Robot-assisted fulcrum effect correction device and method

Abstract

A robot-assisted fulcrum effect compensation device and method are provided. [Solution] Described herein are devices and methods for switching between a fulcrum effect mode and a fulcrum effect compensation mode. In the fulcrum effect mode, the method includes receiving a first input at a handle coupled to a medical instrument. The first input causes a manual reverse movement of the medical instrument about a pivot point. In the fulcrum compensation mode, the method includes activating a control of the handle to engage a sensor assembly and a power actuation unit in communication with the medical instrument, monitoring the position of one or more sensor-equipped joints of the handle, and translating a distal portion of the medical instrument using the power actuation unit in response to detection of a position change by the sensor assembly.

Description

[Technical Field]

[0001] (CROSS-REFERENCE TO RELATED APPLICATIONS) This application claims priority to U.S. Provisional Patent Application No. 63 / 485,715, filed February 17, 2023, the entire contents of which are incorporated herein by reference.

[0002] (Incorporated by reference) All publications and patent applications mentioned in this specification are herein incorporated by reference in their entirety, to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference in its entirety.

[0003] The present disclosure relates to the field of minimally invasive surgery, and more particularly to the field of robotically assisted minimally invasive surgery. Described herein are robotically assisted devices and methods for performing minimally invasive surgery. [Background technology]

[0004] Surgical procedures can be performed either through an open approach, in which a large incision is made to access the surgical site, or through minimally invasive surgery (MIS), in which multiple small incisions are made and long, thin instruments are used to manipulate tissue at the surgical site. MIS, also known as keyhole or laparoscopic surgery, offers numerous benefits to patients, such as reduced blood loss, less scarring, and shorter hospital stays. However, in many cases, the MIS approach is extremely difficult to perform, and an open approach is performed instead.

[0005] While the challenges of MIS can be attributed to several sources, the primary difficulty stems from limitations in the control systems (e.g., interfaces) for surgical instruments. While many control systems have been developed to address some of the challenges, traditional control systems still suffer from shortcomings. A further limitation of traditional MIS procedures that adds to the difficulty is the fulcrum formed at the incision, around which the surgical instrument pivots within the patient. Manipulating the surgical instrument at the fulcrum introduces control of the instrument tip that is inverse to the action at the instrument handle or other control interface. Inverse control (i.e., moving up to move the tip down or right to move the tip left) is counterintuitive to the surgeon and reduces the effectiveness of the MIS device. Summary of the Invention [Problem to be solved by the invention]

[0006] Therefore, a need exists to develop new control mechanisms that allow for improved control of both the orientation and position of the surgical instrument while maintaining a comfortable and ergonomic control interface for the surgeon. [Means for solving the problem]

[0007] In some aspects, the technology described herein relates to a system for performing minimally invasive surgery, comprising: a stabilizing device movable between a non-fixed state and a fixed state; a control assembly including a handle pivotally coupled to the stabilizing device and including one or more sensor-equipped joints; and an instrument actuator interface configured to be reversibly coupled to the handle; and a medical instrument coupled to the handle and operable by the handle, the medical instrument including an elongated body having a proximal portion, a distal portion including one or more distal joints, and an end effector coupled to the distal portion, wherein in a first mode, the stabilizing device is configured in the non-fixed state such that the medical instrument is maneuverable by the handle about a pivot point or in a first three-dimensional space; in a second mode, the handle is configured to manipulate the end effector of the medical instrument; and in a third mode, the stabilizing device is configured in the fixed state such that movement of the one or more sensor-equipped joints causes corresponding distal movement of the one or more distal joints of the medical instrument about the pivot point.

[0008] In some aspects, the technology described herein relates to a system for performing minimally invasive surgery, comprising: an elongate body including a distal end having an end effector and one or more distal joints, and a proximal end opposite the distal end; a handle configured to receive the proximal end of the elongate body, the handle including a sleeve including one or more sensor-equipped joints; a sensor assembly configured to monitor a position of each of the one or more sensor-equipped joints; and an instrument actuator interface coupled to the sleeve of the handle and including a power actuation unit and a controller communicatively linked to the sensor assembly and the power actuation unit, wherein the sensor assembly is configured to monitor at least a first position of the one or more sensor-equipped joints and generate a corresponding sensor signal, the first position being based on proximal movement of the handle; the controller is configured to receive the corresponding sensor signal and generate a corresponding control signal; and the power actuation unit is configured to receive the corresponding control signal and actuate the one or more distal joints to cause translation of the one or more distal joints based on the first position of the one or more sensor-equipped joints.

[0009] In some aspects, the technology described herein relates to a system for minimally invasive surgery that includes a medical instrument including an elongate body having a proximal portion, a distal portion including one or more distal joints, and an end effector; and a control assembly including a handle coupled to the proximal portion of the medical instrument and configured to operate the medical instrument, the handle including one or more sensor-equipped joints and an instrument actuator interface configured to be reversibly coupled to the handle, and configured to selectively perform operations in a first control mode or a second control mode, wherein selecting between the first control mode and the second control mode includes modifying a range of motion associated with the one or more sensor-equipped joints.

[0010] In some aspects, the technology described herein relates to a system for performing minimally invasive surgery, comprising: a control assembly including a handle pivotally coupled to a bedside device, the handle including one or more sensor-equipped joints; and an instrument actuator interface; and a medical instrument coupleable to and operable by the handle, the medical instrument including an elongate body having a proximal portion and a distal portion including one or more distal joints, wherein in a fulcrum effect mode, mechanical movement of the handle coupled to the proximal portion of the medical instrument causes movement of the medical instrument about a pivot point; and in a fulcrum compensation mode, a pivot point is located between the one or more sensor-equipped joints of the handle and the one or more distal joints of the medical instrument, and actuation of the handle causes movement of the one or more sensor-equipped joints, and the movement is mapped by the instrument actuator interface to corresponding distal movement of the one or more distal joints about at least the pivot point.

[0011] In some aspects, the technology described herein relates to a method for performing minimally invasive surgery, including receiving a first input at a handle coupled to a medical instrument in a fulcrum effect mode, the first input causing manual movement of the medical instrument about a pivot point, the pivot point being between a distal portion of the medical instrument and a proximal portion of the medical instrument; activating a control of the handle in a fulcrum compensation mode, the control being configured to engage a sensor assembly in communication with the medical instrument with a power actuation unit to perform electronically assisted movement; and monitoring a position of one or more sensor-equipped joints of the handle using the sensor assembly communicatively coupled to a controller; and translating the distal portion of the medical instrument using the power actuation unit in response to detection of a change in position by the sensor assembly, wherein the translation of the distal portion of the medical instrument is based on the position of the one or more sensor-equipped joints.

[0012] In some aspects, the technology described herein relates to a handle configured to be installed at a bedside of a patient assist device to perform minimally invasive surgery, the handle including: a first input mechanism configured to select a fulcrum effect mode, the first input mechanism configured to attach the handle to a medical instrument mechanically movable about a pivot point; and a second input mechanism configured to select a fulcrum compensation mode, the selection of the second input mechanism configured to activate a sensor assembly, a power actuation unit, and a controller communicatively coupled to the power actuation unit and the sensor assembly. [Brief explanation of the drawings]

[0013] The foregoing is a summary and is therefore necessarily limited in detail. The above-mentioned aspects, together with other aspects, features, and advantages of the technology, are described below in connection with various embodiments and with reference to the accompanying drawings. [Figure 1A] 1 shows a perspective view of an embodiment of a fulcrum effect correction device. [Figure 1B] 1 shows a schematic diagram of an embodiment of a control system for a fulcrum effect compensation device. [Figure 1C] 1 shows a schematic diagram of an embodiment of a control system for a fulcrum effect compensation device. [Figure 2] 1B shows a perspective view of the embodiment of FIG. 1A with a medical device installed. [Figure 3A] 1B illustrates adjustment of the stabilization device of the embodiment of FIG. 1A at a first joint. [Figure 3B] 3B illustrates the opposite adjustment of the first joint of the stabilization device of the embodiment of FIG. 1A to FIG. 3A. [Figure 4A] 1B illustrates adjustment of the stabilization device of the embodiment of FIG. 1A. [Figure 4B] 4A shows the opposite adjustment of the stabilization device of the embodiment of FIG. 1A to that of FIG. 4A. [Figure 5A] 1B illustrates an axial movement of the medical device of the embodiment of FIG. 1A. [Figure 5B] 5A illustrates the axial movement of the medical device of the embodiment of FIG. 1A in the opposite direction to that of FIG. 5A. [Figure 6] 1B illustrates a roll motion of the medical instrument based on manipulation of the input mechanism of the handle of the embodiment of FIG. 1A. [Figure 7] 1B illustrates movement of the wrist assembly of the medical instrument based on manipulation of the input mechanism of the handle of the embodiment of FIG. 1A. [Figure 8] 1B illustrates the embodiment of FIG. 1A switched into fulcrum effect compensation mode. [Figure 9] 9 illustrates the settings of the handle of the embodiment of FIG. 8 and the corresponding settings of the medical instrument in a fulcrum effect compensation mode. [Figure 10A] 1 illustrates an embodiment of a fulcrum effect compensation device in a fulcrum effect mode. [Figure 10B] 1 shows a cross section of a linear guide of a fulcrum effect compensation device. [Figure 11] 10B shows the embodiment of FIG. 10A switched into fulcrum effect compensation mode. [Figure 12] 10B illustrates the settings of the handle of the embodiment of FIG. 10A in fulcrum effect compensation mode and the corresponding settings of the medical instrument. [Figure 13] 1 illustrates an embodiment of a fulcrum effect compensation device in a fulcrum effect mode. [Figure 14] 14 shows the configuration of the embodiment of FIG. 13 in fulcrum effect compensation mode. [Figure 15] 14 illustrates another configuration of the embodiment of FIG. 13 in fulcrum effect compensation mode. [Figure 16] 1 illustrates an embodiment of a fulcrum effect compensation device in a fulcrum effect mode. [Figure 17] 17 shows the embodiment of FIG. 16 switched into fulcrum effect compensation mode. [Figure 18] 18 shows the configuration of the embodiment of FIG. 17 in fulcrum effect compensation mode. [Figure 19] 18 illustrates multiple degrees of freedom of a medical instrument based on one or more input mechanisms of the handle of the embodiment of FIG. 17. [Figure 20] 17 shows a detailed perspective view of the control assembly of the embodiment of FIG. 16. [Figure 21A] 21 illustrates counterclockwise rolling of the handle of the control assembly of FIG. 20. [Figure 21B] 21 illustrates clockwise roll motion of the handle of the control assembly of FIG. 20. [Figure 22A] 21 illustrates a control input for operation of the end effector of the embodiment of FIG. 20 in an unactuated state. [Figure 22B] 21 shows a control input for operation of the end effector of the embodiment of FIG. 20 in an actuated state. [Figure 23A] 10 shows a medical device in an installed position in an embodiment of a handle. [Figure 23B] 23B shows a medical device installed in the handle of the embodiment of FIG. 23A. [Figure 24A] 1 illustrates an embodiment of a control handle in a neutral position. [Figure 24B] 10 illustrates an embodiment of a control handle in a yaw adjustment setting. [Figure 24C] 10 shows an embodiment of a control handle in yaw and pitch adjustment settings. [Figure 25] 16 and 17 show linear guides for axial movement of one or more sensor-equipped joints of the handle that disable or enable the fulcrum effect compensation modes shown in FIGS. 16 and 17, respectively. [Figure 26] 1 illustrates an embodiment of a fulcrum effect compensation device in a fulcrum effect compensation mode. [Figure 27] 27 illustrates another configuration of the embodiment of the fulcrum effect compensation device of FIG. 26 in a fulcrum effect compensation mode. [Figure 28] 27 illustrates the internal components of the linear guide of the embodiment of the fulcrum effect compensation device of FIG. 26 in a fulcrum effect compensation mode. [Figure 29] 1 illustrates an embodiment of a fulcrum effect compensation device with two control input handles. [Figure 30] A method for performing a fulcrum effect procedure with a fulcrum effect compensation device is presented. [Figure 31]1 illustrates a method for performing a fulcrum effect compensation procedure with a fulcrum effect compensation device. The illustrated embodiments are merely examples and are not intended to limit the disclosure. The schematic diagrams are drawn to illustrate features and concepts and are not necessarily drawn to scale. DETAILED DESCRIPTION OF THE INVENTION

[0014] The foregoing is a summary and thus is necessarily limited in detail. The above-mentioned aspects, along with other aspects, features, and advantages of the technology, will now be described in connection with various embodiments. The inclusion of the following embodiments is not intended to limit the disclosure to these embodiments, but rather to enable one of ordinary skill in the art to make and use the discussed inventions. Other embodiments may be utilized, and modifications may be made without departing from the spirit and scope of the subject matter presented herein. Aspects of the disclosure, as described and illustrated herein, can be arranged, combined, modified, and designed in a variety of different forms, all of which are expressly contemplated and form part of this disclosure.

[0015] As used herein, "distal" or "distally" is used to describe the direction of an object, such as a patient, on which a device or system is acting, e.g., a minimally invasive procedure. For example, the distal portion of a device or system is the portion of the device or system that is near the object on which the device or system is acting.

[0016] As used herein, "proximal" or "proximally" is used to describe the direction of a user of a device or system. For example, a proximal portion of a device or system is a portion of the device or system that is near the user of the device or system.

[0017] The devices or systems described herein comprise technological improvements for instrument delivery and manipulation during minimally invasive surgery. Shortcomings previously observed in the state of the art include the counterintuitive nature of using conventional devices. For example, many conventional minimally invasive devices suffer from a "fulcrum effect." Disadvantagously, the fulcrum effect results in an inverse position output relative to a position input. For example, when conventional devices are used during minimally invasive surgery, a fulcrum is formed at the point where the device enters the patient or a trocar inserted into the patient, or at the point where the device or system is attached to a bedside apparatus. When a handle or other input device proximal to the fulcrum pivots about the fulcrum, the portion of the device distal to the fulcrum pivots in the opposite direction about the fulcrum. For linear movements (e.g., insertion or retraction), movement of the proximal end results in a similar movement at the distal end (e.g., insertion at the proximal end results in insertion at the distal end). This type of control operation is referred to as the fulcrum effect mode. The fulcrum effect mode can make these devices awkward and counterintuitive in some cases. At least some of the devices and systems described herein solve these technical problems by providing a control output distal to the fulcrum that moves in the same direction as a control input proximal to the fulcrum, referred to herein as the Fulcrum Effect Compensation (FEC) mode. In some embodiments, one or more sensor-equipped joints proximal to the fulcrum are used that indicate the position and orientation of the handle to actuate one or more driven joints distal to the fulcrum to mimic the movement of the handle.

[0018] The devices and systems described herein may also include fulcrum effect mode operation when desired. The technical solutions provided herein include a handle that allows switching between fulcrum effect mode and fulcrum effect compensation (FEC) mode based on inputs at the handle. The handle is located at the bedside and is attached, for example, to a stabilizer or mount, or directly to the bedside. Previous systems and devices with fulcrum effect compensation mode do not provide such simple and compact devices and systems, and instead require significant space in the work area, require a separate stabilizer, and / or require the surgeon to move between the bedside and a remote console. The devices and systems described herein provide intuitive controls while having a compact configuration that allows for bedside positioning. Furthermore, the devices and systems described herein, at least in some embodiments, allow the user to use and switch between multiple working modes without removing their hands from the device's primary control input.

[0019] The control assembly may include one or more inputs for selecting an operating mode (e.g., fulcrum effect mode, fulcrum effect compensation mode, end effector control mode, etc.). The devices and systems described herein may include one or more controllers stored on the control assembly or on a remote computing device. In some embodiments, various ergonomic features allow for a wide range of control inputs from a single control assembly.

[0020] 1A , the “fulcrum effect” operation of the fulcrum effect compensation device 100 defines the inverse control of the distal portion 112 of the medical instrument 106 (optionally including the end effector 114) relative to the handle 120. In other words, a leftward position change of the handle 120, also referred to as the input position, produces a rightward position change of the distal portion 112 of the medical instrument 106, also referred to as the output position. Furthermore, an upward position change of the handle 120 produces a downward position change of the distal portion 112 of the medical instrument 106. The ratio of the position change between the handle 120 and the distal portion 112 of the medical instrument 106 is based on the ratio of the length of the distal portion 112 to the length of the proximal portion 110 of the medical instrument 106. For example, when the length of the distal portion 112 of the medical instrument 106 is half the length of the proximal portion 110, a position change of the handle of approximately 2.00 cm (0.78 in) to the left can produce a position response of the distal portion 112 of the medical instrument 106 to the right of approximately 1.00 cm (0.39 in).

[0021] As used herein and as shown in FIG. 9 , the fulcrum effect compensation operation of the fulcrum effect compensation device 100 defines a corresponding control of the distal portion 112 of the medical instrument 106 relative to the handle 120. In other words, a leftward position change of the handle 120, also referred to as the input position, produces a leftward position change of the distal portion 112 of the medical instrument 106, also referred to as the output position. Furthermore, an upward position change of the proximal portion 110 of the medical instrument 106 produces an upward position change of the distal portion 112 of the medical instrument 106. The mimicking of the handle 120 by the distal portion 112 of the medical instrument 106 can be scaled. For example, the mimicking of the handle 120 and the distal portion 112 of the medical instrument 106 can be approximately 10:1, 8:1, 6:1, 4:1, 2:1, 1:1, 1:2, 1:4, 1:6, 1:8, or 1:10. As described herein with respect to various embodiments, fulcrum effect compensation can be achieved through the use of electronically assisted operation, for example, through the use of a control assembly and a sensor assembly that includes an instrument actuator interface.

[0022] Generally, the devices and systems described herein include a handle or mechanism that allows switching between fulcrum effect mode and fulcrum effect compensation (FEC) mode. As shown in FIG. 1B , a system 10 for performing minimally invasive surgery includes a medical instrument 6 having an elongated body, an optional wrist assembly 16, and an optional end effector 14. The optional end effector 14 may be coupled to the medical instrument 6 by the optional wrist assembly 16. The optional wrist assembly 16 may be utilized by the system 10 to change the position or orientation of the optional end effector 14 relative to the medical instrument 6. The system 10 may further include a control assembly 18 that includes a handle 20 and an instrument actuator interface 22 that together enable switching between fulcrum effect compensation mode and fulcrum effect mode. The instrument actuator interface 22 coupled to the medical instrument 6 may include motors, mechanisms, etc. for operating the medical instrument 6, as described elsewhere herein. Additionally, in some operational embodiments, the handle 20 may be reversibly coupled to the instrument actuator interface 22, as described elsewhere herein. In some implementations, the control assembly 18 includes an input 23 for placing the system 10 in a fulcrum effect mode and an input 25 for placing the system 10 in a fulcrum effect compensation mode. For example, the inputs 23 and 25 can be mechanical switches (e.g., buttons, toggles, sliders, etc.) or separate gripping portions of the handle 20 that release the handle 20 or attach to the instrument actuator interface 22. Additionally or alternatively, the inputs 23 and 25 can operate electromechanical control mechanisms that activate motors, sensors, processors, etc. to switch between modes via the device. In other implementations, the input 23 is for switching between the fulcrum effect mode and the fulcrum effect compensation mode, while the input 25 is for operating the end effector of the system. The inputs 23 and 25 can be mechanical switches (e.g., buttons, toggles, sliders, joysticks, etc.) or separate gripping portions of the handle 20 that switch between modes and operate the end effector, respectively.

[0023] Additionally, as shown in FIG. 1B , the system 10 may optionally include a stabilizing device 2. The optional stabilizing device 2 may at least partially support the weight of the medical instrument 6, the handle 20, and / or the instrument actuator interface 22. In some implementations, the optional stabilizing device 2 defines a remote center of motion (e.g., pivot point 124 in FIG. 1A ). The optional stabilizing device 2 may have a base member fixedly coupled to or relative to a patient support device (e.g., a bed, operating table, wall, floor, frame, etc.). The stabilizing device 2 may enable movement of the supported surgical instrument in one, two, three, or more degrees of freedom. The stabilizing device allows a user to move the surgical device in substantially the same manner as the device could be moved without the use of the stabilizing device. In some implementations, as described herein, the stabilizing device may also limit movement of the surgical device (when worn) in one or more of the associated degrees of freedom to a predetermined range of motion to enable movement of the surgical device at the remote center of motion. In addition to supporting at least a portion of the weight, this motion restriction serves to guide and / or limit the motion of the distal tip of the attached surgical device within a predetermined range of motion. That is, setting the joints of the stabilizer by limiting the motion of the attached surgical instrument to a range of motion about a pivot point for minimally invasive access, also known as remote motion center setting, facilitates surgery. Through an appropriate user input device, such as a multiple degree-of-freedom (DOF) handle that is part of the device in the example described herein, the surgeon may directly control the position and / or orientation of the end effector of the attached surgical device. With the entire motion device limited and supported by the remote motion center mechanism, the stabilizer has the capability to allow the surgeon to control the position of the distal portion or tip of the medical instrument via the handle in substantially the same manner as a hand-operated instrument.

[0024] As used herein, a remote center of motion (RCM) is understood to refer to a configuration in which a series of joints or degrees of freedom pivot around a single point to which no mechanism (e.g., a stabilizer in this example) is physically connected. RCM can be used for minimally invasive surgical access because it allows surgical instruments to enter a fixed body through a single point (referred to herein as a pivot point or fulcrum) while still allowing the surgical instruments to move within this limit. This configuration helps prevent surgical instruments from slipping at the point of entry into the patient's body (often the abdominal wall), thereby preventing damage to the soft tissue at or around this point. RCM can be achieved either through mechanical joints or software-enforced limits. Joints are typically actuated or driven to achieve a software-enforced RCM. While described with reference to one possible type of surgery, the systems described herein can be used for surgeries where minimally invasive access is feasible and need not be limited to surgeries currently performed via minimally invasive approaches. Additionally, systems in which the remote center of motion is located outside the patient, such as transoral robotic surgery (TORS), can also be used.

[0025] In any alternative embodiment, and as shown in FIG. 1A , any or all of the three RCM joints 104a, 104b, 108 may include suitable damping devices, such as electronically or mechanically controlled brakes, for additional functionality, such as the ability to actively damp any or all joints for fine motor control, virtual fixturing to prevent damage to tissue distant from the surgical site, or the ability to lock one or more joints during a given surgical task. The ability to selectively lock and unlock one or more joints may, for example, allow the surgeon to hold tissue in a specific position or allow the RCM mechanism to maintain its precise position during an instrument change. The advanced features discussed above, such as joint damping, joint locking, or virtual fixturing, may be controlled by the surgeon by multiple mechanisms, for example, via buttons, switches, knobs, etc. This mechanism may be included on a surgical handle, on a touchscreen located within the surgeon's reach, via a foot pedal, etc. In alternative embodiments, the advanced features may be activated by a surgical assistant. In alternative embodiments, any or all of the RCM joints may be powered through the inclusion of actuators such as motors, either integrated into each joint for direct drive or located remotely from the joint and driven via a transmission system, for example using a cable or belt or gear system. Powering the RCM mechanism, in conjunction with sensor equipment (i.e., adding sensors to each joint), may enable more advanced functionality such as active haptic feedback, full teleoperation (where the surgeon controls the robotic unit via a console), or semi-autonomous or fully autonomous surgical tasks.

[0026] As used herein, a stabilizer may be transitionable between a fixed state or setting and an unlocked state or setting. In an unlocked state or setting, the stabilizer is capable of movement about each of the stabilizer's joints. In a locked state or setting, one or more joints of the stabilizer are locked, thereby preventing movement of the stabilizer about one or more of the locked joints. The embodiments of FIGS. 1A and 2-9 may include a stabilizer 102 with RCM capabilities during fulcrum effect mode (i.e., including synchronized movement of the joints 104a, 104b, 108 as described herein). When the stabilizer 102 is locked for fulcrum effect compensation mode, the stabilizer 102 may lock the joints 104a, 104b, 108. 10A-12, 16-25, 26-28 that include linear guides (e.g., linear guides 212, 412, 614) may include a stabilizer 102 with RCM functionality during fulcrum effect mode (i.e., including synchronized operation of joints 104a, 104b, 205 as described herein). When stabilized for fulcrum effect compensation mode, the stabilizer 102 may lock the joints 104a, 104b, 205. In some cases, to adjust the fulcrum, the stabilized joints 108 may be selectively locked and unlocked while the joints 104a, 104b remain locked.

[0027] FIG. 1C depicts a schematic for performing a fulcrum effect compensation task, including an instrument actuator interface 122, a controller 182, a sensor assembly 184, and a medical instrument 186. The instrument actuator interface 122 includes a power actuation unit 180. The sensor assembly 184 may include one or more position sensors. The sensor assembly 184 measures or monitors the position of one or more joints actuated by the handle, such that the medical instrument 186 is actuated based on the position of the one or more joints. Sensor signals output by the sensor assembly 184 are received by the controller 182. The controller 182 may output signals to the instrument actuator interface 122, which may include one or more power actuation units 180. These output signals from the controller 182 activate the one or more power actuation units 180 to manipulate the medical instrument 186, e.g., a distal portion of the medical instrument. When performing a fulcrum effect compensation task, the position of the distal portion of the medical instrument 186 mimics the position of the handle, an input mechanism of the handle, and / or one or more sensor-equipped joints associated with the handle. Further, the movement of the distal portion of the medical instrument 186 mimics the position of the handle, the handle's input mechanism, and / or one or more sensor-equipped joints associated with the handle. Thus, from the user's perspective and in fulcrum effect compensation mode, when the handle's input mechanism, the handle, and / or one or more sensor-equipped joints associated with the handle tilt or move to the left, the medical instrument 186 also tilts or moves to the left. Further illustratively, when the input mechanism, the handle, and / or one or more sensor-equipped joints associated with the handle tilt or move to the right, the medical instrument 186 also tilts or moves to the right. Further illustratively, when the input mechanism, the handle, and / or one or more sensor-equipped joints associated with the handle tilt or move upward, the medical instrument 186 also tilts or moves upward. Further illustratively, when the input mechanism, the handle, and / or one or more sensor-equipped joints associated with the handle tilt or move downward, the medical instrument 186 also tilts or moves downward.

[0028] The sensor-equipped joints described herein include position sensors that measure the orientation and / or position of one or more portions of a device or system (see, e.g., FIGS. 3A-4B, 9, 17-19, 26-29). For example, a sensor-equipped joint can be included in a stabilization device such that motion of the joint about a yaw, pitch, and / or roll axis can be determined or actuated (e.g., FIGS. 3A-4B). Further illustratively, a sensor-equipped joint can be operable in a fulcrum effect compensation mode such that the position of the joint can be determined and a medical instrument can be actuated based on the measured position. Examples of position sensors can be optical encoders, potentiometers, magnetic encoders, capacitive encoders, linear encoders, rotary encoders, or other suitable sensors known in the art.

[0029] A driven joint, actuator, or other mechanism driven by one or more power actuation units described herein may also include a position sensor. The included position sensor may be a potentiometer, optical encoder, or other suitable sensor known in the art. Measuring the position of the driven joint, actuator, or mechanism may be required for control feedback in a controller to ensure accurate positioning of the distal portion of the medical instrument.

[0030] Global motion, as described herein, may be defined as device motion other than fulcrum effect compensation and end effector control mode motion. For example, global motion may include linear motion modes, fulcrum effect motion, control assembly motion, and / or medical instrument motion to position the medical instrument for a pending task. Global motion may use the stabilizer in a non-rigid state or configuration such that the stabilizer joints are operable (see, e.g., FIGS. 3A-5B).

[0031] The medical instruments described herein can have an elongate body portion that can distally terminate in any end effector, which can include graspers, forceps, scissors, suturing devices, cutting tools, ablation elements, freezing elements, cameras, needle drivers, electrocautery tools, and the like. Additionally, the medical instruments described herein can be operatively coupled to and operated by an instrument actuator interface.

[0032] Systems and Devices The general features and structure of the embodiments described herein have been described above with respect to Figures 1B-1C. Now, exemplary embodiments will be described below in accordance with Figures 1A and 2-31.

[0033] 1A depicts an embodiment of a fulcrum effect compensation device 100. The device 100 includes a stabilization apparatus 102, a control assembly 118, and a medical instrument 106.

[0034] The control assembly 118 may include a handle 120, an instrument actuator interface 122, and, optionally, an insertion tube, shaft, or sleeve 140. The handle 120 may have one or more control inputs, such as an input mechanism 126. The instrument actuator interface 122 is detachably coupled to the handle 120. Furthermore, the instrument actuator interface 122 may be operably coupled to the base portion 107 (e.g., shown in FIG. 2 ) and / or the sleeve 140 of the medical instrument 106. The instrument actuator interface 122 may include, for example, a power actuation unit for transferring power across the connection between the instrument actuator interface 122 and the sleeve 140 and / or for transferring power across the connection between the instrument actuator interface 122 and the medical instrument 106. The sleeve 140 may include rails or tracks along which the handle 120 slides when decoupled from the instrument actuator interface 122. As shown in FIG. 2, the sleeve 140 defines a groove or slot 101 within which the coupling portion 129 of the handle 120 can slide, thereby locking the roll orientation of the handle 120 and the sleeve 140. The sleeve 140 can include one or more sensor-equipped joints 160a, 160b (shown in FIG. 9). The one or more sensor-equipped joints 160a, 160b secure and hold portions of the sleeve 140 concentric with one another (shown in FIGS. 1, 2, 6, and 7). The sensor-equipped joints 160a, 160b can be locked (shown in FIG. 8) until the handle 120 is decoupled from the instrument actuator interface 122 and slid proximally past the sensor-equipped joints 160a, 160b. An input at the handle 120 and / or the act of sliding the handle 120 proximally past the sensor-equipped joints 160a, 160b can unlock the sensor-equipped joints 160a, 160b. Some embodiments may include a sleeve 140 with a first portion 119 that is part of the stabilization device. The first portion 119 is distal to the control assembly 118. The sleeve 140 in these embodiments has a second portion 121 that is adjacent to the control assembly 118, and the second portion 121 may be considered part of the control assembly 118. The second portion 121 of the sleeve 140 may include sensor-equipped joints 160a, 160b.Alternatively, the sleeve 140 may be considered part of the stabilizer 102 in some embodiments, and part of the control assembly 118 or handle 120 in other embodiments.

[0035] For example, the locking mechanism for the sensor-equipped joints 160a, 160b can be a directional switch mechanism that can loosen the sensor-equipped joints 160a, 160b when flipped in one direction and re-stiffen the sensor-equipped joints 160a, 160b when flipped in the other direction. Sliding of the handle 120 distally over the sensor-equipped joints 160a, 160b can optionally occur when the portions of the sleeve 140 coupled to each sensor-equipped joint are held concentric with one another, so that the portions of the sleeve 140 are positioned in the proper orientation to lock the sensor-equipped joints. The control assembly 118 can include a controller in or proximal to the handle 120. Additionally, the controller can be located remotely. The controller can include computing capabilities, such as a processor, and can be communicatively coupled to control inputs of the device 100 and / or the handle 120.

[0036] As shown in FIGS. 1A and 2, the device 100 includes a medical instrument 106. The medical instrument 106 includes a distal portion 112, a proximal portion 110, a base portion 107, an optional end effector 114, and an optional wrist assembly 116. As further shown in FIG. 1A, the distal portion 112 and the proximal portion 110 are separated by a pivot point 124. The pivot point 124 can be a predetermined point or can be available or created at the point where the device 100 is inserted into a patient. In some implementations, the pivot point 124 can be a point proximal to, within, or aligned with a trocar or introducer. The distal portion 112 of the medical instrument 106 can include one or more driven joints 162a, 162b (shown in FIG. 9). One or more of the driven joints 162a, 162b, including mechanisms described elsewhere herein, may be actuated by cables, pull wires, or other mechanisms housed within the medical instrument 106. Mechanisms for cable or pull wire actuation, as described elsewhere herein, may be housed within the base portion 107 of the medical instrument 106. A mechanism within the end portion of the medical instrument 106 may receive actuation forces at a connection with the instrument actuator interface 122. Both any end effector 114 and any wrist assembly 116 coupling the end effector 114 to the medical instrument 106, as well as the driven joints 162a, 162b, may be actuated by cables or pull wires within the medical instrument 106. Manipulation of the driven joints 162a, 162b and any wrist assembly 116 ultimately manipulates the position of any end effector 114. Manipulation of any wrist assembly 116 may be advantageous in positioning any end effector 114 during use.

[0037] As shown in FIGS. 1A, 3A, 3B, 4A, and 4B, device 100 includes a stabilizing device 102. Stabilizing device 102 functions to support the weight of control assembly 118 and medical instrument 106. Additionally, stabilizing device 102 allows for overall movement for positioning control assembly 118, and therefore medical instrument 106. In some variations, stabilizing device 102 may include a first arm 103a terminating in a rotational movement mechanism or joint 104a (see, e.g., rotational movement of arm 103b about axis 130 shown in FIGS. 3A and 3B). FIG. 3A illustrates clockwise rotational movement 128 about joint 104a to a first position. FIG. 3B illustrates counterclockwise rotational movement 128 about joint 104b to a second position. Rotational movement of arm 103b relative to arm 103a about joint 104a and axis 130 is the first degree of freedom of the stabilizer 102. The stabilizer 102 may further include a second arm 103b and a third arm 103c. The first arm 103b may include a first linkage set, and the second arm 103c may include a second linkage set, the first and second sets collectively forming a parallelogram motion mechanism. As shown in FIGS. 4A and 4B , the parallelogram motion mechanism of arms 103b and 103c functions to provide coordinated movement, indicated by arrow 132, of the first joint 104a, the second joint 104b, and the stabilized joint 108 about pitch axis 137. Movement about pitch axis 137 is the second degree of freedom of the stabilizer 102. Figure 4A illustrates positioning of the control assembly 118 and the proximal portion 110 of the medical instrument 106 via the stabilizing device 102 in a lowered position about axis 137. Figure 4B illustrates positioning of the control assembly 118 and the proximal portion 110 of the medical instrument 106 via the stabilizing device 102 in a raised position about axis 137. In some embodiments, the stabilizing device 102 further includes a sleeve 140 (e.g., including a prismatic joint) that allows linear movement or a third degree of freedom of the stabilizing device 102, as described in more detail below.

[0038] As shown, the stabilizer 102 includes a first joint 104a connecting a first arm 103a to a second arm 103b and a third arm 103c (which, in some embodiments, jointly form a parallelogram motion mechanism). The first joint 104a may function as a rotational motion joint. For example, as shown in FIGS. 1A, 3A, and 3B, the second arm 103b and the third arm 103c may jointly perform a rotational motion 128 about a yaw axis 130 (shown in FIGS. 3A and 3B) relative to the first arm 103a and perpendicular to the horizontal plane 94 (e.g., motion about the yaw axis 130, which is perpendicular to the horizontal plane 94). Additionally, the first joint 104a may include a hinge mechanism that cooperatively enables motion, indicated by arrow 132, of the second arm 103b and the third arm 103c relative to the first joint 104a about a pitch axis 137, as shown in FIGS. 4A and 4B. As described above, the second arm 103b and the third arm 103c form a parallelogram motion mechanism such that the second arm 103b and the third arm 103c move relative to the arm 103a through coordinated movement of the joints 104a, 104b, and 108. The stabilizing joint 108 allows for pitch adjustment of the medical instrument 106 relative to the stabilizer 102. As shown in FIG. 1A , the adjustment plane 183 of the pitch adjustment effected by the stabilizing joint 108 is perpendicular to the horizontal plane 94.

[0039] Some embodiments include RCM capabilities achieved at the joints 104a, 104b, and 108 of the stabilizer 102. Embodiments with RCM capabilities may include synchronously actuated joints 104a, 104b, and 108. The synchronized movement of the joints 104a, 104b, and 108 may be coupled by mechanical linkages (e.g., parallelogram motion mechanisms) or gears. For embodiments with a stabilizer 102 including motorized RCM joints 104a, 104b, and 108, the synchronized movement of the joints 104a, 104b, and 108 may be via output from a controller that moves each joint 104a, 104b, and 108 relative to one another to maintain a remote center of motion. Whether mechanical or motorized, embodiments with RCM capabilities include synchronized joints 104a, 104b, and 108 that are aligned to maintain a remote center of motion while the instrument is manipulated or positioned. Additionally, the stabilizer 102 may be temporarily fixed in any position. The stabilizer 102 may be locked when the controller receives a corresponding input signal. For example, the input signal may be generated by an input to the handle, and upon receiving the input signal, the controller generates an output signal to lock the stabilizer 102. The stabilizer 102 may be unlocked after the controller receives the same input signal from the handle, or alternatively, a different input signal from the handle. The stabilizer 102 is intended to be securely attached to a linkage 151, as shown in FIGS. 1A, 2-5B, 8-10A, 11, 12, 16-19, 25-29. The linkage 151 may include a bedside, wall, frame, floor, or ceiling mount, or other suitable fixture.

[0040] The device 100 functions in one or more operating modes. The first mode, referred to herein as the fulcrum effect mode, defines a device configuration that enables the aforementioned adjustments of the joints 104a, 104b, and 108 of the stabilizer 102 shown in FIGS. 1A, 3A, 3B, 4A, and 4B. In some embodiments, the adjustments about the joints 104a, 104b, and 108 of the stabilizer 102 can be manual. For example, when the device 100 is used in a minimally invasive procedure, the fulcrum, remote center of motion, or pivot point 124 can occur at a predetermined point or at the point where the device 100 is inserted into the patient's body. The pivot point 124 (i.e., remote center of motion) can include the common intersection of the yaw axis 130 (shown in FIGS. 3A and 3B), pitch axis 137 (shown in FIGS. 4A and 4B), and longitudinal axis 150 (shown in FIG. 1A) of the medical instrument 106. In some implementations, the pivot point 124 can be a point adjacent to, within, or aligned with the trocar. Movement of the medical instrument 106 about the pivot point 124 can result in a fulcrum effect, for example, when positioning the distal portion 112 of the medical instrument 106 or the end effector 114 of the medical instrument 106. The fulcrum effect mode can also include actuation of the end effector 114 as described in FIGS. 6-7. The fulcrum effect mode of the device 100 can be used during a procedure or can also be used for overall movement of the device, for example, in positioning for a pending procedure.

[0041] In some embodiments, the control assembly 118 includes an input mechanism 142 (shown in FIG. 6 ) disposed at or near the handle 120. While the input mechanism 142 is shown as a button, a dial, joystick, switch, or the like may also be used without departing from the scope and spirit of the present disclosure. The input mechanism 142 may be used to actuate the end effector 114. For example, in embodiments including a grasper-type end effector 114, as shown in FIG. 1A , depression or actuation of the input mechanism 142 may cause the end effector 114 to grasp. Furthermore, release of the input mechanism 142 may release or open the grasping mechanism of the end effector 114. In some implementations, the end effector 114 may include an ablation element, a freezing element, a cutting element, a suturing element, a perforating element, a milling element, an electrocautery element, or the like, such that actuation of the input mechanism 142 may initiate ablation, freezing, cutting, suturing, perforating, milling, electrocautery, or the like.

[0042] In some variations, any second mode, or any portion of any of the modes described herein, also referred to herein as end effector control modes, may be implemented by any of the devices described herein. For example, any end effector control mode, when enabled, causes the wrist assembly 116 (shown in FIG. 1A ) of the end effector 114 to be controlled by the control assembly 118. In some embodiments, the control assembly 118 includes an input mechanism 126 (shown in FIGS. 6 and 7 ) for manipulating the medical instrument 106 and the wrist assembly 116 of the end effector 114. While a joystick is shown for the input mechanism 126, dials, knobs, switches, and the like may also be used without departing from the scope and spirit of the present application. As shown in FIG. 6 , the input mechanism 126 is rotatable about a roll axis 144. In some embodiments, rotating the input mechanism 126 in a clockwise direction 148 may rotate the medical instrument 106 in a clockwise direction 146 about its longitudinal axis 150 (or may rotate the wrist assembly 116 about the longitudinal axis 150). Additionally, rotating the input mechanism 126 in a counterclockwise direction (opposite the clockwise direction 148) may rotate the medical instrument 106 about the longitudinal axis 150 (or may rotate the wrist assembly 116 about the longitudinal axis 150) in a counterclockwise direction (opposite the clockwise direction 146). Rotating the medical instrument 106 (or the wrist assembly 116) may ultimately change the orientation of the end effector 114. In some embodiments, the input mechanism 126 includes an electromechanical attachment to the control assembly 118 similar to that of joysticks known in the art.

[0043] 7 , when pitching the input mechanism 126 about a first or pitch axis 154 and / or a second or yaw axis 156, the wrist assembly 116 may pitch the end effector 114 about an end effector first or pitch axis 152 and / or an end effector second or yaw axis 158, respectively, to mimic the position of the input mechanism 126. For example, if the input mechanism 126 is pitched downward about the pitch axis 154, the wrist assembly 116 may pitch the end effector 114 downward about the pitch axis 152. Furthermore, if the input mechanism 126 yaws about the yaw axis 156, the wrist assembly 116 may yaw the end effector 114 in the same direction about the yaw axis 158. As described elsewhere herein, the end effector control mode may optionally be used in conjunction with the fulcrum effect mode or the fulcrum effect compensation mode.

[0044] 1A and 3A-7 illustrate device 100 in a fulcrum effect mode, combined with any end effector control mode in FIG. 7. Device 100 may also function in a third mode, also referred to herein as a fulcrum effect compensation (FEC) mode. As shown in FIG. 8, device 100 may enter fulcrum effect compensation mode by decoupling handle 120 of control assembly 118 from instrument actuator interface 122 and translating handle 120 rearward along sleeve 140. In fulcrum effect compensation mode, stabilizer 102 may be immobilized. Translating handle 120 along sleeve 140 may enable one or more sensor-equipped joints 160a, 160b. These sensor-equipped joints 160a, 160b may include one or more position sensors, housed by a controller in instrument actuator interface 122, that measure the position of the respective joints 160a, 160b. When the device 100 is in FEC mode, the instrument actuator interface 122 can adjust one or more driven joints 162a, 162b of the medical instrument 106 to mimic the position of the sensor-equipped joints 160a, 160b and / or the handle 120, as shown in FIG. 9 . The FEC mode creates a mimicking control map in which inputs at the handle 120 cause movement of the one or more sensor-equipped joints 160a, 160b. The position of each joint 160a, 160b is measured or monitored by a sensor assembly and received by a controller. The controller outputs actuation signals to the one or more driven joints 162a, 162b to position each of the one or more driven joints 162a, 162b to mimic the position of each joint 160a, 160b, respectively. For example, the mimicking plane 95 for the mimicking control map can be the pivot point 124 of FIG. 1A or anywhere along the length of the medical instrument 106. The mimic plane 95 may be perpendicular to the longitudinal length of the medical device 106, as shown in Figure 1 A. The described controls are more intuitive than those described for the fulcrum effect mode.For example, and referring to FIG. 9 , the measured position of the sensor-equipped joint 160a is mimicked by the driven joint 162b, and the measured position of the sensor-equipped joint 160b is mimicked by the driven joint 162a. Furthermore, the device responds to measured movement of the handle 120 to the left by moving the end effector 114 to the left. Furthermore, if it is desired to change the pitch of the distal portion 112 of the medical instrument 106, the handle 120 can pitch in the desired pitch direction. The mimicking of movement of one or more sensor-equipped joints 160a, 160b by one or more driven joints 162a, 162b can be scaled. For example, the mimicking of movement between the sensor-equipped joints 160a, 160b and the driven joints 162a, 162b can be approximately 10:1, 8:1, 6:1, 4:1, 2:1, 1:1, 1:2, 1:4, 1:6, 1:8, or 1:10. Device 100 can be used in a fulcrum effect compensation mode and also in an end effector control mode. In other words, device 100 can perform fulcrum effect compensation movements at the distal portion 112 of medical instrument 106 while simultaneously performing pitch, yaw, and roll movements of end effector 114. Additionally, when in fulcrum effect compensation mode, but also during fulcrum effect mode, it can be beneficial for device 100 to advance ( FIG. 5A ) and retract ( FIG. 5B ) medical instrument 106 as indicated by arrow 123 in FIGS. 5A and 5B . Medical instrument 106 can be coupled to an instrument actuator interface 122, which can be operably coupled to a sleeve 140. Operable coupling of instrument actuator interface 122 to sleeve 140 can drive instrument actuator interface 122 along the length of sleeve 140. 5A and 5B, actuation of the instrument actuator interface 122 along the sleeve 140 while coupled to the medical instrument 106 results in advancement and retraction of the medical instrument 106 along arrow 123. In some embodiments, the position of the instrument actuator interface 122 along the length of the sleeve 140 is related to the position of the handle 120 along the length of the proximal portion 170 of the sleeve 140.The proximal portion 170 of the sleeve 140 is the portion proximal to the sensor-equipped joint 160b. The proximal portion 170 of the sleeve 140 may include one or more position sensors. The position sensors measure the position of the sleeve 140 (and thus the enabled joints 160a, 160b) based on the movement of the handle 120. The position signals are received by the controller, which outputs control signals via the instrument actuator interface 122 to drive the joints 162a, 162b to the mimicked positions, as described elsewhere herein.

[0045] FIG. 2 depicts an embodiment of the device 100 in which a medical instrument 106 is mounted on the device 100. As shown, the stabilizer 102, or in some embodiments, a sleeve 140 operably coupled to an element of the stabilizer 102, defines a lumen 105 through which the elongate body of the medical instrument 106 may slide. A base portion 107 of the medical instrument 106 defines an opening 109 that receives the sleeve 140, with a portion of the lumen 105 defined by the sleeve 140. The medical instrument 106 may slide back and forth over the length of the sleeve 140, but is secured to the sleeve 140 for roll (seen in FIG. 6) or rotation about a longitudinal axis 150 of the sleeve 140. The handle 120, as shown, defines an opening 125 that allows passage of the base portion 107 of the medical instrument 106. Opening 125 in handle 120 includes a coupling portion 129 that engages with slot 101 defined by sleeve 140. In this configuration, when handle 120 is disengaged from instrument actuator interface 122, it is capable of sliding back and forth along the length of sleeve 140, but is fixed to the sleeve for rotation about roll axis 150 (seen in FIG. 6) of sleeve 140.

[0046] 5A and 5B depict embodiments of the device 100, illustrating the overall motion of advancing ( FIG. 5A ) and retracting ( FIG. 5B ) the medical instrument 106. The overall motion of the medical instrument 106 can occur while the handle 120 is coupled to the instrument actuator interface 122, which in turn is coupled to the medical instrument 106. Advancing or retracting the medical instrument 106 while the handle 120 is coupled to the instrument actuator interface 122 can be performed during a fulcrum effect mode. Advancing the medical instrument 106, as shown in FIG. 5A , and retracting the medical instrument 106, as shown in FIG. 5B , can be performed during a fulcrum effect mode by adjusting the joints 104 a, 104 b, and 108 of the stabilizer 102. Some embodiments include a linear motion mode for sliding the handle 120 and the instrument actuator interface 122 while coupled together and while the joints 104 a, 104 b are fixed. The linear motion mode can be entered by actuation of an input mechanism on the handle 120. The mechanism for sliding the handle 120 and the instrument actuator interface 122 back and forth on the sleeve 140 can be achieved by placing the drive mechanism at the connection between the instrument actuator interface 122 and the sleeve 140 in a neutral position (i.e., disengaged from the power actuation unit). In instances where the linear mode of operation is independent of the fulcrum effect mode or the fulcrum effect compensation mode, the stabilizer 102 can be fixed.

[0047] In instances where the linear mode of operation is used in conjunction with the fulcrum effect mode, the friction between the instrument actuator interface 122 and the sleeve 140 (e.g., with the drive mechanism in a neutral position) is less than the friction (adjusted for leverage) at the joints 104a, 104b (shown in FIG. 1A ) of the stabilizer 102. This difference in friction allows for advancement and retraction of the instrument actuator interface 122, handle 120, and medical instrument 106 relative to the stabilizer 102. To further facilitate fulcrum effect mode operation at the stabilizer joints 104a, 104b, the mechanism at the connection between the instrument actuator interface 122 and the sleeve 140 may include a damping mechanism controlled by the input mechanism on the handle 120. The damping mechanism at the connection between the instrument actuator interface 122 and the sleeve 140 may typically be engaged to facilitate fulcrum effect mode operation alone as the default. When a dedicated input mechanism is engaged, the damping mechanism disengages, enabling operation in the linear mode of operation. Alternatively, the reverse may be used instead. For example, the braking mechanism may normally be disengaged to facilitate operation in a default linear mode of operation, and activation of a dedicated input mechanism may engage the braking mechanism and terminate the linear mode of operation. The braking mechanism may be a literal braking mechanism (e.g., as known in the art) at the connection between the tool actuator interface 122 and the sleeve 140, or may be a mechanism at the connection between the tool actuator interface 122 and the sleeve 140 mated to a power activation unit.

[0048] As shown in FIG. 1C , the tool actuator interface 122 may include one or more power actuation units 180. One example of such a power actuation unit may be responsible for translating the tool actuator interface along the actuation length 171 of the sleeve 140. When a control signal is received at the tool actuator interface 122 to translate the tool actuator interface 122 along the sleeve 140, an electric motor is activated to power a linear motion mechanism to move the tool actuator interface 122 relative to the sleeve 140. For example, the linear motion mechanism may be a rack and pinion, where the rack is coupled to the sleeve 140 and the pinion is coupled to and driven by the tool actuator interface 122. Another example of a linear motion mechanism may be one or more wheels coupled to and driven by the tool actuator interface 122. Sufficient friction is generated at the interface between the one or more wheels and the sleeve 140 to cause linear motion when the one or more wheels are powered. Additionally, when the medical instrument 106 is coupled to the instrument actuator interface 122, one or more slave actuators may be operably coupled to the one or more corresponding power actuation units 180 (shown in FIG. 1C ). In some embodiments, these slave actuators housed in the base portion 107 of the medical instrument 106 are responsible for actuating the medical instrument 106, for example, during an end effector control mode or a fulcrum effect compensation mode of operation. At the point where the instrument actuator interface 122 couples with the medical instrument 106, the one or more slave actuators may each be coupled to one or more power actuation units. This coupling may be, for example, a gear-to-gear coupling or a friction wheel-to-friction wheel coupling.

[0049] 7 and 9, the medical instrument 106 of the embodiments described herein may be actuated in a number of ways. For example, for embodiments comprising a medical instrument 106 operably coupled to an instrument actuator interface 122, the base portion 107 of the medical instrument 106 may include one or more slave actuators comprising a drive train that receives power transmission from one or more of the power actuation units via a connection with the instrument actuator interface 122. Each of the one or more slave actuators may include a cable spool or pulley that, when powered by the power actuation unit, tensions or relaxes a cable or pull wire within or along the elongate body of the medical instrument 106. These cables or pull wires may be used to perform one or more functions of the medical instrument 106, such as actuating the end effector 114 (e.g., clamping or unclamping a grasping end effector), driving the rotation mechanism of the wrist assembly 116 of the end effector 114 (shown in FIG. 6), actuating the wrist mechanism of the end effector 114 (shown in FIG. 7), or manipulating the driven joints 162a, 162b (shown in FIG. 9). The driven joints of the above or below embodiments may be steerable. For example, the driven joint may have a U-joint mechanism with cables or pull wires locked at a leverage point to the U-joint. Tension in one or more of these cables locked in this manner may result in various articulation movements. The steerable joints can include planar joints, spatial joints, roll rotation joints, vertical joints, roll-motion roll rotation joints, planar sliding joints, vertical sliding joints, roll-motion sliding joints, vertical roll rotation sliding joints, planar roll rotation sliding joints, roll-motion roll rotation sliding joints, planar flexure joints, vertical flexure joints, and roll-motion flexure joints. These steerable joints can be actuated by pull wires, cables, push rods, or concentric rotating tubes.

[0050] 10A, 10B, 11, and 12 illustrate an embodiment of a fulcrum compensation device. The fulcrum compensation device includes a stabilizer 102, a linear guide 212, a medical instrument 206, and a control assembly 218. The stabilizer 102 may function similarly to the stabilizer 102 described with respect to FIGS. 1A, 3, and 4. For embodiments with RCM capabilities, the linear guide 212 may be considered part of the stabilizer 102, such that the joints 104a, 104b, and 205 function synchronously to maintain a remote center of motion, as described for the joints 104a, 104b, and 108 in FIGS. 1A, 3A-4B. The control assembly 218 may include an instrument actuator interface 207, a handle cradle 204, and a handle 220. The handle 220 may be used as the primary control input element and may include the input mechanism 126 of FIG. 1A and the input mechanism 142 of FIG. 6. The input mechanisms 126, 142 may be housed by a controller and carried by an instrument actuator interface 207 to a medical instrument 206 as described with respect to Figures 6 and 7. This embodiment includes a linear guide 212 to which the instrument actuator interface 207 is operatively coupled and to which the handle cradle 204 is operatively coupled. The linear guide 212 may be coupled to the instrument actuator interface 207 to limit movement of the instrument actuator interface 207 along the length of the linear guide 212 (along the path 209).

[0051] For example, and as shown in the cross section of the linear guide 212 in FIG. 10B, the linear guide 212 can include an internal T-track 290 along a portion of its length, which defines the shape of the upper portion of the instrument actuator interface 207 (shown in FIG. 10A). The handle cradle 204 can also be coupled to the linear guide 212 to limit movement along the path 209 (shown in FIG. 10A). For example, the handle cradle 204 (shown in FIG. 10A) can include an upper portion with a T-shape appropriate for the internal T-track 290 within the linear guide 212. In the case where the handle cradle 204 includes a T-shaped upper portion, the handle cradle 204 can rest on the internal T-track 290 proximal to the upper portion of the instrument actuator interface 207. Another example of coupling the handle cradle 204 to the linear guide 212 can be an external T-track 294 (shown in FIG. 10B) defined by the linear guide 212. The external T-track 294 may include a width 298 that is greater than the width 296 of the entrance opening 292 defined by the internal T-track 290. The handle cradle 204 may have a portion that slides into the externally defined T-track 294 to restrict its movement along the path 209 (shown in FIG. 10A ). The instrument actuator interface 207 may be coupled to the internal T-track 290 with wheels or rollers. The wheels or rollers of the instrument actuator interface 207 may provide a suitable connection for translating the instrument actuator interface 207 along the path 209 and may allow the instrument actuator interface 207 to be operably coupled to one or more power actuation units. Additionally, the handle cradle 204 may be coupled to the linear guide 212 by the internal T-track 290 or the external T-track 294 with wheels or rollers. The wheels or rollers of the handle cradle 204 may assist in the translation of the handle cradle 204 along the path 209. The handle cradle 204 may define an opening between the handle cradle 204 and the linear guide 212 that allows passage of the end portion 208 of the medical instrument 206 and the instrument actuator interface 207 .10B, and the openings described allow the handle cradle 204 to pass through the medical instrument 206 and the instrument actuator interface 207. Additionally, when placing the medical instrument 206, the medical instrument 206 can slide up to the instrument actuator interface 207 without colliding with the handle cradle 204.

[0052] 10A, 10B, 11, and 12 include the capability for global movement of the medical instrument 406 to advance and retract. Additionally, global movement of the medical instrument 406 can occur while the handle 220 is coupled to the instrument actuator interface 207, which in turn is coupled to the medical instrument 206. In some implementations, advancing or retracting the medical instrument 206 while the handle 220 is coupled to the instrument actuator interface 207 can be accomplished during a fulcrum effect mode by adjusting the joints 104a, 104b, and 205 of the stabilizer 102. Alternatively, in some variations where the linear mode of operation is independent of the FE and / or FEC modes, the linear mode of operation can be entered by actuation of an input mechanism of the control assembly while the handle 220 is coupled to the instrument actuator interface 207 and the stabilizer 102 is stationary. A mechanism for sliding the handle 220 and the instrument actuator interface 207 back and forth on the linear guide 212 may be provided by mounting a drive mechanism at the connection between the instrument actuator interface 207 and the linear guide 212 in a neutral position (i.e., disengaged from the power actuation unit).

[0053] In instances where the linear mode of operation is independent of the fulcrum effect mode, the stabilizer 102 may be locked. In instances where the linear mode of operation is used in conjunction with the fulcrum effect mode, the friction at the instrument actuator interface 207 and linear guide 212 (e.g., due to a neutral drive mechanism) is less than the friction (which contributes to leverage) at the joints 104a, 104b of the stabilizer 102. The difference in friction allows the instrument actuator interface 207, handle 220, and medical instrument 206 to move forward and backward relative to the stabilizer 102. To further facilitate fulcrum effect mode operation of the stabilizer joints 104a, 104b, the mechanism at the junction between the instrument actuator interface 207 and linear guide 212 may include a locking mechanism controlled by the input mechanism of the handle 220. The locking mechanism at the junction between the instrument actuator interface 207 and linear guide 212 may typically be engaged to facilitate sole fulcrum effect mode operation as the default. When the dedicated input mechanism is engaged, the brake mechanism disengages to allow linear mode operation. Alternatively, the reverse may be used. For example, the braking mechanism may normally be disengaged to facilitate operation in a linear mode of operation as a default, and activation of a dedicated input mechanism engages the braking mechanism to terminate the linear mode of operation. The braking mechanism may be a literal braking mechanism (i.e., one known in the art) or may be a mechanism at the connection between the tool actuator interface 207 and the linear guide 212 to engage the power activation unit.

[0054] FIG. 10A illustrates an embodiment of a fulcrum compensation device 200 in fulcrum effect mode. As described elsewhere herein, the control assembly 218 includes an instrument actuator interface 207 and a handle 220. A handle cradle 204, which ultimately secures the handle 220, is coupled to or near the instrument actuator interface 207. In fulcrum effect mode, the device is maneuverable with degrees of freedom provided by the stabilizer 102 (e.g., as shown in FIGS. 1A, 3A-4B). The handle 220, coupled to or near the instrument actuator interface 207, allows for global motion to be performed at the handle 220 for fulcrum effect mode operations.

[0055] Figure 11 illustrates the embodiment of Figure 10A switched to fulcrum effect compensation mode. The handle cradle 204 is decoupled from the instrument actuator interface 207 and can slide toward the proximal end 750 of the linear guide 212 via a portion of the instrument actuator interface 207 and a proximal end portion of the medical instrument 206. As shown in Figure 11, the instrument actuator interface 207 remains coupled to the medical instrument 206. In this position, the linkage 308 is available. The linkage 308 links the handle 220 to the handle cradle 204 and may include one or more sensor-equipped joints. With the handle 220 in place and the embodiment in fulcrum effect compensation mode, the linkage 308 may be unlocked.

[0056] 12 shows the device 200 in fulcrum effect compensation mode and with the linkage 308 between the handle 220 and the handle cradle 204 unlocked. The linkage 308 is connected to the handle cradle 204 by a first sensor-equipped joint 309, for example, on or off the linkage 308, and to the handle 220 by a second sensor-equipped joint 312. The position and / or orientation of the handle 220 may be measured by one or more position sensors in one or more of the sensor-equipped joints 309, 312, and the measurements may be received by a controller. In response to the measured positions of the sensor-equipped joints 309, 312, the controller may send control signals to actuate the instrument actuator interface 207 to move the driven joints 162a, 162b and position the distal portion 112 and / or end effector 114 of the medical instrument 106 in a position that mimics the position of the handle 220. Further, in some embodiments, the linkage 308 may include two components that can extend or retract the handle 220 toward or away from the handle cradle 204. The expansion joint may also include one or more position sensors, and the position of the expansion joint measured by the one or more sensors may be received by a controller. The position of the expansion joint measured by the one or more position sensors and received by a controller may be mimicked in terms of its position on the linear guide 212 by the instrument actuator interface 207. The controller receives the measured position of the expansion joint and sends control signals to the instrument actuator interface 207 to translate distally and proximally along the length of the path 209 (shown in FIG. 10A ). For example, pushing the handle 220 forward to shorten the length of the linkage 308, as measured, may cause the instrument actuator interface 207 to drive the medical instrument 206 distally from the handle 220 along the path 209. Pulling on handle 220 to lengthen linkage 308 may cause instrument actuator interface 207 to drive medical instrument 206 proximally along path 209 toward handle 220 .Alternatively, the position of the instrument actuator interface 207 relative to the linear guide 212 may be controlled by measuring the position of the handle cradle 204 relative to the linear guide 212. The connection between the handle cradle 204 and the linear guide 212 may include a position sensor (e.g., a roller with an encoder). The controller receives the measured position of the handle cradle 204 and sends control signals to the instrument actuator interface 207 to translate distally and proximally along the length of the path 209 (shown in FIG. 10A ). Additionally, pushing the handle 220 forward may cause the instrument actuator interface 207 to drive the medical instrument 206 distally along the path 209 from the handle 220. Pulling the handle 220 may cause the instrument actuator interface 207 to drive the medical instrument 206 proximally along the path 209 toward the handle 220.

[0057] Alternatively, in FEC mode, the handle cradle 204 may be secured to the instrument actuator interface 207, thereby securing the proximal and distal motion of the handle 220 to the instrument actuator interface 207. In FEC mode, embodiments in which the handle cradle 204 is secured to the instrument actuator interface 207 allow the handle 220 to manipulate the medical instrument 206 for forward and backward movement. In some implementations, securing the handle cradle 204 to the instrument actuator interface 207 results in or requires prerequisites including one or more of the following: a 1:1 scaling factor between handle movement and movement at the distal tip of the medical instrument; similar types and / or geometries of the handle's proximal joint and the medical instrument's distal joint; and / or the distal joints 162 a,b being able to compensate for undesired movement at the handle imparted to the medical instrument.

[0058] The ability to control the position of the instrument actuator interface 207 relative to the linear guide 212 allows for advancement and retraction of the medical instrument 206 during use in fulcrum effect compensation mode. Additionally, some embodiments may include a handle 220 of the type depicted in FIG. 19 (i.e., handle 401). The position and orientation of the handle 220 may be measured as described with respect to FIG. 19.

[0059] 13, 14, and 15 depict an embodiment of a fulcrum effect compensation device 300 including a control assembly 369, a first arcuate track 360, a second arcuate track 358, a control hub 366, an end effector actuator interface 351, and a medical instrument 368. The control hub 366 may be supported by a mechanical or robotic support arrangement that supports at least a portion of the weight of the device 300. The support arrangement of the device 300 may also include the capability to temporarily fix the control hub 366 of the device 300 in a certain position. Additionally, the support arrangement may be similar to the stabilization device 102 of FIGS. 1A, 3A-4B, but does not require the RCM capabilities described. In other embodiments, the control hub 366 may be anchored to the bedside in other ways. The control hub 366 includes an instrument actuator interface 352, a sensor mounting mechanism 354, and a slave actuator 356. In some embodiments, the control hub 366, the sensor-equipped mechanism 354, and / or the instrument actuator interface 352 may function as part of a stabilization system. For example, the control hub 366 and / or the sensor-equipped mechanism 354 may include functionality similar to the revolute joint 104a (shown in FIG. 1A ). For example, as shown in FIGS. 1A and 3B, the control hub 366 and / or the sensor-equipped mechanism 354 enable rotational movement 128 about a yaw axis 130 (shown in FIGS. 3A and 3B ) relative to the instrument actuator interface 352 and perpendicular to the horizontal plane 94 (e.g., movement is about the yaw axis 130 that is perpendicular to the horizontal plane 94).

[0060] The follower actuator 356 and the sensor outfitting mechanism 354 may be constrained to rotate independently relative to the instrument actuator interface 352 about a concentric axis 355. A first arcuate track 360 may be embedded within the sensor outfitting mechanism 354. The connection between the first arcuate track 360 and the sensor outfitting mechanism 354 may be with one or more position sensors (e.g., a roller coupled to an optical encoder, potentiometer, etc.) to measure the position of the first arcuate track 360 relative to the sensor outfitting mechanism 354. The connection between the sensor outfitting mechanism 354 and the instrument actuator interface 352 may include one or more sensors (e.g., a roller and an optical encoder, potentiometer, etc.) to measure the position of the sensor outfitting mechanism 354 relative to the instrument actuator interface 352. A second arcuate track 358 may be operably coupled within the follower actuator 356. For example, the second arcuate track 358 may include a rack that matches the arcuate shape of the second arcuate track 358, and the follower actuator 356 may include a pinion operably coupled to the rack. Alternatively, the driven actuator 356 may include one or more friction wheels in contact with the second arcuate track 358. Further, the driven actuator 356 may be operably coupled to the instrument actuator interface 352. For example, the driven actuator 356 may include a ring engaged with a pinion from the instrument actuator interface 352, or the instrument actuator interface 352 may include one or more friction wheels in contact with the driven actuator 356. One or more power actuation units of the instrument actuator interface 352 may be operably coupled to the pinion or one or more friction wheels at the interface with the driven actuator 356. Additionally, the driven actuator 356 may include one or more power actuation units coupled to the pinion or one or more wheels at the interface with the second arcuate track 358. Alternatively, the control hub 366 may include one or more mechanisms for manipulating each arcuate trajectory, and thus the medical device, as described in International Publication No. WO 2021046658, filed September 14, 2020, which is incorporated herein by reference in its entirety.

[0061] The control assembly 369 may include a handle 362 mounted to a handle cradle 364 by a set of sensor-equipped joints 363, 365, and 367. The position of the handle 362 may be measured at one or more of the joints 363, 365, and 367. For example, the sensor-equipped joint 367 may measure the roll of the handle 362 about the roll axis 359, the sensor-equipped joint 363 may measure the pitch of the handle 362 about the pitch axis 361, and the sensor-equipped joint 365 may measure the yaw of the handle 362 about the yaw axis 357. The measured position of the handle 362 may be received by a controller, and a corresponding control signal may be sent by the controller for control mode operation for the distal portion of the medical instrument.

[0062] 13, 14, and 15, the fulcrum effect compensation device 300 may perform end effector control mode operations as described with respect to FIGS. 6 and 7, for example, in embodiments in which the distal tip 370 includes an end effector. The end effector control mode may be controlled based on the measured position of the handle 362 or one or more input mechanisms of the handle 362 or the device 300. The end effector disposed at the distal tip 370 may be controlled by an end effector actuator interface 351. The end effector actuator interface 351 may be disposed on a medical instrument 368. The end effector actuator interface 351 may include one or more power actuation units. The one or more power actuation units may actuate the end effector as described with respect to FIG. 7. Additionally, the end effector actuator interface 351 may be coupled to a proximal portion 371 of the medical instrument 368, and a distal portion 373 of the medical instrument 368 may be operably coupled to the end effector actuator interface 351. Operable coupling of the medical instrument 368 to the end effector actuator interface 351 may cause the end effector actuator interface 351 to extend and retract a distal portion 373 of the medical instrument 368. The end effector actuator interface 351 may also include the ability to rotate the distal portion 373 of the medical instrument 368 about a longitudinal axis 375. Extending and retracting the distal portion 373 of the medical instrument 368 may be accomplished by one or more friction wheels in contact with the distal portion 373 of the medical instrument 368. The one or more wheels for extending and retracting the distal portion 373 of the medical instrument 368 may be operably coupled to the end effector actuator interface 351 and to one or more power actuation units within the end effector actuator interface 351. Additionally, rotation of the distal portion 373 of the medical instrument 368 about the longitudinal axis 375 may be effected by one or more friction wheels in contact with the distal portion 373 of the medical instrument 368 .One or more wheels for rotating the distal portion 373 of the medical instrument 368 may be operably coupled to the end effector actuator interface 351 and may be operably coupled to one or more power actuation units within the end effector actuator interface 351. The end effector actuator interface 351 may receive output signals from a controller that trigger the end effector control mode process.

[0063] FIG. 13 illustrates an embodiment of the fulcrum effect compensation device in fulcrum effect mode. The second arcuate track 358 can be coupled to a medical instrument 368. In fulcrum effect mode, the arcuate tracks 358, 360 are physically or virtually fixed relative to one another. As the first arcuate track 360 slides in and out relative to the sensor-equipped mechanism 354, the second arcuate track 358 slides in and out relative to the driven actuator 356. The second arcuate track 358 can mimic the movement of the first arcuate track 360 by fixing the first arcuate track 360 to the second arcuate track 358 and placing the drive mechanism at the connection between the driven actuator 356 and the second arcuate track 358 in a neutral or equivalent state. Alternatively, the first arcuate track 360 and the second arcuate track 358 can be virtually fixed together. For example, the position of the first arcuate track 360 relative to the sensor-equipped mechanism 354 may be measured by one or more of the sensors described, and these measurements may be received by a controller. After receiving the position measurements of the first arcuate track 360, the controller sends a control signal to a power actuator within the driven actuator, which moves the second arcuate track 358 to a corresponding position that matches the position of the first arcuate track 360. Additionally, the first arcuate track 360 and the second arcuate track 358 may be physically or virtually fixed together with respect to their angular positions about the axis 355. As described above, fixing the arcuate tracks 358, 360 may be accomplished by physically fixing the first arcuate track 360 to the second arcuate track 358 and placing the drive mechanism of the linkage between the driven actuator 356 and the instrument actuator interface 352 in a neutral or equivalent state. Alternatively, the first arcuate track 360 and the second arcuate track 358 may be virtually fixed together. For example, the angular position of the first arcuate track 360 may be measured relative to the instrument actuator interface 352 by one or more position sensors as described, and these measurements may be received by a controller. After receiving the angular position measurements of the first arcuate track 360, the controller may send control signals to a power actuator in the instrument actuator interface 352 to move the second arcuate track 358 to a corresponding position that matches the position of the first arcuate track 360.The movement of the second arcuate track 358 relative to the described first arcuate track 360 may be directly proportional (i.e., 1:1) or may be scaled, e.g., 2:1, 1.5:1, 1.1:1, 1:1.1, 1:1.5, 1:2, etc. In fulcrum effect mode, the distal tip 370 may comprise an end effector and may be moved like the end effector of the previous embodiment (FIGS. 6 and 7) in fulcrum effect mode. In other words, when the handle 362 is pushed up, the two arcuate tracks 360, 358 move the sensor-equipped mechanism 354 and the slave actuator 356, respectively, to move the distal tip 370 down. When the handle 362 is pushed to the left, the arcuate tracks 360, 358 rotate about the axis 355 to move the tip 370 to the right in a circle.

[0064] FIG. 14 illustrates device 300 in fulcrum effect compensation mode. Upon entering fulcrum effect compensation mode by activating the input mechanism of handle 362, arcuate tracks 360, 358 are no longer fixed together. As shown, when handle 362 is moved to the left, position sensors at the juncture between tool actuator interface 352 and sensor-equipped mechanism 354 measure this position change, and these measurements are received by the controller. Based on the position measurements, the controller outputs control signals to activate the appropriate power-operated units at tool actuator interface 352, thereby rotating slave actuator 356 about axis 355 to a position angularly opposite to the measured position of handle 362. Additionally, when the handle is pushed up, first arcuate track 360 is pressed against sensor-equipped mechanism 354, which measures the position change via the position sensors. The position change measurements are received by the controller, and corresponding output signals are sent to the instrument actuator interface 352 to drive the slave actuator 356 to move the second arcuate path 358 to the opposite position. Because the distal tip 370 is positioned beyond the axis 355 from the handle, rightward motion by the handle causes rightward motion by the distal tip 370, and leftward motion by the handle causes leftward motion from the distal tip 370. The inverse position change of the second arcuate path 358 based on the measured position of the first arcuate path 360 may be directly proportional (i.e., 1:1) or may be scaled, e.g., 2:1, 1.5:1, 1.1:1, 1:1.1, 1:1.5, 1:2, etc. Thus, fulcrum effect compensation mode operation may be performed by this embodiment. Additionally, end effector control mode operation may be performed by this embodiment in either fulcrum effect mode or fulcrum effect compensation mode, e.g., when the distal tip 370 comprises an end effector. In embodiments where an end effector is included at the distal tip 370 and coupled by the wrist mechanism of Figures 1A, 6, and 7, the end effector actuator interface 351 (shown in Figure 12) can manipulate the end effector as described with respect to Figure 7. Additionally, the end effector actuator interface 351 can be used for actuation of the end effector.For example, in an embodiment with a grasper-type end effector 114 as shown in FIG. 1A, the end effector actuation interface 351 may cause the grasping action of the end effector 114. Actuation of the end effector may be performed after the end effector actuation interface 351 receives a corresponding output signal from a controller.

[0065] Figure 15 illustrates an embodiment of a right input motion of the handle 362. As described in Figure 14, the change in position of the handle 362 and corresponding first arcuate track 360 causes an opposite motion in the second arcuate track 358, causing the distal tip 370 to also move to the right.

[0066] 16-25 illustrate an embodiment of a fulcrum effect compensation device including a stabilizer 102, a linear guide 412, a control assembly 415, and a medical instrument 406. The stabilizer 102 may be the stabilizer 102 of FIGS. 1A, 3A-4B. For embodiments with RCM capabilities, the linear guide 412 may be considered part of the stabilizer 102, such that the joints 104a, 104b, and 205 function synchronously to maintain a remote center of motion, as described for joints 104a, 104b, and 108 of FIGS. 1A, 3A-4B. The control assembly 415 includes a handle 401 coupled to a handle cradle 414 and an instrument actuator interface 402. The handle cradle 414 is coupled to a plurality of sensor-equipped linkages housed within the linear guide 412 during fulcrum effect mode. The handle 220 may be used as the primary control input element, which may include input mechanism 126 of FIG. 1A and input mechanism 142 of FIG. 6. 6 and 7, the input mechanisms 126, 142 may be housed by the controller and carried by the instrument actuator interface 207 to the medical instrument 206. The handle 401 and handle cradle 414 define an opening through which the end portion 404 of the medical instrument 406 may slide.

[0067] 16 illustrates an embodiment of a fulcrum effect compensation device in fulcrum effect mode. Handle 401 is locked in the position shown by release mechanism 410. The device 400 shown in fulcrum effect mode is capable of fulcrum effect mode operation as described with respect to FIGS. 1A, 3A-4B.

[0068] 17 illustrates an embodiment of the fulcrum effect compensation device switched to fulcrum effect compensation mode. After the mode switch input mechanism is selected with the handle 401, the release mechanism 410 is released either manually as a latch or electromechanically. When the handle is released, the multiple sensor-equipped linkage 416 (e.g., a delta mechanism) can slide out of the linear guide 412 until the locking plate 420 engages. Once locked in this position, the device 100 is ready for fulcrum effect compensation mode operation.

[0069] 18 illustrates an embodiment of a fulcrum effect compensation device in a fulcrum effect compensation mode. Each of a plurality of sensor-equipped linkages 416 (three are shown, but other numbers, such as two or four, are contemplated herein) includes a first linkage 430 and a second linkage 432. The first linkage 430 is coupled to the fixed plate 420 by a first sensor-equipped joint 436. The first linkage 430 is coupled to the second linkage 432 by a second sensor-equipped joint 438. The second linkage 432 is coupled to the handle cradle plate 434 by a third sensor-equipped joint 440. Each sensor-equipped linkage of the plurality of sensor-equipped linkages 416 includes the capabilities of a sensor-equipped joint described elsewhere herein and, in doing so, may measure the position of the handle 401. These sensor measurements are received by the controller, which outputs corresponding control signals to the instrument actuator interface 402 to actuate the driven joints 162a, 162b, thereby mimicking the position of the handle 401 at the end effector 114. The sensors of the multiple sensor-equipped linkage 416 (e.g., a delta mechanism) are capable of measuring the handle 401 as a point in three-dimensional space, so that the movement of the driven joints 162a, 162b of the medical instrument 406, in combination with the advancement and retraction of the instrument actuator interface 402, mimics the position of the handle 401 at the end effector 114. The movement of the end effector 114 with respect to the handle 401 as described may be directly proportional (i.e., 1:1) or may be scaled, e.g., 2:1, 1.5:1, 1.1:1, 1:1.1, 1:1.5, 1:2, etc.

[0070] FIG. 19 illustrates additional degrees of freedom measurements that may be performed by the handle 401. The handle 401, which may be a gimbal-type handle 401, may be used to control the orientation mechanism of the end effector 114 during end effector control mode operation. As described above, the end effector 114 may rotate about the roll axis 150 (shown in FIG. 6), and the end effector wrist mechanism allows the end effector 114 to pitch about the pitch axis and yaw about the yaw axis (shown in FIG. 7). The handle 401 is rotatably coupled to a sub-cradle 450 at a first joint 454, which is rotatably coupled to a handle cradle 414 at a second joint 456, which is rotatably coupled to a handle cradle plate 434 at a third joint 452. The first joint 454, the second joint 456, and the third joint 452 enable the device 400 to mimic motions with the end effector 114. Additionally, the first joint 454, the second joint 456, and the third joint 452 may include position sensors that can measure the position of each joint 454, 456, and 452. For example, the first joint 454 may measure the roll of the handle 401 about a roll axis 490, the second joint 456 may measure the pitch of the handle 401 about a pitch axis 494, and the third joint 452 may measure the yaw of the handle 401 about a yaw axis 492. A controller that receives these position measurements can then issue control signals (as described with respect to FIGS. 6 and 7) to adjust the end effector 114 in a manner that mimics the orientation of the handle 401.

[0071] The embodiment of Figures 16-25 includes the capability for global movement to advance and retract the medical instrument 406. Global adjustment of the medical instrument 406 when the handle 401 is connected to the instrument actuator interface 402 can be achieved as described with respect to Figures 10A, 10B, 11, and 12.

[0072] FIG. 20 shows a close-up view of the release mechanism 410 of an embodiment of the fulcrum effect compensation device 300 when the sub-cradle 450 is removably coupled to the instrument actuator interface 402 by the release mechanism 410. While coupled to the instrument actuator interface, the second joint 456 and the third joint 452 (shown in FIG. 19) are locked and secured against rotation. Securing the handle 401 in this manner can be advantageous during operation of the device 300 in the fulcrum effect mode. FIGS. 21A and 21B illustrate the maintenance of roll input capability of the handle 401 when locked in the fulcrum effect mode. Because the first joint 454 (shown in FIGS. 19 and 20) remains unlocked when the sub-cradle 450 (shown in FIG. 16) is locked to the release mechanism 410, the handle 401 is still used to induce roll motion that is measured by the first joint 454 and received by the controller. Based on the roll measurements received by the controller, the controller sends a control output to the implement actuator interface 402 to cause the end effector 114 to perform a roll motion that mimics the roll position of the handle 401 .

[0073] 22A and 22B illustrate another possible control input mechanism for actuation of the end effector. For example, a clasp-type end effector 114 (shown in FIG. 6) can mimic the position of paddles 470, 472. The paddles 470, 472, located near the handle, can be biased to the open position (shown in FIG. 22A). The biasing of the paddles 470, 472 can be achieved by spring loading on the paddle hinges 474, 476. Additionally, the paddle hinges 474, 476 can include position sensors (e.g., potentiometers, etc.). By receiving position measurements from the position sensors of the paddle hinges 474, 476, the controller can output corresponding control signals to the instrument actuator interface to manipulate the end effector to mimic the position of the paddles 470, 472. Alternatively, when the paddles are squeezed together, the device's response could be to clamp the clasp-type end effector, for example. Conversely, when the paddle is released, the response of the device may be to open, for example, a clasp-type end effector.

[0074] 23A and 23B illustrate installation of a medical instrument 406 on an embodiment of a fulcrum effect compensation device. As shown, the sub-cradle 450 defines an opening 451 that allows passage of the end portion 407 of the medical instrument 406 between the sub-cradle 450 and the linear guide 412. The medical instrument 406 has an elongated portion 409 that, when inserted into the opening defined in the instrument actuator interface 402, allows the medical instrument 406 to slide up to a contact point between the end portion 407 and the instrument actuator interface 402. At the contact point, the medical instrument 406 is operably coupled to the instrument actuator interface 402. Changing the medical instrument 406 may require disengagement of the medical instrument 406 from the instrument actuator interface 402. Disengagement may be manual or electromechanical via a control input mechanism at or near the handle 401. Upon disengagement, the medical instrument 406 slides out of the instrument actuator interface 402 and a new medical instrument can be installed and operably coupled to the instrument actuator interface 402 .

[0075] Figures 24A, 24B, and 24C illustrate the handle degrees of freedom for the embodiment of Figures 16-20. For example, Figure 24A shows the neutral position of handle 401, Figure 24B illustrates the rotation of handle 401 about yaw axis 492, and Figure 24C illustrates the rotation of handle 401 about pitch axis 496. The illustrated movements and corresponding position measurements are noted in Figure 19.

[0076] 25 illustrates an embodiment of a fulcrum effect compensation device comprising a transparent linear guide 412. The figure depicts a plurality of sensor-equipped linkages 416 in a folded state and at least partially housed within a hollow opening defined by the linear guide 412. Additionally, a fixture plate 420 and a handle cradle plate 434 may be at least partially housed within the hollow opening defined by the linear guide 412.

[0077] 26, 27, and 28 illustrate an embodiment of a fulcrum effect compensation device 600 including a stabilizer 102, a linear guide 614, an instrument actuator interface 602, a medical instrument 606, a sensor-equipped member 601, and a handle 401. The embodiment may include a stabilizer 102 that functions like the stabilizer 102 of FIGS. 1A and 3A-4B, or other bedside settings or devices known in the art. For embodiments with RCM capabilities, the linear guide 614 is considered part of the stabilizer 102, such that the joints 104a, 104b, and 205 function synchronously to maintain a remote center of motion, as described for joints 104a, 104b, and 108 of FIGS. 1A and 3A-4B. The instrument actuator interface 602 may operate the driven joints 162a, 162b and the end effector 114, as described for FIGS. 16-25. Additionally, the handle 401 and orientation of the handle 401 can be used for end effector control modes as described with respect to Figures 19, 21A, 21B, 22A, and 22B. Furthermore, the medical instrument 606 can be installed or modified in a similar manner as described with respect to Figures 23A and 23B.

[0078] FIG. 26 illustrates an embodiment of a fulcrum effect compensation device 600 in fulcrum effect compensation mode. This embodiment utilizes a sensor-equipped member 601 stored in and deployed from a linear guide 614, similar to multiple sensor-equipped linkages as described herein (FIGS. 16-25). The sensor-equipped member 601 may include a first linkage 608 and a second linkage 610. The first linkage 608 may be coupled to the second linkage 610 by a first sensor-equipped joint 603. The second linkage 610 may be coupled to a handle cradle plate 616 by a second sensor-equipped joint 604. In fulcrum effect compensation mode, the position of the handle 401 may be measured by the first sensor-equipped joint 603 and the second sensor-equipped joint 604, as depicted. These position measurements are received by a controller, which in turn outputs control signals to the instrument actuator interface 602 to operate the driven joints 162a, 162b to mimic the position of the handle 401. Additionally, the device may include a sliding plate 612 that is capable of sliding to different positions within and relative to the linear guide 614. The sliding plate 612 may include a position sensor that measures the position of the sliding plate 612 relative to the linear guide 614. An instrument actuator interface 602, operatively coupled to the linear guide 614, is capable of translating back and forth along the length of the linear guide 614 to advance or retract the medical instrument 606. The controller may receive the sensor-measured position of the sliding plate 612 and output a control signal that changes the position of the instrument actuator interface 602 to mimic an adjustment in the position of the sliding plate 612. With this capability, when the handle 401 is manipulated toward the instrument actuator interface 602, the controller may output a control signal to the instrument actuator interface 602 to push the medical instrument 606 out of the handle 401. When the handle 401 is pulled away from the instrument actuator interface 602 , the controller may output a control signal to the instrument actuator interface 602 to pull or manipulate the medical instrument 606 towards the handle 401 .FIG. 27 illustrates an embodiment in which the sliding plate 612 is pressed to a position proximal to the instrument actuator interface 602, where the instrument actuator interface 602 is moved distally from the handle 401 and along the linear guide 614 in direction 755. FIG. 28 further illustrates the configuration of FIG. 27 in which the linear guide 614 is transparent to show the position of the sliding plate 612 and a portion of the first linkage 608 is within the linear guide 614. Some embodiments may include manual sliding of the instrument actuator interface 602 to advance and retract the medical instrument 606. In these embodiments, the sliding plate 612 may be coupled to the instrument actuator interface 602 when the handle is slid back during FEC mode. For example, the sliding plate 612 may slide within a tube 757 coupled to the instrument actuator interface 602 and may be secured to the tube 757 at its proximal end. With the sliding plate 612 secured to a tube 757 coupled to the instrument actuator interface 602, pushing the handle 401 proximally moves the medical instrument 606 proximally, and pulling the handle 401 distally moves the medical instrument 606 distally.

[0079] FIG. 29 illustrates an embodiment of the fulcrum effect compensation device 600 including a first handle 702 and a second handle 704. The first handle 702 can be capable of operating the device in fulcrum effect mode. The second handle 704 can be used for fulcrum effect compensation mode. As such, the first handle 702 can be used when the device is configured for fulcrum effect mode operation, either through manual input or through an input that provides electromechanical mode switching. In addition, the first handle 702 can have the end effector control mode control capabilities described herein to perform end effector control mode operations during fulcrum effect mode operation. The second handle 704 can be used when the device is configured for fulcrum effect compensation mode operation, either through manual input or through an input that provides electromechanical mode switching. In addition, the second handle 704 can have the end effector control mode capabilities described herein to perform end effector control mode operations during fulcrum effect compensation mode operation. Fulcrum effect compensation mode operation can be described with respect to FIGS. 17, 18, and 19.

[0080] method As shown in FIG. 30 , a method for performing minimally invasive surgery includes, in block S802, positioning an elongate body of a medical instrument with an attached handle for manual movement about a pivot point (i.e., remote center of motion), and, in block S804, controlling the position of a distal end of the medical instrument by countermovement of a proximal end of the medical instrument (e.g., pivoting about the pivot point). The method functions to control the position of the distal end of the medical instrument (optionally including an end effector) during a minimally invasive procedure in a fulcrum effect mode. In some embodiments, the method functions to position the medical instrument in an appropriate position before a control mode switch (e.g., to a fulcrum effect compensation mode, as described with respect to FIG. 31 ) is performed. The method is used in a surgical field, but may additionally or alternatively be used for any suitable application, clinical, or otherwise. The method may be configured and / or adapted to function for any suitable task or procedure.

[0081] As shown in FIG. 30 , one embodiment of a method for performing minimally invasive surgery includes block S802, which depicts positioning an elongate portion of a medical instrument with an attached handle for manual movement about a pivot point. Block S802 functions to introduce the distal end of the medical instrument into a surgical site or control the distal end of the medical instrument near the surgical site. As described above with respect to FIGS. 1A and 3A-4B , the stabilizing device may function to support at least a portion of the weight of the control assembly and medical instrument. The stabilizing device may provide the degrees of freedom necessary to manipulate the medical instrument into a position appropriate for use in surgery. The stabilizing device may be fixed in a position appropriate for the process. The position appropriate for use in surgery may include overall movement in three-dimensional space and / or insertion of the elongate portion of the medical instrument into a trocar or into an access site or incision.

[0082] As shown in FIG. 30 , one embodiment of a method for performing minimally invasive surgery includes block S804, which describes controlling the position of the distal end of the medical instrument by a reverse input motion of the handle that moves the proximal end of the medical instrument. Block S804 functions to control the distal portion of the medical instrument in a fulcrum effect mode. The fulcrum effect mode defines a reverse pivotal control of the distal portion of the medical instrument relative to the handle. In other words, a leftward position change of the handle, also referred to as the input position, will result in a rightward position change of the distal end, also referred to as the output position. Additionally, an upward position change of the handle will result in a downward position change of the distal end.

[0083] Any of the devices shown in Figures 1A-10A and 11-29 can be operable or configured to operate in the fulcrum effect mode described with respect to Figure 30 or elsewhere herein.

[0084] As shown in FIG. 31 , a method for performing minimally invasive surgery includes, in block S902, positioning an elongate body of a medical instrument with an attached handle such that a pivot point separates a distal portion of the medical instrument from a proximal portion of the medical instrument; in block S904, activating a sensor assembly and a power actuation unit in communication with the medical instrument; measuring a position of the handle and / or one or more joints with the sensor assembly in block S906; and in block S908, actuating the distal portion of the medical instrument to mimic the position of the handle about the pivot point. The method functions to control the position of the distal portion of the medical instrument during a minimally invasive procedure in a fulcrum effect compensation mode. The fulcrum effect compensation mode defines corresponding control of the distal end of the medical instrument relative to the handle. In other words, a leftward position change of the handle, also referred to as the input position, generates a leftward position change of the distal end of the medical instrument, also referred to as the output position. Furthermore, an upward position change of the distal end of the medical instrument generates an upward position change of the distal end of the medical instrument. The handle-mimicking action of the distal end of the medical instrument can be scaled. This method is used in the surgical field, but may additionally or alternatively be used in any suitable application, clinical, or otherwise. This method can be configured and / or adapted to function for any suitable task or procedure.

[0085] As shown in FIG. 31 , one embodiment of a method for performing minimally invasive surgery includes block S902, which positions an elongated body of a medical instrument with an attached handle so that a distal portion of the medical instrument is separated from a proximal portion of the medical instrument by a pivot point. Block S902 functions to introduce the distal end of the medical instrument (including any end effectors) to a surgical site or near the surgical site, or to a location suitable for use in surgery. The location suitable for use in surgery may involve inserting the elongated portion of the medical instrument through a trocar or into an access site or incision, such that a first portion of the medical instrument is located within (e.g., distal to) the incision and a second portion of the medical instrument is located outside (e.g., proximal to) the incision. Thus, a pivot point (e.g., a remote center of motion) is provided. With the medical instrument in this position, at least a portion of the stabilizer is locked in place in embodiments employing a stabilizer, as described with respect to FIGS. 8 and 9 . Locking the stabilizer prepares the device for fulcrum effect compensation mode operation. In some implementations, the user may adjust and secure the stabilizer all without removing their control hands from the handle.

[0086] As shown in FIG. 31 , one embodiment of a method for performing minimally invasive surgery includes block S904, which depicts activating a sensor assembly and a power actuation unit in communication with the medical instrument. Block S904 functions to switch to the fulcrum effect compensation mode. The switch can occur without the user removing their hands from the handle. In some embodiments, the switch to the fulcrum effect compensation mode is performed by activating a control input on the handle that, when received by the controller, causes the controller to send a control signal and activates the sensor assembly and a power actuation unit in communication with the medical instrument. In some embodiments, the switch to the fulcrum effect compensation mode is performed by unlocking the handle and sliding the handle proximally to a position appropriate for the fulcrum effect compensation mode. Additionally, sliding the handle distally can be activated by unlocking the sensor assembly.

[0087] As shown in FIG. 31 , one embodiment of a method for performing minimally invasive surgery includes block S906, which describes measuring or monitoring the position of a handle and / or one or more joints comprising a sensor assembly. Block S906 functions to map the position of the handle and / or one or more joints. Mapping the position of the handle and / or one or more joints is performed by receiving measurements from one or more sensors in the sensor assembly (e.g., sensor-equipped joints 160 a, 160 b of FIG. 9 ) and by a controller.

[0088] As shown in FIG. 31 , one embodiment of a method for performing minimally invasive surgery includes block S908, which depicts actuating a distal portion of a medical instrument to mimic the position of a handle and / or one or more joints about a pivot point. Block S908 functions to mimic the position of a handle and / or one or more joints by moving the distal portion of the medical instrument to a position and / or orientation that is equal to or scaled to the position and / or orientation of the handle and / or one or more joints (e.g., as shown in FIG. 9 ). Additionally, an example of a mimicking surface 95 formed at the pivot point 124 for mimicking movement can be seen in FIG. 1A . In some implementations, the described fulcrum effect compensation mode operation does not require the user to release their hands from the handle.

[0089] Any of the devices shown in Figures 1A-10A and 11-29 can be operated or configured to operate in the fulcrum effect compensation mode described with respect to Figure 31 or elsewhere in this specification.

[0090] The systems and methods of the preferred embodiment and variations thereof may be embodied and / or implemented at least in part as a machine configured to receive a computer-readable medium storing computer-readable instructions. The instructions are preferably executed by computer-executable components integrated into the system and one or more portions of the controller and / or processor of the computing device. The computer-readable medium may be stored on any suitable computer-readable medium, such as RAM, ROM, flash memory, EEPROM, optical device (e.g., CD or DVD), hard drive, floppy drive, or other suitable device. The computer-executable component is preferably a general-purpose or application-specific processor, although any suitable dedicated hardware or hardware / firmware combination may alternatively or additionally execute the instructions.

[0091] References herein to "one embodiment," "an embodiment," "an illustrative embodiment," "some embodiments," and the like indicate that the described embodiment may include a particular feature, structure, or characteristic, but that not all embodiments necessarily include the particular feature, structure, or characteristic. Moreover, such phrases do not necessarily refer to the same embodiment. Furthermore, when a particular feature, structure, or characteristic is described in connection with one embodiment, it is deemed to be within the knowledge of one skilled in the art to affect such feature, structure, or characteristic in connection with other embodiments, whether or not explicitly stated.

[0092] As used in the description and claims, the singular forms "a," "an," and "the" include both singular and plural references unless the context clearly dictates otherwise. For example, the term "power-operated unit" can and is considered to include a plurality of power-operated units. At times, claims and disclosures may include terms such as "a plurality," "one or more," or "at least one." However, the absence of such terms is not intended and should not be interpreted to mean that a plurality is not contemplated.

[0093] The words "about" or "approximately," when used before a numerical designation or range (e.g., to define a length or pressure), refer to an approximate number that may vary by (+) or (-) 5%, 1%, or 0.1%. All numerical ranges provided herein are inclusive of the first and last numbers recited. The word "substantially" refers to nearly (i.e., more than 50%) or essentially all of a device, material, or composition.

[0094] As used herein, the terms "comprising" or "comprises" are intended to mean that the devices, systems, and methods include the recited elements and may additionally include other elements. "Consisting essentially of" is intended to mean that the devices, systems, and methods include the recited elements and exclude other elements that are essential to the combination for the purpose of the description. Thus, a system or method consisting essentially of the elements defined herein does not exclude other materials, features, or steps that do not materially affect the basic and novel nature of the claimed disclosure. "Consisting of" is intended to mean that the devices, systems, and methods include the recited elements and exclude more than insignificant or insignificant elements or steps. Embodiments defined by each of these transitional terms are within the scope of this disclosure.

[0095] The examples and examples contained herein illustrate, by way of illustration and not limitation, specific embodiments in which the subject matter may be practiced. Other embodiments may be utilized and derived therefrom, such that structural and logical substitutions or changes may be made without departing from the scope of the present disclosure. Such embodiments of the inventive subject matter may be referred to herein individually or collectively by the term "invention" merely for convenience and are not intended to automatically limit the scope of the present application to a single invention or inventive concept when in fact more than one is disclosed. Thus, while specific embodiments are shown and described herein, any configurations which are expected to achieve the same purpose may be substituted for the specific embodiment shown. The present disclosure is intended to apply to any and all modifications or variations of the various embodiments. Upon reviewing the above description, combinations of the above embodiments, as well as other embodiments not specifically described herein, will be apparent to those skilled in the art.

[0096] example Example 1 A system for performing minimally invasive surgery comprising: a stabilizing device movable between an unlocked state and a locked state; a control assembly comprising: a handle pivotally coupled to the stabilizing device and comprising one or more sensor-equipped joints; and an instrument actuator interface configured to be reversibly coupled to the handle; and a medical instrument coupled to and manipulatable by the handle, the medical instrument comprising an elongated body having a proximal portion and a distal portion comprising one or more distal joints, and an end effector coupled to the distal portion; wherein in a first mode, the stabilizing device is configured in the unlocked state such that the medical instrument is manipulatable by the handle about a pivot point or in a first three-dimensional space; in a second mode, the handle is configured to manipulate the end effector of the medical instrument; and in a third mode, the stabilizing device is configured in the locked state such that movement of the one or more sensor-equipped joints causes corresponding distal movement of the one or more distal joints of the medical instrument about the pivot point.

[0097] Example 2. The system of any one of the preceding examples, particularly example 1, wherein in the first mode, the handle is connected to the instrument actuator interface.

[0098] Example 3. The system of any one of the preceding examples, particularly example 2, wherein the first input of the handle is configured to operate an end effector of a medical instrument.

[0099] Example 4. The system of any one of the preceding examples, particularly example 3, wherein the first input or the second input of the handle is configured to roll the elongate body about the longitudinal axis of the medical device.

[0100] Example 5. The system of any one of the preceding examples, particularly Example 1, wherein the stabilization device comprises one or more joints, and wherein manipulating the elongate body of the medical instrument in the first three-dimensional space comprises moving the medical instrument about a yaw axis of one or more joints of the stabilization device.

[0101] Example 6. The system of any one of the preceding examples, particularly example 1, wherein manipulating the elongate body of the medical device in the first three-dimensional space comprises inserting or retracting the medical device relative to the stabilization device.

[0102] Example 7. The system of any one of the preceding examples, particularly example 1, wherein the handle comprises an input element configured to switch between the first mode, the second mode, and the third mode.

[0103] Example 8. The system of any one of the preceding examples, particularly example 1, wherein the handle comprises a first input element configured to manipulate an end effector of the medical instrument in the second mode.

[0104] Example 9. The system of any one of the preceding examples, particularly example 8, wherein the first input element is manipulatable about a pitch axis, a roll axis, or a yaw axis associated with the first input element to manipulate an end effector of the medical instrument in the second mode.

[0105] Example 10. The system of any one of the preceding examples, particularly example 9, wherein manipulation of the first input element about the first input element pitch axis causes a corresponding movement of the end effector about the end effector pitch axis.

[0106] Example 11. The system of any one of the preceding examples, particularly example 9, wherein manipulation of the first input element about the first input element's yaw axis causes a corresponding movement of the end effector about the end effector's yaw axis.

[0107] Example 12. The system of any one of the preceding examples, particularly example 9, wherein manipulation of the first input element about the roll axis of the first input element causes a corresponding movement of the end effector about the roll axis of the end effector.

[0108] Example 13. The system of any one of the preceding examples, particularly example 1, wherein the pivot point includes a remote pivot point configured to be located proximal to or within a trocar through which a medical instrument is inserted during a procedure.

[0109] Example 14. The system of any one of the preceding examples, particularly example 1, wherein the one or more sensor-equipped joints comprise a sensor assembly, the implement actuator interface comprises a power actuation unit and a controller, and the controller is communicatively linked to the sensor assembly and the power actuation unit.

[0110] Example 15. The system of any one of the preceding examples, particularly Example 14, wherein the sensor assembly is configured to monitor at least a first position of the one or more sensor-equipped joints and generate a corresponding sensor signal, the controller is configured to receive the corresponding sensor signal and generate a corresponding control signal, and the power actuation unit is configured to receive the corresponding control signal and actuate the one or more distal joints based on the first position to cause translation of the one or more distal joints.

[0111] Example 16. The system of any one of the preceding examples, particularly example 1, wherein the handle comprises a sleeve having one or more sensor-equipped joints, and the handle is configured to manipulate the sleeve to cause movement of the one or more sensor-equipped joints.

[0112] Example 17. The system of any one of the preceding examples, particularly example 1, wherein the handle is coupled to a proximal portion of the medical instrument.

[0113] Example 18. The system of any one of the preceding examples, particularly example 1, wherein in the third mode, the handle is configured to be disengaged from the instrument actuator interface.

[0114] Example 19. A system for performing minimally invasive surgery, comprising: an elongate body having a distal end having an end effector and one or more distal joints, and a proximal end opposite the distal end; a handle configured to receive the proximal end of the elongate body, the handle comprising a sleeve having one or more sensor-equipped joints; a sensor assembly configured to monitor a position of each of the one or more sensor-equipped joints; and an instrument actuator interface coupled to the sleeve of the handle, the instrument actuator interface comprising a power actuation unit and a controller communicatively coupled to the sensor assembly and the power actuation unit, wherein the sensor assembly is configured to monitor at least a first position of the one or more sensor-equipped joints and generate a corresponding sensor signal, the first position being based on proximal movement of the handle; the controller is configured to receive the corresponding sensor signal and generate a corresponding control signal; and the power actuation unit is configured to receive the corresponding control signal and actuate the one or more distal joints based on the first position of the one or more sensor-equipped joints to cause translation of the one or more distal joints.

[0115] Example 20. The system of any one of the preceding examples, particularly example 19, further comprising a stabilizing device that is transitionable between an unlocked state and a locked state.

[0116] Example 21. The system of any one of the preceding examples, particularly example 20, wherein the stabilization device is configured to be in a fixed state when the power actuation unit actuates one or more distal joints to cause translation.

[0117] Example 22. The system of any one of the preceding examples, particularly example 21, wherein one or more distal joints are configured to operate about a remote pivot point.

[0118] Example 23. The system of any one of the preceding examples, particularly example 22, wherein the remote pivot point is configured to be aligned with a trocar through which the elongate body is inserted during the procedure.

[0119] Example 24. A system for minimally invasive surgery configured to selectively operate in a first control mode or a second control mode, comprising: a medical instrument comprising an elongate body having a proximal portion and a distal portion comprising one or more distal joints; an end effector; and a handle coupled to the proximal portion of the medical instrument and configured to operate the medical instrument, the control assembly comprising the handle comprising one or more sensor-equipped joints; and an instrument actuator interface configured to be reversibly coupled to the handle, wherein selecting between the first control mode and the second control mode comprises modifying a range of motion associated with the one or more sensor-equipped joints.

[0120] Example 25: The system of any one of the preceding examples, particularly Example 24, wherein the first control mode is a fulcrum effect mode, in which a first input of the handle is configured to manipulate an end effector of a medical instrument, and the second control mode is a fulcrum compensation mode, in which movement of one or more sensor-equipped joints of the handle is possible such that manipulation of the handle causes movement of one or more sensor-equipped joints resulting in corresponding distal movement of one or more distal joints at least about a predetermined pivot point or in a predetermined three-dimensional space.

[0121] Example 26. The system of any one of the preceding examples, particularly example 25, wherein in the first control mode, the first input or the second input is configured to roll the elongate body about the longitudinal axis of the medical device.

[0122] Example 27. A system for performing minimally invasive surgery, comprising: a control assembly including a handle pivotally coupled to a bedside device, the handle having one or more sensor-equipped joints; and an instrument actuator interface; and a medical instrument coupleable to and operable by the handle, the medical instrument having an elongate body having a proximal portion and a distal portion having one or more distal joints, wherein in a fulcrum effect mode, mechanical movement of the handle coupled to the proximal portion of the medical instrument causes movement of the medical instrument about a pivot point; and in a fulcrum compensation mode, the pivot point is between the one or more sensor-equipped joints of the handle and the one or more distal joints of the medical instrument, and actuation of the handle causes movement of the one or more sensor-equipped joints, which is mapped by the instrument actuator interface to corresponding distal movement of the one or more distal joints about at least the pivot point.

[0123] Example 28. A method for performing minimally invasive surgery, comprising: receiving a first input at a handle coupled to the medical instrument in a fulcrum effect mode, the first input causing manual movement of the medical instrument about a pivot point, the pivot point being between a distal portion of the medical instrument and a proximal portion of the medical instrument; activating a control of the handle in a fulcrum compensation mode, the control being configured to perform electronically assisted movement in conjunction with a sensor assembly and a power actuation unit in communication with the medical instrument; monitoring a position of one or more sensor-equipped joints of the handle using a sensor assembly communicatively coupled to a controller; and translating a distal portion of the medical instrument using the power actuation unit in response to detection of a change in position by the sensor assembly, wherein the translation of the distal portion of the medical instrument is based on the position of the one or more sensor-equipped joints.

[0124] Example 29. The method of any one of the preceding examples, particularly example 28, wherein one or more sensor-equipped joints are proximal to the pivot point.

[0125] Example 30. A handle configured for placement at a bedside of a patient assist device to perform minimally invasive surgery, the handle comprising: a first input mechanism configured to select a fulcrum effect mode, the handle configured to be attached to a medical instrument that is mechanically movable about a pivot point; and a second input mechanism configured to select a fulcrum compensation mode, the selection of the second input mechanism configured to activate a sensor assembly, a power actuation unit, and a controller communicatively coupled to the power actuation unit and the sensor assembly.

[0126] Example 31. The handle of any one of the preceding examples, particularly example 30, wherein the first input mechanism comprises a first grip portion of the handle and the second input mechanism comprises a second grip portion of the handle.

[0127] Example 32. The steering wheel of any one of the preceding examples, particularly example 30, wherein the first input mechanism comprises a button, joystick, or grip portion of the steering wheel, and the second input mechanism comprises a second button. [Explanation of symbols]

[0128] 2 Stabilizer 6 Medical equipment 10 Systems 14 End Effector 16 List Assembly 18 Control Assembly 20 Handle 22 Instrument Actuator Interface 23 Input section 25 Input section 94 Horizontal plane 95 Imitation Mask 100 Fulcrum effect correction device 101 Slots 102 Stabilizer 103a First Arm 103b Second Arm 103c Third Arm 104a RCM joint 104b RCM joint 105 Lumen 106 Medical equipment 107 Base part 108 RCM joint 109 Opening 110 Proximal part 112 Distal portion 114 End Effector 116 List Assembly 118 Control Assembly 119 Part 1 120 Handle 121 Part 2 122 Instrument Actuator Interface 124 Turning Point 125 opening 126 Input mechanism 128 Rotational Movement 129 Connection section 130 Yaw axis 132 Cooperative action 137 axes 140 sleeve 142 Input mechanism 144 Roll axis 150 Longitudinal axis 151 Connection part 152 pitch axis 154 Pitch axis 156 Yaw axis 158 Yaw axis 160a Sensor-equipped joint 160b Sensor-equipped joint 162a Driven joint 162b Driven joint 170 proximal part 171 working length 180 Power Operation Unit 182 Control Device 183 Adjustment surface 184 Sensor Assembly 186 Medical equipment 200 Fulcrum Correction Device 204 Handle Cradle 205 Joint 206 Medical equipment 207 Instrument Actuator Interface 208 End part 209 Route 212 Linear Guide 218 Control Assembly 220 Handle 290 Internal T orbit 292 Inlet opening 294 External T orbit 296 width 298 width 300 Fulcrum Effect Correction Device 308 Linkage 309 First sensor equipped joint 312 Second sensor equipped joint 351 End Effector Actuator Interface 352 Instrument Actuator Interface 354 Sensor Equipment Mechanism 355 concentric shaft 356 Follower Actuator 357 Yaw axis 358 Second arcuate orbit 359 Roll axis 360 1st arcuate orbit 361 Pitch axis 362 Handle 363 Sensor-equipped joint 364 Handle Cradle 365 Sensor-equipped joint 366 Control Hub 367 Sensor-equipped joint 368 Medical equipment 369 Control Assembly 370 Distal Tip 371 proximal part 373 Distal part 375 Longitudinal Axis 400 devices 401 Handle 402 Instrument Actuator Interface 406 Medical equipment 407 End part 409 Long part 410 Release mechanism 412 Linear Guide 414 Handle Cradle 415 Control Assembly 416 Sensor-equipped linkage 420 Fixing Plate 430 First Linkage 432 Second Linkage 434 Handle Cradle Plate 436 First sensor-equipped joint 438 Second Sensor-Equipped Joint 440 Third sensor equipped joint 450 Subcradle 451 Opening 452 Third Joint 454 First Joint 456 Second Joint 470 paddle 472 Paddle 474 Paddle Hinge 476 Paddle Hinge 490 Roll axis 492 Yaw axis 494 Pitch axis 496 Pitch axis 600 Fulcrum Effect Correction Device 601 Sensor equipment parts 602 Instrument Actuator Interface 603 First sensor equipped joint 604 Second sensor equipped joint 606 Medical equipment 608 1st Linkage 610 Second Linkage 612 Sliding Plate 614 Linear Guide 616 Handle Cradle Plate 702 First Handle 704 Second Handle 757 Body

Claims

1. 1. A system for performing minimally invasive surgery, comprising: a stabilizing device that is transitionable between an unlocked state and an unlocked state; 1. A control assembly comprising: a handle pivotally coupled to the stabilizer and including one or more sensor-equipped joints; an instrument actuator interface configured to be reversibly coupled to the handle; a control assembly comprising: a medical instrument coupled to and operable by said handle, an elongate body having a proximal portion and a distal portion having one or more distal joints; an end effector coupled to the distal portion; A medical device comprising: Equipped with In a first mode, the stabilization device is configured in the unlocked state such that the medical instrument can be manipulated by the handle about a pivot point or in a first three-dimensional space; In a second mode, the handle is configured to manipulate the end effector of the medical instrument; In a third mode, the stabilizing device is set to the fixed state and the handle is capable of inducing movement of the one or more sensor-equipped joints, such that movement of the one or more sensor-equipped joints induces corresponding distal movement of the one or more distal joints of the medical instrument about the pivot point. system.

2. The system of claim 1 , wherein in the first mode, the handle is connected to the instrument actuator interface.

3. The system of claim 2 , wherein a first input of the handle is configured to manipulate the end effector of the medical instrument.

4. The system of claim 3 , wherein the first input or the second input of the handle is configured to roll the elongate body about the longitudinal axis of the medical device.

5. The system of claim 1 , wherein the stabilizing device comprises one or more joints, and the manipulation of the elongated body of the medical instrument in the first three-dimensional space comprises movement of the medical instrument about a yaw axis of the one or more joints of the stabilizing device.

6. The system of claim 1 , wherein manipulating the elongate body of the medical device in the first three-dimensional space comprises inserting or retracting the medical device relative to the stabilizing device.

7. The system of claim 1 , wherein the handle comprises an input element configured to switch between the first mode, the second mode, and the third mode.

8. The system of claim 1 , wherein the handle comprises a first input element configured to manipulate the end effector of the medical instrument in the second mode.

9. 9. The system of claim 8, wherein the first input element is manipulatable about a pitch axis, a roll axis, or a yaw axis associated with the first input element to manipulate the end effector of the medical instrument in the second mode.

10. The system of claim 9 , wherein manipulation of the first input element about the pitch axis of the first input element causes a corresponding movement of the end effector about an end effector pitch axis.

11. The system of claim 9 , wherein manipulation of the first input element about the yaw axis of the first input element causes a corresponding movement of the end effector about an end effector yaw axis.

12. The system of claim 9 , wherein manipulation of the first input element about the roll axis of the first input element causes a corresponding movement of the end effector about an end effector roll axis.

13. The system of claim 1 , wherein the pivot point comprises a remote pivot point configured to be located proximal to or within a trocar through which the medical instrument is inserted during a procedure.

14. 10. The system of claim 1, wherein the one or more sensor-equipped joints comprise a sensor assembly, and the tool actuator interface comprises a power actuation unit and a controller, the controller being communicatively linked to the sensor assembly and the power actuation unit.

15. 15. The system of claim 14, wherein the sensor assembly is configured to monitor at least a first position of the one or more sensor-equipped joints and generate a corresponding sensor signal, the controller is configured to receive the corresponding sensor signal and generate a corresponding control signal, and the power actuation unit is configured to receive the corresponding control signal and actuate the one or more distal joints to cause translation of the one or more distal joints based on the first position.

16. The system of claim 1 , wherein the handle comprises a sleeve comprising the one or more sensor-equipped joints, the handle configured to manipulate the sleeve to cause movement of the one or more sensor-equipped joints.

17. The system of claim 1 , wherein the handle is coupled to the proximal portion of the medical instrument.

18. The system of claim 1 , wherein in the third mode, the handle is configured to be disengaged from the instrument actuator interface.

19. 1. A system for performing minimally invasive surgery, comprising: an elongate body having a distal end having an end effector and one or more distal joints, and a proximal end opposite the distal end; a handle configured to receive the proximal end of the elongate body, the handle comprising a sleeve having one or more sensor-equipped joints; a sensor assembly configured to monitor the position of each of the one or more sensor-equipped joints; coupled to the sleeve of the handle, a power actuation unit; a controller communicatively linked to the sensor assembly and the power actuation unit; an instrument actuator interface comprising: Equipped with the sensor assembly is configured to monitor at least a first position of the one or more sensor-equipped joints and generate a corresponding sensor signal, the first position being based on proximal movement of the handle; the controller is configured to receive the corresponding sensor signal and generate a corresponding control signal; the power actuation unit is configured to receive the corresponding control signal and actuate the one or more distal joints to cause translation of the one or more distal joints based on the first position of the one or more sensor-equipped joints. system.

20. 20. The system of claim 19, further comprising a stabilizing device that is transitionable between an unlocked state and a locked state.

21. 21. The system of claim 20, wherein the stabilizing device is configured to be in the fixed state when the power actuation unit actuates the one or more distal joints to cause the translation.

22. 22. The system of claim 21, wherein the one or more distal joints are configured to be manipulated about a remote pivot point.

23. 23. The system of claim 22, wherein the remote pivot point is configured to be aligned with a trocar through which the elongate body is inserted during a procedure.

24. 1. A system for minimally invasive surgery, comprising: It is a medical device, an elongate body having a proximal portion and a distal portion having one or more distal joints; an end effector; A medical device comprising: a control assembly, a handle coupled to the proximal portion of the medical instrument and configured to manipulate the medical instrument, the handle comprising one or more sensor-equipped joints; an instrument actuator interface configured to be reversibly coupled to the handle; a control assembly comprising: Equipped with a system configured to selectively operate in a first control mode or a second control mode, wherein selecting between the first control mode and the second control mode includes modifying a range of motion associated with the one or more sensor-equipped joints; system.

25. the first control mode is a fulcrum effect mode, and a first input of the handle is configured to manipulate an end effector of the medical instrument; the second control mode is a fulcrum compensation mode, allowing movement of the one or more sensor-equipped joints of the handle such that manipulation of the handle causes movement of the one or more sensor-equipped joints resulting in corresponding distal movement of the one or more distal joints at least about a predefined pivot point or in a predefined three-dimensional space; 25. The system of claim 24.

26. 26. The system of claim 25, wherein in the first control mode, the first input or the second input is configured to roll the elongate body about a longitudinal axis of the medical device.

27. 1. A system for performing minimally invasive surgery, comprising: a control assembly, a handle pivotally coupled to the bedside device, the handle having one or more sensor-equipped joints; an instrument actuator interface; a control assembly comprising: a medical instrument coupleable to and operable by said handle, an elongate body having a proximal portion and a distal portion having one or more distal joints; A medical device comprising: Equipped with in a fulcrum effect mode, mechanical movement of the handle coupled to the proximal portion of the medical instrument causes movement of the medical instrument about a pivot point; In the fulcrum correction mode, the pivot point is between the one or more sensor-equipped joints of the handle and the one or more distal joints of the medical instrument; actuation of the handle causes movement of the one or more sensor-equipped joints, and the movement is mapped by the instrument actuator interface to corresponding distal movement of the one or more distal joints about at least the pivot point; system.

28. 1. A method for performing minimally invasive surgery, comprising: In fulcrum effect mode, receiving a first input at a handle coupled to the medical instrument, the first input causing manual movement of the medical instrument about a pivot point, the pivot point being between a distal portion of the medical instrument and a proximal portion of the medical instrument; In the fulcrum correction mode, a control configured to activate a control of the handle and mate with a sensor assembly and a power actuation unit in communication with the medical device to perform electronically assisted operation; monitoring the position of one or more sensor-equipped joints of the handle using the sensor assembly communicatively coupled to a controller; responsive to detection of the position change by the sensor assembly, translating the distal portion of the medical instrument using the power actuation unit, wherein the translation of the distal portion of the medical instrument is based on the position of the one or more sensor-equipped joints. method.

29. 30. The method of claim 28, wherein the one or more sensor-equipped joints are proximal to the pivot point.

30. A handle configured to be placed at a bedside of a patient assist device to perform minimally invasive surgery, a first input mechanism configured to select a fulcrum effect mode; Equipped with a handle configured to be attached to a medical instrument that is mechanically movable about a pivot point; a second input mechanism configured to select a fulcrum correction mode; Equipped with Selection of the second input mechanism is configured to activate a sensor assembly, a power actuation unit, and a controller communicatively coupled to the power actuation unit and the sensor assembly. handle.

31. The handle of claim 30, wherein the first input mechanism comprises a first grip portion of the handle and the second input mechanism comprises a second grip portion of the handle.

32. 31. The handle of claim 30, wherein the first input mechanism comprises a button, a joystick, or a grip portion of the handle, and the second input mechanism comprises a second button.

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