Robotic arms and methods for tissue resection and imaging

Abstract

To provide favorable robotic arms and methods for tissue resection and imaging.SOLUTION: A system for treating a target tissue of a patient comprises a first robotic arm coupled to a treatment probe for treating the target tissue of the patient, and a second robotic arm coupled to an imaging probe for imaging the target tissue of the patient. The system further comprises one or more computing devices operably coupled with the first robotic arm and the second robotic arm, the one or more computing devices configured to execute instructions for controlling movement of one or more of the first robotic arm or the second robotic arm.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This application claims the benefit under 35 U.S.C. § 119(e) of U.S. Provisional Application No. 62 / 933,793, filed November 11, 2019, and U.S. Provisional Application No. 62 / 814,966, filed March 7, 2019, the disclosures of which are incorporated by reference in their entireties.

[0002] The subject matter of this application is related to the following patents and patent applications, the entire contents of which are incorporated herein by reference: U.S. Patent Application No. 11 / 968,445, filed January 2, 2008, now U.S. Patent No. 7,882,841; U.S. Patent Application No. 12 / 399,585, filed March 6, 2009, now U.S. Patent No. 8,814,921; U.S. Patent Application No. 14 / 334,247, filed July 17, 2014, now U.S. Patent No. 9,364,251; and International Application No. PCT / US2015 / 048695, filed September 4, 2015. [Background technology]

[0003] The field of the disclosure relates to the treatment of tissue with energy, and more particularly, to the treatment of organs such as the prostate with fluid stream energy.

[0004] Previous methods and devices for treating subjects, such as patients, may, at least in some cases, result in sub-ideal tissue removal. For example, previous methods of prostate surgery may, at least in some cases, result in longer healing times and less desirable outcomes than would be ideal.

[0005] Previous methods and devices for imaging tissue may be sub-ideal for imaging treated tissue. For example, previous ultrasound methods and devices may not be suitable for viewing the treatment site during treatment, and alignment of diagnostic images with treatment images may be sub-ideal. Also, at least some of the previous therapeutic methods and devices for treating tissue may not be suitable for combination with prior art imaging systems. In at least some cases, it would be useful to provide improved imaging of tissue during surgery, such as to provide real-time imaging of tissue that would allow a user to adjust treatment based on real-time images of the tissue. At least some of the previous methods and devices for imaging tissue during surgery may be somewhat cumbersome to use and may result in delays in patient treatment.

[0006] Previous methods and devices for treating organs such as the prostate may provide user interfaces that are somewhat cumbersome for the user and may provide sub-ideal planning of the procedure. Also, at least some of the previous art methods and devices for treating tissue such as prostate tissue may be somewhat less accurate than would be ideal. In at least some instances, the previous methods and devices may provide a sub-ideal user experience. Also, at least some of the previous interfaces may provide sub-ideal coupling of the treatment device with the tissue structure.

[0007] Previous methods and devices for treating tissue with robotic instrumentation may be sub-ideal during treatment. The robotic arm and surgical probe of a robotic surgical system may be aligned with each other and with the patient prior to treatment. In some cases, the robotic arm and surgical probe are first manually moved and positioned before being coupled to each other and locked in place for further controller-based adjustment. For example, a surgical probe or other tool coupled to the robotic arm may be manually guided through the anatomy to reach a target site, such as through the anus and rectum in the case of transrectal ultrasound ("TRUS"), or through the tortuous paths of the urethra, prostate, and bladder neck with sharp turns through sensitive anatomy. In at least some cases, maintenance of the desired alignment and stability of the robotic arm after manual adjustment and during treatment may be sub-ideal. For example, previous robotic arms and end surgical probes may be held too tightly, potentially leading to tissue injury associated with patient movement, or may be held with sub-ideal support strength, leading to sub-ideal alignment with the target site if the robotic arm and surgical probe are disturbed, for example, when bumped or released from the user's grasp following engagement.

[0008] Research relevant to this disclosure suggests that previous approaches to aligning a probe with a robotic arm may be sub-ideal in at least some instances.

[0009] While these aforementioned methods and devices can be highly effective and represent a significant advance over previous luminal tissue treatment approaches, it would be desirable to provide improvements to aid in more precise tissue removal in both fully automatic and physician-assisted modes of operation. At least some of these objectives will be met by the present invention as described hereinafter. Summary of the Invention [Means for solving the problem]

[0010] The embodiments of the present disclosure provide improved methods and apparatus for performing tissue therapy, such as tissue ablation. In some embodiments, an image-guided therapy system includes a therapy probe and an imaging probe. The imaging probe can be configured to provide an image of a target site while the therapy probe performs ablation of the target tissue. In some embodiments, the therapy probe and the imaging probe are each coupled to a robotic arm under the control of one or more computing devices. The therapy probe can be coupled to a first robotic arm configured to provide computer-controlled movement of the therapy probe during tissue ablation with the therapy probe. The imaging probe can be coupled to a second robotic arm configured to provide computer-controlled movement of the imaging probe before and / or during a tissue ablation procedure with the therapy probe during scanning of the target site with the imaging probe. The one or more computing devices can be configured to execute instructions for operating the robotic arm in a passive mode, in which the robotic arm is manually adjusted and configured to position the therapy and imaging probes in a manually set position, such as for imaging from and treating at the same or different tissue site. The one or more computing devices can be configured to execute instructions for maintaining the manually set position of the probe after the robotic arm is released from the manual adjustment. The robotic arm may be configured to maintain a manually set position in one or more of the translation or rotation axes. In some embodiments, the rotation angle is maintained within 5° and the translation position is maintained within 5 mm or less. In some embodiments, the rotation angle and translation position are maintained on each of the three axes, which may improve the accuracy of imaging and treatment with the probe.

[0011] One or more computing devices operably coupled to the first and second robotic arms may be configured to automatically control the movement of the treatment probe and / or the imaging probe, for example, based on a pre-planned or programmed scan profile or according to various pre-programmed parameters. The automatically controlled movement of the treatment probe along the treatment profile may, for example, perform a treatment of the target site. The automatically controlled movement of the imaging probe along the imaging profile may, for example, generate a three-dimensional rendering of the target site. Automatic computer-controlled scanning of the target site with the imaging probe using the robotic arms may also be used to generate useful information regarding the target site for additional treatment. For example, the imaging probe may be configured to perform a color / Doppler scan of the target site after an ablation procedure to identify bleeding sites within the target site requiring hemostasis. Three-dimensional scanning of the target site using the imaging probe may also be used to identify tissue abnormalities in the target site, such as tumors.

[0012] Alternatively or additionally, the one or more computing devices may be configured to control movement of the treatment probe and / or imaging probe in response to user input, for example, through a graphical user interface of the treatment apparatus. In some embodiments, the one or more computing devices may be configured to confine movement of the treatment probe and / or imaging probe within an allowed range of motion that may be programmed into the first and / or second robotic arms prior to initiating use of the first or second arms under computer control.

[0013] The first robotic arm and / or the second robotic arm may be configured to adjust the position and / or orientation of the first arm and / or the second arm to maintain proper position or alignment of the treatment probe and the imaging probe and / or to prevent collision or interference between the treatment probe and the imaging probe outside the patient's body.

[0014] The first robotic arm and / or the second robotic arm may comprise one or more feedback sensing mechanisms. For example, the first robotic arm and / or the second robotic arm may be operably coupled to a force sensor configured to detect compression of tissue in front of the treatment probe and / or imaging probe. The one or more computing devices may comprise instructions to control movement of the robotic arm in response to the force detected by the sensor, for example, to prevent over-compression of the anterior tissue and resulting damage to the tissue and / or probe. Another exemplary feedback sensing mechanism may comprise a position and / or motion sensor operably coupled to the first and / or second robotic arm. The one or more computing devices may comprise instructions to control movement of the robotic arm in response to the position and / or motion detected by the sensor, for example, to adjust the position of the treatment and / or imaging probe in response to patient movement during the treatment and / or scanning procedure.

[0015] These and other embodiments are described in further detail in the following description taken in conjunction with the accompanying drawings. The present invention provides, for example, the following: (Item 1) 1. A system for treating or imaging tissue of a patient, the system comprising: a probe sized for insertion into the patient; a robotic arm configured to couple to the probe; one or more computing devices operably coupled to the robotic arm; Equipped with The one or more computing devices include establishing an acceptable range of motion for the probe, the acceptable range of motion being stored on a memory of one or more computing devices; treating or imaging a target tissue of the patient with the probe; moving the robotic arm to affect movement of the probe within the allowable range of motion for the probe; A system that consists of instructions for performing (Item 2) 2. The system of claim 1, wherein the probe is configured to couple to the robotic arm while the robotic arm is in a passive mode. (Item 3) 2. The system of claim 1, wherein the allowable range of motion for the probe is established while the robotic arm is in a passive mode. (Item 4) 2. The system of claim 1, wherein establishing the acceptable range of motion for the probe includes establishing the acceptable range of motion for the probe in response to user input. (Item 5) 2. The system of claim 1, wherein establishing the acceptable range of motion for the probe includes establishing the acceptable range of motion for the probe in response to a position of the probe. (Item 6) 6. The system of claim 5, wherein the position of the probe relative to the target tissue is determined in response to one or more tissue landmarks in one or more images of the target tissue. (Item 7) 2. The system of claim 1, further comprising updating the acceptable range of motion for the probe in real time. (Item 8) 2. The system of claim 1, further comprising a user input device operably coupled to one or more computing devices, the user input device providing one or more user instructions for controlling movement of the robotic arm, and moving the robotic arm under control of the one or more computing devices includes moving the robotic arm in response to the one or more user instructions for controlling movement of the robotic arm. (Item 9) 9. The system of claim 8, wherein the user input device comprises one or more of a controller near the end of the robotic arm, a user interface on a display screen, a user interface on a console, or a controller responsive to forces on the end of the arm provided by the user to guide a probe on the robotic arm into a fixed position. (Item 10) 2. The system of claim 1, further comprising one or more force sensors operably coupled to the probe and one or more computing devices, the one or more force sensors detecting compression of tissue of the patient with the probe. (Item 11) 11. The system of claim 10, wherein the one or more computing devices comprise a processor configured with instructions for interrupting the therapy in response to detected compression of the tissue exceeding a predetermined threshold level of compression. (Item 12) Item 11. The system of item 10, wherein the one or more force sensors are operably coupled to the robotic arm. (Item 13) Item 13. The system of item 12, further comprising one or more motion sensors operably coupled to the probe and the one or more computing devices, the one or more motion sensors configured to detect movement of the patient, and the one or more computing devices configured to adjust a position of the probe in response to the detected movement of the patient. (Item 14) 2. The system of claim 1, wherein the robotic arm has a passive mode for manually adjusting the probe to a manually set position. (Item 15) Item 15. The system of item 14, wherein in the passive mode, the probe is supported using the robotic arm, the probe comprising a plurality of sensors at an interface between the robotic arm and the probe, the plurality of sensors receiving user input from a handle coupled to the plurality of sensors for the user to guide the probe. (Item 16) Item 16. The system of item 15, wherein a handle coupled to the plurality of sensors is configured to respond to user manipulation of the handle, and the plurality of sensors in the interface are coupled to a processor of the one or more computing devices for operating the probe in response to user manipulation of the handle. (Item 17) 17. The system of claim 16, wherein the plurality of sensors are configured to detect user manipulation of the handle with six degrees of freedom, and the processor is configured to move the probe in six degrees of freedom, the motion corresponding to the six degrees of freedom being responsive to the user manipulation. (Item 18) Item 15. The system of item 14, wherein manually adjusting the robot arm in the passive mode includes manually adjusting the probe in one or more of at least one rotational axis or at least one translational axis. (Item 19) 20. The system of claim 18, wherein the at least one rotation axis comprises a first rotation axis, a second rotation axis orthogonal to the first rotation axis, and a third rotation axis orthogonal to the first and second rotation axes, and the at least one translation axis comprises a first translation axis, a second translation axis orthogonal to the first translation axis, and a third translation axis orthogonal to the first and second translation axes. (Item 20) 20. The system of claim 19, wherein the first rotational axis comprises a pitch axis, the second rotational axis comprises a yaw axis, the third rotational axis comprises a roll axis, the first translational axis comprises an X-axis, the second translational axis comprises a Y-axis, and the third translational axis comprises a Z-axis. (Item 21) Item 15. The system of item 14, wherein the manually set position of the probe is maintained after the robotic arm is released from manual adjustment. (Item 22) 22. The system of claim 21, wherein the robot arm is configured to maintain the manually set position with tolerances in one or more of the rotation or translation axes, optionally the tolerances being within 5° for rotation about one or more of three axes and within 5mm for translation along one or more of three axes, optionally with a rotation tolerance within 3° and optionally a translation tolerance within 3mm, optionally 2mm, for each of one or more of the three axes. (Item 23) 22. The system of claim 21, wherein the probe comprises an imaging probe. (Item 24) The probe comprises a treatment probe, the robotic arm comprises a first robotic arm, and the system comprises: an imaging probe sized for insertion into the patient; a second robotic arm coupled to the imaging probe; and Further equipped with 22. The system of claim 21, wherein the one or more computing devices are configured with instructions for establishing an acceptable range of motion for the imaging probe. (Item 25) 25. The system of claim 24, wherein the imaging probe is configured to image a target area of ​​the patient with the imaging probe, and the second robotic arm is configured to move under control of the one or more computing devices to affect movement of the imaging probe within the allowed range of motion for the imaging probe. (Item 26) 2. The system of claim 1, wherein the one or more computing devices comprise instructions for imaging and treating the tissue. (Item 27) 1. A method of treating a target tissue at a target site in a patient, the method comprising: manually inserting a probe into the patient; coupling the probe to a robotic arm; establishing an acceptable range of motion for the probe, the acceptable range of motion being stored on a memory of one or more computing devices operatively coupled to the robotic arm; treating or imaging a target tissue of the patient with the probe; moving the robotic arm under control of the one or more computing devices operatively coupled to the probe to affect movement of the probe within the allowed range of motion for the probe; A method comprising: (Item 28) 28. The method of claim 27, wherein the probe is coupled to the robotic arm while the robotic arm is in a passive mode. (Item 29) 28. The method of claim 27, wherein the allowable range of motion for the probe is established while the robotic arm is in a passive mode. (Item 30) 28. The method of claim 27, wherein establishing the acceptable range of motion for the probe includes establishing the acceptable range of motion for the probe in response to user input. (Item 31) 28. The method of claim 27, wherein establishing the acceptable range of motion for the probe includes establishing the acceptable range of motion for the probe in response to a position of the probe. (Item 32) 32. The method of claim 31, wherein the position of the probe relative to the target tissue is determined in response to one or more tissue landmarks in one or more images of the target tissue. (Item 33) 28. The method of claim 27, further comprising updating the acceptable range of motion for the probe in real time. (Item 34) 28. The method of claim 27, further comprising receiving one or more user instructions for controlling movement of the robotic arm from a user input device operably coupled to one or more computing devices, wherein moving the robotic arm under control of the one or more computing devices comprises moving the robotic arm in response to the one or more user instructions for controlling movement of the robotic arm. (Item 35) Item 35. The method of item 34, wherein the user input device comprises one or more of a controller on the end of the robotic arm, a user interface on a display screen, a user interface on a console, or a controller responsive to forces on the end of the arm provided by the user to guide a probe on the robotic arm into a fixed position. (Item 36) 28. The method of claim 27, further comprising receiving sensor data from one or more force sensors operably coupled to the one or more computing devices, the one or more force sensors configured to detect compression of tissue of the patient with the probe. (Item 37) 37. The method of claim 36, wherein the one or more computing devices comprise a processor configured with instructions for interrupting the treatment in response to detected compression of the tissue exceeding a predetermined threshold level of compression. (Item 38) Item 37. The method of item 36, wherein the one or more force sensors are operably coupled to the robotic arm. (Item 39) 39. The method of claim 38, further comprising receiving sensor data from one or more motion sensors operably coupled to the one or more computing devices, the one or more motion sensors configured to detect movement of the patient, and moving the robotic arm under control of the one or more computing devices comprises adjusting a position of the probe in response to the detected movement of the patient. (Item 40) 28. The method of claim 27, further comprising manually adjusting the robotic arm in a passive mode and manually adjusting the probe to a manually set position. (Item 41) Item 41. The method of item 40, wherein in the passive mode, the probe is supported using the robotic arm, the probe comprising a plurality of sensors at an interface between the robotic arm and the probe, the plurality of sensors receiving user input from a handle coupled to the plurality of sensors for the user to guide the probe. (Item 42) Item 42. The method of item 41, wherein a handle coupled to the plurality of sensors is configured to respond to user manipulation of the handle, and the plurality of sensors in the interface are coupled to a processor of the one or more computing devices for manipulating the probe in response to user manipulation of the handle. (Item 43) Item 43. The method of item 42, wherein the plurality of sensors are configured to detect user manipulation of the handle with six degrees of freedom, and the processor is configured to move the probe in six degrees of freedom, the movement corresponding to the six degrees of freedom being responsive to the user manipulation. (Item 44) 41. The method of claim 40, wherein manually adjusting the robot arm in the passive mode and manually adjusting the probe includes manually adjusting the probe in one or more of at least one rotational axis or at least one translational axis. (Item 45) Item 45. The method of item 44, wherein the at least one rotation axis comprises a first rotation axis, a second rotation axis orthogonal to the first rotation axis, and a third rotation axis orthogonal to the first and second rotation axes, and the at least one translation axis comprises a first translation axis, a second translation axis orthogonal to the first translation axis, and a third translation axis orthogonal to the first and second translation axes. (Item 46) Item 46. The method of item 45, wherein the first rotational axis comprises a pitch axis, the second rotational axis comprises a yaw axis, the third rotational axis comprises a roll axis, the first translational axis comprises an X axis, the second translational axis comprises a Y axis, and the third translational axis comprises a Z axis. (Item 47) Item 41. The method of item 40, wherein the manually set position of the probe is maintained after the robotic arm is released from manual adjustment. (Item 48) Item 48. The method of item 47, wherein the robot arm is configured to maintain the manually set position with tolerances in one or more of rotation or translation axes, optionally the tolerances being within 5° for rotation about one or more of three axes and within 5 mm for translation along one or more of three axes, optionally with respect to each of one or more of three axes, a rotation tolerance within 3°, optionally a translation tolerance within 3 mm, optionally 2 mm. (Item 49) 28. The method of claim 27, wherein the probe comprises an imaging probe. (Item 50) The probe comprises a treatment probe, the robotic arm comprises a first robotic arm, and the method comprises: manually inserting an imaging probe into the patient; coupling the imaging probe to a second robotic arm; establishing an acceptable range of motion for the imaging probe, the acceptable range of motion being stored on a memory of one or more computing devices operatively coupled to the first robotic arm and the second robotic arm; Item 48. The method of item 47, further comprising: (Item 51) Item 51. The method of item 50, wherein the imaging probe is coupled to the second robotic arm while the second robotic arm is in a passive mode. (Item 52) Item 51. The method of item 50, wherein the allowable range of motion for the imaging probe is established while the second robotic arm is in a passive mode. (Item 53) 51. The method of claim 50, wherein establishing the acceptable range of motion for the imaging probe includes establishing the acceptable range of motion in response to a distance or alignment between the treatment probe and the imaging probe. (Item 54) 51. The method of claim 50, wherein establishing the acceptable range of motion for the imaging probe includes establishing the acceptable range of motion for the imaging probe in response to user input. (Item 55) 51. The method of claim 50, wherein establishing the acceptable range of motion for the imaging probe includes establishing the acceptable range of motion in response to a position of the imaging probe relative to the target tissue. (Item 56) 56. The method of claim 55, wherein the position of the imaging probe relative to the target tissue is determined in response to one or more tissue landmarks in one or more images of the target tissue. (Item 57) 51. The method of claim 50, further comprising updating the allowable range of motion for the imaging probe in real time. (Item 58) 51. The method of claim 50, further comprising receiving one or more user instructions for controlling movement of the second robotic arm from a user input device operably coupled to one or more computing devices, wherein moving the second robotic arm under control of the one or more computing devices comprises moving the second robotic arm in response to the one or more user instructions for controlling movement of the second robotic arm. (Item 59) Item 59. The method of item 58, further comprising establishing an allowable range of motion for the second robotic arm in response to the one or more user commands for controlling movement of the second robotic arm. (Item 60) 51. The method of claim 50, further comprising receiving sensor data from one or more force sensors operably coupled to the one or more computing devices, the one or more force sensors configured to detect compression of the patient's tissue with the imaging probe, and moving the second robotic arm under control of the one or more computing devices comprises moving the imaging probe away from the tissue in response to a determination that the detected compression of the tissue exceeds a predetermined threshold level of compression. (Item 61) Item 61. The method of item 60, wherein the one or more force sensors are operably coupled to the second robotic arm. (Item 62) 51. The method of claim 50, further comprising receiving sensor data from one or more position sensors operably coupled to the one or more computing devices, the one or more position sensors configured to detect a position of one or more of the first robotic arm, the treatment probe, the second robotic arm, or the imaging probe. (Item 63) 51. The method of claim 50, further comprising receiving sensor data from one or more motion sensors operably coupled to the one or more computing devices, the one or more motion sensors configured to detect movement of the patient, and moving the second robotic arm under control of the one or more computing devices comprises adjusting a position of the imaging probe in response to the detected movement of the patient. (Item 64) 51. The method of claim 50, further comprising calibrating the first robotic arm to identify its position relative to the second robotic arm, and calibrating the second robotic arm to identify its position relative to the first robotic arm. (Item 65) 51. The method of claim 50, wherein moving the first robotic arm or the second robotic arm under control of the one or more computing devices includes automatically adjusting movement of the first robotic arm in response to movement of the second robotic arm or automatically adjusting movement of the second robotic arm in response to movement of the first robotic arm. (Item 66) 51. The method of claim 50, wherein moving the first robotic arm or the second robotic arm under control of the one or more computing devices includes moving the first robotic arm or the second robotic arm to prevent contact between a portion of the treatment probe and a portion of the imaging probe that are positioned outside the patient. (Item 67) Item 67. The method of item 66, wherein moving the first robotic arm or the second robotic arm under control of the one or more computing devices includes moving the first robotic arm or the second robotic arm to maintain alignment between the treatment probe and the imaging probe. (Item 68) Item 68. The method of item 67, wherein the alignment maintained between the treatment probe and the imaging probe comprises a parallel alignment between the treatment probe and the imaging probe, wherein a longitudinal axis of the treatment probe and a longitudinal axis of the imaging probe are parallel to each other. (Item 69) 68. The method of claim 67, wherein the alignment maintained between the treatment probe and the imaging probe comprises a co-planar alignment between the treatment probe and the imaging probe, wherein a longitudinal axis of the treatment probe and a longitudinal axis of the imaging probe are co-planar with each other. (Item 70) Item 68. The method of item 67, wherein the alignment maintained between the treatment probe and the imaging probe comprises a non-parallel alignment between the treatment probe and the imaging probe, wherein a longitudinal axis of the treatment probe and a longitudinal axis of the imaging probe are transverse to each other. (Item 71) 51. The method of claim 50, further comprising detecting one or more of a distance or alignment between the treatment probe and the imaging probe. (Item 72) 51. The method of claim 50, wherein moving the first robotic arm or the second robotic arm under control of the one or more computing devices comprises moving the first robotic arm or the second robotic arm to automatically move the treatment probe or the imaging probe along a scanning profile stored on the one or more computing devices. (Item 73) 73. The method of claim 72, wherein moving the first robotic arm under control of the one or more computing devices includes moving the first robotic arm to automatically move the treatment probe across the scanning profile comprising a treatment profile. (Item 74) Item 73. The method of item 72, wherein moving the second robotic arm under the control of the one or more computing devices includes moving the second robotic arm to automatically move the imaging probe across the scanning profile comprising an imaging profile. (Item 75) 75. The method of claim 74, wherein the imaging profile includes multiple transverse or multiple sagittal scans of the target area, the method further including generating a three-dimensional image of the target area. (Item 76) Item 75. The method of item 74, wherein the second robotic arm is moved to automatically move the imaging probe through the scanning profile comprising the imaging profile while the treatment probe is treating the target tissue. (Item 77) 51. The method of claim 50, wherein imaging the target site with the imaging probe includes imaging the target site with the imaging probe operating in a Doppler mode, the method further including identifying areas of high blood flow within the target site based on one or more images of the target site obtained with the imaging probe. (Item 78) 80. The method of claim 77, further comprising applying hemostasis to identified areas of high blood flow within the target site. (Item 79) 80. The method of claim 77, further comprising performing a biopsy of tissue located in an identified area of ​​high blood flow within the target site. (Item 80) 80. The method of claim 77, further comprising identifying the area of ​​high blood flow as cancerous tissue. (Item 81) 80. The method of claim 77, wherein imaging the target site with the imaging probe comprises rotating the imaging probe. (Item 82) 51. The method of claim 50, wherein imaging the target site with the imaging probe includes generating an intraoperative image of the target site. (Item 83) 83. The method of claim 82, further comprising mapping the intraoperative image with a preoperative image of the target site. (Item 84) 84. The method of claim 83, wherein the preoperative image of the target site comprises one or more of an X-ray image, a fluoroscopic image, a computed tomography (CT) image, an ultrasound image, or an MRI image. (Item 85) 84. The method of claim 83, wherein mapping the intraoperative image with the preoperative image includes mapping one or more anatomical regions in the intraoperative and preoperative images to one another. (Item 86) 86. The method of claim 85, wherein the one or more anatomical regions comprise one or more of the bladder neck, the external sphincter, or the verumontanum. (Item 87) 1. A method of operating a robotic arm to image or treat a target tissue at a target site in a patient, the method comprising: coupling at least one probe to at least one robotic arm; manually adjusting the at least one robotic arm in a passive mode and manually adjusting the at least one probe to a manually set position; Releasing the at least one robotic arm from the passive mode. Including, the at least one robotic arm maintains a manually set position of the at least one probe after release from manual adjustment; The method, wherein the at least one probe performs one or more of imaging or treating the target tissue at the target site on the patient from the maintained manually set position. (Item 88) 88. The method of claim 87, wherein the at least one probe is coupled to the at least one robotic arm prior to inserting the at least one probe into the patient. (Item 89) 88. The method of claim 87, wherein the at least one probe is coupled to the at least one robotic arm after inserting the at least one probe into the patient. (Item 90) Item 88. The method of item 87, wherein the at least one robotic arm maintains a manually set position of the at least one probe with a locking configuration of the at least one robotic arm, and optionally sensors of joints of the at least one robotic arm and actuators coupled to the joints of the robotic arm maintain the manually set position of the at least one robotic arm in the locking configuration. (Item 91) 88. The method of claim 87, wherein manually adjusting the at least one robotic arm in the passive mode includes manually adjusting the at least one probe in one or more of at least one rotational axis or at least one translational axis. (Item 92) Item 92. The method of item 91, wherein the at least one rotation axis comprises a first rotation axis, a second rotation axis orthogonal to the first rotation axis, and a third rotation axis orthogonal to the first and second rotation axes, and the at least one translation axis comprises a first translation axis, a second translation axis orthogonal to the first translation axis, and a third translation axis orthogonal to the first and second translation axes. (Item 93) Item 93. The method of item 92, wherein the first rotational axis comprises a pitch axis, the second rotational axis comprises a yaw axis, the third rotational axis comprises a roll axis, the first translational axis comprises an X-axis, the second translational axis comprises a Y-axis, and the third translational axis comprises a Z-axis. (Item 94) Item 88. The method of item 87, wherein the at least one robotic arm maintains the manually set position within a tolerance in one or more of the rotation or translation axes, optionally the tolerance being within 5° for rotation about one or more of three axes and within 5 mm for translation along one or more of three axes, optionally with respect to each of one or more of three axes, a rotation tolerance within 3°, optionally a translation tolerance within 3 mm, optionally 2 mm. (Item 95) 88. The method of claim 87, wherein coupling the at least one probe to the at least one robotic arm includes one or more of coupling a treatment probe to a first robotic arm or coupling an imaging probe to a second robotic arm. (Item 96) 96. The method of claim 95, wherein manually adjusting the at least one robotic arm in the passive mode includes aligning the treatment probe and the imaging probe with respect to one another. (Item 97) 97. The method of claim 96, wherein the treatment probe and the imaging probe are aligned with one another to be one or more of parallel or coplanar. (Item 98) 97. The method of claim 96, wherein the at least one robotic arm maintains the alignment between the imaging probe and the treatment probe after release from manual adjustment. (Item 99) Item 99. The method of item 98, wherein the alignment between the imaging probe and the treatment probe is maintained within a tolerance in one or more of the rotation or translation axes, optionally the tolerance is within 5° for rotation about one or more of three axes and within 5 mm for translation along one or more of three axes, optionally with respect to each of one or more of three axes, a rotation tolerance within 3°, optionally a translation tolerance within 3 mm, optionally 2 mm. (Item 100) A system comprising a processor configured with instructions for performing the method of any one of items 1-99. (Item 101) 1. A system for operating a robotic arm to image or treat a target tissue at a target site in a patient, the system comprising: at least one robotic arm coupled to at least one probe for one or more of treating or imaging the target tissue of the patient; one or more computing devices operatively coupled to the at least one robotic arm; Equipped with The one or more computing devices include operating the at least one probe in a passive mode such that the at least one robotic arm can be manually adjusted to manually adjust the at least one robotic arm to a manually set position; Releasing the at least one robotic arm from the passive mode after the at least one probe is manually adjusted to the manually set position; maintaining the manually set position of the at least one probe after release from the manual adjustment; 23. A system configured to execute instructions to: (Item 102) Item 102. The system of item 101, wherein the at least one probe is configured to couple to the at least one robotic arm prior to inserting the at least one probe into the patient. (Item 103) Item 102. The system of item 101, wherein the at least one probe is configured to couple to the at least one robotic arm after inserting the at least one probe into the patient. (Item 104) Item 102. The system of item 101, wherein the at least one robotic arm maintains the manually set position of the at least one probe using a locking configuration of the at least one robotic arm, and optionally sensors of joints of the at least one robotic arm and actuators coupled to the joints of the robotic arm maintain the manually set position of the at least one robotic arm in the locking configuration. (Item 105) Item 102. The system of item 101, wherein the one or more computing devices are further configured to execute instructions for controlling movement of the at least one robotic arm. (Item 106) Item 102. The system of item 101, wherein the at least one robotic arm is manually adjusted and configured to manually adjust the at least one probe in one or more of at least one rotational axis or at least one translational axis. (Item 107) Item 107. The system of item 106, wherein the at least one rotation axis comprises a first rotation axis, a second rotation axis orthogonal to the first rotation axis, and a third rotation axis orthogonal to the first and second rotation axes, and the at least one translation axis comprises a first translation axis, a second translation axis orthogonal to the first translation axis, and a third translation axis orthogonal to the first and second translation axes. (Item 108) Item 108. The system of item 107, wherein the first rotational axis comprises a pitch axis, the second rotational axis comprises a yaw axis, the third rotational axis comprises a roll axis, the first translational axis comprises an X-axis, the second translational axis comprises a Y-axis, and the third translational axis comprises a Z-axis. (Item 109) Item 107. The system of item 106, wherein the at least one robotic arm is configured to maintain the manually set position with tolerances in one or more of the rotational or translational axes, optionally the tolerances being within 5° for rotation about one or more of three axes and within 5mm for translation along one or more of three axes, optionally with a rotational tolerance within 3° and optionally a translation tolerance within 3mm, optionally 2mm, for each of one or more of the three axes. (Item 110) Item 102. The system of item 101, wherein the at least one probe comprises one or more of a therapy probe or an imaging probe. (Item 111) Item 111. The system of item 110, wherein the at least one probe comprises the treatment probe and the imaging probe, and the at least one robotic arm comprises a first robotic arm coupled to the treatment probe and a second robotic arm coupled to the imaging probe. (Item 112) Item 111. The system of item 110, wherein the at least one probe comprises the treatment probe and the imaging probe, and the treatment probe and the imaging probe are configured to be manually adjusted to align the treatment probe and the imaging probe with each other. (Item 113) Item 113. The system of item 112, wherein the treatment probe and the imaging probe are aligned with one another to be one or more of parallel or coplanar. (Item 114) Item 114. The system of item 113, wherein the at least one robotic arm maintains the alignment between the imaging probe and the treatment probe after release from manual adjustment. (Item 115) Item 115. The system of item 114, wherein the alignment between the imaging probe and the treatment probe is maintained within a tolerance in one or more of a rotational or translational axis. (Item 116) 1. A system for treating target tissue at a target site in a patient, the system comprising: a first robotic arm coupled to a treatment probe for treating the target tissue of the patient; a second robotic arm coupled to an imaging probe for imaging the target tissue of the patient; one or more computing devices operably coupled to the first robotic arm and the second robotic arm; Equipped with The one or more computing devices are configured to execute instructions to control movement of one or more of the first robotic arm or the second robotic arm. (Item 117) Item 117. The system of item 116, wherein the one or more computing devices are configured to execute instructions to control movement of the first robotic arm or the second robotic arm to adjust one or more of a pitch, yaw, roll or linear position of the treatment probe or the imaging probe along an axis of entry of the treatment probe or the imaging probe into the patient. (Item 118) Item 117. The system of item 116, wherein the one or more computing devices are configured to execute instructions including controlling movement of the first robotic arm or the second robotic arm, respectively, to retract the treatment probe or the imaging probe along the entry axis. (Item 119) Item 119. The system of item 118, wherein the one or more computing devices are configured to execute instructions including controlling movement of the first robotic arm or the second robotic arm, respectively, to retract but not advance the treatment probe or the imaging probe along the entry axis. (Item 120) Item 117. The system of item 116, wherein the one or more computing devices are configured to execute instructions including controlling movement of the first robotic arm or the second robotic arm in response to user instructions received using a user input device operably coupled to the one or more computing devices. (Item 121) Item 117. The system of item 116, wherein the one or more computing devices are configured to execute instructions including controlling movement of the first robotic arm or the second robotic arm to move the treatment probe or the imaging probe, respectively, within an allowable range of motion for the treatment probe or the imaging probe stored in the one or more computing devices. (Item 122) Item 122. The system of item 121, wherein the one or more computing devices are configured to execute instructions including establishing the acceptable range of motion for the treatment probe or the imaging probe in response to user input. (Item 123) Item 122. The system of item 121, wherein the one or more computing devices are configured to execute instructions including establishing the acceptable range of motion for the treatment probe or the imaging probe in response to a distance or alignment between the treatment probe and the imaging probe. (Item 124) Item 122. The system of item 121, wherein the one or more computing devices are configured to execute instructions including establishing the acceptable range of motion for the treatment probe or the imaging probe in response to a position of the treatment probe or the imaging probe relative to the target tissue. (Item 125) Item 125. The system of item 124, wherein the one or more computing devices are configured to execute instructions including detecting a position of the treatment probe or the imaging probe relative to the target tissue based on one or more images of the target tissue, the one or more images comprising one or more tissue landmarks. (Item 126) Item 122. The system of item 121, wherein the one or more computing devices are configured to execute instructions to update the acceptable range of motion for the treatment probe or the imaging probe in real time. (Item 127) Item 117. The system of item 116, wherein the one or more computing devices are configured to execute instructions including controlling movement of the first robotic arm or the second robotic arm to maintain alignment between the treatment probe and the imaging probe, optionally wherein the alignment maintains the treatment probe within a field of view of the imaging probe. (Item 128) Item 128. The system of item 127, wherein the alignment maintained between the treatment probe and the imaging probe comprises a substantially parallel alignment between the treatment probe and the imaging probe, wherein a longitudinal axis of the treatment probe and a longitudinal axis of the imaging probe are substantially parallel to each other. (Item 129) Item 128. The system of item 127, wherein the alignment maintained between the treatment probe and the imaging probe comprises a co-planar alignment between the treatment probe and the imaging probe, wherein a longitudinal axis of the treatment probe and a longitudinal axis of the imaging probe are co-planar with each other. (Item 130) Item 128. The system of item 127, wherein the alignment maintained between the treatment probe and the imaging probe includes a non-parallel alignment between the treatment probe and the imaging probe, wherein a longitudinal axis of the treatment probe and a longitudinal axis of the imaging probe are transverse to each other. (Item 131) Item 117. The system of item 116, wherein the one or more computing devices are configured to execute instructions including detecting one or more of a distance or alignment between the treatment probe and the imaging probe. (Item 132) Item 117. The system of item 116, wherein the one or more computing devices are configured to execute instructions including controlling movement of the first robotic arm or the second robotic arm to prevent contact between a portion of the treatment probe and a portion of the imaging probe positioned outside the patient. (Item 133) Item 117. The system of item 116, wherein the one or more computing devices are configured to execute instructions to automatically adjust movement of the first robotic arm in response to movement of the second robotic arm. (Item 134) Item 117. The system of item 116, wherein the one or more computing devices are configured to execute instructions to automatically adjust movement of the second robotic arm in response to a position of the first robotic arm, and optionally, the second robotic arm moves the imaging probe in response to a position of the treatment probe to maintain the treatment probe within a field of view of the imaging probe. (Item 135) Item 117. The system of item 116, wherein the one or more computing devices are configured to execute instructions to control movement of the first robotic arm or the second robotic arm to automatically move the treatment probe or the imaging probe along a scanning profile stored on the one or more computing devices. (Item 136) Item 136. The system of item 135, wherein the one or more computing devices are configured to execute instructions to control movement of the first robotic arm to automatically move the treatment probe along the scanning profile having a treatment profile. (Item 137) Item 136. The system of item 135, wherein the one or more computing devices are configured to execute instructions to control movement of the second robotic arm to automatically move the imaging probe along the scanning profile having an imaging profile. (Item 138) Item 138. The system of item 137, wherein the imaging profile includes multiple axial scans or multiple sagittal scans of the target area, and the one or more computing devices are further configured to execute instructions including generating a three-dimensional image of the target area. (Item 139) Item 138. The system of item 137, wherein the one or more computing devices are configured to execute the instructions for automatically moving the imaging probe along the scanning profile comprising the imaging profile while the treatment probe is treating the target tissue. (Item 140) Item 117. The system of item 116, wherein the one or more computing devices are configured to execute instructions including controlling movement of the first robotic arm or the second robotic arm in response to sensor data received from one or more sensors operably coupled to the one or more computing devices. (Item 141) Item 141. The system of item 140, wherein the one or more sensors are operably coupled to one or more of the first or second robotic arms. (Item 142) Item 141. The system of item 140, wherein the one or more sensors include one or more position sensors coupled to one or more of the first robotic arm, the treatment probe, the second robotic arm, or the imaging probe. (Item 143) Item 141. The system of item 140, wherein the one or more sensors comprise one or more force sensors configured to detect compression of the patient's tissue with the treatment probe or the imaging probe, and the one or more computing devices are configured to execute instructions including moving the treatment probe or the imaging probe away from the tissue in response to a determination that the detected compression of the tissue exceeds a predetermined threshold level of compression. (Item 144) Item 141. The system of item 140, wherein the one or more sensors comprise one or more motion sensors configured to detect movement of the patient, and the one or more computing devices are configured to execute instructions including adjusting a position of the treatment probe or the imaging probe in response to the detected movement of the patient. (Item 145) Item 117. The system of item 116, wherein each of the first robotic arm and the second robotic arm comprises a plurality of joints operably coupled to a plurality of actuators, the plurality of actuators operably coupled to the one or more computing devices, and the instructions for controlling movement of the first robotic arm or the second robotic arm comprise instructions for controlling actuation of one or more of the plurality of actuators. (Item 146) Item 117. The system of item 116, further comprising a mobile base coupled to the first robotic arm and the second robotic arm. (Item 147) Item 147. The system of item 146, wherein the mobile base comprises one or more user input devices operably coupled to the one or more computing devices, the one or more user input devices configured to receive user instructions for controlling movement of one or more of the first robotic arm or the second robotic arm. (Item 148) Item 147. The system of item 146, wherein the mobile base comprises the one or more computing devices configured to execute instructions to control movement of one or more of the first robotic arm or the second robotic arm. (Item 149) Item 117. The system of item 116, wherein the one or more computing devices are operably coupled to one or more of the treatment probe or the imaging probe, and the one or more computing devices are further configured to execute instructions for controlling one or more of a treatment using the treatment probe or imaging using the imaging probe. (Item 150) Item 117. The system of item 116, wherein the one or more computing devices are further configured to execute instructions including displaying one or more images of the target area acquired using an imaging probe on a display operably coupled to the one or more computing devices. (Item 151) Item 117. The system of item 116, wherein the first robotic arm or the second robotic arm comprises a coupling structure configured to magnetically couple to the treatment probe or the imaging probe, respectively. (Item 152) Item 17. The system of item 116, wherein the first robotic arm or the second robotic arm comprises a coupling structure configured to removably couple to the treatment probe or the imaging probe, respectively, using a quick release mechanism, the quick release mechanism configured to decouple the first robotic arm or the second robotic arm from the treatment probe or the imaging probe, respectively, when an error is detected in the operation of the first robotic arm or the second robotic arm. (Item 153) Item 117. The system of item 116, further comprising a common arm, the first robotic arm being operably coupled to the common arm at a first location and the second robotic arm being operably coupled to the common arm at a second location. (Item 154) Item 154. The system of item 153, further comprising a mobile base operably coupled to the common arm. (Item 155) Item 117. The system of item 116, wherein the imaging probe comprises an ultrasound transducer configured to capture ultrasound images of the target tissue. (Item 156) Item 156. The system of item 155, wherein the ultrasound transducer is configured to be operated in a Doppler mode so that areas of high blood flow within the target site can be identified. (Item 157) Item 117. The system of item 116, wherein the one or more computing devices are configured to execute instructions to operate the first robotic arm in a passive mode, and the first robotic arm is configured to be manually adjusted in the passive mode to position the treatment probe at a manually set position. (Item 158) Item 158. The system of item 157, wherein the treatment probe is configured to be manually adjusted in one or more of at least one rotational axis or at least one translational axis when the first robotic arm is in the passive mode. (Item 159) Item 159. The system of item 158, wherein the at least one rotation axis comprises a first rotation axis, a second rotation axis orthogonal to the first rotation axis, and a third rotation axis orthogonal to the first and second rotation axes, and the at least one translation axis comprises a first translation axis, a second translation axis orthogonal to the first translation axis, and a third translation axis orthogonal to the first and second translation axes. (Item 160) Item 159. The system of item 159, wherein the first rotational axis comprises a pitch axis, the second rotational axis comprises a yaw axis, the third rotational axis comprises a roll axis, the first translational axis comprises an X-axis, the second translational axis comprises a Y-axis, and the third translational axis comprises a Z-axis. (Item 161) Item 158. The system of item 157, wherein the one or more computing devices are configured to execute instructions to maintain a manually set position of the treatment probe after the first robotic arm is released from manual adjustment. (Item 162) Item 162. The system of item 161, wherein the first robotic arm is configured to maintain the manually set position with a tolerance in one or more of a rotational or translational axis. (Item 163) Item 117. The system of item 116, wherein the one or more computing devices are configured to execute instructions for operating the second robotic arm in a passive mode, and the second robotic arm is configured to be manually adjusted in the passive mode to position the imaging probe at a manually set position. (Item 164) Item 164. The system of item 163, wherein the imaging probe is configured to be manually adjusted in one or more of at least one rotational axis or at least one translational axis when the second robotic arm is in the passive mode. (Item 165) Item 165. The system of item 164, wherein the at least one rotation axis comprises a first rotation axis, a second rotation axis orthogonal to the first rotation axis, and a third rotation axis orthogonal to the first and second rotation axes, and the at least one translation axis comprises a first translation axis, a second translation axis orthogonal to the first translation axis, and a third translation axis orthogonal to the first and second translation axes. (Item 166) Item 166. The system of item 165, wherein the first rotational axis comprises a pitch axis, the second rotational axis comprises a yaw axis, the third rotational axis comprises a roll axis, the first translational axis comprises an X-axis, the second translational axis comprises a Y-axis, and the third translational axis comprises a Z-axis. (Item 167) Item 164. The system of item 163, wherein the one or more computing devices are configured to execute instructions to maintain a manually set position of the imaging probe after the second robotic arm is released from manual adjustment. (Item 168) Item 168. The system of item 167, wherein the second robotic arm is configured to maintain the manually set position with one or more tolerances in one or more rotational or translational axes. (Item 169) 1. A system for treating a patient, the system comprising: A probe; a coupling structure for receiving the probe; a support for receiving the patient; an arm coupled to the support; a first slider coupled to the arm for translation in a first direction; a second slider coupled to the first slider, the arm, and the support for translation in a second direction transverse to the first direction; an adjustable extension between the second slider and the coupling structure; Equipped with the adjustable expansion portion comprises an expansion joint configured to expand and retract in a third direction transverse to the first direction and the second direction; The coupling structure is supported using the arm, the first slider, the second slider, and the extension to enable the coupling structure to move within a three dimensional volume. (Item 170) Item 170. The system of item 169, further comprising a swivel coupled to the arm and the coupling structure between the coupling structure and the expansion joint, the swivel configured to rotate the coupling structure up and down relative to the patient, optionally with a pivot axis of rotation extending substantially horizontally, optionally with an angle within about 10 degrees of horizontal. (Item 171) Item 171. The system of item 170, further comprising a turret coupled to the arm and the coupling structure between the coupling structure and the expansion joint, the turret configured to enable rotation of the coupling structure about an axis of rotation, optionally the axis of rotation of the turret is within about 10 degrees of vertical, and optionally the turret is coupled to the coupling structure and the arm between the coupling structure and the pivot. (Item 172) Item 172. The system of item 171, wherein each of the first slider, the second slider, the extension joint, the turret, and the pivot comprises a brake, which locks the position of the first slider, the second slider, the extension joint, the turret, and the pivot and maintains the position and orientation of the probe when the probe is inserted into the patient and coupled to the arm using a coupling structure. (Item 173) Item 172. The system of item 171, further comprising a processor-controlled actuator coupled to one or more of the first slider, the second slider, the expansion joint, the turret, or the pivot, the processor-controlled actuator moving the coupling structure toward the coupling structure of the probe when the probe is inserted into the patient. (Item 174) Item 174. The system of item 173, further comprising a linkage coupled to a processor to control one or more of the position or orientation of the coupling structure, the linkage comprising one or more of the first slider, the second slider, the expansion joint, the turret, and the pivot coupled to corresponding actuators. (Item 175) Item 172. The system of item 171, further comprising a second coupling structure for coupling to a second probe, optionally the second coupling structure configured to support the second probe above the probe. (Item 176) Item 172. The system of item 171, further comprising a second coupling structure for coupling to a second probe, the second coupling structure coupled to a second expansion joint, a second turret, and a second pivot, the second coupling structure, the second expansion joint, the second turret, and the second pivot being supported with the arm to support the second probe. (Item 177) Item 170. The system of item 169, wherein the first direction is perpendicular to the second direction. (Item 178) The system of any one of items 1-177, wherein the coupling structure of the probe comprises one or more protrusions or grooves on a lower surface of the probe, and the coupling structure supported by the arm comprises one or more protrusions or grooves on an upper surface of the coupling surface for coupling the coupling structure of the probe to the coupling structure supported by the arm. (Item 179) 1. A mounting assembly for coupling to a patient support, the mounting assembly comprising: a first clamp for attaching to a first rail on a first side of the patient support; a first arm having a first end and a second end, the first end pivotally connected to the first clamp; a second clamp for attaching to a second rail on a second side of the patient support; a second arm having a first end and a second end, the first end pivotally connected to the second clamp; Equipped with A mounting assembly, where an elongated support extends between the first arm and the second arm and supports a probe to be inserted into the patient. (Item 180) Item 179. The mounting assembly of item 179, wherein each of the first arm and the second arm is pivotally connected to the elongated support to accommodate variations in the distance between the first rail and the second rail. (Item 181) Item 181. The mounting assembly of item 180, wherein the first rail is substantially parallel to the second rail, and the first arm and the second arm are pivotally connected to the first clamp and the second clamp, respectively, enabling the first and second clamps to engage the first rail and the second rail in a substantially parallel configuration. (Item 182) a first coupler for pivotally connecting to the first clamp and a first arm, the first coupler configured to releasably couple to the first end of the first arm; and a second coupler for pivotally connecting to the second clamp and a second arm, the second coupler configured to releasably couple to the first end of the second arm; and Item 179. The mounting assembly of item 179, further comprising: (Item 183) Item 183. The mounting assembly of item 182, wherein the first coupler and the second coupler each have a longitudinal axis for receiving a first end of the arm and a pivot axis transverse to the longitudinal axis. (Item 184) Item 184. The mounting assembly of item 183, wherein the first coupler defines a first hollow cavity configured to receive a first end of the first arm and the second coupler defines a second hollow cavity configured to receive a first end of the second arm. (Item 185) Item 179. The mounting assembly of item 179, wherein each of the first clamp and the second clamp includes a first jaw and a second jaw, the first jaw and the second jaw configured for relative movement therebetween to securely connect to the rail. (Item 186) Item 186. The mounting assembly of item 185, wherein the first jaw is movable toward the second jaw using a lever. (Item 187) Item 180. The mounting assembly of item 179, wherein the first rail and the second rail comprise portions of one or more rails of the patient support, optionally the patient support comprising a bed. (Item 188) Item 179. The mounting assembly of item 179, wherein the first arm is configured to pivot relative to the first clamp and the second arm is configured to pivot relative to the second clamp to accommodate a variable space between the first rail on a first side of the patient support and the second rail on a second side of the patient support. (Item 189) Item 179. The mounting assembly of item 179, wherein the mounting assembly is configured to limit movement of the elongated support relative to the first rail and the second rail to 5 mm or less in response to a 150 kg load on the elongated support, and optionally, the movement is 3 mm or less in response to a 100 kg load on the elongated support. (Item 190) Item 179. The mounting assembly of item 179, wherein the elongated support, the first clamp, the first arm, the second clamp, and the second arm are configured to limit movement of the elongated support to 5 mm or less in response to a 150 kg load on the elongated support, and optionally, the movement is 3 mm or less in response to a 100 kg load on the elongated support. (Item 191) Item 191. The mounting assembly of item 190, wherein the probe to be inserted into the patient has a distance in the range of about 20 cm to about 60 cm, and the mounting assembly is configured to move the distal end of the probe no more than 6 mm in response to the load on the elongated support. (Item 192) Item 179. The mounting assembly of item 179, further comprising a robotic arm attached to the extension support. (Item 193) Item 193. The mounting assembly of item 192, wherein the probe is connected to the robotic arm. (Item 194) Item 194. The mounting assembly of item 193, wherein the probe comprises one or more of a treatment probe or an imaging probe. (Item 195) Item 195. The mounting assembly of item 194, wherein the robotic arm comprises a first robotic arm attached to the elongated support and a second robotic arm. (Item 196) Item 196. The mounting assembly of item 195, wherein the treatment probe is coupled to the first robotic arm and the imaging probe is coupled to the second robotic arm. (Item 197) Item 197. The mounting assembly of item 196, wherein the treatment probe and the imaging probe are aligned with one another so as to be substantially coplanar. (Item 198) Item 179. The mounting assembly of item 179, further comprising one or more extendable legs connected to one or more of the elongated support, the first arm, the second arm, the first clamp, or the second clamp and extending downwardly therefrom to engage a floor surface. (Item 199) Item 180. The mounting assembly of item 179, further comprising an extendable leg connected to the elongated support and extending downwardly therefrom to engage a floor surface. (Item 200) Item 179. The mounting assembly of item 179, further comprising a first extendable leg connected to the first clamp and extending downward therefrom to engage a floor surface, and a second extendable leg connected to the second clamp and extending downward therefrom to engage a floor surface. (Item 201) Item 179. The mounting assembly of item 179, further comprising a third clamp for engaging the first rail and a fourth clamp for engaging the second rail, the first clamp coupled to the third clamp with a first brace extending therebetween to distribute a first load along the first rail, and the second clamp coupled to the fourth clamp with a second brace extending therebetween to distribute a first load along the second rail. (Item 202) Item 180. The mounting assembly of item 179, wherein the elongated support comprises a crossbar extending between the first arm and the second arm. (Item 203) 1. A system for treating target tissue at a target site in a patient, the system comprising: A mounting assembly according to any one of items 179-198; a first robotic arm coupled to the elongated support; a treatment probe coupled to the first robotic arm; a second robotic arm coupled to the elongated support; and an imaging probe coupled to the second robotic arm; The system comprises: (Item 204) The system described in item 203, wherein the treatment probe is coupled to a linkage configured to translate the treatment probe along an extension axis and rotate the treatment probe about the extension axis while the end of the first robotic arm remains stationary, and the imaging probe is coupled to a linkage configured to translate the imaging probe along the extension axis of the imaging probe while the end of the second robotic arm remains stationary. (Item 205) 204. The system of claim 203, wherein the first robotic arm comprises a first plurality of joints for translating and rotating the treatment probe, and the second robotic arm comprises a second plurality of joints for translating and rotating the treatment probe. (Item 206) Item 204. The system of item 203, wherein each of the robotic arms has 5 to 7 degrees of freedom. (Item 207) 1. A system for treating a patient, the system comprising: A robot arm; a probe for coupling to the robotic arm, the probe being sized and shaped for insertion into the patient; and a plurality of sensors coupled to the robot arm, the plurality of sensors indicating a relative position and orientation of the probe with respect to the robot arm when the probe is decoupled from the robot arm; a processor operatively coupled to the robotic arm and to the plurality of sensors; Equipped with The system, wherein the processor is configured with instructions for moving the robotic arm to an engagement position and orientation and engaging the probe with the robotic arm. (Item 208) Item 208. The system of item 207, wherein the processor is configured with instructions for exploring the probe with the robotic arm and engaging the probe with the robotic arm. (Item 209) Item 209. The system of item 208, wherein the processor is configured with instructions for exploring the probe with the robotic arm while a user holds the probe steady with the probe inserted into the patient, and optionally, a gap extends between the probe and the robotic arm prior to exploring the probe, and a distal end portion of the robotic arm contacts and engages the probe. (Item 210) Item 208. The system of item 207, wherein the robotic arm is provided with an engagement structure for engaging the probe, and the probe is provided with an engagement structure for engaging the robotic arm at the engagement position and orientation. (Item 211) Item 211. The system of item 210, wherein the processor is configured with instructions to move the robot arm to an orientation corresponding to the engagement orientation prior to contacting the probe, and to translate the robot arm over the probe in the engagement orientation. (Item 212) Item 208. The system of item 207, wherein the plurality of sensors comprises a coarse sensor for the robotic arm to sense the probe at a long distance and a proximity sensor, and optionally the plurality of sensors are located on the robotic arm. (Item 213) Item 213. The system of item 212, wherein the coarse sensor comprises an infrared transmitter and a beacon. (Item 214) Item 213. The system of item 212, wherein the coarse sensor comprises an infrared transmitter and a beacon. (Item 215) Item 208. The system of item 207, wherein the plurality of sensors comprises a sensor array coupled to the robot arm and one or more fiducials on the probe for determining a position and orientation of the probe with respect to the robot arm. (Item 216) Item 208. The system of item 207, wherein the plurality of sensors are oriented toward the probe when the probe is engaged with the robotic arm. (Item 217) 1. A system for treating a patient, the system comprising: A robot arm; a probe for coupling to the robotic arm, the probe sized and shaped for insertion into the patient; and a plurality of sensors coupled to the probe between a distal end of the probe and an engagement structure for coupling to a robotic arm; a processor operatively coupled to the robotic arm and to the plurality of sensors; Equipped with The system, wherein the processor is configured with instructions to move the robotic arm in response to user input detected from the plurality of sensors. (Item 218) Item 218. The system of item 217, wherein the processor is configured with instructions for establishing a zero gravity mode with the probe in a freestanding configuration on the robotic arm prior to inserting the probe into the patient, the zero gravity mode being configured to drive a joint of the robotic arm with a force to substantially counter a weight of the robotic arm with the probe coupled on the arm. (Item 219) Item 218. The system of item 217, wherein the user input comprises a distortion detected using the plurality of sensors, the distortion comprising a distortion associated with a deflection of the probe between the distal end and the engagement structure. (Item 220) 218. The system of claim 217, wherein the probe comprises an elongate probe sized and shaped for insertion into the patient. (Item 221) Item 221. The system of item 220, wherein the probe comprises an extension portion for the user to grasp between the plurality of sensors and the distal end of the probe, and wherein tissue resistance to insertion of the probe pushes against the insertion force from the user's hand, reducing input to the plurality of sensors and reducing advancement of the probe into the patient. (Item 222) Item 222. The system of item 221, wherein the resistance of the tissue to insertion is sensed by the user with reduced advancement of the probe. (Item 223) Item 218. The system of item 217, wherein the plurality of sensors and the probe are arranged to provide tactile feedback to the user when the probe encounters resistance to movement. (Item 224) Item 218. The system of item 217, wherein the robotic arm comprises a plurality of joints and a plurality of internal joint sensors, the processor is configured to implement a passive mode of the probe and enable the user to insert the probe into the patient, and the processor is configured to provide a reaction force to the plurality of internal joints to stabilize the arm in the passive mode. (Item 225) Item 218. The system of item 217, wherein one or more of the probe or the distal portion of the robot arm is equipped with an inertial measurement unit ("IMU") for detecting movement of the probe, and optionally the processor is configured to receive output from the IMU and determine the position and orientation of the probe. (Item 226) Item 226. The system of item 225, wherein the probe is configured to be mounted on the arm at a predetermined position and orientation relative to the IMU to determine a position and orientation of the probe in response to the position and orientation of the IMU, and optionally the IMU is coupled to the arm at a predetermined position and orientation relative to a distal end of the arm. (Item 227) Item 226. The system of item 225, wherein the processor is configured to receive output from the IMU and outputs from the plurality of sensors and determine one or more of a position or orientation for moving the probe. (Item 228) Item 226. The system of item 225, wherein the probe is configured for the user to grasp the probe and the sensor, and the processor is configured to determine the user input in response to the user grasping the probe. (Item 229) 1. A system for treating a patient, the system comprising: a sheath sized and shaped for insertion into the patient, the sheath comprising an elongate shaft; an arm coupled to the sheath; a treatment probe comprising an energy source, the treatment probe comprising an elongated shaft, the treatment probe sized and shaped for insertion into a lumen of the sheath; a robotic arm coupled to the treatment probe; Equipped with The robotic arm is configured to align the extension axis of the treatment probe with the extension axis of the sheath and advance the treatment probe into the sheath. (Item 230) Item 230. The system of item 229, wherein the robotic arm coupled to the treatment probe is configured to align the axis of the treatment probe with the axis of the sheath prior to advancing the treatment probe into the sheath. (Item 231) 230. The system of claim 229, wherein the robotic arm is equipped with a sensor for determining an orientation of the treatment probe, and optionally the sensor is equipped with one or more of an accelerometer, a gyroscope, or an inertial measurement unit. (Item 232) Item 230. The system of item 229, wherein the arm coupled to the sheath comprises a sensor for determining an orientation of the sheath, and optionally the sensor comprises one or more of an accelerometer, a gyroscope, or an inertial measurement unit. (Item 233) Item 230. The system of item 229, wherein the arm coupled to the sheath comprises a robotic arm. (Item 234) 230. The system of claim 229, wherein the sheath has a proximal opening for receiving the treatment probe and a distal opening, the treatment probe having a length sufficient to extend to at least the distal opening. (Item 235) Item 235. The system of item 234, wherein the treatment probe is dimensioned so that the energy source extends to at least the distal opening when the treatment probe is advanced into the sheath. (Item 236) Item 236. The system of item 235, wherein the energy source extends to at least the distal opening with a gap between an end portion of the robotic arm and the sheath. (Item 237) Item 230. The system of item 229, wherein the sheath comprises a rigid sheath. (Item 238) Item 230. The system of item 229, wherein the sheath comprises an irrigation lumen coupled to the one or more openings for providing irrigation fluid through the one or more openings. (Item 239) Item 230. The system of item 229, wherein the sheath includes an aspiration channel extending to an opening in the lumen for aspirating excised tissue from the lumen. (Item 240) Item 230. The system of item 229, wherein the lumens of the sheath are sized to receive the treatment probe, an endoscopic camera and aspiration lumen, and an irrigation lumen. (Item 241) Item 241. The system of item 240, wherein the suction lumen extends to an opening for aspirating tissue ablation products. (Item 242) Item 241. The system of item 240, wherein the irrigation lumen extends to an opening for cleaning the treatment site. (Item 243) Item 241. The system of item 240, wherein the suction lumen and the irrigation lumen comprise lumens of a dual lumen tube. (Item 244) Item 230. The system of item 229, wherein the treatment probe comprises a stiff portion for advancement into the sheath. (Item 245) Item 230. The system of item 229, wherein the treatment probe comprises a flexible portion for advancement into the sheath. (Item 246) Item 230. The system of item 229, wherein the treatment probe is configured to rotate and translate the energy source. (Item 247) Item 247. The system of item 246, wherein the energy source comprises one or more of a laser beam, a water jet, an electrode, or an ultrasonic transducer. (Item 248) Item 247. The system of item 246, wherein the robotic arm is configured to rotate the energy source. (Item 249) Item 247. The system of item 246, wherein the treatment probe is coupled to a linkage mounted on the robotic arm for rotating the treatment probe. (Item 250) Item 250. The system of item 249, wherein the linkage is configured to translate the treatment probe. (Item 251) Item 241. The system of item 240, wherein the endoscopic camera comprises a lens and a sensor array configured to view the treatment probe when advanced into the sheath. (Item 252) Item 252. The system of item 251, wherein the endoscopic camera is coupled to a linkage for advancing and retracting the endoscopic camera. (Item 253) Item 253. The system of item 252, wherein the linkage is coupled to the robotic arm. (Item 254) Item 253. The system of item 252, wherein the endoscopic camera comprises a flexible extension configured to couple to the linkage with sufficient column strength to advance and retract the endoscopic camera within the lumen. (Item 255) Item 253. The system of item 252, wherein the endoscopic camera comprises a rigid extension configured to couple to the linkage. (Item 256) Item 230. The system of item 229, further comprising an arm coupled to the ultrasound probe. (Item 257) Item 257. The system of item 256, wherein the arm coupled to the ultrasound probe comprises a robotic arm. (Item 258) Item 258. The system of item 257, wherein the robotic arm coupled to the ultrasound probe is configured to position a field of view of the ultrasound probe to image the treatment probe. (Item 259) Item 259. The system of item 258, wherein the robotic arm coupled to the ultrasound probe is configured to move the ultrasound probe in response to a position of the treatment probe. (Item 260) Item 257. The system of item 256, wherein the ultrasound probe comprises a transrectal ultrasound (TRUS) probe. (Item 261) 257. The system of claim 256, wherein the ultrasound probe comprises a linkage that translates and rotates the ultrasound probe to position the treatment probe within a field of view of the ultrasound probe. (Item 262) Item 230. The system of item 229, further comprising a coupling assembly configured to couple to an end portion of the robotic arm, the coupling assembly configured to couple the treatment probe to the robotic arm. (Item 263) The system described in Item 262, wherein the coupling assembly is configured to couple to an end portion of the robot arm at an orientation relative to the end portion of the robot arm to establish an orientation of the treatment probe relative to the end portion of the robot arm, and optionally, the orientation of the coupling assembly relative to the end portion comprises a predetermined orientation. (Item 264) Item 264. The system of item 263, wherein the coupling assembly comprises an engagement structure for coupling to the end of the robotic arm, the robotic arm comprising a corresponding engagement structure. (Item 265) Item 263. The system of item 262, wherein the coupling assembly is configured to rotate the treatment probe while the end portion of the robotic arm remains stationary. (Item 266) Item 266. The system of item 265, wherein the coupling assembly is configured to translate the treatment probe while the end portion of the robotic arm remains stationary. (Item 267) Item 267. The system of item 266, wherein the coupling assembly is configured to translate an endoscopic camera while the end portion of the robot assembly remains stationary. (Item 268) Item 267. The system of item 266, wherein the coupling assembly is configured to translate the distal opening of the irrigation lumen while the end portion of the robotic assembly remains stationary. (Item 269) Item 267. The system of item 266, wherein the coupling assembly is configured to translate the distal opening of the aspiration lumen while the end portion of the robotic assembly remains stationary. (Item 270) Item 263. The system of item 262, wherein the coupling assembly is configured to translate the treatment probe, endoscopic camera, irrigation lumen, and suction lumen together. (Item 271) Item 263. The system of item 262, wherein the coupling assembly is configured to independently translate the treatment probe, the endoscopic camera, the irrigation lumen, and the suction lumen. (Item 272) Item 230. The system of item 229, further comprising a processor coupled to the robotic arm. (Item 273) Item 273. The system of item 272, wherein the processor is configured with instructions for advancing the treatment probe into the sheath. (Item 274) Item 273. The system of item 272, wherein the processor is configured to align the extension axis of the treatment probe with the extension axis of the sheath. (Item 275) Item 275. The system of item 274, wherein the processor is configured with instructions to receive an input indicating that the extension axis of the treatment probe is aligned with the extension axis of the sheath, and to advance the treatment probe along the extension axis of the sheath in response to the input. (Item 276) 273. The system of claim 272, wherein the processor is configured to determine an orientation of the rigid sheath, the processor configured with instructions to orient the treatment probe at the orientation of the sheath. (Item 277) Item 277. The system of item 276, wherein the arm coupled to the sheath comprises a sensor for determining an orientation of the sheath. (Item 278) Item 277. The system of item 276, wherein the processor is configured to determine the orientation of the sheath from a joint state of the arm coupled to the sheath. (Item 279) Item 277. The system of item 276, wherein the robotic arm is equipped with a sensor for determining an orientation of the treatment probe. (Item 280) A coupling assembly configured at an end portion of the robot arm, the coupling assembly comprising: a structure for receiving a treatment probe; an engagement structure for coupling to an end portion of a robotic arm and for establishing an orientation of the treatment probe relative to the end portion of the robotic arm; A coupling assembly comprising: (Item 281) Item 281. The coupling assembly of item 280, wherein an orientation of the coupling assembly with respect to the end portion comprises a predetermined orientation to establish a predetermined orientation of the probe relative to the end portion of the robotic arm. (Item 282) Item 281. The coupling assembly of item 280, wherein the robotic arm is provided with corresponding engagement structure. (Item 283) Item 281. The coupling assembly of item 280, wherein the coupling assembly is configured to rotate the treatment probe while the end portion of the robotic arm remains stationary. (Item 284) Item 284. The coupling assembly of item 283, wherein the coupling assembly is configured to translate the treatment probe while the end portion of the robotic arm remains stationary. (Item 285) Item 281. The coupling assembly of item 280, wherein the coupling assembly is configured to translate an endoscopic camera while the end portion of the robot assembly remains stationary. (Item 286) Item 281. The coupling assembly of item 280, wherein the coupling assembly is configured to translate a distal opening of an irrigation lumen while the end portion of the robotic assembly remains stationary. (Item 287) Item 281. The coupling assembly of item 280, wherein the coupling assembly is configured to translate a distal opening of an aspiration lumen while the end portion of the robotic assembly remains stationary. (Item 288) Item 281. The coupling assembly of item 280, wherein the coupling assembly is configured to translate the treatment probe, endoscopic camera, irrigation lumen, and suction lumen together while the end portion of the robotic arm remains stationary. (Item 289) Item 281. The coupling assembly of item 280, wherein the coupling assembly is configured to independently translate the treatment probe, endoscopic camera, irrigation lumen, and suction lumen while the end portion of the robotic arm remains stationary. (Item 290) The coupling assembly of item 280, wherein the coupling assembly includes one or more linkages for moving the treatment probe, endoscopic camera, irrigation lumen, or suction lumen together while the end portion of the robotic arm remains stationary. (Item 291) 1. A method of treating a patient, the method comprising: aligning an extension axis of the treatment probe with an extension axis of the sheath; receiving an input indicating that the extension axis of the treatment probe has been aligned with the extension axis of the sheath; advancing the treatment probe along the elongation axis of the sheath in response to the input; A method comprising: (Item 292) The system or method of any one of claims 1-291, wherein the passive mode comprises a zero gravity mode. (Item 293) The system or method of any one of items 1-292, further comprising a sensor coupled to a clamp, the clamp configured to couple to a rail, and the sensor configured to measure a load on one or more of the clamp, the rail, or a support coupled to a robot arm. (Incorporated by reference)

[0016] All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference. [Brief description of the drawings]

[0017] The novel features of the invention are set forth with particularity in the appended claims. A further understanding of the features and advantages of the present disclosure will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the disclosure are utilized, and the accompanying drawings.

[0018] [Figure 1] FIG. 1 shows a front view of a system for performing tissue ablation in a patient, according to some embodiments.

[0019] [Diagram 2] FIG. 2 diagrammatically illustrates a system for performing tissue ablation in a patient, according to some embodiments.

[0020] [Diagram 3] 3A and 3B show perspective views of a common base or mount for supporting one or more robotic arms, according to some embodiments.

[0021] [Figure 4A] 4A and 4B illustrate perspective and side views, respectively, of a system for performing tissue ablation on a patient with a mobile base, according to some embodiments. [Figure 4B] 4A and 4B illustrate perspective and side views, respectively, of a system for performing tissue ablation on a patient with a mobile base, according to some embodiments.

[0022] [Diagram 5] 5A and 5B show top views of the coupling between a treatment probe and a first robotic arm according to some embodiments, with FIG. 5A showing the treatment probe and first robotic arm uncoupled and FIG. 5B showing the treatment probe and first robotic arm coupled.

[0023] [Figure 6] FIG. 6 shows a flow chart for a method of operating a robotic arm coupled to a treatment probe, according to some embodiments.

[0024] [Figure 7] FIG. 7 illustrates a method of operating a robotic arm coupled to an imaging probe, according to some embodiments.

[0025] [Figure 8A] FIG. 8A illustrates a configuration of a treatment probe and an imaging probe during treatment of a patient, according to some embodiments.

[0026] [Figure 8B] FIG. 8B is a schematic diagram of a robotic arm with a probe and a force detection sensor, according to some embodiments.

[0027] [Figure 9] 9A, 9B, and 9C diagrammatically illustrate alignment of a treatment probe axis with a sagittal plane of an imaging probe, according to some embodiments.

[0028] [Figure 10] FIG. 10 shows an intraoperative image of a surgical field including identification of a bleeding site, according to some embodiments.

[0029] [Figure 11A] 11A, 11B, and 11C show side, front, and perspective views, respectively, of a system for performing tissue ablation on a patient, according to some embodiments, the system including a treatment couch coupled to a system of sliders and mounts for positioning imaging and treatment probes. [Figure 11B] 11A, 11B, and 11C show side, front, and perspective views, respectively, of a system for performing tissue ablation on a patient, according to some embodiments, the system including a treatment couch coupled to a system of sliders and mounts for positioning imaging and treatment probes. [Figure 11C] 11A, 11B, and 11C show side, front, and perspective views, respectively, of a system for performing tissue ablation on a patient, according to some embodiments, the system including a treatment couch coupled to a system of sliders and mounts for positioning imaging and treatment probes.

[0030] [Figure 12] FIG. 12 illustrates a perspective view of a treatment system for performing tissue ablation on a patient, according to some embodiments, comprising a mobile cart with a display and a common robotic arm base for the robotic arm to actuate imaging and treatment probes.

[0031] [Figure 13] FIG. 13 illustrates a perspective view of a treatment system for performing tissue ablation, according to some embodiments.

[0032] [Figure 14] 14A, 14B, and 14C illustrate perspective views of a clamp for use with a treatment system, according to some embodiments.

[0033] [Figure 15]15A, 15B, 15C, and 15D illustrate perspective internal views of a clamp for use with a treatment system, according to some embodiments.

[0034] [Figure 16] 16A, 16B, 16C, and 16D illustrate side internal views of a clamp for use with a treatment system, according to some embodiments.

[0035] [Figure 17] 17A, 17B, and 17C illustrate perspective, side, and oblique views, respectively, of a fastening system according to some embodiments.

[0036] [Figure 18] 18A and 18B illustrate perspective views of a crossbar with a mount for use with a treatment system, according to some embodiments.

[0037] [Figure 19] 19A and 19B illustrate perspective views of a crossbar with a mount for use with a treatment system, according to some embodiments.

[0038] [Figure 20] FIG. 20 illustrates a perspective view of a control handle, according to some embodiments.

[0039] [Figure 21] FIG. 21 illustrates a plan view of an imaging probe and a therapy probe coupled to their respective control handles and showing coplanarity, according to some embodiments.

[0040] [Figure 22] FIG. 22 illustrates a perspective view of a system for positioning imaging and therapy probes, the system including a clamp, a brace, and a robotic arm, according to some embodiments.

[0041] [Figure 23] FIG. 23 illustrates a side view of a system for positioning an imaging and therapy probe, according to some embodiments.

[0042] [Figure 24] FIG. 24 illustrates a perspective view of a treatment system including a wheeled probe mounting and adjustment assembly, according to some embodiments.

[0043] [Diagram 25] FIG. 25 illustrates a system for positioning and calibrating one or more probes, according to some embodiments.

[0044] [Figure 26] FIG. 26 illustrates an arm coupled to a sheath, a robotic arm coupled to a treatment probe, and an arm coupled to an ultrasound probe, according to some embodiments.

[0045] [Figure 27] FIG. 27 illustrates a system including a robotic arm coupled to a treatment probe and an arm coupled to a sheath, as in FIG.

[0046] [Figure 28A] FIG. 28A illustrates a coupling for coupling the robotic arm to the treatment probe.

[0047] [Figure 28B] FIG. 28B illustrates the movement of the treatment probe, endoscope, irrigation lumen, and aspiration lumen provided by a joint such as that of FIG. 28A.

[0048] [Figure 29] FIG. 29 illustrates a method of treatment, according to some embodiments. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0049] The embodiments of the present disclosure provide improved methods and devices for performing tissue treatments such as tissue ablation, e.g., prostate tissue ablation. The methods and devices disclosed herein are well suited for many types of surgical procedures and can be incorporated into many previous systems and methods. Although some embodiments of the present disclosure are directed to transurethral treatment of the prostate, some aspects of the present disclosure can also be used to treat and modify other tissues and associated organs, such as the brain, heart, lungs, intestines, eyes, skin, kidneys, liver, pancreas, stomach, uterus, ovaries, testes, bladder, ears, nose, mouth, bone marrow, adipose tissue, muscle, glandular and mucosal tissue, spinal cord and nerve tissue, soft tissues such as cartilage, hard biological tissues such as teeth, bones, and body lumens and passageways such as sinuses, ureters, colon, esophagus, lung passageways, blood vessels, and throat. The devices disclosed herein can be inserted through existing body lumens or through openings created in body tissues.

[0050] The disclosed method and device are highly suitable for treating many types of tissue with an energy source. The tissue may comprise soft tissue, such as glandular or capsular tissue, or hard tissue, such as bone or obstructions, such as kidney stones. The energy source may comprise one or more of a laser beam, water jet, electrode, ultrasound, high intensity focused ultrasound, mechanical vibration, radio frequency (RF) energy, ultrasonic transducer, microwave energy, cavitation energy, such as cavitation water jet or ultrasonic cavitation, radiation, such as ionizing radiation from a radioisotope, or ion energy from an ionizing electrode, or plasma energy from a plasma electrode. The disclosed method and device are highly suitable for performing lithotripsy, for example, and breaking up kidney stones. The disclosed method and device are highly suitable for treatment with radiation, such as a radioisotope on a treatment probe. Radiation treatment can be provided on the probe, removed with the probe, or implanted from the treatment probe, for example, for the treatment of cancer.

[0051] In some embodiments, the image-guided therapy system includes a therapy probe and an imaging probe. The imaging probe may be configured to provide images of the target site while the therapy probe performs ablation of the target tissue. Each of the therapy probe and the imaging probe may be coupled to a robotic arm under the control of one or more computing devices to enable more precisely controlled movement of one or both of the arms and to improve the safety and efficiency of therapy using the therapy system.

[0052] The robotic arm can be configured in many ways. Research relevant to this disclosure suggests that the TRUS probe may exert a force on the robotic arm. In some embodiments, this force is related to a force from the patient on the probe. In some embodiments, this force is related to a force caused by the operating surgeon moving the probe relative to tissue, displacing tissue, for purposes of improving imaging or tissue position relative to the intended treatment. The length of the probe may result in a corresponding torque on the robotic arm.

[0053] The inventors have conducted experiments to determine the amount of force from a TRUS probe that can be applied to a robotic arm. This force can be measured, for example, at a motor mount external to the patient. The force can range from 0 to about 5 kilograms, depending on the surgical placement of the probe and the patient. In some embodiments, the distance from the arm to the point of contact with the prostate corresponds to the amount of torque on the arm.

[0054] Instrument positioning can have three categories of motion control and capabilities according to some embodiments disclosed herein. The three categories of motion generally include: 1) coarse motion capabilities for movement, retraction, and preparation for surgery, 2) intermediate motion capabilities for aligning the probe with and inserting the probe into the patient, and 3) fine motion capabilities to accommodate positional tolerances for precision surgery.

[0055] The coarse motion capability allows for retraction below and adjacent to the table, for example, during patient positioning.

[0056] The intermediate motions allow for instrument positioning relative to a surgical support structure, e.g., a patient on an operating room ("OR") table, for example, when the system is prepared and positioned for patient entry. A typical range of positions for a TRUS probe or any suitable surgically invasive probe is one that has free motion for insertion into a patient, which may be described using an X, Y, Z coordinate system. With an appropriate coordinate reference system, entry into the patient's lumen may correspond to values ​​of 0, 0, 0 in the X, Y, Z coordinate system. The coordinate reference may also include angular coordinate references of X', Y', Z'. Entry into the lumen may include the patient's anus. With the anal inlet at 0, 0, 0 and the probe collinear with the patient axis, the intermediate motions may include an X motion tolerance of + / - 2 to 15 cm, a Y motion tolerance of + / - 2 to 15 cm, and a Z motion tolerance of + / - 2 to 30 cm. In some embodiments, the X and Y motions correspond to translation of the probe along the X and Y coordinate references. The Z-axis position corresponds to movement along the axis of the lumen and may correspond to advancement and retraction of the probe along the body lumen, e.g., translation into and out of the patient. With X', Y', Z' angular adjustments, the angular position capabilities may comprise X' + / - 0 to 30 degrees, Y' + / - 0 to 30 degrees, and Z' + / - 0 to 30 degrees relative to the patient's natural axes. Research relevant to the present disclosure suggests that a probe with these angle capabilities may be manipulated by a user for insertion into a patient.

[0057] In some embodiments, the fine movement capabilities and tolerances correspond to the configuration of the robotic probe and arm when the probe is positioned within the patient, for example, during tissue ablation and imaging. When the system is used in conjunction with instruments positioned for diagnosis and therapy, the sensors and controls described herein can be configured to prevent tissue damage and also position the therapy and imaging probes to obtain reliable images, for example, optimal images, and the therapy and imaging probes can be precisely positioned and held rigidly in place against tissue pressure. The X, Y, Z reference frame can be centered on the lumen entrance (and the probe collinear with the patient axis) at 0,0,0. In some embodiments, the X motion tolerance is + / -0 to 5 cm, the Y motion tolerance is + / -0 to 5 cm, and the Z motion tolerance is + / -0 to 15 cm. The X and Y motions generally correspond to the translation of the probe, and the Z axis corresponds to the advancement and retraction of the probe into and out of the patient. The corresponding angular adjustment ranges for X', Y', Z' are, for example, X' + / - 0 to 10 degrees, Y' + / - 0 to 10 degrees, and Z' + / - 0 to 15 degrees relative to the patient's natural axes, with reference to the patient's midline with the Z axis running along the patient's midline. While the above values ​​represent the range of motion, the robotic arm and surgical probe may provide tighter tolerances for fixed position configurations of the probe. For example, when the probe is intended to be held in a fixed position, rotational tolerances can be maintained within or less than + / - 5° tolerance, e.g., + / - 3°, for one or more of X', Y', Z'. For translation, the manually set position can be maintained to a positional tolerance of, for example, 5 mm or less, 3 mm or less, or 2 mm or less for one or more of the X, Y, Z axes. In some embodiments, these tolerances are maintained for X, Y, Z and X', Y', Z'. In some embodiments, the probe is manually set and translational and rotational tolerances are maintained within the values ​​above, which can improve the accuracy of tissue treatment and associated imaging. These tolerances may correspond, for example, to the maximum structural slack or load of the arm with the probe mounted thereon.

[0058] The probe can be manipulated and inserted into the patient in many ways. For example, the probe can be manipulated manually and the robotic arm can be moved to align with the probe and coupled to the probe, which maintains the above tolerances when released by the user, and the arm then supports the full weight of the patient and the probe. The arm can be aligned with the probe manually or with at least some automation, where sensors and guidance circuitry are used to align the arm with the probe held by the user. The arm can include coupling structures for engaging the probe with six degrees of freedom, such that the coupling structures on the arm can be precisely aligned with the coupling structures on the probe. The coupling structures can then be engaged and coupled to each other in response to detection of the alignment. In some embodiments, sensors are provided on one or more of the arm or the probe to detect alignment between the arm and the probe, and the coupling structures are engaged in response to the detected alignment. The robotic arm can include a linkage coupled to a processor, which controls the movement of the arm and aligns the arm with the probe held by the user.

[0059] In some embodiments, the urethral probe has similar size, movement, and tolerance capabilities as the TRUS probe.

[0060] In some embodiments, the probe has a mass in the range of about 250 grams to 1,500 grams, and the arm maintains the tolerances described herein with a probe having a mass within this range.

[0061] A robotic arm as described herein can improve alignment between the therapy probe and the imaging probe, which may comprise the sagittal plane of the imaging TRUS probe. For example, the therapy probe can be aligned substantially in the same plane along the sagittal plane of the imaging probe. This coplanarity can provide imaging and alignment of the therapy probe and imaging probe coordinates. In some embodiments, the tolerance of this coplanarity is related to a combination of the width of the therapy probe and the width of the imaging surface capability, e.g., the width of the image captured using ultrasound beamforming. The relative position of the TRUS to the therapy probe can be substantially parallel and aligned within an angular tolerance. The alignment can be within a range of + / - 0 (parallel) to about 30 degrees. In some embodiments, the extension axes of the therapy probe and the TRUS probe are aligned in a substantially coplanar configuration, with the separation distance between the probes varying along the length of the imaging and therapy probes. For example, the distal tip of the therapy probe can be furthest away from the TRUS probe and the proximal end can be closer to the TRUS probe, with the two probes being angled relative to each other but substantially in the same plane. The inclination between the two probes may be related to the tissue constraints of each unique human natural ostium. The distance between the entrances to the naturally available ostium may vary, for example, within a range of about 5 cm to about 25 cm separation.

[0062] In some embodiments, the imaging probe and the therapy probe are aligned such that the therapy probe is within the field of view of the imaging probe. In some embodiments, the alignment is configured to maintain the therapy probe within the field of view of the imaging probe. In some embodiments, the therapy probe is configured to move to a position and the imaging probe is configured to maintain the therapy probe within the field of view.

[0063] FIG. 1 illustrates an exemplary embodiment of a system 400 for performing tissue ablation in a patient. The system 400 may include a treatment probe 450 and an imaging probe 460. The treatment probe 450 may be coupled to a first arm 442, and the imaging probe 460 may be coupled to a second arm 444. One or both of the first arm 442 and the second arm 444 may include a robotic arm whose movement may be controlled by one or more computing devices operably coupled to the arms. The treatment probe 450 may include a device for removing target tissue from a target site within a patient. The treatment probe 450 may be configured to deliver sufficient energy from the treatment probe 450 to the target tissue to remove the target tissue. For example, the treatment probe 450 may include an electrosurgical ablation device, a laser ablation device, a transurethral needle ablation device, a water jet ablation device, or any combination thereof. The imaging probe 460 may be configured to deliver sufficient energy from the imaging probe 460 to the target tissue to image the target tissue. The imaging probe 460 may comprise, for example, an ultrasound probe, a magnetic resonance probe, an endoscope, or a fluoroscopy probe. The first arm 442 and the second arm 444 may be configured to be independently adjustable, adjustable according to a fixed relationship, adjustable according to a user-selected relationship, independently lockable, or simultaneously lockable, or any combination thereof. The first arm 442 and the second arm 444 may have multiple degrees of freedom, for example, six degrees of freedom, for manipulating the treatment probe 450 and the imaging probe 460, respectively. The treatment system 400 may be used to perform tissue ablation in a patient's organ, such as the patient's prostate. The patient may be positioned on a patient support 449, such as a bed, table, chair, or platform. The treatment probe 450 may be inserted into a target site of the patient along an entry axis that coincides with the treatment probe's extension axis 451. For example, the treatment probe 450 may be configured for insertion into the patient's urethra to position the energy delivery region of the treatment probe within the patient's prostate.The imaging probe 460 may be inserted into the patient at or adjacent to the patient's target site along an entry axis coinciding with the imaging probe's extension axis 461. For example, the imaging probe 460 may comprise a transrectal ultrasound (TRUS) probe configured for insertion into the patient's rectum to view the patient's prostate and surrounding tissue. As shown in FIG. 1, the first arm 442 and the second arm 444 may be covered with a sterile drape to provide a sterile surgical environment, keep the robotic arms clean, and reduce the risk of damaging the robotic arms. Further details regarding various components of the system 400 suitable for incorporation with embodiments as disclosed herein may be found in U.S. Pat. Nos. 7,882,841, 8,814,921, 9,364,251, and PCT Publication No. WO2013 / 130895, the entire disclosures of which are incorporated herein by reference.

[0064] FIG. 2 diagrammatically illustrates an exemplary embodiment of a system 400 for performing tissue ablation on a patient. The system 400 includes a treatment probe 450 and may optionally include an imaging probe 460. The treatment probe 450 is coupled to a console 420 and a linkage 430. The linkage 430 may include one or more components of a robotic arm 442. The imaging probe 460 is coupled to an imaging console 490. The imaging probe may be coupled to a second robotic arm 444, for example. The patient treatment probe 450 and the imaging probe 460 can be coupled to a common base 440. The patient is supported using a patient support 449. The treatment probe 450 is coupled to the base 440 using a first arm 442. The imaging probe 460 is coupled to the base 440 using a second arm 444. One or both of the first arm 442 and the second arm 444 may comprise a robotic arm whose movement may be controlled by one or more computing devices operably coupled to the arm, as described in further detail herein.

[0065] Although a common base is referenced, the robotic arms can be coupled to a bedrail, a console, or any suitable support structure to support the base of the robotic arms.

[0066] In some embodiments, the system 400 includes a user input device 496 coupled to the processor 423 for a user to manipulate a surgical instrument on the robotic arm. The user input device 496 can be located in any suitable location, for example, on a console, on a robotic arm, on a mobile base, and there can be one, two, three, four, or more user input devices used in conjunction with the system 400 to provide either redundant means of input, unique input commands, or a combination. In some embodiments, the user input device includes a controller for moving the end of the treatment probe or imaging probe by movement in response to mechanical movement of the user input device. The end of the probe can be shown on the display 425, and the user can manipulate the end of the probe. For example, the user input device can include a six-degree-of-freedom input controller, where the user can move the input device in six degrees of freedom, and the distal end of the probe moves in response to movement of the controller. In some embodiments, the six degrees of freedom include three translational degrees of freedom and three rotational degrees of freedom. The processor can be configured with instructions for probe control to switch between automatic image-guided treatment with the energy source and treatment with the energy source, for example, by user movement of a user input device.

[0067] The patient is positioned on the patient support 449 so that the treatment probe 450 and the ultrasound probe 460 may be inserted into the patient. The patient may be positioned in one or more of a number of positions, such as, for example, prone, supine, upright, or inclined. In some embodiments, the patient may be positioned in a lithotomy position, for example, stirrups may be used. In some embodiments, the treatment probe 450 is inserted into the patient in a first direction on a first side of the patient, and the imaging probe is inserted into the patient in a second direction on a second side of the patient. For example, the treatment probe may be inserted into the patient's urethra from the front of the patient, and the imaging probe may be inserted transrectally into the patient's intestine from the rear of the patient. The treatment probe and the imaging probe may be positioned in the patient with one or more of urethral tissue, urethral wall tissue, prostate tissue, intestinal tissue, or intestinal wall tissue extending therebetween.

[0068] The treatment probe 450 and the imaging probe 460 can be inserted into a patient in one or more of many ways. During insertion, each of the first and second arms can have a substantially unlocked configuration such that the treatment or imaging probe can be rotated and translated as desired to insert the probe into the patient. When the probe is inserted at a desired location, the arms can be locked. In the locked configuration, the probes can be oriented relative to each other in one or more of many ways, such as, for example, parallel, skewed, horizontal, oblique, or non-parallel. To map the imaging probe image data to the treatment probe coordinate reference, it can be useful to determine the orientation of the probe using an angle sensor as described herein. Mapping the tissue image data to the treatment probe coordinate reference space can enable precise targeting and treatment of tissue identified for treatment by an operator, such as a physician.

[0069] In some embodiments, the treatment probe 450 is coupled to the imaging probe 460 to align the treatment with the probe 450 based on images from the imaging probe 460. The coupling can be accomplished with a common base 440 as shown. Alternatively, or in combination, the treatment probe and / or the imaging probe can include magnets to hold the probe in alignment through the patient's tissue. In some embodiments, the first arm 442 is a movable and lockable arm so that the treatment probe 450 can be positioned at a desired location within the patient. When the probe 450 is positioned at a desired location on the patient, the first arm 442 can be locked with an arm lock 427. The imaging probe can be coupled to the base 440 with a second arm 444, which can be used to adjust the alignment of the imaging probe when the treatment probe is locked in place. The second arm 444 can include a lockable and movable probe, for example, under the control of the imaging system, or a console and user interface. The movable arm 444 may be finely actuated so that the imaging probe 460 may be adjusted in relation to the treatment probe 450 with movements as small as, for example, one millimeter.

[0070] In some embodiments, the therapy probe 450 and the imaging probe 460 are coupled to angle sensors such that therapy can be controlled based on the alignment of the imaging probe 460 and the therapy probe 450. The first angle sensor 495 can be coupled to the therapy probe 450 with the support 438. The second angle sensor 497 can be coupled to the imaging probe 460. The angle sensor can comprise one or more of many types of angle sensors. For example, the angle sensor can comprise a goniometer, an accelerometer, and combinations thereof. In some embodiments, the first angle sensor 495 comprises a three-dimensional accelerometer for determining the orientation of the therapy probe 450 in three dimensions. In many embodiments, the second angle sensor 497 comprises a three-dimensional accelerometer for determining the orientation of the imaging probe 460 in three dimensions. Alternatively, or in combination, the first angle sensor 495 can comprise a goniometer for determining the angle of the therapy probe 450 along the extension axis 451 of the therapy probe. The second angle sensor 497 may comprise a goniometer for determining the angle of the imaging probe 460 along the extension axis 461 of the imaging probe 460. The first angle sensor 495 is coupled to the controller 424 of the treatment console 420. The imaging probe's second angle sensor 497 is coupled to the processor 492 of the imaging console 490. Alternatively, or in combination, the second angle sensor 497 may be coupled to the controller 424 of the treatment console 420.

[0071] The console 420 includes a display 425 that is coupled to a processor system among the components used to control the treatment probe 450. The console 420 includes a processor 423 having a memory 421. A communication circuit 422 is coupled to the processor 423 and the controller 422. The communication circuit 422 is coupled to the imaging console 490 via a communication circuit 494 of the imaging console. An arm lock 427 of the console 420 may be coupled to the first arm 442 to lock the first arm or to allow the first arm to be freely movable for inserting the probe 450 into a patient.

[0072] Optionally, the console 420 may include components of an endoscope 426 that are coupled to anchors 24 of the treatment probe 450. The endoscope 426 may include components of the console 420 and an endoscope that is insertable with the treatment probe 450 to treat a patient.

[0073] Optionally, the console 420 may include one or more of modules operably coupled to the treatment probe 450 to control aspects of treatment with the treatment probe. For example, the console 420 may include one or more of an energy source 22 for providing energy to the treatment probe, a balloon inflation control 26 for affecting inflation of a balloon used to anchor the treatment probe at the target treatment site, an injection / irrigation control 28 for controlling injection and irrigation of the probe, an aspiration control 30 for controlling suction by the probe, an insufflation control 32 for controlling insufflation of the target treatment site (e.g., the prostate), or a light source 33, such as an infrared, visible, or ultraviolet light source, for providing light energy to the treatment probe.

[0074] The processor, controller, and control electronics and circuitry may include one or more of many suitable components, such as one or more processors, one or more field programmable gate arrays (FPGAs), and one or more memory storage devices. In some embodiments, the control electronics controls a graphic user interface (hereinafter "GUI") control panel to provide pre-procedure planning according to user-defined treatment parameters, as well as to provide user control over the surgical procedure.

[0075] The treatment probe 450 may include an anchor 24. The anchor 24 may anchor a distal end of the probe 450 while energy is delivered to the energy delivery region 20 with the probe 450. The probe 450 may include a nozzle 200.

[0076] The treatment probe 450 may be coupled to the first arm 442 using a linkage 430. The linkage 430 may comprise components for moving the energy delivery region 20 to a desired target location on the patient, for example, based on an image of the patient. The linkage 430 may comprise a first portion 432, a second portion 434, and a third portion 436. The first portion 432 may comprise a substantially fixed tether portion. The substantially fixed tether portion 432 may be fixed to a support 438. The support 438 may comprise a reference frame for the linkage 430. The support 438 may comprise a rigid chassis or frame or housing for rigidly or rigidly coupling the first arm 442 to the treatment probe 450. The first portion 432 may remain substantially fixed, while the second portion 434 and the third portion 436 may move and direct energy from the probe 450 to the patient. The first portion 432 may be fixed a substantially constant distance 437 to the anchor 24. The substantially fixed distance 437 between the anchor 24 and the fixed first portion 432 of the linkage allows the treatment to be precisely placed. The first portion 432 may include a linear actuator for precisely positioning the high pressure nozzle 200 within the energy delivery region 20 at a desired axial location along the extension axis 451 of the treatment probe 450.

[0077] The extension axis 451 of the probe 450 generally extends between a proximal portion of the probe 450 near the linkage 430 and a distal end having an anchor 24 attached thereto. The third portion 436 can control a rotation angle 453 about the extension axis 451. During treatment of a patient, a distance 439 between the energy delivery area 20 and the first portion 432 of the linkage can vary with reference to the anchor 24. The distance 439 can be adjusted in a manner 418 responsive to a computer control to set a target location along the extension axis 451 of the treatment probe with reference to the anchor 24. The first portion of the linkage remains fixed while the second portion 434 adjusts the position of the energy delivery area 20 along the axis 451. The third portion of the linkage 436 adjusts the angle 453 about the axis with reference to the controller 424 so that the distance along the axis in the angle of treatment can be very precisely controlled with reference to the anchor 24. The probe 450 may comprise a rigid member, such as a spine, extending between the support 438 and the anchor 24 such that the distance from the linkage 430 to the anchor 24 remains substantially constant during treatment. The treatment probe 450 is coupled to a treatment component as described herein to enable treatment with one or more forms of energy, such as mechanical energy from a jet, electrical energy from an electrode, or light energy from a light source, such as a laser source. The light source may comprise infrared, visible, or ultraviolet light. The energy delivery region 20 may be moved under the control of the linkage 430, such as to deliver a desired form of energy to the target tissue of the patient.

[0078] The imaging console 490 may include a memory 493, a communication circuit 494, and a processor 492. The processor 492 in corresponding circuitry is coupled to the imaging probe 460. An arm controller 491 is coupled to the arm 444 for precisely positioning the imaging probe 460. The imaging console may further include a display 425.

[0079] To facilitate precise control of the treatment probe and / or imaging probe during treatment of a patient, each of the treatment probe and imaging probe may be coupled to a robotic computer-controllable arm. For example, with reference to the system 400 shown in FIG. 2, one or both of the first arm 442 coupled to the treatment probe 450 and the second arm 444 coupled to the imaging probe 460 may comprise a robotic computer-controllable arm. The robotic arm may be operably coupled to one or more computing devices configured to control the movement of the robotic arm. For example, the first robotic arm 442 may be operably coupled to the processor 423 of the console 420, or the second robotic arm 444 may be operably coupled to the processor 492 of the imaging console 490 and / or to the processor 423 of the console 420. The one or more computing devices, such as the processors 423 and 492, may comprise computer-executable instructions for controlling the movement of the one or more robotic arms. The first and second robotic arms may be substantially similar in structure and function, or they may differ to accommodate the specific functional requirements for controlling movement of the treatment probe versus the imaging probe.

[0080] The robotic arm may include six, seven, or more joints to allow the arm to move under computer control. Suitable robotic arms are commercially available from several manufacturers, such as RoboDK Inc., Kinova Inc., and other manufacturers.

[0081] One or more computing devices operably coupled to the first and second robotic arms may be configured to automatically control the movement of the treatment probe and / or the imaging probe. For example, the robotic arms may be configured to automatically adjust the position and / or orientation of the treatment probe and / or the imaging probe during treatment of the patient according to one or more preprogrammed parameters. The robotic arms may be configured to automatically move the treatment probe and / or the imaging probe along a preplanned or programmed treatment or scan profile, which may be stored on a memory of the one or more computing devices. As an alternative to or in addition to automatic adjustment of the robotic arms, the one or more computing devices may be configured to control the movement of the treatment probe and / or the imaging probe in response to user input, for example, through a graphical user interface of the treatment device. As an alternative to, or in addition to, automatic adjustment of the robotic arm, the one or more computing devices may be configured to control movement of the treatment probe and / or imaging probe in response to real-time positioning information, e.g., in response to anatomical structures recognized in one or more images captured by the imaging probe or other imaging source (from which an acceptable range of motion of the treatment probe and / or imaging probe may be established), and / or position information of the treatment probe and / or imaging probe from one or more sensors coupled to the probe and / or robotic arm.

[0082] 3A and 3B show an exemplary embodiment of a common base or mount 440 for supporting one or more robotic arms of an image-guided therapy system as disclosed herein. FIG. 3A shows a patient support 449 including one or more rails 452. The patient support 449 may include a surgical table or platform. One or more robotic arms associated with one or more of the treatment probe or imaging probe may be mounted to the rails 452 such that the rails function as the common base 440. FIG. 3B shows the common base 440 including a floor stand 454 configured to couple to a first robotic arm connected to the treatment probe and / or a second robotic arm connected to the imaging probe. The floor stand 454 may be positioned between the patient's legs during a therapy procedure.

[0083] 4A and 4B illustrate an exemplary embodiment of a treatment system 400 as described herein comprising a mobile base 470. FIG. 4A is a front view and FIG. 4B is a side view of the treatment system 400. The treatment system 400 comprises a treatment probe 450 coupled to a first robotic arm 442 and an imaging probe 460 coupled to a second robotic arm 444. Each of the first robotic arm 442 and the second robotic arm 444 comprises a proximal end and a distal end, the distal end coupled to the treatment probe 450 and the imaging probe 460, respectively, and the proximal end coupled to a common base 440 comprising the mobile base 470. The first robotic arm 442 may comprise a first arm coupling structure 504 for coupling to the treatment probe 450, and the second robotic arm 444 may comprise a second arm coupling structure 505 for coupling to the imaging probe 460. The treatment probe 450 may be coupled to a distal end of the first robotic arm 442 via a mounting device 500, which may include a linkage configured to affect translation (e.g., rotation, translation, pitch, etc.) of the treatment probe as described herein. The coupling of the treatment probe 450 to the first robotic arm 442 may be fixed, releasable, or user-adjustable. Similarly, the coupling of the imaging probe 460 to the second robotic arm 444 may be fixed, releasable, or user-adjustable.

[0084] The first robotic arm 442 may articulate at one or more first arm joints 443. The imaging arm 444 may articulate at one or more second arm joints 445. Each arm joint 443 or 445 may be operatively coupled to a computer-controllable actuator, such as a stepper motor, to affect movement at the joint. Each arm joint 443 or 445 may comprise one of a variety of kinematic joints, including, but not limited to, a rectangular cylinder, a revolute, a parallel cylinder, a cylinder, a spherical, a planar, an edge slider, a cylinder slider, a point slider, a spherical slider, or a cross cylinder joint, or any combination thereof. Additionally, each arm joint 443 or 445 may comprise a linear, orthogonal, revolute, torsional, or revolute joint, or any combination thereof.

[0085] The system 400 may further comprise a console 420 as described herein, which may be supported by a mobile support 480 separate from the mobile base 470. The console 420 may be operatively coupled to the mobile base 470 via a power and communication cable 475 to enable control of a treatment probe 450 coupled to the mobile base via a first robotic arm. The treatment console 420 comprises a processor and a memory having stored thereon computer executable instructions for execution by the processor to control various modules or functions of the treatment console, such as an energy source, infusion / irrigation control, aspiration control, and other components as described herein with reference to FIG. 2. The treatment console 420 may further comprise a display 425 in communication with the processor. The display 425 may be configured to display one or more of the following: vital signs of the subject, such as, for example, heart rate, respiratory rate, temperature, blood pressure, oxygen saturation, or any physiological parameter, or any combination thereof; the status of the procedure; one or more pre-taken images or a series of images of the treatment site from one or more views; one or more real-time images or a series of images of the treatment site from one or more views obtained by the imaging probe 460; a treatment mode, such as, but not limited to, cutting or coagulation; the intensity of the treatment; the time elapsed during the treatment; the time remaining during the treatment; the depth of the treatment; the area or volume of the treatment site that has been treated; the area or volume of the treatment site that will be treated; the area or volume of the treatment site that will not be treated; a set of treatment parameters including location information of the treatment probe 450 or the imaging probe 460 or both; treatment adjustment controls, such as a means for adjusting the depth of the treatment, the intensity of the treatment, the location and / or orientation of the treatment probe 450, the depth of imaging, or the location and / or orientation of the imaging probe 460, or any combination thereof; or system configuration parameters.

[0086] The mobile base 470 may further comprise one or more computing devices for controlling the movement of one or more robotic arms. For example, the mobile base may comprise a processor and a memory having computer-executable instructions stored thereon for execution by the one or more processors. The memory may also have instructions stored thereon for operating one or more robotic arms coupled to the mobile base. The processor may be operatively coupled to the robotic arms via suitable electromechanical components to affect the movement of the robotic arms. For example, each of one or more joints of the robotic arms may comprise a step motor, and the processor may be operatively coupled to the stepper motor at each joint to actuate the motor by a prescribed increment in a prescribed direction. Alternatively, the one or more robotic arms may be operatively coupled to one or more processors of the console 420 or a separate imaging console (such as the imaging console 490 shown in FIG. 2), and the one or more console processors may be configured to execute instructions for controlling movement of the one or more robotic arms and may communicate the instructions to the robotic arms via communications circuitry (such as the communications circuitry 422 of the console 420 or the communications circuitry 494 of the console 490 shown in FIG. 2). The computer-executable instructions for controlling movement of the robotic arms may be pre-programmed and stored on the memory, or may be provided by a user via one or more user inputs during or during treatment of a patient using the treatment system.

[0087] One or more computing devices operably coupled to the first and / or second robotic arms may be configured to control movement of the arms to adjust the pitch, yaw, roll, and / or linear position of the treatment probe and / or imaging probe along the target site.

[0088] The mobile base 470 may include one or more user input devices to allow a user to control the movement of the robotic arms under computer instructions. For example, as shown in FIGS. 4A and 4B, the mobile base may include a keyboard 474 and / or a foot switch 471, which is operably coupled to the mobile base via a foot switch cable 472. The keyboard 474 and foot switch 471 may be configured to control the movement of the first robotic arm 442 and / or the second robotic arm 444, independently or in combination, for example, via articulation of one or both robotic arms at one or more joints. The keyboard and foot switch may be in communication with one or more processors, which are configured to control the movement of the robotic arms. When a user inputs instructions into the keyboard and / or foot switch, the user instructions may be received by the one or more processors and converted into electrical signals, which may be transmitted to one or more computer-controllable actuators operably coupled to the one or more robotic arms. The keyboard and / or footswitch may control the movement of one or both arms to or away from a treatment position, a position of interest, a pre-determined location, or a user-defined location, or any combination thereof.

[0089] Optionally, the keyboard 474 and footswitch 471 may be configured to control operation of the treatment probe 450 and / or the imaging probe 460, independently or in combination. For example, the keyboard 474 and / or footswitch 471 may be configured to start, stop, pause, or resume treatment with the treatment probe. The keyboard 474 and / or footswitch 471 may be configured to begin capturing, or to freeze, save, or display on the display 425, an image or series of images previously or currently acquired by the imaging probe.

[0090] The mobile base 470 and mobile support 480 of the console 420 may be independently positionable around a patient supported by a patient support 449, such as a platform. For example, the mobile base 470, supporting the first and second robotic arms and the treatment and imaging probes, may be positioned between the patient's legs, while the mobile support 480 carrying the console 420 and display 425 may be positioned to the side of the patient, such as near the patient's torso. The mobile base 470 or mobile support 480 may include one or more movable elements, such as multiple wheels, that allow the base or support to move. The mobile base 470 may be covered with a sterile draping throughout the treatment procedure to prevent contamination and fluid ingress.

[0091] 5A-5B show an example coupling between a treatment probe 450 and a first robotic arm 442. FIG. 5A shows the treatment probe uncoupled from the robotic arm. FIG. 5B shows the treatment probe coupled to the robotic arm. As shown, the treatment probe 450 may be coupled to the robotic arm 442 with a mounting device 500, which may include a reusable motor pack. The treatment probe 450 may be removably coupled to the mounting device 500. The mounting device may further include a connector 502 configured to couple to the robotic arm and lock the mounting device in place. The robotic arm 442 may include a coupling structure 504 disposed at a distal end of the arm, configured to lock and receive the connector 502 of the mounting device 500. When the treatment probe and the robotic arm are coupled together, movement of the treatment probe may be controlled by moving the robotic arm (e.g., by articulating one or more joints of the robotic arm under computer control).

[0092] In some embodiments, the treatment probe is coupled to the robotic arm via a quick release mechanism such that the coupling between the probe and the robotic arm is capable of quick disconnection to prevent injury to the patient in the event that the robotic arm loses position or is otherwise unable to operate properly. The treatment probe and the robotic arm may be coupled to each other in a number of ways, such as mechanically (e.g., broom clips) and / or magnetically. For example, in the embodiment shown in FIGS. 5A and 5B, the coupling structure 504 may include a slot 506 having a magnet 508 disposed therein, and the connector 502 may include a ferromagnetic fastener configured to fit within the slot 506 and engage the magnet 508. The coupling structure 504 may further include a latching mechanism 510 for selectively engaging or disengaging the connector 502 with the magnet 508. For example, as shown in FIGS. 5A and 5B, the latching mechanism 510 may include a rotatable knob that may be rotated to affect engagement of the magnet 508 of the coupling structure 504 with the connector 502 of the mounting device 500. The latching mechanism may be engaged or disengaged automatically or manually by a user to respectively couple or decouple the attachment device 500, and thus the treatment probe 450 coupled thereto, to the robotic arm 442. In some embodiments, the coupling structure 504 may be operatively coupled to one or more computing devices configured to control the robotic arm, and the one or more computing devices may comprise instructions to release the coupling of the coupling structure to the probe when an error is detected in the operation of the robotic arm.

[0093] In some embodiments, the first robotic arm 442 may be configured to automatically locate the treatment probe 450 in response to sensor location data from one or more of the mounting device 500 or coupling structure 504. The first robotic arm 442 may be operated in a "search" mode, for example, to locate the mounting device 500. In some embodiments, the probe comprises one or more reference targets and the robotic arm comprises corresponding sensors of sufficient resolution and positioning to identify the relative position of the probe in 3D space. In some embodiments, the processor is configured with instructions to search for the treatment probe or imaging probe with a mounting structure on the robotic arm, for example, while the user holds the probe steady as the probe is positioned within the patient.

[0094] The sensors on a robotic arm, such as the first robotic arm 442, and the sensors on a probe, such as a treatment probe, can be arranged in many ways, for example, as shown in FIG. 8B.

[0095] The processor can be coupled to a sensor near the end of the robot arm or on the probe to dynamically update the relative location during movement of the robot arm while attempting to engage the probe on the arm. The sensor on the robot arm may comprise multiple sensors comprising one or more of capacitive, capacitive displacement, Doppler, inductive, magnetic, optical, radar, sonar, ultrasonic, or Hall effect sensors to determine the relative distance between the robot arm and the probe. In some embodiments, the probe comprises multiple targets and the sensor is configured to generate a signal in response to distance from the multiple targets. Alternatively, or in combination, the sensor can be located on the probe and on the targets on the robot arm. In some embodiments, the sensor comprises a close-contact mechanical sensor to confirm docking of the probe on or near the robot arm to sense the position of the probe relative to the robot arm, for example, when the probe and arm are within millimeters of docking of each other. The close-contact mechanical sensor may comprise one or more of a micro-motion switch, a whisker touch sensor, or a pin-in-hole contact switch. In some embodiments, the probe and robotic arm include an integrated locking mechanism to provide a non-moving locking engagement in the final position of contact. The integrated locking mechanism may include one or more of magnetic, electromagnetic, latch, screws such as multi-turn latch screws or quarter-turn lock screws, vacuum, or other mechanical means of reversible attachment as would be understood by one of skill in the art.

[0096] In some embodiments, multiple sensors are used, such as one or more sensors for a close separation distance between the probe and the robotic arm, one or more sensors for a medium separation distance, one or more sensors for a far separation distance, etc. A coarse location sensor, e.g., a beacon, can be used to determine the approximate location of the probe. One or more sensors, e.g., a proximity sensor, can be used for fine location positioning of the probe relative to the robotic arm. In some embodiments, one or more markers on the probe are used in conjunction with a camera and machine vision detection of the one or more markers.

[0097] In some embodiments, a coarse location sensor may be provided, which may be an infrared (IR) beacon, that allows for a coarse spatial location for homing detection of the robotic arm to the probe. In some cases, a homing beacon such as an IR beacon allows for homing across longer distances compared to sensors that may rely on visual recognition as a baseline.

[0098] In some embodiments, the docking detection sensor verifies that the robot arm is engaged with or in close proximity to the probe. As an example, a Hall effect sensor can be used in conjunction with a permanent magnet to affect the sensor output. In some embodiments, the Hall effect sensor is noise-resistant, contactless, and has a consistent detection range. Any of several different types of Hall sensors can be utilized, and in many cases the sensor acts as a simple switch and linear range measurement and detection, with the overall output voltage set by the supply voltage and varying proportionally to the strength of the magnetic field. This provides a distance measurement between the sensor and the location magnet, which can be used to measure the distance between the robot arm and the probe and aid in docking. The sensor and beacon can be located within the housing of the robot arm and the probe, respectively.

[0099] In some embodiments, position sensing of the robot arm is performed by an inertial measurement unit (IMU), which may include detection of up to nine axes. In some cases, a six-axis IMU, which may be located in a joint of the robot arm, may be used for motion detection, vibration detection, position orientation information, redundancy, and backup of the primary encoder signal. The IMU may perform the dual function of docking with the robot arm and probing the probe for force detection and motion compensation as described herein. The described sensors may be used in combination with any robot arm or probe described herein.

[0100] According to some embodiments, the procedure for docking the robot arm with the probe may include an IR beacon to provide a coarse position and spatial location for homing detection, fiducials on either the arm or the probe, optical sensors to view the fiducials that may be used to enable fine alignment of the location in the XY plane, and a Hall effect sensor to detect Z-direction proximity for docking. The IR beacon allows for longer distance seeking of the home position of the robot arm relative to the probe. The fiducials and optical sensors may enable high speed low latency detection of the 2D location and 2D orientation of the probe by the robot arm. A user interface, which may be located on the robot arm, on the probe, or on the robot arm control unit, may indicate distance, position, docked status, or other information. In some embodiments, the user interface includes one or more visual cues, such as LED indicators, to indicate the relative positions of the arm and probe and / or the docking status.

[0101] 5A and 5B are described in relation to coupling a treatment probe to a first robotic arm, a substantially similar mechanism may also be used to couple an imaging probe to a second robotic arm 444. For example, the coupling structure of the second robotic arm 444 may include a similar coupling mechanism for engaging an attachment device connected to the imaging probe.

[0102] FIG. 6 illustrates a method 600 for operating a robotic arm coupled to a treatment probe, according to some embodiments.

[0103] In step 605, the treatment probe is inserted into the patient manually, semi-automatically, or automatically with the robotic arm standing by on one side of the patient. For example, for a prostate tissue ablation system, the treatment probe may be manually inserted into the patient's urethra toward the prostate. The treatment probe may be manipulated as it is advanced to follow the tortuous path of the urethra, prostate, and bladder neck. After entering the urethra, the treatment probe may be pivoted (e.g., 90 degrees) before further advancement through the urethral bulb. Instructions may be provided to the user to perform such a pivot, or in cases where the insertion is automatic or semi-automatic, the robotic arm may be instructed to make such a pivot in response to image, position, and / or force feedback data. In some embodiments, the treatment probe is inserted into the patient in parallel with or after the imaging probe, and in some cases the treatment probe insertion may be guided by image data from the inserted imaging probe.

[0104] In step 610, the robotic arm is coupled to the treatment probe. A user can manually align the robotic arm coupling structure to the attachment device of the treatment probe as described herein while the robotic arm remains in a passive or "zero gravity" mode. The attachment device and the coupling structure of the robotic arm can together attach the robotic arm to the treatment probe.

[0105] In step 615, the allowable range of motion for the robotic arm is programmed. For example, a user can manually move, rotate, and angle the treatment probe while the probe is connected to the robotic arm with the robotic arm still in passive mode to set boundaries for the allowable range of motion of the treatment probe. The user may set the boundaries based on a combination of cystoscopy, ultrasound, and haptic feedback. Alternatively, the boundaries may be based on biological structures such as anatomical models or tissue conditions. A processor operatively coupled to the robotic arm can detect and store boundaries for the allowable range of motion such that the robotic arm can use these boundaries and avoid movement outside the allowable range of motion when switched to active mode.

[0106] In some embodiments, the treatment probe is manually inserted into the penile urethra and placed with the distal end about 1 cm past the middle lobe and in the patient's bladder. The probe can be imaged using ultrasound, such as, for example, a TRUS probe. An image of the probe may show the probe manually positioned near its final location in the patient anatomy, for example, about 1 cm past the middle lobe in the bladder. In some embodiments, the range of motion is manually calibrated by the physician maneuvering the probe parallel to the angle of initial insertion docking the treatment probe upwards in the pubic bone or urethral arch, and restricting motion to within about 3 mm to about 5 mm laterally in the X-plane and about 0 mm to about 10 mm downwards in the Y-plane. The trained motion on the Z-plane (into and out of the patient) will be set to 0 cm inward toward the patient and full extraction out of the patient. For example, a 30 cm probe may be retracted as much as 30+ cm to remove it from the patient, and much less when adjusting for the effective area for clinical treatment. Angularly, as measured from the physician's full insertion position, the safe range of motion within the patient depends on anatomical structures such as tissue elasticity and bone structure. As an example of angular positioning with a fulcrum at the pelvic notch bone structure, the allowable angular range of motion can be set, for example, within a range of about 0 degrees to about + / - 5 degrees in the lateral X direction, within a range of about 0 degrees to + / - 25 degrees vertically along the Y plane, or a combination of motion within these ranges depending on the patient anatomy.

[0107] Alternatively or in addition, the boundaries for the allowable range of motion of the treatment probe may be determined automatically or semi-automatically using one or more system processors in response to automated analysis of image data of the target site, such as from an imaging probe or other imaging source (e.g., cystoscope, external ultrasound source, CT scanner, MRI system, fluoroscopic imaging system, etc.). The image data may be generated in real time. For example, the one or more system processors may be instructed to recognize anatomical structures (e.g., prostate, external sphincter, verumontanum, bladder neck, etc.), if any, in the image data, and in response determine the boundaries for the allowable range of motion. Alternatively or in addition, the boundaries for the allowable range of motion of the treatment probe may be determined automatically or semi-automatically using one or more system processors in response to treatment probe position and / or force feedback data from one or more position and / or force sensors on the treatment probe and / or treatment probe robotic arm. For example, one or more force sensors on the treatment probe and / or treatment probe robotic arm may provide tissue pressure data that may indicate areas where probe advancement is more restricted and may present a risk of tissue damage.

[0108] In some embodiments, the joint sensor in the robotic arm comprises a force feedback sensor for detecting a force on the probe inserted into the patient. Alternatively, or in combination, a sensor coupled to the processor can be located on one or more of the probes or at an interface between the probe and the robotic arm. For example, a probe sensor in the probe can sense pressure near the distal end of the probe. The processor can be configured with instructions to translate or rotate to adjust the distal end of the probe in response to the sensed distal pressure. The sensor can comprise one or more of a multi-planar strain gauge element located along the probe to sense the pressure of the probe against the tissue. The processor can be configured with instructions to implement threshold limits and avoid undesired tissue damage. The multi-planar strain gauge element can comprise one or more of an electrical conductivity thin film sensor, a semiconductor sensor, a piezoresistor, a nanoparticle-based strain sensor, a capacitive sensor, an optical ring resonator, a fiber optic sensor, or a conductive fluid in an elastomer. In some embodiments, the probe shaft comprises a spring constant and embedded strain gauges at periodic locations along the shaft to measure bending and axial pressure at specific points along the shaft. These sensor measurements can be combined with the arm joint sensors. In some embodiments, the processor is configured with instructions to identify a source of pressure resistance, such as one or more of a bone constraint associated with proximity to bone, a firm tissue entry fulcrum, or the distal tip of the probe being pushed against internal anatomy tissue. Alternatively, or in combination, the probe on the probe may include an elastomeric tubular sheath with an exposed "touch area" coupled with a pressure sensor that reports information from an element such as a ring around the probe, a linear side structure, or a button sensor element near the distal end of the probe.

[0109] In step 620, the robotic arm is operated under computer control through user input. The user may operate the robotic arm motion via input provided to a graphic user interface of the image-guided therapy system (e.g., user interface software provided through a therapy console as described herein). For example, the user may affect adjustment of the rotation, translation, and / or pitch angle of the therapy probe. While in active mode, the robotic arm may be configured to move only within the boundaries of the allowable range of motion as set in step 615. While in active mode, the robotic arm may be configured to retract the therapy probe from the patient but not advance the therapy probe into the patient to ensure patient safety, and any advancement of the probe into the patient may be performed manually by the user. During retraction of the probe, the robotic arm may be programmed to keep the probe on a linear track such that the z-axis position of the probe remains substantially constant. The robotic arm and therapy probe may be operated under computer control to perform a therapy protocol, which may be automatic. In some embodiments, the tissue ablation procedure is automatically planned based on image data from the imaging probe or other imaging source. For example, one or more system processors may be instructed to recognize the prostate or other relevant anatomical structures, generate a treatment protocol responsive to the location of the anatomical structures and probe, and allow a user to modify and / or accept the treatment protocol before it is implemented by manipulating the robotic arms and / or treatment probe.

[0110] In step 625, the robotic arm is automatically operated under computer control to adjust the position of the treatment probe. The position of the treatment probe may be adjusted according to preprogrammed parameters, user instructions, real-time feedback (e.g., from imaging, position, and / or force feedback data), or a combination thereof. For example, the imaging system may be configured to detect the location of the treatment probe during treatment using smart image recognition based on, for example, ultrasound images of the target site acquired with an ultrasound imaging probe. Based on the detected location of the treatment probe, the robotic arm may be operated to automatically adjust the position and / or orientation of the treatment probe to align the treatment probe to the patient's target tissue and / or to the imaging probe and / or to compensate for patient movement.

[0111] The treatment probe is decoupled from the robotic arm in step 630. When the treatment procedure is completed, the user can disconnect the treatment probe from the robotic arm, manually move the robotic arm aside, and then remove the treatment probe from the patient.

[0112] One or more steps of method 600 may be implemented using circuitry as described herein, such as one or more of the processors or logic circuits of the systems described herein. The circuitry may be programmed to provide one or more steps of method 600, and the program may include program instructions stored on a computer readable memory, or programmed steps of logic circuitry, such as those involving programmable array logic or field programmable gate arrays.

[0113] Although the above steps illustrate a method 600 of operating a robotic arm coupled to a treatment probe, according to some embodiments, one of ordinary skill in the art will recognize many variations based on the teachings described herein. For example, the steps may be completed in a different order. One or more steps may be added or omitted. Some of the steps may include sub-steps. Many of the steps may be repeated as often as necessary or desired.

[0114] FIG. 7 illustrates a method 700 for operating a robotic arm coupled to an imaging probe, according to some embodiments.

[0115] In step 705, an imaging probe is inserted into the patient, either manually, semi-automatically, or automatically, with a robotic arm standing by on one side of the patient. For example, for an image-guided prostate tissue ablation system, the imaging probe may comprise a TRUS probe and may be manually inserted into the patient's rectum. In some embodiments, the imaging probe is inserted in parallel with or before the treatment probe. The imaging probe may provide one or more images along a transverse plane. The imaging probe may provide one or more images along a sagittal plane, which may be generated as the imaging probe (and / or the imaging transducer within the imaging probe) is advanced and / or retracted. The transverse and / or sagittal images may be combined to generate a three-dimensional image.

[0116] In step 710, a robotic arm is coupled to the imaging probe. For example, the robotic arm and the imaging probe may be coupled together using a coupling mechanism substantially similar to those described herein with reference to the treatment probe.

[0117] In step 715, the allowable range of motion for the robotic arm is programmed. For example, a user can manually move, rotate, and angle the imaging probe while the probe is connected to the robotic arm with the robotic arm still in passive mode to set boundaries for the allowable range of motion of the imaging probe. The user may set the boundaries based on a combination of cystoscopic, ultrasound, and haptic feedback.

[0118] In some embodiments, the probe is manually positioned near its final location within the patient's rectal anatomy. The range of motion is manually calibrated by the physician, for example, by manipulating the probe approximately parallel to the angle of initial insertion. The physician moves the inserted probe within an acceptable range of motion, for example, with boundaries along one or more of the lateral X-plane or vertical Y-plane within a range of about 3 cm to about 5 cm. In some embodiments, the physician moves the probe along the Z-plane (into and out of the patient). In some embodiments, the range of motion along the Z-plane can be within a range of 0 cm inward toward the patient (0 to avoid accidental robot-induced rectal injury) to full extraction out from the patient. For example, a 10 cm probe can be retracted 10+ cm to remove it from the patient. Angularly, the safe range of motion within the patient, as measured from the physician's full insertion position, depends on anatomy such as tissue elasticity and bone structure. As an example of angular positioning of a probe with a fulcrum at a tissue surface (or alternatively at a plane defined by bony structures), the allowable range of motion can be set, for example, from 0 degrees to about + / - 15 degrees, e.g., from about 0 to about + / - 30 degrees, in one or more of the X or Y planes. In some embodiments, the angular boundaries can comprise a combination of movements corresponding to tracing a cone within these boundaries.

[0119] A processor operatively coupled to the robotic arm can detect and store boundaries for the allowable range of motion such that when the robotic arm is switched to an active mode, it can use these boundaries to avoid movement outside the allowable range of motion. Alternatively, or in addition, boundaries for the allowable range of motion of the imaging probe can be determined automatically or semi-automatically using one or more system processors in response to automated analysis of image data of the target site, such as from the imaging probe or other imaging source (e.g., cystoscope, external ultrasound source, CT scanner, MRI system, fluoroscopic imaging system, etc.). The image data can be generated in real time. For example, one or more system processors can be instructed to recognize anatomical structures (e.g., prostate, external sphincter, verumontanum, bladder neck, etc.) in the image data, and, if any, the treatment and / or imaging probe, and responsively determine boundaries for the allowable range of motion. Alternatively, or in addition, boundaries for the allowable range of motion of the imaging probe may be determined automatically or semi-automatically using one or more system processors in response to imaging probe position and / or force feedback data from one or more position and / or force sensors on the imaging probe and / or the therapy probe robotic arm. For example, one or more force sensors on the imaging probe and / or the imaging probe robotic arm may provide tissue pressure data that may indicate areas where probe advancement is more restricted and may present a risk of tissue damage.

[0120] In step 720, the robotic arm is automatically operated under computer control to scan the tissue. For example, during planning of a treatment procedure, the robotic arm can be preprogrammed to automatically scan the target site and render a three-dimensional image of the target site. While in active mode, the robotic arm can be configured to move only within the boundaries of the allowable range of motion as set in step 715. While in active mode, the robotic arm can be configured to retract the treatment probe from the patient but not advance the treatment probe into the patient to ensure patient safety, and any advancement of the probe into the patient can be performed manually by a user. During retraction of the probe, the robotic arm can be programmed to keep the probe on a linear track such that the z-axis position of the probe remains substantially constant.

[0121] In step 725, the robot arm is operated under computer control through user input. The user may manipulate the robot arm motion via input provided to a graphic user interface of the image-guided therapy system (e.g., user interface software provided through a therapy or imaging console as described herein). For example, the user may affect adjustment of the rotation, translation, and / or pitch angle of the imaging probe. While in active mode, the robot arm may be configured to move only within the boundaries of the allowable range of motion as set in step 715. While in active mode, the robot arm may be configured to retract the therapy probe from the patient but not advance the therapy probe into the patient to ensure patient safety, and any advancement of the probe into the patient may be performed manually by the user.

[0122] In step 730, the robotic arm is automatically manipulated under computer control to adjust the position of the imaging probe. The position of the imaging probe may be adjusted according to preprogrammed parameters, user commands, real-time feedback (e.g., from imaging, position, and / or force feedback data), or a combination thereof. For example, the imaging system may be configured to detect the location of the treatment probe during treatment, e.g., using smart image recognition based on ultrasound images of the target site acquired with the ultrasound imaging probe. Based on the detected location of the treatment probe, the robotic arm may be manipulated to automatically adjust the position and / or orientation of the imaging probe to align it with the treatment probe and / or to compensate for patient movement.

[0123] The imaging probe is decoupled from the robotic arm in step 735. When the treatment procedure is completed, the user can disconnect the imaging probe from the robotic arm, manually move the robotic arm aside, and then remove the imaging probe from the patient.

[0124] One or more steps of method 700 may be implemented using circuitry as described herein, such as one or more of the processors or logic circuits of the systems described herein. The circuitry may be programmed to provide one or more steps of method 700, and the program may include program instructions stored on a computer readable memory, or programmed steps of logic circuitry, such as those with programmable array logic or field programmable gate array logic.

[0125] Although the above steps illustrate a method 700 of operating a robotic arm coupled to an imaging probe, according to some embodiments, one of ordinary skill in the art will recognize many variations based on the teachings described herein. For example, the steps may be completed in a different order. One or more steps may be added or omitted. Some of the steps may include sub-steps. Many of the steps may be repeated as often as necessary or desired.

[0126] FIG. 8A illustrates the configuration of the treatment probe 450 and the imaging probe 460 during treatment of a patient with a treatment system as described herein. In some embodiments, it is desirable to ensure that the treatment probe and the imaging probe outside the patient's body do not collide or otherwise interfere with each other during use of the system, thereby maintaining the accuracy of the movement of the probes and the sterility of the system. The robotic arms as described herein coupled to the treatment probe and the imaging probe and configured to control their movement may be configured to maintain boundaries and prevent collision or interference between the two probes. For example, one or both of the first robotic arm coupled to the treatment probe and the second robotic arm 444 coupled to the imaging probe may be configured to sense the distance 520 between the two probes and maintain the distance substantially constant or above a minimum threshold to prevent collision. Alternatively or additionally, as described with reference to the methods shown in FIGS. 6 and 7, a user may program an allowable range of motion for one or both of the treatment probe and the imaging probe to set boundaries for the range of motion that will prevent collision or interference between the probes.

[0127] For example, before the robot arm is switched into active mode, the user may rotate one or both of the probes through a range of allowable probe pitch angles 525, programming the allowable range of motion of the probes within which the two probes do not touch each other.

[0128] With additional reference to FIG. 8B, the robotic arm 442 is coupled to a motor pack 802 as described herein. The motor pack 802 may be coupled to a handpiece of the probe 450. In some embodiments, one or both of the robotic arms coupled to the treatment probe and the imaging probe may include one or more feedback sensing mechanisms. For example, the first robotic arm 442 and / or the second robotic arm 444 may be operatively coupled to a force sensor configured to detect compression of tissue in front of the treatment probe and / or the imaging probe. In some embodiments, the force exerted by the imaging probe is in the range of 0-4 kg exerted upwards to compress the tissue and achieve visualization of the treatment probe and the target tissue region. In some embodiments, the force exerted by the treatment probe is related to the position of the probe within a lumen such as the urethra. In some embodiments, the force is related to the fulcrum at the urethral notch and pivoting to lift the target anatomy. These forces may be in the range of 0-10 kg for bony structures and 0-2 kg force on the target anatomy such as the prostate, respectively.

[0129] According to some embodiments, one or more X-direction force sensors 810, one or more Y-direction force sensors 812, and / or one or more Z-direction force sensors 814 may be provided on the robotic arm 442, the hand piece 804, and / or the probe 450. The one or more force sensors may comprise, for example, a strain gauge, a pressure sensor, or a piezoelectric transducer. In some embodiments, the strain gauge comprises any of several configurations of a Wheatstone bridge. A Wheatstone bridge circuit converts a small change in resistance into a measurable voltage difference that may be equal to the applied force. The force sensors may be coupled to a hand piece, such as any of the hand piece embodiments described herein. In some cases, the one or more force sensors are operably coupled to the imaging probe, the treatment probe, or both.

[0130] In some embodiments, the circuitry for operating the force sensor is insulated and isolated from the imaging probe and the treatment probe. This allows the probe to meet any patient leakage current requirements and reduces any noise that would be picked up by the probe, thus improving the signal-to-noise ratio (S / N) of the force sensor. In some embodiments, the signal wires from the force sensor can be twisted together and optionally shielded to maintain signal integrity, improve resistance, and maintain a suitable S / N ratio. The force sensor can be formed from any suitable material, and in some cases is formed from a biocompatible material for the portion of the sensor that may come into contact with the patient before, during, or after treatment.

[0131] In some embodiments, one or more force sensors are sized to fit on or within a probe shaft, such as an imaging probe or a therapy probe shaft. The force sensor may be configured with any suitable strain sensitivity "k", which is the proportionality factor between the relative changes in resistance. Strain sensitivity is dimensionless and is a number called the gauge factor ("GF"). A linear pattern strain gauge may be used to measure strain in a single direction on a handpiece. A conductive signal wire may be bonded to the pads of the sensor that carry the signal to an input amplifier. One or more sensors may be bonded to one or more probes on a carrier substrate, which may insulate the sensor from any metal in the probe, such as a metal probe shaft.

[0132] Displacement of the hand piece in the Z direction can be detected by the spring and sensor 814. Utilizing this configuration, the entire probe assembly can be able to slide a suitable distance and provide protection from the probe being driven into the tissue wall. The probe assembly can be arranged on a sliding trolley 820 that can be bounced against a simple spring to provide a constant and known force "K" spring constant. Accurate distance measurement of the hand piece, such as any displacement of the trolley, is possible over short distances with suitable arrangements, such as less than 2 inches. Other position encoder linear sensors can be used in combination or instead. For example, a Linear Variable Differential Transformer (LVDT) is an electromechanical sensor used to convert mechanical motion into a variable current and can be used to measure resistance to the insertion force of the probe. An optical encoder, or any of several suitable inductive linear encoders. The sensor can measure force based on an inductive linear encoder 824 and can be arranged for non-contact to ensure high reliability. A high resolution encoder 824 can be provided for linear resolution of about 15 micrometers for a digital encoder to about 54 micrometers for an analog encoder, etc.

[0133] One or more sensors may be provided on one or more robotic arms to measure position, orientation, force, or some other parameter. In some cases, two sensors may be part of the robotic arm assembly and can be utilized to determine unintentional movement. These sensors may be internal encoders, which may be located at one or more joints of the robotic arm and may be an inertial measurement unit (IMU) 822. IMUs are electronic sensor devices that measure and orient one or more parameters such as force, angular rate, and / or orientation of the sensor and may use a combination of accelerometers, gyroscopes, and / or magnetometers. Some IMUs suitable for incorporation into one or more robotic arms may have a full acceleration range of ±2 / ±4 / ±8 / ±16g (the "g" value relating to acceleration due to gravity) and a wide angular rate range of ±125 / ±250 / ±500 / ±1,000 / ±2,000 / ±4,000 degrees per second ("dps"). The IMU can detect forces on the robotic arm and communicate the magnitude and / or direction of the external force to a computing device, such as a robotic control system. One or more IMUs 822 can provide feedback that can be used to control one or more robotic arms and compensate for vibrations, position awareness, and stabilization compensation.

[0134] As described herein, the robotic arm 442 can be docked with the probe 450 through the use of sensors to aid in one or more of coarse, intermediate, and fine alignment. For example, the probe may be associated with a beacon 830, such as an IR beacon, and the robotic arm 442 may carry an IR receiver 832 that can detect emissions from the IR beacon 830 for coarse alignment. One or more alignment references 834 may be associated with the probe 450, and one or more alignment sensors 836 may be associated with the robotic arm 442. The alignment sensors 836 can detect the position of the alignment references and thus determine the position of the robotic arm 442 relative to the probe 450, as described herein. In some embodiments, a proximity sensor or switch, such as a Hall effect sensor, is used to detect alignment between the probe and the arm to engage the probe and the arm, e.g., to latch the probe onto the arm when the arm is suitably maneuvered into position.

[0135] In some embodiments, when treatment is completed, the arm can be decoupled from the probe while the user is holding the probe, and the arm can be detached from the probe, e.g., automatically detached from the probe.

[0136] One or more computing devices (such as the processor of console 420 or console 490 as described herein) operably coupled with the robotic arm may comprise instructions to control the movement of the robotic arm in response to the force detected by the sensor, for example, to prevent over-compression of the anterior tissue and resulting damage to the tissue and / or the probe. In an exemplary use case of the treatment system for prostate tissue ablation, the treatment probe is ideally positioned in the anterior center of the patient's prostate cavity, but without over-compressing the anterior prostate to prevent inadvertent injury to the urethra / prostate (e.g., excessive bleeding, necrosis, tissue perforation) and / or damage to the imaging probe and / or the treatment probe. Similarly, the imaging probe, which may be a TRUS probe, is ideally positioned in the patient's rectum with sufficient anterior compression to view the prostate and the treatment probe, but without over-compressing the tissue, to avoid inadvertent injury to the rectum (e.g., bleeding or tissue perforation) and / or damage to the imaging probe and / or the treatment probe. The treatment probe, the first robotic arm coupled thereto, the imaging probe, and / or the second robotic arm coupled thereto may comprise a force sensor configured to detect anterior compression of tissue with the probe. The detected force level may be communicated to a processor operatively coupled to the robotic arm and compared to a force threshold preprogrammed or stored in the memory of the computing system. If the detected force exceeds the threshold, the movement of the robotic arm may be adjusted to move the probe away from the anterior tissue, thereby at least partially relieving the anterior tissue compression.

[0137] Another exemplary feedback sensing mechanism may comprise a position and / or motion sensor operably coupled to the first and / or second robotic arm 444. One or more computing devices operably coupled to the robotic arm may comprise instructions to control the movement of the robotic arm in response to the position and / or motion detected by the sensor, for example, to adjust the position of the therapeutic and / or imaging probe in response to patient movement during a therapeutic and / or scanning procedure. Patient movement while a rigid element such as a therapeutic or imaging probe is positioned inside the patient's body may potentially cause injury to the patient and may necessitate removal of the probe during movement and subsequent repositioning of the probe. A robotic arm that automatically adjusts the position of the probe in response to sensed movement of the patient may improve the safety and efficiency of the procedure. One or more position or motion sensors, such as coils and / or accelerometers, may be attached to the patient, and the sensors may be operably coupled to a computing device that controls the robotic arm. The sensors may be configured to generate small localized electromagnetic fields or other signals to aid in determining, for example, the location and / or movement of the patient. The processor receives the detected patient movement data and can therefore adjust the movement of the robotic arm to substantially match the patient movement such that a probe coupled to the robotic arm can remain within an acceptable range of position relative to the tissue or patient organ, hi some embodiments, the processor is configured to interrupt treatment if the force on the sensor exceeds a threshold amount.

[0138] Optionally, in some embodiments, the robotic arms may be configured to move automatically in a chained manner. For example, when a user of the system moves a first robotic arm, the second robotic arm 444 may be configured to automatically adjust its position accordingly. In an exemplary use case of a treatment system for prostate tissue ablation, a patient's prostate may not be symmetrical in anatomy, and the user may need to adjust the position or orientation of the treatment probe accordingly (e.g., push the probe aside, adjust the pitch angle of the probe, etc.). The robotic arm coupled to the imaging probe may be configured to automatically detect adjustments made to the robotic arm coupled to the treatment probe and make corresponding adjustments to the imaging probe position and / or orientation. Such chained movement of the two robotic arms may be useful to maintain the treatment and imaging probes in a desired positional relationship relative to each other, for example, with the extension axis of the treatment probe substantially aligned with the extension axis of the imaging probe.

[0139] 9A-9C diagrammatically illustrate the alignment of the treatment probe axis 451 with the sagittal plane 950 of the imaging probe 460. FIG. 9A is a side view of the treatment probe 450 at an angle relative to the imaging probe 460. The treatment probe 450 includes an extension axis 451, which in turn includes an extension axis 461 that provides a reference for the image generated by the imaging probe. The extension axis 461 may at least partially define the sagittal image plane 950. FIG. 9B is a top view of the treatment probe 450 substantially aligned with the sagittal image plane 950. When the treatment probe axis 451 is substantially aligned with the sagittal image plane 950, a substantial portion of the treatment probe is within the field of view of the ultrasound probe and is visible in the sagittal image. In some embodiments, the two probes are substantially aligned when the extension axes are aligned within about 5 degrees of each other relative to a plane perpendicular to the sagittal image plane. With a larger tilt angle between the probes, the treatment probe will extend across the field of view of the ultrasound probe and only the portion of the probe within the field of view of the ultrasound probe will be visible in the ultrasound image.

[0140] When the probe is substantially aligned in the sagittal image plane but tilted at an angle as shown in FIG. 9A, the treatment probe and tissue may appear rotated in the sagittal image, with an acceptable amount of rotation being, for example, greater than 5 degrees. FIG. 9C is a top view of the treatment probe 450 across the sagittal image plane 950. When the imaging probe is not fully aligned with the treatment probe, the treatment probe may appear distorted in the sagittal image, with only a portion of the treatment probe extending through the sagittal field appearing in the image. In some embodiments, the treatment and imaging probes may include one or more sensors to confirm the desired alignment (parallel and / or coplanar) of the probes to each other. For example, the system may include a first orientation sensor 473 and a second orientation sensor 476 on the treatment probe 450 and imaging probe 460, respectively. In some embodiments, the first and second orientation sensors 476 comprise magnetic elements, Hall effect sensors, dials, variable resistors, potentiometers, accelerometers, or any combination thereof that may indicate the relative position and orientation of the probes to each other. In some embodiments, the angle of the sagittal plane of the ultrasound imaging probe can be rotated by rotating the ultrasound imaging probe about its extension axis. For example, in some patients, the prostate is not symmetrical or the urethral notch is deformed, the imaging probe and the treatment probe can be located on opposite sides of the patient or at least offset relative to each other relative to the patient's midline, and rotation of the imaging probe about its extension axis can rotate the sagittal plane of the ultrasound probe and bring the treatment probe and tissue treatment area into the field of view of the ultrasound imaging probe. The alignment, orientation, and relative positioning of the treatment and imaging probes can continue to be monitored during the treatment procedure.

[0141] When the treatment probe and the imaging probe are sufficiently aligned, a user can use an image of the treatment probe acquired with the imaging probe to align the treatment probe with the imaging probe, for example, by providing user input in a GUI to control a robotic arm coupled to the treatment probe or the imaging probe. Alternatively, or in addition, the robotic arm can be programmed to automatically adjust movement to maintain the probe in sufficient alignment, as described herein. For example, when a user adjusts the position or orientation of the treatment probe by controlling a first robotic arm coupled to the treatment probe, a second robotic arm 444 coupled to the imaging probe can automatically detect the adjustment made to the first robotic arm and make corresponding adjustments to substantially match the pitch, roll, yaw, and / or linear position of the treatment probe along the treatment probe axis.

[0142] To provide for automatic chaining of the two robotic arms, a calibration step may be added to the treatment procedure, with each arm identifying its position relative to the other arm. For example, each robotic arm may be equipped with a "target" on the arm at a known location, and during the calibration procedure, a user may manipulate the first arm and touch a target located on the second arm with the first arm coupling structure, and manipulate the second arm and touch a target located on the first arm with the second arm coupling structure. Automatically chaining the movement of the two robotic arms may thus expedite the treatment procedure by eliminating the need for a user to separately adjust the movement of the second arm after moving the first arm. In addition, chaining the movement of the two arms may help improve the safety and efficiency of the treatment procedure when the patient moves while the probe is inserted into the patient's body, as described herein.

[0143] Optionally, in some embodiments, the robotic arm coupled with the treatment probe can be configured to move the treatment probe along a pre-programmed treatment profile to perform treatment of the target site. For example, the treatment profile can comprise a tissue ablation profile of the target site, which can be programmed by a user of the treatment system and stored in the memory of one or more computing devices operably coupled with the robotic arm. Further details regarding automated treatment using programmed treatment profiles can be found in PCT Publication No. WO2013 / 130895, previously incorporated by reference herein.

[0144] Optionally, in some embodiments, a robotic arm coupled to the imaging probe may be configured to move the imaging probe along a pre-programmed imaging profile to generate a three-dimensional rendering of the target site before and / or during treatment with the treatment probe. A three-dimensional image of the target site may be derived from the bi-planar imaging probe by 1) rotating the imaging probe in a fixed position with the imaging probe capturing sagittal view images of the target site and then interpolating the sagittal view images, or 2) translating the imaging probe (along the z-axis of the probe) across the target site with the imaging probe capturing axial view images of the target site and then interpolating the axial view images. To improve the efficiency of 3D image rendering and the resolution of the resulting 3D image, the robotic arm may be configured to rapidly scan the target site along a pre-programmed imaging profile, and the 3D image may be generated using software to render a 3D image of the treatment site in substantially real time. The pre-programmed imaging profile may be stored on the memory of one or more computing devices and may comprise multiple sagittal scans taken at pre-determined time intervals while the imaging probe is rotated in place, and / or multiple transverse scans taken at pre-determined time intervals while the imaging probe is translated (along the z-axis or extension axis of the imaging probe) across the target site.

[0145] Automated computer-controlled scanning of the target site with an imaging probe using a robotic arm can also be used to generate useful information about the target site for further treatment. For example, the imaging probe can be configured to perform color / Doppler scanning of the target site after an ablation procedure to identify bleeding sites within the target site requiring hemostasis.

[0146] In some embodiments, the Doppler ultrasound image shows blood moving away from the ultrasound probe as blue and blood moving toward the ultrasound probe as red. In some embodiments, the tissue ablation profile can be adjusted prior to tissue ablation to reduce, and in some cases avoid, ablation of blood vessels present in the Doppler ultrasound image. For example, the ultrasound image may comprise a 3D ultrasound image and a 3D ablation profile that is adjusted to reduce or avoid blood vessels.

[0147] FIG. 10 illustrates the identification of a high blood perfusion site 810 from an ultrasound image 800 of a patient's tissue 805. As described herein, a robotic arm coupled to the imaging probe can be automatically moved to acquire a scan from the imaging probe while the imaging probe is operating in a Doppler imaging mode. The high blood perfusion site 810 can be identified from the resulting Doppler scan image based on detection of blood flowing closer to or farther from the imaging plane of the imaging probe. In some cases, the high blood perfusion site 810 comprises a bleeding site, and based on the Doppler information, a user can efficiently identify and treat the bleeding, for example, by using a focal cautery or a hemostatic agent such as a gel and matrix, thereby reducing bleeding, cauterization time, and thermal or other effects on the tissue. The high blood perfusion site 810 may also, in some cases, comprise abnormal or even cancerous tissue growth. These areas can be flagged or identified for subsequent treatment. For example, normal tissue can be ablated around the abnormal tissue to leave islands of abnormal tissue that are later treated using local drug delivery or the like.

[0148] Three-dimensional scanning of a target site using an imaging probe can also be used to identify tissue abnormalities in the target site, such as tumors. For example, tumors can be identified from images of the target site acquired by automated scanning of the target site with an imaging probe based on the difference between hyperechoic and hypoechoic areas of the imaged tissue. Robotic scanning of the target site can improve the speed of image analysis and therefore the accurate detection of tissue abnormalities. In addition, the imaging probe can be operated in a Doppler imaging mode during the automated scan to identify areas of higher blood flow that may correspond to potential cancer locations. Biopsies can be performed in the identified areas of tissue to improve cancer detection.

[0149] 11A, 11B, and 11C illustrate an exemplary embodiment of a treatment system 1100 including a treatment couch. The system 1100 may include one or more components of the system 400 and may include coupling structures on the probe mount and swivel for coupling the arms to one or more of the imaging probe 460 and the treatment probe 450 to the patient after one or more of the probes are inserted into the patient. FIG. 11A is a side view, FIG. 11B is a front view, and FIG. 11C is a perspective view of the treatment system showing the positioning of the patient P. FIGS. 11A-11C also show a three-dimensional coordinate system legend including an X-axis, a Y-axis, and a Z-axis, each of which is perpendicular to one another, the X-axis, the Y-axis, and the Z-axis being orthogonal horizontal axes, and the Y-axis being a vertical axis, to aid in viewing and explaining the system 1100. The treatment system 1100 may include a treatment probe 450, an imaging probe 460, a platform 1113, and a probe mounting and adjustment assembly 1120.The probe mounting and adjustment assembly 1120 includes a probe mount 1104, a swivel 1105, a vertical turret 1106, a first horizontal slider 1107 for translating the vertical turret 1106 along a first Z translation direction 1133 (i.e., along the Z axis or an axis parallel thereto), a pair of first horizontal arms 1108 oriented along the Z direction, a pair of vertical arms 1111 oriented along the Y direction (i.e., along the Y axis or an axis parallel thereto), a pair of first locking mechanisms 1110 for the pair of vertical arms 1111, and a second locking mechanism 1112 for translating the pair of vertical arms 1111 along a second Z translation direction 1131 (i.e., along the Z axis or an axis parallel thereto). The patient support may include a patient support such as a platform 1113 having a pair of second horizontal sliders 1112 coupled thereto, a pair of second horizontal arms 1114 oriented along the X direction with each second horizontal arm 1114 coupled to a respective first horizontal arm 1108, a pair of second locking mechanisms 1115 for the pair of first horizontal arms 1108, a horizontal adjuster 1116 for the vertical turret 1106, a third locking mechanism 1117 for the vertical turret 1106, and a third horizontal slider 1118 for translating the first horizontal slider 1107 in a first X translation direction 1136 (i.e., along the X axis or an axis parallel thereto). The arms, sliders, and locking mechanisms may be one or more of robotically or manually actuated or repositioned relative to one another. The treatment probe 450 and the imaging probe 460 may be aligned to be parallel or coplanar with respect to one another as described herein. One or more of the treatment probe 450, the imaging probe 460, the various arms, the various sliders, or the various mechanisms may be covered with one or more protective drapes to facilitate providing a sterile surgical environment or to minimize subsequent cleaning for the various components of the system 1100.

[0150] The therapy probe 450 and the imaging probe 460 may be substantially vertically aligned and rigidly (e.g., rigidly) and adjustably connected to one or more probe coupling mounts 1104 that can rotate about an axis defined by a swivel 1105 in a first rotational direction 1135 (i.e., about an X-axis or an axis parallel thereto) relative to a vertical turret 1106, such as in a YZ plane (or a plane parallel thereto) as shown in FIGS. 11A-11C. In some embodiments, the position of the extension axis 451 of the therapy probe 450 relative to the extension axis 461 of the imaging probe 460 may be set by adjusting the position of the therapy probe 450 relative to the probe mount 1104 and by adjusting the position of the imaging probe 460 relative to the probe mount 1104. In some embodiments, each of the treatment probe 450 and the imaging probe 460 is removably mounted to the probe coupling mount 1104 by fasteners comprising screws, nuts, washers, bolts, pins, pivots, hinges, bearings, clamps, straps, thumb screws, latches, collets, dovetails, channels, springs, magnets, threads, keys, slots, gears, pulleys, racks, pinions, or any combination thereof. In some embodiments, the treatment probe 450 is removably mounted to a first probe coupling mount 1104 and the imaging probe 460 is removably mounted to a second probe coupling mount 1104. In some embodiments, the probe coupling mount 1104 comprises an electrical connector for transmitting power and / or data to or from the treatment probe 450 and / or the imaging probe 460 to a computer or processor. In some embodiments, the probe coupling mount 1104 comprises a hose connector for transmitting liquid and / or gas to the treatment probe 450. In some embodiments, the fasteners, electrical connectors, and hose connectors comprise only one component. In some embodiments, the fasteners and electrical connectors comprise multiple components.In some embodiments, the position of the therapy probe 450 relative to the probe mount 1104 and the position of the imaging probe 460 relative to the probe mount 1104 are adjusted manually, by driven actuators, or both. In some embodiments, the position of the therapy probe 450 relative to the probe mount 1104 and the position of the imaging probe 460 relative to the probe mount 1104 are adjusted by thumb screws, pivots, hinges, pins, slots, bearings, pulleys, racks, pinions, linear actuators, motors, solenoids, or any combination thereof.

[0151] In some embodiments, the probe coupling mount 1104 further comprises a manual actuation feature that allows a user to manually manipulate its position, hi some embodiments, the manual actuation feature comprises a handle, knob, handle, bar, grip, or any combination thereof.

[0152] In some embodiments, the probe coupling mount 1104 can rotate about the first rotational orientation 1135 at least about 315 degrees, at least about 300 degrees, at least about 280 degrees, at least about 260 degrees, at least about 240 degrees, at least about 220 degrees, at least about 200 degrees, at least about 180 degrees, at least about 160 degrees, at least about 140 degrees, at least about 120 degrees, at least about 100 degrees, or at least about 80 degrees.

[0153] In some embodiments, the probe coupling mount 1104 further comprises cable guides, cable relief members, slip rings, or any combination thereof to restrain and protect any cables exiting the treatment probe 450 or the imaging probe 460.

[0154] In some embodiments, the generally vertical turret 1106 additionally extends and retracts in a first Y translation direction 1132 (i.e., along the Y axis or an axis parallel thereto) to set the height of the probe mount 1104 relative to the first horizontal slider 1107. The turret may include an expansion joint to allow extension and retraction, such as a telescoping slide tube, or a threaded assembly, and combinations thereof. In some embodiments, the position of the vertical turret 1106 is adjusted manually, or by a driven actuator, or both. Rotation of the probe mount 1104 relative to the vertical turret 1106 may be robotically controlled or set manually. In some embodiments, rotation of the vertical turret 1106 about its vertical axis of symmetry (i.e., about the Y axis or an axis parallel thereto) in a second rotation direction 1134 can be set and locked by a third locking mechanism 1117. In some embodiments, a pair of first horizontal sliders 1107 can translate the treatment probe 450 and the imaging probe 460 toward or away from the patient P. In some embodiments, the first horizontal slider 1107 comprises a manual actuator, a driven actuator, or both. In some embodiments, the position of the vertical turret 1106 toward or away from the patient is modified by the horizontal slider 1107. A horizontal adjuster 1116 can translate the robot arm in the X direction across the patient support. The horizontal adjuster 1116 can be operated by a manual actuator, a driven actuator, or both.

[0155] In some embodiments, the third horizontal slider 1118 allows translation of the first horizontal slider 1107, and thus the treatment probe 450 and imaging probe 460, in a horizontal direction (i.e., along the X-axis) toward the patient's left or right side, and one or more third locking mechanisms 1117 may engage and disengage the ability of the vertical turret 1106 to translate horizontally along the third horizontal slider 1118. In some embodiments, each end of the third horizontal slider 1118 may be attached to a second horizontal arm 1114, each second horizontal arm 1114 may be vertically attached to a first horizontal arm 1108, and each first horizontal arm 1108 may be vertically attached to a vertical arm 1111. In some embodiments, each vertical arm 1111 is attached to a second horizontal slider 1112 on the platform 1113, which is capable of translating the one or more vertical arms 1111 horizontally (i.e., along the Z axis) toward or away from the patient, and one or more first locking mechanisms 1110 set the position of the one or more vertical arms 1111 relative to the platform 1113.

[0156] In some embodiments, one or more of the exemplary embodiments of the components of the treatment system 1100 are made of metal, plastic, fabric, cloth, foam, wood, carbon fiber, fiberglass, glass, or any combination thereof.

[0157] In some embodiments, the vertical turret 1106, the first horizontal slider 1107, the second horizontal slider 1112, and the third horizontal slider 1118 comprise actuators, bearings, shafts, worm drives, racks, pinions, gears, belts, chains, pulleys, slides, collars, shafts, or any combination thereof. In some embodiments, at least one of the vertical turret 1106, the first horizontal slider 1107, the second horizontal slider 1112, and the third horizontal slider 1118 further comprises an encoder, which measures translational or rotational displacement.

[0158] In some embodiments, the first locking mechanism 1110, the second locking mechanism 1115, and the third locking mechanism 1117 comprise cams, screws, handles, knobs, shafts, clamps, or any combination thereof.

[0159] In some embodiments, the slider, turret, and vertical expansion joint each include an actuator that is coupled to the processor to control the position and angle of the coupling structure. In some embodiments, the coupling between the horizontal arm 1108 and the second horizontal arm 1114 includes a motorized joint. In some cases, the motorized joint is under robotic control of the processor and can be actuated to move hardware out of the way, assist with patient extraction from the patient support, etc.

[0160] In some embodiments, the system includes a linkage coupled to a processor, the linkage including one or more of a slider, a turret, and a vertical expansion joint, each of which may include an actuator coupled to the processor to control the position and angle of the linkage structure on the arm in response to control signals from the processor.

[0161] The arm may, for example, comprise multiple arms and a slider.

[0162] In some embodiments, one or more of the exemplary embodiments of the treatment system 1100 components may be disassembled, portable, or both. In some embodiments, the treatment system 1100 further comprises cable management, wheels, a platform, a power source, a mounting, or any combination thereof.

[0163] One or more image sensors 1145 may be provided at one or more locations centered around the treatment system 1100 and may be provided on the first and / or second horizontal arms. The one or more image sensors may be used to obtain images of fiducial markers on the imaging probe 460 or treatment probe 450 or both to assist in aligning and / or docking the robotic arm with the probe or to detect the position, orientation, or alignment of the probe. A user interface 1140 may be provided on the robotic arm, the probe, or both to indicate the docked status of the robotic arm with the probe. In some instances, the user interface is one or more visual indicators, such as LED indicators. The one or more visual indicators may convey additional operation or status information of the robotic arm or probe.

[0164] 12 illustrates an exemplary embodiment of a treatment system 1200 comprising a treatment platform. System 1200 may comprise one or more components of system 400 or system 1100 as described herein. FIG. 12 is a perspective view of treatment system 1200. Treatment system 1200 may comprise a treatment cart 1210. The cart 1210 may include a housing 1213, a common robotic arm 1214 that may rotate or move in translation relative to the housing 1213, a fluid container hanger 1215, a fluid container 1216, such as for saline, a push handle 1217, one or more wheels 1218, a support 1219, one or more display screens 1220, a treatment probe robotic arm 442 that may rotate or move in translation relative to the common robotic arm 1214, a treatment probe 450 coupled to the treatment probe robotic arm 442, an imaging probe robotic arm 444 that may rotate or move in translation relative to the common robotic arm 1214, and an imaging probe 460 coupled to the imaging probe arm 444.

[0165] In some embodiments, the treatment probe robotic arm 442 and the imaging probe robotic arm 444 cooperate with the common robotic arm 1214 to position the treatment probe 450 and the imaging probe 460, respectively, in alignment (i.e., parallel and / or coplanar alignment) with one another. In some embodiments, the housing 1213 contains a power source, a pressure source, a communication member, a power cable, a drug, or any combination thereof. In some embodiments, the common robotic arm 1214 can pivot or translate with respect to the housing 1213 in about one or more degrees of freedom. In one example, the common robotic arm 1214 can pivot about a vertical axis perpendicular to the floor about an angle of about 220 degrees. In some embodiments, the common robotic arm 1214 can extend and retract. In some embodiments, the cart 1210 is portable and may include a push handle 1217, and one or more wheels 1218, as well as a support 1219 for maintaining stability of the cart 1210 during patient treatment. In some embodiments, the cart 1210 further comprises a fluid container hanger 1215 capable of supporting a saline or fluid container 1216 that stores a quantity of fluid or saline for use with the treatment probe 450, which may provide a pressurized fluid jet for tissue ablation. In some embodiments, the cart 1210 further comprises one or more screens 1220 capable of displaying information to a physician or patient from the imaging probe 1202 or other sources. In some embodiments, the treatment system 1200 further comprises a container for storing the removed tissue and used saline.

[0166] 13 illustrates an exemplary embodiment of a probe mounting and adjustment assembly 1600. The probe mounting and adjustment assembly 1600 is attached to a patient support by a number of clamps 1302. According to some embodiments, the patient support is a bed, table, or platform, and the clamps are attached to the patient support, such as by mechanical fastening onto rails of the patient support. The probe mounting and adjustment assembly 1600 may include two, three, four, six, or more clamps 1302 for attachment to the patient support. In some embodiments, the mounting assembly 1600 supports the first robotic arm 442 with the first probe 460 mounted thereon, and the second robotic arm 444 with the second probe 450 mounted thereon, in a substantially "crash-proof" configuration such that a medical professional colliding with one or more of the mounting assembly 1600, the first robotic arm 442, the first probe 460, the second robotic arm 444, or the second probe 450 results in a clinically acceptable amount of movement to the probe being inserted into the patient, e.g., about 5 mm or less.

[0167] The mounting assembly 1600 can be configured in many ways, but in some embodiments, the mounting assembly is configured to limit movement of the elongated support 1310 relative to the first and second rails to 5 mm or less in response to a 150 kg load on the elongated support 1310, for example on the crossbar 1310.

[0168] As used herein, the terms "elongated support" and "crossbar" are used interchangeably. In some embodiments, the movement is 3 mm or less in response to a 100 kg load on the elongated support 1310. In some embodiments, the elongated support 1310, first clamp 1302, first arm 442, second clamp 1304, and second arm 444 may be configured to limit the movement of the elongated support 1310 to 5 mm or less in response to a 150 kg load on the elongated support 1310, and the movement may be 3 mm or less in response to a 100 kg load on the elongated support 1310. In some embodiments, the probe to be inserted into the patient comprises a distance in the range of about 20 cm to about 60 cm, and the mounting assembly 1600 is configured to move the distal end of the probe 6 mm or less in response to a load on the elongated support 1310.

[0169] The probe mounting and adjustment assembly 1600 can be a modular system consisting of a collapsible universal operating table mounting system and a pair of lockable positioning arms disposed on a universal mount. The universal mount is easy and intuitive to adjust to fit most commonly used operating tables, including tables with different size mounting rails, varying table widths, and removable and foldable leg supports. It provides a rigid platform on which the mounting arms 1312, 1314 are optimized for weight, stiffness, fluid transfer, and range of motion, providing superior surgical planning capabilities.

[0170] The two mechanical arms 442, 444 allow for smooth fluid movement within the defined surgical planning field. They aid in probe alignment and streamline surgical planning while providing tactile feedback of the patient anatomy, minimizing the risk of injury. When locked, the mechanical arms 442, 444 provide a rigid interface that holds both the imaging and therapy probes where the operator wishes them to be positioned. During procedure setup and disassembly, the probe mounting and adjustment assembly 1600 can be split into compact, easily manageable components that can be deployed by one person and mounted in / on the console for storage.

[0171] According to some embodiments, the probe mounting and adjustment assembly 1600 comprises two similar, e.g., substantially identical, rail clamps 1302, 1304 and a crossbar 1310. The rail clamps 1302, 1304 can be adjusted and set to fit all commonly used table rail sizes and deployed / removed with a simple throw of the lever 1406. The lever 1406 is the primary touch point of the rail clamps, allowing them to be deployed one-handed in a single motion. The crossbar 1310 docks into two receptacles 1316 of the rail clamps 1302, 1304, completing the table mounting system and folding flat for storage. It is deployed by squeezing two control triggers, one in each hand. The control triggers unlock the corner pivots, allowing folding for storage as well as fine width adjustment for mounting to a patient support. The control triggers also unlock the mechanism that secures the crossbar 1310 to the rail clamps. According to some embodiments, the features on the crossbar 1310 self-engage and self-lock when pushed into place to minimize the possibility of improper assembly. The crossbar 1310 may also have a width adjustment mechanism for coarse adjustment to different operating table widths. The components can be positioned in a symmetrical fashion to create an isosceles trapezoid geometry relative to the OR table. In some embodiments, the rail clamps 1302, 1304 can be placed at different Z positions and the patient can be placed at different X positions and angled on the table at a Z' angle creating multiple asymmetries. The design of the mounting assembly 1600, including the rail clamps 1302, 1304, rail clamp receptacles 1316, lockable crossbar mounting arms 1312, 1314, and crossbar 1310 (including arm rotation about the Y axis), provides adjustment of the arm structure allowing precise location of the imaging probe 460 and treatment probe 450 to accommodate all variables of equipment settings, patient anatomy, and patient position.

[0172] According to some embodiments, the mechanical arms 442, 444 comprise two similar arms (e.g., substantially identical arms) and a lateral adjustment mechanism. Each arm may comprise three rotatable / lockable joints connected together by arm segments, an interface on the bottom for secure mounting to a crossbar 1310, and a control handle 1318 and stepper mount 1320 at the top. The joints may be configured to rotate about the X-axis. The control handle 1318 is the primary touch point for operation and allows for one-handed positioning and adjustment of each probe 450, 460. The stepper mount 1320 provides a drape-safe interface for mounting steppers used for fine control of the imaging probe 460 and the therapy probe 450. Each mechanical arm 442, 444 may be covered with surgical draping to minimize contamination and simplify cleaning after the procedure. The control handle 1318 may have a two-stage actuation mechanism, a first stage to unlock all the joints in unison and keep them unlocked, and a second stage to re-lock the system when in the desired position. This may reduce the need to hold each arm in a tight grip during manipulation for improved feel and more precise control. In some embodiments, the control handle 1318 comprises a handle for manipulating the robotic arm, with a button or switch to engage or disengage the locking mechanisms in the joints and enable or disable manual manipulation of the robotic arm.

[0173] The clamps 1302, 1304 are connected to the receptacle 1316 by a clamp coupling 1324. The clamp coupling 1324 allows for a degree of freedom between the clamp 1302 and the receptacle 1316, thereby allowing for adjustment of the orientation or position of the clamp 1302 and may facilitate fastening to the patient support. The receptacle 1316 is connected to a mounting arm 1312. In some embodiments, the receptacle 1316 defines a recess and the mounting arm 1312 couples with the receptacle 1316 by fitting inside the recess and may be secured through any suitable mechanical interaction such as a ball detent, friction fit, set screw, thumb screw, keyway, protrusions and pockets, pins, interference structure, or some other suitable connection structure. In some embodiments, the mounting arm 1312 includes a lever that pivots a locking pin to allow a secure connection between the mounting arm 1312 and the receptacle 1316. In exemplary use, according to some embodiments, the mounting arm 1312 may be inserted into a recess in the receptacle 1316 and the locking pin may retract as the mounting arm 1312 engages within an inner surface of the receptacle 1316. Upon full insertion, the locking pin or other protruding structure, which may be biased to extend away from the mounting arm 1312, may snap outwardly from the mounting arm and into a recess, cavity, hole, or pocket formed in the receptacle 1316, securely connecting the mounting arm 1312 to the receptacle 1316. A lever on the mounting arm 1312 may be coupled to the protruding structure such that when the lever is depressed, the protruding structure is pulled into the mounting arm 1312, facilitating the mounting arm 1312 being pulled out of the receptacle 1316.

[0174] The mounting arm 1312 is connected to the crossbar 1310, such as by a crossbar coupling 1326. The crossbar coupling 1326 may allow for pivotal movement between the mounting arm 1312 and the crossbar 1310. As shown, a pair of mounting arms 1312, 1314 may be connected to the crossbar 1310 at either end of the crossbar 1310. The pair of mounting arms 1312, 1314 may be rotated or pivoted about the crossbar coupling 1326 to vary the distance between the clamps 1302, 1304. In this manner, the distance between the clamps 1302, 1304 can be adjusted to fit on a variety of differently sized patient supports.

[0175] The crossbar 1310 carries a mechanical arm base 1328. The mechanical arm base 1328 may be slidably connected to the crossbar 1310 allowing the mechanical arm base 1328 to slide along an X-axis and move horizontally side to side relative to the patient. The mechanical arm base 1328 may be secured to the crossbar 1310 in any suitable manner, such as by a screw, thumb screw, cam, lever, lock, twist lock, or any suitable structure for securing the mechanical arm base 1328 to the crossbar 1310.

[0176] The mechanical arm base 1328 provides attachment points for one, two, or more mechanical arms 442, 444. As shown, in some embodiments, two mechanical arms are connected to the mechanical arm base 1328. The mechanical arms 442, 444 may be connected by any type of secure connection, such as screws, slide locks, clips, or other suitable connectors. The components of the probe mounting and adjustment assembly 1600 can be formed from any suitable material, and in some embodiments, one or more components are formed from a metal, such as stainless steel, titanium, tantalum, platinum, palladium, or any suitable alloy. The components of the probe mounting and adjustment assembly 1600 may alternatively or additionally be formed from any suitable polymer, such as, for example, one or more of polyvinyl chloride (PVC), polypropylene (PP), polyethylene (PE), polystyrene (PS), nylon, polyethylene terephthalate (PET), polyimide (PA), polycarbonate (PC), acrylonitrile butadiene (ABS), polyether ether ketone (PEEK), or polyurethane (PU).

[0177] In some embodiments, the clamp 1302, the clamp coupling 1324, the receptacle 1316, the mounting arm 1312, the crossbar coupling 1326, the crossbar 1310, the mechanical arm base 1328, or the mechanical arm 444 comprises an actuator, a bearing, a shaft, a worm drive, a rack, a pinion, a gear, a belt, a chain, a pulley, a slide, a collar, a shaft, or any combination thereof. In some embodiments, at least one of the clamp 1302, the clamp coupling 1324, the receptacle 1316, the mounting arm 1312, the crossbar coupling 1326, the crossbar 1310, the mechanical arm base 1328, or the mechanical arm 444 comprises an encoder, which measures translational or rotational displacement or position.

[0178] The mechanical arm 442, 442 may comprise one or more segments separated by joints that provide degrees of freedom between the segments. For example, the mechanical arm may have two, three, four, or more segments 1330 each coupled to one another by joints 1332 that allow relative pivoting or rotational movement between adjacent segments 1330. The mechanical arm itself may be coupled to the mechanical arm base 1328 by joints that allow rotation of the mechanical arm about one or more axes.

[0179] The mechanical arm 442 carries a probe mount 1334 to which the probe 450 may be mounted. As shown, the first mechanical arm 442 carries the imaging probe 460 and the second mechanical arm 444 carries the therapy probe 450. In some embodiments, the probe mount 1334 includes a riser 1336 configured to elevate a probe such as the therapy probe 450 in the Y direction such that the therapy probe 450 is higher than the imaging probe 460. Thus, in the case where the therapy probe 450 and the imaging probe 460 are vertically aligned with one another, the riser 1336 facilitates the therapy probe 450 avoiding contact with the imaging probe 460 as they are vertically spaced apart from one another.

[0180] The treatment probe 450 has an axis of extension along its shaft, and similarly, the imaging probe 460 has an axis of extension along its shaft. In some configurations, the treatment probe axis and the imaging probe axis are aligned in a plane; that is, the axes are parallel to each other, thus making them coplanar. In some embodiments, the configuration of the mechanical arms 442, 444 and the probe mount 1334 can position the treatment probe axis and the imaging probe axis coplanar with each other in a vertical plane. In other words, the two axes can be vertically aligned, with one probe directly above the other.

[0181] According to some embodiments, the probe is movable within the surgical field in the X, Y, and Z directions, as well as with rotational movement about any of these axes. In some cases, the imaging probe 460 and the treatment probe 450 are independently positionable in the YZ plane, and in some cases there is limited relative movement along the X axis. According to some embodiments, the imaging probe 460 has a limited range of translational movement, in some cases about ±2 inches from a center position in the X direction, -3 inches to +4 inches in the Y direction, and -9 inches to +2 inches in the Z direction (and an additional 100 mm in the Z direction with fine control of the stepper motor). The imaging probe 460 may have a limited range of rotational movement, and in some embodiments can be rotated anywhere from 0° to about 45° about the X axis, ±15° about the Y axis, and ±32° about the Z axis.

[0182] According to some embodiments, the treatment probe 450 may have a limited range of motion that may be about ±2 inches from center along the X axis, 3 inches to 12 inches from the top of the patient support, and -9 inches to 2 inches (and an additional about 100 mm under stepper motor control) in the Z direction. In some embodiments, the treatment probe 450 may be rotated about ±30° about the X axis, about ±15° about the Y axis, and with very small adjustments about the Z axis, etc.

[0183] The mechanical arms may also include a control handle 1318. According to some embodiments, the control handle 1318 is coupled to one or more of the mechanical arms and allows an operator to manually position the mechanical arms 442, 444 and, concomitantly, the probe carried by the mechanical arms. The control handle 1318 may be of any suitable configuration that provides a way to manually adjust or move the mechanical arms. In some embodiments, the control handle 1318 includes a lever that disengages clutches in one or more of the joints that separate the segments of the mechanical arms. In some cases, the lever of the control handle 1318, when depressed, disengages one, two, three, or more joints, allowing the joints to pivot, rotate, or some combination that allows the operator to manually position the mechanical arms. The control handle 1318 may be connected to or formed integrally with the probe slider 1340. The probe slider 1340 allows the imaging probe 460 or the therapy probe 450, or both, to translate substantially in the Z direction into and out of the patient. The probe slider 1340 can be manually operated, robotically operated, or a combination of both.

[0184] In use, the clamps 1302, 1304 are coupled to a patient support. There may be two clamps, four clamps, six clamps, or more coupled to a patient support, which in some cases is a bed. The clamps may include clamp adjusters 1342 that allow for spacing of the jaws within the clamp. A handle 1408 on each clamp is manipulated by an operator so that the jaws of the clamp firmly grip the patient support. The receptacle 1316 may be manipulated to position the receptacle 1316 in an orientation configured to mate with a mounting arm 1312 of the probe mounting and adjustment assembly 1600. The mounting arms 1312, 1314 are then coupled to the receptacle 1316 and secured to the mounting arm in any suitable manner.

[0185] The crossbar 1310 may be connected to a mounting arm 1312; however, in some embodiments, the crossbar 1310 and the mounting arms 1312, 1314 are not removable from one another, and coupling of the mounting arms to the receptacles 1316 places the crossbar 1310 in the proper position for treatment of the patient. Once the crossbar 1310 is in position, the mechanical arms 442, 444 may be secured to the mechanical arm base 1328 of the crossbar 1310. The imaging probe 460, the therapy probe 450, or both, are then coupled to the probe mount 1334. An operator may then manually manipulate the mechanical arms 442, 444, such as by using the control handle 1318, to position the imaging probe 460 and the therapy probe 450.

[0186] The mechanical arms 442, 444 may then be robotically controlled or manually controlled during part or all of the procedure. In some embodiments, the mechanical arms 442, 444 are placed in a starting position. The modular nature of the probe mounting and adjustment assembly 1600 allows the components to be separated and easily managed and individually configured. The illustrated configuration further enables treatment planning by automatically aligning the imaging probe 460 and the treatment probe 450 in the same plane, allowing smooth tactile positioning and adjustment of the probe. Additionally, in some embodiments, the mechanical arms allow positioning and compression adjustments to the probe, while stepper motors in the joints allow computer controlled Z-positioning and angular adjustment of the probe. In some embodiments, the description refers to only the mechanical arm 442, mounting arm 1312, and associated hardware components, but it should be understood that additional mechanical arms may have the same or similar hardware.

[0187] 14A, 14B, and 14C illustrate an exemplary embodiment of a clamp 1302 that may be used with the probe mounting and adjustment assembly 1600. The clamp 1302 has a fixed jaw 1402, a movable jaw 1404, and a lever 1406 that varies the distance between the fixed jaw 1402 and the movable jaw 1404. The lever 1406 includes a handle 1408 configured to grip and manipulate the clamp. The lever 1406 is mechanically coupled to the movable jaw 1404 such that when the handle 1408 is in an upward position relative to the clamp 1302, the jaws are spaced apart, and as the lever 1406 is moved downward relative to the clamp 1302, the movable jaw 1404 is brought closer to the fixed jaw 1402 from a first position 1410 to a second position 1412. In some instances, both the upper jaw 1402 and the lower jaw 1404 are movable relative to one another, however, in the illustrated embodiment, the upper jaw 1402 is illustrated as fixed and the lower jaw 1404 is movable.

[0188] The clamp 1302 includes a clamp coupling 1324 that attaches the clamp to the receptacle 1316. In some embodiments, the receptacle 1316 has a recess 1420 configured to receive a portion of the mounting arm 1312 therein and facilitate a secure attachment between the receptacle 1316 and the mounting arm 1312. The clamp coupling 1324 provides for rotational movement of the receptacle 1316 relative to the clamp 1302. This allows the clamp 1302 to be coupled to the patient support at any angle or configuration and allows the receptacle 1316 to be oriented in a preferred manner to receive the mounting arm 1312. While the illustrated embodiment shows a rotational coupling between the receptacle 1316 and the clamp 1302, other forms of attachment are also contemplated, such as, for example, a ball and socket joint, hinge, pivot, or other structure to allow the receptacle to move relative to the clamp 1302.

[0189] A clamp adjuster 1342 is provided to provide an initial adjustment of the clamp 1302. For example, the clamp adjuster 1342 can be used to move the movable jaw 1404 to a first position 1410. The handle 1408 can then be used to move the movable jaw 1404 to a second position 1412, where the patient support is gripped between the fixed jaw 1402 and the movable jaw 1404. If the grip on the patient support is not tight enough, the clamp 1302 can be disengaged from the patient support and the clamp adjuster 1342 can be used to reposition the movable jaw 1404 to the first position 1410. The lever 1406 can then be used to move the movable jaw 1404 to the second position 1412, where the fixed jaw 1402 and the movable jaw 1404 are tightly engaged on the patient support. As used herein, the first position 1410 of the moveable jaw 1404 is associated with the clamp in a disengaged configuration and the second position 1412 of the moveable jaw 1404 is associated with the clamp in an engaged configuration. The clamp adjuster 1342 can be used to vary the first position 1410, which has the effect of varying the clamping force when the moveable jaw 1404 is moved to the second position 1412.

[0190] 15A, 15B, 15C, and 15D illustrate the internal structure of an exemplary clamp 1302 that can be used with embodiments of the probe mounting and adjustment assembly 1600 described herein. FIGS. 15A and 15B illustrate the clamp in a disengaged configuration, and FIGS. 15C and 15D illustrate the clamp in an engaged configuration. The clamp 1302 includes a lever 1406 with a handle 1408 formed therein. The lever 1406 is pivotally coupled to the fixed jaw 1402 by a lever shaft 1502 and configured to pivot between an upper disengaged orientation and a lower engaged orientation. The lever shaft 1502 is coupled to a lever arm 1504, which is in turn coupled to an adjuster block 1506. The adjuster block 1506 is connected to the adjuster post 1508, such as by forming internal threads on the adjuster block 1506 that cooperate with threads formed on the adjuster post 1508.

[0191] In some embodiments, the lever shaft 1502 is pivotally connected to the lever arm 1504 at the lever arm upper joint 1510 and to the adjuster block 1506 at the lever arm lower joint 1518, such that movement of the lever 1406 about the lever shaft 1502 causes movement of the lever arm upper joint 1510 about the lever shaft 1502. The lever arm 1504 is pivotally connected to the adjuster block 1506, such that pivotal movement of the lever arm 1504 about the lever shaft 1502 causes translational movement of the adjuster block 1506 and, consequently, translational movement of the adjuster post 1508.

[0192] The movable jaw 1404 includes a through hole that captures a pair of jaw posts 1512 that allow slidable movement of the movable jaw 1404 over the jaw posts 1512. The jaw posts 1512 extend between the clamp base 1514 and the fixed jaw 1402. The adjuster block 1506 includes a jaw mover 1516 protrusion configured to contact the movable jaw 1404, and as the adjuster block 1506 moves upward, the jaw mover 1516 contacts the movable jaw 1404 and moves the movable jaw 1404 between a first position and a second position. The adjuster post 1508 can be rotated, such as by a thumb screw or knob on the clamp adjuster 1342, to vary the first position of the adjuster block 1506 depending on the size of the patient support to which the clamp is to be attached. In some embodiments, the clamp 1302 may have indicia corresponding to a first position of the moveable jaw 1404 so that adjustment of the adjuster post 1508 and adjuster block 1506 may be repeated for subsequent clamps or subsequent procedures. For example, once the first clamp 1302 is dialed in to apply the appropriate amount of clamping force on the patient support, the indicia may visually indicate a position or setting of the clamp adjuster 1342 that may be used to adjust subsequent clamps, such as the second clamp 1304, third clamp, fourth clamp, etc., so that all clamps have similar clamping force on the patient support. The present clamping method relies on a highly stressed linkage across the center to achieve high clamping force and prevention of release (although a latch locking feature (not shown) may be used to prevent release). In some embodiments, when tightening onto a bed rail, as the lever 1406 is lowered, closing the jaw gap (the distance between the fixed jaw 1402 and the moveable jaw 1404), the jaws contact the rail before the lever 1406 is in its home position. At this point, the linkage and jaws (both fixed and moveable) are subjected to a force that moves them within the elastic deformation of the material. This elastic deformation increases the "feel" of the force on the closing lever 1406, at a point where the linkage design provides significant lever arm mechanical efficiency.All metal becomes stressed as the clamp is closed and the linkage traverses the maximum distance of deformation to a less (but still significant) position of deformation. This smaller distance requires a force to move it back over the maximum distance to release the clamp 1302. Relevant to the performance of this clamping is the consideration of the material properties of the fixed and movable jaws (linear spring), lever arm 1504 (c or s-shaped spring), lever shaft 1502, including spring constant (k), material modulus, and design considerations to prevent reaching the elastic yield of the material that would cause permanent deformation of the components. In addition, if the above components were a fully rigid system, this may require a spring element to be designed into the adjuster block 1506.

[0193] 16A, 16B, 16C, and 16D illustrate side views of a clamp that may be used with a probe mounting and adjustment assembly 1600 according to some embodiments, shown in sequence as the handle 1408 is moved through its range of motion from a disengaged position to halfway, three-quarters, and fully engaged positions, respectively. In use, the clamp adjuster 1342 is used to establish an initial, first position of the lower jaw 1404 by pivoting the clamp adjuster 1342 and advancing the adjuster block 1506 along the threaded portion of the adjuster post 1508. This allows an initial, first position of the movable jaw 1404 to be established while the lever 1406 remains in the disengaged position.

[0194] The lever arm upper joint 1510 is offset from the lever shaft 1502 by a distance M, and the lever arm upper joint 1510 rotates about the lever shaft 1502. Note that, as illustrated in FIG. 16A, the movable jaw 1404 is free to move downwardly away from the fixed jaw 1402 until it contacts the adjuster block 1506, which limits the movement of the movable jaw 1404 in a direction away from the fixed jaw 1402. As the lever 1406 is moved from the position shown in FIG. 16A to the position illustrated in FIG. 16D, the lever arm upper joint 1510 rotates about the lever shaft 1502 and moves from a position approximately below the lever shaft 1502 to a position approximately directly above the lever shaft 1502. This motion results in a linear translation of the adjuster block 1506 a distance of 2M. Correspondingly, the adjuster block 1506 and the movable jaw 1404 also move a linear distance equal to 2M. For example, in FIG. 16D, the top pin is A (the lever arm upper joint 1510), the middle pin is B (the lever shaft 1502), and the bottom pin is C (the lever arm lower joint 1518). B is located in space and is immovable relative to the fixed jaw 1402. A rotates about B, causing the lever arm 1504 to rotate about C. The movement of the lever arm 1504 causes C to translate in the Y axis (causing the movable jaw to move). Points B and C can be imagined as remaining collinear along the Y axis (the axis designated BCY), with A traversing arcs of different radii centered on B and C. Each of A, B, and C has imaginary parallel X-rays Ax, Bx, Cx passing through them, and the distance between them changes when the handle 1408 is moved. Furthermore, the distance between Ax and Cx is D rotate (Many positions), D max (A is the highest) (this is the maximum force that can be obtained), and D locked (A crosses the BCY axis) (this is the sustained clamping force). The locking mechanism of this design ensures that the distance between Ax and Cx during handle 1408 closure is a maximum distance D maxDepending on the locking position of A that is reached when the locking position of A is reached, and depending on the further closing of the lever 1406, the distance between Ax and Cx becomes D. locked D to reach max This position is based on A crossing the axis BCY.

[0195] The components of the clamp 1302 can be formed from any suitable material, and in some embodiments, the fixed jaw 1402 and the movable jaw 1404 are formed from a suitable metal, such as any of various steels or steel alloys, aluminum, or other types of metals or metal alloys. The lever 1406 and the handle 1408 can be formed from any suitable material, which may be a polymeric material, and in some cases is a reinforced polymer. The fixed jaw 1402 and the movable jaw 1404 can be any suitable shape, and in some embodiments, one or more of the fixed jaw 1402 and the movable jaw 1404 are wedge-shaped, U-shaped, L-shaped, or some other suitable cross-sectional shape for clamping onto various patient supports. In some cases, the fixed jaw 1402 and the movable jaw 1404 are configured to clamp onto rails shaped as tubes, flat bars, oval tubes, or rails having some other geometric shape. In use, the clamp can be affixed to a patient support as a first step in preparation for a procedure. The crossbar 1310 can then be mounted to a clamp by means of mounting arms and receptacles 1316 .

[0196] 17A, 18B, and 17C illustrate a clamp 1302 affixed to a rail 1702 in rear, side, and front perspective views, respectively. The illustrated clamp 1302 is substantially as described elsewhere herein, such as with respect to FIGS. 16A-16D. The patient support 1113 includes a rail 1702 along its side. The rail 1702 can be spaced from the patient support 1113 a distance to allow people and objects to grasp and / or be mounted to the rail 1702. The clamp 1302 can be mounted to the rail with sufficient clamping force to create a secure engagement with the rail 1702 and the patient support 1113. In some embodiments, the clamp 1302 has a low profile and does not extend above the top surface of the patient support 1113. As used herein, the term "low profile" is used to describe the clamp 1302 that does not extend upwardly above the upper surface of the patient support 1113. This facilitates attaching the clamp 1302 to the patient support 1113 before the patient is placed on the patient support 1113. The low profile clamp does not interfere with the patient being placed on the patient support.

[0197] In some embodiments, the sensor 1399 is coupled to one or more clamps as described herein, such as a clamp configured to couple to a rail. In some embodiments, the sensor 1399 comprises multiple sensors coupled to clamps on each side of the rail. The sensors can be configured to measure the load of one or more of the clamps, the rail, or a support coupled to a robotic arm as described herein.

[0198] 18A and 18B illustrate perspective views of an exemplary embodiment of a crossbar 1310 with attached mounting arms 1312, 1314 that may be used in conjunction with a probe mounting and adjustment assembly 1600 as described herein. The crossbar 1310 has a first end and a second end, both of which may be connected to the mounting arm 1312. A crossbar coupling 1326 connects the mounting arm 1312 to the crossbar 1310 and provides for pivotal movement of the mounting arm 1312 relative to the crossbar 1310. The crossbar coupling 1326 allows for pivotal movement of the mounting arm 1312 during setup of the probe mounting and adjustment assembly 1600, allows the clamp 1302 to be properly positioned on the patient support 1113 for clamping, and in some embodiments can be tightened to resist pivotal movement of the mounting arm 1312 relative to the crossbar 1310. The crossbar coupling 1326 may be any suitable coupling that allows for adjustability of the mounting arm 1312 and may comprise an actuator, a bearing, a shaft, a worm drive, a rack, a pinion, a gear, a belt, a chain, a pulley, a slide, a collar, a shaft, or any combination thereof. The crossbar coupling 1326 may further include a locking mechanism for selectively fixing the relative position of the mounting arm 1312 and the crossbar coupling 1326. In some embodiments, the locking mechanism comprises a cam, a screw, a handle, a knob, a shaft, a clamp, or any combination thereof.

[0199] A mechanical arm base 1328 may be slidably disposed on the crossbar 1310 and configured to selectively slide along the length of the crossbar 1310. The mechanical arm base 1328 can be selectively secured to the crossbar 1310 at a desired location by any mounting mechanism, such as a screw, cam, handle, knob, clamp, or any combination thereof. In some embodiments, the mechanical arm base 1328 is rigidly fixed to the crossbar 1310 and is not movable along the crossbar 1310. The mechanical arm base 1328 includes one, two, three, or more arm mounts 1802 configured to receive and hold a mechanical arm 442, which may be a robotic arm, a manually actuated arm, or a combination of mechanical and robotic actuated.

[0200] In some embodiments, the mechanical arm base 1328 includes a first arm 1802 mount and a second arm mount 1804, the first and second arm mounts configured for coupling with the first and second mechanical arms. The first and second mechanical arms may carry the treatment probe 450 and the imaging probe 460, respectively. The first and second arm mounts may be spaced a fixed distance from each other along the crossbar 1310. In some instances, the fixed and known spacing between the arm mounts, and thus the mechanical arms, can be used by the controller to align the treatment probe 450 and the imaging probe 460 relative to each other. For example, with the fixed positions of the arm mounts 1802, 1804, the controller can determine the home positions of the probes relative to each other, which can also facilitate proper alignment of the treatment probe axis relative to the imaging probe axis.

[0201] The mechanical arms are secured to the arm mounts by any suitable mechanism, such as screws, knobs, cams, clips, detents, clamps, or any combination. In some embodiments, the mechanical arm base 1328 provides a mount for the two mechanical arms to be affixed, and the arm mounts 1802, 1804 may be a fixed distance apart. This facilitates the orientation and alignment of the probes mounted on the mechanical arms, and also aids in calibrating the position of the probes.

[0202] 19A and 19B, an exemplary embodiment of a crossbar 1310 is shown and the range of motion of the mounting arms is shown along with mounting configurations on various sizes of patient supports. The mounting arms are attached to the crossbar 1310 by a crossbar coupling 1326 that allows pivotal movement of the mounting arms relative to the crossbar 1310. The mounting arms are selectively movable between a first position 1902, which may be used for storage of the probe mounting and adjustment assembly 1600 or during transport, and a second position 1904, in which the mounting arms are rotated away from the crossbar 1310 and spread apart to facilitate mounting on a patient support. The mounting arms 1312, 1314 are selectively movable through an angle α and can be secured in any orientation. In some embodiments, the range of motion α is at least 90°, and in some embodiments, the range of motion of the mounting arms is 100°, 110°, 120°, 130°, 140°, 150°, 160°, 170°, or 180°. In some embodiments, the mounting arms 1312, 1314 are not positioned symmetrically, and thus the angle α is not consistent between the mounting arms. For example, the first mounting arm 1312 may be positioned at an angle α of 100°, and the second mounting arm 1314 may be positioned at an angle α of 125°.

[0203] As shown in FIG. 19B, the mounting arms 1312, 1314 are illustrated with clamps 1302 attached thereto, and the mounting arms can be spread apart to accommodate patient supports having varying widths. For example, a first patient support 1906 has a first width, and the mounting arms can be spread apart a first distance to position the clamps coupled to the mounting arms to be mounted on the patient support. As the mounting arms are rotated through a range of motion to accommodate the patient support width, the clamps can be rotated so that the jaws of the clamp are aligned with the patient support. When mounting to a second patient support 1908 having a larger width than the first patient support, the mounting arms can be spread apart further to accommodate this larger sized patient support. As shown, the further apart the mounting arms are spread, the closer the crossbar 1310 is to the patient support. By providing the mounting arm with a range of pivotal motion relative to the crossbar 1310 and allowing the clamp 1302 to pivot relative to the mounting arm, the probe mounting and adjustment assembly 1600 can fit onto many differently sized patient supports. In some embodiments, the clamp 1302 can be attached to a longer mounting arm that can be used in conjunction with the crossbar 1310 for further adjustability to fit a wider range of sizes of patient supports.

[0204] FIG. 20 illustrates an exemplary embodiment of a mechanical arm 442 with a control handle 1318. The mechanical arm 442 is a robotic arm and may be under the control of one or more computing devices to allow for precision movement of the robotic arm and the probe attached thereto. The robotic arm may be articulated with two, three, or more segments 2002 joined by joints 2004. The segments 2002 may be joined by joints 2004 that allow for rotation between adjacent segments 2002. The joints 2004 may be any suitable joint and may include a locking mechanism to allow selective movement of the mechanical arm 442 and locking of the mechanical arm. The joints 2004 may include a cone-shaped clutch lock joint and may include hydraulics to facilitate movement of the mechanical arm. Other suitable joints include single plate clutches, multiple plate clutches, locking cam interfaces, interlocking gear teeth, hydraulic actuation, push rod actuation, motorized actuation, and cable actuation. Each joint 2004 may comprise one of a variety of kinematic joints, including, but not limited to, a rectangular cylinder, revolute, parallel cylinder, cylindrical, spherical, planar, edge slider, cylindrical slider, point slider, spherical slider, or cross cylinder joint, or any combination thereof. Additionally, each joint 2004 may comprise a linear, orthogonal, revolute, torsional, or swivel joint, or any combination thereof. In some embodiments, the joints 2004 have a limited range of motion to reduce the possibility of pinch hazards.

[0205] The mechanical arm 442 includes a mounting cleat 2006 to facilitate attachment of the mechanical arm 442 to a mechanical arm base 1328 that is coupled to the crossbar 1310 (FIG. 13). The mechanical arm 442 further includes a mount 2008 configured to receive a probe slider 1340. The probe slider 1340 may include a motor that allows a probe attached thereto to be advanced or retracted in the Z direction under computer control. In some embodiments, the probe slider 1340, which may include a stepper motor, may be configured to provide fine control of the probe attached thereto. In some embodiments, the probe mounting and adjustment assembly 1600 includes two mechanical arms, each with a probe mounted thereto, and each probe can be advanced in a controlled Z direction by commands that actuate a computing device and a stepper motor of the probe slider 1340.

[0206] A control handle 1318 is attached to the mechanical arm 442 and can be used to manually manipulate the mechanical arm 442. A control lever 2010 is coupled to each joint 2004 in the mechanical arm. The control lever 2010 may be mechanically coupled to the joint, such as by a pull wire, belt, chain, or the like. Alternatively, the control lever 2010 may be electronically coupled to the joint 2004. As described herein, the joint 2004 may include an actuator to enable robotic actuation of the mechanical arm 442. In some embodiments, the control lever 2010 is operable to disengage the actuator and enable manual operation of the mechanical arm 442. For example, the joint 2004 may include a clutch mechanism that selectively disengages the actuator in the joint 2004. Thus, when an operator pulls the control lever 2010, a clutch in the joint disengages the actuator, allowing the operator to move the mechanical arm 442 by applying a force on the handle 1318. The mechanical arm 442 may provide movement about the axis of each joint 2004 and may further allow rotational movement about the mechanical arm base 1328. Manual actuation of the mechanical arm 442 allows an operator to position the mechanical arm 442 and attached probe in the Y direction (e.g., vertical) and Z direction (e.g., closer to or away from the patient). The operator can manually position the probe attached to the mechanical arm, calibrate the position of the probe tip, and command one or more computing devices to operate the mechanical arm according to a treatment plan.

[0207] In some embodiments, the geometry of the mechanical arm 442 includes three rotating joints 2004 to allow for fluid movement within a constrained surgical field area. In some embodiments, the mechanical arm 442 includes three rotating joints 2004 that all allow for movement of the mechanical arm segments 2002 about the X-axis. As a result, the mechanical arm 442 can be moved freely in the YZ plane, limiting its ability to be manipulated in the XY plane. In some cases, the joints 2004 can be unlocked to allow for fluid movement with low resistance, which allows for precise positioning and tactile feedback of the patient anatomy.

[0208] 21 illustrates two mechanical arms with attached probes, where the two probes are aligned in a vertical plane. A first arm 442 and a second arm 444 are coupled to a common base, such as a mechanical arm base 1328, carried on the crossbar 1310 of the probe mounting and adjustment assembly 1600. The first and second arms are mounted and spaced apart by a distance, which may be a fixed distance dictated by the mechanical arm base 1328. The first arm carries an imaging probe 460, which has an imaging probe axis 2102. The second arm 444 carries a therapy probe 450, which has a therapy probe axis. The mechanical arms are adjusted, if necessary, to orient the imaging probe axis 2102 to be parallel to the therapy probe axis. In some embodiments, the imaging probe axis 2102 and the therapy probe axis are coplanar in a vertical plane, which can facilitate proper positioning of the imaging probe 460 and the therapy probe 450 relative to the anatomy of a patient undergoing a procedure. As described with reference to FIG. 13, the second arm 444 may incorporate a riser 1336 in the probe mount for elevating the therapy probe 450 above the imaging probe 460 such that the first arm and the second arm 444 do not interfere with each other when the imaging probe axis 2102 and the therapy probe axis are aligned in the vertical plane. The imaging probe axis 2102 and the therapy probe axis may be coplanar in a plane that may be near-vertical rather than vertical, and they may be aligned under computer control of the first arm and the second arm 444.

[0209] 22 illustrates an exemplary embodiment of a probe mounting and adjustment assembly 1600 attached to a patient support 1113. A crossbar 1310 carries two mechanical arms 442, 444 that are independently attached to the crossbar 1310 and therefore may move independently along the crossbar 1310. The crossbar 1310 may also include additional support structures such as legs 2202, brace material 2204, stretchers 2206, cross brace material 2208, and feet 2210. In some embodiments, the crossbar 1310 is coupled to one or more legs 2202 that extend from the crossbar 1310 to the floor. The legs 2202 may be adjustable and configured to carry a large percentage of the weight of the probe mounting and adjustment assembly 1600. One or more of the legs 2202 may include feet 2210 to spread the load on the ground and may include a non-skid material to reduce the tendency of the legs 2202 to slide on the floor. One or more stretchers 2206 may be provided between two or more of the legs 2202 to reduce the tendency of the legs to tilt in response to tilting forces.

[0210] One or more cross braces 2208 may be attached between the legs 2202 to provide stiffness to the support structure. One or more braces 2204 may be provided to increase stiffness of the clamp coupling 1324, such as by connecting one or more braces from the top of the legs to a location near where the clamp connects to the mounting arm. The use of legs, cross braces, stretchers, braces, and any combination thereof, can be selected to increase stiffness and rigidity of the probe mounting and adjustment assembly 1600 compared to a probe mounting and adjustment assembly without the extra support structure. In some embodiments, the support structure reduces relative motion between the probe mounting and adjustment assembly and the patient support.

[0211] Additionally or alternatively, one or more additional clamps 1302 can be connected to the legs, stretchers, crossbar 1310, or cross braces at suitable locations. Additional clamps can be used in addition to the clamps already shown and described as connected to the ends of the crossbar 1310 to provide additional attachment points between the probe mounting and adjustment assembly 1600 and the patient support.

[0212] FIG. 23 illustrates a probe mounting and adjustment assembly 1600 utilizing a second clamp on one side of the patient support. The clamp assembly may include a first clamp 1302 and a second clamp 1304 coupled together with a brace material and spaced a fixed distance apart. The clamp assembly is configured to allow the first clamp 1302 and the second clamp 1304 to clamp to a rail 1702 on the same side of the patient support 1113, such as by clamping on the same rail of the patient support. The first clamp 1302 and the second clamp 1304 may be rigidly spaced or may have adjustability in their relative spacing to accommodate clamping to different patient support structures. In those embodiments in which the spacing between the first and second clamps is adjustable, the spacing between the clamps may be rigidly fixed once the relative spacing is selected. For example, the spacing may be rigidly fixed by a screw, cam, lock, knob, or some other fixing structure.

[0213] Similar clamp assemblies may be provided for the opposing side of the patient support and coupled to the crossbar 1310. In this configuration, there may be four clamps coupling the probe mounting and adjustment assembly 1600 to the patient support. Multiple attachment points to the patient support may reduce relative movement between the patient support and the probe mounting and adjustment assembly 1600 compared to using fewer clamps. It should be understood that the clamp assembly illustrated in FIG. 23 may be used in conjunction with any of the other structures shown or described, such as the structure shown in FIG. 22, which include one or more of legs, stretchers, braces, cross braces, and the like.

[0214] In some embodiments, a sensor 1399 is coupled to one or more clamps configured to couple to the rail. In some embodiments, the sensor 1399 comprises multiple sensors coupled to the clamps on each side of the rail. The sensor can be configured to measure the load of one or more of the clamps, the rails, or the supports coupled to the robotic arm. The one or more sensors can be located in any suitable location to measure the load, such as on the clamp, an extension coupled to the clamp, or a support to which the one or more robotic arms are coupled, such as a crossbar. In some embodiments, the clamp is operably coupled to one or more computing devices as described herein. In some embodiments, the processor is configured to generate an alert to a user when the load exceeds a threshold amount. In some embodiments, the sensor is located, for example, on the jaws of the clamp or another locking structure of the clamp. In some embodiments, it is, for example, a pressure sensor, a piezoelectric sensor, or a strain gauge as described herein.

[0215] 24 illustrates an exemplary embodiment of a treatment system 2400 as described herein that includes a mobile base 2402. The treatment system includes a treatment probe 450 coupled to a first robotic arm 442 and an imaging probe 460 coupled to a second robotic arm 444. In some instances, the treatment probe 450 and the imaging probe 460 may be coupled to the same robotic arm and may have a probe mount that provides relative movement and alignment between the two probes.

[0216] Each of the first robotic arm 442 and the second robotic arm 444 includes a proximal end and a distal end, the distal end being coupled to the treatment probe 450 and the imaging probe 460, respectively, and the proximal end being coupled to a common base, which includes the mobile base 2402. The first robotic arm 442 may include a first arm coupling structure for coupling to the treatment probe 450, and the second robotic arm 444 may include a second arm coupling structure for coupling to the imaging probe 460. The treatment probe 450 may be coupled to the distal end of the first robotic arm 442 by a probe mount, which may include a linkage configured to enable movement (e.g., rotation, translation, pitch, etc.) of the treatment probe 450 as described herein. The coupling of the treatment probe 450 to the first robotic arm 442 may be fixed, releasable, or user adjustable. Similarly, the coupling of the imaging probe 460 to the second robotic arm 444 may be fixed, releasable, or user adjustable.

[0217] The first robotic arm 442 may articulate at one or more arm joints 2004. The imaging arm may articulate at one or more second arm joints. Each arm joint may be operatively coupled to a computer-controllable actuator, such as, for example, a stepper motor, to affect movement at the joint. Each arm joint may comprise one of a variety of kinematic joints, including, but not limited to, a rectangular cylinder, a revolute, a parallel cylinder, a cylinder, a spherical, a planar, an edge slider, a cylinder slider, a point slider, a spherical slider, or a cross cylinder joint, or any combination thereof. Additionally, each arm joint may comprise a linear, orthogonal, revolute, torsional, or revolute joint, or any combination thereof. In some embodiments, the first robotic arm 442 and the second robotic arm 444 provide arm joints 2004 that allow the treatment probe 450 and the imaging probe 460 to move in six degrees of freedom, and in some cases, additional degrees of freedom. Movement of the imaging probe 460 and therapy probe 450 may be performed manually, robotically under computer control, or a combination of both.

[0218] The treatment system may further include a console (not shown) as described herein. The console may be operatively coupled to the mobile base 2402 via power and communication cables to enable control of the treatment probe 450 coupled to the mobile base via the first robotic arm 442. The treatment console includes a processor and memory having stored thereon computer executable instructions for execution by the processor to control various modules or functions of the treatment console, such as the energy source, infusion / irrigation control, aspiration control, and other components as described elsewhere herein. The treatment console may further include a display in communication with the processor. The display may be configured to display one or more of the following: vital signs of the subject, such as, for example, heart rate, respiratory rate, temperature, blood pressure, oxygen saturation, or any physiological parameter, or any combination thereof; the status of the procedure; one or more pre-taken images or a series of images of the treatment site from one or more views; one or more real-time images or a series of images of the treatment site from one or more views obtained by the imaging probe 460; a treatment mode, such as, but not limited to, cutting or coagulation; the intensity of the treatment; the time elapsed during the treatment; the time remaining during the treatment; the depth of the treatment; the area or volume of the treatment site that has been treated; the area or volume of the treatment site that will be treated; the area or volume of the treatment site that will not be treated; a set of treatment parameters including location information of the treatment probe 450 or the imaging probe 460 or both; treatment adjustment controls, such as a means for adjusting the depth of the treatment, the intensity of the treatment, the location and / or orientation of the treatment probe 450, the depth of imaging, or the location and / or orientation of the imaging probe 460, or any combination thereof; or system configuration parameters.

[0219] The mobile base 2402 may further comprise one or more computing devices for controlling the movement of one or more robotic arms. For example, the mobile base may comprise a processor and a memory having computer executable instructions stored thereon for execution by the one or more processors. The memory may also have instructions stored thereon for operating one or more robotic arms coupled to the mobile base. The processor may be operatively coupled to the robotic arms via suitable electromechanical components to affect the movement of the robotic arms. For example, each of one or more joints of the robotic arms may comprise a step motor, and the processor may be operatively coupled to the stepper motor at each joint to actuate the motor by a prescribed increment in a prescribed direction. Alternatively, the one or more robotic arms may be operatively coupled to one or more processors of the console or a separate imaging console, and the one or more console processors may be configured to execute instructions for controlling the movement of the one or more robotic arms and may communicate the instructions to the robotic arms via a communication circuit. Computer executable instructions for controlling the movement of the robotic arm may be pre-programmed and stored on the memory, or may be provided by a user via one or more user inputs during or during treatment of a patient using the treatment system.

[0220] One or more computing devices operably coupled to the first and / or second robotic arms may be configured to control the movement of the arms and adjust the pitch, yaw, roll, and / or linear position of the treatment probe 450, the imaging probe 460, or both along the target site.

[0221] The treatment system may include one or more user input devices to allow a user to control the movement of the robotic arm, mobile base, imaging probe 460, treatment probe 450, or any of the operable components associated with the treatment system under computer command. For example, the mobile base may include a keyboard, mouse, touch screen, digital pen, touch pad, voice control input, and / or foot switch. The user input devices may be configured to control the movement of the first robotic arm 442 and / or the second robotic arm 444, for example, via articulation of one or both robotic arms at one or more joints. The user input devices may be in communication with one or more processors configured to control the movement of the robotic arms. The user input devices may be located in any suitable location, for example, on the console, on the robotic arm, on the mobile base, and there may be one, two, three, four, or more user input devices used in conjunction with the treatment system to provide either redundant means of input, unique input commands, control discrete parts of the treatment system, or a combination. In use, when a user inputs commands via a user input device, the user commands can be received by one or more processors and converted into electrical signals that can be transmitted to one or more computer-controllable actuators operatively coupled to one or more robotic arms. The user input device can control the movement of one or both arms toward or away from a treatment position, a position of interest, a pre-determined location, or a user-defined location, or any combination thereof.

[0222] Optionally, the user input device may be configured to control the operation of the treatment probe 450 and / or the imaging probe 460. For example, the user input device may be configured to start, stop, pause, or resume treatment with the treatment probe 450, or start, stop, freeze, save, or display an image with the imaging probe 460.

[0223] The mobile base may further have one or more deployable supports 2404 to stabilize the treatment system by creating contact with the floor. For example, one, two, three, or more deployable supports may extend from the mobile base and contact the ground as the mobile base is wheeled into position. The deployable supports 2404 may extend downward from the mobile base to reduce the chance that the wheels of the mobile base 2402 will lift off the floor and the treatment system may move during the procedure. The deployable supports 2404 may be manually actuated or motor deployed when the treatment system is in position. In some cases, the deployable supports 2404 are manually actuated by a foot pedal that the user presses to deploy the deployable supports and lock them in place.

[0224] The treatment system may include a mobile power system, such as a battery, electrically coupled to the treatment probe 450, the imaging probe 460, the display, the one or more computing devices, the first and second robotic arms, and other equipment associated with the treatment system to enable the treatment system to be mobile and wheeled from room to room within a self-contained treatment system.

[0225] The treatment system may include one or more sensors configured to detect movement due to impact with the treatment system or patient support, an increase in pressure on the treatment system or table support, movement of the patient support, or movement of the patient. The sensors may be configured to adjust the position of the imaging probe 460 and / or the treatment probe 450 in response to sensed movement of the treatment system, the patient support, or the patient. Additionally, an alarm may be configured to alert an operator when there is movement of the patient support, and may be configured to provide an audible, visual, or combined alert when movement of the patient support or patient exceeds a threshold movement magnitude.

[0226] In some embodiments, the mobile base is equipped with casters, and may include three, four, five, or more casters. The casters may include brakes, which may be manual or motorized, to limit the movement of the mobile base. One or more of the casters may have motors therein to enable movement of the mobile base, such as under the control of one or more computing devices. The casters allow the mobile base to transport the treatment system throughout a hospital and within treatment rooms (e.g., operating rooms) to position the treatment system for procedures.

[0227] The mobile base carries a crossbar 1310 and mounts the robotic arm and two, three, four, or more clamps to the patient support. In some embodiments, two clamps are held by opposing adjustable mounting arms to allow the clamps to be positioned on the sides of the patient support. According to some embodiments, additional clamps are provided to increase the number of engaging supports between the treatment system and the patient support and to increase the stiffness of the connection between the treatment system and the patient support. For example, one or more clamps 1302 can be coupled to the crossbar 1310 and fastened onto a proximal portion of the patient support. Additional clamps can be coupled to the crossbar 1310 and fastened onto other portions of the patient support, such as bases, legs, supports, frames, rails, or other structures of the patient support.

[0228] The embodiment shown and described offers numerous advantages not previously seen: deployment of the probe mounting and adjustment assembly 1600 is efficient and can be easily handled by one person, the flexible design provides the ability to work with a wide range of patient supports, patient presentations, and be disposed offset from and facilitates mounting stirrups on the ends of the patient support.

[0229] According to some embodiments, the individual components of the probe mounting and adjustment assembly 1600, when disassembled, have a weight of less than about 8 pounds, less than about 10 pounds, or less than about 12 pounds.

[0230] 25 illustrates a system 2500 for one or more of positioning a probe, calibrating a probe, or training the system with calibrated probe movement. In some embodiments, a calibration device 2502 includes receptacles for receiving a treatment probe 450 and an imaging probe 460. The receptacles are sized and shaped to receive the probes and to allow the probes to be moved to positions where they may be used during a surgical procedure. The position of the arms and probe can be monitored during the calibrated movement prior to placement of the probe within the patient.

[0231] In some embodiments, the processor is configured with instructions to accommodate mechanical movement of the probe and establish one or more boundaries, e.g., for collision avoidance with another probe or another robotic arm. In some embodiments, the processor is configured to implement a "teaching session" and establish boundaries, e.g., prior to placing one or more of the probes in a patient. During the teaching session, a sterile protective calibration guide 2502, also referred to as a calibration device, can be provided into which the imaging probe 460 can be inserted and used to measure geographic location data for incorporation into the position database of the robotic arm. In some embodiments, the guide comprises one or more of a capture lumen 2504 for receiving the imaging probe 460, a touch point 2506 for identifying the tip of the treatment probe 450, one or more double notch structures 2508, 2510 for identifying a linear shaft location relative to the imaging probe 460, or a planar surface for identifying a "non-transecting" anatomical plane. Alternatively, or in combination, multiple cameras and machine vision software instructions can be used to measure probe positions in 3D space relative to their respective origins and generate a database of allowed relative positions between the two probes.

[0232] The calibration device 2502 may be provided sterile with features that allow for positioning on the first probe 460 and placement for calibration of the second probe 450 relative to the first probe 460. The capture lumen 2504 or open structure allows one method for positioning the first probe 460 in a known position and orientation. The first probe 460 may be moved into the capture lumen 2504 at a controlled placement depth into the calibration device 2502 and an envelope of the spatial boundary, e.g., a bounding volume, may be generated and stored in a database.

[0233] In some embodiments, the calibration device 2502 includes a tip location pocket 2506 for detecting contact with the tip of the second probe 450. The first cut-out structure 2508 provides a guide for the shaft of the second probe 450 as the second probe 450 is advanced to the touch point 2506. The combination of the first cut-out structure 2508 and the touch point 2506 thus provides an instruction path for placement of the second probe 450, the position of which can be stored in a position database, which also stores the relative locations of the first probe 460 and the second probe 450.

[0234] With the tip of the second probe in the tip location pocket of the calibration device 2502, the shaft of the second probe can be positioned relative to the shaft of the first probe and a signal can be sent to the processor to note the positions of both arms holding the first and second probes.

[0235] Similarly, the shafts of the first probe 460 and the second probe 450 can be moved to another spatial orientation relative to each other, such as by advancing the second probe 450 along the second cutout structure 2510, and a calibration signal can be sent to the processor to store the relative positions of the first probe and the second probe.

[0236] In addition, the calibration device 2502 can be configured to receive second probe characteristics and detect and determine rotational compensation of the second probe 450 as well as the rotational position of the first probe 460, which can be used, for example, to align the treatment probe nozzle with respect to both the transverse and sagittal planes of ultrasound.

[0237] The calibration device 2502 can thus provide a reliable physical capture area to ensure simple installation and docking of the tip relative to the calibration device 2502, and its position and orientation can be stored in a spatial database to teach the robot arm controller system the allowable spatial envelope of the relative positions and orientations of the first probe 460 relative to the second probe 450.

[0238] The methods and devices disclosed herein can be configured in many ways and may include fiducials and a processor configured with instructions for providing navigation and surgical guidance to a user, such as a surgeon. For example, the imaging probe 460, such as a TRUS probe, the treatment probe 450, the proximal end of the treatment probe 450, the proximal end of the imaging probe 460, or one or more of the robotic arms may include navigation fiducials. These navigation fiducials can be detected using sensors to provide position and orientation information of the treatment probe 450 and the imaging probe 460 relative to a fixed reference frame, such as the patient and a base as described herein. The fiducials may include, for example, reflective structures, energy emitting structures, coils, magnets, or visual references. These fiducials can provide position information to a computing navigation system and inform a user of deviant motion. The position information can be used to measure and control the location and movement of the treatment and imaging probes. The position information can also be shown on a display that is visible to the user. The processor may include instructions to show the treatment fiducials on the display in relation to the target location on the patient, e.g., to align, in real time, a real-time image of the patient with the target treatment profile.

[0239] In some embodiments, position information is used to monitor relative motion and as a feedback loop to control intentional motion or respond to unintentional motion.

[0240] FIG. 26 illustrates a system 2600 comprising an arm 2610 coupled to a sheath 2620, a robotic arm 2630 coupled to a treatment probe 2640, and an arm 2670 coupled to an ultrasound probe 2680. The arms are coupled to a base 2690, which may comprise any suitable base as described herein, such as, for example, a crossbar coupled to a rail of a patient support. The arm 2610 may comprise any arm as described herein, and may comprise a robotic arm or a manually adjustable arm, for example, configured to lock into place. The sheath 2610 is configured for insertion into a patient lumen, such as the urethra, and may comprise, for example, a rigid sheath or a flexible sheath. The robotic arm 2630 may comprise any suitable robotic arm as described herein. The treatment probe 2640 may comprise any suitable treatment probe as described herein. The arm 2670 may comprise any suitable arm as described herein and may comprise a manually lockable arm or a robotic arm as described herein. The ultrasound probe 2680 may comprise any suitable ultrasound probe as described herein, for example, a TRUS probe. The robotic arm, the therapy probe, and the ultrasound probe are operably coupled to a processor as described herein.

[0241] FIG. 27 illustrates a robotic arm 2630 coupled to a treatment probe 2640, as in FIG. 26, and an arm 2610 coupled to a sheath 2620. The sheath 2620 is coupled to the arm 2610. In some embodiments, the sheath 2620 includes an irrigation lumen 2622 that extends to one or more openings 2624 to irrigate the surgical site. The irrigation lumen can be connected to a source of irrigation fluid, such as saline. The sheath can include a lumen 2626 that is sized to receive the treatment probe. The lumen 2626 includes a proximal opening 2625 and extends to a distal opening 2627. In some embodiments, the sheath 2620 includes an aspiration channel 2629 that extends to an opening into the lumen 2620 and fluidly couples the lumen 2626 to an aspiration pump to remove ablation products. The treatment probe 2640 is coupled to an energy source as described herein, such as a laser, water pump, or power source, and includes an energy emission structure, such as a nozzle, fiber optic end, aperture, or electrode, for directing energy toward tissue. The treatment probe is configured to translate 2646 and rotate 2648 energy 2644 from the treatment probe. An endoscope 2650 extends within the sheath. The endoscope includes a viewing port, such as a viewing port for an endoscopic camera 2652, configured to translate 2654. The endoscope is coupled to a video display for viewing the treatment probe and treatment site with the endoscope.

[0242] A coupling 2700 is coupled to an end portion of a robotic arm 2630. The coupling 2700 includes one or more engagement structures 2710 for coupling to the end portion of the robotic arm. The robotic arm 2630 includes one or more corresponding engagement structures 2712 for connecting the coupling 2700 to the robotic arm. In some embodiments, the coupling 2700 includes internal structures, such as linkages and actuators as described herein, for translating one or more of the treatment probe, endoscope, irrigation lumen, or aspiration lumen relative to the robotic arm. In some embodiments, the coupling 2700 is configured to rotate the treatment probe independently of the endoscope, irrigation lumen, and aspiration lumen. In some embodiments, the coupling 2700 includes structures for receiving the treatment probe and defining an orientation of the treatment probe relative to the coupling. The structures for receiving the treatment probe may include, for example, one or more of an opening or a channel coupled to the linkage. In some embodiments, the coupling portion 2700 couples to an end portion of a robotic arm and includes an engagement structure for establishing an orientation of the treatment probe relative to the end portion of the robotic arm.

[0243] In some embodiments, one or more of the arms or sheaths include a sensor 2750 for determining the orientation of the sheath when placed in a patient. In some embodiments, the robotic arm 2752 includes an orientation sensor 2752 for determining the orientation of the treatment probe 2640 coupled to the robotic arm. Alternatively, or in combination with the sensor, the joint state of the robotic arm 2630 can be used to determine the orientation of the treatment probe and the joint state of the arm 2610 can be used to determine the orientation of the sheath.

[0244] In some embodiments, the treatment probe comprises an elongated shaft and the sheath comprises an elongated shaft for receiving the treatment probe.

[0245] The system can be configured in many ways to treat a patient in many ways. In some embodiments, a sheath is sized and shaped for insertion into a patient. The sheath comprises an elongated axis, and an arm is coupled to the sheath. A treatment probe comprises an energy source and an elongated axis. The treatment probe is sized and shaped for insertion into a lumen of the sheath. A robotic arm is coupled to the treatment probe and configured to align an elongated axis of the treatment probe with an elongated axis of the sheath and advance the treatment probe into the sheath. The robotic arm coupled to the treatment probe is configured to align an axis of the treatment probe with an axis of the sheath prior to advancing the treatment probe into the sheath.

[0246] In some embodiments, the robotic arm includes a sensor for determining an orientation of the treatment probe, the sensor including one or more of an accelerometer, a gyroscope, or an inertial measurement unit (IMU). Alternatively, or in combination, the arm coupled to the sheath includes a sensor for determining an orientation of the sheath. The sensor may include one or more of an accelerometer, a gyroscope, or an IMU.

[0247] In some embodiments, the sheath comprises a proximal opening for receiving the treatment probe and a distal opening, the treatment probe having a length sufficient to extend at least to the distal opening, hi some embodiments, the treatment probe is dimensioned such that when the treatment probe is advanced into the sheath, the energy source extends at least to the distal opening.

[0248] In some embodiments, the energy source extends to at least the distal opening with a gap between the end portion of the robotic arm and the sheath.

[0249] Although reference is made to a coupling structure that rotates the treatment probe, in some embodiments, the robotic arm 2630 is configured to rotate the treatment probe.

[0250] The processor can be coupled to one or more of the arm 2610, the arm 2630, or the arm 2720. In some embodiments, the processor is configured with instructions for advancing the treatment probe into the sheath, which may facilitate alignment of the treatment probe with the sheath. In some embodiments, the processor is configured to align the extension axis of the treatment probe with the extension axis of the sheath. In some embodiments, the processor receives an input indicating that the extension axis of the treatment probe has been aligned with the extension axis of the sheath, and is configured with instructions for advancing the treatment probe along the extension axis of the treatment probe in response to the input. The input may comprise a user input, or the input may comprise an input from sensor data. In some embodiments, the arm coupled to the rigid sheath comprises a sensor operably coupled to the processor to determine an orientation of the sheath, and the processor is configured with instructions for orienting the treatment probe with the sheath in response to an orientation of the rigid sheath measured with the sensor. In some embodiments, the robotic arm comprises a sensor for determining an orientation of the treatment probe. Alternatively, or in combination, the orientation of the treatment probe can be determined from a joint state of the robotic arm. In some embodiments, the orientation of the sheath is determined from the joint state of the arms coupled to the rigid sheath.

[0251] 28A illustrates a coupling 2700 for coupling a robotic arm 2630 to a treatment probe 2640. In some embodiments, the coupling 2700 is configured to couple a treatment probe 2740, an endoscope 2650, an irrigation lumen 2812, and an aspiration lumen 2814 to the robotic arm. Each of these lumens may be defined by an elongated tube that defines the lumen. In some embodiments, the irrigation lumen and the aspiration lumen comprise lumens of a dual lumen tube, such as a catheter. Alternatively, the irrigation lumen and the aspiration lumen may comprise separate catheters.

[0252] FIG 28B illustrates the movement of the treatment probe 2640, endoscope 2650, irrigation lumen 2812, and aspiration lumen 2814 provided by a joint such as that of FIG 28A. Irrigation lumen 2812 extends to opening 2813 to emit irrigation fluid. Aspiration lumen 2814 extends to opening 2814 to receive ablation products. The sheath 2620 is sized to receive these lumens and corresponding structures that define the lumens, e.g., tubes. The sheath 2620 is sized to receive the treatment probe. In some embodiments, the sheath 2620 is sized to receive the endoscope 2650.

[0253] The coupling 2700 can be configured in many ways to move one or more of the treatment probe, endoscope, irrigation lumen, or aspiration lumen. In some embodiments, the coupling connects to a robotic arm 2630, which provides motion to the treatment probe. For example, the robotic arm can be configured to rotate the treatment probe. Alternatively, or in combination, the robotic arm can be configured to rotate and translate the treatment arm.

[0254] In some embodiments, the coupling 2700 is configured to rotate the treatment probe. For example, the coupling can be configured to rotate 2648 the treatment probe. The robotic arm can be configured to translate 2646 the treatment probe while the coupling 2700 rotates the treatment probe. In some embodiments, the endoscope 2750 is configured to translate 2654 with the treatment probe. In some embodiments, the irrigation lumen and the aspiration lumen are configured to translate with the treatment probe.

[0255] In some embodiments, the coupling 2700 is configured to provide independent translation to one or more of the treatment probe and the endoscope, the irrigation lumen, or the aspiration lumen. In some embodiments, the coupling is configured to provide independent translation to one or more of the treatment probe, the endoscope, and the irrigation probe or the aspiration probe.

[0256] FIG. 29 illustrates a method 2900 of treatment, according to some embodiments.

[0257] In step 2910, the orientation of the sheath is determined. The orientation of the sheath can be determined from one or more sensors coupled to the sheath, such as an orientation sensor on an arm coupled to the sheath, or from the joint state of the arm coupled to the sheath.

[0258] In step 2920, the orientation of the treatment probe is determined. The orientation of the treatment probe can be determined from one or more sensors coupled to the treatment probe, such as an orientation sensor on an arm coupled to the treatment probe, or from a joint state of an arm coupled to the treatment probe.

[0259] In step 2930, the extension axis of the treatment probe is aligned with the extension axis of the sheath. This alignment can be performed manually. Alternatively, the processor can be configured with instructions to align the extension axis of the treatment probe with the extension axis of the sheath.

[0260] At step 2940, input is received indicating that the extension axis of the treatment probe has been aligned with the extension axis of the sheath. This input may comprise user input based on visualization, or input from sensor data, or a combination thereof.

[0261] In step 2950, ​​the treatment probe is advanced along the elongated axis of the sheath in response to the input.

[0262] As described herein, the computing devices and systems described and / or illustrated herein broadly represent any type or form of computing device or system capable of executing computer-readable instructions such as those contained within the modules described herein. In their most basic configurations, these computing devices may each include at least one memory device and at least one physical processor.

[0263] The term "memory" or "memory device" as used herein generally refers to any type or form of volatile or non-volatile storage device or medium capable of storing data and / or computer-readable instructions. In one embodiment, a memory device may store, load, and / or maintain one or more of the modules described herein. Examples of memory devices include, but are not limited to, random access memory (RAM), read-only memory (ROM), flash memory, hard disk drive (HDD), solid state drive (SSD), optical disk drive, cache, one or more variations or combinations of the same, or any other suitable storage memory.

[0264] Additionally, the term "processor" or "physical processor" as used herein generally refers to any type or form of hardware-implemented processing unit capable of interpreting and / or executing computer-readable instructions. In one embodiment, the physical processor may access and / or modify one or more modules stored in the memory device described above. Examples of physical processors include, but are not limited to, a microprocessor, a microcontroller, a central processing unit (CPU), a field programmable gate array (FPGA) implementing a soft-core processor, an application specific integrated circuit (ASIC), one or more portions of the same, one or more variations or combinations of the same, or any other suitable physical processor.

[0265] Although illustrated as separate elements, the method steps described and / or illustrated herein may represent parts of a single application. Additionally, in some embodiments, one or more of these steps may represent or correspond to one or more software applications or programs that, when executed by a computing device, may cause the computing device to perform one or more tasks, such as method steps.

[0266] In addition, one or more of the devices described herein may transform data, physical devices, and / or representations of physical devices from one form to another. Additionally or alternatively, one or more of the modules described herein may transform a processor, volatile memory, non-volatile memory, and / or any other portion of a physical computing device from one form of computing device to another form of computing device by executing on the computing device, storing data on the computing device, and / or otherwise interacting with the computing device.

[0267] The term "computer-readable medium" as used herein generally refers to any form of device, carrier, or medium capable of storing or carrying computer-readable instructions. Examples of computer-readable media include, but are not limited to, transmission-type media such as carrier waves, and non-transitory type media such as magnetic storage media (e.g., hard disk drives, tape drives, and floppy disks), optical storage media (e.g., compact discs (CDs), digital video discs (DVDs), and BLU-RAY discs), electronic storage media (e.g., solid-state drives and flash media), and other distribution systems.

[0268] Those skilled in the art will recognize that any process or method disclosed herein may be modified in many ways. The process parameters and sequences of steps described and / or illustrated herein are given by way of example only and can be varied as desired. For example, although the steps illustrated and / or described herein may be shown or discussed in a particular order, these steps do not necessarily have to be performed in the order shown or discussed.

[0269] The various exemplary methods described and / or illustrated herein may also omit one or more of the steps described or illustrated herein, or may comprise additional steps in addition to those disclosed. Furthermore, the steps of any method as disclosed herein can be combined with one or more steps of any of any other methods as disclosed herein.

[0270] A processor as described herein may be configured to perform one or more steps of any of the methods disclosed herein. Alternatively, or in combination, a processor may be configured to combine one or more steps of one or more methods as disclosed herein.

[0271] Unless otherwise stated, the terms "connected to" and "coupled to" (and their derivatives) as used in this specification and the claims shall be interpreted as allowing both direct and indirect (i.e., via other elements or components) connections. Additionally, the terms "a" or "an" as used in this specification and the claims shall be interpreted as meaning "at least one of." Finally, for ease of use, the terms "including" and "having" (and their derivatives) as used in this specification and the claims shall be synonymous with and have the same meaning as the term "comprising."

[0272] A processor as disclosed herein may be configured with instructions to perform any one or more steps of any method as disclosed herein.

[0273] It should be understood that the terms "first," "second," "third," etc. may be used herein to describe various layers, elements, components, regions, or sections without reference to any particular order or sequence of events. These uses are merely used to distinguish one layer, element, component, region, or section from another layer, element, component, region, or section. A first layer, element, component, region, or section as described herein could be referred to as a second layer, element, component, region, or section without departing from the teachings of the present disclosure.

[0274] As used herein, the term "or" is used inclusively to refer to items as alternatives and in combination.

[0275] As used herein, letters such as numbers refer to similar elements.

[0276] As used herein, the terms "crude" and "total" are used interchangeably.

[0277] As used herein, the terms "one or more computing devices" and "processor" are used interchangeably.

[0278] This disclosure includes the following numbered appendices:

[0279] (Supplementary Note 1) A system for treating or imaging tissue of a patient, the system comprising: a probe sized for insertion into the patient; a robotic arm configured to couple to the probe; and one or more computing devices operably coupled to the robotic arm and configured with instructions to establish an acceptable range of motion for the probe, the acceptable range of motion stored on a memory of the one or more computing devices, treat or image a target tissue of the patient with the probe, and move the robotic arm to affect movement of the probe within the acceptable range of motion for the probe.

[0280] (Appendix 2) The system of Appendix 1, wherein the probe is configured to couple to the robot arm while the robot arm is in a passive mode.

[0281] (Appendix 3) The system of Appendix 1, wherein the allowable range of motion for the probe is established while the robotic arm is in a passive mode.

[0282] (Appendix 4) The system of Appendix 1, wherein the step of establishing an acceptable range of motion for the probe includes a step of establishing an acceptable range of motion for the probe in response to user input.

[0283] (Appendix 5) The system of Appendix 1, wherein the step of establishing an acceptable range of motion for the probe includes a step of establishing an acceptable range of motion for the probe in response to a position of the probe.

[0284] (Appendix 6) The system of Appendix 5, wherein the position of the probe relative to the target tissue is determined in response to one or more tissue landmarks in one or more images of the target tissue.

[0285] (Appendix 7) The system of Appendix 1, further comprising a step of updating the allowable range of motion for the probe in real time.

[0286] (Appendix 8) The system of Appendix 1, further comprising a user input device operably coupled to the one or more computing devices to provide one or more user instructions for controlling movement of the robotic arm, wherein moving the robotic arm under control of the one or more computing devices includes moving the robotic arm in response to the one or more user instructions for controlling movement of the robotic arm.

[0287] (Appendix 9) The system of Appendix 8, wherein the user input device includes one or more of a controller near the end of the robotic arm, a user interface on a display screen, a user interface on a console, or a controller that responds to a force on the end of the arm provided by a user and guides a probe on the robotic arm into a fixed position.

[0288] (Appendix 10) The system of Appendix 1, further comprising one or more force sensors operably coupled to the probe and one or more computing devices to detect compression of the patient's tissue with the probe.

[0289] (Supplementary Note 11) The system of Supplementary Note 10, wherein the one or more computing devices include a processor configured with instructions to interrupt treatment in response to detected compression of tissue exceeding a predetermined threshold level of compression.

[0290] (Supplementary Note 12) The system of Supplementary Note 10, wherein the one or more force sensors are operably coupled to the robot arm.

[0291] (Appendix 13) The system of Appendix 12, further comprising one or more motion sensors operably coupled to the probe and the one or more computing devices to detect patient movement, the one or more computing devices configured to adjust a position of the probe in response to detected movement of the patient.

[0292] (Appendix 14) The system of Appendix 1, wherein the robotic arm has a passive mode for manually adjusting the probe to a manually set position.

[0293] (Appendix 15) The system of Appendix 14, wherein in a passive mode, the probe is supported using a robotic arm and the probe includes a plurality of sensors at an interface between the robotic arm and the probe for receiving user input from a handle coupled to a plurality of sensors for the user to guide the probe.

[0294] (Appendix 16) The system of Appendix 15, wherein the handle coupled to the plurality of sensors is configured to respond to user manipulation of the handle, and the plurality of sensors in the interface are coupled to a processor of one or more computing devices to manipulate the probe in response to user manipulation of the handle.

[0295] (Appendix 17) The system described in Appendix 16, wherein the multiple sensors are configured to detect user manipulation of the handle with six degrees of freedom, and the processor is configured to move the probe in six degrees of freedom in response to the user manipulation with motion corresponding to the six degrees of freedom.

[0296] (Addendum 18) The system of Addendum 14, wherein the step of manually adjusting the robot arm in passive mode includes a step of manually adjusting the probe in one or more of at least one rotational axis or at least one translational axis.

[0297] (Supplementary Note 19) The system described in Supplementary Note 18, wherein the at least one rotation axis includes a first rotation axis, a second rotation axis perpendicular to the first rotation axis, and a third rotation axis perpendicular to the first and second rotation axes, and the at least one translation axis includes a first translation axis, a second translation axis perpendicular to the first translation axis, and a third translation axis perpendicular to the first and second translation axes.

[0298] (Supplementary Note 20) The system of Supplementary Note 19, wherein the first rotational axis comprises a pitch axis, the second rotational axis comprises a yaw axis, the third rotational axis comprises a roll axis, the...

Claims

1. A system for treating target tissue at a target site in a patient, the system comprising: a first robotic arm coupled to a treatment probe for treating the target tissue of the patient; a second robotic arm coupled to an imaging probe for imaging the target tissue of the patient; one or more computing devices operatively coupled to the first robotic arm and the second robotic arm; Equipped with The one or more computing devices are configured to execute instructions to control movement of one or more of the first robotic arm or the second robotic arm.

2. The system of claim 1, wherein the one or more computing devices are configured to execute instructions to control movement of the first robotic arm or the second robotic arm to adjust one or more of pitch, yaw, roll or linear position of the treatment probe or imaging probe along an axis of entry of the treatment probe or imaging probe into the patient.

3. The system of claim 1, wherein the one or more computing devices are configured to execute instructions including controlling movement of the first robotic arm or the second robotic arm, respectively, to retract the treatment probe or the imaging probe along the entry axis.

4. The system of claim 3, wherein the one or more computing devices are configured to execute instructions including controlling movement of the first robotic arm or the second robotic arm, respectively, to retract but not advance the treatment probe or the imaging probe along the entry axis.

5. The system of claim 1, wherein the one or more computing devices are configured to execute instructions including controlling movement of the first robotic arm or the second robotic arm in response to user instructions received using a user input device operably coupled to the one or more computing devices.

6. The system of claim 1, wherein the one or more computing devices are configured to execute instructions including controlling movement of the first robotic arm or the second robotic arm, respectively, to move the treatment probe or the imaging probe within an allowable range of motion for the treatment probe or the imaging probe stored within the one or more computing devices.

7. The system of claim 6, wherein the one or more computing devices are configured to execute instructions including establishing the acceptable range of motion for the treatment probe or the imaging probe in response to user input.

8. The system of claim 6, wherein the one or more computing devices are configured to execute instructions including establishing the allowable range of motion for the treatment probe or the imaging probe in response to a distance or alignment between the treatment probe and the imaging probe.

9. The system of claim 6, wherein the one or more computing devices are configured to execute instructions including establishing the allowable range of motion for the treatment probe or the imaging probe in response to a position of the treatment probe or the imaging probe relative to the target tissue.

10. The system of claim 9, wherein the one or more computing devices are configured to execute instructions including detecting a position of the treatment probe or the imaging probe relative to the target tissue based on one or more images of the target tissue, the one or more images comprising one or more tissue landmarks.

11. The system of claim 6, wherein the one or more computing devices are configured to execute instructions to update the allowable range of motion for the treatment probe or the imaging probe in real time.

12. The system of claim 1, wherein the one or more computing devices are configured to execute instructions including controlling movement of the first robotic arm or the second robotic arm to maintain alignment between the treatment probe and the imaging probe, optionally, the alignment maintaining the treatment probe within a field of view of the imaging probe.

13. The system of claim 1, wherein the one or more computing devices are configured to execute instructions to control movement of the first robotic arm or the second robotic arm to automatically move the treatment probe or the imaging probe along a scanning profile stored on the one or more computing devices.

14. The system of claim 1, wherein the one or more computing devices are configured to execute instructions including controlling movement of the first robotic arm or the second robotic arm in response to sensor data received from one or more sensors operably coupled to the one or more computing devices.

15. The system of claim 1, further comprising a common arm, the first robotic arm being operably coupled to the common arm at a first location, and the second robotic arm being operably coupled to the common arm at a second location.

16. The system of claim 1, wherein the one or more computing devices are configured to execute instructions for operating the first robotic arm in a passive mode, and the first robotic arm is configured to be manually adjusted in the passive mode to position the treatment probe at a manually set position.

17. The system of claim 1, wherein the one or more computing devices are configured to execute instructions for operating the second robotic arm in a passive mode, and the second robotic arm is configured to be manually adjusted in the passive mode to position the imaging probe at a manually set position.

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