Surgical system for minimally invasive robotic surgery

Abstract

The invention relates to a surgical system for minimally invasive robotic surgery, having: a holder arm (4.2) having a mount for the handle unit of a conventional endoscope (4.10), and having a patient-side unit (4.13) which is fastenable in the vicinity of the patient and enables defined positioning of the patient access, characterized by a fluid container (4.6), and a pump unit (4.7) for pumping an irrigation fluid into the patient's body.

Description

Surgery system for minimally invasive robotic surgery The invention relates to a surgical system for minimally invasive robotic surgery. In endoscopy, particularly ureteroscopy (endoscopic procedures in the urethra, bladder, ureter, and kidney), endoscopes are used to perform diagnostic tasks (e.g., visual examination of organs) or manipulations (e.g., taking biopsies, removing foreign bodies such as kidney stones) within hollow organs. These can be either rigid ("rigid endoscopes") or bendable in at least one degree of freedom ("flexible endoscopes"). During the procedure, the endoscopes are typically guided manually by the surgeon, which is technically demanding, especially with flexible endoscopes: The surgeon holds the handle of the flexible endoscope in one hand and, using a lever on the handle, actuates the bending of the endoscope tip and, by turning the handle, the rotation of the endoscope around its longitudinal axis. With the other hand, they control the advancement of the flexible endoscope shaft into the patient. Commercially available accessories for flexible endoscopes, such as the LithoVue Empower (Boston Scientific, Marlborough, MA, USA), allow the surgeon to perform individual steps (such as stone retrieval) independently. Such accessories are compact and do not impair the surgeon's haptic feedback, as the surgeon still manually controls all three endoscopic degrees of freedom (advancement, rotation around the longitudinal axis, and angulation). Currently, the Avicenna Roboflex is a commercially available surgical system for flexible ureteroscopy: The flexible endoscope is docked to a holding arm located on a cart, which also offers actuation options for bending the endoscope tip and moving the laser fiber. Intuitive Ion is a surgical system for minimally invasive peripheral lung biopsies that can telemanipulate a flexible bronchoscope through the bronchi of the lung. Auris Monarch is another surgical system for peripheral bronchoscopy. Hansen Medical developed two systems for catheter manipulation, the Magellan Surgical System and the Sensei Surgical System. The Magellan was designed for peripheral vascular robotic procedures, while the Sensei was designed for interventional electrophysiological interventions. Corindus CorPath GRX is a robotic system for the telemanipulated positioning of catheters in vascular surgery. Another telemanipulated system for urology, the Zamenix R (ROEN Surgical Inc., Daejeon, Korea), is currently being launched as a commercial product. Its basic concept is very similar to the Avicenna Roboflex, except for the design of the surgeon's controller (see patent W0002020218678A1). The robotic systems for controlling flexible endoscopes in research papers can be classified into two categories: Dockable actuation units [see sources 1-6 below] actuate some or all of the degrees of freedom on the endoscope handle and are either handheld by the surgeon together with the endoscope or attached to a passive holding arm. These units are compact, but most do not actuate all of the endoscope's degrees of freedom, and haptic feedback is impaired in the actuated endoscope degrees of freedom. Handheld systems increase the weight the surgeon has to bear. Attaching them to a passive holding arm makes system handling cumbersome in interventions that require frequent repositioning of the endoscope handle: With each repositioning, the combined weight of the endoscope, holding arm, and actuation unit must be moved, and the passive holding arm restricts the range of motion. Sources: [1] Olds, K., Hillel, A., Kriss, J., Nair, A., Kim, H., Cha, E., Curry, M., Akst, L., Yung, R., Richmon, J., Taylor, R. : A robotic assistant for trans-oral surgery: the robotic endolaryngeal flexible (robo-ELF) scope. Journal of Robotic Surgery 6(1), 13-18 (2011). [2] Fang, C., Cesmeci, D., Gumprecht, J.D.J., Krause, E.-M., Strauss, G., Lueth, T.C. : Amo- torized hand-held flexible rhino endoscope in ENT diagnoses and its clinical experiences. In: IEEE (ed.) 2012 4th IEEE RAS & EMBS International Conference on Biomedical Robotics and Biomechatronics (BioRob), pp. 853-858 (2012). https: / / doi.org / 10.1109 / biorob, 2012.6290784 [3] Zhang, L.A., Khare, R., Wilson, E., Wang, S.X., Peters, C.A., Cleary, K. : Robotic assistance for manipulating a flexible endoscope. In : IEEE (ed.) 2014 IEEE International Conference on Robotics and Automation (ICRA), pp. 5380-5385 (2014). https: / / doi.ora / 10.1109 / icra.2014.6907650 [4] Ruiter, J.G., Bonnema, G.M., van der Voort, M.C., Breeders, I.A.M.J. : Robotic control of a traditional flexible endoscope for therapy. Journal of Robotic Surgery 7(3), 227-234 (2013). https: / / doi.org / 10.1007 / sll701-013-0405-4 [5] Iwasa, T., Nakadate, R., Onogi, S., Okamoto, Y., Arata, J., Oguri, S., Ogino, H., Ihara, E., Ohuchida, K., Akahoshi, T., Ikeda, T., Ogawa, Y., Hashizume, M. : A new robotic-assisted flexible endoscope with singlehand control: endoscopic submucosal dissection in the ex vivo porcine stomach. Surgical Endoscopy 32(7), 3386-3392 (2018). https: / / doi.ora / 10.1007 / s00464-018-6188-v [6] Lee, D.-H., Cheon, B., Kim, J., Kwon, D.-S. : easyEndo robotic endoscopy system : Development and usability test in a randomized controlled trial with novices and physicians. The International Journal of Medical Robotics and Computer Assisted Surgery 17(1), 1-14 (2020). https: / / doi.org / 10.1002 / rcs.2158 Teleoperation systems [7 - 12] enable remote control of the endoscope and its end effectors in all degrees of freedom from a surgeon's console. The surgeon no longer has to support the weight of the components. However, in the actuated degrees of freedom, haptic feedback is impaired or technically complex and expensive force or moment sensors must be provided. In addition, the combined footprint of the robot and surgeon's console is large and a second surgeon is required at the operating table, for example, to insert the endoscope into the patient. An intraoperative switch to manual endoscopy (e.g. because haptic feedback is advantageous, or a malfunction occurs) is complex, as the surgeon has to dress sterilely, Endoscope must be removed from the robotic system and the robot must be removed from the patient. Sources: [7] Desai, M.M., Grover, R., Aron, M., Ganpule, A., Joshi, S.S., Desai, M.R., Gill, LS. : Robotic flexible ureteroscopy for renal calculi: Initial clinical experience. Journal of Urology 186(2), 563-568 [8] Rassweiler, J., Fiedler, M., Charalampogiannis, N., Kabakci, A.S., Saglam, R., Klein, J.-T. : Robot-assisted flexible ureteroscopy: an update. Urolithiasis 46(1), 69-77 (2017). httDs: / / doi.ora / 10.1007 / s00240-017-1024-8 [9] Geavlete, P., Saglam, R., Georgescu, D., Mul^escu, R., lordache, V., Kabakci, A.S., Ene, C., Geavlete, B. : Robotic flexible ureteroscopy versus classic flexible ureteroscopy in renal stones: the initial Romanian experience. Chirurgia 111, 326-329 (2016)

[0010] Shu, X., Chen, Q., Xie, L. : A novel robotic system for flexible ureteroscopy. The International Journal of Medical Robotics and Computer Assisted Surgery 17(1), 1-11 (2020). https: / / doi.orq / 10.1002 / rcs.2191

[0011] Zhao, J., Li, J., Cui, L., Shi, C., Wei, G. : Design and performance investigation of a robot- assisted flexible ureteroscopy system. Applied Bionics and Biomechanics 2021, 1- 13 (2021).

[0012] Park, J., Gwak, C.H., Kim, D., Shin, J.H., Lim, B., Kim, J., Cheon, B., Han, J., Kwon, D.- S., Park, H.K. : The usefulness and ergonomics of a new robotic system for flexible ureteroscopy and laser lithotripsy for treating renal stones. Investigative and Clinical Urology 63(6), 647 US 2012 / 0065470 A1 describes a robotic system for guiding a commercially available flexible endoscope, particularly in laryngology. The flexible endoscope is placed in a suitable holder, and the actuating element for bending the endoscope tip is inserted into a clamp that can actuate the actuating element. The entire holder can be rotated around the endoscope's longitudinal axis and moved along the endoscope's longitudinal axis using appropriate drives. The drives for the three The degrees of freedom are located either in close proximity to the respective mechanisms or together in a motor housing, with the rotation and angulation motion transmitted via Bowden cables. The robotic system is controlled via a compact control unit with two joysticks (one with one degree of freedom, one with two degrees of freedom), which can be positioned either on a suitable surface or attached to the side rails of the operating table. The robotic system is connected to the operating table side rail via a passive tripod and roughly positioned. WO 2013 / 029 045 A1 describes an endoscope adapter consisting of a holder for the flexible endoscope and a manipulation mechanism that selectively moves the flexible endoscope shaft and / or a tool to be inserted into the working channel of the endoscope in the axial direction. For this purpose, the manipulation mechanism uses rollers, with at least one roller being pressed against the endoscope shaft / tool ​​by a spring. It is optionally possible to drive at least one of the two rollers to actively control the movement. In one embodiment (Fig. 12), attachment of the manipulation mechanism to the patient is proposed. WO 2019 139 941 A1 describes an adapter with which a rigid endoscope can be attached to the instrument interface of a medical robot in minimally invasive surgery. This adapter enables the rotation of an output of the instrument drive unit (for faster rotation) or, alternatively, the rotation of the entire instrument drive unit by a drive in the instrument holder (for slower rotation) to be converted into a rotation of the endoscope around its longitudinal axis. Various commercially available standalone endoscopes can be used with the adapter (the endoscope mounting shells may need to be replaced for this purpose). Depending on the design, the endoscope is permanently installed in the adapter (Figs. 3-6) or can be removed from it after opening a lock (Figs. 8-11; Figs. 21A-24). US10,219,867 B2 describes the Avicenna Roboflex surgical system: Various commercially available flexible endoscopes can be attached to a holder on the end effector of a robot mounted on a cart. This holder can be moved translationally back and forth in the direction of the endoscope axis and rotated around the endoscope axis. Furthermore, the holder contains a mechanism for actuating the angulation degree of freedom of the flexible endoscope. In addition, mechanisms for actuating auxiliary tools (laser fiber, forceps, retrieval baskets, etc.) as well as a pump unit for controlling the working channel irrigation are available. The system is operated by the surgeon from a The console is remotely controlled using two force-feedback joysticks (one allowing forward and backward movement and rotation around the joystick axis, the second with a lever for coarse control of the endoscope angulation), a control wheel for fine control of the endoscope angulation, foot pedals (e.g., for laser fiber and fluoroscopy), and a touchscreen. Several safety features are integrated (the laser cannot be fired in the working channel of the endoscope, the endoscope is straightened upon insertion of the laser fiber), as well as autonomy functions (compensation for the patient's breathing movement through translational movement of the endoscope). US Patent No. 9,763,741 B2 describes a robotic system for telemanipulating a flexible endoscope. The endoscope is an instrument specifically designed for this robotic system, which is attached to a drive unit that can be positioned by a support arm. While the robot translates and rotates the endoscope around its longitudinal axis, the drive unit actuates the bending of the endoscope tip. The flexible endoscope shaft is guided by a rigid sleeve guided by a second support arm, into which the endoscope shaft is inserted. US 2017 / 0119412 A1 describes the guidance of a retrieval basket by holding arms that can be remotely controlled from a surgeon's console or moved in hands-on mode. When the retrieval basket is pulled together to capture an object, the robots automatically adjust the position of the retrieval basket so that the object remains in the center of the basket. Once the object is captured, it can be fragmented (by laser, fluid, or mechanical means) through a central working channel and removed from the basket. US 2018 / 0092517 A1 describes a calibration method for flexible endoscopes in which the robotic system moves the endoscope to various target positions and receives feedback on the actual endoscope position via suitable sensors (e.g., electromagnetic sensor systems, cameras, fiber optic sensors). Based on this, correction factors for the endoscope actuation are determined and stored. These can depend on various factors (e.g., actuated cables, length of the endoscope tip outside the sheath, rotation of the endoscope relative to the sheath) and are stored in a calibration matrix. By integrating strain gauges into the instrument drive unit, the cable forces occurring on the endoscope can also be monitored. US 2019 / 0191967 A1 describes a robotic telemanipulation system with optional haptic feedback, in which the robotic instruments (consisting of holding arm and end effector) and the flexible endoscope for imaging are guided through the working channels of a flexible transport endoscope. The transport endoscope can be attached to a docking station during the surgical procedure. The degrees of freedom of the robotic instruments are actuated by a common motor box, while an endoscope support system remotely controls insufflation, suction, and irrigation of the transport endoscope. The endoscope for imaging and the robotic instruments can be translated as a whole along their longitudinal axis and rotated about their longitudinal axis. To enable precise motion transmission from the motor unit to the robotic instruments, the pretension of the transmitting wire cables can be adjusted automatically at system start-up or intraoperatively. German patent application 10 2019 134 352.6 describes a surgical robot for endoscopic applications in very general terms. A flexible endoscope with its handle unit is detachably attached to an instrument baseplate, while the movement and advancement of the shaft are carried out by a robotic arm. The angular freedom of the endoscope is controlled by an additional actuator. Various possible assistance functions are described (gravity compensation, automatic advancement and retraction of the endoscope, automatic changing of instruments such as laser fibers and retrieval baskets, motion compensation for patient movement, automatic image orientation, mapping, and display of additional functions via augmented reality). The entire system is mobile and mounted on a rollable platform. The German patent application 10 2022 118 388.2 describes a system for the manipulation of flexible endoscopes with a holder arm, a fastening for the endoscope handle unit on the holder arm, a patient-side unit and an output unit for the system status. Manual handling of the endoscope has several disadvantages: • Physical strain due to the weight of the handle • Unergonomic hand position due to twisting the handle and / or actuating the controls. The range of motion of the endoscope inside the body is also sometimes limited by the range of motion of the human hand. • During intraoperative X-rays, the surgeon stands in the area of ​​the X-ray machine. This requires wearing a lead vest and increases the X-ray exposure of the surgeon. • Second surgeon required o Confined working conditions, as the available space (typically between the patient's spread legs in ureteroscopic procedures) is limited. o Complex coordination: When using a tool such as a laser fiber or a retrieval basket, the movements of the endoscope and tool must be coordinated, which requires good coordination between the two surgeons The commercially available robotic solutions also have disadvantages: • Pure telemanipulation systems: o Conversion to manual surgery is difficult o Loss of surgical sensitivity when moving the endoscope / catheter o Repeated insertion and removal of the endoscope during stone retrieval in urology requires support from sterile personnel at the operating table • Highly specialized systems: o Surgical systems tailored for a specific application => especially interesting for large clinics with high treatment volumes o Apart from Roboflex Avicenna: Use of special robotic instruments, which must be purchased in addition to the hand instruments Furthermore, the publications mentioned have the following disadvantages with regard to the guidance of flexible endoscopes: US 2012 / 0065470 Al: The actuated degrees of freedom only allow small movements (especially during translation); for larger movements, the locks on the passive stand must be opened, the system components repositioned, and the locks closed again. Intraoperative manual movement of the endoscope is not readily possible because removing the endoscope from the holder is complex (opening the holder and opening the clamp for the actuation lever), and appropriate sensors are missing to enable hands-on control of the system. W02013 / 029 045 Al: The roller mechanism shown can actuate the translation of the flexible endoscope shaft or the tool in the working channel of the flexible endoscope shaft. However, the rotation of the endoscope around its longitudinal axis cannot be actuated with the described mechanism. However, this is indispensable, particularly for smaller endoscopes that can only be angled in one plane (e.g., ureteroscopes), in order to be able to perform all desired manipulation tasks inside the patient. Furthermore, a rapid release of the frictional connection between the endoscope shaft and the rollers is apparently not possible because the rollers are spring-loaded. This means that the surgeon cannot advance the endoscope manually using their fingertips. The adapter described in WO 2019 139 941 A1 is designed for rigid endoscopes. Therefore, it does not allow for the actuation of the endoscope deflection. Furthermore, a robot with such an adapter can position and align the handle of a flexible endoscope in space, but not the endoscope tip, since there is no guidance of the flexible endoscope shaft and thus no clear transmission of the handle movement to the endoscope tip movement. The Avicenna Roboflex system described in US10,219,867 B2 has the above-mentioned disadvantages of robotic systems. The robotic system for procedures using flexible endoscopes described in US 9,763,741 B2, US 2017 / 0119412 A1, and US 2018 / 0092517 A1 also exhibits the aforementioned disadvantages of robotic systems. Furthermore, the use of specialized instruments and the high technical complexity of the system shown (three holding arms are required to perform an endoscopic procedure in the kidney) are likely to significantly hamper its cost-effective use, especially in smaller clinics with low case volumes. Patent US 2019 / 0191967 A1 focuses on the actuation of the imaging endoscope and the robotic instruments, both of which are designed exclusively for use with this system. The transport endoscope is still controlled manually, and the flexible shaft is only fixed at the position of the handle and patient access. Compared to the German patent application 10 2019 134 352.6, the present solution further develops the mechanical design of the system. In particular, the design of the attachment of the endoscope handle to the holding arm, the design of the Locking device at the access to the patient and the possible integration of virtual fixtures to support the surgeon. Compared to patent application 10 2021 114 429.9, the present solution represents a technically simplified approach in which the lack of actuation of the endoscope's degrees of freedom eliminates the possibility of telemanipulation. The placement of the endoscopic end effectors and a control unit for controlling external devices near the handle allows the surgeon ergonomic control of the system functions required intraoperatively. Virtual fixtures can support the physician intraoperatively and can also be used in the training of young surgeons. The object of the invention is to provide a surgical system for minimally invasive robotic surgery that enables simplified handling of an endoscope. The object is achieved according to the invention by the features of claim 1. The surgical system according to the invention for minimally invasive robotic surgery comprises a holder arm that has a mount for the handle unit of a conventional endoscope. Furthermore, a patient-side unit is provided, which can be attached near the patient and enables defined positioning of the patient access. Furthermore, a fluid container and a pump unit are provided for pumping a rinsing fluid into the patient's body. The pump unit can preferably be actuated by the surgeon operating the endoscope with the same hand. For this purpose, it is preferred that the endoscope has at least one actuation button for actuating the pump unit and / or a laser. For example, if the endoscope has an actuation button for actuating the pump unit, the laser can be actuated via another input device, such as a foot pedal. Alternatively, the laser can be operated via the actuation button on the endoscope and the pump unit via the other actuation device. For example, a tube from the outlet side of the pump unit can be connected to the working channel of a ureteroscope, e.g., via a three-way valve. Typically, the tubes for this purpose are equipped with Luer-Lock connectors. The present invention allows a surgeon to grasp the endoscope's control unit with one hand and enter all necessary commands there. With the other hand, the surgeon can grasp and guide the endoscope's flexible shaft as usual. A particular advantage of the present invention is the possibility of operating the necessary additional devices during the surgical procedure (e.g. pump, laser and / or retrieval basket) by a single surgeon without having to interrupt the manipulation of the flexible endoscope. Preferably, the endoscope holder has a translation unit on its side for translationally moving a tool inserted into the endoscope. The translation unit is positioned on the endoscope holder in such a way that it can be operated with the same hand when a surgeon grasps the endoscope. The tool can be, for example, a retrieval basket for removing kidney stones. Furthermore, the endoscope or the endoscope holder preferably has a lever for bending the endoscope tip, wherein the lever is connected to a position encoder via a transmission element, so that a state in which the endoscope tip is bent can be detected. This can prevent the endoscope from being pulled out of the patient's body, for example, when its tip is bent, which would lead to patient injury and / or damage to the endoscope. The lever is preferably ball-bearing mounted, so that improved feedback of the forces and moments occurring at the surgical site to the surgeon is possible with as little interference as possible. Furthermore, the endoscope holder preferably has a capacitive sensor on its inside, which detects when a surgeon grasps the endoscope holder, thereby enabling switching between different surgical modes. For example, switching can occur from StopIF (robot is switched on but merely maintains its position) to cartImp_torIF (gravity-compensated movement of the robot arm and its payload is possible, with optional virtual fixtures being used to assist the surgeon). Furthermore, it is preferred that the translation unit limits the advance of a cylinder piston by means of a clamping force, wherein the clamping force is provided by two seals, which are compressible, in particular, by means of a screw or a nut, thereby increasing the clamping force. In other words, the seal determines how much force must be applied to perform a translational movement, i.e., how firmly the translation unit holds its position. This allows each surgeon to individually adapt the operability during the translational advancement of the tool. The screw and / or nut can be operated by the surgeon, in particular, without the need for tools. Furthermore, it is preferred that the pump cassette of the pump unit can be replaced without tools. The pump cassette can be a commercially available peristaltic pump. A flexible silicone tube can be positioned along the inside of the round pump housing. This is preferably compressed by three rollers that are rotatably mounted relative to a roller carrier. The drive motor rotates the roller carrier (which in turn is rotatably mounted relative to the pump housing) about its central axis, causing the rollers to roll on the silicone tube. The advantage of the tool-free replaceable cassette is that it simplifies compliance with sterility requirements: Since the rinsing fluid enters the patient's interior, it must be sterile. Therefore, a fresh sterile cassette must be attached before each procedure. It is further preferred that the surgical system comprises a fastening device for attaching the patient-side unit to the side rails of the operating table. This allows for simple and secure attachment. It is further preferred that the patient-side unit comprises a support structure to which an auxiliary arm with a movable shaft and a clamp for holding a laser fiber or a safety wire is attached. This can further improve the one-handed operability of the surgical system. In the following, preferred embodiments of the invention are explained with reference to figures. They show: Figure 1 : Manual operation of a flexible ureteroscope Figure 2: Detailed view of the endoscope tip in the uncurved and curved state Figure 3: Typical end effectors that are inserted into the working channel of flexible ureteroscopes Figure 4: Hardware architecture of a system for collaborative robotic endoscopy Figure 5: A modular software architecture of the system for collaborative robotic endoscopy Figures 6 and 7: An embodiment of the robot-side unit Figure 8: Cross section through the translation unit of the robot-side unit Figure 9: Position encoder for determining the lever position on the endoscope handle Figure 10: A flow chart for pump control using two buttons Figure 11: A pump unit for active flushing Figure 12: An embodiment of the patient-side unit of the system according to the invention Figure 1 shows the manual operation of a flexible ureteroscope (endoscope for urological procedures): The physician holds the handle (1.1) in one hand (left image), while the other hand guides the flexible shaft (1.2), usually near the patient access point. By moving the actuating element (1.3), the endoscope tip (1.4) can be curved in one plane. The plane in which the endoscope tip curves can be varied by rotating the entire endoscope around its longitudinal axis. The endoscope tip is advanced by translating the entire endoscope. Through the working channel (1.5) Various tools can be inserted, such as a fiber optic cable for a laser or a retrieval basket for removing kidney stones. Figure 2 shows a detailed view of the endoscope tip in its non-bent state (solid lines) and in its bent state (dashed lines). The flexible section of the endoscope tip 2.1 is bent by actuating the adjustment wheel on the handle using cables / rods running inside the endoscope shaft. The endoscope tip 2.2 and the rest of the shaft 2.3 remain rigid during this process. Figure 3 shows typical end effectors that are inserted into the working channel of flexible ureteroscopes: laser fiber for fragmenting kidney stones (left), and retrieval baskets for grasping stone fragments (right). By translating the black handle element (3.1) in the direction of the arrow, the retrieval basket (3.2) at the tip of the end effector is opened and closed. Figure 4 shows the hardware architecture of the system for collaborative robotic endoscopy: The mobile cart (4.1) contains the robot arm (4.2), the light source (4.3) and the video unit (4.4) of the flexible endoscope, monitors (4.5) for displaying the endoscope image and the graphical interface of the robotic system, PCs and the laser light source (inside the cart, not shown), fluid for irrigation (4.6), and a pump unit for active irrigation (4.7). The robot base is preferably height-adjustable and tiltable in at least one axis. The robot-side unit (RSU; 4.8) with the flexible endoscope (4.9) is attached to the robot's tool interface. Optionally, holders for the flexible endoscope (4.10) and the RSU (4.11) are attached to the mobile cart. Intraoperatively, the mobile cart is positioned near the operating table (4.12). The patient-side unit (PSU; 4.13) is located in the immediate vicinity of the patient.Attachment to the operating table is preferred, and attachment to the side rails of the operating table is particularly preferred. At least one support arm (4.14) for the sheath holder (4.15) is attached to the PSU structure. Preferably, at least one auxiliary arm (4.16) is also integrated into the PSU. Figure 5 shows the modular software architecture of the system for collaborative robotic endoscopy: The workflow can be triggered and parameterized externally and contains several state machines. A state machine activates and parameterizes the various control modes of the robot arm, for example, a Cartesian impedance controller (cartImp_torIF), a position controller (ipoLposIF), a stop controller (StopIF) and a force controller (gravComp_torIF). The robot controller communicates via the hardware The abstraction framework communicates with the robot hardware (motors, sensors, and user interface) at a 3 kHz clock rate. Another state machine controls the active irrigation. State machines 3 and 4 control the X-ray device and the laser light source. The workflow can address external sensors or external active devices via microcontrollers (in this example, an Arduino Micro, whose firmware represents the hardware abstraction framework in this context). For documentation, error diagnosis, or research purposes, data from various sources (robot, workflow, camera images) can be logged using a logging framework. The middleware implements communication between the high-level software components (robot control, workflow, and logging). Figure 6 shows a rendering of the robot-side unit (RSU): The RSU structure (6.1) connects the docking element for the robot tool interface (6.2) to the upper end of the endoscope handle holder (6.3). Preferably, the lower end of the endoscope handle holder (6.4) is also connected to the RSU structure to increase the stability of the endoscope fixation. The endoscope handle (6.5) can preferably be fixed in the endoscope handle holder without tools, e.g., using a knurled screw (6.6). The endoscope handle holder has recesses for an upper button (6.7) and a lower button (6.8), as well as a clamp (6.9) for attaching the retrieval basket handle (6.10). The translation unit (6.11) is attached to the working channel of the endoscope. A transmission element (6.12) transmits the movement of the lever for angling the endoscope tip (6.13) to a position encoder (6.14). The transmission element and encoder are connected via a two-part clamp (6.15).15) is rotatably connected to the RSU structure, which is round in this area. One or more microcontrollers (6.16) process the signals from the buttons, the position encoder, and the capacitive sensor mounted on the inside of the endoscope handle before forwarding them to the workflow. Figure 7 shows the robot-side unit (RSU) loose (left) and with the flexible endoscope (7.1) attached to the tool interface of the robot arm (7.2) (right). The capacitive sensor on the inside of the endoscope handle holder (7.3) detects when the user grasps the RSU, while membrane buttons (7.4) on the outside of the endoscope handle holder allow the control of external devices such as the pump unit for active irrigation. The shaft of the retrieval basket (7.5) or, alternatively, a laser fiber is connected to the movable piston of the translation unit (7.7) via a union nut (7.6). The hose for the irrigation fluid (7.8) is typically also connected to the inlet to the working channel of the endoscope, for example, via a three-way valve, as shown here. The cables of the microcontroller (7.9) and the flexible endoscope (7.10) are connected using cable clamps, Velcro, or similar. (7.11) is fixed to the robot structure. The LED ring on the robot's tool interface (7.12) informs the user about the system status. Figure 8 shows a cross-section through the translation unit of the RSU: The translation unit is screwed either directly onto the working channel of the flexible endoscope or onto an intermediate piece with a irrigation connection. The corresponding thread is located in the bore (8.1). The user can move the cylinder piston (8.2) relative to the structure of the translation unit (8.3) by grasping it at the handle (8.4). The seals (8.5) prevent leakage of the irrigation fluid. Preferably, the compression of the seals and thus the resistance when moving the piston can be varied using a screwed cover (8.6) or similar. A sealing element (e.g. O-ring) must be provided between the end effector and the structure to prevent leakage. A laser fiber or other end effector can be inserted and secured at the Luer lock (8.7) using a union nut.Once the end effector is fixed, the user can move the end effector by moving the cylinder piston with one hand. Figure 9 shows a position encoder for determining the lever position on the endoscope handle: A rotatably mounted shaft (9.1) and the transmission element (9.2) transmit the movement of the lever for angling the endoscope tip (not shown) to the position encoder (9.3). The two-part clamp (9.4) and (9.5) with the hinge pin (9.6) allows the encoder assembly to be rotated around the RSU structure, which is round in this area. The encoder assembly is clamped by tightening at least one screw (9.7). Figure 10 shows a flow chart for pump control using two buttons: After the program starts, the state machine is first parameterized with the stored default values ​​for the pump's switch-on state (off), the pump speed (default), the minimum pump speed (Speed_min), and the maximum pump speed (Speed_max). These default values ​​are predetermined and cannot be changed by the surgeon. A while loop then starts, which runs continuously as long as the state machine is active. Within the loop, the current pump speed is first shown on the pump unit's display. User inputs are then requested using the two buttons on the RSU. If only the upper button is pressed and the pump speed is lower than the maximum pump speed, the pump speed is increased by one level.If only the lower button is pressed and the pump speed is greater than the minimum pump speed, the pump speed will be reduced by one level. If both buttons are pressed simultaneously, the pump's power state is changed (from off to on or vice versa). The loop then starts again. To avoid missing any user input during program runtime, a flag can be set via an interrupt routine when a button is pressed. This flag is reset after the user input has been processed. Figure 11 shows a pump unit for active irrigation: The pump unit has a screen for displaying the pump speed (11.1) and two clamps (11.2) for attaching the tubing to the fluid reservoir (11.3) and the flexible endoscope (11.4). The pump cassette (11.5) can be replaced without tools to ensure sterility. Figure 12 shows a rendering of the patient-side unit (PSU) of the system for collaborative robotic endoscopy: The PSU structure (12.1) is attached to the side rails of the operating table using suitable fasteners (e.g., clamps (12.2)). At least one holding arm (12.3) for the UAS holder (12.4) with the ureteral access sheath (UAS) (12.5) is attached to the PSU structure. This holding arm is preferably movable in several degrees of freedom and can be easily locked (e.g., using the knurled screw 12.6). In addition, at least one auxiliary arm (12.7) consisting of a movable shaft (12.8) and a clamp (12.9) is attached to the PSU structure.

Claims

Patent claims 1. Surgical system for minimally invasive robotic surgery, comprising: a holder arm (4.2) having a holder for the handle unit of a conventional endoscope (4.10), a patient-side unit (4.13) which can be fastened near the patient and enables a defined positioning of the patient access, characterized by a fluid container (4.6), a pump unit (4.7) for pumping a rinsing fluid into the patient's body.

2. Method according to claim 1, characterized by an endoscope which has at least one actuating button for actuating the pump unit (4.7) and / or a laser.

3. Method according to claim 1 or 2, characterized in that the endoscope holder (7.3) has a translation unit (7.7) on the side for translationally moving a tool or end effector inserted into the endoscope, wherein the translation unit is placed on the endoscope holder (7.3) in such a way that it can be operated with the same hand when a surgeon grasps the endoscope.

4. Method according to claims 1 to 3, characterized by a lever (6.13) for bending the endoscope tip, wherein the lever (6.13) is connected to a position encoder via a transmission element (6.12) so that a state in which the endoscope tip is bent can be detected, wherein the lever (6.13) is in particular ball-bearing mounted.

5. Method according to claim 4, characterized in that the endoscope holder (7.3) has a capacitive sensor on its inside by means of which detection takes place when a surgeon grips the endoscope holder (7.3), whereby in particular a switching between different operation modes takes place.

6. Method according to claim 3, characterized in that the translation unit (8.3) can limit the advance of a cylinder piston (8.2) by means of a clamping force, wherein the clamping force is generated by two seals (8.5) which are compressible in particular by means of a screw in such a way that the clamping force is thereby increased.

7. Method according to claim 6, characterized in that the pump cassette (11.5) of the pump unit can be replaced without tools.

8. Method according to claims 1 to 7, characterized by a fastening device (12.2) for fastening the patient-side unit to the side rails of the operating table.

9. Method according to claims 1 to 8, characterized in that the patient-side unit has a holding structure (12.1) to which an auxiliary arm (12.7) with a movable shaft (12.8) and a clamp (12.3) for holding a laser fiber is attached.

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