Telescopic robot

Abstract

Apparatus and method for deploying and / or controlling the movement of a flexible tubular member, such as an endoscope, using a sliding link assembly to support the flexible tubular member. For example, these apparatus may include a base and a link assembly, the link assembly comprising a plurality of links connected to the base and adjacent to each other perpendicularly, where adjacent pairs of links are slidably coupled together by opposing flexible bands extending around the cylindrical surface of a shuttle. A linear drive may drive the extension and retraction of the links by engaging with just one shuttle of the link assembly.

Description

TECHNICAL FIELD

[0001]

[0001] This patent application claims priority to U.S. Provisional Patent Application No. 63 / 586,398, filed on September 28, 2023, entitled "TELESCOPING ROBOT", the entire contents of which are incorporated herein by reference.

[0002]

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

BACKGROUND ART

[0003]

[0003] Medical procedures such as endoscopy may involve accessing and visualizing the interior of a patient's anatomy for diagnostic and / or therapeutic purposes. For example, gastroenterology, urology, and bronchoscopy involve medical procedures that allow physicians to examine patient lumens such as the digestive tract, urinary tract, vasculature, and airways. During these procedures, flexible tools or instruments, commonly referred to as flexible tubular members such as endoscopes, over-tubes, catheters, or guidewires, are inserted into the patient through an orifice (e.g., a natural orifice or incision) and advanced toward the identified tissue site for subsequent diagnosis and / or treatment. Medical instruments can be controllable and articulable to facilitate navigation through anatomy.

[0004]

[0004] Managing these devices can be particularly challenging in an already crowded operating room. One example of a device that can be long and difficult to manage is the colonoscope, in this case the endoscope, especially in the case of a robotic system where forward / backward and / or steering may be driven by a controller such as a robotic controller. A colonoscope is used for navigation of the small intestine, and colonoscopes can be even longer in length. Similar challenges exist with catheters, which are similarly long and flexible. Vascular catheters may advance into the cerebrovascular system, peripheral vascular system, pulmonary vascular system, as well as the cardiac and coronary vascular system. Guidewires may be used in conjunction with catheters in the vascular system. Overtubes may be used with endoscopes. Overtubes may be used in conjunction with endoscopes, or the endoscope may be retracted so that only the overtube remains.

[0005]

[0005] Numerous elongated, flexible, and insertable tools (flexible tubular members, such as endoscopes, catheters, overtubes, and guidewires) have been used or proposed for use in medical procedures, but controlling the insertion and operation of such devices becomes increasingly difficult as their length increases. Therefore, there is a need for methods and devices for housing and deploying elongated medical instruments, including flexible tubular members such as endoscopes, catheters, overtubes, and guidewires, that enable compact and efficient operation. [Overview of the Initiative] [Means for solving the problem]

[0006]

[0006] Robotic devices (e.g., systems, devices, etc.) and methods for positioning, loading, distributing or deploying, driving (e.g., forward / backward, steering, etc.), and retracting one or more flexible tubular members (relative to a patient) are described herein. Flexible tubular members may include one or more endoscopes, catheters, overtubes, and / or guidewires, as well as, in particular, one or more elongated endoscopes, including colonoscopes and intestinal endoscopes. The methods and devices described herein may address the challenges of positioning, loading, distributing or deploying, driving, and retracting and / or otherwise operating such elongated medical instruments.

[0007]

[0007] Generally, these devices may offer significant advantages over the delivery and control platforms described in the past, providing flexible tubular members, in particular, telescopic platforms for supporting and controlling nesting robotic endoscopes. In particular, the telescopic platform may allow the platform (e.g., link assembly) to extend and retract relative to the base in both proximal and distal directions (e.g., bidirectionally) from a non-extended neutral position having a compact footprint. This design may generally be significantly more compact than the positioning and / or control systems described in the past, and in particular compared to the telescopic positioning and / or control systems described in the past.

[0008]

[0008] In some cases, it may be particularly beneficial to configure the link assembly of the device (e.g., a system) such that the link assembly is oriented with multiple links adjacent to each other in the vertical direction. Each link may be a long and thin platform or plank shape overall. Each link may have a width less than its length and height and may include a first main surface along both the front and rear sides (along its length and height). A link may enclose one or more elements, such as a belt (e.g., a synchronization belt as described below), within its thickness. The links of the link assembly may be similar or identical in their overall shape. The innermost link may be coupled to a mount assembly or attachment for a flexible tubular member and / or a flexible tubular member driver. The mount assembly may be configured to include multiple working areas that may be mounted separately on different regions of the flexible tubular member, or in some cases, on an inner endoscope and an outer overtube that may move relative to each other. The outermost link may be coupled to a link assembly driver and / or to the rest of the system, e.g., a base or an arm supported by the base. In some examples, the links may have a rectangular cross-section (or be rectangular overall, for example, a rectanguloid), where the rectangular cross-section is smaller than its height (vertical height) and has a thickness that is longer (proximal to distal) than it is wider or taller. Generally, arranging the link assembly with the links in a vertical orientation provides excellent support when the links are joined adjacent to each other vertically along their width (e.g., sintered together), and may allow the mounting area for flexible tubular members (in some cases, for example, both inner and outer members of a nested device mounted on different parts of a mounting assembly) to be positioned below the top of the vertically arranged link assembly (e.g., near the floor).In some embodiments, the distance between the surface of the bed or table on which the patient is positioned and the entry point into the patient's anatomical structure (e.g., anus, mouth, etc.) may be limited; therefore, this configuration may allow access that is consistent with the patient's body. As used herein, a link may refer to a body such as a plate, panel, frame, leaf, slab, etc. A link may be solid or hollow and / or include one or more internal structures. A link may include one or more windows, openings, or passages through which there are windows, openings, or passages.

[0009]

[0009] Generally, the flexible tubular members described herein may be elongated medical instruments and may be called robotic elongated medical instruments, robotic endoscopes, or robotscopes. These elongated medical instruments may include endoscopes which may be operated by a drive system, including a robotic drive system, as described herein. Endoscopes may include colonoscopes, bronchoscopes, colposcopes, cystoscopes, esophagoscopes, gastroscopy, laparoscopes, thoracoscopy, and intestinal endoscopes. In particular, the methods and apparatus described herein may be especially desirable to use with longer elongated medical instruments (for example, having lengths longer than 0.7m, 0.8m, 0.9m, 1m, 1.2m, 1.4m, 1.6m, 2.0m, 2.1m, 3m, etc.).

[0010]

[0010] These devices may work well with flexible tubular members. These devices may work particularly well with elongated medical instruments that include nesting (i.e., two or more) components that may extend and retract relative to one another, such as telescopic elongated medical instruments. For example, a telescopic elongated medical instrument may include an inner robot scope and an outer overtube. For example, a telescopic elongated medical instrument may include an inner robot scope and an outer robot scope. Either or both of the inner and outer robot scopes may be steerable and may include one or more steering members (e.g., steering tensioners) that may mate with a steering interface on the device. Either or both of the inner and outer scopes may include a vision system. The drive system may include a steering interface for the robot scope and, in some examples, for either or both of the inner and outer members of the robot scope. Nesting systems involve more elements and more DOF (Degrees of Freedom), so their storage, loading, deployment, driving, and retraction and kinematic control are particularly challenging for robotics, and therefore a particularly good fit. This is because robotic systems can perform complex kinematic maneuvers in a simpler way, including the use of software, algorithms, sensors, and actuators.

[0011]

[0011] The methods and apparatus described herein may be particularly well suited to controlling rigid elongated medical instruments (i.e., Dynamic Rigidization®). Rigidized elongated medical instruments may include, but are not limited to, elongated medical instruments that are rigidized by multiple methods. One method for rigidization is the application of pressure (e.g., positive and / or negative pressure). For example, the apparatus and methods described herein may be particularly well suited to a telescopic rigid elongated medical instrument, in which the outer member of the robot scope is a rigidizable member that may be rigidized by the application of pressure, and the inner member is a rigidizable member that may be rigidized by the application of pressure. The inner and outer members may be rigidized separately and / or independently (or in a coordinated manner) and may be integrated with a drive system (e.g., a robotic drive system).

[0012]

[0012] Any device of these apparatuses may be configured with components that are single-use ("disposable"), multiple-use or multi-use ("resposable"), sheathed, or reusable ("reusable") for many uses. These elements may be designed to reduce costs and waste disposal. These elements may be designed for a low and effective cost per case. These elements may be designed for ease of use, ease of installation, quick procedure setup, and ease of removal. Any device of these apparatuses may include one or more disposable components, such as trays, cartridges, or similar, to enable use with multiple robot scopes, which may include sterile versions or sterile boundaries or layers, and which are configured to allow reuse of the drive system and frame as well as other components coupled to the drive system. In any example of these examples, the apparatus may be configured so that reusable components (e.g., vertically positioned link assemblies, mount assemblies, etc.) are kept away from the sterile field, for example, by the use of drapes or covers. Therefore, drapes that may be coupled to or engaged with devices including a drive system described herein are also described herein.

[0013]

[0013] For example, an apparatus (e.g., a system) for deploying a flexible tubular member is described herein, the apparatus comprising: a base; a vertically arranged link assembly comprising a plurality of links perpendicular to each other, wherein each adjacent pair of links is slidably coupled together by one or more mechanical moving couplings, e.g., flexible bands, which extend at least partially around the cylindrical surface of the shuttle, and the pairs of shuttles between adjacent links of adjacent pairs of links are coupled together on a synchronous belt; a driver (e.g., a linear driver) coupled to a first shuttle of the pair of shuttles; and a first part of a mount assembly which may be coupled to the vertically arranged link assembly, configured to be coupled to a flexible tubular member.

[0014]

[0014] In one example, the apparatus (e.g., system) for deploying a flexible tubular member includes: a base; a vertically arranged link assembly comprising a plurality of links perpendicular to each other, wherein adjacent pairs of links are slidably coupled together by a pair of opposing flexible bands extending (e.g., bending around) around the cylindrical surface of the shuttle in opposite directions, and pairs of shuttles between adjacent links of adjacent pairs of links are coupled together on a synchronous belt; a driver (e.g., a linear driver) coupled to a first shuttle of the pair of shuttles; and a mount assembly comprising a first part coupled to the vertically arranged link assembly, wherein the first part of the mount assembly is configured to be coupled to a flexible tubular member.

[0015]

[0015] In some examples, the vertically arranged link assembly is configured to have two, three, or four or more links (for example, three or more links, more than two). For example, an apparatus (e.g., a system) for deploying a flexible tubular member includes: a base and; a vertically positioned link assembly connected to the base, comprising a first link, a second link, and a third link, the first link, the second link, and the third link being adjacent to each other perpendicularly; a first shuttle between the first link and the second link and a second shuttle between the second link and the third link, the first shuttle being movably coupled between the first link and the second link, and the second shuttle being movably coupled between the second link and the third link, so that the second and third links may slide distally and proximal to the first link, the first shuttle comprising a first vertical cylindrical surface, and the second shuttle comprising a second vertical cylindrical surface; and a linear dry coupling to the first shuttle. A vertically positioned link assembly comprising: a first flexible band between a first link and a second link, the first flexible band extending around the surface of a first vertical cylinder from a first end region of the first link to a first end region of the second link; a second flexible band between a second link and a third link, the second flexible band extending around the surface of a second vertical cylinder from a first end region of the second link to a first end region of the third link, such that proximal and / or distal movement of the second link relative to the first link by a linear driver results in proximal and / or distal movement of the third link; and a mount assembly including a first portion coupled to the vertically positioned link assembly, the first portion of the mount assembly configured to be coupled to a flexible tubular member.

[0016]

[0016] In any of these devices, the device may include a synchronizing belt which may be configured to move the first shuttle in the opposite direction to the second shuttle. The synchronizing belt may be in a link between two shuttles to which the synchronizing belt is connected. The synchronizing belt may be coupled to a pair of pulleys such that the movement of the first shuttle distally moves the second shuttle proximal, and vice versa.

[0017]

[0017] Generally, bands extending between links are coupled to opposing sides of the links (e.g., sides of links facing each other) at the same end, for example, the distal or proximal end. In some cases, a pair of bands arranged in an opposing configuration may connect the ends of the links facing each other in the link assembly after passing around the cylindrical surface (e.g., a pulley) in different regions of the cylindrical surface. For example, the first end of the first band of the opposing bands may be coupled to the distal end region of the first link of an adjacent pair of links, and to the distal end region of the second link of an adjacent pair of links. The first end of the second band of the opposing bands may be coupled to the proximal end region of the first link of an adjacent pair of links, and to the proximal end region of the second link of an adjacent pair of links.

[0018]

[0018] Generally, flexible bands and / or belts may be formed from a flat, relatively thin, and flexible material, including a thin, flat metal (e.g., stainless steel). Thus, a flexible band may comprise a flat band. The width of the flat band may be several times the thickness (e.g., 5 times, 10 times, 15 times, 20 times, etc.). For example, a flexible band may have widths of 0.5 cm, 1 cm, 1.5 cm, 2 cm, 3 cm, 4 cm, 5 cm, etc.

[0019]

[0019] In any of these devices, each of the multiple links may have a vertical height greater than the width and less than the distal-to-proximal length. In some examples, each of the multiple links may have a vertical height less than the distal-to-proximal length and at least twice the width. For example, a link may have a length between about 10 cm and 100 cm (e.g., between 15 cm and 75 cm, between 20 cm and 60 cm, etc.), a height between about 3 cm and 30 cm (e.g., between 4 cm and 20 cm, between 5 cm and 18 cm, etc.), and a width between about 0.5 cm and 6 cm (e.g., between about 1 cm and 5 cm, between about 0.5 cm and 4 cm, etc.).

[0020]

[0020] As stated above, a mount assembly for coupling to a flexible tubular member (e.g., one or more parts of a mount assembly) may be coupled to one of the outer links of a link assembly, such as to an outer link of a plurality of links of a vertically arranged link assembly. The mount assembly may include one or more drivers for steering and / or otherwise manipulating the flexible tubular member. In an example where the flexible tubular member is a nested device having an inner endoscope and an outer overtube (e.g., a nested rigid-granting robotic device), the mount assembly may include a first region (or part) configured to mount on the outer overtube and a second region (or part) configured to mount on the inner endoscope. The mount assembly may be configured such that these two regions can move relative to each other to allow relative movement of the inner member versus the outer member of the nested device. For example, the first mount region may be configured to couple to a nested robotic device having an overtube in which the endoscope is nested. In one example, the mount assembly may include an overtube mount (first mount area) and an endoscope mount (second mount area), the endoscope mount being configured to move proximal and / or distal to the overtube mount.

[0021]

[0021] Any device of these devices may be configured to allow the position of the link assembly (and thus the endoscope) to be adjusted in multiple degrees of freedom. For example, these devices may be configured to allow the height of the link assembly to be adjusted relative to the base (e.g., the floor). Any device of these devices may include a vertical lift arm that connects a vertically positioned link assembly to the base, and the vertical lift arm is configured to raise and lower the vertically positioned link assembly relative to the base. In one example, the device may include a yaw adjustment member between the vertically positioned link assembly and the base, and the yaw adjustment member is configured to pivot the vertically positioned link assembly around the base. These adjustments may be controlled and / or driven, for example, by a drive member and / or a controller that controls the drive member. The device may include one or more locks for locking these devices in a particular configuration. Generally, the link assembly may be connected to the base directly or through one or more arms.

[0022]

[0022] Any suitable drive (e.g., drive subsystem, driver, etc.) may be used to drive the movement of the shuttle, and thus the extension and / or retraction of the link assembly. The drive may be a linear drive (e.g., a linear drive that converts rotational motion into linear (distal / proximal) motion). For example, the drive may include a ball screw nut assembly. In some examples, the linear drive is housed in the first link of a plurality of links (e.g., a link directly or indirectly coupled to the base). In some examples, the drive for the link assembly (e.g., a linear drive) may be separate from the link assembly and outside the links, but may be coupled to the shuttle (a first shuttle, which may also be called a drive shuttle) through the first link.

[0023]

[0023] Any device of the apparatus described herein may include one or more processors and a controller which includes a control circuit for receiving control inputs and providing outputs for controlling and / or coordinating the extension / retraction of link assemblies and / or flexible tubular member drivers (e.g., overtube drivers and / or endoscope drivers in a nested configuration). For example, the controller may be configured to control a linear drive to move links of multiple links (e.g., plates) distally and proximal to the base by controlling the operation of a linear driver. The controller may include control logic (software, firmware, and / or hardware) to carry out any method of the method described herein. The controller may coordinate with catheter steering and / or stiffening in examples where a stiffening device is used. The controller may receive user input and may automate some or all of the guidance of the apparatus. The controller may receive and process (or transmit and / or store) inputs from one or more sensors.

[0024]

[0024] Any device of the apparatus described herein may include a flexible tubular member support that is coupled to a vertically positioned link assembly and configured to prevent buckling of the flexible tubular member as the flexible tubular member extends distally from the vertically positioned link assembly. The flexible tubular member support (hereinafter referred to herein as the endoscope support or simply the support) may be a strut, beam, rod, pole, etc., which may support the length of the flexible tubular member as the flexible tubular member extends distally and / or proximal outward from the link assembly. In some examples, the flexible tubular member support may include one or more loops or straps to hold (and support) a portion of the flexible tubular member.

[0025]

[0025] Any of the devices described herein may include a tool driver for operating or assisting in operating a tool inserted into or through a working channel (internal or external working channel) of a flexible tubular member. For example, the tool driver may be coupled to a vertically arranged link assembly and configured to actuate the tool within the working channel of an endoscope comprising the flexible tubular member.

[0026]

[0026] As noted, any of these devices may include one or more sensors configured to detect one or more operational parameters for the system. For example, the device may include one or more load sensors configured to detect a load applied to the vertically arranged link assembly. The one or more load sensors may be configured, for example, as current sensors that detect the current of the linear driver.

[0027]

[0027] Any of the devices described herein may be configured to work with various elongated medical instruments (roboscopes). However, in any of these devices, an elongated medical instrument (e.g., a roboscope) may be included as part of the system.

[0028]

[0028] As noted, any of these devices may include an elongated medical instrument (e.g., a roboscope). For example, the system may include a roboscope, which may be a colonoscope. In one example, the roboscope included in the device is a stiffenable flexible tubular member comprising a stiffenable inner member concentrically positioned within a stiffenable outer member. In general, any of these devices may include a pressure input configured to couple the roboscope to a pressure source to control the stiffness of the roboscope, including either or both of the inner member and the outer member in variations that include the inner and outer members.

[0029]

[0029] For example, a system for deploying a flexible tubular member is described herein, the system comprising: a base; a telescoping link assembly connected to the base and comprising a plurality of adjacent links, each adjacent pair of links being slidably coupled together, wherein the plurality of links is configured to extend from a compact configuration to a length of 0.6 m or more; a linear driver configured to drive movement of the links of the telescoping link assembly; and a mount assembly coupled to the link assembly, the mount assembly being configured to couple to the flexible tubular member.

[0030]

[0030] In general, the compact configuration may have a length that is significantly smaller than the extended length of the device (e.g., extending in a distal-to-proximal direction). For example, the length of the compact configuration may be 50% or less (e.g., 45% or less, 40% or less, 35% or less, 30% or less, 25% or less, 20% or less, etc.) of the length of the fully extended configuration.

[0031]

[0031] As noted, any of these devices may be bidirectional such that the device can extend distally or proximally from the compact configuration. For example, the telescoping link assembly may be bidirectional, and the compact configuration may be a neutral configuration, whereby the plurality of links may be extended distally from the neutral configuration to a length of 0.6 m or more, or proximally from the neutral configuration to a length of 0.6 m or more. Bidirectional extension provides many advantages, particularly when compared to systems that only expand in one direction, for example, from a stable or fixed base. A bidirectional system may allow for a much more compact footprint in the compact configuration, enabling use of the device in even very narrow or space-constrained areas, including next to a hospital bed or surgical table. A bidirectional device may provide a longer travel distance when moving along the distal-to-proximal axis.

[0032]

[0032] Any device of the apparatus described herein may include a plurality of links that are perpendicular to each other with respect to the ground. Therefore, the links may be arranged side by side rather than above each other.

[0033]

[0033] Generally, any device of these devices may be configured such that moving any link of individual links results in the coordinated movement of all or some of the other links; for example, driving the movement of a first link (proximal / distal movement) may cause a set of links to extend in the same direction of movement. This may advantageously allow control of movement by a single driver (or, for example, a set of drivers operating on a single link, coupled to a base). In any device of these devices, this may be achieved using one or more synchronizing members coupled to each link of a plurality of links, configured such that when a force is applied to one of the links, all movement of the links is coordinated. The synchronizing members may be mechanical (e.g., belts, bands, etc.) and / or may include software or firmware to coordinate between different links. For example, each link may be driven individually, and the activity of the drivers may be coordinated by one or more processors.

[0034]

[0034] In any of these examples, the mount assembly may include an overtube mount and an endoscope mount, the endoscope mount being configured to move proximal and / or distal to the overtube mount.

[0035]

[0035] The link assembly may be configured to extend from a compact configuration to any suitable length. For example, the link assembly may be configured to extend to a length of 1 m or more (e.g., 1.1 m or more, 1.2 m or more, 1.3 m or more, 1.4 m or more, 1.5 m or more, 1.6 m or more, 1.7 m or more, 1.8 m or more, 1.9 m or more, 2 m or more, etc.).

[0036]

[0036] The devices described herein may have very small distal clearance heights or offsets. Therefore, the height of the mount assembly relative to the link assembly may be adjustable and / or relatively low. For example, the vertical distance from the mount assembly to the lowest surface of the link assembly may be less than 20 cm (e.g., 20 cm or less, 19 cm or less, 18 cm or less, 17 cm or less, 16 cm or less, 15 cm or less, 14 cm or less, 12 cm or less, 10 cm or less, etc.). Therefore, the distal ends of the mount assembly and link assembly may extend distally to a patient positioned on a bed or table and may be positioned to coincide with the patient orifice without interference between the bed / table and the distal ends of the extended device, even when the patient orifice is relatively close to the bed / table surface (e.g., less than 20 cm).

[0037]

[0037] Generally, links may be configured to slide smoothly against each other to extend / retract distally and / or proximal. In any of these examples, the links may be configured such that adjacent pairs of links are slidably coupled together by a pair of opposing flexible bands extending in opposite directions around one or more surfaces of the shuttle. For example, a link assembly may have one or more (e.g., a pair) shuttles between adjacent links of adjacent pairs of links; the shuttles may be coupled together on a synchronization member (e.g., a synchronization belt).

[0038]

[0038] A system for deploying a flexible tubular member is also described herein, the system comprising: a base; a bidirectional telescopic link assembly connected to the base and comprising a plurality of adjacent links, each adjacent pair of links being slidably coupled together, the plurality of links being configured to extend proximal from a compact neutral configuration to a proximal extension configuration and distal from a compact neutral configuration to a distal extension configuration, the compact neutral configuration having a length of 50% or less of the length of the proximal extension configuration and 50% or less of the length of the distal extension configuration; a linear driver configured to drive the movement of the links of the telescopic link assembly; and a mount assembly coupled to the link assembly and configured to be coupled to a flexible tubular member.

[0039]

[0039] As stated, in any device of these devices (e.g., a system), the links may be adjacent to each other perpendicularly. Alternatively, in some examples, the links may be adjacent to each other horizontally (e.g., stacked). As stated, any device of these devices may include one or more synchronizing members coupled to each link of the multiple links, configured to coordinate all movement of the links when a force is applied to one of the links. The mount assembly may comprise an overtube mount and an endoscope mount, the endoscope mount being configured to move proximal and / or distal to the overtube mount. The link assembly may be configured to extend from a compact configuration to a length of 1 m or more. The vertical distance from the mount assembly to the lowest surface of the link assembly may be less than 20 cm. The multiple links may be configured such that adjacent pairs of links are slidably coupled together by a ball screw nut assembly. The multiple links may be configured such that adjacent pairs of links are slidably coupled together by a pair of opposing flexible bands extending in opposite directions around one or more surfaces of the shuttle. Any of these devices may include one or more (e.g., a pair) shuttles between adjacent links of adjacent pairs of links that are coupled together on the synchronization belt.

[0040]

[0040] A system for deploying a flexible tubular member is also described herein, the system comprising: a base; a vertically arranged link assembly comprising a plurality of links, each adjacent to the base and perpendicular to one another, wherein each adjacent pair of links is slidably coupled together by a pair of opposing flexible bands extending in opposite directions around one or more surfaces of the shuttle, and the pairs of shuttles between adjacent links of adjacent pairs of links are coupled together on a synchronization belt; a linear driver coupled to a first shuttle of the pair of shuttles; and a mount assembly coupled to the vertically arranged link assembly, configured to be coupled to a flexible tubular member.

[0041]

[0041] The synchronization belt may be configured to move the first shuttle in opposite directions relative to the second shuttle. The first end of the first band of the opposing band may be coupled to the distal end region of the first link of an adjacent pair of links and to the distal end region of the second link of an adjacent pair of links, and the first end of the second band of the opposing band may be coupled to the proximal end region of the first link of an adjacent pair of links and to the proximal end region of the second link of an adjacent pair of links. The flexible band may comprise a flat band. For example, the flexible band may comprise a metal band. Each of the multiple links may have a vertical height greater than the width and less than the distal-to-proximal length. Each of the multiple links may have a vertical height less than the distal-to-proximal length and at least twice the width. The cylindrical surface may comprise pulleys.

[0042]

[0042] In any of these devices, the mount assembly may be coupled to the outer links of a plurality of links of a vertically arranged link assembly.

[0043]

[0043] Any of these devices may include a vertical lift arm having a vertical axis connecting a vertically positioned link assembly to a base, the vertical lift arm being configured to raise and lower the link assembly positioned perpendicular to the base.

[0044]

[0044] Any of these devices may include a yaw adjustment member between a vertically positioned link assembly and a base, the yaw adjustment member being configured to pivot the vertically positioned link assembly around the base. The mounting assembly may be configured to connect to a flexible tubular member comprising a nested robotic device having an overtube nested therein.

[0045]

[0045] The mount assembly may include an overtube mount and an endoscope mount, the endoscope mount being configured to move proximal and / or distal to the overtube mount.

[0046]

[0046] In any of these devices, the linear drive may comprise a ball screw nut assembly or any other suitable linear driver. The linear drive may be housed within the first link of a plurality of links. Alternatively, in some examples, the linear driver may be housed outside the first link.

[0047]

[0047] Any of these devices may include a controller configured to control the linear drive to move the links of a plurality of links distally and proximal to the base by controlling the operation of the linear driver.

[0048]

[0048] Any of these devices may include a flexible tubular member support that is coupled to a vertically positioned link assembly and configured to prevent buckling of the flexible tubular member when the flexible tubular member extends distally from the vertically positioned link assembly.

[0049]

[0049] In one example, the mounting assembly may be located below the top of a vertically positioned link assembly. The apparatus described herein may include a tool driver coupled to a vertically positioned link assembly and configured to actuate a tool within a working channel of a flexible tubular member.

[0050]

[0050] Generally, any device of these devices may include one or more sensors configured to detect one or more operating parameters of the system. For example, these devices may include one or more load sensors configured to detect a load applied between a vertically positioned link assembly and a patient. The load may be transmitted through one or more flexible tubular members (e.g., an endoscope). One or more load sensors may include current sensors configured to detect the current of a linear driver.

[0051]

[0051] The mount assembly (for example, coupled in one example to a vertically positioned link assembly) may be coupled to the base directly or through one or more arms.

[0052]

[0052] For example, a system for arranging a flexible tubular member, comprising a base and a vertically positioned link assembly connected to the base, comprising a first link, a second link, and a third link, wherein the first link, the second link, and the third link are adjacent to each other perpendicularly; comprising a first shuttle between the first link and the second link and a second shuttle between the second link and the third link, wherein the first shuttle is movably coupled between the first link and the second link, and the second shuttle is movably coupled between the second link and the third link, so that the second link and the third link may slide distally and proximal to the first link, the first shuttle comprises a first vertical cylindrical surface, and the second shuttle comprises a second vertical cylindrical surface; coupled to the first shuttle A vertically positioned link assembly comprising: a linear driver; a first flexible band between a first link and a second link, the first flexible band extending around the surface of a first vertical cylinder from the first end region of the first link to the first end region of the second link; a second flexible band between a second link and a third link, the second flexible band extending around the surface of a second vertical cylinder from the first end region of the second link to the first end region of the third link, such that proximal and / or distal movement of the second link relative to the first link by the linear driver results in proximal and / or distal movement of the third link; and a mount assembly coupled to the vertically positioned link assembly, the mount assembly configured to be coupled to a flexible tubular member. The apparatus may include a third flexible band between a first link and a second link, extending around the surface of a first vertical cylinder from the second end region of the first link to the second end region of the second link, and a fourth flexible band between a second link and a third link, extending around the surface of a second vertical cylinder from the second end region of the second link to the second end region of the third link.

[0053]

[0053] Any of these devices may include a synchronization belt coupled to the first shuttle and the second shuttle, configured to move the first shuttle relative to the second shuttle.

[0054]

[0054] In any of these devices, the motion of the linear drive may be transmitted to the third link in a ratio of 4:1 or greater.

[0055]

[0055] In general, any device of the apparatus described herein may include link assemblies and mounting assemblies for use with elongated telescopic members (e.g., nested members). For example, a system for deploying a nested robotic device having an inner stiffening member disposed at least partially slidably within an outer stiffening member is described herein, the system comprising: a base and; a vertically arranged link assembly connected to the base, comprising a first link, a second link, and a third link, the first link, the second link, and the third link being adjacent to each other perpendicularly; a first shuttle between the first link and the second link and a second shuttle between the second link and the third link, the first shuttle being movably coupled between the first link and the second link, and the second shuttle being movably coupled between the second link and the third link, so that the second and third links may slide distally and proximal to the first link, the first shuttle comprising a first vertical cylindrical surface, and the second shuttle comprising a second vertical cylindrical surface; a linear driver coupled to the first shuttle; and between the first link and the second link A vertically positioned link assembly comprising: a first flexible band between the second and third links, the first flexible band extending around the surface of the first vertical cylinder from the first end region of the first link to the first end region of the second link; a second flexible band between the second and third links, the second flexible band extending around the surface of the second vertical cylinder from the first end region of the second link to the first link to the first link by a linear driver, such that proximal and / or distal movement of the second link relative to the first link by a linear driver results in proximal and / or distal movement of the third link; and a mount assembly comprising: a first mount region coupled to the third link of the vertically positioned link assembly and configured to be coupled to an external stiffening device; and a second mount region linearly movable proximal and distal to the first mount region and configured to be coupled to an internal stiffening device.

[0056]

[0056] Methods for operating any of the devices of the apparatus described herein are also described herein. For example, a method for deploying an endoscope nested with an overtube may include advancing and / or retracting the overtube together with the endoscope by moving a first link of a bidirectional telescopic link assembly, wherein the overtube is coupled to an overtube mount on the first link, and the endoscope is coupled to an endoscope mount on the first link, and the bidirectional link assembly comprises a plurality of links, including the first link, which are slidably coupled together and adjacent to each other, and advancing the overtube includes extending the plurality of links distally from a compact neutral configuration to a proximal extension configuration, and retracting the overtube includes retracting the plurality of links proximal from a compact neutral configuration to a proximal extension configuration, wherein the compact neutral configuration has a length of no more than 50% of the length of the proximal extension configuration and no more than 50% of the length of the distal extension configuration, and advancing and / or retracting; and moving the endoscope distally into or out of the overtube by changing the relative position of the endoscope mount and the overtube mount on the first link.

[0057]

[0057] Any method of these methods may include extending a plurality of links using a linear driver configured to drive the movement of the links in a telescopic link assembly. Any method of these methods may include coupling an overtube to an overtube mount and / or coupling a nested endoscope within the overtube to an endoscope mount.

[0058]

[0058] For example, a method of deploying an endoscope nested with an overtube may include advancing and / or retracting the overtube together with the endoscope by moving a first link of a bidirectional telescopic link assembly, wherein the overtube is coupled to an overtube mount on the first link, and the endoscope is coupled to an endoscope mount on the first link, and the bidirectional link assembly comprises a plurality of links, including the first link, which are slidably coupled together and adjacent to each other, and advancing the overtube includes extending the plurality of links distally from a compact neutral configuration to a proximal extension configuration, and retracting the overtube includes retracting the plurality of links proximal from a compact neutral configuration to a proximal extension configuration, wherein the compact neutral configuration has a length of 50% or less of the length of the proximal extension configuration and 50% or less of the length of the distal extension configuration, and advancing and / or retracting; and moving the endoscope distally into or out of the overtube by changing the relative position of the endoscope mount and the overtube mount on the first link. Extending multiple links may include using a linear driver to drive the movement of the links in a telescopic link assembly. As stated above, any of these methods may include connecting the overtube to an overtube mount and / or connecting the endoscope nested within the overtube to an endoscope mount.

[0059]

[0059] Apparatuses including one or more supports configured to support a nested telescopic apparatus (e.g., an overtube and an endoscope) during operation of the apparatus, and methods of using the apparatus are also described herein. For example, the apparatus may include: a telescopic link assembly comprising a plurality of adjacent vertical links, each adjacent pair of vertical links configured to be slidably coupled together and move toward each other and toward a base link; a first mount coupled to a first link of the link assembly and configured to engage with an overtube; a second mount coupled to the first link and configured to engage with an overtube and a nested endoscope, the overtube and endoscope being configured to move along a distal-to-proximal line by sliding the vertical links of the telescopic link assembly toward a base link; and a plurality of supports movably coupled to the telescopic link assembly, each support of the plurality of supports comprising a seating area configured to hold the overtube and endoscope aligned with a distal-to-proximal line.

[0060]

[0060] Each support of the plurality of supports may be configured such that, as the plurality of links of the telescopic link assembly extend distally, the seat area of ​​each support moves out of the line from distal to proximal. At least some of the supports of the plurality of supports may be configured such that, as the plurality of links of the telescopic link assembly extend distally, they are deflected downward and laterally.

[0061]

[0061] As stated above, any of these devices may include a base. Any of these devices may include a linear driver configured to drive the movement of the vertical link of the telescopic link assembly. At least one of the multiple supports may be configured to move from a deployed configuration, in which the seating area of ​​the support is configured to hold the overtube and endoscope aligned with the distal-to-proximal line, to a pre-deployment configuration, in which the support is lifted vertically out of the plane of the distal-to-proximal line.

[0062]

[0062] At least one of the multiple supports may be coupled to an extender on the link assembly which is configured to extend distally from the link assembly. The first and / or second mounts may be configured to move relative to each other on the first link to adjust the relative positions of the endoscope and the overtube.

[0063]

[0063] For example, the device includes a base and; a bidirectional telescopic link assembly comprising a plurality of vertical links connected to the base and adjacent to each other, wherein each adjacent pair of vertical links is slidably coupled together and configured to move bidirectionally relative to the base link; a linear driver configured to drive the movement of the vertical links of the bidirectional telescopic link assembly; a first mount coupled to a first link of the link assembly and configured to engage with an overtube; and a second mount coupled to the first link and configured to engage with the overtube and a nested endoscope. The overtube and endoscope are configured to move along a distal-to-proximal line by sliding the vertical links of a bidirectional telescopic link assembly to a second mount and a plurality of supports coupled to the telescopic link assembly, each of the plurality of supports having a seating area, the seating area being configured to move between a first configuration, the seating area holding the overtube and endoscope in alignment with a distal-to-proximal line, and a second configuration, the seating area of ​​each support being configured to move out of the distal-to-proximal line as the plurality of links of the telescopic link assembly extend distally.

[0064]

[0064] All of the methods and apparatus described herein can be used in any combination to achieve the benefits intended and described herein.

[0065]

[0065] A better understanding of the features and advantages of the methods and apparatus described herein can be obtained by referring to the following detailed description and accompanying drawings which illustrate illustrative embodiments. [Brief explanation of the drawing]

[0066] [Figure 1A]

[0066] This figure shows an example of an elongated medical instrument, such as a nested robotoscope device, which may be used in conjunction with the methods and apparatus described herein. The elongated medical instrument in this example is an endoscope (for example, a colonoscope in one example) having nested inner and outer members that together selectively provide rigidity. [Figure 1B] This figure shows an example of an elongated medical instrument, such as a nested robotoscope device, which may be used in conjunction with the methods and apparatus described herein. The elongated medical instrument in this example is an endoscope (for example, a colonoscope in some cases) having nested inner and outer members that together selectively provide rigidity. [Figure 1C] This figure shows an example of an elongated medical instrument, such as a nested robotoscope device, which may be used in conjunction with the methods and apparatus described herein. The elongated medical instrument in this example is an endoscope (for example, a colonoscope in some cases) having nested inner and outer members that together selectively provide rigidity. [Figure 1D] This figure shows an example of an elongated medical instrument, such as a nested robotoscope device, which may be used in conjunction with the methods and apparatus described herein. The elongated medical instrument in this example is an endoscope (for example, a colonoscope in some cases) having nested inner and outer members that together selectively provide rigidity. [Figure 2]

[0067] This figure shows an example of a mechanism for operating an elongated medical device similar to the devices shown in Figures 1A to 1D. [Figure 3A]

[0068] This figure shows an example of a system for distributing (e.g., deploying) and controlling nested robotic devices in a first configuration. [Figure 3B]

[0069] This diagram shows a system for deploying and controlling the nested robotic device shown in Figure 3A in the second configuration. [Figure 3C]

[0070] This figure shows an example of a system similar to the one shown in Figures 3A-3B, which includes flexible tubular members (e.g., rigidity-adding nested overtubes and internal endoscopes). [Figure 3D] This figure shows an example of a system similar to the one shown in Figures 3A-3B, which includes flexible tubular members (e.g., rigidity-adding nested overtubes and internal endoscopes). [Figure 4]

[0071] This figure shows an example of a system for deploying and controlling nested robotic devices exhibiting 8 degrees of freedom. [Figure 5A]

[0072] This figure shows an example of a set of vertically arranged linear links for use with a system for deploying nested robotic devices, including a first (e.g., overtube) linear driver and a second (e.g., endoscope) linear driver on an inner linear link. [Figure 5B]

[0073] Figure 5A shows the vertically arranged linear links with the second linear driver in a proximal position on the inner link. [Figure 6A]

[0074] This figure shows an example of a set of vertically arranged linear link assemblies for use with a system for deploying and controlling a telescopic, nested robotic device. [Figure 6B]

[0075] This is an upper front perspective view of an example of a portion of a linear link assembly for controlling a flexible tubular member. [Figure 6C] This is a bottom front perspective view of an example of a portion of a linear link assembly for controlling a flexible tubular member. [Figure 6D] This is a bottom perspective view of an example of a portion of a linear link assembly for controlling a flexible tubular member. [Figure 7A]

[0076] This diagram schematically illustrates an example of a vertically arranged assembly of linear links for use with a system for deploying nested robotic devices. [Figure 7B]

[0077] This figure schematically illustrates an example of a vertically arranged assembly of linear links for use with a system for deploying and controlling nested robotic devices similar to the device shown in Figure 7A, further including synchronization bands for coordinating the movement of shuttles between links and for synchronizing the movement of the links. [Figure 7C]

[0078] This diagram schematically illustrates the bidirectional operation of a vertically arranged linear link assembly, showing an unextended configuration in which the inner and intermediate links align with the outer links. [Figure 7D] This diagram schematically illustrates the bidirectional operation of a vertically arranged linear link assembly, showing a proximal extension configuration in which the inner and intermediate links fit proximal to the outer link. [Figure 7E] This diagram schematically illustrates the bidirectional operation of a vertically arranged linear link assembly, showing a distal extension configuration in which the inner and intermediate links fit distally to the outer link. [Figure 7F]

[0079] This diagram schematically illustrates the bidirectional operation of a linear link assembly, showing an unextended configuration in which the inner and intermediate links align with the outer link. [Figure 7G] This diagram schematically illustrates the bidirectional operation of a linear link assembly, showing a proximal extension configuration in which the inner and intermediate links fit proximal to the outer link. [Figure 7H] This diagram schematically illustrates the bidirectional operation of a linear link assembly, showing a distal extension configuration in which the inner and intermediate links fit distally to the outer link. [Figure 7I]

[0080] This diagram schematically illustrates the bidirectional operation of a linear link assembly, showing an unextended configuration in which the inner and three intermediate links align with the outer link. [Figure 7J] This diagram schematically illustrates the bidirectional operation of a linear link assembly, showing a proximal extension configuration. [Figure 7K] This diagram schematically illustrates the bidirectional operation of a linear link assembly, showing a distal extension configuration. [Figure 7L]

[0081] This figure shows another example of a top view of a linear link assembly in a robotic device, indicating the maximum telescopic length in both the proximal and distal directions. [Figure 8]

[0082] This figure shows an example of a configuration between a patient, a patient bed (e.g., a table, cart, etc.), a nesting robotic device, and a system for deploying the nesting robotic device as described herein. [Figure 9]

[0083] This diagram schematically illustrates an example of a system for deploying nested robotic devices within a linear link assembly, where the devices are positioned horizontally (rather than vertically). [Figure 10A]

[0084] This figure shows an example of relative distances and axes for accessing a patient using a system for deploying nested robotic devices. [Figure 10B] This figure shows an example of relative distances and axes for accessing a patient using a system for deploying nested robotic devices. [Figure 10C] This figure shows an example of relative distances and axes for accessing a patient using a system for deploying nested robotic devices. [Figure 11]

[0085] This diagram schematically illustrates an example of a draping system for protecting a system used to deploy nested robotic devices during operation. [Figure 12]

[0086] This diagram schematically illustrates an example of a support structure (e.g., support arm(s)) for use with a system for deploying nested robotic devices. [Figure 13]

[0087] This figure shows the vertical and yaw adjustments of a system for deploying nesting robotic devices similar to those shown in Figures 3A-3B and Figure 4. [Figure 14]

[0088] This figure shows an example of a tool manipulator (e.g., an insertion tool) that may be used with any of the systems described herein. [Figure 15A]

[0089] This figure shows an example of a system described herein for performing lower gastrointestinal procedures. [Figure 15B] This figure shows an example of a system described herein for performing lower gastrointestinal procedures. [Figure 15C] This figure shows an example of a system described herein for performing lower gastrointestinal procedures. [Figure 16A]

[0090] This is a schematic side perspective view illustrating an example of a robot-enabled system described herein. [Figure 16B] This is a schematic top view illustrating an example of a robot-compatible system described herein. [Figure 17A]

[0091] This figure shows the operation of the flexible tubular member support when extending and retracting the set of linear links of the system described herein. [Figure 17B] This figure shows the operation of the flexible tubular member support when extending and retracting the set of linear links of the system described herein. [Figure 17C] This figure shows the operation of the flexible tubular member support when extending and retracting the set of linear links of the system described herein. [Figure 17D] This figure shows the operation of the flexible tubular member support when extending and retracting the set of linear links of the system described herein. [Figure 17E] This figure shows the operation of the flexible tubular member support when extending and retracting the set of linear links of the system described herein. [Figure 17F] This figure shows the operation of the flexible tubular member support when extending and retracting the set of linear links of the system described herein. [Figure 17G]This figure shows the operation of the flexible tubular member support when extending and retracting the set of linear links of the system described herein. [Figure 17H] This figure shows the operation of the flexible tubular member support when extending and retracting the set of linear links of the system described herein. [Figure 18A]

[0092] This diagram schematically illustrates an example of a link assembly including multiple supports configured to support a nested telescopic assembly (e.g., a rigidity-granting overtube / endoscopy), showing that the supports are fully deployed and configured to support the nested telescopic assembly on the insertion axis. [Figure 18B] Figure 18A is a top view of a link assembly, such as the one shown, which includes multiple supports configured to support a nested telescopic assembly (e.g., a rigid-giving overtube / endoscope), showing that the supports are fully deployed and support a portion of the nested telescopic assembly on the insertion axis. [Figure 19A]

[0093] This figure shows an example of preparing a device, including a link assembly and support (e.g., a flexible tubular member support) for use with a nested telescopic device (e.g., a flexible tubular member), showing that the device is in a storage configuration before loading the nested telescopic device. [Figure 19B] This figure illustrates an example of preparing a device including a link assembly and support (e.g., a flexible tubular support) for use with a nested telescopic device (e.g., a flexible tubular member), showing the setup of a link assembly including a support for receiving the nested telescopic device. [Figure 19C] This figure illustrates an example of preparing a device including a link assembly and support (e.g., a flexible tubular support) for use with a nested telescopic device (e.g., a flexible tubular member), showing the setup of a link assembly including a support for receiving the nested telescopic device. [Figure 19D]This figure illustrates an example of preparing a device including a link assembly and support (e.g., a flexible tubular support) for use with a nested telescopic device (e.g., a flexible tubular member), showing the setup of a link assembly including a support for receiving the nested telescopic device. [Figure 19E] This figure shows an example of the preparation of a device including a link assembly and support (e.g., a flexible tubular member support) for use with a nested telescopic device (e.g., a flexible tubular member), and illustrates the loading of the nested telescopic device onto the device. [Figure 19F] This figure shows an example of the preparation of a device including a link assembly and support (e.g., a flexible tubular member support) for use with a nested telescopic device (e.g., a flexible tubular member), and illustrates the loading of the nested telescopic device onto the device. [Figure 19G] This figure shows an example of the preparation of a device including a link assembly and support (e.g., a flexible tubular member support) for use with a nested telescopic device (e.g., a flexible tubular member), and illustrates the loading of the nested telescopic device onto the device. [Figure 19H] This figure shows an example of the preparation of a device including a link assembly and support (e.g., a flexible tubular support) for use with a nested telescopic device (e.g., a flexible tubular member), showing the pre-deployment configuration in which the nested telescopic device is mounted and in a stowed configuration that can be positioned relative to the patient at any time. [Figure 20A]

[0094] This diagram illustrates the movement of a support when a nested telescopic device is inserted and / or retracted, showing that the support moves along or away from the insertion axis as needed to support the nested telescopic device. [Figure 20B]This diagram illustrates the movement of a support when a nested telescopic device is inserted and / or retracted, showing that the support moves along or away from the insertion axis as needed to support the nested telescopic device. [Figure 20C] This diagram illustrates the movement of a support when a nested telescopic device is inserted and / or retracted, showing that the support moves along or away from the insertion axis as needed to support the nested telescopic device. [Figure 20D] This diagram illustrates the movement of a support when a nested telescopic device is inserted and / or retracted, showing that the support moves along or away from the insertion axis as needed to support the nested telescopic device. [Figure 20E] This diagram illustrates the movement of a support when a nested telescopic device is inserted and / or retracted, showing that the support moves along or away from the insertion axis as needed to support the nested telescopic device. [Figure 20F] This diagram illustrates the movement of a support when a nested telescopic device is inserted and / or retracted, showing that the support moves along or away from the insertion axis as needed to support the nested telescopic device. [Figure 20G] This diagram illustrates the movement of a support when a nested telescopic device is inserted and / or retracted, showing that the support moves along or away from the insertion axis as needed to support the nested telescopic device. [Figure 20H] This diagram illustrates the movement of a support when a nested telescopic device is inserted and / or retracted, showing that the support moves along or away from the insertion axis as needed to support the nested telescopic device. [Figure 20I]This diagram illustrates the movement of a support when a nested telescopic device is inserted and / or retracted, showing that the support moves along or away from the insertion axis as needed to support the nested telescopic device. [Figure 21A]

[0095] This is a side view of a portion of the apparatus, including a link assembly having supports, as described herein, in this configuration of the link assembly and supports, the two supports are shown in a stowed configuration folded away from the plane of the insertion axis. [Figure 21B] This is a front view of a portion of the apparatus, including a link assembly having supports, as described herein, in this configuration of the link assembly and supports, two of the supports are shown in a stowed configuration folded away from the plane of the insertion axis. [Figure 22]

[0096] Another diagram (e.g., a side view) of a device similar to the one shown in Figures 21A-21B, including a nested telescopic device schematically shown in a preloaded configuration that is positioned and deployed relative to the patient at any time. [Figure 23]

[0097] This is a magnified view of two connection areas of the device's support structure, showing the connection points to the link assembly. [Figure 24]

[0098] This figure schematically illustrates an example of an optical sight (aiming device) that may be incorporated into any of the devices described herein to assist in aligning the insertion axis of the device with the patient. [Modes for carrying out the invention]

[0067]

[0099] Aspects of this disclosure may be integrated into a robot-enabled medical system capable of performing a variety of medical procedures, including both minimally invasive procedures—such as laparoscopy—and non-invasive procedures—such as endoscopy. Among endoscopic procedures, the system may be capable of performing colonoscopy, endoscopic examinations, bronchoscopy, ureteroscopy, gastroscopy, and the like.

[0068]

[0100] In addition to performing a wide range of procedures, the system may offer further benefits to assist physicians, such as improved imaging and guidance. Furthermore, the system may provide physicians with the ability to perform procedures from an ergonomic position without the need for awkward arm movements and positioning. Moreover, the system may provide physicians with the ability to perform procedures with improved ease of use, such that one or more of the system's instruments can be controlled by a single user. The apparatus (e.g., system, device, etc.) for operating and / or deploying the robotoscope may be configured to extend (distally) and / or retract (proximally) to control the movement of the flexible tubular member.

[0069]

[0101] Generally, these devices may be used to deliver flexible tubular members, including nested endoscopes that include both an outer "overtube" and an inner endoscope, which may be moved proximal / distal to each other, and which may each be given rigidity to guide and / or steer the devices through the patient's body. These devices may include a telescopic set of links, in particular, vertically arranged links. For example, the devices, systems, etc. described herein may be configured as part of a robotic system for delivering a pair of nested endoscope devices, including an inner endoscope and an outer overtube, which are capable of relatively high and low levels of compliance, respectively.

[0070]

[0102] The devices described herein may have an overall linear form factor and therefore may provide a linear kinematics system for device delivery. The main linear axis that may position the device (e.g., the overtube of an endoscope) within the patient includes a telescopic mechanism formed by a link assembly. The bidirectional telescopic action of this link assembly may also allow a relatively long linear axis to be relatively short when its full extension is not required, thereby addressing room size limitations in some facilities. In examples including a flexible tubular member system having both inner and outer members, the position of the inner endoscope relative to the outer overtube may be controlled by an independent linear axis. These devices may be used with virtually any flexible tubular member, but may be particularly useful when using nesting, especially rigid-granting endoscopes, such as dual rigid-granting endoscopes.

[0071]

[0103] For example, Figures 1A to 1D show an example of a robot scope configured as a dual stiffening endoscope. In Figures 1A to 1D, the dual stiffening endoscope 100 is configured as a nested system including a stiffening-enabled (e.g., stiffening) outer member 112 and a stiffening-enabled inner member 110. In Figure 1A, the steerable inner stiffening member 110 is positioned within the outer stiffening member 112, so that the distal end of the inner stiffening member 110 extends outside the outer stiffening member. In some cases, the inner stiffening member 110 may be completely retracted into the outer stiffening member 112. Figure 1B shows that the distal end of the inner stiffening member 112 is slightly bent in a desired direction / orientation (e.g., by a steering cable or other steering mechanism) and then stiffened (e.g., using positive or negative pressure). 112 may also be bent. This is because the outer stiffening member 112 is in a flexible state to follow the curvature of 110, and is then stiffened. In Figure 1C, the outer stiffening member 112 (in its flexible configuration) is advanced along the stiffened inner stiffening member 110 (including along the bent distal section). Once the distal end of the outer stiffening member 100 has advanced sufficiently along the distal end of the inner stiffening member 110, the outer stiffening member 112 may be stiffened (for example, using positive or negative pressure as described herein). In Figure 1D, the inner stiffening member 110 may then be transitioned to a flexible state (for example, in some cases by removing positive or negative pressure, and by allowing the steering cable to loosen so that the tip can move easily), and may be advanced and directed / orient / steering as desired. Alternatively, in Figure 1D, the inner stiffening member 110 may be actively steered (manually or by computer control) when it exits, thereby minimizing the load on the stiffened outer tube. Minimizing the load on the outer stiffening member may facilitate the tube maintaining its stiffened shape.When the internal stiffening member 110 is stiffened, the external stiffening member 112 can transition to a flexible state and be moved forward along the internal stiffening member 110. The process can then be repeated to navigate through more meandering anatomical structures. However, coordinating the movement of the internal and external members, including moving the internal or external or both forward / backward and selectively stiffening them, can be particularly challenging, making robotically controlled systems particularly advantageous. The repeated process may result in "shape copying," where the internal and external stiffening members may, while in a flexible configuration, continuously match (or replicate) the shape of any member in a stiff configuration.

[0072]

[0104] Examples of robot scopes shown in Figures 1A to 1D illustrate the operation of just one type of medical device that may be used with the methods and apparatus described herein. Furthermore, these devices may be configured to function as an endoscope, including one or more of the following: imaging, irrigation, illumination, and a steering channel for removing or applying material. For example, robot scope 100 may be a “navigation” device comprising a camera, illumination, and a distal steering section. The navigation device (scope or part of the scope) may be well sealed to facilitate cleaning between procedures. In some examples, the navigation device is fully sheathed, including both outside and through the working channel, and therefore does not need to be cleaned. In some examples, a second internal device may then be positioned inside a rigidly reinforced outer member and advanced beyond the distal end of the outer member. The second internal member may be a “therapeutic” tube comprising elements such as a camera, light, water, suction tools, and various other tools. The “treatment” device may not have a steering section or the ability to provide rigidity, thereby giving further space within the body of the treatment tube for the inclusion of other features, such as tools for performing treatment. Once positioned, the tools on the “treatment” tube may be used to perform intra-body treatments, such as mucosal resection or incision in the human gastrointestinal tract.

[0073]

[0105] In some cases, the stiffening members described herein can transition from a flexible configuration to a rigid configuration, and the stiffness may be selected by the user or system, and may therefore be considered “variable stiffness.” For example, each stiffening member may be stiffened by applying positive or negative pressure to or within the walls of the stiffening member. With the positive or negative pressure removed (or reversed), the layers can be easily sheared or moved relative to one another; the release of positive or negative pressure may allow the layers to transition to a state exhibiting substantially improved ability to resist shear, movement, bending, torque, and buckling, thereby providing stiffness to the system. In the apparatus described above, the examples shown provide stiffness by applying pressure (e.g., positive or negative pressure), but the methods and apparatus described herein are not limited to positive or negative pressure stiffening apparatuses and may be used with any suitable stiffening member(s). For example, the stiffening member described herein may refer to any suitable stiffening device, which may include a member that is stiffened by jamming particles, by phase change and / or shape memory alloys, by a connecting component (e.g., a cable having a disk or cone), by an EAP (electro-active polymer), or by any other stiffening mechanism.

[0074]

[0106] Any device of a stiffening device described herein may include a stiffening layer or region that engages with a compression layer (which may be a bladder or include a bladder) to apply force to the stiffening layer to stiffen it, or in some cases to destabilize the stiffening layer (e.g., release it from stiffening). In some examples, these stiffening devices may include a stiffening layer that may include a blade, knit, fabric, chopped segment, randomly distributed or randomly oriented filament or strand, engager, link, scale, plate, segment, particle, granule, intersecting filament, or other material forming the stiffening layer. For example, the stiffening layer may have multiple strand lengths or strand segments that intersect each other (e.g., as part of a blade, knit, fabric, etc.); the compression layer may apply force to drive the intersecting strand lengths or strand segments relative to each other. Many of the examples shown herein are blades, but any device of these devices may instead or additionally include a general stiffening layer having intersecting strand lengths or strand segments. Examples of stiffening devices described herein may selectively and controllably provide stiffness using pressure (positive pressure) and / or negative pressure. In some examples, the methods described herein may be used in conjunction with any suitable stiffening device.

[0075]

[0107] Sequences identical or similar to those shown in Figures 1A to 1D may be carried out by the apparatus described herein, in particular, including the rotating system described herein.

[0076]

[0108] Generally, robotic scopes may be steered automatically or manually, including by user operation, so that the robotic scope is steered into a known, assumed, or measured shape as it is advanced into an anatomical structure. This can be particularly useful and important when navigating dual-stiffening endoscopes, such as those shown in Figures 1A–1D (but not limited to). For example, the distal tip of the inner stiffening member may be steered (including steering to set or match the shape of a section of the outer stiffening member). Typically, regions of the inner and / or outer members of the scope may be steered in regions immediately adjacent to the distal tip.

[0077]

[0109] Therefore, generally, the apparatus described herein may include effectors for controlling the movement of a scope operated by the device, including for steering, rigidification, navigation, imaging, illumination, etc. For example, effectors (e.g., end effectors) of some variation of the robotic arm of the system may include an instrument driver, which may incorporate electromechanical means for acting on (e.g., steering) a medical instrument, and may include a mounting assembly for detachably coupling to a scope or part of a scope (e.g., an inner member, an outer member, etc.). For example, PCT application PCT / US2023 / 064999, filed on 27 March 2023, titled “METHODS AND APPARATUSES FOR NAVIGATING USING A PAIR OF RIGIDIZING DEVICES,” describes an example of an apparatus including a nesting device which may be used in conjunction with any of the methods and apparatus described herein. Other examples of apparatus that may be used in conjunction with the methods and apparatus described herein include, for example, U.S. Patent Application No. 17 / 902,770, titled “NESTED RIGIDIZING DEVICES,” filed on 8 September 2022; U.S. Patent Application No. 18 / 000,062, titled “RIGIDIZING DEVICES,” filed on 26 May 2021; Patent Application No. PCT / US2022 / 014497, titled “DEVICES AND METHODS TO PREVENT INADVERTENT MOTION OF DYNAMICALLY RIGIDIZING DEVICES,” filed on 31 January 2022; and “METHODS AND APPARATUSES FOR REDUCING CURVATURE OF A This may include nesting catheters such as those described in patent application PCT / US2022 / 082300, named "COLON," and patent application PCT / US2023 / 062206, named "DYNAMICALLY RIGIDIZING COMPOSITE MEDICAL STRUCTURES," filed on February 8, 2023.Each of these applications is incorporated herein in its entirety by reference.

[0078]

[0110] In some examples, a robot scope, such as the dual stiffening device shown in Figures 1A to 1D, may be robotically controlled. For example, the proximal end(s) of the robot scope may include a connector for connecting the robot scope to a frame. In the examples shown in Figures 1A to 1D, the outer stiffening member 112 and the inner stiffening member 110 may each include controls and / or connectors for connecting to steering inputs, air lines (e.g., suction), water lines, video lines (e.g., monitors), and / or one or more tool channels. In some examples, the proximal end of the robot scope (or, in the case of a dual stiffening scope, each of the inner and outer members) may include a connector area such as the cassette 257 schematically shown in Figure 2. Each of the inner and outer members may include a separate cassette.

[0079]

[0111] For example, the cassette may include connections for controlling steering, for example, by one or more steering tensioners, within the inner and / or outer members. For example, cassette 257 may include discs 271a, 271b, which may be connected to cables 263a, 263b, respectively, to steer (e.g., bend or deflect) the tip of the inner stiffening member 210. Other steering mechanisms (e.g., pneumatic, hydraulic, shape memory alloy, EAP (electroactive polymer), or motor) are also possible. Again, in examples with different steering mechanisms, one or more discs within cassette 257 (e.g., discs 271a, 271b) may be used to actuate the steering.

[0080]

[0112] Cassette 257 may further include pressurized connections 203a, 203b, which may be connected to pressure sources, respectively, to provide rigidity to the inner and / or outer members. Pressure (positive or negative, depending on the robot scope) may pass through the pressure pipeline 205z and change the pressure in the pressure gap of the inner rigidifying member 210 (e.g., increasing under positive pressure, or decreasing under negative pressure, i.e., vacuum), causing the rigidifying devices 210, 212 to become rigid. The initiation of pressure (positive or negative) may be applied sequentially and / or simultaneously, as shown in Figures 1A to 1D. In some examples, cassette 257 may include pressure connectors 274a, b for sealing coupling to one or more pressure sources. Other mechanisms are also possible for providing rigidity to the robot scope (e.g., inner and outer rigidifying members).

[0081]

[0113] Cassette 257 may include connectors for connecting to further lumens and / or wiring within an external or internal stiffening device(s). For example, in Figure 2, cartridge 257 is coupled to internal stiffening member 110, and connector 225y may include connections for both suction and water delivery to the tip of the internal stiffening device. Connector 225y may include an electrical connector for connecting a camera mounted on the tip of the internal stiffening device 110 to an external monitor and / or video processing unit. Connector 225y may include a mechanical connector for connecting to a hollow tube (e.g., a working channel) following the tip of the internal stiffening device 210. By including connector 225y, control of all components of system 200 can be performed through cassette 257, and may be controlled manually or automatically by the apparatus described herein.

[0082]

[0114] In some cases, control connections (e.g., disks 289, 271a, 271b, etc.) may be accessible from the bottom of cassette 257. The control connections may have features such as splines, pins, or teeth for transmitting torque. These features can enable the control connections to be operated (e.g., by a drive system / subsystem). The drive system may be part of the link assembly described herein, or the drive system may be integrated with the link assembly. The same controller may operate the drive assembly and other components of the apparatus (e.g., linear drives for the link assembly, height adjustment, pitch, etc.), including stiffening / releasing controls.

[0083]

[0115] Figures 3A and 3B schematically illustrate a first example of a device (e.g., a system) for deploying and / or controlling a flexible tubular member. In Figures 3A-3B, and in many of the figures described herein, a device configured for use with a flexible tubular member configured as a nested endoscope is shown, including both an outer "overtube" and an inner endoscope, which may be moved proximal / distal to each other and may be stiffened respectively to guide and / or steer the device through the patient's body (as described above). However, it should be understood that these devices may be used with any flexible tubular member, including a member that is not nested and is not stiffened (e.g., a standalone endoscope).

[0084]

[0116] In Figure 3A, the system 300 shown includes a base which may support the weight of the rest of the system, including any flexible tubular members attached to the system. The base 341 may be weighted to allow the telescopic link assembly and any attached flexible tubular members to cantilever distally or proximally away from the base while remaining stable. The base may house one or more further components, including a power source, power conditioner, motor, pressure source / pressure supply unit, controller, control circuit unit, etc. The base 341 may include wheels 351 to allow the device to be moved and positioned relative to a patient's bed. In some examples, the base 341 may include anchor areas 353 which may be lowered and / or raised to allow or prevent movement. The wheels may be lockable or lockable.

[0085]

[0117] Figure 3A shows a link assembly 301 configured as a vertically arranged link assembly, comprising three links: a first link 305 (e.g., an outer link or base link which may be coupled to a base), a second link 307 (e.g., an intermediate link), and a third link 309 (e.g., an inner link). The first link is coupled to a yaw adjust arm 337 which also constitutes (or may be coupled to) a vertical lift arm 335 connecting the link assembly 301 to a base 341. The system 300 shown in Figure 3A also includes a mount assembly comprising a pair of mount regions 323, 333 which are coupled to the third link. In this example, the first mount region 323 is configured as an overtube mount for coupling to the overtube of an endoscope. The overtube mount includes an overtube drive assembly (e.g., a driver) 321 located in or near the distal end region of the third link which may interface with the overtube of an endoscope. In some examples, the overtube drive assembly may include a drive component for controlling rolling for steering (optionally, in examples where the overtube may be steered at the distal end) and / or pressure input / output for stiffening / releasing. The overtube mount 323 may be configured to be fixed to the overtube portion separately from the internal endoscope. In some examples, the overtube mount 323 may be fixed by including a fixing mechanism such as a clamp, clasp, latch, or lock.

[0086]

[0118] The second mounting region 333 is configured as an internal endoscope mount and may similarly include an internal endoscope drive assembly 331, as shown. The internal endoscope drive assembly (driver) may interface with the internal endoscope member and may include the drive components described above with reference to Figure 2, including steering components (e.g., for steering the distal end / tip region), rolling control, and pressure input / output (e.g., for stiffening / releasing stiffening). The internal endoscope mount 331 may be configured to be fixed to the internal endoscope separately from the overtube by including a fixing mechanism such as a clamp, clasp, latch, or lock.

[0087]

[0119] Figure 3C shows another example of a robotic system 300' including a telescopic link assembly 301 and a base 341 similar to those shown in Figures 3A and 3B. This example also includes a flexible tubular member attached to the system. The flexible tubular member in this example is configured as a pair of nested rigidity-granting devices similar to the device shown in Figures 1A and 1B, including an outer overtube 312 and an inner endoscope 310. In this example, the base 341 supports the telescopic link assembly 301 and the attached endoscope, so the link assembly may move smoothly from a relatively low-footprint centrally positioned neutral configuration to a partially or fully extended configuration (as shown in Figure 3B), or to a partially or fully retracted configuration (as shown in Figure 3C). The flexible tubular member may be distally extended. In some examples, the device may include one or more supports to prevent buckling or crushing of the flexible tubular member, as will be shown and described in more detail below.

[0088]

[0120] In Figures 3C and 3D, the link assembly 301 is configured as a vertically positioned link assembly, but any orientation of the links (e.g., horizontally positioned, angled, hybrid horizontal / vertical / angled, etc.) may be used. Three links 305, 307, and 309 are shown, but any number of links may be included. The flexible tubular member is coupled to a mount assembly coupled to the innermost (third) link 309. The mount assembly includes a first mount region 323 to which the proximal end region of the overtube 312 is coupled. The first mount region may include a drive assembly 321 that includes one or more actuators for operating the movement of the elongated flexible member (e.g., the overtube). For example, the first mount region 323 may include one or more roll actuators for rolling the overtube relative to the internal endoscope. In some examples, the overtube may be steerable by including, for example, one or more steering members (e.g., pull wire, tendon, etc.). The first mount region may include actuators for operating the steering of the overtube. The overtube may be connected to a pressure source (e.g., positive and / or negative pressure) to stiffen / de-stiffen the overtube. Therefore, the first mounting assembly may include a pressure port and be configured to connect the overtube to the pressure source. In some examples, the pressure source may be included within the system, or the system may be configured to connect to a positive and / or negative pressure source.

[0089]

[0121] The internal endoscope of the flexible tubular member is also connected to the mount assembly by a connection to a second mount region 333. The second mount region may include a second drive assembly 331 which includes one or more actuators for operating the flexible member (e.g., the internal endoscope). For example, the second mount region 333 may include one or more roll actuators for rolling the internal endoscope against the overtube. The internal endoscope may be steerable by including, for example, one or more steering members (e.g., pull wires, tendons, etc.). The second mount region may include actuators for operating the steering of the internal endoscope. The internal endoscope may also be connected to a pressure source (e.g., positive and / or negative pressure) for stiffening / releasing the internal endoscope. Therefore, the second mount assembly may include a pressure port and be configured to connect the internal endoscope to the pressure source.

[0090]

[0122] The mounting assembly may be configured as a whole to move the first and second mounting regions relative to each other, and therefore move the overtube and the internal endoscope relative to each other. Thus, the internal endoscope may be partially or completely retracted into the overtube, or it may extend outside the overtube for a certain distance (as shown in Figures 3C and 3D). Figure 3D shows a top view of system 300' in Figure 3C.

[0091]

[0123] As described above, the mount assembly (for example, a first mount region and a second mount region in some examples) may be configured to be fixed as a whole to the flexible tubular member. The mount assembly may be configured to be releasably coupled to the flexible tubular member by one or more fixing mechanisms such as clamps, clasps, latches, or locks. In the examples shown in Figures 3C to 3D, the mount assembly may be configured such that the first mount region of the mount assembly is separately coupled to the overtube, and the second mount region is separately coupled to the internal endoscope.

[0092]

[0124] Figure 5A shows the device's link assembly fully retracted proximal. Figure 5B shows the device's link assembly fully extended distally. As the link assembly moves proximal and distally (e.g., extends and retracts), the overtube mount moves and engages in and out as the link assembly moves. The internal endoscope mount 333 may be configured to move distally or proximal to the overtube mount (and link assembly). In one example, the internal endoscope mount 333 may move relative to the external overmount 323, as described below in Figures 5A and 5B.

[0093]

[0125] In general, these devices may include multiple (e.g., 8 or more) degrees of freedom for the mount assembly, and therefore for the flexible tubular member. For example, Figure 4 shows an example of system 400 similar to the systems shown in Figures 3A-3B, in which a link assembly (including a first link 405, a second link 407, and a third link 409) moved in a proximal-to-distal direction when extending and retracting. Insertion and retraction may be driven by an overtube insertion motor 415 (e.g., a linear drive such as a ball screw / nut assembly). The overtube mount 423 also includes an overtube roll motor 426. The internal endoscope mount 433 includes an endoscope driver 431 including an endoscope roll motor 435 and multiple steering motors 437. The link assembly is pivotably mounted to a yaw adjustment arm 337 (which may be directly or indirectly coupled to the base link 305) and a vertical lift arm 335.

[0094]

[0126] As described above, in some examples, a mount assembly for a flexible tubular member may include one or more separate drives for driving the relative movement of the outer member (e.g., overtube) and the inner member (e.g., inner endoscope) of the flexible tubular member. Figures 5A and 5B show an example of a vertically arranged link assembly including a mount assembly that includes an overtube mount 523 and an inner endoscope mount 533 that operates separately. These regions of the mount assembly are configured to work together to provide relative motion between the first and second regions. The regions may be directly or indirectly coupled together. For example, in Figures 5A and 5B, the first mount region (overtube mount 523) and the second mount region (endoscope mount 533) that form the mount assembly are coupled to a third link 590.

[0095]

[0127] Therefore, in this example, the vertically positioned link assembly 501 includes a first link 505 (e.g., a base link), a second link 507, and a third link 509, which are positioned perpendicular to each other and separated by shuttles (e.g., a first shuttle 519 and a second shuttle 518), and which may be coupled to one or more bands and / or belts to allow the links to extend and retract in coordination. As stated, the mounting assembly, e.g., the first mounting area and the second mounting area, is coupled to the third link. The first mounting area 523 for the overtube is firmly coupled (e.g., fixed) to the third link 509 and similarly includes an overtube driver (e.g., an overtube roll motor 526) to drive the overtube rolling in clockwise and / or counterclockwise directions. A second mounting area 533 for the internal endoscope is located adjacent to the first mount and is configured to move distally / proximal along the endoscope insertion track 569, and includes one or more drivers for operating the internal endoscope, such as an internal endoscope roll motor 535 and / or an internal endoscope steering motor 537. In some examples, a third link may include a drive for driving the second mounting area. For example, in Figure 5A, the second mounting area is shown entirely distal to the first mounting area; in Figure 5B, the second mounting area is shown entirely proximal to the first mounting area.

[0096]

[0128] Figures 6A–6D show another example of a vertically arranged link assembly 601 similar to the assembly shown in Figures 5A–5B, which shows an intermediate configuration of a set of vertically arranged links. In general, any device of the apparatus described herein may include four or more links; for example, these devices may include four links, five links, six links, and so on. Further links may be configured and controlled as shown here for three links. The outer links may be coupled (directly or indirectly) to a base, and the inner links may be coupled to a mounting assembly (including one or more mounting areas). In Figure 6A, the second and third links are shown as partially transparent. In general, the motion of a telescopic assembly may be achieved by a single drive (e.g., a single motor) in any example of these examples. The motion of the links may be coordinated using bands and / or synchronous belts. For example, the bands (and / or belts) may be steel bands. This is also schematically shown in Figure 7A, which shows the use of two shuttle links (proximal and distal).

[0097]

[0129] Figures 6B–6D show further detail of a portion of the vertically arranged link assembly 601 in Figure 6A, showing the first link 505 and the second link 507, as well as the first shuttle 518 and the second shuttle 519. In Figures 6B–6D, a pair of thin flexible bands 655, 656 are shown coupled to the second shuttle 519 and positioned between the second link 507 and the third link (not shown). A similar arrangement of flexible band 655' connects between the first and second links. Bands 655, 656 are respectively coupled to the same respective ends of the second link 507 and the third link by attachments 659, 659', 659'', and the bands may wrap around the pulley surface (e.g., cylindrical surface 671) within the shuttle 519. The bands may wrap around the pulley surface or different pulley surfaces that may be adjacent to each other.

[0098]

[0130] Figures 6C and 6D also show an example of a synchronous belt 527, which is shown coupled to the lower part of a second conduit 507, to which a first shuttle 618 and a second shuttle 619 are coupled. The first shuttle is coupled to the synchronous belt by a lower attachment 588 that wraps around a second link. The second shuttle is also coupled to the synchronous belt by a lower attachment 589 that wraps around a second link. The synchronous belt may move by rolling around a pair of synchronous pulleys 529, 529' (which may drive the opposing but coordinated movement of the attached shuttles).

[0099]

[0131] In Figures 7A and 7B, third (or higher-order) links are not shown for simplicity. In this example, the first link 705 may support and / or include a linear drive 712, shown in this example as a ball screw nut assembly. Rotation of the ball screw 743 drives the linear movement of the ball nut 744. The drive is coupled to a first shuttle 518, which may be coupled through the first link. Thus, the first shuttle may be driven proximal and distal by rotating the ball screw clockwise or counterclockwise. In Figure 7A, the first shuttle is configured to slide between the first link 705 (e.g., the base link) and the second link 707; however, a pair of opposing flexible bands 717, 714 are attached to both the first and second links and wrapped around a cylindrical surface (e.g., a pulley) within the first shuttle 518. For example, in Figure 7A, the first distal band 717 is attached at its first end 748 to the distal end region of the first link, for example, on the inner surface facing the second link. The second end 749 of the first distal band 717 is attached to the distal end region of the second link. The first distal band extends between the first link and the second link, around the cylindrical (e.g., pulley) surface 756 of the first shuttle.

[0100]

[0132] The first proximal band 714 is similarly constructed but oriented in the opposite direction. For example, the first end of the first proximal band, which is also a flat ribbon (e.g., a flat metal ribbon), is attached to the first link in its proximal end region 742, passes around the cylindrical (e.g., pulley) surface 756 of the first shuttle, and then the first end is connected to the proximal end region 746 of the second link (e.g., on the side facing the first link). Thus, the shuttle and band are configured to act as a pinion and rack interface between the first and second links. Moving the shuttle to the right (e.g., by the action of the linear drive 712) moves the second link 707 to the right (retracts it), while moving the shuttle to the left moves the second link 707 to the left (extends the second link 707 distally). A similar configuration may be used between the second and third links for a second shuttle 519 (not shown). Alternatively, in a certain configuration, the link assembly may include only the first and second links.

[0101]

[0133] In some examples where three or more links are used, a synchronization belt may be used to synchronize the movement of a pair of shuttles. This is schematically shown in Figure 7B (and Figures 7C-7E). Figure 7B is similar to Figure 7A in other ways, but includes a synchronization band 727 in a second link 707 coupled to both the first shuttle 518 and the second shuttle 519. The synchronization belt 727 may roll around a pulley at either end of the belt, and is configured such that the proximal movement of the first shuttle 518 results in the distal movement of the second shuttle 519, and vice versa. Thus, the motion of the first shuttle is synchronized to the central (second) link via the flexible band, and to the motion of the second shuttle via the synchronization belt.

[0102]

[0134] In one example, motion may be transmitted from a driver (e.g., a ball screw) to a flexible tubular member attached to a third link, with a ball screw motion to tip motion ratio of 4:1, but other configurations with different ratios may be used.

[0103]

[0135] In any of these examples, the band may also function as a substrate and / or support for one or more electrical and / or electronic conduits (wires, traces, etc.), allowing the transmission of control and / or power through the link assembly (e.g., from a first link to a third or higher-order link) even when the links move and interlock. The ribbon-shaped flexible band may therefore provide a relatively constant path length between the links.

[0104]

[0136] Figures 7A to 7E show examples in which both the first distal band 717 and the first proximal band 714 are used, but it should be noted that in some examples only the first distal band or only the first proximal band may be used. For example, the shuttle may include channels through which the band passes in order to provide both proximal and distal reaction surfaces for the band; when the shuttle is driven proximal and distal, the band may be driven and slide against either reaction surface to move the second link.

[0105]

[0137] Figures 7C–7E show an example illustrating the operation of a set of three links in a vertically arranged link assembly. In this example, the first link 705 includes (e.g., at least partially accommodates) a drive, such as a ball nut 744 and a ball screw 734, which moves the first shuttle 518. The first distal band 717 and the first proximal band 714 extend in opposite directions between the first link 705 and the second link 707 and around the cylindrical surface of the first shuttle. The third link 709 is similarly connected to the second link 707 via a second distal band 712 and a second proximal band 716 that curve around the cylindrical surface (e.g., a pulley) of the second shuttle 519. Furthermore, both the first and second shuttles are coupled to a synchronization belt 727 in or coupled to the second link. Therefore, as shown in Figure 7D, the linear drive 748 drives the first shuttle proximal, and the second and third links are driven proximal, as shown. Similarly, as shown in Figure 7E, the linear drive 746 drives the first shuttle distal, and the second and third links are driven distal in coordinated telescopic movement.

[0106]

[0138] Figures 7C–7E show top (overhead) views of vertically positioned link assemblies, which are not necessarily drawn according to a constant proportional scale. Figure 7C shows a vertically positioned link assembly in a neutral position with a relatively compact footprint, while Figures 7D and 7E show fully telescopic configurations (proximal and distal, respectively).

[0107]

[0139] The examples described in Figures 6A–6D and 7A–7B show that the shuttle is slidably coupled to the link via multiple bands and / or belts, but any suitable moving coupling may be used. For example, the shuttle may be moved by a rack and pinion arrangement configuration.

[0108]

[0140] Figures 7F–7H show another example illustrating the operation of a set of three links in a vertically arranged link assembly similar to the assembly shown in Figures 7C–7E, however, the link movement is synchronized using a ball screw actuator rather than a synchronization band. In general, the telescopic movement of a link may be synchronized using any suitable movement synchronization mechanism, including bands, ball screws, etc. In this example, the first link 705 includes a drive, e.g., a ball nut 744 and a ball screw 743 (for example, they may be at least partially housed), which moves the first shuttle 518. The first distal band 717 and the first proximal band 714 extend in opposite directions between the first link 705 and the second link 707 and around the cylindrical surface of the first shuttle. The third link 709 is similarly connected to the second link 707 via a second distal band 712 and a second proximal band 716 that curve around the cylindrical surface (e.g., a pulley) of the second shuttle 519. Furthermore, both the first and second shuttles are coupled to a ball screw actuator 787 in or coupled to the second link. Thus, as shown in Figure 7G, a linear drive 748 drives the first shuttle proximal, and the second and third links are driven proximal, as shown. Similarly, as shown in Figure 7E, a linear drive 746 drives the first shuttle distal, and the second and third links are driven distal in coordinated telescopic movement.

[0109]

[0141] Figures 7F to 7H show top (overhead) views of vertically positioned link assemblies, which are not necessarily drawn according to a constant proportional scale. Figure 7F shows a vertically positioned link assembly in a neutral position with a relatively compact footprint, while Figures 7G and 7H show fully telescopic configurations (proximal and distal, respectively).

[0110]

[0142] Figures 7F–7H show another example illustrating the operation of a set of three links in a vertically arranged link assembly similar to the assembly shown in Figures 7C–7E, however, the link movement is synchronized using a ball screw actuator rather than a synchronization band. In general, the telescopic movement of a link may be synchronized using any suitable movement synchronization mechanism, including bands, ball screws, etc. In this example, the first link 705 includes a drive, e.g., a ball nut 744 and a ball screw 743 (for example, they may be at least partially housed), which moves the first shuttle 518. The first distal band 717 and the first proximal band 714 extend in opposite directions between the first link 705 and the second link 707 and around the cylindrical surface of the first shuttle. The third link 709 is similarly connected to the second link 707 via a second distal band 712 and a second proximal band 716 that curve around the cylindrical surface (e.g., a pulley) of the second shuttle 519. Furthermore, both the first and second shuttles are coupled to a ball screw actuator 787 in or coupled to the second link. Thus, as shown in Figure 7G, a linear drive 748 drives the first shuttle proximal, and the second and third links are driven proximal, as shown. Similarly, as shown in Figure 7E, a linear drive 746 drives the first shuttle distal, and the second and third links are driven distal, respectively, in coordinated telescopic movement. This operating scheme may be repeated three or more times consecutively to achieve movement.

[0111]

[0143] Figures 7F to 7H show top (overhead) views of vertically positioned link assemblies, which are not necessarily drawn according to a constant proportional scale. Figure 7F shows a vertically positioned link assembly in a neutral position with a relatively compact footprint, while Figures 7G and 7H show fully telescopic configurations (proximal and distal, respectively).

[0112]

[0144] Figures 7I–7K show another example illustrating the operation of a link assembly similarly configured for bidirectional telescopic movement of a set of links in a link assembly similar to those shown in Figures 7C–7E and 7F–7H, however, the link movement is synchronized in this example using multiple mechanical moving coupling members with ball screw actuators. This configuration does not include separate synchronization bands. In general, the telescopic movement of a link may be synchronized by the operation of a ball screw, by which each stage is coupled to an adjacent stage. Thus, compared to the example shown in Figures 7C–7K, all the bands are replaced by ball screw actuators, and the shuttle is instead an additional intermediate link. This may address the stroke of the ball screw. The ball screw / nut may be biased to the end of the link in the nominal (centered) position, as shown in Figure 7I. For example, the first link 705 includes a drive, e.g., a ball nut 744 and a ball screw 743 (for example, they may at least partially house or be coupled to them), which moves the first intermediate link 707'', and the first intermediate link 707'' also houses the ball nut 744' and the ball screw or is otherwise coupled to them. This pattern may be repeated for the second intermediate link 707' and the third intermediate link 707. Thus, as shown in Figure 7J, a linear drive 748 drives the first shuttle proximal, and the upper links are driven proximal, as shown; the links may be positioned so as to extend only a minimum amount over the bed / table to allow maneuvering close to the patient. Similarly, as shown in Figure 7K, a linear drive 746 drives the first shuttle distally away from the patient, and the upper links (third link 709 and intermediate link 707) are driven distally in coordinated telescopic movement, respectively.

[0113]

[0145] The linear link assembly may be of any suitable size and may be configured to provide a range of motion during operation. As described above, in one configuration, the device may be configured to sweep the overtube (the outer member of the telescopic assembly) over a length between approximately 0.2 m and 3 m, for example between approximately 0.5 m and 2.2 m, in a deformation in which the overtube mount 523 is fixed to the first link (this range may be larger if the overtube mount may move relative to the link assembly). Since the inner endoscope mount 533 translates linearly with respect to the first link 709 of the link assembly, the sweep length of the endoscope mount may be greater than the sweep length of the overtube mount 523 by, for example between approximately 0.2 m and 3.5 m, for example between approximately 0.5 m and 2.6 m. Figure 7L shows a top view of an example of a linear link assembly of a robotic device, including exemplary dimensions. In Figure 7L, extensions to the right 746 (e.g., distal extension) and to the left 748 (e.g., proximal extension) are shown. For example, in Figure 7L, the distance between the front of the cart (base) and the proximal end of the first link 709 may be between, for example, 0.25m and 2m; in the specific unrestrictive example shown in Figure 7L, the distance is shown as approximately 1.69m, and therefore the maximum proximal extension is approximately 1.6m. In the same unrestrictive example, the maximum range of motion (ROM) of the proximal end of the overtube mount, and therefore the overtube, is shown as approximately 1.953m, and therefore the sweep length of the inner member (e.g., inner endoscope mount 533) is approximately 2.57m.

[0114]

[0146] Other mechanical moving coupling elements, including software or firmware, may be used; in some cases, each link may be moved by a driver (e.g., a motor) which may be integrated with the link (e.g., coupled to, or contained within).

[0115]

[0147] Figure 8 shows an example of how to use the system 800 for deploying and / or controlling a flexible tubular member as described herein, which includes a vertically positioned link assembly 801 schematically shown engaging with an endoscope 890 to deploy and control the endoscope when the endoscope is inserted into a patient 881. The patient is shown lying on a table 882 with his side down. In this example, the device is initially positioned at the foot of the bed, and the system must initially hold the endoscope, which is about 1.5 m long, outside the patient's body before it is inserted into the patient's rectum to perform a colonoscopy. The links of the vertically positioned link assembly 801 are positioned perpendicular to the ground and may initially engage distally (as shown) to provide sufficient clearance outside the body, while still allowing the system to be positioned adjacent to the edge of the table / bed 882. Furthermore, the vertical positioning configuration of the links allows the endoscopic device to be positioned in conjunction with the patient at the height of the insertion point. Thus, this configuration may have a minimum distance from the device axis (e.g., the endoscope axis) to the top of the bed mattress.

[0116]

[0148] As an alternative, the configuration described herein may instead be used with horizontally positioned links (e.g., parallel to the ground), as shown in Figure 9. In Figure 9, the system 900 includes a set of horizontally positioned linear links 901 which may engage with the proximal end of an endoscope 990 (e.g., a robotic stiffening endoscope as described herein). In Figure 9, the device may retract and extend as described above for the vertically positioned link assembly, however, proximal advancement of the device may be subject to interference from the bed 982 (e.g., mattress), limiting the approach angle when inserting into the patient 981.

[0117]

[0149] For example, Figures 10A–10C show typical distances between the device axis (e.g., the long axis of the endoscope) and the top of the table or mattress (e.g., the bed) relative to the patient's anatomical structure. Figure 10A shows the patient and bed position and dimensions for a left lateral approach to the lower gastrointestinal tract. In this example, the patient is shown lying sideways on the bed 982 in the patient longitudinal position 1075. The device axis 1078 required for insertion into the rectum from this position requires a height 1076 above the bed, which may be within a certain average range. This height may be significantly higher than the height for a supine approach to the lower gastrointestinal tract, as shown in Figure 10B. In this example, the patient is lying supine in the longitudinal position 1075', and the height of the device axis 1078' above the bed 1076' is lower than in 10A.

[0118]

[0150] Figure 10C shows an example of an upper gastrointestinal procedure using this system, with the patient in a left lateral position (prone and supine positions, with the head rotated approximately 90 degrees). In this example, the device axis 1078'' for accessing the patient's mouth is typically at approximately the height of the patient's head above the mattress 1076''.

[0119]

[0151] In general, any of these systems and devices may be configured for use with drapes, shields, or screens to prevent contamination or soiling of the device. For example, Figure 11 schematically shows an example of draping the system as described herein to limit contamination of the device by patient fluids, which may help minimize cross-contamination between patients. In some examples, these systems may be draped as shown to form a non-sterile barrier to minimize soiling or excessive soiling of the robotic system. In some examples, the draping 1193 may be configured to provide a non-sterile but hygienic cover for a system including a base and / or link assembly 1101 (e.g., a vertically positioned link assembly). The draping may be two or more parts, as shown, including a first part that covers the base and a second part that covers the link assembly. Alternatively, in some examples, the system or at least the vertically positioned link assembly may be covered with a sterile drape. As stated above, any of these devices and methods may include sterilization and / or packaging within a sterile outer cover.

[0120]

[0152] Any of these devices may include a support arm 1176 that may extend from a vertically positioned link assembly 1176, as shown in Figures 11 and 12. The endoscopes described herein may prevent or limit buckling of the endoscope under compressive load. For example, in Figure 12, the system 1200 includes a vertically positioned link assembly 1201 from which an elongated support arm 1276 may extend, and the elongated support arm 1276 may engage with the endoscope 1290 discussed herein to prevent or suppress buckling. In some examples, the support arm 1276 may include multiple supports for the device along their length to provide a parallel path to the mechanical ground. These supports may be passive (sliding / rotating) or motorized. A laser pointer may be mounted on the anti-buckling support or another distal part of the machine.

[0121]

[0153] As described above, these devices and methods are generally configured to allow adjustment and / or readjustment of the link assembly 1301 relative to the patient or bed. Figure 13 shows different movement and adjustment axes for a device similar to those shown in Figures 3A-3B and 4 above. In Figure 13, the system includes a base 1341 and a wheel 1351 supporting an arm (e.g., column, shaft, etc.) 1335, the arm 1335 may change the relative position of the linear link assembly to the base. For example, the height of the link assembly may be adjusted on the vertical axis 1335' using, for example, the vertical lift 1335 shown. Alternatively or additionally, the angle of a link assembly positioned perpendicular to the bed or patient may be adjusted, for example, by rotating the perpendicularly positioned link assembly around the yaw axis 1337'. The position of the link assembly may be adjusted before performing a procedure using the system. For example, the position of the telescopic robot relative to the cart may be adjusted in terms of yaw and / or vertical. These axes may be locked out during surgery. In some cases, these axes may also be placed in a floating state to allow for repositioning of the patient during surgery. In any of these devices, the cart wheels may be unlocked and / or locked to allow for positioning of the robot in a plane relative to the patient.

[0122]

[0154] In general, one or more additional tools (such as actuators, drivers) may be used with the endoscope, including, for the link assembly 1401 (e.g., a vertically oriented link assembly), and may be included in and / or mounted on the system, and may be used to insert and / or operate through the working channel of the endoscope. In one example, the endoscope may include an entry point in the endoscope handle for a tool to enter the endoscope's internal working channel (IWC). In one example, a ninth robot axis may be used to control the insertion depth of this tool. The use of such additional tools may generate additional degrees of freedom (DOF) to control more axes of the tool within the IWC.

[0123]

[0155] For example, Figure 14 shows a schematic diagram of a typical internal work channel (IWC) tool 1462 for entry into a work channel. The device 1462 may be coupled to the mount assembly on the link assembly 1401 as shown, and may engage with the mount assembly (or, in some cases, a second mount region and / or a first mount region) for operation.

[0124]

[0156] As described above, these devices may be used in conjunction with various procedures. For example, these systems 1500 may be used as part of a lower gastrointestinal procedure, as shown in Figures 15A to 15C. In these examples, the system 1500, including a vertically positioned linear link assembly 1501, may be used with the patient 1581 in substantially any orientation on a bed / cart 1582. The system may be positioned at the foot of the patient's bed. Figure 15A shows the patient in a lateral position. Figure 15B shows a top view of the colonoscopy procedure described above. The flexible tubular member is part of the system 1500 and is inserted and manipulated using the vertically positioned linear link assembly 1501. In Figure 15C, the patient 1581 remains substantially the same, and the angle of approach may be adjusted as shown.

[0125]

[0157] Any of these devices may be used, similarly or alternatively, as part of an upper gastrointestinal procedure, as shown in Figures 16A and 16B. In this example, the cart of system 1600 is positioned beside the bed 1682 so that the flexible tubular member, held by a link assembly, can be used to insert, manipulate, and retract the flexible tubular member into the patient's body. Anti-buckling support

[0126]

[0158] Any device of the apparatus described herein may include one or more supports to prevent crushing or other unintended movement of the flexible tubular member during distribution / deployment (insertion and / or retraction), including during deployment of a nested telescopic device which may include an endoscope and a nested overtube. Generally, one or more supports ("supports", "endoscope support", or "anti-buckling support") may be coupled to a link assembly and may be configured to prevent buckling of the flexible tubular member as it extends distally from the link assembly. The flexible tubular member support may be a strut, beam, rod, pole, etc., which may support the length of the flexible tubular member as it extends distally and / or proximal outward from the link assembly. In some examples, the flexible tubular member support may include one or more loops or straps to hold (and support) a portion of the flexible tubular member.

[0127]

[0159] Supports (e.g., anti-buckling supports) are configured to support the nested device (e.g., endoscope and overtube) during setup and throughout the procedure. This may be achieved through the use of one or more (e.g., two, three, four, five, etc.) anti-buckling supports, which may be positioned away from the distal side of the robot assembly and may be part of or coupled to a link assembly. In some cases, for example, when support(s) are needed / not needed to support the nested device due to insertion depth, the supports may be configured away from the scope and any moving part of the robot and / or the bed / table (e.g., Gurney) or patient path. For example, the supports may be located behind or under the robot cart. One or more supports may then automatically return to provide support for the nested system as the device retracts. The supports may be part of the overall robotic apparatus and may be configured to be cleanable in the same manner as the rest of the apparatus.

[0128]

[0160] In some cases, the flexible tubular member support may be coupled to a link in a link assembly and include a beam or arm extending therefrom. The support may be deflectable so that it can be deflected so that it does not obstruct when not needed, or to prevent interference with another link or part of the system. For this purpose, the support may be coupled to the link in a movable joint such as a hinge pivot or ball joint. The movable joint may be biased so that it returns to its predetermined position after it has been deflected and the interfering part of the system has moved out of the area of ​​interference. For example, the movable joint may be biased to assume a support position by a spring or other bias.

[0129]

[0161] The portion of the support configured to hold the flexible tubular member may be referred to herein as a seat or seat area. The seat may be configured as a loop, ring, etc., through which the flexible tubular member may pass. Alternatively, the seat may be open, for example, in the upper region, so that the flexible tubular member may be inserted and removed along its length. In some examples, the seat may be open / closed for insertion / removal of the flexible tubular member. The seat may be configured to allow the flexible tubular member to slide or move within the seat. For example, the seat may include a lubricating (e.g., slippery) surface to allow the flexible tubular member to slide against the seat. In some examples, the seat may include a rolling or moving surface (e.g., roller, wheel, ball bearing, etc.) to allow the flexible tubular member to move against the seat.

[0130]

[0162] Figures 17A–17H illustrate the operation of an example of a pair of supports coupled to a link assembly. In this example, the first support 1730 is coupled to the distal end region of the first link 1705. The second support 1730' is coupled to the distal end region of the second link (e.g., an intermediate link). The third link 1709 includes a mounting assembly to which a flexible tubular member is attached. In this example, for simplicity when demonstrating the operation of the supports, the flexible tubular member includes only the outer overtube 1710. As shown in Figure 17A, when the link assembly is fully retracted proximal, the first support 1730 and the second support 1730' extend outward (perpendicular to the front / rear axis) to provide support for the flexible tubular member 1710 held in the seats of each support. In Figure 17B, the third stage to which the mounting assembly holding the proximal end of the flexible tubular member is connected is advanced distally, for example, to insert the flexible tubular member into the body. As the third stage is advanced, the flexible tubular member may slide against the support. In this example, when the link is in a nearly neutral position as shown in Figures 17C and 17D, the support 1730, 1730' may pivot so as not to interfere with the adjacent link and no longer need to engage with the flexible tubular member. The support is no longer needed as the flexible tubular member approaches the patient insertion site. Alternatively, in some examples, the support may extend proximal and / or above (or in some cases below) the link to avoid interference and continue to support the flexible tubular member in a more distal configuration.

[0131]

[0163] Figure 17E shows a distally extended link assembly with the seat displaced so as not to obstruct the distally advanced link. Figures 17F–17H show the link assembly moving proximal so that the support can be biased to return to an extended position supporting the flexible tubular member, as shown in Figure 17F. In this example, the support may be biased by a spring so that when the link assembly moves proximal, for example to retract, the support returns to a position below the flexible tubular member.

[0132]

[0164] As stated, in some examples, the support(s) may extend distally from the link to support a flexible tubular member, even when the link assembly is in a neutral (centralized) configuration and / or is distally extended (e.g., inserted into a patient). For example, the support(s) may include distally extended arm segments, which may be fixed in length or telescopic when the link assembly is fitted into them.

[0133]

[0165] In general, any device of the apparatus described herein may include one or more supports configured to support a telescopic device (e.g., the overtube portion of the device) outside the patient's body. These supports may be configured to move so as not to interfere with the link assembly as the link assembly drives the telescopic device proximal and distal as described above. In some cases, these supports may be configured to move so as not to interfere with a bed or table on which the patient is positioned. Any of these supports may, in particular, be configured to move to a stowed position having a minimum footprint within the plane of motion of the link assembly. The supports may be configured to have a pre-deployment configuration in which one or more supports may be separated from the plane of motion of the link assembly, a deployed configuration in which supports may be positioned and held within the plane of motion to support a portion of the telescopic device outside the patient's body, and a post-deployment configuration in which one or more supports move so as not to interfere with the link as the device moves toward the patient in order to avoid interference with the operation of the telescopic device.

[0134]

[0166] Any appropriate number of supports may be included. In some cases, the supports may be coupled to links and / or shuttles. The number of supports may be based on the length of the extended endoscope. The supports may be arranged to provide minimum support at intervals of 0.15m and 0.7m (e.g., between approximately 0.2m and 0.5m, between approximately 0.25m and 0.5m, etc.). This separation distance between supports may be adjusted based on the characteristics of the telescopic device (e.g., its size, flexibility, etc., and therefore how much support the device may require). The distance between supports may change with the operation of the device, for example, when the telescopic device is inserted / removed.

[0135]

[0167] Figure 18A shows an example of a device including multiple supports that may be deployed during link movement to support a telescopic device (not shown). In Figure 18A, the device includes four supports 1830, 1831, 1832, and 1833 as shown in the deployment configuration. The first support (support 1830) is coupled to a shuttle 1819 between the first link 1805 and the second link 1807. This support may be deployed when the second link 1807 and the third link 1809 extend proximal, as shown in Figure 18A. In the deployment configuration, the seat area of ​​the first link coincides with the direction of insertion and / or movement of the link assembly. Otherwise, the support, including the arm coupled to the seat area, may rotate downward and out of the plane of movement of the link. A bias mechanism, such as a spring or elasticity, may drive the support upward and in the plane of movement when the second and third links extend proximal. In some cases, the first support may be coupled to the shuttle by a biased swivel coupling, and one or more cam surfaces may be used to drive the support out of the plane of movement (for example, so that the support rotates downward and away from the links and mounts holding the telescopic device). Thus, the first support 1830 includes a pre-deployment configuration in which the arm region rotates the seat region downward and away from the link assembly and mount(s). As stated above, the first support may be driven by a bias that drives the seat region in the plane of movement when the link assembly retracts proximally, for example, from the pre-deployment configuration to the deployed configuration, fully (or in some cases, partially).

[0136]

[0168] The second support 1831 in Figure 18A is coupled to the second link 1807 on the lower region of the distal end of the second link. This second support also includes an arm region or portion coupled to the seat region. The second support may be coupled to the second link at the first end; the seat region may be at the second end of the arm region and / or extend from the second end. The arm region of the second support 1831 extends laterally from the second link to position the seat region in the plane of movement (and in line with the insertion / movement direction of the link assembly). In Figure 18A, the second support 1831 is also pivotably connected to the link assembly, for example, to the second link 1807, so that the second support 1831 has a first (e.g., pre-deployment) configuration in which the second support 1831 rotates downward and out of the plane of movement of the link assembly, as shown in Figure 18A, and a second (e.g., deployed) configuration in which the second support rotates upward so that the seat area is within the plane of movement of the link assembly. In some cases, the device may include a bias that tends to drive the second support from the pre-deployment configuration to the deployed configuration. The bias may be a spring and / or elastomer material.

[0137]

[0169] In Figure 18A, the third support 1832 also includes an arm region coupled to the second end of the third arm. The arm of the third support includes an elongated length and is configured to extend a certain distance (e.g., between approximately 0.1m and 0.5m, or between 0.2m and 4m) from the proximal end of the first link 1805. The third support may be movably coupled to the first link 1808 of the link assembly so that the third support may move within and out of the plane of movement of the link assembly. In Figure 18A, the third support is shown with the seating region of the third support 1832 located within the plane of movement of the link assembly and coinciding with the seating regions of the other supports, so that all of these seating regions may support the telescopic device in a conduit extending from the mount when the telescopic device is inserted or retracted. The elongated length of the support (e.g., the elongated body) may have a curved or bent shape. For example, in Figure 18A, the elongated length of the third support 1832 has a bend in the post-deployment configuration such that the elongated length moves slightly downward clockwise (e.g., between 3 cm and 20 cm, e.g., between 3 and 12 cm, between 3 and 10 cm, less than 10 cm, etc.) and laterally away from the plane of movement of the link assembly, so that the elongated length does not interfere with the link assembly or the bed / table (e.g., Gurney) on which the patient is positioned. The attachment between the elongated body of the third support and the first link of the link assembly may be configured to have one or more cam surfaces that direct the movement of the support between the deployment configuration and the post-deployment configuration. In some cases, a bias may be positioned to drive the third support to the deployment configuration (or from the deployment configuration to the post-deployment configuration). The third support may also have a pre-deployment configuration on which the arms of the third support move upward and away from the plane of movement of the link assembly, as will be described in more detail below.

[0138]

[0170] Figure 18A also includes a fourth support 1833 that similarly extends from the first link. In some cases, the fourth support may extend from the first link on an extendable arm 1836 that can extend distally from the first link or retract proximally. The extendable arm may be manually or automatically extended and / or retracted. The distal end of the extendable arm may be coupled to the first end of the fourth support 1833 and may include a swivel or bend joint similar to the joint used for the third support. The fourth support also includes a bend or curved arm region and a seat region on the second end of the arm (e.g., arm region). In Figure 18A, the fourth support arm bends so that the seat region matches the seat regions of the first, second, and third supports when the first, second, and third supports are in their deployment region. The fourth support is also configured such that it can be deflected downward and laterally when the link assembly advances the second and / or third links distally. For example, the fourth support may be deflected slightly downward (e.g., between 3 cm and 20 cm, e.g., between 3 and 12 cm, between 3 and 10 cm, less than 10 cm, etc.) and laterally in a clockwise direction away from the plane of movement of the link assembly so as not to interfere with the link assembly or the bed / table (e.g., Gurney) on which the patient is positioned. The downward deflection may be limited so as not to collide with the bed / table surface (e.g., Gurney). The fourth support may also be configured such that the arm of the fourth support has a pre-deployment configuration that moves upward (e.g., vertically or nearly vertically) and away from the plane of movement of the link assembly, as will be described in more detail below.

[0139]

[0171] Therefore, as described above, the apparatus may generally include one or more supports movably coupled to the link assembly such that the supports may move in or out of the movement plane of the link assembly based on the position of the link assembly. Each support may be operably coupled to the link assembly (e.g., a link or shuttle) such that the support may move in and out of a predetermined position depending on the configuration of the link assembly.

[0140]

[0172] Figure 18B shows another example of a link assembly containing multiple supports similar to those shown in Figure 18A. Figure 18B also shows an example of spacing dimensions between supports, purely for illustrative purposes. These dimensions are not intended to be restrictive, as stated above, and may vary based on the configuration of the link assembly and / or telescopic device. A portion of the telescopic device 1810 is shown in Figure 18B; in fact, the telescopic device may extend all the way to and within the body 1890 (e.g., the anus).

[0141]

[0173] In general, the supports shown in Figures 17A-17H and 18A-18B may include arm regions or portions coupled to the seat region. In Figure 18B, supports 1830, 1831, 1832, and 1833 may each include elongated and rigid arm regions coupled at their second ends to the seat regions 1830', 1831', 1832', and 1833'. The seat region may be flat or may include sides that can hold telescopic devices (e.g., overtubes and endoscopes), as shown in Figure 18B. For example, the seat region may form a channel with side walls (e.g., an open channel). In any of these devices, the seat region may be configured to allow the telescopic device to slide relative to the seat region. In some cases, the channel may be lubricated and / or include one or more moving surfaces (e.g., rollers, bearings, treads, etc.).

[0142]

[0174] As stated herein, the seating area may be configured to accommodate sliding when the telescopic device (e.g., overtube) is driven distally and / or proximal by the link assembly (including by the mount). Thus, as used herein, “seating” refers to the ability to hold the telescopic assembly in a dynamic (e.g., sliding) manner.

[0143]

[0175] The seating area may alternatively be referred to herein as a channel. Generally, the seating area may be configured to support the telescopic device even under lateral forces so that the seating area can prevent the telescopic device from falling out of the seating area. As stated, in some cases the seating area includes a side wall area. In some cases the seating area may include a cover or retainer that wraps at least partially around the telescopic device, while still allowing the telescopic device to slide in and out (distally / proximal) and vice versa. Thus, in some examples the seating area may be configured to include sides that, when seated in the seating area, extend about 140 degrees or more around the sides of the telescopic device (e.g., 150, 160, 170, 180 degrees, etc.). In some cases the side walls of the seating area have a height between 0.4 and 3 times the radius of the telescopic device, such as between about 0.5 and 2 times, or between about 0.6 and 1.5 times. The inner surface of the seat area (e.g., the seat surface) may be cylindrical and, for example, have an inner radius that is larger than the outer radius of the telescopic device (e.g., between 1.1 and 3 times, or between 1.1 and 2 times). In some cases, the seat area may have a length between 1 mm and 10 cm, for example, between 0.5 cm and 5 cm, or between 0.5 cm and 4 cm.

[0144]

[0176] Figures 19A–19H show an example of a device including supports prepared for use with a telescopic device. In Figure 19A, the device 1900 is shown in an initial, e.g., retracted configuration, before deployment and before the telescopic device is attached. The device includes a link assembly to which multiple fluid lines are attached, as well as four supports similar to the examples shown in Figures 18A–18B. In Figure 19A, the third support 1932 and the fourth support 1933 are shown in a pre-deployment configuration, in which the two supports are positioned vertically above and out of the plane of movement of the link assembly, providing a more compact configuration. Furthermore, the link assembly is shown in an unextended configuration in which the inner and intermediate links are aligned with the outer links. In some cases, the device may include release catches to release and lower the fourth and / or third supports, and the release catches may be pulled beyond a spring detent to lower the arms.

[0145]

[0177] The apparatus may be prepared for deployment by attaching a telescopic device (e.g., an overtube and an endoscope). For example, as shown in Figure 19B, the link assembly may be manually or automatically retracted proximal by extending the inner link 1909 in the proximal direction, as shown. The fourth support 1933 may then extend from the outer link 1905, as shown in Figure 19C. Since both the third support 1932 and the fourth support may then be moved downward (e.g., unfolded), the seating areas of the supports coincide with the seating areas of the first support 1930 and the second support 1931, as shown in Figures 19C and 19D. The telescopic device (e.g., an overtube and an endoscope) may then be attached, as shown in Figures 19E–19F. In Figure 19E, the telescopic device is mounted with the overtube coupled to an overtube mount at its proximal end, and the elongated rigidity-granting body 1912 of the overtube supported within the seating areas of supports 1930, 1931, 1932, and 1933. In Figure 19F, the internal member of the telescopic device, e.g., an endoscope or an endoscope covered with a sheath (e.g., a rigidity-granting sheath), is inserted into the body by inserting the internal member 1910 through the lumen of the overtube from the proximal end to the distal end of the overtube. The proximal end of the internal member may be coupled to a mount (e.g., an internal endoscope mount). In this example, the internal member may be initially supported by a fourth support before loading, as shown in Figure 19G. In Figure 19G, the entire assembly is shown loaded and ready for deployment.

[0146]

[0178] However, in some cases, it may be desirable to preload a telescopic assembly (e.g., an overtube and endoscope) onto the device and then move the telescopic device to a position close to the patient so that the telescopic assembly is aligned with the patient. Figure 19H shows an example in which the device is preloaded onto the robotic assembly described above, and the supports are moved to a pre-deployment configuration by moving the third and fourth supports in an upright configuration and retracting the link assembly into a compact configuration. In this example, the telescopic assembly may be held by one or more hooks or other areas on the supports until the cart containing the device is positioned close to the patient and can be used to control the operation of the device.

[0147]

[0179] Once the device is loaded, the user may decide how far back the system should be retracted. For example, in some cases, the fourth support may not need to be lowered to a predetermined position, and only the third support arm may be lowered for loading. This may depend on the size of the room being used.

[0148]

[0180] Figures 20A–20I illustrate the operation of the apparatus in Figures 19A–19H after the overtube and endoscope have been installed. Figure 20A shows the apparatus ready for the patient (e.g., on the Gurney) so that it can be aligned with the patient. The apparatus may first be positioned close to the Gurney and the patient with the overtube / endoscope in the staged pre-deployment configuration shown in Figure 19H. Once the patient is in place, the device may be operated to move forward and backward robotically (or optionally, manually), including being inserted into the patient and steered.

[0149]

[0181] As described below, in any of these methods and apparatuses, the apparatus may be aligned using, for example, an integrated aiming component (e.g., a laser) that coincides with the insertion axis for the apparatus. In Figures 20B–20C, the apparatus may be inserted into the patient and advanced by moving the links of the link assembly from a proximal retracted position (shown in Figure 20) to a more distal position (shown) (both the overtube and the endoscope). As the links are moved proximal, the elongated body of the overtube 1912 (and the endoscope within the overtube) slides distally within the support seat area. In Figures 20A–20B, the first support 1930 is deflected downward and away from the link assembly when advanced distally. Similarly, as the link assembly is further advanced distally, in Figures 20C–20D, the second support 1931 is deflected downward and away from the link assembly. Further distal advancement of the link assembly, and therefore the overtube / endoscope (telescopic device), is achieved by deflecting the third support 1932 downward, as shown in Figure 20E, and then laterally, as shown in Figure 20F, so that the support does not interfere with the advancement of the link assembly and the telescopic device.

[0150]

[0182] Figure 20G shows that the link assembly further extends the overtube / endoscope distally, eventually moving closer to the fourth support 1933, as shown in Figures 20H and 20I, causing the fourth support to be driven slightly downward without contacting the table / bed, and then deflected laterally, as shown in Figure 20I. The same step may be repeated in reverse when the device is retracted proximal, allowing the fourth support to be moved laterally backward and rotated backward upward so that the support seat area aligns with the overtube / endoscope insertion / retraction axis, followed by the third support moving laterally backward and rotating backward upward so that the support seat area aligns with the overtube / endoscope insertion / retraction axis, then the second support rotating backward upward so that the support seat area aligns with the overtube / endoscope insertion / retraction axis, and then the first support rotating backward upward so that the support seat area aligns with the overtube / endoscope insertion / retraction axis. This process may be performed robotically by one or more drives driving the link assembly described above, and / or during manual or manual override procedures. At any point during insertion and / or retraction, the endoscope may be moved separately from the overtube by moving their respective mounts (and vice versa).

[0151]

[0183] As stated above, any of these devices may include a pre-deployment configuration in which one or more of the supports move out of the moving plane of the link assembly. For example, Figures 21A and 21B show a top view and a front view, respectively, of a device including a link assembly having four supports, including supports configured to fold upward in the pre-deployment configuration (e.g., a third support 1932 and a fourth support 1933). In the pre-deployment configuration, the third and / or fourth supports 1932, 1933 include a hook or other attachment 2138 configured to hold a looped-over telescopic device (e.g., an overtube / endoscope) in a staged pre-deployment configuration. Figure 21B shows the hook 2138 on the fourth support, although the hook 2138 may optionally be on the third support. Furthermore, the second support 1931 also includes an attachment 2139 (which may be called a staging device tip pocket), shown as an adjacent seating area for holding the telescopic device. A pre-deployment configuration with staging of the telescopic device is shown in Figure 19H, for example, in Figure 22.

[0152]

[0184] In Figure 22, the telescopic device 2212 is shown in a preloaded and retracted configuration, with the telescopic assembly ready for deployment at any time. As described above, this keeps the telescopic assembly ready for deployment at any time, so that the entire device, including the link assembly and overtube / endoscope, can be positioned adjacent to the patient for deployment. Once positioned, the supports 1932, 1933 can be moved down from the retracted position shown in Figure 22 so that the seat areas 1932', 1933' align with the insertion / retraction axis.

[0153]

[0185] Figure 22 is a rear view showing the attachment between the support and the first link of the link assembly; the fourth support 1933 is connected to an extendable arm extending from the first link. In the retracted configuration shown in Figures 22 and 23, this extendable arm retracts into the link assembly and is not visible. The connections for the fourth support 1933 and / or the third support 1932 may include a latch (e.g., a support release latch) 2346. In some cases, for example, the attachment for the third support may be held by a bias or other mechanism and / or an electro / magnetic retainer to prevent accidental deployment. For example, in Figure 23, the attachment for the third support to the link assembly includes a spring ball detent 2347 to prevent accidental deployment; to deploy the support, the user may apply force to overcome the detent and rotate the support so that the seat area aligns with the deployment axis.

[0154]

[0186] Any device of the apparatus described herein may include an aiming guide to assist in aligning the robot's insertion axis with the patient and, for example, an insertion area on the patient (e.g., the patient's anus / rectum). For example, any device of these apparatus may include an optical sight (e.g., a laser sight, an LED sight) configured to aim at a mount (e.g., an endoscope mount, an overtube mount, etc.) on a link assembly, for example, an inner / third link, on one of the supports of a support, etc. In some cases, the optical sight is a low-power (e.g., Class I) visible light laser (e.g., red light, blue light, white light, etc.) that projects a light beam indicating where the insertion axis from the apparatus will come into contact with the patient. The optical sight may be configured to move into and / or out of the insertion axis. For example, when setting up the apparatus from a pre-deployment configuration, the optical sight may be moved into a predetermined position relative to the insertion axis (or may be automatically positioned into a predetermined position). In some cases, this may displace the preloaded telescopic assembly of the overtube / endoscope. In other cases, the optical sight may be used before coupling the telescopic overtube / endoscope.

[0155]

[0187] Figure 24 shows an example of a device including an optical sight 2452 coupled to a second support 2431 in this example. The second support may be moved manually or automatically, for example, by pivoting, so that the overtube / endoscope is displaced and the optical sight is moved into the insertion axis. For example, the second support may include a pivot 2454 that allows the second support to move a seat area that holds a preloaded telescopic device (e.g., overtube / endoscope) so that light 2450 (e.g., a laser) is emitted as a beam that will indicate, for example, the point of contact with the insertion axis on the patient's body. For example, the optical sight may be moved into place and used to align the device. In some cases, the projected light may be projected as, for example, an image of crosshairs. The device may be configured to manually or automatically (or semi-automatically) confirm the targeting of the patient's entry point. The base of the device, which may be movable, may be locked in place once aiming is confirmed, and the optical sight (e.g., laser) may be turned off and moved away from the insertion axis so as not to interfere with the overtube / endoscope.

[0156]

[0188] In some cases, the device (e.g., an optical sight) may be configured to provide range data, and the system may determine whether the distance to the patient is sufficient or insufficient (e.g., whether the device should be moved closer to / further away from the patient).

[0157]

[0189] At the end of the procedure, the nested telescopic device (e.g., the overtube / endoscope) may be removed, and the support may be thoroughly wiped clean along with the rest of the system (e.g., the third and fourth support arms may be retracted vertically as described above).

[0158]

[0001] It should be recognized that all combinations of the above concepts and any further concepts discussed in more detail below (where such concepts do not contradict each other) are intended to be part of the subject matter of the inventions disclosed herein and may be used to achieve the benefits described herein.

[0159]

[0002] The process parameters and sequence of steps described and / or shown herein are given merely as examples and may be varied as desired. For example, the steps shown and / or described herein may be shown or discussed in a particular order, but these steps do not necessarily have to be performed in the order shown or discussed. Various exemplary methods described and / or shown herein may also omit one or more of the steps described or shown herein, or include additional steps in addition to the disclosed steps.

[0160]

[0003] Any method of the methods described herein (including the user interface) may be implemented as software, hardware, or firmware, and may be described as a non-temporary computer-readable storage medium that stores a set of instructions that can be executed by a processor (e.g., a computer, tablet, smartphone, etc.), and when executed by the processor, the set of instructions causes the processor to control and perform any step of the steps, including, but not limited to, displaying, communicating with a user, analyzing, modifying parameters (including timing, frequency, intensity, etc.), determining, issuing alarms, or the like. For example, any method of the methods described herein may be at least partially implemented by an apparatus that includes one or more processors having memory that stores a non-temporary computer-readable storage medium that stores a set of instructions for the process(s) of the method.

[0161]

[0004] When a feature or element is referred to herein as being "on" another feature or element, it may also be directly on or interposing to the other feature or element. In contrast, when a feature or element is referred to as being "directly on" another feature or element, there is no interposing feature or element. When a feature or element is referred to as being "connected," "attached," or "coupled" to another feature or element, it will also be understood that it may be directly connected, attached, or coupled to the other feature or element, or there may be an interposing feature or element. In contrast, when a feature or element is referred to as being "directly connected," "directly attached," or "directly coupled" to another feature or element, there is no interposing feature or element. Features and elements described or shown in reference to one embodiment may be applicable to other embodiments. It will also be recognized by those skilled in the art that references to structures or features positioned "adjacent" to another feature may have portions that overlap with or lie beneath the adjacent feature.

[0162]

[0005] The terms used herein are for the sole purpose of describing specific embodiments and are not intended to limit the invention. For example, as used herein, the singular forms “a,” “an,” and “the” are intended to also include the plural form unless the context otherwise explicitly indicates. As used herein, the terms “comprises” and / or “comprising” specify the presence of the described features, steps, operations, elements, and / or components, but do not exclude the presence or addition of one or more other features, steps, operations, elements, components, and / or groups thereof. As used herein, the term “and / or” includes any and all combinations of one or more of the enumerated items relating to the invention, and may be abbreviated as “ / ”.

[0163]

[0006] Spatially relative terms such as “under,” “below,” “lower,” “over,” “upper,” and similar terms may be used herein to describe the relationship of one element or feature shown in the figures to another element or feature(s). It will be understood that spatially relative terms are intended to encompass different orientations of the device in use or operation, in addition to the orientation shown in the figures. For example, if the device in the figure is inverted, an element described as “under” or “beneath” another element or feature will be oriented “over” the other element or feature. Thus, the exemplary term “under” can encompass both up and down orientations. The device may be oriented in other ways (rotated 90 degrees or to other orientations), and the spatially relative descriptors used herein will be interpreted accordingly. Similarly, the terms “upwardly,” “downwardly,” “vertical,” “horizontal,” and similar terms are used herein solely for illustrative purposes unless otherwise specified.

[0164]

[0007] The terms “first” and “second” may be used herein to describe various features / elements (including steps), but unless the context indicates otherwise, these features / elements should not be limited by these terms. These terms may be used to distinguish one feature / element from another. Thus, without departing from the teachings of the present invention, the first feature / element discussed below may be called the second feature / element, and similarly, the second feature / element discussed below may be called the first feature / element.

[0165]

[0008] Throughout this specification and the subsequent claims, unless the context requires otherwise, the word “comprise” and variations such as “comprising” and “comprising” mean various components that may be used together in methods and articles (e.g., compositions and apparatus including devices and methods). For example, the term “comprising” will be understood to mean the inclusion of any element or step stated, but not the exclusion of any other element or step.

[0166]

[0009] Generally, any apparatus and method described herein should be understood to be inclusive, but all or a subset of components and / or steps may be, alternatively, exclusive, and may be expressed as "consisting of" or, alternatively, "consisting essentially of" various components, steps, subcomponents, or substeps.

[0167]

[0010] As used in the examples and as used in the specification and claims, including, unless otherwise expressly specified, all numbers may be read as if preceded by the word “about” or “approximately,” even if the term does not appear expressly. The phrase “about” or “approximately” may be used when describing size and / or location to indicate that the described value and / or location is within a reasonable expected range of the value and / or location. For example, a number may have a value that is + / -0.1% of the stated value (or range of value), + / -1% of the stated value (or range of value), + / -2% of the stated value (or range of value), + / -5% of the stated value (or range of value), + / -10% of the stated value (or range of value), and so on. Any number given herein should also be understood to include its value about or approximately, unless the context indicates otherwise. For example, if the value "10" is disclosed, "about 10" is also disclosed. Any numerical ranges cited herein are intended to include all subranges contained therein. It is also understood, as will be well understood by those skilled in the art, that when a value is disclosed as "less than or equal to the value" or "greater than or equal to the value," the possible range between the values ​​is also disclosed. For example, if the value "X" is disclosed, "less than or equal to X" and "greater than or equal to X" (for example, X is a number) are also disclosed. It is also understood that throughout the application, the data will be provided in a number of different formats, and that this data will represent a range for any combination of end points, start points, and data points. For example, if a particular data point "10" and a particular data point "15" are disclosed, it is understood that for 10 and 15, the possible ranges are greater than, greater than, less than, less than, equal to, and between 10 and 15.It is also understood that each unit between two specific units is disclosed. For example, if 10 and 15 are disclosed, then 11, 12, 13, and 14 are also disclosed.

[0168]

[0011] Although various illustrative embodiments are described above, any of the numerous modifications may be made to various embodiments without departing from the scope of the invention as described by the claims. For example, the order in which the various method steps described are performed may often be changed in alternative embodiments, and in other alternative embodiments, one or more method steps may be skipped together. Optional features of various device and system embodiments may be included in some embodiments and not in others. Therefore, the above description is provided primarily for illustrative purposes and should not be construed as limiting the scope of the invention, for the scope of the invention is described in the claims.

[0169]

[0012] The examples and illustrations included herein illustrate, not as limitations, specific embodiments in which the subject matter may be implemented. As stated, other embodiments may be utilized and derived from specific embodiments, thereby allowing structural and logical substitutions and modifications without departing from the scope of the disclosure. Such embodiments of the subject matter of the invention may be referred herein by the term “invention” individually or collectively, for convenience only, and without the intention of voluntarily limiting the scope of this application to any single invention or concept of invention if more than one is actually disclosed. Thus, any arrangement configuration that is calculated to achieve the same objective as a specific embodiment shown and described herein may replace the specific embodiment shown. The disclosure is intended to cover any and all adaptations or variations of various embodiments. Combinations of the above embodiments and other embodiments not specifically described herein will become apparent to those skilled in the art as they consider the above description.

Claims

1. A device for arranging flexible tubular members, Bass and, A vertically positioned link assembly, connected to the base, A vertically arranged link assembly comprising a plurality of links, each adjacent to each other perpendicularly, wherein adjacent pairs of links are slidably coupled together by a pair of opposing flexible bands extending in opposite directions around one or more surfaces of the shuttle, and pairs of shuttles between adjacent pairs of links are coupled together on a synchronization belt. A linear driver coupled to the first shuttle of the pair of shuttles, A mount assembly coupled to the vertically arranged link assembly, wherein the mount assembly is configured to be coupled to the flexible tubular member. A device equipped with the following features.

2. The apparatus according to claim 1, wherein the synchronization belt is configured to move the first shuttle in the opposite direction to the second shuttle.

3. The apparatus according to claim 1 or 2, wherein the first end of the first band of the opposing band is coupled to the distal end region of the adjacent pair of first links of the link and to the distal end region of the adjacent pair of second links of the link, and the first end of the second band of the opposing band is coupled to the proximal end region of the adjacent pair of first links of the link and to the proximal end region of the adjacent pair of second links of the link.

4. The apparatus according to any one of claims 1 to 3, wherein the flexible band comprises a flat band.

5. The apparatus according to any one of claims 1 to 4, wherein the flexible band comprises a metal band.

6. The apparatus according to any one of claims 1 to 5, wherein each of the plurality of links has a vertical height greater than the width and less than the length from distal to proximal.

7. The apparatus according to any one of claims 1 to 6, wherein each of the plurality of links has a vertical height that is less than the distal-to-proximal length and at least twice the width.

8. The apparatus according to any one of claims 1 to 7, wherein the cylindrical surface is equipped with a pulley.

9. The apparatus according to any one of claims 1 to 8, wherein the mounting assembly is coupled to the outer links of the plurality of links of the vertically arranged link assembly.

10. The apparatus according to any one of claims 1 to 9, further comprising a vertical lift arm having a vertical axis connecting the vertically arranged link assembly to the base, wherein the vertical lift arm is configured to raise and lower the vertically arranged link assembly relative to the base.

11. The apparatus according to any one of claims 1 to 10, further comprising a yaw adjustment member between the vertically positioned link assembly and the base, wherein the yaw adjustment member is configured to pivot the vertically positioned link assembly around the base.

12. The apparatus according to any one of claims 1 to 11, wherein the mounting assembly is configured to be coupled to the flexible tubular member comprising a nested robotic device having an overtube nested therein.

13. The apparatus according to claim 12, wherein the mounting assembly comprises an overtube mount and an endoscope mount, the endoscope mount being configured to move proximal and / or distal to the overtube mount.

14. The apparatus according to any one of claims 1 to 13, wherein the liner drive comprises a ball screw nut assembly.

15. The apparatus according to any one of claims 1 to 14, wherein the liner drive is housed in the first link of the plurality of links.

16. The apparatus according to any one of claims 1 to 15, further comprising a controller configured to control the linear drive to move the links of the plurality of links distally and proximal to the base by controlling the operation of the linear driver.

17. The apparatus according to any one of claims 1 to 16, further comprising a flexible tubular member support connected to the vertically arranged link assembly and configured to prevent buckling of the flexible tubular member when the flexible tubular member extends distally from the vertically arranged link assembly.

18. The apparatus according to any one of claims 1 to 17, wherein the mounting assembly is located below the upper part of the vertically positioned link assembly.

19. The apparatus according to any one of claims 1 to 18, further comprising a tool driver coupled to the vertically arranged link assembly and configured to actuate a tool within the working channel of the flexible tubular member.

20. The apparatus according to any one of claims 1 to 19, further comprising one or more sensors configured to detect one or more operating parameters for the apparatus.

21. The apparatus according to any one of claims 1 to 20, further comprising one or more load sensors configured to detect a load applied between the vertically arranged link assembly and a patient.

22. The apparatus according to claim 21, wherein the one or more load sensors include a current sensor configured to detect the current of the linear driver.

23. The apparatus according to any one of claims 1 to 22, wherein the mounting assembly of the vertically arranged link assembly is coupled to the base directly or through one or more arms.

24. A device for arranging flexible tubular members, Bass and, A vertically positioned link assembly, connected to the base, It comprises a first link, a second link, and a third link, wherein the first link, the second link, and the third link are adjacent to each other perpendicularly. The system comprises a first shuttle between the first link and the second link and a second shuttle between the second link and the third link, wherein the first shuttle is movably coupled between the first link and the second link, and the second shuttle is movably coupled between the second link and the third link, so that the second link and the third link may slide distally and proximal to the first link, the first shuttle has a first vertical cylindrical surface, and the second shuttle has a second vertical cylindrical surface. The system comprises a linear driver coupled to the first shuttle, A first flexible band is provided between the first link and the second link, the first flexible band extending around the surface of the first vertical cylinder from the first end region of the first link to the first end region of the second link, A vertically positioned link assembly comprising a second flexible band between the second link and the third link, wherein proximal and / or distal movement of the second link relative to the first link by the linear driver results in proximal and / or distal movement of the third link, the second flexible band extends from the first end region of the second link and to the first end region of the third link around the surface of the second vertical cylinder, Mount assembly coupled to the vertically positioned link assembly and A device comprising, wherein the mounting assembly is configured to be coupled to the flexible tubular member.

25. The apparatus according to claim 24, further comprising a synchronization belt coupled to the first shuttle and the second shuttle, configured to move the first shuttle relative to the second shuttle.

26. The apparatus according to claim 24 or 25, further comprising: a third flexible band between the first link and the second link, extending around the surface of the first vertical cylinder from the second end region of the first link to the second end region of the second link; and a fourth flexible band between the second link and the third link, extending around the surface of the second vertical cylinder from the second end region of the second link to the second end region of the third link.

27. The apparatus according to any one of claims 24 to 26, wherein the first flexible band and the second flexible band each comprise a flat band.

28. The apparatus according to any one of claims 24 to 27, wherein the first flexible band and the second flexible band each comprise a metal band.

29. The apparatus according to any one of claims 24 to 28, wherein the motion of the linear drive is transmitted to the third link in a ratio of 4:1 or greater.

30. The apparatus according to any one of claims 24 to 29, wherein the first, second, and third links each have a vertical height greater than the width and less than the length from distal to proximal.

31. The apparatus according to any one of claims 24 to 30, wherein the first, second, and third links each have a vertical height that is less than the distal-to-proximal length and at least twice the width.

32. The apparatus according to any one of claims 24 to 31, wherein the first vertical cylindrical surface and the second vertical cylindrical surface are provided with pulleys.

33. The apparatus according to any one of claims 24 to 32, wherein the mounting assembly is coupled to the third link of the vertically arranged link assembly.

34. The apparatus according to any one of claims 24 to 33, further comprising a vertical lift arm having a vertical axis connecting the vertically positioned link assembly to the base, wherein the vertical lift arm is configured to raise and lower the vertically positioned link assembly relative to the base.

35. The apparatus according to any one of claims 24 to 34, further comprising a yaw adjustment member between the vertically positioned link assembly and the base, wherein the yaw adjustment member is configured to cause the vertically positioned link assembly to swing relative to the base.

36. The apparatus according to any one of claims 23 to 35, wherein the mounting assembly is configured to be coupled to a flexible tubular member comprising a nested robotic device having an overtube nested therein.

37. The apparatus according to claim 36, wherein the mount assembly comprises an overtube mount and an endoscope mount, the endoscope mount being configured to move proximal and / or distal to the overtube mount.

38. The apparatus according to any one of claims 24 to 37, wherein the liner drive comprises a ball screw nut assembly.

39. The apparatus according to any one of claims 24 to 38, wherein the liner drive is housed within the first link.

40. The apparatus according to any one of claims 24 to 39, further comprising a controller configured to control the linear drive to move the third link relative to the first link by controlling the operation of the linear driver.

41. The apparatus according to any one of claims 24 to 40, further comprising a flexible tubular member support coupled to the vertically arranged link assembly and configured to prevent buckling of the flexible tubular member when the flexible tubular member extends distally from the vertically arranged link assembly.

42. The apparatus according to any one of claims 24 to 41, wherein the mounting assembly is located below the upper part of the vertically positioned link assembly.

43. The apparatus according to any one of claims 24 to 42, further comprising a tool driver coupled to the vertically arranged link assembly and configured to actuate a tool within the working channel of the flexible tubular member.

44. The apparatus according to any one of claims 24 to 43, further comprising one or more sensors configured to detect one or more operating parameters for the apparatus.

45. The apparatus according to any one of claims 24 to 44, further comprising one or more load sensors configured to detect a load applied to the vertically arranged link assembly between the vertically arranged link assembly and a patient.

46. The apparatus according to claim 35, wherein the one or more load sensors include a current sensor configured to detect the current of the linear driver.

47. The apparatus according to any one of claims 24 to 46, wherein the vertically arranged link assembly further comprises one or more further links perpendicularly adjacent to the first link, the second link, and the third link.

48. The apparatus according to any one of claims 24 to 47, wherein the mounting assembly of the vertically positioned link assembly is coupled to the base directly or through one or more arms.

49. An apparatus for deploying a nested robot device having an inner rigidity-granting member that is at least partially slidably disposed within an outer rigidity-granting member, Bass and, A vertically positioned link assembly, connected to the base, It comprises a first link, a second link, and a third link, wherein the first link, the second link, and the third link are adjacent to each other perpendicularly. The system comprises a first shuttle between the first link and the second link and a second shuttle between the second link and the third link, wherein the first shuttle is movably coupled between the first link and the second link, and the second shuttle is movably coupled between the second link and the third link, so that the second link and the third link may slide distally and proximal to the first link, the first shuttle has a first vertical cylindrical surface, and the second shuttle has a second vertical cylindrical surface. The system comprises a linear driver coupled to the first shuttle, A first flexible band is provided between the first link and the second link, the first flexible band extending around the surface of the first vertical cylinder from the first end region of the first link to the first end region of the second link, A vertically positioned link assembly comprising a second flexible band between the second link and the third link, wherein proximal and / or distal movement of the second link relative to the first link by the linear driver results in proximal and / or distal movement of the third link, the second flexible band extends from the first end region of the second link and to the first end region of the third link around the surface of the second vertical cylinder, Mounting assembly, A first mounting region coupled to the third link of the vertically arranged link assembly, configured to be coupled to an external stiffening device, and A mount assembly comprising a second mount region that is linearly movable proximal and distal to the first mount region and configured to be coupled to an internal stiffening device, and A device equipped with the following features.

50. A device for arranging flexible tubular members, Bass and, A telescopic link assembly, connected to the base, A telescopic link assembly comprising multiple adjacent links, wherein each adjacent pair of links is slidably connected to the other, and the multiple links are configured to extend from a compact configuration, A linear driver configured to drive the movement of the link in the telescopic link assembly, A mount assembly coupled to the link assembly, wherein the mount assembly is configured to be coupled to the flexible tubular member. A device equipped with the following features.

51. The apparatus according to claim 50, wherein the plurality of links are configured to extend from the compact configuration to a length of 0.6 m or more.

52. The apparatus according to claim 50, wherein the length of the compact configuration is 50% or less of the length of the fully extended configuration.

53. The apparatus according to claim 50, wherein the telescopic link assembly is bidirectional, the compact configuration is a neutral configuration, and the plurality of links may extend distally to a length of 0.6 m or more from the neutral configuration, or proximal to a length of 0.6 m or more from the neutral configuration.

54. The apparatus according to claim 50, wherein the plurality of links are adjacent to each other perpendicularly.

55. The apparatus according to claim 50, further comprising one or more synchronizing members coupled to each link of the plurality of links, which are configured to coordinate the movement of all the links when a force is applied to one of the links.

56. The apparatus according to claim 50, wherein the mount assembly comprises an overtube mount and an endoscope mount, the endoscope mount being configured to move proximal and / or distal to the overtube mount.

57. The apparatus according to claim 50, wherein the link assembly is configured to extend from the compact configuration to a length of 1 m or more.

58. The apparatus according to claim 50, wherein the vertical distance from the mount assembly to the lowest surface of the link assembly is less than 20 cm.

59. The apparatus according to claim 50, wherein the plurality of links are configured such that adjacent pairs of links are slidably coupled together by a pair of opposing flexible bands that extend in opposite directions around one or more surfaces of the shuttle.

60. The apparatus according to claim 59, further comprising a pair of shuttles between adjacent links of adjacent pairs of links that are coupled together on a synchronization belt.

61. A device for arranging flexible tubular members, Bass and, A bidirectional telescopic link assembly, connected to the base, A bidirectional telescopic link assembly comprising a plurality of adjacent links, wherein adjacent pairs of links are slidably coupled together, and the plurality of links are configured to extend proximal from a compact neutral configuration to a proximal extension configuration, and distal from the compact neutral configuration to a distal extension configuration, wherein the compact neutral configuration has a length of 50% or less of the length of the proximal extension configuration and 50% or less of the length of the distal extension configuration, A linear driver configured to drive the movement of the link in the telescopic link assembly, A mount assembly coupled to the link assembly, wherein the mount assembly is configured to be coupled to the flexible tubular member. A device equipped with the following features.

62. The apparatus according to claim 61, wherein the plurality of links are adjacent to each other perpendicularly.

63. The apparatus according to claim 61, further comprising one or more synchronization members coupled to each link of the plurality of links, which are configured to coordinate the movement of all the links when a force is applied to one of the links.

64. The apparatus according to claim 61, wherein the mounting assembly comprises an overtube mount and an endoscope mount, the endoscope mount being configured to move proximal and / or distal to the overtube mount.

65. The apparatus according to claim 61, wherein the link assembly is configured to extend from a compact configuration to a length of 1 m or more.

66. The apparatus according to claim 61, wherein the vertical distance from the mount assembly to the lowest surface of the link assembly is less than 20 cm.

67. The apparatus according to claim 61, wherein the plurality of links are configured such that adjacent pairs of links are slidably coupled together by a ball screw nut assembly.

68. The apparatus according to claim 61, wherein the plurality of links are configured such that adjacent pairs of links are slidably coupled together by a pair of opposing flexible bands extending in opposite directions around one or more surfaces of the shuttle.

69. The apparatus according to claim 68, further comprising a pair of shuttles between adjacent links of adjacent pairs of links coupled together on a synchronization belt.

70. A method for deploying an overtube and a nested endoscope, A step of advancing and / or retracting the overtube together with the endoscope by moving a first link of a bidirectional telescopic link assembly, wherein the overtube is coupled to an overtube mount on the first link, the endoscope is coupled to an endoscope mount on the first link, and the bidirectional link assembly comprises a plurality of links, including the first link, which are slidably coupled together and adjacent to each other, wherein the step of advancing the overtube includes extending the plurality of links distally from a compact neutral configuration to a proximal extension configuration, and the step of retracting the overtube includes retracting the plurality of links proximal from the compact neutral configuration to a proximal extension configuration, wherein the compact neutral configuration has a length of 50% or less of the length of the proximal extension configuration and 50% or less of the length of the distal extension configuration, The steps of moving the endoscope distally into or out of the overtube by changing the relative positions of the endoscope mount and the overtube mount on the first link, and Methods that include...

71. The method according to claim 70, wherein extending the plurality of links includes using a linear driver to drive the movement of the links in the telescopic link assembly.

72. The method according to claim 70, further comprising coupling the overtube to the overtube mount.

73. The method according to claim 70, further comprising connecting the endoscope, which is nested within the overtube, to the endoscope mount.

74. A method for deploying an overtube and a nested endoscope, A step of advancing and / or retracting the overtube together with the endoscope by moving a first link of a bidirectional telescopic link assembly, wherein the overtube is coupled to an overtube mount on the first link, the endoscope is coupled to an endoscope mount on the first link, and the bidirectional link assembly comprises a plurality of links, including the first link, which are slidably coupled together and adjacent to each other, wherein the step of advancing the overtube includes extending the plurality of links distally from a compact neutral configuration to a proximal extension configuration, and the step of retracting the overtube includes retracting the plurality of links proximal from the compact neutral configuration to a proximal extension configuration, wherein the compact neutral configuration has a length of 50% or less of the length of the proximal extension configuration and 50% or less of the length of the distal extension configuration, The steps of moving the endoscope distally into or out of the overtube by changing the relative positions of the endoscope mount and the overtube mount on the first link, and Methods that include...

75. The method according to claim 74, wherein extending the plurality of links includes using a linear driver to drive the movement of the links in the telescopic link assembly.

76. The method according to claim 74, further comprising coupling the overtube to the overtube mount.

77. The method according to claim 74, further comprising connecting the endoscope, which is nested within the overtube, to the endoscope mount.

78. A telescopic link assembly comprising a plurality of adjacent vertical links, wherein each adjacent pair of vertical links is configured to be slidably coupled together and to move relative to each other and relative to a base link, A first mount coupled to the first link of the link assembly, configured to engage with the overtube, A second mount, coupled to the first link and configured to engage with the overtube and a nested endoscope, wherein the overtube and the endoscope are configured to move along a distal-to-proximal line by sliding the vertical link of the telescopic link assembly relative to the base link, A plurality of supports movably coupled to the telescopic link assembly, each of the plurality of supports having a seating area configured to hold the overtube and the endoscope aligned with the distal-to-proximal line, and A device equipped with the following features.

79. The apparatus according to claim 78, wherein each of the plurality of supports is configured such that when the plurality of links of the telescopic link assembly extend distally, the seating area of ​​each support is deflected so that it moves away from the distal to proximal line.

80. The apparatus according to claim 78, wherein at least some of the plurality of supports are configured to deflect downward and laterally when the plurality of links of the telescopic link assembly are extended distally.

81. The apparatus according to claim 78, further comprising a linear driver configured to drive the movement of the vertical link of the telescopic link assembly.

82. The apparatus according to claim 78, wherein at least one of the plurality of supports is configured to move from a deployed configuration, wherein the seating area of ​​the support is configured to hold the overtube and the endoscope in alignment with the distal-to-proximal line, to a pre-deployment configuration, wherein the support is lifted vertically outside the plane of the distal-to-proximal line.

83. The apparatus according to claim 78, wherein at least one of the plurality of supports is coupled to an extender on the link assembly which is configured to extend distally from the link assembly.

84. The apparatus according to claim 78, wherein the first mount and / or the second mount are configured to move relative to each other on the first link to adjust the relative positions of the endoscope and the overtube.

85. Bass and, A bidirectional telescopic link assembly comprising a plurality of vertical links connected to the base and adjacent to each other, wherein adjacent pairs of vertical links are slidably coupled together and configured to move bidirectionally relative to the base link, A linear driver configured to drive the movement of the vertical link of the bidirectional telescopic link assembly, A first mount coupled to the first link of the link assembly, configured to engage with the overtube, A second mount, coupled to the first link and configured to engage with the overtube and the endoscope nested within it, wherein the overtube and the endoscope are configured to move along a distal-to-proximal line by sliding the vertical link of the bidirectional telescopic link assembly, A plurality of supports coupled to the telescopic link assembly, each of the plurality of supports having a seating area, the seating area being configured to move between a first configuration, wherein the seating area holds the overtube and the endoscope aligned with the distal-to-proximal line, and a second configuration, wherein as the plurality of links of the telescopic link assembly extend distally, the seating area of ​​each support moves away from the distal-to-proximal line. A device equipped with the following features.

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