Telescopic robot

Abstract

Apparatuses and methods for deploying and / or controlling movement of a flexible tubular member, such as an endoscope, use a sliding link assembly to support the flexible tubular member. For example, these apparatuses can include a base, a link assembly connected to the base, the link assembly including a plurality of links vertically adjacent to one another, where adjacent pairs of links are each slidably coupled together by opposing flexible bands extending around cylindrical surfaces of the reciprocating members. Linear drives can drive extension and retraction of the links by engaging with only one reciprocating member of the link assembly.

Description

Priority requirements

[0001] This patent application claims priority to U.S. Provisional Patent Application No. 63 / 586,398, filed September 28, 2023, entitled “Telescopin Grobot,” which is incorporated herein by reference in its entirety. By incorporating via reference

[0002] All publications and patent applications mentioned in this specification are incorporated herein by reference in their entirety, to the extent that each individual publication or patent application is specifically and individually indicated to be incorporated by reference. background

[0003] Medical procedures such as endoscopy can involve accessing and visualizing the interior of a patient's anatomy for diagnostic and / or therapeutic purposes. For example, gastroenterology, urology, and bronchoscopy involve procedures that allow physicians to examine a patient's internal cavities, such as the gastrointestinal tract, urinary tract, vascular system, and airway. During these procedures, flexible instruments or devices (often referred to as flexible tubular structures, such as endoscopes, cannulas, catheters, or guidewires) are inserted into the patient through orifices (e.g., natural orifices or incisions) and advanced toward tissue sites identified for subsequent diagnosis and / or treatment. Medical devices can be controlled and articulated to facilitate navigation through anatomical structures.

[0004] Managing these devices can be particularly challenging in an already crowded operating room. Colonoscopes, just one example of devices (in this case, endoscopes), can be long and difficult to manage, especially for robotic systems where advancement / retraction and / or steering can be driven by controllers such as robot controllers. Colonoscopes are used for navigation in the small intestine, and they can be even longer. Catheters present similar challenges due to their length and greater flexibility. Vascular catheters can be advanced into the neurovascular system, peripheral vascular system, pulmonary vascular system, and cardiac and coronary vascular systems. Guidewires can be used in vascular systems, often in conjunction with catheters. Outer cannulas can be used with endoscopes. Outer cannulas can be used in conjunction with endoscopes, or the endoscope can be retracted, leaving only the outer cannulas.

[0005] Although numerous long, flexible insertable tools (flexible tubular components, such as endoscopes, catheters, cannulas, guidewires, etc.) are used or have been recommended in medical procedures, controlling their insertion and manipulation becomes increasingly inconvenient as their length increases. Therefore, there is a need for methods and apparatuses for storing and deploying long medical devices, including flexible tubular components such as endoscopes, catheters, cannulas, and guidewires, that allow for compact and efficient manipulation. Overview of this disclosure

[0006] This document describes robotic devices (e.g., systems, apparatuses, etc.) for positioning (relative to a patient), loading, dispensing or deploying, actuating (e.g., advancing / retracting, steering, etc.) and retracting one or more flexible tubular components. The flexible tubular components may include one or more endoscopes, catheters, cannulas, and / or guidewires, and particularly include longer endoscopes such as colonoscopes and colonoscopes. The methods and apparatus described herein address the challenges of positioning, loading, dispensing or deploying, actuating and retracting, and / or otherwise manipulating such elongated medical devices.

[0007] Typically, these devices provide telescopic platforms for supporting and controlling flexible tubular components, particularly nested robotic endoscopes, which offer significant advantages over the previously described delivery and control platforms. In particular, telescopic platforms allow for extension and retraction relative to the base in both proximal and distal directions (e.g., bidirectional) from a non-extended neutral position, in which the platform (e.g., linkage assembly) has a compact footprint. This design can generally be significantly more compact than previously described positioning and / or control systems, and particularly than previously described telescopic positioning and / or control systems.

[0008] In some cases, it may be particularly advantageous to configure the linkage assembly of a device (e.g., a system) such that the linkage assembly is oriented so that multiple links are arranged adjacent to each other in the vertical direction. Each link may be platform or slat shape, typically long and thin. Each link may have a width less than its length and height, and may include a first main surface along the front and rear sides (along its length and height). The link may surround one or more elements, such as belts (e.g., timing belts, as described below), within its thickness. The links of the linkage assembly may be similar or identical in their overall shape. The innermost link may be coupled to a mounting assembly or attachment for the flexible tubular member and / or the flexible tubular member actuator. The mounting assembly may be configured to include multiple actuation regions that may be individually mounted to different regions of the flexible tubular member, or in some cases to an internal endoscope and an external sheath that can move relative to each other. The outermost link may be coupled to the linkage assembly actuator and / or may be coupled to the rest of the system, for example, to a base or an arm supported by the base. In some examples, the link may have a rectangular cross-section (or a generally rectangular, e.g., a rectangle) with a thickness less than its height (vertical height) and a length (in the proximal to distal direction) greater than its width or height. Typically, a link assembly with links arranged vertically can provide excellent support when the links are vertically connected adjacent to each other along their width (e.g., in pairs), and can also allow the mounting area for flexible tubular components (in some cases, both internal and external components of a nested device, e.g., mounted to different parts of the mounting assembly) to be positioned below the top of the vertically arranged link assembly (e.g., closer to the floor). Since the distance between the surface of the bed or table where the patient is located and the entry point to the patient's anatomy (e.g., anus, mouth, etc.) may be limited in some embodiments, this configuration can allow entry in a straight line with the patient's body. As used herein, a link may refer to a body such as a plate, panel, frame, leaf, slab, etc. Links may be solid or hollow, and / or may include one or more internal structures. Links may include one or more windows, openings, or passageways through them.

[0009] Generally, the flexible tubular components described herein can be elongated medical devices and can be referred to as robotic elongated medical devices, robotic endoscopes, or robotic observation instruments. These elongated medical devices can include endoscopes that can be actuated by a drive system (including a robotic drive system) as described herein. Endoscopes can include colonoscopes, bronchoscopes, colposcopes, cystoscopes, esophagoscopes, gastroscopes, laparoscopes, thoracoscopes, colonoscopes, etc. In particular, the methods and apparatus described herein are particularly desirable for use with relatively long elongated medical devices (e.g., having lengths greater than 0.7 m, 0.8 m, 0.9 m, 1 m, 1.2 m, 1.4 m, 1.6 m, 2.0 m, 2.1 m, 3 m, etc.).

[0010] These devices can work well with flexible tubular components. They are particularly well suited to slender medical devices comprising nested (i.e., two or more) components that can extend and retract relative to each other, such as telescopic slender medical devices. For example, a telescopic slender medical device may include an internal robotic endoscope and an external sheath. Either or both of the internal and external robotic endoscopes may be steerable, for example, and may include one or more steerable members (e.g., steerable ribs, etc.) that can mate with a steerable interface on the device. Either or both of the internal and external endoscopes may include a vision system. The drive system may include a steerable interface for the robotic endoscope (and in some examples, for either or both of the internal and external components of the robotic endoscope). Because nested systems involve more elements and more degrees of freedom (DOF), their storage, loading, deployment, actuation, and retraction, as well as kinematic control, are particularly challenging and therefore particularly well-suited to robotics, as robotic systems can perform complex kinematic manipulations more easily, including through the use of software, algorithms, sensors, and actuators.

[0011] The methods and apparatus described herein are particularly well-suited for controlling rigid, elongated medical devices (i.e., Dynamic Rigidization). TM Rigidized elongated medical devices may include, but are not limited to, elongated medical devices rigidified by a variety of methods. One method for rigidification is applying pressure (e.g., positive and / or negative pressure). For example, the apparatus and methods described herein are particularly well suited to telescopic rigidized elongated medical devices, wherein the outer component of the robotic endoscope is a rigidifiable component that can be rigidified by applying pressure, and the inner component is a rigidifiable component that can be rigidified by applying pressure. The inner and outer components can be rigidified controllably, individually and / or independently (or in a coordinated manner), and can be integrated with a drive system (e.g., a robot drive system).

[0012] Any of these devices may be configured with single-use (“disposable”), multiple-use (“reusable”), sheathed, or very-multiple-use (“reusable”) components. These components may be designed to reduce costs and landfill impact. They may be designed to have a low effective cost per bin. They may be designed to be easy to use, easy to install, quick to set up, and easy to remove. Any of these devices may be configured to allow reuse of the drive system and frame, as well as other components coupled to the drive system, and may include one or more disposable components (such as trays, box-like pieces, etc.) to allow use with multiple robotic mirrors, which may include sterile models or sterile boundaries or layers. In any of these examples, the device may be configured such that reusable components (e.g., vertically arranged linkage assemblies, mounting assemblies, etc.) may be configured to remain separated from sterile areas, for example, by using a cover or shroud. Therefore, covers that can engage with devices coupled to or including the drive system described herein are also described herein.

[0013] For example, this document describes an apparatus (e.g., a system) for deploying a flexible tubular member, the apparatus comprising: a base; a vertically arranged linkage assembly connected to the base and including a plurality of links vertically adjacent to each other, wherein adjacent links are slidably coupled together by one or more mechanical motion couplings (e.g., flexible strips extending at least partially around a cylindrical surface of a reciprocating member), wherein pairs of reciprocating members between adjacent links of adjacent links are coupled together on a timing belt; a driver (e.g., a linear driver) coupled to a first reciprocating member of the pair of reciprocating members; and a first portion of a mounting assembly coupled to the vertically arranged linkage assembly, wherein the first portion of the mounting assembly is configured to be coupled to the flexible tubular member.

[0014] In some examples, an apparatus (e.g., a system) for deploying a flexible tubular member includes: - a base; - a vertically arranged linkage assembly connected to the base and including a plurality of vertically adjacent links, wherein each adjacent link pair is slidably coupled together by a pair of opposing flexible bands extending in opposite directions around a cylindrical surface of a reciprocating element (e.g., bending around a cylindrical surface of a reciprocating element), wherein reciprocating element pairs between adjacent links of adjacent link pairs are coupled together on a timing belt; a driver (e.g., a linear driver) coupled to a first reciprocating element in the reciprocating element pair; and a mounting assembly including a first portion coupled to the vertically arranged linkage assembly, wherein the first portion of the mounting assembly is configured to be coupled to the flexible tubular member.

[0015] In some examples, the vertically arranged linkage assembly is configured to have two, three, or more links (e.g., more than two, three, or more links, etc.). For example, an apparatus (e.g., a system) for deploying a flexible tubular member may include: a base; and a vertically arranged linkage assembly and a mounting assembly connected to the base and including: a first link, a second link, and a third link, wherein the first link, the second link, and the third link are vertically adjacent to each other; a first reciprocating member between the first link and the second link and a second reciprocating member between the second link and the third link, wherein the first reciprocating member is movably coupled between the first link and the second link, and the second reciprocating member is movably coupled between the second link and the third link, such that the second link and the third link are slidable distally and proximally relative to the first link, and wherein the first reciprocating member includes a first vertical cylindrical surface, and the second reciprocating member includes a second vertical cylindrical surface. Two vertical cylindrical surfaces; a linear actuator coupled to a first reciprocating member; a first flexible band between a first link and a second link, the first flexible band extending from a first end region of the first link, around the first vertical cylindrical surface, and extending to the first end region of the second link; a second flexible band between the second link and a third link, the second flexible band extending from the first end region of the second link, around the second vertical cylindrical surface, and extending to the first end region of the third link, whereby the linear actuator causes the second link to move proximal and / or distally relative to the first link, causing the third link to move proximal and / or distally; a mounting assembly including a first portion coupled to a vertically arranged link assembly, wherein the first portion of the mounting assembly is configured to be coupled to a flexible tubular member.

[0016] In any of these devices, the device may include a timing belt that can be configured to move the first reciprocating member in opposite directions relative to the second reciprocating member. The timing belt may be within a linkage, i.e., between the two reciprocating members to which it is connected. The timing belt may be coupled to a pair of pulleys such that movement of the first reciprocating member in the distal direction causes movement of the second reciprocating member in the proximal direction, and vice versa.

[0017] Generally, bands extending between links are coupled to opposite sides of the links (e.g., to the sides of the links facing each other) at the same end (e.g., the distal end or the proximal end). In some cases, a pair of bands arranged in an opposing configuration may connect the ends of opposing links of a link assembly after passing over a cylindrical surface (e.g., a pulley) at different regions of the cylindrical surface. For example, a first end of the first band in opposing bands may be coupled to the distal end region of the first link in an adjacent link pair and the distal end region of the second link in an adjacent link pair. A first end of the second band in opposing bands may be coupled to the proximal end region of the first link and the proximal end region of the second link in an adjacent link pair.

[0018] Generally, flexible belts and / or straps can be formed from flat, relatively thin, and flexible materials, including thin, flat metals (e.g., stainless steel). Therefore, flexible belts can include flat belts. The width of a flat belt can be many times its thickness (e.g., greater than 5, 10, 15, 20 times, etc.). For example, a flat belt can have widths of 0.5 cm, 1 cm, 1.5 cm, 2 cm, 3 cm, 4 cm, 5 cm, etc.

[0019] In any of these devices, the links may each have a vertical height greater than the width and less than the length from the distal to the proximal side. In some examples, the links may each have a vertical height less than the length from the distal to the proximal side and at least twice the width. For example, the length of the links may be between approximately 10 cm and 100 cm (e.g., between 15 cm and 75 cm, between 20 cm and 60 cm, etc.), the height between approximately 3 cm and 30 cm (e.g., between 4 cm and 20 cm, between 5 cm and 18 cm, etc.), and the width between approximately 0.5 cm and 6 cm (e.g., between approximately 1 cm and 5 cm, between approximately 0.5 cm and 4 cm, etc.).

[0020] As mentioned above, a mounting assembly (e.g., one or more portions of the mounting assembly) for coupling to a flexible tubular member can be coupled to one of the outer links of a linkage assembly, such as an outer link of a plurality of links in a vertically arranged linkage assembly. The mounting assembly may include one or more actuators for steering and / or otherwise manipulating the flexible tubular member. In an example where the flexible tubular member is a nested device with an internal endoscope and an external sheath (e.g., a nested rigid robotic device), the mounting assembly may include a first region (or portion) configured to be mounted to the external sheath and a second region (or portion) configured to be mounted to the internal endoscope. The mounting assembly may be configured such that these two regions are movable relative to each other to allow relative movement between the internal and external components of the nested device. For example, the first mounting region may be configured to be coupled to a nested robotic device with an external sheath in which the endoscope is nested. In some examples, the mounting components may include an outer cannula mount (first mounting area) and an endoscope mount (second mounting area), wherein the endoscope mount is configured to move proximally and / or distally relative to the outer cannula mount.

[0021] Any of these devices can be configured to allow the linkage assembly (and therefore the endoscope) to be positioned in multiple degrees of freedom. For example, these devices can be configured to allow the device to adjust the height of the linkage assembly relative to a base (e.g., a floor). Any of these devices may include a vertical lifting arm that couples the vertically arranged linkage assembly to the base, wherein the vertical lifting arm is configured to raise and lower the vertically arranged linkage assembly relative to the base. In some examples, the device may include a yaw adjustment member between the vertically arranged linkage assembly and the base, wherein the yaw adjustment member is configured to pivotally yaw the vertically arranged linkage assembly about the base. These adjustments may be controlled and / or driven, for example, by a drive member and / or a controller that controls the drive member. The device may include one or more locks for locking these devices in a particular configuration. Generally, the linkage assembly may be coupled directly to the base or via one or more arms.

[0022] Any suitable actuator (e.g., drive subsystem, driver, etc.) can be used to drive the movement of the reciprocating element, and thus drive the extension and / or retraction of the linkage assembly. The actuator can be a linear actuator (e.g., one that converts rotational motion into linear (farward / proximal) movement). For example, the actuator can include a ball screw nut assembly. In some examples, the linear actuator is housed within a first link (e.g., a link directly or indirectly connected to a base) among multiple links. In some examples, the actuator for the linkage assembly (e.g., a linear actuator) can be separate from the linkage assembly and can be a permanent part of the link, but can be coupled to the reciprocating element (the first reciprocating element, which may also be referred to as the driving reciprocating element) via the first link.

[0023] Any device described herein may include a controller and control circuitry. The controller includes one or more processors, and the control circuitry is configured to receive control inputs and provide outputs to control and / or coordinate the extension / retraction of linkage assemblies and / or flexible tubular member actuators (e.g., a sheath actuator and / or an endoscope actuator in a nested configuration). For example, the controller may be configured to control a linear actuator to move a link (e.g., a plate) in a plurality of linkages distally and proximally relative to a base, thereby controlling the operation of the linear actuator. The controller may include control logic (software, firmware, and / or hardware) for performing any of the methods described herein. The controller may be coordinated with steering and / or, in examples using rigidification devices, with the rigidification of a catheter. The controller may receive user input and may automate some or all of the guidance of the device. The controller may receive and process (or send and / or store) inputs from one or more sensors.

[0024] Any of the devices described herein may include a flexible tubular member support coupled to a vertically arranged linkage assembly and configured to prevent buckling of the flexible tubular member as it extends distally from the vertically arranged linkage assembly. The flexible tubular member support (referred to herein as an endoscope support or simply a support) may be a strut, beam, rod, column, etc., which supports the length of the flexible tubular member as it extends distally and / or proximally away from the linkage assembly. In some examples, the flexible tubular member support may include one or more loops or strips for retaining (and supporting) a portion of the flexible tubular member.

[0025] Any of the devices described herein may include a tool actuator for operating or facilitating the operation of a tool inserted into or passing through a working channel (internal or external working channel) of a flexible tubular member. For example, the tool actuator may be coupled to a vertically arranged linkage assembly and configured to actuate a tool within the working channel of an endoscope (including a flexible tubular member).

[0026] As mentioned above, any of these devices may include one or more sensors configured to detect one or more operating parameters of the system. For example, the device may include one or more load sensors configured to detect loads applied to a vertically arranged linkage assembly. One or more load sensors may be configured as current sensors to detect, for example, the current of a linear drive.

[0027] Similarly, any of the devices described herein can be configured to work with a variety of elongated medical instruments (robotic observation instruments). However, in any of these devices, elongated medical instruments (e.g., robotic observation instruments) can be included as part of a system.

[0028] As mentioned, any of these devices may include an elongated medical instrument (e.g., a robotic observation instrument). For example, the system may include a robotic observation instrument, which may be a colonoscope. In some examples, the robotic observation instrument included within the device is a rigidifiable flexible tubular member including a rigidifiable inner member concentrically positioned within a rigidifiable outer member. Typically, any of these devices may include a pressure input configured to couple the robotic endoscope to a pressure source to control the stiffness of the robotic endoscope. In variations including both an inner and outer member, the robotic endoscope includes either or both of the inner and outer members.

[0029] For example, this document describes a system for deploying a flexible tubular member, the system including a base, a telescopic linkage assembly, and a mounting assembly. The telescopic linkage assembly is connected to the base and includes: a plurality of adjacent links, wherein adjacent links are slidably coupled together, wherein the plurality of links are configured to extend from a compact configuration to a length of 0.6 m or longer; a linear actuator configured to drive movement of the links of the telescopic linkage assembly; and a mounting assembly coupled to the linkage assembly, wherein the mounting assembly is configured to be coupled to the flexible tubular member.

[0030] Generally, a compact configuration can have a length that is significantly smaller than the extended length of the device (e.g., extending in the distal to proximal direction). For example, the length of a compact configuration can be 50% or less of the length of a fully extended configuration (e.g., 45% or less, 40% or less, 35% or less, 30% or less, 25% or less, 20% or less, etc.).

[0031] As described above, any of these devices can be bidirectional, allowing them to extend from a compact configuration to either the distal or proximal side. For example, a telescopic linkage assembly can be bidirectional, and the compact configuration can be neutral, allowing multiple links to extend distally to a length of 0.6 m or longer, or proximally to a length of 0.6 m or longer, from the neutral configuration. Bidirectional extension offers numerous advantages, particularly compared to systems that extend in only one direction (e.g., from a stable or fixed base). Bidirectional systems can allow for a more compact footprint in a compact configuration and can allow the device to be used in even very narrow or space-constrained areas, including beside hospital beds or operating tables. Bidirectional devices can provide a longer travel distance when moving along a distal-to-proximal axis.

[0032] Any device described herein may include multiple links that are vertically adjacent to each other relative to the ground. Therefore, the links may be arranged side by side rather than stacked on top of each other.

[0033] Generally, any of these devices can be configured such that moving any single link causes coordinated movement of all or some of the other links; for example, a driven movement (proximal / distal) of the first link can cause the group of links to extend in the same direction of movement. This can advantageously allow movement to be controlled by a single actuator (or a group of actuators operating, for example, on a single link coupled to a base). In any of these devices, this can be achieved using one or more synchronizing elements coupled to each of the plurality of links and configured to coordinate the movement of all links when a force is applied to one of the links. The synchronizing elements can be mechanical (e.g., belts, straps, etc.) and / or can include software or firmware for coordination between different links. For example, each link can be driven individually, and the activity of the actuators can be coordinated by one or more processors.

[0034] In any of these examples, the mounting components may include an outer cannula mount and an endoscope mount, wherein the endoscope mount is configured to move proximally and / or distally relative to the outer cannula mount.

[0035] The linkage assembly can be configured to extend from a compact configuration to any suitable length. For example, the linkage assembly can be configured to extend to a length of 1m or longer (e.g., 1.1m or longer, 1.2m or longer, 1.3m or longer, 1.4m or longer, 1.5m or longer, 1.6m or longer, 1.7m or longer, 1.8m or longer, 1.9m or longer, 2m or longer, etc.).

[0036] The device described herein may have a very small distal clearance height or offset. Therefore, the height of the mounting assembly relative to the linkage assembly may be adjustable and / or relatively low. For example, the vertical distance from the mounting assembly to the lowest surface of the linkage assembly may be less than 20 cm (e.g., 20 cm or less, 19 cm or less, 18 cm or less, 17 cm or less, 16 cm or less, 15 cm or less, 14 cm or less, 12 cm or less, 10 cm or less, etc.). Therefore, the distal ends of the mounting assembly and linkage assembly may extend distally to the patient located on the bed or table and may be positioned in a straight line with the patient's orifice, without causing interference between the bed / table and the distal end of the extended device, even if the orifice is relatively close to the bed / table surface (e.g., less than 20 cm).

[0037] Generally, links can be configured to slide smoothly relative to each other to extend / retract distally and / or proximally. In any of these examples, multiple links can be configured such that adjacent links are each slidably coupled together by a pair of opposing flexible bands extending in opposite directions around one or more surfaces of a reciprocating element. For example, a link assembly may include one or more (e.g., a pair) reciprocating elements between adjacent links of adjacent links; the reciprocating elements may be coupled together on a synchronizing member (e.g., a synchronizing belt).

[0038] This document also describes a system for deploying a flexible tubular member, the system including a base, a bidirectional telescopic linkage assembly, and a mounting assembly. The bidirectional telescopic linkage assembly is connected to the base and includes: a plurality of adjacent links, wherein adjacent links are slidably connected together, wherein the plurality of links are configured to extend from a compact neutral configuration to a proximal extension configuration and from a compact neutral configuration to a distal extension configuration, wherein the length of the compact neutral configuration is 50% or less of the length of the proximal extension configuration and 50% or less of the length of the distal extension configuration; a linear actuator configured to drive movement of the links of the telescopic linkage assembly; and a mounting assembly coupled to the linkage assembly, wherein the mounting assembly is configured to be coupled to the flexible tubular member.

[0039] As described above, in any of these devices (e.g., systems), multiple links may be vertically adjacent to each other. Alternatively, in some examples, multiple links may be horizontally adjacent to each other (e.g., stacked). As described above, any of these devices may include one or more synchronizing members coupled to each of the multiple links and configured to coordinate the movement of all links when a force is applied to one of the links. The mounting assembly may include an outer tube mount and an endoscope mount, wherein the endoscope mount is configured to move proximally and / or distally relative to the outer tube mount. The link assembly may be configured to extend from a compact configuration to a length of 1 m or longer. The vertical distance from the mounting assembly to the lowermost surface of the link assembly may be less than 20 cm. Multiple links may be configured such that adjacent links are slidably connected together by ball screw nut assemblies. Multiple links may be configured such that adjacent links are slidably connected together by a pair of opposing flexible bands extending in opposite directions around one or more surfaces of the reciprocating member. Any of these devices may include one or more (e.g., a pair) reciprocating motion elements connected together on a timing belt between adjacent links of adjacent linkage pairs.

[0040] This document also describes a system for deploying a flexible tubular member, the system comprising: a base; a vertically arranged linkage assembly and a mounting assembly, the vertically arranged linkage assembly being connected to the base and comprising: a plurality of links vertically adjacent to each other, wherein adjacent links are slidably coupled together by a pair of opposing flexible bands extending in opposite directions around one or more surfaces of a reciprocating element, wherein reciprocating element pairs between adjacent links of adjacent links are coupled together on a timing belt; a linear actuator coupled to a first reciprocating element in the reciprocating element pair; and a mounting assembly coupled to the vertically arranged linkage assembly, wherein the mounting assembly is configured to be coupled to the flexible tubular member.

[0041] A timing belt can be configured to move a first reciprocating member in opposite directions relative to a second reciprocating member. A first end of the first belt in the opposing belts is connected to the distal end region of a first link in an adjacent link pair and to the distal end region of a second link in the adjacent link pair, wherein a first end of the second belt in the opposing belts is connected to the proximal end region of a first link in an adjacent link pair and to the proximal end region of a second link in the adjacent link pair. A flexible belt may include a flat belt. For example, a flexible belt may include a metal belt. Multiple links may each have a vertical height greater than the width and less than the distal-to-proximal length. Multiple links may each have a vertical height less than the distal-to-proximal length and at least twice the width. A cylindrical surface may include a pulley.

[0042] In any of these devices, the mounting assembly can be connected to an external link among a plurality of links of a vertically arranged linkage assembly.

[0043] Any of these devices may include a vertical lifting arm having a vertical axis, the vertical lifting arm connecting a vertically arranged link assembly to a base, wherein the vertical lifting arm is configured to raise and lower the vertically arranged link assembly relative to the base.

[0044] Any of these devices may include a yaw adjustment member between a vertically arranged link assembly and a base, wherein the yaw adjustment member is configured to pivotally yaw the vertically arranged link assembly about the base. The mounting assembly may be configured to engage with a flexible tubular member comprising a nested robotic device with an outer tube, within which an internal endoscope is nested.

[0045] The mounting assembly may include an outer tube mount and an endoscope mount, wherein the endoscope mount is configured to move proximally and / or distally relative to the outer tube mount.

[0046] In any of these devices, the linear actuator may include a ball screw nut assembly or any other suitable linear actuator. The linear actuator may be housed within the first link of a plurality of links. Alternatively, in some examples, the linear actuator may be housed outside the first link.

[0047] Any of these devices may include a controller configured to control the linear drive to move a link of a plurality of links distally and proximally relative to the base, thereby controlling the operation of the linear drive.

[0048] Any of these devices may include a flexible tubular member support coupled to a vertically arranged link assembly and configured to prevent the flexible tubular member from buckling as it extends distally from the vertically arranged link assembly.

[0049] In some examples, the mounting assembly may be located below the top of a vertically arranged link assembly. The apparatus described herein may include a tool actuator coupled to a vertically arranged connector assembly and configured to actuate a tool within a working channel of a flexible tubular member.

[0050] Generally, any of these devices may include one or more sensors configured to detect one or more operating parameters of the system. For example, these devices may include one or more load sensors configured to detect loads applied between a vertically arranged linkage assembly and the patient. The load may be transmitted through one or more flexible tubular members (e.g., endoscopes, etc.). One or more load sensors may include current sensors configured to detect current in a linear actuator.

[0051] Mounting components (e.g., in some examples, linkages to vertically arranged linkages) can be directly or via one or more arms to the base.

[0052] For example, a system for deploying a flexible tubular member includes: a base; a vertically arranged linkage assembly and a mounting assembly, the vertically arranged linkage assembly being connected to the base and including: a first link, a second link, and a third link, wherein the first link, the second link, and the third link are vertically adjacent to each other; a first reciprocating member between the first link and the second link and a second reciprocating member between the second link and the third link, wherein the first reciprocating member is movably connected between the first link and the second link, and the second reciprocating member is movably connected between the second link and the third link, such that the second link and the third link are slidable distally and proximally relative to the first link, and wherein the first reciprocating member includes a first vertical cylindrical surface, and the second reciprocating member... The moving element includes a second vertical cylindrical surface; a linear actuator coupled to a first reciprocating moving element; a first flexible band between a first link and a second link, the first flexible band extending from a first end region of the first link, around the first vertical cylindrical surface, and extending to a first end region of the second link; a second flexible band between the second link and a third link, the second flexible band extending from a first end region of the second link, around the second vertical cylindrical surface, and extending to a first end region of the third link, whereby the linear actuator causes proximal and / or distal movement of the second link relative to the first link to cause proximal and / or distal movement of the third link; and a mounting assembly coupled to a vertically arranged link assembly, wherein the mounting assembly is configured to be coupled to a flexible tubular member. The device may include: a third flexible strip between the first link and the second link, the third flexible strip extending from the second end region of the first link, bypassing the first vertical cylindrical surface, and extending to the second end region of the second link; and a fourth flexible strip between the second link and the third link, the fourth flexible strip extending from the second end region of the second link, bypassing the second vertical cylindrical surface, and extending to the second end region of the third link.

[0053] Any of these devices may include a timing belt coupled to a first reciprocating member and a second reciprocating member, and configured to move the first reciprocating member relative to the second reciprocating member.

[0054] In any of these devices, the motion of the linear actuator can be transmitted to the third link in a ratio of 4:1 or greater.

[0055] Generally, any device described herein may include a link assembly and a mounting assembly for use with telescopic (e.g., nested) elongated members. For example, this document describes a system for deploying a nested robotic device having an inner rigid member slidably disposed at least partially within an outer rigid member. The system includes a base; a vertically arranged link assembly; and a mounting assembly connected to the base and including: a first link, a second link, and a third link, wherein the first, second, and third links are vertically adjacent to each other; a first reciprocating member between the first and second links and a second reciprocating member between the second and third links, wherein the first reciprocating member is movably coupled between the first and second links, and the second reciprocating member is movably coupled between the second and third links such that the second and third links are slidable distally and proximally relative to the first link, and wherein the first reciprocating member includes a first vertical cylindrical surface, and the second reciprocating member includes a second vertical cylindrical surface; a linear drive. The linear actuator is coupled to a first reciprocating motion member; a first flexible band between a first link and a second link, the first flexible band extending from a first end region of the first link, around a first vertical cylindrical surface, and extending to a first end region of the second link; a second flexible band between the second link and a third link, the second flexible band extending from a first end region of the second link, around a second vertical cylindrical surface, and extending to a first end region of the third link, whereby the linear actuator causes the second link to move proximally and / or distally relative to the first link, causing the third link to move proximally and / or distally; the mounting assembly includes: a first mounting region coupled to the third link of a vertically arranged link assembly, wherein the first mounting region is configured to be coupled to an external rigidification device; and a second mounting region linearly movable proximally and distally relative to the first mounting region and configured to be coupled to an internal rigidification device.

[0056] This document also describes methods of operating any of the devices described herein. For example, a method of deploying an endoscope nested with an outer tube may include: advancing and / or retracting the outer tube and endoscope together by moving a first link of a bidirectional telescopic linkage assembly, wherein the outer tube is coupled to an outer tube mount on the first link, and wherein the endoscope is coupled to an endoscope mount on the first link, and wherein the bidirectional linkage assembly includes a plurality of links, including the first link, which are slidably connected together and adjacent to each other, and wherein advancing the outer tube includes extending the plurality of links distally from a compact neutral configuration to a proximal extension configuration, and wherein retracting the outer tube includes retracting the plurality of links proximally from the compact neutral configuration to the proximal extension configuration, wherein the length of the compact neutral configuration is 50% or less of the length of the proximal extension configuration and 50% or less of the length of the distal extension configuration; and moving the endoscope distally into or out of the outer tube by changing the relative positions of the endoscope mount and the outer tube mount on the first link.

[0057] Any of these methods may include using a linear actuator to extend a plurality of links, the linear actuator being configured to drive movement of the links of the telescopic link assembly. Any of these methods may include coupling an outer tube to an outer tube mount, and / or coupling an endoscope nested within the outer tube to an endoscope mount.

[0058] For example, a method of deploying an endoscope nested with an outer cannula may include: advancing and / or retracting the outer cannula and endoscope together by moving a first link of a bidirectional telescopic linkage assembly, wherein the outer cannula is coupled to an outer cannula mount on the first link, and wherein the endoscope is coupled to an endoscope mount on the first link, and wherein the bidirectional linkage assembly includes a plurality of links, including the first link, which are slidably connected together and adjacent to each other, and wherein advancing the outer cannula includes extending the plurality of links distally from a compact neutral configuration to a proximal extension configuration, and wherein retracting the outer cannula includes retracting the plurality of links proximally from the compact neutral configuration to the proximal extension configuration, wherein the length of the compact neutral configuration is 50% or less of the length of the proximal extension configuration and 50% or less of the length of the distal extension configuration; and moving the endoscope distally into or out of the outer cannula by changing the relative positions of the endoscope mount and the outer cannula mount on the first link. Extending the plurality of links may include using a linear actuator to drive the movement of the links of the telescopic linkage assembly. As mentioned, any of these methods may include connecting an outer tube to an outer tube mount and / or connecting an endoscope nested within the outer tube to an endoscope mount.

[0059] This article also describes an apparatus comprising one or more supports and methods of using the same, the supports being configured to support nested telescopic devices (e.g., sheaths and endoscopes) during operation of the apparatus. For example, an apparatus may include: a telescopic linkage assembly comprising a plurality of vertical links adjacent to each other, wherein adjacent vertical links are slidably connected together and configured to move relative to each other and relative to a base link; a first mounting member coupled to a first link of the linkage assembly, wherein the first mounting member is configured to engage an outer sleeve; a second mounting member coupled to the first link and configured to engage an endoscope nested with the outer sleeve, wherein the outer sleeve and the endoscope are configured to be moved in a distal to proximal straight line by sliding the vertical links of the telescopic linkage assembly relative to the base link; and a plurality of supports movably coupled to the telescopic linkage assembly, wherein each of the plurality of supports includes a placement area configured to keep the outer sleeve and the endoscope aligned with the distal to proximal straight line.

[0060] Each of the plurality of supports can be configured to be deflected such that, as the plurality of links of the telescopic linkage assembly extend distally, the placement area of ​​each support shifts out of a straight line from distal to proximal. At least some of the plurality of supports can be configured to deflect downward and laterally as the plurality of links of the telescopic linkage assembly extend distally.

[0061] As mentioned above, any of these devices may include a base. Any of these devices may include a linear actuator configured to drive movement of the vertical link of the telescopic linkage assembly. At least one of the plurality of supports may be configured to move from a deployment configuration to a pre-deployment configuration, in which the placement area of ​​the support is configured to keep the outer sleeve and endoscope aligned with a distal-to-proximal line, and in the pre-deployment configuration, the support is vertically raised beyond the plane of the distal-to-proximal line.

[0062] At least one of the plurality of supports may be coupled to an extender on the linkage assembly, the extender being configured to extend distally from the linkage assembly. A first mount and / or a second mount may be configured to move relative to each other on a first linkage to adjust the relative position of the endoscope and the outer cannula.

[0063] For example, an apparatus may include: a base; a bidirectional telescopic linkage assembly connected to the base and including a plurality of vertical links adjacent to each other, wherein adjacent vertical links are slidably coupled together and configured to move bidirectionally relative to the base; a linear actuator configured to drive movement of the vertical links of the bidirectional telescopic linkage assembly; a first mounting member coupled to a first link of the linkage assembly, wherein the first mounting member is configured to engage an outer sleeve; and a second mounting member coupled to the first link and configured to engage with a nested outer sleeve. An endoscope, wherein an outer tube and an endoscope are configured to move in a straight line from distal to proximal by sliding a vertical link of a bidirectional telescopic linkage assembly; and a plurality of supports coupled to the telescopic linkage assembly, wherein each of the plurality of supports includes a placement area configured to move between a first configuration and a second configuration, wherein in the first configuration the placement area maintains the outer tube and the endoscope in a straight line from distal to proximal, and in the second configuration the placement area of ​​each support is configured to move out of the straight line from distal to proximal as the plurality of links of the telescopic linkage assembly extend distally.

[0064] Any combination of all methods and apparatuses described herein is contemplated herein and can be used to achieve the benefits described herein. Brief description of the attached diagram

[0065] A better understanding of the features and advantages of the methods and apparatus described herein will be obtained by referring to the following detailed description of illustrative embodiments and the accompanying drawings, in which: Figures 1A to 1D An example of an elongated medical device (such as a robotic observation instrument) that can be used with the methods and apparatus described herein is shown. In this example, the elongated medical device is an endoscope (e.g., a colonoscope in some examples) having nested internal and external components that are selectively rigidified.

[0066] Figure 2 It shows a device similar to actuation Figures 1A to 1D An example of a structure for an elongated medical device is shown.

[0067] Figure 3A An example of a system in a first configuration for distributing (e.g., deploying) and controlling nested robotic devices is shown.

[0068] Figure 3B The second configuration is shown for deployment and control. Figure 3A A system of nested robotic devices.

[0069] Figures 3C to 3D It shows something similar to Figures 3A to 3B Examples of the systems shown include flexible tubular components (e.g., rigid nested outer tubes and internal endoscopes).

[0070] Figure 4 An example of a system for deploying and controlling nested robotic devices is shown, illustrating eight degrees of freedom.

[0071] Figure 5A An example of a set of vertically arranged linear links for use with a system for deploying nested robotic devices is shown, including a first (e.g., outer tube) linear actuator and a second (e.g., endoscope) linear actuator on an inner linear link.

[0072] Figure 5B It shows Figure 5A A vertically arranged linear link, wherein the second linear actuator is located on the proximal side of the inner link.

[0073] Figure 6A An example of a set of vertically arranged linear linkage assemblies in a telescopic configuration for use with a system for deploying and controlling nested robotic devices is shown.

[0074] Figures 6B to 6D This is a view showing an example of a portion of an assembly used to control a flexible tubular member via a linear link. Figure 6B A top front perspective view is shown. Figure 6C It is a front-bottom perspective view, and Figure 6D This is a bottom perspective view.

[0075] Figure 7A An example of a vertically arranged linear link assembly is shown schematically for use with a system for deploying nested robotic devices.

[0076] Figure 7B It schematically shows something similar to Figure 7A The example shown is a vertically arranged linear link assembly used with a system for deploying and controlling nested robotic devices, which also includes a timing belt to synchronize the movement of the links, thereby coordinating the movement of reciprocating motion components between the links.

[0077] Figures 7C to 7E The schematic diagram illustrates the bidirectional operation of a vertically arranged linear linkage assembly, showing: the non-extended configuration ( Figure 7C ), in which the inner and middle links are aligned with the outer links; the configuration extends towards the proximal side ( Figure 7D ), wherein the inner link and the intermediate link extend and retract towards the proximal side relative to the outer link; and the configuration extends to the distal side ( Figure 7E (), in which the inner link and the intermediate link extend and retract to the far side relative to the outer link.

[0078] Figures 7F to 7H The schematic diagram illustrates the bidirectional operation of the linear linkage assembly, showing: the non-extended configuration ( Figure 7F ), wherein the inner link and the intermediate link are aligned with the outer link; a proximal extension configuration (Fig. 7G); wherein the inner link and the intermediate link extend proximally relative to the outer link; and a distal extension configuration ( Figure 7H (), in which the inner link and the intermediate link extend and retract to the far side relative to the outer link.

[0079] Figures 7I to 7K The schematic diagram illustrates the bidirectional operation of the linear linkage assembly, showing: the non-extended configuration ( Figure 7I ), in which the inner and middle links are aligned with the outer links; the configuration extends towards the proximal side ( Figure 7J ); and configurations extending to the distal side ( Figure 7K ).

[0080] Figure 7L Another example of a top view of a linear link assembly of a robotic device is shown, illustrating the maximum telescoping length in both the proximal and distal directions.

[0081] Figure 8 An example of the arrangement between a patient, a patient bed (e.g., a table, a trolley, etc.), a nested robotic device, and a system for deploying the nested robotic device as described herein is shown.

[0082] Figure 9 An example of a system for deploying nested robotic devices is illustrated, in which linear link assemblies are arranged horizontally (rather than vertically).

[0083] Figures 10A to 10C An example of using a system for deploying nested robotic devices to approach a patient at relative distances and along axes is shown.

[0084] Figure 11 An example of a covering system is illustrated for protecting a system used to deploy nested robotic devices during use.

[0085] Figure 12 An example of a support (e.g., a support arm) used with a system for deploying nested robotic devices is shown schematically.

[0086] Figure 13 The vertical and yaw adjustments of a system for deploying nested robotic devices are shown. The nested robotic devices are similar to... Figures 3A-3B and Figure 4 The nested robot device shown.

[0087] Figure 14Examples of tool manipulators (e.g., insertion tools) that can be used with any of the systems described herein are shown.

[0088] Figures 15A to 15C An example of the system described herein for executing lower GI programs is shown.

[0089] Figure 16A and Figure 16B An example of the robot enabling system described herein is illustrated schematically. Figure 16A A side perspective view is shown, and Figure 16B A top view is shown.

[0090] Figures 17A to 17H The operation of the flexible tubular member support is illustrated when a set of linear links of the system described herein are extended and retracted.

[0091] Figure 18A and Figure 18B An example of a linkage assembly is illustrated, comprising multiple supports configured to support a nested telescopic assembly (e.g., a rigid sheath / endoscope). Figure 18A A support is shown that is fully deployed and configured to support a nested telescopic assembly on the insertion axis. Figure 18B The linkage assembly (such as) is shown Figure 18A A top view of the linkage assembly shown, in which the support is fully deployed and supports a portion of the nested telescopic assembly on the insertion axis.

[0092] Figures 19A to 19H An example of the preparation of an apparatus including a linkage assembly and a support (e.g., a flexible tubular member support) is shown, the support being used in conjunction with a nested telescopic device (e.g., a flexible tubular member). Figure 19A The device is shown in its storage configuration before the nested telescopic device is loaded. Figures 19B to 19D An arrangement including a linkage assembly for receiving a support member of a nested telescopic device is shown. Figures 19E to 19H The diagram shows the installation of a nested telescopic device onto the apparatus. Figure 19H A pre-deployment configuration is shown, ready for positioning relative to the patient, in which a nested telescopic device is attached and in a storage configuration.

[0093] Figures 20A to 20I The operation of the support is illustrated when the nested telescopic device is inserted and / or retracted. Figures 20A to 20I In this process, the support members are moved in or out of the insertion axis as needed to support the nested telescopic device.

[0094] Figure 21A and Figure 21BSide and front views of a portion of the device described herein, including a linkage assembly with supports, are shown respectively. In this configuration of the linkage assembly and supports, two of the supports are shown in a storage configuration, folded out of the plane of the insertion axis.

[0095] Figure 22 It shows the relationship with Figures 21A to 21B Another view (e.g., a side view) of a device similar to the one shown includes a nested telescopic device schematically illustrated in a preloaded configuration, ready for positioning and deployment relative to the patient.

[0096] Figure 23 This is an enlarged view of the connection area between two of the device's supports, showing the connection with the linkage assembly.

[0097] Figure 24 An example of an optical sight (aiming device) is illustrated schematically, which can be incorporated into any of the devices described herein to help align the device's insertion axis with the patient. Detailed description

[0098] The aspects of this disclosure can be integrated into robotic medical systems capable of performing various medical procedures, including both minimally invasive procedures (such as laparoscopy) and non-invasive procedures (such as endoscopy). In endoscopic procedures, the system can perform colonoscopy, enteroscopy, bronchoscopy, ureteroscopy, gastroscopy, etc.

[0099] In addition to performing a wide range of procedures, the system can provide additional benefits such as enhanced imaging and assistance for physician guidance. Furthermore, the system can provide physicians with the ability to perform surgery from ergonomic postures, eliminating the need for clumsy arm movements and positions. Further still, the system can provide physicians with the ability to perform surgery with improved ease of use, allowing one or more instruments of the system to be controlled by a single user. Devices for operating and / or deploying robotic observation instruments (e.g., systems, devices, etc.) can be configured to extend (distally) and / or retract (proximal) to control the operation of flexible tubular components.

[0100] Generally, these devices can be used to deliver flexible tubular components, particularly nested endoscopes comprising an outer "outer cannula" and an inner endoscope, both movable proximally / distally relative to each other, and each can be reinforced to guide and / or manipulate the device through a patient's body. These devices may include retractable linkage assemblies, particularly vertically arranged linkages. For example, the devices (equipment, systems, etc.) described herein can be configured as part of a robotic system for delivering a pair of nested endoscopic devices comprising an inner endoscope and an outer cannula, each capable of having relatively high and low levels of compliance.

[0101] The devices described herein can have a generally linear form factor and thus provide a linear motion system for delivering the device. The primary linear axis (which positions the device (e.g., the outer cannula of an endoscope) within the patient) comprises a telescopic mechanism formed by a linkage assembly. The bidirectional telescopic movement of this linkage assembly allows a relatively long linear axis to be relatively short when its full extension is not required, addressing spatial constraints in some facilities. In examples of flexible tubular component systems comprising both internal and external components, the position of the internal endoscope relative to the external cannula can be controlled by a separate linear axis. While these devices can be used with virtually any flexible tubular component, they can be particularly useful when using nested, especially rigid, endoscopes (e.g., double-rigid endoscopes).

[0102] For example, Figures 1A to 1D An example of a robotic observation instrument configured as a dual-rigidity endoscope is shown. Figures 1A to 1D In this configuration, the dual-rigidity endoscope 100 is arranged as a nested system comprising a rigidifiable (e.g., rigid) outer member 112 and a rigidifiable inner member 110. Figure 1A In this configuration, the steerable inner rigid member 110 is positioned within the outer rigid member 112 such that the distal end of the inner rigid member 110 extends outside the outer rigid member. In some cases, the inner rigid member 110 can be completely retracted into the outer rigid member 112. Figure 1B The distal end of the internal rigidification member 112 is shown to be slightly bent in a desired direction / orientation (e.g., via a steering cable or other steering mechanism) before being rigidified (e.g., using positive or negative pressure). 112 can also be bent, as it is in a flexible state while following the bending of 110, and then subsequently rigidified. Figure 1CIn this configuration, the outer rigidifying member 112 (in a flexible configuration) is advanced onto the rigidified inner rigidifying member 110 (including on the curved distal segment). Once the distal end of the outer rigidifying member 110 is sufficiently advanced onto the distal end of the inner rigidifying member 110, the outer rigidifying member 112 can be rigidified (e.g., using positive or negative pressure as described herein). Figure 1D In this configuration, the internal rigid member 110 can then be (e.g., in some examples by removing positive or negative pressure and by allowing the end of the steering cable to slack off, making it easy to move) transition to a flexible state and can be advanced and guided / oriented / steered as needed. Alternatively, in Figure 1D In this system, when the internal rigid member 110 is exposed, it can be actively steered (manually or via computational control) to minimize the load on the rigidified outer tube. Minimizing the load on the external rigid member makes it easier for the tube to maintain its rigidified shape. Once the internal rigid member 110 is rigidified, the external rigid member 112 can transition to a flexible state and advance thereon. This process can then be repeated to navigate through more twisted anatomy structures. However, coordinating the movement of the internal and external members can be particularly difficult, including advance / retraction and selectively rigidifying the internal or external member or both, making robot-controlled systems particularly advantageous. The repeated process can result in "shape replication," whereby the internal and external rigid members can continuously conform to (or replicate) the shape of any member in a rigid configuration when in a flexible configuration.

[0103] Figures 1A to 1DThe operation of only one type of medical device that can be used with the methods and apparatus described herein is illustrated. Furthermore, these devices can be configured as endoscopes, including one or more of the following: imaging, irrigation, illumination, a steering channel for removing or applying materials, etc. For example, the robotic observation instrument 100 can be a "navigation" device, including a camera, illumination, and a distal steering section. The navigation device (or part of the observation instrument) can be well-sealed, making it easy to clean between procedures. In some examples, it does not need to be cleaned because it is completely covered by a sheath, both externally and when passing through the working channel. In some examples, a second internal device can then be placed inside a rigid external member and advanced through the distal end of the external member. The second internal member can be a "treatment" tube, which includes elements such as a camera, illumination, water, a suction device, and various tools. The "treatment" device may not have the ability to have a steering section or rigidification, thus providing additional space within the body of the treatment tube to include other features, such as tools for performing treatments. Once in place, the tools on the "treatment" tube can be used to perform treatments inside the body, such as mucosal resection or dissection in the human gastrointestinal tract (GItract).

[0104] In some examples, the rigidifying members described herein can be transformed from a flexible configuration to a rigid configuration, and the stiffness can be considered “variable stiffness” because it can be selected by the user or the system. For example, each rigidifying member can be rigidified by applying positive or negative pressure to or within the walls of the rigidifying member. When the positive or negative pressure is removed (or vice versa), the layers can readily shear or move relative to each other; the release of the positive or negative pressure can allow the layers to transform into a state in which they exhibit significantly enhanced resistance to shear, movement, bending, torque, and buckling, thereby providing system rigidification. Although the examples shown above in the described devices are rigidified by applying pressure (e.g., positive or negative pressure), the methods and devices described herein can be used with any suitable rigidifiable member, not limited to positive or negative pressure rigidification devices. For example, the rigidifiable member described herein can refer to any suitable rigidification device, including members that can be rigidified by plugging particles, by phase change and / or shape memory alloys, by interlocking components (e.g., cables with discs or cones), EAP (electroactive polymers), or any other rigidification mechanism.

[0105] Any rigidifying device described herein may include a rigidifying layer or region engaged with a compression layer (which may be or may include a bladder) that applies force to the rigidifying layer to rigidify it or, in some cases, to derigidify it (e.g., release it from rigidification). In some examples, these rigidifying devices may include a rigidifying layer that may comprise a braid, knit, woven fabric, chopped segments, randomly distributed or randomly oriented filaments or strands, a connector, a link, scales, a plate, a segment, a particle, a granular body, cross-filaments, or other material forming the rigidifying layer. For example, the rigidifying layer may comprise multiple strand length segments or strand segments that cross each other (e.g., as part of a braid, knit, woven fabric, etc.); the compression layer may apply force to drive the cross strand length segments or strand segments against each other. Although many examples shown herein are braided fabrics, any of these devices may alternatively or additionally include a general rigidifying layer comprising cross strand length segments or strand segments. Examples of rigidification devices described herein can use pressure (positive pressure) and / or negative pressure to selectively and controllably rigidify. In some examples, the methods described herein can be used with any suitable rigidification device.

[0106] and Figures 1A to 1D The same or similar sequences shown can be executed by the apparatus described herein (in particular, the rotary system described herein).

[0107] Typically, robotic endoscopes can be actively steered, either automatically or manually, including through user-operated devices, such that when advanced into an anatomical structure, the robotic endoscope is steered to a known, assumed, or measured shape. This is useful for navigation such as (but not limited to)... Figures 1A to 1D This can be particularly useful and important when using a dual-rigidity endoscope as shown. For example, the distal end of the internal rigidity member can be steered (including steered to set or match the shape of a segment of the external rigidity member). Typically, the areas of the internal and / or external members of the endoscope can be steered in the area immediately adjacent to the distal end.

[0108] Therefore, the apparatus described herein can generally include actuators for controlling the operation of an observation instrument operated by the device, including for steering, rigidification, navigation, imaging, illumination, etc. For example, some variant actuators of the system's robotic arm (e.g., end effectors) can include instrument drivers that can be combined with electromechanical devices for actuating (e.g., steering) medical instruments and can include mounting components for detachably attaching to the observation instrument or a portion of the observation instrument (e.g., internal components, external components, etc.). For example, PCT application PCT / US2023 / 064999, filed March 27, 2023, entitled "METHODS AND APPARATUSES FOR NAVIGATING USING A PAIR OF RIGIDIZING DEVICES", describes an example of an apparatus including a nested device that can be used with any of the methods and apparatuses described herein. Other examples of devices that can be used with the methods and apparatus described herein may include nested conduits, such as U.S. Patent Application No. 17 / 902,770, filed September 8, 2022, entitled “NESTED RIGIDIZING DEVICES”; U.S. Patent Application No. 18 / 000,062, filed May 26, 2021, entitled “RIGIDIZING DEVICES”; U.S. Patent Application No. PCT / US2022 / 014497, filed January 31, 2022, entitled “DEVICES AND METHODS TO PREVENTINADVERTENT MOTION OF DYNAMICALLY RIGIDIZING DEVICES”; and U.S. Patent Application No. 2022 / 014497, filed December 22, 2022, entitled “METHODS AND APPARATUSES FOR REDUCING CURVATURE OF A The applications described herein are those in patent application No. PCT / US2022 / 082300 entitled "COLON (Method and apparatus for reducing colonic curvature)" and patent application No. PCT / US2023 / 062206 entitled "DYNAMICALLYRIGIDIZING COMPOSITE MEDICAL STRUCTURES" filed on February 8, 2023. Each of these applications is incorporated herein by reference in its entirety.

[0109] In some examples, robotic observation instruments, such as Figures 1A to 1DThe dual-rigidification device shown can be robot-controlled. For example, one or more proximal ends of the robotic mirror may include connectors for attaching the robotic mirror to the frame. Figures 1A to 1D In the example shown, the external rigidification member 112 and the internal rigidification member 110 may each include controls and / or connectors for coupling to a steering input, an air line (e.g., a suction unit), a water line, a video line (e.g., a monitor, etc.), and / or one or more tool channels. In some examples, the proximal end of the robot observation instrument (or, in the case of a double rigidification mirror, each of the internal and external members) may include a connector region, such as Figure 2 Box 257 is shown schematically in the diagram. Each of the internal and external components may include a separate box.

[0110] For example, the housing may include a connector for controlling steering, for example, via one or more steering ribs within internal and / or external components. For instance, housing 257 may include discs 271a and 271b, which may be connected to cables 263a and 263b, respectively, to steer (e.g., bend or deflect) the end of the internal rigidification member 210. Other steering mechanisms (e.g., pneumatic, hydraulic, shape memory alloy, EAP (electroactive polymer), or motors) are also possible. Similarly, in examples with different steering mechanisms, one or more discs (e.g., discs 271a and 271b) of housing 257 may be used to actuate steering.

[0111] Box 257 may also include pressurized connections 203a and 203b, which can be respectively connected to pressure sources for rigidifying the internal and / or external components. Pressure (positive or negative, depending on the robotic mirror) can be applied through pressure lines 205z, causing a change in pressure in the pressure gap of the internal rigidification component 210 (e.g., increasing under positive pressure or decreasing under negative pressure (i.e., vacuum), thereby causing the rigidification devices 210 and 212 to become rigid. Figures 1A to 1D As shown, activation can be achieved by applying pressure (positive or negative) sequentially and / or simultaneously. In some examples, housing 257 may include pressure connectors 274a, 274b for hermetically coupled to one or more pressure sources. Other mechanisms that cause rigidification of the robotic mirror (e.g., internal and external rigidification members) are also possible.

[0112] Box 257 may include connectors for connection to additional cavities and / or wiring in external or internal rigidification devices. For example, in Figure 2In this configuration, housing 257 is coupled to internal rigidification member 110, and connector 225y may include a connection for delivering both suction and water to the end of the internal rigidification device. Connector 225y may include an electrical connector for connecting a camera mounted to the end of internal rigidification device 110 to an external monitor and / or video processing unit. Connector 225y may include a mechanical connector connected to a hollow tube (e.g., a working channel) extending to the end of internal rigidification device 210. By including connector 225y, control of all components of system 200 can be performed via housing 257 and can be manually or automatically controlled by the device described herein.

[0113] In some examples, control connectors (e.g., discs 289, 271a, 271b, etc.) are accessible from the bottom of housing 257. Control connectors may have features such as splines, pins, or teeth to transmit torque. These features may allow them to be manipulated (e.g., via a drive system). The drive system may be part of the linkage assembly described herein, or the drive system may be integrated with the linkage assembly. The same controller may operate the drive assembly and other components of the device (e.g., linear drive, altitude adjustment, pitch, etc. for the linkage assembly), including stiffening / destressing control.

[0114] Figure 3A and Figure 3B A first example of a device (e.g., a system) for deploying and / or controlling a flexible tubular member is schematically illustrated. Many of the figures described herein include... Figures 3A to 3B In this embodiment, the device is shown configured for use with a flexible tubular member configured as a nested endoscope comprising an outer "outer cannula" and an inner endoscope, which are movable proximally / distally relative to each other and can each be rigidified to guide the device and / or steer the device through the patient's body (as described above). However, it should be understood that these devices can be used with any flexible tubular member, including those that are not nested and not rigidified (e.g., monocular endoscopes).

[0115] like Figure 3AAs shown, the system 300 includes a base that supports the weight of the rest of the system, including any flexible tubular components attached to the system. The base 341 can be weighted to allow the telescopic linkage assembly and any attached flexible tubular components to cantilever distally or proximally away from the base while maintaining stability. The base may house one or more additional components, including a power source, power regulator, motor, pressure source / pressure supply, controller, control circuitry, etc. The base 341 may include wheels 351 to allow movement and positioning of the device relative to the patient's bed. In some examples, the base 341 may include an anchoring region 353, which can be lowered and / or raised to allow or prevent movement. The wheels may be lockable or lockable.

[0116] Figure 3A A linkage assembly 301 is shown, configured as a vertically arranged linkage assembly including three links: a first link 305 (e.g., an outer link or base link that can be coupled to a base), a second link 307 (e.g., an intermediate link), and a third link 309 (e.g., an inner link). The first link is coupled to a yaw adjustment arm 337, which is also configured (or can be coupled to) a vertical lifting arm 335, which connects the linkage assembly 301 to the base 341. Figure 3A The illustrated system 300 also includes a mounting assembly comprising a pair of mounting regions 323, 333 coupled to a third link. In this example, the first mounting region 323 is configured as an outer tube mount for coupling with the outer tube of an endoscope. The outer tube mount is located at or near the distal end region of the third link and includes an outer tube drive assembly (e.g., a actuator) 321 that can engage with the outer tube of the endoscope. In some examples, the outer tube drive assembly may include drive components for controlling tumbling, for steering (optionally, in examples where the outer tube can be steered at the distal end), and / or pressure inputs / outputs for rigidification / derigidification. The outer tube mount 323 may be configured to be secured separately from the internal endoscope to the outer tube portion. In some examples, the outer tube mount 323 may be secured by a securing mechanism including clamps, hooks, latches, locks, etc.

[0117] The second mounting area 333 is configured as an internal endoscope mount and may also include an internal endoscope drive assembly 331, as shown in the figure. The internal endoscope drive assembly (driver) can engage with the internal endoscope component and may include the above-referenced... Figure 2The described drive components include steering components (e.g., for steering the distal end / terminal region), roll control, and pressure input / output (e.g., for stiffening / de-stiffening, etc.). The endoscope mount 331 can be configured to be secured to the endoscope separately from the outer tube, for example, by a securing mechanism including clamps, hooks, latches, locks, etc.

[0118] Figure 3C Another example of the robot system 300' is shown, including with Figures 3A to 3B The example shows a similar retractable linkage assembly 301 and base 341. It also includes a flexible tubular member attached to the system. The flexible tubular member in this example is configured similarly to... Figure 1A and Figure 1B The rigid device shown is a pair of nested rigid devices, including an outer sheath 312 and an inner endoscope 310. In this example, a base 341 supports a telescopic linkage assembly 301 and the attached endoscope, allowing the linkage assembly to smoothly move from a relatively low-footprint, centrally located neutral configuration to a partially or fully extended configuration (such as...). Figure 3B (as shown) or partially or completely retracted configuration (such as) Figure 3C (As shown). The flexible tubular member can extend distally. In some examples, as shown and described in more detail below, the device may include one or more supports to prevent buckling or collapse of the flexible tubular member.

[0119] exist Figure 3C and Figure 3DIn this configuration, link assembly 301 is configured as a vertically arranged link assembly, but links of any orientation can be used (e.g., horizontal, angled, mixed horizontal / vertical / angled, etc.). Although three links 305, 307, and 309 are shown, any number of links may be included. A flexible tubular member is coupled to a mounting assembly that is coupled to the innermost (third) link 309. The mounting assembly includes a first mounting region 323 to which the proximal end region of the outer sleeve 312 is coupled. The first mounting region may include a drive assembly 321 that includes one or more actuators for actuating movement of the elongated flexible member (e.g., the outer sleeve). For example, the first mounting region 323 may include one or more tumbling actuators for tumbling the outer sleeve relative to the endoscope. In some examples, the outer sleeve may be steerable, for example by including one or more steering members (e.g., ties, braces, etc.). The first mounting region may include actuators for actuating steering of the outer sleeve. The outer sheath can be connected to a pressure source (e.g., positive and / or negative pressure) for rigidifying / deriggering the outer sheath. Therefore, the first mounting component may include a pressure port and can be configured to connect the outer sheath to the pressure source. In some examples, the pressure source may be included with the system, or the system may be configured to connect to a positive and / or negative pressure source.

[0120] The flexible tubular endoscope is also connected to the mounting assembly via a second mounting region 333. The second mounting region may include a second drive assembly 331, which includes one or more actuators for actuating the flexible tubular member (e.g., the endoscope). For example, the second mounting region 333 may include one or more tumbling actuators for tumbling the endoscope relative to the outer sheath. The endoscope may be steerable, for example, by including one or more steering members (e.g., ties, braces, etc.). The second mounting region may include actuators for actuating the steering of the endoscope. The endoscope may also be connected to a pressure source (e.g., positive and / or negative pressure) for rigidifying / deriggering the endoscope. Therefore, the second mounting assembly may include a pressure port and may be configured to couple the endoscope to a pressure source.

[0121] The mounting components can typically be configured to allow the first and second mounting areas to move relative to each other, and thus the outer cannula and the internal endoscope to move relative to each other. Therefore, the internal endoscope can be partially or completely retracted into the outer cannula, or can extend a certain distance from the outer cannula (e.g., Figure 3C and Figure 3D (As shown). Figure 3D It shows Figure 3C A top view of the system at 300'.

[0122] As mentioned, mounting components (e.g., in some examples, a first mounting area and a second mounting area) can be configured to be substantially secured to the flexible tubular member. The mounting components can be configured to be releasably coupled to the flexible tubular member via one or more securing mechanisms (such as clamps, hooks, latches, locks, etc.). Figures 3C to 3D In the example shown, the mounting component can be configured to connect a first mounting area of ​​the mounting component separately to the outer sleeve, and a second mounting area can be configured to connect separately to the internal endoscope.

[0123] Figure 5A The linkage assembly of the device in a fully retracted proximal configuration is shown. Figure 5B A linkage assembly of the device in a fully distally extended configuration is shown. As the linkage assembly moves proximally and distally (e.g., extends and retracts), the outer tube mount moves with the linkage assembly, extending and retracting in and out. The internal endoscope mount 333 can be configured to move distally or proximally relative to the outer tube mount (and the linkage assembly). In some examples, the internal endoscope mount 333 can be moved relative to the outer tube mount 323, as will be described below. Figures 5A to 5B As described in [the text].

[0124] Typically, these devices may include multiple (e.g., eight or more) degrees of freedom for mounting components and therefore for flexible tubular members. For example, Figure 4 It shows something similar to Figures 3A to 3B An example of system 400 shown in the diagram includes a linkage assembly (including a first link 405, a second link 407, and a third link 409) that moves in a proximal to distal direction during extension and retraction. Insertion and retraction can be driven by an outer tube insertion motor 415 (e.g., a linear actuator, such as a ball screw / nut assembly). The outer tube mount 423 also includes an outer tube tumbling motor 426. The internal endoscope mount 433 includes an endoscope actuator 431, which includes an endoscope tumbling motor 435 and a plurality of steering motors 437. The linkage assembly is pivotally attached to a yaw adjustment arm 337 (which may be directly or indirectly coupled to a base link 305) and a vertical lifting arm 335.

[0125] As mentioned above, in some examples, the mounting assembly for the flexible tubular member may include one or more separate actuators for driving the relative movement of the outer member (e.g., outer sheath) and the inner member (e.g., internal endoscope) of the flexible tubular member. Figures 5A to 5BAn example of a vertically arranged linkage assembly is shown, comprising a mounting assembly including an outer tube mount 523 and a separately actuated internal endoscope mount 533. These regions of the mounting assembly are configured to operate together to provide relative movement between a first region and a second region. These regions may be directly or indirectly coupled together. For example, in Figure 5A and Figure 5B In the middle, the first mounting area (outer tube mounting member 523) and the second mounting area (endoscope mounting member 533) of the mounting assembly are both connected to the third link 590.

[0126] Therefore, in this example, the vertically arranged linkage assembly 501 includes a first linkage 505 (e.g., a base linkage), a second linkage 507, and a third linkage 509, which are arranged vertically relative to each other and separated by reciprocating motion elements (e.g., a first reciprocating motion element 519 and a second reciprocating motion element 518), which may be coupled to one or more belts and / or straps to allow them to coordinate extension and retraction. As described above, mounting components (e.g., a first mounting area and a second mounting area) are coupled to the third linkage. A first mounting area 523 for the outer tube is rigidly (e.g., fixedly) coupled to the third linkage 509 and also includes an outer tube actuator (e.g., an outer tube tumbling motor 526) to drive the outer tube to tumble in a clockwise and / or counterclockwise direction. A second mounting region 533 for the endoscope is adjacent to the first mounting member and configured to move distally / proximally along the endoscope insertion track 569, and includes one or more actuators for operating the endoscope, such as an endoscope tumbling motor 535 and / or an endoscope steering motor 537. In some examples, a third link may include an actuator for driving the second mounting region. For example, in Figure 5A In the diagram, the second mounting area is shown as being completely distal relative to the first mounting area; Figure 5B In the image, the second mounting area is shown as being completely proximal to the first mounting area.

[0127] Figures 6A to 6D It shows something similar to Figures 5A to 5B Another example of the vertically arranged link assembly 601 shown illustrates an intermediate configuration of a vertically arranged link group. Typically, any device described herein may include more than three links; for example, such devices may include four links, five links, six links, etc. Additional links can be configured and controlled as shown here for three links. Outer links may be (directly or indirectly) coupled to a base, and inner links may be coupled to a mounting assembly (including one or more mounting areas). Figure 6AIn the diagram, the second and third links are shown as partially transparent. Typically, in any of these examples, the movement of the retractable component can be achieved using a single actuator (e.g., a single motor). Belts and / or timing belts can be used to coordinate the movement of the links. For example, the belt (and / or strap) can be a steel belt. This is also... Figure 7A The diagram schematically illustrates the use of two reciprocating links (proximal and distal).

[0128] Figures 6B to 6D It shows Figure 6A Additional details of a portion of the vertically arranged link assembly 601 are shown, illustrating the first link 505 and the second link 507, as well as the first reciprocating member 518 and the second reciprocating member 519. Figures 6B to 6D In the diagram, a pair of thin, flexible strips 655 and 656 are shown attached to a second reciprocating member 519, which is positioned between a second link 507 and a third link (not shown). A similarly arranged flexible strip 655' is attached between the first and second links. Strips 655 and 656 are attached to the same corresponding ends of the second and third links via attachments 659, 659', and 659'', respectively, and are wound around a pulley surface (e.g., cylindrical surface 671) in the reciprocating member 519. The strips may be wound around a pulley surface or different pulley surfaces (which may be adjacent to each other).

[0129] Figure 6C and Figure 6D An example of a timing belt 527 is also shown, which is depicted as being attached to the bottom of a second link 507, and both a first reciprocating member 618 and a second reciprocating member 619 are attached to the timing belt 527. The first reciprocating member is attached to the timing belt via a bottom attachment 588, which is wound around the second link. The second reciprocating member is also attached to the timing belt via a bottom attachment 589, which is wound around the second link. The timing belt can be moved by rolling around a pair of timing pulleys 529, 529' (driving coordinated but opposite movements of the attached reciprocating members).

[0130] exist Figures 7A to 7B For simplicity, a third (or more) link is not shown. In this example, the first link 705 may support and / or may contain a linear actuator 712, shown in this example as a ball screw nut assembly. Rotation of the ball screw 743 drives linear motion of the ball nut 744. The actuator is coupled to a first reciprocating member 518, which can be connected via the first link. Therefore, the first reciprocating member can be driven proximally and distally by rotating the ball screw clockwise or counterclockwise. Figure 7AIn this configuration, the first reciprocating member is configured to slide between a first link 705 (e.g., a base link) and a second link 707. However, a pair of opposing flexible bands 717, 714 are attached to both the first and second links and wound around a cylindrical surface (e.g., a pulley) within the first reciprocating member 518. For example, in Figure 7A In this configuration, a first distal band 717 is attached at a first end 748 to the distal end region of the first link, for example, on the inner surface facing the second link. A second end 749 of the first distal band 717 is attached to the distal end region of the second link. The first distal band extends between the first and second links and around the cylindrical (e.g., pulley) surface 756 of the first reciprocating member.

[0131] The first proximal band 714 is similarly configured, but oriented in the opposite direction. For example, a first end of the first proximal band (which is also a flat strip (e.g., a flat metal strip)) is attached to the first link at a proximal end region 742 and passes around the cylindrical (e.g., pulley) surface 756 of the first reciprocating member, where the first proximal band then connects to the proximal end region 746 of the second link (e.g., on the side facing the first link). Thus, the reciprocating member and the band are configured to act as a rack and pinion engagement between the first and second links. Moving the reciprocating member to the right (e.g., by the action of the linear actuator 712) causes the second link 707 to move to the right (retract), while moving the reciprocating member to the left causes the second link 707 to move to the left (extend it distally). A similar configuration may be used between the second and third links for the second reciprocating member 519 (not shown). Alternatively, in some configurations, the link assembly may consist only of the first and second links.

[0132] In some examples that use more than two links, a timing belt can be used to synchronize the movement of a pair of reciprocating motion components. This is in Figure 7B (and Figures 7C to 7E It is illustrated schematically in (). Figure 7B Similar to in other aspects Figure 7A However, a timing belt 727 is included within the second link 707, connecting both the first reciprocating member 518 and the second reciprocating member 519. The timing belt 727 can roll around pulleys at both ends and is configured such that proximal movement of the first reciprocating member 518 causes distal movement of the second reciprocating member 519, and vice versa. Therefore, the movement of the first reciprocating member is synchronized with the intermediate (second) link via the flexible belt and with the movement of the second reciprocating member via the timing belt.

[0133] In some examples, motion can be transmitted from a driver (e.g., a ball screw) to a flexible tubular member attached to a third link, where the ratio of ball screw motion to end motion is 4:1, but other configurations with different ratios can be used.

[0134] In one of these examples, the strip can also serve as a substrate and / or support for one or more electrical and / or electronic circuits (wires, traces, etc.), thereby allowing the transmission of control and / or power (e.g., from a first link to a third or more links) through the linkage assembly, even as the links move and extend. Thus, the strip-shaped flexible strip can provide a relatively constant path length between links.

[0135] Note that, although Figures 7A to 7E An example using both the first distal belt 717 and the first proximal belt 714 is shown, but in some examples, only the first distal belt or the first proximal belt may be used. For example, the reciprocating member may include a channel through which the belt passes to provide proximal and distal reaction surfaces for the belt; when the reciprocating member is driven proximally and distally, the belt may be driven and slide against either reaction surface to move the second link.

[0136] Figures 7C to 7E An example of the operation of a set of three links in a vertically arranged linkage assembly is shown. In this example, the first link 705 includes (e.g., at least partially accommodates) an actuator for moving a first reciprocating member 518, such as a ball nut 744 and a ball screw 743. A first distal belt 717 and a first proximal belt 714 extend in opposite directions between the first link 705 and the second link 707 and around the cylindrical surface of the first reciprocating member. A third link 709 is similarly connected to the second link 707 via a second distal belt 712 and a second proximal belt 716, the second proximal belt 716 being curved around the cylindrical surface of the second reciprocating member 519 (e.g., a pulley). Additionally, both the first and second reciprocating members are coupled to a timing belt 727, which is either within or coupled to the second link. Thus, as... Figure 7D As shown, when the linear actuator drives the first reciprocating member proximally (748), the second and third links are each driven proximally, as illustrated. Similarly, as... Figure 7E As shown, when the linear actuator drives the first reciprocating motion member to the distal end 746, the second and third links are each driven to the distal end with coordinated telescopic movements.

[0137] Figures 7C to 7E The diagram shows a top view (looking down) of a vertically arranged linkage assembly, and is not necessarily drawn to scale. Figure 7C The diagram shows a vertically arranged link assembly in a neutral position, which has a relatively compact footprint. Figure 7D and Figure 7E The fully telescoping configuration is shown (towards the proximal or distal sides, respectively).

[0138] Despite Figures 6A to 6D and Figures 7A to 7B A reciprocating motion element is shown that is slidably connected to a linkage via multiple belts and / or straps, but any suitable moving connection can be used. For example, the reciprocating motion element can be moved by a rack and pinion mechanism.

[0139] Figures 7F to 7H Another example is shown, illustrating the operation of a set of three links in a vertically arranged linkage assembly, which is related to... Figures 7C to 7E Similar to the example shown, however, a ball screw actuator is used instead of a timing belt to synchronize the linkage movements. Typically, the telescopic movements of the linkage can be synchronized using any suitable motion synchronization mechanism, including belts, ball screws, etc. In this example, the first linkage 705 includes (and may at least partially house) an actuator for moving the first reciprocating member 518, such as a ball nut 744 and a ball screw 743. A first distal belt 717 and a first proximal belt 714 extend in opposite directions between the first linkage 705 and the second linkage 707 and around the cylindrical surface of the first reciprocating member. A third linkage 709 is similarly connected to the second linkage 707 via a second distal belt 712 and a second proximal belt 716, the second proximal belt 716 being bent around the cylindrical surface of the second reciprocating member 519 (e.g., a pulley). Furthermore, both the first and second reciprocating motion components are connected to a ball screw actuator 787, which is either within or connected to the second link. Therefore, as shown in Figure 7G, when the linear actuator drives the first reciprocating motion component proximally 748, the second and third links are each driven proximally, as shown. Similarly, as... Figure 7E As shown, when the linear actuator drives the first reciprocating motion member to the distal end 746, the second and third links are each driven to the distal end with coordinated telescopic movements.

[0140] Figures 7F to 7H The diagram shows a top view (looking down) of a vertically arranged linkage assembly, and is not necessarily drawn to scale. Figure 7F The diagram shows a vertically arranged link assembly in a neutral position, with a relatively compact footprint, while Figure 7G and... Figure 7H The fully telescoping configuration is shown (towards the proximal or distal sides, respectively).

[0141] Figures 7F to 7H Another example is shown, illustrating the operation of a set of three links in a vertically arranged linkage assembly, which is related to... Figures 7C to 7ESimilar to the example shown, however, a ball screw actuator is used instead of a timing belt to synchronize the linkage movements. Typically, the telescopic movements of the linkage can be synchronized using any suitable motion synchronization mechanism, including belts, ball screws, etc. In this example, the first linkage 705 includes (and may at least partially house) an actuator for moving the first reciprocating member 518, such as a ball nut 744 and a ball screw 743. A first distal belt 717 and a first proximal belt 714 extend in opposite directions between the first linkage 705 and the second linkage 707 and around the cylindrical surface of the first reciprocating member. A third linkage 709 is similarly connected to the second linkage 707 via a second distal belt 712 and a second proximal belt 716, the second proximal belt 716 being bent around the cylindrical surface of the second reciprocating member 519 (e.g., a pulley). Furthermore, both the first and second reciprocating motion components are connected to a ball screw actuator 787, which is either within or connected to the second link. Therefore, as shown in Figure 7G, when the linear actuator drives the first reciprocating motion component proximally 748, the second and third links are each driven proximally, as shown. Similarly, as... Figure 7E As shown, when the linear actuator drives the first reciprocating member distally (746), the second and third links are each driven distally with coordinated telescopic movements. This actuation scheme can be repeated two or more times to achieve the motion.

[0142] Figures 7F to 7H The diagram shows a top view (looking down) of a vertically arranged linkage assembly, and is not necessarily drawn to scale. Figure 7F The diagram shows a vertically arranged link assembly in a neutral position, with a relatively compact footprint, while Figure 7G and... Figure 7H The fully telescoping configuration is shown (towards the proximal or distal sides, respectively).

[0143] Figures 7I to 7K Another example is shown, illustrating the operation of a linkage assembly also configured for bidirectional telescopic movement of a set of links, similar to... Figures 7C to 7E and Figures 7F to 7H As shown, however, multiple mechanical linkage components (including ball screw actuators in this example) are used to synchronize the linkage motion. This configuration does not include a separate synchronization band. Typically, the telescopic motion of the linkage is synchronized by the operation of a ball screw, with each stage connected to the adjacent stage via a ball screw. Therefore, with Figures 7C to 7K In the example comparison shown, all the belts have been replaced by ball screw actuators, and the reciprocating motion components have been replaced by additional intermediate connecting rods. This allows for adjustment of the ball screw's travel. The ball screw / nut can be biased to the end of the connecting rod at a nominal (centered) position, such as... Figure 7IAs shown. For example, the first link 705 includes (e.g., and may at least partially accommodate or be coupled to) a drive, such as a ball nut 744 and a ball screw 743, moving a first intermediate link 707'', which also accommodates or is otherwise coupled to the ball nut 744' and the ball screw. This pattern can be repeated for the second intermediate link 707' and the third intermediate link 707. Thus, as Figure 7J As shown, when the linear actuator drives the first reciprocating member proximally 748, the top links are each driven proximally, as illustrated; the links can be arranged such that they extend over the top of the bed / table, but by a minimal amount to allow for manipulation near the patient. Similarly, as... Figure 7K As shown, when the linear actuator moves away from the patient 746 and drives the first reciprocating motion component distally, the top link (third link 709 and intermediate link 707) each moves distally with coordinated telescopic motion.

[0144] The linear linkage assembly can be of any suitable size and can be configured to provide a working range of motion during operation. As mentioned, in some configurations, in a variation where the outer tube mount 523 is fixed to the first link, the device can be configured to allow the outer tube (the outer component of the telescopic assembly) to sweep across a length of approximately 0.2 m to 3 m (e.g., between approximately 0.5 m to 2.2 m, etc.) (this range can be greater if the outer tube mount can move relative to the linkage assembly). Because the endoscope mount 533 is linearly translated relative to the first link 709 of the linkage assembly, the sweep length of the endoscope mount can be greater than the sweep length of the outer tube mount 523, for example, between approximately 0.2 m to 3.5 m, for example, between approximately 0.5 m to 2.6 m, etc. Figure 7L A top view showing an example of a linear linkage component of a robotic device, including exemplary dimensions. Figure 7L The diagram illustrates an extension to the right 746 (e.g., distal extension) and a leftward extension 748 (e.g., proximal extension). For example, in... Figure 7L In the middle, the distance between the front of the trolley (base) and the proximal end of the first link 709 can be, for example, between 0.25 meters and 2 meters; Figure 7L In the specific non-limiting example shown, the distance is shown as approximately 1.69 m, and therefore the maximum proximal extension is approximately 1.6 m. In the same non-limiting example, the maximum range of motion (ROM) of the outer sleeve mount and therefore the proximal end of the outer sleeve is shown as approximately 1.953 m, thus the ideal length of the internal component (e.g., the internal endoscope mount 533) is approximately 2.57 m.

[0145] Other mechanical motion coupling elements can be used, including software or firmware; in some cases, each link can be moved by a drive (e.g., a motor, etc.) that can be integrated into the link (e.g., coupled to the link, contained within the link, etc.).

[0146] Figure 8 An example of a method using a system 800 for deploying and / or controlling a flexible tubular member, as described herein, is shown. The system 800 includes a vertically arranged linkage assembly 801, schematically shown to engage with an endoscope 890 to deploy and control the endoscope during insertion into a patient 881. The patient is shown lying on their side on a table 882. In this example, the device is initially located at the foot of the bed, and the system must initially hold the endoscope, approximately 1.5 meters in length, outside the patient before insertion into the patient's rectum for a colonoscopy. The linkage of the vertically arranged linkage assembly 801 is arranged perpendicular to the ground and can initially extend distally (as shown) to provide sufficient clearance outside the body while still allowing the system to be positioned near the edge of the table / bed 882. Furthermore, the vertical arrangement of the linkage allows the endoscopic device to be positioned in a straight line with the patient at the height of the insertion point. Therefore, this configuration can have a minimum distance from the device axis (e.g., the endoscope axis) to the top of the mattress.

[0147] As an alternative, the configuration described herein can be used with horizontally arranged (e.g., parallel to the ground) links, such as... Figure 9 As shown. In Figure 9 In this system 900, a set of horizontally arranged linear links 901 are included, which can engage with the proximal end of an endoscope 990 (e.g., a robotic rigid endoscope as described herein). Figure 9 In this configuration, the device can be retracted and extended as described above for a vertically arranged linkage assembly, but the device’s proximal advancement is subject to interference from the bed 982 (e.g., a mattress), thus limiting the approach angle when inserted into the patient 981.

[0148] For example, Figures 10A to 10C The diagram shows a representative distance between the device axis (e.g., the long axis of the endoscope) and the top of the table or mattress (e.g., the bed) relative to the patient's anatomy. Figure 10A The patient and bed positions and dimensions for the left-sided lower GI approach are shown. In this example, the patient is shown lying on their side on bed 982 in the patient longitudinal position 1075. The device axis 1078 required for rectal insertion from this position needs to be at a height above the bed as shown in 1076, which is within the average range. This height can be significantly higher than the height of the supine lower GI approach, such as... Figure 10BAs shown. In this example, the patient is supine in a longitudinal position 1075', and the device axis 1078' is at a height below the height in 10A above the bed 1076'.

[0149] Figure 10C An example of an upper GI procedure using this system is shown, with the patient in a left lateral decubitus position (prone and supine, with their head turned approximately 90 degrees). In this example, the device axis 1078'' for accessing the patient's mouth is typically at approximately the height of the patient's head above the mattress 1076''.

[0150] Typically, any of these systems and devices can be configured for use with a cover, protective covering, or shield to prevent the device from becoming contaminated or soiled, for example, Figure 11 Examples of covering systems as described herein to limit the contamination of devices by patient bodily fluids are schematically illustrated, which can help minimize cross-contamination between patients. In some examples, these systems can be covered, as shown, to form a non-sterile barrier, thereby minimizing contamination or over-contamination of the robotic system. In some examples, drape 1193 can be configured to provide a hygienic but non-sterile cover to the system, including the base and / or linkage assembly 1101 (e.g., a vertically arranged linkage assembly). The drape can be two or more parts, as shown, including a first part covering the base and a second part covering the linkage assembly. Alternatively, in some examples, the system or at least the vertically arranged linkage assembly can be covered with a sterile drape. As described above, any of these devices and methods can include sterilization and / or wrapping with a sterile cover.

[0151] Any of these devices may include a support arm 1176, which may extend from a vertically arranged link assembly 1176, such as Figure 11 and Figure 12 As shown in the figure. The endoscope described herein can prevent or limit buckling of the endoscope under compressive loads. For example, in Figure 12 In this system 1200, a vertically arranged linkage assembly 1201 is included, from which an elongated support arm 1276 extends and can engage with an endoscope 1290 as just discussed to prevent or inhibit buckling. In some examples, the support arm 1276 may include multiple supports along its length for the device to provide a parallel path to mechanical ground. These supports may be passive (sliding / rotating) or motorized. A laser pointer may be attached to the buckling-resistant support or another distal portion of the machine.

[0152] As described above, these devices and methods are typically configured to allow adjustment and / or readjustment of the linkage assembly 1301 relative to the patient or bed. Figure 13 It shows the use of the above Figures 3A to 3B and Figure 4 The device shown has different moving and adjusting axes similar to those of other devices. Figure 13 The system includes a base 1341 and wheels 1351. Wheels 1351 support arms (e.g., columns, axles, etc.) 1335 and can change the relative position of the linear linkage assembly with respect to the base. For example, the height of the linkage assembly can be adjusted on the vertical axis 1335' using a vertical lifter 1335 as shown. Alternatively or additionally, the angle of the vertically arranged linkage assembly relative to the bed or patient can be adjusted, for example, by rotating the vertically arranged linkage assembly about a yaw axis 1337'. The position of the linkage assembly can be adjusted before the procedure is performed using the system. For example, the position of the telescopic robot relative to the trolley can be adjusted for yaw and / or vertical position. These axes can be locked during surgery. In some examples, these axes can also be in a floating state to allow for repositioning of the patient during surgery. In any of these devices, the trolley wheels can be unlocked and / or locked to allow the robot to be planar positioned relative to the patient.

[0153] Typically, one or more additional tools (actuators, drivers, etc.) may be included and / or mounted to the system, including mounting to linkage assembly 1401 (e.g., a vertically oriented linkage assembly), to aid in the manipulation of multiple different end effectors that can be used with the endoscope, including insertion and / or manipulation through the endoscope's working channel. In some examples, the endoscope may include an entry point located in the endoscope handle for the tool to enter the endoscope's internal working channel (IWC). In one example, a ninth robot axis may be used to control the insertion depth of the tool. Using such additional tools can generate additional degrees of freedom (DOF) to control more axes of the tool within the IWC.

[0154] For example, Figure 14 A schematic diagram is shown of a universal internal working channel (IWC) tool 1462 for accessing the working channel. The device 1462 can be coupled to a mounting assembly on the linkage assembly 1401 and can engage with the mounting assembly (in some cases, on a second mounting area and / or a first mounting area) for operation.

[0155] As described above, these devices can be used with a variety of programs. For example, these systems 1500 can be used as part of a lower GI program, such as... Figures 15A to 15C As shown in the illustration. In these examples, a system 1500, including a vertically arranged linear linkage assembly 1501, can be used with a patient 1581 on a bed / cart 1582 in virtually any orientation. The system can be positioned at the foot of the patient's bed. Figure 15A The patient is shown in a lateral position. Figure 15BA top view of the colonoscopy procedure described above is shown. A flexible tubular member is part of system 1500 and is inserted and manipulated using a vertically arranged linear linkage assembly 1501. Figure 15C In the middle, patient 1581 remains roughly the same and the approach angle can be adjusted, as shown in the figure.

[0156] Any of these devices can also be used, or alternatively, as part of the GI process, such as Figures 16A to 16B As shown. In this example, the trolley of system 1600 is located on one side of bed 1682, such that the flexible tubular member held by the linkage assembly can be used to insert, manipulate, and retract the flexible tubular member into the patient.

[0157] Buckling support Any device described herein may include one or more supports to prevent collapse or other unintended movement of the flexible tubular member during dispensing / deployment (insertion and / or retraction), particularly during deployment of a nested telescopic device that may include an outer sheath nested with an endoscope. Typically, one or more supports (“supports”, “endoscope supports”, or “buckling-resistant supports”) may be coupled to the endoscope and configured to prevent buckling of the flexible tubular member as it extends distally from the linkage assembly. The flexible tubular member support may be a strut, beam, rod, column, etc., which may support the length of the flexible tubular member as it extends distally and / or proximally away from the linkage assembly. In some examples, the flexible tubular member support may include one or more rings or strips for retaining (and supporting) a portion of the flexible tubular member.

[0158] Supports (e.g., buckling-resistant supports) are configured to support the nested device (e.g., endoscope and sheath) during setup and throughout the procedure. This can be achieved by using one or more buckling-resistant supports (e.g., 2, 3, 4, 5, etc.) positioned distally outside the robotic assembly and may be part of or coupled to the linkage assembly. In some cases, when supports are not needed to support the nested device, for example due to insertion depth, supports may be configured to move away from any moving parts of the observation instrument and robot, and / or the bed / table (e.g., wheelchair) or the patient's path. For example, supports may be moved under or "rear" from the robotic trolley. One or more supports may then automatically return to provide support to the nested system when the device is retracted. Supports may be part of the entire robotic device and may be configured to be cleaned in the same manner as the rest of the device.

[0159] In some cases, the flexible tubular support member may include a beam or arm that is coupled to and extends from the link of the linkage assembly. The support member may be deflectable, allowing it to be deflected away when not needed, or to prevent interference with another link or portion of the system. Therefore, the support member may be coupled to the link in a movable joint (such as a hinge pivot, ball joint, etc.). The movable joint may be biased so that it returns to a predetermined position after it has been deflected and the interfering portion of the system has moved out of the interference area. For example, the movable joint may be biased by a spring or other biasing device to present a supported position.

[0160] The portion of the support configured to hold the flexible tubular member may be referred to herein as a seat or placement area. The seat may be configured as a ring, loop, etc., through which the flexible tubular member can pass. Alternatively, the seat may be open, for example, in a top region, allowing the flexible tubular member to be inserted and removed along its length. In some examples, the seat may be open / closed to insert / remove the flexible tubular member. The seat may be configured to allow the flexible tubular member to slide or move therein. For example, the seat may include a lubricated (e.g., smooth) surface to allow the flexible tubular member to slide relative to the seat. In some examples, the seat may include a rolling or moving surface (e.g., a roller, wheel, ball bearing, etc.) to allow the flexible tubular member to move relative to the seat.

[0161] Figures 17A to 17H An example of operation of a pair of supports coupled to a linkage assembly is shown. In this example, a first support 1730 is coupled to the distal end region of a first link 1705. A second support 1730' is coupled to the distal end region of a second link (e.g., an intermediate link). A third link 1709 includes a mounting assembly to which a flexible tubular member is attached. In this example, to simplify the demonstration of support operation, the flexible tubular member only includes an outer sleeve 1710. Figure 17A As shown, when the linkage assembly is fully retracted proximally, the first support 1730 and the second support 1730' extend outward (perpendicular to the front / rear axis) to provide support for the flexible tubular member 1710 held in a seat within each support. Figure 17B In this process, the third stage, to which the mounting assembly connected to the proximal end of the flexible tubular member is attached, is advanced distally, for example, to insert the flexible tubular member into the body. As the flexible tubular member advances, it can slide relative to the support. In this example, the link is in a generally neutral position, such as... Figure 17C and Figure 17DAs shown, supports 1730, 1730' can pivot away from adjacent links and no longer engage with the flexible tubular member. Supports 1730, 1730' may no longer be necessary when the flexible tubular member is closer to the patient insertion site. Alternatively, in some examples, the supports may extend proximally and / or above the links (or in some cases below the links) to avoid interference, and may continue to support the flexible tubular member in more distal configurations.

[0162] Figure 17E A link assembly extending distally is shown, in which a seat shifts to allow the link to advance distally. Figures 17F to 17H The linkage assembly that moves proximally is shown, such that... Figure 17F As shown, the supports can be biased back to an extended position to support the flexible tubular member. In this example, when the linkage assembly moves proximally (e.g., retracts), the supports can be spring-biased back to their position below the flexible tubular member.

[0163] As described above, in some examples, the support can extend distally from the link to support the flexible tubular member, or even support the link, when the link assembly is in a neutral (central) configuration and / or extended distally (e.g., inserted into a patient). For example, the support may include a distally extending arm segment, which may be of a fixed length or extend and retract with the extension and retraction of the link assembly.

[0164] Typically, any device described herein may include one or more supports configured to support a telescopic device (e.g., an outer sleeve portion of the device) outside the patient's body. These supports may be configured to move away from the linkage assembly as the linkage assembly drives the telescopic device proximally and distally, as just described. In some cases, these supports may be configured to move in such a way that they do not interfere with the bed or table where the patient is located. Any of these supports may be configured to move to a storage location with minimal footprint, particularly in the plane of motion of the linkage assembly. The supports may be configured to have: a pre-deployment configuration, in which one or more supports can move away from the plane of motion of the linkage assembly; a deployment configuration, in which the support can be positioned and held in the plane of motion to support a portion of the telescopic device outside the patient's body; and a post-deployment configuration, in which one or more supports move away from the linkage as it moves toward the patient to avoid interfering with the operation of the telescopic device.

[0165] This may include any appropriate number of supports. In some cases, supports may be connected to linkages and / or reciprocating components. The number of supports may be based on the length of the endoscope to be extended. Supports may be arranged such that they provide minimum support at intervals between 0.15m and 0.7m (e.g., between approximately 0.2m and 0.5m, between approximately 0.25m and 0.5m, etc.). This spacing between supports may be adjusted based on the characteristics of the telescopic device (e.g., based on its size, flexibility, etc., and therefore how much support it may require). The distance between supports may change as the device is operated, for example, when the telescopic device is inserted / removed.

[0166] Figure 18A An example of a device including multiple supports is shown, which can be deployed during linkage movement to support a telescopic device (not shown). Figure 18A The device includes four supports 1830, 1831, 1832, and 1833, shown in a deployment configuration. A first support (support 11830) is connected to a reciprocating member 1819 between a first link 1805 and a second link 1807. This support can be deployed when the second link 1807 and the third link 1809 extend proximally, as... Figure 18A As shown. In the deployment configuration, the placement area of ​​the first link is aligned with the insertion and / or movement direction of the link assembly. Otherwise, the support member, including the arm coupled to the placement area, can rotate downwards and away from the plane of motion of the link. As the second and third links extend proximally, a biasing mechanism (e.g., a spring, elastic element, etc.) can drive the support member upwards and into the plane of motion. In some cases, the first support member can be coupled to a reciprocating member via a biased pivot joint, and one or more cam surfaces can be used to drive the support member away from the plane of motion (e.g., causing the support member to rotate downwards and away from the link and mounting member holding the telescopic device). Thus, the first support member 1830 includes a pre-deployment configuration in which the arm region causes the placement area to rotate downwards and away from the link assembly and mounting member. As described above, when the link assembly is fully (or in some cases partially) retracted proximally (e.g., from the pre-deployment configuration to the deployment configuration), the first support member can be driven by a biasing device that drives the placement area into the plane of motion.

[0167] Figure 18AThe second support member 1831 can be connected to the second link 1807 on the lower region of the distal end of the second link. The second support member also includes an arm region or portion and a placement region, the arm region or portion being connected to the placement region. The second support member can be connected to the second link at a first end; the placement region can be at and / or extend from the second end of the arm region. The arm region of the second support member 1831 extends laterally from the second link to position the placement region in the plane of motion (and align with the insertion / movement direction of the link assembly). Figure 18A In this configuration, the second support member 1831 can also be pivotally connected to the linkage assembly, for example, to the second link 1807, such that it has a first (e.g., pre-deployed) configuration and a second (e.g., deployed) configuration. In the first (e.g., pre-deployed) configuration, the second support member 1831 rotates downward and away from the plane of motion of the linkage assembly. In the second (e.g., deployed) configuration, the second support member rotates upward such that the placement area is within the plane of motion of the linkage assembly. Figure 18B As shown. In some cases, the device may include a biasing device that tends to drive the second support member from a pre-deployment configuration to a deployment configuration. The biasing device may be a spring and / or an elastomeric material.

[0168] exist Figure 18A In this embodiment, the third support 1832 also includes an arm region that is coupled to the second end of the third arm. The arm of the third support includes an extended length and is configured to extend a distance (e.g., between about 0.1 and 0.5 m, 0.2 and 4 m, etc.) from the proximal end of the first link 1805. The third support is movably coupled to the first link 1808 of the linkage assembly, allowing the third support to move into and out of the plane of motion of the linkage assembly. In 18A, a third support is shown where the seating region of the third support 1832 is located in the plane of motion of the linkage assembly and is aligned with the seating regions of other supports, such that when the telescopic device is inserted or retracted, these seating regions can support the telescopic device in a straight line extending from the mounting member. The elongated length of the support (e.g., an elongated body) can have a curved or bent shape. For example, in… Figure 18AIn this configuration, the extended length of the third support member 1832 has a bend, such that in the deployed configuration, the third support member 1832 moves both slightly downward (e.g., between 3 and 20 cm, between 3 and 12 cm, between 3 and 10 cm, less than 10 cm, etc.) and laterally clockwise away from the plane of motion of the linkage assembly, so that the third support member 1832 does not interfere with the linkage assembly or the bed / table (e.g., wheelchair) on which the patient is located. The connection between the elongated body of the third support member and the first link of the linkage assembly can be configured with one or more cam surfaces that guide the movement of the support member between the deployed and deployed configurations. In some cases, a biasing device can be arranged to drive the third support member to the deployed configuration (or from the deployed configuration to the deployed configuration). The third support member can also have a pre-deployment configuration in which the arm of the third support member moves upward and out of the plane of motion of the linkage assembly, as will be described in more detail below.

[0169] Figure 18A It also includes a fourth support 1833 extending from the first link. In some cases, the fourth support may extend from the first link on an extendable arm 1836, which may extend distally or retract proximally from the first link. The extendable arm may extend and / or retract manually or automatically. The distal end of the extendable arm may be coupled to the first end of the fourth support 1833 and may include a pivoting or bending joint similar to that used in the third support. The fourth support also includes a bent or flexed arm region and a placement area (e.g., an arm region) at the second end of the arm. Figure 18A In this configuration, the fourth support arm bends such that when the first, second, and third supports are in the deployment area, the placement area is aligned with the placement areas of the first, second, and third supports. The fourth support is also configured such that when the linkage assembly advances the second and / or third links distally, the fourth support can also deflect downwards and laterally. For example, the fourth support can deflect slightly downwards (e.g., between 3 and 20 cm, between 3 and 12 cm, between 3 and 10 cm, less than 10 cm, etc.) and laterally clockwise away from the plane of motion of the linkage assembly, so that the fourth support does not interfere with the linkage assembly or the bed / table (e.g., a wheelchair) on which the patient is located. Downward deflection can be limited to avoid collision with the bed / table surface (e.g., a wheelchair). The fourth support can also be configured to have a pre-deployment configuration in which the arm of the fourth support moves upwards (e.g., vertically or nearly vertically) and out of the plane of motion of the linkage assembly, as will be described in more detail below.

[0170] Therefore, as described above, the device typically includes one or more supports movably coupled to the linkage assembly, such that the supports can move into or out of the motion plane of the linkage assembly based on the position of the linkage assembly. Each support can be operatively coupled to the linkage assembly (e.g., a link or reciprocating member), such that each support can move into and out of position according to the configuration of the linkage assembly.

[0171] Figure 18B It shows including similar Figure 18A Another example of a linkage assembly of multiple support members shown. For illustrative purposes only. Figure 18B Examples of the spacing dimensions between the supports are also shown. These dimensions are not intended to be limiting and may vary depending on the configuration of the linkage assembly and / or telescopic device, as described above. A portion of the telescopic device 1810 is in Figure 18B As shown, in practice, the telescopic device can extend all the way to and enter the body 1890 (e.g., the anus).

[0172] generally, Figures 17A to 17H and Figures 18A to 18B The support shown may include an arm area or portion that is connected to the placement area. Figure 18B In this configuration, supports 1830, 1831, 1832, and 1833 may each include an elongated and rigid arm region, which is connected at a second end to placement regions 1830', 1831', 1832', and 1833'. The placement regions may be flat or may include sides capable of holding telescopic devices (e.g., sheaths and endoscopes), such as... Figure 18B As shown. For example, the placement area can form a channel with sidewalls (e.g., an open channel). In any of these devices, the placement area can be configured to allow the telescopic device to slide relative to the placement area. In some cases, the channel can be lubricated and / or may include one or more moving surfaces (e.g., rollers, bearings, treads, etc.).

[0173] As mentioned, the seating area can be configured to accommodate sliding when the telescopic device (e.g., outer sleeve) is driven distally and / or proximally by the linkage assembly (including by the mounting element). Therefore, as used herein, “seating” refers to the ability of the telescopic assembly to be held in a dynamic (e.g., sliding) manner.

[0174] The placement area may be alternatively referred to herein as a channel. Typically, the placement area is configured to support the telescopic device even under lateral forces, preventing it from falling out. As mentioned above, in some cases, the placement area includes a sidewall region. In some cases, the placement area may include a cover or retainer that at least partially encloses the telescopic device while still allowing it to slide in / out (towards the distal / proximal side) and vice versa. Thus, in some examples, the sealing area may be configured to include a side that extends about 140 degrees or more around the side of the telescopic device when it is placed therein (e.g., 150 degrees, 160 degrees, 170 degrees, 180 degrees, etc.). In some cases, the height of the sidewall of the placement area is between 0.4 and 3 times the radius of the telescopic device, such as between about 0.5 and 2 times, or between about 0.6 and 1.5 times, etc. The inner surface of the placement area (e.g., the placement surface) can be cylindrical, for example, in some cases having an inner diameter larger than the outer diameter of the telescopic device (e.g., between 1.1 and 3 times, between 1.1 and 2 times, etc.). In some cases, the placement area can have a length between 1 mm and 10 cm, for example, between 0.5 cm and 5 cm, between 0.5 cm and 4 cm, etc.

[0175] Figures 19A to 19H An example of a device is shown, including a support member prepared for use with a telescopic device. Figure 19A In the diagram, device 1900 is shown in its initial (e.g., stored) configuration before deployment and before attachment of the telescopic device. The device includes: a linkage assembly to which multiple fluid lines have been attached; and four support members, similar to... Figures 18A to 18B The example shown. In Figure 19A In the diagram, the third support member 1932 and the fourth support member 1933 are shown in a pre-deployment configuration, in which they are arranged vertically upward and outside the plane of motion of the linkage assembly, thus providing a more compact configuration. Additionally, the linkage assembly is shown in a non-extended configuration, in which the inner and intermediate links are aligned with the outer links. In some cases, the device may include a release latch to release and lower the fourth and / or third support member, the release latch being able to pull through a spring pawl to lower the arm.

[0176] The device can be prepared for deployment by attaching telescopic devices (e.g., a sheath and an endoscope). For example, as... Figure 19B As shown, by extending the inner link 1909 in the proximal direction, the link assembly can be manually or automatically retracted proximally, as illustrated. Then, the fourth support 1933 can extend from the outer link 1905, as shown... Figure 19CAs shown. Then, both the third support 1932 and the fourth support can be moved downwards (e.g., unfolded) so that the placement area of ​​the supports is aligned with the placement areas of the first support 1930 and the second support 1931. This is in Figure 19C and Figure 19D As shown in the diagram. Telescopic devices (e.g., sheaths and endoscopes) can then be attached, as in... Figure 19E and Figure 19F As shown. In Figure 19E In this configuration, the telescopic device is attached, the outer sleeve is connected to the outer sleeve mounting at its proximal end, and the elongated rigid body 1912 of the outer sleeve is supported within the placement area of ​​the supports 1930, 1931, 1932, and 1933. Figure 19F In this embodiment, the internal component of the telescopic assembly (e.g., an endoscope or an endoscope covered by a sheath (e.g., a rigid sheath)) is inserted into the body by inserting the internal component 1910 from the proximal end of the outer sheath through the lumen of the outer sheath and exiting from the distal end of the outer sheath. The proximal end of the internal component may be coupled to a mount (e.g., an endoscope mount). In this example, the internal component may initially be supported by a fourth support after installation, such as... Figure 19G As shown. In Figure 19G In the image, the entire component is shown as loaded and ready for deployment.

[0177] However, in some cases, it may be desirable to preload the device with telescopic components (e.g., sheaths and endoscopes) and then move the device to a position near the patient so that it can be aligned with the patient. Figure 19H An example is shown in which the device is pre-loaded onto the robot assembly as just described, and the supports are moved to the pre-deployment configuration by moving the third and fourth supports to the upright configuration and retracting the linkage assembly into the compact configuration. In this example, the telescopic assembly may be secured by one or more hooks or other areas on the mount until a trolley including the device can be positioned near the patient and used to control the operation of the device.

[0178] When loading the device, the user can decide how far the system should be retracted. For example, in some cases, the fourth support does not need to be lowered into place, and only the third support arm needs to be lowered for loading. This may depend on the size of the room being used.

[0179] Figures 20A to 20I This shows the effect after the outer tube and endoscope are installed. Figures 19A to 19H The operation of the device. Figure 20A An apparatus prepared for use with a patient (e.g., on a wheelchair) is shown, allowing the apparatus to be aligned with the patient. The apparatus can be positioned close to the wheelchair and the patient, initially with the cannula / endoscope in place. Figure 19HThe tiered pre-deployment configuration is shown. Once the patient is in place, the device can be inserted into the patient and operated to advance and retract robotically (or optionally manually), including steering.

[0180] As described below, in any of these methods and apparatuses, an alignment component (e.g., a laser) integrated with the apparatus can be used to align the apparatus, for example, to align it with the insertion axis of the apparatus. Figures 20B to 20C In this process, the device is inserted into the patient's body and can be retracted from the proximal position by retracting the linkage assembly's link (e.g., ...). Figure 20C (As shown) Move to a more distal position as shown in the figure to advance (both the outer tube and the endoscope). As the link is moved proximally, the elongated body of the outer tube 1912 (and the endoscope within the outer tube) slides distally within the support placement area. Figures 20A to 20B In the process, as the first support member 1930 advances distally, the first support member 1930 deflects downward and moves away from the linkage assembly. Similarly, as the linkage assembly advances further distally, in Figures 20C to 20D In the middle, the second support member 1931 deflects downward and away from the linkage assembly. Further advancement of the linkage assembly, and thus the outer tube / endoscope (telescopic device) distalizes, causing the third support member 1932 to deflect downward (as...). Figure 20E As shown), then lateral deflection (as shown) Figure 20F As shown in the figure, this ensures that the support does not interfere with the propulsion of the linkage assembly and the telescopic device.

[0181] Figure 20G The linkage assembly is shown to extend the outer cannula / endoscope further distally until the linkage assembly approaches the fourth support 1933, as shown. Figure 20H and Figure 20I This causes the fourth support to be driven slightly downwards without contacting the table / bed, and then deflected laterally, as... Figure 20IAs shown. When the device is retracted proximally, the same steps can be repeated in reverse, allowing the fourth support to move laterally back and rotate upwards back, so that the support placement area is aligned with the insertion / retraction axis of the outer cannula / endoscope. Subsequently, the third support moves laterally back and rotates upwards back, so that the support placement area is aligned with the insertion / retraction axis of the outer cannula / endoscope. Then, the second support rotates upwards back, so that the support placement area is aligned with the insertion / retraction axis of the outer cannula / endoscope, and the first support rotates upwards back, so that the support placement area is aligned with the insertion / retraction axis of the outer cannula / endoscope. This process can be performed robotically, by one or more actuators of the drive linkage assembly as described above, and / or during manual or manual overdrive procedures. At any point during insertion and / or retraction, the endoscope can be moved separately from the outer cannula by moving the corresponding mounting (and conversely, the outer cannula can be moved separately from the endoscope by moving the corresponding mounting).

[0182] As described above, any of these devices may include a pre-deployment configuration in which one or more supports are moved out of the plane of motion of the linkage assembly. Figure 21A and Figure 21B Top and front views of an apparatus including a linkage assembly with four supports, including supports (e.g., third support 1932 and fourth support 1933) configured to fold in a pre-deployment configuration, are shown respectively. In the pre-deployment configuration, the third support 1932 and / or the fourth support 1933 includes hooks or other attachments 2138 configured to hold a looped telescopic device (e.g., an outer cannula / endoscope) in a tiered pre-deployment configuration. Figure 21B Hook 2138 is shown on the fourth support member, but the hook may optionally be on the third support member. Additionally, the second support member 1931 also includes an attachment 2139, shown as an adjacent placement area for holding the telescopic device (attachment 2139 may be referred to as the end bag of the grading device). Figure 19H China and in Figure 22 The diagram shows a tiered pre-deployment configuration with telescopic devices.

[0183] exist Figure 22 In the diagram, telescopic device 2212 is shown as a telescopic assembly in a pre-loaded and stored configuration, ready for deployment. As described above, this keeps the telescopic assembly ready for deployment, allowing the entire device, including the linkage assembly and the outer cannula / endoscope, to be positioned proximal to the patient for deployment. After positioning, supports 1932, 1933 can be accessed from... Figure 22 The storage position shown is moved downwards so that the placement areas 1932' and 1933' are collinear with the insertion / retraction axis.

[0184] Figure 22 This is a rear view showing the attachment between the first link and the support member and linkage assembly; the fourth support member 1933 is connected to an extendable arm extending from the first link. Figure 22 and Figure 23 In the storage configuration shown, the extendable arm retracts into the linkage assembly and is not visible. Connections for the fourth support 1933 and / or the third support 1932 may include latches (e.g., support release latches) 2346. In some cases, such as attachments for the third support, the attachment may be held by a biasing device or other mechanical and / or electromagnetic retainer to prevent accidental deployment. For example, in Figure 23 In the process, the attachment of the third support to the linkage assembly includes a spring ball pawl 2347 to prevent accidental deployment; to deploy the support, the user can apply force to overcome the stop and rotate the support so that the placement area is aligned with the deployment axis.

[0185] Any device described herein may include alignment guides to aid in aligning the robot's insertion axis with the patient, for example, with an insertion area on the patient's body (e.g., the patient's anus / rectum). For example, any of these devices may include an optical aiming device (e.g., a laser aiming device, an LED aiming device, etc.) configured to aim at linkage assemblies, such as an internal link / third link, one of the supports, or a mounting component (e.g., an endoscope mounting component, a sheath mounting component, etc.). In some cases, the optical aiming device is a low-power (e.g., Class I) visible light laser (e.g., red, blue, white, etc.) that projects a beam of light indicating where the insertion axis of the device will contact the patient. The optical aiming device may be configured to move into and / or out of the insertion axis. When, for example, setting up the device from a pre-deployment configuration, the optical aiming device may move relative to the insertion axis (or may be automatically positioned). In some cases, this may displace the pre-device telescopic assembly of the sheath / endoscope. In some cases, the optical aiming device may be used prior to coupling the telescopic sheath / endoscope.

[0186] Figure 24An example of a device including an optical aiming device 2452 is shown, in which the optical aiming device 2452 is coupled to a second support 2431. The second support is configured such that it can be moved manually or automatically, for example, pivoting, so that the cannula / endoscope is displaced and the optical aiming device is moved into the insertion axis. For example, the second support may include a pivot 2454 that allows the second support to move the placement area of ​​the pre-installed telescopic device (e.g., cannula / endoscope) into or out of the insertion axis, such that light 2450 (e.g., a laser) is emitted as a beam that indicates the position in contact with the insertion axis, for example, on the patient's body. For example, the optical aiming device can be moved into place and used to align the device. In some cases, the projected light can be projected as an image of, for example, a crosshair. The device can be configured to manually or automatically (or semi-automatically) confirm the entry point for aiming at the patient. Once the aiming is confirmed, the base of the device (which may be movable) can be locked in place, and the optical aiming device (e.g., a laser) can be turned off and removed from the insertion axis so that the optical aiming device does not interfere with the outer cannula / endoscope.

[0187] In some cases, the device (e.g., an optical sight) can be configured to provide range data, and the system can determine whether the distance from the patient is sufficient or insufficient (e.g., and the device should be moved closer to / further away from the patient).

[0188] At the end of the procedure, the nested telescopic device (e.g., outer tube / endoscope) can be removed, and the support members can be wiped clean along with the rest of the system, and the support members (e.g., the third and fourth support arms) can be retracted vertically, as described above.

[0189] It should be understood that all combinations of the foregoing concepts and other concepts discussed in more detail below (provided that such concepts do not contradict each other) are contemplated as part of the inventive subject matter disclosed herein and can be used to achieve the benefits described herein.

[0190] The process parameters and order of the steps described and / or illustrated herein are given by way of example only and may vary as needed. For example, while the steps shown and / or described herein may be shown or discussed in a particular order, these steps do not necessarily need to be performed in the order shown or discussed. The various example methods described and / or illustrated herein may also omit one or more of the steps described or illustrated herein, or include additional steps beyond those disclosed.

[0191] Any method described herein (including a user interface) can be implemented as software, hardware, or firmware, and can be described as a non-transitory computer-readable storage medium storing a set of instructions executable by a processor (e.g., a computer, tablet, smartphone, etc.), which, when executed by the processor, causes the processor to control the execution of any steps, including but not limited to: displaying, communicating with the user, analyzing, modifying parameters (including timing, frequency, intensity, etc.), determining, issuing reminders, etc. For example, any method described herein can be executed at least in part by a device including one or more processors having a memory storing a set of instructions for the procedures of the method.

[0192] When a feature or element is described herein as "on another feature or element," it may be directly on the other feature or element, or there may be intermediate features or elements present. Conversely, when a feature or element is described as "directly on another feature or element," no intermediate features or elements are present. It should be understood that when a feature or element is described as "connected," "attached," or "joined" to another feature or element, it may be directly connected, attached, or joined to the other feature or element, or there may be intermediate features or elements present. Conversely, when a feature or element is described as "directly connected," "directly attached," or "directly joined" to another feature or element, no intermediate features or elements are present. Although described or illustrated with respect to one embodiment, the features and elements thus described or illustrated can be applied to other embodiments. Those skilled in the art will understand that a structure or feature referring to being "adjacent" to another feature may have portions overlapping with or below the adjacent feature.

[0193] The terminology used herein is for the purpose of describing particular embodiments only and is not intended to limit the invention. For example, unless the context clearly indicates otherwise, the singular forms “a,” “an,” and “the” as used herein are intended to include the plural forms as well. It should also be understood that the terms “comprises” and / or “comprising,” when used in this specification, specify the presence of stated features, steps, operations, elements, and / or components, but do not exclude the presence or addition of one or more other features, steps, operations, elements, components, and / or groups thereof. As used herein, the term “and / or” includes any and all combinations of one or more of the associated listed items and may be abbreviated as “ / .”

[0194] Spatial terms such as “under,” “below,” “lower,” “over,” and “upper” may be used herein to describe the relationship of one element or feature as shown in the accompanying drawings to one or more other elements or features. It should be understood that spatial terms are intended to encompass different orientations of the device in use or operation, in addition to those depicted in the drawings. For example, if the device in the drawings is reversed, an element described as “below” or “beneath” would be oriented “over”. Thus, the exemplary term “below” can encompass both orientations above and below. The device may be otherwise oriented (rotated 90 degrees or otherwise), and the spatial terms used herein are interpreted accordingly. Similarly, unless otherwise specifically stated, terms such as “upwardly,” “downwardly,” “vertical,” and “horizontal” are used herein for illustrative purposes only.

[0195] While the terms "first" and "second" may be used herein to describe various features / elements (including steps), these features / elements should not be limited by these terms unless the context otherwise requires. These terms may be used to distinguish one feature / element from another. Therefore, without departing from the teachings of the invention, the first feature / element discussed below may be referred to as the second feature / element, and similarly, the second feature / element discussed below may be referred to as the first feature / element.

[0196] In this specification and the appended claims, unless the context otherwise requires, the term "comprise" and its variations such as "comprises" and "comprising" mean that various components may be used together in methods and articles of manufacture (e.g., compositions and apparatuses and methods including devices). For example, the term "comprising" will be understood to imply the inclusion of any of the stated elements or steps, but does not exclude any other elements or steps.

[0197] Generally, any apparatus and method described herein should be understood as inclusive, but all or a subset of the components and / or steps may instead be exclusive and may be expressed as “consisting of various components, steps, sub-components or sub-steps” or alternatively “consisting substantially of various components, steps, sub-components or sub-steps”.

[0198] As used herein in the specification and claims, including in the examples, and unless otherwise expressly stated, all figures may be read as if they begin with the words “about” or “approximately,” even if the term is not explicitly stated. The phrase “about” or “approximately” may be used when describing values ​​and / or locations to indicate that the described value and / or location is within a reasonably expected range of value and / or location. For example, numerical values ​​may have values ​​of + / - 0.1% of the stated value (or range of values), + / - 1% of the stated value (or range of values), + / - 2% of the stated value (or range of values), + / - 5% of the stated value (or range of values), + / - 10% of the stated value (or range of values), etc. Any numerical value given herein should also be understood to include about or approximately that value, unless the context otherwise requires. For example, if the value “10” is disclosed, then “about 10” is also disclosed. Any numerical ranges listed herein are intended to include all subranges contained therein. It should also be understood that, as those skilled in the art will properly understand, when a value is disclosed, "less than or equal to" that value, "greater than or equal to" that value, and possible ranges between the value are also disclosed. For example, if the value "X" is disclosed, then "less than or equal to X" and "greater than or equal to X" (e.g., where X is a numerical value) are also disclosed. It should also be understood that throughout the application, data is provided in a variety of different formats, and this data represents the endpoints and starting points, as well as the range, of any combination of data points. For example, if specific data point "10" and specific data point "15" are disclosed, it should be understood that greater than, greater than or equal to, less than, less than or equal to, and equal to 10 and 15, as well as between 10 and 15, are considered disclosed. It should also be understood that each unit between two specific units is also disclosed. For example, if 10 and 15 are disclosed, then 11, 12, 13, and 14 are also disclosed.

[0199] While various illustrative embodiments have been described above, any of several changes may be made to the various embodiments without departing from the scope of the invention as described in the claims. For example, in alternative embodiments, the order in which the various described method steps are performed may typically be changed, and in other alternative embodiments, one or more method steps may be skipped together. Optional features of the various device and system embodiments may be included in some embodiments but not in others. Therefore, the foregoing description is provided primarily for illustrative purposes and should not be construed as limiting the scope of the invention as set forth in the claims.

[0200] The examples and illustrations included herein are shown by way of illustration, not limitation, of specific embodiments in which the subject matter can be practiced. As mentioned, other embodiments can be utilized and derived therefrom, allowing for structural and logical substitutions and changes without departing from the scope of this disclosure. For convenience only, such embodiments of the inventive subject matter may be referred to herein individually or collectively by the term "invention," and if actually more than one is disclosed, it is not intended to actively limit the scope of this application to any single invention or inventive concept. Thus, while specific embodiments have been illustrated and described herein, any arrangement considered to achieve the same purpose may replace the specific embodiments shown. This disclosure is intended to cover any and all modifications or variations of the various embodiments. After reading the above description, those skilled in the art will understand the combinations of the above embodiments and other embodiments not specifically described herein.

Claims

1. An apparatus for deploying a flexible tubular member, the apparatus comprising: Base; A vertically arranged linkage assembly connected to the base, comprising: a plurality of links vertically adjacent to each other, wherein adjacent links are slidably connected together by a pair of opposing flexible belts extending in opposite directions around one or more surfaces of a reciprocating element, wherein the reciprocating element pairs between adjacent links are connected together on a timing belt; A linear actuator, the linear actuator being coupled to a first reciprocating motion member in one of the plurality of pairs of reciprocating motion members; and Mounting components are connected to the vertically arranged link assembly, wherein the mounting components are configured to be connected to the flexible tubular member.

2. The apparatus according to claim 1, wherein, The timing belt is configured to cause the first reciprocating member to move in the opposite direction to the second reciprocating member.

3. The apparatus according to any one of claims 1-2, wherein, The first end of the first band in the opposing bands is connected to the distal end region of the first link in the adjacent link pair and the distal end region of the second link in the adjacent link pair, and wherein the first end of the second band in the opposing bands is connected to the proximal end region of the first link in the adjacent link pair and the proximal end region of the second link in the adjacent link pair.

4. The apparatus according to any one of claims 1-3, wherein, The flexible strip includes a flat strip.

5. The apparatus according to any one of claims 1-4, wherein, The flexible strip includes a metal strip.

6. The apparatus according to any one of claims 1-5, wherein, Each of the plurality of links has a vertical height greater than its width and less than the length from the far side to the near side.

7. The apparatus according to any one of claims 1-6, wherein, Each of the plurality of links has a vertical height that is less than the length from the far side to the near side and is at least twice the width.

8. The apparatus according to any one of claims 1-7, wherein, The cylindrical surface includes a pulley.

9. The apparatus according to any one of claims 1-8, wherein, The mounting assembly is connected to the outer link of the plurality of links of the vertically arranged link assembly.

10. The apparatus according to any one of claims 1-9, further comprising a vertical lifting arm having a vertical axis for connecting the vertically arranged link assembly to the base, wherein the vertical lifting arm is configured to raise and lower the vertically arranged link assembly relative to the base.

11. The apparatus according to any one of claims 1-10, further comprising a yaw adjustment member between the vertically arranged link assembly and the base, wherein the yaw adjustment member is configured to pivotally yaw the vertically arranged link assembly about the base.

12. The apparatus according to any one of claims 1-11, wherein, The mounting assembly is configured to connect to the flexible tubular member, which includes a nested robotic device having an outer tube in which an internal endoscope is nested.

13. The apparatus according to claim 12, wherein, The mounting assembly includes an outer tube mount and an endoscope mount, wherein the endoscope mount is configured to move proximally and / or distally relative to the outer tube mount.

14. The apparatus according to any one of claims 1-13, wherein, The linear drive includes a ball screw nut assembly.

15. The apparatus according to any one of claims 1-14, wherein, The linear actuator is housed within the first link of the plurality of links.

16. The apparatus according to any one of claims 1-15, further comprising a controller configured to control the linear actuator to move one of the plurality of links distally and proximally relative to the base, thereby controlling the operation of the linear actuator.

17. The apparatus according to any one of claims 1-16, further comprising a flexible tubular member support, the flexible tubular member support being coupled to the vertically arranged link assembly and configured to prevent the flexible tubular member from buckling as it extends distally from the vertically arranged link assembly.

18. The apparatus according to any one of claims 1-17, wherein, The mounting assembly is located below the top of the vertically arranged link assembly.

19. The apparatus according to any one of claims 1-18, further comprising a tool driver coupled to the vertically arranged linkage assembly and configured to actuate a tool within the working channel of the flexible tubular member.

20. The apparatus according to any one of claims 1-19, further comprising one or more sensors configured to detect one or more operating parameters of the apparatus.

21. The apparatus according to any one of claims 1-20, further comprising one or more load sensors configured to detect loads applied between the vertically arranged linkage assembly and the patient.

22. The apparatus according to claim 21, wherein, The one or more load sensors include current sensors configured to detect the current of the linear drive.

23. The apparatus according to any one of claims 1-22, wherein, The mounting assembly of the vertically arranged linkage assembly is directly or via one or more arms connected to the base.

24. An apparatus for deploying a flexible tubular member, the apparatus comprising: - Base; - A vertically arranged link assembly, the vertically arranged link assembly being connected to the base and comprising: -- A first link, a second link, and a third link, wherein the first link, the second link, and the third link are vertically adjacent to each other; -- A first reciprocating motion member and a second reciprocating motion member, the first reciprocating motion member being between a first link and a second link, the second reciprocating motion member being between a second link and a third link, wherein the first reciprocating motion member is movably connected between the first link and the second link, and the second reciprocating motion member is movably connected between the second link and the third link, such that the second link and the third link can slide distally and proximally relative to the first link, and wherein the first reciprocating motion member includes a first vertical cylindrical surface, and the second reciprocating motion member includes a second vertical cylindrical surface; -- A linear driver, the linear driver being coupled to the first reciprocating motion member; -- A first flexible strip, which is located between the first link and the second link, extends from the first end region of the first link, around the first vertical cylindrical surface, and extends to the first end region of the second link; -- A second flexible strip, located between the second link and the third link, extends from the first end region of the second link, around the second vertical cylindrical surface, and extends to the first end region of the third link, whereby a linear actuator causes proximal and / or distal movement of the second link relative to the first link, resulting in proximal and / or distal movement of the third link; and - An installation assembly connected to the vertically arranged link assembly, wherein the installation assembly is configured to be connected to the flexible tubular member.

25. The device of claim 24, further comprising a timing belt coupled to the first reciprocating member and the second reciprocating member, and configured to move the first reciprocating member relative to the second reciprocating member.

26. The apparatus according to any one of claims 24-25, further comprising: A third flexible strip is located between the first link and the second link. The third flexible strip extends from the second end region of the first link, bypasses the first vertical cylindrical surface, and extends to the second end region of the second link. A fourth flexible strip is located between the second link and the third link. The fourth flexible strip extends from the second end region of the second link, passes around the second vertical cylindrical surface, and extends to the second end region of the third link.

27. The apparatus according to any one of claims 24-26, wherein, The first flexible strip and the second flexible strip each include a flat strip.

28. The apparatus according to any one of claims 24-27, wherein, The first flexible strip and the second flexible strip each comprise a metal strip.

29. The apparatus according to any one of claims 24 to 28, wherein, The motion of the linear actuator is transmitted to the third link in a ratio of 4:1 or greater.

30. The apparatus according to any one of claims 24-29, wherein, The first link, the second link, and the third link each have a vertical height greater than the width and less than the length from the far side to the near side.

31. The apparatus according to any one of claims 24 to 30, wherein, The first link, the second link, and the third link each have a vertical height that is less than the length from the far side to the near side and is at least twice the width.

32. The apparatus according to any one of claims 24-31, wherein, The first vertical cylindrical surface and the second vertical cylindrical surface include pulleys.

33. The apparatus according to any one of claims 24-32, wherein, The mounting assembly is connected to the third link of the vertically arranged link assembly.

34. The apparatus according to any one of claims 24-33, further comprising a vertical lifting arm having a vertical axis and connecting the vertically arranged link assembly to the base, wherein the vertical lifting arm is configured to raise and lower the vertically arranged link assembly relative to the base.

35. The apparatus according to any one of claims 24-34, further comprising a yaw adjustment member between the vertically arranged link assembly and the base, wherein the yaw adjustment member is configured to yaw the vertically arranged link assembly relative to the base.

36. The apparatus according to any one of claims 23-35, wherein, The mounting assembly is configured to connect to a flexible tubular member, the flexible tubular member including a nested robotic device having an outer tube in which an internal endoscope is nested.

37. The apparatus according to claim 36, wherein, The mounting assembly includes an outer tube mount and an endoscope mount, wherein the endoscope mount is configured to move proximally and / or distally relative to the outer tube mount.

38. The apparatus according to any one of claims 24-37, wherein, The linear drive includes a ball screw nut assembly.

39. The apparatus according to any one of claims 24-38, wherein, The linear actuator is housed within the first link.

40. The apparatus according to any one of claims 24-39, further comprising a controller configured to control the linear drive by controlling the operation of the linear drive to move the third link relative to the first link.

41. The apparatus according to any one of claims 24-40, further comprising a flexible tubular member support, the flexible tubular member support being coupled to the vertically arranged link assembly and configured to prevent the flexible tubular member from buckling as it extends distally from the vertically arranged link assembly.

42. The apparatus according to any one of claims 24-41, wherein, The mounting assembly is located below the top of the vertically arranged link assembly.

43. The apparatus according to any one of claims 24-42, further comprising a tool driver coupled to the vertically arranged linkage assembly and configured to actuate a tool within the working channel of the flexible tubular member.

44. The apparatus according to any one of claims 24-43, further comprising one or more sensors configured to detect one or more operating parameters of the apparatus.

45. The apparatus of any one of claims 24 to 44, further comprising one or more load sensors configured to detect a load applied to the vertically arranged linkage assembly between the vertically arranged linkage assembly and the patient.

46. ​​The apparatus according to claim 35, wherein, The one or more load sensors include current sensors configured to detect the current of the linear drive.

47. The apparatus according to any one of claims 24 to 46, wherein, The vertically arranged link assembly also includes one or more additional links that are vertically adjacent to the first link, the second link, and the third link.

48. The apparatus according to any one of claims 24-47, wherein, The mounting assembly of the vertically arranged linkage assembly is directly or via one or more arms connected to the base.

49. An apparatus for deploying a nested robotic device, the nested robotic device having an inner rigidifying member at least partially slidably disposed within an outer rigidifying member, the apparatus comprising: - Base; - A vertically arranged link assembly, the vertically arranged link assembly being connected to the base and comprising: -- A first link, a second link, and a third link, wherein the first link, the second link, and the third link are vertically adjacent to each other; -- A first reciprocating motion member and a second reciprocating motion member, the first reciprocating motion member being between a first link and a second link, the second reciprocating motion member being between a second link and a third link, wherein the first reciprocating motion member is movably connected between the first link and the second link, and the second reciprocating motion member is movably connected between the second link and the third link, such that the second link and the third link can slide distally and proximally relative to the first link, and wherein the first reciprocating motion member includes a first vertical cylindrical surface, and the second reciprocating motion member includes a second vertical cylindrical surface; -- A linear driver, the linear driver being coupled to the first reciprocating motion member; -- A first flexible strip, which is located between the first link and the second link, extends from the first end region of the first link, around the first vertical cylindrical surface, and extends to the first end region of the second link; -- A second flexible strip, located between the second link and the third link, extends from the first end region of the second link, around the second vertical cylindrical surface, and extends to the first end region of the third link, whereby the linear actuator causes proximal and / or distal movement of the second link relative to the first link, resulting in proximal and / or distal movement of the third link; and - Installation components, the installation components including: -- A first mounting area, the first mounting area being connected to the third link of the vertically arranged link assembly, wherein the first mounting area is configured to be connected to the external rigidification device; and -- A second mounting area, which is linearly movable relative to the first mounting area in both proximal and distal directions, and is configured to be coupled to the internal rigidification device.

50. An apparatus for deploying a flexible tubular member, the apparatus comprising: Base; A telescopic linkage assembly connected to the base and comprising a plurality of links adjacent to each other, wherein adjacent links are slidably connected together, wherein the plurality of links are configured to extend from a compact configuration; A linear actuator configured to drive movement of the link in the telescopic linkage assembly; and Mounting assembly, which is coupled to the linkage assembly, wherein the mounting assembly is configured to be coupled to the flexible tubular member.

51. The apparatus according to claim 50, wherein, The plurality of links are configured to extend from the compact configuration to a length of 0.6m or longer.

52. The apparatus according to claim 50, wherein, The length of the compact configuration is 50% or less of the length of the fully extended configuration.

53. The apparatus according to claim 50, wherein, The telescopic linkage assembly is bidirectional, and the compact configuration is a neutral configuration, allowing the plurality of links to extend distally from the neutral configuration to a length of 0.6m or longer, or proximally from the neutral configuration to a length of 0.6m or longer.

54. The apparatus according to claim 50, wherein, The plurality of links are vertically adjacent to each other.

55. The apparatus of claim 50, further comprising one or more synchronizing members coupled to each of the plurality of links, the one or more synchronizing members being configured to coordinate the movement of all the links when a force is applied to one of the links.

56. The apparatus according to claim 50, wherein, The mounting assembly includes an outer tube mount and an endoscope mount, wherein the endoscope mount is configured to move proximally and / or distally relative to the outer tube mount.

57. The apparatus according to claim 50, wherein, The linkage assembly is configured to extend from the compact configuration to a length of 1m or longer.

58. The apparatus according to claim 50, wherein, The vertical distance from the mounting assembly to the lowest surface of the link assembly is less than 20 cm.

59. The apparatus according to claim 50, wherein, The plurality of links are configured such that adjacent links are slidably connected together by a pair of opposing flexible bands that extend in opposite directions around one or more surfaces of the reciprocating member.

60. The apparatus of claim 59 further comprises a pair of reciprocating motion elements connected together on a timing belt between adjacent links of an adjacent link pair.

61. An apparatus for deploying a flexible tubular member, the apparatus comprising: Base; A bidirectional telescopic linkage assembly connected to the base, comprising: a plurality of adjacent links, wherein adjacent links are slidably connected together, wherein the plurality of links are configured to extend from a compact neutral configuration to a proximal extension configuration and from the compact neutral configuration to a distal extension configuration, wherein the length of the compact neutral configuration is 50% or less of the length of the proximal extension configuration and 50% or less of the length of the distal extension configuration; A linear actuator, configured to drive movement of the link in the telescopic linkage assembly; and Mounting assembly, which is coupled to the linkage assembly, wherein the mounting assembly is configured to be coupled to the flexible tubular member.

62. The apparatus according to claim 61, wherein, The plurality of links are vertically adjacent to each other.

63. The apparatus of claim 61, further comprising one or more synchronizing members coupled to each of the plurality of links, the one or more synchronizing members being configured to coordinate the movement of all the links when a force is applied to one of the links.

64. The apparatus according to claim 61, wherein, The mounting assembly includes an outer tube mount and an endoscope mount, wherein the endoscope mount is configured to move proximally and / or distally relative to the outer tube mount.

65. The apparatus according to claim 61, wherein, The linkage assembly is configured to extend from the compact configuration to a length of 1m or longer.

66. The apparatus according to claim 61, wherein, The vertical distance from the mounting assembly to the lowest surface of the link assembly is less than 20 cm.

67. The apparatus according to claim 61, wherein, The plurality of links are configured such that adjacent link pairs are slidably connected together by ball screw nut assemblies.

68. The apparatus according to claim 61, wherein, The plurality of links are configured such that adjacent links are slidably connected together by a pair of opposing flexible bands that extend in opposite directions around one or more surfaces of the reciprocating member.

69. The apparatus of claim 68 further comprises a pair of reciprocating motion members connected together on a timing belt between adjacent links of an adjacent link pair.

70. A method of deploying an endoscope nested within an outer cannula, the method comprising: The outer tube and / or endoscope are advanced and / or retracted together by moving a first link of a bidirectional telescopic linkage assembly, wherein the outer tube is coupled to an outer tube mount on the first link, and wherein the endoscope is coupled to an endoscope mount on the first link, and wherein the bidirectional linkage assembly includes a plurality of links, the plurality of links including the first link, the plurality of links being slidably connected together and adjacent to each other, and wherein advancing the outer tube includes extending the plurality of links from a compact neutral configuration to a distal extension configuration, and wherein retracting the outer tube includes retracting the plurality of links from the compact neutral configuration to a proximal extension configuration, wherein the length of the compact neutral configuration is 50% or less of the length of the proximal extension configuration and 50% or less of the length of the distal extension configuration; and By changing the relative positions of the endoscope mounting component and the outer tube mounting component on the first connecting rod, the endoscope can be moved distally into or out of the outer tube.

71. The method according to claim 70, wherein, Extending the plurality of links includes using a linear actuator to drive the movement of the links of the telescopic link assembly.

72. The method of claim 70, further comprising: Connect the outer tube to the outer tube mounting component.

73. The method of claim 70, further comprising connecting the endoscope nested within the outer sleeve to the endoscope mounting member.

74. A method of deploying an endoscope nested within an outer cannula, the method comprising: The outer tube and / or endoscope are advanced and / or retracted together by moving a first link of a bidirectional telescopic linkage assembly, wherein the outer tube is coupled to an outer tube mount on the first link, and wherein the endoscope is coupled to an endoscope mount on the first link, and wherein the bidirectional linkage assembly includes a plurality of links including the first link, the plurality of links being slidably connected together and adjacent to each other, and wherein advancing the outer tube includes extending the plurality of links from a compact neutral configuration to a distal extension configuration, and wherein retracting the outer tube includes retracting the plurality of links from the compact neutral configuration to a proximal extension configuration, wherein the length of the compact neutral configuration is 50% or less of the length of the proximal extension configuration and 50% or less of the length of the distal extension configuration; and By changing the relative positions of the endoscope mounting component and the outer tube mounting component on the first connecting rod, the endoscope can be moved distally into or out of the outer tube.

75. The method according to claim 74, wherein, Extending the plurality of links includes using a linear actuator to extend the plurality of links to drive movement of the links of the telescopic link assembly.

76. The method of claim 74, further comprising: Connect the outer tube to the outer tube mounting component.

77. The method of claim 74, further comprising connecting the endoscope nested within the outer sleeve to the endoscope mount.

78. An apparatus comprising: A telescopic linkage assembly comprising: a plurality of vertical links adjacent to each other, wherein the adjacent vertical links are slidably connected together and configured to move relative to each other and relative to a base link; A first mounting member is connected to a first link of the link assembly, wherein the first mounting member is configured to engage an outer sleeve. A second mounting element, coupled to the first link and configured to engage an endoscope nested within the outer sleeve, wherein the outer sleeve and the endoscope are configured to move in a straight line from distal to proximal by sliding the vertical link of the telescopic link assembly relative to the base link; and Multiple support members are movably connected to the telescopic linkage assembly, each of the multiple support members including a placement area configured to keep the outer sleeve and endoscope aligned with the distal-to-proximal line.

79. The apparatus according to claim 78, wherein, Each of the plurality of supports is configured to be deflected such that when the plurality of links of the telescopic linkage assembly extend distally, the placement area of ​​each support is moved out of the straight line from distal to proximal.

80. The apparatus according to claim 78, wherein, At least some of the plurality of supports are configured to deflect downward and laterally as the plurality of links of the telescopic linkage assembly extend distally.

81. The apparatus of claim 78, further comprising a linear actuator configured to drive movement of the vertical link of the telescopic linkage assembly.

82. The apparatus according to claim 78, wherein, At least one of the plurality of supports is configured to move from a deployment configuration to a pre-deployment configuration, wherein in the deployment configuration, the placement area of ​​the support is configured to keep the outer sleeve and the endoscope aligned with the distal-to-proximal line, and in the pre-deployment configuration, the support is vertically raised beyond the plane of the distal-to-proximal line.

83. The apparatus according to claim 78, wherein, At least one of the plurality of supports is connected to an extension on the link assembly, the extension being configured to extend distally from the link assembly.

84. The apparatus according to claim 78, wherein, The first mounting member and / or the second mounting member are configured to move relative to each other on the first link to adjust the relative position of the endoscope and the outer tube.

85. An apparatus comprising: Base; A bidirectional telescopic linkage assembly connected to the base and comprising a plurality of vertical links adjacent to each other, wherein the adjacent vertical links are slidably connected together and configured to move bidirectionally relative to the base link; A linear actuator configured to drive the movement of the vertical link of the bidirectional telescopic linkage assembly; A first mounting member is connected to a first link of the link assembly, wherein the first mounting member is configured to engage an outer sleeve. A second mounting element is coupled to the first link and configured to engage an endoscope nested within the outer tube, wherein the outer tube and the endoscope are configured to move in a straight line from distal to proximal by sliding the vertical link of the bidirectional telescopic link assembly. and A plurality of support members are connected to the telescopic linkage assembly, wherein each of the plurality of support members includes a placement area configured to move between a first configuration and a second configuration, wherein in the first configuration the placement area maintains the outer sleeve and the endoscope in alignment with the distal-to-proximal line, and in the second configuration the placement area of ​​each support member is configured to move out of the distal-to-proximal line as the plurality of links of the telescopic linkage assembly extend distally.

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