Dual control of a mechanical surgical arm

Abstract

A surgical system for use in performing surgery and a method of using the system.SOLUTION: A surgical system comprising an articulated mechanical arm having a plurality of arm joints, first and second user input devices for controlling the arm, and a surgical end effector at a distal end of the arm, initially operates in a cambering mode with the first user input device active and directing only flexion and rotation of one given arm joint and the second user input device disabled. While in the retroflex mode, the distal portion of the arm is retroflexed by the flexion and rotation of one given arm joint. With the arm retroflexed, the system transitions to a surgical operation mode in which a second user input device can bend and rotate any or all of the arm joints to move the surgical end effector to perform one or more surgical actions.SELECTED DRAWING: Figure 14D

Description

[Technical Field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application claims the benefit of U.S. Provisional Application No. 62 / 944,351, filed December 5, 2019, the entirety of which is incorporated herein by reference.

[0003] The present invention relates to surgical systems for use in performing surgical procedures and methods of using such systems, particularly those that use multiple modes of motion and input devices to control the bending and rotation of portions of an articulated mechanical arm. [Background technology]

[0004] This section is intended to introduce the reader to various aspects of art that may be related to various aspects of the present invention, which are described and / or claimed below. This discussion is believed to be helpful in providing the reader with background information to facilitate a better understanding of the various aspects of the present invention. As such, it should be understood that these statements are to be read in this light, and not as admissions of prior art.

[0005] The advantages of minimally invasive surgery are well established. Such surgical instruments typically comprise surgical end effectors located at the distal end of articulated surgical arms (preferably having minimal diameters) that are inserted through small openings (e.g., body wall incisions, natural orifices) to reach the surgical site. In some instances, the surgical instruments are passed through cannulas, and an endoscope can be used to provide imaging of the surgical site.

[0006] For convenience, precision, and patient well-being, surgical instruments utilizing end effectors (e.g., surgical tools for welding or cutting tissue, or measurement tools) have been developed. In some cases, articulated surgical arms have one or more bends that are remotely controlled using various input devices (e.g., hand controls or foot controls) to ultimately control the position of the end effector and change its orientation relative to the longitudinal axis of the surgical arm. In some cases, the surgical arm can be bent to deflect relative to the longitudinal axis of the surgical arm.

[0007] Clinical studies have demonstrated the superiority of minimally invasive transvaginal approaches in gynecological surgery compared with abdominal approaches. Benefits include reduced postoperative recovery time, morbidity, infection, mortality, complications, blood loss, and patient satisfaction. Currently, the American College of Gynaecologists (ACOG) has stated that transvaginal approaches are preferred for gynecological surgery whenever possible. To enable transvaginal medical device use in gynecological surgery, articulated surgical arms must be able to bend into a recumbent position.

[0008] The current state of the art lacks devices and methods that can provide optimal control elements and methods of use to ensure a risk-free approach to the preliminary deflection step without affecting the ergonomic comfort and convenience of an input device optimized for difficult surgical procedures. Therefore, a solution is needed that does not affect the surgeon's ergonomics, while also being suitable for reducing risks during deflection of the surgical arm and allowing maximum freedom of movement during the surgical procedure. Summary of the Invention

[0009] According to an embodiment, a method of operating a surgical system is disclosed that includes: (i) an articulated mechanical arm having a plurality of arm joints; (ii) a first user input device and a second user input device for controlling the arm; and (iii) a surgical end effector at a distal end of the arm. The method is: (a) initiating operation of the surgical system in a reflex mode (with respect to flexion and rotation of the arm joints, (i) the first user input device is active to direct flexion and rotation of only a given joint of the arm joints, and (ii) the second user input device is disabled); (b) while in the deflection mode, deflecting a distal portion of the articulated mechanical arm by flexing and rotating the given one of the arm joints in response to an electronic control output from the first user input device to bring the end effector into a deflection operating position; (c) transitioning the surgical system from the deflection mode to a surgical operation mode to enable the second user input device for flexing and rotating at least one of the arm joints of the arm other than the given one of the arm joints; (d) while in the surgical operating mode, in response to electronic control output from the second user input device, effectively flexing and rotating at least two of the arm joints according to their respective degrees of freedom (thereby moving the surgical end effector to perform one or more surgical acts).

[0010] In some embodiments, the surgical system may further comprise control circuitry effective to limit the actuation of arm joints other than the one arm joint while the surgical system is in the deflection mode.

[0011] In some embodiments, the transitioning step may include calibrating the input device with respect to at least one of a position and an orientation of the end effector or a distal portion of the arm.

[0012] In some embodiments, the first input device may be configured to control actuation of the one arm joint and / or may be configured not to control actuation of arm joints other than the one arm joint.

[0013] In some embodiments, the step of transitioning to the surgical operating mode may be responsive to and conditioned on detecting that the arm is in a recoiled position.

[0014] A surgical system according to an embodiment includes: (a) an articulated mechanical arm having a plurality of arm joints and a surgical end effector at a distal end of the arm; and (b) first and second user input devices for controlling the arm. (i) a recoil mode in which a distal portion of the articulated mechanical arm is operated to recoil in response to an electronic control output from the first user input device to bring the end effector into a recoil operating position; and (ii) a surgical mode of operation in which at least two of the arm joints are actuated to flex and rotate in response to electronic control output from the second user input device to thereby move the surgical end effector to perform one or more surgical acts is configured to operate asynchronously; (A) while in the reflex mode, with respect to flexion and rotation of the arm joints, the first user input device is active to direct flexion and rotation of only a given joint of the arm joints, and the second user input device is inactive; and (B) While in the surgical operating mode, the second user input device is effective with respect to flexion and rotation of at least one of the arm joints of the arm other than a given one of the arm joints in accordance with the respective degrees of freedom of each arm joint.

[0015] In some embodiments, the surgical system may further comprise control circuitry effective to limit the actuation of arm joints other than the one arm joint while the surgical system is in the deflection mode.

[0016] In some embodiments, the surgical system can be configured such that the transitioning step includes the step of calibrating the input device with respect to at least one of a position and orientation of the end effector or a distal portion of the arm.

[0017] In some embodiments, the first input device may be configured to control actuation of the one arm joint and / or may be configured not to control actuation of arm joints other than the one arm joint.

[0018] In some embodiments, the surgical system can be configured such that the step of transitioning to the surgical operating mode can be responsive to and conditioned on detecting that the arm is in a recoiled position.

[0019] According to an embodiment, a method of operating a surgical system is disclosed, the surgical system comprising: (i) a user input device; and (ii) an articulated mechanical arm comprising a plurality of arm joints and a surgical end effector at a distal end of the arm. The method comprises: (a) initiating operation of the surgical system in a reflex mode (with respect to flexion and rotation of the arm joints, the user input device being active to direct flexion and rotation of only a given one of the arm joints); (b) while in the deflection mode, deflecting a distal portion of the articulated mechanical arm by bending and rotating the given one of the arm joints in response to an electronic control output from the user input device to bring the end effector into a deflection operating position; (c) transitioning the surgical system from the deflection mode to a surgical operation mode to enable the user input device for flexing and rotating at least one of the arm joints of the arm other than the given one of the arm joints; (d) while in the surgical operating mode, in response to electronic control output from the user input device, effectively flexing and rotating at least two of the arm joints according to their respective degrees of freedom (thereby moving the surgical end effector to perform one or more surgical acts).

[0020] In some embodiments of the method, the surgical system may further include control circuitry effective to limit actuation of arm joints other than a given one of the arm joints while the surgical system is in the deflection mode, hi some such embodiments, the limiting step may be performed by disabling actuation of the arm joints of the arm other than the given one of the arm joints.

[0021] In some embodiments, the user input device is capable of controlling the actuation of the plurality of arm joints in both the reflex mode and the surgical operation mode.

[0022] In some embodiments, the user input device may be prevented from generating or transmitting control outputs that control actuation of arm joints of the arm other than the given one of the arm joints.

[0023] In some embodiments, the surgical mode transition step may be in response to, and be the detection condition of, the arm being in a recoiled position.

[0024] In some embodiments, the transitioning step may include calibrating the user input device with respect to at least one of a position and orientation of the end effector or a distal portion of the arm.

[0025] In some embodiments, the method may further include unbending the distal end of the arm to bring the arm into an unbent position following operation in the second mode.

[0026] According to an embodiment, a surgical system is disclosed that includes: (a) a user input device; and (b) an articulated mechanical arm that includes (i) a plurality of arm joints and (ii) a surgical end effector at a distal end of the arm. The surgical system includes: (A) a recoil mode in which a distal portion of the articulated mechanical arm recoils in response to an electronic control output from the user input device to bring the end effector into a recoil operating position; and (B) a surgical operating mode in which at least two of the arm joints flex and rotate in response to electronic control outputs from the user input device to thereby move the surgical end effector to perform one or more surgical acts is configured to operate asynchronously; (A) while in the reflex mode, with respect to flexion and rotation of the arm joints, the user input device is active to direct flexion and rotation of only a given joint of the arm joints; and (B) While in the surgical operating mode, the user input device is effective for flexion and rotation of at least one of the arm joints of the arm other than a given one of the arm joints according to the respective degrees of freedom of each arm joint.

[0027] In some embodiments, the surgical system may further include control circuitry effective to limit actuation of arm joints other than a given one of the arm joints while the surgical system is in the deflection mode, hi some such embodiments, the limiting step may be performed by disabling actuation of the arm joints of the arm other than the given one of the arm joints.

[0028] In some embodiments, the user input device may be effective to control the actuation of the plurality of arm joints in both the reflex mode and the surgical operation mode.

[0029] In some embodiments, the surgical system can be configured such that the user input device can be prevented from generating or transmitting a control output that controls actuation of arm joints of the arm other than the given one of the arm joints.

[0030] In some embodiments, the surgical system can be configured such that the surgical mode transition step is responsive to and / or can be a detection condition of the arm being in a recoiled position.

[0031] In some embodiments, the surgical system can be configured such that the transitioning step can include a step of calibrating the user input device with respect to at least one of a position and orientation of the end effector or a distal portion of the arm.

[0032] In some embodiments, the surgical system may be further configured to effectively unbend the distal end of the arm to bring the arm to an unbent position following operation in the second mode.

[0033] According to an embodiment, a method of operating a surgical system is disclosed, comprising: (i) an articulated mechanical arm comprising a surgical end effector and a plurality of arm joints at a distal end of the articulated mechanical arm, and (ii) an input device array of one or more user input devices, the arm joints configured to flex and rotate in response to electronic control outputs from one or more user input devices of the input device array. The method comprises: (a) commencing operation of the surgical system in a first mode of operation defined for a given one of the arm joints, the first mode of operation excluding actuation of any arm joint of the arm that is not the given one of the arm joints and allowing control of actuation of the one of the arm joints to cause flexion and rotation of the one of the arm joints; (b) while the surgical system is in the first mode of operation, (i) deflecting the distal end of the arm by flexing and rotating the one arm joint in response to control signals generated by one or more of the user input devices of the input device array to bring the end effector into a deflected operating position, and (ii) monitoring a state of the mechanical arm to detect whether the arm is in a deflected position. (c) in response to, and conditioned on, detecting that the arm is in a recoiled position, transitioning operation of the surgical system from the first mode of operation to a second mode of operation that enables the system to control flexion and rotation of at least one arm joint excluded in the first mode according to a respective degree of freedom of each arm joint; (d) operating the surgical system in the second mode of operation to perform a surgical procedure using the end effector.

[0034] In some embodiments, the surgical system can further include control circuitry effective to limit actuation of arm joints other than the one arm joint while the surgical system is in the first mode of operation. In some such methods, the limiting step can be performed by disabling actuation of arm joints of the arm other than the one arm joint. In some such embodiments, the input device can be prevented from generating or transmitting control outputs that control actuation of arm joints of the arm other than the one arm joint. In some such embodiments, the limiting step can include disabling the ability of the first input device. In some such embodiments, (i) a first input device of the input device array controls actuation of the one arm joint while the surgical system is in the first mode of operation and a second input device controls actuation of the plurality of arm joints while the surgical system is in the second mode of operation, and / or (ii) the limiting step can be performed by providing a first input device, the first input device configured to control actuation of the one arm joint and not configured to control actuation of arm joints other than the one arm joint.

[0035] In some embodiments, the transitioning step may include calibrating the input device with respect to at least one of a position and an orientation of the end effector or a distal portion of the arm.

[0036] In some embodiments, a first input device of the input device array can control actuation of the one arm joint while the surgical system is in the first mode of operation, and / or a second input device of the input device array can control actuation of the multiple arm joints while the surgical system is in the second mode of operation.

[0037] In some embodiments, the transitioning step can include calibrating the second input device with respect to at least one of a position and an orientation of the end effector or a distal portion of the arm.

[0038] In some embodiments, a single user input device can control actuation of the plurality of arm joints in both the first mode of operation and the second mode of operation.

[0039] In some embodiments of the method, the surgical system may further include a control console having a display screen, and at least one user input device of the input device array is located on or adjacent to the display screen.

[0040] In some embodiments, an additional user input device for actuating linear advancement and retraction of the arm may be located on, co-located with, or adjacent to at least one user input device of the input device array.

[0041] In some embodiments, the deflection operating position can be located at or adjacent to a surgical procedure site.

[0042] In some embodiments, the operating step in the second mode can be a state in which the arm is in the retracted position.

[0043] In some embodiments, the method may further include, following the step of operating in the second mode, unbending the distal end of the arm to bring the arm into an unbent position.

[0044] According to an embodiment, a surgical system for use with a surgical end effector, wherein the first and second modes of operation are configured to operate asynchronously, includes: (a) an input device array of one or more user input devices; and (b) a surgical end effector at a distal end of the articulated mechanical arm, and an articulated mechanical arm having a plurality of arm joints configured to bend and rotate in response to control signals generated by one or more input devices in said array of input devices, wherein: (i) the first operation mode is defined with respect to a given one of the arm joints, and the first operation mode excludes actuation of any arm joint of the arm other than the given one arm joint, and is capable of controlling actuation of the one arm joint to cause flexion and rotation of the one arm joint; (ii) the system is configured to, during the first mode of operation, actuate the one arm joint in response to electronic control output from one or more of the user input devices of the input device array to cause flexion and rotation of the one arm joint to deflect the distal end of the arm so as to bring the surgical end effector into a deflected operating position; (iii) the second mode of operation is defined with respect to the plurality of arm joints, the second mode of operation enabling control of actuation of at least one arm joint excluded in the first mode according to a respective degree of freedom of each arm joint; (iv) the system is configured to transition from the first operational mode to the second operational mode in response to, and conditioned on, detecting that the arm is in a recoiled position, and to perform a surgical act using the end effector during the second operational mode.

[0045] In some embodiments, the surgical system can further include control circuitry effective to limit actuation of arm joints other than the one arm joint while the surgical system is in the first mode of operation. In some such embodiments, the limiting step can be performed by disabling actuation of arm joints of the arm other than the one arm joint. In some such embodiments, the input device can be prevented from generating or transmitting control outputs that control actuation of arm joints of the arm other than the one arm joint. In some such embodiments, the limiting step can include disabling the ability of the first input device. In some such embodiments, (i) a first input device of the input device array controls actuation of the one arm joint while the surgical system is in the first mode of operation and a second input device controls actuation of the plurality of arm joints while the surgical system is in the second mode of operation, and / or (ii) the limiting step can be performed by providing a first input device, the first input device configured to control actuation of the one arm joint and not configured to control actuation of arm joints other than the one arm joint.

[0046] In some embodiments, the system can be configured such that the transitioning step can include the step of calibrating the input device with respect to at least one of a position and orientation of the end effector or a distal portion of the arm.

[0047] In some embodiments, a first input device of the input device array can be effective to control actuation of the one arm joint while the surgical system is in the first mode of operation, and / or a second input device of the input device array can be effective to control actuation of the multiple arm joints while the surgical system is in the second mode of operation.

[0048] In some embodiments, the system can be configured such that the transitioning step can include calibrating the second input device with respect to at least one of a position and orientation of the end effector or a distal portion of the arm.

[0049] In some embodiments, a single user input device may be effective to control actuation of the plurality of arm joints in both the first mode of operation and the second mode of operation.

[0050] In some embodiments, the surgical system may further include a control console having a display screen, and at least one user input device of the input device array is located on or adjacent to the display screen.

[0051] In some embodiments, an additional user input device for actuating linear advancement and retraction of the arm may be located on, co-located with, or adjacent to at least one user input device of the input device array.

[0052] In some embodiments, the deflection operating position can be located at or adjacent to a surgical procedure site.

[0053] In some embodiments, the operating step in the second mode can be a state in which the arm is in the retracted position.

[0054] In some embodiments, following the operating step in the second mode, the device may be further configured to effectively unbend the distal end of the arm to bring the arm to an unbent position. According to an embodiment, a method of operating a surgical system is disclosed that includes: (i) an articulated mechanical arm having a plurality of arm joints and a surgical end effector at a distal end of the arm; and (ii) an input device array of one or more user input devices for controlling the arm. The method comprises: (a) deflecting a distal end of the articulated mechanical arm by bending and rotating a given one of the arm joints in response to electronic control output from the input device array to bring the end effector into a deflected operating position without bending or rotating any arm joint other than the given one of the arm joints; (b) the bending and rotating step includes, in response to, and conditional on, detecting that the arm is in a reflexed position, effectively bending and rotating at least two of the arm joints according to their respective degrees of freedom in response to electronic control outputs from the input device array (thereby moving the surgical end effector to perform one or more surgical acts).

[0055] In some embodiments of the method, the surgical system may further comprise control circuitry effective to limit actuation of arm joints other than a given one of the arm joints during the deflecting step.

[0056] In some embodiments, the method can further include unflexing the distal end of the arm to bring the arm to an unflexed position after performance of the one or more surgical procedures.

[0057] According to an embodiment, the surgical system comprises: (a) an articulated mechanical arm comprising: (i) a plurality of arm joints; and (ii) a surgical end effector at a distal end of the arm; and (b) an input device array of one or more user input devices for controlling the arm; The surgical system includes: (i) configured to deflect a distal portion of the articulated mechanical arm by bending and rotating a given one of the arm joints in response to electronic control output from the input device array to bring the end effector into a deflected operating position without bending or rotating any other one of the arm joints; and (ii) configured to, in response to, and conditional on, detecting that the arm is in a deflected position and in response to electronic control output from the input device array, effectively flex and rotate at least two of the arm joints according to a respective degree of freedom of each arm joint, thereby moving the surgical end effector to perform one or more surgical acts.

[0058] In some embodiments, the surgical system may further comprise control circuitry effective to limit actuation of arm joints other than a given one of the arm joints during the deflection step.

[0059] In some embodiments of the method, the surgical system may further comprise control circuitry effective to limit actuation of arm joints other than a given one of the arm joints during the deflecting step.

[0060] In some embodiments, the method can further include unflexing the distal end of the arm to bring the arm to an unflexed position after performance of the one or more surgical procedures.

[0061] According to an embodiment, a method of using a surgical system is disclosed, the method comprising: (a) providing an articulated mechanical arm having a surgical end effector at a distal end thereof, said arm comprising a plurality of arm segments connected in series by a corresponding plurality of arm joints configured to bend and rotate in response to electronic control outputs from a user input device, said providing being performed such that said end effector is displaced; (b) steering the end effector to a deflected operating position while operating in a first input mode, the first input mode translating a displacement of an input device or a displaceable portion of the input device into a velocity of at least one of (i) a bending of an arm joint and (ii) a rotation of an arm joint; (c) in response to, and conditioned on, detecting that the end effector is in the recoiled operating position, transitioning from operation in the first input mode to operation in a second input mode, wherein the second input mode converts a displacement of an input device or a displaceable portion of the input device into a corresponding displacement of at least one arm segment; and d. performing a surgical procedure using the end effector after the transitioning step and while operating in the second input mode.

[0062] In some embodiments, a single user input device may be used in both the first input mode and the second input mode.

[0063] In some embodiments, the first input mode may use a first input device and / or the second input mode may use a second input device.

[0064] In some embodiments, an additional user input device can be used to actuate the linear advancement and retraction of the arm.

[0065] In some embodiments, the deflection operating position can be located at or adjacent to a surgical procedure location.

[0066] According to an embodiment, a surgical system for use with a surgical end effector includes: (a) an articulated mechanical arm having a surgical end effector at a distal end thereof, the arm comprising a plurality of arm segments connected in series by a corresponding plurality of arm joints configured to bend and rotate in response to electronic control outputs from a user input device; and (b) an array of one or more input devices for controlling the arm; The surgical system includes: (i) (A) a first input mode that converts a displacement of an input device or a displaceable portion of said input device into a velocity of bending and rotation of an arm joint, and (B) a second input mode that converts a displacement of an input device or a displaceable portion of said input device into a corresponding displacement of at least one arm segment, are configured to operate asynchronously; (ii) configured to steer the end effector to a deflected operating position during a first stage of displacement of the end effector while operating in the first input mode; and (iii) configured to perform a surgical act using the end effector while operating in the second input mode.

[0067] In some embodiments, the system may be configured to allow a single user input device to be used in both the first input mode and the second input mode.

[0068] In some embodiments, the system may be configured to use a first input device in the first input mode and / or a second input device in the second input mode.

[0069] In some embodiments, the system can be configured to use an additional user input device to actuate the linear advancement and retraction of the arm.

[0070] In some embodiments, the deflection operating position can be located at or adjacent to a surgical procedure location. [Brief explanation of the drawings]

[0071] The invention will now be further described, by way of example only, with reference to the accompanying drawings, in which dimensions of components and features shown in the figures have been chosen for convenience and clarity of presentation and are not necessarily drawn to scale.

[0072] [Figure 1] FIG. 1 is a schematic diagram of a surgical system according to an embodiment of the present invention.

[0073] [Figure 2] Figure 2A is a schematic perspective view of a surgical system including a mechanical surgical arm according to an embodiment of the present invention, and Figure 2B shows a distal portion of the mechanical surgical arm according to an embodiment of the present invention.

[0074] [Figure 3] 3A-C show a distal portion of a mechanical surgical arm in various bent and deflected positions according to an embodiment of the present invention.

[0075] [Figure 4] FIG. 4 illustrates a distal portion of a mechanical surgical arm having an arm curve shape, according to an embodiment of the present invention. [Figure 5] FIG. 5 illustrates a distal portion of a mechanical surgical arm having an arm curve shape, according to an embodiment of the present invention.

[0076] [Figure 6] FIG. 6 is a flowchart of a method of operating a surgical mechanical arm using two modes of operation, according to an embodiment of the present invention.

[0077] [Figure 7] FIG. 7 is a schematic illustration of a control console for a surgical system having an input device located proximate to the surgical system, in accordance with an embodiment of the present invention.

[0078] [Figure 8] FIG. 8 is a schematic diagram of a user input device according to an embodiment of the present invention.

[0079] [Figure 9] FIG. 9 is a chart illustrating an exemplary scheme for using an input device to control the flexion and rotation of an arm joint, according to an embodiment of the present invention.

[0080] [Figure 10] FIG. 10 is a schematic diagram illustrating an articulated user input device according to an embodiment of the present invention.

[0081] [Figure 11] FIG. 11 is a schematic diagram of a handle member of the user input device of FIG. 10 according to an embodiment of the present invention.

[0082] [Figure 12] 12A-B illustrate exemplary graphical aids for use in aligning the respective positions of a mechanized surgical arm and an articulated user input device, according to an embodiment of the present invention.

[0083] [Figure 13] FIG. 13 shows an example of a screen display for use in aligning the respective positions of a mechanized surgical arm and an articulated user input device, according to an embodiment of the present invention.

[0084] [Figure 14A]FIG. 14A is a time sequence of images showing an exemplary control of a surgical mechanical arm using an input device according to an embodiment of the present invention. [Figure 14B] FIG. 14B is a time sequence of images showing an exemplary control of a surgical mechanical arm using an input device according to an embodiment of the present invention. [Figure 14C] FIG. 14C is a time sequence of images showing an exemplary control of a surgical mechanical arm using an input device according to an embodiment of the present invention. [Figure 14D] FIG. 14D is a time sequence of images showing an exemplary control of a surgical mechanical arm using an input device according to an embodiment of the present invention. [Figure 14E] FIG. 14E is a time sequence of images showing an exemplary control of a surgical mechanical arm using an input device according to an embodiment of the present invention.

[0085] [Figure 15] FIG. 15 is a block diagram of a surgical system according to an embodiment of the present invention.

[0086] [Figure 16] FIG. 16 is a flowchart of a method of operating a surgical system in two different modes of operation, according to an embodiment of the present invention.

[0087] [Figure 17] Figure 17A is a flow chart of a method for dual control of a surgical arm according to an embodiment of the present invention, and Figures 17B and 17C are schematic diagrams of a control console with dual control means according to an embodiment of the present invention.

[0088] [Figure 18] FIG. 18 is a flowchart of a method of using a haptic handle to control one or more surgical arms according to an embodiment of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0089] The present invention will now be described, by way of example only, with reference to the accompanying drawings. Referring now in detail and specifically to the drawings, it is emphasized that the illustrated features are presented by way of example only for the purpose of illustrative discussion of preferred embodiments of the invention, and to provide what is believed to be the most useful and readily understandable explanation of the principles and conceptual aspects of the invention. In this regard, no attempt has been made to show structural details of the invention in more detail than is necessary for a fundamental understanding of the invention, and the description taken together with the drawings will make apparent to those skilled in the art how several forms of the invention may be embodied in practice. Like reference characters are typically used throughout the drawings to designate like elements.

[0090] The embodiments disclosed herein relate to controlling one or more surgical mechanical arms, i.e., articulated mechanical arms, using a number of different modes of operation and / or a number of different input devices.

[0091] Whenever "arm" is used in this specification or the appended claims, it refers to an articulated, mechanical arm that is part of a surgical or electrosurgical system and is used to perform or assist in performing a surgical (including electrosurgical) procedure inside a human subject. Unless specified, "surgical procedure" includes any medical, surgical-related, or diagnostic procedure performed inside the human body. This includes, but is not limited to, tissue cutting, tissue dissection, tissue manipulation, tissue suturing, tissue retraction, tissue welding, taking measurements, and imaging. It may be desirable for a surgical arm to be sized and / or shaped to be suitable for insertion into the human body. For example, the arm can be sized and / or shaped to be suitable for insertion through a laparoscopic port and / or for performing laparoscopic surgery. For example, the arm can be sized and / or shaped to be suitable for insertion through a natural body orifice (e.g., vagina, anus, trachea, esophagus, ear canal).

[0092] The arm can include an end effector. End effector is used herein to mean a tool or device used in connection with surgery, electrosurgery, diagnosis, or imaging when deployed within the human body. The end effector may be included as part of the arm, i.e., already included, mechanically attached, and / or integrated with the arm's power and communication conveyor. In some embodiments, the arm and end effector may be separately prepared for assembly and / or integration into a treatment unit prior to or during a surgical procedure, i.e., prior to insertion into a subject's body. In any event, terms such as "arm including an end effector" and "arm configured for use with an end effector" should be understood as equivalent for purposes of this disclosure and the claims appended hereto.

[0093] As used herein, an "input device," or equivalently, a "user input device," can be any device capable of receiving user input (i.e., input received from a user of a surgical system). Input devices can include, but are not limited to, buttons, switches, toggles, wheels, knobs, small sticks such as thumbsticks (alternatively referred to as nipples), and joysticks (whether articulated or not). The disclosure of a particular device type for any particular input device is not intended to exclude the substitution of other types of input devices for the particular input device. Input devices can be standalone, grouped on a single control member or a small number of control members, located on another input device, or collocated on or near, for example, a control console, a display screen, or the like. A user can operate an input device using one or more fingers, thumbs, hands, or feet. Additionally, or alternatively, and without limitation, an input device can be controlled by eye or hand movements, voice, or facial expressions.

[0094] The arm and input device, and other aspects and features of the present invention, may be understood in combination with any teachings of co-pending U.S. patent application Ser. No. 16 / 121,704, filed Sep. 5, 2018, and published as U.S. Patent Application Publication No. 20190000574, which is hereby incorporated by reference in its entirety.

[0095] "Handle," or equivalently, "handle member," is used herein to describe a user input device or a hand-operated portion of a user input device that is typically operated by hand. In some embodiments, it is used to describe a user input device or portion thereof that is held by hand or held by fingers. The drawings and accompanying descriptions of handles and hand-operated user input devices in this disclosure are provided by way of example, and such drawings and accompanying descriptions should not be understood as limiting the scope of the embodiments related to the design, connectivity, and functionality of the handles / handle members.

[0096] In this disclosure, a "module" and / or "electrical circuit" or "electronic circuit" and / or "control circuit" and / or element and / or unit and / or controller and / or module and / or sensor and / or detector may include any combination of analog and / or digital circuits and / or software / computer readable code modules and / or firmware and / or hardware elements, including but not limited to digital computers, CPUs, volatile or non-volatile memory, field programmable logic array (FPLA) elements, hardwired logic elements, field programmable gate array (FPGA) elements, and application specific integrated circuit (ASIC) elements. Any instruction set architecture may be used, including but not limited to reduced instruction set computer (RISC) architecture and / or complex instruction set computer (CISC) architecture.

[0097] In different embodiments, any computational or analytical procedure may be performed using any combination of analog and / or digital circuitry and / or software / computer readable code modules and / or firmware and / or hardware elements, including but not limited to digital computers, CPUs, volatile or non-volatile memory, field programmable logic array (FPLA) elements, hardwired logic elements, field programmable gate array (FPGA) elements, and application specific integrated circuit (ASIC) elements. Any instruction set architecture may be used, including but not limited to reduced instruction set computer (RISC) architecture and / or complex instruction set computer (CISC) architecture.

[0098] Referring now to the figures, FIG. 1 shows a schematic diagram of a surgical system 100 according to an embodiment. The system 100 of FIG. 1 includes two surgical mechanical arms 102. In other examples of surgical systems, a single surgical arm is provided. In other examples, two or more (e.g., three or four) surgical arms are provided. The surgical mechanical arms 102 are preferably sized and / or shaped for insertion into a human body or patient 106. Each surgical mechanical arm 102 is actuated by a respective motor unit 108. In this simple example, the surgical arms 102 and / or motor units 108 are supported by attachment to a patient support 116 (e.g., a bed), but may also be supported by a patient side cart or any other suitable equipment.

[0099] In embodiments in which the surgical system is used in electrosurgery, power to the arm 102 and motor unit 108 can be supplied by an electrosurgical generator 112. As is known in the electrosurgery arts, electrosurgical generators provide high frequency (e.g., radio frequency), alternating polarity, current. The electrosurgical generator 112 can be configured to provide various frequencies and / or power levels suitable, for example, for cutting and / or coagulating and / or sealing and / or desiccating and / or fulgurating tissue. Power is supplied to the motor unit 108 via one or more cables 114 configured to transmit radio frequency electrosurgical power.

[0100] Movement of the surgical arms 102 is controlled by a control console 118. Movement is responsive to signals generated by one or more input devices. The control console 118 comprises multiple user interfaces, including one or more of the following: an input device (e.g., an input device arm 120 where the control console is configured to generate control signals based on movement of the input device arm 120), a display screen 128 configured to receive user input and / or display, for example, system status information or imaging of the surgical zone (e.g., displaying images collected by a camera inserted into the patient 106 using one of the surgical arms 102 or displaying the position and orientation of the arm), and one or more additional user interfaces 130 (e.g., buttons, switches, etc.).

[0101] Control console 118 includes a processor (not shown) configured to receive signals from one or more user inputs and send control signals to motor unit 108 and / or electrosurgical generator 112. Foot pedal 126 and / or electrosurgical generator 112 include a processor (not shown) configured to receive a control signal (e.g., generated by a user pressing a portion of foot pedal 126) and vary the power supplied to motor unit 108 based on the control signal. The foot pedal control signal does not necessarily pass through the control unit processor.

[0102] As described in more detail below, in one control mode, movement of the input device arm 120 controls the movement of the respective surgical device arm 102. A user 124 can position and / or move the input arm 120 by grasping an input device arm handle 127. An input arm is one form of input device and is shown here for illustrative purposes. In other embodiments, other types or forms of input devices can be used.

[0103] 2A-2B, the arm unit 104 has a proximal end shaped to receive the motor unit 108 and a distal end to which an end effector 174, such as a multi-jaw grasper (shown by way of non-limiting example only) is attached, as shown on the arm 102.

[0104] The use of the relative terms "proximal" and "distal" is consistent with the arrows shown in FIG. 2A and will be used in this manner throughout this disclosure and the appended claims. As shown, the distal end of the arm 102, where the end effector 174 is located, is furthest from the motor unit 108 and is the first portion of the arm inserted into the human subject 19. Thus, the proximal end is the end opposite the distal end closest to the motor unit 108. As used herein, the term "distal portion" refers to any portion of the arm 102 that includes the distal end / tip (optionally including the end effector 174) and is less than half the length of the arm 102. In FIG. 2B, the bendable portion 170 of the arm 102, i.e., the portion that includes one or more bendable joints, is located along the length of the arm near the distal end. The bendable portion 170 may include a series of "laminated links" 199 that provide flexibility relative to the outer contour / surface of the arm 102. An example of multiple stacked links 199 in the bendable section 170 of the arm 102 is shown in FIG. 2B.

[0105] As used herein, "mode of operation" or its equivalent "mode" (which can be used with various non-limiting descriptive terms, e.g., "reflex mode," "surgical mode of operation," etc.) refers to an operating regime imposed on the use of a surgical system or arm by hardware, firmware, or software design, or by the control circuitry of a surgical system, or by other methods. For clarity, the word "operation" in "mode of operation" means "operational" or "functional," and describes, for example, the operation of an arm, and does not imply the performance of a surgical procedure. That is, an "operational mode" may, but does not necessarily, include the performance of a procedure. The imposed operating regime can include, but is not exhaustive, steps that restrict or not restrict certain operations or certain portions of a surgical system performing one or more operations. Restricting or not restricting steps can include enabling or disabling, locking or unlocking, and precluding or allowing, or similar terms and / or equivalents. In some embodiments herein, a mode may be assigned or directed to accomplish one goal, such as deflecting a distal portion of an arm, and may be limited to one or more specific time periods, hi other embodiments, a mode may incorporate an unlimited number of goals and actions, and unlimited or undefined time periods.

[0106] The operation of the surgical system may be distinguished between different modes in various ways, as described further below. For example, the distinction may be based on the following (non-exhaustive list): The difference between dedicated input devices (or multiple input devices) for each mode, differences in constraints or limitations on specific arm movements and / or specific arm joints and arm segments; Differences in the translation scheme (e.g., displacement to velocity, displacement to displacement) of the input device or input device control element from displacement to arm movement (whether the translation of user input to arm movement is robotic / semi-autonomous or teleoperated), and Whether the manipulation of the input device directly addresses flexion and rotation of the arm joints (through the mechanics and electronics of the surgical system) or indirectly addresses arm segment displacement, it produces the flexion and rotation necessary to displace the arm segments as commanded. Such distinctions can be used in combination, and in multi-arm systems can vary from arm to arm. In some embodiments, the distinctions can be changed while the system is in a given mode.

[0107] Some mode distinctions can be implemented in more than one way. As a non-limiting example, if the mode distinction involves restricting or limiting certain arm movements (e.g., flexion and rotation of particular joints) or allowing only certain arm movements, the distinction can be implemented by using different input devices for each mode, or by using one input device in both modes but enforcing a user-switchable or system-enforceable software or hardware constraint. Whether an embodiment requires one input device or more, a software- or hardware-implemented solution may actively allow actuation of one given arm joint or actively prevent or preclude actuation of any arm joints (of the same arm) that are not this one arm joint.

[0108] It should be noted that when actuation or movement of a singular “arm” (as opposed to multiple “arms”) is discussed herein, this is for convenience only and is not intended to indicate whether a second arm (or other arms) is actuated or moved in a similar or other manner. Each arm can be controlled and actuated independently of any other arm by a respective input device. On the other hand, when an “arm” (singular) is disclosed as being constrained or limited with respect to actuation or movement, the limit or restriction may apply equally to both / all arms of the surgical system, for example, when in an operational mode characterized by such a limit or restriction. However, in some embodiments, a limit or restriction may apply to one or more given arms, while other arms are not constrained or limited at all or in the same manner.

[0109] In embodiments employing two distinct modes of operation, the first mode of operation is typically used when introducing or removing and / or guiding the surgical arm or arms into or out of the body (or from a first point to a second point within the body), particularly toward or away from a desired surgical site. The second mode of operation is typically used when performing a surgical act (e.g., dissecting tissue, manipulating tissue, suturing tissue, taking measurements, imaging, etc.). "Guiding" in the first mode may include deflecting one or more arms to place at least a portion of the arm or a distal portion of the arm in a deflected position, or equivalently, to place the end effector in a deflected operating position (treatment position).

[0110] It may be desirable to have a clearly defined transition or "handoff" from one operating mode to another. In some embodiments, the transition involves a handoff from one input device (or multiple input devices) to another. In other embodiments, the transition is entirely related to a change in the control aspects that distinguish one mode from another. Tasks assigned to both modes can be performed by a single input device or by the same input device(s). The transition can be initiated and managed by the surgical system, or it can be user initiated.

[0111] In a non-limiting example of transitioning from a first mode to a second mode, the transition may include terminating limitations or restrictions imposed during first mode operation, such as limiting joint flexion and rotation to a given arm joint (e.g., an elbow joint) of any particular arm. Additionally or alternatively, the transition may include enabling actuation of arm joints that were disabled (or not specifically enabled) during first mode operation (i.e., in addition to the given joint enabled in the first mode). Enabling may include allowing unlimited movement of the joints according to their respective degrees of freedom. For example, if a given arm joint is configured only for rotation and not flexion, enabling would only be enabled for rotation. Additionally or alternatively, the transition may enable actuation of all arm joints. Additionally or alternatively, the transition may change the processing of control output from a user input device from displacement-to-velocity conversion to displacement-to-displacement conversion. In a further non-limiting example, the transition may be performed automatically by control circuitry in response to an event. For example, the transition can be implemented based on a user input such as a pressed button or a rotated switch, or by noting that the user has stopped using a first input device and started using a second input device. In a further non-limiting example, the transition is a user interface-based mediated transition.

[0112] In a non-limiting example of transitioning from the second mode to the first mode, the transition may include restoring limitations or constraints that were removed during the transition to the second mode of operation, such as limitations on joint flexion and rotation for a given arm joint (e.g., elbow joint) of any particular arm. Additionally or alternatively, the transition may include disabling actuation of arm joints that were enabled in the second mode of operation. Additionally or alternatively, the transition may revert processing of control output from the user input device from displacement-to-displacement conversion to displacement-to-velocity conversion. In a further non-limiting example, the transition may be implemented based on a user input, such as, for example, a pressed button or rotated switch, or upon noting that the user has ceased using an input device dedicated to second mode operation and begun using a different input device dedicated to first mode operation.

[0113] In some embodiments, particularly those in which the input device employed in the second mode is avatar-like and converts input arm displacements into surgical arm displacements, the transition step from the first to the second operating mode can include an alignment calibration. In the alignment calibration, discussed in more detail with respect to FIGS. 12A-12B , the orientation of the surgical arm, including multiple arm elements (e.g., arm joints and / or arm segments) that are “inward” from one another, is corrected to match the “shape” or “curve” that indicates the orientation of the corresponding input arm that will take over operational control of the surgical arm in the transition to the second operating mode. There is not necessarily a corresponding alignment calibration when transitioning from the second operating mode back to the first operating mode.

[0114] Conversion of user input into arm movement (flexion and rotation) can be achieved in a variety of ways. For example, the displacement of an input device or the displacement (or displacement force) of an input device control element can be converted to arm movement (e.g., velocity, speed, angular velocity). It may be desirable to use this type of conversion in a first mode, which includes insertion / withdrawal and deflection (or deflection / non-flexion). In some embodiments, it may be preferable to perform these limited, less precise movements in a simpler robotic or semi-autonomous mode rather than a teleoperated or avatar mode. In contrast, movements required in a second mode, specialized for performing various surgical acts, may be better suited to controlled displacement-to-displacement conversion. Displacement of the input device or the input device control element is preferably converted to arm segment displacement, and indirectly to joint rotation and flexion. For example, in the second mode, it may be desirable to ensure that articulation of the articulatable input device corresponds to the surgical arm in an internal orientation (i.e., inter-segment orientation) so that the displacement-to-displacement conversion is more intuitive, ergonomic, and accurate.

[0115] In the first mode, it may be desirable to limit arm movement to flexion and / or rotation of one given arm joint of the arm (or each arm). This can be preferably implemented by configuring the surgical system to receive inputs from the input device used in the first mode that directly address the flexion and rotation of a particular arm joint, such as one given arm joint that is permitted to be actuated (in the first operating mode). In other words, the user "controls" the arm joint itself via the input device and appropriate control circuitry. In this case, the movement intended to be actuated is specifically the flexion and / or rotation of the arm joint. Whether the actual arm movement is performed semi-automatically in response to the user's control input, the user perceives that they are controlling the actuation of the joint. Concomitant displacement and redirection of the end effector are likely the intended result of controlling the joint.

[0116] In contrast, in the second mode, particularly in embodiments in which the input device employed in the second mode is avatar-like and converts input arm displacement into surgical arm displacement, it may be desirable for the surgical system to receive and process inputs that directly address arm segment displacement. Flexion and rotation of the arm joints are then addressed indirectly by the surgical system by controlling the arm joints to flex and rotate to the extent necessary to achieve the desired arm segment displacement and orientation. In other words, the user "controls" the displacement and orientation of the arm segment (or, for purposes of this discussion, the end effector, which acts similarly to any arm segment in that controlling its position and orientation is the user's goal). The surgical system's control circuitry uses this information to determine the required flexion and rotation of each affected arm joint. In one embodiment, the user can manipulate the avatar-like input arm to assume a shape or configuration that predicts or drives the intended shape of the surgical arm after movement.

[0117] In an exemplary first mode of operation, movement of the surgical arm can be at least partially limited or constrained, and certain movements can be eliminated while other movements can be permitted. For clarity, "movement" of the arm can include, for example, displacement and / or redirection of any portion of the arm, such as one or more segment members of the arm.

[0118] As used herein, the terms "elbow joint," "wrist joint," and "shoulder joint" refer to specific joints of a mechanical arm according to a particular implementation in which the arm comprises three actuatable joints. In such cases, the joint closest to the distal end effector is known as the "wrist joint," the middle joint of the three is known as the "elbow joint," and the most proximal joint is known as the "shoulder joint." In some embodiments, the wrist joint is limited to rotation only, i.e., is not configured to flex. The various joints are shown in FIG. 3A and described later in this specification.

[0119] In the case of arm joints (i.e., multiple joints in an arm), unless otherwise specified, the term "joint" as used in this disclosure and the appended claims refers to any actuatable member that can flex (e.g., bend in a plane) and / or rotate. It should be noted that articulatable / avatar-like input arms (a type of input device) can also have joints, and these are referred to as "articulated members" of the input device. Typically, arm segments are non-actuatable (in terms of flexion / rotation) members of an arm that can be joined in series by actuatable arm joints. Here, the term "jointed in series" only refers to a joint being interposed between two consecutive segment members. The joints can be actuated, for example, mechanically and / or electronically, to cause bending of one arm segment (and any portion of the arm distally disposed therefrom) relative to the base arm segment (2181 in FIG. 3A) or another (adjacent) arm segment, and / or rotation of one arm segment (and any portion of the arm distally disposed therefrom) relative to the base arm segment or another arm segment. In some embodiments, the joints include multiple components. In some examples, a joint may include both a flexion-facilitating component (or subassembly) and a rotation-facilitating component (or subassembly). For ease of reading, such a combination of components will be referred to herein as a joint or arm joint.

[0120] In embodiments, arm movement may be limited according to the type of articulation (e.g., rotation or flexion), the speed of movement, which portions of the surgical arm can move, etc. Movement of the surgical arm during the first mode of operation may be limited to movement of a given arm joint (the elbow joint only) (e.g., including flexion and / or rotation of the elbow joint) and linear movement of the surgical arm as a single unit (e.g., including linear advancement and retraction of the arm). It may be desirable to limit arm movement during the first mode of operation to facilitate introduction of the surgical arm through narrow passages and with a minimal volume to the desired surgical site.

[0121] It may also be desirable to limit the movement of the arm during the first mode of operation to deflect the arm in a minimal volume to avoid collisions and potential tissue damage within the human body. FIG. 3A is a simplified schematic side view of a surgical machine arm 102 in various configurations described herein for illustrative purposes. Dashed line 2177 represents an obstacle, e.g., patient tissue. The movement of the arm 102 during deflection is preferably controlled to prevent the arm 102 (and particularly the end effector 174) from contacting or colliding with the obstacle 2177. Three scenarios, labeled A, B, and C, are shown in FIG. 3. The arm 102 comprises a proximal segment 2181 and a distal bendable section 170. The bendable section 2179 has a shoulder joint 2101 and an elbow joint 2103. These are variously labeled 2101a, 2101bc, 2103a, 2103b, and 2103c to indicate which of one or more scenarios (A, B, or C) the joint instance is associated with. For example, joint 2103a is the position of the elbow joint in scenario A. Scenario A therefore involves bending only the elbow joint 2103a (the shoulder joint 2101a is not actuated and remains unbent). Notably, it can be seen that bending only the elbow joint 2103a does not result in a collision between the end effector 174 and the obstacle 2177. On the other hand, in scenario B, in which only the shoulder joint 2101b is bent, a collision between the end effector 174 and the obstacle 2177 occurs. The difference in collision / non-collision results between scenarios A and B is due to the fact that the length from the elbow joint 2103 to the distal portion of the arm 102 is shorter than the length from the shoulder joint 2101 to the distal portion of the arm. The wrist joint 2105 of the arm 102 in Figure 3A is designed or configured to rotate but not flex, and therefore is not involved in any of the three scenarios in the non-limiting example of Figure 3A. In scenario C, which is a continuation of scenario A, it can be seen that flexing the shoulder joint 2101c after flexing the elbow joint 2103a (here 2103c) allows for smooth, continuous avoidance of a collision between the end effector 174 and the obstacle 2177.

[0122] FIG. 3B shows an example of the elbow joint 2103 bending from a non-flexed orientation to various orientations relative to the proximal arm base segment 2181 (flexed orientations ranging from less than 90° to more than 180°).

[0123] In embodiments, the flexion range of motion at the elbow joint is >90°, >120°, >140°, >160°, >180°, >190°, >200°, or about 210°±10°. In some embodiments, the end effector 174 can be positioned >90°, >120°, >140°, >160°, >180°, >190°, >200°, or about 210°±10° relative to the base 2181 of the arm 102. In some embodiments, the end effector 174 can be parallel to the base 2181 of the arm 102 when fully flexed, or alternatively can reach the base 2181 of the arm 102. Additionally, the elbow rotational joint range of motion can be at least 200°, at least 250°, at least 300°, at least 310°, at least 320°, at least 330°, at least 350°, or about 360°. FIG. 3C shows the arm 102 rotated from the unflexed orientation shown in FIG. 3B to bring the arm 102 into a reflexed configuration or equivalently a reflexed position, and the end effector 174 into a reflexed operating position, with the elbow joint 2103 flexed by more than 180°.

[0124] In some embodiments, deflection of the surgical arm can be automatic, i.e., by configuring the arm to respond to one or a limited number of electronic control outputs by flexing and / or rotating one arm joint until the arm and / or the end effector at the distal end of the arm reaches a preprogrammed deflection position.

[0125] FIG. 4 shows a front view of the arm 102 with elbow joint 2103 bent and then rotated, similar to elbow joint 2103a in scenario A of FIG. 3B. That is, elbow joint 2103 in FIG. 4 is both flexed and rotated. Rotation of any arm joint can be independent of flexion of that same arm joint. In some embodiments, flexion and rotation can occur simultaneously. In other embodiments, they may be forced to be non-simultaneous, for example, by constraints in the hardware design or software components of the control circuitry governing the joint actuation.

[0126] Figure 5 shows a front view of the arm 102 with the shoulder joint 2101 bent along with the elbow joint 2103 such that the elbow joint 2103 is bent and rotated to form a complex "S" shape, similar to that of Figure 4. In some embodiments, such as Scenario C in Figure 3B, it is preferable to actuate the shoulder joint 2101 to bend and rotate only after the bending of the elbow joint 2103 has "cleared" (avoided a collision with) the obstacle 2177.

[0127] Referring now to FIG. 6, a flowchart of a general method for controlling a surgical mechanical arm using various modes of operation is shown, according to some embodiments.

[0128] The processes described herein can be implemented for various types of surgery, such as gynecological surgery, laparoscopic surgery, ear, nose and throat surgery, etc., that are performed at least in part using one or more mechanical surgical arms inserted inside the patient's body.

[0129] As previously described herein, the surgical mechanical arm is capable of operating according to a number of operating modes, optionally selected according to the surgical step to be performed and / or according to the current stage of the surgical procedure.

[0130] The different modes of operation can be characterized by different ways in which user input (through manipulation of a user input device) is translated into respective movements of the surgical mechanical arm (movement of an input device or control element of the input device). Additionally or alternatively, the different modes of operation can be characterized by different limitations on the articulation of the surgical arm (e.g., limiting the articulation (e.g., flexion) of one or more surgical arm joints, limiting the range of movement, or limiting the articulation of the arm to selected degrees of freedom). Additionally or alternatively, the different modes of operation can be characterized by different types of feedback to the user (e.g., feedback perceived by a user controlling the surgical arm via one or more input devices).

[0131] In some embodiments, selection and / or switching between operational modes is controlled by a user, e.g., a surgeon. Optionally, selection of operational mode can be made via a user interface of the system, e.g., via a touchscreen and / or via another input device, or via buttons or other input devices located on or in proximity to a control console or display screen. Additionally or alternatively, selection of operational mode can be made automatically, e.g., performed by appropriate control circuitry such as a system controller or processor. In some embodiments, selection and / or switching between operational modes is triggered by and conditioned on one or more of the following (non-exhaustive list): Determining the current "anatomical" position of the surgical arm or the arm's end effector (e.g., using electromechanical devices such as encoders or other sensors (not shown) associated with the arm's actuators and / or motors (e.g., 104 or 108), or by accessing and analyzing (through imaging processing or vision) images of the arm 102 obtained by a camera). Identifying the current position of the input device. Performing certain articulation movements of the surgical arm. Receiving an indication of one or more position sensors of the surgical arm. Time indication (e.g. by determining when the operating mode is changed).

[0132] The flowchart in FIG. 6 describes how a surgical mechanical arm operates using two modes of operation, according to some embodiments.

[0133] The method includes:

[0134] Step S01: In a first operation mode, one or more surgical arms are inserted and guided to a predetermined position.

[0135] In a first mode of operation, the surgical arm is introduced into the body and guided to a selected anatomical location and / or a selected arm position. The surgical arm may be introduced into the body via a natural body orifice (e.g., vagina, anus, trachea, esophagus, ear canal) and / or via an incision.

[0136] In some embodiments, in the first operating mode, articulation of the arm is restricted. For example, one or more arm joints may be restricted or prevented from articulating (flexing and rotating). In one example, the arm includes three joints: a shoulder joint, an elbow joint, and a wrist joint that rotates but does not flex, and articulation of one or two of the joints is prevented. In a specific example, only elbow joint movement (e.g., elbow flexion, extension, and / or rotation) is permitted, while shoulder and wrist joint movement is restricted.

[0137] Also, during the first operation mode, the arm as a whole can be allowed to move linearly (including only linear movement) such as moving forward or backward in one dimension.

[0138] In some embodiments, the constraints on arm movement are implemented mechanically, for example, by one or more locks (e.g., solenoid locks) that affect the actuation of the arm joints. Additionally or alternatively, the constraints on arm movement can be implemented by applicable circuitry, for example, by implementing software control functions that limit the range and / or type of movement.

[0139] In some embodiments, limiting the range of arm movement and / or limiting certain types of movement is performed in response to the current arm position, e.g., as indicated by one or more position sensors in the arm. In some embodiments, limiting the range of arm movement and / or limiting certain types of movement is performed in response to the current anatomical position of the arm, e.g., as visualized by optical means (e.g., a camera introduced intracorporeally and optionally with the surgical arm).

[0140] Step S02: Articulate one or more surgical arms to a base position in a first mode of operation.

[0141] Additionally, in the first mode of operation, one or more surgical arms are articulated to a base position. In some embodiments, the base position includes a recumbent position of the arm when the arm is bent at least 120 degrees, at least 150 degrees, at least 180 degrees, or an intermediate, greater, or lesser angle, for example. In some embodiments, the base position positions the arm to enable the user to perform a surgical procedure from a selected orientation (e.g., an orientation corresponding to a abdominal orientation) that may be more comfortable or familiar to the user.

[0142] In some embodiments, control of movement of the surgical arm in the first mode of operation comprises robotic control. Optionally, manipulation of the input device by the user in the first mode of operation includes only limited types of user movement (e.g., limited movement of the input device along defined axes and / or button presses). In one example, moving the input device along a first defined axis actuates rotation of a selected arm joint (e.g., elbow), moving the input device along a second defined axis actuates flexion of a selected arm joint (e.g., elbow), and pressing one or more buttons actuates linear advancement or retraction of the surgical arm.

[0143] In some embodiments, in the first mode of operation, user manipulation of the input device is translated into a rate of movement of the surgical arm, for example, when the user moves the input device relative to a rest position of the input device, the extent to which the input device is moved relative to the rest position of the input device sets the relative rate of movement of the surgical arm.

[0144] Step S03: Transition to a second operating mode, and perform a surgical procedure using one or more surgical arms.

[0145] In the second mode of operation, the user performs a surgical act via the surgical arm, such as, for example, grasping tissue, dissecting tissue, moving tissue, suturing tissue, etc. In some embodiments, the second mode of operation begins at the end of step S02 when the arm is moved to a selected base position (e.g., a reflexed position).

[0146] In some embodiments, the user switches input devices when transitioning from the first operating mode to the second operating mode, or alternatively, the user uses the same input device in both the first operating mode or guidance operating mode and the second operating mode or surgical mode.

[0147] In some embodiments, in the second mode of operation, movement of the surgical arm is not as limited as in the first mode of operation. By way of example, all arm joints (shoulder, elbow, wrist) are capable of articulation (e.g., flexion and / or rotation). In some embodiments, the range and / or speed of arm movement during the second mode of operation is limited based on safety precautions, such as to avoid damaging surrounding tissue and to avoid movement at speeds that are too fast and risk injury.

[0148] In some embodiments, controlling the surgical arms in the second mode of operation includes teleoperated control. Optionally, respective displacements of the surgical arms mimic displacements of an input device by a user. Optionally, a rate of movement of each of the surgical arms reflects a rate of displacement of the input device by the user.

[0149] Step S04: Transition (return) to the first operating mode and withdraw one or more surgical arms from the body.

[0150] According to some embodiments, once the surgical procedure is completed, the arms are optionally retracted outwardly from the patient's body. In some embodiments, retraction occurs in a first mode of operation. Optionally, the arms are straightened before and / or during retraction.

[0151] Retraction in the first mode of operation can be advantageous because it limits the range and / or type of movement of the arm, thereby reducing the possibility of damaging tissue surrounding the anatomical passageway (e.g., vagina) through which the arm is retracted.

[0152] Referring now to FIG. 7, the control console 118 may include a display screen 407 and an input device 405 located adjacent thereto, i.e., opposite the side of the screen 407 in the non-limiting example of FIG. 7.

[0153] Each input device 405 (in the form of a "thumbstick") has a nipple-style controller 409 suitable for operation by a user's thumb. In embodiments, the range of movement of the nipple 409 relative to a central resting position can be translated into a selected surgical arm movement speed, as previously described herein. In one example, the farther the nipple 409 is pushed from this central resting position, the faster the resulting surgical arm movement speed. In another example, the more force applied to the nipple 409, the faster the resulting surgical arm movement speed.

[0154] In some embodiments, when controlling the surgical arm via the thumbstick 405, movement of one or more joints of the surgical arm (e.g., shoulder joint, wrist joint) is limited, and only flexion and / or rotation of the elbow joint is enabled. In some embodiments, linear movement of the surgical arm (as a single body) is also enabled, for example, to advance or retract the arm. In some embodiments, movement of the nipple 409 actuates flexion and / or rotation of the elbow joint. In some embodiments, linear movement of the arm 102 is actuated by a separate actuator. For example, actuation is performed using a separate pair of input devices, such as input devices 406, 408, which in the illustrated example of FIG. 7 are implemented as push buttons located on the body of the input device (thumbstick assembly) 405 itself. In other examples, push buttons 406, 408 can be provided independently or on (or closer to) the display screen 407. In one example, button 406 advances the surgical arm distally (e.g., toward the abdomen), and button 408 retracts the surgical arm proximally. In an embodiment, input devices 406, 408 may be used during a first mode that excludes flexion and rotation of arm joints other than the elbow joint, since linear motion does not require either flexion or rotation.

[0155] In some embodiments, while the thumbstick 405 is in use, other input devices, such as the avatar input arm 411 provided for use in a second mode without any of the limitations of the first mode, are locked in a rest position, for example by a solenoid lock. In some embodiments, the rest position of the input arm 411 is selected as a recoil position for the surgical arm 102, so that when the surgical arm 102 is recoiled (e.g., with the thumbstick), the user can pick up the avatar input arm 411 and continue the procedure. In some embodiments, when the avatar input arm 411 is enabled during the second mode, operation of the thumbstick is disabled.

[0156] In some embodiments, during insertion of the surgical arm 102 into the patient 106, the surgical arm is straight, i.e., unflexed. In some cases, it is inserted through a cannula. At the same time, the avatar input arm is in a rest position, which can be a locked position and a reflexed position. Optionally, after reflexing the surgical arm using the thumbstick 405, the surgeon can release the thumbstick 405 and move their hand to the avatar input arm 411. When the surgeon grasps and optionally lifts the avatar input arm 411, control over the surgical arm 102 can be automatically switched or transferred from the first user input device 405 to the second user input device 411, and the surgeon can continue the procedure using the avatar input arm 411.

[0157] In some embodiments, when one or more avatar-input arm joints are locked by a solenoid lock, the solenoid lock is automatically released by the surgeon lifting the avatar-input arm. Additionally or alternatively, manual locking of the avatar-input arm joints is released, for example, via a sensor that detects the position of the avatar-input arm.

[0158] In some embodiments, the system (e.g., a system processor) is configured to recognize one or more positions of the input device (e.g., the current position of the thumbstick and / or the current position of the avatar input arm) and optionally present the positions on a user interface screen. In some embodiments, determining the positions is aided by the use of a position sensor.

[0159] Figure 8 shows an image of one example of a thumb-operated input device 501 that includes a gripping handle 503 and, optionally, a textured surface to facilitate gripping, such as a surface having ridges 505. One or more control buttons 507 may be located along the gripping handle 503. For example, the thumbstick input device 501 of Figure 8 includes two control buttons 507, one for actuating distal linear advancement of the surgical arm and one for actuating proximal linear retraction of the arm.

[0160] In some embodiments, the thumbstick 501 includes a nipple 509, e.g., extending from the proximal end of the grip handle 503. In some embodiments, the nipple 509 is shaped and / or sized to fit a user's thumb. In some embodiments, the nipple 509 has a rounded profile. In some embodiments, the proximal surface of the nipple 509 is formed with a plurality of circumferentially disposed protrusions 511. The circumferential protrusions can help maintain the thumb positioned on the nipple 509 and potentially prevent or reduce the thumb from sliding away from the nipple 509.

[0161] In some embodiments, nipple 509 behaves like a spring: optionally, after pushing nipple 509 away from this initial rest position (e.g., a central position where nipple 509 is centrally aligned with thumbstick long axis 513), the nipple springs back to this central position.

[0162] 9 is a schematic diagram illustrating an example of the control of the thumb-operated input 501, according to some embodiments. In some embodiments, moving ("displacing") the nipple 509 relative to a first axis actuates a first type of surgical arm movement (e.g., bending), and displacing the nipple 509 relative to a second axis actuates a second type of surgical arm movement (e.g., rotation).

[0163] In some embodiments, the thumbstick 501 is used during a first mode of operation in which at least some of the joints (e.g., the shoulder joint 2101 and the wrist joint 2105) are restricted. Optionally, displacement of the nipple 509 along the Y-axis causes flexion of the elbow joint 2103 of the surgical arm 102, and displacement of the nipple 509 along the X-axis causes rotation of the elbow joint. In some embodiments, simultaneous actuation of bending and rotation can be achieved by pushing the nipple against both axes (e.g., diagonally relative to the center).

[0164] 10 and 11, side and front view images of an exemplary avatar-like input arm 701 are shown, which includes multiple joints for actuating the movement of each of the surgical arm joints. As shown, the joints include a shoulder joint 703, an elbow joint 705, and a wrist rotation knob 707 for controlling the wrist joint 2105 of the surgical arm 102.

[0165] In some embodiments, the avatar input arm can include additional input devices, such as buttons or levers 709. These input devices can control the operation of surgical tools of the surgical arm 102 (such as the end effector 174).

[0166] 10-11 include a pause-resume button 711 and buttons 713, 715 for actuating linear forward and backward movement of the arm 102, respectively. A user can actuate linear forward and / or backward movement using buttons 713, 715 on the avatar input arm and / or buttons 406, 408 located on the thumbstick 405. Additionally or alternatively, linear movement of the arm can be actuated via a screen interface of a control console (e.g., via a touchscreen interface).

[0167] In some embodiments, a set of two avatar input arms is provided for controlling a left arm and a right arm, respectively. For example, a first avatar input arm 701 can control a first motor unit 108 associated with a first surgical arm 102 (e.g., the "right" arm), and a second avatar input arm 701 can control a second motor unit 108 associated with a second surgical arm 102 (e.g., the "left" arm). In some embodiments, any or all of the input arms 120, 411, and 701 can be the same.

[0168] In one example of the prior art, both the first and second modes use the same input device, an avatar-like input arm. As described above, the input arm is used in a limited mode to deflect the arm, at which point it transitions to fully functional use in the second mode. However, at this point, the input arm, or at least the handle member (e.g., handle member 702 in FIG. 10 ), may be inverted by as much as or more than 180°, depending on the angle of bending used for deflection. This means that (a) the handle 702 is awkwardly “upside down” from the surgeon’s perspective, and (b) the coordinate system used in the surgical system is “upside down.” The surgeon’s perspective switches from looking “distal” to deflect the arm to looking “proximal” to perform surgery with the arm in the deflected position. As a result, the displacement vectors or turning arcs of the segment members are not transformed into corresponding (eg, parallel) displacement vectors or turning arcs in the same xyz space.

[0169] We now disclose that the step of transitioning from a first input device of an array of one or more input devices to a second input device of the array when transitioning from a first mode to a second mode can overcome the aforementioned drawbacks. The handle member 702 of the second input device (avatar-like input arm 701) can be pre-positioned in an orientation that is not "upside down" from the surgeon's perspective. The reflexion can be performed using an input device (e.g., input device 501 / 405). Use of the input device does not involve or require moving the handle member 702 of the second input device, or if moved, not beyond 90°, which could be the "tipping point" at which it becomes "upside down" from the surgeon's perspective. Furthermore, the control circuitry controlling the second input device (input arm 701) can be configured (e.g., programmed) to use a "direct" coordinate transformation matrix. A "direct" coordinate transformation matrix is ​​one that transforms the displacement vector of an input arm segment into a corresponding (e.g., parallel, or at a minimum, having the same sign in each of the x, y, and z directions or at least two of the three directions) displacement vector of a corresponding surgical arm segment, and / or transforms the turning arc of an input arm segment into a corresponding turning arc of a corresponding surgical arm segment.

[0170] Therefore, it may be desirable to ensure a handoff (transition) from a first mode to a second mode in which control of arm movement is transferred from a first input device (such as a "thumbstick" as detailed herein) to an avatar-like input arm based on optimally oriented handle members and a directly translatable (input arm to surgical arm) coordinate transformation matrix to ensure ergonomic comfort and convenience.

[0171] It should be noted that the exemplary designs of input device 701 and handle member 702 are provided for illustrative purposes, and that in other examples and embodiments, the input device and handle member may be designed and implemented differently. For example, in some embodiments, the handle member may be physically detachable from the input device of which it is functionally a part. As another example, in some embodiments, an avatar-like input device or joystick-like input device is comprised entirely, almost entirely, or largely of a handle member that can be manipulated and / or grasped by hand. As another example, in some embodiments, the handle member may incorporate multiple control functions into the handle member design by including buttons, switches, toggles, wheels, knobs, and / or small sticks such as thumbsticks (not exhaustive). Multiple input devices and their respective functions may be "combined" into what visually appears to be a single input device. While the input device 701 and handle member 702 of FIG. 10 are shown repeatedly herein for convenience and ease of understanding, it should be understood that this is not a limitation on the design of the input device and handle member.

[0172] 12A and 12B. In an embodiment, alignment of an input device, such as an avatar input arm, with the current position of the surgical mechanical arm is performed. In one example, alignment is performed when a user switches between different input devices (e.g., when switching from a thumb-operated input to the avatar input arm). In another example, alignment of the input device with the surgical arm position is performed at system initialization, for example, at the start of or before a surgical procedure. In another example, alignment of the input device with the current position of the surgical mechanical arm is performed when resuming control after a pause. Optionally, in pause mode, movement of the input device does not actuate relative movement of the surgical mechanical arm. Upon resumption of control, the position of the input arm may be required to be adjusted to match the current position of the surgical mechanical arm in order to continue operation in a smooth, uninterrupted manner.

[0173] In some embodiments, control is resumed in an automatic or semi-automatic manner, for example, the user performs a selected articulation of the input device (e.g., straightening the elbow joint of the avatar input arm) to resume control of the surgical arm.

[0174] 12A and 12B, the relative position of the input device (i.e., the input arm) is represented using a cross-shaped diagram 801. In some embodiments, there are two cross-shaped diagrams, one for the shoulder joint and one for the elbow joint. In some embodiments, the cross represents a specific joint of the surgical mechanical arm (e.g., shoulder joint, elbow joint). In some embodiments, each line of the slot represents a different type of joint movement. For example, horizontal line 803 represents joint rotation, and vertical line 805 represents joint flexion. In use, the user manipulates the input device according to the joint position indicated on the cross-shaped diagram by a two-colored dot 807. As the position of the input device (in response to user manipulation) approaches the position of the surgical mechanical arm, the colored dot moves closer to the center of the cross-shaped diagram (see FIG. 12B). Optionally, when sufficient alignment between the position of the input device and the position of the surgical arm is achieved, the color of the dot changes color, for example, from red to green, as shown in FIGS. 12A-B.

[0175] 12A and 12B can be used in alignment calibration as part of a transition step from a first mode using a first input device to a second mode using an avatar-like input arm. In these embodiments, the first input device can be used to adjust the position of the surgical arm to align with the fixed position of the input arm.

[0176] 13 is an example of a screen displayed to a user during alignment, according to some embodiments. In the example shown, a first input device (corresponding to the right avatar arm) is shown properly aligned with a first surgical arm, as indicated by, for example, check marks 809 at both the elbow and shoulder joint positions, and / or a locked lock 811. A second input device (corresponding to the left arm) is shown in a position that is not yet aligned with the surgical arm. This joint position is represented by two cross-shaped diagrams, for example, as described above herein, and is unlocked.

[0177] In some embodiments, certain articulations and / or functions are disabled during alignment, for example, the speed of the surgical arm is limited, electrosurgery functions are disabled, and / or other functions are disabled.

[0178] 14A-E are a series of images illustrating exemplary control of a surgical mechanical arm using multiple different input devices, according to some embodiments. In the non-limiting example of FIGS. 14A-E, two arms are shown, although in other examples there can be a single arm or more than two arms.

[0179] 14A illustrates the control of two surgical mechanical arms 901 during introduction of the arms into a model 903 that simulates access to a body through a vagina, according to some embodiments. In this example, control of the surgical arms 901 during advancement of the arms into the body (e.g., through the vaginal canal) is via thumb-operated input, including, for example, a pair of thumbsticks 905, as described herein above.

[0180] 14B shows manipulation of the surgical arm into a reclined position via the thumbstick 905. In the example shown, the arm is bent (e.g., 120, 150, 180, 210 degrees or intermediate, greater or lesser angles) to achieve the reclined position.

[0181] 14C shows the surgical arm in a recoiled position. In some examples, after recoil, the user can switch input devices by, for example, releasing the thumbstick and picking up the avatar input arm. At this point, alignment of the avatar input arm with the current position of the surgical arm can be performed, for example, as described in FIGS. 12A-B and 13.

[0182] 14D and 14E illustrate, according to some embodiments, steering a surgical arm using a pair of avatar input arms 907. It can be seen that each position of the surgical arm corresponds to a position of the input arm.

[0183] The block diagram in FIG. 15 illustrates the articulated arm 102, the input device array 1500, and the detector 1520. Those skilled in the art will understand that not all elements shown in FIG. 15 are required in all embodiments. While the input device array 1500 shown in FIG. 15 illustrates two user input devices 1510A (e.g., thumbstick 501) and 1510B (e.g., joystick 701), those skilled in the art will understand that different embodiments may include fewer or more user input devices. In one example, the joystick 701 can be both the first user input device 1510A and the second user input device 1510B. In other words, the first user input device 1510A and the second user input device 1510B can be the same single user input device. In implementations in which the first user input device 1510A and the second user input device 1510B are the same single user input device, they are typically more versatile or flexible devices such as the joystick 701. The term user input device refers to a device for converting input received from a user into electronic output and / or signals. Examples of user input devices include, but are not limited to, joysticks, touchscreens, thumbsticks, mice, keyboards, gesture detection devices (including, for example, cameras [not shown]), etc. Unless otherwise specified, the term "array" refers to one or more items.

[0184] 15, the articulated arm 102 has one or more objects 1530 attached to its distal end. The one or more objects 1530 may be provided with the arm 102 or may be added or replaced separately. Examples of such objects 1530 include, but are not limited to, end effectors, e.g., surgical end effectors. Associated surgical tools may include (but are not limited to): Surgical end effector tools such as endoscopes for diagnostic / surgical feedback, needle holders (e.g., large needle holders, curved needle holders), monopolar and bipolar instruments (e.g., monopolar scissors, bipolar forceps), clip appliers (e.g., large clip appliers, medium clip appliers), vessel sealers, graspers or dissectors (e.g., Maryland dissectors, tenacious forceps, micro forceps, long tip forceps, retractors, Fundus graspers, alligator graspers, Cadiere forceps), scissors (e.g., Potts scissors, curved scissors), hooks (e.g., cautery hooks), and spatulas (e.g., cautery spatulas).

[0185] As discussed elsewhere, in some embodiments, the arm 102 and / or one or more objects 1530 operate in response to one or more electronic control outputs of one or more control devices. The terms "control output" and "control signal" are used interchangeably. In different embodiments, the control output may be transmitted to the arm 102 and / or arm controller via wired and / or wireless communication.

[0186] Also shown in FIG. 15 is detector 1520. As discussed elsewhere, in some embodiments, a mode transition from a first operating mode of surgical system 999 to a second operating mode of surgical system 999 is responsive to and / or dependent on the output of detector 1520. Surgical system 999 may be functionally equivalent to surgical system 100 shown in FIG. 1. In one non-limiting example, detector 1520 detects whether a portion (e.g., a distal portion) of arm 102 is deflected and / or in a deflected position. In one example, a camera captures images of arm 102, and detector 1520 can detect the position via the camera and imaging processing circuitry. In another example, an encoder (not shown) or other electromechanical sensor (e.g., sensor 104 or 108) can be used for monitoring and detection to track, for example, the orientation of one or more joints of arm 102. Other examples may involve position detection using one or more magnetic detectors, or capacitive detectors, or ultrasound and / or light, for example based on triangulation (eg time of flight).

[0187] As used in this disclosure and the claims appended hereto, "monitoring" and "detecting" are actions (and / or functions and / or potential actions and / or capabilities) that may be performed by one or more components of a surgical system, by one or more users, or by any combination of system components and a human user. The descriptive language used herein with respect to automated or machine-based monitoring or detection is intended to be non-limiting, and in any such embodiment, user intervention can be part of the design and / or operation. In some embodiments, user intervention is required for safety reasons. In one non-limiting example, one or more sensors relay information about the surgical arm or one of its components to a display screen, and the user is trained and / or positioned to monitor and detect the curvilinear shape of the arm when it is in a desired position and orientation (e.g., reflexed at the surgical procedure site), with or without automated or semi-automated visual aids. In another non-limiting example, the monitoring and / or detection is communicated to the user in a non-visual manner (such as, but not limited to, by an audible announcement, by tactile feedback, or by locking a control or input device). Of course, any of these types of communication can also be combined with visual information.

[0188] Those skilled in the art will also understand that additional elements may be included in the surgical system 999, and that not all components of all elements shown in FIG. 15 are required in all embodiments.

[0189] Referring now to FIG. 16 , in step S101, the surgical system 999 operates in a first operating mode. In step S121, the surgical system 999 operates in a second operating mode. As discussed elsewhere, in different embodiments, the first operating mode and / or the second operating mode may be related to one or more specific capabilities and / or limitations of the input device. Alternatively or additionally, the first operating mode and / or the second operating mode may be related to one or more specific capabilities and / or limitations of the arm 102 and / or the elements of the object 1530. Examples of such elements include joints and articulators. Alternatively or additionally, the first operating mode and / or the second operating mode may be related to the relationship between the operation of one or more input devices 1510 and the arm 102 or one or more components thereof (e.g., whether the configuration of the input device 1510 or its components translates to the velocity or position of the arm 102 or its components).

[0190] In step S101, one or more operations are performed while the surgical system 999 is operating in a first mode. In one example, when the surgical system operates in the first mode, the distal portion of the arm 102 is deflected, possibly starting from an unbent and / or straight position, although this is not necessarily the case. In another example, when the surgical system 999 operates in the first mode, the distal portion of the arm 102 is brought so that its curved shape (e.g., a 3D curved shape or a planar projection thereof) conforms to a predetermined curved shape (e.g., one useful for initiating a surgical procedure, such as a deflected shape or an "S" curved shape).

[0191] Step S109 relates to monitoring and may be performed simultaneously with step S101. For example, step S109 may be performed at least in part by detector 1520. In some embodiments, the monitoring of step S109 may include determining whether the arm is in a recoiled position.

[0192] Step S113 relates to a mode transition trigger event, i.e., a detectable event whose detection causes the surgical system 999 to transition from the first mode of step S101 to the second mode of step S121. An example of step S113 is as follows: In response to, and conditional on, detecting that the arm 102 is in a deflected position, i.e., that the arm 102 has transitioned from a non-deflected position to a deflected position, e.g., by detector 1520, the surgical system 999 transitions from the first operating mode to the second operating mode. As described herein above, the transition can include an alignment calibration of the surgical arm 102 with the input arm 701.

[0193] The transition of step S117 may be triggered, for example, by and / or in response to and / or as a condition of detecting that the arm 102 has been deflected or that the end effector 1530 is in a deflected position.

[0194] Comparison of the first mode in step S101 and the second mode in step S121

[0195] In some embodiments, step S101 may provide one or more of the following features, either alone or in combination:

[0196] (A1) The configuration of the arm 102, or at least a distal portion thereof, may be controlled by and responsive to electronic control outputs from the user input device 1510A. In some embodiments, the user input device 1510A may be a first user input device, such as the thumbstick 501. In other embodiments, the user input device 1510A may be one and the same user input device 1510A / 1510B, such as the joystick 701.

[0197] (A2) While the surgical system is in the first mode (e.g., to deflect), the configuration of the arm is controlled by the output of the user input device (e.g., thumbstick device 501) such that the magnitude of displacement (magnitude of displacement from a base position and / or initial position and / or start position and / or center position) relative to the displacement speed of the user input device or a displaceable part thereof (e.g., a part located on the tiltable nipple 409 or 509) is converted into the speed of flexion and / or rotation of an arm joint such as the elbow 2103.

[0198] (A3) While the surgical system is in a first mode (e.g., to recoil), the configuration of the arm is controlled by the output of a user input device such that the position of an element of the user input device (e.g., a thumbstick), selected from a plurality of candidate positions (e.g., defined by a plurality of tiltable angles of a nipple or equivalent), specifies (e.g., commands) a target velocity for movement of an element of the arm, selected from a plurality of candidate velocities (e.g., the greater the tilt of the nipple, the greater the velocity).

[0199] (A4) While the surgical system is in the first mode, the configuration of the arm is controlled by the output of the user input device such that the controlling user input device has a plurality of positions or configurations, where (i) for a subset of the plurality of positions or configurations, each subset specifies movement in the same bending plane or rotational direction, (ii) a first position or configuration specifies / commands a first velocity, and (iii) a second position or configuration specifies (e.g., commands) a second velocity that exceeds the first velocity.

[0200] (A5) The control circuitry of the surgical system is effective to limit actuation of all but one arm joint while the surgical system is in the first mode of operation.

[0201] Second operating mode In some embodiments, step S121 may provide one or more of the following features, either alone or in combination:

[0202] (B1) The configuration of the arm 102, or at least its distal section, is controlled by the user input device 1510B (e.g., the joystick 701), e.g., in response to a control output from the user input device 1510B.

[0203] (B2) While the surgical system is in the second mode, for example, to perform a surgical procedure, the configuration of the arm 102 is controlled by the output of the user input device 1510B such that the magnitude of displacement of a given input device or displaceable portion thereof is translated into a corresponding displacement of at least a portion of the arm and / or at least one arm segment of the arm. For example, in FIG. 10, the displacement of the shoulder element 703 of the joystick 701 can be translated into a corresponding displacement of the shoulder joint 2101 of the arm 102, and / or for example, in FIG. 10, the displacement of the elbow element 705 of the joystick 701 can be translated into a corresponding displacement of the elbow joint 2103 of the arm 102.

[0204] (B3) While the surgical system is in the second mode (e.g., to perform a surgical procedure), the configuration of the arm is controlled by the output of the user control device such that the magnitude of displacement of a given input device or displaceable portion specifies (e.g., fully specifies, e.g., commands) a target position of the arm element (i.e., a position different from the currently prevailing position) and / or a target configuration of the arm (e.g., a configuration different from the currently prevailing configuration).

[0205] First and second operating modes In some embodiments, steps S101 and S121 may collectively provide one or more of the following salient features (eg, any combination):

[0206] (C1) In some embodiments, a first input device 1510A (e.g., a thumbstick) of the input device array 1500 controls the actuation of one arm joint (e.g., elbow 2103) while the surgical system is in a first operating mode, and a second input device 1510B (e.g., a joystick) of the input device array 1500 controls the actuation of multiple arm joints (e.g., elbow 2103 and shoulder 2101) while the surgical system is in a second operating mode.

[0207] (C2) In some embodiments, the array of input devices includes a first 1510A input device (e.g., thumbstick 501) and a second 1510B input device (e.g., joystick 701). (ii) The first input device is configured to control the actuation of one arm joint (e.g., elbow 2103) and is not configured to control the actuation of arm joints (e.g., shoulder 2101, etc.) other than the one arm joint (e.g., elbow 2103). (iii) A second input device controls actuation of multiple arm joints (eg, both elbow 2103 and shoulder 2101) during a second mode of operation. (iv) The control circuit is effective to implement a restriction that allows control of the arm 102 by the first input device 1510A while disabling control of the arm by the second input device 1510B while the surgical system is in the first operating mode. Thus, the transition from the first operating mode to the second operating mode (eg, the transition to step S121) may "hand off" control from the first user input device 1510A to the second user input device 1510B.

[0208] (C3) In some embodiments, both user input devices 1510A, 1510B are the same user input device, such as a joystick 701 or similar articulated device, i.e., a device having segment members and segment joints corresponding to the arm segments and arm joints of arm 102.

[0209] Next, several embodiments of Figure 16 will be described. Those skilled in the art will understand that these embodiments are not necessarily mutually exclusive (embodiments or features thereof may be combined). In some embodiments, not all of the features and / or method steps need be present.

[0210] First embodiment of FIG.

[0211] A first embodiment relates to a method of operating a surgical system, the surgical system comprising: (i) An input device array of one or more user input devices. (ii) an articulated mechanical arm comprising a surgical end effector at a distal end of the arm and a plurality of arm joints configured to bend and rotate in response to electronic control outputs from said user input device; The method includes the following steps. (a) Steps for commencing operation of the surgical system in a first operating mode S101 defined with respect to a given one of the arm joints (e.g., elbow 2103), the first mode excluding actuation of any arm joints of the arm that are not the given one of the arm joints (e.g., including shoulder 2101) and permitting control of actuation of the one of the arm joints (e.g., elbow 2103) to cause flexion and rotation of the joint of the arm (e.g., elbow 2103). (b) while the surgical system is in a first operating mode (e.g., S101), (i) deflecting the distal end of the arm by flexing and rotating one arm joint (e.g., elbow 2103) in response to control signals generated by one or more of the user input devices (e.g., thumbstick 501) to bring the end effector 174 into a deflected operating position, and (ii) monitoring the state of the mechanical arm 102 (e.g., S109) to detect whether the arm is in a deflected position. (c) in response to and conditional on detecting that the arm 102 is in a recoiled position (step S113), transitioning the operation of the surgical system from the first mode to a second mode (e.g., the "YES" branch from S113 to S121), in which the system is capable of controlling flexion and rotation of at least one arm joint excluded in the first mode (e.g., elbow 2103) according to each arm joint's respective degrees of freedom. (d) The surgical system operates in a second mode (e.g., at S121) to perform a surgical act using the end effector.

[0212] Second embodiment of FIG.

[0213] The surgical system includes: (i) A first user input device 1510A (eg, thumbstick 501) and a second user input device 1510B (eg, joystick 701). (ii) an articulated mechanical arm 102 with multiple arm joints (e.g., elbow 2103 and shoulder 2101) and a surgical end effector 174 at the distal end of the arm; The method of operation of the surgical system includes the following steps. (a) Steps for initiating operation of the surgical system in a reflex mode (e.g., the first mode of S101): With respect to flexion and rotation of the arm joints, (i) the first user input device 1510A (e.g., the thumbstick 501) is active to direct flexion and rotation of only a given joint of the arm joints, and (ii) the second user input device 1510B (e.g., the joystick 701) is disabled. (b) while in the recoil mode, recoiling a distal portion of the articulated mechanical arm in response to electronic control output from the first user input device 1510A by flexing and rotating a predetermined joint of the arm joint (e.g., elbow 2013) to bring the end effector into a recoil operating position. (c) transitioning the surgical system from a reflexion mode to a surgical operation mode to enable the second user input device 1510B for flexion and rotation of at least one of the arm joints of the arm (e.g., shoulder 2101) other than a given joint of the arm joint (e.g., elbow 2103). (d) while in the surgical operation mode, flexing and rotating at least two of the arm joints (e.g., the shoulder and elbow) according to their respective degrees of freedom in response to electronic control outputs from the second user input device 1510B, thereby moving the surgical end effector to perform one or more surgical operations.

[0214] Third embodiment of FIG.

[0215] The surgical system includes: (i) An input device array 1500 of one or more user input devices. (ii) an articulated mechanical arm 102 including multiple arm joints (e.g., shoulder 2101 and elbow 2103) and a surgical end effector 1764 at the distal end of the arm; The method of operation of the surgical system includes the following. (a) Steps for initiating operation of the surgical system in a reflex mode (e.g., S101). For arm joint flexion and rotation, the input device array is active to command flexion and rotation of only a given joint of the arm joint (e.g., elbow 2103). (b) while in the deflection mode, deflecting a distal portion of the articulated mechanical arm by flexing and rotating a given joint of the arm joint in response to electronic control output from the input device array to bring the end effector into a deflection operating position. (c) transitioning the surgical system from the deflection mode to a surgical motion mode to enable the input device array for flexion and rotation of arm joints other than the given one of the arm joints; (d) during the surgical operating mode, in response to electronic control outputs from the input device array, effectively flexing and rotating at least two of the arm joints (e.g., at least both the elbow 2013 and the shoulder 2101) according to their respective degrees of freedom, thereby moving the surgical end effector to perform one or more surgical acts.

[0216] Fourth embodiment of FIG.

[0217] The surgical system includes: (i) A user input device (eg, joystick 701). (ii) an articulated mechanical arm 102 with multiple arm joints and a surgical end effector at the distal end of the arm; The method of operation of the surgical system includes the following steps. (a) Steps for initiating operation of the surgical system in a reflex mode (e.g., S101): For flexion and rotation of the arm joints, a user input device is active to direct flexion and rotation of only a given joint of the arm joint (e.g., elbow). (b) while in the recoil mode, recoiling a distal portion of the articulated mechanical arm by flexing and rotating a given one of the arm joints in response to an electronic control output from the user input device to bring the end effector into a recoil operating position. (c) transitioning the surgical system from the reflex mode to a surgical operation mode (e.g., 121) to enable the user input device with respect to flexing and rotating at least one of the arm joints of the arm other than the given joint of the arm joint. (d) during the surgical operating mode, in response to electronic control output from the user input device, effectively flexing and rotating at least two of the arm joints according to a respective degree of freedom of each arm joint, thereby moving the surgical end effector to perform one or more surgical operations.

[0218] Fifth embodiment of FIG.

[0219] A method of using a surgical system, the method comprising the following steps. (a) Providing an articulated mechanical arm capable of displacing a surgical end effector 174 at a distal end of the arm, the arm comprising a plurality of arm segments connected (e.g., in series) by a corresponding plurality of arm joints (e.g., elbows and shoulders), the arm joints configured to flex and rotate in response to electronic control outputs from a user input device. (b) maneuvering the end effector to a deflected operating position while operating in a first input mode, in which displacement of an input device (e.g., 1510A, such as a thumbstick) or a displaceable portion thereof is translated into flexion and / or rotational velocities of arm joints. (c) in response to, and conditional on, detecting the end effector in a recoiled operating position, transitioning from operation in the first input mode to operation in a second input mode, in which displacement of an input device (e.g., joystick 1510B) or a displaceable portion thereof is translated into a corresponding displacement of at least one arm segment. (d) after the transitioning step, performing a surgical act with the end effector while operating in the second input mode.

[0220] The present invention has been described using detailed descriptions, which are provided by way of example only and are not intended to limit the scope of the invention. The described embodiments have different features, not all of which are required in all embodiments of the invention. Some embodiments of the invention utilize only some of the features or possible combinations of the features. Those skilled in the art to which the present invention pertains will recognize variations of the described embodiments of the invention and embodiments of the invention having various combinations of the features noted in the described embodiments.

[0221] Additional explanation

[0222] According to an aspect of some embodiments, there is provided a method for controlling one or more surgical mechanical arms insertable into a patient's body via one or more input devices, each of the surgical mechanical arms including a plurality of movable joints, the method comprising the steps of: guiding a surgical mechanical arm into a patient's body in a first mode of operation; Performing a surgical procedure with the surgical mechanical arm in a second mode of operation. Here, in the first mode of operation, the movement of each surgical mechanical arm is limited to movement of one joint of the plurality of joints and linear movement of the surgical mechanical arm as a single unit.

[0223] In some embodiments, the guiding step includes deflecting a surgical mechanical arm within the patient.

[0224] In some embodiments, in the first mode of operation, the surgical mechanical arm is controlled by thumb-operated input.

[0225] In some embodiments, in the second mode of operation, the surgical arm is controlled by an avatar input arm.

[0226] In some embodiments, the surgical mechanical arm is controlled by a haptic handle during both the first and second modes of operation.

[0227] In some embodiments, in a first mode of operation, manipulation of the input device by the user is converted into a velocity of movement of the surgical mechanical arm, and in a second mode of operation, displacement of the input device by the user is converted into a relative displacement of the surgical mechanical arm.

[0228] In some embodiments, in the second mode of operation, a clutch-like mode is active, disconnecting control of the surgical arm by one or more input devices.

[0229] In some embodiments, a control console is provided for controlling one or more surgical mechanical arms, the control console comprising a thumb-operated input for controlling a first mode of operation, a hand-operated input for controlling a second mode of operation, and a screen interface.

[0230] In some embodiments, the thumb-operated input comprises a nipple engageable by a user's thumb, and pushing the nipple from a central resting position actuates movement of the respective surgical machine arm, with the speed of movement affecting the extent to which the nipple is pushed relative to this resting position.

[0231] In some embodiments, in the second mode of operation, manipulation of the manual input by the user is translated into a similar articulation movement of the surgical arm.

[0232] According to an aspect of some embodiments there is provided a method of operating on a patient, the method comprising the steps of: introducing one or more surgical arms into the abdominal cavity through the vagina; bending the one or more surgical arms to a reflexed position (during introduction and bending, articulation of the one or more surgical arms is limited to linear movement and movement of only one arm joint); and Operating within the abdominal cavity with one or more surgical arms in a recumbent position.

[0233] In some embodiments, during linear movement, the surgical arm moves as a single unit, and movement of one arm joint includes flexion and extension of the elbow joint.

[0234] A general aspect of some embodiments of the present invention relates to the control of one or more surgical mechanical arms using a first mode of operation for guiding the arms to selected locations and positions within a patient's body and a second mode of operation for performing surgical actions within the selected locations. In some embodiments, control in the first mode includes translating user (e.g., surgeon) manipulation of an input arm (e.g., an avatar arm, a joystick) into respective articulation movements of the surgical arm. The movement rate of the surgical arm thereby varies as the range of manipulation of the input arm relative to a rest position of the input arm changes.

[0235] In some embodiments, control in the second mode includes translating user manipulation of the input arm into a respective position of the surgical arm (e.g., identical articulation), e.g., such that the position is directly set according to the input arm position. In some embodiments, user displacement of the input arm is translated into a relative displacement command to the surgical arm. In some embodiments, the second mode includes different control, e.g., one in which the user's range of manipulation of the input arm is in a different ratio than a similar movement made by the surgical arm.

[0236] In some embodiments, movement of the surgical arm in the first mode is limited, for example, resulting in only flexion and / or extension of the elbow joint of the surgical arm and linear movement of the surgical arm as a single unit. Optionally, other joints of the surgical arm (e.g., shoulder joint, wrist joint) are fixed and optionally locked in position. Alternatively, at least partial, limited movement of one or more other joints is permitted.

[0237] In some embodiments, introduction of the surgical arm into the body (e.g., through the vagina), guidance of the arm (e.g., into the abdomen), and optionally deflection of the surgical arm are performed when controlling the surgical arm using the first mode of operation. A potential advantage of limiting articulation of the surgical arm during introduction and / or deflection of the arm includes reducing the bend radius of the surgical arm, thereby reducing the likelihood of impinging on surrounding obstacles, such as the internal abdominal wall. Another potential advantage of limiting articulation of the surgical arm during guidance and / or deflection processes is potentially improved control over the surgical arm. In some embodiments, the first mode of operation (speed control mode) allows the user to continuously control the movement of the surgical arm, even when the relative direction (e.g., up and down) is reversed and during deflection of the arm.

[0238] In some embodiments, the system configured to control the surgical arm in both modes includes a dual control means including two different control sets. In some embodiments, a first control set is used for insertion of the surgical arm into the body and a second control set is used for performing the surgical act within the body. Alternatively, both sets are used in at least one of the phases (insertion and operation), and alternatively, only one set is used in both phases.

[0239] In some embodiments, the first mode is controlled by a pair of thumbsticks. Optionally, the degree to which each thumbstick presses on the nipple, relative to a resting position in the center of the nipple, affects the speed at which the arm articulates. Optionally, when the user lifts their thumbs, the nipples spring back to this resting position. In some embodiments, the second mode of operation is controlled using a pair of avatar input arms manipulated by the user's hands.

[0240] Additionally or alternatively, a set of haptic handles (e.g., including two handles, one for controlling each surgical arm) is used to implement both modes of operation. Optionally, in the first mode of operation, the handles are configured to provide a counterresistance, optionally a spring-like resistance, to user movement in response to movement of the arms away from their rest positions. Optionally, in the second mode of operation, the haptic handles are configured (e.g., preprogrammed) to provide a selected or variable resistance in response to manipulation by the user.

[0241] Additional explanation

[0242] Here, reference is made to FIGS. 17A to 17C.

[0243] In some embodiments, control of one or more surgical arms can be achieved via one or more input arms, joysticks, control handles, and / or other means suitable for manipulation by a user (e.g., a surgeon), which is then translated into corresponding articulation movements of one or more surgical arms.

[0244] As referenced in the flowchart of FIG. 17A , in the example described herein, some embodiments include dual control of the surgical arm. In some embodiments, a first user input (in this example, thumbstick 4005 in FIG. 17B ) is used to introduce the surgical arm into the patient's body, for example, through the vagina, and then deflect (4001) the surgical arm. In some embodiments, deflection (e.g., bending backward) of the surgical arm within the patient's body is performed to reduce the area over which the surgical arm is positioned. Optionally, deflection is performed during surgery to avoid obstacles, such as particular organs or portions thereof, such as the inner wall of the abdomen. Optionally, deflection is performed to position the surgical arm in an orientation familiar to laparoscopic surgeons for performing surgery.

[0245] In some embodiments, a second user input, in this example in the form of an input arm 4011 (eg, an avatar joystick), is then used 4003 to perform the remainder of the surgical procedure.

[0246] In some embodiments, the thumbsticks 4005 are positioned adjacent to the control console screen 4007 (e.g., on opposite sides of the screen). In some embodiments, each thumbstick 4005 includes a nipple-style controller 4009 shaped and sized to fit a user's thumb. In some embodiments, the thumbstick nipple is configured to have a rest position when centered and to spring back to the rest position when the thumb is released. In some embodiments, the degree of movement of the nipple relative to its center rest position determines the resulting speed of movement of the surgical arm. For example, the farther the nipple is pushed away from this center rest position, the greater the speed of movement of the surgical arm (and vice versa).

[0247] In some embodiments, when controlling the surgical arm via a thumbstick, movement of one or more surgical arm joints (e.g., shoulder joint, wrist joint) is restricted. In some embodiments, movement of all surgical arm joints except the elbow joint is prevented, and only flexion and / or rotation of the elbow joint is active. In some embodiments, linear movement of the surgical arm (as a unit) is also active, for example, to advance or retract the arm. In some embodiments, movement of the nipple actuates flexion and / or rotation of the elbow joint. In some embodiments, linear movement of the arm is actuated by a separate actuator, for example, using push buttons such as 4006, 4008 configured along the body of the thumbstick 4005. In one example, button 4006 advances the surgical arm distally (e.g., into the abdomen) and button 4008 retracts the surgical arm proximally.

[0248] In some embodiments, while the thumbstick is in use, the input arm 4011 is locked in a rest position, for example by a solenoid lock. In some embodiments, the rest position of the input arm is selected as the reflex position. Optionally, this position allows the surgeon to use the thumbstick to continue the procedure directly following the reflex. In some embodiments, manipulation of the thumbstick is disabled when manipulating the input arm.

[0249] A potential advantage of using a thumbstick for guiding and deflecting the surgical arm to the body while a selected arm joint, such as the shoulder joint, remains stationary is that it may reduce the bend radius of the surgical arm, thereby reducing the chance of impinging on surrounding obstacles, such as the internal abdominal wall. Another potential advantage of using a thumbstick during the guiding and / or deflection process is the potential for improved control over the surgical arm compared to, for example, performing the guiding and deflection with an input arm, where the ergonomics of the handle may be less suited to support the rotational movements that the surgeon must make while holding the handle in order to deflect.

[0250] In some embodiments, during introduction of the surgical arm into the body, the surgical arm is straight (optionally for insertion through a cannula) while the input arm is in a resting, locked, retracted position. Optionally, after retracting the surgical arm using the thumbstick, the surgeon releases the thumbstick and moves their hand to the input arm. The surgeon's gripping and optional lifting of the input arm automatically controls the surgical arm, allowing the surgeon to continue the procedure using the input arm. In some embodiments, when one or more input arm joints are locked by a solenoid lock, lifting the input arm by the surgeon automatically releases the solenoid lock. Additionally or alternatively, manual locking of the input arm joints is released, for example, via a sensor that detects the input arm position.

[0251] In some embodiments, the system (e.g., a system processor) is configured to recognize one or more positions of the input arm, for example when the input arm is in this rest position, and optionally display the current positions to the user.

[0252] Reference is now made to FIG. 18 . In some embodiments, a haptic handle (a suitable example of which is the “omega.7” haptic device available from Force Dimension of Nyon, Switzerland) that provides force feedback to the user is used to control the movement and articulation of the surgical arm throughout the operation. In some embodiments, the haptic handle is configured with a counter-resistance to prevent the user from moving in a direction that the surgical arm does not support (e.g., bending the elbow joint of the surgical arm backward, touching a joint in a different segment of the same arm (e.g., the elbow joint), and / or other). In some embodiments, the handle is configured with a counter-resistance that varies depending on the current anatomical position and / or orientation of the surgical arm. As an example, resistance may be increased if the user attempts to move into a disallowed anatomical area, such as an organ that should be avoided.

[0253] In some embodiments, the haptic handle is programmed to operate according to various control modes. Optionally, the control mode is selected according to the current stage in the surgical procedure. In some embodiments, switching between different modes is performed via one or more of a screen interface, one or more buttons on the control console or handle, a foot pedal, and / or the like.

[0254] In some embodiments, during the first stage of the procedure, in which the surgical arm is introduced into the patient and, optionally, deflected, the haptic handle is used in a “speed control” mode (5001). Optionally, in speed control mode, the speed at which the surgical arm is moved is set by the movement of the handle relative to its resting position. As the user moves the handle further away from its resting position, the speed increases, and vice versa. For example, moving the handle to the right of its resting position can cause the arm joint (e.g., elbow joint) to also rotate to the right, at a speed determined by the handle's distance from its resting position. In some embodiments, in speed control mode, the haptic handle is configured to have an elastic (spring-like) counter-resistance to the user's movement. In some embodiments, in speed control mode, a control algorithm is applied to translate the current configuration of the haptic handle into a velocity command issued to the actuators (e.g., motors) of the surgical arm (e.g., increasing the rotational speed of one or more motor gears, etc.).

[0255] A potential advantage of using the speed control mode during introduction and optional deflection of the surgical arm within the body is that although direction reverses during deflection (e.g., upward / downward), since the movement of the surgical arm is limited and it is the speed of movement that changes, this change can be ignored and the operation can continue naturally.

[0256] In some embodiments, the haptic handle is set to a "position control" mode (5003) during the second phase of the surgical procedure, and optionally for the remainder of the procedure. Optionally, in the position control mode, the spatial position of the handle sets the respective position of the surgical arm. In the position control mode, the user's displacement of the haptic handle is translated into a relative displacement command to the surgical arm. In some embodiments, the step of translating the haptic handle displacement is controlled according to an algorithm. In some embodiments, the control is performed according to a known algorithm (e.g., an inverse Jacobian algorithm). Additionally or alternatively, in some embodiments, the control is by a custom algorithm. In one example, the custom algorithm is configured to scale the user's movements, such as to increase the accuracy of the movements. Such scaling may include amplifying the required movement on the part of the user by a selected ratio to generate a similar, unamplified movement of the surgical arm. For example, for the arm to move a distance X, the user needs to move the handle by A*X (A>1). In another example, an algorithm is selected to filter the signal, for example, using a low pass filter to reduce the tremors of the user's hands.

[0257] In some embodiments, in position control mode, a clutch mechanism is provided that allows the user to temporarily disconnect control from the surgical arm (so that movement of the input haptic handle no longer controls the surgical arm). Optionally, when disconnected, the user is free to reposition the haptic handle. In one example, the user repositions the haptic handle to a position and / or orientation that is more comfortable for the user to perform and control the next movement.

[0258] In some embodiments, the degree of resistance a user feels in response to movement of the handle is selectable and controllable. In one example, a floating mode is set, in which the user is free to move the handle in any direction with substantially no resistance. Additionally or alternatively, the level of resistance felt by the user can be adjusted (e.g., the user may feel high resistance in response to some movements and low or no resistance in response to other movements).

[0259] In some embodiments, the amount of resistance is controlled based on the anatomical location of the surgical arm. For example, if an obstacle (e.g., the abdominal wall) is found near the surgical arm, the resistance may be set high. In a specific example, if an obstacle is found on the right side of the surgical arm, the user may experience high resistance to moving the handle to the right. If no obstacle is found on the left side of the arm, the user may experience low or no resistance to moving the handle to the left. Optionally, the degree of resistance is defined by system-defined settings that create wall-type resistance, rubber-like resistance, sand-type resistance, and / or other resistance.

[0260] Any feature or combination of features described herein may be incorporated by reference in any manner whatsoever in connection with U.S. Patent Application No. 16 / 121,704, filed September 5, 2018, and published as U.S. Patent Application Publication No. 20190000574; U.S. Patent Application No. 16 / 377,280, filed April 8, 2019, and published as U.S. Patent Application Publication No. 201902314445; U.S. Patent Application No. 15 / 9, filed March 8, 2018, and published as U.S. Patent Application Publication No. 20180256246; No. 15,237, filed March 9, 2017, published as U.S. Patent Application Publication No. 20170258539, and U.S. Patent Application No. 15 / 501,862, filed February 6, 2017, published as U.S. Patent Application Publication No. 20170239005, all of which are incorporated by reference herein as if fully set forth in their entirety.

[0261] In the specification and claims of this disclosure, the verbs "comprise," "include," and "have," and their conjugations, are used to indicate that the object or objects of the verb are not necessarily an exhaustive list of components, constituents, elements, or parts of the subject or subjects of the verb. As used herein, the singular forms "a," "an," and "the" include plural references unless the context clearly dictates otherwise. For example, the terms "marking" or "at least one marking" can include a plurality of markings.

Claims

1. 1. A method of operating a surgical system comprising: (i) an articulated mechanical arm comprising a plurality of arm joints; (ii) first and second user input devices for controlling the arm; and (iii) a surgical end effector at a distal end of the arm, comprising: a. an initiation step; b. a recurve step; c. Transition steps, and d. Including bending and rotating steps; The initiating step is a step for initiating operation of the surgical system in a reflex mode, the initiating step including: With respect to the flexion and rotation of the arm joints, (i) the first user input device is active to direct flexion and rotation of only a given joint of the arm joints, and (ii) the second user input device is inactive; in the deflecting step, while in the deflection mode, deflecting a distal portion of the articulated mechanical arm by bending and rotating the given one of the arm joints in response to an electronic control output from the first user input device to bring the end effector into a deflection operating position; The transitioning step transitions the surgical system from the deflection mode to a surgical operation mode and enables the second user input device with respect to flexion and rotation of at least one of the arm joints of the arm other than the given one of the arm joints; wherein the bending and rotating step, while in the surgical operation mode, effectively bends and rotates at least two of the arm joints according to their respective degrees of freedom in response to electronic control output from the second user input device, thereby moving the surgical end effector to perform one or more surgical acts.

2. 2. The method of claim 1, The method, wherein the surgical system further comprises control circuitry effective to limit actuation of arm joints other than the one arm joint while the surgical system is in the deflection mode.

3. 3. The method of claim 1 or 2, The method, wherein the transitioning step includes calibrating the input device with respect to at least one of a position and an orientation of the end effector or a distal portion of the arm.

4. The method according to any one of claims 1 to 3, The method of claim 1, wherein the first input device is configured to control actuation of the one arm joint and not to control actuation of arm joints other than the one arm joint.

5. The method according to any one of claims 1 to 4, The method, wherein the step of transitioning to the surgical operating mode is responsive to and conditioned on detecting that the arm is in a recoiled position.

6. 1. A surgical system comprising: a. an articulated mechanical arm comprising a plurality of arm joints, and a surgical end effector at a distal end of said arm; b. a first user input device and a second user input device for controlling the arm; The surgical system (i) a recoil mode in which a distal portion of the articulated mechanical arm is operated to recoil in response to an electronic control output from the first user input device to bring the end effector into a recoil operating position; and (ii) a surgical mode of operation in which at least two of the arm joints are operated to flex and rotate in response to electronic control output from the second user input device to thereby move the surgical end effector to perform one or more surgical acts is configured to operate asynchronously; A. while in the reflex mode, with respect to flexion and rotation of the arm joints, the first user input device is active to direct flexion and rotation of only a given joint of the arm joints, and the second user input device is inactive; and B. A system wherein while in the surgical operating mode, the second user input device is effective with respect to flexion and rotation of at least one of the arm joints of the arm other than the given joint of the arm according to a respective degree of freedom of each arm joint.

7. 1. A method of operating a surgical system, comprising: the surgical system comprising: (i) a user input device; and (ii) an articulated mechanical arm comprising a plurality of arm joints and a surgical end effector at a distal end of the arm; The method comprises: a. an initiation step; b. a recurve step; c. Transition steps, and d. Including bending and rotating steps; The initiating step is a step for initiating operation of the surgical system in a reflex mode, the initiating step including: With respect to flexion and rotation of the arm joints, the user input device is active to direct flexion and rotation of only a given joint of the arm joints; in the deflecting step, while in the deflection mode, deflecting a distal portion of the articulated mechanical arm by bending and rotating the given one of the arm joints in response to an electronic control output from the user input device to bring the end effector into a deflection operating position; the transitioning step transitions the surgical system from the deflection mode to a surgical operation mode and enables the user input device with respect to flexing and rotating at least one of the arm joints of the arm other than the given one of the arm joints; wherein the bending and rotating step, while in the surgical operating mode, effectively bends and rotates at least two of the arm joints according to their respective degrees of freedom in response to electronic control output from the user input device, thereby moving the surgical end effector to perform one or more surgical acts.

8. 8. The method of claim 7, The method, wherein the surgical system further comprises control circuitry effective to limit actuation of the arm joints other than the given one of the arm joints while the surgical system is in the deflection mode.

9. 9. The method of claim 8, A method wherein the limiting step is performed by disabling the actuation of the arm joints of the arm other than the given one of the arm joints.

10. The method according to any one of claims 7 to 9, The method, wherein the user input device controls actuation of the plurality of arm joints in both the reflex mode and the surgical operation mode.

11. The method according to any one of claims 7 to 10, The method, wherein the user input device is prevented from generating or transmitting control outputs that control actuation of the arm joints of the arm other than the given one of the arm joints.

12. The method according to any one of claims 7 to 11, The method, wherein the step of transitioning to the surgical mode is responsive to and conditioned on detecting that the arm is in a recoiled position.

13. The method according to any one of claims 7 to 12, The method, wherein the transitioning step includes the step of calibrating the user input device with respect to at least one of a position and an orientation of the end effector or a distal portion of the arm.

14. The method according to any one of claims 7 to 13, The method further includes the step of unflexing the distal ends of the arms to bring the arms into an unflexed position following operation in the surgical operating mode.

15. 1. A surgical system comprising: a. a user input device; and b. an articulated mechanical arm comprising: (i) a plurality of arm joints; and (ii) a surgical end effector at a distal end of said arm; The surgical system includes: (A) a recoil mode in which a distal portion of the articulated mechanical arm recoils in response to an electronic control output from the user input device to bring the end effector into a recoil operating position; and (B) a surgical operating mode in which at least two of the arm joints flex and rotate in response to electronic control outputs from the user input device to thereby move the surgical end effector to perform one or more surgical acts is configured to operate asynchronously; A. while in the reflex mode, with respect to flexion and rotation of the arm joints, the user input device is active to direct flexion and rotation of only a given joint of the arm joints; and B. A system wherein while in the surgical operating mode, the user input device is effective with respect to flexion and rotation of at least one of the arm joints of the arm other than the given joint of the arm according to a respective degree of freedom of each arm joint.

16. 1. A method of operating a surgical system comprising: (i) an articulated mechanical arm comprising a surgical end effector and a plurality of arm joints at a distal end of the articulated mechanical arm; and (ii) an input device array of one or more user input devices, the method comprising: a. an initiation step; b. i. deflecting, and ii. monitoring while the surgical system is in a first mode of operation; c. A transition step, and d. comprising the steps of: the arm joints are configured to flex and rotate in response to electronic control outputs from one or more user input devices of the input device array; the initiating step is for initiating operation of the surgical system in the first mode of operation defined for a given one of the arm joints; the first mode of operation excludes actuation of any arm joint of the arm other than the given one arm joint and allows control of actuation of the one arm joint to cause flexion and rotation of the one arm joint; the deflecting step includes deflecting a distal end of the arm by bending and rotating the one arm joint in response to control signals generated by one or more of the user input devices of the input device array to bring the end effector into a deflected operating position; the monitoring step includes monitoring a state of the mechanical arm and detecting whether the arm is in a recurved position; the transitioning step is responsive to and conditioned on detecting that the arm is in a recoiled position, and transitions operation of the surgical system from the first mode of operation to a second mode of operation; in the second mode of operation, the system allows for controlling flexion and rotation of at least one arm joint excluded in the first mode according to a respective degree of freedom of each arm joint; The operating step comprises operating the surgical system in the second operating mode to perform a surgical procedure using the end effector.

17. 17. The method of claim 16, The method, wherein the surgical system further comprises control circuitry effective to limit actuation of arm joints other than the one arm joint while the surgical system is in the first mode of operation.

18. 18. The method of claim 17, A method wherein the limiting step is performed by disabling actuation of arm joints of the arm other than the one arm joint.

19. 18. The method of claim 17, The method, wherein the input device is prevented from generating or transmitting control outputs that control actuation of arm joints of the arm other than the one arm joint.

20. 18. The method of claim 17, The method, wherein the restricting step includes disabling capabilities of a first input device.

21. 18. The method of claim 17, (i) a first input device of the input device array controls actuation of the one arm joint while the surgical system is in the first mode of operation, and a second input device controls actuation of the plurality of arm joints while the surgical system is in the second mode of operation; and (ii) the limiting step is performed by providing the first input device; The method of claim 1, wherein the first input device is configured to control actuation of the one arm joint and not to control actuation of arm joints other than the one arm joint.

22. The method according to any one of claims 16 to 21, The method, wherein the transitioning step includes calibrating the input device with respect to at least one of a position and an orientation of the end effector or a distal portion of the arm.

23. The method according to any one of claims 16 to 22, a first input device of the input device array controls actuation of the one arm joint while the surgical system is in the first mode of operation; A second input device of the input device array controls actuation of the plurality of arm joints while the surgical system is in the second mode of operation.

24. 24. The method of claim 23, The method, wherein the transitioning step includes the step of calibrating the second input device with respect to at least one of a position and an orientation of the end effector or a distal portion of the arm.

25. 17. The method of claim 16, A method wherein a single user input device controls actuation of the plurality of arm joints in both the first mode of operation and the second mode of operation.

26. The method according to any one of claims 16 to 25, the surgical system further comprising a control console including a display screen; The method, wherein at least one user input device of the input device array is positioned on or in proximity to the display screen.

27. The method according to any one of claims 16 to 26, an additional user input device for actuating linear advancement and retraction of the arm is located on, co-located with, or proximate to at least one user input device of the input device array.

28. The method according to any one of claims 16 to 27, The method wherein the deflection operating position is at or adjacent to a surgical procedure site.

29. The method according to any one of claims 16 to 28, The method, wherein the operating step in the second mode is with the arm in the retracted position.

30. 30. The method according to any one of claims 16 to 29, The method further includes, following the step of operating in the second mode, unflexing the distal end of the arm to bring the arm to an unflexed position.

31. 1. A surgical system for use with a surgical end effector, wherein a first mode of operation and a second mode of operation are configured to operate asynchronously, the system comprising: a. an input device array of one or more user input devices; and b. an articulated mechanical arm having a plurality of arm joints configured to bend and rotate in response to control signals generated by said surgical end effector at a distal end of the articulated mechanical arm and one or more input devices in said input device array; iii. the first operating mode is defined with respect to a given one of the arm joints; iv. the system is configured to deflect the distal end of the arm; v. the second mode of operation is defined with respect to the plurality of arm joints; vi. the system is configured to transition from the first mode of operation to the second mode of operation; in the first mode of operation, actuation of any arm joint of the arm other than the given one arm joint can be excluded and actuation of the one arm joint can be controlled to cause flexion and rotation of the one arm joint; deflecting the distal end of the arm by the system during the first mode of operation by actuating the one arm joint to cause flexion and rotation of the one arm joint in response to electronic control outputs from one or more of the user input devices of the input device array to bring the surgical end effector into a deflected operating position; the second mode of operation allows control of the actuation of at least one of the arm joints excluded in the first mode according to the respective degrees of freedom of each arm joint; The transition of the system is responsive to, and conditioned upon, detecting that the arm is in a recoiled position, and the system performs a surgical act using the end effector during the second mode of operation.

32. 1. A method of operating a surgical system comprising: (i) an articulated mechanical arm comprising a plurality of arm joints and a surgical end effector at a distal end of said arm; and (ii) an input device array of one or more user input devices for controlling said arm, comprising: a. a recurve step, and b. Including bending and rotating steps; the deflecting step includes deflecting a distal end of the articulated mechanical arm by bending and rotating a given joint of the arm joints in response to electronic control outputs from the input device array so as to bring the end effector into a deflected operating position without bending or rotating any arm joints other than the given joint of the arm joints; wherein the bending and rotating step, in response to, and conditioned on, detecting that the arm is in a deflected position, effectively bends and rotates at least two of the arm joints according to a respective degree of freedom of each arm joint in response to electronic control output from the input device array, thereby moving the surgical end effector to perform one or more surgical acts.

33. 33. The method of claim 32, the surgical system further comprising control circuitry effective to limit actuation of arm joints other than the given one of the arm joints during the deflecting step.

34. 34. The method of claim 32 or 33, The method further comprises the step of unflexing a distal end of the arm to bring the arm to an unflexed position after performance of the one or more surgical actions.

35. 1. A surgical system comprising: a. an articulated mechanical arm comprising: (i) a plurality of arm joints; and (ii) a surgical end effector at a distal end of said arm; b. an input device array of one or more user input devices for controlling said arm; The surgical system includes: i. configured to deflect a distal portion of the articulated mechanical arm by bending and rotating a given one of the arm joints in response to electronic control output from the input device array to bring the end effector into a deflected operating position without bending or rotating any other one of the arm joints; ii. a system configured to, in response to and conditional on detecting that the arm is in a deflected position and in response to electronic control output from the input device array, effectively flex and rotate at least two of the arm joints according to a respective degree of freedom of each arm joint to thereby move the surgical end effector to perform one or more surgical acts.

36. 1. A method of using a surgical system, comprising: providing an articulated mechanical arm having a surgical end effector at a distal end thereof; b. while operating in a first input mode, steering the end effector to a deflected operating position; c. transitioning from operation in the first input mode to operation in a second input mode; d. performing a surgical procedure using the end effector after the transitioning step and while operating in the second input mode; the arm comprising a plurality of arm segments connected in series by a corresponding plurality of arm joints configured to bend and rotate in response to electronic control outputs from a user input device; The providing step provides for displacing the end effector, In the first input mode, a displacement of the input device or a displaceable part of the input device is converted into a velocity of at least one of (i) a bending of an arm joint and (ii) a rotation of an arm joint; the transitioning step is responsive to and conditional on detecting that the end effector is in the deflected operating position; In the second input mode, a displacement of an input device or a displaceable portion of the input device is converted into a corresponding displacement of at least one arm segment.

37. 37. The method of claim 36, A method using a single user input device in both the first input mode and the second input mode.

38. 37. The method of claim 36, The method wherein the first input mode uses a first input device and the second input mode uses a second input device.

39. 39. The method according to any one of claims 36 to 38, A method using an additional user input device to actuate the linear advancement and retraction of the arm.

40. 40. The method according to any one of claims 36 to 39, The method wherein the deflection operating location is at or adjacent to a surgical procedure location.

41. 1. A surgical system for use with a surgical end effector, the system comprising: a. an articulated mechanical arm having the surgical end effector at a distal end of the articulated mechanical arm; b. an array of one or more input devices for controlling said arm; the arm comprising a plurality of arm segments connected in series by a corresponding plurality of arm joints configured to bend and rotate in response to electronic control outputs from a user input device; The surgical system includes: i. the first input mode and the second input mode are configured to operate asynchronously; (A) in the first input mode, converting a displacement of the input device or a displaceable part of the input device into a bending and rotation velocity of an arm joint; (B) in the second input mode, converting a displacement of the input device or a displaceable portion of the input device into a corresponding displacement of at least one arm segment; ii. configured to steer the end effector to a deflected operating position during a first stage of displacement of the end effector while operating in the first input mode; and iii. The system is configured to perform a surgical act using the end effector while operating in the second input mode.

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