Surgery platform with motorized arms

Abstract

The surgical robotic system may include a column-based mounting platform and at least one robotic arm coupled to the mounting platform. The robotic arm may include a setup linkage and a distal manipulator linkage that collectively define a remote center of motion. The setup linkage may be adjusted to manipulate the attitude of the distal manipulator linkage and the location of the remote center of motion. Furthermore, the distal manipulator linkage may be configured to decouple the degrees of freedom of motion of a tool coupled thereto to articulate the tool about the remote center of motion. Optionally, the mounting platform may be supported by a column of the operating table or system. Furthermore, the setup linkage may be robotic. Furthermore, the distal manipulator linkage may use a hardware-constrained remote center of motion. In some embodiments, the distal manipulator linkage may include a parallelogram linkage.

Description

[Technical field]

[0001] The systems and methods disclosed herein relate to medical devices, and more particularly, to robotic systems. [Background technology]

[0002] Robotic systems may assist physicians in performing medical procedures. Various medical procedures involve locating the three-dimensional position of a medical instrument within a patient's body to provide diagnosis and / or treatment. Articulated robotic arms may be operated partially autonomously or fully autonomously under the control of a physician to position the medical instrument in the correct location. Due to the use of robotic systems, procedures may be performed with greater precision, smaller incisions, reduced blood loss, and faster healing times, to name a few. Summary of the Invention [Means for solving the problem]

[0003] One challenge with medical robotic systems is that there are a wide variety of medical procedures, each with its own set of kinematic requirements for the robotic arms available during the procedure. For example, the requirements for a robotic-assisted endoscopy are different from those for a robotic-assisted laparoscopy, particularly with respect to system bandwidth, stiffness, workspace coverage and positioning, and speed. As a result, existing medical robotic systems are typically purpose-built for a specific medical procedure and cannot perform other types of medical procedures. Thus, hospitals or other clinics seeking to use such robotic systems incur increased costs associated with acquiring (e.g., purchasing or renting) and storing multiple systems. This, in turn, can result in increased costs that are passed on to patients undergoing such procedures.

[0004] Some embodiments disclosed herein may implement a robotic arm kinematic layout for performing laparoscopic surgery on a bed-base surgical robotic platform. For example, according to some embodiments disclosed herein, it is recognized that current robotic systems continue to face certain limitations and challenges including, among others, the available reach of the robotic arm, the potential access and maneuverability of the robotic arm, the stiffness of the robotic arm and support architecture, and the performance of the system.

[0005] Further, according to some embodiments, disclosed herein is the realization and recognition of the increased complexity of robotic systems utilizing software-constrained remote centers of motion. Indeed, these and other challenges may be particularly acute in robotic systems using six robotic arms. Thus, some embodiments disclosed herein may be configured to address these and other considerations to provide a robotic system utilizing a common mounting platform for robotic arms, robotic setup joints, and distal manipulator linkages that utilize hardware-constrained remote sensors of motion.

[0006] These and other optional features may be implemented in a robotic system to provide improved stiffness, reduce collisions, and increase maneuverability and positioning of the system's robotic arms. Additionally, some embodiments may optionally implement hardware constrained centers of motion for one or more robotic arms of the system to reduce complexity, increase reliability, and streamline the operation of the system. [Brief description of the drawings]

[0007] The disclosed aspects are hereinafter described in conjunction with the accompanying drawings, which illustrate, but are not limiting of, the disclosed aspects, and in which like designations refer to like elements and in which: [Figure 1]1 illustrates one embodiment of a cart-based robotic system positioned for diagnostic and / or therapeutic bronchoscopy procedure(s). [Diagram 2] 2 illustrates a further embodiment of the robotic system of FIG. 1. [Diagram 3] 2 illustrates an embodiment of the robotic system of FIG. 1 positioned for ureteroscopy. [Figure 4] 2 illustrates an embodiment of the robotic system of FIG. 1 positioned for a vascular procedure. [Diagram 5] 1 illustrates one embodiment of a table-based robotic system positioned for a bronchoscopy procedure. [Figure 6] 6 provides an alternative view of the robotic system of FIG. 5. [Figure 7] 1 illustrates an embodiment of a system configured to accommodate a robotic arm(s). [Figure 8] 1 illustrates one embodiment of a table-based robotic system configured for a ureteroscopy procedure. [Figure 9] 1 illustrates one embodiment of a table-based robotic system configured for a laparoscopic procedure. [Figure 10] FIG. 10 illustrates one embodiment of the table-base robotic system of FIGS. 5-9 with pitch or tilt adjustment. [Figure 11] FIGS. 5-10 provide detailed illustrations of the interface between the table and columns of the table-based robotic system. [Figure 12] 1 illustrates an exemplary instrument driver. [Figure 13] 1 illustrates an exemplary medical instrument having a pair of instrument drivers. [Figure 14] 13 shows an alternative design of the instrument driver and instrument, where the axis of the drive unit is parallel to the axis of the elongate shaft of the instrument. [Figure 15] FIG. 15 shows a block diagram illustrating a localization system that estimates the position of one or more elements of the robotic system of FIGS. 1-10, such as the position of the instrument of FIGS. 13-14, in accordance with an exemplary embodiment. [Figure 16]1 illustrates an exemplary command console for a medical robotic system such as those shown in FIGS. 1-5 and 8-10, according to some embodiments. [Figure 17] FIG. 1 is an end view of an embodiment of a robotic system including two single-link motorized arms for positioning arm supports. [Figure 18] FIG. 1 illustrates an isometric view of one embodiment of a powered arm and arm support. [Figure 19A] 1A and 1B show perspective and end views, respectively, of an embodiment of a robotic system including two single-link motorized arms in a configuration. [Figure 19B] 1A and 1B show perspective and end views, respectively, of an embodiment of a robotic system including two single-link motorized arms in a configuration. [Figure 20] FIG. 1 illustrates a perspective view of an embodiment of a robotic system including two single-link motorized arms and six robotic arms in a stowed configuration. [Figure 21] FIG. 1 illustrates an isometric view of a robotic arm, according to one embodiment. [Figure 22A] 1A-1C show perspective views of an embodiment of a dual link powered arm in extended and stowed configurations, respectively. [Figure 22B] 1A-1C show perspective views of an embodiment of a dual link powered arm in extended and stowed configurations, respectively. [Figure 23] FIG. 13 is a perspective view of an embodiment of an arm support linkage and attached arm support. [Figure 24] 2 illustrates one embodiment of a robotic arm that can be used with the systems and components illustrated in FIGS. 1-23. [Diagram 25] 2 illustrates another embodiment of a robotic arm that can be used with the systems and components illustrated in FIGS. 1-23. [Figure 26A] 25 shows the robot arm of FIG. 24 beginning to be operated in a first operational mode. [Figure 26B] 25 illustrates a table-based robotic system including several robotic arms as shown in FIG. 24 configured to operate in a first mode for a laparoscopic procedure. [Figure 27A] 25 illustrates several robotic arms of FIG. 24 configured in a second operational mode. [Figure 27B] FIG. 26B shows the table-based robotic system including some of the robotic arms configured as shown in FIG. 27A to operate in a second mode for endoscopic procedures. [Figure 28A] 25 illustrates a range of positions for an instrument driver mounted on the robotic arm of FIG. 24. [Figure 28B] 25 illustrates a range of positions for an instrument driver mounted on the robotic arm of FIG. 24. [Figure 29A] 26B shows a series of exemplary steps for configuring the robot arm of FIG. 24 to operate in a first mode shown in FIG. 26A. [Figure 29B] 26B shows a series of exemplary steps for configuring the robot arm of FIG. 24 to operate in a first mode shown in FIG. 26A. [Figure 29C] 26B shows a series of exemplary steps for configuring the robot arm of FIG. 24 to operate in a first mode shown in FIG. 26A. [Figure 29D] 26B shows a series of exemplary steps for configuring the robot arm of FIG. 24 to operate in a first mode shown in FIG. 26A. [Figure 30A] In the first mode shown in FIG. 26A, different sub-modes for operating the robot arm of FIG. 25 are shown. [Figure 30B] In the first mode shown in FIG. 26A, different sub-modes for operating the robot arm of FIG. 25 are shown. [Figure 30C] In the first mode shown in FIG. 26A, different sub-modes for operating the robot arm of FIG. 25 are shown. [Figure 31A] In the first mode shown in FIG. 26A, different sub-modes for operating the robot arm of FIG. 24 are shown. [Figure 31B]In the first mode shown in FIG. 26A, different sub-modes for operating the robot arm of FIG. 24 are shown. [Figure 32A] 27B illustrates the addition of a second instrument driver to the robotic arm of FIG. 25 while operating in the second mode shown in FIG. 27A. [Figure 32B] 27B illustrates the addition of a second instrument driver to the robotic arm of FIG. 25 while operating in the second mode shown in FIG. 27A. [Diagram 33] 26 illustrates the robot arm of FIG. 25 in a stowed configuration. [Diagram 34] 1 illustrates a robotic system having multiple robotic arms, according to some embodiments. [Diagram 35] 36 illustrates optional features of a robotic arm for use with the robotic system of FIG. 35, according to some embodiments. [Diagram 36] 36 illustrates optional features of a robotic arm for use with the robotic system of FIG. 35, according to some embodiments. [Figure 37] 27B shows the table-base robotic system of FIG. 17 including some of the robotic arms configured as shown in FIG. 27A for operating in a second mode for endoscopic procedures. [Figure 38] 1 illustrates various embodiments of a robotic arm according to the present disclosure. [Figure 39] 20 shows a flowchart of an exemplary process for operating the robotic arm of FIGS. 24-38. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0008] 1. Overview. Aspects of the present disclosure may be integrated into a robot-enabled medical system capable of performing a variety of medical procedures, including both minimally invasive procedures such as laparoscopy, and non-invasive procedures such as endoscopy, among other endoscopic procedures, such as bronchoscopy, ureteroscopy, gastroscopy, and the like.

[0009] In addition to performing a wide range of procedures, the system may provide additional benefits such as enhanced imaging and guidance to assist the physician. Additionally, the system may provide the physician with the ability to perform procedures from an ergonomic position without the need for awkward arm movements and positions. Additionally, the system may provide the physician with the ability to perform procedures with improved ease of use, such that one user may control one or more instruments of the system.

[0010] Various embodiments are described below in conjunction with the drawings for illustrative purposes. It should be understood that many other implementations of the concepts of the present disclosure are possible, and that various advantages may be achieved by implementing the concepts of the present disclosure. Headings are included herein for reference and to aid in locating various sections. The headings do not limit the scope of the concepts described therein. Such concepts may be applied throughout the entire specification.

[0011] A. Robotic System - Cart. A robot-enabled medical system may be configured in a variety of ways depending on the particular procedure. FIG. 1 illustrates one embodiment of a cart-based robot-enabled system 10 arranged for a diagnostic and / or therapeutic bronchoscopy procedure. During a bronchoscopy procedure, the system 10 may include a cart 11 having one or more robotic arms 12 for delivering medical instruments, such as a steerable endoscope 13, which may be a procedure-specific bronchoscope for bronchoscopy, to a natural orifice access point (i.e., the mouth of a patient positioned on a table in this example) for delivering diagnostic and / or therapeutic tools. As shown, the cart 11 may be positioned adjacent to the patient's upper torso to provide access to the access point. Similarly, the robotic arms 12 may be actuated to position a bronchoscope relative to the access point. The arrangement of FIG. 1 may also be utilized when performing a Gastro-Intestinal (GI) procedure with a gastroscope, an endoscope specialized for GI procedures. FIG. 2 depicts an example embodiment of the cart in more detail.

[0012] With continued reference to FIG. 1, once the cart 11 is properly positioned, the robotic arm 12 may insert the steerable endoscope 13 into the patient robotically, manually, or a combination thereof. As shown, the steerable endoscope 13 may include at least two telescoping parts, such as an inner leader section and an outer sheath section, each section coupled to a separate instrument driver from a set of instrument drivers 28, each instrument driver coupled to the distal end of an individual robotic arm. This linear arrangement of the instrument drivers 28, which facilitates coaxial alignment of the leader section with the sheath section, creates a "virtual rail" 29 that can be repositioned in space by manipulating one or more robotic arms 12 to different angles and / or positions. The virtual rails described herein are depicted in the figures using dashed lines, which therefore do not depict any physical structure of the system. Translation of the instrument driver 28 along the virtual rail 29 nests the inner leader portion relative to the outer sheath portion or advances or retracts the endoscope 13 from the patient. The angle of the virtual rail 29 can be adjusted, translated, or pivoted based on the clinical application or physician preference. For example, in bronchoscopy, the angle and position of the virtual rail 29 shown represents a compromise between providing the physician access to the endoscope 13 and minimizing friction that results from bending the endoscope 13 into the patient's mouth.

[0013] After insertion, the endoscope 13 may be directed downstream of the patient's trachea and lungs using precise commands from the robotic system until the targeted location or surgical site is reached. To enhance navigation through the patient's pulmonary network and / or to reach a desired target, the endoscope 13 may be manipulated to telescope the inner leader portion from the outer sheath portion to enhance articulation and increase bend radius. The use of a separate instrument driver 28 also allows the leader and sheath portions to be driven independently of one another.

[0014] For example, the endoscope 13 may be directed to deliver a biopsy needle to a target, such as a lesion or nodule in the patient's lung. The needle may deploy a working channel that runs the length of the endoscope to obtain a tissue sample that is analyzed by a pathologist. Depending on the results of the pathology, additional tools may be deployed down the working channel of the endoscope for additional biopsies. After identifying the nodule as malignant, the endoscope 13 may endoscopically deliver a tool to ablate the potential cancerous tissue. In some cases, diagnostic and therapeutic procedures may need to be delivered in separate procedures. In these situations, the endoscope 13 may also be used to deliver fiducials to "mark" the location of the targeted nodule. In other cases, diagnostic and therapeutic procedures may be delivered during the same procedure.

[0015] The system 10 may also include a movable tower 30 that may be connected to the cart 11 via a support cable to provide support for control, electronics, fluidics, optics, sensors, and / or power to the cart 11. Placing such functionality in the tower 30 may reduce the form factor of the cart 11, allowing the cart 11 to be more easily adjusted and / or repositioned by the surgeon and his / her staff performing the procedure. Additionally, the division of functionality between the cart / table and the support tower 30 reduces clutter in the operating room and promotes improved clinical workflow. The cart 11 may be positioned near the patient, while the tower 30 may be housed in a remote location out of the way during the procedure.

[0016] To support the robotic system described above, the tower 30 may include computer-based control system component(s) that store computer program instructions in a non-transitory computer-readable storage medium, such as, for example, a persistent magnetic storage drive, a solid-state drive, or the like. Execution of these instructions, whether execution occurs in the tower 30 or in the cart 11, may control the entire system or its subsystem(s). For example, when executed by a processor in the computer system, the instructions may cause the robotic system components to actuate the carriage and arm attachments, actuate the robotic arm, and control the medical instrument. For example, in response to receiving a control signal, motors in the joints of the robotic arm may position the arm in a particular pose.

[0017] The tower 30 may also include pumps, flow meters, valve controls, and / or fluid access to provide controlled irrigation and aspiration capabilities to a system that may be deployed through the endoscope 13. These components may also be controlled using the computer system of the tower 30. In some embodiments, irrigation and aspiration capabilities may be provided directly to the endoscope 13 via separate cable(s).

[0018] The tower 30 may include voltage and surge protection designed to provide filtered and protected power to the cart 11. By doing so, the placement of power transformers and other auxiliary power components within the cart 11 is avoided, making the cart 11 smaller and more mobile.

[0019] The tower 30 may also include support equipment for sensors deployed throughout the robotic system 10. For example, the tower 30 may include optoelectronic equipment for detecting, receiving, and processing data received from optical sensors or cameras throughout the robotic system 10. In combination with a control system, such optoelectronic equipment may be used to generate real-time images for display on any number of consoles deployed throughout the system, including in the tower 30. Similarly, the tower 30 may also include electronic subsystems for receiving and processing signals from deployed ElectroMagnetic (EM) sensors. The tower 30 may also be used to house and position EM field generators for detection by EM sensors in or on a medical instrument.

[0020] The tower 30 may also include a console 31 in addition to other consoles available to the rest of the system, such as a console mounted on top of a cart. The console 31 may include a user interface and a display screen, such as a touch screen, for the operator physician. The consoles of the system 10 are typically designed to provide both robotic control and pre-operative and real-time information for the procedure, such as navigation and localization information for the endoscope 13. If the console 31 is not the only console available to the physician, a second operator, such as a nurse, may use the console 31 to monitor the patient's health or vital signs and the operation of the system, as well as provide procedure-specific data, such as navigation and localization information.

[0021] The tower 30 may be coupled to the cart 11 and endoscope 13 via one or more cables or connections (not shown). In some embodiments, the support functions of the tower 30 may be provided to the cart 11 through only one cable, simplifying and decluttering the operating room. In other embodiments, certain functions may be coupled in separate wiring and connections. For example, power may be provided to the cart through only one power cable, while support for the controls, optics, fluidics, and / or navigation may be provided through separate cables.

[0022] FIG. 2 provides a detailed illustration of an embodiment of a cart from the cart-based robot-enabled system shown in FIG. 1. The cart 11 generally includes an elongated support structure 14 (often referred to as a "column"), a cart base 15, and a console 16 at the top of the column 14. The column 14 may include one or more carriages, such as a carriage 17 (alternatively an "arm support"), for supporting the deployment of one or more robotic arms 12 (three are shown in FIG. 2). The carriage 17 may include individually configurable arm attachments that rotate along orthogonal axes to adjust the base of the arm 12 for better positioning relative to the patient. The carriage 17 also includes a carriage interface 19 that allows the carriage 17 to translate vertically along the column 14.

[0023] The carriage interface 19 is connected to the post 14 through slots, such as slots 20 positioned on either side of the post 14 to guide the vertical translation of the carriage 17. The slots 20 contain the vertical translation interfaces to position and hold the carriage at various vertical heights relative to the cart base 15. The vertical translation of the carriage 17 allows the cart 11 to adjust the reach of the robotic arm 12 to meet various table heights, patient sizes, and physician preferences. Similarly, the individually configurable arm mounts on the carriage 17 allow the robotic arm base 21 of the robotic arm 12 to be angled in various configurations.

[0024] In some embodiments, a slot cover may be added to the slot 20 flush and parallel to the slot surface to prevent dirt and fluids from entering the internal chamber of the strut 14 and the vertical translation interface as the carriage 17 translates vertically. The slot cover may be deployed through a pair of spring spools positioned near the vertical top and bottom of the slot 20. The cover is coiled within the spools until deployed so that it extends and retracts from the coiled state as the carriage 17 translates vertically up and down. The spring loading of the spools provides a force to retract the cover onto the spool as the carriage 17 translates towards the spool, while also maintaining a seal as the carriage 17 translates away from the spool. The cover may be connected to the carriage 17 using, for example, a bracket at the carriage interface 19 to ensure that the cover extends and retracts properly as the carriage 17 translates.

[0025] The support 14 may contain internal mechanisms such as gears and motors designed to use a vertically aligned, leadscrew to mechanically translate the carriage 17 in response to control signals generated in response to user input, such as input from the console 16.

[0026] The robotic arm 12 may generally include a robotic arm base 21 and an end effector 22 separated by a series of linkages 23 connected by a series of joints 24, each joint including an independent actuator, each actuator including an independently controllable motor. Each separately controllable joint represents an independent degree of freedom available to the robotic arm. Each of the arms 12 has seven joints, thus providing seven degrees of freedom. A large number of joints provides a large number of degrees of freedom, allowing for "redundant" degrees of freedom. The redundant degrees of freedom allow the robotic arm 12 to position its respective end effector 22 at a specific position, orientation, and trajectory in space using different linkage positions and joint angles. This allows the system to position and orient the medical instrument from a desired point in space, while allowing the physician to move the arm joints to a clinically advantageous position away from the patient to create greater access while avoiding arm collisions.

[0027] The cart base 15 balances the weight of the columns 14, carriage 17, and arms 12 on the floor. Thus, the cart base 15 houses the heavier parts such as electronics, motors, power supplies, as well as components that allow the cart to be both mobile and / or immobilized. For example, the cart base 15 includes casters 25 in the form of rollable wheels that allow the cart to be easily moved around the room prior to a procedure. After reaching the proper position, the casters 25 may be prevented from moving using wheel locks to hold the cart 11 in place during a procedure.

[0028] The console 16 positioned at the vertical end of the column 14 allows for both a user interface and a display screen (or dual-purpose device, e.g., touch screen 26) for receiving user input to provide both pre-operative and intra-operative data to the physician user. Potential pre-operative data on the touch screen 26 may include pre-operative planning, navigation and mapping data derived from a pre-operative Computerized Tomography (CT) scan, and / or notes from a pre-operative patient interview. Intra-operative data on the display may include vital patient statistics such as respiration, heart rate, and / or pulse, along with optical information provided from tools, sensor information from sensors, and coordinate information. The console 16 may be positioned and tilted to allow the physician to access the console from the side of the column 14 opposite the carriage 17. From this position, the physician can view the console 16, the robotic arm 12, and the patient while operating the console 16 from behind the cart 11. As shown, the console 16 also includes a handle 27 to help manipulate and stabilize the cart 11.

[0029] FIG. 3 illustrates one embodiment of the robot-enabled system 10 positioned for ureteroscopy. In a ureteroscopy procedure, the cart 11 may be positioned to deliver a ureteroscope 32, a procedure-specific endoscope designed to pass through the patient's urethra and ureters, to the patient's lower abdominal region. In a ureteroscopy, it may be desirable for the ureteroscope 32 to be aligned directly with the patient's urethra to reduce friction and forces on sensitive anatomical structures in the area. As shown, the cart 11 may be aligned to a table leg to allow the robotic arm 12 to position the ureteroscope 32 for direct linear access to the patient's urethra. From the table leg, the robotic arm 12 may insert the ureteroscope 32 along a virtual rail 33 directly through the urethra and into the patient's lower abdomen.

[0030] After insertion into the urethra, using control techniques similar to those in bronchoscopy, the ureteroscope 32 may be navigated to the bladder, ureters, and / or kidneys for diagnostic and / or therapeutic applications. For example, the ureteroscope 32 may be directed to the ureter and kidney to break up formed kidney stones using a laser or ultrasonic lithotripsy device deployed down the working channel of the ureteroscope 32. After stone fragmentation is complete, the basket that deploys the ureteroscope 32 may be used to remove the resulting stone fragments.

[0031] FIG. 4 shows an embodiment of a robot-enabled system similarly positioned for a vascular procedure. In a vascular procedure, the system 10 may be configured such that the cart 11 may deliver a medical instrument 34, such as a steerable catheter, to an access point in the femoral artery in the patient's leg. The femoral artery provides both a larger diameter for navigation and a less circuitous and tortuous path to the patient's heart, which simplifies navigation. As in a ureteroscopy procedure, the cart 11 may be oriented and positioned at the patient's leg and lower abdomen to allow the robot arm 12 to provide direct linear access to the femoral artery access point in the patient's thigh / hip region on the virtual rail 35. After insertion into the artery, the medical instrument 34 may be oriented and inserted by translating the instrument driver 28. Alternatively, the cart may be positioned around the patient's upper abdomen to reach alternative vascular access points, such as the carotid and arm arteries near the shoulder and wrist.

[0032] B. Robot system-table. An embodiment of a robot-enabled medical system may also incorporate a patient table. Incorporation of a table reduces the amount of capital equipment in the operating room by removing the cart and allows better access to the patient. FIG. 5 shows one embodiment of such a robot-enabled system deployed for a bronchoscopy procedure. The system 36 includes a support structure or support 37 for supporting a platform 38 (shown as a "table" or "bed") across the floor. Much like the cart-based system, the end effector of the robotic arm 39 of the system 36 includes an instrument driver 42 designed to manipulate an elongated medical instrument, such as the bronchoscope 40 of FIG. 5, through or along a virtual rail 41 formed from the linear alignment of the instrument driver 42. In practice, by placing emitters and detectors around the table 38, a C-arm for providing fluoroscopic imaging may be positioned across the patient's upper abdominal region.

[0033] FIG. 6 provides an alternative view of the system 36 without the patient and medical instruments for discussion purposes. As shown, the post 37 may include one or more carriages 43, shown as a ring shape, in the system 36, which may be the base for one or more robotic arms 39. The carriages 43 may translate along a vertical post interface 44 that runs the length of the post 37 to provide different vantage points from which the robotic arms 39 may be positioned to reach the patient. The carriage(s) 43 may rotate about the post 37 using mechanical motors positioned within the post 37 to enable the robotic arms 39 to have access to multiple sides of the table 38, such as both sides of the patient. In embodiments having multiple carriages, the carriages may be separately positioned on the post and may translate and / or rotate independently of the other carriages. The carriages 43 need not surround the post 37, or even be circular, but the ring shape shown facilitates rotation of the carriages 43 about the post 37 while maintaining structural balance. Rotation and translation of carriage 43 allows the system to position medical instruments such as endoscopes and laparoscopes to different access points on the patient.

[0034] The arm 39 may be attached to the carriage via a set of arm mounts 45, which comprise a series of joints that may be individually rotated and / or telescopically extended to provide additional configurability to the robotic arm 39. Additionally, the arm mounts 45 may be positioned on the carriage 43 such that, when the carriage 43 is properly rotated, the arm mounts 45 may be positioned either on the same side of the table 38 (as shown in FIG. 6), on opposite sides of the table 38 (as shown in FIG. 9), or on adjacent sides of the table 38 (not shown).

[0035] The column 37 structurally provides support for the table 38 and a path for the vertical translation of the carriage. Internally, the column 37 may be equipped with a lead screw to guide the vertical translation of the carriage and a motor to mechanize the translation of that carriage based on the lead screw. The column 37 may transmit power and control signals to the carriage 43 and to a robotic arm 39 attached thereto.

[0036] The table base 46 serves a similar function as the cart base 15 of the cart 11 shown in FIG. 2, housing the heavier components to counterbalance the table / bed 38, columns 37, carriage 43 and robotic arm 39. The table base 46 may also incorporate rigid casters to provide stability during a procedure. The casters that deploy from the bottom of the table base 46 extend in opposite directions on either side of the base 46 and may be retracted when the system 36 needs to be moved.

[0037] Continuing with FIG. 6, the system 36 may also include a tower (not shown) that divides the functionality of the system 36 between the table and the tower to reduce the form factor and bulk of the table. As seen in the previously disclosed embodiments, the tower may provide various support functions to the table, such as processing, computing, and control capabilities, power, fluidics, and / or optical and sensor processing. The tower may also be moved to be positioned away from the patient to improve physician access and reduce clutter in the operating room. Furthermore, placing components in the tower allows for more storage space at the table base for possible storage of a robotic arm. The tower may also include a console that provides both a user interface for user input, such as a keyboard and / or pendant, and a display screen (or touch screen) for pre-operative and intra-operative information, such as real-time imaging, navigation, and tracking information.

[0038] In some embodiments, the table base may house and store the robot arm when not in use. Figure 7 shows a system 47 for housing the robot arm in one embodiment of a table base system. In the system 47, the robot arm 50, arm mount 51, and carriage 48 may be translated vertically into the base 49 to house the robot arm 50, arm mount 51, and carriage 48 within the base 49. The base cover 52 may be translated and retracted open to deploy the carriage 48, arm mount 51, and arm 50 about the post 53, and closed to store and protect them when not in use. The base cover 52 may be sealed with a membrane 54 along the edge of its opening to prevent dirt and fluid ingress when closed.

[0039] 8 shows one embodiment of a robot-enabled table base system configured for a ureteroscopy procedure. For ureteroscopy, the table 38 may include a swivel 55 to position the patient at an off angle from the column 37 and table base 46. The swivel 55 may rotate or pivot about a pivot point (e.g., located below the patient's head) to position the bottom of the swivel 55 away from the column 37. For example, pivoting the swivel 55 may allow a C-arm (not shown) to be positioned over the patient's lower abdomen without competing for space with the column (not shown) below the table 38. By rotating the carriage 35 (not shown) about the column 37, the robotic arm 39 may insert the ureteroscope 56 directly into the patient's groin area along the virtual rail 57 to reach the urethra. In ureteroscopy, stirrups 58 may also be secured to swivel section 55 of table 38 to support the position of the patient's legs throughout the procedure and allow clear access to the patient's groin area.

[0040] In a laparoscopic procedure, minimally invasive instruments (elongated in shape to accommodate the size of the incision or incisions) may be inserted into the patient's anatomy through small incision(s) in the patient's abdominal wall. After distension of the patient's abdominal cavity, the instruments, often referred to as laparoscopes, may be oriented to perform surgical tasks such as grasping, cutting, ablation, suturing, etc. FIG. 9 illustrates an embodiment of a robotically controllable table-based system configured for a laparoscopic procedure. As shown in FIG. 9, the carriage 43 of the system 36 may be rotated and adjusted vertically to position a pair of robotic arms 39 on either side of the table 38 such that a laparoscope 59 may be positioned using arm attachments 45 to pass through minimal incisions on either side of the patient to reach the patient's abdominal cavity.

[0041] To accommodate laparoscopic procedures, the robotic table system may also tilt the platform to a desired angle. FIG. 10 illustrates an embodiment of a robotic medical system with pitch or tilt adjustment. As shown in FIG. 10, the system 36 accommodates the tilt of the table 38 to position one portion of the table higher off the floor than another portion. Additionally, the arm mount 45 may rotate to match the tilt such that the arm 39 maintains the same planar relationship as the table 38. To accommodate steeper angles, the post 37 may also include a telescoping portion 60 that allows for vertical extension of the post 37 to prevent the table 38 from contacting the floor or colliding with the base 46.

[0042] FIG. 11 provides a detailed illustration of the interface between the table 38 and the column 37. The pitch rotation mechanism 61 may be configured to vary the pitch angle of the table 38 relative to the column 37 in multiple degrees of freedom. The pitch rotation mechanism 61 may be enabled by positioning orthogonal axes 1, 2 at the column-table interface, each axis actuated by a separate motor 2, 4 in response to an electrical pitch angle command. Rotation along one screw 5 will allow tilt adjustment in one axis 1, while rotation along the other screw 6 will allow tilt adjustment along the other axis 2.

[0043] For example, pitch adjustment is particularly useful when attempting to position the table in the Trendelenburg position, i.e., positioning the patient's lower abdomen higher off the floor than the patient's lower abdomen for lower abdominal surgery. The Trendelenburg position allows gravity to slide the patient's internal organs toward their upper abdomen, emptying the abdominal cavity for entry of minimally invasive tools to perform lower abdominal surgical procedures such as laparoscopic prostatectomy.

[0044] Other features and aspects of the system and robotic arm are disclosed in the applicant's own U.S. Patent Application Publication Nos. 2019 / 0000576 and 2020 / 0268460, the entireties of which are incorporated by reference herein.

[0045] C. Instrument drivers and interfaces. The end effector of the robotic arm of the system comprises (i) an instrument driver (alternatively referred to as an "instrument drive mechanism" or "instrument device manipulator") that incorporates electromechanical means for actuating the medical instrument, and (ii) a removable or detachable medical instrument that may lack any electromechanical components such as a motor. This dichotomy may be caused by the need to sterilize medical instruments used in medical procedures and the inability to adequately sterilize expensive capital equipment due to the complex mechanical assembly and sensitive electronics of medical instruments. Thus, medical instruments may be designed to be detached, removed, and replaced from the instrument driver (and thus the system) upon individual sterilization or disposal by a physician or physician's staff. In contrast, the instrument driver does not need to be replaced or sterilized and may be draped for protection.

[0046] FIG. 12 illustrates an exemplary instrument driver. The instrument driver 62, positioned at the distal end of the robotic arm, is comprised of one or more drive units 63 arranged with parallel axes to provide a controlled torque to the medical instrument via a drive axis 64. Each drive unit 63 comprises a separate drive axis 64 for interacting with the instrument, a gearhead 65 for converting motor axis rotation to a desired torque, a motor 66 for generating the drive torque, an encoder 67 for measuring the rotational speed of the motor axis and providing feedback to the control circuit, and a control circuit 68 for receiving control signals to operate the drive unit. Each drive unit 63 is controlled and motorized independently of the others, and the instrument driver 62 may provide multiple (four shown in FIG. 12) independent drive outputs to the medical instrument. In operation, it is believed that the control circuit 68 receives the control signal, sends a motor signal to the motor 66, compares the resulting motor rotational speed measured by the encoder 67 to a desired speed, and modulates the motor signal to generate the desired torque.

[0047] For procedures requiring a sterile environment, the robotic system may incorporate a drive interface, such as a sterile adapter connected to a sterile drape, located between the instrument driver and the medical instrument. The primary purpose of the sterile adapter is to transfer angular motion from the instrument driver's drive axis to the instrument's drive input while maintaining physical separation of the drive axis and the drive input, and therefore sterility. Thus, an example sterile adapter may be configured with a set of rotational inputs and outputs intended to mate with the instrument driver's drive axis and the drive input to the instrument. The sterile drape, which is connected to the sterile adapter, is constructed of a thin flexible material, such as a clear or translucent plastic, and is designed to cover the instrument driver, the robot arm, and capital equipment, such as a cart (in a cart-based system) or a table (in a table-based system). The use of the drape allows the capital equipment to be positioned in close proximity to the patient while still being located in an area that does not require sterility (i.e., the non-sterile field). On the other side of the sterile drape, the medical instrument may interface with the patient in an area that requires sterility (i.e., the sterile field).

[0048] D. Medical equipment. 13 shows an exemplary medical instrument with a paired instrument driver. Similar to other instruments designed for use with a robotic system, the medical instrument 70 comprises an elongated shaft 71 (or elongated body) and an instrument base 72. The instrument base 72, also referred to as an "instrument handle" due to its design intended for manual interaction by a physician, may comprise a rotary drive input 73, e.g., a receptacle, pulley, or spool, designed to mate with a drive output 74 that passes through a drive interface on an instrument driver 75, typically at the distal end of a robotic arm 76. When physically connected, latched, and / or coupled, the mating drive input 73 of the instrument base 72 may share a rotational axis with the drive output 74 in the instrument driver 75, allowing for the transfer of torque from the drive output 74 to the drive input 73. In some embodiments, the drive output 74 may comprise a spline designed to mate with a receptacle on the drive input 73.

[0049] The elongated shaft 71 is designed to be delivered through either an anatomical opening or lumen, such as in an endoscope, or a minimally invasive incision, such as in a laparoscopy. The elongated shaft 66 may be either flexible (e.g., having properties similar to an endoscope) or rigid (e.g., having properties similar to a laparoscope), or may include a customized combination of both flexible and rigid sections. If designed for laparoscopy, the distal end of the rigid elongated shaft may be connected to an end effector including a jointed wrist formed from a clevis having an axis of rotation, and a surgical tool, e.g., a grasper or scissors, that can be actuated based on forces from tendons as the drive input rotates in response to torque received from the drive output 74 of the instrument driver 75. If designed for endoscopy, the distal end of the flexible elongated shaft may include a steerable or controllable bend that can be articulated and bent based on torque received from the drive output 74 of the instrument driver 75.

[0050] Torque from the instrument driver 75 is transmitted down the elongated shaft 71 using tendons within the shaft 71. These individual tendons, such as pull wires, may be individually secured to individual drive inputs 73 in the instrument handle 72. From the handle 72, the tendons are directed down one or more pull lumens in the elongated shaft 71 and secured to a distal portion of the elongated shaft 71. In laparoscopy, these tendons may be coupled to a distally mounted end effector, such as a wrist, grasper, or scissors. Under such an arrangement, torque exerted on the drive input 73 would actuate the end effector in some manner by transmitting tension to the tendons. In laparoscopy, the tendons can rotate the articulation about an axis, thereby moving the end effector in either direction. Alternatively, the tendons may be connected to one or more jaws of a grasper at the distal end of the elongated shaft 71, where tension from the tendons causes the grasper to close.

[0051] In endoscopy, the tendons may be coupled to a bending or articulating section positioned along the elongate shaft 71 (e.g., at the distal end) via adhesive, control rings, or other mechanical fixation. When fixedly attached to the distal end of the bending section, torque exerted on the drive input 73 is transmitted to the tendons, causing the softer bending section (sometimes referred to as the articulating section or articulating region) to bend or articulate. Along the non-bending section, it may be convenient to make the individual pull lumens that direct the individual tendons along (or inwardly of) the wall of the endoscope shaft helical or spiral to counterbalance the radial forces resulting from tension in the pull wires. The angle of the helix and / or spacing between them may be modified or engineered for specific purposes, with narrower helices exhibiting poor shaft compression under load forces, while lesser helices provide superior shaft compression under load forces, but also limited bending. At the other end of the spectrum, orienting the pull lumen parallel to the longitudinal axis of the elongate shaft 71 can allow for controlled articulation at the desired bend or articulation.

[0052] In endoscopy, the elongated shaft 71 houses several components that aid in robotic procedures. The shaft may include a working channel for deploying surgical tools, irrigation, and / or suction to the surgical area at the distal end of the shaft 71. The elongated shaft 71 may also house wires and / or optical fibers that carry signals at the distal tip to / from an optical assembly that may include an optical camera. The shaft 71 may also house optical fibers for carrying light from a proximally located light source, such as a light emitting diode, to the distal end of the shaft.

[0053] At the distal end of the instrument 70, the distal tip may include a working channel opening for delivering tools to the surgical site for diagnosis and / or treatment, irrigation, and aspiration. The distal tip may also include a port for a camera, such as a fiberscope or digital camera, to capture images of the internal anatomical space. In this regard, the distal tip may also include a port for a light source to illuminate the anatomical space when using the camera.

[0054] 13, the drive shaft axis, and therefore the drive input axis, is perpendicular to the axis of the elongate shaft. However, this arrangement complicates the roll ability of the elongate shaft 71. Allowing the elongate shaft 71 to roll along its axis while holding the drive input 73 stationary can result in undesirable tangling of the tendons as they extend from the drive input 73 and enter the pull lumen within the elongate shaft 71. Such resulting tangling of tendons can destroy any control algorithm intended to predict the movement of a flexible elongate shaft during an endoscopic procedure.

[0055] FIG. 14 shows an alternative design of the instrument driver and instrument, in which the axis of the drive unit is parallel to the axis of the elongated shaft of the instrument. As shown, a circular instrument driver 80 comprises four drive units with their drive outputs 81 aligned in parallel at the end of a robotic arm 82. The drive units and their respective drive outputs 81 are housed in a rotating assembly 83 of the instrument driver 80 that is driven by one of the drive units in that assembly 83. In response to torque provided by the rotating drive units, the rotating assembly 83 rotates along a circular bearing that connects the rotating assembly 83 to a non-rotating portion 84 of the instrument driver. Power and control signals may be conveyed from the non-rotating portion 84 of the instrument driver 80 to the rotating assembly 83 through electrical contacts and may be maintained throughout the rotation by a brushed slip ring connection (not shown). In other embodiments, the rotating assembly 83 may be responsive to a separate drive unit that is integrated into the non-rotatable portion 84 and is therefore not parallel to the other drive units. The rotation mechanism 83 enables the instrument driver 80 to rotate the drive units and their respective drive outputs 81 as a single unit about the instrument driver axis 85 .

[0056] Similar to the previously disclosed embodiments, the instrument 86 may include an elongated shaft 88 and an instrument base 87 (shown with a transparent exterior skin for purposes of discussion) that includes a number of drive inputs 89 (such as receptacles, pulleys, and spools) configured to receive the drive outputs 81 in the instrument driver 80. Unlike the previously disclosed embodiments, the instrument shaft 88 extends from the center of the instrument base 87 with its axis being substantially parallel to the axis of the drive input 89, rather than orthogonal as seen in the design of FIG.

[0057] When coupled to the rotation assembly 83 of the instrument driver 80, the medical instrument 86, including the instrument base 87 and the instrument shaft 88, rotates with the rotation assembly 83 about the instrument driver axis 85. Because the instrument shaft 88 is positioned in the center of the instrument base 87, the instrument shaft 88 is coaxial with the instrument driver axis 85 when attached. Rotation of the rotation assembly 83 therefore causes the instrument shaft 88 to rotate about its own longitudinal axis. Also, because the instrument base 87 rotates with the instrument shaft 88, any tendons connected to the drive input 89 at the instrument base 87 do not become entangled during rotation. Thus, the parallelism of the axes of the drive output 81, drive input 89, and instrument shaft 88 allows shaft rotation without entangling any of the control tendons.

[0058] E. Navigation and Control. Traditional endoscopy may involve the use of fluoroscopy (e.g., as may be delivered through a C-arm) and other forms of radiologically based imaging modalities to provide intraluminal guidance to the operator-physician. In contrast, the robotic systems contemplated by the present disclosure may provide non-radiologically based navigation and localization means to reduce the physician's exposure to radiation and reduce the amount of equipment in the operating room. As used herein, the term "localization" may refer to determining and / or monitoring the location of an object within a reference coordinate system. Techniques such as preoperative mapping, computer vision, real-time EM tracking, and robotic command data may be used individually or in combination to achieve a radiation-free surgical environment. In other cases where radiologically based imaging modalities are still used, preoperative mapping, computer vision, real-time EM tracking, and robotic command data may be used individually or in combination to improve on information available only through radiologically based imaging modalities.

[0059] FIG. 15 is a block diagram illustrating a localization system 90 for estimating the position of one or more elements of a robotic system, such as the position of an instrument, according to an exemplary embodiment. The localization system 90 may be a set of one or more computing devices configured to execute one or more instructions. The computing devices may be embodied by a processor (or processors) and computer readable memory in one or more of the components discussed above. As an example, but not limited to, the computing devices may be present in the tower 30 shown in FIG. 1, the cart shown in FIGS. 1-4, and the bed shown in FIGS. 5-10.

[0060] 15, the localization system 90 may include a localization module 95 that processes the input data 91-94 to generate position data 96 of the distal tip of the medical instrument. The position data 96 may be data or logic that represents the position and / or orientation of the distal end of the instrument relative to a frame of reference, which may be relative to the patient's anatomy or relative to a known object such as an EM field generator (see discussion of EM field generators below).

[0061] The various input data 91-94 will now be described in more detail. Pre-operative mapping may be accomplished through the use of acquisition of low-dose CT scans. Pre-operative CT scans, for example, generate two-dimensional images each representing a "slice" of a cutaway view of the patient's internal anatomy. When analyzed as a whole, an image-based model may be generated that covers the anatomical cavities, anatomical spaces, and anatomical structures of the patient's anatomy, such as the patient's pulmonary network. Techniques such as centerline geometry may be determined and approximated from the CT images to generate a three-dimensional volume of the patient's anatomy, referred to as pre-operative model data 91. The use of centerline geometry is discussed in U.S. Patent Application Serial No. 14 / 523,760, the contents of which are incorporated herein in their entirety. Network topological models may also be derived from CT images and are particularly suitable for bronchoscopy.

[0062] In some embodiments, the instrument may be equipped with a camera to provide visual data 92. A localization module 95 may process the visual data to enable positional tracking of one or more visual bases. For example, pre-operative model data may be used in conjunction with visual data 92 to enable computer vision base tracking of a medical instrument (e.g., an endoscope or an instrument advancing through a working channel of the endoscope). For example, using the pre-operative model data 91, the robotic system may generate a model-based predicted endoscopic image library based on the expected path of travel of the endoscope, with each image linked to a location in the model. During surgery, this library may be referenced by the robotic system to compare real-time images captured by a camera (e.g., a camera at the distal end of the endoscope) to those in the image library to aid in localization.

[0063] Other computer vision based tracking techniques use feature tracking to determine the motion of the camera, and therefore the endoscope. Some features of the localization module 95 may identify circular geometric shapes in the pre-operative model data 91 that correspond to anatomical lumens, and track changes in those geometries to determine which anatomical lumens have been selected and the relative rotational and / or translational motion of the camera. The use of a phase map may further enhance the visual base algorithm or visual base technology.

[0064] Optical flow, another computer vision based technique, may analyze the displacement and translation of image pixels in a video sequence in visual data 92 to infer camera movement. By comparing multiple frames over multiple iterations, the movement and position of the camera (and therefore the endoscope) can be determined.

[0065] The localization module 95 can use real-time EM tracking to generate a real-time position of the endoscope in a global coordinate system that can be registered to the patient's anatomy represented by the pre-operative model. In EM tracking, an EM sensor (or tracker), consisting of one or more sensor coils embedded in a medical instrument (e.g., an endoscopic instrument) at one or more positions and orientations, measures the variations in an EM field generated by one or more static EM field generators positioned at known positions. The position information detected by the EM sensor is stored as EM data 93. The EM field generator (or transmitter) may be placed near the patient to generate a low-intensity magnetic field that can be detected by the embedded sensor. The magnetic field induces a small current in the sensor coil of the EM sensor, which may be analyzed to determine the spacing and angle between the EM sensor and the EM field generator. This spacing and orientation may be "registered" intraoperatively to the patient's anatomy (e.g., the pre-operative model) to determine a geometric transformation that aligns a position in the pre-operative model of the patient's anatomy with a single position in the coordinate system. Once registered, an EM tracker embedded at one or more locations on the medical instrument (e.g., the distal tip of an endoscope) can provide a real-time indication of the medical instrument's progression through the patient's anatomy.

[0066] The robotic commands and kinematic data 94 may also be used by a localization module 95 to provide localization data 96 for the robotic system. During pre-operative calibration, the pitch and yaw of the device resulting from the articulation commands may be determined. Intra-operatively, these calibration measurements may be used in combination with known insertion depth information to estimate the position of the instrument. Alternatively, these calculations may be analyzed in combination with EM, vision, and / or phase modeling to estimate the position of the medical instrument within the network.

[0067] As Fig. 15 illustrates, several other input data may be used by the localization module 95. For example, although not shown in Fig. 15, an instrument utilizing shape sensing fibers may provide shape data that the localization module 95 can use to ascertain the position and shape of the instrument.

[0068] The localization module 95 may use a combination(s) of the input data 91-94. In some cases, such a combination may use a probabilistic approach in which the localization module 95 assigns confidence weights to the location determined from each of the input data 91-94. Thus, if the EM data is unreliable (e.g., in the presence of EM interference), the reliability of the location confirmed by the EM data 93 may be reduced, and the localization module 95 may rely more heavily on the vision data 92 and / or the robot command and kinematics data 94.

[0069] As discussed above, the robotic systems discussed herein may be designed to incorporate a combination of one or more of the above-mentioned technologies. The computer-based control system of the tower, bed, and / or cart-based robotic system may store computer program instructions in a non-transitory computer-readable storage medium, such as, for example, a persistent magnetic storage drive, a solid-state drive, etc., that, when executed, cause the system to receive and analyze sensor data and user commands, generate system-wide control signals, and display navigation and localization data, such as instrument position within a global coordinate system, anatomical maps, etc.

[0070] 2. Medical robot systems and technologies

[0003] Embodiments of the present disclosure relate to multi-purpose robotic systems and motion techniques associated with a single robotic system capable of performing multiple types of medical procedures. As discussed above, due to the various requirements of different medical procedures, a robotic system may be specifically designed and built to perform a single medical procedure and, as a result, may not be able to meet the requirements for performing other medical procedures.

[0071] For example, one existing system is dedicated for laparoscopic surgery. The existing system is designed with a robot arm kinematics including a mechanically constrained remote sensor, which is provided for the robot arm to insert, pitch, and yaw a medical instrument relative to the remote sensor. The mechanically constrained remote sensor is provided by multiple joints connected to each other by bands so that it can be controlled by motors connected to each other by bands. Although the inertia of the robot arm is generally low and the robot arm can maintain the remote sensor even under power loss, a potential drawback of this design is that it cannot be used to perform non-laparoscopic procedures. For example, due to the mechanical remote sensor, it may be difficult to utilize the robot arm for endoscopic procedures because the mechanically constrained remote sensor makes it difficult to align the robot arm along a virtual rail. It should be noted that the band used to generate the mechanical remote sensor prevents compact storage of the robot arm.

[0072] Similarly, existing serial link manipulators used for endoscopic procedures do not translate well to laparoscopy due to the difficulty of meeting the stiffness and speed requirements for laparoscopy while maintaining a low inertia arm.

[0073] The above-mentioned problems are addressed, among others, by the multipurpose robotic system and associated motion techniques described herein, which can accommodate a wide range of procedures. For example, a robotic arm according to the present disclosure includes a universal kinematic chain and is controlled by computer-implemented instructions that enable the robotic arm to operate in various modes, the different modes being usable for different types of medical procedures. The kinematic chain includes a rotary motorized joint at the proximal end of the robotic arm (e.g., closest to the setup joint or base of the robotic system), a prismatic motorized joint at the distal end of the robotic arm (e.g., closest to the medical instrument), and several motorized joints connected in series by a linkage, with several additional motorized joints positioned in series between the first and second motorized joints. The additional motorized joints can be either rotary or prismatic, as described in more detail below. The robotic arm can operate in a first mode relative to a remote sensor to perform a laparoscopic procedure and in a second mode relative to a virtual rail to perform an endoscopic procedure. Although the present disclosure provides examples of first and second operating modes for laparoscopic and endoscopic procedures, respectively, the disclosed robotic system may also be used to perform other types of medical procedures.

[0074] The disclosed robotic system may be controlled by a physician or other operator to perform a medical procedure according to the disclosed modes. FIG. 16 illustrates an exemplary command console 200 for a medical robotic system as described herein, for example, in a medical robotic system as shown in FIGS. 1-5 and 8-10. The command console 200 may be used, for example, as the command console 105 in the exemplary operating environment 100. The command console 200 includes a console base 201, a display module 202 (e.g., a monitor), and a control module (e.g., a keyboard 203 and a joystick 204). In some embodiments, one or more of the functions of the command console 200 may be integrated into the base of the medical robotic system as shown in FIGS. 1-5 and 8-10, or into another system communicatively coupled to the medical robotic system. A user 205 (e.g., a physician) uses the command console 200 to remotely control the medical robotic system from an ergonomic position.

[0075] The console base 201 may include a controller 206 including one or more processors and memory, and optionally one or more data buses and associated data communication ports. The controller 206 is responsible for interpreting and processing signals, such as robot position data, camera images, and tracking sensor data, from medical instruments, such as the endoscope 13, ureteroscope 32, medical instrument 34, laparoscope 59, gastroscope, bronchoscope, or another procedure-specific medical instrument. The memory of the controller 206 may store instructions for the operation of the medical instruments and robotic system described herein. In some embodiments, both the console base 201 and the base of the medical robotic system may perform signal processing for load balancing, and thus the controller 206 may be divided among different system components. The controller 206 may also process commands and instructions provided by the user 205 through the control modules 203 and 204. In addition to the keyboard 203 and joystick 204 shown in FIG. 16, the control module may include other devices, such as controls such as a computer mouse, trackpad, trackball, control pad, handheld remote controller, and sensors (e.g., motion sensors or cameras) that capture hand and finger gestures. For example, in some laparoscopic robotic systems, the control module includes a pair of seven degrees of freedom ("7DOF") haptic masters. The haptic master is a force-controlled haptic interface that converts input (e.g., force applied by a human user) into output (e.g., displacement of an end effector of the robotic system) and also provides haptic feedback to the user. The 7DOF haptic master may provide three degrees of motion in the X, Y, and Z directions, and four degrees of motion: pitch, yaw, roll, and articulation. The controller may include a set of user inputs (e.g., buttons, joystick, directional pad, etc.) that are mapped to instrument movements (e.g., articulation, actuation, irrigation, etc.).

[0076] The user 205 may use the command console 200 in a velocity mode or a position control mode to control the medical instrument via the robotic arm as described herein. In the velocity mode, the user 205 directly controls the pitch and yaw motion of the distal end of the medical instrument based on direct manual control using the control module. For example, the motion of the joystick 204 may be mapped to yaw and pitch motion at the distal end of the medical instrument. The joystick 204 may provide haptic feedback to the user 205. For example, the joystick 204 may vibrate to indicate that the medical instrument cannot translate or rotate any further in a particular direction. The command console 200 may also provide visual feedback (e.g., a pop-up message) and / or audible feedback (e.g., a beep) to indicate that the medical instrument has reached a maximum translation or rotation.

[0077] In the position control mode, the command console 200 controls the medical instrument using a 3D map of the patient's luminal network and input from a navigation sensor as described herein. The command console 200 provides control signals to a robotic arm of the medical robotic system to steer the medical instrument to a target location. Because of the reliance on the 3D map, the position control mode may require precise mapping of the patient's anatomy.

[0078] In some embodiments, a user 205 may manually operate the robotic arms of a surgical robotic system without using the command console 200. During setup in the surgical room, a user 205 may move the robotic arms, medical instruments, and other surgical equipment to access the patient. The medical robotic system may rely on force feedback and inertial control from the user 205 to determine the appropriate configuration of the robotic arms and equipment.

[0079] The displays 202 may include electronic monitors (e.g., liquid crystal displays, LED (Light-Emitting Diode) displays, touch-sensitive displays), virtual reality viewing devices, such as goggles or glasses, and / or other display devices. For example, for some procedures (e.g., laparoscopy), the displays may include a miniature stereo viewer having a pair of openings through which a user may view stereoscopic images without the aid of glasses or goggles. This may be used, for example, to display stereoscopic laparoscopic images. In some embodiments, the display module 202 is integrated into the control module, for example, as a tablet device with a touch screen. In some embodiments, one of the displays 202 may display a 3D model of the patient's luminal network and virtual navigation information (e.g., a virtual representation of the end of the endoscope in the model based on the position of the EM sensor), while the other of the displays 202 may display image information received from a camera or another sensing device at the end of the medical instrument. In some implementations, the user 205 may use the integrated display 202 and control module to both view data and input commands to the medical robotic system. The display 202 may use a stereoscopic device, e.g., a visor or goggles, to display 2D renderings and / or 3D images of 3D images. The 3D images provide an "endo view" (i.e., an endoscopic field of view), which is a computer 3D model showing the patient's anatomy. The "end view" provides a virtual environment of the patient's interior and the expected location of the medical instrument within the patient. The user 205 compares the "end view" model with an actual image captured by a camera to help mentally orient and ensure that the medical instrument is in the correct (or generally correct) position within the patient's body. The "end view" provides information about the anatomical structures around the distal end of the medical instrument, e.g., the shape of the patient's airways, circulatory vessels, or intestines or colon. The display module 202 may simultaneously display a 3D model and a CT scan of the anatomical structures around the distal end of the medical instrument.Additionally, the display module 202 can overlay a previously determined navigation path of the medical instrument onto the 3D model and the CT scan image.

[0080] In some embodiments, a model of the medical instrument is displayed along with the 3D model to help show the status of the surgical procedure. For example, a CT scan identifies a lesion in the anatomical structure that may require a biopsy. During operation, the display module 202 may show a reference image captured by the medical instrument that corresponds to the current position of the medical instrument. The display module 202 may automatically display different views of the model of the medical instrument depending on the user settings and the particular surgical procedure. For example, the display module 202 shows an overhead X-ray perspective of the medical instrument during a navigation step as the medical instrument approaches the surgical area of ​​the patient. Such user-guided movement of the medical instrument may be constrained according to various predefined operating modes for the robotic arm as described herein.

[0081] 2.Adjustable mounting platform According to some embodiments, the robotic system may include one or more mounting platform(s), such as an adjustable arm support, for supporting and positioning a robotic arm for use during a robotic medical or surgical procedure. For example, the adjustable arm support may include a bar or rail to which one or more robotic arms may be attached. In this example, the bar or rail may be coupled to a table support by a bar or rail connector and carriage, as described in applicant's U.S. Patent Application Publication No. 2020 / 0268460, the entirety of which is incorporated herein by reference. The adjustable arm support may be adjustable with several degrees of freedom that allow the bar or rail of the adjustable arm support to be positioned in multiple positions relative to the table. The adjustable arm support may also be configured to transition to a stowed position, where the adjustable arm support and the attached robotic arm are stowed below the surface of the table.

[0082] In some embodiments, the connector of the system may include various features and structures for connecting the bar or rail of the adjustable arm support to the table column. For example, as described below, the connector may include a motorized arm that connects the rail or bar of the adjustable arm support to the table column. In some embodiments, the motorized arm may include, for example, a carriage and rail or bar connector as described above. In some embodiments, the motorized arm may alternatively or additionally include one or more of the additional features described in this section with reference to FIGS. 17-23.

[0083] As described more fully below, a motorized arm may include one or more links configured to raise, lower, tilt, and / or otherwise position an arm support (e.g., an adjustable arm support bar or rail) that supports a robotic arm. In some examples, a motorized arm may be considered a base or set arm or joint, as it may be designed and configured to position the arm support prior to actuation of the robotic arm during a medical procedure. For example, in some cases, the motorized arm is configured to move the arm support (and the robotic arm attached thereto) from a stowed position to a set position. In some examples, in the set position, the motorized arm and arm support may remain stationary, while the robotic arm attached to the arm support moves to perform the medical procedure. In some examples, the motorized arm and / or arm support also move during a medical procedure. Thus, in some embodiments, the motorized arm may be configured to raise, lower, and angle the arm support to move the attached robotic arm from a lower stowed position to an elevated position in preparation for surgery. In some embodiments, the motorized arm may allow a clinician or physician to have better access to the patient's head or feet, thereby enabling procedures such as urological and gastrointestinal (GI) procedures.

[0084] As described in this section and above, various embodiments for the motorized arm supporting the arm support are possible, and several examples are provided below. For example, FIGS. 17-20 provide a first example in which the motorized arm includes a single link. FIGS. 21-23 relate to a second example in which the motorized arm includes a dual link design. These two examples are described in detail below and further in Applicant's U.S. Patent Application Publication No. 2020 / 0268460 (incorporated herein by reference in its entirety) and are provided by way of example and not limitation. Those skilled in the art will appreciate that, in light of the present disclosure, the various features described in connection with the illustrated examples can be modified and combined in various ways. For example, features of the first illustrated example can be combined with features of the second illustrated example, and vice versa.

[0085] 2(A).Single link motorized arm. FIG. 17 shows an end view of a medical robotic system 2200 including two motorized arms 2205 that position a robotic arm support or rail 2207. In this example, each motorized arm 2205 includes a single link 2211 extending between a shoulder 2209 and the arm support 2207. The term "link" as used throughout this application may refer to any link and its associated structure that is kinematically associated with one or more degrees of freedom and / or articulation. In some embodiments, a single "link" may include two or more structural parts coupled together. For example, as shown in FIG. 18 (described in more detail below), the link 2211 includes a first lateral piece 2223 and a second lateral piece 2225 that are structurally coupled together to form the single link 2211. The arm support 2207 may include a bar or rail to which one or more robotic arms may be attached, as described above. As described below, the link 2211 can be configured to rotate in a sweeping or "bicep curl" type motion about the shoulder 2209. This biceps curl type motion of the link 2211, in conjunction with the additional degrees of freedom of the powered arm 2205, can advantageously provide a significant range of motion that can provide a large number of possible positions for the arm support 2207. For example, in some embodiments, the powered arm includes a significant range of motion to adequately achieve many or all of the positions required for a robotic medical procedure or surgery, such as robotic laparoscopic surgery.

[0086] In the illustrated embodiment, two motorized arms 2205 are positioned on either side of a post 2202 that supports a table 2201 on a base 2203. That is, one motorized arm 2205 is positioned on a first side of the post 2202 and the other motorized arm 2205 is positioned on a second side of the post 2202 opposite the first side. In this configuration, one motorized arm 2205 may be configured to position an connected arm support 2207 on a first side of the table 2201 and the other motorized arm 2205 may be configured to position an connected arm support 2207 on a second side of the table 2201. As shown in the example of FIG. 17, each motorized arm 2205 may be independently controllable and positionable such that the arm support 2207 may be positioned in different positions on each side of the table 2201. The two motorized arms 2205 may be independently controllable and positionable, but may have similar features. Thus, the following discussion focuses on one of the motorized arms 2205, with the understanding that the other motorized arms 2205 may be similar. In some embodiments, the robotic system 2200 includes only one motorized arm 2205. In some embodiments, the robotic system 2200 includes more than one motorized arm 2205. For example, the robotic system 2200 may include two motorized arms 2205 (as shown), three motorized arms 2205, four motorized arms 2205, etc.

[0087] The single link motorized arm 2205 may include one or more innovative features that allow it to perform effective bed-mounted robotic laparoscopic or endoscopic surgery (or other robotic medical procedures) while being housed in a compact configuration within or proximal to the base 2203 to allow access for manual surgery, for example, as illustrated in Fig. 17. To be usable for a wide variety of medical procedures, the arm support 2207 must be positionable in multiple positions or configurations relative to the table 2201. As previously discussed, the motorized arm 2205 provides a significant range of motion to properly achieve these positions.

[0088] As described above, the link 2211 of the powered arm 2205 extends between the shoulder 2209 and the arm support 2207. The link 2211 may extend between a proximal end 2213 and a distal end 2215. The proximal end 2213 of the link 2211 may be coupled to the shoulder 2209. In some embodiments, the proximal end 2213 of the link 2211 is coupled to the shoulder 2209 using a revolute joint. The revolute joint coupling the proximal end 2213 of the link 2211 to the shoulder 2209 may provide a rotational degree of freedom 2217, as shown, that allows the link 2211 to rotate relative to the shoulder 2209. A rotational joint between the shoulder 2209 and the link 2211 may extend through the proximal end 2213 of the shoulder 2209 and the link 2211 to provide a rotational degree of freedom 2217 and may be configured to enable rotation about an axis parallel to the longitudinal axis about the table 2201.

[0089] In some embodiments, the rotational degrees of freedom 2217 are configured to allow for at least 120 degrees, at least 140 degrees, at least 150 degrees, at least 160 degrees, at least 170 degrees, at least 180 degrees, or more of rotation. The rotational degrees of freedom 2217 may be measured from a fully lowered position where the arm support 2207 is positioned proximal to the base 2203. In some embodiments, the link 2211 wraps around the post 2202 allowing for additional rotation (as described below). In some embodiments, the range of rotation may be as wide as possible while still avoiding collision with the table 2201 or other structure.

[0090] Such rotation allows the link 2211 to rotate relative to the shoulder 2209 to deploy the arm support 2207 in the sweep or bicep curl type motion described above. In some embodiments, the rotation of the articulation between the link 2211 and the shoulder 2209 allows the arm support 2207 to be positioned laterally closer to or further from the table 2201 or column 2202 only at certain rotation angles. Thus, in some embodiments, the motorized arm 2205 may include an additional degree of freedom 2219 that allows the height of the arm support 2207 to also be adjusted at various rotation angles. This can effectively allow the user or system to have vertical and lateral position control of the position of the arm support 2207 relative to the table 2201, which advantageously allows flexible positioning of the arm support 2207 to accommodate different surgical or medical procedures, as well as to clear patient positioning accessories and accommodate various patient widths.

[0091] As shown in FIG. 17, the degrees of freedom 2219 may include a translational degree of freedom 2219 along an axis parallel to the axis of the strut 2202. This translational degree of freedom 2219 may be provided by a connection or joint of a shoulder 2209 to the strut 2202. For example, the shoulder 2209 may be coupled to the strut 2202 at a joint that translates vertically along the strut 2202. The joint between the shoulder 2209 and the strut 2202 may comprise a linear, sliding, or prismatic joint to enable the translational degree of freedom 2219 of the motorized arm 2205. In some embodiments, this joint translates along the z-axis and may be referred to as a "z-lift" mechanism. In some embodiments, the translational degree of freedom 2219 is configured to translate along the length of the strut 2202. In some embodiments, the translational degree of freedom 2219 is configured to allow translation along 30%, 40%, 50%, 60%, 70%, 80%, 90%, or more of the length of the strut 2202. In some embodiments, the translational degree of freedom 2219 is configured to allow translation along the length of the strut 2202 of at least 20 cm, at least 30 cm, at least 40 cm, at least 50 cm, or more.

[0092] The combination of the shoulder 2209, the link 2211, the rotational degree of freedom 2217 (provided by a rotational joint between the shoulder 2209 and the link 2211), and the translational degree of freedom 2219 (provided by a joint between the shoulder 2209 and the post 2202) may provide the motorized arm 2205 with a high range of motion that allows the arm support 2207 (positioned at the distal end 2215 of the link 2211) to be positioned at many horizontal and vertical distances relative to the table 2201. Specifically, rotation of the link 2211 about the shoulder 2209 (which has a rotational degree of freedom 2219) may allow the arm support 2207 to be positioned at different horizontal and vertical distances relative to the table 2201, and translation of the shoulder 2209 along the post 2202 (which has a translational degree of freedom 2219) may allow the arm support 2207 to be positioned at different vertical distances relative to the table 2201. In some embodiments, rotation of the link 2211 about the shoulder 2209 (with rotational degree of freedom 2219) may enable the arm support 2207 to have a circular sweep about a pivot point at the shoulder 2209.

[0093] 17, the distal end 2215 of the link 2211 may be coupled to the arm support 2207. In some embodiments, the distal end 2215 of the link 2211 may be coupled to the arm support 2207 using a rotary joint that provides a rotational degree of freedom 2221. The rotational degree of freedom 2221 may be configured to allow the motorized arm 2205 to tilt or rotate the arm support 2207 that supports the robot arm. In some embodiments, an additional mechanism is provided at the distal end 2215 of the link 2211 that allows the arm support 2207 to translate relative to the link 2211 (one example is shown in FIGS. 22 and 23 and described below).

[0094] In some embodiments, the rotational degree of freedom 2221 may be constrained to the rotational degree of freedom 2217 to maintain the orientation of the arm support 2207 during rotation of the link 2211 about the shoulder 2209. For example, in some embodiments, it may be beneficial to maintain the arm support 2207 such that the top surface of the arm support 2207 remains horizontal (e.g., parallel to the surface of the table 2201 or floor) regardless of the rotational position of the link 2211. A mechanism may be configured and implemented to constrain the rotational degree of freedom according to some embodiments.

[0095] In some embodiments, an actuator comprising a motor and gearbox may be positioned at the proximal end of the link 2211 to control the rotation of the motorized arm 2205 (i.e., the sweep or bicep curl movement of the link 2211). Additionally, in some embodiments, additional features may be incorporated to increase the stiffness of the motorized arm 2205 to enable precise robotic arm use. For example, in some embodiments, high torsional stiffness brakes may be added to the link 2211 at the proximal end 2213 and / or distal end 2213 as shown in FIG.

[0096] FIG. 18 shows an isometric view of an embodiment of a motorized arm 2205 including a proximal torsional stiffness feature 2402 (shown as an arbor) and a distal torsional stiffness feature 2404 (shown as an arbor). The proximal torsional stiffness feature 2402 and the distal torsional stiffness feature 2405 may be configured to increase the stiffness of the motorized arm 2205. As shown in FIG. 18, in some embodiments, the link 2211 may include a first side 2223 and an opposing second side 2225. In some embodiments, an actuator 2405 including one or more of a motor, a brake, a sensor, and / or a gearbox may be positioned within the proximal end 2213 of the link 2211 at the first side 2223. In some embodiments, the actuator 2405 may include a brake in the form of an electromagnetic brake. At the second side 2225, the proximal end 2213 of the link 2211 may include a proximal torsional stiffness feature 2402. Thus, the actuator 2405 including the motor may be positioned on one side of the link 2211 and the proximal torsional stiffness mechanism 2402 may be positioned on the other side. The proximal torsional stiffness mechanism 2402 may be a high torsional stiffness brake. In some embodiments, the proximal torsional stiffness mechanism 2402 may be part of a hydraulic arbor brake system. The proximal torsional stiffness mechanism 2402 may be configured to increase the stiffness of the powered arm 2205 upon actuation.

[0097] For example, in some embodiments, an actuator 2405 including a motor is used to rotate the link 2211 into a rotated position. The torsional stiffness mechanism brake 2402 may be disengaged prior to rotation of the link 2211. Once positioned in place, the proximal torsional stiffness mechanism 2402 may be engaged to increase the stiffness of the motorized arm 2205. In some embodiments, the proximal torsional stiffness mechanism 2402 or brake system may be considered part of a hydraulic extension arbor brake system. The distal torsional stiffness mechanism 2404 may be used to similarly increase the torsional stiffness of the motorized arm 2205 at the joint between the link 2211 and the arm support 2207. Other types of brakes may also be used.

[0098] For example, in some embodiments, one or both of the proximal torsional stiffness mechanism 2402 and the distal torsional stiffness mechanism 2404 can be an arbor (as described below), a spring-loaded electromagnetic tooth brake, or a spring-loaded hydraulically released tooth brake. In some embodiments, alternatively or additionally, a higher stiffness gearbox (such as a cycloidal gearbox instead of a harmonic gearbox) in the actuator 2405 can be used to increase the torsional stiffness.

[0099] FIG. 18 also shows that a second brake or distal brake 2404 may be included at the distal end 2215 of the link 2211. In the illustrated embodiment, the distal brake 2404 may be included on the second side 2225 of the link 2211. That is, in some embodiments, both the proximal brake 2402 and the distal brake 2404 are on the same side of the link 2211. This need not be the case in all embodiments. For example, the distal brake 2404 may be included on the first side 2223. The distal brake 2404 may operate similarly to the proximal brake 2402. For example, the distal brake 2404 may be configured to increase the stiffness of the motorized arm 2205. In some embodiments, like the proximal brake 2402, the distal brake 2404 may be part of a hydraulic expansion arbor brake system as described further below. Instead of a hydraulic expanding arbor brake system, other types of brakes may be used, including a spring-engaged electromagnetic tooth brake system or a spring-engaged hydraulic release tooth brake system.

[0100] The motorized arm 2205 described herein with reference to FIGS. 17-18 may also be configured to provide unique advantages for compactly housing a robotic arm attached to a patient platform. For example, the motorized arm 2205 may lower the arm support 2207 (and attached robotic arm) below the table 2201 to a position proximal to the base 2203 or floor to house the robotic arm. This may allow, for example, access to the patient for manual surgery, as well as access for additional systems (e.g., fluoroscopy C-arm) to be provided near the patient platform. To facilitate loading, in some embodiments, the motorized arm 2205 is configured such that the link 2211 wraps around the support 2202, thereby moving the motorized arm 2205 as close to the support 2250 as possible to remain within the footprint of the table 2201. This may be advantageous from this perspective as it may not limit patient access when the robotic system is not in use. These features are shown, for example, in FIGS. 19A, 19B, and 20.

[0101] 2(B).Dual link electric arm. Several embodiments of a medical robotic system including two motorized arms may be implemented. For example, FIGS. 21-23 illustrated a medical robotic system in which a motorized arm 2705 includes a dual link configuration including a first link 2711 and a second link 2712. As shown, the first link 2711 is connected to a shoulder 2709. The shoulder 2709 may be connected to a post 2702 as described above. The post 2702 extends between the table 2701 and the base 2703. The first link 2711 is also connected to a second link 2712. The second link 2712 is connected to an arm support 2707. The arm support 2707 may include a bar or rail (e.g., bar or rail 1307) to which one or more robotic arms may be attached, as described above. In contrast to the single link design of the motorized arm 2205 of FIGS. 17-20, the dual link design of the motorized arm 2705 of FIGS. 21-23 includes a first link 2211 and a second link 2212 that extend between the shoulder 2709 and the arm support 2707. As described in more detail below, the second link 2212 may be configured to rotate relative to the first link 2211 to provide an additional rotational degree of freedom to the motorized arm 2705. This additional degree of freedom may allow for increased clinical workspace and reach upwards of the table 2701, thereby providing greater flexibility for positioning the arm support 2707 and attached robotic arm. Additionally, in some embodiments, the additional rotational degree of freedom between the first link 2711 and the second link 2712 may reduce the likelihood that the motorized arm 2705 will contact the side of the table 2701.

[0102] In the illustrated embodiment, two motorized arms 2705 are positioned on either side of a support 2702 that supports a table 2701 on a base 2703. In some embodiments, each motorized arm 2705 may be independently controllable and positionable such that the arm support 2707 may be positioned at different positions on each side of the table 2701. The two motorized arms 2705 may be independently controllable and positionable, but may comprise similar features. Thus, this discussion focuses on one of the motorized arms 2705, with the understanding that the other motorized arms 2705 may be similar. In some embodiments, the robotic system 2700 includes only one motorized arm 2705. In some embodiments, the robotic system 2700 includes more than two motorized arms 2705. For example, the robotic system 2700 may include two motorized arms 2705 (as shown), three motorized arms 2705, four motorized arms 2705, etc. Additionally, each motorized arm 2705 and arm support 2707 may support two or three robotic arms. In other embodiments, other numbers of robotic arms may be used.

[0103] 21 further illustrates that, similar to the systems described above, the motorized arm 2705 of the robotic medical system 2700 can be configured to be stored in a compact space beneath a table 2701. For example, the motorized arm 2705 can be configured to move the arm support 2707 to a position within or proximal to the base 2703, as shown. As described more fully below, the motorized arm 2705 can be configured to move from a stowed configuration (e.g., as shown in FIG. 21 ) to a range of deployed positions that allow the robotic arm to be employed during a robotic surgical or medical procedure.

[0104] 22A and 22B show an embodiment of the motorized arm 2705 alone. FIG. 22A shows the motorized arm 2705 in an exemplary deployed position, and FIG. 22B shows the motorized arm 2705 in an exemplary stowed position. As shown in FIGS. 22A and 28B, the motorized arm 2705 includes a shoulder 2709, a first link 2711, and a second link 2712. Although not shown in FIGS. 22A and 22B, the second link 2712 is further configured to connect to the arm support 2707 as shown in FIG. 21 and described in more detail below with reference to FIG. 32. The shoulder 2709 may be similar to the shoulder 2209 described above with reference to FIGS. 17-20. For example, the shoulder 2709 may be coupled to the strut 2702 at a joint that allows the shoulder 2709 to translate along the strut 2702, for example, in a z-lift motion as described above.

[0105] The first link 2711 extends between a proximal end 2713 and a distal end 2715. As illustrated in FIGS. 22A and 22B, the proximal end 2713 may be connected to the shoulder 2709 by a rotational joint. The rotational joint between the proximal end 2713 of the first link 2711 and the shoulder 2709 may be configured to allow the first link 2711 to rotate with respect to the shoulder 2709 with a first rotational degree of freedom 2717. In some embodiments, the first rotational degree of freedom 2717 allows for 180 degrees of rotation of the first link 2711, although this need not be the case in all embodiments. For example, in some embodiments, the first rotational degree of freedom 2717 allows for greater than or less than 180 degrees of rotation for the first link 2711. In some embodiments, the first rotational degree of freedom 2717 allows the first link 2711 to move relative to the shoulder 2709 in a bicep curl or sweep motion.

[0106] As shown in FIGS. 22A and 22B, the first link 2711 may include a first side 2723 and a second side 2725. As shown, the first side 2723 may be separated from the second side 2725 to create a space therebetween. The shoulder 2709 may be positioned between the first side 2723 and the second side 2725 of the first link 2711. That is, the first side 2723 may be connected to the first side of the shoulder 2709, and the second side 2725 may be connected to the second side of the shoulder 2709. This configuration may advantageously allow the first link 2711 to rotate over a large range of motion (e.g., 180 degrees) relative to the shoulder 2709 without the first link 2711 contacting the shoulder 2709.

[0107] The second link 2712 may also extend between a proximal end 2714 and a distal end 2716. As illustrated in FIGS. 22A and 22B, the proximal end 2714 of the second link 2712 may be connected to the distal end 2715 of the first link 2711 by a rotational joint. The rotational joint between the proximal end 2714 of the second link 2712 and the distal end 2715 of the first link 2711 may be configured to allow the second link 2712 to rotate relative to the first link 2711 with a second rotational degree of freedom 2718. In some embodiments, the second rotational degree of freedom 2718 allows for 150 degrees of rotation of the second link 2712 relative to the first link 2711, although this need not be the case in all embodiments. For example, in some embodiments, the second rotational degree of freedom 2718 allows for greater than or less than 150 degrees of rotation of the second link 2712 relative to the first link 2711. In some embodiments, the second rotational degree of freedom 2718 allows the second link 2712 to move in a biceps curl or sweep motion relative to the first link 2711.

[0108] Similar to the first link 2711, the second link 2712 may also include a first side 2724 and a second side 2726. As shown, the first side 2724 may be separated from the second side 2726 to create a space therebetween. The first link 2711 may be positioned between the first side 2724 and the second side 2726 of the second link 2712. That is, the first side 2724 of the second link 2712 may be coupled to the first side 2723 of the first link 2711, and the second side 2726 of the second link 2712 may be coupled to the second side 2725 of the first link 2711. This configuration may advantageously allow the second link 2712 to rotate over a wide range of motion (e.g., 150 degrees) relative to the first link 2711 without the second link 2712 contacting the first link 2711. This configuration may also allow the powered arm 2705 to fold into a small, compact size in a stowed configuration, as shown, for example, in Figures 21 and 22B.

[0109] The distal end 2716 of the second link 2712 can be configured to connect to an arm support 2707 (not shown in FIGS. 22A and 22B ) configured as a rail or bar for supporting one or more robotic arms. Features of the distal end 2716 of the second link 2712 are described in more detail below with reference to FIG.

[0110] Because the motorized arm 2705 includes two links 2711, 2712, each configured to rotate with its own rotational degree of freedom 2717, 2718, the motorized arm 2705 can move the attached arm support to a wider range of positions to facilitate a robotic medical procedure. In some embodiments, for example, the inclusion of the second link 2712 and the additional rotational degree of freedom 2718 allows the motorized arm 2705 to reach around the table 2701 next to the patient.

[0111] 3. A robotic arm associated with an adjustable arm support. The adjustable arm supports described above may be configured to be mounted to a table, column, or base and are adjustable (movable with various degrees of freedom) to support a robot arm positioned on the adjustable arm support. Since the adjustable arm support may be configured to be mounted below the surface of a table, it may be advantageous to use certain types of robot arms with the adjustable arm support, according to some embodiments. In particular, a robot arm with increased movement and flexibility may be desirable so that the robot arm can "work up" from a lower position and avoid collisions (e.g., with a table). This section outlines certain features of robot arms configured for use with adjustable arm supports.

[0112] For example, in some embodiments, a robot arm configured for use with an adjustable arm support differs from a parallelogram remote sensor robot arm. In one example, a robot arm configured for use with an adjustable arm support may include a shoulder having at least two degrees of freedom, an elbow having at least one degree of freedom, and a wrist having at least two degrees of freedom. The kinematics associated with such an arm allow the arm base to be arbitrarily positioned relative to the workspace, enabling setups that would be difficult for a parallelogram remote sensor robot mounted along a bed.

[0113] Additionally, in some embodiments, a robotic arm configured for use with an adjustable arm support may include a hemispherical or spherical wrist configured with at least three degrees of freedom. Such a wrist may enable the robotic arm to roll its wrist joint such that an instrument drive mechanism positioned at the distal end of the robotic arm may be below the arm wrist. This may enable surgery where the target workspace is far above the port.

[0114] Some surgical robotic arms include mechanically constrained remote sensors (e.g., parallelogram robotic arms) that do not have redundant degrees of freedom. That is, at any remote sensor location, the distance to the base is mechanically constrained. Robotic arms coming from under the bed, such as when the robotic arms are mounted on the adjustable arm supports described above, may be limited by their mounting structure and cannot reach the optimal configuration that makes parallelogram robotic arms superior. To address this issue, robotic arms configured for use with the adjustable arm supports described above may include one or more redundant degrees of freedom. The redundant degrees of freedom can allow the arm to swing and advance in its null space without moving the tool tip, which allows for intraoperative collision avoidance that is not possible with previously known surgical robotic arms.

[0115] Figure 24 illustrates one embodiment of a robotic arm 1700 that can be used with the systems and components illustrated in Figures 1-23. The robotic arm 1700 includes a RRRPP serial chain manipulator, where "R" refers to a revolute joint and "P" refers to a prismatic joint, labeling such joints starting at the most proximal joint 1705A and moving continuously along the robotic arm toward the most distal joint 1705E. The robotic arm 1700 can be configured for use as a low inertia remote sensor laparoscopy system or as a virtual rail endoscopy system.

[0116] The robot arm 1700 includes a plurality of motorized joints 1705A to 1705E connected in series by link mechanisms 1710A to 1710D. The first link mechanism 1710A connects the first motorized joint 1705A and the third motorized joint 1705B, the second link mechanism 1710B connects the third motorized joint 1705B to the fourth motorized joint 1705C, the third link mechanism 1710C connects the fourth motorized joint 1705C to the fifth motorized joint 1705D, and the fourth link mechanism 1710D connects the fifth motorized joint 1705D to the second motorized joint 1705E.

[0117] The first powered joint 1705A at the proximal end of the robotic arm (e.g., closest to the set-up joint or base of the robotic system to which the robotic arm 1700 is attached) is a revolute joint that causes rotational movement of the medical instrument 1725 about the yaw axis 1735A. The second powered joint 1705E at the distal end of the robotic arm (e.g., closest to the medical instrument 1725) is a prismatic joint that moves linearly along the distal face 1710B of the fourth linkage 1715D. Additional powered joints 1705B, 1705C, 1705D are positioned in series between the first and second powered joints.

[0118] The fifth motorized joint 1705D is a prismatic joint that moves linearly along the proximal surface 1715A of the fourth linkage 1710D. Although the axes of the prismatic joints 1705D and 1705E are shown as being parallel to one another due to the shape of the fourth linkage 1710D, in other embodiments the axes may not be parallel and the shape of the fourth linkage 1710D may change accordingly.

[0119] The third powered joint 1705B and the fourth powered joint 1705C are rotary joints that each rotate in a plane positioned orthogonal to the plane of rotation of the first powered joint 1705A. Actuation of the third powered joint 1705B and the fourth powered joint 1705C can rotate the medical instrument 1725 about the pitch axis 1735C.

[0120] Each powered joint 1705A-1705E may comprise a motor, a position sensor, and a gearbox. In some embodiments, the motor may be an interior permanent magnet motor including a stator, a rotor rotatable within the stator, and a plurality of windings wound through the stator and configured to carry one or more phases of current. The rotor may comprise a magnetically permeable material and at least one permanent magnet embedded within the magnetically permeable material. One example of a position sensor is an optical encoder positioned with a field of view that encompasses the rotor such that the optical encoder can capture image data representative of the rotor, which image data can be used to determine a position of the rotor. Other examples of suitable position sensors include a closed loop position control system that monitors current in one or more of the motor's windings (e.g., via a Hall sensor or other current sensor), as well as an angular joint sensor (e.g., one or more of an accelerometer, gyroscope, magnetometer, conductive fiber, etc.) that generates data usable to determine the angle between adjacent linkages. The output from the position sensors of each powered joint 1705A-1705E may be used by the controller 206 to control the actuation of the robotic arm 1700 in the operational modes described herein. The gearbox may include several gears to achieve a desired gear ratio for each joint. One exemplary joint may have a gear ratio of 100:1 to 150:1 to achieve a desired stiffness for operation during an endoscopic medical procedure. The gearbox may be a harmonic gearbox using strain wave gearing, thus offering advantages over traditional gear-based gearboxes by providing little or no backlash and being more compact and lightweight.

[0121] The instrument driver 1720 may be coupled to the second motorized joint 1705E to fix and / or manipulate the medical instrument 1725. The instrument driver 1720 may be the instrument driver described with respect to FIG. 12 in some embodiments. Movement of the second motorized joint 1705E along the distal surface 1715B of the fourth linkage 1710D and / or movement of the fifth motorized joint 1705D along the proximal surface 1715A of the fourth linkage 1710D may be translated into linear motion of the medical instrument 1725 along the insertion axis 1725B. The medical instrument 1725 may also be moved along the insertion axis 1725B by actuating the motorized joints 1705A-C in conjunction with one or more set-up joints. The instrument driver 1720 may move the medical instrument 1725 in other degrees of freedom, such as rolling the medical instrument 1725 about the insertion axis 1725B, deflecting the tip of a steerable medical instrument, etc. The medical instrument 1725 may be any endoscopic or laparoscopic tool, such as a bronchoscope, gastroscope, ureteroscope, colonoscope, steerable catheter, laparoscope, tools positioned within the working channel of such a scope (e.g., needles, forceps, cytology brushes, augers, etc.), electrosurgical scissors, and other medical instruments used in the disclosed procedures.

[0122] In some medical procedures, the instrument 1725 may extend into a cannula 1730, for example, positioned at an incision that forms an opening in the patient's body. In other medical procedures, the instrument 1725 may extend directly into a natural opening that forms an opening to the patient's luminal network, thus eliminating the cannula 1730. Some embodiments of the robotic arm 1700 may further include a dock (not shown, see, for example, dock 1840 in FIG. 25) that may couple the fourth linkage 1710D to the cannula 1730. The cannula 1730 may be snap-fitted into the dock, which may be detachable from the fourth linkage 1710D. While not retaining a fixed position on the cannula may provide an advantage when adapting an arm from an endoscopic procedure to a laparoscopic procedure, the proximity between the fourth linkage 1710D and the portion of the insertion axis that passes through the cannula allows for providing a dock to hold the cannula. Such a dock can help resolve force on the medical instrument and keep the cannula aligned with the medical instrument axis for medical instrument exchange. This dock can be removable when the robotic arm 1700 is configured for an endoscopic procedure, and the fourth linkage 1710D can include a coupling for attachment to the dock, an additional instrument driver, or another type of attachment, such as a patient introducer.

[0123] The particular illustrated locations of the axes 1735A, 1735B, 1735C may vary depending on the positioning of the robotic arm 1700, with the yaw axis 1735A extending through the center of the first powered joint 1705A and the insertion axis 1735B extending through the instrument driver 1720 coupled to the second powered joint 1705E. It will be appreciated that multiple joints 1705A-E may be simultaneously actuated to move the instrument 1725 along or about multiple axes simultaneously. The yaw axis 1735A may be considered the axis of rotation of the revolute joint 1705A and the coaxial axis of rotation of the motion translated to the medical instrument 1725. Additionally, in this disclosure, the yaw axis 1735A is referred to as the "first axis," the insertion axis 1735B as the "second axis," and the pitch axis 1735C as the "third axis."

[0124] Actuation of the motorized joints 1705A-1705E of the robotic arm 1700 can be programmatically controlled by the controller 206 (automatically or in response to user guidance at the console 200) based on different sets of motion constraints corresponding to different medical procedures. For example, in a laparoscopic configuration, configuring the robotic arm 1700 into a low inertia remote sensor laparoscopic system is accomplished by identifying the location of the remote sensor 1745 (corresponding to a point on the cannula and / or the location of the incision in the patient's body), orienting the first axis of rotation 1735A to pass through the remote sensor 1745, constraining the actuation of the three intermediate RRP joints (powered joints 1705B, 1705C, and 1705D) based on software instructions to form a remote pitch axis 1735C that is fixed in space and passes through the remote sensor 1745, and orienting a distal column axis parallel to the insertion axis 1735B (along the linear distal surface 1715B of the fourth linkage 1710D) so that the medical instrument 1725 is inserted through the remote sensor 1745. Thus, in this first mode of operation, the structure of the robot arm 1700 which generates the first axis 1735A and the second axis 1735C are oriented such that these axes pass through the location of the remote sensor 1745, while the remote pitch axis 1735C is defined by a software constraint and is fixed in space so as to pass through the remote sensor 1745. During use in the first mode, the actuation of the powered joints 1705A-1705E are controlled to keep these three axes 1735A, 1735B, 1735C passing through the remote sensor 1745. Thus, in the first mode, the robot arm 1700 can be considered as an RRRPP serial chain manipulator, with a first R axis 1735A configured to point at the remote sensor 1745, a final P axis configured to be parallel to the insertion axis 1735B, and a software constrained remote pitch axis 1735C formed by the intermediate RRP joints, and the robot arm 1700 is controlled such that the axes 1735A, 1735B, 1735C intersect each other at a pre-specified remote sensor position.The geometry of the remote sensor (eg, its distance along the yaw axis 1735A from the first powered joint 1705A) can be adjusted during use as described in more detail below with respect to Figures 31A and 31B.

[0125] In the endoscopic configuration, the software constraints on the remote sensors are removed, and instead the motorized joints 1705A-1705E are operated relative to a virtual rail. The virtual rail can be considered as a linear axis in space that is aligned with the patient's opening, e.g., a natural opening that leads to the patient's internal lumen network. In some embodiments, an additional instrument driver 1720 can be attached to one end of the fourth linkage 1710D in the endoscopic mode. In some embodiments, the motorized joints 1705A-1705E can be used to position a series of robotic arms 1700 adjacent to each other with their insertion axes aligned along the virtual rail. Although the insertion axes of the various instrument drivers and / or arms need to coincide, the instrument drivers can be spaced along the virtual rail to provide maximum working space and / or to avoid collisions.

[0126] In some embodiments, the instrument driver 1720 may rotate relative to the second powered joint 1705E because for some endoscopic procedures it is desirable to have top-loading medical instruments. This may be accomplished by adding a rotational degree of freedom between the instrument driver 1720 and the second powered joint 1705E. This degree of freedom may be either an active or passive set-up joint. A passive set-up joint may include detent positions or an integer number of positions that may be latched to facilitate rotating the instrument driver 1720 in 90 degree increments, for example.

[0127] The robot arm 1700 may be delivered by an active setup joint or a passive setup joint. When the setup joint is active, it may reposition the working space of the robot arm 1700 during the procedure while maintaining the intersection of the axes 1735A, 1735B, 1735C with the remote sensor. The setup joint may also reposition the first motorized joint 1705A so that the first axis 1735A passes through the remote sensor. One advantage of using such a setup joint is that it puts a set of fast axes (e.g., axes with suitable performance for performing laparoscopic procedures with limited working space) on a set of slow axes (e.g., axes with large working space but not suitable for performing only laparoscopic procedures). Thus, it is possible to perform a zero space movement to keep the medical instrument 1725 centered on the fast axes, thus allowing the robot arm 1700 to have high speed performance over a large working space. This design reflects a trade-off for the robotic arm 1700 between its range of motion and minimizing size while still meeting the requirements of a laparoscopic procedure.

[0128] Figure 25 illustrates another embodiment of a robotic arm 1800 that can be used with the systems and components illustrated in Figures 1-23. The robotic arm 1800 includes an RRRRP serial chain manipulator such that the joints are labeled starting at the most proximal joint 1805A and moving sequentially along the robotic arm toward the most distal joint 1805E.

[0129] The robot arm 1800 includes a plurality of electric joints 1805A to 1805E connected in series by link mechanisms 1810A to 1810D. The first link mechanism 1810A connects the first electric joint 1805A to a third electric joint 1805B, the second link mechanism 1810B connects the third electric joint 1805B to a fourth electric joint 1805C, the third link mechanism 1810C connects the fourth electric joint 1805C to a fifth electric joint 1805D, and the fourth link mechanism 1810D connects the fifth electric joint 1805D to the second electric joint 1805E. 25, the second linkage 1810B is shorter than the first linkage 1810A such that the fourth powered joint 1805C can be rotated in a full circle by actuation of the third powered joint 1805B. For example, the fourth powered joint 1805C can rotate from its illustrated position on a first side of the first linkage 1805A past the first powered joint 1810A to a second side of the first linkage 1810A due to the shorter length of the second linkage 1810B. During such movement, the fourth joint 1805C can be actuated to prevent collision between the first powered joint 1805A and structures positioned distally from the fourth powered joint 1805C (e.g., the third link mechanism 1810C, the fifth powered joint 1805D, the fourth link mechanism 1810D, the second powered joint 1805E, the instrument driver 1810, and the medical instrument 1825).

[0130] The first powered joint 1805A at the proximal end of the robotic arm (e.g., closest to the set-up joint or base of the robotic system to which the robotic arm 1800 is attached) is a revolute joint that causes rotational movement of the medical instrument 1825 about the yaw axis 1835A. The second powered joint 1805E at the distal end of the robotic arm (e.g., closest to the medical instrument 1825) is a prismatic joint that moves linearly along the distal face 1815B of the fourth linkage 1810D. The additional powered joints 1805B, 1805C, 1805D are positioned in series between the first and second powered joints and are revolute joints that each rotate in a plane positioned orthogonal to the plane of rotation of the first powered joint 1805A. Actuation of the additional powered joints 1805B, 1805C, 1805D may rotate the medical instrument 1825 about the pitch axis 1835C. Each powered joint 1805A-1805E may include a motor, position sensor, and gearbox, as described above with respect to the robotic arm 1700. Output from the position sensor of each of the powered joints 1805A-1805E may be used to control the actuation of the robotic arm 1800 in the operational modes described herein.

[0131] The instrument driver 1820 may be coupled to the second powered joint 1805E to secure and / or manipulate the medical instrument 1825. The instrument driver 1820 may be the instrument driver described with respect to FIG. 12 in some embodiments. Movement of the second powered joint 1805E along the distal face 1815B of the fourth linkage 1810D and / or coordinated movement of the additional powered joints 1805A-1805E, alone or in conjunction with one or more set-up joints, may be translated into linear motion of the medical instrument 1825 along the insertion axis 1825B. The instrument driver 1820 may move the medical instrument 1825 in other degrees of freedom, such as roll of the medical instrument 1825 about the insertion axis 1825B, deflection of the tip of the steerable medical instrument, etc. The medical instrument 1825 can be any endoscopic or laparoscopic tool, such as a bronchoscope, gastroscope, ureteroscope, colonoscope, steerable catheter, laparoscope, tools positioned within the working channel of such a scope (e.g., needles, forceps, cytology brushes, augers, etc.), electrosurgical scissors, and other medical instruments used in the disclosed procedures.

[0132] In some medical procedures, the instrument 1825 may extend into a cannula 1830, for example, positioned at an incision that forms an opening in the patient's body. The robotic arm 1800 may further include a dock 1840 that may couple the fourth linkage 1810D to the cannula 1830. The cannula 1830 may be snap-fitted to the dock, which may be detachable from the fourth linkage 1810D. While not rigidly coupling the robotic arm 1800 to the cannula 1830 may provide advantages when adapting from an endoscopic procedure to a laparoscopic procedure arm, the proximity between the fourth linkage 1810D and the portion of the insertion axis that passes through the cannula 1830 allows for the provision of a dock 1840 to hold the cannula. The dock 1840 may help resolve forces of the medical instrument and keep the cannula aligned with the medical instrument axis for medical instrument exchange. The dock 1840 may be removable when the robotic arm 1800 is configured for an endoscopic procedure, and the fourth linkage 1810D may include a coupling for attachment to the dock 1840, an additional instrument driver, or another type of attachment, such as a patient introducer. In some medical procedures, the instrument 1825 may extend directly into a natural opening that forms an opening to the patient's luminal network, thus eliminating the cannula 1830.

[0133] The particular illustrated locations of the axes 1835A, 1835B, 1835C may vary depending on the positioning of the robotic arm 1800, with the yaw axis 1835A extending through the center of the first powered joint 1805A and the insertion axis 1835B extending through the instrument driver 1820 coupled to the second powered joint 1805E. It will be appreciated that multiple joints 1805A-E may be simultaneously actuated to move the instrument 1825 along or about multiple axes simultaneously. The yaw axis 1835A may be considered the axis of rotation of the revolute joint 1805A and the coaxial axis of rotation of the motion translated to the medical instrument 1825. Additionally, in this disclosure, the yaw axis 1835A is referred to as the "first axis," the insertion axis 1835B as the "second axis," and the pitch axis 1825C as the "third axis."

[0134] Actuation of the motorized joints 1805A-1805E of the robotic arm 1800 may be programmatically controlled by the controller 206 (automatically or in response to user guidance at the console 200) based on different sets of motion constraints corresponding to different medical procedures. As described above with respect to the robotic arm 1700, in a first mode suitable for laparoscopic procedures, the robotic arm 1800 may be controlled via a software-constrained remote sensor architecture such that the first R axis 1835A points to the remote sensor 1845, the software-defined remote pitch axis 1835C passes through the remote sensor 1845, and the insertion axis 1835B points to the remote sensor 1845. This remote sensor constraint may be removed to operate the robotic arm 1800 in a second mode suitable for endoscopic procedures, in which the robotic arm 1800 is controlled relative to the virtual rail such that the insertion axis 1835B is maintained coaxial with the virtual rail.

[0135] 24 and 25, it will be understood that the illustrated shapes and sizes of the linkages may be varied. For example, the linkages may be curved rather than straight in variations of the illustrated embodiment, and certain linkages may be longer or shorter.

[0136] 4. Overview of Exemplary Operational Modes FIG. 26A shows the robotic arm 1700 of FIG. 24 beginning to be operated in a first operating mode 1900. The first operating mode 1900 may be suitable for laparoscopic procedures. The robotic arm 1800 of FIG. 25 may be operated in a similar manner in the first operating mode. For clarity of the drawing, certain reference numbers shown for the robotic arm 1700 of FIG. 24 that are not specifically referenced in the description of FIG. 26A have been omitted from FIG. 26A, and reference numbers relating to the structure of the robotic arm 1700 are provided only for the first position 1905A of the five positions 1905A-1905E shown.

[0137] In a first operational mode 1900, the movement of the robot arm 1700 is controlled such that the first axis 1705A points at the remote sensor 1910 and the second axis 1735B also points at the remote sensor 1910. In the illustrated embodiment, a software-defined remote pitch axis (third axis) extends through the page of FIG. 26A at the location of the remote sensor 1910.

[0138] During use in the first operational mode 1900, the robotic arm 1700 may be positioned in a number of different positions 1905A-1905E spanning a range of possible positions between a first position 1905A and a final position 1905E (as well as other positions intermediate between the depicted positions). In each position, the powered joint 1705A is oriented such that the first axis 1705A passes through the remote sensor 1910. Additionally, in each position, the actuation of the powered joints 1705B-1705D is coordinately controlled such that the third axis intersects the remote sensor 1910. Additionally, in each position, the instrument driver 1720 is positioned such that the second axis 1735B passes through the remote sensor 1910. Movement between the illustrated positions 1905A-1905E is accomplished by controlling the third, fourth, and fifth powered joints 1705B-1705D to rotate the medical instrument 1725 about the remote pitch axis and remote sensor 1910. Other movements are also possible while controlling the robotic arm 1700 under the constraints of the first operational mode 1900.

[0139] As shown, the position and orientation of the first linkage 1710A may remain stationary or the orientation may rotate about the first axis 1735A while its position remains stationary. In some embodiments, the position of the first linkage 1710A may be varied by a set-up articulation while maintaining the intersection of the first axis 1735A with the remote sensor 1910. The positions and orientations of the second, third, and fourth linkages 1710B-1710D may be varied relative to the position of the first powered joint 1705A and relative to each other as the robot arm 1700 rotates about the remote pitch axis through a range of positions 1905A-1905E under the control of the first operational mode 1900. While the instrument driver 1720 as shown in FIG. 26B is maintained at a fixed distance from the cannula 1730, in other embodiments, the distance between the instrument driver 1720 and the cannula 1730 may be varied to adjust the insertion depth of the medical instrument 1725 into the patient's body.

[0140] Figure 26B shows a table-based robotic system 1955 including several robotic arms as depicted in Figure 24 in a first configuration 1950 suitable for operating in a first mode 1900 for a laparoscopic procedure. As shown, four robotic arms 1700A-1700D each control a medical instrument to rotate about a remote sensor located at (or near) an incision 1945 in the abdomen of a patient 1940. For clarity of the drawing, certain reference numbers shown for the robotic arms 1700 of Figure 24 that are not specifically referenced in the description of Figure 26A have been omitted from Figure 26A, and each robotic arm 1700A-1700D is controlled relative to a different remote sensor located at (or near) a different incision, although only one incision 1945 is shown. Robot arm 1800 may alternatively be used in place of one, some, or all of robot arms 1700 in other embodiments, and table-based robot system 1950 may include more or less than four robot arms.

[0141] The table-based robotic system 1950 includes four setup arms 1960, each including several setup joints 1920 connected in series by linkages 1915. The setup joints 1920 of the setup arms 1960 may be passive, active, or mixed. The configuration of the setup arms 1960 may vary depending on the intended use of the table-based robotic system 1950. Each setup arm 1960 is attached to one of the robotic arms 1700A-1700D, and thus positions the corresponding robotic arm in the space surrounding the patient 1940.

[0142] In the illustrated embodiment, the setup arm 1960 is attached to a carriage 1925 secured around a post 1930 positioned under the bed such that the setup arm 1960 emerges from under the patient table 1935. The post 1930 is illustrated with three carriages 1925 and four robotic arms 1700A-1700D, where two arms are attached to the same carriage and one of the carriages may have no arm or may be omitted. In other embodiments, the third carriage may have an additional arm or two arms, and the particular configuration of the carriages and robotic arms may be modified based on the requirements of the system 1950. Furthermore, the disclosed robotic arms are not limited to a table-based system as illustrated, but in other embodiments may be mounted to a mobile cart or ceiling-mounted base. Regardless of how they are attached, the robotic system 1950 including multiple arms 1700A-1700D retains the advantage of being able to perform both laparoscopic and endoscopic procedures using the same system 1950.

[0143] During operation in the first mode, a single controller 206 or a group of controllers in communication with each other may be used to control the movement of each of the robotic arms 1700A-1700D and the setup arm 1960 such that the various physical structures do not collide or interfere with one another. Each controller 206 may include one or more processors and associated memory configured with computer executable instructions for controlling the joint actuation in the various operating modes based on user guidance via input controls, data from the joint position encoders, motion constraints, and accommodated size parameters of the structures of the robotic arms 1700A-1700D. Thus, the controller 206 may limit the range of motion or workspace of a particular one or more arms to prevent collisions. Such limits may be set at the start of a procedure or may be dynamically changed during a procedure based on the positions of the other arms. Although not shown, in some embodiments, the table-based robotic system 1950 may include one or more image sensing devices positioned about the table 1935 and in communication with the controller 206 to identify the location of medical personnel around the patient and control the robotic arms 1700A-1700D to avoid the medical personnel's locations. The controller 206 may be positioned within the table 1935, the column 1930, or the control system (e.g., the console base 201), or may be split among these structures.

[0144] FIG. 27A illustrates three of the robotic arms 1700A-1700C of FIG. 24 configured in a second operational mode 2000. The second operational mode 2000 may be suitable for endoscopic procedures. The robotic arm 1800 of FIG. 25 may be similarly operated in the second operational mode 2000. For clarity of the drawing, certain reference numbers shown for the robotic arm 1700 of FIG. 24 that are not specifically referenced in the description of FIG. 27A have been omitted from FIG. 27A, and reference numbers relating to the structure of the robotic arm 1700 are provided only on the first robotic arm 1700A.

[0145] In the second operational mode 2000, the robotic arms 1700A-1700C are positioned such that an insertion axis (unnumbered) passing through the instrument driver 1720 of each robotic arm 1700A-1700C is aligned to be coaxial with the virtual rail 2005. The robotic arms 1700A-1700C are further positioned such that none of the linkages 1710A-1710D, articulations 1705A-1705E, or instrument drivers 1720 of a particular robotic arm interferes with the required range of motion of the instrument driver of the other robotic arm. Thus, each of the robotic arms 1700A-1700C may be used to position and actuate (via the instrument driver) one of several coaxial medical instruments during an endoscopic procedure. For example, robotic arm 1700A may position and actuate a bronchoscope having a working channel, robotic arm 1700B may position and actuate a catheter (steerable or non-steerable) in and potentially beyond the working channel of the bronchoscope, and robotic arm 1700C may position a conduit that extends into the catheter and is coupled at its distal end to a needle or other medical tool. For example, robotic arm 1700C may extend and retract a needle relative to the catheter by actuating second motorized joint 1705E, fifth motorized joint 1705D, and / or a combination of motorized joints 1705B-1705E (with or without setup joint movement).

[0146] FIG. 27B illustrates a second configuration 2050 of the table-based robotic system 1955 of FIG. 26B including the robotic arms 1700A-1700C configured as shown in FIG. 27A to operate in a second mode 2000 suitable for endoscopic procedures. The fourth arm 1700D folds into a compact stowed configuration (one embodiment of which is shown in FIG. 33 for arm 1800) but is not visible in the view of FIG. 27B. The robotic arms 1700A-1700C position the concentric intraluminal medical instruments 1725A, 1725B, 1725C along a virtual rail 2005 that is shown to be coaxial with the insertion axis 1725B of each robotic arm 1700A-1700C. The virtual rail 2005 is aligned with a natural opening 2045 (mouth) of the patient 1940.

[0147] In some medical procedures, it may be desirable to operate one or a subset of the robotic arms 1700A-1700D of the table-base robotic system 1955 in a first mode 1900 and another or a different subset of the robotic arms 1700A-1700D in a second mode 2000. For example, some hysteroscopic procedures involve a first medical instrument that enters the kidney through an incision, which may be controlled by a robotic arm in the first mode 1900, and a second medical instrument that is passed endoluminally through the ureter to the kidney, which may be controlled by a robotic arm in the second mode 2000.

[0148] 28A and 28B show the range Rext of position options for the tool driver 1720 mounted on the robot arm of FIG. 24 given a fixed position of the fourth motorized joint 1705C. For example, the position of the fourth motorized joint 1705C may be fixed in the second operating mode 2000 to maintain the coaxial insertion axis and software constrained virtual rail position. The range Rext is provided by the "double insertion axis" resulting from the linear motion of the second motorized joint 1705E along the distal face 1715B of the fourth linkage 1710D and the linear motion of the fifth motorized joint 1705D along the proximal face 1715A of the fourth linkage 1710D. FIGS. 28A and 28B show the first motorized joint 1705A aligned along the axis 2105 to accurately illustrate the range Rext.

[0149] In Fig. 28A, the robotic arm 1700 is positioned in a first configuration 2100A with the second powered joint 1705E and the tool driver 1720 positioned at a first end of the fourth linkage 1710D and the fifth powered joint 1705D positioned at a second end of the fourth linkage 1710D, the second end facing the first end with a proximal surface 1715A and a distal surface 1715B extending therebetween. In Fig. 28B, the robotic arm 1700 is positioned in a second configuration 2100B with the second powered joint 1705E and the tool driver 1720 positioned at a second end of the fourth linkage 1710D and the fifth powered joint 1705D positioned at a first end of the fourth linkage 1710D. As shown, this provides a range of possible positions Rext that the instrument driver 1720 may be moved to during operation of the robotic arm 1700 in, for example, the second mode of operation 2000 using only the fifth motorized joint 1705D and the second motorized joint 1705E. Although the instrument driver 1720 is depicted facing the same direction in Figs. 28A and 28B, the instrument driver 1720 may be rotated 180° to cover the entire depicted range Rext. Thus, the dual insertion axis provides an advantage for endoscopic procedures, since it provides an insertion range of motion that is twice the length of the range of motion that would be provided using a single prismatic joint at the distal end of the robotic arm (e.g., as in the embodiment of Fig. 25). This larger range of motion gives the robotic arm 1700 greater flexibility for endoscopic procedures.

[0150] Figures 29A-29D show a series of example steps of a setup process 2200 for configuring the robotic arm of Figure 25 to operate in the first mode 1900 shown in Figure 26A. A similar setup process may be performed using the robotic arm 1700 and other disclosed variations.

[0151] 29A shows a robotic arm 1800 with a dock 1840 separated from a cannula 1830. Although depicted as floating in space, in use, the cannula 1830 may be positioned within an opening to the patient's body.

[0152] In block 2210 shown in FIG. 29B, the dock 1840 of the robotic arm 1800 is coupled to the cannula. For example, the motorized joints 1705A-1705E may be operated in a passive mode such that a user can manually move the robotic arm 1800 to connect the dock 1840 and the cannula 1830. The controller 206 of the robotic arm 1800 may identify when the cannula 1830 is docked, for example, by a sensor or mechanical button in the dock 1840, or based on user input in the control system. Once docked, the controller 206 may identify the location of the remote sensor 2225 as a point along or within the cannula 1830. The location may be identified based on a user input specifying the depth of insertion of the cannula into the opening, or may be identified automatically and then adjusted by user input, based on a predefined spatial relationship between the docked portion of the cannula 1830 and the remote sensor. In block 2210, the yaw axis 1835A (the rotation axis of the first powered joint 1705A) does not yet intersect the remote sensor 2225, but the insertion axis (not shown) passes through the remote sensor 2225 due to the docking of the cannula 1930 and the geometric shape of the dock 1840.

[0153] 29C, the controller 206 may actuate a set-up joint (such as the set-up joint 1920 or a variation thereof) to position the first axis 1835A to intersect the identified location of the remote sensor 2225. At the same time, the controller 206 may actuate some or all of the powered joints 1705A-1705E to maintain a fixed position and orientation of the cannula 1830. Thus, the actuation of the robot arm 1800 and any set-up joints in block 2215 may be considered a null space movement that maintains the orientation of the insertion axis and the position of the remote sensor 2225.

[0154] 29D, the instrument driver 1820 is actuated along the distal face 1815B of the fourth linkage 1810D to insert the medical instrument 1825 through the cannula 1830. Block 2220 may further include actuating the robotic arm 1800 in the first mode 1900 described herein.

[0155] The setup process 2200 offers advantages over setup with existing systems that have mechanical remote sensors that maintain a parallelogram (or virtual parallelogram) configuration of the robot arm linkage. In such existing systems, the user must move the entire arm to connect it to the cannula, which is accomplished with a passive setup joint. Some challenges with this existing process are that the user must either struggle to make the movement fluid during docking, or the user's effort can be minimized at the expense of forcing other engineering and design tradeoffs, and the high inertia of the arm makes small adjustments difficult. With the ability to break the "parallelogram" of the arm by implementing software-based remote sensor constraints, the disclosed robot arm has additional degrees of freedom over the existing systems described, and these additional degrees of freedom allow the user to easily dock to the cannula 1830. The controller 206 can then actuate the motorized joints 1805A-E to reconstruct the remote sensor constraints (and create a parallelogram if necessary, as described in more detail below) as described above with respect to block 2215. This is accomplished by having the yaw axis point over the remote sensor and then putting the arm into admittance mode. The configurer then has 3DOF positioning control for the cannula mount and can dock it.

[0156] 30A-30C show different sub-modes for operating the robot arm of FIG. 25 in the first mode 1900 shown in FIG. 26A. Since the open kinematic chain of the robot arm 1800 is not mechanically constrained to maintain a parallelogram, the controller 206 can vary the distance of the third motorized joint 1810B from the remote sensor 2225 along the yaw axis 1835A and calculate the required motion to actuate the motorized joints 1805A-1805E to achieve the required movement of the medical instrument 1825 while operating under the remote sensor architecture described for the first mode 1900. This achieves an additional degree of freedom in the setup that may advantageously simplify the set-up joint system. The trade-off for this additional degree of freedom is a relatively more limited range of motion about the pitch axis and nonlinear joint speeds for pitch motion, which in turn results in the requirement of faster joints in the design of the robot arm 1800 to obtain an equivalent pitch speed. These nonlinearities can be minimized by design optimization and further workspace constraints.

[0157] 30A shows a parallelogram setup 2300A in which the configuration of the robot arm 1800 forms a parallelogram 2340A. As implied by the geometric terminology, the parallelogram 2340A has a first set of parallel sides 2325, 2305A of equal length and a second set of parallel sides 2315, 2335A of equal length. A side 2325 is defined along the third linkage 1810C between the center 2330 of the fifth joint 1805D and the center 2320 of the fourth powered joint 1805C. A side 2315 is defined along the second linkage 1810B between the center 2330 of the fourth powered joint 1805C and the center 2310 of the third powered joint 1805B. A side 2335A is defined between the center 2330 of the fifth powered joint 1805D and the remote sensor 2225. A side 2305A, also referred to as the "virtual link," is defined between the remote sensor 2225 and the center 2310 of the third powered joint 1805B. In some embodiments, the controller 206 may configure the robot arm 1800 into a parallelogram setup 2300A in block 2215 of FIG. 29C.

[0158] FIG. 30B illustrates a broken parallelogram setup 2300B with a virtual link 2305B longer than the virtual link 2305A in the parallelogram setup 2300A. Such a configuration is achievable with the open kinematic chain and software constrained remote sensor architecture of the arm 1800. In the broken parallelogram setup 2300B, the virtual link 2305B is still parallel to the side 2325, but the length of the virtual link 2305B is longer than the length of the side 2325. As a result, the sides 2335B and 2315 are not parallel and can have unequal lengths. Thus, a "broken" parallelogram 2340B is formed with a virtual link 2305B longer than the side 2325. In some embodiments, the controller 206 may configure the robot arm 1800 with the broken parallelogram setup 2300B in block 2215 of FIG. 29C. In some embodiments, the controller 206 can transition the robotic arm 1800 intraoperatively between the parallelogram setup 2300A and the broken parallelogram setup 2300B by actuating at least some of the motorized joints 1805A-1805E together with the motorized setup joints. During such transitions, the position of the remote center 2225 remains unchanged.

[0159] FIG. 30C illustrates a broken parallelogram setup 2300C with a virtual link 2305C that is shorter than the virtual link 2305A in the parallelogram setup 2300A. Such a configuration is achievable with the open kinematic chain and software constrained remote sensor architecture of the arm 1800. In the broken parallelogram setup 2300C, the virtual link 2305C is still parallel to the side 2325, but the length of the virtual link 2305C is shorter than the length of the side 2325. As a result, the sides 2335C and 2315 are not parallel and may have unequal lengths. Thus, a "broken" parallelogram 2340C is formed with a virtual link 2305C that is shorter than the side 2325. In some embodiments, the controller 206 may configure the robot arm 1800 in the broken parallelogram setup 2300C in block 2215 of FIG. 29C. In some embodiments, the controller 206 can transition the robotic arm 1800 intraoperatively between the parallelogram setup 2300A or the broken parallelogram setup 2300B and the broken parallelogram setup 2300C by actuating at least some of the motorized setup joints 1805A-1805E together with the motorized setup joints. During such transitions, the position of the remote center 2225 remains unchanged.

[0160] 31A and 31B show different sub-modes for operating the robotic arm 1700 of FIG. 24 in the first mode 1900 shown in FIG. 26A. The controller 206 may configure the robotic arm 1700 in one of the sub-modes 2400A, 2400B (or a similar sub-mode with a fixed distance between the first motorized joint 1705A and the remote sensor) at the start of operation in the first mode 1900, or may transition the robotic arm 1700 intraoperatively between the sub-modes 2400A, 2400B using a motorized set-up joint. The particular distance between the first motorized joint 1705A and the remote sensor is provided merely as an example, and the first motorized joint 1705A and the remote sensor may be positioned any mechanically possible distance apart along the first axis 1735A in use. Thus, another null space reconfiguration enabled by the open kinematic chain of the robotic arm 1700 adjusts the distance between the first powered joint 1705A and the remote sensor intraoperatively. By doing this, the robotic system can trade off the extent of the workspace of the robotic arm 1700 with the ability to operate at shallower pitch angles. This can be useful when the space in which the robotic arm 1700 can operate is limited, for example to avoid interference or collision with other robotic arms, medical equipment, or medical personnel.

[0161] 31A and 31B show the effect on the range of motion and the minimum arm angle of increasing the distance between the first powered joint 1705A and the remote sensor. FIG. 31A shows a first configuration 2400A of the robot arm 1700 where the remote sensor 2405 is located at a first distance D1 from the first powered joint 1705A along the yaw axis 1735A. In the first configuration 2400A, the robot arm 1700 has a minimum angle α1 of 40 degrees between the insertion axis 1735B and the yaw axis 1735A and has a range of motion ROM1 of 100 degrees. FIG. 31B shows a second configuration 2400B of the robot arm 1700 where the remote sensor 2405 is located at a second distance D2 from the first powered joint 1705A along the yaw axis 1735A, the second distance D2 being greater than the first distance D1. In the second configuration 2400B, the robotic arm 1700 has a minimum angle α2 of 25 degrees between the insertion axis 1735B and the yaw axis 1735A, and a range of motion ROM2 of 73 degrees. This may help the robotic arm 1700 operate closer to obstacles (e.g., other robotic arms, patient beds, etc.) without colliding with the obstacles. Although the distances D1 and D2 are shown as being measured between the remote sensor 2405 and the cap of the powered joint 1705A, the distances may alternatively be measured between the remote sensor 2405 and any structure of the arm 1700 positioned along the first axis 1735A, such as the center of the revolute joint 1705B.

[0162] 32A and 32B illustrate the addition of a second instrument driver 2510 to the robotic arm 1800 of FIG. 25 during operation in the second mode 2000 shown in FIG. 27A. As shown, the second instrument driver 2510 includes a mounting portion 2525 that is secured to a docking port of the fourth linkage 1810D instead of the dock 1840. The addition of the second instrument driver 2510 enables the robotic arm 1800 to control a first coaxial medical instrument 2505 and a second coaxial medical instrument 2515. System insertion of the medical instruments 2505, 2515 may be controlled, for example, relative to a virtual rail defined along the axis of the first medical instrument 2505.

[0163] As shown in Figure 32A, the robotic arm 1800 may be positioned in a first configuration 2500A with the instrument driver 2510 positioned by the second powered joint 1805E as far as possible from the second instrument driver 1820. As shown in Figure 32B, the second powered joint 1805E may be actuated along the distal face 1815B of the fourth linkage 1810D to move the instrument driver 1820 toward the second instrument driver 2510. In the second configuration 2400B, this actuation advances the first medical instrument 2505 further through the second medical instrument 2515 and beyond the end 2520 of the second medical instrument 2515 than in configuration 2500A. The second powered joint 1805E can continue to be actuated until the instrument driver 1820 is adjacent to the second instrument driver 2510 when it is desired to effect relative movement of the first medical instrument 2505 and the second medical instrument 2515.

[0164] FIG. 33 shows the robot arm 1800 of FIG. 25 in a stowed configuration 2500C. In the stowed configuration 2500C, the first, second, and third linkages 1810A-1810C are positioned in a substantially parallel stack with the second linkage 1810B positioned between the first linkage 1810A and the third linkage 1810C. The fourth linkage 1810D rests on the third linkage 1810C and is substantially parallel to the other linkages 1810A-1810C. Substantially parallel refers to folding the arm as compactly as possible with the proximal face of the fourth linkage 1810D resting against the third linkage 1810C and the first, second, and third linkages 1810A-1810C positioned in the compact stack shown. Deviations from true parallel positioning depend on the particular geometry of the linkages and may be varied from the illustrated geometry in some embodiments. The stowed configuration 2500C is possible due to the open kinematic chain of the robotic arm 1800, which allows for disconnection of the virtual links used during the first mode of operation, providing compact stowage. This may be advantageous for a multi-arm system, as shown in FIG. 27B, where some arms are not used in a particular procedure and can be stowed out of the way of the remaining arms and medical personnel, freeing up limited operating room space.

[0165] In addition to the embodiments described herein, some embodiments may implement a robotic arm kinematic layout for performing laparoscopic surgery on a bed-base surgical robot platform. For example, according to some embodiments disclosed herein, there is a recognition that current robotic systems continue to face certain limitations and challenges, including, among others, the available reach of the robotic arm, the potential access and maneuverability of the robotic arm, the stiffness of the robotic arm and support architecture, and the performance of the system. Furthermore, according to some embodiments, disclosed herein is the realization and recognition of the increased complexity of robotic systems utilizing software-constrained remote centers of motion. Indeed, these and other challenges may be particularly acute in robotic systems using six robotic arms. Thus, some embodiments disclosed herein may be configured to address these and other considerations to provide a robotic system utilizing a common mounting platform for the robotic arms, robotic setup joints, and distal manipulator linkages using hardware-constrained remote sensors of motion. These and other optional features may be implemented in the robotic system to provide improved stiffness, reduce collisions, and increase maneuverability and positioning of the robotic arms of the system. Additionally, some embodiments may optionally implement hardware constrained centers of motion for one or more robotic arms of the system to reduce complexity, increase reliability, and streamline operation of the system.

[0166] 34-37, embodiments disclosed herein may implement a unique combination of features to provide a robotic system that overcomes some of the aforementioned challenges. For example, FIG. 34 shows a surgical robotic system 2600 having a table base robotic system 2602 including six robotic arms 2604 coupled to a table base 2606 (having a table 2607) via a mounting platform 2608 suitable for laparoscopic procedures. As shown, the robotic arms 2604 may be supported on a shared mounting platform 2610, illustrated as a bar or rail to which one or more of the robotic arms 2604 may be mounted. In other embodiments, the robotic arms 2604 may be directly coupled to a table on which a patient resides via a mounting portion. In the illustrated example, the bar or rail 2610 may be coupled to a support 2612 of the table base 2606 by a bar or rail connector and carriage as described above with reference to FIGS. 17-23. One advantage of such a system is that the shared mounting platform 2610 allows multiple arms 2604 to be supported, with a structure that is much larger and more rigid than would be possible if each of the arms 2604 were individually supported or coupled to the table base 2606. As a result, such an embodiment may provide significantly improved rigidity, precision, and dynamic performance. The direct mounting of the mount platform 2610 to the support column 2612 may provide a structural advantage over alternative configurations in which the mounting platform 2610 is directly coupled to the table 2607, which would otherwise require a rigid path to pass through the joints of the table 2607 that may experience other forces (such as those static and dynamic forces generated by supporting a patient on the table 2607). Additionally, the shared mounting platform 2610 may provide an architecture that allows for great setup flexibility, such as by allowing the robotic arms 2604 to be mounted high and low, allowing significant longitudinal translation and arm positioning at locations that would otherwise be far from the support column 2612.

[0167] 35, the system 2600 may be configured such that one or more of the robotic arms 2604 include a hardware-constrained remote center of motion. A hardware-constrained remote center of motion may include any mechanism that can separate a degree of freedom (DoF) of laparoscopic tool motion into the motion of a single joint or set of joints that performs only that motion.

[0168] 35 may be configured to separate the angulation of the tool shaft 2620 about the yaw axis 2620A and remote center of motion 2622 into at least one joint or set of joints. The yaw motion of the tool shaft 2620 about the yaw axis 2620A and remote center of motion 2622 is provided by a distal yaw joint 2620B of the tool 2624, whose yaw axis 2620A points directly at the remote center of motion 2622. The yaw axis 2620A represents the axis along which the tool 2624 can roll and / or translate (the instrument insertion axis via prismatic motion). Because the yaw axis 2620A points directly at the remote center of motion 2622, motion of the tool 2624 about the yaw axis 2620A does not affect the position of the remote center of motion 2622, and thus, motion of the tool 2624 is decoupled.

[0169] In the kinematics shown in FIG. 35 , pitch motion of the tool shaft 2620 about a remote center of motion 2622 is provided by a distal manipulator linkage 2626. The distal manipulator linkage may include a parallelogram linkage 2628 that can articulate about the remote center of motion 2622. The parallelogram linkage 2628 may be comprised of multiple joints. For example, the parallelogram linkage 2628 may include powered joints and / or passive joints. Furthermore, in some embodiments, the parallelogram linkage may include a single powered joint and two passive joints. A “passive joint” may be a joint whose rotation is mechanically constrained by a band, belt, chain, link, and / or other means.

[0170] In some embodiments, the distal manipulator linkage may include a set-up linkage that may be adjusted to manipulate the attitude of the distal manipulator linkage and the location of the remote center of motion.

[0171] For example, in the embodiment shown in FIG. 35, the distal manipulator linkage 2626 may include a yaw link 2630 that may be coupled to a distal end portion of the setup linkage 2631. The distal manipulator linkage 2626 may also include a pitch base link 2632, a first pitch link 2634, a second pitch link 2636, and a stage link 2638. The yaw link 2630 may be rotatably coupled to the setup linkage 2631 at a first joint 2639 and to the pitch base link 2632 at a second joint 2640. The yaw link 2630 may define a second yaw axis 2630A that may intersect the remote center of motion 2622 and the first yaw axis 2620A. The yaw link 2630 may also be rotatably coupled to the pitch base link 2632 at a base yaw joint 2630B. Advantageously, the setup linkage / joint and the distal manipulator linkage / joint can independently and in concert reorient and / or reposition the base yaw joint 2630B while maintaining a remote center of motion. This capability is available whether the RCM is fixed in space or moved with a specific active motion. The pitch base link 2632 can be rotatably coupled to a first pitch link 2634 at a first pitch joint 2642. Further, the first pitch link 2634 can be coupled to a second pitch link 2636 at a second pitch joint 2644. Finally, the second pitch link 2636 can be coupled to a stage link 2638 at a third pitch joint 2646. The first, second, and third pitch joints 2642, 2644, and 2646 can enable the parallelogram linkage 2628 to change the pitch of the tool shaft 2620 while maintaining the first yaw axis 2620A and the second yaw axis 2620B aligned and intersecting with the remote center of motion 2622.

[0172] Optionally, in some embodiments, the distal manipulator linkage 2626 may thereby provide a hardware-constrained remote center of motion. Note that an advantage of some embodiments is that the parallelogram linkage 2628 may advantageously provide a relatively slim profile (relative to alternative architectures) that allows the distal manipulator linkage 2626 to operate within a narrower patient-side working volume, thereby reducing the possibility of collisions. According to some embodiments, gimbals used on some haptic input devices may provide motion around a remote sensor by pointing all of their axes inward toward a central remote center of motion. However, gimbals may also have a relatively large sweep motion for a given workspace and operate in a larger patient-side working volume, and therefore have more collision potential than a relatively slim parallelogram-type linkage.

[0173] 35 illustrates that the set-up linkage 2631 may include a first set-up link 2650 and a second set-up link 2652. The first set-up link 2650 may be rotatably coupled to the second set-up link 2652 at a first set-up joint 2654. Additionally, the second set-up link 2652 may include a roll joint 2656 that allows an end of the second set-up link 2652 to rotate about the longitudinal axis of the second set-up link 2652 (i.e., the roll joint 2656 may provide yaw motion about the longitudinal axis of the set-up link 2652).

[0174] Figure 36 illustrates an additional embodiment, which is a robotic arm 2660. The robotic arm 2660 can include all of the features and components described above with respect to the robotic arm 2604 illustrated in Figure 35. For example, the robotic arm 2660 can include a set-up linkage 2662. However, in contrast to the robotic arm 2604 illustrated in Figure 35, the robotic arm 2660 can omit the roll joint of the set-up linkage.

[0175] Additionally, FIG. 36 also shows that the robotic arm 2660 (or other such embodiments of a robotic arm as shown in FIG. 35 ) can be coupled to a mounting platform, such as a bar 2664 , at a prismatic joint 2666 .

[0176] 35 and 36 show that, according to some embodiments, the robotic arm of the system can also include a robotic setup linkage or joint. The robotic setup linkage can be adjusted to manipulate the attitude of the distal manipulator linkage and the location of the remote center of motion. In such embodiments, the term "robotic" can refer to one or more joints being motorized and controlled with closed-loop control. Robotic joints can enable advantages over having passively damped joints, such as the ability to dynamically provide gravity balance to the user, the ability to have the robotic arm provide scripted movements (e.g., retract / release, etc.), and the ability to use extra or redundant joints in the setup linkage to perform repositioning movements (e.g., the base of the distal manipulator linkage can be moved while maintaining alignment with the remote center of motion), thereby improving access and / or reducing collisions.

[0177] 37, desired modifications to the robotic arms of the system may be implemented to achieve further benefits and advantages. For example, in addition to the features described above with respect to FIGS. 34-36, the robotic arm(s) of the system may be configured to include a force sensor at the A0 joint while omitting a contact-sensing shell and / or a force / torque sensor (e.g., a 6DoF torque sensor). Optionally, all six or more joints in the robotic arms 2604, 2660 may be backdrivable and subject to various impedance controls as desired.

[0178] According to some embodiments, the robotic arm 2604, 2660 of the system may be configured to omit a proximal joint (such as one of joints 2639, 2630B, or 2640 in FIG. 35) relative to the distal parallelogram. This may result in a robotic arm with a joint count of five between A0 and the ADM (as labeled in FIG. 37), which may reduce the total kinematic chain DoF count of the arm from eight to seven. Furthermore, such an embodiment may also constrain the parallelogram setup by one DoF, while still maintaining the nullspace redundancy of one DoF in the entire kinematic chain.

[0179] Thus, some embodiments may incorporate the features described in Figures 34-37 to realize several advantages over devices of different attributes. For example, according to some embodiments, the distal manipulator linkage may provide a hardware constrained remote center of motion that limits the momentum during teleoperated laparoscope actuation to the manipulator joints, which has the potential to reduce collisions and provide more predictable motion to the user (the proximal portion of the robotic arm does not need to move during teleoperated motion). The positioning of the system may also provide a very stable and flexible arm support for high setup flexibility and dynamic performance. The robotic setup joints may also provide capabilities not enabled by the manual brake setup joints, such as constrained repositioning and scripted movements to aid in workflow.

[0180] 5. Further Exemplary Flexible Kinematic Chains 38 shows a table 2700 illustrating various embodiments of robotic arms and their kinematic chains that can be operated in various modes (e.g., 1900 and 2000) and sub-modes (e.g., 2200, 3200A-2300C, 2400A-2400B) of the present disclosure or positioned in various configurations (e.g., 2500A-2500C). The various illustrated arms are also shown along with a setup arm that may be suitable for use with such arms in, for example, a table-based, cart-based, or ceiling-based robotic system. As illustrated by the table, robotic arm 2705 is one embodiment of a RRRRP kinematic chain, robotic arm 2710 is another embodiment of a RRRRP kinematic chain, robotic arm 2715 is one embodiment of a RRRPP kinematic chain, robotic arm 2720 is another embodiment of a RRRPP kinematic chain, robotic arm 2725 is another embodiment of a RRRPP kinematic chain, robotic arm 2730 is one embodiment of a RRPRP kinematic chain, and robotic arm 2735 is one embodiment of a RPRPP kinematic chain. Each of these robotic arms is suitable for use in both the first 1900 and second 2000 modes of operation described herein.

[0181] Other configurations of kinematic chains are also possible within the scope of this disclosure. For example, if a design starts with a revolute joint at the proximal end of the robot arm with a rotation axis that can point through a remote sensor, and ends with a prismatic joint at the distal end of the robot arm with a linear translation axis parallel to the tool insertion axis, the design provides a flexible R(XXX)P kinematic chain where X can be populated with either R or P to assemble a series of joints that can implement software constrained remote sensors as described herein. There are eight categories of robot arms that can fill a flexible R(XXX)P kinematic chain. Of these, R(PPP)P is not suitable for the first mode of operation because at least one rotation is required to create a remote pitch axis as described herein. There are various ways that each of the axes can be positioned and still have the same designation. For example, for the R(RRP)P robot arms 2715, 2720, and 2725, the last two prism axes are parallel to each other. However, in other embodiments, these axes may also be configured to be at an angle to one another.

[0182] 6. Overview of Operation Technology Figure 39 shows a flow chart of an example process 2800 for operating the robotic arms 1700, 1800, 2705-2735 of Figures 24, 25, and 33. The process 2800 can be implemented in whole or in part by the controller 206 based on computer executable instructions that control the actuation of the motorized joints of the robotic arm, or may involve some movements imparted by a human operator, as described below.

[0183] In block 2805, the controller 206 may activate the robotic arms 1700, 1800, 2705-2735, for example, by removing the robotic arms 1700, 1800, 2705-2735 from the storage configuration 2500C and / or by actuating motorized set-up joints to position the robotic arms 1700, 1800, 2705-2735 near the patient or patient table.

[0184] At block 2810, the controller 206 may receive an instruction to operate the robotic arms 1700, 1800, 2705-2735 in either the first operating mode 1900 or the second operating mode 2000. At decision block 2815, the controller 206 may recognize the instruction and retrieve the appropriate operating instruction from memory.

[0185] If the instruction is to operate the robotic arm 1700, 1800, 2705-2735 in the first mode of operation 1900, the process 2800 moves to block 2820 to perform a set-up procedure. As shown in FIGS. 29A-29D, the set-up procedure may include (i) fixing the position of the remote sensor such that a second axis is aligned with the patient's opening and passes through the remote sensor, and (ii) constraining the movement of the plurality of powered joints when operated in the first mode of operation such that the second axis passes through the remote sensor. Fixing the position of the remote sensor may be accomplished based on docking the robotic arm 1700, 1800, 2705-2735 to a cannula and identifying a position as a point along or within the cannula. Block 2820 may involve one or more null space movements to align the yaw axis defined by the rotation axis of the proximal rotational joint of the robot arm 1700, 1800, 2705-2735 with the remote sensor and create a remote pitch axis that passes through the remote sensor.

[0186] In decision block 2825, the controller 206 may determine whether to maintain a parallelogram (or virtual parallelogram) in the configuration of the robot arms 1700, 1800, 2705-2735 in the first operational mode 1900, as described with respect to Figures 30A-30B.

[0187] If so, the process 2800 moves to block 2830, where the controller 206 configures the robot arm 1800, 2705 via null space movement to form a parallelogram 2340A with a virtual link 2305A passing through the remote sensor 2225, and constrains the actuation of the joints to maintain the parallelogram 2340A.

[0188] If not, the process 2800 transitions to block 2835 where the controller 206 configures the robotic arm 1800, 2705 to form the broken parallelogram 2340B, 2340C, and optionally transition between several different broken parallelogram shapes, while maintaining the position of the remote sensor 2225. The process 2800 may loop back to block 2825 intra-operatively after either of blocks 2830 and 2835 if the workspace or range of motion requirements for the robotic arm 1800, 2705 change.

[0189] For the disclosed robotic arms, such as the robotic arm 1700, which may not be able to form a parallelogram (or virtual parallelogram), blocks 2825-2835 may instead include the controller 206 determining the distance along the yaw axis 1735A between the remote sensor and the first powered joint 1705A, as described with respect to Figures 31A and 31B.

[0190] If the command is to operate the robotic arms 1700, 1800, 2705-2735 in the second operational mode 2000, the process 2800 moves to block 2840 to identify the positioning of the virtual rail based on the positioning of the second axis when aligned with the patient opening. The second axis may be aligned with the patient opening by a user manually moving the robotic arms 1700, 1800, 2705-2735, by user control via the command console 200, or by the controller 206.

[0191] In block 2850, the controller 206 controls the movement of the medical instruments along the virtual rail. As described with respect to FIG. 27B, this may include controlling the movement of multiple medical instruments 1725A-1725C by multiple robotic arms 1700A-1700C along the virtual rail 2005. As described with respect to FIGS. 32A and 32B, this may include controlling the movement of multiple medical instruments 2505, 2515 by a single robotic arm 1800. In some embodiments, the robotic arms 1700A-1700C of FIG. 27B may be configured with additional instrument drivers as shown in FIGS. 32A and 32B. In some embodiments, for example, if patient movement requires repositioning of the virtual rail, the process 2800 may return to block 2840.

[0192] Blocks 2825-2835 of the first mode 1900 or block 2850 of the second mode 2000 may continue for the duration of the medical procedure. In block 2855, the controller 206 receives a stow command for some or all of the robotic arms of the robotic system. Thus, in block 2860, the controller 206 (or a user) may position the robotic arm 1800 in a stowed configuration 2500C with the linkages positioned substantially parallel to one another. The other disclosed robotic arms 1700, 2705-2735 may have similar compact stowed configurations and may be controlled to be positioned in such configurations manually or by the controller 206.

[0193] 7. Best Mode for Carrying Out the Invention Various embodiments of aspects of the present disclosure are described as numbered items (1, 2, 3, etc.) for convenience. These are provided as examples and not as limitations of the subject technology. Figure and reference number identification are provided below for purposes of example and explanation only, and the sections are not to be limited by those identifications.

[0194] Item 1. A surgical robotic system comprising: a column-based mounting platform having a table supported on a column; and a robotic arm coupled to the table, the robotic arm comprising a set-up joint and a distal manipulator linkage that collectively define a remote center of motion, the set-up joint being adjustable to manipulate the attitude of the distal manipulator linkage and the location of the remote center of motion, the distal manipulator linkage being configured to isolate degrees of freedom of motion of a tool coupled thereto to articulate the tool about the remote center of motion.

[0195] Item 2. The surgical robot system of item 1, wherein the post-based mounting platform further comprises a base and a post extending therefrom.

[0196] Item 3. The surgical robot system of any one of items 1 to 2, wherein the column-based mounting platform further comprises a shoulder connected to the column, a first link connected to the shoulder by a first rotary joint, and a second link connected to the first link by a second rotary joint.

[0197] Item 4. The surgical robotic system of item 3, wherein the column-based mounting platform further comprises an adjustable arm support coupled to the second link, the adjustable arm support configured to support a robotic arm thereon.

[0198] Item 5. The surgical robotic system of item 4, wherein the adjustable arm support comprises a bar.

[0199] Item 6. A surgical robot system described in any one of items 1 to 5, wherein the distal manipulator linkage constrains tool movement at a single joint.

[0200] Item 7. A surgical robot system described in any one of items 1 to 6, wherein a distal manipulator linkage constrains tool movement at a set of joints.

[0201] Item 8. The surgical robot system of any one of items 1 to 7, wherein the robot arm includes a base yaw joint connecting the set-up joint to a distal manipulator linkage, the base yaw joint having an axis of rotation extending through a remote center of motion.

[0202] Item 9. A surgical robot system described in any one of items 1 to 8, wherein the robot arm can reposition the distal manipulator linkage while maintaining a remote center of motion.

[0203] Item 10. A surgical robot system according to any one of items 1 to 9, wherein the distal manipulator linkage of the robot arm includes a parallelogram linkage.

[0204] Item 11. The surgical robotic system of item 10, wherein the parallelogram linkage is configured to articulate about a remote center of motion.

[0205] Item 12. A surgical robot system according to any one of items 10 or 11, wherein the parallelogram linkage comprises one powered joint and two passive joints.

[0206] Item 13. The surgical robot system according to Item 12, wherein rotation of the passive joint is mechanically constrained by a limiter mechanism.

[0207] Item 14. The surgical robot system of item 13, wherein the limiter mechanism comprises a band, belt, chain, or link.

[0208] Item 15. A surgical robot system according to any one of items 10 to 14, wherein the parallelogram linkage mechanism comprises four links rotatably connected to each other at three rotary joints, and the three rotary joints are configured to rotate in a 1:1:1 ratio.

[0209] Item 16. The surgical robot system of item 15, wherein the four links include a pitch base link, a first pitch link, a second pitch link, and a stage link, the pitch base link being connected to the first pitch link via a first pitch joint, the first pitch link being connected to the second pitch link via a second pitch joint, and the second pitch link being connected to the stage link via a third pitch joint.

[0210] Item 17. The surgical robot system of item 16, wherein the stage link is configured to support a tool driver, whereby the tool driver supports a tool for articulation about a remote center of motion.

[0211] Item 18. A surgical robot system according to any one of items 1 to 17, wherein the set-up joint includes a prismatic joint coupled to a mounting platform.

[0212] Item 19. A surgical robot system described in any one of items 1 to 18, wherein the setup joint includes a plurality of links rotatably connected to each other.

[0213] Item 20. A surgical robot system according to any one of items 1 to 19, wherein the setup joint includes a roll joint.

[0214] Item 21. A surgical robot system according to any one of items 1 to 20, wherein the setup joint is a robotic setup joint.

[0215] Item 22. The surgical robot system of item 21, wherein the setup joint is motorized.

[0216] Item 23. A surgical robot system according to any one of items 1 to 22, wherein the remote center of motion is hardware constrained.

[0217] Item 24. A surgical robot system according to any one of items 1 to 23, wherein the remote center of motion is software constrained.

[0218] Item 25. A robot arm connectable to a table of a surgical robot system, the robot arm comprising: a robot set-up joint adjustable to manipulate the attitude of a distal manipulator linkage and the position of a remote center of motion relative to the table; and a distal manipulator linkage connected to the robot set-up joint to collectively define a remote center of motion, the distal manipulator linkage configured to isolate degrees of freedom of motion of a tool connected thereto to articulate the tool about the remote center of motion.

[0219] Item 26. A robotic arm as described in item 25, wherein the distal manipulator linkage constrains tool motion at a single joint.

[0220] Item 27. A robotic arm as described in item 25, wherein a distal manipulator linkage constrains tool motion at a set of joints.

[0221] Item 28. A robotic arm according to any one of items 25 to 27, wherein the robotic arm comprises a base yaw joint connecting the set-up joint to a distal manipulator linkage, the base yaw joint having an axis of rotation extending through a remote center of motion.

[0222] Item 29. A robot arm described in any one of items 25 to 28, wherein the distal manipulator linkage of the robot arm includes a parallelogram linkage.

[0223] Item 30. The robotic arm of item 29, wherein the parallelogram linkage is configured to articulate about a remote center of motion.

[0224] Item 31. A robot arm as described in Item 29, wherein the parallelogram linkage comprises one powered joint and two passive joints.

[0225] Item 32. A robot arm according to item 31, wherein rotation of the passive joint is mechanically constrained by a limiter mechanism.

[0226] Item 33. The robot arm of item 32, wherein the limiter mechanism includes a band, belt, chain, or link.

[0227] Item 34. A robot arm described in any one of items 29 to 33, wherein the parallelogram linkage mechanism has four links rotatably connected to each other at three rotary joints, and the three rotary joints are configured to rotate in a 1:1:1 ratio.

[0228] Item 35. The robot arm of item 34, wherein the four links include a pitch base link, a first pitch link, a second pitch link, and a stage link, the pitch base link being connected to the first pitch link via a first pitch joint, the first pitch link being connected to the second pitch link via a second pitch joint, and the second pitch link being connected to the stage link via a third pitch joint.

[0229] Item 36. The robot arm of item 35, wherein the stage link is configured to support a tool driver, whereby the tool driver supports a tool for articulation about a remote center of motion.

[0230] Item 37. A robot arm described in any one of items 25 to 36, wherein the setup joint includes a plurality of links rotatably connected to each other.

[0231] Item 38. A robot arm according to any one of items 25 to 37, wherein the setup joint includes a roll joint.

[0232] Item 39. The robot arm of any one of items 25 to 38, wherein the setup joint is electrically powered.

[0233] Item 40. A robot arm according to any one of items 25 to 39, wherein the remote center of motion is constrained by hardware.

[0234] Item 41. A robot arm according to any one of items 25 to 40, wherein the remote center of motion is constrained by software.

[0235] Item 42. A surgical method comprising: receiving a setup command for positioning a setup joint of a robotic arm at a setup position, the robotic arm being coupled to a table; and in response to the setup command, driving one or more motorized joints of the setup joint of the robotic arm to position the setup joint at the setup position; receiving an adjustment command for positioning a distal manipulator linkage about a remote center of motion; and in response to the adjustment command, driving the distal manipulator linkage of the robotic arm to the adjusted position, the distal manipulator linkage constraining a degree of freedom of motion of a tool coupled thereto to articulate the tool about the remote center of motion.

[0236] Item 43. The method of item 42, wherein in response to a setup command, the method further includes driving the column-based mounting platform to move the robot arm toward the setup position.

[0237] Item 44. The method of any one of items 42 or 43, wherein actuation of the distal manipulator linkage includes constraining articulation of the tool at a single joint.

[0238] Item 45. A method according to any one of items 42 to 44, wherein actuation of the distal manipulator linkage includes constraining articulation of the tool at a set of joints.

[0239] Item 46. The method of any one of items 42 to 45, wherein driving the distal manipulator linkage includes articulating a parallelogram linkage.

[0240] Item 47. The method of item 46, wherein driving the distal manipulator linkage includes articulating a parallelogram linkage having four links rotatably connected to each other at three rotary joints, the three rotary joints being driven in a 1:1:1 ratio.

[0241] Item 48. The method of item 47, further comprising articulating a tool driver to control operation of the tool.

[0242] Item 49. The method of any one of items 42 to 48, further comprising constraining the remote center of motion via hardware.

[0243] Item 50. The method of any one of items 42 to 49, further comprising constraining the remote center of motion via software.

[0244] 8. Further Considerations In some embodiments, any of the clauses herein may be dependent on any one of the independent clauses or any one of the dependent clauses. In an aspect, any of the clauses (e.g., dependent clauses or independent clauses) may be combined with any other clause or clauses (e.g., dependent clauses or independent clauses). In an aspect, a claim may include some or all of the words (e.g., steps, operations, means, or components) recited in a clause, sentence, phrase, or paragraph. In an aspect, a claim may include some or all of the words recited in one or more clauses, sentences, phrases, or paragraphs. In an aspect, some of the words in each of the clauses, sentences, phrases, or paragraphs may be removed. In an aspect, additional words or elements may be added to a clause, sentence, phrase, or paragraph. In an aspect, the subject technology may be implemented without utilizing some of the components, elements, functions, or operations described herein. In an aspect, the subject technology may be implemented utilizing additional components, elements, functions, or operations.

[0245] The implementations disclosed herein provide systems, methods, and apparatus for a transformable medical robotic system that leverages a versatile open kinematic chain along with a set of medical procedure-specific software-controlled actuation constraints to perform a variety of medical procedures.

[0246] It should be noted that, as used herein, the terms "couple," "coupling," "coupled," or other variations of the word coupled, may indicate either an indirect connection or a direct connection. For example, when a first component is "coupled" to a second component, the first component may be either indirectly connected to the second component through another component, or directly connected to the second component.

[0247] The various functions for controlling the operation of the robotic arm described herein according to the disclosed modes of operation may be stored as one or more instructions on a processor-readable medium or computer-readable medium. The term "computer-readable medium" refers to any available medium that can be accessed by a computer or processor. Such medium may consist of Random Access Memory (RAM), Read Only Memory (ROM), Electrically Erasable Programmable ROM (EEPROM), Flash memory, Compact Disk Read-Only Memory (CD-ROM) or other optical disk storage, magnetic disk storage or other magnetic storage, or any other medium that can be used to store desired program code in the form of instructions or data structures and that can be accessed by a computer. It should be noted that computer-readable medium may be tangible and non-transitory. As used herein, the term "code" may refer to software, instructions, code, or data that is executable by a computing device or processor.

[0248] The methods disclosed herein include one or more steps or acts for achieving the described method. The method steps and / or acts may be interchanged with one another without departing from the scope of the claims. In other words, unless a specific order of steps or acts is required for the proper operation of the described method, the order and / or use of specific steps and / or acts may be modified without departing from the scope of the claims.

[0249] As used herein, the term "plurality" refers to two or more. For example, a plurality of elements refers to two or more elements. The term "determining" covers a wide variety of acts, and thus, "determining" can include calculating, computing, processing, deriving, investigating, looking up (e.g., consulting a table, database, or another data structure), ascertaining, and the like. "Determining" can also include receiving (e.g., receiving information), accessing (e.g., accessing data in a memory), and the like. "Determining" can also include resolving, selecting, choosing, establishing, and the like.

[0250] The phrase "based on" does not mean "based only on," unless expressly specified otherwise. In other words, the phrase "based on" describes both "based only on" and "based at least on."

[0251] The foregoing description of the disclosed implementations is provided to enable any person skilled in the art to make or use the present invention. Various modifications to these implementations will be readily apparent to those skilled in the art, and the general principles defined herein may be applied to other implementations without departing from the scope of the present invention. For example, those skilled in the art will recognize that many corresponding alternatives, equivalent structural details, such as similar manners of fastening, mounting, coupling, or engaging tool components, equivalent mechanisms for producing specific actuation motions, and equivalent mechanisms for delivering electrical energy, may be employed. Thus, the present invention is not intended to be limited to the implementations shown herein, but is to be accorded the widest scope consistent with the principles and novel features disclosed herein.

[0252] [Embodiment] (1) A surgical robotic system, comprising: a column-based mounting platform having a table supported on the column; a robotic arm coupled to the table, the robotic arm comprising a set-up joint and a distal manipulator linkage that collectively define a remote center of motion, the set-up joint being adjustable to manipulate the attitude of the distal manipulator linkage and the position of the remote center of motion, the distal manipulator linkage being configured to isolate a degree of freedom of motion of a tool coupled thereto to articulate the tool about the remote center of motion. (2) The surgical robot system of claim 1, wherein the pillar-based mounting platform further comprises a base and a pillar extending therefrom. (3) A surgical robot system according to any one of embodiments 1 to 2, wherein the column-based mounting platform further comprises a shoulder connected to the column, a first link connected to the shoulder by a first rotary joint, and a second link connected to the first link by a second rotary joint. (4) The surgical robot system of claim 3, wherein the column-based mounting platform further comprises an adjustable arm support coupled to the second link, the adjustable arm support configured to support the robotic arm thereon. (5) The surgical robot system of claim 4, wherein the adjustable arm support comprises a bar.

[0253] (6) A surgical robot system according to any one of embodiments 1 to 5, wherein the distal manipulator link mechanism constrains the movement of the tool at a single joint. (7) A surgical robot system according to any one of embodiments 1 to 6, wherein the distal manipulator link mechanism constrains the movement of the tool at a set of joints. (8) A surgical robot system according to any one of claims 1 to 7, wherein the robot arm includes a base yaw joint connecting the set-up joint to the distal manipulator linkage, the base yaw joint having a rotation axis extending through the remote center of motion. (9) A surgical robot system according to any one of claims 1 to 8, wherein the robot arm is capable of repositioning the distal manipulator linkage while maintaining the remote center of motion. (10) A surgical robot system according to any one of embodiments 1 to 9, wherein the distal manipulator link mechanism of the robot arm includes a parallelogram link mechanism.

[0254] (11) The surgical robot system of claim 10, wherein the parallelogram linkage is configured to articulate about the remote center of motion. (12) A surgical robot system according to embodiment 10 or 11, wherein the parallelogram linkage comprises one powered joint and two passive joints. (13) A surgical robot system according to embodiment 12, wherein rotation of the passive joint is mechanically constrained by a limiter mechanism. (14) The surgical robot system of embodiment 13, wherein the limiter mechanism includes a band, belt, chain, or link. (15) A surgical robot system according to any one of embodiments 10 to 14, wherein the parallelogram link mechanism includes four links rotatably connected to each other at three rotary joints, and the three rotary joints are configured to rotate in a 1:1:1 ratio.

[0255] (16) The surgical robot system of embodiment 15, wherein the four links include a pitch base link, a first pitch link, a second pitch link, and a stage link, the pitch base link being connected to the first pitch link via a first pitch joint, the first pitch link being connected to the second pitch link via a second pitch joint, and the second pitch link being connected to the stage link via a third pitch joint. (17) The surgical robot system of claim 16, wherein the stage link is configured to support a tool driver, whereby the tool driver supports a tool for articulation about the remote center of motion. (18) A surgical robot system according to any one of embodiments 1 to 17, wherein the setup joint includes a prismatic joint coupled to the mounting platform. (19) A surgical robot system according to any one of embodiments 1 to 18, wherein the setup joint includes a plurality of links rotatably connected to each other. (20) A surgical robot system according to any one of embodiments 1 to 19, wherein the setup joint includes a roll joint.

[0256] (21) A surgical robot system according to any one of embodiments 1 to 20, wherein the setup joint is a robot setup joint. (22) The surgical robot system of embodiment 21, wherein the setup joint is motorized. (23) A surgical robot system according to any one of embodiments 1 to 22, wherein the remote center of motion is hardware constrained. (24) A surgical robot system according to any one of embodiments 1 to 23, wherein the remote center of motion is software constrained. (25) A robot arm connectable to a table of a surgical robot system, the robot arm comprising: a robot set-up joint adjustable to manipulate the attitude of the distal manipulator linkage and the position of the remote center of motion relative to the table; a distal manipulator linkage coupled to the robot set-up joints to collectively define a remote center of motion, the distal manipulator linkage configured to isolate degrees of freedom of motion of a tool coupled thereto to articulate the tool about the remote center of motion.

[0257] (26) The robot arm of embodiment 25, wherein the distal manipulator linkage constrains the movement of the tool at a single joint. (27) The robot arm of embodiment 25, wherein the distal manipulator linkage constrains the movement of the tool at a set of joints. (28) A robot arm according to any one of embodiments 25 to 27, wherein the robot arm comprises a base yaw joint connecting the set-up joint to the distal manipulator linkage, the base yaw joint having an axis of rotation extending through the remote center of motion. (29) A robot arm according to any one of embodiments 25 to 28, wherein the distal manipulator linkage of the robot arm includes a parallelogram linkage. (30) The robot arm of embodiment 29, wherein the parallelogram linkage is configured to articulate about the remote center of motion.

[0258] (31) A robot arm as described in embodiment 29, wherein the parallelogram linkage comprises one powered joint and two passive joints. (32) A robot arm as described in embodiment 31, wherein rotation of the passive joint is mechanically constrained by a limiter mechanism. (33) The robot arm of embodiment 32, wherein the limiter mechanism includes a band, belt, chain, or link. (34) A robot arm described in any of embodiments 29 to 33, wherein the parallelogram link mechanism comprises four links rotatably connected to each other at three rotary joints, and the three rotary joints are configured to rotate in a 1:1:1 ratio. (35) A robot arm as described in embodiment 34, wherein the four links include a pitch base link, a first pitch link, a second pitch link, and a stage link, the pitch base link being connected to the first pitch link via a first pitch joint, the first pitch link being connected to the second pitch link via a second pitch joint, and the second pitch link being connected to the stage link via a third pitch joint.

[0259] (36) The robot arm of embodiment 35, wherein the stage link is configured to support a tool driver, whereby the tool driver supports a tool for articulation about the remote center of motion. (37) A robot arm according to any one of embodiments 25 to 36, wherein the setup joint includes a plurality of links rotatably connected to one another. (38) A robot arm according to any one of embodiments 25 to 37, wherein the setup joint includes a roll joint. (39) A robot arm according to any one of embodiments 25 to 38, wherein the setup joint is electrically powered. (40) A robot arm described in any one of embodiments 25 to 39, wherein the remote center of motion is hardware constrained.

[0260] (41) A robot arm described in any one of embodiments 25 to 40, wherein the remote center of motion is software constrained. (42) A surgical method comprising: receiving a set-up command for positioning a set-up joint of a robot arm at a set-up position, the robot arm being coupled to a table; in response to the setup command, actuating one or more motorized joints of the setup joint of the robot arm to position the setup joint at the setup position; receiving an adjustment command for positioning a distal manipulator linkage about a remote center of motion; and in response to the adjustment command, driving a distal manipulator linkage of the robotic arm to an adjusted position, the distal manipulator linkage constraining a degree of freedom of motion of a tool coupled thereto and articulating the tool about the remote center of motion. (43) The method of claim 42, wherein in response to the setup command, the method further includes driving a column-based mounting platform to move the robot arm toward the setup position. (44) The method of any one of claims 42 to 43, wherein the actuation of the distal manipulator linkage includes constraining the articulation of the tool at a single joint. (45) The method of any one of embodiments 42 to 44, wherein the actuation of the distal manipulator linkage includes constraining the articulation of the tool at a set of joints.

[0261] (46) The method of any one of embodiments 42 to 45, wherein the actuation of the distal manipulator linkage includes articulating a parallelogram linkage. (47) The method of embodiment 46, wherein the actuation of the distal manipulator linkage includes articulating a parallelogram linkage having four links rotatably connected to one another at three rotary joints, the three rotary joints being actuated in a 1:1:1 ratio. (48) The method of claim 47, further comprising articulating a tool driver to control movement of the tool. (49) The method of any one of embodiments 42 to 48, further comprising constraining the remote center of motion via hardware. (50) The method of any of embodiments 42 to 49, further comprising constraining the remote center of motion via software.

Claims

1. 1. A surgical robotic system, comprising: a column-based mounting platform having a table supported on the column; a robotic arm coupled to the table, the robotic arm comprising a set-up joint and a distal manipulator linkage that collectively define a remote center of motion, the set-up joint being adjustable to manipulate the attitude of the distal manipulator linkage and the position of the remote center of motion, the distal manipulator linkage being configured to isolate degrees of freedom of movement of a tool coupled thereto to articulate the tool about the remote center of motion.

2. 2. The surgical robotic system of claim 1, wherein the column-based mounting platform further comprises: a shoulder coupled to the column; a first link coupled to the shoulder by a first revolute joint; and a second link coupled to the first link by a second revolute joint.

3. 3. The surgical robotic system of claim 2, wherein the column-based mounting platform further comprises an adjustable arm support coupled to the second link, the adjustable arm support configured to support the robotic arm thereon.

4. The surgical robotic system of claim 1 , wherein the distal manipulator linkage constrains the motion of the tool at a single joint.

5. The surgical robotic system of claim 1 , wherein the distal manipulator linkage constrains the movement of the tool at a set of joints.

6. 2. The surgical robotic system of claim 1, wherein the robotic arm comprises a proximal yaw joint connecting the set-up joint to the distal manipulator linkage, the proximal yaw joint having an axis of rotation extending through the remote center of motion.

7. The surgical robotic system of claim 1 , wherein the robotic arm can reposition the distal manipulator linkage while maintaining the remote center of motion.

8. 10. The surgical robotic system of claim 1, wherein the distal manipulator linkage of the robotic arm includes a parallelogram linkage configured to articulate about the remote center of motion.

9. 9. The surgical robot system of claim 8, wherein the parallelogram linkage comprises one powered joint and two passive joints, and rotation of the passive joints is mechanically constrained by a limiter mechanism including a band, a belt, a chain, or a link.

10. 9. The surgical robotic system of claim 8, wherein the parallelogram linkage comprises four links rotatably connected to one another at three revolute joints, the three revolute joints configured to rotate in a 1:1:1 ratio.

11. 11. The surgical robot system of claim 10, wherein the four links comprise a pitch base link, a first pitch link, a second pitch link, and a stage link, the pitch base link being connected to the first pitch link via a first pitch joint, the first pitch link being connected to the second pitch link via a second pitch joint, and the second pitch link being connected to the stage link via a third pitch joint.

12. The surgical robotic system of claim 11 , wherein the stage link is configured to support a tool driver such that the tool driver supports a tool for articulation about the remote center of motion.

13. The surgical robotic system of claim 1 , wherein the set-up joint comprises a prismatic joint coupled to the mounting platform.

14. The surgical robot system of claim 1 , wherein the setup joint includes a plurality of links rotatably coupled to one another.

15. The surgical robot system of claim 1 , wherein the setup joint comprises a roll joint.

16. The surgical robot system of claim 1 , wherein the setup joint is a robotic setup joint that is motorized.

17. 1. A robotic arm coupleable to a table of a surgical robotic system, the robotic arm comprising: a robot setup joint; a distal manipulator linkage coupled to the robot set-up joints to collectively define a remote center of motion; the robot set-up joint is adjustable to manipulate the attitude of the distal manipulator linkage and the position of the remote center of motion relative to the table; A robotic arm, wherein the distal manipulator linkage is configured to isolate degrees of freedom of movement of a tool coupled thereto to articulate the tool about the remote center of motion.

18. A method comprising: a system receiving a setup command to position a setup joint of a robotic arm at a setup position, the robotic arm being coupled to a table; In response to the setup command, the system actuates one or more motorized joints of the setup joint of the robot arm to position the setup joint at the setup position; receiving an adjustment command from the system to position a distal manipulator linkage about a remote center of motion; and in response to the adjustment command, the system drives a distal manipulator linkage of the robot arm to an adjusted position, the distal manipulator linkage constraining a degree of freedom of movement of a tool coupled thereto and articulating the tool about the remote center of motion.

19. 20. The method of claim 18, further comprising: in response to the setup command, the system actuating a column-based mounting platform to move the robotic arm toward the setup position.

20. 20. The method of claim 18, wherein the actuation of the distal manipulator linkage comprises constraining the articulation of the tool at a single joint or at a set of joints.

Images