Fastener management

Abstract

To provide a robot system.SOLUTION: Wherein the actuator is configured to cause axial movement of the endoscope and / or the basket device, wherein the basket device is configured to expand radially outward from the axial extension, and wherein the sensor is configured to generate a signal indicative of a force experienced by the actuator due to expansion of the basket device into the tubular organ; A control circuit communicatively coupled to the sensor is configured to advance and retract the basket device in an axial dithering motion within the tubular organ, receive a signal from the sensor indicative of a force experienced by the actuator during the axial dithering motion of the basket device within the tubular organ, determine that the force exceeds a predetermined threshold, and perform a response action in response to determining that the force exceeds the predetermined threshold.SELECTED DRAWING: Figure 5

Description

[Technical Field]

[0001] (CROSS-REFERENCE TO RELATED APPLICATIONS) This application claims priority to U.S. Provisional Patent Application No. 63 / 033,089, filed June 01, 2020, and entitled "STUCK INSTRUMENT MANAGEMENT," the disclosure of which is incorporated herein by reference in its entirety.

[0002] FIELD OF THE INVENTION FIELD OF THE DISCLOSURE The present disclosure relates to the field of medical devices and procedures. [Background technology]

[0003] Various medical procedures involve the use of one or more medical instruments in an anatomical cavity. Retraction and / or removal of such instruments from the anatomical cavity can present certain complications resulting in damage to biological tissue, instrument components, and / or other adverse events. Summary of the Invention [Means for solving the problem]

[0004] Described herein are systems, devices, and methods that facilitate managing and / or determining stuck instrument conditions associated with performing certain medical procedure steps, such as instrument retraction.

[0005] In some implementations, the present disclosure relates to a method for detecting a stuck basket condition, the method including retracting an endoscope within an anatomical cavity of a patient, the endoscope having a basket device at least partially disposed within a working channel thereof, determining that a force reading associated with at least one of the basket device and the endoscope exceeds a predetermined threshold, and determining that the basket device is in a stuck condition based at least in part on determining that the force reading exceeds the predetermined threshold.

[0006] The method may further include axially dithering the basket device, and determining that a force reading associated with at least one of the basket device or the endoscope exceeds a predetermined threshold is performed while dithering the basket device. The method may further include accessing an anatomical cavity using an endoscope through a patient's urinary anatomical structure, advancing a basket device from a working channel of the endoscope, capturing an object disposed in the anatomical cavity using the basket device, determining that at least one of the basket device and the endoscope has entered a danger zone, and initiating axial dithering of the basket device in response to determining that at least one of the basket device and the endoscope has entered the danger zone. For example, determining that at least one of the basket device and the endoscope has entered the danger zone is based at least in part on robotic actuator data generated by one or more robotic actuators configured to actuate one or more of the endoscope and the basket device. In some implementations, determining that at least one of the basket device and the endoscope has entered the danger zone is based at least in part on position sensor data associated with one or more of the endoscope and the basket device. In some embodiments, the danger zone includes the ureteropelvic junction of the patient's kidney. Dithering the basket device can be relative to the distal end of the endoscope. Dithering the basket can involve dithering the endoscope.

[0007] The method may further include reducing a retraction rate of the endoscope based at least in part on the determined sticking condition of the basket device. In some embodiments, the force reading indicates an axial force experienced at a proximal portion of a sheath of the basket device. In some embodiments, the force reading indicates an axial force on one or more tines of the basket device. In some embodiments, the force reading indicates an axial force experienced at a proximal portion of the endoscope. The method may further include causing a warning to be presented in response to the determined sticking condition.

[0008] In some implementations, the present disclosure relates to a robotic system comprising: one or more robotic arms; one or more instrument manipulators coupled to each of the one or more robotic arms; one or more actuators associated with at least one of the one or more instrument manipulators and configured to cause axial movement of at least one of an endoscope, a sheath of a basket device at least partially disposed within the endoscope, and the tines of the basket device; one or more sensors associated with the one or more instrument manipulators and configured to generate signals indicative of forces experienced by the one or more actuators; and control circuitry communicatively coupled to the one or more instrument manipulators and the one or more sensors, the control circuitry configured to: advance and retract the basket device in a dithering motion; receive signals from the one or more sensors indicative of forces experienced by the one or more actuators while the basket device is moving in the dithering motion; determine that the force exceeds a predetermined threshold; and perform a response action in response to determining that the force exceeds the predetermined threshold.

[0009] The response action may involve providing a warning to the user indicating that the basket device is stuck. In some embodiments, the response action may involve reducing the retraction rate of the endoscope. In some embodiments, the response action may involve stopping retraction of the endoscope. The one or more actuators may comprise one or more basket sheath actuators. In some embodiments, the one or more actuators comprise one or more basket tine actuators. In some embodiments, the one or more actuators comprise one or more endoscope actuators. The one or more sensors may be configured to determine at least one of an insertion force and a retraction force on the endoscope.

[0010] In some implementations, the present disclosure relates to a method for detecting a sticking condition of a medical instrument, the method including: determining that a force on a component of the medical instrument exceeds a predetermined force threshold while the medical instrument is being retracted with a dithering motion; starting a timer in response to determining that the force exceeds the predetermined threshold; determining that the timer has passed a predetermined time threshold; and initiating a response action in response to determining that the timer has passed the predetermined time threshold.

[0011] The responsive action may involve generating a warning indicating that the medical device is in a sticking condition. The responsive action may involve stopping retraction of the medical device. The method may further include initiating dithering of one or more components of the medical device in response to determining that a portion of the medical device is positioned within the sticking danger zone. For example, the method may further include determining the sticking danger zone based at least in part on a location of a distal end of a sheath within which the medical device is at least partially disposed.

[0012] In some implementations, the present disclosure relates to a computing device comprising: a robotic system interface; and a control circuit communicatively coupled to the robotic system interface, the control circuit comprising one or more processors and one or more data storage devices. The control circuit can be configured to dither the basket device relative to a working channel of an endoscope in which the basket device is at least partially disposed, and to determine, while the basket device is dithering, that a force experienced by one or more components of the basket device is indicative of a stuck condition of the basket device.

[0013] The determination that the force indicates a sticking condition can be based on one or more of data indicative of a driving behavior of a user driving the endoscope and a size of the object captured by the basket device. In some embodiments, the control circuitry is further configured to disable basket dithering in response to determining that the basket device and endoscope have been retracted within the access sheath. In some embodiments, the control circuitry is further configured to stop movement of the endoscope in response to a sticking condition.

[0014] For purposes of summarizing the present disclosure, certain aspects, advantages, and novel features have been described. It is to be understood that not necessarily all such advantages may be achieved in accordance with any particular embodiment. Thus, the disclosed embodiments may be practiced in a manner that achieves or optimizes one advantage or group of advantages as taught herein without necessarily achieving other advantages as may be taught or suggested herein. [Brief explanation of the drawings]

[0015] Various embodiments are depicted in the accompanying drawings for illustrative purposes and should not be construed as limiting the scope of the present invention in any way. In addition, various features of different disclosed embodiments can be combined to form additional embodiments that are part of the present disclosure. Throughout the drawings, reference numerals may be reused to indicate correspondence between referenced elements. [Figure 1] 1 illustrates an embodiment of a medical system including one or more basket components, according to one or more embodiments. [Figure 2] 2 illustrates medical system components that may be implemented in the medical system of FIG. 1, according to one or more embodiments. [Figure 3] 1 illustrates a ureteroscope including a basket device within a working channel disposed in a portion of a patient's urinary system, according to one or more embodiments. [Figure 4A] 1 illustrates various configurations of basket systems according to one or more embodiments. [Figure 4B] 1 illustrates various configurations of basket systems according to one or more embodiments. [Figure 4C] 1 illustrates various configurations of basket systems according to one or more embodiments. [Figure 4D] 1 illustrates various configurations of basket systems according to one or more embodiments. [Figure 4E] 1 illustrates various configurations of basket systems according to one or more embodiments. [Figure 5] 1 illustrates various medical instruments including particular basket device components disposed within portions of a patient's renal anatomy, according to one or more embodiments. [Figure 6A] 1 illustrates an endoscopic camera field of view with a basket device visible therein, according to one or more embodiments. [Figure 6B] 6B illustrates a side view of a medical instrument assembly corresponding to the configuration of the basket device relative to the endoscopic camera of FIG. 6A, in accordance with one or more embodiments. [Figure 7A] 1 illustrates an endoscopic camera view with a basket device in a stuck state visible therein, according to one or more embodiments. [Figure 7B] 7B illustrates a side view of a medical instrument assembly corresponding to the configuration of the basket device relative to the endoscopic camera of FIG. 7A, in accordance with one or more embodiments. [Figure 8] 1 illustrates a fixation instrument image recognition architecture, according to one or more embodiments. [Figure 9-1] FIG. 1 shows a flow diagram illustrating a process for managing fixation device status, according to one or more embodiments. [Figure 9-2] FIG. 1 shows a flow diagram illustrating a process for managing fixation device status, according to one or more embodiments. [Figure 10-1] 9-1 and 9-2 illustrate certain images corresponding to various blocks, states, and / or operations associated with the processes of FIG. 9-1 and FIG. 9-2, in accordance with one or more embodiments. [Figure 10-2] 9-1 and 9-2 illustrate certain images corresponding to various blocks, states, and / or operations associated with the processes of FIG. 9-1 and FIG. 9-2, in accordance with one or more embodiments. [Figure 11] FIG. 10 is a flow diagram illustrating a process for addressing a fixation device situation, according to one or more embodiments. [Figure 12] FIG. 10 is a flow diagram illustrating a process for managing false positive sensor readings on an insertion axis, according to one or more embodiments. [Figure 13] FIG. 10 is a flow diagram illustrating a process for managing false positive sensor readings on an insertion axis, according to one or more embodiments. [Figure 14] FIG. 10 illustrates a false positive remediation action, according to one or more embodiments. [Figure 15] FIG. 10 is a flow diagram illustrating a process for adjusting dithering zones / ranges according to one or more embodiments. [Figure 16]16 illustrates certain images corresponding to various blocks, states, and / or operations associated with the process of FIG. 15, in accordance with one or more embodiments. [Figure 17] 1 shows a flow diagram illustrating a process for adjusting dithering zones / ranges according to one or more embodiments. [Figure 18] 18 illustrates certain images corresponding to various blocks, states, and / or operations associated with the process of FIG. 17, in accordance with one or more embodiments. [Figure 19] FIG. 10 is a flow diagram illustrating a process for managing false positive sensor readings on an open shaft, according to one or more embodiments. [Figure 20] FIG. 10 is a flow diagram illustrating a process for managing false positive sensor readings on an open shaft, according to one or more embodiments. DETAILED DESCRIPTION OF THE INVENTION

[0016] The headings provided herein are for convenience only and do not necessarily affect the scope or meaning of the claimed invention. While certain preferred embodiments and examples are disclosed below, the inventive subject matter extends beyond the specifically disclosed embodiments to other alternative embodiments and / or uses, as well as to modifications and equivalents thereof. Accordingly, the scope of claims that may arise from this specification is not limited by any of the specific embodiments described below. For example, in any method or process disclosed herein, the acts or operations of the method or process may be performed in any suitable order and are not necessarily limited to any particular disclosed order. Various operations may be described as multiple separate operations in a manner that may be helpful in understanding a particular embodiment. However, the order of description should not be construed to imply that these operations are order-dependent. Additionally, structures, systems, and / or devices described herein may be embodied as integrated or separate components. For purposes of comparing various embodiments, certain aspects and advantages of these embodiments are described. Not necessarily all such aspects or advantages are achieved by any particular embodiment. Thus, for example, various embodiments may be implemented in a manner that achieves or optimizes one advantage or group of advantages as taught herein without necessarily achieving other aspects or advantages that may also be taught or suggested herein.

[0017] Certain standard anatomical terms of location are used herein to refer to animal, i.e., human, anatomical structures with respect to preferred embodiments. While certain spatially relative terms, such as "outer," "inner," "superior," "lower," "below," "upper," "vertical," "horizontal," "top," "bottom," and similar terms, are used herein to describe the spatial relationship of one device / element or anatomical structure to another, it is understood that these terms are used herein for ease of description to describe the positional relationships between elements / structures as illustrated in the drawings. It should be understood that spatially relative terms are intended to encompass different orientations of elements / structures during use or operation in addition to the orientation depicted in the drawings. For example, an element / structure described as "above" another element / structure may represent a position below or beside such other element / structure relative to the intended patient or alternative orientations of the element / structure, and vice versa.

[0018] Overview The present disclosure relates to systems, devices, and methods for managing the retraction and / or advancement of medical instruments in a patient's anatomy, such as during the performance of a medical procedure. While certain aspects of the present disclosure are described in detail herein in the context of renal, urinary, and / or nephrological procedures, such as kidney stone removal / treatment procedures, it should be understood that such perspective is provided for convenience and clarity, and the concepts of fixation instrument determination and / or instrument retraction / advancement disclosed herein are applicable to any suitable medical procedure. However, as noted, a description of the anatomy of the renal / urinary system and related medical problems and procedures is presented below to aid in explaining the inventive concepts disclosed herein.

[0019] Kidney stone disease, also known as urolithiasis, is a medical condition involving the formation of solid pieces of material in the urinary tract, referred to as "kidney stones," "urinary stones," "nephrolithiasis," "nephrolithiasis," or "nephrolithiasis." Urinary stones can form and / or be found in the kidneys, ureters, and bladder (referred to as "bladder stones"). Such urinary stones can form as a result of concentrated minerals in the urinary fluid and can cause significant abdominal pain if they become large enough to obstruct the flow of urine through the ureter or urethra. Urinary stones can be formed from calcium, magnesium, ammonia, uric acid, cysteine, and / or other compounds, or combinations thereof.

[0020] Generally, there are several methods for treating patients with kidney stones, including observation, medical treatment (such as drainage therapy), non-invasive treatment (such as extracorporeal shock wave lithotripsy (ESWL)), and surgical treatment (such as ureteroscopy and percutaneous nephrolithotomy ("PCNL"). In surgical approaches (e.g., ureteroscopy and PCNL), a physician accesses the object to be removed (e.g., a kidney stone), the object is broken into smaller pieces or fragments, and the smaller stone fragments / particles are mechanically extracted from within the kidney.

[0021] To remove urinary stones from the bladder and ureters, a surgeon may insert a ureteroscope through the urethra and into the urinary tract. Typically, the ureteroscope includes a scope / camera at its distal end configured to allow visualization of the urinary tract. The ureteroscope may also include a lithotripsy device for capturing or fragmenting urinary stones. During a ureteroscopy procedure, one physician / technologist may control the position of the ureteroscope, while another physician / technologist may control the lithotripsy device.

[0022] To remove relatively large stones from the kidney, physicians may use percutaneous nephrolithotomy ("PCNL") techniques, which involve inserting a nephroscope through the skin (i.e., percutaneously) and intervening tissue to provide access to a treatment site for breaking up and / or removing the stone. The percutaneous access device (e.g., nephroscope, sheath, and / or catheter) (and / or direct entry endoscope) used to provide an access channel to the target anatomical site may include one or more fluid channels for providing irrigation fluid flow to the target site and / or for aspirating fluid from the target site (e.g., through passive outflow and / or active suction).

[0023] Robotic devices and / or systems can be employed in connection with various medical procedures, such as kidney stone removal procedures, where the robotic tools can enable a physician / urologist to perform endoscopic (e.g., ureteroscope) target access, as well as percutaneous access / treatment, or other aspects of a medical procedure. Advantageously, aspects of the present disclosure relate to systems, devices, and methods for detecting and managing stuck instrument situations utilizing robotic devices and systems. The terms "stuck instrument," "stuck basket," "stuck stone," "capture instrument," "capture basket," and "stuck stone" are used herein according to their broad and ordinary meanings and may refer to any situation or occurrence in which at least a portion of a medical instrument or pathology (e.g., a kidney stone or other object for removal) is at least partially obstructed, impeded, blocked, captured, stuck, restrained, or otherwise prevented from continuing movement during its advancement or retraction in some manner.

[0024] Advancement and retraction of the ureteroscope and / or associated basket device during ureteroscopy can damage certain anatomical features and / or components of one or more medical instruments utilized in the procedure. For example, in cases where a kidney stone or other object is being or is being extracted, and the stone / object is larger in one or more dimensions than the size / dimensions of the ureter / ureteral access sheath used to access the target anatomical structure, tearing or other damage to ureteral / renal tissue can occur at or near the location where the stone / object and / or the basket component in which the stone / object is captured contacts the tissue, e.g., due at least in part to the size of the stone / object.

[0025] In some of the examples described herein, the object removal procedure relates to the removal of kidney stones from a kidney. However, the present disclosure is not limited solely to kidney stone removal and associated instrumentation. For example, the following description is also applicable to other surgical or medical procedures or procedures involving the removal of objects from a patient, including any object that can be removed from a treatment site or patient cavity (e.g., esophagus, ureter, intestine, eye, etc.) via percutaneous and / or endoscopic access, such as gallbladder stone removal, lung (pulmonary / transthoracic) tumor biopsy, or cataract extraction. That is, the fixation device management concepts disclosed herein are applicable to devices that may be fixated during any of such procedures.

[0026] medical system FIG. 1 illustrates an exemplary medical system 100 for performing various medical procedures according to aspects of the present disclosure. The medical system 100 may be used, for example, for endoscopic (e.g., ureteroscopic) procedures. As mentioned and described above, certain ureteroscopic procedures involve the treatment / removal of kidney stones. In some implementations, kidney stone treatment may benefit from the assistance of certain robotic techniques / devices, such as those shown in FIG. 1 and described in detail below. Robotic medical solutions may provide relatively greater precision, greater control, and / or better hand-eye coordination for certain instruments compared to strictly manual procedures. For example, robotically assisted ureteroscopic access to the kidney with some procedures advantageously allows the urologist to perform both endoscope control and basket control.

[0027] While the system 100 of FIG. 1 is presented in terms of a ureteroscopic procedure, it should be understood that the principles disclosed herein can be implemented in any type of endoscopic and / or percutaneous procedure. Furthermore, some of the examples described herein relate to object removal procedures involving the removal of kidney stones from a kidney. However, the present disclosure is not limited to kidney stone removal alone. For example, the following description is also applicable to other surgical or medical procedures involving the removal of objects from a patient, including any object that can be removed from a treatment site or patient cavity (e.g., esophagus, ureter, intestine, eye, etc.) via percutaneous and / or endoscopic access, such as gallbladder stone removal, lung (pulmonary / transthoracic) tumor biopsy, or cataract extraction.

[0028] The medical system 100 includes a robotic system 10 (e.g., a mobile robotic cart) configured to engage and / or control a medical instrument 40 (e.g., a ureteroscope) and perform a direct entry procedure on a patient 7. The term "direct entry" is used herein according to its broad and ordinary meaning and may refer to any entry of instrumentation through a natural or artificial opening in a patient's body. For example, with reference to FIG. 1 , direct entry of a scope 40 into the urinary tract of a patient 7 may occur via the urethra 65.

[0029] It should be understood that the direct entry instrument 40 can be any type of medical instrument, including an endoscope (e.g., a ureteroscope), a catheter (e.g., a steerable or non-steerable catheter), a nephroscope, a laparoscope, or other type of medical instrument. The embodiments of the present disclosure relating to basket solutions implemented in connection with a ureteroscopic procedure for removing kidney stones through a ureteral access sheath (e.g., ureteral access sheath 90) are also applicable to solutions for removing objects through percutaneous access, such as through a percutaneous access sheath. For example, an instrument may percutaneously access the kidney, e.g., through a percutaneous access sheath, to capture and remove a kidney stone, and the instrument used to capture such a stone may become anchored to the internal renal anatomical structure and / or on the percutaneous access sheath (e.g., at the opening of the percutaneous access sheath). The term "percutaneous access" is used herein in accordance with its broad and ordinary meaning and may refer to entry, such as by puncture and / or small incision, of an instrument through a patient's skin and any other body layers necessary to reach the target anatomical location associated with the procedure (e.g., the calyceal rete of kidney 70).

[0030] The medical system 100 includes a control system 50 configured to interface with the robotic system 10 to provide information regarding the procedure and / or perform various other operations. For example, the control system 50 may include one or more displays 56 configured to present certain information to assist the physician 5 and / or other technicians or individuals. The medical system 100 may include a platform 15 configured to hold a patient 7. The system 100 may further include an electromagnetic (EM) field generator 18, which may be carried by one or more of the robotic arms 12 of the robotic system 10 or may be a stand-alone device. While various robotic arms are shown in various positions and coupled to various instrumentation, it should be understood that such configurations are depicted for convenience and illustrative purposes, and that such robotic arms may have different configurations over time and / or at different points during a medical procedure. Additionally, the robotic arms 12 may be coupled to instruments different from those shown in FIG. 1, and in some cases or periods, one or more of the arms may not be utilized or coupled to a medical instrument (e.g., an instrument manipulator / coupling).

[0031] In an exemplary use case, if a patient 7 has a kidney stone 80 located in a kidney 70, a physician may perform a procedure to remove the stone 80 through the ureter (63, 60, 65). In some embodiments, the physician 5 may interact with the control system 50 and / or the robotic system 10 to cause / control the robotic system 10 to advance and navigate a medical instrument 40 (e.g., a scope) from the urethra 65, through the bladder 60, up the ureter 63, and into the renal pelvis 71 and / or calyx of the kidney 70 where the stone 80 is located. The physician 5 may further interact with the control system 50 and / or the robotic system 10 to cause / control the advancement of a basket device 30 through the working channel of the instrument 40, the basket device 30 being configured to facilitate capture and removal of the kidney stone. The control system 50 may provide information associated with the medical instrument 40 and / or other instruments of the system 100, such as real-time endoscopic images captured therewith, via the display 56 to assist the physician 5 in navigating / controlling such instruments.

[0032] Renal anatomy is described herein for reference with respect to specific medical procedures related to aspects of the inventive concept. Kidneys 70, shown generally in a typical anatomical location in FIG. 1 , generally comprise two bean-shaped organs located on the left and right sides, respectively, within the retroperitoneal space. In an adult human, the kidneys generally measure approximately 11 cm in height / length. The kidneys receive blood from paired renal arteries 69, and blood leaves the kidneys via paired renal veins 67. Each kidney 70 is fluidly connected to a respective ureter 63, which generally comprises a tube that carries urine drained from the kidney 70 to the bladder 60.

[0033] The kidneys 70 typically lie relatively high within the abdominal cavity, in a retroperitoneal position at a slight oblique angle. Asymmetry within the abdominal cavity, generally caused by the position of the liver, typically causes the right kidney to be slightly lower and smaller than the left, and slightly more centrally located than the left kidney (as shown in detail in FIG. 1 ). Above each kidney is an adrenal gland (not shown). The upper portion of the kidney 70 is partially protected by the 11th and 12th ribs (not shown). Each kidney, along with its adrenal gland, is generally surrounded by two layers of fat: perirenal fat, which resides between the renal fascia and the renal capsule, and pararenal fat, which resides above the renal fascia.

[0034] The kidneys 70 are responsible for regulating the volume of various body fluid compartments, fluid osmolality, acid-base balance, various electrolyte concentrations, and the removal of toxins. The kidneys 70 provide a filtration function by secreting certain substances and reabsorbing others. Examples of substances secreted in urine are hydrogen, ammonium, potassium, and uric acid. In addition, the kidneys also perform various other functions, such as hormone synthesis and others.

[0035] The recessed area on the concave border of kidney 70 is the renal hilum 81, where the renal artery 69 (not shown in the detailed view of kidney 70) enters kidney 70 and where the renal vein 67 (not shown in the detailed view) and ureter 63 exit. Kidney 70 is surrounded by a tough fibrous tissue, the renal capsule 74, which is itself surrounded by perirenal fat, renal fascia, and pararenal fat. The anterior (front) surface of these tissues is the peritoneum, while the posterior (back) surface is the transversalis fascia.

[0036] The functional matrix, or parenchyma, of the kidney 70 is divided into two major structures: the outer renal cortex 77 and the inner renal medulla 87. These structures each take the form of multiple, roughly conical renal lobes containing a renal cortex surrounding a portion of the medulla called the renal pyramids 72. Between the renal pyramids 72 are processes of the cortex called the renal columns 73. The urine-producing functional structure of the kidney, the nephron (not shown in detail in FIG. 1 ), spans the cortex 77 and medulla 87. The initial filtering portion of the nephron is the renal corpuscle, located in the cortex, followed by the renal duct, which enters the cortex deep into the medullary pyramid. The medullary ray, part of the renal cortex, is a collection of tubules that drain into a single collecting duct.

[0037] The tip / apex, or papilla 79, of each renal pyramid drains urine into a respective minor calyx 75, which drains into a major calyx 76, which then drains into the renal pelvis 71, where it empties into the ureter 63. The manifold-shaped collection of minor and major calyxes may be referred to herein as the kidney's "calyx network." At the renal hilum 81, the ureter 63 and renal vein 67 exit the kidney and the renal artery 69 enters. Hilar fat and lymphatic tissue, along with lymph nodes, surround these structures. The hilar fat is adjacent to a fat-filled cavity called the renal sinus. The renal sinus collectively contains the renal pelvis 71 and calyxes 75, 76 and separates these structures from the renal medullary tissue. The funnel-shaped / tubular anatomical structure associated with the calyx may be referred to as the infundibulum. That is, the infundibulum generally marks the end of the calyx, where the papilla is exposed within the calyx.

[0038] With further reference to the medical system 100, a medical instrument 40 (e.g., a scope, direct entry instrument, etc.) can be advanced through the urinary tract and into the kidney 70. Specifically, a ureteral access sheath 90 can be disposed within the urinary tract to a region near the kidney 70. The medical instrument 40 can be passed through the ureteral access sheath 90 to access the internal anatomical structure of the kidney 70, as shown. Upon reaching the site of the kidney stone 80 (e.g., within the target calyx 75 of the kidney 70 where the stone 80 is accessible), the medical instrument 40 can be used to guide / direct the basket device 30 to the target location. Once the stone 80 is captured within the distal basket portion 35 of the basket device 30, the kidney stone 80 can be extracted from the patient 7 using the utilized ureteral access pathway.

[0039] System 100 may be advantageously configured to implement certain stuck instrument detection / determination features as disclosed in detail herein. Such stuck instrument detection / determination may advantageously provide for effective detection / determination of stuck instrument conditions, generation and / or provision of a user alert regarding the stuck instrument condition, and / or in some cases prevention or risk reduction of a stuck medical instrument during its retraction. Sticky instrument detection features according to aspects of the present disclosure may advantageously provide a layer of safety with respect to at least partially robotic basket implementations. For example, as described in detail herein in connection with various embodiments, robotically assisted stuck instrument detection may provide an additional layer of stuck instrument detection beyond the care and judgment of the operating physician or technician, thereby providing improved safety conditions for the patient and / or reducing the risk of instrument damage. Furthermore, compared to certain manual basket solutions, systems / embodiments of the present disclosure that provide enhanced stuck basket detection functionality based on instrument actuator force readings can allow the user to manipulate the basket device to safely retract the captured object / stone, such a solution requiring only a single operator while providing the same or greater amount of protection against damage from stuck instrument situations due to both visual and force feedback from the robotic system.

[0040] Various scope-type instruments disclosed herein, such as scope 40 of system 100, can be configured to navigate within the human anatomy, such as within a natural orifice or lumen of the human anatomy. The terms “scope” and “endoscope” are used herein according to their broad and ordinary meaning and may refer to any type of elongated medical instrument having imaging, viewing, and / or capturing capabilities and configured to be introduced into any type of organ, cavity, lumen, chamber, or space in the body. Scopes can include, for example, ureteroscopes (e.g., for accessing the urinary tract), laparoscopes, nephroscopes (e.g., for accessing the kidneys), bronchoscopes (e.g., for accessing the airways such as the bronchi), colonoscopes (e.g., for accessing the colon), arthroscopes (e.g., for accessing joints), cystoscopes (e.g., for accessing the bladder), colonoscopes (e.g., for accessing the colon and / or rectum), borescopes, etc. The scope / endoscope may, in some cases, comprise a rigid or flexible tube and may be sized to be passed within an outer sheath, catheter, introducer, or other luminal device, or may be used without such a device.

[0041] 1 and 2 , which illustrate an exemplary embodiment of the control system 50 of FIG. 1 in accordance with one or more embodiments of the present disclosure, the control system 50 can be configured to provide various functions to assist in performing a medical procedure. In some embodiments, the control system 50 can be coupled to the robotic system 10 and operate in cooperation with the robotic system 10 to perform a medical procedure on the patient 7. For example, the control system 50 can communicate with the robotic system 10 via a wireless or wired connection (e.g., to control the robotic system 10). Further, in some embodiments, the control system 50 can communicate with the robotic system 10 to receive position data therefrom regarding the position of the distal end of the scope 40, the access sheath 90, or the basket device 30. Such position data regarding the position of the scope 40, the access sheath 90, or the basket device 30 can be derived using one or more electromagnetic sensors associated with the respective components. Further, in some embodiments, the control system 50 can communicate with the table 15 to position the table 15 in a particular orientation or otherwise control the table 15. In some embodiments, the control system 50 may be in communication with the EM field generator 18 to control the generation of the EM field in the area surrounding the patient 7 .

[0042] FIG. 2 further illustrates an exemplary embodiment of the robotic system 10 of FIG. 1 , in accordance with one or more embodiments of the present disclosure. The robotic system 10 can be configured to at least partially facilitate the performance of a medical procedure. The robotic system 10 can be configured in a variety of ways depending on the particular procedure. The robotic system 10 can include one or more robotic arms 12 configured to engage and / or control, for example, a scope 40 and / or a basket system 30 to perform one or more aspects of the procedure. As shown, each robotic arm 12 can include multiple arm segments 23 coupled to joints 24 that can provide multiple degrees of movement / freedom. In the example of FIG. 1 , the robotic system 10 is positioned adjacent a patient's leg, and the robotic arm 12 is actuated to engage and position the scope 40 for access within an access opening, such as the urethra 65 of the patient 7. Once the robotic system 10 is properly positioned, the scope 40 can be inserted into the patient 7 robotically using the robotic arm 12, manually by the physician 5, or a combination thereof. A scope-driver instrument coupling 11 (i.e., an instrument device manipulator (IDM)) may be attached to the distal portion of one of the arms 12b to facilitate robotic control / advancement of the scope 32. Another of the arms 12c may have associated therewith an instrument coupling / manipulator 19 configured to facilitate advancement and manipulation of the basket device 30. The scope 40 may include one or more working channels through which additional tools, such as lithotriptors, basket devices, forceps, etc., may be introduced into the treatment site.

[0043] The robotic system 10 can be coupled to any component of the medical system 100, such as the control system 50, the stage 15, the EM field generator 18, the scope 40, the basket system 30, and / or a percutaneous access device (e.g., a needle, a catheter, a nephroscope, etc.). In some embodiments, the robotic system 10 is communicatively coupled to the control system 50. For example, the robotic system 10 can be configured to receive control signals from the control system 50 to perform a particular operation, such as positioning one or more of the robotic arms 12 in a particular manner, manipulating the scope 40, or manipulating the basket system 30. In response, the robotic system 10 can control the components of the robotic system 10 to perform the operation using particular control circuits 211, actuators 217, and / or other components of the robotic system 10. In some embodiments, the robotic system 10 and / or control system 50 are configured to receive from the scope 40 and / or display images based on images and / or image data representative of the internal anatomical structure of the patient 7, i.e., the urinary system with respect to the particular depiction of FIG. 1 .

[0044] 2, the robotic system 10 generally includes an elongated support structure 14 (also referred to as a "column"), a robotic system base 25, and a console 13 atop the column 14. The column 14 may include one or more arm supports 17 (also referred to as a "carriage") for supporting the deployment of one or more robotic arms 12 (three are shown in FIG. 2). The arm supports 17 may include individually configurable arm mounts that rotate along a vertical axis to adjust the base of the robotic arms 12 for more desired positioning relative to the patient.

[0045] The arm support 17 can be configured to translate vertically along the column 14. In some embodiments, the arm support 17 can connect to the column 14 through slots 20 positioned on either side of the column 14 to guide the vertical translation of the arm support 17. The slots 20 contain vertical translation interfaces for positioning and holding the arm support 17 at various vertical heights relative to the robotic system base 25. The vertical translation of the arm support 17 allows the robotic system 10 to adjust the reach of the robotic arm 12 to meet various table heights, patient sizes, and physician preferences. Similarly, individually configurable arm mounts on the arm support 17 can allow the robotic arm base 21 of the robotic arm 12 to be angled in various configurations.

[0046] The robotic arm 12 may generally comprise a robotic arm base 21 and end effectors 22 separated by a series of articulated arm segments 23 connected by a series of joints 24, each joint comprising one or more independent actuators 217. Each actuator may comprise an independently controllable motor. Each independently controllable joint 24 may provide or represent an independent degree of freedom available to the robotic arm. In some embodiments, each of the arms 12 has seven joints, thus providing seven degrees of freedom, including “redundant” degrees of freedom. The redundant degrees of freedom allow the robotic arms 12 to position their respective end effectors 22 at specific positions, orientations, and trajectories in space using different joint positions and joint angles. This allows the system to position and orient medical instruments from a desired point in space while also allowing the physician to move the arm joints to clinically advantageous positions away from the patient to create better access while avoiding arm collisions.

[0047] The robotic system base 25 balances the weight of the column 14, arm support 17, and arm 12 on the floor. Thus, the robotic system base 25 can house certain relatively heavier components, such as electronics, motors, power supplies, and components that selectively enable movement or immobilize the robotic system. For example, the robotic system base 25 can include casters 28 in the form of wheels that allow the robotic system to be easily moved around the operating room before a procedure. After reaching the appropriate position, the casters 28 can be locked using wheel locks to hold the robotic system 10 in place during a procedure.

[0048] When positioned at the top of the column 14, the console 13 can provide both a user interface for receiving user input and a display screen 16 (or dual-purpose device, e.g., a touchscreen) for providing both pre- and intra-operative data to the physician / user. Potential pre-operative data on the console / display 16 or display 56 can include pre-operative planning, navigation and mapping data derived from a pre-operative computerized tomography (CT) scan, and / or notes from a pre-operative patient interview. Intra-operative data on the display can include optical information provided by tools, sensor and coordinate information from sensors, and vital patient statistics such as respiration, heart rate, and / or pulse. The console 13 can be positioned and tilted to allow a physician to access the console from the side of the column 14 opposite the arm support 17. From this position, the physician can view the console 13, robotic arm 12, and patient while operating the console 13 from behind the robotic system 10. As shown, the console 13 also includes a handle 27 to assist in maneuvering and stabilizing the robotic system 10.

[0049] Each end effector 213 of the robotic arm 12 may include or be configured to couple to an instrument device manipulator (IDM), which may be attached using a mechanism changer interface (MCI). In some embodiments, the IDM may be removed and replaced with a different type of IDM; for example, a first type 11 IDM may operate an endoscope, while a second type 19 IDM may operate a basket device. Another type of IDM may be configured to hold the electromagnetic field generator 18. The MCI may provide a power and control interface. For example, the interface may include connectors for transmitting air pressure, power, electrical signals, and / or optical signals from the robotic arm 12 to the IDM. The IDM 213 may be configured to operate a medical instrument (e.g., a surgical tool / instrument), such as the scope 40, using techniques including, for example, direct drive, harmonic drive, gear drive, belt and pulley drive, magnetic drive, and the like. In some embodiments, a medical device manipulator 213 can be attached to each of the robotic arms 212, which are configured to insert or retract each associated medical instrument into or from the treatment site.

[0050] As mentioned above, system 100 may include certain control circuits configured to perform certain functions described herein, including control circuitry 211 of robotic system 10 and control circuitry 251 of control system 50. That is, the control circuitry of system 100 may be part of robotic system 10, control system 50, or some combination thereof. Accordingly, all references to control circuitry herein may refer to circuitry embodied in a robotic system, a control system, or any other component of a medical system, such as medical system 100 shown in FIG. 1 . The term “control circuitry” is used herein according to its broad and ordinary meaning and may refer to any collection of processors, processing circuits, processing modules / units, chips, dies (e.g., semiconductor dies including one or more active and / or passive devices and / or connectivity circuits), microprocessors, microcontrollers, digital signal processors, microcomputers, central processing units, field programmable gate arrays, programmable logic devices, state machines (e.g., hardware state machines), logic circuits, analog circuits, digital circuits, and / or any devices that manipulate signals (analog and / or digital) based on hard-coded and / or operational instructions in the circuits. The control circuits referred to herein may further include one or more circuit boards (e.g., printed circuit boards), conductive traces and vias, and / or mounting pads, connectors, and / or components. The control circuits referred to herein may further include one or more storage devices, which may be embodied in a single memory device, multiple memory devices, and / or embedded circuitry of a device. Such data storage devices may include read-only memory, random access memory, volatile memory, non-volatile memory, static memory, dynamic memory, flash memory, cache memory, data storage registers, and / or any device that stores digital information.It should be noted that in embodiments in which the control circuitry comprises hardware and / or software state machines, analog circuits, digital circuits, and / or logic circuits, the data storage devices / registers that store any associated operational instructions may be embedded within or external to the circuitry that comprises the state machines, analog circuits, digital circuits, and / or logic circuits.

[0051] The control circuits 211, 251 may include computer-readable media configured to store and / or store hard-coded and / or operational instructions corresponding to at least some of the steps and / or functions illustrated in one or more of the present figures and / or described herein. Such computer-readable media may, in some cases, be included in an article of manufacture. The control circuits 211 / 251 may be maintained / distributed entirely locally or may be at least partially remotely located (e.g., indirectly communicatively coupled via a local area network and / or wide area network). Either of the control circuits 211, 251 may be configured to perform any aspect of the various processes disclosed herein, including the processes shown in FIGS. 9 and 11, as described below.

[0052] With respect to robotic system 10, at least a portion of control circuitry 211 may be integrated with base 25, column 14, and / or console 13 of robotic system 10, and / or another system communicatively coupled to robotic system 10. With respect to control system 50, at least a portion of control circuitry 251 may be integrated with console base 51 and / or display unit 56 of control system 50. It should be understood that any description herein of functional control circuitry or associated functionality may be understood to be embodied in robotic system 10, control system 50, or any combination thereof, and / or at least partially in one or more other local or remote systems / devices.

[0053] 2 , the control system 50 may include various I / O components 258 configured to assist the physician 5 or others in performing a medical procedure. For example, the input / output (I / O) components 258 may be configured to allow user input to control / navigate the scope 40 and / or basket system within the patient 7. In some embodiments, for example, the physician 5 may provide input to the control system 50 and / or the robotic system 10, and in response to such input, may send control signals to the robotic system 10 to operate the scope 40 and / or the catheter basket system 30. The control system 50 may include one or more display devices 56 to provide various information regarding the procedure. For example, the display 56 may provide information regarding the scope 40 and / or the basket system 30. For example, the control system 50 may receive real-time images captured by the scope 40 and display the real-time images via the display 56. Additionally or alternatively, control system 50 may receive signals (e.g., analog, digital, electrical, acoustic / sonic, pneumatic, tactile, hydraulic, etc.) from medical monitors and / or sensors associated with patient 7, and display 56 may present information regarding the health or environment of patient 7. Such information may include, for example, information displayed via the medical monitor, such as heart rate (e.g., ECG, HRV, etc.), blood pressure / blood velocity, muscle biosignals (e.g., EMG), body temperature, blood oxygen saturation (e.g., SpO2), CO2, brain waves (e.g., EEG), environmental and / or local or core body temperature information.

[0054] To facilitate the function of control system 50, the control system may include various components (sometimes referred to as "subsystems"). For example, control system 50 may include control electronics / circuitry 251, as well as one or more power sources / power interfaces 259, pneumatic devices, light sources, actuators, data storage devices, and / or communications interfaces 254. In some embodiments, control system 50 is mobile, while in other embodiments, control system 50 is a substantially stationary system. Although various functions and components are discussed as being implemented by control system 50, any of such functions and / or components may be integrated into and / or performed by other systems and / or devices, such as, for example, robotic system 10, basket system 30, platform 15, and / or others.

[0055] 1 , the medical system 100 can provide various benefits, such as providing guidance (e.g., instrument tracking, instrument alignment information, etc.) to assist a physician in performing a procedure, allowing a physician to perform a procedure from an ergonomic position without requiring awkward arm movements and / or positions, allowing a single physician to perform a procedure using one or more medical instruments, avoiding radiation exposure (e.g., associated with fluoroscopy techniques), allowing a procedure to be performed in a single operating setting, and providing continuous suction to more efficiently remove objects (e.g., removing kidney stones). For example, the medical system 100 can provide guidance information to assist a physician in accessing target anatomical features using various medical instruments while minimizing bleeding and / or damage to anatomical structures (e.g., vital organs, blood vessels, etc.). Furthermore, the medical system 100 can provide non-radiation-based navigation and / or localization techniques to reduce physician and patient radiation exposure and / or reduce the amount of equipment in the operating room. Furthermore, the medical system 100 can provide distributed functionality between the control system 50 and the robotic system 10, which may be independently mobile. Such distribution of functionality and / or mobility can allow the control system 50 and / or robotic system 10 to be placed in a location that is optimal for a particular medical procedure, thereby maximizing the working area around the patient 7 and / or providing an optimized location for the physician 5 to perform the procedure.

[0056] The various components of system 100 can be communicatively coupled to one another over a network, which can include wireless and / or wired networks. Exemplary networks include one or more personal area networks (PANs), local area networks (LANs), wide area networks (WANs), Internet area networks (IANs), cellular networks, the Internet, personal area networks (PANs), body area networks (BANs), etc. For example, the various communication interfaces of the system of FIG. 2 can be configured to communicate with one or more devices / sensors / systems, such as over wireless and / or wired network connections. In some embodiments, the various communication interfaces can implement wireless technologies such as Bluetooth, Wi-Fi, near field communication (NFC), etc. Furthermore, in some embodiments, the various components of system 100 can be connected for data communication, fluid exchange, power exchange, etc. via one or more supporting cables, conduits, etc.

[0057] The control system 50, basket system 30, and / or robotic system 10 may include specific user controls (e.g., controls 55), which may comprise any type of user input (and / or output) device or device interface, such as one or more buttons, keys, joysticks, handheld controllers (e.g., video game-type controllers), computer mice, trackpads, trackballs, control pads, and / or sensors (e.g., motion sensors or cameras) that capture hand and finger gestures, touchscreens, and / or interfaces / connectors therefor. Such user controls are communicatively and / or physically coupled to respective control circuits.

[0058] In some embodiments, a user can manually manipulate the robotic arm 12 of the robotic system 10 without the use of electronic user controls. For example, during a surgical operating room setting, a user may move the robotic arm 12 and / or any other medical instruments to provide desired access to a patient. The robotic system 10 may rely on force feedback and inertial control from the user to determine the appropriate configuration of the robotic arm 12 and associated instrumentation.

[0059] The basket system 30 includes various hardware and control components. For example, as shown in FIG. 2 , the processing system 30 can include a basket 35 formed from one or more wire tines 36. For example, the basket system 30 can include four wire tines disposed along its length within a basket sheath 37, with the tines protruding from the distal end of the sheath 37 to form the basket shape 35. The tines 36 extend further from the proximal end of the sheath 37. The tines 36 can be configured to be slidable within the basket sheath 37 with some frictional resistance. The tines 36 and sheath 37 can be coupled to respective actuators 75 of the basket cartridge component 32. The relationship between the actuators 75 of the basket cartridge 32 and the tines 36 and sheath 37 is described in more detail below with reference to FIGS. 4A-4E . The basket cartridge 32 can be physically and / or communicatively coupled to the handle portion / component 31 of the basket system 30. The handle component 31 may be configured to be used to assist in basket control either manually or through robotic control.

[0060] The basket system 30 may be powered through a power interface 39 and / or controlled through a control interface 38, each or both of which may interface with the robotic arms / components of the robotic system 10. The basket system 30 may further include one or more sensors 72, such as pressure and / or other force reading sensors, configured to generate signals indicative of forces experienced at / by the actuator 75 and / or one or more of the other couplings of the basket system 30. Such sensor readings may be used to determine a stuck basket condition, as described in detail herein. In some embodiments, the sensors 72 include one or more sensors configured to directly measure forces at or near the basket portion 35 of the tines 36. For example, force sensors on the tip of the basket 35 and / or at the tip of an access sheath through which the basket device 30 accesses the target anatomy may be used to directly detect forces on the basket 35 resulting from the basket 35 sticking to the anatomy or an opening in the end of the access sheath.

[0061] Basket Control FIG. 3 illustrates a ureteroscope 40 disposed in a portion of a patient's urinary system, according to one or more embodiments of the present disclosure. As mentioned above, ureteroscopic procedures can be implemented to investigate and / or treat abnormalities within a person's ureter. For example, ureteroscopic procedures can be implemented to treat and / or remove kidney stones. Such procedures can be performed at least partially manually and / or at least partially using robotic technology, such as the robotic system 10 shown in FIG. 1. For example, the use of robotic devices and / or systems for certain endoscopic procedures can provide relatively greater precision, control, and / or coordination compared to strictly manual procedures. In some embodiments, the scope 40 includes a working channel 44 for deploying a basket device 30 (e.g., basket component 35) into a working region at the distal end of the scope.

[0062] The access sheath 90 through which the scope 40 is passed to access the target anatomical structure can advantageously have a diameter sufficient to pass the scope 40 in addition to the object / stone captured in the basket 35 when the object / stone is not too large. The access sheath 90 can be advanced through the ureter 63 to a position near the renal pelvis 71 and / or the ureteropelvic junction 71. The distal end of the access sheath 90 can be placed at a position within the ureter 63 and / or the renal pelvis 71, and such a placement location can depend, at least in part, on the anatomy. That is, the access sheath 90 can be placed as deep within the renal anatomy as permitted by the urinary pathway, which may be somewhat tortuous within that particular portion. Generally, the access sheath 90 may not be able to articulate to the same extent as the scope 40, and therefore, it may be impractical to navigate / drive the access sheath 90 into the kidney.

[0063] Scope 40 may be articulatable, such as with respect to at least a distal portion of the scope, so that the scope can be maneuvered within the human anatomy. In some embodiments, scope 40 is configured to be articulated with five degrees of freedom, including, for example, X, Y, and Z coordinate translation, as well as pitch and yaw. In some embodiments, scope 40 is articulatable with six degrees of freedom, including X, Y, and Z coordinate translation, as well as pitch, yaw, and roll. Position sensors on scope 40 may similarly have similar degrees of freedom with respect to the position information they generate / provide.

[0064] For robotic implementations, the robotic arm of the robotic system can be configured / configurable to manipulate the scope 40 using elongated movement members. The elongated movement members can include one or more pull wires (e.g., pull or push wires), cables, fibers, and / or flexible shafts. For example, the robotic arm can be configured to actuate multiple pull wires (not shown) coupled to the scope 40 to deflect the tip 42 of the scope 40. The pull wires can include any suitable or desirable material, such as metallic and non-metallic materials, such as stainless steel, Kevlar, tungsten, carbon fiber, and the like. In some embodiments, the scope 40 is configured to exhibit non-linear behavior in response to forces applied by the elongated movement members. The non-linear behavior can be based on the stiffness and compressibility of the scope and variability in slack or stiffness between different elongated movement members.

[0065] The scope (e.g., endoscope / ureteroscope) 40 may comprise a tubular, flexible medical instrument configured to be inserted into a patient's anatomy to capture images of the anatomy. In some embodiments, the scope 40 may house an optical assembly that may include an imaging device 48, such as an optical camera, and wires and / or fiber optics for transmitting signals to / from the distal end 42 of the scope 40. The scope 40 may further include a light source 49, such as an LED or fiber optic light source / lens.

[0066] The camera / imaging device 48 can be used to capture images of an internal anatomical space, such as the target calyx of the kidney 70. The scope 40 can be further configured to accommodate an optical fiber for carrying light from a proximally located light source, such as a light emitting diode, to the distal end 42 of the scope. The distal end 42 of the scope 40 can include a port for a light source to illuminate the anatomical space when the camera / imaging device is in use. In some embodiments, the scope 40 is configured to be controlled by a robotic system similar in one or more respects to the robotic system 10 shown in FIGS. 1 and 2. The imaging device 48 can include optical fibers, a fiber array, and / or lenses. The optical components move with the tip of the scope 40 such that movement of the tip of the scope results in changes in the images captured by the imaging device 48.

[0067] In some embodiments, the medical instrument (e.g., scope) 40 includes a sensor configured to generate and / or transmit sensor position data to another device, or to generate a detectable distortion or signature in an electromagnetic field. The sensor position data can indicate the position and / or orientation of the medical instrument 40 (e.g., its distal end 42) and / or can be used to determine / estimate the position / orientation of the medical instrument. For example, the sensor (sometimes referred to as a “position sensor”) can include an electromagnetic (EM) sensor having a coil of conductive material or other form / embodiment of an antenna. In some embodiments, the scope 40 includes an electromagnetic sensor embedded in the distal end of the scope 40 and 42. The electromagnetic sensor (not shown) can include the end of a wire or other conductive element configured to induce an electrical current in the presence of an electromagnetic field. Additionally, the medical instrument / scope 40 and / or basket device 30 can include other types of sensors, such as shape-sensing fibers, accelerometers, gyroscopes, satellite-based positioning sensors (e.g., global positioning system (GPS) sensors), radio frequency transceivers, etc. In some embodiments, sensors on the medical instrument can provide sensor data to a control system, which is then used to determine the position and / or orientation of the medical instrument. Position data derived using one or more position sensors associated with the scope 40 or basket device 30 can be used to determine when the scope and / or basket 35 is within or near a stuck instrument danger zone, as described in detail herein.

[0068] The scope 40 and / or basket device 30 may be controllable in any suitable or desirable manner, either based on manual manipulation of handle components, electronic user input, or automatically. For example, image 311 shows an exemplary robotic control configuration for controlling the scope 40 and / or basket device 30, and image 312 shows an exemplary manual control configuration. In some embodiments, the scope 40 and / or basket device 30 can be controlled using two-handed controllers 55, as shown in FIG. 1. Although the controllers 55 are shown as handheld controllers, user input can be received using any type of I / O device, such as a touchscreen / pad, mouse, keyboard, microphone, etc.

[0069] 4A-4D illustrate various configurations of basket control systems according to one or more embodiments. In connection with various embodiments of the present disclosure, as shown in FIGS. 4A-4D , the basket may be implemented at least in part using one or more robotic instrument device manipulators (IDMs), such as scope driver IDM 11 and basket IDM 19. The IDMs 11, 19 may be coupled to one or more robotic arms of a robotic system. Control signals for controlling the various actuators associated with the IDMs 11, 19 may be provided using a control interface between the IDMs and their respective coupled robotic arms.

[0070] In some embodiments, the basket IDM 19 can include a handle component 31 and a basket cartridge component 32. The handle component 31 can be coupled to the scope 40 at the proximal end of the scope and can include a channel through which the basket device sheath 37 can enter the scope 40, and as described above with respect to FIG. 3 , the basket sheath 37 can be at least partially disposed within the working channel 44 of the scope 40 (with basket tines disposed therein). The scope 40 and the basket device 30 can generally be in relatively fixed positions in the handle component 31, and the relative position between the scope 40 and the basket 30 can be changed through actuation of one or more of the actuators 33, 34 of the basket cartridge 32. Actuation of the basket sheath actuator 33 can cause insertion and retraction of the basket device 30 relative to the scope 40.

[0071] In some embodiments, in some implementations of the scope and / or basket retraction process, the basket device 30 may be dithered relative to the scope 40 for various purposes, including improving stuck instrument detection sensitivity and / or preventing instrument sticking. As described in detail below in connection with various stuck instrument detection solutions disclosed herein, the dithering motion of the basket device 30 may be implemented at least in part by sliding the basket sheath actuator 33 back and forth (e.g., distally and proximally) such that the basket 35 moves back and forth relative to the distal end of the scope 40.

[0072] The scope 40 may be advanced from the distal end of the access sheath 90 by actuating one or more actuators 38 associated with the scope driver IDM 11. For example, such actuators 38 may comprise wheel-type actuators or the like. The actuators 38 may be used to advance and retract the scope 40. During a kidney stone removal procedure, the actuators 38 may be utilized to retract the scope 40 following successful capture of the kidney stone 80 within the basket 35, as shown in FIG. 4E. In some embodiments, the access sheath 90 is fixedly coupled to the scope driver IDM 11 using a sheath coupling component 91.

[0073] The basket cartridge 32 may include multiple actuators 33, 34. For example, the actuators 33, 34 may include sliding carriage-type actuators. Specifically, the cartridge 32 may include a first actuator 33 secured to a sheath component 37 of the basket device 30 and a second actuator 34 secured to wires / tines 36 of the basket device 30, and the tines 36 may pass through and / or otherwise be at least partially disposed within the basket sheath 37. In some embodiments, the basket 35 is formed at its distal portion from the tines 36 that protrude from the distal end of the basket sheath 37.

[0074] By sliding the sheath actuator 33, the basket device 30 can be protruded from the distal end of the scope 40. For example, as shown in FIG. 4B, the actuator 30 can be slid forward to create a corresponding forward advancement of the basket device 30 and basket 35. The basket actuator 34 can be used to open the basket 35 by pulling the tines proximally, which pulls the distal end 39 of the basket 35 toward the distal opening of the sheath 37, thereby causing an outward bending / expansion of the basket portion 35 of the tines. With the tines 35 in the expanded / open position shown in FIG. 4B, the basket 35 can be positioned around a stone / object 80, thereby capturing the stone / object 80 within the basket tines 35.

[0075] 4C, the basket 35 may collapse around the stone 80, thereby trapping the stone therein. For example, the basket tine actuator 34 may be advanced a certain amount relative to the sheath actuator 33, thereby pushing the basket tines further out of its distal end of the sheath 37, thereby elongating / lengthening the basket 35 and bringing the tines closer to the axis of the basket device 30. The sheath actuator 33 may be pulled proximally to return the basket device 30 closer to the distal end of the scope 40. For example, it may be desirable to position the basket 35 close / adjacent to the distal end of the scope 40 during retraction of the scope and basket device 30.

[0076] In some implementations, basket 35 may be further tightened / folded around stone 80 by pulling tines 36 further proximally, thereby drawing tines 35 further into sheath 37 and reducing the length of the tines protruding distally from the distal end of basket sheath 37. Figure 4D shows basket 35 reduced in size by moving actuator 34 proximally relative to actuator 33.

[0077] Once the stone 80 has been captured and the basket 35 has been brought to a desired location near the distal end of the scope 40, the actuator 38 can be engaged to retract the scope 40 through the opening 93 in the access sheath 90 and further through the access sheath 90, as shown in FIG. 4E. In some embodiments, the basket device 30 can be retracted along with the scope 40 as the scope 40 is pulled proximally. For example, the frictional force between the basket sheath 37 and the working channel 44 of the scope 40 can be such that the basket device 30 drags the scope 40 along as the scope 40 is retracted / moved.

[0078] One or more force sensors may be associated with one or more of the actuators and / or coupling interfaces of the basket system shown in FIGS. 40A-40E. For example, a force sensor (e.g., a pressure sensor) may be associated with one or more of the basket tine actuator 34, basket sheath actuator 33, scope driver actuator 38, and / or access sheath coupling 91. For example, in some embodiments, a force present and / or sensed at the basket tine actuator 34 may indicate a securement instrument condition in which the basket tines 35 are captured and / or pulled distally on the actuator 34 during retraction of the scope 40. In some embodiments, a force reading at the basket sheath actuator 33 may indicate a securement instrument condition. For example, when the basket tines 35 are pulled against and / or along one or more portions of the distal opening of the basket sheath 37, such force / friction may be at least partially manifested at the sheath actuator 33. Accordingly, embodiments of the present disclosure may involve evaluating / analyzing sensor readings associated with the basket sheath actuator 33 to determine / identify an instrument sticking condition. Generally, movement of the sheath actuator 33 causes the basket sheath 37 and tines 36 to move in tandem.

[0079] In some embodiments, a sensor associated with the scope driver actuator 38 can provide a signal indicative of a stuck instrument status. For example, with the basket 35 stuck on an anatomical structure or at the opening of the access sheath 90, friction between the basket device 30 and the working channel 44 of the scope 40 can prevent retraction of the scope. For example, in some embodiments, the basket device 30 can be clamped or otherwise secured to one or more portions of the scope 40, such as at or near the handle component 31. Thus, forces associated with a stuck basket can be felt and / or read at the actuator 38 coupled to the scope 40. In some embodiments, forces experienced by the access sheath 90 can be felt / sensed at least in part at the sheath coupling 91, providing an indication of the stuck instrument status. It should be understood that any of the embodiments disclosed herein can be implemented to determine a stuck instrument status based on sensor readings associated with the basket tine actuator 34, the basket sheath actuator 33, the scope driver actuator 38, and / or the sheath coupling 91, or any combination thereof.

[0080] In some embodiments, the basket portion 35 of the tines 36 of the basket device 30 may have one or more force sensors associated therewith, such as at the distal end 39 of the basket 35. Such sensors may provide signals with reduced friction losses compared to signals experienced / generated at more proximal components / locations associated with other actuators / couplings of the basket system. Accordingly, embodiments of the present disclosure implementing force sensors associated with the distal basket portion 35 of the basket device 30 may provide relatively sensitive readings indicative of fixation device status. In some embodiments, one or more force sensors may be disposed at the base of the basket 35 at or near the distal opening of the basket sheath 37. Such sensors may provide readings that may serve as the basis for determining fixation device status according to embodiments of the present disclosure.

[0081] 5 illustrates various medical instruments including certain basket device components disposed within portions of a patient's renal anatomy, according to one or more embodiments. In particular, FIG. 5 shows the scope 40 and basket device 30 in various positions associated with a stone / object capture and removal procedure, according to aspects of the present disclosure.

[0082] As mentioned above, attempts to extract relatively large stones can result in lacerations or other damage to the ureter and / or other anatomical features. With reference to the illustration of FIG. 5 , if the stone 80 is too large to fit within the access sheath 90 (e.g., a ureteral access sheath) such that the basket 35c becomes trapped at the distal end or other portion of the access sheath 90, the withdrawal force on the scope 40 and / or basket device 30 can displace the access sheath 90 and potentially result in abrasion on the inner wall of the ureter 63. Furthermore, in situations where the size of the stone 80 trapped within the basket 35 prevents the basket from fitting cleanly within the access sheath 90, attempts to retract the basket 35 into the access sheath 90 can damage or break the basket tines 35.

[0083] In situations where the target stone / object 80 is too large to be cleanly retracted through the ureteropelvic junction 78 and into the access sheath 90 for various reasons, embodiments of the present disclosure can provide an effective solution for detecting a stuck instrument situation or the risk of instrument sticking / entrapment. As an exemplary use case, when the target stone / object is broken up (e.g., using a laser as part of a lithotripsy procedure), the surgeon may not be able to confidently determine the exact size or diameter of the stone and / or whether the stone / fragments are small enough to pass through the ureter and / or ureteral access sheath. With some manual procedures, physicians may attempt to laser-ablate the stone / object to generate stone fragments small enough to fit cleanly through the ureteropelvic junction 78 and access sheath 90, based on their personal experience with such procedures. Nevertheless, such physicians may encounter stuck instrument situations over time during the procedure. For manual procedures, when faced with a stuck instrument situation, the physician holding the ureteroscope and monitoring the real-time scope camera image may be able to identify / notice on the camera that the stone / basket appears further away from the scope camera field of view than expected, which may be due to the basket / stone getting stuck in a particular anatomy and / or at the opening of the access sheath 90. Additionally, if the basket control is also manually operated, the stuck instrument / stone situation may be felt tactilely on the control instrument in the form of a force opposing retraction of the scope and / or basket.

[0084] As mentioned above, the size of the stone 80 relative to one or more dimensions of the stone 80 may cause the stone 80 to become stuck within the patient's anatomy and / or at the opening of the scope 40, basket 35, and access sheath 90 through which the object 80 trapped in the basket is retracted. However, depending on the particular solution, the location and / or system may not be able to determine the exact size of the stone 80. Thus, in some cases, the risk of instrument sticking / trapping may not be completely avoidable. Furthermore, for robotic-assisted ureteroscopic procedures, while a camera view from an endoscopic camera may be available for monitoring by the physician / technician, the scope and / or basket device are robotically controlled rather than held by a human surgical staff member, and force feedback may not be felt by the human user. Therefore, detecting / determining a stuck instrument / stone situation may be more difficult in certain respects for robotically implemented scope-driven and / or basket procedures.

[0085] If the stone 80 and / or basket 35 become anchored within the patient's anatomy, further retraction of the basket 35 from the anchored position may result in tissue tears (e.g., ureteral tears). Additionally, if the basket 35c becomes anchored at the opening of the access sheath 90, further retraction of the basket 35c and / or scope 40c may result in displacement / removal of the access sheath 90 from its indwelling position and / or damage to the basket 35.

[0086] Embodiments of the present disclosure provide stuck instrument detection based on force readings associated with actuators and / or couplings associated with one or more components of the access sheath 90, the scope 40, and / or the basket device 30. For example, when the scope 40 is retracted once an object 80 is captured by the basket 35, force readings for one or more components of the instrument can be analyzed to determine whether such forces exceed a predetermined threshold indicative of a stuck instrument condition. In some implementations, the sensitivity of such stuck instrument determination can be improved by implementing basket dithering according to embodiments of the present disclosure.

[0087] Basket dithering may be implemented when the scope 40 and / or basket 35 enter the danger zone 99, which may be an area of ​​relatively high risk of instrument sticking / entrapment. For example, the sticking instrument danger zone 99 may generally cover the area at or near the ureteropelvic junction 78 and / or the area just prior to (i.e., distal to) the opening of the access sheath 90, which may generally be associated with a higher risk of entrapment in the urinary tract anatomy and the opening of the access sheath 90, respectively. For example, strictures of the urinary tract as the anatomy moves from the renal pelvis 71 into the ureter 63 present a narrowing of the channel / lumen, which may result in instrument entrapment where the basket 35 and / or the stone / object 80 trapped therein have a width / diameter or other dimension greater than a particular dimension of the anatomical passageway. Furthermore, the opening of the access sheath 90 is generally narrower than the anatomy through which the basket 35 retracts into the access sheath 90. Thus, the access sheath 90 represents a relatively narrow passageway, and the basket 35 and / or the stone / object 80 trapped therein may become lodged when its dimensions are greater than the diameter of the access sheath opening. Thus, the danger zone 99 advantageously includes one or both of the narrowed region of the ureteropelvic junction 78 and the region immediately preceding the opening 93 of the access sheath 90. In some embodiments, the area of ​​the danger zone 99 may be determined based at least in part on the location of the opening / distal end of the access sheath 90, such that the danger zone 99 occupies an area a predetermined distance forward of the access sheath 90.

[0088] Basket dithering can be implemented to amplify the difference in force signals between a stuck and non-stuck instrument situation. For example, slightly advancing and retracting the basket while the scope and basket are retracted can help ensure that stuck instrument sensor readings are clearly distinguishable. For example, as described in detail herein, the use of basket dithering can result in reduced noise and / or improved sensitivity of force readings on various instruments. For example, implementing basket dithering, which advances and retracts the basket 35 a certain distance to oscillate, can reduce or avoid the effects of static friction forces. Generally, static friction forces can be present when the basket 35 is in a relatively stationary position and in contact with the walls of the anatomical structure. As the basket 35 moves in an oscillating manner, the friction experienced on the instrument can be primarily in the form of kinetic friction, which is typically associated with a smaller coefficient of friction compared to static friction. Therefore, when basket dithering is employed, the signal-to-noise ratio of the forces exerted on the various instrument components can be relatively high compared to a solution in which the scope 40 and / or basket 35 are retracted without basket dithering.

[0089] As the basket retracts into and through the danger zone 99, force feedback readings on actuators associated with one or more components of the basket system 30, scope 40, and / or sheath 90 can be analyzed to determine when such forces increase consistent with a fixation device situation and / or the risk associated therewith. When such a determination is made, such as when a force reading rises above a given threshold level, the retraction rate of the scope 40 and / or basket 30 can be automatically reduced, thereby guiding the user / operator to continue manipulating and / or retracting the scope with more caution.

[0090] In some embodiments, the basket 35 includes one or more electromagnetic sensors, which may provide a sensor signal and / or otherwise indicate the position of the basket 35, and such position information may serve as the basis for determining when the basket 35 is in or near the danger zone 99. Additionally, position information determined using the electromagnetic sensors associated with the basket 35 may be used to trigger the initiation of dithering for stuck instrument detection.

[0091] To provide effective detection of a stuck device condition and reduce the incidence of false positives related to stuck device detection, which may be frustrating or distracting to a user, the stuck device danger zone 99 may be configurable to cover an area determined to be particularly susceptible to stuck device risk. For example, the danger zone 99 may be configurable based on the location of the access sheath 90, with the danger zone 99 covering a particular distance in front of and / or around the distal opening of the access sheath 90. Dithering the basket 30c around the access sheath 90 may advantageously improve the sensitivity of detecting a stuck basket 35c at the entrance / opening of the access sheath 90, while dithering the basket 35b further from the access sheath 90 may improve the sensitivity of detecting a stuck basket condition at or near the relatively narrow opening of the ureteropelvic junction 78.

[0092] In some cases, the exact position of the scope 40 and / or access sheath 90 is unknown. For example, an estimate of the scope and / or sheath position may be based on knowledge / data indicating one or more of the robotic arm / mechanism positions, scope length, sheath length, and / or other known data; the scope may be longer / farther than expected, uncertainty may be increased by the feed roller arm holding the UAS; position data determined based on data generated using one or more position sensors; camera image analysis; and / or the like. However, such measurements may not be associated with sufficiently tight tolerances in some cases. Generally, it may be desirable to consider the entire relevant tolerance chain to ensure that the fixation device-determining features disclosed herein are implemented in a zone / region that includes the distal end of the access sheath 90, and to ensure that such features are implemented until the basket is safely seated within the access sheath.

[0093] In some implementations, image processing may be implemented to identify that the scope 40 is within the access sheath 90 before disabling a particular stuck instrument detection mechanism. For example, disabling one or more of the stuck instrument determination mechanisms disclosed herein may be triggered, at least in part, by visual identification (e.g., by either physician / technologist analysis or digital image processing) of one or more features associated with the interior and / or distal end of the access sheath.

[0094] In situations where access sheath positional tolerances result in a range of areas where the distal end of the access sheath may be located, it may be desirable to operate according to a relatively enlarged danger zone to ensure that the access sheath is at least partially positioned therein. Thus, while the illustrated danger zone 99 is shown as ending at or near the actual location of the opening 93 of the access sheath 90, it should be understood that in some implementations, the zone in which some of the disclosed fixation device determination mechanisms disclosed herein are implemented may extend further into the ureter 63 than shown in FIG. 5 and / or cover an area overlapping the distal end of the access sheath 90. In some embodiments, the danger zone 99 in which a particular fixation device determination mechanism is implemented includes an area corresponding to the extent of the scope 40. That is, the danger zone 99 may extend into the kidney 70 as far as the scope 40 and / or basket 30 can and / or will reach.

[0095] As described in detail herein, force readings that may be utilized as inputs for determining fixation instrument status may include force readings indicative of forces present on one or more of the scope drive (i.e., insertion and / or retraction) actuator / pulley, the access sheath coupling, the basket sheath insertion / retraction actuator, the basket tine insertion / retraction actuator, and / or torque sensors on one or more robotic arms or other robotic components (e.g., an insertion / retraction rail-type system). For example, referring back to FIGS. 4A-4E , the force on the distal drive feed roller / pulley 38 may be resolved to determine fixation instrument status. While force sensors are described throughout this disclosure, it should be understood that such sensors may be any type of sensor configured to generate and / or provide a signal indicative of forces experienced on actuators, couplings, and / or other mechanical components of a machine and / or robotic system / device, including direct torque sensors, current sensors, and / or the like.

[0096] In connection with any of the disclosed embodiments, the fixation instrument status can be determined based on sensor readings indicative of forces on any type of insertion and / or retraction mechanism, whether such mechanism drives the insertion and / or retraction of an access sheath, endoscope, basket sheath, basket tines, or other component of a surgical system. For example, sensor data on which the determination of the fixation instrument status can be based can be generated and / or provided by sensors associated with a rail-based instrument drive system. Such sensor data can advantageously indicate traction forces on one or more components of the system. In some embodiments, such an insertion / retraction mechanism can be implemented as a virtual or actual rail system, with such a system configured to generate linear (i.e., rail-type) movement of one or more components of the surgical system. Insertion / retraction forces detected using such sensors can serve as the basis for determining the fixation instrument status.

[0097] Vision-based Fixation Device Determination In some implementations, endoscopic camera images can provide the basis for stuck instrument determination. Such vision-based instrument stuckness determination functionality can be implemented by the medical system's control circuitry using certain image processing techniques. Figure 6A illustrates an endoscopic camera field of view 701 with a basket device 35 visible therein, in accordance with one or more embodiments of the present disclosure. Figure 6B illustrates a side view of a medical instrument assembly corresponding to the configuration of the basket device 35 relative to the endoscopic camera 48 used to capture image 701 of Figure 6A, in accordance with one or more embodiments. In image 701, the basket 35 and stone 80 are relatively large in the field of view due to the basket 35's proximity to the endoscopic camera 48.

[0098] FIG. 7A illustrates a field of view 702 of an endoscopic camera 48 with a basket device 35 in a stuck state visible therein, according to one or more embodiments of the present disclosure. FIG. 7B illustrates a side view of the medical instrument assembly of FIG. 6B corresponding to the configuration of the basket device 35 relative to the endoscopic camera 48 shown in FIG. 7A, according to one or more embodiments. Compared to the image of the basket 35 and stone 80 in image 701 of FIG. 6A, the image of the basket 35 and stone 80 in image 702 of FIG. 7A is smaller in size and positioned higher within the image frame 702. Such a change in image size and / or position can be caused by, and provide an indication of, the basket 35 having stuck as the scope 40 is retracted. Accordingly, image processing mechanisms configured to identify significant changes in image size and / or position relative to the basket tines and / or captured object can be implemented to determine a stuck instrument condition.

[0099] Unlike solutions in which only basket system actuator forces are used to detect / determine the fixation instrument status, some embodiments of the present disclosure involve implementing visual analysis / processing to determine the fixation instrument status. For example, images captured by an endoscopic camera can provide information regarding the fixation instrument status. For example, scope images can be processed to determine and / or estimate the distance between the distal end / tip of the scope 40, which may be generally associated with the scope's camera 48 and thus the camera view windows 701, 702 presented to the user, and the basket 35 or portions thereof, or the stone 80.

[0100] Endoscope image 701 associated with Figure 6A may represent an image captured by endoscope 40, with basket 35 visible as being loose and therefore relatively close to camera 48 of endoscope 40 within field of view 701. As shown in Figure 6B, which may generally be considered to correspond to image 701 captured by scope camera 48 shown in Figure 6A, stone 80 may be at a distance d1 relatively close to the distal end of scope 40.

[0101] Image 702 of Figure 7A shows stone 80 at a greater distance d2 from the end of scope 40. Such greater distance d2 may be the result of basket 35 and / or stone 80 adhering to particular anatomical structures or instrumentation, such that retraction of scope 40 causes basket device 30 to be withdrawn from working channel 44 of scope 40. Thus, in image 702, stone 80 and basket 35 are shown at a relatively smaller size, and the increasing distance that stone 80 and basket 35 are away from scope camera 48 indicates the position of stone 80 and basket 35 further away from scope camera 48.

[0102] In some implementations, the medical device or system's control circuitry may be configured to determine the shape and / or size associated with stone and / or basket features visible within the camera view, and such shape and / or distance information may be used to determine changes in the stone and / or basket's distance relative to the endoscopic camera and / or its absolute distance determination. Thus, a determination that the basket and / or stone is smaller in a subsequent image compared to a previously captured image may indicate the presence of a stuck instrument condition. Certain remedial actions may be implemented in response to such a determination, as described in detail herein.

[0103] In some embodiments, electromagnetic sensors or other position sensors associated with the basket 35 and / or basket device 30 may be used to determine the position of the basket 35 relative to the position of the scope 40, which may be indicated by a position sensor associated with the distal end of the scope 40. Such position information may be used to determine the distance between the basket 35 and the scope 40, which may be indicative of a fixation instrument status.

[0104] In some embodiments, the basket tines may have color-type characteristics that are at least partially stress-dependent. For example, such tines may be configured such that, in the presence of a stress load caused by a fixed basket condition, a change is apparent in the basket's visual characteristics, visible within the field of view of the endoscope's camera. That is, a displayed camera image presented to a user may have a color characteristic that indicates to the user the stress experienced by the basket, and thus the fixation device condition. In some embodiments, optical fibers may be utilized to provide shape-sensing functionality. For example, the basket may be fitted with a relatively thin optical fiber having a grading that can be examined, for example, by stimulating it with a pulse train of light, and the system's control circuitry is configured to interpret such readings and make a determination of the fixation device based, at least in part, thereon.

[0105] FIG. 8 illustrates a fixation instrument architecture 800 according to one or more embodiments. Architecture 800 provides a framework (e.g., a feature identification and / or force sensor analysis framework) for identifying one or more instruments, anatomical features, and / or stone / object features in an endoscopic camera image, and / or one or more robotic actuators / couplings associated with one or more components of a robotic surgical system, to dynamically determine / identify a fixation instrument status based on its characteristics, according to one or more embodiments of the present disclosure. Framework 800 may be embodied in specific control circuitry, including one or more processors, data storage devices, connectivity features, substrates, passive and / or active hardware circuit devices, chips / dies, and / or the like. For example, framework 800 may be embodied at least in part in control circuitry 251 and / or control circuitry 211 shown in FIG. 2 and described above. Framework 800 may employ machine learning capabilities to perform automatic fixation device status determination / detection, for example, on ureteroscopic images of the internal renal anatomy, the images including specific device components and / or kidney stones or other objects. Additionally or alternatively, framework 800 may employ machine learning capabilities to perform automatic fixation device status determination / detection, for example, with respect to robotic endoscope and / or basket actuator forces, as described in detail herein.

[0106] Framework 800 may be configured to operate on a particular image-type data structure, such as image data representing at least a portion of a treatment site associated with one or more medical procedures and / or instrument components used in such procedures. In some embodiments, framework 800 may be configured to operate on robotic actuator force profile data, as described herein. Such input data / data structures may be operated on in some manner by particular transformation circuitry 820 associated with the image processing portion of framework 800. Transformation circuitry 820 may comprise any suitable or desirable transformation and / or classification architecture, such as any suitable or desirable artificial neural network architecture.

[0107] The transformation circuitry 820 may be trained according to known image and / or actuator / coupling force profiles 812. For example, the image data may include representations of medical instrument components (e.g., baskets) and / or kidney stones or other objects and target labels 832 corresponding to the respective images 812 as input / output pairs, and the transformation / classification framework 820 is configured to adjust one or more parameters or weights associated therewith to associate the known input and output image data. Additionally or alternatively, the data 812 may comprise robotic actuator / coupling force reading profiles, which may be provided as inputs to the transformation / classification framework 820, and the transformation circuitry is configured to correlate the known force profiles with known fixation instrument output labels. For example, the transformation circuitry 820 (e.g., a convolutional neural network) may be trained using a labeled dataset and / or machine learning. In some implementations, the machine learning framework may be configured to perform learning / training in any suitable or desirable manner.

[0108] The known target labels 832 may be generated, at least in part, by manually labeling images and / or force profiles as being associated with a fixation device condition or not. For example, the manual labels may be determined and / or applied by an associated medical professional to label, for example, where a basket component / structure is located within an image and / or whether a representation of the basket component / structure and / or force profile is indicative of a fixation device condition or not. The known input / output pairs may indicate parameters of the conversion circuit 820, which may be dynamically updatable in some embodiments.

[0109] The known fixation instrument label 832 may identify the boundary and / or interior region of the target instrument feature present therein and / or may indicate whether the associated image corresponds to a fixation instrument condition. In some embodiments, the framework 800 may be configured to generate the real-time target label 835 in a manner that indicates in a binary manner whether a particular image and / or force profile of the real-time data 815 indicates a fixation instrument condition or not.

[0110] The framework 800 may be further configured to use the trained version of the conversion circuitry 820 to generate a real-time target label 835 associated with the real-time scope image 815. For example, during retraction of a medical instrument (e.g., basket and / or scope) during a medical procedure, the conversion circuitry 820 may be used to process a real-time scope image showing the medical instrument to generate a real-time target label 835 that identifies the presence of a stuck instrument situation in the real-time image. For example, in some implementations, a ureteroscope image may be processed by the conversion circuitry 820 to identify a stuck basket. A user notification of the same may be provided in response to the real-time stuck instrument label determination 835.

[0111] The transformation framework 820 may comprise an artificial neural network, such as a convolutional neural network. For example, the framework 820 may implement a deep learning architecture that takes in an input image and assigns learnable weights / biases to various aspects / objects in the image to distinguish one from another. The filters / characteristics of the framework 820 may be manually designed or may be learned through machine learning.

[0112] The framework 820 may include a plurality of neurons 825 (e.g., a layer of neurons as shown in FIG. 8 ) corresponding to overlapping regions of the input image that cover the visual region of the input image. The framework 820 may further operate to flatten the input image or portions thereof in some manner. The framework 820 may be configured to capture spatial and / or temporal dependencies within the input image 815 through the application of specific filters. Such filters may be performed with various convolution operations to achieve desired output data. Such convolution operations may be used to extract features such as edges, contours, and the like. The framework 820 may include any number of convolution layers, with more layers providing higher-level feature identification. The framework 820 may further include one or more pooling layers that may be configured to reduce the spatial size of the convolved features, which may be useful for extracting features that are rotationally and / or position-invariant, as well as certain anatomical features. Once prepared through flattening, pooling, and / or other processes, the image data may be processed by a multilevel perceptron and / or a feedforward neural network. Additionally, backpropagation may be applied at each iteration of training. The framework may be capable of distinguishing between dominant features and specific low-level features in the input image and classifying them using any suitable or desirable technique. In some embodiments, the neural network architecture comprises any of the following known convolutional neural network architectures: LeNet, AlexNet, VGGNet, GoogLeNet, ResNet, or ZFNet.

[0113] The framework 800 may be trained with a sufficient amount of driving data, such as endoscopic image data, and a truth table may be generated based on known labels of fixed and non-fixed instrument situations. During operation, real-time images 815 and / or other driving information may be used as input to the system 820 to provide real-time fixed instrument predictions / results as output 835.

[0114] Hardened stone status management process 9-1 and 9-2 show a flow diagram illustrating a process 900 for managing a stuck instrument status, according to one or more embodiments. FIGS. 10-1 and 10-2 show certain images corresponding to various blocks, states, and / or operations associated with the process 900 of FIGS. 9-1 and 9-2, according to one or more embodiments. In performing the process 900 of FIG. 9, a user may provide certain controls through a control system coupled to a robotic basket system (e.g., a robotic system having one or more instrument device manipulators (IDMs) coupled to the robotic system for controlling the basket device and / or scope). Such a control system may provide real-time endoscopic camera images and / or other information related to the procedure. In some embodiments, one or more aspects of the process 900 may be implemented by control circuitry of a control system coupled to the robotic basket system and / or control circuitry associated with the robotic basket system. Various force sensor readings associated with various operational steps of process 900 can be provided by a robotic system, which can be configured to determine torque / force readings of one or more actuators of the robotic basket system.

[0115] At block 901, the process 900 involves capturing a stone within a patient's anatomical cavity with the basket 35. For example, the stone 80 may be captured in a region of the renal anatomy beyond the ureteropelvic junction 78, as shown in image 1001 of FIG. 10-1. At block 902, the process 900 involves retracting the scope 40 and / or basket 35 into the fixation device danger zone 99, as shown in image 1003 of FIG. 10-1.

[0116] The determination that the basket 35 has entered the fixation device danger zone 99 can be based, at least in part, on one or more basket location mechanisms that can be used to locate the location of the basket 35 within the anatomy and / or a particular stage of the procedure. The danger zone 99 can include, for example, the ureteropelvic junction 78 and / or the area just distal / anterior to the opening 93 of the access sheath 90. The determination that the basket 35 is within the danger zone 99 can be accomplished in any suitable or desirable manner. In some embodiments, the location of the basket 35 can be indicated by commands of a robotic system controlling the scope 40 and / or the basket 35. For example, additional known information regarding the location of the scope 40 relative to the distal end 93 of the sheath 90 can provide information indicative of the location of the basket 35 and / or the distal end of the scope 40. The location of the basket 35 can be determined using any suitable or desirable location mechanism. In some embodiments, basket dithering and / or basket location may be triggered upon entry of the basket 35 and / or scope 40 into the ureteropelvic junction 78 and / or danger zone 99. In some implementations, basket 35 location and / or basket dithering may be triggered automatically in response to a determination of successful capture of the stone 80.

[0117] In block 904, the process 900 involves activating dithering of the basket 35, as shown in image 1005 of FIG. 10-1 . Such dithering action may advantageously improve the sensitivity of relevant force sensor readings associated with one or more actuators / couplings of the scope 40 and / or the robotic mechanisms used to control the basket device 30. Dithering may be implemented according to any of the embodiments disclosed herein. For example, dithering may involve relatively slow forward and backward movement of the basket 35 relative to the scope 40. The dithering distance may advantageously be relatively short to reduce the impact of dithering on user control / experience. The implemented dithering speed may be set to a speed slower than the normal drive speed of the scope 40. Furthermore, the dithering distance may be set to be a portion of the overall basket travel range / distance to avoid obstructing or confusing the operating physician / technician during basket retraction.

[0118] 9 describes retracting the basket 35 into the danger zone 99, in some implementations, basket dithering and / or other stuck instrument detection functions may be automatically triggered when a stone 80 is captured by the basket 35, and / or such functions may be stopped when the basket 35 is safely advanced into the access sheath 90. In some implementations, stuck basket determination based on force readings from sensors associated with the robotically controlled actuators or couplings may be implemented without basket dithering. That is, any of the embodiments disclosed herein for stuck instrument determination may be performed / implemented with or without basket dithering.

[0119] In some implementations, certain precautions / features may be implemented to prevent a stuck instrument situation. For example, some embodiments provide a mechanism whereby the robotic system is configured to slip / advance the basket forward in a manner that mimics or resembles a manual basket adjustment when a stuck instrument force is detected. In this manner, stuck instrument forces that may result in physiological and / or instrumentation damage can be set greater than such slip forces, and after a stuck instrument situation is detected, the user can manually resolve the stuck instrument situation and place the basket back into a non-slip position.

[0120] At block 906, process 900 involves retracting the distal end of the basket 35 and / or scope 40 through the ureteropelvic junction / ureteropelvic junction area / ostium. For example, the retraction associated with the operation of block 906 can be performed while the basket 35 is dithering, as shown in image 1005, which may provide desired sensor sensitivity for the inference of a stuck device. If the forces detected in one or more actuators associated with the basket device 30 and / or endoscope 40 indicate a stuck device condition, process 900 may proceed to block 910, where a specific stuck device repair action may be implemented.

[0121] Sticky instrument detection may be based on one or more torque / force readings for one or more axes / actuators associated with the robotic basket system, such as the torque / force experienced at a basket insertion driver / actuator (e.g., engaged with the basket sheath). In some implementations, a determination that a stuck instrument condition exists may be based on a determination that a basket insertion axis force experienced at one or more actuators associated with the basket sheath and / or basket tines is greater than a predetermined threshold for a threshold time. For example, in some embodiments, when a first force and / or time threshold is met, a remedial action involves slowing the scope retraction speed to allow sufficient time for the stuck instrument detection function to be implemented and / or reducing the force generated by the stuck basket to reduce the magnitude and / or risk of harm caused thereby. In some embodiments, if, after the retraction speed is slowed, the basket force continues to increase beyond another predetermined threshold level, such as a fault threshold level, scope retraction may be stopped to prevent damage and allow correction of the stuck instrument condition.

[0122] In embodiments in which the corrective action associated with block 910 involves stopping / pausing retraction of the scope in response to a determined stuck instrument condition, such action can help prevent or reduce the risk of user error, such as may occur when a physician / technician does not pay sufficient attention to the endoscopic image and / or the feel of the instrumentation when retracting the scope 40 and / or basket 30.

[0123] If a stuck instrument condition is not determined, process 900 proceeds to block 908, where the distal end of basket 35 and / or scope 40 is retracted into access sheath 90 through distal opening 93 of access sheath 90. If a stuck instrument condition is detected in connection with retraction into sheath 90, process 900 may proceed to block 910, where remedial action associated with the stuck instrument condition may be implemented in any suitable or desirable manner.

[0124] The corrective action associated with block 910 may allow the user to clear the fixation device obstruction, readjust the basket / stone position, and continue retraction in some cases to allow recovery. After the corrective action of block 910, process 900 may continue by returning to any of the subsequent steps of the process and / or may result in the end of the process at block 916. After the corrective action in connection with block 910 is successfully performed, further force readings above the associated threshold level may result in retriggering and / or returning to the corrective action at block 910.

[0125] At block 912, process 900 involves disengaging basket dithering. For example, such disengagement of dithering may be triggered by a determination that the basket 35 and / or the distal end of the scope 40 have entered the access sheath 90. At block 914, process 900 involves retracting the basket through the access sheath 90. Such retraction through the access sheath 90 may, in some implementations, occur at an accelerated rate. That is, once within the access sheath 90, the retraction rate may be increased to reduce procedure time and / or for other purposes related to convenience and / or efficiency. Once the basket has been retracted through the access sheath 90, process 900 may end at block 916.

[0126] 11 is a flow diagram illustrating a process 600 for handling a fixation device situation, according to one or more embodiments. In block 602, the process 600 involves retracting a basket having an object (e.g., a stone) trapped therein toward a ureteral access sheath. For example, the basket may be retracted along with an endoscope, with the basket positioned within the working channel of the endoscope.

[0127] At block 604, process 600 involves determining whether the basket is in a stuck instrument situation based on force readings from sensors associated with the robotic scope and / or basket control actuators. For example, the determination at decision block 604 may involve determining that force readings at one or more actuators of the basket system are greater than a predetermined stuck instrument detection threshold. In some implementations, the determination at block 604 may be performed while the basket is operating in a dithering motion, which may provide relatively high sensitivity for stuck instrument detection / determination, as described in detail herein.

[0128] The determination of whether the forces experienced by one or more actuators of the basket and / or robotic system indicate a stuck instrument condition may be supplemented and / or informed by certain other information / data regarding the procedure and / or the user. For example, information regarding the patient's specific anatomical structure, the operator's driving behavior, and / or stone size information may be used as inputs to determine whether the current condition indicates a stuck instrument condition, in connection with decision block 604. In some implementations, the control circuitry configured to determine the stuck instrument condition may be at least partially adaptive and configured to predict possible stuck instrument conditions and adjust input parameters associated with such a determination to further improve stuck instrument detection accuracy.

[0129] If the force readings analyzed in connection with block 604 indicate a stuck tool condition, a timer may be started in block 605. The timer may run for a period of time during which the force readings exceed an associated threshold value. That is, the period of time associated with block 605 may correspond to a period of time during which force readings associated with one or more actuators of the robotic basket system remain above a stuck tool threshold level.

[0130] If the time that the force exerted on the associated actuator remains above a predetermined threshold is greater than a fault threshold, as determined at decision block 607, process 600 may proceed to block 608. If the time that the force on the basket and / or scope exceeds the stuck instrument threshold, as indicated by, for example, a stuck instrument timer, is greater than the fault threshold, a soft fault may be thrown and the operator will not be allowed to further retract the basket / scope until the stuck instrument situation is resolved at block 608.

[0131] If the period during which the force on the actuator is greater than the stuck instrument threshold is not long enough to trigger the fault condition associated with block 608, but is greater than a predetermined warning threshold, process 600 proceeds to block 610, where a warning or other notification may be generated and / or provided to the user indicating the stuck instrument condition and / or risk thereof. Such a warning may prompt the operator / user to proceed with caution in adjusting the basket and / or retracting the basket.

[0132] In addition to providing a user warning, in some implementations, process 600 involves reducing the retraction rate of the scope and / or basket device in response to one or more of determining that a stuck instrument condition exists at block 604, determining that the timer period is greater than the warning threshold at block 609, and / or determining that the timer period is greater than the fault threshold at block 607. Reducing the rate of retraction can help prevent force spikes without sufficient time to stop retraction and prevent physiological and / or instrument damage. In some embodiments, noisy data is filtered, and the stuck instrument timer can be reset whenever the detected force falls below a predefined stuck instrument force threshold to reduce the risk of a single spike in basket force triggering a false alarm. At block 612, process 600 involves retracting the basket and scope into the access sheath.

[0133] If the fixation instrument condition is met in either box 607 or 609, or if the fixation instrument condition is not determined in block 604, process 600 may proceed to block 606, where the fixation instrument timer, if currently running, is stopped. At decision block 611, process 600 involves determining whether the distal end of the basket and / or endoscope is within the fixation instrument danger zone. If so, process 600 involves initiating basket dithering according to aspects of the present disclosure at block 613. If the distal end of the basket and / or endoscope is still not within the fixation instrument danger zone, process 600 may return to block 602, where retraction of the basket / scope toward the ureteral access sheath continues.

[0134] Dealing with false positives 12 is a flow diagram illustrating a process 1200 for managing false positive sensor readings on a basket device insertion shaft, according to one or more embodiments. In block 1202, the process 1200 involves capturing a stone within a patient's kidney using a basket device. For example, one stone fragment of multiple stone fragments may be captured. The stone may be captured by actuating the opening shaft of the basket device, which may control the opening and closing of the basket tines / wires by extending and / or retracting the tines / wires from and / or into a sheath of the basket device. Capturing the stone may further involve actuating the insertion shaft of the basket device, which may cause actuation of the basket sheath to insert and / or retract the basket relative to an endoscope in which the basket device is disposed (e.g., within the working channel of the scope).

[0135] At sub-process block 1204, process 1200 involves retracting the scope and basket while dithering the basket relative to the distal end of the scope, as described in detail herein. Such dithering can be implemented within a fixation device danger zone, and the dithering process can be implemented for fixation stone detection, as described in detail throughout this disclosure. During scope retraction, which can involve retracting the scope and basket proximally within a specific distance distal / outside of the access sheath used to access the target anatomical structure (e.g., a ureteral access sheath) and / or the distal end / opening of the access sheath, the basket insertion axis can be dithered back and forth to provide improved sensitivity for fixation device detection, as described in detail above. Generally, the dithering distance / range of motion can be set to a relatively small distance that is not noticeable by the user, while still generating dynamic movement of the basket insertion axis to provide improved fixation device detection sensitivity.

[0136] At block 1206, it is determined whether an elevated force is detected on an insertion axis associated with the basket device. For example, one or more force sensors associated with a sheath of the basket device may indicate an elevated force that may potentially indicate an impacted stone condition. The insertion axis may be associated with a slider / actuator of a handle / cartridge associated with the basket device, and the slider actuator may be configured to control insertion and retraction of the basket and / or its sheath relative to the scope when the basket is disposed within the working channel of the scope.

[0137] As described in detail above, robotic manipulator (e.g., robotic instrument device manipulator (IDM), end effector, etc.) torque sensing can be used as an input source for stuck instrument detection. For example, a stuck instrument detection function according to aspects of the present disclosure can be implemented to detect insertion axis force peaks / levels that may occur when a true stuck instrument condition exists, thereby notifying a user of a potential stuck instrument condition before damage or injury to the instrumentation and / or anatomical structures occurs. The elevated force detection associated with block 1206 can relate to the force on the insertion axis becoming high enough to reach a threshold level, at which point scope deceleration, possibly implemented as a fixation instrument remedial action, can reduce the retraction speed of the scope to avoid the insertion axis force increasing too quickly, causing the system to throw a fault and trigger a fixed instrument remedial action. If elevated force on the insertion axis is not detected in block 1206, process 1200 proceeds to block 1216, where a captured stone is collected, such as proximal to an access sheath used to access the target anatomical structure.

[0138] If an elevated force on the insertion axis is detected in block 1206, process 1200 proceeds to decision block 1208, where it is determined whether a soft-stop position (e.g., a soft-stop position providing a buffer distance from a possible hard-stop position) was previously set for the insertion axis (e.g., a soft-stop position associated with the movement of the insertion axis slider / actuator). For example, a soft-stop position may function as a software limit on the movement (e.g., proximal and / or retraction) of a basket slider / actuator configured to control the insertion axis (e.g., basket sheath insertion / retraction). Thus, if a soft-stop position is set, dithering and / or other movement (e.g., retraction) of the insertion axis of the basket device may be artificially limited at a position that is not a physical hard-stop position. In some implementations, detection of an elevated force on the insertion axis triggers recording / setting of a hard-stop insertion axis actuator position for future reference as a position associated with a potential physical hard stop.

[0139] If a soft-stop position has been previously set, process 1200 proceeds to block 1210, where a fixation instrument remedial action is implemented. That is, if an elevated force is detected on the insertion axis after a soft-stop position has been previously set, it can be determined that the elevated force on the insertion axis indicates a true stuck instrument condition, and therefore, a remedial action is warranted. The fixation instrument remedial action may involve slowing down the scope retraction to prevent the insertion axis force from rising too quickly, causing the system to throw a fault. If the insertion axis force continues to rise while a slow scope retraction is implemented, a stuck instrument warning / fault may be thrown to notify the user of a potential stuck instrument condition and trigger an interruption / halt of scope retraction. The stuck instrument remedial action may involve requesting user / practitioner acknowledgement of the stuck instrument condition and / or its resolution.

[0140] If a soft-stop position has not been previously set / recorded, certain operations may be implemented to determine whether the elevated force detected on the insertion axis in block 1206 is actually not the result of a stuck instrument condition, but rather represents a false positive condition that may be caused by the insertion axis actuator contacting a physical hard stop. For example, the slider / actuator may hit a physical limit (e.g., a rear / proximal limit) of the track along which it slides / actuates. The basket device / system may include a proximal basket cartridge / handle that includes one or more actuators, such as an insertion axis actuator and / or a release axis actuator (which control the movement of the basket tines within the basket sheath and are described in more detail below with respect to FIGS. 19 and 20). When the basket cartridge / handle is coupled or engaged to a robotic manipulator (e.g., an end effector), the positions of the actuators may be unknown or may be at any or offset positions, such that during various stages of process 1200, their positions may or may not be within close proximity of a hard-stop position within their respective tracks. Thus, if an elevated insertion axis force is sensed and a soft-stop position has not been previously set, process 1200 proceeds to block 1212, where the insertion shaft and / or basket may be urged forward relative to the scope by some predetermined distance / amount. That is, the basket may be advanced forward by some amount (e.g., a nominal amount) to offset the basket and associated actuator from the location where the elevated insertion axis force was detected. If the force increase was caused by contact with a hard stop on the insertion shaft, urging the insertion shaft forward may move the insertion shaft actuator further away from the true hard-stop boundary, thereby causing the basket to protrude relatively farther from the distal end of the scope.

[0141] In addition to advancing / biasing the basket relative to the distal end of the scope, process 1200 may involve, in block 1214, setting a soft-stop position associated with the insertion axis / basket position when an elevated force on the insertion axis was detected. For example, the soft-stop position may be the determined / suspected hard-stop position, or the recorded soft-stop position may advantageously be positioned a buffer distance (i.e., soft-stop buffer) away from the determined / suspected hard-stop position. That is, the set / recorded soft-stop position may be a position distal (i.e., further inserted) relative to the basket position at the time / point when the elevated force was detected. The soft-stop position may be set to a position that thereby provides a buffer between the soft-stop position and a potential hard-stop position where an elevated force was detected. Setting a soft-stop may prevent the insertion axis actuator from moving to a position where an elevated insertion axis force was detected, which may be associated with a physical hard-stop on the insertion axis actuator / slider.

[0142] In addition to and / or as a result of setting a soft-stop position, process 1200 may further involve shifting the dithering range of motion forward for implementations when dithering the basket to a region distal to the soft-stop position as a means of determining whether elevated forces on the insertion axis are from a hard stop of the insertion axis actuator / slider and therefore potentially false positive readings do not indicate a true stuck instrument situation. The modified dithering zone may be bounded at one end (e.g., the proximal end) by the recorded soft-stop position and / or the identified hard-stop position.

[0143] After biasing the basket forward, setting the soft-stop position, and / or shifting the dithering zone forward, process 1200 may return to sub-process 1204, which retracts the basket and scope while implementing basket dithering, or process 1200 may proceed to fixation device remedial action at block 1210. While the flow diagram of FIG. 12 describes sub-process 1204 as involving basket dithering, it should be understood that process 1200 may be implemented without implementing basket dithering and / or without shifting the dithering zone. Process 1200 may continue from sub-process 1204, and because the soft-stop position was previously set, if an elevated force on the insertion axis is subsequently detected at block 1206, process 1200 may proceed to remedial action operation at block 1210, where such elevated force may be interpreted as an indication of a true fixed device condition. If no further lift force is detected after urging the insertion axis / basket forward, it can be determined that the previously detected lift force is associated with a true hard stop situation for the insertion axis actuator. In some implementations, the hard stop position for the insertion axis can be recorded / maintained in some manner at least until the basket cartridge / handle and the robotic manipulator (e.g., end effector) are decoupled.

[0144] After collecting the captured stones in block 1216, it can be determined in block 1218 whether additional stones and / or stone fragments remain to be collected. If so, the process can proceed to block 1220, where previously set soft stop positions can be cleared / reset and / or dithering zones can be returned / reset to default ranges / zones. The scope and basket are reinserted into the target anatomy in block 1222, after which additional stones / fragments are captured in block 1202.

[0145] 13 is a flow diagram illustrating a process 1300 for managing false positive sensor readings on a basket device insertion shaft, according to one or more embodiments. In block 1302, the process 1300 involves capturing a stone within a patient's kidney using a basket device. For example, one stone fragment of multiple stone fragments may be captured. The stone may be captured by actuating the opening shaft of the basket device, which may control the opening and closing of the basket tines / wires by extending and / or retracting the tines / wires from and / or into a sheath of the basket device. Capturing the stone may further involve actuating the insertion shaft of the basket device, which may cause actuation of the basket sheath to insert and / or retract the basket relative to an endoscope in which the basket device is disposed (e.g., within the working channel of the scope).

[0146] With further reference to FIG. 13 , blocks 1305 and 1307 of process 1300 may be implemented to reset the dither zone of the basket device with respect to dithering operation of the basket device's insertion axis if the user moves the basket outside (or inside) the initially set dither zone. At decision block 1305, it is determined whether the user has inserted or retracted the basket from a default position. For example, the determination at block 1305 may involve determining whether the user has actuated the basket device's insertion axis, such as by manually or robotically manipulating an insertion axis actuator / slider. For example, when the scope is being retracted, the basket may generally dither within a predetermined dither zone / range. If the user inserts or retracts the basket for some reason unrelated to the basket's dithering operation and then continues scope retraction, it may be desirable to modify the range of the dither zone.

[0147] If a basket is inserted or retracted by the user, process 1300 proceeds to block 1307, where the basket dithering zone can be modified / set to compensate for the basket insertion or retraction implemented by the user. For example, if the user inserts the basket by a certain amount, the dithering zone can be moved forward by a corresponding amount, and a similar modification can be implemented for retraction.

[0148] At sub-process block 1304, process 1300 involves retracting the scope and basket while dithering the basket relative to the distal end of the scope, as described in detail herein. Such dithering can be implemented within a fixation device danger zone, and the dithering process can be implemented for fixation stone detection, as described in detail throughout this disclosure. This can involve retracting both the scope and basket proximally within a specific distance distal / outside of the access sheath used to access the target anatomical structure (e.g., a ureteral access sheath) and / or the distal end / opening of the access sheath. During scope retraction, the basket insertion shaft can be dithered back and forth to provide improved sensitivity for fixation device detection, as described in detail above. Generally, the dithering distance / range of motion can be set to a relatively small distance that is not noticeable to the user, while generating dynamic movement of the basket insertion shaft to provide improved fixation device detection sensitivity. Although the flow diagram of FIG. 13 describes sub-process 1304 as involving basket dithering, it should be understood that process 1300 may be implemented without implementing basket dithering and / or without shifting the dithering zone.

[0149] In block 1306, it is determined whether an elevated force is detected on an insertion axis associated with the basket device. For example, one or more force sensors associated with a sheath of the basket device may indicate an elevated force that may potentially indicate an impacted stone condition. The insertion axis may be associated with a slider / actuator of a handle / cartridge associated with the basket device, and the slider actuator may be configured to control insertion and retraction of the basket and / or its sheath relative to the scope when the basket is disposed within the working channel of the scope.

[0150] As described in detail above, robotic manipulator (e.g., robotic instrument device manipulator (IDM), end effector, etc.) torque sensing can be used as an input source for stuck instrument detection. For example, a stuck instrument detection function according to aspects of the present disclosure can be implemented to detect insertion axis force peaks / levels that may occur when a true stuck instrument condition exists, thereby notifying a user of a potential stuck instrument condition before damage or injury to the instrumentation and / or anatomical structures occurs. The elevated force detection associated with block 1306 can relate to the force on the insertion axis becoming high enough to reach a threshold level, at which point deceleration of the scope, and possibly a fixation instrument remedial action, can be implemented to reduce the retraction speed of the scope to avoid the insertion axis force increasing too quickly, causing the system to throw a fault and trigger a fixed instrument remedial action. If elevated force on the insertion axis is not detected in block 1306, process 1300 proceeds to block 1316, where a captured stone is collected, such as proximal to an access sheath used to access the target anatomical structure.

[0151] If an increased force on the insertion axis is detected at block 1306, process 1300 proceeds to decision block 1308, where it is determined whether a hard stop position has previously been set / recorded for the insertion axis (e.g., a hard stop position associated with the movement of the insertion axis slider / actuator). The reference hard stop position may be an actual confirmed physical hard stop limit or another position limit identified as a potential hard stop limit.

[0152] If a hard stop position has been previously set, process 1300 proceeds to block 1310, where a stuck instrument remedial action is implemented. That is, if an elevated force is detected on the insertion axis after a hard stop position was previously recorded, the elevated force on the insertion axis may be determined to indicate a true stuck instrument condition, and therefore, remedial action is warranted. The stuck instrument remedial action may involve slowing down the scope retraction to prevent the insertion axis force from rising too quickly, causing the system to throw a fault. If the insertion axis force continues to rise while a slow scope retraction is implemented, a stuck instrument warning / fault may be thrown to notify the user of a potential stuck instrument condition and trigger an interruption / halt of scope retraction. The stuck instrument remedial action may involve requesting user / practitioner acknowledgement of the stuck instrument condition and / or its resolution.

[0153] If hard stop limits / positions have not been previously set / recorded, certain operations may be implemented to account for the possibility that the elevated force detected on the insertion axis in block 1306 may not actually be the result of a stuck instrument condition, but rather may represent a false positive condition that may be caused by the insertion axis actuator contacting a physical hard stop. For example, the slider / actuator may hit a physical limit (e.g., a rear / proximal limit) of the track along which it slides / actuates. The basket device / system may include a proximal basket cartridge / handle that includes one or more actuators, such as an insertion axis actuator and / or a release axis actuator (which control the movement of the basket tines within the basket sheath and are described in more detail below with respect to FIGS. 19 and 20). When the basket cartridge / handle is coupled or engaged to a robotic manipulator (e.g., an end effector), the positions of the actuators may be unknown or may be at any or offset positions, such that during various stages of process 1300, their positions may or may not be within close proximity of the hard stop positions in their respective tracks. Thus, if an elevated insertion axis force is sensed and a potential hard stop limit has not been previously set, process 1300 proceeds to block 1312, where the insertion axis and / or basket may be biased forward relative to the scope by some predetermined distance / amount. That is, the basket may be advanced forward an amount to offset the basket and associated actuator from the location where the elevated insertion axis force was detected (i.e., the potential hard stop limit). Biasing the insertion axis forward may move the insertion axis actuator further away from the true hard stop boundary if the force increase was caused by contact with a hard stop on the insertion axis, thereby causing the basket to protrude relatively farther from the distal end of the scope. Biasing the basket forward may provide the basket with a cushion (or greater cushion) from the physical hard stop proximal to the insertion axis.

[0154] In addition to advancing / biasing the basket forward relative to the distal end of the scope, process 1300 may involve, in block 1314, recording a potential hard-stop position associated with the insertion shaft / basket position when increased force on the insertion shaft is detected. Process 1300 may also involve shifting the dithering zone / range of motion forward for implementations that dither the basket to a region that is a distance more distal. Such a distance may be a buffer distance away from the recorded hard-stop position, such that the proximal limit of the dithering zone / range is a soft-stop position that is the buffer distance away from the hard-stop position. After recording the potential hard-stop position, if it is later determined that the insertion shaft can be driven beyond such limit without a physical hard stop, the recorded hard-stop position may be modified accordingly.

[0155] After urging the basket forward, recording the hard stop position, and / or shifting the dithering zone forward, process 1300 may proceed to corrective action associated with block 1310 and ultimately further enable continued retraction of the scope in connection with block 1304. Process 1300 may continue from sub-process 1304, and because the hard stop position was previously recorded, if an elevated force on the insertion shaft is subsequently detected at block 1306, process 1300 may proceed to corrective action at block 1310, where such elevated force may be interpreted as an indication of a true stuck instrument condition. If no further elevated force is detected after urging the insertion shaft / basket forward, process 1300 may proceed to collection without incident. At block 1310, the system may throw a fault, after which the user may acknowledge the fault (block 1311) to verify whether a true stuck instrument condition exists. Once the fault is acknowledged, the user may be allowed to drive the scope again (eg, return to block 1302 or 1304).

[0156] After collecting the captured stone in block 1316, it may be determined whether additional stones and / or stone fragments remain to be collected in block 1318. If so, the process may proceed to block 1322, where the scope and basket are reinserted into the target anatomy, after which additional stones / fragments are captured in block 1302.

[0157] FIG. 14 illustrates hard stop force detection and recovery action in accordance with one or more embodiments. The diagram in FIG. 14 includes a time axis moving from the top to the bottom of the page, with time progressing in such direction, and an insertion axis extending from left to right and increasing, representing the relative distance of the basket to the distal end of the scope. The zigzag movement of line 1401 indicates dithering movement of the basket relative to the scope due to actuation of the insertion axis actuator / slider, as described in detail herein. The basket dithering action can be within a predetermined dithering zone / range of movement 1405 during a first time window 1409.

[0158] At point 1402, which represents a particular point in time while dithering the basket and / or corresponding basket insertion position 1403, an elevated force is detected on the insertion axis, which may be caused by a true stuck instrument condition or may be a false positive reading caused by the insertion axis actuator / slider hitting a physical hard stop position. For example, the slider / actuator may hit the rear / physical limit of the track along which it slides / actuates. In response, the position at which the elevated force on the insertion axis is detected may be stored, set, and / or otherwise recorded as a hard stop position.

[0159] In response to the detected increased force on the insertion axis, the basket may be biased forward a distance that may be equal to and / or related to the illustrated distance D1, with such forward bias of the basket represented by at least a portion of line segment 1407 and / or line segment 1408. A soft-stop insertion axis position 1404 may be set and / or implemented, and such soft-stop basket insertion position 1404 may be the same as hard-stop position 1403 or may be biased forward a distance D1 relative to hard-stop position 1403, as shown. Additionally, a dithering zone / range of motion for dithering the basket may be biased forward to a modified zone / range 1406, which may be determined and / or positioned such that the proximal-most insertion position during an associated dithering action does not exceed the soft-stop boundary 1404.

[0160] Figure 15 shows a flow diagram illustrating a process 1500 for adjusting dithering zones / ranges according to one or more embodiments of the present disclosure, such as may be implemented in connection with processes 1200 and 1300 described above. Figure 16 shows certain images corresponding to various blocks, states, and / or operations associated with process 1500 of Figure 15, according to one or more embodiments. In Figure 16, the illustrated single-sided arrow may represent movement of the basket, such as movement relative to scope 103.

[0161] Process 1500 provides for adjustment of the dither zone, such as when dithering movement of the basket during scope retraction causes the basket insertion shaft to penetrate a distal hard stop. For example, block 1502 involves the user retracting the scope while dithering the basket, which the user may or may not be aware of, as basket dithering may be automatically implemented as a responsive system process. Image 1602 shows the basket tines 101 and / or the distal end of the basket sheath 102 dithering within the dither zone. The distal end 102 of the basket sheath and / or one or more portions of the basket 101 distal to the sheath 102 are referred to below as the basket 104, and such references may refer to any of such components / portions.

[0162] At block 1504, process 1500 involves detecting a hard stop when inserting the basket forward in conjunction with the dithering motion. For example, it can be understood that an elevated insertion axis force reading generated during basket insertion is likely or certain to be the result of an actuator hard stop contact; a true stuck stone situation generally fails to generate a relatively high force during basket insertion. At block 1505, process 1500 involves recording the insertion axis position 105 associated with the hard stop.

[0163] At block 1506, process 1500 involves adjusting the dither zone proximally. In some implementations, such dither zone adjustment may include a buffer between a hard stop position 105 and the distal end 106 of the adjusted dither zone. For example, in connection with adjusting the dither zone, the insertion axis may be driven backward a distance to relieve tension on the driver of the insertion axis actuator (e.g., a robotic manipulator / end effector driver coupled in driving engagement with the input of the basket device cartridge / handle). Distance D2 may be considered a soft stop buffer, representing the distance the basket 104 is driven backward to relieve tension on the device and prevent it from continually hitting a physical limit of the device / system.

[0164] Figure 17 shows a flow diagram illustrating a process 1700 for adjusting dithering zones / ranges according to one or more embodiments of the present disclosure, such as may be implemented in connection with processes 1200 and 1300 described above. Figure 18 shows certain images corresponding to various blocks, states, and / or operations associated with process 1700 of Figure 17, according to one or more embodiments. In Figure 18, the illustrated single-sided arrow may represent movement of the basket, such as movement relative to scope 103.

[0165] Process 1700 provides for adjustment of the dither zone, such as when dithering movement of the basket during scope retraction causes the basket insertion shaft to penetrate a proximal hard stop. For example, block 1702 involves the user retracting the scope while dithering the basket, which the user may or may not be aware of, as basket dithering may be automatically implemented as a responsive system process. Image 1802 shows the basket tines 101 and / or the distal end of the basket sheath 102 dithering within the dither zone. The distal end 102 of the basket sheath and / or one or more portions of the basket 101 distal to the sheath 102 are referred to below as the basket 104, and such references may refer to any of such components / portions.

[0166] At block 1704, the process 1700 involves changing the dither direction from forward insertion to rearward retraction as a result of the basket 104 reaching the distal boundary of the dither zone. At block 1706, the process 1700 involves detecting a hard stop when retracting the basket rearward in conjunction with the dithering motion. At block 1705, the process 1700 involves recording the insertion axis position 107 associated with the hard stop.

[0167] At block 1706, process 1700 involves adjusting the dither zone distally. In some implementations, such dither zone adjustment may include a buffer between a hard stop position 107 and the proximal end 108 of the adjusted dither zone. For example, in connection with adjusting the dither zone, the insertion axis may be driven forward a distance to relieve tension on the driver of the insertion axis actuator (e.g., a robotic manipulator / end effector driver coupled in driving engagement with the input of the basket device cartridge / handle). Distance D3 may be considered a soft stop buffer, representing the distance the basket 104 is driven forward to relieve tension on the device and prevent it from continually hitting a physical limit of the device / system.

[0168] 19 is a flow diagram illustrating a process 1900 for managing false positive sensor readings on the opening shaft, according to one or more embodiments. As mentioned above, a fixation instrument condition may result in relatively high forces being transmitted to the basket opening shaft, and therefore, for any of the embodiments of the present disclosure, it may be advantageous to monitor the forces on the opening shaft in connection with fixation instrument management. For example, actuating a basket slider / actuator configured to actuate the basket tines relative to the basket sheath may be implemented for stone capture. As mentioned above, such actuation may be considered an "opening shaft" actuation, where the forces and actuations associated therewith are relative to what may be considered the "opening shaft" of the basking system.

[0169] In block 1902, process 1900 involves capturing a stone or stone fragment with a basking device deployed from the working channel of an endoscope (referred to herein for convenience as a "scope"). For example, capturing the stone in a basket may involve manipulating the opening shaft of the basket device to retract one or more wire tines or other basket components into (or out of) the basking sheath and / or around the captured stone. Closing of the basket tines around the scope may be implemented at least in part by proximally (or otherwise) actuating a basket slider / actuator, which may be associated with a proximal portion of the basking device / system and associated with a basket cartridge driven by a robotic manipulator. In some cases, when closing the basket tines around the stone / fragment, the tines are forced against the sides of the basket sheath to reduce the amount of force sensed on the opening shaft. However, in some cases the tines may not close tightly enough around the captured stone chip, making the force readings on the open shaft more sensitive, and in some such instances the stuck tool condition on the open shaft can be felt.

[0170] At block 1904, process 1900 involves proximally retracting the scope and basket together toward and / or into the distal opening of the access sheath, through which the scope and basket access the target anatomical chamber / location. Decision block 1906 relates to whether an elevated force is detected on the opening shaft of the basking system during retraction in connection with block 1904. For example, the basket device / system may include one or more force sensors associated with the opening shaft and configured to generate a signal indicative of the force experienced on the opening shaft, such as a force pulling on the basket tines.

[0171] If no elevated force is detected on the opening axis, process 1900 may proceed to complete retraction of the scope and basket and collect the stone / fragment in connection with the operations associated with block 1912. If additional stones / fragments remain to be collected, as indicated by decision block 1919, the process may involve reinserting the scope and basket through the access sheath into the target anatomical chamber (e.g., the calyceal rete of the kidney), as indicated by block 1918, and further looping back to sub-process 1902 for further capture of one or more additional stones / fragments by the basket.

[0172] If an increased force is detected on the opening shaft during scope and basket retraction, as determined in block 1906, the process may continue to block 1908, where it may be determined whether the opening shaft is currently in a forward biased position. For example, a forward bias of the opening shaft (e.g., basket tines) may have been previously implemented in connection with an increased force previously detected on the opening shaft.

[0173] If the opening shaft has not previously been biased forward, as determined in block 1908, process 1900 may proceed with certain actions aimed at identifying and / or managing the possibility that the elevated force detected on the opening shaft is associated with a false positive condition that does not indicate a true stuck instrument condition, such as may be the result of the opening shaft actuator / slider contacting a hard stop during retraction of the scope and basket. For example, such actions may involve biasing the opening shaft forward, such as by actuating the opening shaft actuator / slider in the forward / distal direction a predetermined distance, such as 1-5 mm, 5-10 mm, or more, as shown in block 1910. Biasing the opening shaft forward may be considered and / or implemented as setting and driving a soft stop position associated with the forward biased position of the opening shaft.

[0174] After biasing the open access forward, process 1900 may return to the retract 1904 and / or stone capture 1902 operations of process 1900. If, after biasing the open shaft forward in block 1910, elevated forces are detected on the open shaft during stone capture and / or scope / basket retraction, the path from decision block 1908 may proceed to block 1916 relating to fixation of the fixation device. For example, if elevated forces are detected on the open shaft after a proactive forward bias of the open shaft actuator is implemented, it may be determined that the elevated forces indicate a true fixation device condition, and therefore, process 1900 may proceed to implementing operations associated with fixation device condition repair actions, as described in detail in this section.

[0175] FIG. 20 is a flow diagram illustrating a process 2000 for managing false positive sensor readings on the open shaft, according to one or more embodiments. As mentioned above, a fixation device situation may result in relatively high forces being transmitted to the basket open shaft, and therefore, for any of the embodiments of the present disclosure, it may be advantageous to monitor the forces on the open shaft in connection with fixation device management. For example, actuating a basket slider / actuator configured to actuate the basket tines relative to the basket sheath may be performed for stone capture. As mentioned above, such actuation may be considered an "open shaft" actuation, where the forces and actuations associated therewith are relative to what may be considered the "open shaft" of the basking system.

[0176] In block 2002, process 2000 involves capturing a stone or stone fragment with a basking device deployed from the working channel of an endoscope (referred to herein for convenience as a "scope"). For example, capturing the stone in a basket may involve manipulating the opening shaft of the basket device to retract one or more wire tines or other basket components into (or out of) the basking sheath and / or around the captured stone. Closing of the basket tines around the scope may be implemented at least in part by proximally (or otherwise) actuating a basket slider / actuator, which may be associated with a proximal portion of the basking device / system and associated with a basket cartridge driven by a robotic manipulator. In some cases, when closing the basket tines around the stone / debris, the tines are forced against the sides of the basket sheath to reduce the amount of force sensed on the opening shaft. However, in some cases the tines may not close tightly enough around the captured stone chip, making the force readings on the open shaft more sensitive, and in some such instances the stuck tool condition on the open shaft can be felt.

[0177] In block 2004, process 2000 involves proximally retracting the scope and basket together toward and / or into the distal opening of the access sheath, through which the scope and basket access the target anatomical chamber / location. Decision block 2006 relates to whether an elevated force (e.g., a force above a predetermined threshold) is detected on the opening shaft of the basking system during retraction in connection with block 2004. For example, the basket device / system may include one or more force sensors associated with the opening shaft and configured to generate a signal indicative of the force experienced on the opening shaft, such as a force pulling on the basket tines.

[0178] If no elevated force is detected on the release axis, process 2000 may proceed to complete retraction of the scope and basket and collect the stone / debris in connection with the operations associated with block 2012. If additional stones / debris remain to be collected, as indicated by decision block 2019, process 2000 may involve reinserting the scope and basket through the access sheath into the target anatomical chamber (e.g., the calyceal rete of the kidney), as indicated by block 2018, and further looping back to sub-process 2002 for further capture of one or more additional stones / debris by the basket.

[0179] If an elevated force on the opening shaft is detected during scope and basket retraction, as determined in block 2006, the process may continue to block 2010, which may involve driving the opening shaft forward a predetermined soft-stop buffer distance, such as by actuating the opening shaft actuator / slider in the forward / distal direction a predetermined distance (e.g., 1-5 mm, 5-10 mm, or more). The forward driving / biasing of the opening shaft may be implemented to provide some clearance from a possible hard-stop boundary / limit associated with the elevated force detected in block 2006.

[0180] Even though it may be unclear whether the elevated force is due to a stuck instrument condition or simply due to a hard stop collision / contact, process 2000 can proceed with stuck instrument-related repair actions similar to those associated with block 2016. Driving the release shaft forward may be considered part of the stuck instrument repair actions associated with block 2016. Among other things, the repair actions associated with block 2016 may involve notifying the user of a potential stuck instrument condition. The user may then check the camera view and / or other parameters to see if a true stuck instrument condition exists. If so, the user may manipulate the basket, scope, and / or other instruments to resolve the stuck instrument condition. Once the user acknowledges that the stuck instrument condition (block 2011), if any, has been resolved, the system may allow further actuation (e.g., retraction) of the scope. For example, process 2000 may proceed to any of blocks 2002, 2004, 2012, 2019, or terminate in some manner.

[0181] If false positive handling as depicted in Figures 12, 12, 20, and / or 20 is not implemented, elevated insertion and / or axial opening forces may be triggered due to physical hard stop conditions for the respective actuators / sliders, resulting in repeated faults being thrown due to false identification of such elevated forces as being due to a stuck instrument condition. Thus, the process illustrated in Figures 12-20 may enable stuck instrument management according to embodiments of the present disclosure without the risk of catastrophic or problematic hard stop interference / excursions.

[0182] Additional Embodiments Depending on the embodiment, certain acts, events, or functions of any of the processes or algorithms described herein may be performed in a different order, added, merged, or omitted entirely. Thus, in a particular embodiment, not all described acts or events may be required to practice a process.

[0183] In particular, conditional language used herein, such as "can," "could," "might," "may," "eg," and the like, unless specifically stated otherwise or understood otherwise within the context in which it is used, is intended to have its ordinary meaning and is generally intended to convey that certain embodiments include certain features, elements, and / or steps, while other embodiments do not. Thus, such conditional language is generally not intended to suggest that features, elements, and / or steps are required in any way for one or more embodiments, or that one or more embodiments necessarily include logic for determining whether those features, elements, and / or steps are included in or performed in any particular embodiment, with or without author input or prompting. Terms such as "comprising," "including," "having," and the like, are used in their ordinary sense and are used inclusively in a non-limiting manner and do not exclude additional elements, features, acts, operations, etc. Also, when the term "or" is used, for example, to connect a list of elements, the term "or" is used in its inclusive sense (and not its exclusive sense) to mean one, some, or all of the listed elements. Unless specifically stated otherwise, conjunctive language such as the phrase "at least one of X, Y, and Z" is understood in the context as it is commonly used to convey that an item, term, element, etc. can be either X, Y, or Z. Thus, such conjunctive language is not generally intended to suggest that a particular embodiment requires that at least one of X, at least one of Y, and at least one of Z, respectively, be present.

[0184] In the foregoing description of the embodiments, it should be understood that various features are sometimes grouped together in a single embodiment, figure, or description thereof for the purpose of streamlining the disclosure and aiding in understanding one or more of the various inventive aspects. However, this method of disclosure should not be interpreted as reflecting an intention that any claim requires more features than are expressly recited in that claim. Moreover, any component, feature, or step illustrated and / or described in a particular embodiment herein may be applied to or used in conjunction with any other embodiment. Moreover, no component, feature, step, or group of components, features, or steps is necessary or essential for each embodiment. Accordingly, it is intended that the scope of the invention(s) disclosed herein and hereinafter claimed should not be limited by the specific embodiments described above, but should be determined solely by a fair reading of the following claims.

[0185] It should be understood that certain ordinal terms (e.g., "first" or "second") may be provided for ease of reference and do not necessarily imply any physical characteristics or ordering. Thus, as used herein, ordinal terms (e.g., "first," "second," "third," etc.) used to modify elements such as structures, components, operations, etc., do not necessarily indicate a priority or order of the element relative to any other elements, but rather may generally distinguish the element from other elements having a similar or identical name (apart from the use of the ordinal terminology). Furthermore, as used herein, the indefinite articles ("a" and "an") may indicate "one or more" rather than "one." Furthermore, an action performed "based on" a condition or event may also be performed based on one or more other conditions or events not expressly recited.

[0186] Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the exemplary embodiments belong. It is further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning consistent with their meaning in the context of the relevant art, and should not be interpreted in an idealized or overly formal sense unless expressly so defined herein.

[0187] Spatially relative terms such as "outside," "inside," "upper," "lower," "below," "upper," "vertical," "horizontal," and similar terms may be used herein for ease of description to describe the relationship between one element or component and another element or component as illustrated in the figures. It should be understood that spatially relative terms are intended to encompass different orientations of the device in use or operation in addition to the orientation depicted in the figures. For example, if a device shown in the figures is inverted, a device positioned "below" or "under" another device may be disposed "above" the other device. Thus, the illustrative term "lower" can include both lower and upper positions. Devices may also be oriented in other directions, and thus spatially relative terms may be interpreted differently depending on the orientation.

[0188] Unless otherwise specified, comparative and / or quantitative terms such as "less," "more," "greater than," etc. are intended to encompass the notion of equality. For example, "less" can mean "less than" in the strict mathematical sense, but also "less than or equal to."

[0189] [Embodiment] (1) A method for detecting a stuck basket condition, comprising: retracting an endoscope within an anatomical cavity of a patient, the endoscope having a basket device at least partially disposed within a working channel thereof; determining that a force reading associated with at least one of the basket device or the endoscope exceeds a threshold; determining that the basket device is in a stuck condition based at least in part on the determination that the force reading exceeds the predetermined threshold. (2) The method of embodiment 1, further comprising axially dithering the basket device, wherein determining that the force reading associated with at least one of the basket device or the endoscope exceeds the predetermined threshold is performed while dithering the basket device. (3) accessing the anatomical cavity with the endoscope via the patient's urinary tract; advancing the basket device from the working channel of the endoscope; capturing an object disposed within the anatomical cavity with the basket device; determining that the at least one of the basket device and the endoscope has entered a danger zone; The method of embodiment 2, further comprising initiating the axial dithering of the basket device in response to determining that at least one of the basket device or the endoscope has entered the danger zone. (4) The method described in embodiment 3, wherein determining that at least one of the basket device or the endoscope has entered the danger zone is based at least in part on robotic actuator data generated by one or more robotic actuators configured to operate one or more of the endoscope or the basket device. (5) The method of embodiment 3, wherein determining that at least one of the basket device or the endoscope has entered the danger zone is based at least in part on position sensor data associated with one or more of the endoscope or the basket device.

[0190] (6) The method of embodiment 3, wherein the danger zone comprises the ureteropelvic junction of the patient's kidney. (7) The method of embodiment 2, wherein the dithering of the basket device is performed on the distal end of the endoscope. (8) The method of embodiment 2, wherein the dithering of the basket involves dithering the endoscope. (9) The method of embodiment 1, further comprising reducing a retraction speed of the endoscope based at least in part on the determined sticking status of the basket device. (10) The method of embodiment 1, wherein the force reading indicates an axial force experienced at a proximal portion of the sheath of the basket device.

[0191] (11) The method of embodiment 1, wherein the force reading indicates an axial force on one or more tines of the basket device. (12) The method of embodiment 1, wherein the force reading indicates an axial force experienced at a proximal portion of the endoscope. (13) detecting a hard stop force reading associated with at least one of an opening axis or an insertion axis associated with the basket device; 2. The method of claim 1, further comprising: driving the at least one of the release shaft or the insertion shaft forward a predetermined distance in response to the hard stop force reading. (14) A robot system, one or more robotic arms; one or more instrument manipulators coupled to each of the one or more robotic arms; one or more actuators associated with at least one of the one or more instrument manipulators and configured to cause axial movement of at least one of an endoscope, a sheath of a basket device at least partially disposed within the endoscope, or tines of the basket device; one or more sensors associated with the one or more instrument manipulators and configured to generate signals indicative of forces experienced by the one or more actuators; a control circuit communicatively coupled to the one or more instrument manipulators and the one or more sensors; and advancing and retracting the basket device in a dithering motion; receiving the signals from the one or more sensors indicative of the forces experienced by the one or more actuators while the basket device is moving in the dithering motion; determining that the force exceeds a predetermined threshold; and performing a response action in response to determining that the force exceeds the predetermined threshold. (15) The robotic system of embodiment 14, wherein the response action involves providing a warning to a user indicating that the basket device is stuck.

[0192] (16) The robotic system of embodiment 14, wherein the response action involves reducing the retraction speed of the endoscope. (17) The robotic system of embodiment 14, wherein the response action involves stopping retraction of the endoscope. (18) The robot system of embodiment 14, wherein the one or more actuators comprise one or more basket sheath actuators. (19) The robot system of embodiment 14, wherein the one or more actuators comprise one or more basket tine actuators. (20) The robot system of embodiment 14, wherein the one or more actuators include one or more endoscopic actuators.

[0193] (21) The control circuit Detecting a hard stop force reading associated with at least one of an opening axis or an insertion axis associated with the basket device; 15. The robot system of claim 14, further configured to: drive the at least one of the opening axis or the insertion axis forward using at least one of the one or more actuators in response to the hard stop force reading. (22) A method for detecting a sticking state of a medical device, comprising: determining that a force on a component of the medical device exceeds a predetermined force threshold while the medical device is being retracted in a dithering motion; starting a timer in response to the determination that the force exceeds the predetermined threshold; determining that the timer has exceeded a predetermined time threshold; and initiating a response action in response to the determination that the timer has exceeded the predetermined time threshold. 23. The method of claim 22, wherein the response action involves generating a warning indicating that the medical device is in a stuck state. (24) The method of claim 22, wherein the response action involves stopping retraction of the medical instrument. (25) The method of embodiment 22, further comprising initiating dithering of one or more components of the medical device in response to determining that a portion of the medical device is positioned within a sticking danger zone.

[0194] (26) The method of claim 25, further comprising determining the sticking danger zone based at least in part on a location of a distal end of a sheath in which the medical device is at least partially disposed. (27) A computing device, a robot system interface; a control circuit communicatively coupled to the robotic system interface and including one or more processors and one or more data storage devices; dithering the basket device relative to a working channel of an endoscope in which the basket device is at least partially disposed; and determining, while the basket device is dithering, that a force experienced by one or more components of the basket device is indicative of a stuck state of the basket device. (28) A computing device as described in embodiment 27, wherein the determination that the force indicates the stuck state is based on one or more of data indicating the driving behavior of a user driving the endoscope and the size of an object captured by the basket device. (29) The computing device of embodiment 27, wherein the control circuit is further configured to disable dithering of the basket in response to determining that the basket device and the endoscope have been retracted within the access sheath. (30) The computing device of embodiment 27, wherein the control circuitry is further configured to stop movement of the endoscope in response to the sticking condition.

Claims

1. 1. A robotic system comprising: one or more robotic arms; one or more instrument manipulators coupled to each of the one or more robotic arms; one or more actuators associated with at least one of the one or more instrument manipulators and configured to cause axial movement of at least one of an endoscope or a basket device at least partially disposed within the endoscope, the basket device configured to expand radially outward from the axial extension; and one or more sensors associated with the one or more instrument manipulators and configured to generate signals indicative of forces experienced by the one or more actuators due to expansion of the basket device into a tubular organ; a control circuit communicatively coupled to the one or more instrument manipulators and the one or more sensors; and advancing and retracting the basket device in an axial dithering motion within the tubular organ; receiving the signals from the one or more sensors indicative of the forces experienced by the one or more actuators while the basket device is undergoing the axial dithering motion within the tubular organ; determining that the force exceeds a predetermined threshold; and performing a response action in response to determining that the force exceeds the predetermined threshold.

2. The robotic system of claim 1 , wherein the endoscope is a cystoscope and the tubular organ is a ureter.

3. the basket device includes one or more electromagnetic sensors; The robotic system of claim 1 , wherein the one or more electromagnetic sensors indicate position information of the basket device.

4. The control circuit determining, based on the position information, that the basket device is at or near the ureteropelvic junction; 4. The robotic system of claim 3, further configured to initiate the axial dithering motion in response to determining that the basket device is at or near the ureteropelvic junction.

5. 10. The robotic system of claim 1, wherein the response action involves providing a warning to a user indicating that the basket device is stuck or reducing or stopping the retraction rate of the endoscope.

6. 10. The robotic system of claim 1, wherein the one or more actuators comprise one or more basket sheath actuators, one or more basket tine actuators, or one or more endoscope actuators.

7. The control circuit Detecting a hard stop force reading associated with at least one of an opening axis or an insertion axis associated with the basket device; 2. The robotic system of claim 1, further configured to: drive the at least one of the opening axis or the insertion axis forward using at least one of the one or more actuators in response to the hard stop force reading.

8. 1. A computing device, comprising: a robot system interface; a control circuit communicatively coupled to the robotic system interface and including one or more processors and one or more data storage devices; advancing and retracting the basket device within the tubular organ in an axial dithering motion relative to a working channel of an endoscope in which the basket device is at least partially disposed, the basket device being configured to expand radially outward from the axial extension; determining a force resulting from expansion of the basket device within the tubular organ; and determining that the force indicates a stuck state of the basket device while the basket device is performing the axial dithering motion within the tubular organ.

9. The computing device of claim 8 , wherein the endoscope is a cystoscope and the tubular organ is a ureter.

10. the basket device includes one or more electromagnetic sensors; The computing device of claim 8 , wherein the one or more electromagnetic sensors indicate location information of the basket device.

11. The control circuit determining, based on the position information, that the basket device is at or near the ureteropelvic junction; 11. The computing device of claim 10, further configured to initiate the axial dithering motion in response to determining that the basket device is at or near the ureteropelvic junction.

12. The computing device of claim 8, wherein determining that the force indicates the stuck state is based on one or more of data indicating the driving behavior of a user driving the endoscope and the size of an object captured by the basket device.

13. The control circuit determining that the basket device and the endoscope have been retracted within the access sheath; 9. The computing device of claim 8, further configured to disable the axial dithering motion of the basket device in response to determining that the basket device and the endoscope have been retracted within the access sheath.

14. The computing device of claim 8 , wherein the control circuitry is further configured to stop movement of the endoscope in response to the sticking condition.

15. 1. A method for detecting a stuck device condition, comprising: retracting an endoscope, the endoscope having a basket device at least partially disposed within a working channel of the endoscope, the basket device configured to expand radially outward from an axial extension; advancing and retracting the basket device in an axial dithering motion within the tubular organ while retracting the endoscope; determining a force generated by expansion of the basket device into the tubular organ; determining that the force exceeds a threshold value while the basket device is performing the axial dithering motion within the tubular organ; determining that the basket device is in a stuck condition based at least in part on determining that the force exceeds the threshold.

16. 16. The method of claim 15, wherein the endoscope is a cystoscope and the tubular organ is a ureter.

17. the basket device includes one or more electromagnetic sensors; The method of claim 15, wherein the one or more electromagnetic sensors indicate position information of the basket device.

18. determining, based on the position information, that the basket device is at or near the ureteropelvic junction; 18. The method of claim 17, further comprising initiating the axial dithering motion in response to determining that the basket device is at or near the ureteropelvic junction.

19. determining that at least one of the endoscope or the basket device has entered a danger zone; 16. The method of claim 15, further comprising initiating the axial dithering motion in response to determining that at least one of the endoscope or the basket device has entered the danger zone.

20. The method of claim 19, wherein determining that at least one of the endoscope or the basket device has entered the danger zone is based at least in part on robotic actuator data generated by one or more robotic actuators configured to operate one or more of the endoscope or the basket device or position sensor data associated with one or more of the endoscope or the basket device.

21. Detecting a hard stop force reading associated with at least one of an opening axis or an insertion axis associated with the basket device; 16. The method of claim 15, further comprising: driving the at least one of the release shaft or the insertion shaft forward a predetermined distance in response to the hard stop force reading.

22. 1. A method for detecting a stuck condition of a basket device, comprising: retracting the basket device through the tubular organ in an axial dithering motion, wherein the basket device is configured to expand radially outward from the axial extension; determining a force generated by expanding the basket device into the tubular organ; determining that the force exceeds a predetermined force threshold; starting a timer in response to determining that the force exceeds the predetermined force threshold; determining that the timer has exceeded a predetermined time threshold; and initiating a response action in response to determining that the timer has exceeded the predetermined time threshold.

23. 23. The method of claim 22, wherein the tubular organ is a ureter.

24. the basket device includes one or more electromagnetic sensors; The method of claim 22, wherein the one or more electromagnetic sensors indicate position information of the basket device.

25. determining, based on the position information, that the basket device is at or near the ureteropelvic junction; 25. The method of claim 24, further comprising initiating the axial dithering motion in response to determining that the basket device is at or near the ureteropelvic junction.

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