Robotic Instrument Drive Control

Abstract

The robotic system includes a medical instrument comprising an elongate shaft dimensioned to be at least partially disposed within an access sheath, and a control circuit configured to at least partially retract the elongate shaft within the access sheath, determine a position of a distal end of the elongate shaft relative to the access sheath, and modify a rate of retraction of the elongate shaft based on the determined position of the distal end of the elongate shaft relative to the access sheath.

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This application claims priority to U.S. Provisional Application No. 63 / 132,771, entitled "POSITION-BASED INSTRUMENT FEEDER CONTROL," filed December 31, 2020, and U.S. Provisional Application No. 63 / 150,277, entitled "POSITION-BASED INSTRUMENT FEEDER CONTROL," filed February 17, 2021, the disclosures of which are incorporated by reference in their entireties herein. [Background technology]

[0002] The present disclosure relates to robotic medical systems. Certain robotic medical procedures may involve the use of shaft-type instruments, such as endoscopes, which may be inserted into a patient through a bore (e.g., a natural orifice) and advanced to a target anatomical site. The medical instruments may be controllable and articulatable to facilitate navigation in and out of the patient's anatomy. Instrument feeder devices and systems may control the axial movement of the shaft-type medical instruments during a medical procedure. [Brief description of the drawings]

[0003] Various embodiments are depicted in the accompanying drawings for illustrative purposes and should not be construed as limiting the scope of the present invention in any way. In addition, various features of different disclosed embodiments may be combined to form further embodiments that are part of this disclosure. Throughout the drawings, reference numbers may be reused to indicate correspondence between referenced elements. [Figure 1] FIG. 1 illustrates an embodiment of a robotic medical system including an instrument feeder device controllable via a robotic arm interface, in accordance with one or more embodiments. [Diagram 2] FIG. 1 illustrates a robotic system deployed for diagnostic and / or therapeutic bronchoscopy, according to one or more embodiments. [Diagram 3] FIG. 1 illustrates a pedestal-based robotic system in accordance with one or more embodiments. [Figure 4] FIG. 4 illustrates medical system components that may be implemented in any of the medical systems of FIGS. 1-3, according to one or more embodiments. [Diagram 5] FIG. 4 illustrates medical system components that may be implemented in any of the medical systems of FIGS. 1-3, according to one or more embodiments. [Figure 6] 1A-1C show a ureteroscope disposed within a portion of a patient's urinary system and including a basket device within its working channel in driving engagement with an instrument feeder, according to one or more embodiments. [Figure 7] 1A-1C show a ureteroscope disposed within a portion of a patient's urinary system and including a basket device within its working channel in driving engagement with an instrument feeder, according to one or more embodiments. [Figure 8] FIG. 1 illustrates an exploded view of an instrument manipulator assembly associated with a robotic arm in accordance with one or more embodiments. [Figure 9] FIG. 1 is a perspective view of a robotic arm having an endoscope and an instrument feeder device coupled thereto, according to one or more embodiments. [Figure 10] FIG. 1 is a top view of an instrument feeder configured to drive axial movement of an elongate shaft of a medical instrument, according to one or more embodiments. [Figure 11] FIG. 1 illustrates a scope position determination image recognition architecture in accordance with one or more embodiments. [Figure 12] FIG. 1 is a flow diagram illustrating a process for capturing, retracting, and collecting stone fragments in accordance with one or more embodiments of the present disclosure. [Figure 13-1] FIG. 11 is a flow diagram illustrating a process for automatically modifying an axial drive speed of a medical instrument, in accordance with one or more embodiments. [Figure 13-2]FIG. 11 is a flow diagram illustrating a process for automatically modifying an axial drive speed of a medical instrument, in accordance with one or more embodiments. [Figure 13-3] FIG. 11 is a flow diagram illustrating a process for automatically modifying an axial drive speed of a medical instrument, in accordance with one or more embodiments. [Figure 13-4] FIG. 11 is a flow diagram illustrating a process for automatically modifying an axial drive speed of a medical instrument, in accordance with one or more embodiments. [Figure 14-1] 13-1, 13-2, 13-3, and 13-4, respectively, in accordance with one or more embodiments. [Figure 14-2] 13-1, 13-2, 13-3, and 13-4, respectively, in accordance with one or more embodiments. [Figure 14-3] 13-1, 13-2, 13-3, and 13-4, respectively, in accordance with one or more embodiments. [Figure 14-4] 13-1, 13-2, 13-3, and 13-4, respectively, in accordance with one or more embodiments. [Figure 15] FIG. 1 illustrates a robotic system including instruments and an instrument driver / feeder mounted on respective robotic end effectors, in accordance with one or more embodiments. [Figure 16] FIG. 1 illustrates an assembly of an instrument driver / feeder device and an access sheath assembly according to one or more embodiments, where specific speed zones are identified. [Figure 17] FIG. 1 illustrates an assembly of an instrument driver / feeder device and an access sheath assembly according to one or more embodiments, where specific speed zones are identified. [Figure 18] FIG. 11 is a flow diagram illustrating a process for verifying sheath position, according to one or more embodiments of the present disclosure. [Figure 19] FIG. 11 is a flow diagram illustrating a process for inserting an instrument, according to one or more embodiments of the present disclosure. [Figure 20] FIG. 11 is a flow diagram illustrating a process for retracting an instrument, in accordance with one or more embodiments of the present disclosure. [Figure 21] FIG. 13 is a flow diagram illustrating a process for removing a specimen using lateral scope base translation. [Figure 22A] 1A and 1B are overhead and side views, respectively, of a robotic system including one or more robotic end effectors configured to be translated within a specific zone to perform instrument retraction, in accordance with an aspect of the present disclosure. [Figure 22B] 1A and 1B are overhead and side views, respectively, of a robotic system including one or more robotic end effectors configured to be translated within a specific zone to perform instrument retraction, in accordance with an aspect of the present disclosure. [Figure 23-1] FIG. 13 is an overhead view of the scope base / handle in various rotational states associated with scope retraction, in accordance with one or more embodiments. [Figure 23-2] FIG. 13 is an overhead view of the scope base / handle in various rotational states associated with scope retraction, in accordance with one or more embodiments. [Figure 23-3] FIG. 13 is an overhead view of the scope base / handle in various rotational states associated with scope retraction, in accordance with one or more embodiments. [Figure 24-1] FIG. 13 is an overhead view of the scope base / handle in various rotational and lateral translation states associated with scope retraction, in accordance with one or more embodiments. [Figure 24-2] FIG. 13 is an overhead view of the scope base / handle in various rotational and lateral translation states associated with scope retraction, in accordance with one or more embodiments. [Figure 24-3]FIG. 13 is an overhead view of the scope base / handle in various rotational and lateral translation states associated with scope retraction, in accordance with one or more embodiments. [Figure 25-1] 11A-11C are overhead views of an instrument base in various measurement and translation states associated with instrument retraction and / or insertion, according to one or more embodiments. [Figure 25-2] 11A-11C are overhead views of an instrument base in various measurement and translation states associated with instrument retraction and / or insertion, according to one or more embodiments. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0004] The headings provided herein are merely for convenience and do not necessarily affect the scope or meaning of the claimed invention. Although certain preferred embodiments and examples are disclosed below, the inventive subject matter extends beyond the specifically disclosed embodiments to other alternative embodiments and / or applications, as well as to modifications and equivalents thereof. Thus, the scope of claims that may arise from this specification is not limited by any of the specific embodiments described below. For example, in any method or process disclosed herein, the acts or operations of the method or process may be performed in any suitable order and are not necessarily limited to any particular disclosed order. Various operations may be described in sequence as multiple separate operations in a manner that may be helpful in understanding a particular embodiment. However, the order of description should not be construed to imply that these operations are order-dependent. Furthermore, structures, systems, and / or devices described herein may be embodied as integrated or separate components. For purposes of comparing various embodiments, certain aspects and advantages of these embodiments are described. Not necessarily all such aspects or advantages are realized by any particular embodiment. Thus, for example, various embodiments may be implemented in a manner that achieves or optimizes one advantage or group of advantages as taught herein without necessarily achieving other aspects or advantages that may also be taught or suggested herein.

[0005] While certain spatially relative terms, such as "outer," "inner," "upper," "lower," "below," "upper," "vertical," "horizontal," "top," "bottom," and similar terms, are used herein to describe the spatial relationship of one device / element or anatomical structure to another device / element or anatomical structure, it is understood that these terms are used herein for ease of description to describe positional relationships between elements / structures, such as with respect to the illustrated orientation of the drawings. It is understood that spatially relative terms are intended to encompass different orientations of the elements / structures in use or operation in addition to the orientation shown in the drawings. For example, when an element / structure is described as being "above" another element / structure, it may represent a position below or to the side of such other element / structure with respect to the intended patient or alternative orientations of the element / structure, and vice versa. It is understood that spatially relative terms, including those listed above, may be understood with respect to the illustrated orientation of each of the referenced figures.

[0006] Certain reference numbers are reused across different figures of the set of figures of this disclosure for convenience of devices, components, systems, features, and / or modules that have characteristics that may be similar in one or more respects. However, with respect to any of the embodiments disclosed herein, the reuse of a common reference number in a figure does not necessarily indicate that such features, devices, components, or modules are identical or similar. Rather, a person skilled in the art may be informed by the context as to the extent to which the use of a common reference number may imply similarity between the referenced subject matter. The use of a particular reference number in the context of the description of a particular figure may be understood to relate to the device, component, aspect, feature, module, or system identified in that particular figure, and not necessarily to any device, component, aspect, feature, module, or system identified by the same reference number in another figure. Furthermore, aspects of separate figures identified with a common reference number may be interpreted as sharing characteristics or as being entirely independent of each other.

[0007] The present disclosure provides systems, devices, and methods for implementing automatic pausing, deceleration, and / or other speed control / modifications with respect to the axial movement of a shaft-type instrument using an instrument feeder, where such speed control / modifications are based at least in part on determining the position of an instrument and / or its components or parts engaged or driven by the instrument feeder. For example, some implementations relate to implementations that automatically pause, decelerate, or accelerate an instrument feeder actuator mechanism upon exit of an associated instrument from a body cavity or introducer / access sheath that provides access to an associated treatment site. With respect to instrument feeder devices and other medical devices related to the present disclosure, the term "device" is used according to its broad and ordinary meaning and may refer to any type of tool, instrument, assembly, system, subsystem, apparatus, component, or the like. In some contexts herein, the term "instrument" may be used substantially interchangeably with the term "device."

[0008] Although certain aspects of the present disclosure are described in detail herein in the context of renal, urological, and / or nephrological procedures, such as kidney stone removal / treatment procedures, it should be understood that such context is provided for convenience and clarity, and that the axial drive control, instrument location / detection, and specimen collection concepts disclosed herein are applicable to any suitable medical procedure, such as robotic bronchoscopy. However, as noted, a description of the anatomy of the renal / urinary system and associated medical problems and procedures is presented below to aid in the explanation of the inventive concepts disclosed herein.

[0009] Certain medical procedures, such as ureteroscopy procedures, may utilize an elongated medical instrument that accesses the procedure site through an access sheath to remove debris, such as kidney stones and stone fragments or other waste or contaminants, from the procedure site. Kidney stone disease, also known as urolithiasis, is a medical condition involving the formation of solid pieces of material in the urinary tract, referred to as "kidney stones," "urinary stones," "nephrolithiasis," or "nephrolithiasis." Urinary stones may form and / or be found in the kidneys, ureters, and bladder (referred to as "bladder stones"). Such urinary stones may form as a result of the concentration of minerals in the urinary fluid, and may cause significant abdominal pain if such stones reach a size sufficient to obstruct urine flow through the ureter or urethra. Urinary stones may be formed from calcium, magnesium, ammonia, uric acid, cystine, and / or other compounds, or combinations thereof.

[0010] To treat patients with kidney stones, several methods can be used, including observation, medical procedures (such as drainage therapy), non-invasive treatments (such as extracorporeal shock wave lithotripsy (ESWL)), and minimally invasive or surgical treatments (such as ureteroscopy and percutaneous nephrolithotomy ("PCNL"). In some approaches (e.g., ureteroscopy and PCNL), a physician accesses the stone, the stone is broken into smaller pieces or fragments, and the smaller stone fragments / particles are removed from the kidney using a basket device and / or suction.

[0011] In some procedures, a surgeon may insert an endoscope (e.g., a ureteroscope) through the urethra and into the urinary tract to remove urinary stones from the bladder and ureters. Typically, the ureteroscope includes a camera at its distal end configured to allow visualization of the urinary tract. The ureteroscope may also include a lithotripsy device configured to capture or fragment urinary stones or allow a lithotripsy device to be placed within the working channel of the ureteroscope. During a ureteroscopic procedure, one physician / technologist may control the position of the ureteroscope while another physician / technologist may control the lithotripsy device.

[0012] In some procedures, such as those to remove relatively large stones, physicians may use percutaneous nephrolithotomy ("PCNL") techniques, which involve inserting a nephroscope through the skin (i.e., percutaneously) and intervening tissue to gain access to the treatment site for breaking up and / or removing the stone. The percutaneous access devices (e.g., nephroscopes, sheaths, sheath assemblies, and / or catheters) (and / or direct entry endoscopes) used to provide an access channel to the target anatomical site may include one or more fluid channels for providing irrigation fluid flow to the target site and / or for aspirating fluid from the target site (e.g., through passive outflow and / or active suction).

[0013] In the case of ureteroscopic procedures, physicians may perform procedures to break larger kidney stones into smaller fragments to facilitate their removal. For example, certain instruments may be utilized to break the stone into smaller fragments, such as by laser irradiation or by application of other cleaving forces to the kidney stone. According to some procedures, a basket device / system may be used to capture smaller stone fragments and extract them from the treatment site and out of the patient. Generally, once a stone is captured, the surgeon may wish to quickly extract the stone through the ureteral access sheath before opening the basket to deposit / drop the stone into a specimen collection structure or area, after which the basket may be closed and reinserted through the access sheath (e.g., into the working channel of the endoscope / ureteroscope) for the purpose of extracting any remaining stone or stone fragments.

[0014] Robot-assisted ureteroscopic procedures can be performed in connection with various medical procedures, such as kidney stone removal procedures, where robotic tools can enable physicians / urologists to perform endoscopic target access as well as percutaneous access / treatment. Advantageously, aspects of the present disclosure relate to systems, devices, and methods for robotically controlling the axial insertion and / or retraction of an endoscope / ureteroscope to improve procedure efficiency and effectiveness. For some ureteroscopic procedures, it may be necessary to capture and extract up to 30 or more stone fragments, each requiring an advancement, capture, and retraction sequence / trip. The process of retracting the basket and scope through the access sheath, dropping / depositing the captured stone fragments, and reinserting the scope / basket in and through the access sheath, ideally, can be repeatable in an efficient manner. However, such a process may require the physician to monitor the scope camera image / view during retraction to see when the scope clears the proximal opening of the access sheath so that the stone fragments and basket are extracted out of the access sheath. It may then be necessary or desirable to coordinate with another technician to ascertain when to open and close the basket to allow the captured stone fragments to fall / deposit. Careful movements may then be required when inserting the scope / basket into the access sheath to prevent the scope from advancing too quickly outside the access sheath and causing injury or damage to the patient's physiology and / or surgical structures / devices.

[0015] In some of the examples described herein, the object removal procedure relates to the use of a robotic system and medical instruments / devices to remove stones from a kidney. However, the present disclosure is not limited to kidney stone procedures only. For example, the following description is also applicable to other surgical or medical procedures for diagnosis or treatment, such as procedures involving the removal of objects from a patient, including any object that can be removed from a treatment site or a patient's body cavity (e.g., esophagus, ureter, intestine, eye, etc.) or other anatomical site via endoscopic and / or percutaneous access, such as gallbladder stone removal, lung (pulmonary / transthoracic) tumor biopsy, or cataract removal. Certain embodiments of the present disclosure advantageously obviate problems associated with retracting a scope or other elongated shaft using an instrument feeder, with respect to the retraction speed of the scope and / or the location where retraction is stopped / paused.

[0016] Healthcare System FIG. 1 illustrates an example medical system 100 for performing various medical procedures according to aspects of the present disclosure. The medical system 100 may be used, for example, for endoscopic (e.g., ureteroscopic) procedures. As mentioned and described above, certain ureteroscopic procedures involve the treatment / removal of kidney stones. In some implementations, kidney stone treatment may benefit from the assistance of certain robotic techniques / devices. Robotic medical solutions may provide relatively high precision, better control, and / or better hand-eye coordination for certain instruments compared to strictly manual procedures. For example, robotically assisted ureteroscopic access to the kidney with some procedures advantageously allows the urologist to individually perform both endoscope control and basket control.

[0017] Although the system 100 of FIG. 1 is presented in terms of a ureteroscopic procedure, it should be understood that the principles disclosed herein may be implemented in any type of endoscopic procedure. Additionally, some of the examples described herein relate to object removal procedures, including the removal of kidney stones from the kidney. However, the present disclosure is not limited to kidney stone removal alone. For example, the following description is also applicable to other surgical or medical procedures or procedures involving the removal of objects from a patient, including any object that can be removed from a treatment site or patient cavity (e.g., esophagus, ureter, intestine, eye, etc.) via percutaneous and / or endoscopic access, such as gallbladder stone removal, lung (pulmonary / transthoracic) tumor biopsy, or cataract extraction.

[0018] The medical system 100 includes a robotic system 10 (e.g., a mobile robotic cart) configured to engage and / or control a medical instrument 40 (e.g., a ureteroscope) and perform a direct entry procedure on a patient 7. The term "direct entry" is used herein according to its broad and ordinary meaning and may refer to any entry of instrumentation through a natural or artificial opening in the patient's body. For example, with reference to FIG. 1, direct entry of a scope 40 into the urinary tract of a patient 7 may occur via the urethra 65.

[0019] It should be understood that the direct entry instrument 40 may be any type of medical instrument, including an endoscope (such as a ureteroscope), a catheter (such as a steerable or non-steerable catheter), a nephroscope, a laparoscope, or other type of medical instrument. The embodiments of the present disclosure related to a ureteroscopic procedure for removing kidney stones through a ureteral access sheath (e.g., ureteral access sheath 90) are also applicable to solutions for removing objects via percutaneous access, such as through a percutaneous access sheath. For example, an instrument may access the kidney percutaneously, such as through a percutaneous access sheath, to capture and remove a kidney stone, and the insertion and retraction rate of such an instrument may be modified / controlled based on the instrument position according to aspects of the present disclosure. The term "percutaneous access" is used herein according to its broad and ordinary meaning and may refer to entry, such as by puncture and / or small incision, of an instrument through a patient's skin and any other body layers necessary to reach a target anatomical location associated with the procedure (e.g., the calyx rete of the kidney 70).

[0020] The medical system 100 includes a control system 50 configured to interface with the robotic system 10 to provide information regarding the procedure and / or perform various other operations. For example, the control system 50 may include one or more displays 56 configured to present certain information to assist the physician 5 and / or other technicians or individuals. The medical system 100 may include a platform 15 configured to hold a patient 7. The system 100 may further include an electromagnetic (EM) field generator 18, which may be carried by one or more of the robotic arms 12 of the robotic system 10 or may be a stand-alone device. While various robotic arms are shown in various positions and coupled to various tools / devices, it should be understood that such configurations are illustrated for convenience and illustrative purposes and that such robotic arms may have different configurations over time and / or at different points during a medical procedure. Additionally, the robotic arms 12 may be coupled to different devices / instruments than those shown in FIG. 1, and in some cases or periods, one or more of the arms may not be utilized or may not be coupled to a medical instrument (e.g., an instrument manipulator / coupling).

[0021] In an exemplary use case, if a patient 7 has a kidney stone (or stone fragment) 80 located in a kidney 70, a physician may perform a procedure to remove the stone 80 through the ureter (63, 60, 65). In some embodiments, the physician 5 may interact with the control system 50 and / or the robotic system 10 to cause / control the robotic system 10 to advance and navigate a medical instrument 40 (e.g., a scope) from the urethra 65, through the bladder 60, up the ureter 63, and into the renal pelvis 71 and / or calyx of the kidney 70 where the stone 80 is located. The physician 5 may further interact with the control system 50 and / or the robotic system 10 to cause / control the advancement of a basket device 30 through the working channel of the instrument 40, the basket device 30 being configured to facilitate capture and removal of the kidney stone. The control system 50 may provide information associated with the medical instrument 40 (e.g., real-time endoscopic images captured by the medical instrument 40) and / or information associated with other instruments of the system 100 via the display 56 to assist the physician 5 in navigating / controlling such instruments.

[0022] Renal anatomy is described herein for reference with respect to certain medical procedures related to aspects of the inventive concept. The kidneys 70, shown generally in a typical anatomical location in FIG. 1, generally comprise two bean-shaped organs located on the left and right sides, respectively, in the retroperitoneal space. In an adult human, the kidneys generally are about 11 cm in height / length. The kidneys receive blood from paired renal arteries 69, and blood leaves the kidneys via paired renal veins 67. Each kidney 70 is fluidly connected to a respective ureter 63, which generally comprises a tube that carries urine drained from the kidney 70 to the bladder 60.

[0023] The kidneys 70 are typically located relatively high within the abdominal cavity, in a retroperitoneal position at a slight oblique angle. Intraperitoneal asymmetries generally caused by the position of the liver typically result in the right kidney being slightly lower and smaller than the left, and slightly more centrally located than the left kidney (as shown in detail in FIG. 1). Above each kidney is an adrenal gland (not shown). The upper portion of the kidney 70 is partially protected by the eleventh and twelfth ribs (not shown). Each kidney with its adrenal gland is generally surrounded by two layers of fat: perirenal fat, which resides between the renal fascia and the renal capsule, and pararenal fat, which resides above the renal fascia.

[0024] The kidneys 70 are responsible for controlling the volumes of various body fluid compartments, fluid osmolality, acid-base balance, various electrolyte concentrations, and the removal of toxins. The kidneys 70 provide a filtration function by secreting certain substances and reabsorbing others. Examples of substances secreted in urine are hydrogen, ammonium, potassium, and uric acid. In addition, the kidneys also perform various other functions, such as hormone synthesis.

[0025] The recessed area on the concave border of kidney 70 is the renal hilum 81, where the renal artery 69 (not shown in the detailed view of kidney 70) enters kidney 70 and where the renal vein 67 (not shown in the detailed view) and ureter 63 exit. Kidney 70 is surrounded by a tough fibrous tissue, the renal capsule 74, which is itself surrounded by perirenal fat, renal fascia, and pararenal fat. The anterior (front) surface of these tissues is the peritoneum, while the posterior (back) surface is the transversalis fascia.

[0026] The functional matrix or parenchyma of the kidney 70 is divided into two major structures: the outer renal cortex 77 and the inner renal medulla 87. These structures each take the form of multiple roughly conical renal lobes that contain a renal cortex surrounding a portion of the medulla called the renal pyramids 72. Between the renal pyramids 72 are processes of the cortex called the renal columns 73. The urine-producing functional structure of the kidney, the nephron (not shown in detail in FIG. 1 ), spans the cortex 77 and medulla 87. The initial filtering portion of the nephron is the renal corpuscle, located in the cortex, followed by the renal duct, which enters the cortex deep into the medullary pyramid. The medullary ray, which is part of the renal cortex, is a collection of tubules that drain into a single collecting duct.

[0027] The tip / apex, or papilla 79, of each renal pyramid drains urine into a respective minor calyx 75, which drains into a major calyx 76, which drains into the renal pelvis 71 where it passes into the ureter 63. The manifold-shaped collection of minor and major calyxes may be referred to herein as the "calyx network" of the kidney. At the renal hilum 81, the ureter 63 and renal vein 67 exit the kidney and the renal artery 69 enters. Hilar fat and lymphatic tissue with lymph nodes surround these structures. The renal hilar fat is adjacent to a fat-filled cavity referred to as the renal sinus. The renal sinus collectively contains the renal pelvis 71 and calyxes 75, 76 and separates these structures from the renal medullary tissue. The funnel-shaped / tubular anatomical structure associated with the calyx may be referred to as the infundibulum. That is, the infundibulum generally provides the terminal end of the calyx where the papilla is exposed within the calyx.

[0028] With further reference to the medical system 100, the medical instrument 40 (e.g., a scope, direct entry instrument, etc.) may be advanced through the urinary tract into the kidney 70. Specifically, a ureteral access sheath 90 may be disposed in a region near the kidney 70 within the urinary tract. As shown, the medical instrument 40 may be passed through the ureteral access sheath 90 to access the internal anatomical structure of the kidney 70. Upon arriving at the site of the kidney stone 80 (e.g., within the target calyx 75 of the kidney 70 where the stone 80 is accessible), the medical instrument 40 may be used to guide / direct the basket device 30 to the target location. Once the stone 80 is captured within the distal basket portion 35 of the basket device 30, the kidney stone 80 may be extracted from the patient 7 using the utilized ureteral access pathway.

[0029] Various scope-type instruments disclosed herein, such as the scope 40 of the system 100, can be configured to travel within the human anatomy, such as within a natural orifice or lumen of the human anatomy. The terms "scope" and "endoscope" are used herein according to their broad and ordinary meaning and may refer to any type of elongated medical instrument having imaging, viewing, and / or capturing capabilities and configured to be introduced into any type of organ, cavity, lumen, chamber, or space of the body. Scopes can include, for example, ureteroscopes (e.g., for accessing the urinary tract), laparoscopes, nephroscopes (e.g., for accessing the kidneys), bronchoscopes (e.g., for accessing the airways such as the bronchi), colonoscopes (e.g., for accessing the colon), arthroscopes (e.g., for accessing joints), cystoscopes (e.g., for accessing the bladder), colonoscopes (e.g., for accessing the colon and / or rectum), borescopes, and the like. The scope / endoscope, in some cases, may comprise at least a partially rigid and / or flexible tube and may be sized to be passed through an outer sheath, catheter, introducer, or other luminal device, or may be used without such a device.

[0030] System 100 may advantageously be configured to implement specific scope retraction speed control / modifications based on determined / detected scope position as disclosed in detail herein. Such scope speed control may advantageously provide efficient stone removal and prevention or reduction of risk of damage to tissue and / or instrumentation during scope insertion and retraction.

[0031] FIG. 2 illustrates a cart-based robotic system 101 arranged for diagnostic and / or therapeutic bronchoscopy, according to one or more embodiments. During bronchoscopy, the arm 12 of the robotic system 10 may be configured to drive a medical instrument, such as a steerable endoscope 52, which may be a procedural bronchoscope for bronchoscopy, through a natural orifice access point (e.g., the mouth of a patient 7, which in this example is positioned on a table 15) to deliver diagnostic and / or therapeutic tools. As shown, the robotic system 10 (e.g., a cart) may be positioned adjacent to the upper torso of the patient to provide access to the access point. Similarly, the robotic arm 12 may be actuated to position the bronchoscope 52 relative to the access point. The arrangement of FIG. 2 may also be utilized when performing Gastro-Intestinal (GI) procedures using a gastroscope, an endoscope specialized for GI procedures.

[0032] Once the robotic system 10 is properly positioned, the robotic arm 12 can insert the steerable endoscope 52 into the patient robotically, manually, or a combination thereof. The steerable endoscope 52 can include at least two telescopic parts, such as an inner leader section and an outer sheath section, each section coupled to a separate instrument driver from a set of instrument feeders 11, each instrument feeder coupled to the distal end of a respective robotic arm 12. This linear arrangement of the instrument feeders 11 creates a "virtual rail" 103 that can be repositioned in space by manipulating one or more of the robotic arms 12 into different angles and / or positions. The virtual rail / path described herein is generally depicted in the figures using dashed lines that do not depict any physical structure of the system. Translation of one or more of the instrument feeders 19 along the virtual rail 103 can advance or retract the endoscope 52 from the patient 7. Additionally or alternatively, implementation of one or more axial drive actuators of one or more of the instrument feeders 11 can cause axial movement of the scope 52.

[0033] The endoscope 52 can be directed downstream of the patient's trachea and lungs after insertion using precise commands from the robotic system 10 until the target surgical site is reached. The use of a separate instrument feeder 19 can allow for independent actuation of separate parts of the endoscope / assembly 52. ​​For example, the endoscope 52 may be directed to deliver a biopsy needle to a target, such as a lesion or nodule in the patient's lung. A biopsy needle can be deployed down a working channel that extends the length of the endoscope to obtain a tissue sample that is analyzed by a pathologist. Depending on the results of the pathology, additional tools can be deployed down the working channel of the endoscope for further biopsies. For example, after qualifying a nodule as malignant, the endoscope 52 can endoscopically deliver a tool to ablate the potentially cancerous tissue. In some cases, diagnostic and therapeutic procedures can be performed in separate procedures. In these situations, the endoscope 52 may also be used to deliver fiducials to "mark" the location of the targeted nodule. In other examples, diagnostic and therapeutic procedures can be performed during the same procedure.

[0034] In the system 101, the patient introducer 102 is attached to the patient 7 via a port (not shown, e.g., surgical tubing). The curvature of the introducer 102 may allow the robotic system 10 to manipulate the instruments 52 from a position that is not in direct axial alignment with the patient access port, thereby allowing greater flexibility in placement of the robotic system 10 in a room. Additionally, the curvature of the introducer 102 may allow the robotic arm 12 of the robotic system 10 to be substantially horizontally aligned with the patient introducer 102, which may facilitate manual movement of the robotic arm 12 as needed. The control system 50 and / or the robotic cart 10 may include control circuitry configured to implement scope speed control / correction based on a current position of the scope 52 or a portion thereof in accordance with the inventive concepts disclosed herein.

[0035] 3 illustrates a pedestal-based robotic system 104 according to one or more embodiments of the present disclosure. The system 104 incorporates a robotic component 105 having a pedestal 147, thereby allowing for a reduced amount of capital equipment in an operating room compared to some cart-based robotic systems, which in some cases may allow for greater access to the patient 7. Similar to cart-based systems, the instrument device manipulator assembly associated with the robotic arm 212 of the system 104 may include instruments and / or instrument feeders generally designed to manipulate elongated medical instruments, such as catheters or the like, along a virtual rail or path.

[0036] As shown, the robot-enabled table system 104 can include a column 144 coupled to one or more carriages 141 (e.g., a ring-shaped movable structure) from which one or more robotic arms 212 may emerge. The carriage 141 can translate along a vertical column junction through at least a portion of the length of the column 144 to provide various vantage points from which the robotic arms 212 can be positioned to reach the patient 7. The carriage 141 can rotate about the column 144 in some embodiments using a mechanical motor positioned within the column 144, which can allow the robotic arms 212 to access multiple sides of the table 104, for example. The rotation and / or translation of the carriage 141 can enable the system 104 to align medical instruments, such as endoscopes and laparoscopes, with different access points on the patient. By providing vertical adjustment, the robotic arms 212 can be advantageously configured to be compactly stored under a platform 147 of the table system 104 and then elevated during a procedure.

[0037] The robot arm 212 may be mounted on the carriage 141 via one or more arm mounts 145, which may include a series of joints that may be individually rotated and / or telescopically extended to provide additional configurability to the robot arm 212. The column 144 structurally provides a path for support of the platform 147 and vertical translation of the carriage 141. The column 144 may also transmit power and control signals to the carriage 141 and / or the robot arm 212 mounted thereon. The system 104 may include a specific control circuit configured to control the axial drive of the instrument 148 using an instrument feeder 211, which may be coupled to an end effector of one of the arms 212, and the instrument feeder 211 is controlled to automatically modify the axial drive speed for the elongated instrument (e.g., endoscope) 148 based on a determined position of the distal end of the instrument 148. For example, when the distal end of the instrument 148 is positioned at a predetermined automatic pause location, the instrument feeder 211 can be controlled / driven to automatically pause / stop axial retraction to allow for specimen collection, as described in detail herein.

[0038] The term "end effector" is used herein according to its broad and ordinary meaning and may refer to any type of robotic manipulator device, component, and / or assembly. When an adapter, such as a sterile adapter, is coupled to a robotic end effector or other robotic manipulator, the term "end effector" may refer to the adapter (e.g., a sterile adapter) or any other robotic manipulator device, component, or assembly associated with and / or coupled to the end effector. In some contexts, the combination of a robotic end effector and an adapter may be referred to as an instrument manipulator assembly, and such an assembly may or may not also include a medical instrument (or instrument handle / base) physically coupled to the adapter and / or end effector. The terms "robotic manipulator" and "robotic manipulator assembly" are used according to their broad and ordinary meaning and may collectively or individually refer to a robotic end effector and / or a sterile adapter or other adapter component coupled to the end effector. For example, a "robotic manipulator" or a "robotic manipulator assembly" may refer to an instrument device manipulator (IDM) that includes one or more drive outputs, whether embodied in a robotic end effector, a sterile adapter, and / or other components. The terms "robotic manipulator" and "robotic manipulator assembly" may further refer to a robotic arm or other robotic translator associated with an end effector. The term "end effector" as used herein may be understood to refer to any type of robotic manipulator.

[0039] 1-3 and 4, which illustrates an exemplary embodiment of a control system for any of the above, an associated control system 50 can be configured to provide various functions to assist in performing a medical procedure. In some embodiments, the control system 50 can be coupled to the robotic system 10 and operate in cooperation with the robotic system 10 to perform a medical procedure on the patient 7. For example, the control system 50 can communicate with the robotic system 10 via a wireless or wired connection (e.g., to control the robotic system 10). Additionally, in some embodiments, the control system 50 can communicate with the robotic system 10 to receive therefrom positional data regarding the position of the distal end of the scope 40, the access sheath 90, or the basket device 30. Such positional data regarding the position of the scope 40, the access sheath 90, or the basket device 30 can be derived using one or more electromagnetic sensors associated with the respective components, scope image processing capabilities, and / or based at least in part on robotic system data (e.g., arm position data, known parameters / dimensions of various system components, etc.). Additionally, in some embodiments, the control system 50 may be in communication with the table 15 to position the table 15 in a particular orientation or otherwise control the table 15. In some embodiments, the control system 50 may be in communication with the EM field generator 18 to control the generation of the EM field in the area around the patient 7 and / or around the instrument feeder 11.

[0040] FIG. 4 further illustrates an exemplary embodiment of the robotic system of any of FIGS. 1-3. The robotic system 10 can be configured to at least partially facilitate the performance of a medical procedure. The robotic system 10 can be configured in a variety of ways depending on the particular procedure. The robotic system 10 can include one or more robotic arms 12 configured to engage and / or control a scope 40 and / or a basket system 30, for example, to perform one or more aspects of the procedure. As shown, each robotic arm 12 can include multiple arm segments 23 coupled to joints 24 that can provide multiple degrees of movement / freedom. In the example of FIG. 1, the robotic system 10 is positioned proximate to a patient's leg, and the robotic arm 12 is actuated to engage and position the scope 40 for access into an access opening, such as the urethra 65 of the patient 7. Once the robotic system 10 is properly positioned, the scope 40 can be inserted into the patient 7 robotically using the robotic arm 12, manually by the physician 5, or a combination thereof. A scope-driver instrument coupling 11 (i.e., an instrument device manipulator (IDM)) may be attached to the distal end effector 22 of one of the arms 12b to facilitate robotic control / advancement of the scope 40. Another of the arms 12a may have associated therewith an instrument coupling / manipulator 19 configured to facilitate advancement and movement of the basket device 30. The instrument coupling 19 may further provide a handle 31 for the scope 40, which is physically coupled to the handle 31 at a proximal end of the scope 40. The scope 40 may include one or more working channels through which additional tools, such as a lithotriptor, basket device, forceps, etc., may be introduced to the treatment site.

[0041] The robotic system 10 can be coupled to any component of the medical system 100, such as the control system 50, the platform 15, the EM field generator 18, the scope 40, the basket system 30, and / or any type of percutaneous access instrument (e.g., needle, catheter, nephroscope, etc.). In some embodiments, the robotic system 10 is communicatively coupled to the control system 50. For example, the robotic system 10 can be configured to receive control signals from the control system 50 to perform a particular operation, such as positioning one or more of the robotic arms 12 in a particular manner, manipulating the scope 40, manipulating the basket system 30, etc. In response, the robotic system 10 can use certain control circuits 211, actuators 217, and / or other components of the robotic system 10 to control the components of the robotic system 10 to perform the operation. For example, the control circuit 211 can control the axial movement of the scope 40 by actuating the drive output 402 of the end effector 22 coupled to the instrument feeder 11. In some embodiments, the robotic system 10 and / or control system 50 are configured to receive images and / or image data from the scope 40 representing the internal anatomical structure of the patient 7 and / or a portion of the access sheath or other device component.

[0042] The robotic system 10 generally includes an elongated support structure 14 (also referred to as a "column"), a robotic system base 25, and a console 13 at the top of the column 14. The column 14 may include one or more arm supports 17 (also referred to as a "carriage") to support the deployment of one or more robotic arms 12 (three are shown in FIG. 1). The arm supports 17 may include individually configurable arm mounts that rotate along a vertical axis to adjust the base of the robotic arms 12 for more desired positioning relative to the patient.

[0043] The arm support 17 can be configured to translate vertically along the column 14. In some embodiments, the arm support 17 can be connected to the column 14 via slots 20 positioned on either side of the column 14 to guide the vertical translation of the arm support 17. The slots 20 contain vertical translation interfaces to position and hold the arm support 17 at various vertical heights relative to the robotic system base 25. The vertical translation of the arm support 17 allows the robotic system 10 to adjust the reach of the robotic arm 12 to meet various table heights, patient sizes, and physician preferences. Similarly, an individually configurable arm mount on the arm support 17 can allow the robotic arm base 21 of the robotic arm 12 to be angled in various configurations.

[0044] The robotic arm 12 may generally comprise a robotic arm base 21 and an end effector 22 separated by a series of articulated arm segments 23 connected by a series of joints 24, each joint having one or more independent actuators 217. Each actuator may comprise an independently controllable motor. Each independently controllable joint 24 may provide or represent an independent degree of freedom available to the robotic arm. In some embodiments, each of the arms 12 has seven joints, thus providing seven degrees of freedom, including a "redundant" degree of freedom. The redundant degrees of freedom allow the robotic arm 12 to position its respective end effector 22 at a specific position, orientation, and trajectory in space using various linkage positions and joint angles. This allows the system to position and orient the medical instrument from a desired location in space, while allowing the physician to move the arm joints to a clinically convenient position away from the patient to improve access while avoiding arm collisions.

[0045] The robotic system base 25 balances the weight of the column 14, arm support 17, and arm 12 on the floor. Thus, the robotic system base 25 can house certain relatively heavier components, such as electronics, motors, power supplies, and components that selectively enable or immobilize the robotic system. For example, the robotic system base 25 can include casters 28 in the form of wheels that allow the robotic system to be easily moved around the operating room prior to a procedure. After reaching the proper position, the casters 28 can be locked using wheel locks to hold the robotic system 10 in place during a procedure.

[0046] When positioned at the top of the column 14, the console 13 can provide both a user interface for receiving user input and a display screen 16 (or dual-purpose device, e.g., a touch screen) for providing both pre-operative and intra-operative data to the physician / user. Potential pre-operative data on the console / display 16 or display 56 can include pre-operative planning, navigation and mapping data derived from a pre-operative computerized tomography (CT) scan, and / or notes from a pre-operative patient interview. Intra-operative data on the display can also include vital patient statistics such as respiration, heart rate, and / or pulse, along with optical information provided from tools, sensor information from sensors, and coordinate information. The console 13 can be positioned and tilted to allow the physician to access the console from the side of the column 14 opposite the arm support 17. From this position, the physician can view the console 13, the robotic arm 12, and the patient while operating the console 13 from behind the robotic system 10. As shown, the console 13 may also include a handle 27 to assist in steering and stabilizing the robotic system 10.

[0047] Each end effector 22 of the robotic arm 12 may include or be configured to be coupled to an instrument device manipulator (IDM) 29, which in some cases may be attached using a sterile adapter component. The combination of the end effector 22 and associated IDM, and any intervening mechanisms or couplings (e.g., sterile adapters), may be referred to as a manipulator assembly 111. In some embodiments, the IDM 29 may be removed and replaced with a different type of IDM, for example, a first type 11 IDM may be configured to manipulate an endoscope and a second type 19 IDM may manipulate a basket device and / or support the proximal end of the endoscope. Another type of IDM may be configured to hold the electromagnetic field generator 18. The IDM may provide a power and control interface. For example, the interface may include connectors for transmitting pneumatic, power, electrical, and / or optical signals from the robotic arm 12 to the IDM. The IDM 29 can be configured to manipulate a medical instrument (e.g., a surgical tool / instrument), such as a scope 40, using techniques including, for example, direct drive, harmonic drive, gear drive, belt and pulley, magnetic drive, and the like. In some embodiments, a device manipulator 29 can be attached to each of the robotic arms 12, which are configured to insert or retract their respective coupled medical instruments into or from a treatment site.

[0048] As mentioned above, system 100 may include certain control circuits configured to perform certain functions described herein, including control circuitry 211 of robotic system 10 and control circuitry 251 of control system 50. That is, the control circuitry of systems 100, 101, 104 may be part of robotic system 10, control system 50, or some combination thereof. Thus, any reference to control circuitry herein may refer to circuitry embodied in a robotic system, a control system, or any other component of a medical system, such as medical systems 100, 101, and 104 shown in Figures 1-3, respectively. The term "control circuitry" is used herein according to its broad and ordinary meaning and may refer to any collection of processors, processing circuits, processing modules / units, chips, dies (e.g., semiconductor dies including one or more active and / or passive devices and / or connectivity circuits), microprocessors, microcontrollers, digital signal processors, microcomputers, central processing units, field programmable gate arrays, programmable logic devices, state machines (e.g., hardware state machines), logic circuits, analog circuits, digital circuits, and / or any devices that manipulate signals (analog and / or digital) based on hard-coded and / or operational instructions in the circuits. Control circuitry referred to herein may further include one or more circuit boards (e.g., printed circuit boards), conductive traces and vias, and / or mounting pads, connectors, and / or components. Control circuitry referred to herein may further comprise one or more storage devices that may be embodied within a single memory device, multiple memory devices, and / or embedded circuits of the device. Such data storage devices may comprise read-only memory, random access memory, volatile memory, non-volatile memory, static memory, dynamic memory, flash memory, cache memory, data storage registers, and / or any device that stores digital information.It should be noted that in embodiments in which the control circuitry comprises hardware and / or software state machines, analog circuits, digital circuits, and / or logic circuits, the data storage devices / registers that store any associated operational instructions may be embedded within or external to the circuitry that comprises the state machines, analog circuits, digital circuits, and / or logic circuits.

[0049] The control circuitry 211, 251 may include a computer-readable medium that stores and / or is configured to store hard-coded instructions and / or operational instructions corresponding to at least some of the steps and / or functions illustrated in one or more of the figures and / or described herein. Such a computer-readable medium may be included in an article of manufacture in some cases. The control circuitry 211 / 251 may be maintained / disposed entirely locally or may be at least partially remotely located (e.g., indirectly communicatively coupled via a local area network and / or a wide area network). Any of the control circuits 211, 251 may be configured to perform any aspect of the various processes disclosed herein, including the processes shown in FIG. 12 and FIG. 13, as described below.

[0050] With respect to the robotic system 10, at least a portion of the control circuitry 211 may be integrated with the base 25, column 14, and / or console 13 of the robotic system 10, and / or another system communicatively coupled to the robotic system 10. With respect to the control system 50, at least a portion of the control circuitry 251 may be integrated with the console base 51 and / or display unit 56 of the control system 50. It should be understood that any description herein of functional control circuitry or associated functionality may be understood to be embodied in the robotic system 10, the control system 50, or any combination thereof, and / or at least partially in one or more other local or remote systems / devices.

[0051] With further reference to FIG. 4 , the control system 50 can include various I / O components 258 configured to assist the physician 5 or others in performing a medical procedure. For example, the input / output (I / O) components 258 can be configured to allow user input to control / navigate the scope 40 and / or basket system within the patient 7. In some embodiments, for example, the physician 5 can provide input to the control system 50 and / or the robotic system 10, and in response to such input, can send control signals to the robotic system 10 to operate the scope 40 and / or the catheter basket system 30. The control system 50 can include one or more display devices 56 to provide various information regarding the procedure. For example, the display 56 can provide information regarding the scope 40 and / or the basket system 30. For example, the control system 50 can receive real-time images captured by the scope 40 and display the real-time images via the display 56. Additionally or alternatively, the control system 50 may receive signals (e.g., analog, digital, electrical, acoustic / sonic, pneumatic, tactile, hydraulic, etc.) from medical monitors and / or sensors associated with the patient 7, and the display 56 may present information related to the health or environment of the patient 7. Such information may include, for example, information displayed via the medical monitor, such as information related to heart rate (e.g., ECG, HRV, etc.), blood pressure / blood velocity, muscle biosignals (e.g., EMG), body temperature, blood oxygen saturation (e.g., SpO2), CO2, brain waves (e.g., EEG), environmental and / or local or core body temperature.

[0052] To facilitate the functioning of the control system 50, the control system may include various components (sometimes referred to as "subsystems"). For example, the control system 50 may include control electronics / circuitry 251, as well as one or more power sources / power interfaces 259, pneumatic devices, light sources, actuators, data storage devices, and / or communications interfaces 254. In some embodiments, the control system 50 is mobile, while in other embodiments, the control system 50 is a substantially stationary system. Although various functions and components are discussed as being implemented by the control system 50, any of such functions and / or components may be integrated into and / or performed by other systems and / or devices, such as, for example, the robotic system 10, the basket system 30, the platform 15, and / or others.

[0053] 1, the medical system 100 can provide various benefits such as providing guidance (e.g., instrument tracking, instrument alignment information, etc.) to assist the physician in performing the procedure, allowing the physician to perform the procedure from an ergonomic position without requiring awkward arm movements and / or positions, allowing one physician to perform the procedure with one or more medical instruments, avoiding radiation exposure (e.g., associated with fluoroscopy techniques), allowing the procedure to be performed in a single motion setting, providing continuous suction to more efficiently remove objects (e.g., removing kidney stones), etc. For example, the medical system 100 can provide guidance information to assist the physician in accessing target anatomical features with various medical instruments while minimizing bleeding and / or damage to anatomical structures (e.g., critical organs, blood vessels, etc.). Additionally, the medical system 100 can provide non-radiation based navigation and / or localization techniques to reduce the physician and patient's exposure to radiation and / or reduce the amount of equipment in the operating room. Additionally, the medical system 100 can provide functions distributed between the control system 50 and the robotic system 10, which may be independently mobile. Such distribution of functionality and / or mobility can allow the control system 50 and / or robotic system 10 to be placed in a location that is optimal for a particular medical procedure, thereby maximizing the working area around the patient 7 and / or providing an optimized location for the physician 5 to perform the procedure.

[0054] The various components of the system 100 can be communicatively coupled to one another over a network, which can include wireless and / or wired networks. Exemplary networks include one or more personal area networks (PANs), local area networks (LANs), wide area networks (WANs), Internet area networks (IANs), cellular networks, the Internet, personal area networks (PANs), body area networks (BANs), and the like. For example, the various communication interfaces of the system of FIG. 4 can be configured to communicate with one or more devices / sensors / systems, such as over wireless and / or wired network connections. In some embodiments, the various communication interfaces can implement wireless technologies, such as Bluetooth, Wi-Fi, near field communication (NFC), or the like. Additionally, in some embodiments, the various components of the system 100 can be connected for data communication, fluid exchange, power exchange, and the like, via one or more supporting cables, tubes, and the like.

[0055] The control system 50, basket system 30 (see FIG. 5), and / or robotic system 10 may include certain user controls (e.g., controls 55), which may comprise one or more buttons, keys, joysticks, handheld controllers (e.g., video game-type controllers), computer mice, track pads, track balls, control pads, and / or any type of user input (and / or output) device or device interface, such as sensors (e.g., motion sensors or cameras) that capture hand and finger gestures, touch screens, and / or interfaces / connectors therefor. Such user controls are communicatively and / or physically coupled to respective control circuits.

[0056] In some embodiments, a user can manually manipulate the robotic arm 12 of the robotic system 10 without the use of electronic user controls. For example, during a surgical room setup, a user may move the robotic arm 12 and / or any other medical instruments to provide a desired access to a patient. The robotic system 10 may rely on force feedback from the user and inertial control to determine the appropriate configuration of the robotic arm 12 and associated instrumentation.

[0057] FIG. 5 illustrates medical system components, including a scope and / or basket assembly 519 and an instrument feeder assembly 511, that may be implemented in any of the medical systems of FIGS. 1-3, according to one or more embodiments. The scope / basket system 519 comprises various hardware and control components. In some embodiments, the scope / basket system 519 includes a handle 31 coupled to an endoscope 40. For example, the endoscope (i.e., scope) may include an elongated shaft that includes one or more lights 49 and one or more cameras or other imaging devices 48. The scope 40 may further include one or more working channels 44 that may extend the length of the scope 40. In some embodiments, such channels may be utilized to provide access for elongated basket wires / tines through the scope 40.

[0058] The scope / basket system 519 can include a basket 35 formed from one or more wire tines 36. For example, the basket system 30 can include four wire tines disposed within a basket sheath 37 over its length, with the tines protruding from a distal end of the sheath 37 to form a basket shape 35. The tines 36 extend further from a proximal end of the sheath 37. The tines 36 can be configured to be slidable within the basket sheath 37 with some frictional resistance. The tines 36 and sheath 37 can be coupled to respective actuators 75 of the basket cartridge component 32. The basket cartridge 32 can be physically and / or communicatively coupled to a handle portion / component 31 of the scope / basket system 519. The handle component 31 can be configured to be used to assist in basket control and / or scope control, either manually or through robotic control.

[0059] The scope / basket system 519 may be powered through a power interface 79 and / or controlled by a control interface 78, each or both of which may interface with the robotic arms / components of the robotic system 10. The scope / basket system 519 may further include one or more sensors 72, such as pressure and / or other force reading sensors, which may be configured to generate signals indicative of forces experienced at / by one or more of the actuators 75 and / or other couplings of the scope / basket system 519. Such sensor readings may be used to determine a stuck basket status, as described in detail herein.

[0060] FIG. 5 further illustrates an instrument feeder / driver assembly 511 including an instrument feeder / driver 11 and an access sheath assembly 92 that may be physically coupled to the instrument feeder 11. The terms "feeder" and "driver" are used substantially interchangeably in some contexts herein. Thus, references herein to a scope or instrument feeder may be understood to refer to any type of scope or instrument driver, and vice versa, such devices / systems configured to actuate or cause actuation of a shaft-type instrument in an axial dimension. The instrument feeder assembly 511 may include a channel 39 that is sized and / or configured to position at least a portion of a shaft-type instrument, such as an endoscope or equivalent, therein. For example, the instrument may be at least partially nested within the channel 39 when positioning such an instrument to allow the instrument feeder 11 to axially drive the scope or equivalent. Although illustrated with a channel 39, in some embodiments, instrument feeder devices and assemblies according to aspects of the present disclosure may not include such a channel.

[0061] The actuator 38 may comprise a feed roller in some embodiments. As used herein, the term "feed roller" may include any number of rollers / wheels configured to effect axial movement of a shaft engaged therewith. "Feed roller" may further include the shaft channel 39 as well as any input or output drive associated with the implement feeder 11 that directly or indirectly causes movement of the rollers / wheels.

[0062] In some embodiments, the access sheath 92 is not docked to the instrument feeder 11, but rather is coupled to a robotic arm, stand, or other structure. Although certain embodiments described herein refer to an access sheath assembly including a port / introducer structure and a sheath component, it should be understood that embodiments of the present disclosure may implement an access sheath having integrated port and sheath components. Thus, references herein to an "access sheath" or simply a "sheath" may refer to the sheath portion, the port portion, or both of the access sheath / assembly. That is, references herein to any component or portion of the access sheath assembly may be understood to refer to the sheath portion / component, the port / introducer portion / component, or both. Additionally, the access sheath assembly described herein may be a single device, form, or structure, rather than an assembly of separate components.

[0063] The implement feeder assembly 511 further includes an axial actuator means or mechanism 38, which may comprise one or more shaft engaging wheels, conveyor belts, gears, tracks, or other actuators. The actuator 38 is configured to move a shaft type implement positioned in engagement therewith relative to the implement axis. The actuator 38 may be controlled by engagement with one or more drive inputs 83, which may actuate the actuator means / mechanism 38 and / or allow for physical engagement with mechanical components of the implement feeder 11, which may directly actuate the actuator means / mechanism 38.

[0064] The instrument feeder assembly 511 further includes a sheath clip 47, which may be associated with the instrument feeder 11 and configured to secure or hold in place at least a portion of the access sheath assembly 92. For example, the clip 47 may be configured to clamp onto or over at least a portion of a funnel port structure 91 of the access sheath assembly 92, as shown. The access sheath assembly 92 includes an access sheath tube or conduit 90, which may be physically coupled at its proximal end to a funnel port structure 91, which may provide an at least partially conical introducer opening into the access sheath 90, the proximal opening of the port 91 having an area or diameter that is greater than the cross-sectional area or diameter of the access sheath 90. The clip 47 may be supported by one or more clip support arms 94.

[0065] In some embodiments, the instrument feeder assembly 511 includes a specimen collector structure 85, which may be at least partially secured to one or more components of the instrument feeder assembly 511 and / or the instrument feeder 11. The specimen collector 85 may comprise a cup-like or other structure configured to allow a kidney stone or other specimen or debris retracted through the access sheath assembly 92 to sit or fall therein. In some embodiments, the specimen collector 85 is disposed between the distal opening of the channel 39 and the funnel port structure 91, and the instrument may be retracted to a position above the specimen collector 85 such that the stone / specimen may fall or sit within the specimen collector 85.

[0066] Scope / Feeder Control FIG. 6 illustrates a ureteroscope 40 disposed in a portion of a patient's urinary system, including a basket device 30 within its working channel, according to one or more embodiments. As mentioned above, ureteroscopic procedures can be implemented to investigate and / or treat abnormalities within a human ureter. For example, ureteroscopic procedures can be performed to treat and / or remove kidney stones. Such procedures can be performed at least in part manually and / or at least in part using robotic technology. For example, the use of robotic devices and / or systems for certain endoscopic procedures can provide relatively greater precision, control, and / or coordination compared to strictly manual procedures. In some embodiments, the scope 40 includes a working channel 44 for deploying the basket device 30 (e.g., basket component 35) into a working area at the distal end of the scope.

[0067] The access sheath 90 through which the scope 40 is passed to access the target anatomy can advantageously have a diameter sufficient to pass the scope 40 in addition to the object captured in the basket 35 when the object / stone is not too large in size. The access sheath 90 can be advanced through the ureter 63 to a position near the renal pelvis 71 and / or the ureteropelvic junction 71. The distal end of the access sheath 90 can be placed at a position within the ureter 63 and / or the renal pelvis 71, which may depend at least in part on the anatomy. That is, the access sheath 90 can be placed as far into the renal anatomy as permitted by the urinary pathway, which may be somewhat tortuous within that particular portion. Generally, the access sheath 90 may not be articulatable to the extent that the scope 40 can articulate, and therefore it may not be practical to navigate / drive the access sheath 90 into the kidney.

[0068] Scope 40 may be articulatable, for example, relative to at least a distal portion of the scope, so that the scope can be steered within the human anatomy. In some embodiments, scope 40 is configured to be articulated in five degrees of freedom, including, for example, XYZ coordinate movement, as well as pitch and yaw. In some embodiments, scope 40 is articulatable in six degrees of freedom, including XYZ coordinate movement, as well as pitch, yaw, and roll. Certain position sensors (e.g., electromagnetic sensors) of scope 40 may similarly have similar degrees of freedom with respect to the position information they generate / provide, if implemented. Position sensor data disclosed herein may include data generated by / using an electromagnetic position sensor positioned at the distal end of the elongated shaft, or a fiber optic shape sensor disposed within at least a portion of the elongated shaft.

[0069] For robotic implementations, a robotic arm of a robotic system can be configured / configurable to manipulate the scope 40. For example, an instrument device manipulator can be coupled to an end effector of the robotic arm and can manipulate the scope 40 using an elongated movement member. The elongated movement member can include one or more pull wires (e.g., pull or push wires), cables, fibers, and / or flexible shafts. For example, the robotic arm can be configured to actuate multiple pull wires (not shown) coupled to the scope 40 to deflect the tip 42 of the scope 40. The pull wires can include any suitable or desired material, such as metallic and non-metallic materials, such as stainless steel, Kevlar, tungsten, carbon fiber, and the like. In some embodiments, the scope 40 is configured to exhibit non-linear behavior in response to forces applied by the elongated movement members. The non-linear behavior can be based on the stiffness and compressibility of the scope and the slack or stiffness variability between different elongated movement members.

[0070] In embodiments including an endoscopic-type instrument 19 (e.g., including a handle 31 and an elongate shaft 40), such as in Figure 6, the basket 35 can be considered the distal end of the instrument 19. For example, references herein to the distal end of a scope instrument can refer to the distal end of the scope shaft, the distal end of a basket or basket instrument protruding from the distal end of the scope shaft, the distal end of a combined scope shaft and basket instrument, or the distal end of any other type of instrument or tool associated with and / or protruding from the scope / shaft and / or disposed within its working channel.

[0071] The scope (e.g., endoscope / ureteroscope) 40 may comprise a tubular and flexible medical shaft / instrument configured to be inserted into a patient's anatomy to capture images of the anatomy and to perform a specific task using its one or more working channels. In some embodiments, the scope 40 may house an optical assembly that may include an imaging device 48, such as an optical camera, and wires and / or optical fibers for transmitting signals to / from the distal end 42 of the scope 40. The scope 40 may further include a light source 49, such as an LED or fiber optic light source / lens.

[0072] The camera / imaging device 48 can be used to capture images of an internal anatomical space, such as a target cupule of a kidney 70. The scope 40 can be further configured to accommodate an optical fiber for carrying light from a proximally located light source, such as a light emitting diode, to the distal end 42 of the scope. The distal end 42 of the scope 40 can include a port for a light source to illuminate the anatomical space when the camera / imaging device is in use. In some embodiments, the scope 40 is configured to be controlled by a robotic system similar in one or more respects to the robotic systems 100, 101, and 104 shown in Figures 1, 2, and 3, respectively. The imaging device 48 can include optical fibers, fiber arrays, and / or lenses. The optical components move with the tip of the scope 40 such that movement of the tip of the scope results in changes in the images captured by the imaging device 48.

[0073] In some embodiments, the medical instrument (e.g., scope) 40 includes a sensor configured to generate and / or transmit sensor position data to another device or generate a detectable distortion or signature in an electromagnetic field. The sensor position data can indicate the position and / or orientation of the medical instrument 40 (e.g., its distal end 42) and / or can be used to determine / estimate the position / or orientation of the medical instrument. For example, the sensor (sometimes referred to as a "position sensor") can include an electromagnetic (EM) sensor having a coil of conductive material, or other form / embodiment of an antenna. In some embodiments, the scope 40 includes an electromagnetic sensor embedded in the distal end 42 of the scope 40. The electromagnetic sensor (not shown) can include an end of a wire or other conductive element configured to induce a current in the presence of an electromagnetic field. Additionally, the medical instrument / scope 40 and / or basket device 30 can include other types of sensors, such as shape-sensing fibers, accelerometers, gyroscopes, radio frequency transceivers, etc. In some embodiments, the sensor on the medical instrument can provide sensor data to a control system, which is then used to determine the position and / or orientation of the medical instrument. Position data derived using one or more position sensors associated with the scope 40 or basket device 30 can be used to determine when the scope and / or basket 35 is within or near another position threshold / area associated with an automatic scope pausing location and / or automatic scope insertion or retraction speed correction according to aspects of the present disclosure.

[0074] Embodiments of the present disclosure relate to implementing modifications / alterations of the axial drive speed of an instrument / scope using an instrument feeder device / system, which may be based at least in part on the current position of the instrument relative to one or more other structures, anatomical structures, or devices. For example, a robotic instrument feeder according to aspects of the present disclosure may be configured to operate to increase or decrease the drive speed of the instrument based on the position of the instrument as determined by control circuitry associated with the instrument feeder, the robotic system, and / or other components, devices, or systems. FIG. 7 illustrates a ureteroscope 40 disposed in a portion of a patient's urinary system, where the scope 40 is controlled to retract and / or advance at various speeds through different zones / areas and / or based on the scope position, according to one or more embodiments.

[0075] Similar to FIG. 6, the illustrated system 700 of FIG. 7 includes an access sheath 90, which is inserted into the urinary anatomy of a patient to provide a conduit through which a shaft 40 of a medical instrument 19 (e.g., an endoscopic instrument manipulator / handle) can be inserted. The medical instrument 19 includes an instrument base / handle 31 coupled to a proximal portion of the shaft 40 (e.g., an endoscope). The shaft 40 can extend from or through the base / handle 31. According to some embodiments, the instrument 19 can support multiple medical instruments and the drive device 11 can be configured to drive the movement of any one or more of the multiple medical instruments. For example, the instrument 19 can support a first medical instrument having a working channel, such as an endoscope or catheter, and a second medical instrument, which can be a working channel instrument extending into the working channel, such as a biopsy tool, basket tool, laser fiber tool, resection tool, or other instrument configured to manipulate or interact with a target in the patient's anatomy.

[0076] The instrument base / handle 31 may be configured to be attached, mounted, or otherwise connected or coupled to a robotic arm (not shown). The robotic arm may include an instrument drive mechanism to which the instrument base / handle 31 may be attached. The instrument drive mechanism may include a drive output configured to engage and actuate a corresponding drive input on the instrument base / handle 31 to manipulate the medical instrument 19. The robotic arm may also be configured to move to manipulate the position of the instrument base / handle 31 in space.

[0077] The shaft 40 can be engaged with the drive device 11. In the illustrated embodiment, the drive device 11 includes rollers 38 that can engage or contact the shaft 40. In some embodiments, the rollers 38 can comprise or include a deformable material that provides grip, friction, traction or pressure between the rollers 38 and the shaft 40. In some embodiments, the deformable material includes silicone rubber. In the illustrated embodiment, as the rollers 38 rotate, the shaft 40 can be pulled, pushed or otherwise driven axially through the drive device 11. Rotating the rollers 38 in a first direction can cause insertion of the shaft 40 (e.g., in a distal direction toward the patient) and rotating the rollers 38 in an opposite second direction can cause retraction of the shaft 40 (e.g., in a proximal direction away from the patient). Here, the direction of the rollers 40 refers to the direction of the portion of the rollers 38 or other axial actuator means / mechanism that is engaged with the shaft 40. For example, rotation in a first direction to insert shaft 40 refers to the engaged portions of rollers 38 rotating in a distal direction, and rotation to retract refers to the engaged portions of rollers 38 rotating in a proximal direction. In terms of the illustration of rollers 38 as seen in FIG. 7, this means that to rotate rollers 38 distally, left roller 701 rotates counterclockwise while right roller 702 rotates clockwise, and vice versa, to rotate rollers 38 proximally. As mentioned above, other actuator means / mechanisms can be used in place of or in addition to rollers 38.

[0078] The shaft 40 can pass through a channel 39 of the drive device 11. The channel 39 can comprise a closed channel or an open channel. The use of an open channel can facilitate loading the shaft 40 of the medical instrument 19 into the drive device 11, as shown in FIG. 7, thereby simplifying use of the device and reducing operation time. For example, the open channel can facilitate loading and / or unloading of the medical instrument 19 during an operation or medical procedure and allow a user to manually adjust the medical instrument 19 without having to fully retract the shaft 40 from within the patient. In some embodiments, the drive device 11 can include a robotically actuated cover that allows the channel 39 to be selectively opened and closed to facilitate loading and retaining the shaft on the drive device as needed.

[0079] The drive device 11 can be attached, mounted, or otherwise connected or coupled to a second robotic arm. The second robotic arm can include an instrument drive mechanism including a drive output configured to engage and actuate a corresponding drive input of the drive device (see, for example, drive inputs 334, 338 in FIG. 8 ) to actuate or operate the drive device 11. The robotic arm can also be configured to move to manipulate the position of the drive device 11 in space. As shown in FIG. 7 , in some embodiments, the drive device 11 can be configured to be attached to the access sheath assembly 92 (e.g., using clips 47). Attaching the drive device 300 to the access sheath assembly 92 can facilitate movement or repositioning of the access sheath as desired via movement or repositioning of the drive device 11 or associated robotic arm 204.

[0080] The access sheath 90 portion of the access sheath assembly 92 may comprise a tube or other structure through which the shaft 40 may be inserted. In some embodiments, the access sheath 90 may comprise an elongated, flexible access sheath configured to be inserted into an anatomical lumen. In some embodiments, an access sheath is not used and the elongated shaft 40 of the medical instrument 19 may be inserted directly into the patient (e.g., through a natural orifice or other surgical access port or incision in the patient).

[0081] 7 also illustrates that the drive device 11 may include a collector structure 85. Objects removed from a patient using the medical instrument 19 may be deposited in the collector 85. For example, in the case of ureteroscopy, the medical instrument 19 may include a basket device 30 configured to capture and retrieve stones or stone fragments from within the patient. Once stone fragments are captured, the shaft 40 may be retracted until the distal end 42 is positioned above the collector 85. The basket 35 may then be opened to allow the stone to fall into the collector 85. The collector 85 need not be positioned on the drive device.

[0082] The shaft 40 of the medical instrument 19 can extend directly between the instrument base / handle 31 and the drive device 11. In such a configuration, as the drive device 11 drives the axial movement of the elongated shaft, the robotic arm supporting the base / handle 31 can move the base / handle 31 at a speed and direction corresponding to the speed of the axial movement of the shaft 40. Thus, the insertion speed of the shaft 40 can be limited to the speed at which the robotic arm coupled to the base / handle 31 can move. This can be preferable for relatively slow speeds.

[0083] In some configurations, the elongated shaft 40 of the medical instrument 19 is positioned to form a service loop 49 between the medical instrument 19 and the instrument feeder 14 and / or associated robotic arm. The service loop 49 may include the length of the shaft 40 between the instrument base / handle 31 and the drive device 11. When the length of the shaft 40 exceeds the distance between the instrument base / handle 31 and the drive device 11, the shaft 40 may sag downward (and / or to the side), forming a service loop 49 between the instrument base / handle 31 and the drive device 11. The service loop 49 may provide slack in the shaft 40 that may be used to allow for faster insertion and / or retraction. For example, during insertion, the service loop 49 may be taken up in slack (shortening or contracting the service loop 49). During retraction, the service loop 49 may be created (increasing or expanding in length). As used herein, expanding or contracting the service loop 49 may involve increasing or decreasing the amount of excess length available in the service loop 49 to provide axial freedom to the flexible shaft. As an example, using the service loop 49, the drive device 11 can drive the insertion at a faster speed than the robotic arm coupled to the instrument 19 can move.

[0084] In some embodiments, the use of the service loop 49 may allow the instrument feeder 11 to be configured to insert and / or retract the shaft 40 at a relatively high speed, at a speed of about 100-300 mm per second (e.g., a speed of 130-190 mm per second). Other speeds for relatively high speed insertion or retraction outside of these ranges are also possible. This type of high speed insertion or retraction may be preferred, for example, when the distal tip 42 of the shaft 40 is positioned within the access sheath 90, since the access sheath 90 may protect the surrounding tissue of the patient. In some embodiments, when the distal tip 42 of the shaft 40 extends beyond / outside the access sheath 90, the associated control circuitry controlling the operation of the instrument feeder 11 may automatically transition to a relatively slower insertion or retraction speed. For example, a relatively slower insertion and / or retraction speed according to aspects of the present disclosure may be at a speed of about 5-80 mm per second (e.g., 20-50 mm per second). Other speeds for the slow insertion or retraction outside of these ranges are also possible, where the slow insertion / retraction speed is slower than the relatively fast insertion / retraction speed. The slower insertion / retraction speed can operate, for example, as described below with respect to Figures 12 and 13.

[0085] During retraction, when the distal tip of the shaft 40 is positioned beyond the access sheath, as shown as scope position 705, the drive device 11 can drive the retraction of the scope 40 at a relatively slow speed. When the tip 42 of the shaft 220 enters the access sheath 90, such as to scope position 706, the instrument feeder 11 can automatically transition to retracting the scope at a faster speed. The coordinated action of the drive device 11 and the slow movement of the robotic arm coupled to the instrument 19 can help mitigate shaft buckling that can lead to imprecise drive response if axial motion of the shaft 40 is performed solely by robotic arm motion.

[0086] For robotic ureteroscope procedures, generally, it may not be necessary for the surgeon to hold the ureteroscope handle 19 and manually retract the scope 40 to withdraw it from the patient. However, according to some solutions, certain user controls can be engaged to effect / initiate retraction of the scope 40. For example, in some implementations, the droop retract joystick 59 may be engaged in a certain manner, such as by pulling and / or holding downwards or in other directions (e.g., as shown in FIG. 7 ), to move the instrument handle 19 proximally and / or to cause proximal axial actuation of the scope 40 by the axial actuator means 38 (e.g., shaft engagement wheels / rollers) of the instrument feeder 11.

[0087] While robotically inducing retraction of the scope 40, it may be necessary or desirable for the physician to monitor the scope camera image to allow the scope 40 to be retracted relatively quickly through the access sheath 90 while preventing the scope 40 from being retracted too far. For example, it may be desirable to prevent the distal end 42 of the scope 40, such as the basket 35 protruding from the distal end 42 of the scope 40, from being drawn into the axial actuator mechanism / means 38 (e.g., wheels / rollers). For example, it may be desirable to prevent the distal end 42 of the scope 40 and / or the basket 35 from reaching the opening / threshold 33 of the driver scope channel 39 and even the axial actuator means 38 within the channel 39. However, if the physician is overly cautious in retracting the scope 40, they may stop retraction of the scope 40 sooner than is ideal, or may undesirably slow retraction of the scope while the distal end 42 of the scope 40 is within the access sheath 90, thereby increasing the overall procedure time. Furthermore, if the physician is not careful enough with retraction or is distracted during the retraction process, the scope 40 may be retracted too far and / or the stone / basket may become stuck within the drive channel 39, which may damage the instrument and / or prolong the procedure time.

[0088] Embodiments of the present disclosure advantageously allow for the implementation of automatic retraction (and / or insertion) speed corrections, such as those implemented by an instrument feeder for driving an elongated shaft, such as a ureteroscope or other device. For example, in some embodiments, the present disclosure provides for an automatic robotic pause of the retraction of the scope / catheter upon exit from an access sheath assembly through which the scope / catheter is retracted. Such a pause may be implemented as a soft stop in an area outside of the associated access sheath that provides a convenient scope / catheter position for performing a procedural operation, such as the drop / deposition of a captured specimen (e.g., kidney stone fragments extracted from a kidney) associated with an associated medical procedure. It should be understood that references herein to scope retraction speed corrections may be understood to relate to scope advancement speed corrections, unless otherwise stated.

[0089] Automatic pausing and / or other modification of the retraction speed of the elongated instruments may be based at least in part on certain conditions and / or information associated with the associated robotic system. For example, in embodiments in which the instrument feeder 11 and instruments 19 are operatively coupled to respective end effectors of a robotic arm of a robotic system, the system (e.g., the robotic cart and / or a communicatively coupled tower) may be configured to determine and / or generate certain robotic system parameters that may provide a basis for scope position determination, which may be used to determine when and how to modify the scope retraction / insertion speed. For example, such parameters may include, perhaps among others, the current scope insertion position, the current scope and / or instrument feeder dimensions, and the length of the access sheath.

[0090] As shown in the detailed image of the renal anatomy in FIG. 7, the scope basket 35 may first be retracted into the distal opening 93 of the access sheath 90. In conjunction with retraction into the access sheath 90, a confirmation process or sub-process may be performed to confirm the position or presence of the scope 40 and / or the distal end 42 of the basket 30 within the access sheath 90. For example, the user interface may issue an alert to the user to request confirmation from the user that the scope 40 and / or basket 35 are within the access sheath 90. The user may determine the position of the scope 40 and / or its distal end 42 based on the camera image and / or other available position information.

[0091] Once the position of the scope 40 within the access sheath 90 has been confirmed, control circuitry associated with the robotic instrument feeder system (e.g., the robotic cart, the control tower / system, and / or the instrument feeder 11) may be configured to enable a fast retraction mode. In some implementations, by a user engaging a particular user control 55, such as a pendant joystick 59 or the like, to indicate a retract command (e.g., by pulling down on the joystick 59), automatic retraction of the scope through the sheath at a relatively fast rate may be effected until the scope is determined to have reached a predetermined auto-pause position 101, at which point the associated control circuitry may effect an automatic pause / stop of the axial movement / retraction of the scope 40.

[0092] In some implementations, once the automatic pause is performed, the physician / user may release the retract signaling joystick of the user control and check through the camera view or directly at the proximal end of the access sheath assembly 92 and / or the instrument feeder 11 to confirm or determine whether the scope 40 is in the desired position for stone fragment collection. If so, the user may actuate a particular user control to command the basket 35 to open to allow the stone fragments captured therein to fall out of the basket. In some implementations, once the user releases the retract joystick, the automatic pause function may be deactivated so that the user may perform fine adjustments of the scope position to reach the desired stone collection position. Such fine adjustments of the scope position may be performed using the pendant insertion joystick operation.

[0093] FIG. 8 illustrates an exploded view of an instrument device manipulator assembly 150 associated with a robotic arm 12, according to one or more embodiments. The instrument device manipulator assembly 150 includes an end effector 6 associated with a distal end of the robotic arm 12. The instrument manipulator assembly 150 further includes an instrument feeder 11. The instrument feeder 11 can incorporate electromechanical means for actuating an instrument 40, such as an endoscope or other shaft-type instrument. Descriptions of upwardly and downwardly facing surfaces, plates, faces, components, and / or other features or structures herein may be understood with reference to the particular orientation of the instrument device manipulator assembly 150 shown in FIG. 8. That is, although the end effector 6 may generally be configurable to face and / or be oriented in a range of directions and orientations, for convenience, descriptions of such components herein may be made in the context of the generally vertically facing orientation of the end effector 6 shown in FIG. 10.

[0094] In some embodiments, the instrument device manipulator assembly 150 further includes an adapter component 8 configured to provide a driver interface between the end effector 6 and the instrument feeder 11. The adapter 8 and / or the instrument feeder 11 may be removable or detachable from the robot arm 12 and, in some embodiments, may lack any electromechanical components such as motors. This dichotomy may be caused by the need to sterilize medical instruments used in medical procedures and the inability to adequately sterilize expensive capital equipment due to the complex mechanical assemblies and sensitive electronics of medical instruments. Thus, the instrument feeder 11 and / or the adapter 8 may be designed to be detached, removed, and replaced from the end effector 6 (and thus the system) for individual sterilization or disposal. In contrast, the end effector 6 does not need to be replaced or sterilized in some cases and may be loosely covered (e.g., using a drape 301) for protection.

[0095] The adapter 8 may include connectors for communicating air pressure, power, electrical signals, and / or optical signals from the robotic arm 12 and / or end effector 6 to the instrument driver 11. The robotic arm 12 may advance / insert or retract the coupled instrument feeder 11 into and out of a treatment site. In some embodiments, the instrument feeder 11 may be removed and replaced with a different type of instrument. The end effector 6 of the robotic arm 12 may include various components / elements configured to connect to and / or align with components of the adapter 8, the instrument feeder 11, the access sheath assembly 92, and / or the instrument 40. For example, the end effector 6 may include a drive output 302 (e.g., a drive spline, gear, or rotatable disk with engagement features) for controlling / articulating the medical instrument, a reader 304 for reading data from the medical instrument (e.g., a radio-frequency identification (RFID) reader for reading a serial number from the medical instrument), one or more fasteners 306 for attaching the instrument feeder 11 and / or the adapter 8 to the instrument feeder 6, and a marker 308 for aligning with an instrument (e.g., the access sheath 90) that is manually attached to the patient and / or for defining a front face of the device manipulator assembly 150. In some embodiments, a portion (e.g., a plate) 315 of the adapter 8, when coupled to the end effector 6, may be configured to rotate / spin independently of one or more other components of the adapter 8 and / or the end effector 6.

[0096] In some configurations, a sterile drape 301, such as a plastic sheet, may be disposed between the end effector 6 and the adapter 8 to provide a sterile barrier between the robotic arm 12 and the instrument feeder 11. For example, the drape 301 may be coupled to the adapter 8 to allow for the transfer of mechanical torque from the end effector 6 to the adapter 8. The adapter 8 may be generally configured to maintain a seal around its working components such that the adapter 8 itself provides a sterile barrier. By using the drape 301 coupled to the adapter 8 and / or more other components of the device manipulator assembly 19, a sterile barrier may be provided between the robotic arm 12 and the surgical field, thereby permitting the use of a robotic cart associated with the arm 12 in a sterile surgical field. The end effector 6 may be configured to be coupled to various types of sterile adapters that may be loaded onto and / or removed from the end effector 6 of the robotic arm 12. With the arm 12 covered in plastic, a physician and / or other technician may interact with the arm 12 and / or other components of the robotic cart (e.g., a screen) during a procedure. Draping may provide additional protection from biohazard contamination of the equipment and / or minimize post-procedure cleaning.

[0097] The instrument feeder 11 may include a plurality of drive inputs 334, 338 on a lower surface 336 of the housing of the instrument feeder 11. In the illustrated embodiment, the instrument feeder 11 includes three drive inputs 334, 338, although other embodiments may include other numbers of drive inputs. The drive inputs may be at spaced apart, fixed locations along the lower mating surface 336 of the instrument feeder 11, facilitating coupling of the drive inputs 334, 338 to corresponding drive outputs 302 of the end effector 6, which may be at spaced apart, fixed locations along a corresponding mating surface that is designed to be modularly used to attach a variety of other instruments.

[0098] The mechanical assembly within the instrument feeder 11 can use the drive inputs 334, 338 to drive the rotation of opposing rollers or other actuator means / mechanisms for axial movement of the shaft of the medical instrument as well as to allow for change in position of the opposing rollers to allow for loading of the shaft or other uses. In the illustrated embodiment, the three drive inputs include two roller drive inputs 334 and an open / close drive input 338. Each of the drive inputs 334, 338 can be configured to engage with a corresponding drive output 302 on the robotic arm 12. For example, each drive input can include a receptacle configured to mate with a drive output configured as a spline. The drive inputs and drive outputs can be configured to engage to transfer motion therebetween. Thus, the drive outputs can be rotated to cause corresponding rotation of the drive inputs 334, 338 to control various functions of the instrument feeder 11.

[0099] References herein to an "instrument device manipulator assembly," "instrument manipulator assembly," "manipulator," "manipulator assembly," and other variations thereof, may refer to any subset of the components of the assembly 150 shown in FIG. 8, including the robot arm, the end effector of the robot arm, an adapter configured to be coupled to the robot end effector, an instrument feeder configured to be coupled to the end effector and / or adapter, and an actuator of the instrument feeder (e.g., feed rollers, shaft channels, and / or other actuator components, means, and / or mechanisms associated with the instrument feeder). Additionally, it should be understood that references herein to an "actuator" may refer to any component of the assembly 150 shown in FIG. 8 that affects or causes movement, whether directly or indirectly, of an instrument engaged with, coupled to, or otherwise actuable by the instrument feeder. For example, according to embodiments disclosed herein, an "actuator" may comprise any set or subset of the following devices or components: feed rollers, shaft actuation wheels / rollers, feed roller channels, instrument feeder drive inputs, adapter drive outputs, adapter drive inputs, end effector drive outputs, and / or control circuitry configured to cause actuation thereof.

[0100] FIG. 9 is a perspective view of a robotic arm with an endoscope and an instrument feeder device coupled thereto, respectively, according to one or more embodiments. As described in detail herein, a robotic medical system such as those described above with reference to FIGS. 1-8 can be used for robotic medical procedures involving removing objects, specimens, or samples from a patient, such as kidney stone fragment removal. During a robotic kidney stone retrieval procedure, a physician can operate various robotic medical instruments (such as the endoscope and laparoscope described above) using a controller and / or specific control circuitry. The physician can control the system to capture the kidney stone with a basket device disposed within the working channel of the endoscope. Once the kidney stone fragments are captured, the robotic ureteroscope can be retracted to remove the kidney stone from the patient. Once positioned outside the patient's body, the basket device can be opened to release the stone. The robotic ureteroscope can then be reinserted into the body to retrieve additional stones as needed.

[0101] The specimen collector 85 can be configured to allow the robotic medical system to robotically deposit specimens therein, thereby minimizing manual or physical interaction. The specimen collector 85 can be configured to be integrated with and / or supported by components of the robotic medical system, such as the instrument feeder 11, in a location where the robotically controlled medical instrument can quickly and efficiently deposit the specimen. The specimen / stone can be deposited at a location 101 between the opening of the access sheath introducer 91 and the axial actuator 38, for example, approximately halfway between the opening of the introducer 91 or sheath 90 and the distal end 43 of the instrument feed channel associated with the axial actuator 38. In some embodiments, the specimen collector 85 can be integrated with a sterile drape 901 configured to cover various robotic components of the system. The specimen collector can be positioned in a location directly beneath the robotically controlled basket device when the basket device is retracted from the patient and / or the access sheath introducer 91. In such a location, the basket device can simply open and allow the retrieved object to fall into the specimen collector 85. The specimen collector 85 may be constructed with at least one porous portion that allows fluid to drain therethrough while retaining matter deposited therein.

[0102] The system 900 of FIG. 9 includes a medical instrument 19 including an instrument base / handle 31 and an elongated shaft 40. In the illustrated embodiment, the proximal end of the elongated shaft 40 extends from the instrument base 31. In some embodiments, the elongated shaft 40 includes a flexible shaft and / or an articulating shaft. The distal end of the elongated shaft 40 is configured to be inserted into an access sheath introducer 91. As with other figures of the present disclosure, the instrument feeder 11 is configured to drive the insertion and / or retraction of the elongated shaft 40 such that the distal end of the elongated shaft 40 can be inserted into and retracted from the access sheath 90. In the illustrated embodiment, the instrument 19 is illustrated in a position where the distal end of the elongated shaft 40 is retracted from the access sheath 90. Although the examples described herein relate to the removal of kidney stones, the medical instrument 19 can be configured to collect and retrieve other types of objects, specimens, or samples within a patient. For example, in some embodiments, the medical instrument 19 is configured to take a biopsy sample from the patient's anatomy.

[0103] The instrument feeder 11 is configured to engage the elongated shaft 40 of the medical instrument 19 and drive axial movement (e.g., insertion and / or retraction) of the distal tip of the elongated shaft 40 into and out of the access sheath 90. For example, as shown in FIG. 9, the instrument feeder 11 includes rollers 38 or other axial actuator means / mechanisms that can engage or contact the elongated shaft 40. In some embodiments, the rollers 38 can include a deformable material that provides grip between the rollers 38 and the elongated shaft 40. In some embodiments, the material includes silicone rubber. In the illustrated embodiment, as the rollers 38 rotate, the elongated shaft 40 can be pulled, pushed, or otherwise driven axially through the instrument feeder 11. Rotating the rollers 38 in a first direction can cause insertion of the elongated shaft 40, and rotating the rollers 38 in a second, opposite direction can cause retraction of the elongated shaft 40. In some embodiments, other drive means / mechanisms can be used in place of or in addition to the rollers 38. In the illustrated embodiment, the elongate shaft 40 passes through a channel 39 of the instrument feeder 11. The channel 39 may comprise a closed and / or open channel. In the illustrated embodiment, the sterile adapters 8a, 8b are positioned between the robotic arms 12a, 12b and the respective coupled instruments / devices 19, 11.

[0104] While the illustrated embodiment of the system 900 includes an instrument feeder 11 for driving axial motion of the elongated shaft 40 of the medical instrument 204, other types of robotic manipulators may be used to drive the axial motion in other embodiments. For example, in some embodiments, the axial motion is driven by moving a robotic arm 12a to which a base / handle 31 of the medical instrument 19 is attached. Thus, the description herein of instrument retraction / insertion speed modification based on instrument position may relate to modifying the speed of movement in space of a robotic arm directly or indirectly coupled to the instrument.

[0105] The specimen collector 85 provides a receptacle, container, vessel, or repository in which the specimen can be deposited. The specimen collector 85 can include a flexible material, such as a plastic sheet. In some embodiments, the collector 85 comprises a flexible bag. The specimen collector 85 can be positioned within the sterile field. The collector 85 can be attached to a sterile adapter 8b, to an access sheath introducer 91, or to an instrument feeder 11. In the illustrated embodiment, the specimen collector 85 is positioned at a location below (e.g., directly below) the distal tip 42 of the elongate shaft 40 of the medical instrument 19 when the distal tip 42 is withdrawn from the access sheath 91. In this position, depositing the specimen into the collector 85 can be accomplished by releasing the specimen (e.g., opening a basket device) and allowing the specimen to fall by gravity into the collector 85. This position of the specimen collector 85 can also maintain alignment between the elongate shaft 40 and the access sheath 90, such that after the specimen is deposited in the collector 85, the distal tip 42 of the elongate shaft 40 can be quickly reinserted into the access sheath 90 to continue the procedure. This can shorten the overall length of the procedure and improve patient outcomes.

[0106] In the illustrated embodiment, a predetermined automatic scope pause / stop position is set at a position directly above the specimen collector 85. For example, such an automatic pause / stop position 101 may be positioned on the distal (i.e., patient-facing) side 43 of the instrument feeder 11 and / or axial actuator 38. This position may beneficially minimize the amount of movement required to position the distal tip 42 of the shaft 40 above the specimen collector 85. Again, this may shorten the overall length of the procedure. The specimen collector 85 and automatic pause / stop position, which may be an identifiable location in space along the axis of movement of the shaft 40, are positioned immediately proximal to the access sheath 90 and / or access sheath introducer 91.

[0107] FIG. 10 is a top view of an embodiment of the instrument feeder 11 shown in FIG. 9, where the instrument feeder is configured to drive axial motion of an elongated shaft of a medical instrument. FIG. 10 illustrates the instrument feeder 11 and the access sheath 90, and identifies certain parameter features that may provide a basis for an automatic retraction rate and / or pause function as described herein. FIGS. 9 and 10 illustrate the distal tip 42 of the scope 40 suspended at an automatic pause location 101 between the proximal opening of the access sheath introducer 91 and its associated axial actuator 38 and / or drive channel 39. FIG. 10 illustrates the collector 85 positioned generally below the automatic pause / stop location 101. In some embodiments, the collector 85 is coupled to a mounting tab 89. The mounting tab 89 can be configured to attach to a component of the instrument feeder 11 and / or system 900 that supports the specimen collector 85.

[0108] FIG. 10 illustrates various dimensions that may serve as a basis for scope position determination with scope retraction / insertion speed correction as disclosed herein. For example, a first dimension d1 may correspond to the distance between the opening 43 to the scope channel 39 and the proximal end or center of the clip component 47 associated with the instrument feeder 11 configured to hold and secure in place the proximal opening / funnel component 91 of the access sheath assembly 92. In some implementations, the desired auto pause position 101 may be determined as a midway position between the proximal end of the clip 47 and the opening of the channel 43, as shown in FIG. 10. That is, embodiments of the present disclosure provide an auto pause execution with respect to the axial movement of the retracted scope between the access sheath clip and the scope channel and / or axial actuator mechanism / means. In determining the scope position for auto pause and / or other speed correction functions, the position of the scope 40 relative to the distal end 42 of the scope 40 may serve as a basis for certain position determination / calculation. For example, FIG. 10 shows a dimension d3 representing the distance between the opening 43 to the scope channel 39 and the distal end 93 of the access sheath 90, which may be used to calculate the position of the scope. In some implementations, the distance d1 between the channel opening 43 and the clip 47 may be determined, at least in part, by subtracting a known or selected access sheath length d2 from the dimension d3 representing the scope insertion length at the access sheath tip 93. In some systems, the distance d1 may be derived directly from the mechanical dimensions of the instrument feeder 11. The pause position 101 may further be determined by subtracting half the distance d1 between the clip 47 and the opening of the channel 43. For example, the automatic scope pause position / location 101 may be determined according to the formula (1) listed below. Pause location = sheath tip - d2 - 0.5 * d1(1) Where "pause location" refers to the automatic scope pause / stop location 101, "sheath tip" refers to the scope insertion configuration when the tip 42 of the scope 40 is at the tip 93 of the access sheath 90, and d1 and d2 refer to any of the possible dimensions of such parameters shown in FIG. 10. "sheath tip" can refer to the relative insertion / position of the scope handle 19, taking into account the roller actuation of the scope and / or the scope service length, when the tip 42 of the scope 40 is positioned at the distal tip 93 of the access sheath 90. In some implementations, the above equation (1) further includes subtraction of the dimension d4 on the right hand side of the equation, depending on how the dimensions d1 and d2 are defined, to determine the position 101 as illustrated for the automatic pause location.

[0109] Automatic insertion or retraction speed correction according to aspects of the present disclosure may be based on any type of robotic system data indicative of the scope position relative to one or more other system components, such as an access sheath, a specimen collector, and / or other components. For example, data indicative of a scope's current scope insertion may be used to determine / detect the current position of the scope or its components. The current scope insertion data may indicate the degree to which the scope is translated from a particular calibrated position. For example, if the scope length is known (e.g., based on an RFID identification associated with the scope), the current scope insertion may be determined based on the distance between the end effectors of the robotic arms coupled to the instrument feeder 11 and the scope handle 19, respectively. For example, FIGS. 1, 7, and 9 show a dimensional callout D representing the distance between the center points of the end effectors of the two robotic arms. a , one of the robotic arms is fixed to the scope base / handle 19. Thus, triggering automatic scope insertion or retraction speed corrections or stopping / pausing can be based at least in part on a known relative distance between two or more robotic arms used in the associated medical procedure.

[0110] In some embodiments, the automatic scope retraction / insertion speed correction may be based at least in part on a predetermined distance between the center of the roller / wheel 38 and the center of the sheath clip 47, such distance being shown as a variation of distance d1 in FIG. 10. Additionally, the distance between the center of the clip 47 and the proximal end of the sheath 90 may be pre-determined, such distance being shown as distance d4 in FIG. 10. Such data points, for example, along with a known length d2 of the access sheath 90, may be used to determine the position of the distal end 93 of the sheath 90 relative to the instrument feeder 11, such position information may serve as a basis for determining the position of the scope 40 for purposes of triggering an automatic speed correction according to aspects of the present disclosure. In general, the determination of the position of the scope 40 may be based on a current distance D between the respective robotic arm supporting the instrument feeder 11 and the scope 19. A It may further be based on.

[0111] In some embodiments, the determination / detection of the scope position is based at least in part on the access sheath length d2, which may be understood to be generally the length between the distal tip 93 of the access sheath 90 and the proximal end of the sheath 90, the center of the clip 47, or the proximal end of the funnel port / introducer structure 91. In some embodiments, the sheath 90 has a length of about 55 cm, while the funnel port / introducer structure 91 has a length of about 2 cm. However, it should be understood that any length of sheath, scope, port, or other component of the system may be utilized in accordance with aspects of the present disclosure.

[0112] In some cases, the length d2 of the access sheath 90 may also be known. For example, such a length data point may be input by the physician / user at some point during an associated calibration or initialization process. In some embodiments, the length d2 of the access sheath 90 may be indicated by one or more sensors associated therewith, such as a magnetic tag or sensor, or the like. When the instrument feeder 11 is physically coupled to the access sheath assembly 92, as in Figures 6, 7, and 10, the position of the distal end 93 of the access sheath 90 may be determined / derived from position data regarding the robotic arm and the access sheath length d2 coupled to the instrument feeder 11, as well as information regarding the position and / or dimensions of the sheath clip 47 and / or funnel port structure 91, each of which may serve as a basis for automatic retraction or insertion speed correction according to aspects of the present disclosure.

[0113] In some implementations, the current position of the tip 42 of the scope 40 is determined by first calibrating the position of one or more of the robotic arms and the position of the scope tip 42, and subsequent relative or absolute movement of the robotic arms can indicate the current position of the scope tip 42 based on the deviation of the robotic arms from the initial position and / or the amount / degree of actuation of the rollers 38. Specifically, the arm 12b coupled to the instrument driver can be generally stationary clipped to the ureteral access sheath 90, so that movement of the robotic arm 12a connected to the scope can be monitored to determine the position of the scope. Clipping the access sheath assembly 92 to the instrument feeder 11 can advantageously reduce the risk of injury to the patient due to tearing or other friction or blunt contact between the access sheath 90 and adjacent anatomical structures.

[0114] In some implementations, a point 153 associated with a threshold at the proximal end of the funnel port structure 91 can be registered during a calibration process relative to the tip 42 of the scope 40. In some embodiments, the pause position 101 can be registered relative to the position of the robotic arm 12a holding the scope 19, and the position of the scope 19 at a position where the distal tip 42 of the scope 40 is within the automatic pause / stop area 101 can be determined by visual confirmation and / or other means or mechanisms. After such registration / calibration, determination of the position of the scope can be based at least in part on the registered position information.

[0115] In addition to or as an alternative to using robotic system data to determine / detect the position of at least a portion of the scope for the purpose of triggering an automatic retraction or insertion speed modification by the instrument feeder assembly / device, other mechanisms may be implemented to determine the position of the scope and / or basket for the purpose of triggering a speed modification, including an automatic retraction pause / stop as described in detail herein. For example, in some implementations, signals generated by one or more position sensors may be used to detect when the scope, basket, and / or other components of the scope assembly reach a particular position, and a speed modification according to aspects of the present disclosure is triggered by such determined / detected position. For example, a related system (e.g., an embodiment of the system 100 shown in FIG. 1) may include one or more sensors (e.g., electromagnetic position sensors, or the like) configured to generate data indicative of a current position of the distal tip of the scope, an entry and / or exit position of the access sheath, or the like, and the control circuitry of the system is configured to implement a speed modification (e.g., a retraction pause) in response to the position detection / determination. In some implementations, the detected / determined position may be based on data indicative of a relative position of one or more components or portions of the scope relative to one or more components or portions of the access sheath or access sheath assembly.

[0116] As described in connection with various embodiments of the present disclosure, modifying the retraction and / or insertion rate of the scope by an instrument feeder device / tool ​​according to aspects of the present disclosure may be based on determining the position of the portion of the scope being driven by the device / tool, as described in detail herein. For example, such position determination may involve determining that the distal end of the scope has been withdrawn proximally from a proximal opening of the access sheath. Such determination / detection may involve determining when the distal end of the scope and / or a basket device protruding from the distal end of the scope clears an opening in the access sheath shaft and / or a proximal opening of a funnel port structure associated with the proximal end of the sheath assembly.

[0117] In some implementations, modification of the axial drive speed of the scope or other shaft-type instrument may be based on determining / detecting that a component or portion of the scope and / or basket device / assembly has been advanced into the access sheath assembly, at which point a high-speed insertion mode may be triggered and the distal end of the scope may be advanced through the access sheath at a relatively high speed rate. Such determining / detecting may involve determining or detecting that the distal end of the scope and / or a basket device protruding therefrom has entered a funnel port structure associated with the access sheath assembly or a proximal opening of the access sheath physically coupled to the funnel port structure.

[0118] FIG. 16 illustrates an instrument feeder 11 and an associated access sheath assembly 92 clipped thereto, identifying different scope insertion / retraction speed zones Z0-Z3 associated with the access sheath assembly 92 and the instrument feeder 11. The various zones are areas internal and / or external to the sheath 90 and / or sheath assembly 92, where different speeds of retraction and / or insertion may be automatically implemented / triggered according to aspects of the present disclosure. When the tip of a scope device (not shown) driven by the instrument feeder 11 is within the fast retraction zone Z2 of the sheath 90, the scope may be configured to retract at a relatively high speed. For example, such fast retraction may be implemented while a user presses down on a control joystick of an associated user input device to retract the scope, and the speed of retraction may be increased in response to determining that the scope tip is within the fast retraction zone Z2.

[0119] In some implementations, during fast retraction mode, control circuitry of one or more components of the system may be configured to compare the current scope insertion / position to the determined automatic pause location 101 to determine whether to initiate automatic pausing / stopping of scope retraction. In some embodiments, a slow retraction zone Z3 may be associated with a proximal portion of the access sheath assembly 92 such that scope retraction is initially slowed as it proximally exits the access sheath 90 before pausing / stopping at the pause location 101. In some implementations, fast retraction may continue automatically unless the comparison between the current scope location and the pause location 101 matches or is sufficiently close. Once the scope tip is determined to be at or near the pause location 101, the associated control circuitry may advantageously initiate / execute automatic pausing / stopping of the scope at that location through control of the drive mechanism.

[0120] 16, in some implementations, a slow retraction zone Z3 may be implemented in which the speed of retraction of the scope is slowed down when it is determined / detected that the distal end of the scope and / or the basket protruding therefrom has reached a sheath entry position 151, which may be located at the proximal end of the sheath 90, the center point of the clip 47, or the proximal end of the funnel port structure 91, or other location. That is, in some implementations, retraction of the scope may first be slowed down when in the slow retraction zone Z3 before being stopped / paused completely upon reaching an automatic pause / stop area or position 101. In some embodiments, slow retraction may be automatically triggered while the scope and / or basket are still within the access sheath 90 in an area just distal to the proximal end of the sheath 90. It should be understood that any reference or description herein of determining / detecting the position of a scope or component thereof may also refer to determining / detecting the position of a basket form / device protruding from the distal end of the scope.

[0121] When advancing / inserting the scope 40 distally through the sheath 90, upon determining / detecting that the scope (and / or associated basket) has reached a location 152 in the distal area of ​​the sheath 90, a speed modification of the axial insertion / advancement may be triggered to slow such scope speed. For example, the insertion / advancement speed may be automatically reduced past a threshold 152 to reduce the risk of tissue damage upon exiting the sheath 90. In some implementations, such a speed reduction may be triggered by a determination of an insertion force that is above a predetermined threshold insertion force. Such a force may be indicated by a reading on one or more torque sensors associated with an actuator or other component of the instrument feeder 11. In some embodiments, the location 152 is about 20 mm or less from the axial end 93 of the access sheath 90.

[0122] During insertion of the scope 40 into the access sheath 90, the fast insertion mode may be automatically triggered and initiated when the scope tip 42 and / or basket pass the threshold point 151 or another point within the proximal area of ​​the sheath 90. In some embodiments, the determination that the scope tip and / or basket have entered the fast insertion / retraction zone Z2 may be based on a determination that the distal end 42 of the scope and / or basket protruding therefrom has passed the clip 47 that secures the access sheath assembly 92 to the instrument feeder 11. For example, the determination of entry into the access sheath 90 and / or fast insertion / retraction zone Z2 may be based on information indicative of the axial length of the funnel port / introducer structure 91 and / or a known distance of the distal end of the funnel port structure 91. For example, it may be advantageous to maintain a slow insertion speed while the scope and / or basket are within the internal channel of the funnel port structure 91 until the tip of the scope and / or basket crosses the threshold into the tubular structure 90 of the access sheath assembly 92.

[0123] With respect to the illustrated system 100 of FIG. 1, as well as other systems disclosed herein, if the implemented electromagnetic field generator 18 is configured to broadcast an electromagnetic field covering an area in which the instrument feeder 11 is disposed, such electromagnetic field may be relied upon to determine the position of the tip 42 of the scope 40 based on electromagnetic positioning as described herein. In some implementations, the electromagnetic position sensor may be used to determine the position of the scope tip 45 at the tip 93 of the access sheath 90, and one or more of the predetermined data points associated with the sheath assembly and / or the instrument feeder 11 may be used to determine the position of the distal tip 42 of the scope 40 relative to the automatic pause / stop position 101, as described in detail above. That is, the electromagnetic position sensor information may be used to calibrate the position of the scope tip 42 relative to the sheath assembly 92 and / or the instrument feeder 11, and such calibration may be used to determine the position of the scope relative to the automatic stop / pause position 101 based on the calibrated movement of the actuator 38 and / or the robotic arm 12a coupled to the scope assembly 19. Such calibration may also be utilized to determine the scope position when it crosses other velocity threshold points, as shown in Figure 16. In some embodiments, the tip 42 of the scope 40 may include an electromagnetic sensor that may be used for such purposes.

[0124] In some implementations, the modification of the axial drive of the scope by the instrument feeder device / assembly involved stopping or pausing the axial movement of the scope in response to determining / detecting that the scope (e.g., the distal end of the scope) and / or a basket protruding therefrom has reached a specimen collection zone, area, location, etc. For example, such a location may be an area or location 101 located approximately midway between the proximal opening of the access sheath and / or associated funnel port structure and the distal opening to the drive shaft of the scope or the interface with the scope channel and / or axial actuator (e.g., roller) associated with the instrument feeder device / assembly. The illustrated automatic pause / stop area / location 101 shown in Figures 7, 10, and 15 represent example locations, and detection of a portion of the scope and / or associated basket at such a location may trigger an automatic retraction pause in association with an embodiment of the present disclosure. Any type of sensor may be used to determine the scope position, including electrical, optical, or other types of sensors. Additionally, in some embodiments, multiple sensors may be used to provide increased accuracy of the position determination / detection. The sensor information may be relied upon to account for unanticipated issues, such as relative slippage between the scope 40 and the driver actuator 38, that may affect the position determination described herein.

[0125] With further reference to Figure 10, the instrument feeder 11 can include rollers 38 or other axial actuator means configured to drive axial movement of the medical instrument shaft. As mentioned above, the rollers 38 can be positioned on either side of the channel 39 such that the rollers 38 are positioned on either side of the shaft 40 of the medical instrument 19 when the shaft 40 is loaded into the instrument feeder 11. The rollers 38 can thus be considered opposed rollers. The rollers 38 can rotate in a first direction to drive the insertion of the medical instrument shaft and can rotate in a second direction to drive the retraction of the medical instrument shaft.

[0126] In some embodiments, the instrument feeder 11 includes a spring 88 configured to bias the rollers 38 toward a closed position in which the rollers 38 engage the elongated shaft 40. In addition to biasing the rollers 38 inwardly toward the channel 39, the spring 88 can also be configured to provide the pressure or friction necessary to engage the rollers 38 with the medical instrument shaft 40. For example, the spring 88 determines how hard the rollers 38 apply pressure to the medical instrument shaft 40. The force of the spring 88 can be selected to provide a desired pressure or friction against the medical instrument shaft 40. In some embodiments, the spring force of the spring 88 can be used to control or limit the pressure or force that the medical instrument shaft can apply to the patient's anatomy during insertion and retraction. This can be accomplished by selecting or setting a spring force that corresponds to a friction drive force of the rollers 38 such that at a predetermined load, the rollers 38 begin to slide on the medical instrument shaft. By adjusting this drive force, the system can maintain a level of applied force that is determined or defined as acceptable or safe for the patient. In some embodiments, the system's control circuitry is configured to determine when slippage occurs between roller 38 and shaft 40 for purposes of determining scope position.

[0127] Vision-Based Scope Position Determination As referenced throughout, automatic speed correction for scope insertion and / or retraction may be triggered by a determination or detection of a current scope position during the insertion or retraction process. In some implementations, the determination of the current scope position (e.g., distal tip position detection / determination) may be based on camera data generated by and / or using one or more cameras of the scope. For example, the system's control circuitry may be configured to implement image processing functions to recognize the environment of the scope relative to the access sheath and / or other components of the access sheath assembly and / or instrument feeder. In some embodiments, camera images captured by the scope cameras during retraction or insertion may be compared to each other and / or to certain reference images to classify / determine the position of the scope with respect to whether the scope is within the access sheath and / or in or near which portion of the access sheath the scope is positioned. Such position determination may serve as a basis for triggering an automatic speed correction or stop / pause according to aspects of the present disclosure.

[0128] In some embodiments, specific markings may be applied and / or formed on various surfaces or portions / components of the access sheath that are identifiable using image recognition capabilities implemented by the control circuitry of the system. For example, specific color coding may be implemented to indicate the location of the scope to the system control circuitry based on identification of such color-coded features that may be associated with specific structures and / or portions / components of the access sheath or other components of the system. For example, visual markings may be applied and / or present on the inside of the funnel port structure 91 and / or support arm / structure 96 of the instrument feeder 11.

[0129] In some embodiments, location determination / detection may be based on image recognition functions that may be based at least in part on output from a neural network framework implemented by the control circuitry of the system. For example, endoscopic camera images may provide the basis for scope location determination. Such vision-based scope location functions may be implemented by the control circuitry of the medical system using certain image processing techniques.

[0130] FIG. 11 illustrates a scope location determination image recognition architecture 1100 according to one or more embodiments. The architecture 1100 provides a framework for identifying one or more instruments and / or anatomical features in an endoscopic camera image to dynamically determine a scope location based on characteristics of the camera image, according to one or more embodiments of the present disclosure. The framework 1100 may be embodied with specific control circuitry, including one or more processors, data storage devices, connectivity features, substrates, passive and / or active hardware circuit devices, chips / dies, and / or the like. For example, the framework 1100 may be embodied at least in part with the control circuitry 251 and / or control circuitry 211 shown in FIG. 4 and described above. The framework 1100 may employ machine learning capabilities to perform automatic scope location determination / detection, for example, on ureteroscopic images of internal renal anatomy, the interior of access sheath components, and / or the like.

[0131] The framework 1100 may be configured to operate on a particular image type data structure, such as image data representing at least a portion of a treatment site associated with one or more medical procedures and / or instrument components used in such procedures. Such input data / data structure may be operated on in some manner by a particular transformation circuit 1120 associated with the image processing portion of the framework 1100. The transformation circuit 1120 may comprise any suitable or desirable transformation and / or classification architecture, such as any suitable or desirable artificial neural network architecture.

[0132] The transformation circuitry 1120 may be trained according to known image data. For example, the image data may include representations of medical instrument components and target labels 1132 corresponding to the respective images 1112 as input / output pairs, and the transformation / classification framework 1120 is configured to adjust one or more parameters or weights associated therewith to correlate the known input and output image data. For example, the transformation circuitry 1120 (e.g., a convolutional neural network) may be trained using a labeled dataset and / or machine learning. The machine learning framework may be configured to perform the learning / training in any suitable or desirable manner.

[0133] The known target labels 1132 may be generated, at least in part, by manually labeling an image as being associated with a particular scope position. For example, a manual label may be determined and / or applied by an associated medical professional or other technician to label, for example, the location of the distal end of the scope relative to the access sheath assembly in the known scope image / data. The known input / output pairs may indicate parameters of the conversion circuit 1120, which may be dynamically updatable in some embodiments.

[0134] The framework 1100 may be further configured to generate a real-time target label 1135 associated with the real-time scope image 1115 using a trained version of the conversion circuit 1120. For example, during retraction of a medical instrument (e.g., a scope) during a medical procedure, a real-time scope image showing the medical instrument may be processed using the conversion circuit 1120 to generate a real-time target label 1135 indicating the position of the scope when the real-time image was captured. For example, in some implementations, a ureteroscope image may be processed by the conversion circuit 1120 to identify a scope position. A user notification of the scope position may be provided in response to the real-time scope position label determination 1135. In some implementations, an output from the framework 1100 may trigger a change in a retraction or insertion speed of the scope by an instrument feeder, and the instrument feeder may be configured to modify the speed or pause / stop the retraction or insertion based at least in part on the output. In some embodiments, the framework 1100 can be configured to generate real-time target labels 1135 in a manner that indicates in a binary manner whether a particular image shows whether the scope is positioned in the auto pause / stop position.

[0135] The transformation framework 1120 may comprise an artificial neural network, such as a convolutional neural network. For example, the framework 1120 may implement a deep learning architecture that takes an input image and assigns learnable weights / biases to various aspects / objects in the image to distinguish one from another. The filters / characteristics of the framework 1120 may be hand-designed or may be learned by machine learning.

[0136] The framework 1120 may include a number of neurons 1125 (e.g., a layer of neurons as shown in FIG. 11 ) corresponding to overlapping regions of the input image that cover the visual area of ​​the input image. The framework 1120 may further operate to flatten the input image or a portion thereof in some manner. The framework 1120 may be configured to capture spatial and / or temporal dependencies within the input image 1115 through application of certain filters. Such filters may be performed with various convolution operations to achieve desired output data. Such convolution operations may be used to extract features such as edges, contours, and the like. The framework 1120 may include any number of convolution layers, with more layers providing higher levels of feature discrimination. The framework 1120 may further include one or more pooling layers that may be configured to reduce the spatial size of the convolved features, which may be useful for extracting features that are rotation and / or position invariant, as well as certain anatomical features. Once prepared through flattening, pooling, and / or other processes, the image data may be processed by a multi-level perceptron and / or a feed-forward neural network. Additionally, back-propagation may be applied to each iteration of training. The framework may be capable of distinguishing between dominant features and specific low-level features in the input image and classifying them using any suitable or desired technique. In some embodiments, the neural network architecture comprises any of the following known convolutional neural network architectures: LeNet, AlexNet, VGGNet, GoogLeNet, ResNet, or ZFNet.

[0137] The framework 1100 may be trained with a sufficient amount of driving data, such as endoscopic image data, and a truth table may be generated based on known labels of the scope position conditions. In operation, real-time images 1115 and / or other driving information may be used as inputs to the system 1120 to provide real-time scope position determination results as output 1135.

[0138] Stone Retrieval Process 12 is a flow diagram illustrating a process 1200 for capturing, retracting, and collecting stone fragments in connection with a ureteroscopy procedure, according to one or more embodiments of the present disclosure. In block 1202, the process 1200 includes advancing a stone fragmentation tool to an internal anatomical site where a kidney stone is present, such as within the internal calyx network of a kidney or other anatomical structure. For example, the fragmentation tool may include a lithotripsy tool or other tool configured to be used to fragment relatively large stones or other objects. The fragmentation tool may be advanced through an access sheath, such as a urethral access sheath described herein. The fragmentation tool may be associated with an elongated shaft-type instrument, such as a catheter, endoscope, or the like, and the fragmentation tool may be associated with a distal end of such an instrument and / or disposed within a working channel thereof.

[0139] At block 1202, the process 1200 includes fragmenting the concretion into two or more smaller stone fragments using a fragmentation tool. For example, the process 1200 may include laser-breaking, perforating, or otherwise cleaving or damaging the concretion to generate smaller fragments therefrom. At block 406, the process 1200 includes inserting a stone capture device into the kidney and into an area where one or more of the stone fragments are located. In some implementations, a basket may be inserted into the capture site through a working channel of an endoscope (e.g., a ureteroscope), the basket comprising a means for capturing the stone fragments therein, such as a wireform basket configured to expand and contract as described in detail herein. At block 1208, the process 1200 involves capturing the target stone fragment with the basket. The basket can be extended from the distal tip / end of the scope and expanded to allow the basket to be placed over the target stone fragment, and contraction of the basket can secure the stone fragment within the basket and allow for its removal.

[0140] At block 1210, process 1200 involves retracting the distal end of the basket and scope into an access sheath, which in some implementations may be positioned / disposed at or near the ureteropelvic junction. Some embodiments of the present disclosure provide automatic slow retraction in an area distal to the distal end of the access sheath. That is, the control circuitry of the associated system may be configured to limit the retraction speed of the scope and basket prior to entering the access sheath.

[0141] At block 1212, process 1200 entails retracting the basket and scope through the access sheath. For example, according to some implementations, the relatively fast retraction rate can be automatically triggered and implemented in response to determining or detecting that the distal end of the scope and / or basket has entered the access sheath or has been inserted / retracted a threshold distance into the access sheath.

[0142] At block 1214, process 1200 entails withdrawing / retracting the distal end of the scope and / or basket through the proximal opening of the access sheath. According to some embodiments, a determination or detection that the distal end of the scope and / or basket has crossed a threshold point associated with the proximal opening / end of the access sheath assembly may trigger a slowdown in the retraction rate of the scope / basket. Such a threshold location / point may be associated with the proximal end of the access sheath, the proximal end of a funnel port structure coupled to the access sheath, the midpoint of the funnel port structure, or some point within the access sheath proximal to the proximal end of the access sheath.

[0143] At block 1216, the process 1200 includes collecting the captured stone fragments in a collector structure. For example, the collector may be disposed in some manner under a portion of the instrument feeder device / assembly used to retract the scope, with the release of the basket causing the captured stone fragments to fall into the collector. At decision block 1218, the process 1200 includes determining whether additional stone fragments remain to be removed from the treatment site. If so, the process loops back to block 1206, where the scope and / or basket are reinserted into the treatment site within the kidney to capture and remove additional stone fragments.

[0144] Figures 13-1, 13-2, 13-3, 13-4, and 13-5 show flow diagrams illustrating a process for aligning a medical instrument, according to one or more embodiments. Figures 14-1, 14-2, 14-3, 14-4, and 14-5 show specific images corresponding to various blocks, states, and / or operations associated with the processes of Figures 13-1, 13-2, 13-3, 13-4, and 13-5, respectively, according to one or more embodiments.

[0145] In block 1302, the process 1300 includes capturing stone fragments 80 in a basket 35 of a basket device 30, as illustrated in image 1401 of FIG. 14-1. For example, the basket device 30 may access a target treatment site through a working channel of an endoscope 40, as described in detail herein. The target stone fragments 80 may be disposed within a patient's renal anatomy, accessed via the urethra 65, bladder 60, ureter 63, and ureteropelvic junction 78, as described herein. An access sheath 90 may be initially positioned within the urinary tract anatomy to provide the scope 40 with access to the treatment site, and the scope 40 is inserted and retracted through the access sheath 90. A distal end 93 of the access sheath 90 may be disposed within the ureteropelvic junction, as shown.

[0146] At block 1304, the process 1300 includes retracting the scope 40 to the distal end / opening 93 of the access sheath 90. In some implementations, a determination that the scope is within the ureteropelvic junction and / or distal to the opening 93 of the access sheath 90 may trigger an automatic speed adjustment or modification to ensure that the retraction speed prior to entry into the access sheath 90 is limited or reduced in some manner to prevent injury or damage to the instrument and / or anatomical structures.

[0147] At block 1306, the process 1300 includes confirming the location of the scope 40 and / or basket 35 at the distal end 93 of the access sheath 90. For example, such confirmation may indicate that the distal end 42 of the scope and / or basket 35 is disposed just outside the distal end 93 of the access sheath 90, at the distal end 93 of the access sheath 90, or within the distal end 93 of the access sheath 90. The confirmation may be provided through a user input, the physician / user may visually confirm the location of the scope 40 and / or basket through a scope image generated by a camera associated with the scope 40, or through other imaging techniques / modalities such as CT or equivalent. Alternatively, the location of the scope tip 42 and / or basket 35 may be substantially automatically determined / detected according to any of the location determination / detection processes or mechanisms described herein.

[0148] Determining / detecting that the scope tip 42 and / or basket 35 are disposed within the access sheath 90 or in an area proximate thereto may automatically trigger a modification of the retraction speed of the scope. For example, in some implementations, determining that the scope and / or basket are disposed within the access sheath may trigger the activation of a relatively high retraction speed. In block 1308, the process 1300 involves retracting the scope 40 through the access sheath at a high speed, as enabled by confirmation of the position of the scope and / or basket. In some implementations, the user may engage the retraction control mechanism and provide a retraction command when the scope is outside the access sheath, and in response to such a command, the associated system control circuitry is configured to retract the scope 40 through the instrument feeder at a first relatively slow speed until it is determined / detected that the scope 40 has entered the access sheath, at which point the control circuitry may modify the speed of retraction to increase the speed for high speed retraction through the sheath 90. That is, in some implementations, a single engagement of the retraction control mechanism by the user (e.g., pulling down on the joystick) can initiate retraction, with the rate of retraction being modified according to a position determination along the retraction path. Alternatively, high speed retraction within the access sheath 90 can be initiated via a separate engagement of the retraction control input mechanism by the user. That is, after confirming the position of the scope and / or basket, the user can subsequently transmit a command to engage the retraction control mechanism to retract along with the access sheath, and the rate of retraction can be enabled to a relatively high rate of speed based on the confirmed location within the access sheath.

[0149] Retraction of the scope may be controlled by an axial actuator mechanism 38 (e.g., one or more wheels) of the driver device 11 as detailed herein. During retraction, the process 1300 may involve comparing the determined / detected current scope position to a predefined acquisition pause / stop location 101 to determine whether the scope and / or basket are currently at the predefined pause / stop location 101, as shown in decision block 1310. For example, the predefined pause location / position 101 (see image 1407 in FIG. 14-2) may be a point between the opening of the access sheath assembly (e.g., the opening of the access sheath 90 and / or funnel port structure 91) and the scope actuation mechanism 38 and / or channel 39. The current scope position may be determined according to any of the position determining / detecting means, mechanisms, and / or processes disclosed herein.

[0150] If the scope is not yet at the predetermined pause location 101, the process 1300 includes continuing high speed retraction of the scope through the access sheath, pertaining to block 1308, and further including determining and comparing a current location to the predetermined pause location to determine if the scope tip 42 and / or basket 35 are at the pause location 101, pertaining to block 1310. In some implementations, prior to reaching the predetermined pause location 101, the system control circuitry may be configured to perform a retraction speed correction to reduce the speed of retraction from a high speed retraction speed to a slower speed prior to reaching the predetermined pause location 101. For example, such a correction speed may be automatically triggered by a determination that the scope tip 42 and / or basket 35 have crossed a threshold associated with a proximal portion of the access sheath assembly. For example, the threshold may be associated with a proximal portion of the access sheath 90, an interior of the funnel port structure 91, or an area proximal to the proximal end of the funnel port structure 91. In such implementations, the position comparison step at block 1310 may involve determining whether the current scope location indicates that the scope and / or basket have crossed a retraction deceleration threshold.

[0151] If it is determined that the scope is currently at the predetermined pause location 101, the process 1300 includes, in connection with block 1312, automatically pausing / stopping the retraction with the scope tip 42 and / or basket 35 in / on the pause location / area 101, as shown in image 1409 of FIG. 14-2. For example, the system control circuitry may cause the actuator 38 to automatically stop the retraction in response to the position determination / detection. The automatic pause / stop location or area 101 may be positioned above the specimen collector structure 85 such that when the scope tip 42 and / or basket 35 are positioned at the automatic pause location 101, the basket 35 may be released to allow captured stone fragments to fall into the collector 85.

[0152] In some implementations, after the scope has been paused at the auto pause location 101, the process 1300 may involve the user releasing the retraction control mechanism (e.g., joystick), as shown in block 1313. That is, the system control circuitry may receive a signal (or detect a loss of signal) indicating disengagement or release of the retraction control / command. Releasing the retraction control mechanism may allow fine adjustment / positioning of the scope by the user. In some implementations, a new retraction command may be received after the initial cessation of the retraction command associated with block 1308. In response, the associated control circuitry may be configured to resume retraction of the scope.

[0153] At decision block 1314, the process 1300 includes determining whether the current scope position is suitable for stone collection. For example, the user may visually confirm whether the scope tip 42 and / or basket 35 are in an appropriate position for stone fragment collection. If the current scope position is not suitable, the process 1300 includes performing minor adjustments to the scope position by the user at block 1315, which may be based on visual monitoring / confirmation. If the position of the scope and / or basket is suitable (e.g., after adjustments at block 1315), the process 1300 proceeds to block 1316, where the stone fragments captured in the basket are collected in the specimen collector 85, as shown in image 1413 of FIG. 14-3.

[0154] After depositing the stone fragments 80 in the collector 85, if additional stone fragments remain to be collected, as determined at decision block 1318, the process 1300 proceeds to block 1319, where the scope is inserted relatively slowly into the access sheath 90. For example, the process 1300 may involve automatically limiting the insertion speed of the scope 40 until the position of the scope within the access sheath 90 and / or funnel port structure 91 is determined or detected, and such determination / detection may trigger an automatic increase in the insertion speed. For example, as shown at block 1320 of the process 1300, in the access sheath 90, the scope may be inserted relatively quickly to allow efficient execution of the process 1300. When inserting the scope 40 into and through the access sheath 90, the basket 35 may protrude from the distal tip 42 of the scope 40 and may be retracted into the working channel of the scope, as shown.

[0155] Further automatic insertion speed modifications may be triggered by a determination or detection that the scope tip 42 and / or basket 35 have crossed a threshold associated with a distal portion of the access sheath 90. For example, such a threshold may be associated with a location inside the access sheath 90 at the distal portion of the access sheath 90 and may be associated with an area just distal and outside the access sheath 90. Once a threshold is crossed, the system control circuitry may automatically reduce and / or limit the speed of insertion to a relatively slower speed to avoid injury or damage to the instruments and / or anatomical structures.

[0156] By providing automatic scope retraction and / or insertion speed correction in response to determining the scope position, aspects of the present disclosure can advantageously provide a relatively low cognitive load for the user / physician to determine the scope specimen drop position. For example, embodiments of the present disclosure provide a fully automatic and / or semi-automatic solution that allows the user to maintain input control of retraction / insertion to initiate scope retraction and / or insertion, and such retraction / insertion speed correction can be performed automatically without further input from the user to prevent damage to the equipment and / or patient anatomy and / or to improve the efficiency of a particular procedure. Some embodiments advantageously provide automatic stopping / pausing of the scope insertion or retraction when the scope reaches a predetermined position relative to one or more components of the robotic system performing the procedure. Some embodiments further allow the user the flexibility to fine-tune the scope position after the automatic speed correction (e.g., automatic pausing / stopping) to adjust the position relative to the automatic stopping / pausing position. By requiring less cognitive load from the physician when performing scope retraction and / or insertion in connection with a medical procedure, the physician may be able to focus on relatively more complex tasks associated with, for example, kidney stone capture and / or other processes. Additionally, embodiments of the present disclosure may reduce user errors related to slowing, stopping, and / or accelerating scope movement during a medical procedure.

[0157] As mentioned above, in ureteroscopy, a physician may break up a relatively large stone into relatively small fragments, for example by laser irradiation or other means, and then use a basket device / system to capture and extract each small fragment outside the patient's body. After a kidney stone fragment is captured, the physician may wish to extract the stone / fragment relatively quickly through the ureteral access sheath and open the basket to allow the stone to fall into a collection structure. After collection, the basket can be closed and the scope can be reinserted into the access sheath to extract more stones / fragments. Generally, the majority of the time taken during the stone extraction process may be associated with stone capture, and once the scope tip has been safely retracted into the distal end of the access sheath without issues of clogging at the access sheath opening due to the size of the stone, the retraction process through the access sheath can be performed almost instantly.

[0158] In certain robotic ureteroscopy procedures, both the scope / shaft feeder and the robotic end effector (e.g., the distal end of the robotic arm) to which the scope is attached can be used to translate the scope / shaft. FIG. 15 shows a robotic system 1500 including a first medical instrument 19 (e.g., an endoscope / ureteroscope, or equivalent) including an elongated shaft 40 associated with a first robotic arm 12a. In the description of FIG. 15, as with any other embodiment disclosed herein, the robotic arm is described for convenience, but it should be understood that the description of the robotic arm and the end effector associated with the distal end of the robotic arm can be any type of robotic manipulator (e.g., end effector) that can translate in space, such as along an insertion / retraction path / rail. Thus, references herein to a robotic arm can be understood to refer to any type of robotic manipulator, such as any type of robotic insertion mechanism, linear actuator / translator, rail drive, or equivalent.

[0159] The instrument 19 may include a handle 31 that may be attached or mounted to an end effector 6a and / or adapter component 8a associated with the robotic arm 12a. The system 1500 further includes an instrument feeder device 11 configured to axially retract and / or insert the elongate shaft 40 of the instrument 19 when configured as shown in FIG. 15. The instrument feeder 11 is associated with the second robotic arm 12b. For example, the instrument feeder 11 may be attached or mounted to an end effector 6b and / or adapter component 8b associated with the robotic arm 12b as described and illustrated in this disclosure.

[0160] The system 1500 can be configured to retract and insert the elongate shaft 40 through and / or at least partially into the sheath 90 of the access sheath assembly 92. The access sheath assembly 92 can include an introducer port 91, which can be secured to a clip 47 or other feature of the instrument feeder 11. To effect such insertion and / or retraction, an actuator means / mechanism 38 (e.g., a feed roller wheel, track, belt, or equivalent) of the instrument feeder 11 can move the elongate shaft 40 axially relative to the feeder device 11. Additionally, the insertion and / or retraction can be facilitated by movement of the robot arm 12a and / or end effector 6a in a direction parallel to the axis 1501 of the sheath 90 and / or at least a portion of the elongate shaft 40, as shown in FIG. 15. For example, when retracting the elongate shaft 40, the axial actuator means / mechanism 38 of the feeder device 11 can retract the shaft 40 in a proximal direction. Additionally or alternatively, the robotic arm 12a may be actuated to move the end effector 6a in a proximal direction along the axis / rail 1501 to withdraw at least a portion of the shaft 40 proximally, thereby causing the feeder 11 to move closer to the distance D between the robotic arms 12a and 12b. a11 and 12b. a It may be necessary or desirable for the robotic arm 12a to be moved distally toward the feeder 11 to avoid losing slack in the service loop 49 as the instrument feeder 11 inserts the shaft 40, as may occur if the insertion is performed by the instrument feeder without increasing the distance D. a If the slack is not reduced accordingly, the lack of slack may limit the ability of the feeder device 11 to further insert the shaft 40. Furthermore, damage may occur to the shaft 40, the actuator means / mechanism 38, the instrument 19, the robotic arms 12a / 12b, and / or other instrumentation if further insertion is attempted without any available slack in the shaft 40 between the instrument feeder 11 and the instrument handle 31.

[0161] If the instrument feeder 11 (e.g., scope driver) and the instrument end effector 6a are operated at the same speed throughout the stone insertion or retraction process, the process may be undesirably slow due to the relatively limited motion speed of translating the end effector relative to the motion speed of the feeder's shaft actuator. Such translation speed limitations may result from safety and / or injury concerns regarding the patient and / or instrumentation, or may be based on other physical and / or environmental constraints, where high speed robotic end effector movements (e.g., for the instrument arm 12a) may be perceived as relatively dangerous and may cause collisions with other objects. At the same time, large retraction distances / lengths may require relatively large workspaces for arm / end effector movements, which may be difficult to achieve. Taking such considerations into account, driving the feeder actuator and the scope / instrument end effector 6a at different speeds during one or more stages of the insertion or retraction process may advantageously make the procedure more efficient, safe, and / or sustainable. With respect to the stone extraction / retraction process, efficiency can be improved by driving the feeder actuator 38 at a relatively high speed during stone extraction. However, the distance D between the robot arms by translating the end effector 6a (and / or end effector 6b) in space is reduced. a Without a corresponding increase in, a relatively large curvature may form in the service loop 49 between the instrument / scope feeder 11 and the instrument end effector 6a, which may cause damage to the scope. Thus, coordination between feeder motion (e.g., via translation of the robotic end effector 6a) and instrument handle translation during stone extraction (e.g., insertion and / or retraction) may be important to improve efficiency and avoid damage to the instrument in connection with various embodiments disclosed herein.

[0162] In some systems, it may be necessary or desirable to limit the proximal or distal speed and / or distance of movement / translation of the robot arm 12a and / or end effector 6a based on workspace limitations. For example, the arm 12a may have a limited range of motion within the physical parameters of the robot system. That is, the arm 12a and / or end effector 6a may only be permitted to move a limited range along a rail 1501, which may be a virtual rail in which the end effector 6a is configured to actuate to keep the shaft 40 substantially axial and / or in line with the channel 39 of the feeder device 11 and / or the access sheath 90. Additionally, the speed of movement of the robot arm 12a may be limited by mechanical constraints and / or as a means of maintaining safe operation of the robot system. For example, if the robot arm 12a and / or end effector 6a are translated at too high a speed, the accuracy of movement and / or position may be compromised.

[0163] Generally, the axial actuator means / mechanism 38 of the instrument driver 11 may be configured to axially move (e.g., insert and / or retract) the elongated shaft 40 at a speed that is greater than a maximum distal and / or proximal translation speed of the robotic arm 12a, the end effector 6a, and / or the instrument handle 31. It may be desirable to insert and / or retract the shaft 40 at such a relatively high speed during certain parts of the retraction and / or insertion process to provide desired and / or improved efficiency for the performance of the procedure. That is, it may not be desirable to limit the axial actuation of the shaft 40 by the instrument feeder 11 to the maximum retraction and / or insertion speed of the robotic arm 12a associated with the instrument handle 31. Thus, the processes disclosed herein may involve maintaining and / or utilizing certain service loop configurations and / or conditions during insertion and / or retraction as a means to allow a relatively high retraction / insertion speed of the instrument feeder 11 to be utilized to rapidly insert and / or retract the elongated shaft 40.

[0164] Certain embodiments are disclosed herein with respect to the insertion and / or retraction of elongate shafts of certain medical / surgical instruments, where such insertion / retraction is accomplished using an instrument feeder device and / or actuator components thereof. However, it should be understood that any description herein of the insertion or retraction of elongate shafts or other instruments may be accomplished / performed using instrument feeder actuation and / or robotic arm / end effector translation, as shown in the exemplary implementation of FIG. 15. Additionally, while FIG. 15 and other figures of the present disclosure show an instrument handle and driver / feeder attached to an end effector associated with the distal end of a robotic arm, it should be understood that robotic end effector translation associated with instrument insertion and / or retraction processes / functions may be accomplished using any type of end effector, whether associated with a robotic arm or not. For example, some systems may include a robotic end effector disposed on a track or other structure, and such end effector translation can be accomplished by sliding / running along the track or other structure.

[0165] As a means of promoting safety and efficiency in connection with various embodiments of the present disclosure, the instrument shaft 40 may advantageously be retracted or inserted at different speeds depending on the determination of the current position of the distal end of the shaft 40 by any of the position determination means / mechanisms disclosed herein. For example, the position of the shaft tip 42 relative to the tip 93 of the access sheath 90 and / or the automatic pause location 101 (not shown in FIG. 15) may be used to govern the speed of the translational movement of the feeder actuator 38 and / or the end effector 6a. In some embodiments, the position determination and / or retraction / insertion speed control is based on specific system data, which may be input into the system in some manner by the user. For example, the scope length d4, the sheath length d2, the distance D between the scope arm end effector 6a and the scope feeder end effector 6b, etc. aData regarding can be obtained from the system and / or input by a user. Such information can be used to determine / calculate the position of the distal end 93 of the sheath 90 relative to the position of the distal end of the shaft 40. If the collection location (e.g., automatic pause location) is set to be outside the proximal end of the access sheath assembly 92 (e.g., with some amount of buffering), then once the position of the access sheath is determined, the collection location can be calculated based at least in part on such information.

[0166] Although end effector translation (e.g., for an end effector associated with a medical instrument such as an endoscope) is generally disclosed herein as being along a rail that is in line with the feeder channel and / or sheath axis, such translation need not be along such a rail, but rather may be along a path that is angled relative to such a reference line. Furthermore, up-down translation may be performed in connection with various processes disclosed herein to achieve a desired end effector / instrument distance. Additionally, plates or other components of the end effector or end effector adapter may be rotated to provide a desired distance for a shaft service loop and / or to reduce curvature present within such service loop.

[0167] 16 illustrates the assembly of an instrument driver / feeder device 11 and an access sheath assembly 92, according to one or more embodiments, with specific scope retraction speed zones identified. With regard to the process of retracting the scope 40 into and through the access sheath assembly 92, such as may be performed after stone fragments have been retrieved following insertion, the insertion and retraction process may advantageously be repeated multiple times in a single surgical setting. Retraction of the scope 40 into the sheath 90 of the access sheath assembly 92 may require the physician to use extreme caution and / or operate the retraction at a relatively slow speed in order to avoid damage to the patient, the scope assembly 92, and / or other instrumentation that may result from overly aggressive retraction out of the distal end 93 of the sheath.

[0168] According to some position-based retraction speed control schemes of the present disclosure, the entire travel path of the distal end of the associated instrument shaft 40 may be divided into two, three, four or more different zones, and the speed of retraction may be performed / determined differently based on which zone the shaft tip is currently in. For example, such zones may be slow retraction zones Z1, Z3, normal / fast retraction buffer zones Z4, Z5, Z6, Z7, Z8, Z9, Z10, Z11, Z12, Z13, Z14, Z15, Z16, Z17, Z18, Z19, Z20, Z21, Z22, Z23, Z24, Z25, Z26, Z27, Z28, Z29, Z30, Z31, Z32, Z33, Z34, Z35, Z36, Z37, Z38, Z39, Z40, Z41, Z42, Z43, Z44, Z45, Z46, Z47, Z48, Z49, Z50, Z51, Z52, Z53, Z54, Z55, Z56, Z57, Z58, Z59, Z60, Z61, Z62, Z63, Z64, Z65, Z66, Z67, Z68, Z69, Z70, Z71, Z72, Z73, Z74, Z75, Z76, Z75, Z86, Z87, Z88, Z90, Z91, Z92, Z93, Z94, Z95, Z96, Z106, Z110, Z120, Z130, Z140, Z150, Z161, Z172, Z183, Z194, Z195, Z196, Z197, Z198, Z199, B1 , Z B2 , a fast reverse zone Z2, and / or a pause / stop zone / location 101, and the reverse speed implemented in each zone may be implemented automatically.

[0169] When initially retracting the distal end of the scope or other elongated shaft instrument 40 into the access sheath 90, the retraction involves placing the distal end 42 of the scope into the distal opening 93 of the access sheath 90. According to the scheme of FIG. 16 , the area just distal to the access sheath 90 may be within a slow retraction zone Z1. The system control circuitry may be configured to control the retraction rate of the shaft 40 at a relatively slow rate to permit retraction of the distal end 42 of the shaft 40 into the distal end 93 of the access sheath 90, and to provide a confirmation input confirming successful entry of the distal end 42 of the shaft and / or the basket 35 or other working instrument associated therewith. According to some implementations, the sheath entry confirmation zone Z0 represents an area distal to the distal end 93 of the sheath 90 and covering a distal portion of the sheath 90, where the operator / technician may provide an indication of successful entry into the access sheath 90 upon successful entry of the distal tip 42 of the shaft 40 into the access sheath 90. While the shaft 40 is in the confirmation zone Z0, a pop-up window or other graphical interface may be generated and / or presented to the operator / technician to confirm the location of the distal end 93 of the access sheath 90. For example, to ensure safety, the high speed retraction mode may be enabled / allowed only after the user has confirmed the location of the sheath tip 93 (e.g., visible on the camera image of the instrument camera). Retraction of the shaft 40 may be performed at a relatively slow speed (e.g., "normal" speed) until the location of the tip 93 of the sheath 90 and / or successful entry of the shaft 40 into the sheath 90 is confirmed. Control of the retraction rate of the shaft 40, implemented using any control circuitry of the system, may be based on determining the presence / position of the tip 42 of the shaft 40 within any of the various zones shown in FIG. 16 (and FIG. 17 described below).

[0170] After the scope tip 42 is retracted into the sheath tip 93, the scope tip 42 may enter a "normal" or "buffer" retraction zone (Z B1 and / or Z B2, and in some contexts also referred to as "fast retraction buffer zone" for convenience and / or clarity. The fast retraction buffer zone can be implemented to ensure that the basket tip 35 (or other working instrument) protruding from the shaft 40 can also be safely retracted into the sheath 90 without getting stuck. As an additional consideration, the distance between the robot end effector (e.g., robot arm end effector) associated with the instrument handle and the end effector associated with the instrument feeder 11 may also need to be above a certain threshold distance when fast retraction is initiated to ensure that the curvature associated with the shaft's service loop is not too tight (which could cause damage to the instrument shaft 40). As a result, depending on the length d2 of the access sheath 90, fast retraction may be initiated once the shaft tip 42 passes the threshold 152 associated with the distal boundary of the fast retraction zone Z2. In some implementations, an additional fast retraction buffer zone Z B2 However, the initial fast retreat buffer zone Z B1 and a fast retract zone Z2, and the shaft retract speed is increased beyond the first buffer zone Z to increase the distance between the feeder and the implement handle until it meets the minimum distance required to initiate fast retraction. B1 The fast retraction zone (Z2) is driven relatively faster than the fast retraction zone, but slower than the fast retraction zone. After the scope tip 42 is retracted into the fast retraction zone (Z2), the instrument feeder actuator can be accelerated to a maximum operating speed. In some embodiments, once fast retraction is initiated, the instrument shaft can be retracted at the fast retraction speed until the automatic pause position 101 is reached. During the retraction process, if the instrument handle end effector reaches the retraction workspace limit, the retraction translation of the instrument end effector can be paused such that retraction is accomplished solely by axial actuation of the shaft 40 by the instrument feeder 11.

[0171] In some implementations, the sheath entry verification zone Z0 may overlap with the slow retraction zone Z1, which may span the distal region of the access sheath 90 as well as a distal portion of the access sheath 90. In some implementations, the slow retraction zone Z1 includes only a region distal to the distal end 93 of the access sheath 90, which represents a threshold transition to another, more proximal zone. Within the slow retraction zone Z1, the retraction speed may be limited to a relatively slow speed, such as approximately 5 mm / s, or other speed that is relatively slow as compared to other retraction speeds implemented in connection with the retraction scheme associated with FIG. 16 and / or any other embodiment of the present disclosure.

[0172] According to some retraction (and / or insertion) strategies, the control of retraction (or insertion) may be implemented in relation to multiple speeds, including, for example, where a slow insertion / retraction speed represents the slowest speed or speed limit of the associated retraction / insertion strategy. A "slow" insertion or retraction speed according to aspects of the present disclosure may be a speed of 10 mm / s or less, such as 5-10 mm / s, about 5 mm / s, 3-5 mm / s, or a speed less than 3 mm / s. A "normal" insertion / retraction speed may represent a speed of retraction / insertion that is more than a slow speed, and may represent a default retraction / insertion speed or other speed typical of a particular treatment stage of an insertion or retraction process. A normal insertion / retraction speed may be approximately 10-30 mm / s, such as a speed of 20-30 mm / s or 10-20 mm / s. For example, in some implementations, a normal speed of retraction / insertion may be approximately 11 mm / s. A "medium" speed (also referred to as "medium-fast") may represent a speed of retraction / insertion that is more than a normal speed. The intermediate insertion / retraction speed may be approximately 30-100 mm / s, such as a speed of 50-100 mm / s or 30-50 mm / s. For example, in some implementations, the intermediate retraction / insertion speed may be approximately 30 mm / s. In some implementations, the intermediate retraction / insertion speed may correspond to a maximum desired or allowable robotic end effector translation speed, such as a robotic arm translation speed, as described above. A "fast" insertion / retraction speed may represent a speed of retraction / assertion that is greater than the intermediate speed and may represent a maximum possible or allowable retraction / insertion speed. For example, such a fast retraction / insertion speed may be strictly implemented within the access sheath to avoid damage to the instrumentation and / or patient anatomy. The fast insertion / retraction speed may be approximately 100-200 mm / s, such as a speed of 100-150 mm / s or 150-200 mm / s. For example, in some implementations, the fast retraction / insertion speed may be approximately 170 mm / s.

[0173] According to the retreat speed zone method of FIG. 16, the portion of the slow retreat zone Z1 is a fast retreat buffer zone Z B1For example, positioning of the distal end 42 of the shaft 40 between the distal end 93 of the access sheath 90 and a particular distance threshold 155 from the distal end 93 of the access sheath may indicate that the shaft 40 is within the access sheath 90, but is not far enough within the access sheath 90 to ensure that a basket 35 or other working instrument associated with the shaft 40 is also within the access sheath 90. In some embodiments, the fast retraction buffer zone Z B1 The threshold 155 associated with the proximal boundary of the slow retraction zone Z1 may correspond to the threshold 152 associated with the proximal end of the slow retraction zone Z1. In some implementations, the slow retraction zone Z1 and / or the fast retraction buffer zone Z2 may be B1 The retraction speed within the retraction chamber may be limited to a normal retraction speed (eg, a speed of about 11 mm / s).

[0174] Low speed reverse zone Z1 and / or high speed reverse buffer zone Z B1 The region within the sheath 90 proximal to the one may be considered a fast retraction zone Z2, where the retraction speed may be increased to a relatively fast speed, such as about 170 mm / s or other speed, which may represent the maximum retraction speed of the system. B2 may be between the proximal threshold 152 of the slow retreat zone Z1 and the distal threshold of the fast retreat zone Z2. B2 Retraction in may be performed at an intermediate speed that is faster than the normal speed but slower than the fast retraction speed. For example, the intermediate (also referred to as medium-high) speed may be about 30 mm / s, which in some embodiments may correspond to the maximum robot translational speed associated with a robotic end effector attached to the handle or base of the instrument being retracted.

[0175] In some embodiments, the fast retraction zone Z2 may extend proximally beyond the proximal end of the sheath 90 and / or the introducer component 91 of the access sheath 92. For example, the fast retraction zone Z2 may extend to the automatic pause / stop location 101, as described in detail herein. For example, the system control circuitry may be configured to perform fast retraction through the proximal end of the access sheath assembly 92 and automatically stop / pause at location 101. In some embodiments, a slow retraction zone Z3 may be implemented between the proximal portion of the access sheath assembly 92 and the automatic pause location 101, such that retraction of the scope may proceed at maximum speed through the fast retraction zone Z2, but may slow down to a relatively slower speed (e.g., intermediate, normal, or slow, as defined above) before finally stopping / pausing at the automatic pause location 101.

[0176] 17 illustrates the assembly of the instrument feeder device 11 and the access sheath assembly 92, according to one or more embodiments, with specific scope insertion speed zones identified. With respect to the process of inserting the scope 40 into and through the access sheath assembly 92, such as may be performed after stone fragments have been deposited following retraction, the insertion and retraction process may advantageously be repeated multiple times in a single surgical setting. Reinsertion of the scope 40 into the sheath 90 may require the physician to pay close attention to the scope camera view in order to guide the physician to slow down the scope insertion when accessing the distal exit 93 of the access sheath 90 to avoid tissue damage that may result from inserting too aggressively outside the distal end 93 of the sheath.

[0177] For robotic systems in which the physician / operator inserts the scope / shaft 40 using a pendant joystick or other user input control, the physician may hold the control in the insertion position / engagement to perform high speed insertion through the access sheath 90. If the physician is too cautious, he or she may slow down too soon inside the access sheath 90, thereby lengthening the overall procedure time. If the physician is not careful or becomes distracted during the insertion process, there is a risk of overinsertion, which can cause tissue damage. In addition to the need to time correctly to transition from a fast insertion speed / mode to a relatively slower insertion speed / mode, the physician may benefit from feedback indicating when there is / is a relatively high insertion force at / on the scope tip. For systems in which manual feedback from the scope is not provided to the physician, for example, certain robotic solutions where the scope is inserted through an instrument feeder roller instead of being held by the physician's hand, it may be advantageous for the system to provide an indication to the physician of when a high force is sensed from the drive roller, which may indicate that the scope / shaft is hitting a protrusion and high force is being exerted on the tip.

[0178] After the operator / physician collects a specimen (e.g., stone fragments) near the auto pause position 101, the operator may proceed by reinserting the shaft 40 into the sheath 90. Since the sheath entrance is generally relatively narrow, if fast insertion begins too early the operator may miss the entrance, potentially damaging instruments and / or anatomical structures. Therefore, in zone Z4 adjacent to the sheath 90 (and / or covering the proximal portion within the sheath 90), it may be desirable to drive the shaft 40 at a normal insertion speed. Once the shaft tip 42 is inserted past the proximal end 161 of the sheath 90, a fast insertion zone Z5 is entered where the scope accelerates to its maximum speed.

[0179] Generally, due to the support of the access sheath 90, the articulating section of the shaft (e.g., the distal portion of the shaft 40) may not be fully exposed in the area just distal to the distal end 93 of the access sheath 90. That is, the shaft 40 may be relatively stiff and less likely to buckle when the distal end 42 of the shaft 40 is advanced out of the end 93 of the access sheath 90. Thus, the area just distal to the end 93 of the access sheath 90 may be considered a high risk area for causing ureteral avulsion, and thus high insertion speeds may pose undesirable risks. To limit scope insertion forces and prevent harm to the patient, physicians should generally be careful not to insert past the distal end 93 of the access sheath 90 at high speeds. Driving / inserting the shaft 40 at a relatively slow speed through the distal exit 93 of the sheath 90, as made possible through automatic speed correction triggered by scope position determination / detection according to aspects of the present disclosure, may help the physician stop the insertion in time when sensing any protrusion from the drive to avoid avulsion.

[0180] To prevent the shaft 40 from being inserted through the sheath 90 at a high speed, a threshold 162 transitioning to a slow insertion zone Z6 is set at or near the distal end 93 of the sheath 90. The transition to the slow insertion zone Z6 provides a buffer for slow insertion and can help prevent the distance between the instrument end effector and the feeder end effector from becoming too close, which could cause the shaft service loop to become too curved. During high speed insertion, both the shaft tip 42 and the instrument end effector position can be monitored, and translation of the end effector associated with the base / handle of the instrument 40 can be automatically paused when the tip 42 of the shaft 40 reaches the distal boundary of the fast insertion zone Z5 until no more (or a threshold amount) of the service loop remains. In some implementations, when no more service loops remain in the shaft 40 between the feeder 11 and the instrument base / handle (not shown in FIG. 17, see FIG. 15), the fast insertion may automatically end and operation may transition to a slow insertion speed (e.g., slow insertion zone Z6). That is, the distal boundary of the fast insertion zone Z5 may dynamically change based on when the service loop is used up (or predicted to be used up). Depending on the length d2 of the sheath 90, a relatively high insertion speed zone may be implemented for insertion between the end 162b of the fast insertion zone Z5 and the beginning 162a of the slow insertion zone Z6. Once the shaft tip 40 enters the slow insertion zone Z6 near the sheath distal tip 93, the insertion speed is reduced, allowing the operator to drive the shaft 40 relatively slowly and safely out of the sheath tip 93 while monitoring the insertion force to prevent tissue damage.

[0181] Various solutions presented herein for determining the current shaft position may be implemented to determine when the shaft tip 42 enters the slow insertion zone Z6. For example, other than using robotic data to determine the position of the distal tip 42 of the shaft 40, other solutions may include the use of other sensors to detect when the shaft 40 reaches the distal tip 93 of the access sheath 90. Any mechanism for determining when the shaft enters the slow insertion zone Z6 may be implemented. As disclosed in detail herein, in some embodiments, a camera of the instrument 40 may be utilized to detect the position of the tip 42 of the shaft 40. For example, computer vision algorithms may be utilized to recognize the environment near the tip 93 of the sheath 90. In some embodiments, an electromagnetic sensor may be used in a system in which the distal tip 42 of the shaft 40 includes an electromagnetic sensor and is positioned in an electromagnetic field generated by an electromagnetic field generator. For example, during shaft insertion, the system's control circuitry can be configured to compare the electromagnetic sensor position data against the position (e.g., electromagnetic sensor determined position) of the distal end 93 of the access sheath 90 and automatically initiate a transition to a slower insertion speed upon entering the slow insertion zone Z6. In some embodiments, signals / data from multiple sensors can be combined / utilized to provide scope position determination.

[0182] With respect to insertion speed control in the slow insertion zone Z6, some embodiments of the present disclosure provide dynamic speed adjustment based on one or more parameters. For example, rather than implementing a fixed speed while driving through the slow insertion zone Z6, the system's control circuitry can be configured to adjust the insertion (or retraction) speed based on the amount of force sensed / determined on or against the axial actuator (e.g., roller) of the instrument feeder 11. In some embodiments, the shaft 40 may initially transition from a relatively fast insertion speed to a relatively slow insertion speed, and such relatively slow speed may be maintained through the end 93 of the access sheath 90 if the force on the drive actuator roller remains below a predetermined threshold. If the force on the drive actuator roller increases beyond a predetermined threshold, the insertion (or retraction) speed may be automatically further reduced to allow more time to detect and react to potential high forces and avoid relatively sudden peaks in force.

[0183] In some embodiments, the tip 42 of the shaft 40 may include or be associated with a force sensor. In such embodiments, when the shaft 40 is inserted through a particular insertion mechanism (e.g., the access sheath assembly 92), force sensing in the insertion mechanism may be used to detect changes in the force profile due to a relatively high tip 42 insertion force, as indicated by a signal from the tip force sensor. In some implementations, shape sensing may be implemented to detect a relatively high insertion force. For example, in a situation where at least a portion of the articulation portion of the shaft 40 is disposed distal to the distal end 93 of the access sheath 90, the shaft 40 may have a tendency to buckle when encountering a relatively large force. Such buckling may be captured through shape sensing of the buckled scope portion. Shape sensing may be implemented using a scope camera image, or any type of imaging or position sensing modality, such as computed tomography (CT), ultrasound, electromagnetic position sensing, or the like.

[0184] In some implementations, the instrument feeder 11 is configured to automatically slow down the shaft insertion speed when approaching the exit / opening of the sheath 90, such as when the shaft tip 42 exits the access sheath 90 or when the shaft tip 42 exits the distal end 93 of the sheath 90. The slow insertion / retraction zone Z6 can be set such that its proximal threshold 162 is a particular distance inside the distal portion of the sheath 90. The distal threshold 163 of the slow insertion / retraction zone Z6 can be a distance distal outside the sheath end 93. The various thresholds shown in Figs. 16 and 17, which can serve as a basis for automatic scope speed correction according to embodiments of the present disclosure, can function only for either insertion or retraction, respectively, or can serve as speed correction triggers, but not both, according to some implementations. For insertion, the entrance / threshold 152 of the slow insertion zone Z6 can be set at a position where the physician can visually see the tip 93 of the sheath 90 on the scope camera image when transitioning from fast insertion to slow insertion. The exit of the slow insertion zone Z6 can be set at a position that covers at least a portion of the articulation portion of the shaft 40. After exiting the slow insertion zone Z6 during insertion, the articulation portion of the scope can be completely outside the sheath 90. In such a position, the shaft 40 may no longer be substantially supported by the access sheath 90, and thus the exposed portion of the shaft 40 may be relatively more flexible than when the scope articulation portion is disposed mostly within the sheath 90, and high insertion forces at the tip 42 may be less likely to occur. Thus, distal to the threshold 163, the instrument feeder 11 can be configured to automatically increase the insertion speed of the scope, such as to a normal insertion speed mode.

[0185] When a user activates an insertion control to send a scope insertion command (e.g., moving a joystick or other control in an up / forward direction), the instrument feeder 11 may be configured to insert the shaft 40 through the access sheath 90, and the system control circuitry may be configured to monitor the position of the shaft tip 42 during insertion. The position of the shaft tip 42 relative to the access sheath tip 93 may be determined from the system using certain known parameters, such as the instrument feeder insertion distance, the access sheath length, the scope / shaft length, and / or the distance between the instrument connection robot arm and the instrument feeder connection robot arm, such parameters / dimensions being described in detail above with respect to FIG. 10 and other figures. When the position of the shaft tip 42 is determined to be within the slow insertion zone Z6, the system control circuitry and / or the instrument feeder 11 may be configured to automatically reduce the insertion speed to a speed lower than the normal drive speed of the scope.

[0186] In some embodiments, the torque on the instrument feeder axial actuator (e.g., rollers) may also be monitored during insertion. For example, if the force experienced by the shaft 40 at the shaft tip 42 as it is driven through the actuator rollers of the feeder 11 is relatively large, some of the force at that tip may be detectable / transduced back to the drive shaft of the axial actuator mechanism of the instrument feeder 11. In some embodiments, such force may be detected using one or more torque sensors associated with the drive shaft of the instrument feeder 11. At relatively slow drive speeds, the force on the tip 42 of the shaft 40 may increase relatively gradually rather than being presented as a spike in force, which may provide the system with more time to detect and react to high insertion forces before the force becomes problematic. In embodiments in which the axial actuator / driver means of the instrument feeder 11 comprises two rollers, the sum of the forces on the two drive rollers may be determined continuously, periodically, or sporadically during the insertion of the shaft 40, as described in detail herein. If the sum of the drive roller / wheel forces exceeds a predetermined force threshold, the system control circuitry and / or the instrument feeder 11 may stop or slow down the shaft 40. In such a case, a high insertion force fault may be thrown to notify the user of the detected high tip force. Such an implementation may advantageously provide an alternative feedback mechanism compared to textile sensing on the scope shaft to the user during certain manual procedures.

[0187] Embodiments of the present disclosure may provide certain advantages over other scope insertion and / or retraction solutions. For example, the systems, devices, and methods disclosed herein may provide a relatively efficient, comfortable, and safe means for inserting and retracting scopes and other shaft-type instruments through and from an access sheath. Furthermore, the automatic nature of the instrument insertion / retraction speed correction solutions presented herein may require relatively little cognitive load on the user to determine when to slow down at the distal and / or proximal ends / openings of the access sheath and / or access sheath assembly. Automatic transitions from relatively fast to relatively slow insertion / retraction speeds according to aspects of the present disclosure may allow for maximum / high insertion / retraction speeds to be implemented when driving through the main portion of the access sheath, and may also simulate the natural user behavior generally associated with manual procedures of slowing down and driving with caution when inserting / retracting a scope outside of the access sheath.

[0188] With regard to the safety advantages provided by the embodiments of the present disclosure, for example, driving the scope at a relatively slow speed in a predetermined detected zone associated with an area with a relatively high risk of ureteral avulsion can provide the associated robotic system with more / sufficient time to detect / determine the presence of a relatively high force signal associated with the portion of the shaft being driven and react quickly enough to prevent any potential damage. Additionally, the associated user / physician may be able to control the insertion / retraction process, for example, through a pendant joystick control via the robotic system interface. This can reduce fatigue caused by manually holding the scope for a relatively long period of time and facilitate the physician to focus on other tasks associated with the procedure. Additionally, the embodiments of the present disclosure can allow the physician / user to experience feedback to confirm the relatively high insertion force present on the scope tip. For example, the robotic system of the present disclosure can allow the user / physician to hold the scope instrument in a manner similar to a particular manual procedure in one or more respects and undock the scope instrument for the purpose of manual handling.

[0189] 18 is a flow diagram illustrating a process 1800 for verifying sheath position, according to one or more embodiments of the present disclosure. For example, sheath position verification may be implemented as a means to enable fast retraction and / or insertion speeds for stone fragment retrieval cycles, according to aspects of the present disclosure. Process 1800 may be performed, at least in part, by the control circuitry of an associated system and / or by a physician and / or other user / technician.

[0190] Process 1800 may be implemented at least initially when a user retracts an instrument into an access sheath in connection with a surgical procedure. As described herein, various instrument insertion / retraction speed corrections may be implemented in response to a determined position of the instrument relative to the access sheath. Such position determination may be based on system / robot specific data. Due to potential variations in actual sheath length / dimensions, it may be necessary or desirable for the user to confirm (e.g., visually) the position of the distal end (and / or other portions) of the access sheath. Such confirmation may be obtained through a user input / output mechanism (e.g., engagement / interaction with an electronic display).

[0191] At block 1802, process 1800 involves indicating one or more parameters associated with the associated access sheath, such as length, brand, and / or other characteristics. For example, a user interface may be implemented to allow user input indicating such parameters. As an example, the control system 50 of the medical system 100 shown in FIG. 1 may be used to implement the associated user input / output for sheath parameter registration in connection with block 1802. The operations associated with block 1802 may be performed prior to connecting the shaft-type instruments and / or instrument feeders to the respective robotic end effectors.

[0192] At block 1804, process 1800 entails loading and / or configuring a particular instrument to be utilized in the associated medical procedure. For example, such instruments may include medical instruments including an elongated shaft, such as an endoscope or equivalent, and an instrument feeder device, or equivalent, as described in detail herein. Such loading may involve mounting the instruments to a respective robotic end effector, as described herein. In some embodiments, the operations associated with block 1804 may involve mounting a basket cartridge / system to a robotic end effector and loading one or more components thereof into a working channel of the medical instrument shaft. Block 1804 may further involve loading an elongated shaft of the medical instrument into a working channel of the instrument feeder device, as described in detail herein.

[0193] At block 1806, process 1800 may further involve indicating one or more instrument speed modification thresholds that may correspond to particular relative positions of the medical instrument (e.g., shaft tip) with respect to the access sheath. For example, one or more thresholds may be indicated associated with proximal and / or distal boundaries of a high speed retraction / insertion zone.

[0194] At block 1808, the process involves inserting a medical instrument (e.g., a shaft) at least partially through the access sheath. For example, an elongated shaft, such as an endoscope, may be inserted through the sheath in connection with a medical procedure, such as a kidney stone removal procedure. Aspects of such an instrument insertion process may include features described below in connection with FIG.

[0195] At block 1810, the process 1800 involves capturing a biological specimen, such as a kidney stone or kidney stone fragment, to be extracted through the access sheath. Such capturing may be accomplished using a basket device that protrudes from the distal end of the shaft and is at least partially disposed within a working channel thereof. At block 1812, the process 1800 involves retracting the medical instrument shaft toward the distal end of the access sheath having the captured specimen. For example, the distal end of the access sheath may be positioned within an internal conduit, vessel, cavity, or other anatomical region, such as the patient's ureter, bladder, urethra, and / or ureteropelvic junction. Such retraction toward the access sheath may be advantageously performed at a relatively slow speed to avoid damage to the access sheath and / or surrounding anatomical structures.

[0196] At block 1814, process 1800 involves determining whether the position of the distal end of the medical instrument shaft within the distal end of the access sheath has been determined or confirmed. For example, such position confirmation may be performed while the distal end of the shaft is within a confirmation zone, such as, for example, zone Z0 shown in FIG. 16. When the distal end of the shaft is within the confirmation zone, as indicated by the flow path resulting from decision block 1816, a user output may be presented to solicit a confirmation instruction from the operator, as indicated at block 1824. Any other suitable or desirable means or mechanisms for confirming the position of the distal end of the shaft within the access sheath may be implemented in connection with process 1800. The user confirmation output may include a pop-up window presented on an electronic display. The user may engage a confirmation input feature (e.g., a button) to confirm the length of the sheath.

[0197] Once the position of the distal end of the shaft within the distal end of the access sheath is confirmed, a high speed retraction speed may be enabled, as shown in block 1822. For example, in some implementations, confirmation of the position of the shaft at the distal end / opening of the access sheath may indicate the position of the distal end of the access sheath, and such determined position of the distal end of the access sheath may be used in subsequent control of retraction and / or insertion speed based at least in part on a determination that the instrument shaft distal end is within the access sheath.

[0198] Once the fast retraction rate is enabled, process 1800 may proceed to sub-process 1820 for retracting the instrument through the access sheath and into a specimen collection area proximal to the access sheath assembly. Aspects of such a retraction process are described below in connection with FIG. 20. If the sheath length / position has not been confirmed and the distal end of the instrument shaft is outside the confirmation zone, the fast retraction rate may be disabled or may remain disabled, as shown in block 1818. In such a case, process 1800 may return to block 1812 or the instrument may continue to retract toward the distal opening of the access sheath.

[0199] The process 1800 provides a means / mechanism for a user to obtain sheath information through user input of sheath information such as length, and further allows the user to confirm the sheath length when the shaft is positioned within the sheath. In some implementations, the system control circuitry can provide an output to the user requesting that the user stop retracting at the tip of the sheath and provide a confirmation input (e.g., engagement of a button or other user interface feature) to mark the location of the distal end of the sheath. In some implementations, the system control circuitry is configured to automatically confirm the sheath position by implementing a computer vision algorithm to identify the sheath tip based on the camera image.

[0200] 19 is a flow diagram illustrating a process 1900 for inserting an instrument, according to one or more embodiments of the present disclosure. Process 1900 may be performed, at least in part, by control circuitry of an associated system and / or by a physician and / or other user / technician. Process 1900 may begin with a distal end of a shaft of a medical instrument disposed or positioned proximal to a proximal opening or end of an access sheath, as shown in block 1902.

[0201] At block 1904, the process 1900 involves inserting the distal end of the instrument shaft into the proximal end / opening of the access sheath at a normal speed. For example, the normal speed may be a speed greater than a slow insertion speed (e.g., about 5 mm / s or less) but less than a maximum / fast insertion speed (e.g., greater than 150 mm / s, about 170 mm / s). For example, the normal insertion speed may be about 11 mm / s in some implementations. The various speeds described in connection with FIG. 19 (and FIG. 20) may be interpreted according to the description of relative insertion and / or retraction speeds above. To insert the shaft at the normal speed, the process 1900 may involve operating an axial actuator mechanism / means of the instrument feeder device at the normal speed. In addition, the robotic end effector to which the base / handle of the medical instrument is attached may be further operated / translated in a distal direction at the normal speed. For example, the end effector may be a distal end component of a robotic arm, or any other type of robotic end effector.

[0202] At decision block 1906, process 1900 may involve determining whether the distal end of the shaft is within a rapid insertion zone. For example, the determination associated with block 1906 may involve any location determination process or function described herein or known to one of skill in the art. Further, the rapid insertion zone may correspond to a region or space associated with the access sheath, as shown in FIG. 17 and described above (e.g., the rapid insertion zone may be an inner portion of the access sheath).

[0203] If the instrument shaft is within the fast insertion zone, the process 1900 may proceed to block 1908, where the process 1900 involves inserting the instrument shaft at a high speed. To perform such a high speed insertion, the instrument feeder may be operated such that its axial actuator mechanism / means advances / inserts the shaft at a high speed, which in some embodiments may be the maximum operating speed of the feeder and / or the axial actuator. Generally, the high speed insertion speed may be greater than the normal insertion speed. In some implementations, the high speed insertion speed may be greater than about 150 mm / s, such as about 170 mm / s. Furthermore, to provide sufficient slack for insertion at high speed, the end effector coupled to the instrument base / handle may be translated / advanced at an intermediate speed that is greater than the normal speed. For example, the intermediate speed may be a speed between the normal speed and the high speed, which in some embodiments may correspond to the maximum translation speed of the end effector. In some embodiments, the intermediate speed is about 30 mm / s. As with other parts of process 1900, the operation of end effector translation may be performed only if end effector translation has not been paused due to workspace limits and / or other constraints.

[0204] If it is determined at decision block 1906 that the instrument shaft is not within the fast insertion zone, the process may involve determining whether the robot arm or end effector associated with the instrument base / handle is positioned in a pause position and / or whether a service loop of the shaft exists between the instrument feeder and the robot end effector. With respect to determining whether a service loop exists, the decision associated with block 1910 may involve determining whether a particular length or amount / degree of service loop exists. That is, the presence of a degree of service loop in the instrument shaft may not necessarily result in a positive determination at block 1910, but rather only a determination that a threshold amount of service loop exists with respect to speed of insertion and / or other considerations. If the determination associated with block 1910 is positive, the process 1900 may involve pausing the robot end effector translation (e.g., pausing the robot arm to which the instrument base / handle is coupled) such that further insertion translation of the robot end effector is disabled. For example, if there is a service loop above a certain predetermined threshold length or degree, it may not be necessary to translate the end effector to facilitate shaft insertion. Additionally, if the end effector is relatively close to the instrument feeder, it may be desirable or necessary to pause translation of the end effector when a certain amount of service loop is present to avoid collision with the instrument feeder and / or undesirable kinking or other damage to the instrument shaft that may result from bringing the robotic end effector too close to the instrument feeder. Pausing translation of the end effector can further encourage or ensure that the shaft tip remains inside the sheath when rapid insertion is stopped.

[0205] 19, it should be understood that the decision of whether and / or when to pause translation of the end effector may be made at any point in the process 1900. For example, such a decision may be made prior to any start of insertion and / or change in insertion speed.

[0206] At decision block 1914, process 1900 involves determining whether the instrument shaft is within a slow insertion zone. For example, the slow insertion zone may be distal to the fast insertion zone, such as an area at and / or distal to the distal end of the access sheath.

[0207] If the shaft is not determined to be within the slow insertion zone, the process 1900 may involve inserting the instrument at an intermediate speed, which may be between a normal speed and a fast speed. In some contexts, the intermediate speed may be referred to as a medium-high speed because the speed is faster than the normal insertion speed. In some embodiments, the intermediate speed may be about 30 mm / s and may or may not correspond to a maximum translation speed of the robot end effector. When inserting the instrument shaft at an intermediate speed, the instrument feeder may be configured to operate the shaft at the intermediate speed, and the end effector may be configured to translate at the intermediate speed as well, assuming the end effector is not paused, in which case no translation of the end effector may be performed.

[0208] If, at block 1914, it is determined that the instrument shaft is within the slow insertion zone, the process 1900 may proceed to block 1918, where the instrument shaft may be inserted at a slower than normal speed. For example, the slow speed may be less than about 10 mm. The slow speed may be implemented to reduce the risk of injury or damage to the instrumentation and / or anatomical structures distal to the distal end of the access sheath. When inserting the instrument shaft at a slow speed, the instrument feeder may implement an axial actuator means / mechanism to advance the shaft at a slow speed, and the robotic end effector may translate at a slow speed as well if not previously paused in connection with block 1912. In some implementations, there may be an amount of buffering between the sheath ends to allow the user to insert slowly into the sheath distal tube.

[0209] At block 1920, process 1900 may involve capturing a specimen, such as a kidney stone or stone fragments, within the calyx rete of the patient's kidney. After the specimen has been captured, such as by using a basket device disposed at least partially within a working channel of the instrument shaft, process 1900 may proceed to an instrument retraction sub-process 1922, which may involve one or more actions associated with retraction process 2000 shown in FIG. 20 and described below.

[0210] FIG. 20 is a flow diagram illustrating a process 2000 for retracting an instrument, according to one or more embodiments of the present disclosure. Process 2000 may be performed, at least in part, by the control circuitry of an associated system and / or by a physician and / or other user / technician. Process 2000 may be performed after capturing a specimen from within a chamber, vessel, or region of a patient's anatomy, such as within a patient's kidney. For example, process 2000 may be performed following implementation of one or more aspects of process 2000 of FIG. 19, as described above. Process 2000 begins with a distal end of an instrument shaft retracted into a distal end of an access sheath positioned and / or secured within the patient's anatomy (e.g., the urethra, bladder, ureter, ureter at the pelvic junction of the patient's anatomy).

[0211] In block 2004, the process 2000 involves determining whether a robotic end effector coupled to a base or handle of a medical instrument associated with the shaft is at a translation limit. For example, such limits may be established by a maneuverable workspace associated with the robotic system and / or a reach or other boundary of the robotic system. For example, the limit of the robotic end effector may be a physical limit of the movement of the robotic arm along a retract path / rail. If the robotic end effector is at a workspace limit, the process 2000 may involve pausing and / or disabling translation of the robotic end effector.

[0212] If the robot end effector is not at the workspace limit, the process 2000 may involve, at decision block 2008, determining whether the distal end of the instrument shaft is within a normal retraction zone, which may be referred to herein as a "buffer zone," "buffer retraction zone," or "fast retraction buffer zone" for convenience or clarity in some contexts. For example, the normal retraction zone (i.e., the "fast retraction buffer zone") may be understood with reference to FIG. 16. Additionally, other retraction speed zones shown in FIG. 20 and described in the associated written description may be understood with reference to the scheme illustrated in FIG. 16 and described in detail above. In some embodiments, the normal retraction / fast retraction buffer zone may cover an area distal to the distal end of the access sheath and / or an area within a distal portion of the access sheath.

[0213] If the instrument shaft is within the normal retraction zone, the process 2000 may involve retracting the instrument at a normal speed, which may be understood according to the associated description of retraction insertion speed herein. For example, the normal speed may be about 11 mm / s. Retracting the instrument shaft at a normal speed may involve operating an actuator means / mechanism of the instrument feeder at a normal speed, thereby retracting the shaft through the instrument feeder at a normal speed. Additionally, if translation of the end effector is not suspended, retracting the instrument shaft at a normal speed may involve translating the robot end effector at a normal speed as well.

[0214] If the instrument shaft is not within the normal retraction zone, the process 2000 may involve determining whether the instrument shaft is between the normal retraction zone (e.g., proximal to the normal retraction zone) and the fast retraction zone in decision block 2012, and such intermediate zone between the normal retraction zone (i.e., fast retraction buffer zone) and the fast retraction zone may be referred to as an "intermediate retraction zone" in some contexts herein. That is, in block 2012, the process 2000 may involve determining whether the distal end of the instrument shaft is proximal to the normal retraction zone but distal to the fast retraction zone, and under such conditions, the process may proceed to block 2014, and the instrument shaft is retracted at an intermediate speed. In some implementations, the intermediate speed may be faster than the normal speed but not exceed the maximum end effector translation speed. When retracting the shaft at an intermediate speed, the instrument feeder may operate to actuate the shaft axially at an intermediate speed. Additionally, if not previously paused, the end effector may be translated at an intermediate speed as well. The intermediate retraction zone can help ensure that any basket or other working implement is completely inside the sheath before being fast retracted.

[0215] If the instrument shaft is not determined to be within the intermediate retraction zone at decision block 2012, the process 2000 may involve determining whether the instrument shaft is currently disposed within the fast retraction zone, as shown in decision block 2016. If so, the process 2000 may proceed to block 2018, where retraction of the instrument shaft may be performed at a fast retraction speed, which may be faster than the normal speed and the intermediate speed. For example, the fast retraction speed may be greater than 150 mm / s (e.g., about 170 mm / s, etc.). To perform the fast retraction, the instrument feeder may operate the axial actuator means / mechanism at a high speed. Conversely, if not paused, the robot end effector may retract proximally at an intermediate speed, which may represent the maximum translational speed of the end effector, subject to constraints on physical capabilities and / or injury / damage prevention. The fast retraction speed of the feeder may build a service loop in the shaft proximal to the feeder. Translation of the end effector associated with the instrument handle may help reduce the amount of service loop buildup. It may be desirable to ensure there is enough distance between the instrument end effector and the feeder end effector to avoid too much curvature in the service loop, which could cause damage to the instrument shaft if fast retraction is initiated too soon. Having enough safety clearance between the two end effectors / arms allows for fast retraction.

[0216] Process 2000 may involve continuing to retract the instrument shaft at a high speed until a negative outcome at decision block 2016 indicates that the distal end of the instrument shaft has reached a proximal threshold of the fast retraction zone. At such point, process 2000 may proceed to block 2020 where retraction of the instrument shaft may be slowed down or paused. For example, an automatic pause may be implemented upon exiting the fast retraction zone, as described in detail above. In some embodiments, the proximal threshold of the fast retraction zone may be at a point between the proximal opening of the access sheath assembly and the distal opening of the channel through which the instrument shaft is axially actuated within the feeder, and such a position may be considered an automatic pause / stop position, as described in detail above. Additionally or alternatively, at block 2020, the retraction speed may be slowed down to a slower speed, such as 5 mm / s or less (e.g., 3 mm / s), for final retraction to the specimen collection location and / or to perform fine adjustments in the positioning of the instrument shaft for collection.

[0217] At block 2022, process 2000 entails collecting the captured specimen in a collector structure or other device or structure. After collection, if additional specimens (e.g., stone fragments) remain to be collected, process 2000 may proceed to an instrument insertion sub-process at block 2026, which may be similar in one or more respects to process 1900 of FIG. 19. If no further specimens remain to be collected, process 2000 may end.

[0218] The disclosed embodiments can advantageously make the robotic stone extraction process relatively safe and efficient. For example, the division of the operable region from the sheath distal tip to the stone drop location into multiple sub-regions can be based at least in part on clinical need to ensure safe instrument drive. Additionally, information obtained from the system and / or the user can be utilized to identify which region the scope tip is in and adjust the instrument end effector and instrument feeder to drive at different speeds to activate and deactivate fast retraction and insertion speeds at the right time to prevent injury to the patient or instrumentation. Any of the shaft actuation speed modifications disclosed herein can be implemented automatically. In some embodiments, the user can press a stone extraction button to have the system automatically implement the fast retraction, stone drop, and / or fast insertion process without additional input.

[0219] Instrument Stress Reduction Using Lateral Instrument Base Translation 15, discussed in detail above, some implementations of fast retraction of a scope or other instrument involve translation of a robotic end effector 6a (e.g., a distal end effector of a robotic arm) coupled to the scope handle / base 31 in a direction generally parallel to and / or in line with a virtual rail 1501 aligned with the axis of the access sheath 90, the instrument / scope feeder channel 39, and / or alignment between the end effector 6a and an end effector 8b associated with the scope driver / feeder 11. That is, the robotic movement / translation of the arm 12a and / or end effector 6a may generally be in a direction / dimension 1502 (also identified as the "x" dimension in the reference coordinate system) during fast retraction and / or insertion of the scope 40, such movement may advantageously facilitate relatively fast retraction / insertion and / or reduce the size of the service loop 49 formed in the scope 40 and / or the radius of the bend formed in the scope 40 associated with the service loop 49.

[0220] Translation of the end effector 6a in the proximal direction during scope retraction reduces the distance D between the scope driver / feeder 11 and the scope base 31. b can be advantageously increased, thereby decreasing the length of the scope that is angled into a bundle to form the service loop 49, relative to an implementation in which no proximal scope handle / base translation occurs. If the proximal translation of the end effector 6a is constrained to a linear alignment / dimension 1502 / 1501, referred to in some contexts herein for convenience as the "x" dimension, the distance D between the scope driver 11 and the base 31 of the scope 40 that results from translation of the end effector 6a is b may generally be equal to the translation distance in the "x" / linear dimension. Such translation in the "x" / linear dimension may be limited by mechanical constraints of the end effector 6a and / or associated robotic arm / system. Thus, the amount of strain relief provided by linear (i.e., x-dimensional) translation of the scope handle 31 as shown in FIG. 15 may also be limited by such mechanical constraints.

[0221] As mentioned above, the service loop 49 may result when the length of the scope 40 disposed between the scope driver / feeder 11 and the scope handle / base 31 is increased by retraction of the scope driver 11 at a speed that is greater than the retraction translation speed of the scope end effector 6a. As shown, the service loop 49 may be angled to result in a U-shaped configuration that includes base bends 99a, 99c on either side of an apex bend 99b. Generally, the longer the length of the scope forming the service loop 49, the greater the lateral deflection d of the service loop 49. t The deflection d of the service loop 49 becomes larger. t As increases, generally, the radius of curvature of the bend 99 formed in the scope decreases, thereby resulting in a relatively sharper / tighter bend in the scope shaft 40.

[0222] As described in detail herein, it may be desirable to avoid forming relatively tight / sharp bends in the scope 40 to avoid damage to the scope due to mechanical stress. FIG. 15 shows the service loop 49 forming three bends 99, including a first bend 99a between the scope driver / feeder 11 and the apex 1504 of the service loop 49, illustrated as having a radius of curvature r1 that may be undesirably short in some implementations where the feed roller retraction speed for proximal retraction of the scope end effector 6a is undesirably high. The apex bend 99b is shown as having a radius of curvature labeled r2, while the third bend between the base 62 of the scope 40 and the apex 1504 of the service loop 49 has a radius of curvature labeled r3. An embodiment of the present disclosure may advantageously reduce the radius of curvature of such bends as a result of lateral and / or proximal scope base translation during scope driver retraction.

[0223] As described in more detail herein, the retraction speed implemented by the scope driver (e.g., feed roller) 11 during the retraction process may be greater than 150 mm / s (e.g., about 170 mm / s, etc.). Meanwhile, the linear translation of the scope end effector 6a along the virtual rail path 1501 may be less than about 30 mm / s (e.g., about 20 mm / s or 10 mm / s, etc.) during such period. In general, the difference between the retraction speed of the scope driver 11 and the linear translation speed of the end effector 6a along the virtual rail 1501 may cause the scope 40 to form a service loop 49, and the severity of the mechanical stress / strain imposed by the various bends of the service loop 49 may depend at least in part on the proximal translation distance traversed during the retraction feed of the scope driver 11.

[0224] In general, it may be desirable to implement a scope retraction solution that maximizes the bend radius of the bend formed in the scope as part of the service loop 49, with such maximization of bend radius being achieved taking into account the particular workspace constraints and retraction speed associated with the robotic system / configuration. In some embodiments, it may be desirable to prevent the bend radius of the bend associated with the scope service loop from falling below 70 mm for a particular embodiment of the scope / instrument. In some implementations, a scope instrument may be utilized that can accommodate a bend radius of less than 50 mm (such as, for example, about 45 mm) without causing damage to the scope and / or exceeding the strain limits of the instrument.

[0225] 15 illustrates linear scope translation in the "x" dimension along the virtual rail 1501, in some implementations, the scope retraction solutions associated with the present disclosure may involve scope end effector translation in directions / dimensions lateral / angular to the virtual rail 1501. For example, translation of the scope base in the illustrated "y" and / or "z" dimensions may, separately or in combination with each other and / or in combination with translation in the "x" dimension, reduce the distance D between the scope base 31 and the scope driver 11. b (as shown in FIGS. 15 and 25-1) can be increased and / or angular / orientation positions of various portions of the scope 40 can be created that reduce the bend radius of curvature in one or more areas associated with the service loop.

[0226] FIG. 21 is a flow diagram illustrating a process 2100 for removing a specimen from a target anatomy of a patient using lateral scope base translation. For example, the process 2100 may be performed when removing a specimen such as a stone fragment or the like during retraction and / or insertion of a scope for such purpose. As used herein, "lateral" translation may be understood as translation in a direction / angle that is deflected away from a virtual rail and / or axis of the scope portion that is fed through the scope driver (e.g., feed rollers) and / or the access sheath / introducer through which the scope is driven. For example, lateral translation relative to the illustrated coordinate reference of FIG. 15 may be associated with a vector that projects at least in part into the "y" and / or "z" dimensions, rather than exclusively into the "x" dimension 1502.

[0227] In block 2102, the process 2100 may involve capturing a stone and / or fragments thereof within a target anatomical region of a patient, such as within a calyx rete of a kidney of the patient, as described herein. Capturing the stone / fragment may be performed according to any embodiment disclosed herein, such as by use of a basket tool, which may be robotically controlled in some implementations. As described herein, the basket of the basket tool may be deployed from a distal end of an endoscope (e.g., a ureteroscope), and upon capture, the stone and basket may be drawn proximally toward the distal end of the scope and held adjacent thereto for retraction.

[0228] At block 2104, the process 2100 entails retracting the scope with the basket and captured stone into the distal opening of the access sheath, as described in detail herein. Such retraction may be performed manually by a surgeon / technician and / or may be performed using automated robotic retraction according to aspects of the present disclosure.

[0229] In block 2106, the process 2100 involves performing a fast retraction, as described herein, to relatively quickly retract the scope, basket, and captured specimen through at least a portion of the access sheath, which may span the patient's urinary tract or other anatomical structure, to a proximal opening of the access sheath. A fast retraction through the access sheath may be desirable to reduce the overall round trip time associated with specimen collection. Such a retraction speed may be achieved by driving the feed roller actuator at a relatively high speed to perform the fast retraction. However, as referenced above, if the feed roller (or other scope drive mechanism) retraction speed exceeds the translation speed of the robotic end effector associated with the base of the scope, a service loop bend may be formed in the portion of the scope between the scope base and the driver / feed roller channel due to a reduction in the distance between the scope handle / base and the scope driver relative to the length of the scope disposed in such region. If the length of the scope forming the service loop, and / or the relative position and / or orientation of the scope driver and scope handle / base are not managed to avoid the presence of relatively sharp bends and / or shear stresses on the scope, there can be a risk of undesirable damage to the scope and / or other instrumentation.

[0230] Rather than simply translating the scope base and / or associated robot end effector along a linear virtual rail, the operations associated with block 2106 of process 2100 may involve performing lateral translations in one or more dimensions that are angled (e.g., orthogonal) relative to the linear virtual rail (see, e.g., linear virtual rail 1501 in FIG. 15) to reduce shear stress on the scope in the area of ​​service loop formation. For example, such lateral translations may be in the same vertical plane as the virtual rail (e.g., in a plane parallel to the ground) and in a direction away from the virtual rail, such as toward a robot cart from which the robot arm / end effector is exiting; such in-plane-biased (e.g., orthogonal) translations may be considered to be at least partially in a "y" direction / dimension (see, e.g., the "y" dimension in the illustrated coordinate frame of FIG. 15), the "y" direction / dimension being orthogonal to an "x" direction / dimension defined by and / or parallel to the virtual rail. Additionally or alternatively, lateral translation of the scope handle / base may be in the form of vertically ascending above the vertical plane of the virtual rail, and such vertical translation may be described herein as being in the "z" direction / dimension.

[0231] In some implementations, process 2100 involves rotating the end effector (see block 2107), and thus the handle / base associated with the scope, about a vertical axis (i.e., out of the page with respect to the illustrated orientation of FIG. 15) simultaneously with the lateral translation associated with block 2106; such rotation may serve to reduce strain at one or more stress points / bends in the scope / service loop. For example, such rotation may be generally in the opposite direction to the lateral translation direction in the "y" direction / dimension. For example, with respect to the illustrated perspective view of FIG. 15, a lateral translation to the left may be coupled with a clockwise rotation of the end effector, whereas a lateral translation to the right may be coupled with a counterclockwise rotation.

[0232] At block 2108, the process 2100 involves releasing the captured stone / specimen from the basket device into a collector or other structure. At block 2110, the process 2100 involves rapidly reinserting the scope through the access sheath to return the scope and / or basket to the target anatomy for additional stone / fragment collection. In some implementations, the rapid insertion operation associated with block 2110 may involve effectively reversing the translation and / or rotation of the scope handle / base performed in association with blocks 2106 and / or 2107, thereby returning the scope and associated end effector to an in-line configuration with the scope driver (e.g., feed rollers) along a virtual rail.

[0233] At block 2112, the process 2100 may involve reinserting the scope and / or basket into the target anatomical region, and the process 2100 may be repeated any number of times to successfully retrieve / remove the desired number of stones / fragments from the target anatomical structure.

[0234] 22A and 22B show overhead and side views, respectively, of a robotic system including one or more robotic end effectors configured to be translated within a particular zone to perform instrument retraction according to an embodiment of the present disclosure. Specifically, FIG. 22A shows multiple robotic arms 12 configured to perform fast scope retraction according to an embodiment of the present disclosure. The image of FIG. 22A shows particular kinematic workspace regions 2201 and 2203 that may correspond to regions where mechanical attributes of the system may allow translation / movement of the end effector 6a associated with the scope handle / base 31. Specifically, the kinematic workspace region 2201 represents an area where the robotic end effector 6a may be translated along a virtual rail 1501 that is generally coaxial with at least one of the proximal portion of the access sheath 90, the portion of the scope within the feed roller channel 39, and / or the alignment axis along which the end effectors 6a, 6b are aligned in the configuration shown in FIG. 22A. That is, in a scope retract implementation where scope-based translation is limited in the "x" direction / dimension relative to the labeled coordinate frame of the image of FIG. 22A, translation of the end effector 6a during scope retraction may be limited to a region within the workspace 2201. The boundaries of the workspace region 2201 in the "x" dimension may be based on the associated robot specificity and / or clinical workspace limitations associated with the robotic system. For example, the illustrated workspace limits of the robotic system may represent regions outside of which there is a risk of undesirable collisions between robotic arm components and / or between the robotic arm and the cart 10. Such limitations may further be based on the physical length of the associated robotic arm.

[0235] As mentioned above, if the scope base translation is limited to the virtual rail dimension 1501, the formation of a service loop 49 during a relatively fast scope driver retraction may result in a bend being formed in the scope shaft between the scope driver 11 (e.g., feed roller) and the scope base / handle 31. Thus, in such implementations, the scope driver retraction speed may be limited by the associated bend radius compatibility of the scope machine shaft design. To increase the speed limit of such a scope driver, embodiments of the present disclosure allow for non-linear / lateral scope base translation. For example, such translation may be within a kinematic workspace 2203 extending in the "y" dimension / direction toward the robotic system / cart 10. Generally, the lateral workspace 2203 shown in FIG. 22A may be in a common vertical plane with the linear workspace 2201.

[0236] Lateral scope base / end effector translation according to aspects of the present disclosure may be in the vertical / "z" dimension in some implementations. For example, FIG. 22B is a side view of a robotic cart 10 and includes a representation of a kinematic workspace 2205 in which the scope end effector 6a may be translated vertically for purposes of stress relief of a fast retract scope shaft, as described herein. The "z" dimension according to the illustrated coordinate frame of FIG. 22A and other figures herein is described as a vertical dimension in some contexts, but it should be understood that such terminology is used for convenience and that in other robotic systems, such a dimension may not be a true vertical dimension. That is, references to a vertical dimension herein should be understood to refer to a dimension that is generally orthogonal to the linear kinematic workspace 2201, as shown.

[0237] It should be understood that any description herein of lateral / non-linear scope base / handle translation may be in the "y" dimension and / or the "z" dimension. Generally, translation of the scope base in the vertical / "z" dimension may be performed in such a way that the scope end effector 6a is raised (i.e., moves upward relative to the orientation illustrated in FIG. 22B), and lowering of the scope base / handle and / or end effector 6a may be constrained by mechanical constraints and / or avoided to prevent interference with a sterile barrier that may be present in the operating environment. For example, a sterile barrier may be present at the height of the bed / platform on which the patient is placed, and it may be undesirable or unacceptable for the end effector 6a to be lowered below such a level.

[0238] In implementations in which scope handle / base translation in the vertical / "z" dimension is performed during fast scope retraction, the end effector 6a may be cooperatively tilted such that its plane P1 is tilted downward toward the scope driver 11 in order to reduce bending stresses in the scope 40 as the scope handle / base 31 rises above the plane of the virtual rail 1501. Such tilting may be performed gradually as the end effector rises above the plane of the virtual rail 1501.

[0239] 22B, the service loop 49 of the scope shaft 40 may be formed and / or project in any dimension, such as the "z" dimension and / or the "y" dimension relative to the illustrated coordinate frame. That is, the service loop 49 may have a U-shaped configuration with an apex that projects generally away from the virtual rail / axis 1501 at any angle and / or in any dimension / vector.

[0240] 23-1, 23-2, and 23-3 show overhead views of the scope base / handle 31 in various rotational states associated with scope retraction, according to one or more embodiments. The scope base / handle 31 is coupled to the end effector 6a of the robot arm 12a, and the base / handle 31 is coupled to the proximal end of the scope shaft 40 that feeds through the scope driver 11. The scope driver 11 is coupled to the end effector 6b of the robot arm 12b. As described above, during scope retraction, in addition to or instead of translation of the scope base in the linear / serial and / or lateral dimensions, rotation of the scope base may be performed to provide strain relief for the scope. For example, FIGS. 23-1 to 23-3 illustrate continuous rotational states of the scope handle / base 31 about an axis A1 that is lateral to the virtual rail 1501. The base / handle 31 may be rotated as the scope driver / feeder 11 retracts the scope 40 proximally. In some implementations, the 90° rotation θ b can be implemented gradually during scope retraction. For example, Fig. 23-3 illustrates a final rotation state of the scope handle 31 rotated 90° relative to the starting position of the scope base shown in Fig. 23-1. Although the particular rotation scheme implemented in Figs. 23-1-23-3 illustrates the rotation of the scope base 31 such that the base 62 of the scope 40 is rotated away from the robot arm 12a and / or associated robotic system / cart, it should be understood that the rotation can be in any direction (e.g., counterclockwise or clockwise relative to the illustrated orientation).

[0241] Rotation of the scope base 31 according to FIGS. 23-1-23-3 and / or in conjunction with any of the disclosed embodiments advantageously results in a larger radius of curvature r than would otherwise be present if such rotation were not performed. a , r b may be produced during the retraction process. Thus, rotation of the scope base / handle 31 about the lateral axis A1 may reduce the risk of damage to the scope 40 during high speed retraction.

[0242] 24-1, 24-2, and 24-3 show overhead views of the scope base / handle 31 in various rotational and lateral translational states associated with scope retraction, according to one or more embodiments. The scope base / handle 31 is coupled to the end effector 6a of the robot arm 12a, and the base / handle 31 is coupled to the proximal end of the scope 40, which is fed through a scope driver 11 coupled to the end effector 6b of the robot arm 12b. In the implementation illustrated in FIGS. 24-1-24-3, rotation of the scope base / handle 31 about the lateral axis A1 is performed in a manner similar to that shown and described in connection with FIGS. 23-1-23-3. In addition, the implementations shown in 24-1-24-3 involve rotating the scope base 31 while simultaneously translating the end effector 6a laterally.

[0243] Combining scope rotation and lateral translation advantageously reduces the radius of curvature r of the scope during fast retraction. c 24-1 to 24-3, the retraction of the scope through the scope driver / feed rollers 11 is generally an axial dimension / direction substantially orthogonal to the "y" direction. The lateral translation of the end effector 6a may generally be within the boundaries of a kinematic workspace 2203 defined taking into account the specific mechanical constraints of the robotic system, as described in detail herein. The lateral translation 2401 may be considered to be in the "y" dimension according to a specific coordinate frame identified on the drawing sheets associated with FIGS. 24-1 to 24-3, and the retraction of the scope through the scope driver / feed rollers 11 is generally an axial dimension / direction substantially orthogonal to the "y" direction.

[0244] Although shown as involving lateral translation in the "y" direction, it should be understood that the illustrated lateral translation may additionally or alternatively be performed at least in part in the "z" direction, the "z" direction representing a direction out of the page with respect to the illustrated orientation, and such dimension being orthogonal to the "x" and "y" dimensions as identified in the illustrated reference frame. That is, the scope end effector 6a may be vertically raised above the horizontal plane 2203 while the scope handle / base 31 is rotated. Such "z" dimensional translation may be performed simultaneously with "y" dimensional translation in some embodiments. Furthermore, in some embodiments, "x" dimensional translation may be performed in combination with an amount of "y" dimensional and / or "z" dimensional translation. That is, translation of the scope end effector may be performed in any combination of directions and / or within any combination of kinematic workspaces during retraction of the scope.

[0245] 25-1 and 25-2 show overhead views of the instrument base 31 in various states of rotation and translation associated with instrument retraction and / or insertion, according to one or more embodiments. FIG. 25-1 illustrates an animation of the scope base 31 being translated according to a fast retraction process as described in connection with various embodiments herein. Specifically, FIG. 25-1 shows an animation of the scope base 31 being translated according to a fast retraction process as described in connection with various embodiments herein. In particular, FIG. 25-1 shows an animation of the end effector 6a coupled to the scope / instrument base 31 being moved a distance D within a kinematic workspace 2503 associated with the robotic system. y 15 shows four stages of the translation / retraction process corresponding to successive periods of time in which the end effector 6a and / or the instrument base 31 are translated in the lateral dimension "y" (and / or in some implementations "z") by only one axis. In addition to lateral translation of the end effector 6a and / or the instrument base 31, rotation of the end effector 6a and / or the base 31 about axis A1 of the end effector 6a may be performed synchronously with the lateral translation and / or translation in series (e.g., along a virtual rail line 1501).

[0246] As described herein, the fast retract scope base translation can be in both the linear "x" and lateral ("y" and / or "z") dimensions / directions. Such translation can thus result in a translation path 2505 that is angled with respect to the virtual rail 1501 and / or the "x" dimension. For example, in the illustrated implementation, the translation path 2505 is a translation "x" vector D x and the translational "y" vector D y That is, the translation between the initial state / position 2501a and the final state / position 2501d is a distance D x and the distance D in the lateral / "y" dimension y Such a translation vector may result in a path 2505 having a deflection angle θ1 relative to the virtual rail 1501. As an example implementation, the deflection angle θ1 of the translated path 2505 may be approximately 15° (or less), 35°, 45°, 60°, 75°, 90° (in which case no translation in the "x" dimension is performed), or any deflection angle value between any pair of the listed numbers. In the particular illustrated implementation of FIG. 25-1, the translation distance D x and D. y The deflection angle θ1 of the translation path 2505 is approximately 45° so that

[0247] Although a straight translation path 2505 is shown in which the relative speed of progression / translation in both the "x" and "y" dimensions is proportional throughout the translation from the initial position 2501a to the final position 2501d, it should be understood that in some embodiments, non-constant / straight translation paths may be implemented. For example, FIG. 25-1 shows a first curved translation path 2506 representing a path in which the translation speed in the "x" dimension relative to the "y" dimension is greater in an initial period of translation and decreases as the translation approaches the final state 2501d. Alternatively, another exemplary non-constant / straight translation path 2507 is shown in which the relative translation speed in the "x" dimension relative to the "y" dimension is relatively smaller in an initial period of translation and increases as the translation approaches the final position / configuration 2501d. References herein to an initial period of translation may refer to translation between the initial state 25 and one or more subsequent states 2501b and / or 25013. The initial translation period may be understood in some contexts to refer to the immediate moment following the start of the translation from the initial state 2501a.

[0248] The angled translation path 2505 is the translation distance D in the "x" dimension. x 2, so that the distance D between the proximal end 62 of the scope and the scope driver 11 (and / or the driver channel 39) is b Increase the distance D b is further increased by the rotation of the scope base 31 without the lateral translation 2505 and roll of the scope, and the distance D between the proximal end 62 of the scope and the scope driver 11 is increased by the rotation of the scope base 31 without the lateral translation 2505 and roll of the scope. b is the combined distance D0 and D x This is approximately equal to the distance D shown in Figure 25-1. b is less than.

[0249] The particular angle of deflection θ1 selected for the retraction process may be based on mechanical constraints or limitations on the translation distance in the lateral ("y" or "z") dimension and / or the available translation speed of the end effector 6a. For example, the lateral translation distance D yis limited by certain mechanical constraints, the deflection angle θ1 may be based on and / or selected to allow the maximum desired / sustainable translational velocity of the end effector 6a to reach the limit “y” simultaneously with cessation of retraction of the scope driver 11, thereby providing relatively uniform translation and retraction of the scope 40. In some embodiments, for example, the “y” dimension limit D y may be about 3 inches (about 7-8 cm), 5 inches (about 12-13 cm), 7 inches (about 17-18 cm), or other distances between or exceeding such amounts.

[0250] In some implementations, the rotation of the end effector 6a may be performed at a constant rotational speed across the translation path (e.g., path 2505). In such implementations, a state / position at which the end effector 6a has traversed exactly half the distance of the translation path (e.g., position 2501c) may be associated with a rotation of the end effector 6a that represents approximately half of the total rotation angle performed between the initial position / state 2501a and the final position / state 2501d. That is, for a 90° rotation as shown in FIG. 25-1, the rotation angle θ at the midpoint of the translation path 2505 may be approximately 1 / 2 the total rotation angle θ at the midpoint of the translation path 2505. c may be approximately 45°.

[0251] In some implementations, the rate of rotation may alternatively be non-constant and may initially be greater in at least a portion of the first half of the translation path than in at least a portion of the second half of the translation period. For example, in the particular implementation shown in FIG. 25-1, the rate of rotation is greater than the angular rotation θ bWhile the angular rotation may be approximately 45°, as represented by state 2501c, about halfway along the translation distance, the angular rotation may be approximately 60°, with a total rotation of 90° being performed between the initial state 2501a and the final state 2501d. Such a relatively high rotation rate in the initial period of translation may be desirable to reduce shear on the scope shaft 40 by reducing the radius of curvature of one or more bends formed in the scope shaft 40 during retraction. It may be beneficial to limit the rotation of the end effector / scope base to an angle of 90° or less, since rotations greater than 90° may introduce relatively sharp angles / shear stresses in the scope shaft 40 in the region of the proximal end 62 of the scope. Furthermore, in some implementations, a relatively tighter service loop bend radius may be formed at the beginning / initial period of high speed retraction of the scope driver / feeder 11. Thus, the rotation rate and / or lateral translation rate may advantageously be performed at a relatively high rate early in the translation process / distance. In some implementations, the total duration of the retraction time may be about 3 seconds and the scope driver / feeder retraction speed during such period may be about 50 mm / s. Furthermore, it may be desirable to limit the speed of rotation to a speed that does not cause undesirable slippage of the scope shaft 40 within the channel 39 of the scope driver 11.

[0252] While lateral translation and rotation of the end effector / base is shown in FIG. 25-1, it should be understood that the retraction process according to aspects of the present disclosure may, in some implementations, include either lateral translation or rotation, but not both.

[0253] In some embodiments, the scope base / handle may be coupled to a robot end effector, such as an instrument manipulator of a robot arm, such that the center of mass of the base / handle is offset from the axial center of the end effector. For example, as shown in FIG. 25-1, a virtual rail 1501, which is in line with the scope shaft 40 at the base 62 of the scope 40, is offset by a distance d0 to one side of the center A1 of the end effector 6a. Thus, when rotating the scope handle / base counterclockwise to a 90° rotation in the final rotation state 2501d, the scope offset d0 may be on the side of the scope driver 11 with respect to the "x" dimension. FIG. 25-2 shows an alternative implementation of a fast retract scope base lateral translation process. Specifically, in FIG. 25-2, rotation of the scope base 31 (clockwise as shown) moves the scope offset position d0 away from the scope driver 11 relative to the axis A1, which can advantageously increase the distance between the scope base 62 and the scope driver 11, thereby potentially reducing the bending curve radius and / or shear stress of the scope shaft 40.

[0254] Generally, the desired rotational direction to be performed on the scope base / handle 31 may be such that when lateral translation of the scope base / handle is performed, the base 62 of the scope 40 moves toward the virtual rail 1501 and / or is positioned on the side of the end effector 6a that is toward the virtual rail 1501, which may advantageously reduce shear applied to the scope shaft 40. For example, with respect to the illustrated orientation / perspective of Figures 25-1 and 25-2, a lateral translation to the right may be associated with a counterclockwise rotation of the scope, while a translation to the left (as in Figure 25-2) may be associated with a clockwise rotation. Whether clockwise or counterclockwise rotation positions the scope offset alignment 1501 toward or away from the scope driver 11 relative to the axial center A1 of the end effector 6a in the "x" dimension may generally depend on which side of the center A1 the scope base 31 is mechanically coupled to the end effector 6a in the initial position 2501a, 2502a. With reference to Figures 25-1 and 25-2, it should be understood that the scope rotation may be performed in either a clockwise or counterclockwise direction, and furthermore, the scope base / handle associated with any embodiment of the present disclosure may be mounted on the respective robot end effector in an offset configuration at any side or orientation relative to the center of the end effector.

[0255] Further embodiments and explanations Described herein are systems, devices, and methods that facilitate efficient and safe axial driving of shaft-type medical instruments through control of an instrument feeder device / system in the context of a particular medical procedure. In particular, systems, devices, and methods according to one or more aspects of the present disclosure can facilitate instrument feeder control to perform automatic axial speed correction and / or pausing / stopping in response to instrument position determination / detection, which may advantageously reduce the risk of damage to patient anatomy and / or medical equipment and improve procedure efficiency.

[0256] In some implementations, the present disclosure relates to a robotic system including a medical instrument including an elongate shaft dimensioned to be at least partially disposed within an access sheath, and a control circuit configured to at least partially retract the elongate shaft within the access sheath, determine a position of a distal end of the elongate shaft relative to the access sheath, and modify a rate of retraction of the elongate shaft based on the determined position of the distal end of the elongate shaft relative to the access sheath.

[0257] The control circuitry can be configured to retract the elongate shaft at least in part by causing an actuator configured to axially move the elongate shaft to retract the elongate shaft and move the robotic manipulator with the medical instrument attached away from the access sheath. For example, the control circuitry can be further configured to determine a position of the robotic manipulator and pause movement of the robotic manipulator based at least in part on the determined position of the robotic manipulator.

[0258] In some embodiments, the location of the distal end of the elongate shaft is within a distal buffering portion of the access sheath, and modifying the rate of retraction of the elongate shaft involves having the actuator retract the elongate shaft at a first speed and moving the robotic manipulator at the first speed. In some embodiments, when the location of the distal end of the elongate shaft is within a fast retraction portion of the access sheath proximal to the distal buffering portion of the access sheath, modifying the rate of retraction of the elongate shaft involves having the actuator retract the elongate shaft at a second speed that is greater than the first speed and moving the robotic manipulator at a third speed that is greater than the first speed but less than the second speed. For example, when the location of the distal end of the elongate shaft is between the fast retraction portion and the distal buffering portion of the access sheath, modifying the rate of retraction of the elongate shaft can involve having the actuator retract the elongate shaft at a third speed and moving the robotic manipulator at the third speed. In some embodiments, modifying the rate of retraction of the elongate shaft involves causing the actuator to stop retracting the elongate shaft when the position of the distal end of the elongate shaft is proximal relative to the proximal end of the access sheath. For example, modifying the rate of retraction of the elongate shaft can further involve stopping movement of the robotic manipulator when the position of the distal end of the elongate shaft is proximal relative to the proximal end of the access sheath.

[0259] When a position of the distal end of the elongate shaft is within the fast retraction portion of the access sheath, modifying the speed of retraction of the elongate shaft can involve causing the actuator to retract the elongate shaft at a first speed and moving the robotic manipulator at a second speed that is less than the second speed.

[0260] In some embodiments, when the position of the distal end of the elongate shaft is within the distal buffering portion of the access sheath, modifying the speed of retraction of the elongate shaft may involve increasing the speed of retraction of the elongate shaft to a first speed. For example, when the position of the distal end of the elongate shaft is within a fast retraction portion of the access sheath proximal to the distal buffering portion of the access sheath, modifying the speed of retraction of the elongate shaft may involve the actuator retracting the elongate shaft at a second speed that is greater than the first speed. For example, when the position of the distal end of the elongate shaft is between the fast retraction portion and the distal buffering portion of the access sheath, modifying the speed of retraction of the elongate shaft may involve the actuator retracting the elongate shaft at a third speed that is greater than the first speed but less than the second speed.

[0261] In some implementations, the present disclosure relates to a robotic system including a medical instrument including an elongate shaft dimensioned for advancement within an access sheath, and a control circuit configured to cause the elongate shaft to be at least partially inserted into the access sheath, determine a position of a distal end of the elongate shaft relative to the access sheath, and modify a rate of insertion of the elongate shaft based on the determined position of the distal end of the elongate shaft relative to the access sheath.

[0262] The control circuitry can be configured to cause the actuator, configured to axially move the elongate shaft, to insert the elongate shaft and to cause the robotic manipulator, having the medical instrument attached thereto, to move toward the access sheath to at least partially insert the elongate shaft.

[0263] The control circuitry can be further configured to determine a position of the robotic manipulator and to pause movement of the robotic manipulator based at least in part on the determined position of the robotic manipulator. For example, in some embodiments, the control circuitry is further configured to determine that a service loop is present in the elongate shaft based at least in part on the position of the robotic manipulator, and pausing movement of the robotic manipulator is based at least in part on the determination that a service loop is present.

[0264] In some embodiments, when the position of the distal end of the elongate shaft is within a fast insertion zone associated with a portion of the access sheath, modifying the speed of insertion of the elongate shaft involves causing the actuator to insert the elongate shaft at a first speed and moving the robotic manipulator at a second speed slower than the first speed. For example, when the position of the distal end of the elongate shaft is within a distal slow insertion zone that includes the distal end of the access sheath, modifying the speed of insertion of the elongate shaft can involve causing the actuator to insert the elongate shaft at a third speed slower than both the first speed and the second speed and moving the robotic manipulator at the third speed. When the position of the distal end of the elongate shaft is between the fast insertion zone and the slow insertion zone, modifying the speed of retraction of the elongate shaft can involve causing the actuator to retract the elongate shaft at a second speed and moving the robotic manipulator at the second speed.

[0265] In some implementations, the present disclosure relates to a robotic system comprising: a medical instrument translation means physically coupled to a handle of a medical instrument; an actuator means configured to axially actuate an elongate shaft of the medical instrument; and a control means, the control means configured to cause the actuator means to at least partially retract the elongate shaft within an access sheath; determine a position of a distal end of the elongate shaft relative to the access sheath; and modify a rate of retraction of the elongate shaft based on the determined position of the distal end of the elongate shaft relative to the access sheath.

[0266] For purposes of summarizing the disclosure, certain aspects, advantages, and novel features have been described. It is to be understood that not necessarily all such advantages may be achieved in accordance with any particular embodiment. Thus, the disclosed embodiments may be practiced in a manner that achieves or optimizes one advantage or group of advantages taught herein without necessarily achieving other advantages as may be taught or suggested herein.

[0267] Depending on the embodiment, certain acts, events, or functions of any of the algorithms or processes described herein may be performed in a different order, added, merged, or omitted entirely, and thus, in some embodiments, not all of the described acts or events are necessary to the performance of a process.

[0268] In particular, conditional language used herein, such as "can," "could," "might," "may," "eg," and the like, unless specifically stated otherwise or understood otherwise within the context in which it is used, is intended to have its ordinary meaning and is generally intended to convey that certain embodiments include certain features, elements, and / or steps, while other embodiments do not. Thus, such conditional language is not intended to generally imply that features, elements, and / or steps are required in any way for one or more embodiments, or that one or more embodiments necessarily include logic for determining whether those features, elements, and / or steps are included or performed in any particular embodiment, with or without author input or prompting. Terms such as "comprising," "including," "having," and the like, are used in their ordinary sense and are used inclusively in a non-limiting manner and do not exclude additional elements, features, acts, operations, etc. Also, when the term "or" is used, for example, to connect a list of elements, the term "or" is used in its inclusive sense (and not its exclusive sense) to mean one, some, or all of the listed elements. Unless specifically stated otherwise, conjunctive language such as the phrase "at least one of X, Y, and Z" is understood in the context as it is commonly used to convey that an item, term, element, etc. can be either X, Y, or Z. Thus, such conjunctive language is not generally intended to suggest that a particular embodiment requires that at least one of X, at least one of Y, and at least one of Z, each be present.

[0269] In the above description of the embodiments, it should be understood that various features are sometimes grouped together in a single embodiment, figure, or description thereof for the purpose of streamlining the disclosure and aiding in the understanding of one or more of the various inventive aspects. However, the method of disclosure should not be interpreted as reflecting an intention that any claim requires more features than are expressly recited in that claim. Moreover, any component, feature, or step illustrated and / or described in a particular embodiment herein may be applied to or used with any other embodiment. Moreover, no component, feature, step, or group of components, features, or steps is necessary or essential for each embodiment. Thus, it is intended that the scope of the invention disclosed herein and hereinafter claimed should not be limited by the specific embodiments described above, but should be determined solely by a fair reading of the following claims.

[0270] It should be understood that certain ordinal terms (e.g., "first" or "second") may be provided for ease of reference and do not necessarily imply physical characteristics or ordering. Thus, as used herein, ordinal terms (e.g., "first," "second," "third," etc.) used to modify an element, such as a structure, component, operation, etc., do not necessarily indicate a priority or order of the element relative to any other elements, but rather may generally distinguish the element from another element having a similar or identical name (apart from the use of the ordinal term). Furthermore, as used herein, the indefinite articles ("a" and "an") may indicate "one or more" rather than "one." Furthermore, an operation performed "based on" a condition or event may also be performed based on one or more other conditions or events not expressly recited.

[0271] Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the example embodiments belong. It is further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning consistent with their meaning in the context of the relevant art, and should not be interpreted in an idealized or overly formal sense unless expressly so defined herein.

[0272] Spatially relative terms such as "outer", "inner", "upper", "lower", "below", "upper", "vertical", "horizontal", and similar terms may be used herein for ease of description to describe the relationship between one element or component and another element or component as illustrated in the figures. It should be understood that the spatially relative terms are intended to encompass different orientations of the device in use or operation in addition to the orientation depicted in the figures. For example, if the device shown in the figures is inverted, a device positioned "below" or "under" another device may be placed "above" the other device. Thus, the illustrative term "lower" may include both lower and upper positions. The device may also be oriented in other directions, and thus the spatially relative terms may be interpreted differently depending on the orientation.

[0273] Unless otherwise specified, comparative and / or quantitative terms such as "less," "more," "greater than," and the like are intended to encompass the notion of equality. For example, "less" can mean not only "less than" in the strict mathematical sense, but also "less than or equal to."

[0274] [Embodiment] (1) A robot system comprising: a medical instrument comprising an elongate shaft dimensioned to be disposed at least partially within the access sheath; A control circuit, the control circuit comprising: retracting the elongate shaft at least partially within the access sheath; determining a position of the distal end of the elongate shaft relative to the access sheath; and modifying a rate of retraction of the elongate shaft based on the determined position of the distal end of the elongate shaft relative to the access sheath. (2) The control circuit causing an actuator configured to axially move the elongate shaft to retract the elongate shaft; 2. The robotic system of claim 1, configured to at least partially retract the elongated shaft by moving a robotic manipulator to which the medical instrument is attached away from the access sheath. (3) The robot system of embodiment 2, wherein the control circuit is further configured to at least partially retract the elongated shaft by moving the robot manipulator laterally relative to an axis of axial movement of the elongated shaft by the actuator. (4) A robot system as described in embodiment 3, wherein the lateral direction is in a direction toward a robot cart of the robot system, and the robot manipulator is associated with the robot cart. (5) The robot system of embodiment 3, wherein the lateral direction is a vertical direction.

[0275] (6) The control circuit determining a position of the robotic manipulator; 3. The robot system of claim 2, further configured to pause movement of the robot manipulator based at least in part on the determined position of the robot manipulator. (7) modifying the rate of retraction of the elongate shaft when the position of the distal end of the elongate shaft is within a distal buffer portion of the access sheath; causing the actuator to retract the elongate shaft at a first speed; 3. The robot system of claim 2, further comprising: moving the robot manipulator at the first velocity. (8) modifying the rate of retraction of the elongate shaft when the position of the distal end of the elongate shaft is within a fast retraction portion of the access sheath proximal to the distal buffer portion of the access sheath; causing the actuator to retract the elongate shaft at a second speed that is greater than the first speed; 8. The robot system of claim 7, further comprising: moving the robot manipulator at a third velocity that is greater than the first velocity but less than the second velocity. (9) modifying the rate of retraction of the elongate shaft when the position of the distal end of the elongate shaft is between the fast retraction portion and the distal buffer portion of the access sheath; causing the actuator to retract the elongate shaft at the third speed; 9. The robot system of claim 8, further comprising: moving the robot manipulator at the third velocity. (10) The robotic system of embodiment 8, wherein modifying the speed of retraction of the elongate shaft involves causing the actuator to stop retraction of the elongate shaft when the position of the distal end of the elongate shaft is proximal to the proximal end of the access sheath.

[0276] (11) The robotic system of embodiment 10, wherein modifying the rate of retraction of the elongate shaft further involves stopping movement of the robotic manipulator when the position of the distal end of the elongate shaft is proximal relative to the proximal end of the access sheath. (12) modifying the rate of retraction of the elongate shaft when the position of the distal end of the elongate shaft is within a fast retraction portion of the access sheath; causing the actuator to retract the elongate shaft at a first speed; 3. The robot system of claim 2, further comprising: moving the robot manipulator at a second velocity that is less than the second velocity. (13) The robotic system of embodiment 1, wherein modifying the speed of retraction of the elongate shaft involves increasing the speed of retraction of the elongate shaft to a first speed when the position of the distal end of the elongate shaft is within a distal buffer portion of the access sheath. (14) The robotic system of embodiment 13, wherein modifying the speed of retraction of the elongate shaft involves retracting the elongate shaft at a second speed greater than the first speed when the position of the distal end of the elongate shaft is within a fast retraction portion of the access sheath proximal to the distal buffer portion of the access sheath. (15) The robotic system of embodiment 14, wherein modifying the speed of retraction of the elongate shaft involves causing the actuator to retract the elongate shaft at a third speed that is greater than the first speed but less than the second speed when the position of the distal end of the elongate shaft is between the fast retraction portion and the distal buffer portion of the access sheath.

[0277] (16) A robot system comprising: a medical instrument having an elongate shaft dimensioned to be advanced within the access sheath; A control circuit, the control circuit comprising: inserting the elongate shaft at least partially into the access sheath; determining a position of the distal end of the elongate shaft relative to the access sheath; and modifying a speed of insertion of the elongate shaft based on the determined position of the distal end of the elongate shaft relative to the access sheath. (17) The control circuit inserting the elongate shaft into an actuator configured to axially move the elongate shaft; 17. The robotic system of claim 16, configured to at least partially insert the elongated shaft by moving a robotic manipulator having the medical instrument attached thereto toward the access sheath. (18) The control circuit determining a position of the robotic manipulator; 18. The robot system of claim 17, further configured to pause movement of the robot manipulator based at least in part on the determined position of the robot manipulator. (19) The control circuitry is further configured to determine that a service loop is present within the elongate shaft based at least in part on the position of the robotic manipulator; 20. The robot system of claim 18, wherein the pausing of the movement of the robot manipulator is based at least in part on the determination that the service loop exists. (20) modifying a speed of insertion of the elongate shaft when the position of the distal end of the elongate shaft is within a high speed insertion zone associated with a portion of the access sheath, causing the actuator to insert the elongate shaft at a first speed; 18. The robot system of claim 17, further comprising: moving the robot manipulator at a second velocity slower than the first velocity.

[0278] (21) The step of modifying the speed of insertion of the elongate shaft when the position of the distal end of the elongate shaft is within a distal slow insertion zone that includes the distal end of the access sheath, further comprising: causing the actuator to insert the elongate shaft at a third speed that is slower than both the first speed and the second speed; 21. The robot system of claim 20, further comprising: moving the robot manipulator at the third velocity. (22) Modifying the rate of retraction of the elongated shaft when the position of the distal end of the elongated shaft is between the high speed insertion zone and the low speed insertion zone, causing the actuator to retract the elongate shaft at the second speed; 22. The robot system of claim 21, further comprising: moving the robot manipulator at the second velocity. (23) A robot system comprising: a medical instrument translating means physically coupled to a handle of the medical instrument; an actuator means configured to axially actuate an elongate shaft of the medical instrument; A control means, the control means comprising: causing the actuator means to at least partially retract the elongate shaft within the access sheath; determining a position of the distal end of the elongate shaft relative to the access sheath; and modifying a rate of retraction of the elongate shaft based on the determined position of the distal end of the elongate shaft relative to the access sheath. (24) A robot system comprising: a robotic end effector configured to be coupled to a base of a medical instrument, the medical instrument comprising a shaft configured to be axially driven in a first dimension by a driver device; and a control circuit, wherein the control circuit controls: A robotic system configured to translate the robot end effector in a second dimension that is transverse to the first dimension. (25) The robot system of claim 24, wherein the control circuit is further configured to translate the robot end effector in the first dimension away from the driver device while the robot end effector is translated in the second dimension.

[0279] (26) The robot system of claim 24, wherein the control circuit is further configured to translate the robot end effector in a third dimension orthogonal to both the first dimension and the second dimension while the robot end effector is translated in the second dimension. (27) The robot system of embodiment 24, wherein the second dimension is in a common vertical plane with the first dimension. (28) The robot system of embodiment 24, wherein the second dimension is a vertical dimension. (29) The robot system of claim 24, wherein the control circuitry is further configured to rotate the robot end effector about an axis while the robot end effector is translated in the second dimension. (30) The robot system of embodiment 29, wherein the axis is transverse to the first dimension.

[0280] (31) The robot system of embodiment 29, wherein the axis is a vertical axis. (32) The robotic system of embodiment 29, wherein the rotating of the robot end effector is in a direction that moves a proximal end of the shaft of the medical instrument toward a virtual rail aligned with the driver device in the first dimension. (33) The robot system of embodiment 32, wherein the translation of the robot end effector forms an angle of 30 to 60 degrees with respect to the virtual rail.

Claims

1. 1. A robot system comprising: a medical instrument comprising an elongate shaft dimensioned to be disposed at least partially within the access sheath; A control circuit, the control circuit comprising: retracting the elongate shaft at least partially within the access sheath; determining that the distal end of the elongate shaft has been retracted beyond a distal opening of the access sheath such that the distal end of the elongate shaft is disposed within the access sheath; and increasing a rate of retraction of the elongate shaft based at least in part on a position of the distal end of the elongate shaft within the access sheath.

2. The control circuit causing an actuator configured to axially move the elongate shaft to retract the elongate shaft; 2. The robotic system of claim 1, configured to at least partially retract the elongate shaft by moving a robotic manipulator having the medical instrument attached thereto away from the access sheath.

3. The robot system of claim 2, wherein the control circuit is further configured to determine that the distal end of the elongated shaft is proximal to the proximal end of the access sheath and, based at least in part on determining that the distal end of the elongated shaft is proximal to the proximal end of the access sheath, cause the actuator to stop retraction of the elongated shaft.

4. 4. The robotic system of claim 3, wherein the control circuitry is further configured to stop movement of the robotic manipulator when the position of the distal end of the elongate shaft is proximal relative to the proximal end of the access sheath.

5. increasing the rate of retraction of the elongate shaft when the position of the distal end of the elongate shaft is within a fast retraction portion of the access sheath; causing the actuator to retract the elongate shaft at a first speed; and moving the robotic manipulator at a second velocity that is less than the first velocity.

6. 2. The robotic system of claim 1, wherein increasing the speed of retraction of the elongate shaft comprises increasing the speed of retraction of the elongate shaft to a first speed when the position of the distal end of the elongate shaft is within a fast retraction buffer portion of the access sheath.

7. 7. The robotic system of claim 6, wherein when the position of the distal end of the elongate shaft is within a fast retraction portion of the access sheath proximal to the fast retraction buffer portion of the access sheath, increasing the speed of retraction of the elongate shaft includes retracting the elongate shaft at a second speed that is greater than the first speed.

8. 8. The robotic system of claim 7, wherein when the position of the distal end of the elongate shaft is between the fast retraction portion and the fast retraction buffer portion of the access sheath, increasing the speed of retraction of the elongate shaft comprises retracting the elongate shaft at a third speed that is greater than the first speed but less than the second speed.

9. 1. A robot system comprising: a medical instrument having an elongate shaft dimensioned to be advanced within the access sheath; A control circuit, the control circuit comprising: inserting the elongate shaft at least partially into the access sheath; determining that the distal end of the elongate shaft has been inserted past a proximal opening of the access sheath such that the distal end of the elongate shaft is disposed within the access sheath; and increasing a rate of insertion of the elongate shaft based at least in part on a position of the distal end of the elongate shaft within the access sheath.

10. 1. A robot system comprising: a medical instrument translation means physically coupled to a handle of the medical instrument; an actuator means configured to axially actuate an elongate shaft of the medical instrument; A control means, causing the actuator means to at least partially retract the elongate shaft within the access sheath; determining that the distal end of the elongate shaft has been retracted beyond a distal opening of the access sheath such that the distal end of the elongate shaft is disposed within the access sheath; and increasing a rate of retraction of the elongate shaft based at least in part on a position of the distal end of the elongate shaft within the access sheath.

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