaction to use one or more of a plurality of AI tools to provide input to one or more selection AI methods, select a different visualization of a recommended treatment plan, or change the importance of data used to generate a treatment plan.

[0423] Clause 13. An apparatus as claimed in any of the preceding clauses, wherein the artificial intelligence or machine learning is trained on patient data for each of a plurality of treated patients and surgical robot data for each of a plurality of treated patients, and a treatment plan for the patient to be treated is determined in response to the artificial intelligence or machine learning, the artificial intelligence or machine learning being trained in response to the treated patient data and the surgical robot data.

[0424] Clause 14. The device of any of the preceding clauses, wherein the target volume of tissue to be removed comprises the total volume of tissue targeted for removal, and the actual volume of tissue removed comprises the actual total volume of tissue removed.

[0425] Clause 15. An apparatus of any of the preceding clauses, wherein artificial intelligence ("AI") or machine learning is configured to train an AI or machine learning algorithm on multiple treatment plans and patient outcomes for multiple treated patients (optionally based on physician or patient reported information) and determine a treatment plan for a patient to be treated.

[0426] Clause 16. The apparatus of clause 15, wherein multiple treatment plans for a patient to be treated are coupled to corresponding outcomes, the corresponding outcomes comprising one or more of quality of life scores, sexual function, treatment persistence, or flow rates, and wherein the AI ​​or machine learning is configured to provide a semi-automatic plan based on the patient's prostate anatomy of the patient to be treated to optimize the treatment profile.

[0427] Clause 17. An apparatus of any of the preceding clauses, wherein outcome data for a plurality of treated patients is used as input to training an AI or machine learning classifier, and optionally, wherein the outcome data comprises one or more of hemoglobin loss, complications, pain scores, time to return to work, urinary flow data, catheterization time, hospital stay, days of abstinence, hemostasis methods, sexual function metrics, balloon models, balloon techniques, catheter tension, Foley catheter tension, catheter tensioning device methods, surgeon case notes, anesthesia used, pain medicine use, or ante-operative urodynamics, and optionally, wherein the AI ​​or machine learning is configured to perform calculations to be determined and an adjusted treatment plan to improve key outcome metrics, and optionally, wherein the adjusted treatment plan comprises an adjusted treatment profile, and optionally, wherein the adjusted treatment profile comprises an optimized treatment profile.

[0428] Clause 18. An apparatus of any of the preceding clauses, wherein the AI ​​or machine learning is trained to automatically adjust penetration depth during treatment in response to image recognition of imaging parameters of tissue images during treatment of the patient based on the AI ​​or machine learning trained on multiple treated patients, and optionally, wherein the automatic adjustment includes comparing expected penetration depth to actual penetration depth, and wherein the AI ​​or machine learning is configured to automatically adjust the cutting profile if there is a mismatch, or to vary the intensity of the source based on tissue density.

[0429] Clause 19. The apparatus of clause 18, wherein the cutting profile is adjusted in response to a value of a biomechanical tissue parameter measured from the patient.

[0430] Clause 20. An apparatus of any of the preceding clauses, wherein the AI ​​or machine learning is trained using baseline data comprising a library of many ultrasound images from charts, using peer-reviewed identification of organ tissue planes and identified anatomical features such as prostate capsule, bladder neck, sphincter, veru, ductus, medial lobe, lateral lobe, and wherein the AI ​​or machine learning is configured to provide physician-assisted guidance to the patient to be treated in response to the data of the patient to be treated, and the AI ​​or machine learning is trained using the baseline data.

[0431] Clause 21. An apparatus for determining a tissue removal profile for prostate surgery in a patient with colliculus verum, the apparatus comprising:

[0432] A processor configured with instructions to:

[0433] Displays an image of the prostate gland;

[0434] Displaying tissue removal sections on an image of the prostate; and

[0435] One or more of an efficacy parameter, a probability of reduced sexual function, or a probability of re-treatment of the prostate with a cutting section and an image of the prostate are displayed.

[0436] Clause 22. The apparatus of clause 21, wherein the processor includes instructions to receive a digital signature from the patient for accepting one or more of an efficacy parameter, a probability of reduced sexual function, or a probability of retreatment.

[0437] Clause 23. The apparatus of clause 22, wherein the processor includes instructions for displaying the digital signature with one or more of an image of the prostate, a cut profile, an efficacy parameter, a probability of reduced sexual function, or a probability of retreatment.

[0438] Clause 24. An apparatus for determining a treatment plan for prostate surgery in a patient with colliculus verum, the apparatus comprising:

[0439] A processor configured with instructions to:

[0440] receiving a user input including a sexual importance parameter corresponding to the importance of sexual activity to the patient and an acceptability parameter corresponding to the patient's tolerance for a second prostate surgery for the patient; and

[0441] Output a treatment plan, wherein the treatment plan includes instructions to remove tissue a distance from the verumontanum, the distance being farther from the verumontanum when the sexual importance parameter corresponds to an increased importance of sexual activity and the receptivity parameter corresponds to an increased receptivity to a second prostate surgical procedure, and the distance being closer to the verumontanum when the sexual activity parameter corresponds to a decreased importance of sexual activity and a decreased receptivity to a second prostate surgical procedure.

[0442] Clause 25. The apparatus of clause 24, wherein the treatment plan includes a tissue removal profile, and the processor includes instructions to generate the tissue removal profile in response to user input.

[0443] Clause 26. The device of clause 25, wherein the tissue removal profile includes a distance to the verumontanum, and the distance increases with increasing importance and receptivity and decreases with decreasing importance and receptivity.

[0444] Clause 27. The apparatus of clause 24, wherein the processor includes instructions for displaying the tissue removal profile on the image of the prostate, and optionally wherein the image includes an image of the patient's prostate.

[0445] Clause 28. The apparatus of clause 27, wherein the image comprises one or more of ultrasound imaging, magnetic resonance imaging, computed tomography (CT) scan imaging, or cystoscopy imaging.

[0446] Clause 29. The device of clause 28, wherein the ultrasound imaging comprises one or more of pulsed ultrasound, echo ultrasound, Doppler ultrasound, or shear wave elastography.

[0447] Clause 30. The apparatus of clause 27, wherein the image of the prostate comprises one or more of a sagittal image or a transverse image of the prostate.

[0448] Clause 31. The apparatus of clause 30, wherein the image of the prostate further comprises one or more of a parasagittal image, a coronal image, a paracoronal image, or a three-dimensional image.

[0449] Clause 32. The apparatus of clause 27, wherein the image comprises the seminal colunm of the prostate, and optionally, wherein the seminal colunm of the prostate comprises an image of the seminal colunm of the patient.

[0450] Clause 33. The apparatus of clause 27, wherein the processor includes instructions to move a removal profile displayed on the display farther away from the cerebrum in response to increasing importance and increasing acceptability and to move the removal profile closer to the cerebrum in response to decreasing importance and increasing acceptability.

[0451] Clause 34. The apparatus of clause 24, wherein the processor includes instructions for receiving a ranking parameter corresponding to a ranking of the importance of sexual activity relative to receptivity to a second prostate surgery, and wherein in response to the ranking parameter indicating that the sexual activity corresponds to a greater importance than receptivity to a second prostate surgery, the distance to the colunculus seminalis increases with increased importance of the sexual activity and decreased receptivity to a second prostate surgery, and wherein in response to the ranking parameter indicating that the sexual activity corresponds to a lesser importance than receptivity to a second prostate surgery, the distance to the colunculus seminalis decreases with increased importance of the sexual activity and decreased receptivity to a second prostate surgery.

[0452] Clause 35. The device of clause 24, wherein the processor includes instructions for generating a first prostate tissue removal profile in response to a first importance of sexual activity and a first receptivity to a second prostate surgery and for generating a second prostate tissue removal profile in response to a second importance of sexual activity and a second receptivity to the second prostate surgery.

[0453] Clause 36. The device of clause 35, wherein the first prostate tissue removal profile comprises a first distance along the first prostate tissue removal profile to the verumontanum, and the second prostate tissue removal profile comprises a second distance along the second prostate tissue removal profile to the verumontanum.

[0454] Clause 37. The device of clause 36, wherein, when the first importance and the first acceptance are less than the second importance and the second acceptance, the first distance is greater than the second distance, and when the first importance and the first acceptance are less than the second importance and the second acceptance, the first distance is less than the second distance.

[0455] Clause 38. The apparatus of clause 37, wherein the processor comprises instructions for generating treatment instructions in response to a user inputting a first importance and a first receptivity or a second importance and a second receptivity to move the energy source to remove prostate tissue to a first distance or a second distance according to the treatment plan.

[0456] 39. A device for removing tissue from an organ of a patient, the device comprising:

[0457] monitor;

[0458] a processor operatively coupled to the display, the processor being configured with instructions to:

[0459] receiving one or more of the patient's safety or efficacy parameters,

[0460] Images of receiving organs,

[0461] determining a resection profile of the organ in response to one or more of the safety or efficacy parameters and the image, and

[0462] The image and the resection section are displayed on a monitor.

[0463] Clause 40. The apparatus of clause 39, wherein the organ comprises a delicate tissue structure and the resection profile comprises a protection zone, and the protection zone of the removal profile is determined in response to an image of the organ and one or more of a safety profile or an efficacy profile.

[0464] Clause 41. The device of clause 40, wherein the organ comprises a prostate and the fine tissue structure comprises a seminal tract of the prostate.

[0465] Clause 42. The device of clause 40, wherein the delicate tissue structure comprises cancerous tissue.

[0466] Clause 43. The apparatus of clause 40, wherein the protection zone is one of a plurality of protection zones, and the plurality of protection zones of the removal profiles are determined in response to at least an image of the organ and one or more of a safety profile or an efficacy profile.

[0467] Clause 44. The device of clause 43, wherein one or more of the plurality of protection zones are associated with a resection profile determined based at least in part on one or more of: avoiding damage to delicate tissue structures or avoiding the spread of pathogenic tissue.

[0468] Clause 45. The apparatus of clause 40, wherein the image of the organ is displayed on the display in a sagittal view and a transverse view with the resection section, and the resection section comprises a three-dimensional volumetric resection section.

[0469] Clause 46. The apparatus of clause 40, wherein the processor is configured with instructions to display the image of the organ with the resection section in one or more of a sagittal view, a parasagittal view, a transverse view, a coronal view, a paracoronal view, or a three-dimensional view.

[0470] Clause 47. The device of clause 46, wherein the processor is configured with instructions to display the safety parameter and the efficacy parameter on the display.

[0471] Clause 48. The device of clause 46, wherein the processor is configured with instructions to receive user input to adjust a resection profile displayed on the display to generate an adjusted resection profile and to determine a second value of one or more of the safety or efficacy parameters on the display in response to the user adjusted resection profile.

[0472] Clause 49. The device of clause 39, wherein the processor is configured with instructions to display the safety parameter and the efficacy parameter on the display.

[0473] Clause 50. The device of clause 39, wherein the processor is configured with instructions for displaying the value of a target safety parameter, the value of a target efficacy parameter, an adjusted safety parameter, and an adjusted efficacy parameter, wherein the adjusted safety parameter and the adjusted efficacy parameter are updated in real time and displayed on the display in response to a user adjusting the resection profile.

[0474] Clause 51. The apparatus of clause 39, wherein the organ comprises a prostate, and the processor is configured with instructions to identify the location of a pars seminalis of the prostate.

[0475] Clause 52. The device of clause 39, wherein the image of the organ comprises one or more of tissue edge identification, tissue plane identification, tissue differentiation detection, fluoroscopy, CT scan imaging, magnetic resonance imaging, radioactivity detection, or radiopaque imaging.

[0476] 53. A device for removing tissue from an organ of a patient, the device comprising:

[0477] monitor;

[0478] a processor operatively coupled to the display, the processor being configured with instructions to:

[0479] Images of receiving organs,

[0480] The resection profile of the recipient organ, and

[0481] The value of one or more of the safety parameter or the efficacy parameter is displayed in response to the resection section and the image.

[0482] Clause 54. The device of clause 53, wherein the organ comprises a fine tissue structure and the processor is configured with instructions to determine a position of the fine tissue structure relative to a resection section and to display a value of one or more of a safety parameter or an efficacy parameter in response to the position of the fine tissue structure and the resection section.

[0483] Clause 55. The device of clause 54, wherein the organ comprises a prostate and the fine tissue structure comprises a seminal tract of the prostate.

[0484] Clause 56. The device of clause 54, wherein the delicate tissue structure comprises cancerous tissue.

[0485] Clause 57. The device of clause 54, wherein the resection profile comprises determining one or more protection zones based at least in part on one or more of: reducing damage to delicate tissue structures or avoiding the spread of pathogenic tissue.

[0486] Clause 58. The apparatus of clause 53, wherein the image of the organ is displayed on the display in a sagittal view and a transverse view with the resection section, and the resection section comprises a three-dimensional volumetric resection section.

[0487] Clause 59. The apparatus of clause 53, wherein the processor is configured with instructions to display the image of the organ covered with the resection section in the sagittal view and the transverse view.

[0488] Clause 60. The device of clause 59, wherein the processor is configured with instructions to display the safety parameter and the efficacy parameter on the display.

[0489] Clause 61. The device of clause 53, wherein the processor is configured with instructions to receive user input to adjust a resection profile displayed on the display to generate an adjusted resection profile and to determine a second value of one or more of the safety or efficacy parameters on the display in response to the user adjusted resection profile.

[0490] Clause 62. The device of clause 53, wherein the processor is configured with instructions to display the safety parameter and the efficacy parameter on the display.

[0491] Clause 63. The device of clause 53, wherein the processor is configured with instructions for displaying the value of a target safety parameter, the value of a target efficacy parameter, an adjusted safety parameter, and an adjusted efficacy parameter, wherein the adjusted safety parameter and the adjusted efficacy parameter are updated in real time and displayed on the display in response to a user adjusting the resection profile.

[0492] Clause 64. The apparatus of clause 53, wherein the organ comprises a prostate, and the processor is configured with instructions to identify the location of a pars seminalis of the prostate.

[0493] Clause 65. The device according to any of the preceding clauses, wherein the resecting profile comprises a cutting profile.

[0494] Item 66. A device according to any of the preceding items, wherein the energy source for resecting tissue to a resection section comprises one or more of mechanical energy, a water jet, electromagnetic energy, laser energy, radio frequency (RF) energy, radiation therapy (RT) energy, ultrasonic energy, steam, water vapor energy, heated water vapor energy, or steam energy.

Claims

1. A device for determining a tissue removal profile for prostate surgery in a patient with colliculus serratus, the device comprising: A processor configured with instructions to: Displays an image of the prostate gland; displaying a tissue removal section on the image of the prostate; as well as One or more of an efficacy parameter, a probability of reduced sexual function, or a probability of retreatment of the prostate with the cutting profile is displayed along with an image of the prostate.

2. The device according to claim 1, wherein: The processor includes instructions for receiving a digital signature from the patient accepting one or more of the efficacy parameter, the probability of reduced sexual function, or the probability of retreatment.

3. The device according to claim 2, wherein: The processor includes instructions to display the digital signature with one or more of an image of the prostate, the cut profile, the efficacy parameter, the probability of reduced sexual function, or the probability of retreatment.

4. An apparatus for determining a treatment plan for prostate surgery in a patient with colliculus ovalis, the apparatus comprising: A processor configured with instructions to: receiving user input including a sexual importance parameter corresponding to the importance of sexual activity to the patient and an acceptability parameter corresponding to the patient's tolerance for a second prostate surgery for the patient; as well as Outputting the treatment plan, wherein the treatment plan includes instructions to remove tissue a certain distance from the spermatic colunm, when the sexual importance parameter corresponds to an increased importance of sexual activity and the receptivity parameter corresponds to an increased receptivity of a second prostate surgical procedure, the distance is farther away from the spermatic colunm, when the sexual activity parameter corresponds to a decreased importance of sexual activity and a decreased receptivity of the second prostate surgical procedure, the distance is closer to the spermatic colunm.

5. The device according to claim 4, wherein: The treatment plan includes a tissue removal profile, and the processor includes instructions for generating the tissue removal profile in response to the user input.

6. The device according to claim 5, wherein: The tissue removal profile includes a distance to the collenchyma, and the distance increases with increasing importance and receptivity and decreases with decreasing importance and receptivity.

7. The device according to claim 4, wherein: The processor includes instructions for displaying a tissue removal profile on an image of the prostate, and optionally wherein the image includes an image of the patient's prostate.

8. A device for removing tissue from an organ of a patient, the device comprising: monitor; a processor operatively coupled to the display, the processor being configured with instructions to: receiving an image of the organ, receiving a resected section of the organ, and Values ​​of one or more of a safety parameter or an efficacy parameter are displayed in response to the resection section and the image.

9. The device according to claim 8, wherein: The organ includes a fine tissue structure, and the processor is configured with instructions to determine a position of the fine tissue structure relative to the resection section and to display the value of the one or more of the safety parameter or the efficacy parameter in response to the position of the fine tissue structure and the resection section.

10. The device according to claim 9, wherein: The resection profile includes determining one or more protection zones based at least in part on one or more of: reducing damage to the delicate tissue structure or avoiding the spread of pathogenic tissue.

Images