Surgical probe for tissue removal using a robotic arm

Abstract

An energy source is coupled to a probe mounted on a robotic arm, and a processor is configured with instructions for releasing energy to ablate tissue in coordination with movement of the robotic arm and probe. The tissue can be ablated according to a defined tissue ablation volume, which can be determined based on images of the patient. The probe is moved to multiple positions with movement of the distal end of the robotic arm, and tissue can be ablated according to a treatment plan. The distal end of the robotic arm can be configured to move to multiple locations and orientations to provide appropriate positions and orientations of the probe tip and energy source. The processor can be configured with instructions for pivoting the probe at a location that reduces tissue movement near the pivot axis, such as an internal location of the patient.

Description

Technical Field

[0001] (Related Application) This application claims priority to U.S. Patent Application No. 16 / 939,972, filed Jul. 27, 2020, which claims the benefit of 35 U.S.C. § 119(e) of U.S. Provisional Patent Application No. 62 / 933,721, filed Nov. 11, 2019, the entire disclosure of which is incorporated herein by reference.

Background Art

[0002] Previous methods and devices for tissue resection may not be ideal in at least some respects. Although robotic arms are used for surgery, previous surgical instruments attached to robotic arms may not be ideal in at least some cases. For example, at least some of the previous surgical instruments attached to robotic arms may non-selectively resect tissue in at least some cases. Previous surgical instruments may also be somewhat more complex than would be desirable when installed on a robotic arm.

[0003] Previous robotic arms have been used such that an operator uses a controller to move a surgical instrument on the robotic arm to perform surgery, but at least some of the previous approaches do not ideally use imaging and image guidance to direct a probe to a target site for tissue resection.

[0004] In light of the above, improved systems, methods, and devices for improved tissue resection would be beneficial.

Summary of the Invention

Means for Solving the Problems

[0005] The systems, methods, and apparatus disclosed herein can be used to provide improved surgical techniques. In some embodiments, an energy source is coupled to a probe mounted on a robotic arm, and a processor comprises commands for releasing energy to selectively excise tissue in coordination with the movement of the robotic arm and probe. The tissue can be excised according to a defined tissue excision volume which may be determined based on images of the patient. The probe is moved to multiple positions as the distal end of the robotic arm moves, and the tissue can be excised according to a treatment plan. The distal end of the robotic arm can move to multiple locations and orientations to provide appropriate positions and orientations for the probe tip and energy source. In some embodiments, the processor comprises commands for rotating the probe at locations that reduce tissue movement near the pivot axis, and the pivot locations may include internal patient locations. In some embodiments, the energy source of the treatment probe is configured to rotate while the distal end of the robotic arm remains in a fixed location and orientation. Alternatively, the robotic arm can be configured to rotate so as to rotate the energy source around the extension axis of the treatment probe.

[0006] In some embodiments, a probe coupled to the distal end of a robotic arm comprises an irrigation lumen, a suction lumen, an endoscope, and an energy source. The irrigation lumen and suction lumen can be used to provide a beneficial environment at the site where tissue is removed. In some embodiments, an enclosure, such as a cup, has an opening for receiving the treatment probe, and the enclosure comprises a barrier material for containing the fluid supplied by the suction lumen.

[0007] (Integrated by reference) All patents, applications, and publications referenced and identified herein are incorporated herein by reference in their entirety, and are deemed to be fully incorporated by reference even if they are referenced elsewhere in this application. [Brief explanation of the drawing]

[0008] A deeper understanding of the features, advantages, and principles of this disclosure will be obtained by referring to the following detailed description and accompanying drawings that illustrate illustrative embodiments.

[0009] [Figure 1] Figure 1 shows a front view of a system for performing tissue resection in a patient, according to several embodiments.

[0010] [Figure 2] Figure 2 schematically illustrates a system for performing tissue resection in a patient, according to several embodiments.

[0011] [Figure 3] Figures 3A and 3B show perspective views of a common base or mount for supporting one or more robot arms, according to several embodiments.

[0012] [Figure 4A] Figures 4A and 4B illustrate perspective and side views, respectively, of systems for performing tissue resection in a patient, each equipped with a mobile base, according to several embodiments. [Figure 4B] Figures 4A and 4B illustrate perspective and side views, respectively, of systems for performing tissue resection in a patient, each equipped with a mobile base, according to several embodiments.

[0013] [Figure 5A] Figure 5A shows a therapeutic probe coupled to a robotic arm, in several embodiments, where the distal end of the robotic arm is configured to move the proximal end of the therapeutic probe with six degrees of freedom.

[0014] [Figure 5B] Figure 5B shows a therapeutic probe coupled to a robotic arm, as in Figure 5A, in several embodiments, in which the distal end of the therapeutic probe has a deflection tip.

[0015] [Figure 5C] Figure 5C shows a probe that rotates around a location, according to some embodiments.

[0016] [Figure 6] Figure 6 shows a treatment probe coupled to the distal end of a robotic arm that includes one or more of perfusion, aspiration, a robotic energy source, or a camera, according to some embodiments.

[0017] [Figure 7A] Figure 7A shows a tissue resection profile, according to some embodiments.

[0018] [Figure 7B] Figure 7B shows a tissue resection profile for removing tissue away from a tumor, according to some embodiments.

[0019] [Figure 7C] Figure 7C shows a 3D tissue resection profile around a tumor for removing tissue away from the tumor, according to some embodiments.

[0020] [Figure 7D] Figure 7D shows a conical tissue resection profile for removing tissue away from a tumor, according to some embodiments.

[0021] [Figure 8] Figure 8 shows a treatment probe that includes a rotating energy source coupled to the distal end of a robotic arm as in Figure 5, according to some embodiments.

[0022] [Figure 9] Figures 9 - 12B show a method of tissue resection using water injection, according to some embodiments. [Figure 10]Figure 9-12B shows several embodiments of tissue excision methods using water jets. [Figure 11] Figure 9-12B shows several embodiments of tissue excision methods using water jets. [Figure 12] Figure 9-12B shows several embodiments of tissue excision methods using water jets.

[0023] [Figure 13] Figure 13 illustrates selective tissue excision and removal of undesirable tissue from an organ using 3D volumetric imaging in several embodiments.

[0024] [Figure 14] Figure 14 shows images of the right and middle hepatic veins of the liver displayed on a screen, relating to 3D tissue removal using 3D volumetric imaging according to several embodiments.

[0025] [Figure 15] Figure 15 shows images of hepatic hemangiomas displayed on a screen, relating to 3D tissue removal using 3D volumetric imaging according to several embodiments.

[0026] [Figure 16] Figure 16 shows images of a liver cancer tumor displayed on a display, relating to 3D tissue removal away from the tumor using 3D volumetric imaging, according to several embodiments.

[0027] [Figure 17] Figure 17 shows cirrhotic liver tissue for removal shown on a display, relating to 3D tissue removal using 3D volumetric imaging according to several embodiments.

[0028] [Figure 18] Figure 18 shows a CT scan of liver tissue displayed on a screen, relating to 3D tissue removal using 3D volumetric imaging, according to several embodiments.

[0029] [Figure 19] Figures 19A, 19B, 19C, and 19D show MRI images of the liver displayed on a screen, relating to 3D tissue removal using 3D volumetric imaging according to several embodiments. [Modes for carrying out the invention]

[0030] The following detailed description provides a deeper understanding of the features and merits of the invention described herein, as provided by the embodiments disclosed herein. While the detailed description includes many specific embodiments, these are provided only as examples and should not be construed as limiting the scope of the invention disclosed herein.

[0031] Embodiments of this disclosure provide improved methods and apparatus for performing tissue resection, such as prostatectomy. The methods and apparatus disclosed herein are highly suitable for many types of surgical procedures and can be incorporated into many prior systems and methods. While some embodiments of this disclosure focus on transurethral treatment of the prostate, some aspects of this disclosure may also be used to treat and modify other tissues and associated organs. These other tissues and associated organs include, but are not limited to, the brain, heart, lungs, intestines, eyes, skin, kidneys, liver, pancreas, stomach, uterus, ovaries, testes, bladder, ears, nose, mouth, bone marrow, adipose tissue, muscle, glandular and mucous tissues, spinal cord and nerve tissue, soft tissues such as cartilage, hard biological tissues such as teeth and bones, and body lumens and passages such as sinuses, ureters, colon, esophagus, pulmonary passages, blood vessels, and throat. The devices disclosed herein may be inserted through existing body lumens or through openings created within body tissue.

[0032] The methods and apparatus disclosed herein are very suitable for treating many types of tissue using an energy source. Tissues may include, for example, soft tissues such as glandular or capsular tissue, or hard tissues such as bone or obstructions such as kidney stones. Energy sources may include one or more of the following: laser beams, water jets, electrodes, ultrasound, high-intensity focused ultrasound, mechanical vibration, radio frequency (RF) energy, ultrasonic transducers, microwave energy, cavitation energy such as cavitation-forming water jets or ultrasonic cavitation, radiation such as ionizing radiation from radioisotopes, or ion energy from ionization electrodes, or plasma energy from plasma electrodes. The methods and apparatus disclosed herein are very suitable, for example, for performing lithotripsy and destroying kidney stones. The methods and apparatus disclosed herein are very suitable for treatment using radiation, such as radioisotopes on a treatment probe. Radiation therapy can be provided on a probe, removed using a probe, or implanted from a treatment probe, for example, for the treatment of cancer.

[0033] In some embodiments, the image-guided therapy system comprises a therapy probe and an imaging probe. The imaging probe may be configured to provide an image of the target site while the therapy probe performs the excision of the target tissue. Each of the therapy probe and the imaging probe may be coupled to a robotic arm under the control of one or more computing devices to enable more precisely controlled movement of one or both of the arms and to improve the safety and efficiency of the therapy using the therapy system.

[0034] Figure 1 shows an exemplary embodiment of a system 400 for performing tissue resection in a patient. The system 400 may comprise a therapeutic probe 450 and an imaging probe 460. The therapeutic probe 450 may be coupled to a first arm 442, and the imaging probe 460 may be coupled to a second arm 444. One or both of the first arm 442 and the second arm 444 may be robotic arms, and the movement of the robotic arms may be controlled by one or more computing devices operably coupled to the arms. The therapeutic probe 450 may comprise a device for removing target tissue from a target site in the patient. The therapeutic probe 450 may be configured to deliver sufficient energy from the therapeutic probe 450 to the target tissue to remove it. For example, the therapeutic probe 450 may comprise an electrosurgical ablation device, a laser ablation device, a transurethral needle ablation device, a water jet ablation device, an ultrasound ablation transducer, or any combination thereof. The imaging probe 460 may be configured to deliver sufficient energy from the imaging probe 460 to the target tissue in order to image the target tissue. The imaging probe 460 may include, for example, an ultrasound probe, a magnetic resonance probe, an endoscope, or a fluoroscopy probe. The first arm 442 and the second arm 444 may be configured to be independently adjustable, adjustable according to a fixed relationship, adjustable according to a user-selection relationship, independently lockable, or simultaneously lockable, or any combination thereof. The first arm 442 and the second arm 444 may each have multiple degrees of freedom, e.g., 6 degrees of freedom, for manipulating the treatment probe 450 and the imaging probe 460. The treatment system 400 may be used to perform tissue resection in the patient's organs, such as the patient's prostate. The patient may be positioned on a patient support 449, such as a bed, table, chair, or platform. The treatment probe 450 may be inserted into the patient's target site along an entry axis that coincides with the extension axis 451 of the treatment probe.For example, the therapeutic probe 450 may be configured for insertion into the patient's urethra to position the energy delivery area of ​​the therapeutic probe within the patient's prostate. The imaging probe 460 may be inserted into the patient at a target site or adjacent to a target site along an entry axis coinciding with the extension axis 461 of the imaging probe. For example, the imaging probe 460 may include a transrectal ultrasound (TRUS) probe configured for insertion into the patient's rectum to visualize the patient's prostate and surrounding tissues. As shown in Figure 1, the first arm 442 and the second arm 444 may be covered with sterile drapes to provide a sterile surgical environment, keep the robotic arms clean, and reduce the risk of damaging the robotic arms. Further details regarding various components of System 400 suitable for incorporation with embodiments as disclosed herein can be found in U.S. Patents 7,882,841, 8,814,921, 9,364,251, and PCT Publication WO2013 / 130895 (the full disclosure of which is incorporated herein by reference).

[0035] Figure 2 schematically illustrates an exemplary embodiment of a system 400 for performing tissue resection in a patient. The system 400 comprises a treatment probe 450 and optionally an imaging probe 460. The treatment probe 450 is coupled to a console 420 and a linkage unit 430. The linkage unit 430 may comprise one or more components of a robotic arm 442. The imaging probe 460 is coupled to an imaging console 490. The imaging probe may be coupled, for example, to a second robotic arm 444. The patient treatment probe 450 and the imaging probe 460 can be coupled to a common base 440. The patient is supported using a patient support 449. The treatment probe 450 is coupled to the base 440 using a first arm 442. The imaging probe 460 is coupled to the base 440 using a second arm 444. One or both of the first arm 442 and the second arm 444 may be a robotic arm, the movement of which may be controlled by one or more computing devices operably coupled to the arm, as will be described in more detail herein.

[0036] A common base is referenced, but the robot arm can be coupled to a bed rail, console, or any suitable support structure to support the base of the robot arm.

[0037] In some embodiments, the system 400 includes a user input device 496 coupled to a processor 423 for the user to operate surgical instruments on a robotic arm. In some embodiments, the user input device includes a controller for moving the end of a treatment probe or imaging probe with movement in response to the mechanical movement of the user input device. The end of the probe may be shown on a display 425, and the user can operate the end of the probe. For example, the user input device may include a 6-degree-of-freedom input controller that allows the user to move the input device with 6 degrees of freedom, and the distal end of the probe moves in response to the movement of the controller. In some embodiments, the 6 degrees of freedom include 3 translational degrees of freedom and 3 rotational degrees of freedom. The processor may consist of instructions for the probe control to switch between automated image-guided therapy with an energy source and therapy with an energy source, for example, by user movement of the user input device.

[0038] The patient is positioned on a patient support 449 so that the treatment probe 450 and the ultrasound probe 460 can be inserted into the patient. The patient can be positioned in one or more of many positions, such as prone, supine, upright, or inclined. In some embodiments, the patient is positioned in a lithotomy position, and stirrups, for example, may be used. In some embodiments, the treatment probe 450 is inserted into the patient in a first direction on the first side of the patient, and the imaging probe is inserted into the patient in a second direction on the second side of the patient. For example, the treatment probe can be inserted into the patient's urethra from the front of the patient, and the imaging probe can be inserted transrectally into the patient's intestines from the rear of the patient. The treatment probe and imaging probe can be positioned in the patient with one or more of the following extending between them: urethral tissue, urethral wall tissue, prostatic tissue, intestinal tissue, or intestinal wall tissue.

[0039] The treatment probe 450 and the imaging probe 460 can be inserted into the patient in one or more of several ways. During insertion, each of the first and second arms may be substantially unlocked so that the treatment or imaging probe can be rotated and translated as desired to insert the probe into the patient. When the probe is inserted in the desired location, the arms can be locked. In the locked configuration, the probes can be oriented relative to each other in one or more of several ways, such as parallel, twisted, horizontal, oblique, or non-parallel. It may be useful to determine the orientation of the probe using an angle sensor, such as those described herein, in order to map the imaging data of the imaging probe to a treatment probe coordinate reference. Mapping tissue image data to a treatment probe coordinate reference space can enable precise targeting and treatment of tissue identified for treatment by an operator such as a physician.

[0040] In some embodiments, the treatment probe 450 is coupled to the imaging probe 460 to align the treatment with the probe 450 based on images from the imaging probe 460. The coupling can be achieved using a common base 440 as shown. Alternatively, or in combination, the treatment probe and / or imaging probe may be equipped with magnets to hold the probes in alignment through the patient's tissue. In some embodiments, a first arm 442 is a movable and lockable arm so that the treatment probe 450 can be positioned at a desired location within the patient. Once the probe 450 is positioned at the desired location in the patient, the first arm 442 can be locked using an arm lock 427. The imaging probe can be coupled to the base 440 using a second arm 444, the second arm can be used to adjust the alignment of the imaging probe when the treatment probe is locked in place. The second arm 444 may be a lockable and movable arm under the control of, for example, an imaging system or console and user interface. The movable arm 444 may be finely adjustable so that the imaging probe 440 can be adjusted with a small movement of about 1 millimeter in relation to, for example, the treatment probe 450.

[0041] In some embodiments, the treatment probe 450 and the imaging probe 460 are coupled to angle sensors so that the treatment can be controlled based on the alignment of the imaging probe 460 and the treatment probe 450. A first angle sensor 495 may be coupled to the treatment probe 450 using a support 438. A second angle sensor 497 may be coupled to the imaging probe 460. The angle sensor may comprise one or more of many types of angle sensors. For example, the angle sensor may comprise a goniometer, an accelerometer, and a combination thereof. In some embodiments, the first angle sensor 495 comprises a three-dimensional accelerometer for determining the orientation of the treatment probe 450 in three dimensions. In some embodiments, the second angle sensor 497 comprises a three-dimensional accelerometer for determining the orientation of the imaging probe 460 in three dimensions. Alternatively, or in combination, the first angle sensor 495 may comprise a goniometer for determining the angle of the treatment probe 450 along the extension axis 451 of the treatment probe. The second angle sensor 497 may include a goniometer for determining the angle of the imaging probe 460 along the extension axis 461 of the imaging probe 460. The first angle sensor 495 is coupled to the controller 424 of the treatment console 420. The second angle sensor 497 of the imaging probe is coupled to the processor 492 of the imaging console 490. Alternatively, or in combination, the second angle sensor 497 may be coupled to the controller 424 of the treatment console 420.

[0042] Console 420 includes a display 425 which is coupled to a processor system and components used to control the therapeutic probe 450. Console 420 includes a processor 423 having memory 421. A communication circuit 422 is coupled to the processor 423 and the controller 422. The communication circuit 422 is coupled to the imaging console 490 via the imaging console's communication circuit 494. An arm lock 427 of console 420 may be coupled to the first arm 442 to lock the first arm or to allow the first arm to move freely to insert the probe 450 into the patient.

[0043] Optionally, the console 420 may include components of an endoscope 426, which are coupled to an anchor 24 of a treatment probe 450. The endoscope 426 may comprise the components of the console 420 and an endoscope that can be inserted together with the treatment probe 450 to treat a patient.

[0044] Optionally, the console 420 may comprise one or more modules operably coupled with the treatment probe 450 to control aspects of treatment using the treatment probe. For example, the console 420 may comprise one or more of the following: an energy source 22 for supplying energy to the treatment probe; a balloon inflation control device 26 for influencing the inflation of a balloon used to fix the treatment probe at a target treatment site; an injection / washing control device 28 for controlling the injection and washout of the probe; an injection control device 30 for controlling aspiration by the probe; an injection control device 32 for controlling blowing of the target treatment site (e.g., prostate); or a light source 33 such as an infrared, visible light, or ultraviolet light source for supplying optical energy to the treatment probe.

[0045] The processor, controller, and control electronics and circuits may include one or more of many preferred components, such as one or more processors, one or more field-programmable gate arrays (FPGAs), and one or more memory storage devices. In some embodiments, the control electronics control a control panel of a graphical user interface (hereinafter referred to as "GUI") to provide pre-procedure planning according to user-defined treatment parameters and to provide user control over the surgical procedure.

[0046] The treatment probe 450 may include an anchor 24. The anchor 24 can anchor the distal end of the probe 450 while energy is being delivered to the energy delivery area 20 using the probe 450. The probe 450 may include a nozzle 200.

[0047] The therapeutic probe 450 may be coupled to a first arm 442 using a linkage section 430. The linkage section 430 may include components for moving the energy delivery area 20 to a desired target location on the patient, for example, based on an image of the patient. The linkage section 430 may comprise a first portion 432, a second portion 434, and a third portion 436. The first portion 432 may comprise a substantially fixed anchoring portion. The substantially fixed anchoring portion 432 may be fixed to a support 438. The support 438 may comprise a reference frame for the linkage section 430. The support 438 may comprise a rigid chassis, frame, or housing for rigidly or stiffly coupling the first arm 442 to the therapeutic probe 450. While the first portion 432 may remain substantially fixed, the second portion 434 and the third portion 436 can move and direct energy from the probe 450 to the patient. The first portion 432 can be fixed at a substantially constant distance 437 from the anchor 24. The substantially fixed distance 437 between the anchor 24 and the fixed first portion 432 of the chain allows the treatment to be precisely positioned. The first portion 424 may include a linear actuator for precisely positioning the high-pressure nozzle 200 within the energy delivery area 20 at a desired axial position along the extension axis 451 of the treatment probe 450.

[0048] The extension axis 451 of the treatment probe 450 generally extends between a proximal portion of the probe 450 near the chain portion 430 and a distal end having a mounted anchor 24. A third portion 436 can control the rotation angle 453 around the extension axis 451. During treatment of a patient, the distance 439 between the energy delivery area 20 and the first portion 432 of the chain portion may vary with respect to the anchor 24. The distance 439 can be adjusted in a manner 418 in response to computer control to set a target location along the extension axis 451 of the treatment probe with respect to the anchor 24. The first portion of the chain portion remains fixed, while the second portion 434 adjusts the position of the energy delivery area 20 along the axis 451. The third portion 436 of the chain portion adjusts the angle 453 around the axis in response to the controller 424 so that the distance along the axis at the treatment angle can be controlled very precisely with respect to the anchor 24. The probe 450 may include a rigid member, such as a spine, extending between the support 438 and the anchor 24, such that the distance from the chain section 430 to the anchor 24 remains substantially constant during treatment. The treatment probe 450 is coupled to a treatment component as described herein to enable treatment using one or more forms of energy, such as mechanical energy from a jet, electrical energy from an electrode, or optical energy from a light source such as a laser source. The light source may be infrared, visible light, or ultraviolet light. The energy delivery area 20 can be moved under the control of the chain section 430 to deliver the intended form of energy to the patient's target tissue, etc.

[0049] The imaging console 490 may include a memory 493, a communication circuit 494, and a processor 492. The processor 492 in the corresponding circuit is coupled to the imaging probe 460. An arm controller 491 is coupled to an arm 444 to precisely position the imaging probe 460. The imaging console may further include a display 425.

[0050] To facilitate precise control of the therapeutic probe and / or imaging probe during patient treatment, each of the therapeutic probe and imaging probe may be coupled to a computer-controllable arm of a robot. For example, referring to system 400 shown in Figure 2, one or both of the first arm 442 coupled to the therapeutic probe 450 and the second arm 444 coupled to the imaging probe 460 may comprise a computer-controllable arm of a robot. The robot arm may be operably coupled to one or more computing devices configured to control the movement of the robot arm. For example, the first robot arm 442 may be operably coupled to the processor 423 of the console 420, or the second robot arm 444 may be operably coupled to the processor 492 of the imaging console 490 and / or to the processor 423 of the console 420. One or more computing devices such as processors 423 and 492 may provide computer-executable instructions for controlling the movement of one or more robot arms. The first and second robotic arms may be substantially similar in structure and function, or they may differ to adapt to specific functional requirements for controlling the movement of the therapeutic probe versus the imaging probe.

[0051] A robotic arm may have six, seven, or more joints to allow the arm to move under computer control. Suitable robotic arms are commercially available from several manufacturers, including RoboDK Inc., Kinova Inc., and several other manufacturers.

[0052] One or more computing devices operably coupled to the first and second robotic arms may be configured to automatically control the movement of the treatment probe and / or imaging probe. For example, the robotic arms may be configured to automatically adjust the position and / or orientation of the treatment probe and / or imaging probe during patient treatment according to one or more pre-programmed parameters. The robotic arms may be configured to automatically move the treatment probe and / or imaging probe along a pre-planned or programmed treatment or scanning profile which may be stored in the memory of one or more computing devices. As an alternative to, or in addition to, automatic adjustment of the robotic arms, one or more computing devices may be configured to control the movement of the treatment probe and / or imaging probe in response to user input, for example, through a graphical user interface of the treatment device. As an alternative to, or in addition to, automatic adjustment of the robotic arm, one or more computing devices may be configured to control the movement of the therapeutic probe and / or imaging probe in response to real-time positioning information, for example, anatomical structures recognized in one or more images captured by the imaging probe or other imaging source (from which the permissible range of motion of the therapeutic probe and / or imaging probe can be established), and / or positional information of the therapeutic probe and / or imaging probe from one or more sensors coupled to the probe and / or robotic arm.

[0053] Figures 3A and 3B illustrate exemplary embodiments of a common base or mount 440 for supporting one or more robotic arms in an image-guided therapeutic system as disclosed herein. Figure 3A shows a patient support 449 comprising one or more rails 452. The patient support 449 may comprise an operating table or platform. One or more robotic arms associated with one or more therapeutic probes or imaging probes may be mounted on the rails 452 such that the rails function as a common base 440. Figure 3B shows a common base 440 comprising a floor stand 454 configured to couple with a first robotic arm connected to a therapeutic probe and / or a second robotic arm connected to an imaging probe. The floor stand 454 may be positioned between the patient's legs during a therapeutic procedure.

[0054] Figures 4A and 4B illustrate exemplary embodiments of a treatment system 400 as described herein, comprising a mobile base 470. Figure 4A is a front view of the treatment system 400, and Figure 4B is a side view thereof. The treatment system 400 comprises a treatment probe 450 coupled to a first robotic arm 442 and an imaging probe 460 coupled to a second robotic arm 444. Each of the first robotic arm 442 and the second robotic arm 444 has a proximal end and a distal end, the distal ends of which are coupled to the treatment probe 450 and the imaging probe 460, respectively, and the proximal end is coupled to a common base 440 comprising a mobile base 470. The first robotic arm 442 may comprise a first arm coupling structure 504 for coupling to the treatment probe 450, and the second robotic arm 442 may comprise a second arm coupling structure 505 for coupling to the imaging probe 460. The treatment probe 450 may be coupled to the distal end of the first robotic arm 442 via a mounting device 500 which may include a chain section configured to bring about movement of the treatment probe as described herein (e.g., rotation, translation, pitch, etc.). The coupling of the treatment probe 450 to the first robotic arm 442 may be fixed, detachable, or user-adjustable. Similarly, the coupling of the imaging probe 460 to the second robotic arm 444 may be fixed, detachable, or user-adjustable.

[0055] The first robotic arm 442 may articulate in one or more first arm joints 443. The imaging arm 444 may articulate in one or more second arm joints 445. Each arm joint 443 or 445 may be operably coupled to a computer-controllable actuator, such as a stepper motor, to influence movement in the joint. Each arm joint 443 or 445 may comprise one of various kinematic joints, including, but not limited to, prism, rotary, parallel cylinder, cylinder, spherical, planar, edge slider, cylindrical slider, point slider, spherical slider, or cross-cylinder joint, or any combination thereof. Furthermore, each arm joint 443 or 445 may comprise a linear, orthogonal, rotary, torsional, or rotary joint, or any combination thereof.

[0056] The system 400 may further comprise a console 420, as described herein, which may be supported by a mobile base 470 and a separate mobile support 480. The console 420 may be operably coupled to the mobile base 470 via power and communication cables 475 to enable control of a treatment probe 450 coupled to the mobile base via a first robotic arm. The treatment console 420 comprises a processor and a memory storing computer-executable instructions for execution by the processor to control various modules or functions of the treatment console, such as an energy source, an infusion / wash control device, a suction control device, and other components, as described herein with reference to Figure 2. The treatment console 420 may further comprise a display 425 that communicates with the processor. The display 425 may be configured to display one or more of the following: target vital signs such as heart rate, respiratory rate, temperature, blood pressure, oxygen saturation, or any physiological parameters, or any combination thereof; the status of the procedure; one or more pre-captured or sequential images of the treatment site from one or more views, one or more real-time or sequential images of the treatment site from one or more views obtained by the imaging probe 460; a set of treatment parameters including, but not limited to, treatment mode such as cutting or coagulation, treatment intensity, time elapsed during treatment, time remaining during treatment, treatment depth, area or volume of the treated treatment site, area of ​​the treatment site to be treated, area or volume of the treatment site not to be treated; location information of the treatment probe 450 or the imaging probe 460 or both; a treatment adjustment control device such as means for adjusting the treatment depth, treatment intensity, location and / or orientation of the treatment probe 450, imaging depth, or location and / or orientation of the imaging probe 460, or any combination thereof; or system configuration parameters.

[0057] The mobile base 470 may further include one or more computing devices for controlling the movement of one or more robot arms. For example, the mobile base may include a processor and a memory that stores computer-executable instructions for execution by one or more processors. The memory may store instructions for operating one or more robot arms coupled to the mobile base. The processor may be operably coupled to the robot arms via suitable electromechanical components to influence the movement of the robot arms. For example, each of one or more joints of the robot arms may include a stepper motor, and the processor may be operably coupled to the stepper motor at each joint to actuate the motor by a predetermined increment in a predetermined direction. Alternatively, one or more robotic arms may be operably coupled to one or more processors in console 420 or a separate imaging console (such as imaging console 490 shown in Figure 2), and one or more console processors may be configured to execute commands to control the movement of one or more robotic arms, and the commands may be communicated to the robotic arms via a communication circuit (communication circuit 422 of console 420 or communication circuit 494 of console 490 shown in Figure 2). Computer-executable commands for controlling the movement of the robotic arms may be pre-programmed and stored in memory, or may be provided by a user via one or more user inputs before or during treatment of a patient using the treatment system.

[0058] One or more computing devices operably coupled to the first and / or second robotic arms may be configured to control the movement of the arms to adjust the pitch, yaw, roll, and / or linear position of the therapeutic probe and / or imaging probe along the target site.

[0059] The mobile base 470 may include one or more user input devices to enable a user to control the movement of the robotic arm under computer commands. For example, as shown in Figures 4A and 4B, the mobile base may include a keyboard 474 and / or a foot switch 471, the foot switch being operably coupled to the mobile base via a foot switch cable 472. The keyboard 474 and the foot switch 471 may be configured independently or in combination to control the movement of a first robotic arm 442 and / or a second robotic arm 444, for example, through the articulation of one or both robotic arms in one or more joints. The keyboard and foot switch may communicate with one or more processors configured to control the movement of the robotic arm. When a user enters a command into the keyboard and / or foot switch, the user command can be received by one or more processors and converted into an electrical signal, which can be transmitted to one or more computer-controllable actuators operably coupled to one or more robotic arms. The keyboard and / or footswitches can control the movement of one or both arms toward or away from a treatment position, a focus position, a predetermined location, or a user-defined location, or any combination thereof.

[0060] Optionally, the keyboard 474 and foot switch 471 may be configured to control the operation of the treatment probe 450 and / or the imaging probe 460, independently or in combination. For example, the keyboard 474 and / or foot switch 471 may be configured to start, stop, pause, or resume treatment using the treatment probe. The keyboard 474 and / or foot switch 471 may be configured to start imaging, or to freeze, save, or display on the display 425 an image or sequence of images previously acquired or currently acquired by the imaging probe.

[0061] The mobile base 470 and mobile support 480 of the console 420 may be independently positioned around the patient, who is supported by a patient support 449 such as a platform. For example, the mobile base 470 supporting the first and second robotic arms and the treatment and imaging probes may be positioned between the patient's legs, while the mobile support 480 carrying the console 420 and display 425 may be positioned to the side of the patient, such as near the patient's torso. The mobile base 470 or mobile support 480 may have one or more movable elements, such as multiple wheels, that allow the base or support to move. The mobile base 470 may be covered with sterile draping throughout the treatment procedure to prevent contamination and fluid ingress.

[0062] Figure 5A shows a therapeutic probe 450 coupled to a robotic arm 442, the distal end of which is configured to move the proximal end of the therapeutic probe as described herein, with six degrees of freedom. The therapeutic probe 450 and the robotic arm 400 may comprise one or more components of a system 400 as described herein. These movements of the proximal end of the probe correspond to the movement of an energy source 455 near the distal end of the probe. In some embodiments, the robotic arm has six degrees of freedom, and the probe is moved according to instructions from a processor, which may have programmed treatment plan instructions, or in response to user input control. The probe tip 462 can be moved to multiple locations to excise tissue 600 as the robotic arm 442 moves. In some embodiments, an inclusion body 602 is placed on the tissue 600 to be excised to provide a beneficial fluid environment for the tissue 600 for tissue excision. Alternatively, the probe tip 462 can be inserted into a recess in the patient, such as an organ 608 as described herein, through an opening into the patient, and it can provide a beneficial fluid environment. In some embodiments, the probe comprises a rigid probe, which allows the position of the probe tip 462 to be precisely positioned and directed in response to the position and orientation of the distal end of the robotic arm. Alternatively, the probe may comprise a flexible probe, in which at least a portion of the probe is flexible. The energy source 455 near the tip 462 of the therapeutic probe 450 may comprise any energy source 455 as described herein.

[0063] Tissue access sites can be accessed in one or more ways, for example, by open surgical access through an incision, by access through a small incision, or by insertion through an external opening of a body lumen such as the urethra. Access may include, for example, access for open prostatectomy or open nephrectomy.

[0064] The encapsulation body 602 may comprise any suitable barrier material that allows a suitable environment to be provided to the tissue 600, such as plastic, silicone, or other material. In some embodiments, the encapsulation body 602 comprises a flexible material that is deformable and contourable with respect to the surface of the tissue 600 in which it is installed.

[0065] Figure 5B shows a therapeutic probe 450 with its distal end portion coupled to a robotic arm 442, as in Figure 5A, which has a deflectable tip 462. The therapeutic probe 450 and the robotic arm 400 may comprise one or more components of a system 400 as described herein. The deflectable tip 462 can be configured in many ways. For example, the deflectable tip 462 may comprise a flexible, elongated tubular member capable of bending and deflecting in response to the internal lumen of a patient. In some embodiments, the deflectable tip 462 comprises a controllable tip in which the amount of deflection 604 can be controlled in response to a command. For example, the tip 462 may comprise a pull wire or other elongated element that allows the angle of deflection to be controlled in response to one or more of the following, for example, a processor, a user interface, or a user input device. In some embodiments, the probe comprises a rigid probe when deflected to a controlled position. The therapeutic probe 450 may be configured to rotate around its extension axis in combination with the movement of the end of a robotic arm as described herein, in order to direct energy to a targeted tissue location. In some embodiments, the probe is configured to deflect its distal end in order to direct energy to a targeted tissue location as the probe rotates around its extension axis. In some embodiments, the probe is equipped with a rigid deflector to resist the force from the water jets emitted from the probe. In some embodiments, the probe is equipped with multiple openings, one opening directed toward the tissue and another water jet directed in the opposite direction, for example toward a shield, to provide a force to counteract the force of the water jets.

[0066] Figure 5C shows the probe rotation of the treatment probe 450 around location 610. The processor can consist of instructions to rotate the probe 450 around rotation location 610, which may have any preferred location. For example, rotation location 610 may correspond to an opening in an inclusion body or an opening to an internal body lumen. In some embodiments, rotation location 610 is near the patient's cumulus, near the external sphincter of the urethra, or between the cumulus and the external sphincter. Alternatively, or in combination, in some embodiments, the surgical rotation location 610 corresponds to the pubic bone.

[0067] While rotational movement can be configured in many ways, it can be configured to move the proximal end of the probe along a path 606 so as to move the tip 462 of the probe along a corresponding path to direct energy to a targeted tissue location. The proximal end path 606 may define an enclosed volume, and the distal end path 608 may define an enclosed volume around the tissue 600 to be removed in order to isolate the tissue 600 to be removed from surrounding tissue such as an organ 608. For example, a therapeutic probe may rotate around a rotation location 610 while benign prostatic hyperplasia is being removed from an organ such as the prostate using an energy source 455 located within the prostatic capsule. Since the tissue near the end of the external opening of the urethra is typically flexible near the open end of the urethra, the tissue near the open end of the urethra can move as well as the proximal end of the probe, and the rotation location 610 is located between the proximal end of the urethra and the distal end of the probe. In some embodiments, a tissue treatment area, such as the prostate, is scanned using a scanning pattern, the external opening to the urethra moves in a corresponding pattern, and the rotating location 610 is located between them.

[0068] The deflectable probe tip 462 can be used in many ways. For example, the flexible probe tip 462 can be used to separate capsular tissue from glandular tissue using an energy source 455 such as a laser energy source as described herein. In some embodiments, the deflectable probe tip 462 can be used to separate glandular tissue from capsular tissue, for example, to separate the prostatic capsule from the glandular tissue of the prostate. In some embodiments, the probe tip 462 deflects in response to the increased resistance of the capsule to movement compared to the resistance of the glandular tissue. In some embodiments, the probe tip 462 can be controlled by a system operator to move along the internal boundary of the capsule in order to separate the capsule from the glandular prostatic tissue. Studies related to embodiments suggest that the capsular tissue is loosely connected to the glandular tissue along the interface between the capsule and the glandular tissue, thereby allowing the capsular tissue to be separated from the glandular tissue using mechanical forces along the interior of the capsular tissue. In some embodiments, the deflectable tip 462 is configured to deflect under user control, for example, using an elongated element extending along the deflectable tip 462, so that the user can control the amount of deflection 604. The deflectable probe tip 462 may be equipped with an energy source 455 as described herein, or mechanical energy may be transferred to the tip 462 as the tip 462 moves, so as to separate the capsular tissue from the glandular tissue.

[0069] In some embodiments, the probe 450 is placed on the capsule of the organ 608 to be excised and pulled to facilitate the separation of the capsule from the glandular tissue.

[0070] Figure 6 shows a therapeutic probe 450 coupled to the distal end of a robotic arm as shown in Figure 5. The therapeutic probe comprises one or more of the following: a fluid delivery lumen such as an irrigation lumen 612 and a delivery port; an endoscope 614 such as a camera for visualizing the surgical site; an energy delivery channel such as a robotic water jet device; an energy source 455 such as a water jet; and a suction lumen 618. The probe may be elongated and may extend over a distance in the range of approximately 5 cm to approximately 50 cm from the proximal end to the distal end. An inclusion body may be placed on the tissue to fluidly separate the tissue in order to create an environment beneficial for tissue resection. For example, the fluid delivery lumen 612 may be connected to a source of fluid such as a gas, e.g., CO2, or a liquid, e.g., water or saline. In some embodiments, the energy source 455 comprises a water jet released from the end of the probe. For example, the energy source 455 may direct energy, for example, in a straight line outside the end of the energy delivery channel, or coaxially aligned with the axis of the energy delivery channel. The energy delivery channel may comprise any suitable structure for delivering energy, such as one or more optical fibers for delivering optical energy, a tube for delivering water jet energy, or a wire for delivering electrical energy or cauterizing or ultrasonic energy to the treatment site.

[0071] In some embodiments, the treatment probe 450 comprises a substantially linear, rigid probe from which a water jet is emitted. The water jet 455 can be scanned to selectively excise tissue in response to the movement of a robotic arm. For example, a robotic arm 442 may be configured to move the distal end of the probe using a scanning pattern by moving the proximal end of the probe coupled to the robotic arm. While a robotic arm with 6 degrees of freedom is referred to, the robotic arm may have fewer degrees of freedom, for example, 3 translational degrees of freedom for moving the water jet from the probe in a scanning pattern.

[0072] In some embodiments, one or more ultrasound probes 620 are coupled to tissue 600. For example, one or more ultrasound probes 620 may comprise external ultrasound probes coupled to tissue 600 through the patient's skin. Alternatively, one or more ultrasound probes 600 may comprise probes inserted into the patient. The ultrasound probes 600 may be configured, for example, to provide three-dimensional imaging.

[0073] In some embodiments, one or more imaging markers 622 may be placed on the tissue 600 to track the movement of the tissue 600 and maintain alignment between the treatment probe 620 and the target tissue.

[0074] In some embodiments, a contrast agent is injected into a blood vessel, such as an artery, to improve imaging of one or more tissues or blood vessels.

[0075] In some embodiments, the robot arm 442 and probe 450 are configured to provide positional accuracy of the probe tip 462 and energy source 455 within a desired tolerance, for example, within about 2 mm of the intended target position of the probe tip.

[0076] The tissue resection profile 700 can be generated using processor instructions to move the tissue in the scanning pattern 702 by moving the proximal end of the robot arm, moving the probe tip and water jet to the appropriate location, and scanning the tissue using the scanning pattern 702.

[0077] Figure 7B shows a tissue resection profile 700 for removing tissue 600 away from undesirable tissue, such as a tumor that may be cancerous or benign. Research related to this disclosure suggests that it may be useful to resect tissue around the tumor boundary so as to leave the tumor substantially intact. Other undesirable tissues, such as cirrhotic tissue or other tissues as described herein, can also be removed. The tissue resection profile 700 can be generated using processor-based instructions to move the tissue in a scanning pattern 702 by moving the proximal end of a robotic arm and moving the tip of a probe and water jet to the appropriate location around the resection boundary 704. Once the tissue 600 is resected around the resection boundary 704 to separate the tumor from healthy tissue, the undesirable tissue can be removed. Figure 7B illustrates tissue resection along layers of resection, but in some embodiments, the tissue is resected sequentially with multiple removal layers. For example, a first layer can be excised and removed up to the excision boundary 600, and a second excision layer can be excised up to the second excision boundary. With respect to 3D tissue excision, multiple excision layers and boundaries 600 can be defined to remove tissue along the 3D boundaries using a 3D tissue elimination profile.

[0078] Figure 7C shows a 3D tissue resection profile 700 around a tumor for removing tissue away from the tumor. A probe on a robotic arm can be scanned using a 3D scanning pattern 702 in response to instructions from a processor. For example, the proximal end of the probe can be moved with 5 or 6 degrees of freedom by moving the robotic arm accordingly, and an energy source such as a water jet can be directed to the target tissue site. In some embodiments, the water jet is directed outward from the end of the probe, which is aligned with the axis of the probe, for example, substantially linearly. The proximal end of the probe can be translated and rotated to provide resection along a 3D tissue resection boundary 704. In some embodiments, the tissue 600 can be resected in multiple layers of substantially equal depth, and the probe removes each subsequent layer after the tissue has been resected along the boundary with respect to the previous layer. The angle of the extension axis of the probe can be tilted at various angles along the tissue resection boundary 704 to reduce the movement of tissue accompanied by the probe as the probe is further inserted into the tissue along the boundary 704.

[0079] Figure 7D shows a cone-shaped tissue resection profile 700 for removing tissue 600 away from the tumor. The probe can be moved and directed along a scanning pattern 702 to direct an energy source, such as a water jet, along the tissue resection boundary 704. For example, the probe can be moved in a direction 630 to multiple positions and orientations 640 corresponding to the frustum of the cone 632, so as to resect the cone resection boundary 704 using an energy source, such as a water jet.

[0080] Figure 8 shows a therapeutic probe 450 comprising a rotating energy source 455, such as a water jet, coupled to the distal end of a robotic arm 442. The probe comprises one or more components of the probe 450 as described herein with reference to Figure 5. In some embodiments, the probe comprises an ultrasound imaging transducer 620 for imaging tissue resection using an energy source such as a water jet. In some embodiments, the energy source 455 is configured to move independently of the end of the robotic arm, for example, using one or more of the following: rotation, translation, rotational vibration, or translational vibration of the energy source relative to the tissue and the end of the robotic arm.

[0081] In some embodiments, the inclusion body 602 is placed on the tissue 600 to be excised in order to provide a beneficial fluid environment for the tissue 600 for tissue excision. The inclusion body 602 may comprise any suitable barrier material that allows a suitable environment to be provided to the tissue 600, such as plastic, silicone, or other material. In some embodiments, the inclusion body 602 comprises a flexible material that can deform and contour with respect to the surface of the tissue 600 on which it is placed. In some embodiments, the barrier may be a cup or a suction cup.

[0082] Figure 9-12B shows a method of tissue resection using water jets with a robotic arm. In some embodiments, the tissue is sequentially resected into multiple excision layers by scanning the water jets in each of the multiple layers.

[0083] In the steps shown in Figure 9, the tissue 600, such as the parenchymal tissue of organ 608, is visualized using imaging techniques described herein, such as using one or more of the following: endoscopy, ultrasound imaging, ultrasound, MRI, or CT scanning. The imaging may include visualization of neurovascular bundles, veins, and blood vessels 634. In some embodiments, one or more markers 622 are placed on the tissue 600 to identify tissue movement and to align treatment with the tissue.

[0084] In the steps shown in Figure 10, tissue resection using energy from energy source 455 is initiated to resection a first layer of tissue 600, for example, by initiating substantial ablation and the creation of depressions within the tissue. The tissue can be resected using low-power energy sources such as lower-pressure water jets for selective tissue resection and low pressure for exposure and visualization of small vessels 643. For example, glandular tissue can be selectively resected while vascular tissue remains intact. An example of selective tissue removal and water jet flow rates for leaving vascular tissue substantially intact is described in U.S. Patent No. 10,251,665, filed November 25, 2015, granted April 4, 2019, titled “Multifluid tissue resection methods and devices” (its entire disclosure is incorporated herein by reference). The selectively exposed vessels can be stapled, clipped, or cauterized.

[0085] In the steps shown in Figure 11, selective tissue resection using energy from an energy source 455, such as a water jet, for example, using jet ablation, is performed to expose larger blood vessels 634 within the parenchymal tissue.

[0086] In the steps shown in Figure 12A, non-vascular tissue, such as parenchymal tissue, is selectively excised to expose the blood vessels 634, accompanied by a supporting layer 601 of the non-excised tissue as shown in Figure 12B. These larger blood vessels 634 can be stapled, cut, or cauterized, one or more of which may be performed. Tissue excision may be continued through the remaining part of the organ and the portion of the removed organ. The portion of the organ may comprise the organ lobes. The removed portion of the organ may comprise undesirable tissue or tissue suitable for, for example, tissue harvesting, e.g., organ donation. In some embodiments, the energy provided by the energy source and the location of the energy source may be controlled to allow the parenchymal tissue surrounding the blood vessels to be ablated, exposing the major blood vessels for incision of the neurovascular bundle and the resulting staple closure of the remaining lobes. The harvested or grafted lobes may be discarded and / or preparation for anastomosis may be performed.

[0087] Figure 9-12B illustrates the method of tissue excision and removal, but donor tissue can be transplanted in similar steps to prepare the organ that will receive the tissue.

[0088] Figure 13 illustrates selective tissue resection and removal of undesirable tissue from an organ using 3D volumetric imaging. Organ tissue can be imaged using volumetric imaging such as 3D tomography, ultrasound, CT scanning, or MRI imaging. Images of the tissue to be resected can be shown to the user on a display 425. The user can select and identify the tissue to be resected 600, the resection boundary 704 profile, and blood vessels 634. For example, the user can input the tissue resection boundary using a touchscreen display. By providing multiple screens, the user can identify these structures on each of the multiple screens to define the 3D tissue resection boundary, the 3D treatment profile, and the 3D shape profile of tissues not to be resected, such as blood vessels, and the scanning pattern 702 for tissue resection.

[0089] Figure 14 shows ultrasound images of the right hepatic vein (RHV) and middle hepatic vein (MHV) of the liver displayed on a screen, relating to 3D tissue removal using 3D volumetric imaging. The images can be displayed on a screen, and the user can input a tissue resection boundary 704 around tissue that should not be resected, along with a region 706 of tissue to be resected, and water sources such as blood vessels. In some embodiments, the tissue resection region extends around the boundary of tissue that should not be resected.

[0090] Figure 15 shows an ultrasound image of a hepatic hemangioma displayed on a screen, relating to 3D tissue removal using 3D volumetric imaging. The image can be displayed on the screen, and the user can input a tissue resection boundary 704.

[0091] Figure 16 shows an ultrasound image of a liver cancer tumor displayed on a screen, relating to 3D tissue removal using 3D volumetric imaging. The image can be displayed on the screen, and the user can input the tissue resection boundary 704.

[0092] Figure 17 shows cirrhotic liver tissue for removal as displayed on a screen, relating to 3D tissue removal using 3D volumetric imaging. The tissue removal boundary 704 and tissue removal region 706 are identified by the user on the display. The tissue is excised along the tissue resection boundary, and the cirrhotic tissue can be removed, for example, by ablation with water jets or by removing an intact portion of the cirrhotic liver separated from the non-cirrhotic liver using an energy source.

[0093] Figure 18 shows a CT scan of liver tissue displayed on a screen for 3D tissue removal using 3D volumetric imaging. The user can input a tissue resection boundary 704 and a tissue resection area 706 around the tissue that should not be resected.

[0094] Figures 19A-D show the MRI of the liver and the resection boundary 704 of the tissue resection area as displayed on the screen, relating to 3D tissue removal using 3D volumetric imaging.

[0095] Figures 15-19 show images displayed on a screen for generating tissue resection profiles and boundaries. The processor can consist of instructions for performing volumetric resection in many ways. For example, the images may comprise tomographic images, and the user views multiple image slices and identifies one or more of the following: tissue resection profiles 700, tissue resection regions 706, or tissue resection boundaries 704 of tissue that should not be resected. The boundaries of tissue that should not be resected may be located within the boundaries of the tissue resection regions. With respect to each of the multiple slices, the user can identify each of one or more regions. In some embodiments, an artificial intelligence algorithm, such as a convolutional neural network, can be trained and used to identify one or more boundaries, e.g., vascular boundaries, from each of the multiple images. From the identified regions with respect to each of the multiple slices, the process can generate in 3D one or more of the following: 3D tissue resection profiles, 3D tissue resection regions, or 3D tissue resection boundaries of tissue that should not be resected within the boundaries of the tissue resection regions. Once the 3D volumetric resection area, tissue resection boundary, and area to be left with tissue are identified, the processor may consist of instructions to move the robotic arm to multiple locations and remove the tissue as described herein.

[0096] Tissue can be imaged in many ways, but in some embodiments, tissue is imaged using ultrasound to identify cancerous tissue, such as ultrasonic shear wave elastography. Tissue can be imaged using Doppler ultrasound or 3D Doppler ultrasound to identify blood vessels. The ultrasound transducer can be located, for example, near the tip of the treatment probe 450. Alternatively, or in combination, the ultrasound transducer can be coupled to the patient with another ultrasound probe or an external ultrasound transducer.

[0097] In some embodiments, the fluid released into an organ or fluid-filled inclusion contains a chemotherapeutic agent. For example, the fluid released using a water jet contains a chemotherapeutic agent.

[0098] As described herein, the computing devices and systems described and / or illustrated herein broadly represent any type or form of computing device or system capable of executing computer-readable instructions, such as those contained within the modules described herein. In their most basic configurations, each of these computing devices may comprise at least one memory device and at least one physical processor.

[0099] As used herein, the terms “memory” or “memory device” generally refer to any type or form of volatile or non-volatile storage device or medium capable of storing data and / or computer-readable instructions. For example, a memory device may store, load, and / or maintain one or more of the modules described herein. Examples of memory devices include, but are not limited to, random-access memory (RAM), read-only memory (ROM), flash memory, hard disk drives (HDDs), solid-state drives (SSDs), optical disk drives, caches, variations or combinations of one or more of the same, or any other suitable storage memory.

[0100] In addition, the terms “processor” or “physical processor” as used herein generally refer to any type or form of hardware implementation processing unit capable of interpreting and / or executing computer-readable instructions. For example, a physical processor may access and / or modify one or more modules stored in a memory device as described above. Examples of physical processors include, but are not limited to, microprocessors, microcontrollers, central processing units (CPUs), field-programmable gate arrays (FPGAs) implementing soft-core processors, application-specific integrated circuits (ASICs), parts of one or more of the same, variations or combinations of one or more of the same, or any other suitable physical processor.

[0101] Although illustrated as separate elements, method steps described and / or illustrated herein may represent part of a single application. In addition, in some embodiments, one or more of these steps may represent or correspond to one or more software applications or programs that, when performed by a computing device, cause the computing device to perform one or more tasks, such as the method steps.

[0102] In addition, one or more of the devices described herein may convert data, physical devices, and / or representations of physical devices from one form to another. In addition, or alternatively, one or more of the modules enumerated herein may convert processors, volatile memory, non-volatile memory, and / or any other parts of a physical computing device from one form to another by running on a computing device, storing data on a computing device, and / or otherwise interacting with a computing device.

[0103] As used herein, the term “computer-readable medium” generally refers to any form of device, carrier, or medium capable of storing or carrying computer-readable instructions. Examples of computer-readable mediums include, but are not limited to, transmission media such as carrier waves, and non-transient media such as magnetic storage media (e.g., hard disk drives, tape drives, and floppy disks), optical storage media (e.g., compact discs (CDs), digital video discs (DVDs), and Blu-ray® discs), electronic storage media (e.g., solid-state drives and flash media), and other distribution systems.

[0104] Those skilled in the art will recognize that any process or method disclosed herein can be modified in many ways. Process parameters and sequences of steps described and / or illustrated herein are given only as examples and can be varied as desired. For example, the steps illustrated and / or described herein may be shown or discussed in a particular order, but these steps do not necessarily have to be performed in the order illustrated or discussed.

[0105] Various exemplary methods described and / or illustrated herein may also omit one or more of the steps described or illustrated herein, or may include additional steps in addition to those disclosed herein. Furthermore, any step of any method as disclosed herein may be combined with one or more steps of any other method as disclosed herein.

[0106] A processor as described herein may be configured to perform one or more steps of any of the methods disclosed herein. Alternatively, or in combination, a processor may be configured to combine one or more steps of one or more methods disclosed herein.

[0107] Unless otherwise stated, the terms “connected to” and “joined to” (and their derivatives) as used herein and in the claims shall be interpreted to allow both direct and indirect (i.e., through other elements or components) connections. In addition, the terms “a” or “an” as used herein and in the claims shall be interpreted to mean “at least one of.” Finally, for ease of use, the terms “containing” and “having” (and their derivatives) as used herein and in the claims shall be synonymous with and have the same meaning as the word “equipped with.”

[0108] A processor as disclosed herein may consist of instructions for performing one or more steps of any of the methods disclosed herein.

[0109] It should be understood that the terms “first,” “second,” “third,” etc., may be used herein to describe various layers, elements, components, regions, or divisions without referring to any particular order or sequence of events. These terms are used simply to distinguish one layer, element, component, region, or division from another layer, element, component, region, or division. A first layer, element, component, region, or division as described herein may be referred to as a second layer, element, component, region, or division without departing from the teachings of this disclosure.

[0110] As used herein, the term "or" is used inclusively to refer to items, both as an alternative and in combination.

[0111] As used herein, numbers and other letters refer to similar elements.

[0112] This disclosure includes the following numbered annotations:

[0113] Note 1. A device for tissue resection, the device comprising a robotic arm, a therapeutic probe having an energy source coupled to the robotic arm, and a processor coupled to the robotic arm for positioning the probe.

[0114] Note 2. The apparatus as described in Note 1, wherein the robotic arm is configured to position the energy source in a position and orientation for tissue resection by moving the proximal end of the probe with three or more degrees of freedom, and the energy source is optionally equipped with a water jet.

[0115] Note 3. The apparatus as described in Note 1, wherein the robotic arm is configured to position the energy source by moving the proximal end of the probe.

[0116] Note 4. The treatment probe is the apparatus described in Note 3, which is equipped with a rigid treatment probe.

[0117] Note 5. The apparatus as described in Note 1, wherein the robotic arm is configured to rotate the probe around an extension axis that extends along the probe.

[0118] Note 6. The apparatus as described in Note 1, wherein the treatment probe is configured to rotate around the extension axis of the probe while the posture of the robotic arm remains fixed.

[0119] Note 7. The energy source is the apparatus described in Note 1, which includes a water jet directed across the extension axis of the probe and discharges the water jet onto the side of the probe.

[0120] Note 8. The device described in Note 1, which has a water jet directed along the extension axis of the probe and releases the water jet toward the tissue in the direction along the extension axis.

[0121] Note 9. The apparatus described in Note 1, wherein the treatment probe comprises an irrigation lumen, an endoscope, a high-pressure lumen coupled to a water jet, and a suction lumen for removing excised tissue.

[0122] Appendix 10. The apparatus described in Appendix 1, wherein the treatment probe comprises an irrigation lumen, an endoscope, a high-pressure lumen coupled to a nozzle for releasing water jets, an ultrasonic transducer, and a suction lumen for removing excised tissue.

[0123] Note 11. The device described in Note 1 is equipped with a water jet as an energy source, releasing water jets from an orifice at a flow rate to remove glandular tissue faster than collagen tissue, and optionally equipped with collagen tissue or vascular tissue.

[0124] Appendix 12. The apparatus as described in Appendix 11, wherein the processor comprises instructions for removing tissue consisting of multiple consecutive layers, each of which is removed using a scanning pattern of water jets.

[0125] Note 13. The processor consists of instructions for moving the distal end of the arm, the movement corresponding to a scanning pattern for each of the multiple layers, as described in Note 12.

[0126] Note 14. The apparatus as described in Note 13, wherein the processor consists of instructions for advancing the probe for subsequent layer excision by moving the distal end of the arm.

[0127] Appendix 15. The apparatus described in Appendix 13, wherein the processor consists of instructions for increasing the flow rate of water injection for the removal of the subsequent layer.

[0128] Appendix 16. The apparatus as described in Appendix 1, wherein the processor consists of commands for advancing the probe along the tissue resection boundary by moving the distal end of the arm, and the processor is configured to point the distal end of the arm and point the probe so that it extends along the tissue resection boundary.

[0129] Appendix 17. The apparatus according to Appendix 1, further comprising an encapsulation body having a barrier material for providing a fluid-filled environment on the surface of the tissue.

[0130] Note 18. The apparatus as described in Note 17, wherein the encapsulated body has an opening for receiving a therapeutic probe.

[0131] Appendix 19. The apparatus as described in Appendix 17, wherein the processor has instructions for orbiting the therapeutic probe near an opening in an inclusion body sized to receive the therapeutic probe.

[0132] Appendix 20. The apparatus as described in Appendix 17, wherein the therapeutic probe extends into the inclusion body through an opening and has a lumen sized to provide fluid into the inclusion body, and the therapeutic probe extends into the inclusion body and has a suction lumen sized to remove tissue excision products.

[0133] Note 21. The apparatus as described in Note 1, wherein the treatment probe comprises an elongated probe sized to extend from the incision site in the patient's skin to the organ.

[0134] Note 22. The apparatus as described in Note 1, comprising an elongated probe sized to extend from an external orifice to the organ.

[0135] Appendix 23. The apparatus as described in Appendix 1, wherein the processor consists of commands to move and direct the distal end of the arm to rotate the probe between the proximal end and the distal end of the probe in order to reduce probe movement on the pivot axis.

[0136] Note 24. The apparatus as described in Note 23, wherein the processor consists of instructions for receiving input corresponding to the location of a blood vessel, and the processor consists of instructions for rotating the probe at a location away from the blood vessel.

[0137] Appendix 25. The apparatus as described in Appendix 23, wherein the processor comprises instructions for receiving input corresponding to a location near the pubic bone, and the processor comprises instructions for rotating the probe in that location to reduce the movement of the probe near the pubic bone.

[0138] Appendix 26. The apparatus as described in Appendix 1, wherein the therapeutic probe comprises an elongated probe sized to extend from the opening of the urethra to the prostate, and the processor consists of commands for rotating the probe in the vicinity of one or more of the following locations: the seminal cumulus of the prostate, the external sphincter of the urethra, or a location between the seminal cumulus and the external sphincter.

[0139] Appendix 27. The apparatus as described in Appendix 1, wherein a portion of the probe proximal to the rotation point is configured to move in the opposite direction to the distal end of the probe, and the external opening to the urethra is optionally moved in the opposite direction to the distal end of the probe.

[0140] Note 28. The probe is the apparatus described in Note 1, which is equipped with a deflectable tip.

[0141] Note 29. The device described in Note 28, wherein the deflectable tip portion is equipped with a flexible tip portion.

[0142] Appendix 30. The apparatus described in Appendix 28, wherein the deflectable tip is configured to separate glandular tissue from capsular tissue along the tissue interface.

[0143] Appendix 31. The apparatus as described in Appendix 28, wherein the deflectable tip is configured to deflect in response to user input to the processor, and optionally, the deflectable tip comprises a plurality of elongated elements for deflecting the tip in response to user input.

[0144] Appendix 32. The apparatus as described in Appendix 28, wherein the deflectable tip comprises a lumen and a nozzle for discharging a fluid flow, and optionally the lumen comprises a high-pressure lumen and the fluid flow comprises a water jet discharged from the nozzle.

[0145] Note 33. The device described in Note 1, wherein the probe is configured for insertion into one or more of the following: the brain, heart, lungs, intestines, eyes, skin, kidneys, liver, pancreas, stomach, uterus, ovaries, testicles, bladder, ears, nose, mouth, bone marrow, adipose tissue, muscle, glandular and mucous membrane tissue, spinal cord and nerve tissue, soft tissues such as cartilage, hard biological tissues such as teeth and bone, and body lumens and passages such as sinuses, ureters, colon, esophagus, pulmonary passages, blood vessels, and throat.

[0146] Appendix 34. The apparatus as described in Appendix 1, wherein the processor presents an image of an organ to the user on a display, receives input from the user, and includes instructions for identifying one or more of the tissue excision boundaries, areas of tissue to be excised, or areas of tissue not to be excised, and optionally, areas of tissue not to be excised are located within the boundaries of the tissue to be excised.

[0147] Appendix 35. The apparatus as described in Appendix 1, wherein the processor comprises instructions for providing multiple images to the user, the multiple images comprising multiple tomographic image slices, the processor receiving input from the user regarding the multiple images and being configured to generate one or more of the following: a 3D tissue excision boundary, a 3D region of tissue to be excised, or a 3D region of tissue not to be excised, and optionally, the 3D region of tissue not to be excised is located within the 3D boundary of tissue to be excised.

[0148] Appendix 36. The apparatus as described in Appendix 1, wherein the processor is equipped with instructions for receiving multiple images of a patient, the multiple images comprising multiple tomographic image slices, and the processor is configured to identify one or more of the following: tissue excision boundaries, areas of tissue to be excised, or areas of tissue not to be excised, and optionally, areas of tissue not to be excised are located within the boundaries of the tissue to be excised in the multiple images.

[0149] Appendix 37. The apparatus as described in Appendix 36, wherein the processor comprises instructions for generating one or more of the following: a 3D tissue excision boundary, a 3D region of tissue to be excised, or a 3D region of tissue not to be excised, and optionally, the 3D region of tissue not to be excised is located within the 3D boundary of tissue to be excised.

[0150] Appendix 38. A method comprising providing or using the apparatus described in any one of the preceding appendices.

[0151] Embodiments of the Disclosure are shown, described and provided as such herein, for illustrative purposes only. Those skilled in the art will recognize numerous adaptations, modifications, variations, and substitutions without departing from the scope of the Disclosure. Several alternatives and combinations of the embodiments disclosed herein may be utilized without departing from the scope of the Disclosure and the Inventions Disclosed herein. Accordingly, the scope of the Inventions Disclosed herein shall be defined solely by the scope of the appended claims and their equivalents.

Claims

1. A device for tissue excision, wherein the device is A robotic arm and A therapeutic probe configured to be coupled to the robot arm, wherein the therapeutic probe is equipped with an energy source, A processor coupled to the robot arm for positioning the treatment probe and The apparatus comprises a processor configured to identify a tissue resection boundary by presenting an image of an organ to the user on a display and receiving input from the user, and the processor configured to move the proximal end of the treatment probe along a path by moving the distal end of the robot arm, thereby advancing the tip of the treatment probe to a position where energy from the energy source can treat the tissue resection boundary, orienting the distal end of the robot arm to direct the energy path of the treatment probe so that the energy can reach the tissue resection boundary, and moving the tip of the treatment probe along a corresponding path around a pivot point located between the proximal end and the distal end of the treatment probe so as to direct the energy to a target tissue location.

2. The apparatus according to claim 1, wherein the robotic arm is configured to position the energy source in a position and orientation for tissue resection by moving the proximal end of the treatment probe with three or more degrees of freedom.

3. The apparatus according to claim 2, wherein the energy source is provided with water injection.

4. The apparatus according to claim 1, wherein the robot arm is configured to position the energy source by moving the proximal end of the treatment probe.

5. The apparatus according to claim 4, wherein the treatment probe comprises a rigid treatment probe.

6. The apparatus according to claim 1, wherein the robotic arm is configured to rotate the treatment probe around an extension axis that extends along the treatment probe.

7. The apparatus according to claim 1, wherein the treatment probe is configured to rotate around the extension axis of the treatment probe while the posture of the robot arm remains fixed.

8. The apparatus according to claim 1, wherein the energy source comprises a water jet directed across the extension axis of the treatment probe, and the water jet is released toward the side surface of the treatment probe.

9. The apparatus according to claim 1, wherein the energy source comprises a water jet directed along the extension axis of the treatment probe, and the water jet is released toward the tissue in a direction along the extension axis.

10. The apparatus according to any one of claims 8 or 9, wherein the treatment probe comprises an irrigation lumen, an endoscope, a high-pressure lumen coupled to a water jet, and a suction lumen for removing excised tissue.

11. The apparatus according to any one of claims 8 or 9, wherein the therapeutic probe comprises an irrigation lumen, an endoscope, a high-pressure lumen coupled to a nozzle for releasing a water jet, an ultrasonic transducer, and a suction lumen for removing excised tissue, the ultrasonic transducer being configured to image the excised tissue.

12. The apparatus according to claim 1, wherein the processor comprises instructions for removing tissue having a plurality of consecutive layers at the tissue excision boundary within each of the plurality of consecutive layers, and each of the plurality of consecutive layers is removed using a scanning pattern of water jets.

13. The apparatus according to claim 12, wherein the processor comprises instructions for moving the distal end of the robot arm, the movement corresponding to the scanning pattern for each of the plurality of consecutive layers.

14. The apparatus according to claim 13, wherein the processor comprises commands for advancing the therapeutic probe for excision of a subsequent layer by moving the distal end of the robot arm.

15. The apparatus according to claim 13, wherein the processor comprises instructions for increasing the flow rate of the water injection for the removal of the subsequent layer.

16. The apparatus according to claim 1, further comprising an encapsulation body having a flexible material that can deform and contour relative to the surface of the tissue, wherein the encapsulation body is configured to be filled with a fluid.

17. The apparatus according to claim 16, wherein the encapsulated body has an opening for receiving the treatment probe.

18. The apparatus according to claim 16, wherein the processor provides instructions for rotating the therapeutic probe near an opening in the encapsulation body which is sized to receive the therapeutic probe.

19. The apparatus according to claim 16, wherein the therapeutic probe extends through an opening into the inclusion body and comprises a lumen sized to supply fluid into the inclusion body, and the therapeutic probe extends into the inclusion body and comprises a suction lumen sized to remove tissue excision products.

20. The apparatus according to claim 1, wherein the treatment probe comprises an elongated probe sized to extend from an incision in the patient's skin to an organ.

21. The apparatus according to claim 1, wherein the treatment probe comprises an elongated probe sized to extend from an external orifice to an organ.

22. The apparatus according to claim 1, wherein the processor comprises commands for moving and directing the distal end of the robot arm to rotate the treatment probe between the proximal end and the distal end of the treatment probe in order to reduce probe movement at the rotation location.

23. The apparatus according to claim 22, wherein the processor comprises commands for receiving input corresponding to the location of a blood vessel, and the processor comprises commands for rotating the treatment probe at a location away from the blood vessel.

24. The apparatus according to claim 22, wherein the processor comprises instructions for receiving an input corresponding to a location near the pubic bone, and the processor comprises instructions for rotating the treatment probe at a location to reduce the movement of the treatment probe near the pubic bone.

25. The apparatus according to claim 1, wherein the therapeutic probe comprises an elongated probe sized to extend from the opening of the urethra to the prostate, and the processor comprises commands for rotating the therapeutic probe in the vicinity of one or more of the following locations: the seminal cumulus of the prostate, the external sphincter of the urethra, or a location between the seminal cumulus and the external sphincter.

26. The apparatus according to claim 22, wherein a portion of the treatment probe proximal to the rotation location is configured to move in the opposite direction to the distal end of the treatment probe.

27. The apparatus according to claim 26, wherein the treatment probe comprises an elongated probe sized to extend from the external opening of the urethra.

28. The apparatus according to claim 1, wherein the treatment probe is provided with a deflectable tip portion.

29. The apparatus according to claim 28, wherein the deflectable tip portion is provided with a flexible tip portion.

30. The apparatus according to claim 28, wherein the deflectable tip portion is configured to separate glandular tissue from capsular tissue along the tissue interface.

31. The apparatus according to claim 28, wherein the deflectable tip portion is configured to deflect in response to user input to the processor.

32. The apparatus according to claim 31, wherein the deflectable tip portion comprises a plurality of elongated elements for deflecting the deflectable tip portion in response to user input.

33. The apparatus according to claim 28, wherein the deflectable tip portion comprises a lumen and a nozzle for discharging a fluid flow.

34. The apparatus according to claim 33, wherein the lumen comprises a high-pressure lumen, and the fluid flow comprises a water jet discharged from the nozzle.

35. The apparatus according to claim 1, wherein the therapeutic probe is configured for insertion into one or more of the brain, heart, lungs, intestines, eyes, skin, kidneys, liver, pancreas, stomach, uterus, ovaries, testicles, bladder, ears, nose, mouth, soft tissue, hard biological tissue, and body lumens and passages.

36. The soft tissue includes bone marrow, adipose tissue, muscle, glandular and mucous membrane tissue, spinal cord and nerve tissue, and cartilage. The aforementioned hard biological tissues include teeth and bones. The apparatus according to claim 35, wherein the body lumens and passages include sinuses, ureters, colon, esophagus, pulmonary passages, blood vessels, and throat.

37. The apparatus according to claim 1, wherein the input from the user further identifies one or more of the areas of tissue to be excised or areas of tissue not to be excised.

38. The apparatus according to claim 37, wherein the region of tissue that should not be excised is located within the boundary of the tissue to be excised.

39. The apparatus according to claim 1, wherein the processor comprises instructions for providing a plurality of images to a user, the plurality of images comprising a plurality of tomographic image slices, and the processor is configured to receive input from the user with respect to the plurality of images and generate one or more of a 3D tissue excision boundary, a 3D region of tissue to be excised, or a 3D region of tissue not to be excised.

40. The apparatus according to claim 39, wherein the 3D region of tissue that should not be excised is located within the 3D boundary of the tissue to be excised.

41. The apparatus according to claim 1, wherein the processor comprises instructions for receiving a plurality of images of a patient, the plurality of images comprising a plurality of tomographic image slices, and the processor is configured to identify one or more of the tissue excision boundary, the region of tissue to be excised, or the region of tissue not to be excised.

42. The apparatus according to claim 41, wherein the region of tissue that should not be excised is located within the boundary of the tissue to be excised in the plurality of images.

43. The apparatus according to claim 42, wherein the processor comprises instructions for generating one or more of the following: a 3D tissue excision boundary, a 3D region of tissue to be excised, or a 3D region of tissue not to be excised.

44. The apparatus according to claim 43, wherein the 3D region of tissue that should not be excised is located within the 3D boundary of the tissue to be excised.

Images