Systems and methods for intubation of medical devices

Abstract

An overtube device is provided, the overtube device including a feature for forming a first lumen for passing a first scope during intubation, the first lumen being deformable to create a second lumen for passing a second scope, the diameter of the second scope being larger than the diameter of the first scope.

Description

[Technical Field]

[0001] cross reference This application claims priority to U.S. Provisional Patent Application No. 63 / 375,436, filed September 13, 2022, which is incorporated herein by reference in its entirety. [Background technology]

[0002] In endoscopy, endoscopes are used to examine the interior of hollow organs or cavities in the body. Unlike many other medical imaging techniques, endoscopes are inserted directly into the organ. Flexible endoscopes, which can provide intuitive navigation and control, are useful for diagnosing and treating diseases accessible through any natural orifice in the body. Depending on the clinical indication, endoscopes may be designated as bronchoscopes, ureteroscopes, colonoscopes, gastroscopes, otolaryngoscopes, and various others. For example, flexible colonoscopes may be intubated to traverse the colon for diagnostic and / or surgical procedures.

[0003] Certain endoscopes, such as colonoscopes or gastroscopes, can be relatively larger and / or more rigid (compared to other types of endoscopes), which can make navigating tortuous anatomical structures more difficult. For example, clinicians may use an overtube to facilitate intubation, which provides a low-friction surface and a defined trajectory for guiding the colonoscope's intubation. In some cases, a reduction technique may be employed to facilitate intubation by reducing the colon's length and tortuosity by anchoring the colon at the distal end and applying tension. However, using an overtube for intubation can be difficult. One such difficulty in the current colonic intubation process is the large size of the overtube device (i.e., balloon overtube) used to create a passageway for the internal endoscope and assist in intubation. Summary of the Invention

[0004] There is a need for an improved intubation process for endoluminal endoscopic devices. The present disclosure addresses this need by providing an improved overtube for endoluminal device intubation. In particular, the overtube device of the present disclosure may facilitate the intubation process without reducing its size or dimensions (as compared to conventional intubation processes or devices).

[0005] In one embodiment, an apparatus for intubating an endoscope into a subject is provided, comprising a flexible overtube including features for forming a first lumen for passing a first scope during intubation, the first lumen being deformable to create a second lumen for passing a second scope, the second scope having a diameter larger than the diameter of the first scope.

[0006] In some embodiments, the diameter of the first lumen is smaller than the diameter of the second lumen. In some embodiments, the feature comprises an expandable tubular structure that adjusts the size of the first lumen or the second lumen. In some cases, the expandable tubular structure is a flat-laid tubular configuration having axial corrugations. In some cases, the expandable tubular structure is a collapsible flat-laid tubular configuration. In some examples, the collapsible flat-laid tubular configuration has separable edges that are engaged using one or more active engagement features. In some examples, the collapsible flat-laid tubular configuration adjusts the diameter of the first lumen to create the second lumen using one or more passive engagement features.

[0007] In some embodiments, the first lumen and the second lumen are two channels separated by a lumen separator in the flexible overtube. In some embodiments, the second scope is a robotic scope. In some cases, the robotic scope includes a handle portion detachably coupled to a robot support. In some cases, the handle portion of the robotic scope is coupled to the robot support after the robotic scope is inserted through the second lumen and assumes a serpentine shape. In some cases, the robotic scope is initialized by adjusting the bending portion of the robotic scope to an internal environment within the subject while removing slack from one or more pull wires for articulation control of the bending portion.

[0008] In another aspect, a method for intubating a robotic endoscope within a subject is provided, the method including: (a) performing an initial intubation to reach a target site within the subject's body with a first scope and an overtube device, the first scope engaged with a first lumen of the overtube device; (b) withdrawing the first scope and inserting a second scope into a second lumen of the overtube device to reach the target site, the second scope being a robotic scope having a diameter larger than that of the first scope; and (c) coupling a handle portion of the second scope to an instrument drive mechanism (IDM) and initializing the second scope while the second scope is within the subject's body.

[0009] In some embodiments, the initialization includes removing slack from one or more puller wires of the second scope, which in some cases are actuated by the IDM to control articulation of a bending section of the second scope in one or more degrees of freedom.

[0010] In some embodiments, the method further includes monitoring tension in one or more puller wires corresponding to one degree of freedom. In some cases, the method further includes comparing the difference in the tension in the one or more puller wires against a predetermined threshold. In some examples, the method further includes controlling one or more actuators of the IDM based on the tension or the difference in the tension.

[0011] In some embodiments, the first lumen is deformable to create a second lumen. In some embodiments, the overtube device includes an expandable tubular structure that adjusts the size of the first lumen or the second lumen. In some cases, the expandable tubular structure is a flat-laid tubular configuration having axial pleats. In some cases, the expandable tubular structure is a collapsible flat-laid tubular configuration. In some cases, the first lumen and the second lumen are two channels separated by a lumen separator of the overtube device.

[0012] In a further aspect, a method for initializing a robotic endoscope within a subject is provided, the method including: (a) driving a pair of puller wires at a constant speed with an instrument drive mechanism while the robotic endoscope is disposed within the subject, the pair of puller wires operating to control joints of a bending portion of the robotic endoscope corresponding to a first degree of freedom, (b) comparing a difference in tension between the pair of puller wires to a first threshold and, when the first threshold is reached, varying movement of the pair of puller wires to reduce the tension difference; and (c) comparing the tension between the pair of puller wires to a second threshold and, when the tension in either one of the pair of puller wires reaches the second threshold, stopping movement of the corresponding puller wire.

[0013] In some embodiments, the second threshold is higher than the first threshold. In some embodiments, steps (a) through (c) are repeated for a pair of puller wires corresponding to a second degree of freedom. In some cases, steps (a) through (c) are performed simultaneously for the first degree of freedom and the second degree of freedom. Alternatively, steps (a) through (c) are performed sequentially for the first degree of freedom and the second degree of freedom.

[0014] In some embodiments, the robotic scope includes a handle portion detachably coupled to the instrument drive mechanism. In some cases, the instrument drive mechanism is supported by an end effector of a robotic arm. In some embodiments, the robotic scope includes a flexible elongate member, the current shape, position, or orientation of the elongate member being unknown.

[0015] Additional aspects and advantages of the present disclosure will become readily apparent to those skilled in the art from the following detailed description. In the following detailed description, only exemplary embodiments of the present disclosure are shown and described. As will be recognized, the present disclosure is capable of other and different embodiments, and its several details are capable of modifications in various obvious respects, all without departing from the present disclosure. Accordingly, the drawings and description are to be regarded as illustrative in nature, and not as restrictive.

[0016] Incorporation by Reference All publications, patents, and patent applications mentioned herein are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference. To the extent that the publications and patents or patent applications incorporated by reference conflict with the disclosure contained herein, the present specification is intended to supersede and / or take precedence over any such conflicting material. [Brief explanation of the drawings]

[0017] The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings (also referred to herein as "Figures" and "FIGs."):

[0018] [Figure 1] FIG. 1 is a schematic diagram of an example of an intubation process. [Figure 2] FIG. 1 illustrates an example of an expandable overtube configured to wrap around an endoscope. [Figure 3A] FIG. 10 shows an example of an overtube with temporary longitudinal seams to provide an expandable overtube device. [Figure 3B] FIG. 10 shows an example of an overtube with temporary longitudinal seams to provide an expandable overtube device. [Figure 3C] FIG. 10 shows an example of an overtube with temporary longitudinal seams to provide an expandable overtube device. [Figure 4] FIG. 1 shows an example of an overtube that provides volume reduction via an internal vacuum during initial intubation. [Figure 5] FIG. 1 illustrates an example of an overtube device comprising a collapsible overtube. [Figure 6A] FIG. 1 illustrates an example of an overtube device having a flexible multi-lumen configuration. [Figure 6B] FIG. 1 illustrates an example of an overtube device having a flexible multi-lumen configuration. [Figure 7] FIG. 1 illustrates an example of a flexible endoscope according to some embodiments of the present disclosure. [Figure 8] FIG. 1 illustrates a robotic endoscope with a handle portion and a flexible elongate member. [Figure 9] FIG. 1 illustrates an example of an instrument drive mechanism that provides a mechanical interface to the handle portion of a robotic endoscope. [Figure 10]FIG. 1 illustrates an example of the distal tip of an endoscope. [Figure 11] 1A-1C illustrate an exemplary distal portion of a catheter having an integrated imaging and illumination device. [Figure 12] FIG. 1 illustrates an example algorithm for initialization of a robotic endoscope (e.g., a robotic colonoscope) to an instrument drive mechanism (IDM). [Figure 13] FIG. 1 illustrates an example of an instrument drive mechanism (IDM) that provides a mechanical interface to the handle portion of a robotic endoscope. [Figure 14] FIG. 1 illustrates an example of an instrument drive mechanism (IDM) that provides a mechanical interface to the handle portion of a robotic endoscope. [Figure 15] FIG. 1 illustrates an example of a robotic colonoscope. [Figure 16] FIG. 1 illustrates an example of a tip for a robotic speculum device. DETAILED DESCRIPTION OF THE INVENTION

[0019] While various embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will occur to those skilled in the art without departing from the invention. It will be understood that various alternatives to the embodiments of the invention described herein may be used.

[0020] The embodiments disclosed herein can be combined in one or more of numerous ways to provide improved diagnosis and treatment for patients. The disclosed embodiments can be combined with existing methods and devices to provide improved treatment, such as in combination with known methods of lung disease diagnosis, surgery, and surgery of other tissues and organs. It is understood that any one or more of the structures and steps described herein can be combined with any one or more additional structures and steps of the methods and devices described herein, and the figures and supporting text provide a description of the embodiments.

[0021] While the exemplary embodiments are primarily directed to devices or systems for colonoscopy or gastroscopy, this is not intended to be limiting, and those skilled in the art will appreciate that the devices described herein may be used for other therapeutic or diagnostic procedures and in various anatomical regions of a patient's body. The provided devices or systems can be used in urology, gynecology, rhinology, otology, laryngoscopy, gastroenterology, along with the above-mentioned endoscopes, and the associated devices include endoscopes and instruments, and endoscopes with localization capabilities. This is not intended to be limiting, and the devices described herein may be used in a variety of applications for other therapeutic or diagnostic procedures and in other anatomical regions of a patient's body, such as the brain, heart, lungs, intestines, eyes, skin, kidneys, liver, pancreas, stomach, uterus, ovaries, testes, bladder, ears, nose, mouth, bone marrow, adipose tissue, muscle, glandular and mucosal tissue, spinal cord and nerve tissue, soft tissues such as cartilage, hard biological tissues such as teeth, bone, and bodily cavities and passageways, such as the sinuses, ureters, colon, esophagus, pulmonary passageways, blood vessels and throat, and many others. Those skilled in the art will understand that the present invention may be used in conjunction with various tools or instruments, such as neuroendoscopes, encephaloscopes, ophthalmoscopes, otoscopes, rhinoscopes, laryngoscopes, gastroscopes, esophagoscopes, bronchoscopes, thoracoscopes, pleuroscopes, angioscopes, mediastinoscopes, nephroscopes, gastroscopes, duodenoscopes, cholangioscopes, cholangioscopes, laparoscopes, amnioscopes, ureteroscopes, hysteroscopes, cystoscopes, rectoscopes, colonoscopes, arthroscopes, salivary gland endoscopes, orthopedic endoscopes, and other forms of endoscopes.

[0022] The systems and devices herein can be combined in one or more of numerous ways to provide improved diagnosis and treatment for patients. The systems and devices provided herein can be combined with existing methods and devices to provide improved treatment, such as in combination with known methods of lung disease diagnosis, surgery, and surgery of other tissues and organs. It is understood that any one or more of the structures and steps described herein can be combined with any one or more additional structures and steps of the methods and devices described herein, and the figures and supporting text provide a description of the embodiments.

[0023] Whenever the term "at least," "greater than," or "greater than or equal to" is listed before the first number in a series of two or more numbers, the term "at least," "greater than," or "greater than or equal to" applies to each and every number in the series. For example, 1, 2, or 3 or more is equivalent to 1 or more, 2 or more, or 3 or more.

[0024] Whenever the term "no more than," "less than," or "less than or equal to" appears before the first number in a series of two or more numbers, the term "no more than," "less than," or "less than or equal to" applies to each of the numbers in the series. For example, 3, 2, or 1 or less is equivalent to 3 or less, 2 or less, or 1 or less.

[0025] As used herein, the terms distal and proximal may generally refer to a location referenced from the device and may be reversed to an anatomical reference. For example, a distal location of a primary shaft or catheter may correspond to a proximal location of an elongate member in a patient, and a proximal location of a primary sheath or catheter may correspond to a distal location of an elongate member in a patient.

[0026] Intubation of an overtube for a robotic endoscopy system For diagnostic and therapeutic procedures in body lumens, clinicians have traditionally performed intubation with manual endoscopes. In the colon, manual colonoscopy can successfully reach targets such as the cecum (the end of the large intestine) relatively easily (e.g., in less than 10 minutes) for most patients. However, the increased size / dimensions of robotic colonoscopy devices can make the intubation process more challenging for robotic colonoscopy systems. During robotic colonoscope-assisted or autonomous intubation processes, an overtube may be utilized to facilitate intubation. An overtube is a sleeve-like device, typically made of semi-rigid plastic or silicone rubber, designed to assist in endoscopy. An overtube with a larger diameter than the diameter of the endoscope is required to provide a pathway through the gastrointestinal (GI) tract.

[0027] Current intubation workflows for robotic colonoscopes can suffer from increased cost, intubation time, and a potential risk of perforation without controlled haptic feedback to the user. A typical workflow for a robotic colonoscope may include docking the colonoscope to a robotic system prior to intubation. As an example, a current intubation workflow for a robotic colonoscope may include engaging an overtube to the colonoscope, coupling the engaged colonoscope and overtube to a robotic drive mechanism, and then intubating the engaged colonoscope and overtube together (controlled by the robotic system) into the subject's lumen through a repetitive process of inflating a balloon, reducing the colon (e.g., shortening and straightening the colon), locking the tip to the colonoscope, deflating the balloon, and advancing the overtube to the tip of the colonoscope, the process being repeated until the device reaches the target site. However, the above workflow can be time-consuming and suffer from a potential risk of perforation without haptic feedback to the user.

[0028] The present disclosure addresses the above-mentioned shortcomings by providing an improved workflow for intubating a robotic colonoscope. Among other things, the workflow may include coupling a robotic colonoscope to a robotic drive mechanism (instrument drive mechanism (IDM)) after the colonoscope has been intubated and while the colonoscope is in a position and orientation dictated by the curvature of the patient's anatomy. Coupling a colonoscope to a robotic drive mechanism is challenging because it is difficult to know the initial colonoscope configuration and orientation once the colonoscope is inside the patient, particularly in a position and orientation dictated by the curvature of the patient's anatomy. Controlling an endoscope (e.g., a colonoscope) requires initialization to couple the endoscope to the robotic drive mechanism, as the robotic system needs to know the initial colonoscope configuration and minimize backlash between the drive mechanism and the tip. Failure to initialize can result in unintended movement and trauma to the patient.

[0029] However, traditional initialization methods may not be suitable for intubated endoscopes. There are generally two initialization approaches for robotic instruments. The first is to place the device in a fixture that maintains the tool in a known position during backlash removal. The second approach is to move toward various degrees of motion and then move away from these limits by a predetermined amount for initialization / calibration. The above approaches are not suitable for docking endoscopic devices that are already intubated or placed within a patient, as they are either impractical (requiring an extra fixture to place the endoscope within the tension fixture) or potentially injurious to the patient (the instrument / colonoscope must be moved to its limits).

[0030] The methods and systems herein may provide an improved docking method for an intubated colonoscope, which can prevent trauma to the patient when coupling the robotic colonoscope to a robotic drive mechanism for robotic endoluminal surgery.

[0031] In an aspect of the present disclosure, a method for intubating a robotic endoscopic device with an overtube is provided. The method may provide an improved workflow, including coupling the robotic colonoscope to a robotic drive mechanism (instrument drive mechanism (IDM)) after the colonoscope has been intubated and while the colonoscope is in a position and orientation defined by the curvature of the patient's anatomy. The method may include intubating the robotic endoscope with the overtube and then coupling the robotic endoscope to the IDM once the intubated robotic endoscope is within the subject's body. The overtube may have a reduced size, details of which are described later in this specification.

[0032] 1 illustrates a schematic diagram of an example intubation process 100 for an endoscopic device. The endoscopic device may be a robotic endoscopic device, such as a robotic colonoscope. The robotic endoscopic device may have increased dimensions due to additional components for robotic control or functionality. For example, the robotic endoscope may have a larger diameter than usual.

[0033] The intubation workflow 100 may include intubating 101 with a first scope 120 (e.g., a manual scope, a manual colonoscope), placing an overtube 110, and advancing both the first scope 120 and the overtube 110 until they reach a certain location. The first scope 120 may be any available endoscope that can be manually inserted into a patient's lumen. The first scope 120 may have dimensions smaller than those of a second scope, such as a robotic scope, that will be intubated. For example, the diameter of the scope 120 may be smaller than the diameter of the robotic scope 130. The intubation process 101 may be a conventional process, such as advancing a curved portion of the scope 120 beyond the tip of the overtube 110 and then advancing the overtube to the tip of the scope 120 until the target site 150 is reached. The overtube 110 may have a reduced size, as will be described in detail later in this specification.

[0034] Once the tip of the scope reaches the target site or area of ​​interest 150, the workflow may include operation 102 of positioning balloon 111 adjacent to the tip of scope 120 by advancing overtube 110 along the bend of scope 120. Next, the workflow may include operation 103 of inflating balloon 111 and removing scope 120, leaving the overtube in place. In some cases, the colon may have been repositioned.

[0035] Next, a second scope, such as a robotic endoscope (e.g., a gastroscope or robotic colonoscope) 130, is inserted through the overtube 104. In some cases, the robotic endoscope 130 may be inserted manually. Once the distal end of the robotic endoscope 130 is positioned at the desired site, the proximal end of the robotic endoscope 130 may be connected to a robotic drive mechanism or instrument drive mechanism (IDM) 140. The workflow may proceed to operation 106, which deflates the overtube balloon, and the overtube may be pulled proximally to expose a bend 131 of the robotic endoscope. In a next operation 107, the overtube balloon 111 is inflated, and the overtube may be grounded, such as via a grounding mechanism 160 located at the proximal end of the overtube.

[0036] The robotic endoscope 130 may then be able to perform any control operations 108 at the site of interest. In some cases, the robotic operations may include an improved initialization process provided by the present disclosure. Once the initialization process is complete, a user or operator may control the robotic colonoscope 130 during surgery. The colonoscope may be operated by a user with robotic controls, such as from a surgeon's console located remotely from the patient. Once the surgery is complete, the robotic colonoscope is disconnected from the robotic drive mechanism and removed from the patient along with the overtube. The overtube may be single-use or disposable. The robotic colonoscope 130 may be single-use or disposable. Alternatively, at least a portion of the robotic colonoscope is reusable.

[0037] Initialization of an intubated endoscope (i.e., the endoscope is already inserted within the patient's anatomy) can be difficult. As noted above, conventional methods are not suitable for docking an endoscopic device (where the scope has a tortuous path) that is already intubated or positioned within the patient, as they are either impractical (requiring an extra fixture to position the endoscope within the tension fixture) or potentially injuring the patient (the instrument / colonoscope must be moved to its limits).

[0038] The methods and systems herein may provide an improved docking method for an intubated colonoscope, which can prevent trauma to the patient when coupling the robotic colonoscope to a robotic drive mechanism for robotic endoluminal surgery.

[0039] 12 shows an example of an algorithm 120 for initialization of a robotic endoscope (e.g., a robotic colonoscope) to an instrument drive mechanism (IDM). In some embodiments, the robotic system may utilize motor current from the IDM to sense transmitted load and utilize pull wires (cables) within the robotic endoscope (e.g., colonoscope, gastroscope) to transmit motion.

[0040] The above method may be applied to any suitable robotic endoscope system. The robotic endoscope system may be the same as that described in FIGS. 13-15 and / or 7-11. As shown in FIGS. 13-15, a robotic endoscope (e.g., colonoscope, gastroscope) 1500 may be detachably coupled to an instrument drive mechanism 1320. The instrument drive mechanism 1320 may be mounted on an arm of the robotic support system 1300 or on any actuation support system, as described elsewhere herein. The instrument drive mechanism may provide a mechanical and electrical interface to the robotic endoscope 1500. The mechanical interface may allow the robotic endoscope 1110 to be detachably coupled to the instrument drive mechanism. For example, the handle portion 1501 of the robotic gastroscope may be attached to the instrument drive mechanism via a quick-attach / release means, such as a magnet and spring-loaded level. In some cases, the robotic gastroscope may be manually coupled to or released from the instrument drive mechanism without tools.

[0041] 13 and 14 show an example of an instrument drive mechanism (IDM) 1320 that provides a mechanical interface to a handle portion of a robotic endoscope 1500. In some cases, a system may include an IDM 1320 for the robotic endoscope attached to the robotic arm 1300 and one or more IDMs 1331, 1333 for one or more instruments (e.g., suturing instruments). As shown in this example, the instrument drive mechanism (IDM) 1320 for the robotic endoscope 1500 may include a set of motors 1401 that are actuated to rotationally drive a set of puller wires of a flexible robotic endoscope or catheter. The handle portion of a catheter assembly may be attached to the instrument drive mechanism 1320 such that the capstans of its pulley assembly or IDM interface 1511 are driven by the set of motors 1401. The number of pulleys may vary based on the puller wire configuration. In some cases, one, two, three, four, or more puller wires may be utilized to articulate the bending section 1505 of a flexible robotic endoscope or catheter. Similarly, an instrument drive mechanism (IDM) 1331 for an instrument (e.g., a suturing instrument) may include a set of motors that are actuated to rotationally drive a set of puller wires for that instrument.

[0042] The handle portion may be designed to allow the robotic gastroscope to be low-cost and disposable. For example, classic manual gastroscopes and robotic gastroscopes may have a cable at the proximal end of the gastroscope handle. The cable often includes an illumination fiber, a camera video cable, and other optional sensor fibers or cables, such as electromagnetic (EM) sensors or shape-sensing fibers. Such composite cables can be expensive and increase the cost of the gastroscope. The provided robotic gastroscope may have an optimized design that allows for simplified structures and components while maintaining mechanical and electrical functionality. In some cases, the handle portion of the robotic gastroscope may use a cable-free design while providing a mechanical / electrical interface to the catheter. The robotic scope may include a tip 1507 with integrated components. Details regarding the robotic endoscope and distal tip are provided later in this specification.

[0043] Referring again to FIG. 12 , the robotic operator may include an instrument drive mechanism (IDM) that houses multiple motors (e.g., four motors) to facilitate independent control of each steering component in an accompanying robotic endoscope (e.g., colonoscope). The robotic colonoscope may be the same as those described elsewhere herein. For example, the robotic colonoscope may have a long, flexible shaft with a steerable distal tip and a proximal handle for coupling to the instrument drive mechanism (IDM). In some embodiments of the initialization process, the colonoscope may be initialized to the instrument drive mechanism by using motor current from the IDM to sense the transmitted load and a pull wire (e.g., cable) within the colonoscope to transmit motion.

[0044] The algorithm 1200 may allow slack removal in the antagonistic transmission of the flexible robotic flexure 1210 while allowing the flexure 1210 to adapt to the environment in which it is initially placed (e.g., the flexure has a position, orientation and / or shape that adapts to the curvature or serpentine shape of the patient's anatomy).

[0045] The above algorithm assumes that a degree of freedom (DOF) is driven in opposition by two actuators. For example, two puller wires may be driven by two actuators, each corresponding to one DOF (e.g., in opposite directions). The two actuators may be independent and controlled by a control algorithm to cooperate with each other to tension and sag the two puller wires. In some cases, both puller wires are pulled to set an initial tensioned state. In some cases, pulling one puller wire while sagging the other provides movement. In some cases, sagging both puller wires may facilitate removal of the endoscopic device from tortuous paths by passively conforming the bend to the anatomy. In an alternative embodiment, one DOF may be driven by a single actuator. For example, two pull wires may be coupled in opposition to the driven pulley to drive the movement of the bend (i.e., in one degree of freedom) such that as the pulley rotates in one direction, one pull wire is tensioned while the second pull wire is slack.

[0046] As shown in FIGS. 14 and 15 , colonoscope 1500 includes an IDM interface 1511, a flexible elongated shaft 1503, and a handle 1501 for attachment to an IDM via a steerable flexure 1505. In the illustrated example, the colonoscope has four cable transmissions (i.e., pull wires) that terminate distally from the steerable flexure and continue via the elongated shaft to a proximal capstan 1513 housed within the handle. When the handle is attached to the IDM (shown in FIG. 14 ), capstan 1513 may be aligned with the output shaft 1403 of IDM motor 1401 so that rotation of the output shaft produces a corresponding rotation in the colonoscope capstan. Rotation of the colonoscope capstan in one direction decreases tension in the cables, while rotation in the other direction increases tension in the cables. In some cases, the cables in the distal portion of the colonoscope are spatially arranged so that one pair of cables (corresponding to one degree of freedom of the bending section, such as yaw) lies in a plane that intersects the neutral axis of the bending section. The other two cables may lie in orthogonal planes that intersect the neutral axis of the bending section (e.g., pitch). The pair of cables corresponding to one degree of freedom may be driven by a pair of actuators (motors).

[0047] Initializing the colonoscope to the IDM may include removing any slack in the pull wires (cables). As shown in FIG. 12, the initialization algorithm 1200 may include commanding a pair of actuators to move 1201 in the respective pull directions. In some cases, the pair of actuators may move at a constant speed in the actuation direction while the applied load is monitored. The constant speed may be within a predetermined range to ensure that the initialization process occurs quickly without damaging the cables. The predetermined range may be based on empirical data. In some cases, the constant speed may vary based on various bend configurations (e.g., pull wire connections / layouts), may be the same or different across various degrees of freedom (e.g., the constant speed associated with pitch may be the same or different from the constant speed associated with yaw), and may be adjusted based on various usage scenarios. In some cases, the constant speed may be configurable by the user via a user interface. Alternatively, the constant speed may be automatically adjusted or determined (e.g., during a calibration process prior to inserting the endoscope into a subject's body).

[0048] The system may monitor the applied load based on any suitable sensor data or measurements. In some embodiments, the system may monitor the applied load based on the motor current of each motor. This advantageously allows for load measurement without requiring extra components.

[0049] The monitoring may include continuously determining whether the difference in load (i.e., tension difference) in the pair of cables is greater than a predetermined “discrimination threshold” (e.g., sub-threshold 1202). If the tension difference is greater than the predetermined discrimination threshold, the actuator with the greater load is paused 1203 while the other actuator continues to move. By constantly comparing the tension difference to various thresholds or sub-thresholds 1202 and adjusting the tension difference accordingly, the tension difference in the pair of cables may be maintained within an acceptable range, and thus movement of the bending section / distal portion of the endoscope is maintained within an acceptable range from its current position / orientation. The sub-threshold 1202 may be predetermined based on empirical data. In some cases, the sub-threshold 1202 may vary based on various bending section configurations (e.g., pull wire connections / layout), may or may not be the same across various degrees of freedom (e.g., the sub-threshold associated with pitch may or may not be the same as the sub-threshold associated with yaw), and may be adjusted based on various usage applications. In some cases, the sub-threshold may be configurable by the user via a user interface. Alternatively, the minor threshold may be adjusted automatically (eg, during a calibration process prior to inserting the endoscope into the subject's body).

[0050] As the other actuator continues to move, the load difference or tension differential decreases, and when the tension differential is detected to be at or below a "discrimination threshold" 1204, both actuators may resume movement in their respective actuation directions 1201. This process may be repeated, increasing the load or tension on the pair of cables until the tension in at least one of the cables reaches a predetermined high threshold (e.g., is detected as being at or above the high threshold) 1205. The high threshold may refer to a load threshold that is higher than the low threshold. The high threshold may be determined based on empirical data. In some cases, the high threshold 1205 may vary based on various bend configurations (e.g., pull wire connections / layout), may be the same or different across various degrees of freedom (e.g., a high threshold associated with pitch may be the same or different from a high threshold associated with yaw), and may be adjusted based on various usage applications (e.g., target site environment, etc.). In some cases, the high threshold may be configurable by a user via a user interface. Alternatively, the high threshold may be automatically adjusted (e.g., during a calibration process prior to inserting the endoscope into a subject's body).

[0051] If the tension in at least one of the cables reaches (e.g., is detected as being at or greater than) a predetermined high threshold, the corresponding actuator may be stopped from moving while the other actuator continues to move until its tension also reaches the high threshold 1207. The algorithm may instruct the other actuator to stop moving, and the initialization process is completed.

[0052] In some cases, once slack is removed for one pair of cables (e.g., corresponding to a first degree of freedom), the process may be repeated for the other pair of cables (e.g., corresponding to a second degree of freedom). In some cases, the process may be performed simultaneously for two or more DOFs to reduce overall initialization time. Alternatively, the process may be performed sequentially for different DOFs to avoid crosstalk between DOFs during initialization.

[0053] The above-described algorithm may beneficially remove any bends or slack present in the tension wires or cables while the robotic colonoscope is positioned inside a subject's body. This above-described method may not require knowledge of the initial (current) shape, orientation, or position of the robotic colonoscope. While the above-described algorithm is described in the context of the robotic scope or colonoscope intubation process, it is noteworthy that the above-described algorithm may be performed or applied in any situation when initialization of the robotic scope is desired while the scope is positioned inside a subject's body, regardless of the type of scope. For example, during a surgical procedure, if the system's operation is suspended for safety reasons or due to any type of malfunction, the robotic scope may be initialized from its current position / orientation without damaging tissue by performing the above-described method.

[0054] Reduced-size overtube device As described in the intubation process of FIG. 1 , intubating or inserting a second scope (e.g., a robotic endoscope, a gastroscope) into the transverse colon can be difficult because the second scope (e.g., a robotic endoscope, a gastroscope) may have a different size or rigidity than the first scope (e.g., a standard colonoscope or a manual scope). For example, a gastroscope may have a larger diameter than a standard colonoscope (e.g., 18 mm vs. 13 mm), a higher rigidity, and a shorter length (e.g., 80 cm vs. 160 cm). Because the diameter difference between the second scope (e.g., a robotic endoscope, a gastroscope) and the first scope (e.g., a standard colonoscope or a manual scope) can be large (e.g., about 5 mm or more), the overtube used to deliver the second scope must be large enough to accommodate the second scope. For example, the diameter of the overtube is larger than (>) the outer diameter of the second scope. However, attempting to intubate the colon with such an overtube in conjunction with a smaller-diameter first scope can pose potential risks and difficulties. For example, the gap between the overtube and a standard colonoscope can cause the overtube to snag on tissue and prevent its advancement. Additionally, one difficulty users experience during balloon-assisted overtube intubation is the large size of the overtube device.

[0055] The present disclosure provides a novel overtube with a reduced size during initial intubation that can be used with an endoscope or colonoscope to facilitate insertion, manipulation, and retraction of the endoscope during colonoscopy, upper gastrointestinal (GI) tract endoscopy, gastroscopy, small intestine endoscopy, or other procedures. In some embodiments, the overtube herein may have a variable internal space size to accommodate the passage of various diameter scopes. In particular, the present disclosure provides a reduced-size overtube device for overtube intubation that has the ability to accommodate various diameter scopes. In some cases, the outer diameter of the overtube during the initial intubation process may be smaller than the outer diameter of the overtube during intubation for a larger scope. The term "initial intubation" as used herein may refer to the intubation process with a smaller diameter scope (e.g., operation 101 in FIG. 1 ). For example, the overtube device may be expandable to deliver a scope (e.g., a gastroscope or robotic scope) larger than the size of the scope used for initial intubation. In some cases, the dimensions of the interior space of the overtube for passing a scope during the initial intubation process may be smaller than the dimensions of the interior space of the overtube during intubation for larger scopes.

[0056] In some aspects of the present disclosure, a reduced-size expandable overtube device is provided. The overtube device may have a substantially tubular shape and a compact configuration. The overtube device may have a deformable elongate body to accommodate various diameters of scopes. In some embodiments, the overtube device may be delivered within a target anatomical structure (e.g., the colon) and have a first diameter (e.g., outer or inner diameter) during the intubation process, and may be radially expanded to allow passage of a device larger than the first diameter of the scope used for intubation.

[0057] In some cases, the overtube may be pleated along its diameter so that the tube in its relaxed state includes one or more folds and creates a small-diameter temporary lumen. The lumen may refer to the space inside a substantially tubular structure. As used herein, the term "lumen" may refer to the space inside a substantially tubular structure, a partial lumen, i.e., the space inside a partial tubular structure (e.g., without a wall), or a space defined by a substantially tubular structure having any suitable cross-sectional shape or dimensions. The temporary lumen may allow passage of a smaller-diameter first scope during intubation. In the actuated state, the inner diameter of the overtube may expand, thereby removing the pleats and allowing passage of a second scope (e.g., a gastroscope). The actuated state may allow insertion of an object (e.g., a gastroscope) larger than the sheath in its relaxed state. The pleated sheath may expand around the larger object to allow passage of the object and conform to the diameter of the object.

[0058] FIG. 2 shows an example of an expandable overtube device 200 used for intubation. The overtube device 201 may be a pleated, radially expandable overtube. In some cases, the overtube device 201 may have a flat tubular configuration, where the flat inner diameter is large enough to allow a second scope (e.g., a gastroscope) 203 to pass through. The expandable overtube 201 may be configured to wrap around the endoscope 203 without completely enclosing it, where the pleating feature may allow the overtube to accommodate scopes having various diameters. As shown in this example, the pleating feature may be along the axial direction of the flat tubular configuration, allowing the flat tubular configuration to radially expand.

[0059] 3A-3B show another example of an expandable overtube 300 with a folding feature. The overtube 300 may include a temporary longitudinal seam 302. In some cases, the overtube may be configured to roll or fold along its longitudinal axis to create a temporary lumen (or partial lumen with a split) 305 for engagement with a first scope (e.g., a smaller diameter scope 311) (e.g., a standard colonoscope) for initial intubation.

[0060] As illustrated in FIG. 3B, the overtube may be folded to engage a standard colonoscope shaft 311 during initial intubation 310. The flat overtube configuration may provide a geometry that can be wrapped around a colonoscope shaft for entry into the anatomy. By wrapping around a standard colonoscope during initial intubation, the outer diameter of the flat overtube is reduced. In some cases, folding or rolling the flat overtube may form a lumen that can be positioned at the tip of the scope or at a predetermined location along the scope shaft. The folding or rolling features may be discrete or continuous. FIG. 3C shows an example of one or more clip features 307 at discrete locations along its length that form the overtube into a substantially tubular lumen for initial intubation. The folding or rolling features 307 may beneficially adjust the size of the tubular lumen, such as by holding the lumen against a smaller diameter scope during initial intubation and then allowing the lumen to expand to accommodate a larger diameter scope.

[0061] Referring again to FIG. 3B , in some embodiments, the overtube may include a main lumen 301 and a temporary lumen 305. The dimensions (e.g., diameter) of each lumen may be adjustable. For example, the diameter of the second lumen (e.g., main lumen 301) is adjusted by collapsing / unfolding the first lumen (e.g., temporary lumen 305). During the process 320 of intubating a larger scope 313, the second lumen (e.g., main lumen 301) may be adapted to receive the larger scope. In some cases, the stationary, flat tube may be rolled along its longitudinal axis such that the rolled tube forms a temporary lumen 305 through which a first scope (e.g., a standard colonoscope 311) can be inserted (shown in FIG. 3B ). The smaller colonoscope 311 may engage the outer surface 303 of the flat temporary lumen 305 against its inner surface. The passage diameter of main lumen 301 is adjusted or determined by at least temporary lumen 305. A larger scope may be inserted through main lumen 301 by contacting the overtube's inner surface 304 or by deploying temporary lumen 305. The assembled overtube and standard colonoscope 311 together have a smaller introduction diameter (outer diameter) than if the colonoscope were placed inside the overtube.

[0062] The temporary lumen 305 may be engaged with a first scope (e.g., a standard colonoscope or smaller scope) for initial intubation 310. Once the assembled first scope and overtube reach the target site illustrated in FIG. 1, the first scope may be withdrawn and a second scope 313 (e.g., a gastroscope or larger scope) may be placed 320 through the main lumen of the overtube until the target site is reached.

[0063] In some embodiments, the dimensions of the tubular structure of the overtube device may be adjustable based on the collapsible configuration of the tube. For example, the main lumen 301 may be expandable to accommodate a larger scope by unfolding the flat main lumen configuration. In some cases, the edges 309 of the collapsed configuration may be removably coupled (e.g., rollable). In some cases, the edges of the collapsed configuration may be separable but actively engaged. Alternatively, the edges of the collapsed configuration may be separated but passively positioned relative to one another. The collapse feature may include passive engagement, active engagement, or a combination of both, as well as various other features.

[0064] In some cases, passive folding features (passive engagement features) may be used to create the desired fold in a resting state. For example, the passive folding feature may include one or more split rings (e.g., split ring clip 205 in FIG. 2) positioned along the length of the flat-laid tube, the resting state of the split rings being closed. FIG. 3C shows an example of one or more clip features 307 that form the overtube into a substantially tubular lumen for initial intubation. In another example, the passive folding feature may include a detachable or peelable bi-lumen, where each lumen is securely attached to one edge of the flat-laid tube, and separating the lumens from each other facilitates deployment of the flat-laid primary lumen configuration. In a further example, the passive folding feature may include a detachable or peelable thermal bond between the edges of the flat-laid tube (or features attached to the flat-laid tube). Various other passive features, such as slidably positioned rings or discs that can be removed from the flat-laid tube, may also be utilized to allow expansion of the overtube.

[0065] In some cases, active engaging or disengaging features of the overtube may be utilized to create the desired energy-mediated collapse. For example, the active engaging features may include one or more magnets positioned along the edges of the flat-laying tube that are attracted to each other or to ferrous materials on opposing sides. In another example, the active engaging features may include a cable or thread that traverses one lumen and then crosses over to anchor in an adjacent lumen at the opposing flat-laying edge, such that tension in the cable pulls the flat-laying edges toward each other, thereby engaging the scope. In a further example, the active engaging features may include a cable or thread that passes through, but is not anchored to, eyelets that alternate the edges of the flat-laying tube. Removing the cable or thread releases and unfolds the flat-laying tube. Other active engagement features may also be utilized, such as positive or negative pressure applied to a closed volume along the flat-laid tube, such that either positive or negative pressure, or a combination of both, provides the stimulus to collapse or unfold the flat-laid lumen, although the above examples are for illustrative purposes only and are not intended to be limiting.

[0066] The flexible overtube may be formed from any suitable material, such as a polyurethane, polypropylene, or polyethylene material. In some cases, a material (e.g., polyurethane) may be selected to more easily bond and create seams by heat or radio frequency welding. The various folding features (e.g., slit ring clip 205) may be formed from any suitable material, such as polyurethane, polypropylene, polyethylene, polycarbonate, or any biocompatible semi-rigid material that can handle the tension required during insertion of a larger colonoscope.

[0067] During intubation, the assembled colonoscope and overtube may be advanced together through the colon to the target site. Once the target site is reached, the overtube balloon may be inflated. Inflating the balloon may anchor the overtube to the colon wall, and the overtube may be pulled proximally to reduce (e.g., shorten and straighten) the colon. The first scope (e.g., colonoscope) may be removed from the colon, and a second scope (e.g., gastroscope) may be placed through the main lumen of the overtube to the target site.

[0068] In some cases, balloon inflation may act as a release mechanism for the temporary lumen. For example, depending on the collapsible function of the overtube, balloon inflation may cause deformation of a split ring at the distal end of the overtube, initial separation of the peelable dual lumens, initial separation of the peelable thermal bond, displacement of a magnet breaking its attractive force, displacement of a thread so that it no longer engages the eyelet, thereby allowing the primary lumen to expand, etc. Initial engagement with the first scope (e.g., a colonoscope) can be released through a variety of other mechanisms that may or may not be related to balloon inflation. For example, fluid flow through the fill lumen may displace a magnet, thereby removing a bond or positioning the magnets in a repelling relationship, creating a positive separation.

[0069] In an alternative embodiment, the overtube device may include concentric radially expanding and stiffening overtubes. The overtube device may comprise a concentric tubular structure with a stiffening medium therebetween. The concentric tubes may have a smaller diameter for primary intubation. After placement of the tubes at the target site, the inner tube may be pressurized, causing the inner and outer tubes to radially expand. While the inner tube is pressurized, the space between the inner and outer tubes may be placed under a vacuum so that the stiffening medium between the inner and outer tubes is locked in place against the surfaces of the expanded inner and outer tubes. After stiffening the structure, the inner tube may be depressurized, preventing the stiffening of the structure from radially collapsing. The stiffening medium may comprise any suitable material or combination of materials, including, but not limited to, a thin film with overlapping edges, a braided structure made from metal or plastic filaments, a foam with a porosity and surface finish that promotes stiffening, or any other granular medium.

[0070] In alternative embodiments, the overtube device may vary the dimensions of the tubular structure using a collapsible configuration. In some cases, the overtube device may comprise a flat overtube sealed at its distal end so that the interior volume can be placed under a vacuum to reduce the exterior profile of the overtube. The reduced exterior profile is used to facilitate insertion of the overtube into the anatomy, and the vacuum is released before exchanging a first scope (e.g., a standard colonoscope) for a larger second scope (e.g., a gastroscope or robotic scope).

[0071] 4 and 5 show an example of an overtube device 400 with a collapsible overtube. FIG. 4 shows an example of an overtube 400 that provides volume reduction through an internal vacuum during initial intubation. The overtube may remove its internal volume through the use of a vacuum. As shown in this example, the internal space between the lumen layers may be reduced by the vacuum. FIG. 5 shows an example of an overtube device with a collapsible overtube.

[0072] In alternative embodiments, the overtube device may include a multi-lumen configuration. In some cases, the overtube device may include a thin-walled multi-lumen configuration with suture folds.

[0073] FIG. 6A shows an example of an overtube device 600 having a multi-lumen configuration. In the illustrated example, the overtube may have a flat tubular configuration with a dividing layer 611 separating a smaller channel 601 from a larger channel 603. The smaller channel may form a first lumen for receiving a smaller scope, and the larger channel may form a second lumen for receiving a larger scope, where the first and second lumens coexist but are variable in size. As shown in this example, the smaller channel 601 may be used to pass a smaller first scope (e.g., a colonoscope) 605, and the larger channel 603 may be able to pass a larger second scope 607. The flexibility of the lumen separator (e.g., dividing layer 611) allows the smaller channel to open for the smaller colonoscope for initial intubation and then collapse when the smaller colonoscope is not engaged. Additionally, the suture may be positioned and pulled to hold the larger lumen in a collapsed state until the physician desires to expand the larger lumen to pass a larger scope. The example in Figure 6B shows an example of a suture 609 that follows a helical pattern to hold the larger lumen. Various other patterns of suture positioning relative to the lumen can be used.

[0074] flexible endoscope The intubation methods and devices can be used in robotic endoscope systems. In some cases, the intubation methods and devices herein may be applied to single-use or reusable robotic endoscopes. Endoscopes have traditionally been made to be reusable, which can require thorough cleaning, disinfection, and / or sterilization after each procedure. In most cases, cleaning, disinfection, and sterilization can be aggressive processes to kill pathogens and / or bacteria. Such procedures can also be harsh on the endoscope itself. Therefore, the design of such reusable endoscopes can often be complex, especially to ensure that the endoscope can survive such harsh cleaning, disinfection, and sterilization protocols. Periodic maintenance and repairs on such reusable endoscopes can often be required.

[0075] Low-cost disposable medical devices designated for single-use have become increasingly popular for instruments that are difficult to properly clean. Single-use disposable devices may be packaged in sterile packaging to avoid the risk of pathogenic cross-contamination with diseases such as HIV, hepatitis, and other pathogens. Hospitals generally welcome the convenience of single-use disposable products because they no longer have to worry about product lifespan, overuse, breakage, malfunction, and sterilization. Traditional endoscopes often include a handle that operators use to manipulate the endoscope. For single-use endoscopes, the handle typically houses a camera, expensive electronics, and mechanical structures at the proximal end to transmit video and allow the user to manipulate the endoscope via a user interface. This can lead to high costs for handles for single-use endoscopes.

[0076] In some embodiments, the overtube devices and methods provided herein may be utilized to intubate a flexible endoscope, which may be single-use or disposable. Alternatively, the flexible endoscope may be reusable. FIG. 7 illustrates an example of a flexible endoscope 1000 according to some embodiments of the present disclosure. As shown in FIG. 7, the flexible endoscope 1000 may include a handle / proximal portion 1009 and a flexible elongate member that is inserted into a subject. The flexible elongate member may be the same as those described above. In some embodiments, the flexible elongate member may include a proximal shaft (e.g., insertion shaft 1001), a steerable tip (e.g., tip 1005), a steerable section (active bending section 1003), and a passive prolapse prevention section 1004. The active bending section, passive prolapse prevention section, and proximal shaft may be the same as those described elsewhere herein. The endoscope 100 may also be referred to as a steerable catheter assembly, as described elsewhere herein. In some cases, endoscope 100 may be a single-use robotic endoscope. In some cases, the entire catheter assembly may be disposable. In some cases, at least a portion of the catheter assembly may be disposable. In some cases, the entire endoscope may be released from the instrument drive mechanism and disposed of. In some embodiments, the endoscope may include varying degrees of stiffness along its axis to improve functional operation.

[0077] The endoscope or steerable catheter assembly 1000 may include a handle portion 1009, which may include one or more components configured to process image data, provide power, or establish communication with other external devices. For example, the handle portion may include circuitry and communication elements to enable electrical communication between the steerable catheter assembly 1000 and instrument drive mechanism (not shown) and any other external systems or devices. In another example, the handle portion 1009 may include circuitry such as a power supply for powering the endoscope's electronics (e.g., camera, electromagnetic sensors, and LED lights).

[0078] One or more components located in the handle may be optimized to reduce costs and simplify the design of the single-use endoscope by allocating expensive and complex components to the robotic support system, handheld controller, or instrument drive mechanism. The handle or proximal portion may provide an electrical and mechanical interface to enable electrical and mechanical communication with the instrument drive mechanism. The instrument drive mechanism may include a set of motors that are actuated to rotationally drive a set of puller wires of the catheter. The handle portion of the catheter assembly may be attached to the instrument drive mechanism such that its pulley / capstan assemblies are driven by the set of motors. The number of pulleys may vary based on the puller wire configuration. In some cases, one, two, three, four, or more puller wires may be utilized to articulate the flexible endoscope or catheter.

[0079] The handle portion may be designed to allow the robotic endoscope to be low-cost and disposable. For example, classic manual endoscopes and robotic endoscopes may have cables at the proximal end of the endoscope handle. The cables often include illumination fibers, camera video cables, and other sensor fibers or cables, such as electromagnetic (EM) sensors or shape-sensing fibers. Such composite cables can be expensive and increase the cost of the endoscope. The provided robotic endoscope may have an optimized design that allows for the use of simplified structures and components while maintaining mechanical and electrical functionality. In some cases, the handle portion of the robotic endoscope may use a cable-free design while providing a mechanical / electrical interface to the catheter.

[0080] An electrical interface (e.g., a printed circuit board) may allow image / video data and / or sensor data to be received by a communication module of the instrument drive mechanism and transmitted to other external devices / systems. In some cases, the electrical interface may establish electrical communication without cables or wires. For example, the interface may include pins soldered onto an electronics board, such as a printed circuit board (PCB). For example, a receptacle connector (e.g., a female connector) may be provided on the instrument drive mechanism as a mating interface. This advantageously allows the endoscope to be quickly plugged into the instrument drive mechanism or robotic support without utilizing extra cables. Such an electrical interface may also serve as a mechanical interface, such that both a mechanical and electrical coupling are established when the handle portion is plugged into the instrument drive mechanism. Alternatively, or in addition, the instrument drive mechanism may provide only the mechanical interface. The handle portion may be in electrical communication with the modular wireless communication device or any other user device (e.g., a portable / handheld device or controller) for transmitting sensor data and / or receiving control signals.

[0081] In some cases, the handle portion 1009 may include one or more mechanical control modules, such as a luer 1011 for interfacing with an irrigation / aspiration system. In some cases, the handle portion may include a lever / knob for articulation control. Alternatively, the articulation control may be located on a detachable controller attached to the handle portion via the instrument drive mechanism.

[0082] The endoscope may be attached to a robotic support system or a handheld controller via an instrument drive mechanism. The instrument drive mechanism may be provided by any suitable controller device (e.g., a handheld controller), which may or may not include a robotic system. The instrument drive mechanism may provide a mechanical and electrical interface to the steerable catheter assembly 1000. The mechanical interface may allow the steerable catheter assembly 1000 to be removably coupled to the instrument drive mechanism. For example, a handle portion of the steerable catheter assembly may be attached to the instrument drive mechanism via a quick-attach / release means, such as a magnet, a spring-loaded level, or the like. In some cases, the steerable catheter assembly may be manually coupled to or released from the instrument drive mechanism without the use of tools. More details regarding the instrument drive mechanism are provided later in this specification.

[0083] In the illustrated example, the distal tip of the catheter or endoscope shaft is configured to articulate / bend in two or more degrees of freedom to provide a desired camera field of view or to control the direction of the endoscope. As illustrated in this example, an imaging device (e.g., a camera) and a position sensor (e.g., an electromagnetic sensor) 1007 are located at the tip of the catheter or endoscope shaft 1005. For example, the camera's line of sight may be controlled by controlling the articulation of the active bending section 1003. In some examples, the camera's angle may be adjustable so that the line of sight can be adjusted without or in addition to articulating the distal tip of the catheter or endoscope shaft. For example, the camera may be oriented at an angle (e.g., tilt) relative to the axial direction of the endoscope tip using an optical component.

[0084] The distal tip 1005 may be a rigid component onto which sensors, such as electromagnetic (EM) sensors, imaging devices (e.g., cameras), and other electronic components (e.g., LED light sources) can be positioned that are embedded at the distal tip.

[0085] In real-time EM tracking, an EM sensor, consisting of one or more sensor coils embedded at one or more locations and orientations in a medical instrument (e.g., the tip of an endoscopic tool), measures variations in an electromagnetic field created by one or more electrostatic field generators positioned near the patient. The position information detected by the EM sensor is stored as EM data. The electromagnetic field generator (or transmitter) may be placed near the patient to create a low-intensity magnetic field that can be detected by the embedded sensor. The magnetic field induces small currents in the EM sensor's sensor coils, which may be analyzed to determine the distance and angle between the EM sensor and the electromagnetic field generator. For example, an electromagnetic field generator may be positioned near the patient's torso during surgery to determine the EM sensor's location in 3D space, or the EM sensor's location and orientation in 5D or 6D space. This may provide visual guidance to the operator as they navigate the endoscope toward the target site.

[0086] The endoscope may have a unique design in the elongate member. In some cases, the endoscope's active bending section 1003, passive anti-pullout section, and proximal shaft may be comprised of a single tube that includes a series of cuts (e.g., reliefs, slits, etc.) along its length to allow for increased flexibility, desired stiffness, and anti-pullout functionality (e.g., defining a minimum bend radius).

[0087] As described above, the active bending section 1003 may be designed to bend (e.g., articulate) in two or more degrees of freedom. Larger degrees of bending, such as 180 degrees and 270 degrees (or other articulation parameters for clinical indications), may be achievable through the unique structure of the active bending section, while kinking or prolapse may be prevented by the passive section following the active bending section. In some cases, the active bending section and / or the passive section may be fabricated separately as modular parts and assembled to the proximal shaft. In some cases, the cut patterns of the active bending section and the passive section may be different such that at least the minimum bend radius of the two sections may differ. In some cases, a variable minimum bend radius along the axial axis of the elongate member may be provided such that the active bending section or the passive section may include two or more different minimum bend radii.

[0088] The articulation of the endoscope may be controlled by applying force to the distal tip of the endoscope via one or more pull wires. The one or more pull wires may be attached to the distal tip of the endoscope. In the case of multiple pull wires, pulling one wire at a time can change the orientation of the distal tip pitch up, down, left, right, or in any direction required. In some cases, the pull wires may be anchored to the distal tip of the endoscope, run through a bend, and enter a handle where they are coupled to a drive component (e.g., a pulley). The handle pulley may interact with an output shaft from a robotic system.

[0089] In some embodiments, the proximal ends or portions of one or more puller wires may be operably coupled to various mechanisms (e.g., gears, pulleys, capstans, etc.) in the handle portion of the catheter assembly. The puller wires may be metal wires, cables, or threads, or polymer wires, cables, or threads. The puller wires may also be made from natural or organic materials or fibers. The puller wires may be any type of suitable wire, cable, or thread capable of supporting various types of loads without deformation, significant deformation, or breakage. The distal ends / portions of one or more puller wires may be anchored or integrated into the distal portion of the catheter, such that operation of the puller wires by the controller may apply a force or tension to the distal portion that can steer or articulate at least the distal portion (e.g., flexible section) of the catheter (e.g., up, down, pitch, yaw, or any direction in between).

[0090] The puller wires may be made from any suitable material, such as stainless steel (e.g., SS316), metals, alloys, polymers, nylon, or biocompatible materials. The puller wires may be wires, cables, or threads. In some embodiments, different puller wires may be made from different materials to vary the load-bearing capacity of the puller wires. In some embodiments, different sections of the puller wires may be made from different materials to vary stiffness and / or load-bearing capacity along the pull. In some embodiments, the puller wires may be utilized to transmit electrical signals.

[0091] The proximal design may improve device reliability without incurring extra costs, thereby enabling a low-cost, single-use endoscope. In another aspect of the present invention, a single-use robotic endoscope is provided. The robotic endoscope may be a gastroscope and may be the same as the steerable catheter assembly described elsewhere herein. Traditional endoscopes may be complex in design and are typically designed to be reused after surgery, thereby requiring extensive cleaning, disinfection, or sterilization after each procedure. Existing endoscopes are often designed with complex structures to ensure they can withstand the cleaning, disinfection, and sterilization processes. The provided robotic endoscope may be a single-use endoscope, which may beneficially reduce cross-contamination between patients and infectious diseases. In some cases, the robotic gastroscope may be delivered to a medical practitioner in a pre-sterilized package and is intended to be disposed of after a single use.

[0092] As shown in FIG. 8, the robotic gastroscope 1120 may include a handle portion 1113 and a flexible elongate member 1111. In some embodiments, the flexible elongate member 1111 may include a shaft, a steerable tip, a steerable / active bending section, and a passive prolapse prevention section. The robotic gastroscope 1120 may be the same as the steerable catheter assembly described in FIG. 7. The robotic gastroscope may be a single-use robotic endoscope. In some cases, only the catheter may be disposable. In some cases, at least a portion of the catheter may be disposable. In some cases, the entire robotic gastroscope may be released from the instrument drive mechanism and disposed of. In some cases, the gastroscope may include varying degrees of stiffness along its axis to improve functional operation. In some cases, the minimum bend radius along the axis may vary such that kink resistance or prolapse prevention may be configurable along the length.

[0093] The robotic gastroscope may be detachably coupled to the instrument drive mechanism 1120. The instrument drive mechanism 1120 may be mounted on an arm of the robotic support system or on any actuation support system, as described elsewhere herein. The instrument drive mechanism may provide a mechanical and electrical interface to the robotic gastroscope 1110. The mechanical interface may allow the robotic gastroscope 1110 to be detachably coupled to the instrument drive mechanism. For example, the handle portion of the robotic gastroscope may be attached to the instrument drive mechanism via quick installation / release means, such as a magnet and spring-loaded level. In some cases, the robotic gastroscope may be manually coupled to or released from the instrument drive mechanism without tools.

[0094] FIG. 9 shows an example of an instrument drive mechanism 1220 that provides a mechanical interface to the handle portion 1213 of a robotic endoscope. As shown in this example, the instrument drive mechanism 1220 may include a set of motors that are actuated to rotationally drive a set of puller wires of a flexible endoscope or catheter. The handle portion 1213 of the catheter assembly may be attached to the instrument drive mechanism such that its pulley assemblies or capstans are driven by the set of motors. The number of pulleys may vary based on the puller wire configuration. In some cases, one, two, three, four, or more puller wires may be utilized to articulate the flexible endoscope or catheter.

[0095] The handle portion may be designed to allow the robotic gastroscope to be low-cost and disposable. For example, classic manual gastroscopes and robotic gastroscopes may have a cable at the proximal end of the gastroscope handle. The cable often includes an illumination fiber, a camera video cable, and other sensor fibers or cables, such as electromagnetic (EM) sensors or shape-sensing fibers. Such composite cables can be expensive and increase the cost of the gastroscope. The provided robotic gastroscope may have an optimized design that allows for simplified structures and components while maintaining mechanical and electrical functionality. In some cases, the handle portion of the robotic gastroscope may use a cable-free design while providing a mechanical / electrical interface to the catheter.

[0096] FIG. 10 shows an example of an endoscope distal tip 1300. In some cases, the distal portion or tip 1300 of the catheter may be substantially flexible so that it can be steered in one or more directions (e.g., pitch, yaw). The catheter may include a tip section, a bending section, and an insertion axis. In some embodiments, the catheter may have variable bending stiffness along the longitudinal axis. For example, the catheter may include multiple sections with different bending stiffnesses (e.g., flexible, semi-rigid, and rigid). The bending stiffness may be varied by selecting materials with different stiffness / stiffness, varying the structure (e.g., cuts, patterns) in various sections, adding additional support components, or any combination of the above. In some embodiments, the catheter may have a variable minimum bend radius along the longitudinal axis. Selecting different minimum bend radii at different locations along the catheter may beneficially provide anti-prolapse capabilities while still allowing the catheter to reach hard-to-reach areas. In some cases, the proximal end of the catheter does not need to bend to a high degree, and thus the proximal portion of the catheter may be reinforced with additional mechanical structure (e.g., additional layers of material) to achieve greater bending stiffness. Such a design may provide support and stability to the catheter. In some cases, variable bending stiffness may be achieved by using different materials during the extrusion process of the catheter. This may advantageously allow for different degrees of stiffness along the catheter axis in the extrusion manufacturing process without the need for additional fastening or assembly of different materials.

[0097] The distal portion of the catheter may be steered by one or more puller wires 1305. The distal portion of the catheter may be made of any suitable material, such as a copolymer, polymer, metal, or alloy, so that it can be bent by the puller wires. In some embodiments, the proximal or distal end of the one or more puller wires 1305 may be coupled to a drive mechanism (e.g., gears, pulleys, capstans, etc.) via a locking mechanism, as described above.

[0098] The puller wires 1305 may be metal wires, cables, or threads, or may be polymer wires, cables, or threads. The puller wires 1305 may also be made from natural or organic materials or fibers. The puller wires 1305 may be any type of suitable wire, cable, or thread capable of supporting various types of loads without deformation, significant deformation, or breakage. The distal ends or portions of one or more puller wires 1305 may be anchored or integrated into the distal portion of the catheter, such that operation of the puller wires by the control unit may apply a force or tension to the distal portion that may steer or articulate at least the distal portion (e.g., flexible section) of the catheter (e.g., up, down, pitch, yaw, or any direction in between).

[0099] The catheter may have certain dimensions such that one or more electronic components can be integrated with the catheter. For example, the outer diameter of the distal tip may be approximately 4 to 4.4 millimeters (mm), and the diameter of the working channel 1303 may be approximately 2 mm, so that one or more electronic components can be embedded in the wall of the catheter. However, depending on various applications, the outer diameter may be anywhere less than 4 mm or greater than 4.4 mm, and the diameter of the working channel may be anywhere depending on the tool size or the particular application.

[0100] The one or more electronic components may include an imaging device, a lighting device, or a sensor. In some embodiments, the imaging device may be a video camera 1313. The imaging device may include an optical element and an image sensor for capturing image data. The image sensor may be configured to generate image data in response to wavelengths of light. Various image sensors, such as a complementary metal-oxide semiconductor (CMOS) or a charge-coupled device (CCD), may be used to capture the image data. The imaging device may be a low-cost camera. In some cases, the image sensor may be provided on a circuit board. The circuit board may be an imaging printed circuit board (PCB). The PCB may include multiple electronic elements for processing the image signal. For example, the circuit for the CCD sensor may include an analog-to-digital converter and an amplifier to amplify and convert the analog signal provided by the CCD sensor. Optionally, the image sensor may be integrated with an amplifier and a converter that converts the analog signal to a digital signal, so that a circuit board is not required. In some cases, the output of the image sensor or circuit board may be image data (a digital signal), which may be further processed by the camera's camera circuitry or processor. In some cases, the image sensor may comprise an array of optical sensors.

[0101] The illumination device may include one or more light sources 1311 positioned at the distal tip. The light sources may be light emitting diodes (LEDs), organic LEDs (OLEDs), quantum dots, or any other suitable light source. In some cases, the light sources may be miniaturized LEDs for compact designs, or dual-tone flashing LED lighting.

[0102] The imaging and illumination devices may be integrated into the catheter. For example, the distal portion of the catheter may include appropriate structure corresponding to at least some dimensions of the imaging and illumination devices. The imaging and illumination devices may be embedded in the catheter. FIG. 11 shows an exemplary distal portion of a catheter with an integrated imaging and illumination device. The camera may be located in the distal portion. The distal tip may have structure to accommodate the camera, illumination, and / or location sensor. For example, the camera may be embedded within a cavity 1410 in the distal tip of the catheter. The cavity 1410 may be integral with the distal portion of the cavity and may have certain dimensions corresponding to the length / width of the camera so that the camera does not move relative to the catheter. The camera may be adjacent to the working channel 1420 of the catheter to provide a near-view of the tissue or organ. In some cases, the attitude or orientation of the imaging device may be controlled by controlling the rotational motion (e.g., roll) of the catheter.

[0103] Power to the camera may be provided by a wired cable. In some cases, the cable wire may be a wire bundle that provides power to the camera and lighting elements or other circuitry at the distal tip of the catheter. The camera and / or light source may be powered from a power source located in the handle portion via wire, copper wiring, or any other suitable means extending through the length of the catheter. In some cases, real-time images or videos of the tissue or organ may be transmitted wirelessly to an external user interface or display. Wireless communication may be via WiFi, Bluetooth, RF communication, or other forms of communication. In some cases, images or videos captured by the camera may be broadcast to multiple devices or systems. In some cases, image and / or video data from the camera may be transmitted down the length of the catheter to a processor located in the handle portion via wire, copper wiring, or any other suitable means. Image or video data may be transmitted to an external device / system via wireless communication components in the handle portion. In some cases, the system may be designed so that wires are not visible or exposed to the operator.

[0104] In traditional endoscopy, illumination may be provided by a fiber optic cable that transmits light from a light source located at the proximal end of the endoscope to the distal end of the robotic endoscope. In some embodiments of the present disclosure, a miniaturized LED light may be used and embedded in the distal section of the catheter to reduce design complexity. In some cases, the distal section may include a structure 1430 with dimensions that match the dimensions of the miniaturized LED light source. As shown in the illustrated example, two cavities 1430 may be integrally molded with the catheter to accommodate two LED light sources. For example, the outer diameter of the distal tip may be approximately 4 to 4.4 millimeters (mm), and the diameter of the working channel of the catheter may be approximately 2 mm so that two LED light sources can be embedded in the distal end. The outer diameter may be anywhere less than 4 mm or greater than 4.4 mm, and the diameter of the working channel may be anywhere depending on the size of the tool or the specific application. Any number of light sources may be included. The internal structure of the distal section may be designed to accommodate any number of light sources.

[0105] In some cases, each LED may be connected to a power wire that may extend to the proximal handle. In some embodiments, the LEDs may be soldered to separate power wires that are later bundled together to form a single strand. In some embodiments, the LEDs may be soldered to a pull wire that provides power. In other embodiments, the LEDs may be crimped or connected directly to a single pair of power wires. In some cases, a protective layer, such as a thin layer of biocompatible adhesive, may be applied to the front of the LEDs to provide protection while still allowing light to be emitted. In some cases, an additional cover 1431 may be placed on the forward end face of the distal tip to provide accurate positioning of the LEDs and sufficient room for the adhesive. The cover 1431 may be made of a transparent material that matches the refractive index of the adhesive to ensure unobstructed illumination.

[0106] The working channels (e.g., working channels 1303, 1420) may be designed to provide protection for internal components, such as flexible instruments (e.g., needles, forceps, etc.). When flexible instruments are passed through conventional working channels, they may be pulled out by the working channel due to kinking, ovalization, and / or high friction. The working channels herein may advantageously address the above-mentioned shortcomings by providing high hoop strength and the ability to achieve a low bend radius. The working channels may also be designed to provide low friction at their interior surfaces.

[0107] FIG. 16 shows another example of a tip 1507 for a robotic endoscopic device. The tip 1507 may include the same image sensor 1613 and light source 1611 described above. The tip may also facilitate other functions, such as lens cleaning and forward irrigation to provide a clear field of view for the camera. The working channels (e.g., instrument channel 1601, auxiliary channel 1615) may be designed to provide protection for internal components, such as flexible instruments (e.g., suturing instruments, forceps, etc.). When flexible instruments pass through conventional working channels, they may become blocked by the working channel due to kinking, ovalization, and / or high friction. The working channel may provide high hoop strength and the ability to achieve a low bend radius. The working channel may also be designed to provide low friction at the interior surface. Suturing instruments, such as those described herein, may be passed through the working channel and advanced beyond the distal tip of the endoscope or retracted into the working channel.

[0108] While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It is understood that various alternatives to the embodiments of the invention described herein may be used in practicing the invention. It is intended that the following claims define the scope of the invention and that methods and structures within the scope of these claims and their equivalents be covered thereby.

Claims

1. 1. A device for intubating an endoscope into a subject, comprising:

1. A flexible overtube including features that form a first lumen for passing a first scope during intubation, the first lumen being deformable to create a second lumen for passing a second scope, the diameter of the second scope being larger than the diameter of the first scope. An apparatus comprising:

2. The device of claim 1 , wherein the diameter of the first lumen is smaller than the diameter of the second lumen.

3. The device of claim 1 , wherein the function comprises an expandable tubular structure that adjusts the size of the first lumen or the second lumen.

4. The device of claim 3 , wherein the expandable tubular structure is a flat-laid tubular configuration having axial pleats.

5. The device of claim 3 , wherein the expandable tubular structure is a collapsible, flat-laying tube configuration.

6. The device of claim 5 , wherein the collapsible, lay-flat tube configuration has separable edges that are engaged using one or more positive engagement features.

7. The device of claim 5 , wherein the collapsible lay-flat tube configuration adjusts the diameter of the first lumen to create the second lumen using one or more passive engagement features.

8. The device of claim 1 , wherein the first lumen and the second lumen are two channels separated by a lumen separator in the flexible overtube.

9. The apparatus of claim 1 , wherein the second scope is a robotic scope.

10. The apparatus of claim 9 , wherein the robotic scope comprises a handle portion removably coupled to a robotic support.

11. The apparatus of claim 10 , wherein the handle portion of the robotic scope is coupled to the robot support after the robotic scope is inserted through the second lumen and configured in a serpentine configuration.

12. 12. The apparatus of claim 11, wherein the robotic scope is initialized by adapting the bending portion of the robotic scope to an internal environment within the subject while removing slack from one or more pull wires for articulation control of the bending portion.

13. 1. A method for intubating a robotic endoscope within a subject, comprising: (a) performing an initial intubation to reach a target site within the subject's body with a first scope and overtube device, the first scope engaging a first lumen of the overtube device; (b) withdrawing the first scope and inserting a second scope into a second lumen of the overtube device to reach the target site, the second scope being a robotic scope having a diameter larger than that of the first scope; and (c) coupling a handle portion of the second scope to an instrument drive mechanism (IDM) and initializing the second scope while the second scope is within the body of the subject. A method comprising:

14. The method of claim 13 , wherein the initialization includes removing slack from one or more puller wires of the second scope.

15. 15. The method of claim 14, wherein the one or more puller wires are actuated by the IDM to control articulation of a bending section of the second scope in one or more degrees of freedom.

16. The method of claim 15 , further comprising monitoring tension in one or more pull wires corresponding to one degree of freedom.

17. 17. The method of claim 16, further comprising comparing the difference in tension of the one or more puller wires against a predetermined threshold.

18. The method of claim 17 , further comprising controlling one or more actuators of the IDM based on the tension or the difference in the tension.

19. The method of claim 13 , wherein the first lumen is deformable to create a second lumen.

20. The method of claim 13 , wherein the overtube device comprises an expandable tubular structure that adjusts the size of the first lumen or the second lumen.

21. 21. The method of claim 20, wherein the expandable tubular structure is a flat-laid tubular configuration having axial pleats.

22. 21. The method of claim 20, wherein the expandable tubular structure is a collapsible, lay-flat tube configuration.

23. 14. The method of claim 13, wherein the first lumen and the second lumen are two channels separated by a lumen separator of the overtube device.

24. 1. A method for initializing a robotic endoscope within a subject, comprising: (a) driving a pair of puller wires at a constant speed with an instrument drive mechanism while the robotic endoscope is positioned within the subject, the pair of puller wires operating to control a joint of a bending portion of the robotic endoscope corresponding to a first degree of freedom; (b) comparing a difference in tension between the pair of puller wires to a first threshold, and when the first threshold is reached, varying the movement of the pair of puller wires to reduce the difference in tension; and (c) comparing the tension in the pair of puller wires with a second threshold, and stopping movement of the corresponding puller wire when the tension in either of the pair of puller wires reaches the second threshold. A method comprising:

25. 25. The method of claim 24, wherein the second threshold is higher than the first threshold.

26. 25. The method of claim 24, wherein (a)-(c) are repeated for a pair of puller wires corresponding to a second degree of freedom.

27. 27. The method of claim 26, wherein (a)-(c) are performed simultaneously for the first degree of freedom and the second degree of freedom.

28. 27. The method of claim 26, wherein (a) through (c) are performed sequentially for the first degree of freedom and the second degree of freedom.

29. 25. The method of claim 24, wherein the robotic scope comprises a handle portion removably coupled to the instrument drive mechanism.

30. 30. The method of claim 29, wherein the instrument drive mechanism is supported by an end effector of a robotic arm.

31. 25. The method of claim 24, wherein the robotic scope comprises a flexible elongate member whose current shape, position, or orientation is unknown.

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