Flexible elongate device engagement control based on tool insertion distance

Abstract

Medical systems and methods include a flexible elongate device having an engageable body portion; and an actuator configured to control engagement of the engageable body portion of the flexible elongate device. A control system determines an insertion distance or position of a tool inserted into the flexible elongate device and controls operation of the actuator to change an engaged state of the engageable body portion.

Description

Technical Field

[0001] The disclosed embodiments relate to the engagement control of a flexible elongation device. Background Technology

[0002] Minimally invasive medical techniques aim to reduce the amount of tissue damaged during medical procedures, thereby reducing patient recovery time, discomfort, and harmful side effects. Such techniques can be performed through natural openings in the patient's anatomy or through one or more surgical incisions. Through these natural openings or incisions, physicians can insert minimally invasive medical instruments (including surgical, diagnostic, therapeutic, and / or biopsy instruments) to reach target tissue locations. One such technique utilizes flexible and / or steerable elongated devices (such as flexible catheters or bronchoscopes) that can be inserted into the anatomical passage and navigated toward regions of interest within the patient's anatomy. Summary of the Invention

[0003] The following presents a brief overview of the various examples described herein and is not intended to identify key or important elements or to depict the scope of the claims.

[0004] In some examples, this document describes a medical system including a flexible elongation device having an engageable body portion and a lumen extending through the engageable body portion. One or more sensors of the medical system are configured to generate sensor data indicating the insertion distance of a distal portion of an instrument within the lumen of the flexible elongation device, and one or more actuators of the medical system are operatively coupled to the flexible elongation device to control the engagement of the engageable body portion. The control system is configured to: determine the insertion distance of the distal portion of the instrument within the lumen of the flexible elongation device based on the sensor data; and control the operation of one or more actuators based on the insertion distance to change the engagement state of the engageable body portion.

[0005] In another example, the engagement state can be changed at least twice as the tool is inserted from the proximal end to the distal end of the flexible elongation device.

[0006] In another example, the control system can be configured to control the operation of one or more actuators based on an insertion distance corresponding to the relaxation start position to transition from an initial engaged state to a relaxed state. In yet another example, the control system can be configured to control the operation of one or more actuators based on an insertion distance corresponding to the relaxation end position to transition an engageable body portion from a relaxed state to a returned engaged state, wherein the returned engaged state has at least one engagement characteristic of the initial engaged state.

[0007] In some examples, this document describes a method for controlling the engagement of a flexible elongation device, the method comprising: determining, based on sensor data from one or more sensors, an insertion distance of a distal portion of a tool within a lumen of the flexible elongation device having an engageable body portion through which the lumen extends; and controlling the operation of one or more actuators based on the insertion distance to alter the engagement state of the engageable body portion.

[0008] In another example, controlling the operation of one or more actuators to change the engagement state of the engageable body portion based on the insertion distance may include: controlling the operation of one or more actuators to change the engagement state at least twice as the tool is inserted from the proximal end to the distal end of the flexible elongation device.

[0009] In another example, controlling the operation of one or more actuators to change the engagement state of the engageable body portion may include controlling the operation of one or more actuators based on an insertion distance corresponding to a relaxation start position to transition from an initial engagement state to a relaxed state. In yet another example, the method may include controlling the operation of one or more actuators based on an insertion distance corresponding to a relaxation end position to transition the engageable body portion from a relaxed state to a returned engagement state, wherein the returned engagement state has at least one engagement characteristic of the initial engagement state.

[0010] In some examples, this document describes a non-transitory computer-readable medium having instructions stored thereon, which, when executed by a computing device, cause the computing device to: determine, based on sensor data from one or more sensors, the insertion distance of a distal portion of a tool within the lumen of a flexible elongating device having an engageable body portion through which the lumen extends; and control the operation of one or more actuators based on the insertion distance to change the engagement state of the engageable body portion.

[0011] In another example, the instructions, when executed, can cause a computing device to control the operation of one or more actuators to change the engagement state at least twice as the tool is inserted from the proximal end to the distal end of the flexible elongation device.

[0012] In another example, when executed, the instruction may cause the computing device to control the operation of one or more actuators based on an insertion distance corresponding to the relaxation start position to transition from an initial engagement state to a relaxed state. In yet another example, when executed, the instruction may also cause the computing device to control the operation of one or more actuators based on an insertion distance corresponding to the relaxation end position to transition the engageable body portion from a relaxed state to a returned engagement state, wherein the returned engagement state has at least one engagement characteristic of the initial engagement state.

[0013] In some examples, this document describes a medical system comprising: a flexible elongation device having an engageable body portion and a lumen extending through the engageable body portion; one or more sensors; and one or more actuators operatively coupled to the flexible elongation device to control engagement of the engageable body portion. The control system of the medical system is configured to: determine, based on sensor data from one or more sensors, that a tool inserted into the lumen of the flexible elongation device has reached a relaxation initiation position of the flexible elongation device; and, in response to determining that the tool has reached the relaxation initiation position, control the operation of one or more actuators to transition the engageable body portion from an initial engaged state to a relaxed state.

[0014] In another example, the control system may be configured to: determine, based on sensor data from one or more sensors, that the tool has reached the slack end position of the flexible elongation device; and control the operation of one or more actuators to transition the engageable body portion from a slack state to a re-engaged state, the re-engaged state having at least one engagement characteristic of the initial engaged state.

[0015] In some examples, this document describes a method for controlling the engagement of a flexible elongation device, the method comprising: controlling the operation of one or more actuators to hold an engageable body portion in an initial engagement state, said one or more actuators controlling the engagement of the engageable body portion of the flexible elongation device; determining, based on sensor data, that a tool inserted into the lumen of the flexible elongation device has reached a relaxation initiation position of the flexible elongation device; and, in response to determining that the tool has reached the relaxation initiation position, controlling the operation of one or more actuators to transition the engageable body portion from the initial engagement state to a relaxation state.

[0016] In another example, the method may include: determining that the tool has reached the slack end position of the flexible elongation device; and controlling the operation of one or more actuators to transition the engageable body portion from a slack state to a re-engaged state, the re-engaged state having at least one engagement characteristic of the initial engaged state.

[0017] In some examples, this document describes a non-transitory computer-readable medium having instructions stored thereon that, when executed by a computing device, cause the computing device to: control the operation of one or more actuators to hold an engageable body portion in an initial engaged state, the one or more actuators controlling the engagement of the engageable body portion of a flexible elongation device; determine, based on sensor data, that a tool inserted into the lumen of the flexible elongation device has reached the relaxation initiation position of the flexible elongation device; and, in response to determining that the tool has reached the relaxation initiation position, control the operation of one or more actuators to transition the engageable body portion from the initial engaged state to a relaxed state.

[0018] In another example, when the instructions are executed, the computing device may also: determine that the tool has reached the slack end position of the flexible elongation device; and control the operation of one or more actuators to transition the engageable body portion from the slack state to a re-engaged state, the re-engaged state having at least one engagement characteristic of the initial engaged state.

[0019] It should be understood that both the foregoing general description and the following detailed description are exemplary and illustrative in nature and are intended to provide an understanding of this disclosure without limiting its scope. In this regard, additional aspects, features, and advantages of this disclosure will be apparent to those skilled in the art from the following detailed description. Attached Figure Description

[0020] Figure 1 This is a simplified diagram of a medical system based on some implementation methods.

[0021] Figure 2A This is a simplified diagram of a medical device system according to some implementation methods.

[0022] Figure 2B This is a simplified diagram of a medical device including a medical tool within an elongation device, according to some embodiments.

[0023] Figure 3 This is a simplified diagram of a device manipulator including a catheter assembly, according to some embodiments.

[0024] Figure 4A and Figure 4B This is a simplified side view of a medical device mounted on an insertion assembly in patient coordinate space, according to some embodiments.

[0025] Figure 5A and Figure 5B This is a simplified diagram of a medical system based on some implementation methods.

[0026] Figure 6This is a flowchart illustrating a method for controlling the engagement of a flexible elongation device according to some embodiments.

[0027] Figure 7 This is a flowchart illustrating a method for operating a medical system according to some embodiments.

[0028] The embodiments and advantages of this disclosure can be better understood by referring to the following detailed description. It should be understood that the same reference numerals are used to identify the same elements shown in one or more of the accompanying drawings, which are shown for illustrative purposes only and not for limiting the embodiments of this disclosure. Detailed Implementation

[0029] In the following description, specific details of some embodiments consistent with this disclosure are set forth. Numerous specific details are set forth to provide a thorough understanding of the embodiments. However, it will be apparent to those skilled in the art that some embodiments may be practiced without some or all of these specific details. The specific embodiments disclosed herein are intended to be exemplary and not restrictive. Other elements within the scope and spirit of this disclosure can be implemented by those skilled in the art, although not specifically described herein. Furthermore, to avoid unnecessary repetition, one or more features shown and described in association with one embodiment may be incorporated into other embodiments unless otherwise specifically described or if one or more features would render the embodiment inoperable. In some cases, well-known methods, processes, components, and circuits have not been described in detail to avoid unnecessarily obscuring aspects of the embodiments.

[0030] This disclosure describes various instruments and parts thereof based on their state in three-dimensional space. As used herein, the term “position” refers to the location of an object or part of an object in three-dimensional space (e.g., three translational degrees of freedom along Cartesian x, y, and z coordinates). As used herein, the term “orientation” refers to the rotational placement of an object or part of an object (e.g., one or more rotational degrees of freedom, such as roll, pitch, and yaw). As used herein, the term “pose” refers to the position of an object or part of an object in at least one translational degree of freedom and the orientation of the object or part of an object in at least one rotational degree of freedom (e.g., up to six total degrees of freedom). As used herein, the term “shape” refers to the set of poses, positions, and / or orientations measured along an object. As used herein, the term “distal” refers to a location closer to the procedural site, and the term “proximal” refers to a location further away from the procedural site. Thus, when an instrument is designed to perform a process, the distal portion or distal end of the instrument is closer to the procedural site than the proximal portion or proximal end of the instrument.

[0031] The systems and methods provided herein enable the detection of tool insertion distance within the lumen of a flexible elongation device using one or more types of sensing modalities. Various types of actions can be controlled based on the tool insertion distance. In one example, the tool insertion distance is used to facilitate tool insertion within the flexible elongation device. The tool insertion distance is detected during tool insertion within the lumen of the flexible elongation device, and the movement of the flexible elongation device (e.g., engagement or insertion depth) can be controlled as the tool is inserted. For example, when the distal portion of the tool enters a flexible region proximal to the engageable body portion of the flexible elongation device, the engageable body portion of the flexible elongation device can relax (e.g., from an initial engagement state, such as a desired state facilitating the use of the tool to perform a biopsy procedure or other types of procedures when inserted through the lumen of the flexible elongation device), allowing the tool to successfully insert through the engageable body portion without damaging the flexible elongation device or the tool. After the distal portion of the tool has passed through the engageable body portion, the engageable body portion can return to its previous engagement state, for example, to perform the procedure. For example, the engageable body portion can be engaged via the operation of one or more actuators, causing the engageable body portion to return to an engaged pose (e.g., having a corresponding position, pose, shape, bending angle, bending radius, etc.). During tool insertion, if the bending angle is too large or the bending radius is too small and / or the tool exerts too much force on the lumen wall of the flexible elongation device, the tool may fail to penetrate the engageable body portion, the lumen of the flexible elongation device may be damaged by the tool, or the tool (e.g., the rigid distal portion of the tool) may be damaged. With the system and method provided herein, a change in the bending angle / radius of the engageable body portion can be initiated based on the detected insertion distance of the tool within the lumen. The engageable body portion can be initiated at the correct time during the process, controlled more precisely, and the tool can be used in a position where the shape of the flexible elongation device is required (where the position would otherwise be unsuitable for tool movement within the lumen).

[0032] One or more types of sensors can be used to monitor the insertion distance of the tool within the lumen of the flexible elongation device (e.g., as measured by the distal portion of the tool). The flexible elongation device includes a flexible portion and an engageable body portion distal to the flexible portion. Monitoring is used to determine when the distal portion of the tool reaches the relaxation initiation location of the flexible elongation device. The relaxation location can be at or near the proximal end of the engageable body portion, or proximal to the engageable body portion within the flexible portion. Upon reaching the relaxation initiation location, one or more actuators controlling the engagement of the engageable body portion of the flexible elongation device can then be controlled to transition the engageable body portion from its initial engagement state to a relaxed state. The transition to the relaxed state can include reducing the tension / torque on the traction line and / or switching to passive control, which reduces the bending angle of the engageable body portion, increases the bending radius of the engagement area, and / or makes the engageable body portion more easily deflected as the tool is inserted through it. In the relaxed state of the engageable body portion, the bending requirements on the tool are reduced, and any rigid portion of the tool will pass through more easily.

[0033] In another example, the insertion distance of the tool can be continuously monitored to determine when the distal portion of the tool reaches the relaxation end location of the flexible elongation device. The relaxation end location can be at or near the distal end of the engageable body portion, or distal to the engageable body portion. Upon reaching the relaxation end location, the actuator can then be controlled to return to the initial engagement state or some other engagement state. For example, returning to the initial engagement state can include the bending angle, bending radius, position, and / or target-aiming direction of the engageable body portion returning to the initial engagement state.

[0034] The insertion distance of a tool can be used to control the system in various other ways. For example, the insertion distance can be used to notify the user that the engagement amount of the engageable body is not suitable for the tool's insertion through the engageable body. This indication may include a message displayed on the system's display device. This allows the user to adjust the engagement, for example by relaxing the engagement amount (e.g., changing the bending radius / angle) to facilitate the safe passage of the tool. In another example, the insertion distance can be used to notify that an external imaging device (e.g., a fluorescence imaging device) is not in use. For example, the external imaging device can be used to verify correct tool positioning during medical procedures performed by the tool, and tool detection and / or insertion distance can be used to help ensure that the external imaging device is activated at the appropriate time or otherwise operates correctly.

[0035] The insertion distance of the tool can also be used to detect the workflow status of the process. For example, the system can detect, based on the tool insertion, that the navigation operation for guiding the flexible elongation device through the anatomical channel to the target tissue has been completed, and that a medical procedure (e.g., biopsy, ablation, electroporation, etc.) has been initiated.

[0036] Monitoring tools can be implemented in a variety of suitable ways, including various sensing modalities at various locations. For example, one or more sensors for monitoring the insertion distance of the tool can be coupled to a manipulator component of the medical system (e.g., an anti-warping guide, control component, etc.), a flexible elongation device (e.g., at the rear end of the flexible elongation device), and / or decoupled from the medical system (e.g., an external imaging device such as a fluorescence imaging device). These sensors can identify the insertion distance of the tool within the flexible elongation device, including when the portion of the tool corresponding to the distal part of the tool reaches the relaxation start position and the relaxation end position. Additionally, the user can input input to the medical system to indicate that the tool has reached the relaxation start position or the relaxation end position.

[0037] The control parameters of the system and method can also be configured according to the characteristics of the type of tool inserted into the flexible elongation device. For example, the material, stiffness, shape, etc., of the tool inserted into the flexible elongation device can be used to determine the relaxation state, such as the minimum bending radius or maximum bending angle of the tool. Subsequently, the actuator can be controlled to ensure that the engageable body portion is shaped so that the tool can be successfully inserted through it.

[0038] Figure 1 This is a simplified diagram of a medical system 100 according to some embodiments. The medical system 100 can be applied to procedures such as surgery, diagnosis (e.g., biopsy), or treatment (e.g., ablation, electroporation, etc.). While some embodiments of such procedures are provided herein, any references to medical or surgical instruments and methods are non-limiting. The systems, instruments, and methods described herein can be used with animal or human cadavers, animal carcasses, parts of human or animal anatomy, for non-surgical diagnostics, and for industrial systems, general-purpose or special-purpose robotic systems, general-purpose or special-purpose remote operating systems, or robotic medical systems.

[0039] like Figure 1As shown, the medical system 100 may include a manipulator assembly 102 that controls the operation of a medical device 104 during various procedures performed on a patient P. The medical device 104 may extend into an internal part of the patient P through an opening within the patient P. The manipulator assembly 102 may be a remotely operated, non-remotely operated, or hybrid remotely and non-remotely operated assembly, having one or more degrees of freedom of motion that can be electrically operated and / or one or more degrees of freedom of motion that can be non-electrically operated (e.g., manually operated). The manipulator assembly 102 may be mounted to and / or positioned near the patient table T. A master assembly 106 enables an operator O (e.g., a surgeon, clinician, internist, or other user) to control the manipulator assembly 102. In some examples, the master assembly 106 enables the operator O to view the procedure site or other graphical or information displays. In some examples, the manipulator assembly 102 may be excluded from the medical system 100, and the device 104 may be directly controlled by the operator O. In some examples, the manipulator assembly 102 can be manually controlled by an operator O. Direct operator control may include various handles and operator interfaces for handheld operation of the instrument 104.

[0040] The main component 106 may be located at a surgeon's console near the patient table T where the patient P is located (e.g., in the same room as the patient table T), such as at the side of the patient table T. In some examples, the main component 106 is located away from the patient table T, such as in a different room or a different building. The main component 106 may include one or more control devices for controlling the manipulator component 102. The control devices may include any number of various input devices, such as joysticks, trackballs, rollers, steering pads, buttons, data gloves, trigger guns, manual controllers, voice recognition devices, motion or presence sensors, etc.

[0041] Manipulator assembly 102 supports medical device 104 and may include a kinematic structure of links providing a setting structure. Links may include one or more non-servo-controlled links (e.g., one or more links that can be manually positioned and locked in place) and / or one or more servo-controlled links (e.g., one or more links that can be controlled in response to commands, for example, from control system 112). Manipulator assembly 102 may include a plurality of actuators (e.g., motors) that drive inputs on medical device 104 in response to commands, for example, from control system 112. Actuators may include a drive system that moves medical device 104 in various ways when coupled to it. For example, one or more actuators may advance medical device 104 into a natural or surgically created anatomical opening. Actuators may control engagement of medical device 104, for example, by moving the distal end (or any other part) of medical device 104 in multiple degrees of freedom. These degrees of freedom may include three degrees of linear motion (e.g., linear motion along the X, Y, Z Cartesian axes) and three degrees of rotational motion (e.g., rotation about the X, Y, Z Cartesian axes). One or more actuators may control the rotation of the medical device about its longitudinal axis. Actuators may also be used to move the engageable end effector of the medical device 104 (e.g., to grasp tissue in the jaws of a biopsy device, etc.), or may be used to move or otherwise control tools inserted within the medical device 104 (e.g., imaging tools, ablation tools, biopsy tools, electroporation tools, etc.).

[0042] The medical system 100 may include a sensor system 108 having one or more subsystems for receiving information about the manipulator assembly 102 and / or the medical device 104. Such subsystems may include: a position sensor system (e.g., using an electromagnetic (EM) sensor or other type of sensor for detecting position or location); a shape sensor system for determining the position, orientation, velocity, rate, pose, and / or shape along one or more segments and / or distal ends of the flexible body of the medical device 104; a visualization system (e.g., using a color imaging device, infrared imaging device, ultrasound imaging device, X-ray imaging device, fluorescence imaging device, computed tomography (CT) imaging device, magnetic resonance imaging (MRI) imaging device, or some other type of imaging device) for capturing images, for example, from the distal end of the medical device 104 or from some other location; and / or an actuator position sensor (e.g., a resolver, encoder, potentiometer, etc.) describing the rotation and / or orientation of the actuator controlling the medical device 104.

[0043] The medical system 100 may include a display system 110 for displaying images or representations of the procedure site and the medical device 104. The display system 110 and the main component 106 may be oriented so that a physician O can use telepresent perception to control the medical device 104 and the main component 106.

[0044] In some embodiments, medical device 104 may include a visualization system that includes an image capture component that records simultaneous or real-time images of the procedure site and provides the images to an operator O via one or more displays of display system 110. The image capture component may include various types of imaging devices. The simultaneous images may be, for example, two-dimensional or three-dimensional images captured by an endoscope positioned within the anatomical procedure site. In some examples, the visualization system may include an endoscope component that may be integrally or removably coupled to medical device 104. Additionally or alternatively, a separate endoscope attached to a separate manipulator assembly may be used with medical device 104 to image the procedure site. The visualization system may be implemented as hardware, firmware, software, or a combination thereof that interacts with or is otherwise executed by one or more computer processors, such as control system 112.

[0045] Display system 110 can also display images of the process site and medical device, which can be captured by a visualization system. In some examples, medical system 100 provides operator O with a telepresented perception. For example, an image captured by an imaging device at the distal portion of medical device 104 can be presented by display system 110 to provide operator O with a perception of the distal portion of medical device 104. Inputs provided by operator O to master component 106 can move the distal portion of medical device 104 in a manner corresponding to the nature of the input (e.g., the distal end turns to the right when the trackball rolls to the right), and cause a corresponding change in the viewing angle of the image captured by the imaging device at the distal portion of medical device 104. Thus, operator O's telepresent perception is maintained when medical device 104 is moved using master component 106. Operator O can manipulate the hand controls of master component 106 and medical device 104 as if observing a workspace in a substantially realistic situation, simulating the experience of physically manipulating medical device 104 from within the patient's anatomy.

[0046] In some examples, the display system 110 may present virtual images of the procedure site created using image data recorded preoperatively (e.g., before the procedure performed by the medical device system 200) or intraoperatively (e.g., simultaneously with the procedure performed by the medical device system 200), such as image data created using computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), fluoroscopy, thermal imaging, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, nanotube X-ray imaging, etc. The virtual images may include two-dimensional, three-dimensional, or higher-dimensional images (e.g., including information based on time or rate). In some examples, one or more models are created based on the preoperative or intraoperative image dataset, and the virtual image is generated using one or more models.

[0047] In some examples, for the purpose of image-guided medical procedures, the display system 110 can display a virtual image generated based on the position of the tracking medical device 104. For example, the tracking position of the medical device 104 can be registered with a model generated using preoperative or intraoperative images (e.g., a dynamic reference), where different parts of the model correspond to different locations of the patient's anatomy. As the medical device 104 moves through the patient's anatomy, the registration is used to determine the parts of the model corresponding to the position and / or viewpoint of the medical device 104, and a virtual image is generated using the determined parts of the model. This allows a virtual image of the internal procedure site corresponding to the tracking position of the medical device 104 to be presented to the operator O from the viewpoint of the medical device 104.

[0048] The medical system 100 may further include a control system 112, which may include processing circuitry to implement some or all of the methods or functions discussed herein. The control system 112 may include at least one memory and at least one processor for controlling the operation of the manipulator assembly 102, medical device 104, main assembly 106, sensor system 108, and / or display system 110. The control system 112 may include instructions (e.g., a non-transitory machine-readable medium storing instructions) that, when executed by at least one processor, configure one or more processors to implement some or all of the methods or functions discussed herein. Although the control system 112... Figure 1 While shown as a single block, control system 112 may include two or more separate data processing circuits, with some processing performed at manipulator component 102, others at main component 106, and so on. In some examples, control system 112 may include other types of processing circuitry systems, such as application-specific integrated circuits (ASICs) and / or field-programmable gate arrays (FPGAs). Control system 112 may be implemented using hardware, firmware, software, or a combination thereof.

[0049] In some examples, the control system 112 may receive feedback from the medical device 104, such as force and / or torque feedback. In response to this feedback, the control system 112 may transmit a signal to the main component 106. In some examples, the control system 112 may transmit a signal instructing one or more actuators of the manipulator component 102 to move the medical device 104. In some examples, the control system 112 may transmit information about the feedback to the display system 110 for presentation or to perform other types of actions based on the feedback.

[0050] Control system 112 may include a virtual visualization system to provide navigational assistance to operator O when controlling medical device 104 during image-guided medical procedures. Virtual navigation using the virtual visualization system may be based on a preoperative or intraoperative dataset of the acquired anatomical pathways of patient P. Control system 112 or a separate computing device may, alone or in combination with operator input, use programmed instructions to transform recorded images into a model of the patient's anatomy. This model may include a segmented two-dimensional or three-dimensional synthetic representation of parts or entire anatomical organs or regions. The image dataset may be associated with the synthetic representation. The virtual visualization system may obtain sensor data from sensor system 108 for calculating the (e.g., approximate) position of medical device 104 relative to the anatomical structures of patient P. Sensor system 108 may be used to register and display medical device 104 and images recorded preoperatively or intraoperatively. For example, PCT disclosure WO 2016 / 191298 (published December 1, 2016, entitled "Systems and Methods of Registration for Image Guided Surgery") discloses an example system, which is incorporated herein by reference in its entirety.

[0051] During the virtual navigation process, sensor system 108 can be used to calculate the (e.g., approximate) position of medical device 104 relative to the anatomical structure of patient P. This position can be used to generate both a macroscopic (e.g., external) tracking image of the anatomical structure of patient P and a virtual internal image of the anatomical structure of patient P. The system may include one or more electromagnetic (EM) sensors, fiber optic sensors, and / or other sensors to register and display the medical device and preoperatively recorded medical images. For example, U.S. Patent No. 8,900,131 (filed May 13, 2011, entitled “Medical System Providing Dynamic Registration of a Model of an Anatomic Structure for Image-Guided Surgery”), which is incorporated herein by reference in its entirety.

[0052] The medical system 100 may also include operating and support systems (not shown), such as lighting systems, steering and maneuvering control systems, irrigation systems, and / or suction systems. In some embodiments, the medical system 100 may include more than one manipulator assembly and / or more than one main assembly. The exact number of manipulator assemblies may depend on factors such as the medical procedure and space constraints within the operating room. Multiple main assemblies may be located in the same location or may be positioned in separate locations. Multiple main assemblies allow more than one operator to control one or more manipulator assemblies in various combinations.

[0053] Figure 2A This is a simplified diagram of a medical device system 200 according to some embodiments. The medical device system 200 includes a flexible elongation device 202 (also referred to as elongation device 202), a drive unit 204, and a medical tool 226, which together serve as an example of the medical device 104 of the medical system 100. The medical system 100 can be a remote operating system, a non-remote operating system, or a hybrid of remote and non-remote operating systems, as shown in reference... Figure 1 As described above, the visualization system 231, tracking system 230, and navigation system 232 are also included. Figure 2A The diagram shows an example component of the control system 112 of the medical system 100. In some examples, the medical device system 200 can be used in non-remotely operated exploration procedures or in procedures involving routine manual operation of medical devices (e.g., endoscopy). The medical device system 200 can be used to collect (e.g., measure) a set of data points corresponding to positions within the anatomical passage of a patient (e.g., patient P).

[0054] The elongation device 202 is coupled to the drive unit 204. The elongation device 202 includes a channel 221 through which a medical instrument 226 can be inserted. The elongation device 202 navigates within the patient's anatomy to deliver the medical instrument 226 to the procedure site. The elongation device 202 includes a flexible body 216 having a proximal end 217 and a distal end 218. In some examples, the flexible body 216 may have an outer diameter of approximately 3 mm. Other flexible bodies may have larger or smaller outer diameters.

[0055] Medical device system 200 may include a tracking system 230 for determining the position, orientation, velocity, rate, pose, and / or shape of a flexible body 216 at its distal end 218 and / or along one or more segments 224 of the flexible body 216, as will be described in further detail below. Tracking system 230 may include one or more sensors and / or imaging devices. The flexible body 216 (e.g., the length between the distal end 218 and the proximal end 217) may include multiple segments 224. Tracking system 230 may be implemented using hardware, firmware, software, or a combination thereof. In some examples, tracking system 230 is... Figure 1 Part of the control system 112 shown.

[0056] Tracking system 230 can use shape sensor 222 to track the distal end 218 and / or one or more segments 224 of flexible body 216. Shape sensor 222 may include an optical fiber aligned with flexible body 216 (e.g., disposed within an internal channel of flexible body 216 or mounted externally along flexible body 216). In some examples, the optical fiber may have a diameter of about 200 μm. In other examples, the diameter may be larger or smaller. The optical fiber of shape sensor 222 can form an optical fiber bending sensor for determining the shape of flexible body 216. Optical fibers including fiber Bragg gratings (FBGs) can be used to provide strain measurements in one or more dimensions of the structure. Various systems and methods for monitoring the shape and relative position of optical fibers in three dimensions, applicable to some embodiments, are described in U.S. Patent Application Publication No. 2006 / 0013523 (filed July 13, 2005, entitled "Fiber optic position and shape sensing device and method relating thereto"), U.S. Patent No. 7,772,541 (filed March 12, 2008, entitled "Fiber Optic Position and / or Shape Sensing Based on Rayleigh Scatter"), and U.S. Patent No. 8,773,650 (filed September 2, 2010, entitled "Optical Position and / or Shape Sensing"), all of which are incorporated herein by reference in their entirety. In some embodiments, the sensor may employ other suitable strain sensing techniques, such as Rayleigh scattering, Raman scattering, Brillouin scattering, and fluorescence scattering.

[0057] In some examples, other techniques may be used to determine the shape of the flexible body 216. For example, the history of the position and / or pose of the distal end 218 of the flexible body 216 may be used to reconstruct the shape of the flexible body 216 over time intervals, such as when the flexible body 216 advances or retracts within a patient's anatomy. In some examples, the tracking system 230 may alternatively and / or additionally use a position sensor system 220 to track the distal end 218 of the flexible body 216. The position sensor system 220 may be a component of an EM sensor system, wherein the position sensor system 220 includes one or more position sensors. Although the position sensor system 220 is shown proximate to the distal end 218 of the flexible body 216 to track the distal end 218, the number and position of the position sensors in the position sensor system 220 may vary to track different regions along the flexible body 216. In one example, the position sensors include conductive coils that can withstand externally generated electromagnetic fields. Each coil of the position sensor system 220 may generate an induced electrical signal having characteristics that depend on the position and orientation of the coil in relation to the externally generated electromagnetic field. Position sensor system 220 can measure one or more position coordinates and / or one or more orientation angles associated with one or more portions of flexible body 216. In some examples, position sensor system 220 can be configured and positioned to measure six degrees of freedom, such as three position coordinates X, Y, Z and three orientation angles indicating pitch, yaw, and roll of a reference point. In some examples, position sensor system 220 can be configured and positioned to measure five degrees of freedom, such as three position coordinates X, Y, Z and two orientation angles indicating pitch and yaw of a reference point. Further description of the position sensor system applicable to some embodiments is provided in U.S. Patent No. 6,380,732 (filed August 11, 1999, entitled "Six-Degree of Freedom Tracking System Having a Passive Transponder on the Object Being Tracked"), which is incorporated herein by reference in its entirety.

[0058] In some implementations, the tracking system 230 may alternatively and / or additionally rely on a set of pose, position, and / or orientation data stored at points on the elongation device 202 and / or medical instrument 226, captured during one or more cycles of alternating movement (e.g., breathing). This stored data can be used to develop shape information about the flexible body 216. In some examples, a series of position sensors (not shown)—such as EM sensors like those in position sensor 220 or some other type of position sensor—can be positioned along the flexible body 216 and used for shape sensing. In some examples, a history of data acquired during the procedure from one or more of these position sensors can be used to represent the shape of the elongation device 202, particularly where the anatomical passage is typically static.

[0059] Figure 2B This is a simplified diagram of a medical tool 226 within an elongation device 202 according to some embodiments. The flexible body 216 of the elongation device 202 may include a channel 221 sized and shaped to receive the medical tool 226. In some embodiments, the medical tool 226 may be used for procedures such as diagnostics, imaging, surgery, biopsy, ablation, illumination, irrigation, aspiration, electroporation, etc. The medical tool 226 can be deployed through the channel 221 of the flexible body 216 and operate at a procedure site within an anatomical structure. The medical tool 226 may be, for example, an image capture probe, a biopsy tool (e.g., a needle, gripper, brush, etc.), an ablation tool (e.g., a laser ablation tool, a radiofrequency (RF) ablation tool, a cryoablation tool, a thermal ablation tool, a heated liquid ablation tool, etc.), an electroporation tool, and / or another surgical, diagnostic, or therapeutic tool. In some examples, the medical tool 226 may include an end effector with a single working member, such as a scalpel, a blunt blade, an optical fiber, an electrode, etc. Other end effector types can include, for example, forceps, grippers, scissors, sutures, clamps, etc. Other end effectors can also include electrically activated end effectors, such as electrosurgical electrodes, transducers, sensors, etc.

[0060] Medical tool 226 may be a biopsy tool for removing sample tissue or cell samples from a target anatomical location. In some examples, the biopsy tool is a flexible needle. The biopsy tool may also include a sheath that can surround the flexible needle to protect the needle and the inner surface of the channel 221 when the biopsy tool is within the channel 221. Medical tool 226 may be an image capture probe that includes a distal portion having a stereo or single-field-of-view camera that can be positioned at or near the distal end 218 of the flexible body 216 for capturing images (e.g., still or video images). The captured images may be processed by visualization system 231 for display and / or provided to tracking system 230 to support tracking of the distal end 218 of the flexible body 216 and / or one or more segments 224 of the flexible body 216. The image capture probe may include a cable for transmitting the captured image data, the cable being coupled to an imaging device at the distal portion of the image capture probe. In some examples, the image capture probe may include a bundle of optical fibers, such as a fiber optic endoscope, coupled to a closer imaging device, such as the visualization system 231. The image capture probe may be monospectral or multispectral, capturing image data in one or more of the visible, near-infrared, infrared, and / or ultraviolet spectra. The image capture probe may also include one or more light emitters that provide illumination to facilitate image capture. In some examples, the image capture probe may use ultrasound, X-ray, fluoroscopy, CT, MRI, or other types of imaging techniques.

[0061] In some examples, an image capture probe is inserted within the flexible body 216 of the elongation device 202 to facilitate visual navigation of the elongation device 202 to the procedure site, and then the image capture probe is replaced within the flexible body 216 with another type of medical instrument 226 for performing the procedure. In some examples, the image capture probe may be located together with another type of medical instrument 226 within the flexible body 216 of the elongation device 202 to facilitate simultaneous image capture and tissue intervention, for example, within the same channel 221 or in different channels. The medical instrument 226 may advance from an opening in the channel 221 to perform the procedure (or some other function) and then retract into the channel 221 upon completion of the procedure. The medical instrument 226 may be removed from the proximal end 217 of the flexible body 216 or along the flexible body 216 from another optional instrument port (not shown).

[0062] In some examples, the extension device 202 may include integrated imaging capabilities instead of utilizing a removable image capture probe. For example, the imaging device (or fiber bundle) and light emitter may be located at the distal end 218 of the extension device 202. The flexible body 216 may include one or more dedicated channels carrying cables and / or optical fibers between the distal end 218 and the visualization system 231. Here, the medical device system 200 can perform imaging and tooling operations simultaneously.

[0063] In some examples, the medical tool 226 is capable of controlled engagement. The medical tool 226 may house a cable (also referred to as a traction cable), linkage, or other actuation controls (not shown), extending between its proximal and distal ends to controllably bend the distal end of the medical tool 226, such as those discussed herein with respect to the flexible elongation device 202. The medical tool 226 may be coupled to the drive unit 204 and the manipulator assembly 102. In these examples, the elongation device 202 may be excluded from the medical device system 200, or may be a flexible device without controlled engagement. Steering maneuvers or instruments applicable to some embodiments are further described in detail in U.S. Patent No. 7,316,681 (filed October 4, 2005, entitled "Articulated Surgical Instrument for Performing Minimally Invasive Surgery with Enhanced Dexterity and Sensitivity") and U.S. Patent No. 9,259,274 (filed September 30, 2008, entitled "Passive Preload and Capstan Drive for Surgical Instruments"), which are incorporated herein by reference in their entirety.

[0064] The flexible body 216 of the elongation device 202 may also, or alternatively, accommodate a cable, linkage, or other steering control (not shown) extending between the drive unit 204 and the distal end 218 to controllably bend the distal end 218, such as by, for example, a cable, linkage, or other steering control. Figure 2A The distal end 218 is depicted by a dashed line 219. In some examples, at least four cables are used to provide independent up-and-down steering maneuvers to control the pitch of the distal end 218 and left-and-right steering maneuvers to control the yaw of the distal end 281. In these examples, the flexible elongation device 202 may be a steerable maneuverable conduit. Examples of steerable maneuverable conduits suitable for some embodiments are described in detail in PCT Publication WO 2019 / 018736 (published January 24, 2019, entitled "Flexible Elongate Device Systems and Methods"), which is incorporated herein by reference in its entirety.

[0065] In embodiments where the elongation device 202 and / or medical tool 226 is actuated by a remotely operated component (e.g., manipulator component 102), the drive unit 204 may include a drive input removably coupled to and receiving power from a drive element (e.g., an actuator) of the remotely operated component. In some examples, the elongation device 202 and / or medical tool 226 may include a grasping feature, a manual actuator, or other components for manually controlling the movement of the elongation device 202 and / or medical tool 226. The elongation device 202 may be steerable, or alternatively, it may be non-steerable, without an integrated mechanism for operator control of bending of the distal end 218. In some examples, one or more channels 221 (which may also be referred to as lumens) may be defined by the inner wall of the flexible body 216 of the elongation device 202, through which the medical tool 226 may be deployed and used at a target anatomical location.

[0066] In some examples, medical device system 200 (e.g., extension device 202 or medical tool 226) may include flexible bronchial instruments, such as bronchoscopes or bronchial tubes, for the examination, diagnosis, biopsy, and / or treatment of the lungs. Medical device system 200 may also be adapted to navigate and treat other tissues within any anatomical system of a variety of anatomical systems via naturally or surgically generated access channels, including the colon, intestine, kidneys and renal calyces, brain, heart, circulatory system including the vascular system, etc.

[0067] Information from tracking system 230 can be sent to navigation system 232, where it can be combined with information from visualization system 231 and / or a preoperatively acquired model to provide real-time location information to physicians, clinicians, surgeons, or other operators. In some examples, the real-time location information can be displayed on display system 110 for controlling medical device system 200. In some examples, navigation system 232 can utilize the location information as feedback for locating medical device system 200. Various systems for registering and displaying surgical instruments and surgical images using fiber optic sensors, applicable to some embodiments, are provided in U.S. Patent No. 8,900,131 (filed May 13, 2011, entitled “Medical System Providing Dynamic Registration of a Model of an Anatomic Structure for Image-Guided Surgery”), which is incorporated herein by reference in its entirety.

[0068] Figure 3An example of an instrument manipulator 306 is shown, which may be substantially similar to instrument manipulator 206. Instrument manipulator 306 may include a base 304, an insertion stage 302, and an instrument holder 308 to which the catheter assembly 310 is coupled. In one or more embodiments, instrument manipulator 306 provides insertion and retraction of the catheter assembly 310 relative to the patient's anatomy by telescoping the instrument holder 308 and the insertion stage 302 relative to the base 304. Therefore, instrument manipulator 306 provides insertion freedom for the insertion and retraction of the flexible catheter 310a. In a medical setting, insertion advances the flexible catheter 310a into the patient's anatomy, while retraction withdraws the flexible catheter 310a from the patient's anatomy.

[0069] The base 304 includes a shaft portion 304a and a main portion 304b. As described in detail below, the shaft portion 304a is removably coupled to a device connector or rotary connector 318 that receives the flexible catheter 310a. An insertion stage 302 is coupled to and translates along the main portion 304b of the base 304. An instrument holder 308 is coupled to and translates along the insertion stage 302. The catheter assembly 310 may include a flexible catheter 310a and a control assembly 310b. The instrument holder 308 is coupled to the control assembly 310b at an instrument interface 314. An instrument manipulator 306 is also coupled to a probe assembly 316, which includes a probe 316b and a probe connector 316a. The probe assembly 316 can be inserted into the working lumen of the flexible catheter 310a via a connector 312 on the control assembly 310b and can pass through the flexible catheter 310a. The probe 316b may include, for example, an endoscope assembly that provides images of the surgical site. The instrument holder 308 may include electronic and optical components that provide endoscopic capabilities to the probe 316b. In some embodiments, the probe assembly 316 is detachable from the instrument manipulator 306 and the flexible catheter control assembly 310b, and can be removed from the catheter assembly 310. Alternative instruments, such as biopsy needles, ablation tools, and other flexible instruments, may be coupled to the instrument manipulator 306 and / or the catheter assembly 310 via the working lumen of the flexible catheter 310a.

[0070] continue Figure 3The device connector or rotary connector 318 may include an operator interface that can be removably coupled to the base 304. In some embodiments, a flexible catheter 310a passes through a catheter guide 322, which is a selectively retractable and extendable device that supports the length of the flexible catheter 310a during movement of the instrument holder 308. A flexible catheter 310a without a guide may buckle in areas without lateral support (e.g., in the space between the instrument interface 314 and the device connector 318). To avoid buckling, the catheter guide 322 may be an anti-buckling guide that provides lateral support to the flexible catheter 310a. Various systems and methods relating to catheter guides are described in PCT / US2017 / 041160 (filed July 7, 2017) (disclosing “Guide Apparatus for Delivery of an Elongate Device and Methods of Use”), which is incorporated herein by reference in its entirety.

[0071] Figure 4A and Figure 4B This is a simplified side view of a medical device mounted on an insertion assembly, according to some embodiments, in patient coordinate space. Figure 4A and Figure 4B As shown, the surgical environment 400 may include a patient P positioned on a patient table T. Patient P may be stationary within the surgical environment 400 because overall patient movement is restricted by sedation, restraint, and / or other means. Periodic anatomical movements of patient P (including respiratory and cardiac movements) may continue. Within the surgical environment 400, a medical device 404 is used to perform medical procedures, which may include, for example, surgery, biopsy, ablation, illumination, irrigation, aspiration, or electroporation. The medical device 404 may also be used to perform other types of procedures, such as a registration process that associates position, orientation, and / or pose data captured by a sensor system 108 with a desired (e.g., anatomical or systemic) reference frame. The medical device 404 may be, for example, medical device 104. In some examples, the medical device 404 may include an elongation device 410 (e.g., a catheter) coupled to an instrument body 412. The elongation device 410 includes one or more channels sized and shaped to receive medical instruments.

[0072] The elongation device 410 may also include one or more sensors (e.g., components of sensor system 108). In some examples, a shape sensor 414 may be fixed at a proximal point 416 on the instrument body 412. The proximal point 416 of the shape sensor 414 may move with the instrument body 412, and the position of the proximal point 416 relative to a desired reference frame may be known (e.g., via a tracking sensor or other tracking device). The shape sensor 414 may measure the shape from the proximal point 416 to another point (e.g., the distal end 418 of the elongation device 410). The shape sensor 414 may be aligned with the elongation device 410 (e.g., disposed within an internal channel or mounted externally). In some examples, the shape sensor 414 may be an optical fiber used to generate shape information of the elongation device 410.

[0073] In some examples, position sensors (e.g., EM sensors) may be incorporated into medical device 404. A series of position sensors may be positioned along the flexible elongation device 410 and used for shape sensing. Position sensors may be used in place of or in conjunction with shape sensor 414, for example, to improve the accuracy of shape sensing or to verify shape information.

[0074] The extension device 410 may accommodate cables, linkages, or other steering control mechanisms that extend between the instrument body 412 and the distal end 418 to controllably bend the distal end 418. In some examples, at least four cables are used to provide independent up-and-down steering control to control the pitch of the distal end 418 and left-and-right steering control to control the yaw of the distal end 418. The instrument body 412 may include a drive input that is removably coupled to and receives power from a drive element (e.g., an actuator) of the manipulator assembly.

[0075] The instrument body 412 may be coupled to the instrument holder 406. The instrument holder 406 may be mounted to an insertion stage 408 fixed within the surgical environment 400. Alternatively, the insertion stage 408 may be movable but has a known position within the surgical environment 400 (e.g., via a tracking sensor or other tracking device). The instrument holder 406 may be a component of a manipulator assembly (e.g., manipulator assembly 102) coupled to the medical device 404 to control insertion motion (e.g., movement along insertion axis A) and / or movement of the distal end 418 of the elongation device 410 in multiple directions, such as yaw, pitch, and / or roll. The instrument holder 406 or the insertion stage 408 may include actuators, such as servo motors, for controlling the movement of the instrument holder 406 along the insertion stage 408.

[0076] Sensor device 420 (which may be a component of sensor system 108) can provide information about the position of instrument body 412 as it moves relative to insertion stage 408 along insertion axis A. Sensor device 420 may include one or more rotary transformers, encoders, potentiometers, and / or other sensors that measure the rotation and / or orientation of actuators controlling the movement of instrument carriage 406, thereby indicating the movement of instrument body 412. In some embodiments, insertion stage 408 has, for example, […]. Figure 4A and Figure 4B The linear track is shown. In some embodiments, the insertion stage 408 may have a curved track or a combination of curved track segments and linear track segments.

[0077] Figure 4A The instrument body 412 and instrument holder 406 are shown in the retracted position along the insertion stage 408. In this retracted position, the proximal point 416 is located at position L0 on the insertion axis A. The position of the proximal point 416 can be set to zero and / or other reference values ​​to provide a basic reference (e.g., corresponding to the origin of the desired reference system) to describe the position of the instrument holder 406 along the insertion stage 408. In the retracted position, the distal end 418 of the extension device 410 can be positioned precisely within the inlet orifice of the patient P. Also in the retracted position, data captured by the sensor device 420 can be set to zero and / or other reference values ​​(e.g., I=0). Figure 4B In this configuration, the instrument body 412 and instrument holder 406 have advanced along the linear track of the insertion stage 408, and the distal end 418 of the elongation device 410 has advanced into the patient P. At this advanced position, the proximal point 416 is at position L1 on the insertion axis A. In some examples, rotation and / or orientation of the actuator measured by the sensor device 420 indicating the movement of the instrument holder 406 along the insertion stage 408 and / or by one or more position sensors associated with the instrument holder 406 and / or the insertion stage 408 can be used to determine the position L1 of the proximal point 416 relative to position L0. In some examples, position L1 can also serve as an indicator of the distance or depth of insertion of the distal end 418 of the elongation device 410 into the channel of the anatomical structure of the patient P.

[0078] Figure 5 is a simplified diagram of a medical system 500 including a flexible elongation device 502. According to... Figure 1 In some embodiments consistent with Figure 4, medical system 500 may correspond to medical device system 200, and / or flexible elongation device 502 may correspond to elongation device 202.

[0079] The flexible elongation device 502 may include a flexible body and a lumen 504 extending through the flexible body. The lumen 504 may provide a delivery channel for a medical instrument 506. The medical instrument 506 may be any suitable tool to be inserted through the flexible body of the flexible elongation device 502, including, for example, a visual probe, a biopsy tool (e.g., a needle, brush, cryoprobe, or forceps), an ablation tool, an electroporation tool, an ultrasound device (e.g., an endobronchial ultrasound (EBUS) probe), a chemical delivery tool, and / or other biopsy or treatment tools.

[0080] As shown in Figure 5, the flexible body of the flexible elongation device 502 may include an engageable body portion 508, which may be located in a distal segment 510 of the body, including its distal end 512. In the illustrated embodiment, the system 500 includes one or more actuators 514 that control the engagement of the engageable body portion 508 via manipulation of one or more control elements 516 (e.g., traction lines, tendons, push rods, etc.) connected to a control structure 518 (e.g., a control ring) of the engageable body portion 508. Operation of the actuator 514 causes the corresponding control element 516 to retract, causing the engageable body portion 508 to bend in the direction of the control element 516, or releases the control element, allowing the engageable body portion 508 to return to a straighter configuration. In some examples, the desired engagement of the engageable body portion 508 is determined based on data from a shape sensor 519 (e.g., a fiber optic shape sensor) extending at least along the engageable body portion 508. Therefore, engagement states and transitions between engagement states, as described herein, can be tracked and controlled based on data from the shape sensor 519.

[0081] As shown, system 500 may include instrument holder 515 (e.g., instrument holder 308). Instrument holder 515 is telescopically movable by an instrument manipulator (not shown) to provide insertion and retraction of flexible extension device 502 relative to patient anatomy. In some examples, instrument holder 515 may include force sensor 517 configured to provide data about tool force. For example, force sensor 517 may provide sensor data indicating that the needle of tool 506 is being inserted into tissue or that tool 506 is being inserted through flexible extension device 502.

[0082] System 500 includes a control system 520 operatively coupled to actuator 514 to control manipulation of the positioning of the engageable body portion 508 of the flexible elongation device 502. System 500 also includes one or more sensors 522 coupled to or positioned adjacent to the flexible elongation device 502, which provide sensor data indicating the insertion distance of a tool 506 (e.g., the distal portion 506a of the tool 506) within the lumen 504 of the flexible elongation device 502.

[0083] The control system 520 can use sensor data to determine the insertion distance of the tool 506 and / or whether the tool 506 has reached the predetermined position of the flexible elongation device 502. In some examples, the tool 506 may have greater stiffness than the flexible elongation device 502 and / or the distal portion 506a (which is or includes a rigid portion), such that if the shape of the engageable body portion 508 has a sufficiently large bending angle and / or a small bending radius, the tool 506 may not be able to navigate through the lumen 504 into the engageable body portion 508.

[0084] Therefore, the control system 520 can control the engagement of the flexible elongation device 502 when the tool 506 is inserted into the lumen 504 of the flexible elongation device 502, so that the tool 506 can be successfully inserted through the engageable body portion 508. For example, the control system 520 can control the operation of the actuator 514 based on the distance the tool 506 is inserted into the lumen 504 of the flexible elongation device 502 to change one or more engagement states of the engageable body portion 508. In some examples, the control system 520 can be configured to change the engagement state at least twice as the tool 506 is inserted from the proximal end 524 to the distal end 510 of the flexible elongation device 502.

[0085] Engagement states can include a relaxed engagement state that allows tool 506 to be successfully inserted through engageable body portion 508, and an initial engagement state (e.g., the engagement of engageable body portion 508 before tool 506 is inserted into lumen 504 of flexible elongation device 502 or before tool 506 reaches engageable body portion 508 of flexible elongation device 502). In some examples, engagement states may also include a return engagement state, wherein engagement of engageable body portion 508 is controlled to at least partially return to the initial engagement state. The return engagement state may be the same as or different from the initial engagement state. In examples where the return engagement state is different, the return engagement state may have one or more engagement characteristics of the initial engagement state. For example, the return engagement state and the initial engagement state may have one or more engagement characteristics, including bending angle, bending radius, position, pose, and / or pointing direction (e.g., direction of aiming at a target). In one example, the return engagement state may differ from the initial engagement state, as long as the shared engagement characteristics of the states enable the tool to reach the target as it extends from the lumen of the flexible elongation device. Therefore, the ends of the flexible elongation device can have the same pointing direction, but other engagement characteristics can differ. For example, the bending angle in the returned engagement state can be smaller than the bending angle in the initial engagement state, and / or the bending radius in the returned state can be larger than the bending radius in the initial engagement state.

[0086] The difference between the initial engagement state and the returned engagement state allows for optimization of the returned engagement state. In one example, the flexible elongation device may not return to the precise initial engagement state, for example, due to stiffness changes caused by tool insertion within the engageable body portion 508. In another example, the returned engagement state may have more optimized engagement characteristics to facilitate tool movement and / or operation.

[0087] The control system 520 determines, based on sensor data, when the tool 506 (e.g., the distal portion 506a) reaches or enters the flexible region 526 of the flexible elongation device 502. Figure 5B In some examples, sensor data may indicate a specific or target structure corresponding to the tool 506 reaching the flexible region 526, and / or may indicate the length of the tool 506 corresponding to the insertion depth of the tool 506 reaching the flexible region 526. Figure 5B As shown, the proximal initiation of the flexible region 526 can be defined by the relaxation start position 526a, and sensor data can indicate when the tool 506 has reached the relaxation start position 526a.

[0088] When it is determined that the tool 506 has reached the flexible region 526, the control system 520 controls the operation of the actuator 514 when the distal portion 506a of the tool 506 enters the flexible region 526 of the flexible elongation device 502, so as to change the initial engagement state to the relaxed state, thereby relaxing the engagement of the engageable main body portion 508 of the flexible elongation device 502.

[0089] In some examples, the control system 520 may then determine, based on sensor data, when the tool 506 (e.g., the distal portion 506a) leaves or reaches the end of the flexible region 526 of the flexible elongation device 502. In some examples, the sensor data may indicate a specific or second target structure corresponding to the end of the tool 506 reaching the flexible region 526, and / or may indicate the length of the tool 506 corresponding to the insertion depth of the tool 506 reaching the end of the flexible region 526. The distal end of the flexible region 526 may be defined by a relaxation end position 526b, and the sensor data may indicate when the tool 506 has reached the relaxation end position 526b.

[0090] When it is determined that the tool 506 has reached the relaxation end position 526b of the flexible region 526, the control system 520 controls the operation of the actuator 514 to at least partially transition the relaxed state to the return engagement state.

[0091] The flexible region 526 of the flexible elongation device 502 can be any suitable portion of the flexible elongation device 502. Similarly, the relaxation start position 526a and relaxation end position 526b can correspond to any suitable location along the flexible elongation device 502. In some examples, the relaxation start position 526a is proximal to or at the proximal end of the engageable body portion 508. In some examples, the relaxation end position 526b can be at or at the distal end of the engageable body portion 508. These positions will allow the tool 506 to be successfully inserted through the engageable body portion 508 without damaging the flexible elongation device 502.

[0092] Compared to the relaxed state, the initial engagement state of the engageable body portion 508 may include a larger bending angle and / or a smaller bending radius for the engageable body portion 508. As will be understood, the initial engagement state may depend on the specific procedure being performed and the patient's anatomy.

[0093] Sensor 522 can be positioned at any suitable location within system 500 to acquire sensor data for control system 520 to determine the insertion depth / position of tool 506 within the lumen 504 of flexible elongation device 502. In some examples, one or more sensors 522 may be mounted or otherwise coupled to a manipulator assembly 528 (e.g., manipulator assembly 102) including actuator 514, anti-warping guide 530 (e.g., anti-warping guide 322) for flexible elongation device 502, rotary connector 532 (e.g., rotary connector 318) for flexible elongation device 502, control assembly 534 (e.g., control assembly 310b) configured to support and position flexible elongation device 502, proximal end 524 of flexible elongation device 502, etc. Sensor 522 may be positioned within the lumen 504 of flexible elongation device 502 along the tool insertion path.

[0094] Sensor 522 may include any type or combination of sensors to provide appropriate sensor data to control system 520. For example, sensor 522 may include at least one of an inductive sensor or a capacitive sensor.

[0095] For the inductive sensor, the sensor data includes inductive data regarding the structure of tool 506 or flexible elongation device 502. Control system 520 can compare the inductive data with stored inductive data to identify a target structure along the length of tool 506 / flexible elongation device 502 corresponding to the tool 506 reaching the relaxation start position 526a. Similarly, control system 520 can compare the inductive data with stored inductive data to identify a second target structure along the length of tool 506 / flexible elongation device 502 corresponding to the tool 506 reaching the relaxation end position 526b.

[0096] For the capacitive sensor, the sensor data includes capacitance data regarding the structure of tool 506 or flexible elongation device 502. Control system 520 can compare the capacitance data with stored capacitance data to identify a target structure along the length of tool 506 / flexible elongation device 502 corresponding to the tool 506 reaching the relaxation start position 526a. Similarly, control system 520 can compare the capacitance data with stored capacitance data to identify a second target structure along the length of tool 506 / flexible elongation device 502 corresponding to the tool 506 reaching the relaxation end position 526b.

[0097] In additional or alternative examples, sensor 522 may include an imaging device configured to generate an image of tool 506 within the lumen 504 of flexible elongation device 502. For example, the imaging device may be a fluorescence imaging device. With this configuration, control system 520 can utilize fluorescence fluoroscopy to determine the depth of tool insertion (e.g., relaxation start position 526a and / or relaxation end position 526b). In some examples, fluorescence fluoroscopy can also be used to determine the number of punctures into the tissue performed by the needle of tool 506.

[0098] In some examples, the control system 520 may check whether the fluorescence imaging device is currently operating in response to receiving sensor data from one or more of other sensors 517, 519, 522 indicating that the tool 506 is being inserted into the lumen 504 of the flexible elongation device. The control system 520 may also check whether the fluorescence imaging device is currently operating in response to sensor data based on the detection that the needle of the tool 506 is penetrating the tissue from the force sensor 517 of the instrument holder 515. In some examples, the control system 520 may be configured to automatically activate the fluorescence imaging device in response to an indication that the tool 506 is being inserted into the lumen 504 of the flexible elongation device 502 and / or that the needle of the tool 506 is penetrating the tissue. Checking whether the fluorescence imaging device is currently operating may include using a frame grabber, etc.

[0099] In additional or alternative examples, one or more sensors 522 may be disposed within or otherwise coupled to tool 506 to measure data associated with the flexible elongation device 502. In this way, control system 520 can compare sensor data from sensors 522 coupled to tool 506 with stored data to identify a target structure along the length of flexible elongation device 502 corresponding to relaxation start position 526a. Similarly, control system 520 can compare sensor data with stored data to identify a second target structure along the length of flexible elongation device 502 corresponding to relaxation end position 526b.

[0100] In some examples, the relaxation state may depend at least in part on the tool type of the tool 506 inserted into the lumen 504 of the flexible elongation device 502. For example, the tool type may identify the stiffness and / or any rigid length of the tool 506, and the corresponding bending angle / bending radius required for the tool 506 to insert through the bent portion of the lumen 504. Different tool types will require different ranges of relaxation relative to a given initial engagement state to successfully insert through the engageable body portion 508. The tool type may be input to the system 500 by a user and / or may be determined by the control system 520 based on analysis of sensor data from one or more of the sensors 522. For example, inductance data may be used to identify a specific structure of the tool type for identification purposes. The control system 520 may then determine the required amount of relaxation relative to the initial engagement state that enables the tool 506 to insert through, and control the operation of the actuator 514 to transition the engageable body portion 508 from the initial engagement state to a relaxation state corresponding to the tool type. In another example, the feedforward terms of the control system 520 can also be adjusted based on the tool type of tool 506 (e.g., spinal stiffness).

[0101] The control system 520 can also be configured to disable the transition to a relaxed state in response to the satisfaction of predetermined criteria or conditions. For example, the control system 520 may determine that the engagementable body portion 508 of the flexible elongation device 502 has a bending angle below a threshold bending angle in its initial engagement state. If the engagementable body portion 508 does not have an excessively bent shape, the change in engagement state may not be necessary to allow the tool 506 to be inserted through the engagementable body portion 508, thus disabling the engagement relaxation function can shorten the overall procedure time. In another example, the control system 520 may determine that the engagementable body portion 508 of the flexible elongation device 502 is positioned in a location within the patient where movement may be harmful. In this case, the engagement relaxation function can be disabled before the procedure based on the expected path or target location, or the user can instruct the control system 520 to disable the engagement relaxation function based on analysis of the position of the engagementable body portion 508. In another example where the control system 520 determines the tool type of tool 506 as described above, the control system 520 may determine, based on the tool type, that tool 506 is sufficiently flexible (e.g., overall stiffness and / or any rigid portion) to pass through the lumen 504 of the flexible elongation device 502 in the initial engagement state.

[0102] like Figure 5AAs shown, the medical system 500 may also include a control panel 536 operatively coupled to the control system 520 and configured to allow a user to intervene in or guide the operation of the engagement relaxation function. In some examples, the control panel 536 may include input and output devices to guide the operation of the system 500 and to inform or inquire about the operation of the system 500. The control panel 536 may include any number of suitable user input / output devices. For example, the control panel 536 may include a touchscreen or other display, a scroll ball, buttons, switches, a microphone for voice commands, a speaker, etc.

[0103] For example, control panel 536 allows the user to disable the engagement slack function before or during a transition (e.g., transitioning from an initial engaged state to a relaxed state and / or from a relaxed state to a return to an engaged state). This allows the user to terminate or abort the engagement slack function at any stage. Upon receiving an instruction from control panel 546, movement of the engageable body portion 508 is stopped, and, under the user's guidance, control of actuator 514 is switched to normal follow mode. A notification that the engagement slack function has been aborted can also be displayed on control panel 536.

[0104] In another example, control panel 536 can be used to instruct control system 520 to control the operation of actuator 514 to transition the engageable body portion 508 from an initial engaged state to a relaxed state and / or from a relaxed state to a re-engaged state. Thus, a user can instruct control system 520 to operate independently of flexible body portion 526 (e.g., relaxation start position 526a and / or relaxation end position 526b). Alternatively or additionally, control panel 536 can provide control system 520 with indications that tool 506, inserted into lumen 504 of flexible elongation device 502, has reached relaxation start position 526a and / or relaxation end position 526b of flexible elongation device 502.

[0105] In another example, control panel 536 can be used to request authorization before changing the engagement state of the engageable body portion 508 of flexible elongation device 502. In this example, after control system 520 determines that tool 506 has reached relaxation start position 526a, control system 520 can ask the user whether they wish to transition from the initial engagement state to the relaxation state. The user can use user input device 536 to authorize or refuse the transition. Similarly, after control system 520 determines that tool 506 has reached relaxation end position 526b or determines that tool 506 is fully inserted, control system 520 can ask the user whether they wish to transition from the relaxation state to the return engagement state. The user can use user input device 536 to authorize or refuse the transition. Determining that tool 506 is fully inserted can include identifying the target structure of tool 506 / flexible elongation device 502 as described herein via user input device or the like.

[0106] The control panel 536 can also be used to notify the user when the predetermined criteria or conditions for disabling the transition to the relaxed state are met and / or when the transition is disabled. For example, the control system 536 can notify the user via the control panel 536 that: the bend angle of the engageable body portion 508 of the flexible elongation device 502 in the initial engagement state is below a threshold bend angle; the engageable body portion 508 of the flexible elongation device 502 is positioned within the patient in a location where movement may be harmful; and / or, based on the tool type of the tool 506, the tool 506 is sufficiently flexible to pass through the lumen 504 of the flexible elongation device 502 in the initial engagement state.

[0107] The control panel 536 can also be used to notify the user when the control system 520 determines, based on sensor data from sensors 517, 519, 522, that the tool 506 is being inserted and the fluorescence imaging device is not currently in operation, and / or when the control system 520 determines, based on sensor data from force sensor 517, that the needle of tool 506 is being inserted into tissue and the fluorescence imaging device is not currently in operation.

[0108] In some implementations, the model may define the relationship between sensor data and the position of tool 506 within the flexible elongation device 502. In this example, the sensor data may include one or more of the following: shape data, position data, bending angle data, encoder data, etc. Therefore, the sensor data may be provided by shape sensor 519 and / or other sensors 522.

[0109] Sensor 522 can take any suitable form, including, for example, position sensors (e.g., electromagnetic sensors) and / or imaging sensors (e.g., camera devices, ultrasonic sensors, fluorescent microscopes, etc.). In embodiments utilizing encoder data, sensor 522 includes one or more actuator encoders for actuator 514. The actuator encoders are configured to generate encoder data regarding the operating state of actuator 514 (e.g., motor position, speed, etc.). In embodiments utilizing actuator torque as input, sensor 522 may further include: a current sensor configured to measure the current through the motor of actuator 514, which is then converted into motor torque; and / or a torque sensor coupled to the output of the gearbox of actuator 514 or coupled to actuator 514.

[0110] The model defines the relationship between the movement of the flexible elongation device 502 (e.g., position data, shape data, bending angle data), the movement of the actuator 514 (e.g., encoder data, torque data), and the position of the tool 506 within the flexible elongation device 502. The control system 520 uses the model and sensor data to determine the current position of the tool 506. Upon receiving new sensor data from sensors 519 and 522, the control system 520 updates the model to determine the new position of the tool 506 within the flexible elongation device 502.

[0111] Figure 6 A method 600 for controlling the engagement of a flexible elongation device (e.g., flexible elongation device 502 and medical system 500) in a medical system, according to some embodiments, is shown. Method 600 is shown as a collection of operations or processes 602 to 624. Not all processes shown can be performed in all embodiments of method 600. Additionally, Figure 6 One or more processes not explicitly shown may be included before, after, between, or as part of processes 602 to 624. Processes may also be executed in different orders. In some embodiments, one or more of processes 602 to 624 may be implemented at least partially in the form of executable code stored on a non-transitory tangible machine-readable medium, which, when run by one or more processors (e.g., the processor of a controller), causes one or more processors to execute one or more processes. In one or more embodiments, processes 602 to 624 may be executed by a controller.

[0112] In process 602, the operation of one or more actuators (e.g., actuator 514) controlling the engagement of the engageable body portion of the flexible elongation device (e.g., engageable body portion 508) is controlled to hold the engageable body portion in an initial engaged state. In process 604, sensor data is measured using one or more sensors (e.g., sensor 522). In process 606, the sensor data is used to determine that a tool (e.g., tool 506) inserted into the lumen of the flexible elongation device (e.g., lumen 504) has reached a relaxation start position (e.g., relaxation start position 526a) of the flexible elongation device. In process 608, the user is asked for authorization to change the engageable body portion from the initial engaged state to the relaxed state. In process 610, in response to determining that the tool has reached the relaxation start position, the operation of one or more actuators is controlled to change the engageable body portion from the initial engaged state to the relaxed state. In some examples, the relaxed state may depend at least in part on the tool type of the tool. In process 612, sensor data is used to determine that the tool has reached the slack end position of the flexible elongation device (e.g., slack end position 526b). In process 614, the user is asked for authorization to change the engageable body portion from the slack state to the re-engaged state. In process 616, the operation of one or more actuators is controlled to change the engageable body portion from the slack state to the re-engaged state.

[0113] In an additional or alternative method, in process 618, after process 602, the receipt of a signal from a user input device (e.g., control panel 536) determines that the tool inserted into the lumen of the flexible elongating device has reached the relaxation start position of the flexible elongating device. In process 620, in response to determining that the tool has reached the relaxation start position, the operation of one or more actuators is controlled to transition the engageable body portion from an initial engaged state to a relaxed state. In some examples, the relaxed state may depend at least in part on the tool type of the tool. In process 622, a signal from the user input device determines that the tool inserted into the lumen of the flexible elongating device has reached the relaxation end position of the flexible elongating device. In process 624, the operation of one or more actuators is controlled to transition the engageable body portion from the relaxed state to a returned engaged state.

[0114] Figure 7 A method 700 for operating a medical system (e.g., medical system 500) according to some embodiments is shown. Method 700 is shown as a collection of operations or processes 702 and 704. Not all processes shown can be performed in all embodiments of method 700. Additionally, Figure 7One or more processes not explicitly shown may be included before, after, between, or as part of processes 702 and 704. Processes may also be executed in different orders. In some embodiments, one or more of processes 702 and 704 may be implemented at least partially in the form of executable code stored on a non-transitory tangible machine-readable medium, which, when run by one or more processors (e.g., the processor of a controller), causes one or more processors to execute one or more processes. In one or more embodiments, processes 702 and 704 may be executed by the controller.

[0115] In process 702, the insertion distance of the tool (e.g., tool 506) within the lumen of the flexible elongation device (e.g., flexible elongation device 502 and lumen 504) is determined based on sensor data (e.g., from sensor 522). In process 704, at least one component of the medical system is controlled based on the insertion distance. For example, the component may include one or more of the following: one or more actuators (e.g., actuator 514) for controlling the engagement of the engageable body portion (e.g., engageable body portion 508) of the flexible elongation device; a user notification device (e.g., control panel 536) for informing the user of the system status and / or querying the user for instructions as described herein; and / or a generator for the system of inserting an electroporation / ablation tool within the lumen of the flexible elongation device.

[0116] One or more components of the embodiments discussed in this disclosure (e.g., control systems 112, 520) may be implemented in software to execute on one or more processors of a computer system. The software may include code that, when executed by one or more processors, configures the processors to perform the various functions discussed herein. The code may be stored in a non-transitory computer-readable storage medium (e.g., memory, magnetic storage device, optical storage device, solid-state storage device, etc.). The computer-readable storage medium may be part of a computer-readable storage device, such as electronic circuitry, a semiconductor device, a semiconductor memory device, a read-only memory (ROM), flash memory, an erasable programmable read-only memory (EPROM), a floppy disk, a CD-ROM, an optical disk, a hard disk, or other storage device. The code may be downloaded to the computer-readable storage medium for storage via a computer network such as the Internet, an intranet, etc. The code may be executed by any of a variety of centralized or distributed data processing architectures. The programming instructions of the code may be implemented as multiple separate programs or subroutines, or they may be integrated into multiple other aspects of the system described herein. Components of the computing system discussed herein may be connected using wired and / or wireless connections. In some examples, wireless connectivity can use wireless communication protocols such as Bluetooth, Near Field Communication (NFC), Infrared Data Association (IrDA), Home RF, IEEE 802.11, Digital Enhanced Cordless Telecommunications (DECT), and Wireless Medical Telemetry Service (WMTS).

[0117] Various general-purpose computer systems can be used to perform one or more processes, methods, or functions described herein. Additionally or alternatively, various special-purpose computer systems can be used to perform one or more processes, methods, or functions described herein. Furthermore, various programming languages ​​can be used to implement one or more processes, methods, or functions described herein.

[0118] While certain implementations and examples have been described above and shown in the accompanying drawings, it should be understood that these implementations and examples are merely exemplary and not limited to the specific constructions and arrangements shown and described, as various other alternatives, modifications and equivalents will be understood by those skilled in the art.

Claims

1. A medical system comprising: a flexible elongate device having an engageable body portion and a lumen extending through the engageable body portion; one or more sensors configured to generate sensor data indicative of an insertion distance of a distal portion of a tool within the lumen of the flexible elongate device; one or more actuators operably coupled to the flexible elongate device to control engagement of the engageable body portion; and a control system configured to: determine, based on the sensor data, the insertion distance of the distal portion of the tool within the lumen of the flexible elongate device; and control operation of the one or more actuators based on the insertion distance to change an engagement state of the engageable body portion. The engagement state is changed at least twice as the tool is inserted from a proximal end to a distal end of the flexible elongate device.

2. The medical system of claim 1, wherein, The control system configured to control operation of the one or more actuators to change the engagement state of the engageable body portion includes the control system configured to control operation of the one or more actuators to transition from an initial engagement state to a relaxed state based on the insertion distance corresponding to a relaxed start position.

3. The medical system of claim 1, wherein, The relaxed state depends at least in part on a tool type of the tool inserted into the lumen of the flexible elongate device.

4. The medical system of claim 3, wherein, The control system is further configured to control operation of the one or more actuators to transition the engageable body portion from the relaxed state to a return engagement state based on the insertion distance corresponding to a relaxed end position, the return engagement state having at least one engagement characteristic of the initial engagement state.

5. The medical system of claim 3, wherein, The relaxed end position is at a distal end of the engageable body portion.

6. The medical system of claim 5, wherein, The relaxed end position is distal of the engageable body portion.

7. The medical system of claim 5, wherein, The initial engagement state and the return engagement state are different.

8. The medical system of claim 5, wherein, 9. The medical system of claim 5, wherein: the return engagement state has a same pointing direction as the initial engagement state; and the return engagement state has a different bend angle or bend radius than the initial engagement state. The initial engagement state of the engageable body portion includes a greater bend angle for the engageable body portion than the relaxed state.

10. The medical system of any of claims 3 to 9, wherein, The initial engagement state of the engageable body portion includes a smaller bend radius for the engageable body portion than the relaxed state.

11. The medical system of any of claims 3 to 9, wherein, The relaxed start position is at a flexible body portion of the flexible elongate device proximal of the engageable body portion.

12. The medical system of any of claims 3 to 9, wherein, The relaxed start position is at a proximal end of the engageable body portion.

13. The medical system of any of claims 3 to 9, wherein, The distal portion of the tool includes a rigid portion.

14. The medical system of any of claims 1 to 9, wherein, The one or more sensors include at least one sensor coupled to a manipulator assembly, the manipulator assembly including the one or more actuators.

15. The medical system of any of claims 1 to 9, wherein, The one or more sensors include at least one sensor coupled to the anti- kinking guide.

16. The medical system of any of claims 1 to 9, further comprising an anti- buckling guide for the flexible elongate device; and wherein, ​ 17. The medical system of any of claims 1 to 9, further comprising a swivel connector for the flexible elongate device; and wherein, The one or more sensors include at least one sensor coupled to the rotary connector.

18. The medical system of any of claims 1 to 9, further comprising a control assembly configured to support and position the flexible elongate device; and wherein, The one or more sensors include at least one sensor coupled to the control assembly along a tool insertion path.

19. The medical system of any of claims 1 to 9, wherein, The one or more sensors include at least one sensor coupled to a proximal end of the flexible elongate device or to the tool.

20. The medical system of any of claims 1 to 9, wherein, The one of the tool or the flexible elongate device includes a target structure; and the control system configured to determine the insertion distance of the distal portion of the tool within the lumen of the flexible elongate device based on the sensor data includes the control system configured to determine the insertion distance of the distal portion of the tool within the lumen of the flexible elongate device based on sensor data from the one or more sensors indicative of a presence of the target structure.

21. The medical system of claim 20, wherein, The target structure of the one of the tool or the flexible elongate device includes a first target structure, and the one of the tool or the flexible elongate device further includes a second target structure spaced distally from the first target structure; and the control system is further configured to determine the insertion distance of the distal portion of the tool within the lumen of the flexible elongate device based on second sensor data from the one or more sensors indicative of a presence of the second target structure.

22. The medical system of any of claims 1 to 9, wherein, The one or more sensors include at least one of an inductive sensor or a capacitive sensor.

23. The medical system of any of claims 1 to 9, wherein, The one or more sensors include an imaging device configured to generate an image of the tool within the lumen of the flexible elongate device.

24. The medical system of claim 23, wherein, The imaging device is a fluorescence imaging device; and the control system is configured to determine at least one of the insertion distance of the distal portion of the tool with fluoroscopy or a number of penetrations into tissue performed with a needle of the tool.

25. The medical system of any one of claims 1-9, further comprising a user input device configured to cause the control system to control operation of the one or more actuators to change the engagement state of the engageable body portion.

26. The medical system of claim 25, wherein, The user input device is configured to indicate to the control system that the tool inserted into the lumen of the flexible elongate device has reached at least one of a relaxed start position or a relaxed end position of the flexible elongate device.

27. The medical system of any of claims 1 to 9, wherein, The control system is configured to disable changing the engagement state of the engageable body portion in response to the control system determining one or more of: receiving an instruction from a user input device to disable changing the engagement state; a bend angle of the engageable body portion of the flexible elongate device in the initial engagement state is below a threshold bend angle; a tool type of the tool inserted into the lumen of the flexible elongate device has a rigidity that is sufficiently flexible to pass through the lumen of the flexible elongate device in a current engagement state; or a tool type of the tool inserted into the lumen of the flexible elongate device has a rigidity that is sufficiently flexible to pass through the lumen of the flexible elongate device in a current engagement state; or The engageable body portion of the flexible elongate device is disposed in a location where movement can be harmful.

28. The medical system of any of claims 1 to 9, wherein, The control system is configured to provide a notification to a user in response to the control system determining one or more of: The bend angle of the engageable body portion of the flexible elongate device in the initial engaged state is below a threshold bend angle; A tool type of the tool inserted into the lumen of the flexible elongate device has a sufficient flexibility to pass through a stiffness of the lumen of the flexible elongate device in a current engaged state; Or The engageable body portion of the flexible elongate device is disposed in a location where movement can be harmful.

29. The medical system of any of claims 1 to 9, wherein, The control system is configured to solicit authorization from a user prior to controlling operation of the one or more actuators to change the engaged state of the engageable body portion.

30. The medical system of any of claims 1 to 9, wherein, The control system is further configured to provide a notification to a user in response to the control system determining that an external imaging device is not operating.

31. The medical system of any of claims 1 to 9, wherein, The control system is configured to determine the location of the tool within the lumen of the flexible elongate device based on a model correlating sensor data to the location of the tool within the lumen of the flexible elongate device.

32. The medical system of any of claims 1 to 9, further comprising an instrument carriage comprising a force sensor, the flexible elongate device being coupled to the instrument carriage for movement therewith; and wherein, The control system is configured to determine at least one of: that the tool is being inserted into the lumen of the flexible elongate device based on sensor data from the force sensor; or that a needle of the tool is being stabbed into tissue based on sensor data from the force sensor.

33. The medical system of claim 32, wherein, The one or more sensors include a fluorescence imaging device configured to generate an image of the tool within the lumen of the flexible elongate device; and the control system is configured to turn on the fluorescence imaging device in response to determining at least one of: that the tool is being inserted into the lumen of the flexible elongate device; or that the needle of the tool is being stabbed into tissue.

34. A method of controlling engagement of a flexible elongate device, the method comprising: determining an insertion distance of a distal portion of a tool within a lumen of a flexible elongate device based on sensor data of one or more sensors, the flexible elongate device having an engageable body portion, the lumen extending through the engageable body portion; and controlling operation of one or more actuators to change an engaged state of the engageable body portion based on the insertion distance.

35. The method of claim 34, wherein, Controlling operation of the one or more actuators to change the engaged state of the engageable body portion based on the insertion distance includes controlling operation of the one or more actuators to change the engaged state at least twice as the tool is inserted from a proximal end to a distal end of the flexible elongate device.

36. The method of claim 34, wherein, Controlling operation of the one or more actuators to change the engaged state of the engageable body portion includes controlling operation of the one or more actuators to transition from an initial engaged state to a relaxed state based on the insertion distance corresponding to a relaxed start position.

37. The method of claim 36, wherein, The relaxed state depends at least in part on a tool type of the tool inserted into the lumen of the flexible elongate device.

38. The method of claim 36, further comprising controlling operation of the one or more actuators based on the insertion distance corresponding to an end-of-relaxation position to transition the engageable body portion from the relaxed state to a return engaged state, the return engaged state having at least one engagement characteristic of the initial engaged state.

39. The method of claim 38, wherein, Determining that the tool has reached the end-of-relaxation position comprises determining that the tool has reached a distal end of the engageable body portion.

40. The method of claim 38, wherein, Determining that the tool has reached the end-of-relaxation position comprises determining that the tool has reached a position distal of the engageable body portion.

41. The method of claim 38, wherein, The initial engaged state and the return engaged state are different.

42. The method of claim 38, wherein: The return engaged state has a same pointing direction as the initial engaged state; and The return engaged state has a different bend angle or bend radius than the initial engaged state.

43. The method of any one of claims 36-42, wherein, The initial engaged state of the engageable body portion comprises at least one of a greater bend angle or a smaller bend radius for the engageable body portion compared to the relaxed state.

44. The method of any one of claims 36-42, wherein, Determining that the tool has reached the start-of-relaxation position comprises determining that the tool has reached a flexible body portion of the flexible elongate device proximal of the engageable body portion.

45. The method of any one of claims 36-42, wherein, Determining that the tool has reached the start-of-relaxation position comprises determining that the tool has reached a proximal end of the engageable body portion.

46. The method of any one of claims 36-42, wherein, Determining that the tool has reached the start-of-relaxation position comprises determining that the distal portion of the tool inserted into the lumen of the flexible elongate device has reached the start-of-relaxation position.

47. The method of any of claims 34-42, further comprising measuring the sensor data with one or more sensors coupled to one or more of: the tool; a manipulator assembly comprising the one or more actuators; an anti-kink guide for the flexible elongate device; a rotary connector for the flexible elongate device; a control assembly configured to support and position the flexible elongate device; and wherein the one or more sensors comprise at least one sensor coupled to the control assembly along a tool insertion path; or a proximal end of the flexible elongate device.

48. The method of any one of claims 34 to 42, wherein, one of the tool or the flexible elongate device comprises a target structure; and determining the insertion distance of the distal portion of the tool within the lumen of the flexible elongate device based on the sensor data comprises determining the insertion distance of the distal portion of the tool within the lumen of the flexible elongate device based on sensor data from the one or more sensors indicative of a presence of the target structure.

49. The method of claim 48, wherein, the target structure of the one of the tool or the flexible elongate device comprises a first target structure, and the one of the tool or the flexible elongate device further comprises a second target structure spaced distally of the first target structure; and the method further comprises determining the insertion distance of the distal portion of the tool within the lumen of the flexible elongate device based on second sensor data from the one or more sensors indicative of a presence of the second target structure.

50. The method of any one of claims 34-42, wherein, The sensor data comprises at least one of inductive sensor data or capacitive sensor data.

51. The method of any of claims 34-42, further comprising generating an image of the tool within the lumen of the flexible elongate device using an imaging device.

52. The method of claim 51, wherein, Determining the insertion distance of the distal portion of the tool comprises determining the insertion distance of the distal portion of the tool using fluoroscopy.

53. The method of any of claims 34-42, further comprising receiving a signal from a user input device to indicate that the tool inserted into the lumen of the flexible elongate device has reached at least one of a relaxed start position or a relaxed end position of the flexible elongate device.

54. The method of any of claims 34-42, further comprising disabling changing the engagement state of the engageable body portion in response to determining one or more of: a bend angle of the engageable body portion of the flexible elongate device in the initial engagement state is below a threshold bend angle; a tool type of the tool inserted into the lumen of the flexible elongate device has a rigidity that is sufficiently flexible to pass through the lumen of the flexible elongate device in a current engagement state; or the engageable body portion of the flexible elongate device is disposed in a position where movement can be harmful.

55. The method of any of claims 34-42, further comprising notifying a user in response to determining one or more of: a bend angle of the engageable body portion of the flexible elongate device in the initial engagement state is below a threshold bend angle; a tool type of the tool inserted into the lumen of the flexible elongate device has a rigidity that is sufficiently flexible to pass through the lumen of the flexible elongate device in a current engagement state; or the engageable body portion of the flexible elongate device is disposed in a position where movement can be harmful.

56. The method of any of claims 34-42, further comprising querying a user for authorization prior to controlling operation of the one or more actuators to change the engagement state of the engageable body portion.

57. The method of any of claims 34-42, further comprising notifying a user in response to determining that an external imaging device is not operational.

58. The method of any of claims 34-42, further comprising determining the position of the tool within the lumen of the flexible elongate device based on a model correlating sensor data to a position of the tool within the lumen of the flexible elongate device. ​ 59. The method of any of claims 34 to 42, further comprising determining at least one of: based on sensor data from a force sensor of an instrument carriage, the tool is being inserted into the lumen of a flexible elongate device coupled to the instrument carriage for movement therewith; or based on sensor data from the force sensor, a needle of the tool is being stabbed into tissue.

60. The method of claim 59, further comprising turning on a fluorescence imaging device in response to determining at least one of: the tool is being inserted into the lumen of the flexible elongate device; or the needle of the tool is being stabbed into tissue.

61. A non-transitory computer-readable medium having instructions stored thereon that, when executed by a computing device, cause the computing device to: determine, based on sensor data of one or more sensors, an insertion distance of a distal portion of a tool within a lumen of a flexible elongate device, the flexible elongate device having an engageable body portion through which the lumen extends; and control operation of one or more actuators to change an engagement state of the engageable body portion based on the insertion distance.

62. The non-transitory computer readable medium of claim 61, wherein, To control operation of the one or more actuators to change the engagement state of the engageable body portion based on the insertion distance, the instructions, when executed, cause the computing device to control operation of the one or more actuators to change the engagement state at least twice as the tool is inserted from a proximal end to a distal end of the flexible elongate device.

63. The non-transitory computer-readable medium of claim 61, wherein, To control operation of the one or more actuators to change the engagement state of the engageable body portion, the instructions, when executed, cause the computing device to control operation of the one or more actuators to transition from an initial engagement state to a relaxed state based on the insertion distance corresponding to a relaxed start position.

64. The non-transitory computer-readable medium of claim 63, wherein, The relaxed state depends at least in part on a tool type of the tool inserted into the lumen of the flexible elongate device.

65. The non-transitory computer-readable medium of claim 63, wherein, The instructions, when executed, further cause the computing device to control operation of the one or more actuators to transition the engageable body portion from the relaxed state to a return engagement state based on the insertion distance corresponding to a relaxed end position, the return engagement state having at least one engagement characteristic of the initial engagement state.

66. The non-transitory computer readable medium of claim 65, wherein, To determine that the tool has reached the relaxed end position, the instructions, when executed, cause the computing device to determine that the tool has reached a distal end of the engageable body portion.

67. The non-transitory computer readable medium of claim 65, wherein, To determine that the tool has reached the relaxed end position, the instructions, when executed, cause the computing device to determine that the tool has reached a position distal of the engageable body portion.

68. The non-transitory computer readable medium of claim 65, wherein, The initial engagement state and the return engagement state are different.

69. The non-transitory computer-readable medium of claim 65, wherein: the return engagement state has a same pointing direction as the initial engagement state; and the return engagement state has a same pointing direction as the initial engagement state; and The return engaged state has a different bend angle or bend radius than the initial engaged state.

70. The non-transitory computer readable medium of any one of claims 63 to 69, wherein, The initial engaged state of the engageable body portion includes at least one of a greater bend angle or a smaller bend radius for the engageable body portion compared to the relaxed state.

71. The non-transitory computer readable medium of any one of claims 63 to 69, wherein, To determine that the tool has reached the relaxation start position, the instructions, when executed, cause the computing device to determine that the tool has reached a flexible body portion of the flexible elongate device proximal to the engageable body portion.

72. The non-transitory computer readable medium of any one of claims 63 to 69, wherein, To determine that the tool has reached the relaxation start position, the instructions, when executed, cause the computing device to determine that the tool has reached a proximal end of the engageable body portion.

73. The non-transitory computer readable medium of any one of claims 63 to 69, wherein, To determine that the tool has reached the relaxation start position, the instructions, when executed, cause the computing device to determine that the distal portion of the tool inserted into the lumen of the flexible elongate device has reached the relaxation start position.

74. The non-transitory computer readable medium of any one of claims 61 to 69, wherein, The instructions, when executed, also cause the computing device to measure the sensor data with one or more sensors coupled to one or more of: the tool; a manipulator assembly including the one or more actuators; an anti-kink guide for the flexible elongate device; a rotational connector for the flexible elongate device; a control assembly configured to support and position the flexible elongate device; and wherein the one or more sensors include at least one sensor coupled to the control assembly along a tool insertion path; or a proximal end of the flexible elongate device.

75. The non-transitory computer readable medium of any one of claims 61 to 69, wherein, one of the tool or the flexible elongate device includes a target structure; and to determine the insertion distance of the distal portion of the tool within the lumen of the flexible elongate device based on the sensor data, the instructions, when executed, cause the computing device to determine the insertion distance of the distal portion of the tool within the lumen of the flexible elongate device based on sensor data from the one or more sensors indicative of a presence of the target structure.

76. The non-transitory computer readable medium of claim 75, wherein, the target structure of the one of the tool or the flexible elongate device includes a first target structure, and the one of the tool or the flexible elongate device also includes a second target structure spaced distally from the first target structure; and the instructions, when executed, also cause the computing device to determine the insertion distance of the distal portion of the tool within the lumen of the flexible elongate device based on second sensor data from the one or more sensors indicative of a presence of the second target structure.

77. The non-transitory computer readable medium of any one of claims 61 to 69, wherein, The sensor data includes at least one of inductive sensor data or capacitive sensor data.

78. The non-transitory computer readable medium of any one of claims 61 to 69, wherein, The instructions, when executed, also cause the computing device to generate an image of the tool within the lumen of the flexible elongate device using an imaging device.

79. The non-transitory computer readable medium of claim 78, wherein, To determine the insertion distance of the distal portion of the tool, the instructions, when executed, cause the computing device to determine the insertion distance of the distal portion of the tool using fluoroscopy.

80. The non-transitory computer readable medium of any one of claims 61 to 69, wherein, The instructions, when executed, also cause the computing device to receive a signal from a user input device to indicate that the tool inserted into the lumen of the flexible elongate device has reached at least one of a relaxed start position or a relaxed end position of the flexible elongate device.

81. The non-transitory computer readable medium of any one of claims 61 to 69, wherein, The instructions, when executed, also cause the computing device to disable changing the engagement state of the engageable body portion in response to determining one or more of: a signal from a user input device to disable changing the engagement state; a bend angle of the engageable body portion of the flexible elongate device in the initial engagement state is below a threshold bend angle; a stiffness of a tool type of the tool inserted into the lumen of the flexible elongate device is sufficiently flexible to pass through the lumen of the flexible elongate device in a current engagement state; or the engageable body portion of the flexible elongate device is disposed in a position where movement can be harmful.

82. The non-transitory computer readable medium of any one of claims 61 to 69, wherein, The instructions, when executed, also cause the computing device to notify a user in response to determining one or more of: a bend angle of the engageable body portion of the flexible elongate device in the initial engagement state is below a threshold bend angle; a stiffness of a tool type of the tool inserted into the lumen of the flexible elongate device is sufficiently flexible to pass through the lumen of the flexible elongate device in a current engagement state; or the engageable body portion of the flexible elongate device is disposed in a position where movement can be harmful.

83. The non-transitory computer readable medium of any one of claims 61 to 69, wherein, The instructions, when executed, also cause the computing device to query a user for authorization prior to controlling operation of the one or more actuators to change the engagement state of the engageable body portion.

84. The non-transitory computer readable medium of any one of claims 61 to 69, wherein, The instructions, when executed, also cause the computing device to notify a user in response to determining that an external imaging device is not operating.

85. The non-transitory computer readable medium of any one of claims 61 to 69, wherein, The instructions, when executed, also cause the computing device to determine the position of the tool within the lumen of the flexible elongate device based on a model correlating sensor data to the position of the tool within the lumen of the flexible elongate device.

86. The non-transitory computer readable medium of any one of claims 61 to 69, wherein, The instructions, when executed, also cause the computing device to determine at least one of: based on sensor data from a force sensor of an instrument carriage to which the flexible elongate device is coupled for movement therewith, that the tool is being inserted into the lumen of the flexible elongate device; or based on sensor data from the force sensor, that a needle of the tool is being stabbed into tissue.

87. The non-transitory computer readable medium of claim 86, wherein, The instructions, when executed, also cause the computing device to turn on a fluoroscopic imaging device in response to determining at least one of: that the tool is being inserted into the lumen of the flexible elongate device; or that the needle of the tool is being stabbed into tissue.

88. A medical system, comprising: a flexible elongate device having an engageable body portion and a lumen extending through the engageable body portion; one or more sensors; one or more actuators operably coupled to the flexible elongate device to control engagement of the engageable body portion; and a control system configured to: determine, based on sensor data from the one or more sensors, that a tool inserted into the lumen of the flexible elongate device has reached a relaxation start position of the flexible elongate device; and control operation of the one or more actuators to transition the engageable body portion from an initial engagement state to a relaxation state in response to determining that the tool has reached the relaxation start position.

89. The medical system of claim 88, wherein, the control system is further configured to: determine, based on sensor data from the one or more sensors, that the tool has reached a relaxation end position of the flexible elongate device; and control operation of the one or more actuators to transition the engageable body portion from the relaxation state to a return engagement state having at least one engagement characteristic of the initial engagement state.

90. The medical system of claim 89, wherein, the relaxation end position is at a distal end of the engageable body portion.

91. The medical system of claim 89, wherein, the relaxation end position is distal to the engageable body portion.

92. The medical system of claim 89, wherein, the initial engagement state and the return engagement state are different.

93. The medical system of claim 89, wherein: the return engagement state has a same pointing direction as the initial engagement state; and the return engagement state has a different bend angle or bend radius than the initial engagement state.

94. The medical system of any of claims 88 to 93, wherein, the initial engagement state of the engageable body portion includes a greater bend angle for the engageable body portion than the relaxation state.

95. The medical system of any of claims 88 to 93, wherein, the initial engagement state of the engageable body portion includes a smaller bend radius for the engageable body portion than the relaxation state.

96. The medical system of any of claims 88 to 93, wherein, the relaxation start position is at a flexible body portion of the flexible elongate device proximal to the engageable body portion.

97. The medical system of any of claims 88 to 93, wherein, the relaxation start position is at a proximal end of the engageable body portion.

98. The medical system of any of claims 88 to 93, wherein, the control system being configured to determine that the tool inserted into the lumen of the flexible elongate device has reached the relaxation start position includes determining that a distal portion of the tool inserted into the lumen of the flexible elongate device has reached the relaxation start position.

99. The medical system of claim 98, wherein, the distal portion of the tool includes a rigid portion.

100. The medical system of any of claims 88 to 93, wherein, the one or more sensors include at least one sensor coupled to a manipulator assembly including the one or more actuators.

101. The medical system of any of claims 88 to 93, further comprising an anti- buckling guide for the flexible elongate device; and wherein, the one or more sensors include at least one sensor coupled to the anti-warping guide.

102. The medical system of any of claims 88 to 93, further comprising a swivel connector for the flexible elongate device; and wherein, the one or more sensors include at least one sensor coupled to the rotary connector.

103. The medical system of any of claims 88 to 93, further comprising a control assembly configured to support and position the flexible elongate device; and wherein, the one or more sensors include at least one sensor coupled to the control assembly along a tool insertion path.

104. The medical system of any of claims 88 to 93, wherein, the one or more sensors include at least one sensor coupled to a proximal end of the flexible elongate device or to the tool.

105. The medical system of any of claims 88 to 93, wherein, The one of the tool or the flexible elongate device includes a target structure; and the control system configured to determine that the tool inserted into the lumen of the flexible elongate device has reached the relaxed start position of the flexible elongate device includes the control system configured to determine that the tool has reached the relaxed start position based on sensor data from the one or more sensors indicative of the presence of the target structure.

106. The medical system of claim 105, wherein, The target structure of the one of the tool or the flexible elongate device includes a first target structure, and the one of the tool or the flexible elongate device further includes a second target structure spaced distally from the first target structure; and the control system is further configured to: determine that the tool inserted into the lumen of the flexible elongate device has reached a relaxed end position of the flexible elongate device based on sensor data from the one or more sensors indicative of the presence of the second target structure; and control operation of the one or more actuators to transition the engageable body portion from the relaxed state to a return engaged state, the return engaged state having at least one engagement characteristic of the initial engaged state.

107. The medical system of claim 106, wherein, The initial engaged state and the return engaged state are different.

108. The medical system of claim 106, wherein: the return engaged state has a same pointing direction as the initial engaged state; and the return engaged state has a different bending angle or bending radius than the initial engaged state.

109. The medical system of any of claims 88 to 93, wherein, The relaxed state depends at least in part on a tool type of the tool inserted into the lumen of the flexible elongate device.

110. The medical system of any of claims 88 to 93, wherein, The one or more sensors include at least one of an inductive sensor or a capacitive sensor.

111. The medical system of any of claims 88 to 93, wherein, The one or more sensors include an imaging device configured to generate an image of the tool within the lumen of the flexible elongate device.

112. The medical system of claim 111, wherein, The imaging device is a fluorescence imaging device; and the control system is further configured to utilize fluoroscopy to determine that the tool has reached a relaxed end position of the flexible elongate device.

113. The medical system of any of claims 88-93, further comprising a user input device configured to cause the control system to control operation of the one or more actuators to transition the engageable body portion from the initial engaged state to the relaxed state.

114. The medical system of claim 113, wherein, The user input device is configured to indicate to the control system that the tool inserted into the lumen of the flexible elongate device has reached at least one of the relaxed start position or a relaxed end position of the flexible elongate device.

115. The medical system of any of claims 88 to 93, wherein, The control system is configured to disable transitioning the engageable body portion to the relaxed state in response to the control system determining one or more of: receiving an instruction from a user input device to disable changing the engagement state; a bend angle of the engageable body portion of the flexible elongate device in the initial engaged state is below a threshold bend angle; a tool type of the tool inserted into the lumen of the flexible elongate device has a rigidity that is sufficiently flexible to pass through the lumen of the flexible elongate device in the initial engaged state; or the engageable body portion of the flexible elongate device is disposed in a location where movement can be harmful.

116. The medical system of any of claims 88 to 93, wherein, the control system is configured to provide a notification to a user in response to the control system determining one or more of: a bend angle of the engageable body portion of the flexible elongate device in the initial engaged state is below a threshold bend angle; a tool type of the tool inserted into the lumen of the flexible elongate device has a rigidity that is sufficiently flexible to pass through the lumen of the flexible elongate device in the initial engaged state; or the engageable body portion of the flexible elongate device is disposed in a location where movement can be harmful.

117. The medical system of any of claims 88 to 93, wherein, the control system is configured to solicit authorization from a user prior to controlling operation of the one or more actuators to transition the engageable body portion from the initial engaged state to the relaxed state.

118. The medical system of claim 117, wherein, the control system is further configured to: determine that the tool has reached an end of relaxation position of the flexible elongate device or that the tool has been fully inserted into the flexible elongate device; and solicit authorization from a user prior to controlling operation of the one or more actuators to transition the engageable body portion from the relaxed state to a return engaged state, the return engaged state having at least one engagement characteristic of the initial engaged state.

119. The medical system of claim 118, wherein, the initial engaged state and the return engaged state are different.

120. The medical system of claim 118, wherein: the return engaged state has a same pointing direction as the initial engaged state; and the return engaged state has a different bend angle or bend radius than the initial engaged state.

121. The medical system of any of claims 88 to 93, wherein, the control system is further configured to provide a notification to a user in response to the control system determining that an external imaging device is not operating.

122. The medical system of any of claims 88 to 93, wherein, the control system is configured to determine the location of the tool within the lumen of the flexible elongate device based on a model correlating sensor data to a location of the tool within the lumen of the flexible elongate device.

123. The medical system of any of claims 88 to 93, further comprising an instrument carriage comprising a force sensor, the flexible elongate device coupled to the instrument carriage for movement therewith; and wherein, the control system is configured to determine at least one of: based on sensor data from the force sensor, that the tool is being inserted into the lumen of the flexible elongate device; or based on sensor data from the force sensor, that a needle of the tool is being stabbed into tissue.

124. The medical system of claim 123, wherein, the one or more sensors include a fluorescence imaging device configured to generate an image of the tool within the lumen of the flexible elongate device; and the control system is configured to turn on the fluorescence imaging device in response to determining at least one of: that the tool is being inserted into the lumen of the flexible elongate device; or that the needle of the tool is being stabbed into tissue.

125. A method of controlling articulation of a flexible elongate device, the method comprising: controlling operation of one or more actuators that control articulation of an articulatable body portion of a flexible elongate device to maintain the articulatable body portion in an initial articulation state; determining, based on sensor data, that a tool inserted into a lumen of the flexible elongate device has reached a relaxation start position of the flexible elongate device; and controlling operation of the one or more actuators to transition the articulatable body portion from the initial articulation state to a relaxed state in response to determining that the tool has reached the relaxation start position.

126. The method of claim 125, further comprising: determining that the tool has reached a relaxation end position of the flexible elongate device; and controlling operation of the one or more actuators to transition the articulatable body portion from the relaxed state to a return articulation state having at least one articulation characteristic of the initial articulation state.

127. The method of claim 126, wherein, Determining that the tool has reached the relaxation end position comprises determining that the tool has reached a distal end of the articulatable body portion.

128. The method of claim 126, wherein, Determining that the tool has reached the relaxation end position comprises determining that the tool has reached a position distal of the articulatable body portion.

129. The method of claim 126, wherein, The initial articulation state and the return articulation state are different.

130. The method of claim 126, wherein: the return articulation state has a same pointing direction as the initial articulation state; and the return articulation state has a different bend angle or bend radius than the initial articulation state.

131. The method of claim 125, wherein, Determining that the tool has reached the relaxation start position comprises determining that the tool has reached a flexible body portion of the flexible elongate device proximal of the articulatable body portion.

132. The method of claim 125, wherein, Determining that the tool has reached the relaxation start position comprises determining that the tool has reached a proximal end of the articulatable body portion.

133. The method of any one of claims 125-132, wherein, Determining that the tool has reached the relaxation start position comprises determining that a distal portion of the tool inserted into the lumen of the flexible elongate device has reached the relaxation start position.

134. The method of any of claims 125-132, further comprising measuring the sensor data with one or more sensors coupled to one or more of: the tool; a manipulator assembly comprising the one or more actuators; an anti-kink guide for the flexible elongate device; a rotary connector for the flexible elongate device; a control assembly configured to support and position the flexible elongate device; and wherein the one or more sensors comprise at least one sensor coupled to the control assembly along a tool insertion path; or a proximal end of the flexible elongate device.

135. The method of any one of claims 125 to 132, wherein, Determining that the tool inserted into the lumen of the flexible elongate device has reached the relaxation start position of the flexible elongate device comprises determining, based on sensor data indicative of the presence of a target structure of the one of the tool or the flexible elongate device, that the tool has reached the relaxation start position.

136. The method of claim 135, wherein, The target structure of the one of the tool or the flexible elongate device comprises a first target structure, and the one of the tool or the flexible elongate device further comprises a second target structure; And the method further comprises: Determining, based on sensor data indicative of the presence of the second target structure, that the tool inserted into the lumen of the flexible elongate device has reached a relaxation end position of the flexible elongate device; And Controlling operation of the one or more actuators to transition the engageable body portion from the relaxed state to a return engaged state.

137. The method of claim 136, wherein, The initial engaged state and the return engaged state are different.

138. The method of claim 136, wherein: The return engaged state has a same pointing direction as the initial engaged state; and The return engaged state has a different bend angle or bend radius than the initial engaged state.

139. The method of any one of claims 125-132, further comprising determining a tool type of the tool, wherein, The relaxed state depends at least in part on the tool type.

140. The method of any one of claims 125 to 132, wherein, The sensor data comprises at least one of inductive sensor data or capacitive sensor data.

141. The method of any of claims 125-132, further comprising generating an image of the tool within the lumen of the flexible elongate device using an imaging device; and wherein, Determining that the tool has reached the relaxation start position of the flexible elongate device comprises analyzing an image of the tool within the lumen of the flexible elongate device.

142. The method of claim 141, further comprising: Determining, with fluoroscopy, that the tool has reached a relaxation end position of the flexible elongate device; Or determining, with fluoroscopy, a number of penetrations into tissue performed with a needle of the tool.

143. The method of any of claims 125-132, further comprising controlling operation of the one or more actuators to transition the engageable body portion from the initial engaged state to the relaxed state in response to receipt of a user input device.

144. The method of claim 143, further comprising determining, based on receipt of a signal from the user input device, that the tool inserted into the lumen of the flexible elongate device has reached the relaxation start position of the flexible elongate device.

145. The method of claim 143, further comprising determining, based on receipt of a signal from the user input device, that the tool inserted into the lumen of the flexible elongate device has reached a relaxation end position of the flexible elongate device.

146. The method of any of claims 125-132, further comprising disabling transition of the engageable body portion to the relaxed state in response to determining one or more of: A bend angle of the engageable body portion of the flexible elongate device in the initial engaged state is below a threshold bend angle; A tool type of the tool inserted into the lumen of the flexible elongate device has a rigidity that is sufficiently flexible to pass through the lumen of the flexible elongate device in the initial engaged state; Or The engageable body portion of the flexible elongate device is disposed in a location where movement can be harmful.

147. The method of any of claims 125-132, further comprising providing a notification to a user in response to determining one or more of: a bend angle of the engageable body portion of the flexible elongate device in the initial engaged state is below a threshold bend angle; a tool type of the tool inserted into the lumen of the flexible elongate device has a rigidity that is sufficiently flexible to pass through the lumen of the flexible elongate device in the initial engaged state; Or The engageable body portion of the flexible elongate device is disposed in a location where movement can be harmful.

148. The method of any of claims 125-132, further comprising querying a user for authorization prior to controlling operation of the one or more actuators to transition the engageable body portion from the initial engaged state to the relaxed state.

149. The method of claim 148, further comprising: determining that the tool has reached a relaxed end position of the flexible elongate device; and querying a user for authorization prior to controlling operation of the one or more actuators to transition the engageable body portion from the relaxed state to a return engaged state, the return engaged state having at least one engagement characteristic of the initial engaged state.

150. The method of claim 149, wherein, The initial engaged state and the return engaged state are different.

151. The method of claim 149, wherein: the return engaged state has a same pointing direction as the initial engaged state; and the return engaged state has a different bend angle or bend radius than the initial engaged state.

152. The method of any of claims 125-132, further comprising notifying a user in response to determining that an external imaging device is not operating.

153. The method of any of claims 125-132, further comprising determining the position of the tool within the lumen of the flexible elongate device based on a model correlating sensor data to a position of the tool within the lumen of the flexible elongate device.

154. The method of any of claims 125-132, further comprising utilizing force sensor data from a force sensor coupled to an instrument carriage of the flexible elongate device to determine at least one of: based on sensor data from the force sensor, that the tool is being inserted into the lumen of the flexible elongate device, or that a needle of the tool is being stabbed into tissue.

155. The method of claim 154, further comprising turning on a fluorescence imaging device for the flexible elongate device in response to determining at least one of: that the tool is being inserted into the lumen of the flexible elongate device; or that the needle of the tool is being stabbed into tissue.

156. A non-transitory computer-readable medium having instructions stored thereon that, when executed by a computing device, cause the computing device to: controlling operation of one or more actuators that control engagement of the engageable body portion to transition the engageable body portion from the initial engagement state to a relaxed state; based on sensor data, determining that a tool inserted into a lumen of the flexible elongate device has reached a relaxed start position of the flexible elongate device; and in response to determining that the tool has reached the relaxed start position, controlling operation of the one or more actuators to transition the engageable body portion from the initial engagement state to the relaxed state.

157. The non-transitory computer readable medium of claim 156, wherein, the instructions, when executed, further cause the computing device to: determine that the tool has reached a relaxed end position of the flexible elongate device; and control operation of the one or more actuators to transition the engageable body portion from the relaxed state to a return engagement state having at least one engagement characteristic of the initial engagement state.

158. The non-transitory computer readable medium of claim 157, wherein, To determine that the tool has reached the relaxed end position, the instructions, when executed, cause the computing device to determine that the tool has reached a distal end of the engageable body portion.

159. The non-transitory computer readable medium of claim 157, wherein, To determine that the tool has reached the relaxed end position, the instructions, when executed, cause the computing device to determine that the tool has reached a position distal of the engageable body portion.

160. The non-transitory computer readable medium of claim 157, wherein, the initial engagement state and the return engagement state are different.

161. The non-transitory computer-readable medium of claim 157, wherein: the return engagement state has a same pointing direction as the initial engagement state; and the return engagement state has a different bend angle or bend radius than the initial engagement state.

162. The non-transitory computer readable medium of claim 156, wherein, To determine that the tool has reached the relaxed start position, the instructions, when executed, cause the computing device to determine that the tool has reached a flexible body portion of the flexible elongate device proximal of the engageable body portion.

163. The non-transitory computer-readable medium of claim 156, wherein, To determine that the tool has reached the relaxed start position, the instructions, when executed, cause the computing device to determine that the tool has reached a proximal end of the engageable body portion.

164. The non-transitory computer readable medium of any one of claims 156-163, wherein, To determine that the tool has reached the relaxed start position, the instructions, when executed, cause the computing device to determine that a distal portion of the tool inserted into the lumen of the flexible elongate device has reached the relaxed start position.

165. The non-transitory computer readable medium of any one of claims 156-163, wherein, the instructions, when executed, further cause the computing device to measure the sensor data with one or more sensors coupled to one or more of: the tool; a manipulator assembly including the one or more actuators; an anti-kink guide for the flexible elongate device; a rotary connector for the flexible elongate device; a control assembly configured to support and position the flexible elongate device; and wherein the one or more sensors include at least one sensor coupled to the control assembly along a tool insertion path; or a proximal end of the flexible elongate device.

166. The non-transitory computer readable medium of any one of claims 156 to 163, wherein, To determine that the tool inserted into the lumen of the flexible elongate device has reached the relaxation start position of the flexible elongate device, the instructions, when executed, cause the computing device to determine, based on sensor data indicative of a presence of a target structure of the one of the tool or the flexible elongate device, that the tool has reached the relaxation start position.

167. The non-transitory computer readable medium of claim 166, wherein, The target structure of the one of the tool or the flexible elongate device comprises a first target structure, and the one of the tool or the flexible elongate device further comprises a second target structure; and wherein the instructions, when executed, further cause the computing device to: determine, based on sensor data indicative of a presence of the second target structure, that the tool inserted into the lumen of the flexible elongate device has reached a relaxation end position of the flexible elongate device; and control operation of the one or more actuators to transition the engageable body portion from the relaxed state to a return engaged state.

168. The non-transitory computer readable medium of claim 167, wherein, The initial engaged state and the return engaged state are different.

169. The non-transitory computer readable medium of claim 167, wherein: the return engaged state has a same pointing direction as the initial engaged state; and the return engaged state has a different bend angle or bend radius than the initial engaged state.

170. The non-transitory computer readable medium of any one of claims 156 to 163, wherein, The instructions, when executed, further cause the computing device to determine a tool type of the tool, wherein the relaxed state depends at least in part on the tool type.

171. The non-transitory computer readable medium of any one of claims 156 to 163, wherein, The sensor data comprises at least one of inductive sensor data or capacitive sensor data.

172. The non-transitory computer readable medium of any one of claims 156 to 163, wherein, The instructions, when executed, further cause the computing device to generate, using an imaging device, an image of the tool within the lumen of the flexible elongate device; and wherein to determine that the tool has reached the relaxation start position of the flexible elongate device, the instructions, when executed, cause the computing device to analyze the image of the tool within the lumen of the flexible elongate device.

173. The non-transitory computer readable medium of claim 172, wherein, The instructions, when executed, further cause the computing device to determine, using fluoroscopy, that the tool has reached a relaxation end position of the flexible elongate device or to determine, using fluoroscopy, a number of penetrations into tissue performed with a needle of the tool.

174. The non-transitory computer readable medium of any one of claims 156 to 163, wherein, The instructions, when executed, further cause the computing device to control operation of the one or more actuators to transition the engageable body portion from the initial engaged state to the relaxed state in response to receipt of a user input device.

175. The non-transitory computer readable medium of claim 174, wherein, The instructions, when executed, further cause the computing device to determine, based on receipt of a signal from the user input device, that the tool inserted into the lumen of the flexible elongate device has reached the relaxation start position of the flexible elongate device.

176. The non-transitory computer readable medium of claim 174, wherein, The instructions, when executed, further cause the computing device to determine, based on receipt of a signal from the user input device, that the tool inserted into the lumen of the flexible elongate device has reached a relaxation end position of the flexible elongate device.

177. The non-transitory computer readable medium of any one of claims 156 to 163, wherein, the instructions, when executed, further cause the computing device to disable the transition of the engageable body portion to the relaxed state in response to determining one or more of: receiving an instruction from a user input device to disable changing the engaged state; a bend angle of the engageable body portion of the flexible elongate device in the initial engaged state is below a threshold bend angle; a tool type of the tool inserted into the lumen of the flexible elongate device has a rigidity that is sufficiently flexible to pass through the lumen of the flexible elongate device in the initial engaged state; or the engageable body portion of the flexible elongate device is disposed in a location where movement can be harmful.

178. The non-transitory computer readable medium of any one of claims 156 to 163, wherein, the instructions, when executed, further cause the computing device to provide a notification to a user in response to determining one or more of: a bend angle of the engageable body portion of the flexible elongate device in the initial engaged state is below a threshold bend angle; a tool type of the tool inserted into the lumen of the flexible elongate device has a rigidity that is sufficiently flexible to pass through the lumen of the flexible elongate device in the initial engaged state; or the engageable body portion of the flexible elongate device is disposed in a location where movement can be harmful.

179. The non-transitory computer readable medium of any one of claims 156 to 163, wherein, the instructions, when executed, further cause the computing device to query a user for authorization prior to controlling operation of the one or more actuators to transition the engageable body portion from the initial engaged state to the relaxed state.

180. The non-transitory computer readable medium of claim 179, wherein, the instructions, when executed, further cause the computing device to: determine that the tool has reached a relaxed end position of the flexible elongate device; and query a user for authorization prior to controlling operation of the one or more actuators to transition the engageable body portion from the relaxed state to a return engaged state, the return engaged state having at least one engaged property of the initial engaged state.

181. The non-transitory computer readable medium of claim 180, wherein, the initial engaged state and the return engaged state are different.

182. The non-transitory computer-readable medium of claim 180, wherein: the return engaged state has a same pointing direction as the initial engaged state; and the return engaged state has a different bend angle or bend radius than the initial engaged state.

183. The non-transitory computer readable medium of any one of claims 156 to 163, wherein, the instructions, when executed, further cause the computing device to notify a user in response to determining that an external imaging device is not operating.

184. The non-transitory computer readable medium of any one of claims 156 to 163, wherein, the instructions, when executed, further cause the computing device to determine the position of the tool within the lumen of the flexible elongate device based on a model correlating sensor data to a position of the tool within the lumen of the flexible elongate device.

185. The non-transitory computer readable medium of any one of claims 156 to 163, wherein, the instructions, when executed, further cause the computing device to utilize force sensor data from a force sensor coupled to an instrument carriage of the flexible elongate device to determine at least one of: based on sensor data from the force sensor, the tool is being inserted into a lumen of the flexible elongate device, or a needle of the tool is being stabbed into tissue.

186. The non-transitory computer readable medium of claim 185, wherein, The instructions, when executed, further cause the computing device to turn on a fluorescence imaging device for the flexible elongate device in response to determining at least one of: the tool is being inserted into the lumen of the flexible elongate device; or the needle of the tool is being stabbed into tissue.

Images