Medical systems and methods of treatment

Abstract

The present disclosure provides medical systems and methods of treatment. The medical system includes a working port having an outer guide for interfacing with a treatment site, an instrument carriage having an inner guide configured to extend within the outer guide of the working port, and an instrument configured to couple to the instrument carriage and be operated via the instrument carriage. The medical system also includes a scope and a scope carriage, wherein the scope and the instrument extend through the inner guide and the outer guide to access the treatment site.

Description

Technical Field

[0001] The disclosed implementation involves a robotic medical access system. Background Technology

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

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

[0004] According to a first example, a medical system is disclosed comprising a working port for docking with a treatment position. The working port includes a proximal end, a distal end, and an external guide. The proximal end is configured to be rotatably coupled to a robotic manipulator arm. The distal end includes a tilting tip. The rotatable coupling of the proximal end allows the tilting tip of the distal end to rotate at the treatment position. The external guide extends at least partially from the distal end to the proximal end. The external guide defines an external guide channel including an external endoscope channel portion, an external instrument channel portion, and a suction portion. The external endoscope channel portion is configured to receive an endoscope, and the external instrument channel portion is configured to receive an instrument. A suction outlet is disposed at the proximal end of the working port and fluidly coupled to the suction portion of the external guide channel.

[0005] In some examples, the medical system may include one or more of the following aspects: the proximal end of the working port includes a basin-like component for fluid collection; the proximal end of the working port defines an opening that is fluidly connected to the aspiration portion for controlling pressure within the aspiration portion; the proximal end includes a magnetic coupling for connecting the working port to a robotic manipulator arm; an external guide of the working port tapers from the proximal end to the distal end such that the instrument channel portion is angled relative to the endoscope channel portion; and / or the external guide has a tapered horizontal cross-section, thereby allowing the endoscope and relatively small-diameter instruments to extend along each other.

[0006] In some examples, the medical system also includes an instrument holder comprising one or more actuators and an internal guide configured to extend within an external guide at the working port. The internal guide defines an internal guide channel including an internal endoscope channel portion for receiving an endoscope and an internal instrument channel portion for receiving an instrument.

[0007] In some examples, the instrument holder is separate from the working port. In other examples, the inner guide defines the flushing passage, and, if desired, the inner guide also includes a flushing inlet fluidly connected to the flushing passage.

[0008] In some examples, the aspiration portion of the external guide channel is defined between the internal and external guides to define the aspiration channel, and / or the internal guide tapers from the proximal end to the distal end, such that the internal instrument channel portion is tilted relative to the endoscope channel portion.

[0009] In some examples, the instrument holder and the working port are combined. In other examples, the suction portion of the outer guide channel is defined between the inner and outer guides to define the suction channel. The outer and inner guides may also define a flushing channel between them, and the suction channel may be recessed relative to the flushing channel if desired. In other examples, the inner and outer guides have a cylindrical shape (e.g., with a circular cross-section).

[0010] In some examples, the device is a first device; and the device holder also includes a second device channel for a second device, the actuators of which include a first set of actuators for the first device and a second set of actuators for the second device. In other examples, the medical system also includes a second device comprising an elongated device and a drive unit configured to engage the second set of actuators.

[0011] In some examples, the medical system also includes an endoscope and an endoscope holder, the endoscope holder being configured to allow the endoscope to move along the insertion axis and to roll about the insertion axis.

[0012] In some examples, the endoscope and endoscope holder are combined with the instrument holder. In other examples, the endoscope and endoscope holder are separate from the working port and instrument holder. In still other examples, the medical system includes a releasable locking mechanism configured to hold the endoscope and instrument holder together such that rolling of the endoscope about the insertion axis causes rolling of the working port and instrument holder about the insertion axis.

[0013] In some examples, the medical system also includes an instrument comprising a flexible, elongated device and a drive unit having drive inputs configured to engage one or more actuators of an instrument holder.

[0014] In some examples, the instrument holder includes at least one actuator, and the drive unit includes at least one drive input to insert the instrument along the insertion axis. In other examples, the instrument holder includes at least three actuators, and the drive unit includes at least three drive inputs to impart degrees of freedom to the instrument, including at least three of the following: insertion along the insertion axis, rolling about the insertion axis, pitching, yaw, or gripping. In still other examples, the length of the drive unit along the insertion axis limits the insertion depth of the instrument, at least one actuator and at least one drive input include slots and ridges for immediate engagement when the instrument is attached to the instrument holder, which provides control of the instrument without the need for repositioning, and / or at least one drive input includes at least one winch.

[0015] In some examples, the device is configured to be releasably coupled to an instrument holder. In other examples, the device includes a plurality of interchangeable devices configured to be releasably coupled to an instrument holder.

[0016] In some examples, the instrument is the Kerrisoner, which includes an internal toothed component and an external conduit.

[0017] In some examples, the medical system also includes an expander assembly comprising multiple members of increasing diameter to expand the initial incision, thereby providing access to the working port. In other examples, the expander assembly is configured to provide an inner diameter access to the working port, or the expander assembly also includes an outer sleeve to provide an outer diameter access to the working port.

[0018] In some examples, the medical system also includes a robotic manipulator arm comprising multiple links rotatably joined together by joints, the robotic manipulator arm configured to operate about a remote center defined by an inclined tip relative to the working port. In other examples, the remote center extends between approximately 2 mm and approximately 10 mm beyond the access opening within the patient's body, the endoscope holder is configured to be coupled to the robotic manipulator arm such that the robotic manipulator arm controls the movement of the endoscope, and / or the instrument holder includes a housing for one or more actuators, the housing having an inclined longitudinal edge to maintain a clearance with the robotic manipulator arm during rotation about the insertion axis.

[0019] In some examples, the medical system also includes a display and a control system, wherein the control system is configured to display images from the endoscope, wherein the instruments are held in the same position relative to the endoscope, even during rolling movements.

[0020] In other examples, the working port, instrument holder, and endoscope are the first entry components, and the medical system also includes a second entry component.

[0021] According to a second example, a medical system is disclosed that includes an instrument holder. The instrument holder includes: a proximal housing including one or more actuators; and an internal guide extending distally away from the proximal housing, the internal guide defining an endoscope channel configured to receive an endoscope, an internal instrument channel configured to receive an instrument, and a flushing channel.

[0022] In some examples, the proximal housing includes a flushing inlet port fluidly coupled to a flushing channel of an internal guide that tapers from a proximal end adjacent to the proximal housing to the opposite distal end, wherein the internal instrument channel is angled relative to the internal endoscope channel, and / or the internal guide has a tapered horizontal cross-section that allows the endoscope and relatively small-diameter instruments to extend along each other.

[0023] In some examples, the medical system also includes a working port comprising: a proximal end portion configured to be rotatably coupled to a robotic manipulator arm; a distal end portion including a tilting tip, the rotatable coupling of the proximal end portion allowing the tilting tip of the distal end portion to rotate at a treatment position; and an external guide extending at least partially from the distal end portion to the proximal end portion and defining an external guide channel, wherein an inner guide portion is configured to extend within the external guide portion of the working port.

[0024] In other examples, the outer guide and the inner guide define a suction channel between the outer guide and the inner guide, the working port includes a suction outlet fluidly coupled to the suction channel, the proximal end of the working port includes a basin-shaped element for liquid collection and defines an opening fluidly coupled to the suction channel for controlling pressure within the suction channel, and / or the inner guide and the outer guide have complementary tapered profiles.

[0025] In some examples, the medical system also includes an endoscope and an endoscope holder, the endoscope holder being configured to allow the endoscope to move along the insertion axis and to roll about the insertion axis.

[0026] In some examples, the medical system further includes: an instrument comprising an elongated device; and a drive unit having one or more drive inputs configured to engage one or more actuators of an instrument holder. In other examples, one or more actuators and one or more drive inputs include three or more actuators and drive inputs to impart degrees of freedom to the instrument, including at least three of the following: insertion along an insertion axis, rolling about the insertion axis, pitching, yaw, or grasping; the length of the drive unit along the insertion axis limits the insertion depth of the instrument; and / or one or more actuators and drive inputs include grooves and ridges for immediate engagement when the instrument is coupled to an instrument holder.

[0027] According to a third aspect, a treatment method is disclosed herein, comprising: inserting an external guide of a working port and an internal guide of an instrument holder through an access opening in the patient to position the distal end of the working port near a treatment position, the internal guide being received within an external guide channel defined by the external guide; rotatably connecting the working port to a working port mount of a robotic manipulator arm; inserting an endoscope through an endoscope channel defined by the internal guide to position the distal end of the endoscope through the instrument holder and the working port; and inserting an instrument through an instrument channel defined by the internal guide to position the distal end of the instrument at a treatment position distal to the working port.

[0028] In some examples, the treatment site is along the patient's spine and / or the method includes inserting the inner guide of the instrument holder into the outer guide channel of the outer guide.

[0029] In some examples, the method includes: flushing the treatment site through a flushing channel defined at least partially by an inner guide; and applying suction through a suction channel defined at least partially by an outer guide. In other examples, the flushing channel is defined between the inner and outer guides and / or the method includes partially retracting the instrument along the insertion axis to clean the instrument near the suction channel by the flushing flow.

[0030] In some examples, the method includes inserting multiple dilatational expander members into an access opening to provide a pathway to a treatment location for a working port. In other examples, the method includes inserting a working port onto multiple expander members to allow the working port to pass through the access opening; or the method includes inserting an outer sleeve onto multiple expander members, removing the multiple expander members, and inserting the working port into the outer sleeve to allow the working port to pass through the access opening.

[0031] In some examples, inserting an instrument through an instrument channel includes coupling a drive unit of the instrument to an instrument holder to engage one or more actuators of the instrument holder; the method includes: retracting the instrument from the instrument channel and inserting a second instrument through the instrument channel to position a second end effector of the second instrument at a treatment position distal to the working port; the method includes performing spinal decompression therapy; and / or the working port, instrument holder, robotic manipulator arm, endoscope, and instrument are a medical system; and the method includes operating the second medical system to insert a second endoscope through a second access opening for viewing the treatment position from another direction.

[0032] It should be understood that both the foregoing general description and the following detailed description are illustrative and explanatory in nature and are intended to provide an understanding of this disclosure, without limiting its scope. In this regard, additional aspects, features, and advantages of this disclosure will be apparent to those skilled in the art from the following detailed description. Attached Figure Description

[0033] Figure 1 This is a perspective view of the manipulator system based on the example described in this article.

[0034] Figure 2A This is a perspective view of a first example medical system comprising a working port, an instrument holder, instruments, an endoscope, and an endoscope holder, based on examples described herein.

[0035] Figure 2B yes Figure 2A A 3D diagram of the medical system.

[0036] Figure 2C yes Figure 2A A cross-sectional view of the working port of the medical system.

[0037] Figure 2D yes Figure 2A A three-dimensional diagram of the instrument rack of a medical system.

[0038] Figure 2E yes Figure 2A A bottom view of the working ports and instrument racks of the medical system.

[0039] Figure 2F yes Figure 2A A three-dimensional diagram of the instrument racks and instruments of the medical system.

[0040] Figure 2G yes Figure 2A A three-dimensional diagram of the instrument racks and instruments of the medical system.

[0041] Figure 2H It is used for Figure 2AA three-dimensional view of the instrument holders and connecting parts of the medical system.

[0042] Figure 2I It is used for Figure 2A A three-dimensional cross-sectional view of an example medical device.

[0043] Figure 2J This is a perspective view of a second example medical system, including a working port, instrument holder, instruments, endoscope, and endoscope holder, based on the examples described herein.

[0044] Figure 2K yes Figure 2J A 3D diagram of the medical system.

[0045] Figure 2L yes Figure 2J A cross-sectional view of the instrument holders and working ports of a medical system.

[0046] Figure 2M yes Figure 2J A bottom view of the working ports and instrument racks of the medical system.

[0047] Figure 2N It is used for Figure 2A and Figure 2J A three-dimensional diagram of the expander system of the medical system.

[0048] Figure 3 This includes examples based on those described in this article. Figure 2A or Figure 2J A schematic diagram of the control system of a medical system.

[0049] Figure 4 This is a flowchart illustrating a treatment method based on the example described in this article.

[0050] The embodiments and advantages of this disclosure are best understood by referring to the following detailed description. It should be understood that the same reference numerals are used to identify one or more of the same elements illustrated in the drawings, which are shown for illustrative purposes and not for limiting the embodiments of this disclosure. Detailed Implementation

[0051] The aspects disclosed herein may be part of a computer-aided remote-operated manipulator system (sometimes referred to as a robot-assisted manipulator system or a robot system). This manipulator system may include one or more manipulators, which may operate with the assistance of an electronic controller (e.g., a computer) to move and control the function of one or more instruments when coupled to the manipulators.

[0052] In the following description, specific details of some embodiments consistent with this disclosure are set forth. Numerous specific details are set forth to provide a comprehensive understanding of the embodiments. However, it will be apparent to those skilled in the art that some embodiments can be practiced without some or all of these specific details. The specific embodiments disclosed herein are intended to be illustrative and not restrictive. Those skilled in the art can implement other elements, although not specifically described herein, that are within the scope and spirit of this disclosure. Furthermore, to avoid unnecessary repetition, one or more features shown and described in association with one embodiment may be incorporated into other embodiments unless otherwise specifically described or if one or more features would render the embodiment inoperable. In some cases, well-known methods, processes, components, and circuits have not been described in detail to avoid unnecessarily obscuring aspects of the embodiments.

[0053] This disclosure describes various instruments and parts thereof based on their state in three-dimensional space. As used herein, the term "position" refers to the location of an object or part of an object in three-dimensional space (e.g., three translational degrees of freedom along Cartesian x, y, and z coordinates). As used herein, the term "orientation" refers to the rotational placement of an object or part of an object (e.g., one or more rotational degrees of freedom, such as roll, pitch, and yaw). As used herein, the term "pose" refers to the position of an object or part of an object in at least one translational degree of freedom and the orientation of the object or part of an object in at least one rotational degree of freedom (e.g., up to six total degrees of freedom). As used herein, the term "shape" refers to a set of poses, positions, and / or orientations measured along an object. As used herein, the term "distal" refers to a location closer to the surgical site, and the term "proximal" refers to a location further away from the surgical site. Thus, when an instrument is designed to perform surgery, the distal portion or distal end of the instrument is closer to the surgical site than the proximal portion or proximal end of the instrument.

[0054] Spinal decompression surgery typically involves removing bone and / or soft tissue to decompress the spinal cord and / or dorsal nerve roots, thereby relieving back pain, sciatica, and improving quality of life. These surgeries face a trade-off between the size of the access opening and the need to remove healthy bone to access the diseased bone, as well as the removal of muscles and soft tissue. Removing healthy bone may compromise spinal stability, while removing muscles and soft tissue may affect pain, recovery time, and complications such as infection.

[0055] The systems, apparatus, and methods described herein utilize a working port to provide access to an intraspinal treatment site for endoscopes and instruments, as well as to flush the treatment site with water. The working port may include a rotatable coupling and a distal, angled tip to allow the user to protect anatomical structures and retract tissue at the treatment site. In some examples, the working port at least partially provides a channel for the flushing fluid to travel away from the treatment site. Therefore, the working port may include a basin-like component for collecting fluid at its proximal end and an aspiration outlet to ensure that the flushing fluid remains contained during the procedure.

[0056] In some examples, the systems, apparatus, and methods described herein also include an instrument holder. The instrument holder includes one or more actuators and an inner guide, the actuators being configured to drive movement of a coupled instrument, and the inner guide being configured to extend within an outer guide at a working port. The instrument holder may be detachable from or coupled to the working port. For example, the inner guide may define a flushing channel for delivering fluid to a treatment position, or the inner and outer guides may define a flushing channel between the inner and outer guides.

[0057] In some examples, the systems, apparatus, and methods described herein also include an endoscope and an endoscope holder, the endoscope holder causing the endoscope to move along an insertion axis and to roll about the insertion axis. The endoscope and endoscope holder can be detached from or attached to an instrument holder. The endoscope and instrument holder may also include a releasable locking mechanism that secures the endoscope to the instrument holder such that rolling of the endoscope about the insertion axis causes the instrument holder and the working port coupled to the instrument holder to roll about the insertion axis.

[0058] In some examples, the systems, apparatus, and methods described herein also include instruments and actuation units, the instruments comprising elongated devices, the actuation units having actuation inputs configured to engage one or more actuators of an instrument holder. For example, the actuation units and actuators may be configured to provide the instrument with three or more degrees of freedom, including insertion along an insertion axis, rolling about the insertion axis, pitching, yaw, or grasping. Furthermore, the actuation units and actuators may include grooves and ridges for immediate engagement when the instrument is coupled to an instrument holder. Using releasable couplings, different instruments can be changed as needed during surgery.

[0059] The aspects disclosed herein may be part of a computer-aided remote-operated manipulator system (sometimes referred to as a robot-assisted manipulator system or a robot system). This manipulator system may include one or more manipulators, which may operate with the assistance of an electronic controller (e.g., a computer) to move and control the function of one or more instruments when coupled to the manipulators.

[0060] Figure 1 An example manipulator system 100 is illustrated. The manipulator system 100 includes a base 120, a main column 140, and a main boom 160 connected to the main column 140. The manipulator system 100 also includes a plurality of manipulator arms 110, 111, 112, and 113, each connected to the main boom 160. Each manipulator arm 110, 111, 112, and 113 includes an instrument mounting portion 122 to which an instrument 130 can be mounted. The instrument mounting portion 122 is illustrated as being attached to the manipulator arm 110. Although the manipulator system 100 is depicted with four manipulator arms, various embodiments may include more or fewer manipulator arms.

[0061] According to one embodiment, the instrument mounting portion 122 may include a drive assembly 123 and a cannula mount 2124, wherein the transmission mechanism 134 of the instrument 130 is connected to the drive assembly 123. The cannula mount 124 is configured to retain a cannula 136 through which the shaft 132 of the instrument 130 can extend to the surgical site during surgical procedures. The drive assembly 123 includes various actuators and other mechanisms controlled to respond to input commands at an operator input system and to transmit force to the transmission mechanism 134 to actuate the instrument 130. Although Figure 1 The embodiment shown depicts an instrument 130 attached only to manipulator arm 110 for ease of observation; however, the instrument may be attached to any and each of manipulator arms 110, 111, 112, and 113. For example, the examples described herein can be used with da Vinci® surgical systems, such as the da Vinci X®, Xi®, or SP® surgical systems, all commercially available from Intuitive Surgical, Sunnyvale, California.

[0062] Figures 2A to 2NA medical system 200 is shown, configured to provide access to a treatment location within a patient, such as within the patient's spinal cord. The medical system 200 includes a working port 202 for docking with the treatment location. The working port 202 includes an external guide 204 defining an external guide channel 4206 through which access to the treatment location is provided. The medical system 200 also includes an instrument holder 208 and an internal guide 212. The instrument holder 208 is configured to be coupled to an instrument 210, and the internal guide 212, coupled to the instrument holder 208, is configured to be inserted into and extend within the external guide 204 of the working port 202. The medical system 200 also includes an endoscope holder 214 configured to be coupled to an endoscope 216 and to move and roll the endoscope 216 about an insertion axis I. In some examples, medical system 200 also includes instruments 210 and endoscopes 216.

[0063] Figures 2A to 2C , Figure 2E and Figures 2J to 2M Details of working ports 202, 202' are shown below. Working port 202 includes a proximal end portion 218 and a distal end portion 222. The proximal end portion 218 is configured to be rotatably coupled to the robot manipulator arm 301 via a working port mount 220, as described below. Figure 3 In more detail, the distal end portion 222 includes a tilted tip 224. The rotatable connection of the proximal end portion 218 allows the tilted tip 224 at the distal end to rotate at the treatment position, which can be advantageously used to move or block tissue, nerve, or other objects at the treatment position. In some examples, the proximal end portion 218 includes a portion of a magnetic coupling (e.g., a magnet or magnetic material) for coupling the working port 202 to the robotic manipulator arm 301.

[0064] As shown, the external guide 204 extends at least partially from the distal end 222 to the proximal end 218. For example, the external guide 204 includes a sloping tip 224 and extends to the proximal end 218. The external guide channel 4206 includes an external endoscope channel portion 228, an external instrument channel portion 230, and a suction portion 232, wherein the external endoscope channel portion 228 is configured to receive an endoscope 216, and the external instrument channel portion 230 is configured to receive an instrument 210. In one example, the external guide 204 includes a tubular wall defining the external guide channel 4206. The external endoscope channel portion 228, the external instrument channel portion 230, and the suction portion 232 form a portion of an open space defined by the tubular wall within the external guide 204.

[0065] The suction outlet 234 of the working port 202 is located at the proximal end 218 and is fluidly coupled to the suction portion 232 of the external guide channel 4206. This configuration allows aspirated fluid and / or other material to be drawn from the treatment position and through the suction outlet 234. In some examples, the proximal end 218 of the working port 202 includes a basin-shaped member 236 for collecting fluid between the suction portion 232 of the external guide channel 4206 and the suction outlet 234. In the illustrated example, the basin-shaped member 236 has a cylindrical shape and a volume extending laterally outward from at least a portion of the external guide 204. As shown, the basin-shaped member 236 is offset from the longitudinal axis of the external guide 204. For some procedures, it may be desirable to control the amount of pressure within the suction portion 232. To limit the pressure to a desired level, the proximal end 218 of the working port 202 may define an opening 238 (e.g., open to the atmosphere) fluidly coupled to the suction portion 232.

[0066] As shown, endoscope 216 and instrument 210 have different diameters, with endoscope 216 having a relatively large diameter. Therefore, when endoscope 216 and instrument 210 are housed side-by-side within external guide 204, external guide 204 can have a tapered horizontal cross-section (e.g., teardrop shape) to minimize the size of the external guide 204 around the diameters of endoscope 216 and instrument 210 as the endoscope 216 and the relatively smaller-diameter instrument extend along each other within the external endoscope channel portion 228 and external instrument channel portion 230. As shown, suction portion 232 extends along one or both sides of the external endoscope channel portion 228 and external instrument channel portion 230.

[0067] In some examples, it may be helpful to slightly angle the instrument 210 relative to the endoscope 216 so that the instrument 210 can extend forward in front of the endoscope 216 at the treatment position, making it visible and easy to work with. Therefore, in these examples, the external guide 204 tapers from the proximal end 218 to the distal end 222 (e.g., the external instrument channel portion 230 is angled inward toward the longitudinal axis of the external guide 204), which allows the instrument channel portion 230 to be angled relative to the endoscope channel portion 228.

[0068] Figures 2D to 2G and Figures 2K to 2M Details of the instrument holder 208 and inner guides 212, 212' are shown. As illustrated, the instrument holder 208 includes one or more actuators 240 configured to drive the instrument 210 along one or more degrees of freedom. Where applicable, the instrument holder 208 may define an opening 241 therein for the actuator 240 to enter, such as for a socket or port of the actuator 240. In some examples, the actuator 240 is a servo system.

[0069] The internal guide 212 extends distally from the instrument holder 208 and defines an internal guide channel 242, which includes an internal endoscope channel portion 244 for receiving an endoscope 216 and an internal instrument channel portion 246 for receiving an instrument 210. The internal guide 212 is configured to extend within the external guide 204 of the working port 202 such that, when the internal guide 212 is within the external guide 204, the endoscope 216 extends through the internal endoscope channel portion 244 of the internal guide 212 and the external endoscope channel portion 228 of the external guide 204, and the instrument 210 extends through the internal instrument channel portion 246 of the internal guide 212 and the external instrument channel portion 230 of the external guide 204.

[0070] In some examples, the endoscope channel portion 244 and the instrument channel portion 246 are separate through-holes extending within the inner guide 212, thus separating the endoscope 216 and the instrument 210 through the inner guide 212. In other examples, the endoscope channel portion 244 and the instrument channel portion 246 are at least partially connected within the inner guide 212.

[0071] The instrument holder 208 and the inner guide 212 can be permanently coupled together to form a single component for the medical system 200. In some alternative examples, the instrument holder 208 and the inner guide 212 can be configured to be releasably coupled together by any suitable mechanism such as a snap-fit, Luer connector, latch, etc.

[0072] In such Figures 2A to 2E In the first example shown, the instrument holder 208 is separated from the working port 202. As described above, due to the different diameters of the endoscope 216 and the instrument 210, the inner guide 212 can have a tapered horizontal cross-section (e.g., teardrop shape) similar to the outer guide 204 to minimize the size of the inner guide 212 around the diameters of the endoscope 216 and the instrument 210 as the endoscope 216 and the relatively small-diameter instrument extend along each other within the inner guide 212. As shown, the suction portion 232 extends along one or both sides of the outer endoscope channel portion 228 and the outer instrument channel portion 230.

[0073] Furthermore, in an example that helps to make the instrument 210 slightly angled relative to the endoscope 216, the internal guide 212 tapers from the instrument holder 208 toward the distal end of the internal guide 212 (e.g., the internal instrument channel portion 246 is angled inward toward the longitudinal axis of the internal guide 212), which allows the internal instrument channel portion 246 to be angled relative to the endoscope channel portion 244.

[0074] For procedures that facilitate flushing, the inner guide 212 defines a flushing channel 248 for delivering flushing fluid to the treatment position. The flushing channel 248 extends within the inner guide 212 along the endoscope channel portion 244 and the instrument channel portion 246, and has an outlet at the distal end of the inner guide 212. In some examples, the inner guide 212 defines multiple flushing channels 248 to accommodate space within the inner guide 212 and deliver a desired amount of flushing fluid to the treatment position. Furthermore, the inner guide 212 includes a flushing inlet port 250 fluidly coupled to the flushing channel 248 to supply flushing fluid to the flushing channel 248. As discussed above, the outer guide channel 4206 includes a suction portion 232 for aspirating flushing fluid from the treatment position. The suction portion 232 may extend along the outer surface of the inner guide 212 such that the inner guide 212 and the outer guide 204 define a suction channel 252 between them.

[0075] exist Figures 2J to 2M Another example is shown. In this example, the inner guide 212' and the working port 202' are combined and fixedly connected to the instrument holder 208. As shown, similar features between the examples have similar reference numerals. Therefore, the feature descriptions included in the above examples are equally applicable. The differences between the examples will be described below.

[0076] In this example, the external endoscope channel portion 228' and the internal endoscope channel portion 244' are defined by the same through-hole, and the external instrument channel portion 230' and the internal instrument channel portion 246' are defined by the same through-hole. The through-holes may be independent or at least partially overlapping. Furthermore, the suction portion 232' of the external guide channel 4206' is defined between the internal guide 212' and the external guide 204' to define a suction channel 252'. The external guide 204' and the internal guide 212' also define a flushing channel 248' between them.

[0077] In some examples, the outlet of the suction channel 252' is recessed relative to the outlet of the flushing channel 248'. This configuration allows the user to partially retract the instrument 210 to place the end of the instrument (e.g., an end effector or other tool) within the flow path between the flushing channel 248' and the suction channel 252', thereby effectively cleaning the end of the instrument in situ without having to fully retract the instrument 210 during the procedure.

[0078] By combining the inner guide 212' and the working port 202', the inner guide 212' and the outer guide 204 can have a generally cylindrical shape, such as having a circular cross-section. In an example that helps to make the instrument 210 slightly angled relative to the endoscope 216, the outer instrument channel portion 230' and the inner instrument channel portion 246' can be tapered (e.g., angled inward toward the longitudinal axis of the inner guide 212' / working port 202'), which allows the instrument channel portions 230', 246' to be angled relative to the outer endoscope channel portion 228' and the inner endoscope channel portion 244'.

[0079] Reference Figures 2D to 2G and Figures 2K to 2M Further details of the instrument holder 208 are described in conjunction with the details of the instrument 210. The instrument 210 includes a flexible elongated device 254 and a drive unit 256 having drive inputs 258 configured to engage one or more actuators 240 of the instrument holder 208. In one example, one or more drive inputs 258 may be a winch for controlling movement of the movable body portion of the flexible elongated device 254 via tendons or cables.

[0080] In some examples, actuator 240 and drive input 258 include one, two, or at least three pairs of devices that impart degrees of freedom to instrument 210, including, for example, movement of instrument 210 and movement or actuation of end effectors of instrument 210. Of course, additional actuators 240 and drive inputs 258 can be provided to impart four, five, six, or more degrees of freedom to instrument 210. The degrees of freedom of the instrument may include one or more, or at least three, of the following: insertion along insertion axis I, rolling about insertion axis I, pitching, yaw, or grasping. In another example, instrument 210 may be a Kerrisoner 210', which includes an internal toothed member 260 and an external conduit 262. One degree of freedom of the Kerrisoner 210' includes moving one of the internal toothed member 260 or the external conduit 262 toward the other to allow the internal toothed member 260 to cut a portion of tissue or other material for sampling.

[0081] The drive unit 256 includes a housing 264 that accommodates the drive input 258. As can be understood, the depth of the housing 264 along the insertion axis I limits or defines the available length of the instrument 210 that can be driven along the insertion axis I, and also limits / defined the insertion depth of the instrument 210. In some examples, the instrument 210 may be flexible enough to coil or wrap within the housing 264, thereby providing additional insertion depth.

[0082] exist Figure 2HAn example engagement configuration for actuator 240 and drive input 258 is shown. As illustrated, actuator 240 and drive input 258 include a coupling 266 having a slot 268 and a ridge 270, which engage with each other when drive unit 256 is coupled to instrument holder 208. Ridge 270 may have a pointed distal end to guide ridge 270 into slot 268 during engagement. Furthermore, one coupling in coupling 266 may be a plug coupling within slot 268 and ridge 270 defined along an outward-facing surface, and another coupling in coupling 266 may be a receptacle coupling with an outer wall defining slot 268 and ridge 270 on an inward-facing surface to receive a plug coupling therein. Due to the above configuration, when the instrument 210 is attached to the instrument holder 208, the slot 268 and the ridge 270 provide direct engagement, which can advantageously provide control of the instrument 210 without the need for the return action required by other types of attachments.

[0083] As discussed, the instrument 210 can be configured to be releasably attached to the instrument holder 208. Securing the instrument 210 to the instrument holder 208 can be accomplished by any suitable mechanism, including latches, press-fitting elements, snap-fitting elements, fasteners, etc., as shown. Furthermore, because the instrument 210 is releasable, the medical system 200 can include multiple different instruments 210 that can be interchanged between or during procedures to provide the user with the desired functionality at the treatment location. Instrument types can include, for example, a kerrison forceps, forceps or other types of grasping devices, cameras, energy therapy devices, etc.

[0084] Although the above examples include a single instrument 210 and associated channel portions 230, 246, the instrument holder 208 can be configured to be coupled to two instruments 210 in a side-by-side relationship. In these examples, the instrument holder 208 includes a first set of actuators 240 for the first instrument 210 and a second set of actuators 240 for the second instrument 210. Furthermore, the outer guide 204 includes two outer instrument channel portions 230, and the inner guide 212 includes two inner instrument channel portions 246 extending along the endoscope channel portions 228, 244. With this configuration, two instruments 210 can be coupled to the instrument holder 208 such that the drive unit 256 engages with the instrument holder 208, and a flexible elongated device 254 is inserted into the channel portions 230, 246.

[0085] like Figure 2AAs shown, the endoscope holder 214 is positioned adjacent to the instrument holder 208 and the instrument 210 to drive the endoscope for insertion and passage through endoscope channel portions 228, 244. In one example, the endoscope 216 and endoscope holder 214 are separate from the working port 202 and instrument holder 208. For example, the endoscope holder 214 may be mounted to and movable via the robotic manipulator arm 301, and the working port 202 may have a separate connection to the robotic manipulator arm 301 for positioning components relative to each other and for access to the patient. Furthermore, in this example, the instrument holder 208 defines a recess or channel 272 for the endoscope 216 to pass through and approach the external endoscope channel portion 228 and the internal endoscope channel portion 244.

[0086] As discussed, the endoscope holder 214 is configured to allow the endoscope 216 to roll about the insertion axis I. In some examples, the medical system 200 includes a releasable locking mechanism 274 configured to hold the endoscope 216 and the instrument holder 208 together such that rolling of the endoscope 216 about the insertion axis I also causes the instrument holder 208 and the working port 202 to roll about the insertion axis I. With this configuration, a user can manipulate and position the tilting tip 224 of the external guide 204 at the treatment position by utilizing the rolling of the endoscope 216.

[0087] In another example, endoscope holder 214 and endoscope 216 may be combined with instrument holder 208, wherein endoscope holder 214 includes a driver (e.g., a servo) to drive the movement of endoscope 216 along and about insertion axis I.

[0088] like Figure 2N As shown, the medical system 200 may include a dilator assembly 276 for dilating an access opening within the patient's body to a size sufficient for insertion of an external guide 204. The dilator assembly 276 includes a plurality of dilator members 278 with increasing diameters, such that the dilator members 278 can be sequentially inserted into the access opening to dilate the initial incision to a sufficiently large size to provide passage to the working port 202. In a first approach, the working port 202 and the dilator assembly 276 may be configured such that the external guide 202 fits onto the largest dilator member 278 and is inserted into the access opening around the largest dilator member 278 (e.g., the dilator assembly 276 provides an inner diameter passage to the working port 202). In a second approach, the dilator assembly 276 further includes an outer sleeve 280 that fits onto the largest dilator 278 and is sized such that the external guide 204 passes through its fitting (e.g., the dilator assembly 276 provides an outer diameter passage to the working port 202).

[0089] Figure 3 The diagram schematically illustrates a manipulator system 300 including the medical system 200 discussed above. System 300 includes a robotic manipulator arm 301 comprising a plurality of links 303 rotatably connected together via joints 305. In an example consistent with the above disclosure, manipulator system 300 may correspond to manipulator system 100.

[0090] The robotic manipulator arm 301 is configured to operate remotely around a tilted tip 224 defined at the distal end relative to the working port 202. In some examples, the remote center extends from about 2 mm to about 10 mm beyond the access opening inside the patient. The endoscope holder 214 is coupled to and driven by the robotic manipulator arm 301, such that the robotic manipulator arm 301 controls the movement of the endoscope 216 (e.g., insertion along the insertion axis I and rolling about the insertion axis I).

[0091] Furthermore, the robotic manipulator arm 301 includes a working port mount 220 configured to engage the working port 202 during surgery. As discussed above, the working port mount 220 and the working port 202 may have a magnetic coupling therebetween. The working port mount 220 aligns the working port 202 with the robotic manipulator arm 301 such that the remote center is precisely reflected in the position of the tilting tip 224.

[0092] In examples where the instrument holder 208 rotates about the insertion axis I, such as via the operation of the endoscope 216 or manual rotation, the housing 264 of the instrument holder 208 may include an inclined longitudinal edge 265 to maintain a gap with the robot manipulator arm 301 when rotating about the insertion axis I.

[0093] As shown, the manipulator system 300 also includes a display 309 and a control system 311. With this configuration, the control system 311 is configured to display images from the endoscope 216 during surgery. Advantageously, the control system 311 can be configured to stabilize or maintain the relative position of the endoscope 216 and the instrument 210 on the display 309, regardless of scrolling motion (e.g., the instrument 210 is always displayed on one side of the display 309, such as the bottom or top of the display 309). With this configuration, the instrument 210, positioned in the same location relative to the endoscope 216, is displayed to the user even during scrolling motion.

[0094] In some examples, the manipulator system 300 also includes a vacuum source 313 and a pump 515, the vacuum source 313 being fluidly connected to the suction outlet 234 and applying suction force through the suction section 232 / suction channel 252, and the pump 515 being fluidly connected to the flushing inlet port 250 for supplying flushing fluid to the treatment site through the flushing channel 248.

[0095] although Figure 3 A single medical system 200 is shown, but one or more additional medical systems 200 may be used to provide access to a treatment location or another adjacent treatment location during surgery. For example, two medical systems 200 may be used for translaminar access on opposite sides of the spine, wherein the two systems 200 provide images of the treatment location from different perspectives. The medical system 200 in this example may include any or all of the components and functions described above.

[0096] Figure 4 The illustration depicts a treatment method 400 for a medical system (e.g., medical system 200, manipulator system 300) according to some embodiments. In one example, the treatment location for method 400 may be along the patient's spine. In one example, treatment method 400 is used to perform spinal decompression therapy. Method 400 is illustrated as a set of operations or procedures 402 to 420. Not all illustrated procedures are performed in all embodiments of method 400. Additionally, Figure 4 One or more processes not explicitly illustrated may be included before, after, between, or as part of processes 402 to 420. Processes may also be executed in different orders. In some embodiments, one or more of processes 402 to 420 may be implemented at least partially in the form of executable code stored on a non-transitory tangible machine-readable medium, which, when run by one or more processors (e.g., the processor of a controller), causes one or more processors to execute one or more processes. In one or more embodiments, processes 402 to 420 may be executed by a controller (e.g., control system 311).

[0097] In process 402, an expander assembly (e.g., expander assembly 276) is used to provide access to a treatment location for a working port (e.g., working port 202). Process 402 may include, for example, inserting a plurality of expander members (e.g., expander member 278) of increasing diameter into an access opening to provide access to the treatment location for the working port. Furthermore, process 402 may include inserting the working port onto the plurality of expander members to insert the working port through the access opening, or inserting an outer sleeve (e.g., outer sleeve 280) onto the plurality of expander members. Additionally, process 402 may include removing the plurality of expander members and inserting the working port into the outer sleeve to insert the working port through the access opening.

[0098] In process 404, the outer guide of the working port (e.g., outer guide 204) and the inner guide of the instrument holder (e.g., instrument holder 208) (e.g., inner guide 212) are inserted through the patient's access opening to position the distal tip of the working port (e.g., distal end 222) near the treatment position. In this configuration, the inner guide is received (e.g., inserted) within an outer guide channel (e.g., outer guide channel 4206) defined by the outer guide. In process 406, the working port is rotatably coupled to a working port mount (e.g., working port mount 220) of a robotic manipulator arm (e.g., robotic manipulator arm 301).

[0099] In process 408, an endoscope (e.g., endoscope 216) is inserted through an endoscope channel (e.g., endoscope channel 244) defined by an internal guide to position the distal end of the endoscope through the instrument holder and the working port. In process 410, an instrument (e.g., instrument 210) is inserted through an instrument channel (e.g., instrument channel 246) defined by an internal guide to position the distal end of the instrument (e.g., an end effector) at a treatment position distal to the working port. In one example, inserting an instrument through the instrument channel includes coupling a drive unit of the instrument (e.g., drive unit 256) to the instrument holder to engage one or more actuators (e.g., actuator 240) of the instrument holder.

[0100] In process 412, the treatment site is flushed through a flushing channel (e.g., flushing channel 248) at least partially defined by the inner guide, and in process 414, suction is applied through a suction channel (e.g., suction channel 252) at least partially defined by the outer guide. In process 416, the instrument is partially retracted along the insertion axis to clean the instrument near the suction channel by the flushing flow.

[0101] In process 418, the instrument is retracted from the instrument channel and the second instrument is inserted through the instrument channel to position the second end actuator of the second instrument at the treatment position at the distal end of the working port.

[0102] In some examples, the working port, instrument holder, robotic manipulator arm, endoscope, and instrument are a system, and method 400 further includes operating a second system (e.g., medical system 200, manipulator system 300) to insert a second endoscope through a second access opening for viewing the treatment location from another direction. The second system may also include a second instrument, a second working port, a second instrument, and an instrument holder, etc.

[0103] One or more components of the embodiments discussed in this disclosure, such as control system 311, can be implemented in software to execute on one or more processors of a computer system. The software may include code that, when executed by one or more processors, configures the processors to perform the various functions discussed herein. The code may be stored in a non-transitory computer-readable storage medium (e.g., memory, magnetic storage device, optical storage device, solid-state storage device, etc.). The computer-readable storage medium may be part of a computer-readable storage device, such as electronic circuitry, a semiconductor device, a semiconductor storage device, a read-only memory (ROM), flash memory, an erasable programmable read-only memory (EPROM), a floppy disk, a CD-ROM, an optical disk, a hard disk, or other storage device. The code may be downloaded to the computer-readable storage medium for storage via a computer network such as the Internet, an intranet, etc. The code may be executed by any of a variety of centralized or distributed data processing architectures. The programming instructions of the code may be implemented as multiple separate programs or subroutines, or they may be integrated into multiple other aspects of the system described herein. Components of the computing system discussed herein may be connected using wired and / or wireless connections. In some examples, wireless connectivity can use wireless communication protocols such as Bluetooth, Near Field Communication (NFC), Infrared Data Association (IrDA), Home RF, IEEE 802.11, Digital Enhanced Cordless Telecommunications (DECT), and Wireless Medical Telemetry Service (WMTS).

[0104] Various general-purpose computer systems can be used to perform one or more processes, methods, or functions described herein. Additionally or alternatively, various special-purpose computer systems can be used to perform one or more processes, methods, or functions described herein. Furthermore, various programming languages ​​can be used to implement one or more processes, methods, or functions described herein.

[0105] Although certain implementations and examples have been described above and shown in the accompanying drawings, it should be understood that such implementations and examples are merely illustrative and are not limited to the specific constructions and arrangements shown and described, as various other alternatives, modifications and equivalents will be understood by those skilled in the art.

Claims

1. A medical system comprising: A working port, used for docking with a treatment location, includes: The proximal end portion is configured to be rotatably coupled to the robot manipulator arm; The distal end includes an inclined tip, and the rotatable connection of the proximal end allows the inclined tip at the distal end to rotate at the treatment position; An external guide extending at least partially from the distal end to the proximal end, defining an external guide channel including an external endoscope channel portion, an external instrument channel portion, and a suction portion, the external endoscope channel portion configured to receive an endoscope, and the external instrument channel portion configured to receive an instrument; and A suction outlet is provided at the proximal end of the working port and is fluidly connected to the suction portion of the external guide channel.

2. The medical system according to claim 1, wherein, The proximal end of the working port includes a basin-shaped component for liquid collection.

3. The medical system according to claim 1, wherein, The proximal end of the working port defines an opening that is fluidly connected to the suction portion for controlling the pressure within the suction portion.

4. The medical system according to claim 1, wherein, The proximal end includes a magnetic coupling for connecting the working port to the robot manipulator arm.

5. The medical system according to claim 1, wherein, The external guide of the working port tapers from the proximal end to the distal end, such that the instrument channel portion is at an angle relative to the endoscope channel portion.

6. The medical system according to claim 1, wherein, The external guide has a tapered horizontal cross-section, allowing the endoscope and relatively small-diameter instruments to extend along each other.

7. The medical system according to any one of claims 1 to 6, further comprising: An instrument holder, the instrument holder comprising one or more actuators; as well as An internal guide is configured to extend within the external guide at the working port, the internal guide defining an internal guide channel including an endoscope channel portion for receiving the endoscope and an instrument channel portion for receiving the instrument.

8. The medical system according to claim 7, wherein, The instrument holder is separated from the working port.

9. The medical system according to claim 8, wherein, The internal guide defines the flushing channel.

10. The medical system according to claim 9, wherein, The inner guide also includes a flushing inlet that is fluidly connected to the flushing channel.

11. The medical system according to claim 7, wherein, The suction portion of the outer guide channel is defined between the inner guide and the outer guide to define the suction channel.

12. The medical system according to claim 7, wherein, The internal guide tapers from the proximal end to the distal end, such that the internal instrument channel portion is at an angle relative to the endoscope channel portion.

13. The medical system according to claim 7, wherein, The instrument holder and the working port are combined together.

14. The medical system according to claim 13, wherein, The suction portion of the outer guide channel is defined between the inner guide and the outer guide to define the suction channel.

15. The medical system according to claim 14, wherein, The outer guide and the inner guide also define a flushing channel between them.

16. The medical system according to claim 15, wherein, The suction channel is recessed relative to the flushing channel.

17. The medical system according to claim 13, wherein, The inner guide and the outer guide have a cylindrical shape.

18. The medical system according to claim 17, wherein, The inner guide and the outer guide have circular cross-sections.

19. The medical system according to claim 7, wherein, The instrument includes a first instrument; and the instrument holder further includes a second instrument channel for a second instrument, the actuator of the instrument holder including a first set of actuators for the first instrument and a second set of actuators for the second instrument.

20. The medical system of claim 19, further comprising the second instrument, the second instrument including an elongated device and a drive unit configured to engage the second set of actuators.

21. The medical system according to claim 7, further comprising: Endoscope; as well as An endoscope holder that causes the endoscope to move along an insertion axis and to roll about the insertion axis.

22. The medical system according to claim 21, wherein, The endoscope and the endoscope holder are combined with the instrument holder.

23. The medical system according to claim 21, wherein, The endoscope and the endoscope holder are separate from the working port and the instrument holder.

24. The medical system of claim 23, further comprising a releasable locking mechanism configured to secure the endoscope and the instrument holder together such that rolling of the endoscope about the insertion axis causes the working port and the instrument holder to roll about the insertion axis.

25. The medical system of claim 21 further includes an instrument comprising a flexible elongated device and a drive unit having a drive input configured to engage one or more actuators of the instrument holder.

26. The medical system according to claim 25, wherein, The instrument holder includes at least one actuator, and the drive unit includes at least one drive input to insert the instrument along the insertion axis.

27. The medical system according to claim 26, wherein, The instrument holder includes at least three actuators, and the drive unit includes at least three drive inputs to impart degrees of freedom to the instrument, the degrees of freedom including at least three of the following: insertion along the insertion axis, rolling about the insertion axis, pitching, yaw, or gripping.

28. The medical system according to claim 26, wherein, The length of the drive unit along the insertion axis limits the insertion depth of the instrument.

29. The medical system according to claim 26, wherein, The at least one actuator and the at least one drive input include grooves and ridges for immediate engagement when the instrument is coupled to the instrument holder.

30. The medical system according to claim 29, wherein, The direct engagement of the groove and the ridge provides control of the device without the need for repositioning.

31. The medical system according to claim 26, wherein, The at least one drive input includes at least one winch.

32. The medical system according to claim 25, wherein, The device is configured to be releasably attached to the device holder.

33. The medical system according to claim 32, wherein, The device includes a plurality of interchangeable devices configured to be releasably connected to the device holder.

34. The medical system according to claim 25, wherein, The instrument includes a Callison bone forceps, which includes an internal toothed component and an external conduit.

35. The medical system of claim 21 further includes an expander assembly comprising a plurality of members with increasing diameters for expanding the initial incision to provide access to the working port.

36. The medical system according to claim 35, wherein, The expander assembly is configured to provide an inner diameter passage for the working port.

37. The medical system according to claim 35, wherein, The expander assembly also includes an outer sleeve for providing an outer diameter passage for the working port.

38. The medical system of claim 21, further comprising a robotic manipulator arm including a plurality of links rotatably connected by joints, the robotic manipulator arm being configured for remote central operation about a tilted tip defined relative to the working port.

39. The medical system according to claim 38, wherein, The remote center extends approximately 2 mm to 10 mm beyond the entry opening inside the patient's body.

40. The medical system according to claim 38, wherein, The endoscope holder is connected to the robotic manipulator arm, which then controls the movement of the endoscope.

41. The medical system according to claim 38, wherein, The instrument holder includes a housing for the one or more actuators, the housing having a sloping longitudinal edge to maintain a gap with the robot manipulator arm when rotating about the insertion axis.

42. The medical system according to claim 21, further comprising: monitor; as well as A control system configured to display images from the endoscope, wherein the instrument remains in the same position relative to the endoscope, even during rolling movements.

43. The medical system according to claim 21, wherein, The working port, the instrument holder, and the endoscope include a first access component and also include a second access component.

44. A medical system comprising: Instrument holder, the instrument holder comprising: Proximal housing, the proximal housing including one or more actuators; and An internal guide extends distally away from the proximal housing, defining an endoscope channel configured to receive an endoscope, an instrument channel configured to receive an instrument, and a flushing channel.

45. The medical system according to claim 44, wherein, The proximal housing includes a flushing inlet port that is fluidly connected to the flushing channel of the inner guide.

46. ​​The medical system according to claim 44, wherein, The internal guide tapers from the proximal end of the proximal housing to the opposite distal end, wherein the internal instrument channel is angled relative to the endoscope channel.

47. The medical system according to claim 44, wherein, The internal guide has a tapered horizontal cross-section, allowing the endoscope and relatively small-diameter instruments to extend along each other.

48. The medical system of claim 44, further comprising a working port, the working port including: The proximal end portion is configured to be rotatably coupled to the robot manipulator arm; The distal end includes a tilted tip, and the rotatable connection of the proximal end allows the tilted tip at the distal end to rotate at the treatment position; And an outer guide that extends at least partially from the distal end to the proximal end and defines an outer guide channel, wherein the inner guide is configured to extend within the outer guide at the working port.

49. The medical system according to claim 48, wherein, The outer guide and the inner guide define a suction channel between the outer guide and the inner guide, and the working port includes a suction outlet fluidly connected to the suction channel.

50. The medical system according to claim 49, wherein, The proximal end of the working port includes a basin-shaped element for liquid collection and defines an opening that is fluidly connected to the suction channel for controlling the pressure within the suction channel.

51. The medical system according to claim 48, wherein, The inner guide and the outer guide have complementary tapered profiles.

52. The medical system according to any one of claims 44 to 51, further comprising: Endoscope; as well as An endoscope holder that causes the endoscope to move along an insertion axis and to roll about the insertion axis.

53. The medical system according to any one of claims 44 to 51, further comprising: An instrument, the instrument comprising an elongated device; as well as A drive unit having one or more drive inputs configured to engage one or more actuators of the instrument bracket.

54. The medical system according to claim 53, wherein, The one or more actuators and the one or more drive inputs include three or more actuators and drive inputs to impart degrees of freedom to the instrument, the degrees of freedom including at least three of the following: insertion along the insertion axis, rolling about the insertion axis, pitching, yaw, or gripping.

55. The medical system according to claim 53, wherein, The length of the drive unit along the insertion axis limits the insertion depth of the instrument.

56. The medical system according to claim 53, wherein, The one or more actuators and the one or more drive inputs include slots and ridges for immediate engagement when the instrument is coupled to the instrument holder.

57. A treatment method comprising: The external guide of the working port and the internal guide of the instrument holder are inserted through the patient's access opening to position the distal tip of the working port near the treatment position, with the internal guide being received within the external guide channel defined by the external guide. The working port is rotatably connected to the working port mounting component of the robot manipulator arm; An endoscope is inserted through an endoscope channel defined by the internal guide to position the distal end of the endoscope through the instrument holder and the working port. as well as The instrument is inserted through the instrument channel defined by the inner guide to position the distal end of the instrument at the treatment position distal to the working port.

58. The treatment method according to claim 57, wherein, The treatment site is along the patient's spine.

59. The treatment method of claim 57 further includes inserting the inner guide of the instrument holder into the outer guide channel of the outer guide.

60. The treatment method according to claim 57, further comprising: The treatment site is flushed through a flushing channel defined at least partially by the internal guide; as well as Suction is applied through a suction channel defined at least partially by the external guide.

61. The treatment method according to claim 60, wherein, The flushing channel is defined between the inner guide and the outer guide.

62. The treatment method of claim 60 further includes partially retracting the instrument along the insertion axis to clean the instrument near the suction channel by a flushing flow.

63. The treatment method of claim 57 further includes inserting a plurality of dilator members of increasing diameter into the access opening to provide access to the treatment position for the working port.

64. The treatment method of claim 63 further includes inserting the working port onto the plurality of expander members to insert the working port through the access opening.

65. The treatment method according to claim 63, further comprising: Insert the outer sleeve into the plurality of expander components; Remove the plurality of expander components; as well as Insert the working port into the outer sleeve so that the working port passes through the inlet opening.

66. The treatment method according to any one of claims 57 to 65, wherein, Inserting the instrument through the instrument channel also includes coupling the drive unit of the instrument to the instrument bracket to engage one or more actuators of the instrument bracket.

67. The treatment method according to any one of claims 57 to 65, further comprising: Retract the instrument from the instrument channel; as well as A second instrument is inserted through the instrument channel to position the second end actuator of the second instrument at the treatment position at the distal end of the working port.

68. The treatment method according to any one of claims 57 to 65 further includes spinal decompression therapy.

69. The treatment method according to any one of claims 57 to 65, wherein, The working port, the instrument holder, the robotic manipulator arm, the endoscope, and the instrument comprise a medical system; and also include operating a second medical system to insert a second endoscope through a second access opening for viewing the treatment location from another direction.

Images