System and method for robotic endoscopic submucosal dissection

Abstract

A robotic device is provided.SOLUTION: The robotic device includes an articulatable elongated member having a proximal end and a distal end, the distal end being steerable via a first drive mechanism, an articulatable imaging instrument removably coupled to the articulatable elongated member via a first lumen of the articulatable elongated member and having a camera located at a distal portion thereof, and an articulatable instrument removably coupled to the articulatable elongated member via a second lumen, movement of the articulatable instrument being captured by the camera of the articulatable imaging instrument.SELECTED DRAWING: Figure 2

Description

[Technical Field]

[0001] Cross-reference to related art

[0001] This application claims the benefit of U.S. Provisional Application No. 63 / 033,428, filed June 2, 2020, which is incorporated herein by reference. [Background technology]

[0002]

[0002] Gastric cancer and colon cancer are common types of cancer. Gastrointestinal (GI) cancers grow from the mucosal layer. The survival rates of patients suffering from these cancers can be improved if pre-cancerous conditions and early cancers are removed at an early stage before they spread to the lymph nodes.

[0003] Flexible endoscopes have been used to examine and treat diseases of the gastrointestinal (GI) tract without the need for creating an opening in the patient's body. The endoscope is introduced into the upper or lower GI tract through the mouth or anus, respectively. A miniature camera at the distal end captures images of the GI wall, helping clinicians diagnose GI diseases. Simple surgical procedures (such as polypectomy and biopsy) can be performed by introducing a flexible tool through the working channel to reach the target site at the distal end. The types of procedures that can be performed in this manner are limited by the lack of maneuverability of the tool. More technically demanding surgical procedures, such as hemostasis of arterial bleeding, suturing to repair perforations, and fundoplication for gastroesophageal reflux, cannot be effectively accomplished using conventional flexible endoscopes. These procedures are currently often performed under open or laparoscopic procedures.

[0004] Endoscopic submucosal dissection (ESD) has been used to treat lesions within the digestive tract. ESD is a procedure in which a diseased portion of the stomach, intestines, etc. is dissected in its entirety under endoscopic guidance. Generally, during an ESD procedure, the edges of the lesion are marked with an electrocautery knife, the lesion is elevated using a submucosal injection, a peripheral incision is made into the submucosal layer around the lesion using a specialized endoscopic electrocautery knife, and the lesion is dissected and removed from the deeper layer beneath the GI tract wall using the electrocautery knife. While ESD effectively removes early-stage gastric and colon cancers, ESD is a technically demanding procedure associated with a higher risk of complications. For example, current flexible endoscopes may have a single instrument channel. Endoscopists can only operate a single accessory at a time, it is difficult to maintain the tip of a flexible endoscope in a stable position inside a hollow organ, and imaging devices are coupled to the instrument, the camera view of which is obstructed by the instrument's operating area. Additionally, current ESD devices suffer from poor end effector responsiveness, inadequate instrument capabilities, and typically require a significant learning curve for the physician to operate the device. Summary of the Invention

[0005]

[0005] Recognized herein is the need for an improved endoscopic submucosal dissection (ESD) system capable of performing surgical or diagnostic procedures with improved patient outcomes and procedural efficiency. The present disclosure provides a modular robotic system and robotic platform for endoscopic submucosal dissection (ESD). In particular, the modular robotic platform of the present disclosure may enable physicians to perform endoscopic submucosal dissection (ESD) in the GI tract. The robotic platform may be configured to accommodate and operate a modular robotic system including a main flexible articulable device (e.g., a main sheath) with multiple lumens that house various flexible articulable surgical instruments. The modular robotic system may incorporate a direct visualization component along with location sensors for tracking the position and shape of the various components. The robotic platform may provide various user interfaces for controlling the ESD device. For example, the user interface may be a handheld joystick interface or a master input interface. The user interface may also provide the user with various visualization modalities, such as a real-time 2D or stereo viewer. This modular robotic endoscopic platform may enable physicians to reach and resect lesions within the GI tract by utilizing the multiple degrees of freedom (DOF) of the flexible instrument and the enhanced stability and control provided to the flexible instrument by the robotic system.

[0006] In some embodiments, the main articulatable flexible device (e.g., a Gastro sheath) may include multiple lumens for multiple independent flexible devices or instruments. In some cases, these independent instruments are individually deployable and articulatable. For example, the flexible instruments may each have an articulation section (e.g., a wrist or bending section) that allows additional degrees of freedom for manipulating the instrument. The articulation section may be located at the base of the end effector of the flexible instrument, allowing the flexible instrument to move relative to the catheter of the main flexible device. The term "articulation section" may refer to a bending section, which are used interchangeably throughout this specification.

[0007] The flexible instruments may have end effectors that provide surgical functions to the user, including, but not limited to, hook-type electrocautery, scissors, forceps, needles, and graspers. The presented articulatable devices and / or modular robotic systems may advantageously enable a physician to transfer surgical functions in an endoluminal approach via a flexible articulatable robotic device.

[0008] In one aspect, the present disclosure provides a robotic device comprising: an articulatable elongate member having a proximal end and a distal end, the distal end being steerable via a first drive mechanism; an articulatable imaging instrument removably coupled to the articulatable elongate member via a first lumen of the articulatable elongate member, the articulatable imaging instrument comprising a camera located at a distal portion of the articulatable imaging instrument; and a first articulatable instrument removably coupled to the articulatable elongate member via a second lumen, the movement of the first articulatable instrument being captured by the camera of the articulatable imaging instrument.

[0009] In some embodiments, the robotic device further includes a second articulatable instrument removably coupled to the articulatable elongate member via the third lumen, wherein the first articulatable instrument, the second articulatable instrument, and the camera are positioned in a triangular configuration. In some embodiments, the articulatable elongate member includes a bending section. For example, the bending section is articulated by one or more pull wires.

[0010] In some embodiments, the articulatable imaging device comprises a bending section, for example, the bending section is articulated by one or more puller wires.

[0011] In some embodiments, the articulable imaging instrument comprises an illumination device located at a distal portion of the articulable imaging instrument. In some embodiments, the articulable imaging instrument comprises one or more nozzles for clearing the camera view. In some embodiments, the camera is controlled to rotate about a longitudinal axis of the articulable elongate member or a longitudinal axis of the articulable imaging instrument. In some embodiments, the camera is controlled to have articulating motion relative to the articulable elongate member.

[0012] In some embodiments, the articulatable imaging instrument and the first articulatable instrument are retracted into the first lumen and the second lumen when the robotic device is in the first mode. In some cases, the articulatable imaging instrument and the first articulatable instrument are extended out of the distal end of the articulatable elongate member when the robotic device is in the second mode.

[0013] In some embodiments, the articulatable imaging device is steerable via a first drive mechanism. In some embodiments, the first drive mechanism is attached to a first robotic support system. In some cases, the first articulatable device is articulated via a second drive mechanism. In some cases, the second drive mechanism is attached to a second robotic support system. For example, the first robotic support system and the second robotic support system are operably coupled to control the robotic device. In some embodiments, a proximal end of the articulatable elongate member is removably coupled to the first drive mechanism.

[0014] In another aspect, the present disclosure provides a method for operating a modular robotic device. The method includes providing an articulatable elongate member, such as a main sheath, having a first lumen and a second lumen, coupling an articulatable imaging device to the articulatable elongate member via the first lumen, coupling the first articulatable device to the articulatable elongate member via the second lumen, and capturing movement of the first articulatable device with a camera of the articulatable imaging device. In some cases, the main sheath includes a third lumen for receiving a second articulatable device. The camera is located at a distal portion of the articulatable imaging device and is independently controlled to have at least articulating movement relative to the main sheath.

[0015] In some embodiments, the method further includes coupling a second articulatable instrument to the articulatable elongate member via the third lumen. In some embodiments, the camera is controlled to have articulated motion relative to the articulatable elongate member. In some embodiments, the articulatable elongate member is steered via a first drive mechanism. In some cases, the first articulatable instrument is actuated via a second drive mechanism. In some cases, the first drive mechanism and the second drive mechanism are operably coupled. In some embodiments, the articulatable imaging instrument is articulated and manipulated via the first drive mechanism.

[0016]

[0016] It should be noted that the various components of the provided modular robotic systems and robotic platforms can be used in a variety of minimally invasive surgical, therapeutic and diagnostic procedures involving various types of tissue, including cardiac, bladder and pulmonary tissue, as well as in other anatomical regions of a patient's body, such as the digestive system, including but not limited to the esophagus, liver, stomach, colon and urinary tract, or the respiratory system, including but not limited to the bronchi, lungs and various others.

[0017]

[0017] Additional aspects and advantages of the present disclosure will become readily apparent to those skilled in the art from the following detailed description, which shows and describes only exemplary embodiments of the present disclosure. As will be understood, the present disclosure is capable of other and different embodiments, and its several details can be modified in various respects, all without departing from the present disclosure. Accordingly, the drawings and description should be regarded as illustrative in nature and not restrictive.

[0018] Incorporation by Reference

[0018] All publications, patents, and patent applications mentioned herein are incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference. To the extent that a publication, patent, or patent application incorporated by reference conflicts with the disclosure contained herein, the present specification is intended to supersede and / or take precedence over any such conflicting material.

[0019] The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings (also referred to herein as "Figure" and "FIG."). [Brief explanation of the drawings]

[0020] [Figure 1]

[0020] FIG. 1 illustrates an example of a modular robotic system, according to some embodiments of the present disclosure. [Figure 2]

[0021] FIG. 1 illustrates an example of a modular robotic system in deployment mode, according to some embodiments of the present disclosure. [Figure 3]

[0022] 1A-1C illustrate examples of flexible articulatable devices according to embodiments of the present disclosure. [Figure 4]

[0023] FIG. 1 illustrates an example of a robotic platform. [Figure 5]

[0024] FIG. 1 illustrates an example of a robotic platform with an assembled control module. [Figure 6]

[0025] 1A-1C illustrate an example of a main articulatable flexible device supported by a robotic support system. [Figure 7]

[0026] FIG. 10 illustrates an example of an instrument drive mechanism that provides a mechanical interface to a handle portion. DETAILED DESCRIPTION OF THE INVENTION

[0021]

[0027] While various embodiments of the present invention have been shown and described herein, it will be apparent to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions may occur to those skilled in the art without departing from the invention. It will be understood that various alternatives to the embodiments of the invention described herein may be employed.

[0022]

[0028] Although the exemplary embodiments are primarily directed to devices or systems for endoscopic submucosal dissection (ESD), those skilled in the art will understand that this is not intended to be limiting and that the devices described herein may be used for other therapeutic or diagnostic procedures and in various anatomical regions of a patient's body, such as the digestive system, including but not limited to the esophagus, liver, stomach, colon, urinary tract, or the respiratory system, including but not limited to the bronchi, lungs, and various others.

[0023]

[0029] The embodiments disclosed herein can be combined in one or more of many ways to provide improved diagnosis and therapy to patients. The disclosed embodiments can be combined with existing methods and devices to provide improved treatment, such as in combination with known methods of lung disease diagnosis, surgery, and surgery on other tissues and organs. It should be understood that any one or more of the structures and steps described herein can be combined with any one or more additional structures and steps of the methods and devices described herein, and the figures and supporting text provide a description according to the embodiments.

[0024]

[0030] Although the definitions of the robotic systems, diagnostics, or surgical procedures described herein are presented in the context of diagnostics or surgery on the gastrointestinal (GI) tract, the methods and devices described herein can be used to treat any tissue of the body, as well as any organ and vessel of the body, including soft tissues such as the brain, heart, lungs, intestines, eyes, skin, kidneys, liver, pancreas, stomach, uterus, ovaries, testes, bladder, ears, nose, mouth, bone marrow, adipose tissue, muscle, glandular and mucosal tissue, spinal cord and nerve tissue, cartilage, hard tissues such as teeth and bone, and body lumens and ducts such as the sinuses, ureters, colon, esophagus, pulmonary tract, blood vessels, and throat.

[0025]

[0031] Whenever the terms "at least," "greater than," or "greater than or equal to" precede a first number in a series of two or more numbers, the terms "at least," "greater than," or "greater than or equal to" apply to each number in the series. For example, greater than or equal to 1, 2, or 3 is equivalent to greater than or equal to 1, greater than or equal to 2, or greater than or equal to 3.

[0026]

[0032] Whenever the terms "less than or equal to," "less than," or "less than or equal to" are placed before the first number in a series of two or more numbers, the terms "less than or equal to," "less than," or "less than or equal to" apply to each number in the series. For example, less than or equal to 3, 2, or 1 is equivalent to less than or equal to 3, less than or equal to 2, or less than or equal to 1.

[0027]

[0033] As used herein, a processor encompasses one or more processors, e.g., a single processor, or multiple processors, e.g., in a distributed processing system. A controller or processor as described herein generally includes a tangible medium for storing instructions for implementing process steps, and a processor may include, for example, one or more of a central processing unit, programmable array logic, gate array logic, or field programmable gate array. In some cases, the one or more processors may be a programmable processor (e.g., a central processing unit (CPU) or microcontroller), a digital signal processor (DSP), a field programmable gate array (FPGA), and / or one or more Advanced RISC Machine (ARM) processors. In some cases, the one or more processors may be operably coupled to a non-transitory computer-readable medium. The non-transitory computer-readable medium may store logic, code, and / or program instructions executable by one or more processor units to perform one or more steps. The non-transitory computer-readable medium may include one or more memory units (e.g., removable media or external storage, such as an SD card or random access memory (RAM)). One or more of the methods or operations disclosed herein may be implemented in hardware components or a combination of hardware and software, such as, for example, an ASIC, a special purpose computer, or a general purpose computer.

[0028]

[0034] As used herein, the terms distal and proximal may generally refer to a location referenced from the device, as opposed to an anatomical reference. For example, a distal location of a primary sheath or catheter may correspond to a proximal location of an elongate member on a patient, and a proximal location of a primary sheath or catheter may correspond to a distal location of an elongate member on a patient.

[0029]

[0035] In one aspect of the present disclosure, a modular robotic system is provided. The modular robotic system may include a main articulatable flexible device (e.g., a Gastrosheath) to which real-time endoscopic vision and multiple instruments are removably coupled to perform complex and precise surgical procedures. Because the modular robotic system can provide real-time endoscopic views, it provides endoscopists with the advantage of performing complex and difficult surgical procedures that use natural orifices to access internal organs, especially the GI tract, without leaving any scars on the patient.

[0030]

[0036] In some embodiments, the main articulatable flexible device (e.g., a Gastrosheath) may include multiple lumens for housing multiple independent flexible devices or instruments. In some cases, these independent instruments may be individually deployable and articulatable. For example, the flexible instruments may each have an articulating section (e.g., a wrist or bending section) that allows for additional degrees of freedom (DOF) for manipulating the instrument. The articulating section may be located at the base of the flexible instrument's end effector, allowing the flexible instrument to move relative to the catheter of the main flexible device. The flexible instrument may have end effectors that provide the user with surgical functions, including, but not limited to, hook-type electrocautery, scissors, forceps, needles, and graspers. The presented articulatable devices and / or modular robotic systems may advantageously enable a physician to transfer surgical functions in an endoluminal approach via a flexible articulatable robotic device.

[0031]

[0037] The modular robotic systems or main articulatable flexible devices described herein include an elongated portion or member, such as a catheter. The terms "elongated member," "catheter," and "sheath" are used interchangeably throughout this specification unless the context suggests otherwise. The elongated member can be positioned directly within a body lumen or cavity. A handle or proximal portion of the modular robotic system can be positioned outside the body cavity. The sheath or catheter can include an articulating section and control mechanisms for steering and articulating the device.

[0032]

[0038] The modular robotic system may be coupled to a support apparatus, such as a robotic manipulator (e.g., a robotic arm), for driving, supporting, positioning, or controlling the movement and / or operation of the modular robotic system. Alternatively or additionally, the modular robotic system may be controllable via a handheld device or other control device, which may or may not include a robotic system. In some embodiments, the robotic system may further include peripheral devices and subsystems, such as an imaging system, that assist and / or facilitate navigation of the elongated member to a target site within a subject's body.

[0033]

[0039] 1 and 2 illustrate an example of a modular robotic system 100 according to some embodiments of the present disclosure. As shown, the modular robotic system 100 may include a main sheath or main articulatable flexible device 101, a plurality of flexible and steerable instruments 123, 125, and an endoscopic instrument 121. In some cases, the endoscopic instrument 121 may be integrated into the main articulatable flexible device. For example, the endoscopic instrument 121 may be integral to the main articulatable flexible device. Alternatively, the endoscopic instrument 121 may be removably coupled to the main articulatable flexible device. The plurality of flexible and steerable instruments 123, 125 and the endoscopic device 121 may be coupled to the modular robotic system as an assembly with at least a portion of the instrument or endoscopic instrument movable relative to the main sheath. In some cases, the plurality of flexible and steerable instruments 123, 125 may be removably coupled to the main sheath.

[0034]

[0040] 1, primary sheath 101 may be the probing portion that leads proximal to the tissue and / or area to be examined. Primary sheath 101 may be steerable and robotically controlled. A robotic control module and user interface for controlling the primary sheath are described later in this specification.

[0035]

[0041] The primary sheath may be constructed of a material suitable for the desired flexibility or bending stiffness. In some cases, the sheath material may be selected to maintain structural support for the internal structure (e.g., the working channel) and to be substantially flexible (e.g., bendable in various directions and orientations). For example, the catheter may be made of any suitable material, such as Provista Copolymer, vinyl (e.g., polyvinyl chloride), nylon (e.g., Vestamid, Grilamid), Pellethene, polyethylene, polypropylene, polycarbonate, polyester, silicone elastomer, acetate, etc. In some cases, the material may be a polymeric material, a biocompatible polymeric material, and the catheter may be flexible enough to be advanced through the passageway without causing pain to the patient.

[0036]

[0042] The primary sheath may comprise a shaft, an articulating section 103, and a steerable distal portion 105, with the articulating section (bending section) 103 connecting the steerable distal portion to the shaft. For example, the bending section may be connected at a first end to the distal tip portion and at a second end to the shaft portion, with the bending section articulated by one or more puller wires. In some cases, the bending section may be manufactured separately as a modular component and assembled to the shaft. In some cases, the bending section may further incorporate minimal features, thereby reducing cost and improving reliability. For example, the bending section may advantageously incorporate a cut pattern that allows for greater tubing flexibility to achieve the desired distal travel relative to the shaft. In some cases, the bending section may be comprised of stainless steel ribbon. The bending section may be formed of other suitable structures or materials to achieve a predetermined bending stiffness while maintaining the desired axial and torsional stiffness with low articulation forces. For example, the bending section may comprise a braided structure for torsional stability.

[0037]

[0043] The distal portion of the main sheath may be steered by a control element, such as one or more puller wires, gears, pulleys, or other drive mechanisms. The distal portion of the main sheath 105 may be made of any suitable material, such as a copolymer, polymer, metal, or alloy, and is steerable by a puller wire. In some cases, the distal tip 105 may be a rigid component that allows for a positioning sensor, such as an electromagnetic (EM) sensor, to be embedded in the distal tip.

[0038]

[0044] In some cases, the distal portion 105 can be configured to articulate / bend in more than one degree of freedom to provide a desired camera view with an articulatable endoscopic instrument or to control the direction of the endoscope. In some embodiments, the proximal end or portion of one or more puller wires can be operably coupled to various mechanisms (e.g., gears, pulleys, etc.) in the handle / proximal portion of the robotic assembly. In some cases, the puller wires can be anchored at the distal tip of the main sheath, passed through a bending section, and entered the handle where they are coupled to a drive component (e.g., a pulley).

[0039]

[0045] The puller wires can be metallic wires, cables, or threads, or can be polymeric wires, cables, or threads. They can also be made of natural or organic materials or fibers. The puller wires can be any type of suitable wire, cable, or thread capable of supporting various types of loads without deformation, significant deformation, or breakage. The distal ends or distal portions of one or more puller wires can be fixed to or integrated with the distal portion (e.g., flexible section) of the main sheath 105 such that operation of the puller wires by the control unit can apply a force or tension to the distal portion 105 that can steer or articulate at least the distal portion (e.g., flexible section) of the main sheath 105 (e.g., up, down, pitch, yaw, or any direction in between).

[0040]

[0046] Modular robotic system 100 can be configured to have at least an endoscopic mode (e.g., colonoscope) as shown in FIG. 1 and a deployed mode as shown in FIG. 2. In endoscopic mode, multiple flexible instruments 123, 125 and articulable endoscopic instrument 121 can be partially or fully retracted into main sheath 101, such as when the main sheath is advanced to a target site within a patient (e.g., colon intubation phase) or withdrawn from a target site (e.g., colonoscope withdrawal). In some cases, when in endoscopic mode, such as when the modular robotic system is navigating to a target site, the location and orientation of the distal end of the endoscope can be tracked by an EM sensor and camera. The camera can be located on articulable endoscopic instrument 121 retracted within the main sheath. The EM sensor can be embedded in distal tip 105 and / or can be located on articulable endoscopic instrument 121.

[0041]

[0047] As the main sheath 100 is advanced to a location near the target site, the flexible and steerable arms of the flexible instruments 123, 125 and articulable endoscopic instrument 121 can be advanced / extended out of the main sheath and further steered or manipulated into position to perform various diagnostic or therapeutic procedures. Each of the steerable arms can include a bending section that allows articulation of the distal end of the flexible shaft, flexible instrument 123, 125, or articulable endoscopic instrument 121. The above description of bending sections and puller wires is applicable to the flexible instruments 123, 125, or articulable endoscopic instrument 121.

[0042]

[0048] The primary sheath 101 may include multiple lumens 107, 108, 109. As previously mentioned, appropriate surgical instruments may be advanced through each lumen of the instrument assembly to perform various diagnostic or therapeutic procedures. In some cases, the first lumen 105 may house a separate articulatable endoscopic instrument 121. The articulatable endoscopic instrument 121 may allow for manipulation or control of the field of view relative to the primary sheath 101 or distal tip 105. This may advantageously provide the user with increased flexibility and ability to optimize the visual working field or field of view without compromising the position or stability of the instrument, primary sheath, and anatomy.

[0043]

[0049] Two of the lumens 107 may accommodate flexible electrosurgical instruments 123, 125, such as forceps, graspers, surgical clip appliers, syringe needles, or scissors. The flexible instruments may be controlled to insert, withdraw, and rotate relative to the primary sheath. These additional degrees of freedom of the instruments may advantageously minimize the risk of compromising the anatomical anchoring of the primary sheath while the instruments interact with the GI lesion.

[0044]

[0050] The primary sheath can have any suitable dimensions such that the lumens can accommodate multiple flexible devices. For example, the outer diameter of the distal tip can be approximately 20 millimeters (mm), and the diameter of one or more of the lumens can be approximately 6 mm. However, it should be noted that, based on different applications, the outer diameter can be within any range less than or greater than 20 mm, and the lumen or working channel can be within any range according to the size of the tool or the particular application.

[0045]

[0051] In some embodiments, the primary sheath may include additional working channels / tool ​​ports 108 to accommodate additional controllable instrument assemblies. By way of example, the working channel 108 may have dimensions such as approximately 2 mm or 6 mm diameter to accommodate standard tools.

[0046]

[0052] The primary sheath may have fewer or more lumens. In some embodiments, the primary sheath may have two lumens for the flexible instruments 123, 125, but the imaging device (e.g., a camera) may be embedded in the distal portion 105 of the primary sheath. In some cases, the imaging device may be embedded in the distal portion of the primary sheath. In some cases, the imaging device may be coupled to the distal portion 105 of the primary sheath, but the viewing angle may be tiltable or rotatable with respect to the distal portion. In some cases, one or more electronic components may be integrated into the distal tip of the primary sheath. For example, a camera and / or a position sensor (e.g., an electromagnetic sensor) may be embedded in the distal tip 105.

[0047]

[0053] 3 shows an example of a flexible articulable instrument according to some embodiments of the present disclosure. In some embodiments, the plurality of flexible articulable instruments may include at least an articulable endoscopic instrument 310 and one or more surgical instruments each having a robotic arm 323, 333, and end effectors or instrument tools 321, 331 that may extend from ports on the main flexible instrument body.

[0048]

[0054] The articulatable endoscopic instrument 310 may include a steerable and articulatable arm 313 and a distal tip 311 at which one or more electronic devices are located. The imaging device or camera is controlled to have articulating motion relative to the main sheath. The articulatable arm may be a robotically controlled robotic arm. The one or more electronic devices may include at least an imaging device 315 and an illumination device 317.

[0049]

[0055] In some cases, the articulable imaging instrument includes one or more nozzles to provide a clear camera view. For example, the distal tip may further include one or more irrigation ports, such as a forward irrigation nozzle 319 and a window cleaning nozzle, to provide a clear camera view. For example, irrigation and suction systems may connect to the working channel for the articulable endoscopic instrument via connectors or luers. The irrigation system may inject fluids such as saline, and the suction system may suction mucus, saline, or other material out of the airway.

[0050]

[0056] The imaging device 315 may be a camera for direct vision. The imaging device may be located at the distal tip of the articulable endoscopic instrument 310. In some embodiments, the imaging device may be a video camera. The imaging device may include optical elements and an image sensor for capturing image data. The image sensor may be configured to generate image data in response to wavelengths of light. Various image sensors may be employed for capturing image data, such as a complementary metal-oxide semiconductor (CMOS) or a charge-coupled device (CCD). The imaging device may be a low-cost camera. In some cases, the image sensor may be provided on a circuit board. The circuit board may be an imaging printed circuit board (PCB). The PCB may include multiple electronic elements for processing the image signal. For example, the circuit for a CCD sensor may include an A / D converter and an amplifier for amplifying and converting the analog signal provided by the CCD sensor. Optionally, the image sensor may be integrated with an amplifier and converter for converting the analog signal to a digital signal, so that a circuit board is not required. In some cases, the output of the image sensor or circuit board may be image data (digital signals) that can be further processed by the camera circuitry or camera processor. In some cases, the image sensor may comprise an array of optical sensors. As described elsewhere herein, the imaging device may be located at the distal tip of a freestanding endoscopic instrument 310 or may be embedded in the distal tip of the main sheath.

[0051]

[0057] Illumination device 317 may comprise one or more light sources positioned at the distal tip of articulatable endoscopic instrument 310. The light sources may be light emitting diodes (LEDs), organic LEDs (OLEDs), quantum dots, or any other suitable light source. In some cases, the light sources may be miniature LEDs for compact designs or dual-tone flash LED illumination.

[0052]

[0058] The flexible endoscopic instrument 310 may be independently controlled to articulate, rotate, insert, withdraw, etc., relative to the main sheath. For example, the flexible endoscopic instrument assembly may be controlled to rotate and insert relative to the main sheath while the distal segment exits the distal portion of the main sheath, and the distal portion 311 of the flexible endoscopic instrument may be guided and oriented by controlling the articulation of the arms 313 and / or the rotational movement of the flexible endoscopic instrument. Rotational movement can be achieved by rotating the elongate body of the flexible endoscopic instrument relative to the main sheath and / or the distal base of the distal tip 311. For example, the camera may have rotational movement relative to the main sheath by rotating the flexible endoscopic instrument assembly about the longitudinal axis of the main sheath. Alternatively or additionally, the flexible endoscopic instrument assembly may include a rotatable wrist that allows the camera to rotate about the longitudinal axis of the flexible endoscopic instrument assembly. Alternatively, the camera view may be rotated via the imaging process (e.g., to align with the direction of gravity). Articulation may be controlled similarly to the main articulatable sheath. For example, separate puller wires and other control elements may be provided to control the movement of the flexible endoscopic instrument 310. As previously mentioned, the articulatable arm 313 may include a bending section that is articulatable similar to the main sheath.

[0053]

[0059] As shown in the examples, the camera can be positioned and oriented with increased flexibility and working range to provide a real-time view of the operating scene from any of a variety of angles and vantage points. By providing a camera at the end of an articulatable arm that is individually controlled relative to the main sheath, a view of the operating scene can be provided without affecting the operation of the robotic manipulators of the other instruments 320, 330. This can advantageously allow the operating environment to be clearly viewed by the surgeon from a user-selected angle. For example, a user can freely adjust the camera's vantage point, location, and field of view without affecting the operation of the instrument.

[0054]

[0060] The two flexible instruments 320, 330 may each comprise a robotic arm 323, 333 including a proximal segment and a distal segment. In some cases, the robotic arm includes a proximal base (not shown), a distal base 335, and a distal tip 331. The distal tip 331 may carry any suitable tool, such as a grasper or other electrosurgical instrument, as described elsewhere herein. In some cases, the tool may be suitable for performing endoscopic submucosal dissection (ESD). The proximal base, distal base, and distal tip may be controlled by control elements of the corresponding robotic arms. For example, the control elements may include puller wires and other control elements, as described elsewhere herein.

[0055]

[0061] Two flexible instruments 320, 330 can meet the flexibility, dexterity, and trigonometry requirements for intraluminal operation. In a preferred configuration, two instrument ports can be located on either side of the port for the endoscopic instrument. This configuration can allow for surgical trigonometry with the distal portion of the instrument assembly.

[0056]

[0062] The flexibility afforded by the articulatable arms of the endoscopic instrument and the two flexible instruments can advantageously enable the instruments to perform triangulation and coverage over the area of ​​interest. For example, by orienting the cameras on the apex and the instrument substantially at the respective lower points of the triangle that creates a converging triad, the instrument's field of view and operational efficiency are maximized. For example, additional degrees of freedom can enable the flexible instruments 320 and 330 to triangulate by spreading or deflecting the arms away from the base as they exit the distal portion of the main sheath. The distal portions can then be steered back toward each other and used to capture and / or apply compressive loads to the subject's tissue structures, etc., with the image capture device's field of view preferably capturing such activity from any desired location relative to the instruments 320, 330. In this way, the arms of the robotic manipulator do not obstruct the endoscopic view, allowing the surgeon to clearly see the operating environment and independently operate the cameras, capturing real-time imaging from any desired vantage point relative to the operating scene without involving instrument movement.

[0057]

[0063] In one aspect, the present disclosure provides a method for operating a modular robotic device. The method includes providing an articulatable elongate member, such as a primary sheath, having a first lumen and a second lumen, coupling an articulatable imaging device to the articulatable elongate member via the first lumen, coupling a first articulatable device to the articulatable elongate member via the second lumen, and capturing movement of the first articulatable device with a camera of the articulatable imaging device. Optionally, the primary sheath includes a third lumen for receiving a second articulatable device. The camera is located at a distal portion of the articulatable imaging device and is independently controlled to have at least articulating movement relative to the primary sheath.

[0058] Robot Platform

[0064] In some embodiments, a robotic platform may be provided that allows a physician to perform endoscopic submucosal dissection (ESD) within the GI tract. The platform may include a modular robotic system that houses a variety of flexible, articulatable surgical instruments, as described above, and a support apparatus, such as a robotic manipulator (e.g., a robotic arm), for driving, supporting, positioning, or controlling the movement and / or operation of the modular robotic system. The robotic platform may further include peripheral devices and subsystems that assist and / or facilitate navigation of the elongated member to a target site within a subject's body.

[0059]

[0065] In some cases, the modular robotic system may also implement a position sensing system, such as electromagnetic (EM), fiber optic, and / or other sensors, for registering and displaying the medical implement with preoperatively recorded surgical images, thereby determining the position of the distal portion of the endoscope relative to the patient's body or a global reference frame. The position sensor may be a component of an EM sensor system including one or more conductive coils that can be exposed to an externally generated electromagnetic field. Each coil of the EM sensor system used to implement the position sensor system then generates an induced electrical signal having characteristics that depend on the coil's position and orientation relative to the externally generated electromagnetic field. In some cases, the EM sensor system used to implement the position sensing system may be configured and positioned to measure at least three degrees of freedom, e.g., three position coordinates: X, Y, and Z. Alternatively or additionally, the EM sensor system may be configured and positioned to measure six degrees of freedom, e.g., three position coordinates: X, Y, and Z, and three orientation angles indicating the pitch, yaw, and roll of a fiducial, or five degrees of freedom, e.g., three position coordinates: X, Y, and Z, and two orientation angles indicating the pitch and yaw of a fiducial. The position sensor may be embedded in the distal tip of the main articulatable flexible device, the integrated flexible and steerable instrument, and / or the integrated endoscopic instrument, as described above. The flexible and steerable instrument and / or the endoscopic instrument may be detachably or integrally integrated into the main articulatable flexible device.

[0060]

[0066] 4 and 5 show an example of a robotic platform 430. In some embodiments, the robotic platform may include a first control module 410 for controlling operation of the primary sheath for endoscopic functionality (e.g., colonic intubation, removal, etc.) and a second control module 420 for controlling operation of the instrument (e.g., ESD operation). The first control module and the second control module may be removably coupled to form a control system 500 of the robotic platform, as shown in FIG.

[0061]

[0067] In some embodiments, each control module 410, 420 may include or be integrated with a robotic support system, including a robotic arm 411, 421, an instrument drive mechanism 413, 423, a robotic control unit, and one or more peripheral devices, such as an irrigation and aspiration system. The robotic arm of the first control module 410 may initiate the positioning of a modular robotic system or other robotic devices. The robotic arm 411 may automatically position the modular robot assembly 415 at an initial position (e.g., an access point) to access a target tissue. In some embodiments, the robotic arm can be passively moved by an operator. In such cases, the operator can push the arm at any position, and the arm will move accordingly. The robot can also be controlled in a compliance mode to improve human-robot interaction. For example, the compliance motion control of the robotic arm can employ a collision avoidance strategy, and the position-force control can be designed to reduce the impact of potential collisions while saving unnecessary energy consumption. The arm may have redundant degrees of freedom that allow its elbow to be moved algorithmically or passively into a configuration that is convenient for the operator.

[0062]

[0068] In some embodiments, the instrument drive 413 can be attached to the robot arm 411. The modular robot system 415 can be releasably coupled to the instrument drive 413. The instrument drive can be attached to the arm of a robotic support system or any actuated support system. The instrument drive can provide a mechanical and electrical interface to the modular robot system 415. The mechanical interface can allow the modular robot system 415 to be releasably coupled to the instrument drive. For example, the handle portion of the modular robot system 415 can be attached to the instrument drive via quick installation / release means such as magnets and spring-loaded levels. In some cases, the modular robot system 415 can be manually coupled to or released from the instrument drive without the use of tools. The instrument drive 413 can be used to drive the primary sheath with more than one degree of freedom (e.g., articulation) and other motions described elsewhere herein.

[0063]

[0069] The modular robotic system 415 can be releasably coupled to the instrument drive mechanism 413 via the handle portion 417. For example, a puller wire in the main sheath can pass through a bending section, the sheath, and into the handle where it is coupled to a drive component (e.g., a pulley). This handle pulley can interact with an output shaft in the instrument drive mechanism.

[0064]

[0070] In some cases, the handle portion 417 may house or include components configured to process image data, provide power, or establish communication with other external devices. In some cases, the communication may be wireless. For example, the wireless communication may include Wi-Fi, radio communication, Bluetooth, IR communication, or other types of direct communication. Such wireless communication capabilities may enable the modular robotic system to be plug-and-play and conveniently disposable after a single use. In some cases, the handle portion may include circuit elements such as a power supply for powering the modular robotic system's electronics (e.g., camera and LED light source).

[0065]

[0071] FIG. 6 shows an example of a main articulatable flexible device 610 supported by a robotic support system. The main articulatable flexible device and robotic support system may be the same as those described above. For example, the main articulatable flexible device may include an elongate member 611 and a handle portion 613. In some embodiments, the main articulatable flexible device 610 may also include an imaging device and / or a position sensor integrated into the distal portion of the elongate member. Alternatively, the main articulatable flexible device 610 may be coupled to an endoscopic instrument to provide endoscopic functionality. The elongate member 611 may include a flexible shaft, a bending section connecting the shaft to a steerable tip, and multiple lumens for accommodating multiple detachable flexible devices or instruments. The elongate member 611 may be the same as the main sheath described above.

[0066]

[0072] The handle portion 613 may be in electrical communication with one or more electronic components coupled to the elongate member 611. For example, when an imaging device, an illumination device, and / or an EM sensor are integrated into the elongate member 611, image / video data and / or sensor data may be transmitted to one or more processors within the handle portion. In some cases, the handle portion may house or comprise components configured to process image data, provide power, or establish communication with other external devices. In some cases, communication may be wireless communication. For example, wireless communication may include Wi-Fi, radio communication, Bluetooth, IR communication, or other types of direct communication. Such wireless communication capabilities may enable the modular robotic system or main articulatable flexible device to function in a plug-and-play manner and may be conveniently disposed of after a single use. In some cases, the handle portion may comprise circuit elements such as a power supply for powering electronics (e.g., a camera and an LED light source) disposed within the modular robotic device or main sheath.

[0067]

[0073] In some cases, the handle portion 613 may be in electrical communication with one or more electronic components that are not integrated into the main sheath. For example, when imaging devices, EM sensors, and other electronic components are located on a detachable endoscopic instrument, the proximal end of the endoscopic instrument may be in electrical communication with or connected to the handle portion 613.

[0068]

[0074] In some cases, the handle portion may electrically communicate with the instrument drive (e.g., instrument drive 620) via an electrical interface (e.g., a printed circuit board) so that image / video data and / or sensor data can be received by a communication module in the instrument drive and transmitted to other external devices / systems. In some cases, the electrical interface may establish electrical communication without cables or wires. For example, the interface may comprise pins soldered onto an electronics board, such as a printed circuit board (PCB). For example, a receptacle connector (e.g., a female connector) may be provided on the instrument drive as a mating interface. This may advantageously allow the endoscope to be quickly plugged into the instrument drive or robotic support without utilizing a special cable. This type of electrical interface may also serve as a mechanical interface, such that both a mechanical and electrical coupling are established when the handle portion is plugged into the instrument drive. Alternatively or additionally, the instrument drive may provide only the mechanical interface. The handle portion may be in electrical communication with the modular wireless communication device or any other user device (e.g., a portable / handheld device or controller) for transmitting sensor data and / or receiving control signals.

[0069]

[0075] In some embodiments, the flexible elongate member 611 may comprise a shaft, a steerable tip, an articulating section, and multiple lumens for receiving the multiple flexible and steerable instruments and / or endoscopic instruments described above. The main articulatable flexible device 610 may be the same as the main sheath or main articulatable flexible device described in FIGS. 1 and 2. In some cases, the main articulatable flexible device 610 may be a disposable device. In some cases, only the catheter may be disposable. In some cases, at least a portion of the catheter may be disposable. In some cases, the entire main articulatable flexible device 610 may be released from the instrument drive mechanism and disposable. In some cases, the main articulatable flexible device may include various levels of stiffness along its shaft to improve functional operation.

[0070]

[0076] The main articulatable flexible device 610 is releasably coupleable to the instrument drive mechanism 620. The instrument drive mechanism 620 may be attached to the arm of a robotic support system or to any actuated support system, as described elsewhere herein. The instrument drive mechanism may provide a mechanical and electrical interface to the main articulatable flexible device 610. The mechanical interface may allow the main articulatable flexible device 610 to be releasably coupled to the instrument drive mechanism. For example, the handle portion of the main articulatable flexible device 610 may be attached to the instrument drive mechanism via quick installation / release means, such as a magnet and spring-loaded level. In some cases, the main articulatable flexible device 610 may be manually coupled to or released from the instrument drive mechanism without the use of tools. Note that any discussion of the handle portion or instrument drive mechanism with respect to the main articulatable flexible device is also applicable to the handle portion or instrument drive mechanism for a multiple articulatable instrument.

[0071]

[0077] 7 shows an example of an instrument drive mechanism 720 that provides a mechanical interface to the handle portion 713 of a main articulatable flexible device or modular robotic system. As shown in the example, the instrument drive mechanism 720 may include a set of motors that are actuated to rotationally drive a set of puller wires of the catheter. The handle portion 713 may be mounted on the instrument drive mechanism such that its pulley assemblies are driven by the set of motors. The number of pulleys may vary based on the puller wire configuration. In some cases, one, two, three, four, or more puller wires may be used to articulate the catheter.

[0072]

[0078] The handle portion can be designed to allow the main articulatable flexible device to be disposable at reduced cost. For example, conventional manual and robotic endoscopes may have cables within the proximal end of the endoscope handle. The cables often include illumination fibers, camera video cables, and other sensor fibers or cables, such as electromagnetic (EM) sensors, or shape-sensing fibers. Such composite cables can be expensive, adding to the cost of the endoscope. The provided modular robotic system or main articulatable flexible device can have an optimized design that allows for simplified structures and components to be employed while retaining mechanical and electrical functionality. In some cases, the handle portion can employ a cable-less design while providing a mechanical / electrical interface to the catheter.

[0073]

[0079] The irrigation and aspiration system may reside on the robotic arm base cart or any other part of the system. The irrigation and aspiration system may connect to the working channel for the articulatable endoscopic instrument via a connector or luer. The irrigation system may inject fluids such as saline, and the aspiration system may suction mucus, saline, or other material out of the airway. As previously mentioned, the irrigation and aspiration system may be used for camera visualization.

[0074]

[0080] In some embodiments, the first control module 410 and the second control module 420 can collectively control the modular robotic system 415. In some embodiments, the instrument drive mechanism and robot control unit of the first control module 410 can be configured to control and operate the main sheath and integrated endoscopic instrument (e.g., a camera). The instrument drive mechanism 423 and robot control unit of the second control module 420 can be used to operate multiple flexible instruments, such as a pair of instruments for performing ESD. For example, articulation, insertion, withdrawal, and various other movements of the flexible instruments are driven by the instrument drive mechanism 423. As shown in FIG. 5 , the drive mechanism 423 of the second control module can be coupled to the drive mechanism 413 of the first control module, thereby driving multiple instruments of the modular robotic system. For example, a proximal portion or handle 511 of the flexible instrument can be connected to the instrument drive mechanism 423 to drive one or more puller wires of the flexible instrument. In some cases, the instrument drive mechanism 423 of the second control module and the instrument drive mechanism 413 of the first control module can be operably coupled. For example, two instrument drives may be robotically controlled to move in unison to collectively control the modular robotic system 415.

[0075]

[0081] The robotic platform 500 may include a user interface 510 located on the patient and robot side. The user interface may enable an operator or user to interact with the robotic system during a surgical procedure. In some embodiments, the user interface 510 may be implemented on a handheld controller. The user interface 510 may, in some cases, include a proprietary user input device and one or more add-on elements that are removably coupled to an existing user device to enhance the user input experience. For example, a physical trackball or roller may replace or supplement the functionality of at least one virtual graphical element displayed on a graphical user interface (GUI) (e.g., a navigation arrow displayed on a touchpad) by providing functionality similar to the graphical element it replaces. Examples of user devices may include, but are not limited to, a mobile device, a smartphone / cell phone, a tablet, a personal digital assistant (PDA), a laptop or notebook computer, a desktop computer, a media content player, etc. In some cases, the user interface 510 may provide real-time vision and vision guidance that may enable the physician to reach and resect lesions within the GI tract by utilizing the multiple degrees of freedom (DOF) of the instrument and the enhanced stability and control provided to the instrument by the robotic system.

[0076]

[0082] In some embodiments, the robotic system may include a navigation and localization subsystem configured to build a virtual airway model based on preoperative images (e.g., preoperative CT images). The navigation and localization subsystem may be configured to identify an approximate segmented lesion location in the 3D-rendered airway model based on the location of the lesion, and the navigation and localization subsystem may generate an optimal path to the lesion in the GI tract with a recommended approach angle toward the lesion for performing a surgical procedure (e.g., ESD). For example, the processing unit may be configured to generate an augmentation layer containing augmented information such as a treatment location or a lesion location. In some cases, the augmentation layer may also include a graphical marker indicating the path to the target site. The augmentation layer may be a nearly transparent image layer including one or more graphical elements (e.g., a box, an arrow, etc.). The augmentation layer may be superimposed on an optical view of an optical image or video stream captured by a fluoroscopic (tomosynthesis) imaging system and / or displayed on a display device. The transparency of the augmentation layer allows a user to view the optical image with the graphical elements superimposed. In some cases, both the segmented lesion image and the optimal path for navigation of the elongated member to reach the lesion may be overlaid on the virtual airway model or pre-operative image. This may allow the surgeon or user to visualize the approximate location of the lesion as well as the planned path of movement of the main sheath. In some cases, segmented and reconstructed images (e.g., CT images) provided prior to operation of the system may be overlaid on the real-time image.

[0077]

[0083] In a registration step prior to driving the modular robotic system to the target site, the system can align a rendered virtual view of the airway with the patient's airway. Image registration can consist of a single registration step or a combination of a single registration step and real-time sensory updates to the registration information. Once registered, all airways can be aligned with the pre-procedure rendered airway. During driving of the modular robotic system toward the target site, the location of the main sheath within the airway can be tracked and displayed. In some cases, the location of the tip of the main sheath relative to the airway can be tracked using a positioning sensor. Other types of sensors (e.g., cameras) can be used instead of or in conjunction with a positioning sensor using sensor fusion techniques. A positioning sensor, such as an electromagnetic (EM) sensor, can be incorporated into the main sheath and / or the distal tip of the flexible endoscopic instrument (e.g., next to the camera), and an EM field generator can be positioned next to the patient's torso during the procedure. The EM field generator can identify the EM sensor location in 3D space or, alternatively, the EM sensor's location and orientation in 5D or 6D space. This may provide a visual guide for the surgeon as he or she drives the robotic system towards the target site.

[0078]

[0084] During operation, the lesion location and various movements of the one or more flexible instruments can be tracked in real time by a camera. In some embodiments, the user interface can include, for example, a user interface handheld device that allows a physician to easily control the robotic endoscope (e.g., colonoscope).

[0079]

[0085] In some cases, the user interface, the robotic control module, and the robotic arm may be mounted on separate mobile carts. It may include a variety of elements, such as a rechargeable power supply in electrical communication with an electrical panel, including one or more computers storing application-specific software for a user interface, as a power source for on-board equipment, for multiple AC and DC receptacles, providing charging ports for portable electronic devices, converters, transformers, and surge protectors.

[0080]

[0086] While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It is understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention. The following claims define the scope of the invention, and it is intended that methods and structures within the scope of these claims and their equivalents be covered thereby.

Claims

1. an articulable elongate member having a proximal end and a distal end, the distal end being steerable via a first drive mechanism; an articulable imaging device removably coupled to the articulable elongate member via a first lumen of the articulable elongate member, the articulable imaging device comprising a camera located at a distal portion of the articulable imaging device; a first articulatable instrument removably coupled to the articulatable elongate member via a second lumen, the movement of the first articulatable instrument being captured by the camera of the articulatable imaging instrument; and A robotic device comprising:

2. a second articulable device removably coupled to the articulable elongate member via a third lumen; The robotic device of claim 1 , wherein the first articulatable machine, the second articulatable machine, and the camera are positioned in a triangular configuration.

3. The robotic device of claim 1 , wherein the articulatable elongate members comprise bent sections.

4. The robotic device of claim 3 , wherein the bending sections are articulated by one or more pull wires.

5. The robotic device of claim 1 , wherein the articulatable imaging instrument comprises a bending section.

6. The robotic device of claim 5 , wherein the bending sections are articulated by one or more pull wires.

7. The robotic device of claim 1 , wherein the articulatable imaging instrument comprises an illumination device located at the distal portion of the articulatable imaging instrument.

8. The robotic device of claim 1 , wherein the articulatable imaging instrument comprises one or more nozzles for clearing a camera view.

9. The robotic device of claim 1 , wherein the camera is controlled to rotate about a longitudinal axis of the articulatable elongate member or a longitudinal axis of the articulatable imaging instrument.

10. The robotic device of claim 1 , wherein the camera is controlled to have articulating motion relative to the articulatable elongate member.

11. The robotic device of claim 1 , wherein the articulatable imaging instrument and the first articulatable instrument are retracted into the first lumen and the second lumen when the robotic device is in a first mode.

12. The robotic device of claim 11 , wherein the articulatable imaging instrument and the first articulatable instrument are extended out from the distal end of the articulatable elongate member when the robotic device is in a second mode.

13. The robotic device of claim 1 , wherein the articulatable imaging instrument is steerable via the first drive mechanism.

14. The robotic device of claim 1 , wherein the first drive mechanism is mounted to a first robotic support system.

15. The robotic device of claim 14 , wherein the first articulatable instrument is articulated via a second drive mechanism.

16. The robotic device of claim 15 , wherein the second drive mechanism is mounted to a second robotic support system.

17. The robotic device of claim 16 , wherein the first robotic support system and the second robotic support system are operably coupled.

18. The robotic device of claim 1 , wherein the proximal end of the articulatable elongate member is removably coupled to the first drive mechanism.

19. providing an articulatable elongate member having a first lumen and a second lumen; coupling an articulatable imaging device to the articulatable elongate member via the first lumen, the articulatable imaging device comprising a camera located at a distal portion of the articulatable imaging device; coupling a first articulatable device to the articulatable elongate member through the second lumen; capturing the operation of the first connectable device with the camera of the connectable imaging device; 11. A method for a robotic device, comprising:

20. 20. The method of claim 19, further comprising coupling a second articulatable device to the articulatable elongate member via a third lumen.

21. The method of claim 19 , wherein the camera is controlled to have articulating motion relative to the articulatable elongate member.

22. The method of claim 19 , wherein the articulatable elongate members are steered via a first drive mechanism.

23. 23. The method of claim 22, wherein the first articulatable device is actuated via a second drive mechanism.

24. 24. The method of claim 23, wherein the first drive mechanism and the second drive mechanism are operably coupled.

25. 20. The method of claim 19, wherein the articulatable imaging device is articulated and operated via the first drive mechanism.

Images