Axial motion drive, system, and method for robotic medical systems

Abstract

Certain aspects relate to systems and techniques for driving axial movement of a shaft of a medical instrument using a driver. The axial movement can include insertion and / or retraction of the instrument. For example, a robotic medical system can include a medical instrument having an instrument base and a flexible shaft configured for insertion into a patient, and a first robotic arm attachable to the instrument base of the medical instrument. The system further includes a driver configured to engage the flexible shaft and a second robotic arm attachable to the driver. The second robotic arm is configured to operate the driver to drive axial movement of the flexible shaft, and the first robotic arm is configured to move in coordination with operation of the driver.

Description

[Technical field]

[0001] (Priority and related applications) This application claims priority to U.S. Provisional Patent Application No. 62 / 887,518, filed August 15, 2019, which is incorporated herein by reference. All applications to which a foreign or domestic priority claim is identified in an Application Data Sheet filed with this application are incorporated herein by reference under 37 CFR 1.57.

[0002] FIELD OF THEINVENTION The systems and methods disclosed herein relate to robotic medical systems and, more particularly, to axial motion drives and related systems and methods for driving axial motion of elongated shafts of medical instruments in robotic medical systems. [Background technology]

[0003] Medical procedures such as endoscopy may provide access to and visualization of the interior of a patient's anatomy for diagnostic and / or therapeutic purposes. For example, in gastroenterology, urology, and pulmonology, medical procedures are performed that allow physicians to inspect a patient's lumens, such as the ureters, gastrointestinal tract, and airways (bronchi and bronchioles). During these procedures, thin, flexible, tubular tools or instruments known as endoscopes are inserted into the patient through an opening (such as a natural orifice) and advanced toward a identified tissue site for subsequent diagnosis and / or treatment. The medical instruments may be controllable and articulatable to facilitate navigation through the anatomy. Summary of the Invention [Means for solving the problem]

[0004] In a first aspect, a robotic medical system is disclosed comprising: a medical instrument including an instrument base and an elongate shaft configured for insertion into a patient; a first robotic arm, where an instrument base of the medical instrument is attached to the first robotic arm and the first robotic arm is articulatable to move the instrument base; a second robotic arm; a driver attached to the second robotic arm and distal to the instrument base, where the driver is configured to engage the elongate shaft of the medical instrument and drive axial movement of the elongate shaft; and a processor configured to drive the axial movement of the elongate shaft of the medical instrument by the driver during a first axial movement period at a first axial movement speed that is greater than a movement speed of the first robotic arm.

[0005] The robotic medical system may include one or more of the following features in any combination. (a) during a first period of axial motion, a portion of the elongate shaft of the medical instrument between the instrument base and the driver has a length that is greater than a distance between the instrument base and the driver, and a portion of the elongate shaft forms a service loop; (b) during the first period of axial motion, a rate of change of the length of the service loop is greater than a rate of change of the distance between the instrument base and the driver; (c) the axial motion includes at least one of retraction or insertion of the elongate shaft; (d) the processor is configured to drive the axial motion of the elongate shaft at a first axial motion speed when a distal tip of the elongate shaft is positioned within the access sheath; (e) the processor is configured to drive the axial motion of the elongate shaft by the driver during a second period of axial motion at a second axial motion speed that is less than or equal to a speed of movement of the first robotic arm; (f) during the second period of axial motion, a portion of the elongate shaft of the medical instrument between the instrument base and the driver has a length substantially equal to the distance between the instrument base and the driver, and a portion of the elongate shaft forms a service loop. (g) during the second axial motion period, a portion of the elongate shaft of the medical instrument between the instrument base and the driver has a length that is greater than a distance between the instrument base and the driver, and a portion of the elongate shaft forms a service loop; (h) during the second axial motion period, a rate of change of the length is less than or equal to a rate of change of the distance between the instrument base and the driver; (i) the processor is configured to drive the axial motion of the elongate shaft at a second axial motion rate when a distal tip of the elongate shaft is positioned beyond the access sheath; (j) the driver is configured to be attached to an access sheath configured to be inserted into a patient, the elongate shaft being configured to be inserted through the access sheath into the patient; (k) the driver includes a clip configured to be attached to a proximal end of the access sheath; (l) the driver is configured to withdraw the distal tip of the elongate shaft from the proximal end of the access sheath and reinsert the distal tip of the elongate shaft into the proximal end of the access sheath.(m) an instrument driver with a plurality of drive outputs positioned at a distal end of the second robotic arm, the drive having a plurality of drive inputs configured to engage the plurality of drive outputs of the instrument driver; (n) a sterile adapter positioned between the instrument driver and the drive; (o) the drive having a pair of opposed rollers configured to drive axial movement of the elongated shaft; (p) the drive having a body including a channel configured to receive an elongated shaft of a medical instrument and the rollers configured to engage the elongated shaft, the second robotic arm driving the axial movement of the elongated shaft received in the channel. (q) upon receiving a pivot command to pivot the elongated shaft, the processor is configured to: cause the first robotic arm to rotate the elongated shaft about a longitudinal axis of the elongated shaft; and (b) cause the second robotic arm to disengage the drive from the elongated shaft; and / or other features described throughout this application.

[0006] In another aspect, a robotic medical system is disclosed comprising: a medical instrument including an instrument base and a flexible shaft configured for insertion into a patient; a first robotic arm attachable to the instrument base of the medical instrument; a drive configured to engage the flexible shaft; and a second robotic arm attachable to the drive, where the second robotic arm is configured to operate the drive to drive axial motion of the flexible shaft, and where the first robotic arm is configured to move in coordination with operation of the drive.

[0007] The robotic medical system may include one or more of the following features in any combination: (a) the second robotic arm is configured to disengage the drive from the flexible shaft while retaining the flexible shaft within the drive by a robotically actuated cover, (b) the second robotic arm is configured to control a rate of axial motion based on a position of the distal end of the flexible shaft relative to the access sheath, (c) the second robotic arm is configured to expand or contract a service loop in a portion of the flexible shaft between the first and second robotic arms, (d) the medical instrument is an endoscope, and / or other features described throughout this application.

[0008] In another aspect, a robotic medical system is disclosed that includes a first robotic arm configured to support an instrument base of a medical instrument, the medical instrument having an elongated shaft extending from the instrument base, and a second robotic arm configured to operate one or more rollers engageable with the elongated shaft to drive axial motion of the elongated shaft.

[0009] The robotic medical system may include one or more of the following features in any combination: (a) the one or more rollers include a pair of opposing rollers of a drive attached to a second robotic arm and configured to drive axial motion of the flexible shaft, (b) the second robotic arm configured to disengage the drive from the flexible shaft and retain the flexible shaft within the drive with a robotically actuated cover, and / or other features described throughout this application.

[0010] In another aspect, a method is disclosed that includes supporting an instrument base of a medical instrument with a first robotic arm, driving axial motion of an elongate shaft of the medical instrument with a second robotic arm, and moving the first robotic arm in coordination with driving the axial motion.

[0011] The method may include one or more of the following features in any combination: (a) driving the axial motion includes operating a pair of opposing rollers with a second robotic arm, (b) the first robotic arm moves at a slower speed than the axial motion of the elongate shaft, (c) the second robotic arm is configured to disengage the drive from the elongate shaft while retaining the elongate shaft within the drive with a robotically actuated cover, and / or other features described throughout this application.

[0012] In another aspect, a drive configured to facilitate axial movement of an elongated shaft of a medical instrument is disclosed, the drive comprising: a housing including a lower surface configured to attach to a robotic arm and an upper surface having a channel formed therein, the channel being configured to receive the elongated shaft of the medical instrument; a first roller positioned within the housing on a first side relative to the channel; and a second roller positioned within the housing on a second side relative to the channel, the first roller and the second roller being movable between a first position and a second position, wherein in the first position the first roller and the second roller are configured to engage the elongated shaft, wherein upon rotation in a first direction the first roller and the second roller drive insertion of the elongated shaft and upon rotation in a second direction the first roller and the second roller drive retraction of the elongated shaft, and wherein in the second position the first roller and the second roller are spaced apart from the elongated shaft.

[0013] The drive may include one or more of the following features in any combination. (a) a proximal clip positioned at a proximal end of the channel; (b) a distal clip positioned at a distal end of the channel; (c) the proximal and distal clips configured to hold the elongate shaft within the channel; (d) a cover operable to close the channel when the first and second rollers are in a first position and to open the channel when the first and second rollers are in a second position; (e) a movement of the cover mechanically coupled to a movement of one of the first and second rollers such that the cover opens and closes as the first and second rollers move between the second and first positions; (f) at an intermediate position between the first and second positions, the cover remains closed and the first and second rollers are disengaged from the elongate shaft; (g) a collector distal to the channel for depositing objects retrieved from within a patient using a medical instrument; (h) a clip configured to support a proximal end of an access sheath; (i) a clip configured to support a proximal end of the access sheath for depositing objects retrieved from within a patient using a medical instrument. (j) a first spring positioned within the housing and configured to urge the first roller towards the first position, and a second spring positioned within the housing and configured to urge the second roller towards the first position; (k) the first spring and the second spring include a torsion spring; (l) a first carrier plate positioned within the housing and configured to rotate about a first axis, the first roller being attached to the first carrier plate, and rotation of the first carrier plate moving the first roller between the first position and the second position; and a second carrier plate positioned within the housing and configured to rotate about a second axis, the second roller being attached to the second carrier plate, and rotation of the second carrier plate moving the second roller between the first position and the second position; (m) a first roller drive input positioned on a lower surface of the housing and attached to the first carrier plate;a first gear driven by the first roller drive input, a first orbital gear attached to the first carrier plate and driven by the first gear, where rotation of the first orbital gear drives rotation of the first roller, a second roller drive input located on the underside of the housing, a second gear attached to the second carrier plate and driven by the second roller drive input, and a second orbital gear attached to the second carrier plate and driven by the second gear, where rotation of the second orbital gear drives rotation of the second roller; (n) a first axis about which the first carrier plate rotates is coaxial with the axis of the first roller input. (o) the first and second carrier plates are intermeshed such that rotation of one of the first and second carrier plates causes rotation of the other of the first and second carrier plates; (p) a carrier plate rotational drive input configured to rotate one of the first or second carrier plate; (q) an off-axis protrusion coupled to the rotational drive input and configured to contact a pocket in the carrier plate to cause rotation of the first carrier plate; and / or other features described throughout this application.

[0014] In another aspect, a drive configured to facilitate axial movement of an elongate shaft of a medical instrument is disclosed, the drive comprising: a body including a channel configured to receive the elongate shaft of the medical instrument; a roller configured to engage the elongate shaft, where upon rotation the roller drives axial movement of the elongate shaft received within the channel; a first drive input coupled to the body, the first drive input operable by a robotic system to rotate the roller; a cover configured to selectively open or close the channel; and a second drive input coupled to the body, the second drive input operable to actuate the cover.

[0015] The driver may include one or more of the following features in any combination: (a) the second drive input is operable to actuate the cover between a first position in which the cover retains the elongate shaft in the channel and a second position in which the cover allows for loading or unloading of the elongate shaft in the channel, (b) a carrier supporting a roller, the carrier being pivotable by a drive input coupled to the body to engage or disengage the elongate shaft received in the channel, (c) the body configured to attach to the access sheath to align the channel with the access sheath, (d) the second drive input is operably coupled to the cover via a cam, (e) one or more clips in the channel, (f) the roller is a first roller, and the driver further comprises a second roller opposing the first roller, and / or other features described throughout this application.

[0016] In another aspect, a robotic medical system is disclosed comprising: a drive including a channel configured to receive an elongate shaft, one or more rollers configured to engage the elongate shaft received in the channel, and a cover configured to selectively close or open the channel; and a driver configured to actuate the drive to a first state in which the one or more rollers are disengaged from the elongate shaft and the cover is open, actuate the drive to a second state in which the one or more rollers are disengaged from the elongate shaft and the cover is closed, and actuate the drive to a third state in which the one or more rollers are engaged with the elongate shaft and the cover is closed.

[0017] The robotic medical system may include one or more of the following features in any combination: (a) the driver is configured to actuate the drive to a first state based on a command to load or unload the elongated shaft, (b) the driver is configured to actuate the drive to a second state based on a command to pivot the elongated shaft, (c) the driver is disposed at an end of a robotic arm, the driver is configured to actuate the drive to a second state based on a command to move the robotic arm, (d) the driver is configured to actuate the drive to a third state to insert or retract the elongated shaft, (e) the driver is configured to operate a first drive input of the drive to rotate the roller relative to the elongated shaft and operate a second drive input of the drive to disengage the roller from the elongated shaft, and / or other features described throughout this application.

[0018] In another aspect, a method of robotic medical procedure is disclosed that includes driving, by a driver, the insertion of a flexible shaft of a medical instrument at a first speed during a first insertion period during which a distal tip of the flexible shaft is positioned within an access sheath inserted into a patient, and transitioning to driving, by the driver, the insertion of the flexible shaft of the medical instrument at a second speed slower than the first speed during a second insertion period during which the distal tip of the flexible shaft is positioned beyond the distal tip of the access sheath.

[0019] The method and system may include one or more of the following features in any combination: (a) transitioning to drive the insertion of the flexible shaft of the medical instrument by the driver at a second speed includes automatically detecting when a distal tip of the flexible shaft is positioned beyond a distal tip of the access, (b) driving the retraction of the flexible shaft of the medical instrument by the driver at a third speed during a first retraction period when the distal tip of the flexible shaft is positioned beyond a distal tip of the access sheath and automatically transitioning to drive the retraction of the flexible shaft of the medical instrument by the driver at a fourth speed faster than the third speed during a second retraction period when the distal tip of the flexible shaft is positioned within the access sheath, and (c) automatically transitioning to drive the retraction of the flexible shaft of the medical instrument by the driver at the fourth speed includes automatically detecting when a distal tip of the flexible shaft is positioned beyond a distal tip of the access. (d) attaching an instrument base of the medical instrument to the first robotic arm, attaching a driver to the second robotic arm, and engaging a flexible shaft of the medical instrument with the driver; (e) engaging the flexible shaft of the medical instrument with the driver includes engaging opposing rollers of the driver with the flexible shaft; (f) engaging the flexible shaft of the medical instrument with the driver further includes inserting the flexible shaft into a channel in a top surface of the driver; (g) moving the instrument base by the first robotic arm towards the driver during insertion, and moving the instrument base by the first robotic arm away from the driver during retraction; and / or other features described throughout this application.

[0020] In another aspect, a robotic medical system is disclosed comprising: a driver including a pair of rollers configured to engage a shaft of a medical instrument; and a processor configured to operate the rollers to drive insertion of the shaft at a first speed during a first insertion period during which a distal tip of the shaft is positioned within an access sheath inserted into a patient, and to transition to driving insertion of the shaft at a second speed slower than the first speed during a second insertion period during which the distal tip of the shaft is positioned beyond the distal tip of the access sheath.

[0021] The robotic medical system may include one or more of the following features in any combination: (a) the processor is configured to detect when the distal tip of the shaft is positioned beyond the distal tip of the access sheath based on geometric information associated with the access sheath and the shaft, (b) the processor is configured to detect when the distal tip of the shaft is positioned beyond the distal tip of the access sheath based on image information obtained by the medical instrument, (c) the processor is configured to operate the rollers to drive retraction of the shaft of the medical instrument at a third speed during a first retraction period when the distal tip of the shaft is positioned beyond the distal tip of the access sheath, and (d) the processor is configured to operate the rollers to drive retraction of the shaft of the medical instrument at a third speed during a first retraction period when the distal tip of the shaft is positioned beyond the distal tip of the access sheath. and during a second retraction period while positioned within the access sheath, operating the rollers to transition to driving retraction of the shaft of the medical instrument at a fourth speed faster than the third speed; (d) a first robotic arm configured to support the medical instrument and a second robotic arm configured to support the drive device; (e) the first robotic arm configured to move an instrument handle of the medical instrument toward the drive device during insertion and the first robotic arm configured to move the instrument handle away from the drive device during retraction; and / or other features described throughout this application.

[0022] In another aspect, a robotic medical system is disclosed that includes an elongated flexible access sheath, a medical instrument including an elongated flexible shaft, and a processor configured to drive insertion of the shaft at a first speed during a first insertion period when a distal tip of the shaft is positioned within the access sheath, and transition to driving the insertion of the shaft at a second speed slower than the first speed during a second insertion period when the distal tip of the shaft is positioned beyond the distal tip of the access sheath.

[0023] The robotic medical system may include one or more of the following features in any combination: (a) the processor is configured to detect when the distal tip of the shaft is positioned beyond the distal tip of the access sheath based on geometric information associated with the access sheath and the shaft, (b) the processor is configured to detect when the distal tip of the shaft is positioned beyond the distal tip of the access sheath based on image information obtained by the medical instrument, and (c) the processor is configured to retract the shaft of the medical instrument at a third speed during a first retraction period when the distal tip of the shaft is positioned beyond the distal tip of the access sheath. and transitioning to driving retraction of the medical instrument shaft at a fourth speed faster than the third speed during a second retraction period during which the distal tip of the shaft is positioned within the access sheath; (d) the processor is configured to operate the driver to drive axial movement of the elongate flexible shaft, move an instrument handle of the medical instrument towards the driver during insertion and move the instrument handle away from the driver during retraction; and / or other features described throughout this application. [Brief description of the drawings]

[0024] The disclosed aspects are hereinafter described in conjunction with the accompanying drawings, which illustrate, by way of example only, and not by way of limitation, the disclosed aspects, and in which like designations refer to like elements. [Figure 1] 1 illustrates an embodiment of a cart-based robotic system positioned for diagnostic and / or therapeutic bronchoscopy. [Diagram 2] 2 depicts a further embodiment of the robotic system of FIG. 1. [Diagram 3] 2 illustrates an embodiment of the robotic system of FIG. 1 positioned for ureteroscopy. [Figure 4] 2 illustrates the embodiment of the robotic system of FIG. 1 positioned for a vascular procedure. [Diagram 5] 1 illustrates an embodiment of a table-based robotic system positioned for a bronchoscopy procedure. [Figure 6] 6 provides an alternative view of the robotic system of FIG. 5. [Figure 7] 1 illustrates an exemplary system configured to accommodate a robotic arm(s). [Figure 8] 1 illustrates an embodiment of a table-based robotic system configured for a ureteroscopy procedure. [Figure 9] 1 illustrates an embodiment of a table-based robotic system configured for a laparoscopic procedure. [Figure 10] 10 illustrates an embodiment of the table-based robotic system of FIGS. 5-9 with pitch or tilt adjustment. [Figure 11] FIG. 11 is a detailed explanatory diagram of the interface between the table and column of the table-based robotic system of FIGS. 5-10. [Figure 12] 1 illustrates an alternative embodiment of a table-based robotic system. [Figure 13] FIG. 13 illustrates an end view of the table-based robotic system of FIG. [Figure 14] FIG. 1 shows an end view of a table-based robotic system with a robotic arm attached. [Figure 15] 1 illustrates an exemplary instrument driver. [Figure 16] 1 illustrates an exemplary medical instrument with a pair of instrument drivers. [Figure 17] 13 shows an alternative design of the instrument driver and instrument, where the axis of the drive unit is parallel to the axis of the elongated shaft of the instrument. [Figure 18] 1 illustrates an instrument having an instrument-based insertion architecture. [Figure 19] 1 illustrates an exemplary controller. [Figure 20] FIG. 1 is a block diagram illustrating a localization system according to an illustrative embodiment that estimates the position of one or more elements of the robotic system of FIGS. 1-10 (such as the position of the tool of FIGS. 16-18). [Figure 21] 1 shows a representation of a robotic medical system including a drive configured to drive axial motion of an elongate shaft of a medical instrument. [Figure 22] 22 illustrates the robotic medical system of FIG. 21 in another configuration in which the elongate shaft of the medical instrument is positioned to form a service loop. [Figure 23] FIG. 1 is an isometric view illustrating one embodiment of a driver configured to drive axial movement of an elongate shaft of a medical instrument. [Figure 24A] FIG. 24 is an isometric view of the drive of FIG. 23 with the top of the housing removed. [Figure 24B] FIG. 24B is a top view of the drive unit of FIG. 24A. [Figure 24C] FIG. 24B is a bottom view of the drive device of FIG. 24A. [Figure 24D] FIG. 24B is a front view of the drive unit of FIG. 24A. [Figure 24E] FIG. 24B is a rear view of the drive unit of FIG. 24A. [Figure 25A] FIG. 24 is an isometric view of one embodiment of a roller assembly of the drive device of FIG. [Figure 25B] FIG. 25B is an isometric view of the roller assembly of FIG. 25A with the rollers removed to illustrate one embodiment of the gearing configuration of the roller assembly. [Figure 25C] FIG. 25C is a top view of the roller assembly and gearing structure of FIG. 25B. [Figure 25D] FIG. 25C is a bottom view of the roller assembly and gearing structure of FIG. 25B. [Figure 26A] FIG. 24 is a top view of the driver of FIG. 23 showing one embodiment of the instrument shaft cover in a closed position. [Figure 26B] FIG. 26B is a rear view of the driver of FIG. 26A with the instrument shaft cover in a closed position. [Figure 26C] FIG. 24 is a top view of the drive unit of FIG. 23 showing the instrument shaft cover in an open position. [Figure 26D] FIG. 26D is a rear view of the driver of FIG. 26C with the instrument shaft cover in the open position. [Figure 27A] FIG. 23B is an isometric view of the driver of FIG. 23A with the top of the housing removed to illustrate one embodiment of an instrument shaft cover. [Figure 27B] FIG. 27B is a top view of the driver of FIG. 27A showing an instrument shaft cover according to one embodiment. [Figure 28] FIG. 24 is a top view of the drive unit of FIG. 23 with the top portion of the housing removed to illustrate one embodiment of a sensor that can be included to detect wearing of the unit. [Figure 29A] FIG. 24 is a top view of the driver of FIG. 23 shown with one embodiment of the locking tab installed. [Figure 29B] FIG. 29B is a bottom view of the driver and locking tab of FIG. 29A. [Figure 29C] FIG. 29B is a front view of the driver and locking tab of FIG. 29A. [Figure 30A] An example of a method for controlling a drive unit to various operating states is shown in FIG. [Figure 30B] An example of how the drive unit can be controlled in various operating states is shown in Figure 30A, where Figure 30B shows a cross section of the drive unit in various states. [Diagram 31] 1 is a schematic diagram of an axial drive system in various states of high speed drive or low speed drive. FIG. [Diagram 32]4 is a flowchart illustrating an exemplary process for transitioning between high and low drive speeds in an axial drive system. [Diagram 33] FIG. 13 is an illustration of several parameters that can be utilized by a robotic system to automatically determine whether to transition between a fast or slow axial drive speed in inserting or retracting an elongate shaft. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0025] 1.Overview Aspects of the present disclosure may be integrated into a robotic-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 endoscopic procedures. Among endoscopic procedures, the system may perform bronchoscopy, ureteroscopy, gastroscopy, etc.

[0026] In addition to performing a wide range of procedures, the system can provide additional benefits such as enhanced imaging and guidance to assist the physician. Additionally, the system can provide the physician with the ability to perform procedures from an ergonomic position without requiring awkward arm movements and postures. Still further, the system can provide the physician with the ability to perform procedures with improved ease of use, such that one or more of the instruments of the system can be controlled by a single user.

[0027] Various embodiments are described below in conjunction with the drawings for purposes of explanation. It should be understood that many other implementations of the disclosed concepts are possible, and that various advantages may be achieved in the disclosed implementations. Headings are included herein for reference and to aid in locating the various sections. These headings are not intended to limit the scope of the concepts described therein. Such concepts may have applicability throughout this specification.

[0028] A. Robot System - Cart A robot-enabled medical system may be configured in a variety of ways depending on the particular procedure. FIG. 1 illustrates an embodiment of a robot-enabled cart-based system 10 arranged for diagnostic and / or therapeutic bronchoscopy. During bronchoscopy, the system 10 may include a cart 11 having one or more robotic arms 12 for delivering medical instruments, such as a steerable endoscope 13, which may be a procedure-specific bronchoscope for bronchoscopy, to a natural orifice access point (i.e., the patient's mouth, which in this example is positioned on a table) for delivering the diagnostic and / or therapeutic tools. As shown, the cart 11 may be positioned adjacent to the patient's upper torso to provide access to the access point. Similarly, the robotic arms 12 may be actuated to position the bronchoscope relative to the access point. The arrangement of FIG. 1 may also be utilized when performing gastro-intestinal (GI) procedures with a gastroscope, a specialized endoscope for GI procedures. FIG. 2 illustrates an exemplary embodiment of the cart in more detail.

[0029] With continued reference to FIG. 1, once the cart 11 is properly positioned, the robotic arm 12 can insert the steerable endoscope 13 into the patient robotically, manually, or a combination thereof. As shown, the steerable endoscope 13 may include at least two nested parts, such as an inner leader portion and an outer sheath portion, each portion coupled to a separate instrument driver from a set of instrument drivers 28, with each instrument driver coupled to the distal end of an individual robotic arm. This linear arrangement of the instrument drivers 28, which facilitates coaxial alignment of the leader portion with the sheath portion, creates a "virtual rail" 29 that can be repositioned in space by manipulating one or more robotic arms 12 to different angles and / or positions. The virtual rails described herein are shown in the figures using dashed lines, and thus do not indicate the physical structure of the system. Translation of the instrument driver 28 along the virtual rail 29 nests the inner leader portion relative to the outer sheath portion, or advances or retracts the endoscope 13 from the patient. The angle of the virtual rail 29 may be adjusted, translated, and pivoted based on clinical application or physician preference. For example, in bronchoscopy, the angle and position of the virtual rail 29 as shown represents a compromise that provides the physician access to the endoscope 13 while minimizing friction from bending the endoscope 13 into the patient's mouth.

[0030] After insertion, the endoscope 13 may be directed down the patient's trachea and lungs using precise commands from the robotic system until the target destination or surgical site is reached. To enhance navigation through the patient's pulmonary network and / or to reach a desired target, the endoscope 13 may be steered to telescope the inner leader portion out from the outer sheath portion for enhanced articulation and a larger bend radius. The use of a separate instrument driver 28 also allows the leader portion and sheath portion to be driven independently of one another.

[0031] For example, the endoscope 13 may be oriented to deliver a biopsy needle to a target, such as a lesion or nodule in the patient's lung. The needle may be deployed down a working channel that spans the length of the endoscope to obtain a tissue sample that is analyzed by a pathologist. Depending on the results of the pathology, additional tools may be deployed down the working channel of the endoscope for additional biopsies. After identifying the nodule as malignant, the endoscope 13 may endoscopically deliver a tool to ablate the potentially cancerous tissue. In some cases, diagnostic and therapeutic procedures may be provided in separate procedures. In these situations, the endoscope 13 may also be used to deliver fiducials to "mark" the location of the target nodule. In other examples, diagnostic and therapeutic procedures may be delivered during the same procedure.

[0032] The system 10 may also include a movable tower 30 that may be connected to the cart 11 via a support cable to provide support for control, electronics, fluidics, optics, sensors, and / or power to the cart 11. Locating such functionality within the tower 30 allows for a smaller form factor cart 11 that can be more easily adjusted and / or repositioned by the operating physician and his / her staff. Additionally, the division of functionality between the cart / table and the support tower 30 reduces clutter in the operating room and facilitates improved clinical workflow. The cart 11 may be positioned in close proximity to the patient, while the tower 30 may be stored in a remote location so as to be out of the way during the procedure.

[0033] In support of the robotic system described above, the tower 30 may include computer-based control system components that store computer program instructions in a non-transitory computer-readable storage medium, such as, for example, a persistent magnetic storage drive, a solid-state drive, or the like. Execution of these instructions, whether execution occurs in the tower 30 or the cart 11, may control the entire system or subsystems thereof. For example, when executed by a processor in the computer system, the instructions may cause the robotic system components to actuate associated carriages and arm mounts, operate a robotic arm, and control a medical instrument. For example, in response to receiving a control signal, a motor in a joint of the robotic arm may position the arm in a particular pose.

[0034] The tower 30 may also include pumps, flow meters, valve controls, and / or fluid access to provide controlled irrigation and aspiration functions to a system that may be deployed through the endoscope 13. These components may also be controlled using the computer system of the tower 30. In some embodiments, irrigation and aspiration capabilities may be delivered directly to the endoscope 13 through separate cables.

[0035] The tower 30 may include voltage and surge protection designed to provide filtered and protected power to the cart 11, thereby avoiding the need to place power transformers and other auxiliary power components within the cart 11 and making the cart 11 smaller and more mobile.

[0036] The tower 30 may also include support equipment for sensors deployed throughout the robotic system 10. For example, the tower 30 may include optoelectronic equipment for detecting, receiving, and processing data received from optical sensors or cameras throughout the robotic system 10. In combination with a control system, such optoelectronic equipment may be used to generate real-time images for display in any number of consoles deployed throughout the system, including in the tower 30. Similarly, the tower 30 may also include electronic subsystems for receiving signals from deployed electromagnetic (EM) sensors and processing the received signals. The tower 30 may also be used to house and position EM field generators for detection by EM sensors in or on the medical instrument.

[0037] The tower 30 may also include a console 31 in addition to other consoles available to the rest of the system, for example a console mounted on top of a cart. The console 31 may include a user interface for the operator physician and a display screen, such as a touch screen. The consoles in the system 10 are generally designed to provide both pre-operative and real-time information of the procedure, such as robotic control and navigation and localization information for the endoscope 13. If the console 31 is not the only console available to the physician, the console 31 may be used by a second operator, such as a nurse, to monitor the patient's health or vitals and the operation of the system 10, as well as provide procedure-specific data, such as navigation and localization information. In another embodiment, the console 31 is housed in a body separate from the tower 30.

[0038] The tower 30 may be coupled to the cart 11 and the endoscope 13 via one or more cables or connections (not shown). In some embodiments, support functions from the tower 30 may be provided to the cart 11 through a single cable, simplifying and decluttering the operating room. In other embodiments, certain functions may be coupled with separate wiring and connections. For example, power may be provided to the cart 11 through a single power cable, while support for control, optics, fluidics, and / or navigation may be provided through separate cables.

[0039] FIG. 2 provides a detailed view of an embodiment of a cart 11 from a cart-based system usable with the robot shown in FIG. 1. The cart 11 generally includes an elongated support structure 14 (often referred to as a "column"), a cart base 15, and a console 16 at the top of the column 14. The column 14 may include one or more carriages, such as a carriage 17 (alternatively an "arm support") for supporting the deployment of one or more robotic arms 12 (three are shown in FIG. 2). The carriage 17 may include an individually configurable arm mount that rotates along a vertical axis to adjust the base of the robotic arm 12 for better positioning relative to the patient. The carriage 17 also includes a carriage interface 19 that allows the carriage 17 to translate vertically along the column 14.

[0040] The carriage interface 19 is connected to the column 14 through slots, such as slots 20 located on either side of the column 14 to guide the vertical translation of the carriage 17. The slots 20 include vertical translation interfaces for positioning and holding the carriage 17 at various vertical heights relative to the cart base 15. The vertical translation of the carriage 17 allows the cart 11 to adjust the reach of the robotic arm 12 to meet various table heights, patient sizes, and physician preferences. Similarly, an individually configurable arm mount on the carriage 17 allows the robotic arm base 21 of the robotic arm 12 to be angled in various configurations.

[0041] In some embodiments, a slot cover may be added to the slot 20 that is flush and parallel with the slot surface to prevent dirt and fluids from entering the interior chamber of the column 14 and the vertical translation interface as the carriage 17 translates vertically. The slot cover may be deployed through a pair of spring spools located near the vertical top and bottom of the slot 20. The cover is coiled within the spools until it is deployed to expand and contract from the coiled state as the carriage 17 translates vertically up and down. The spring loading of the spools provides a force to pull the cover onto the spools when the carriage 17 translates towards the spools, while also maintaining a tight seal when the carriage 17 translates away from the spools. The cover may be connected to the carriage 17 using, for example, a bracket within the carriage interface 19 to ensure that the cover expands and contracts properly as the carriage 17 translates.

[0042] Column 14 may include internal mechanisms, such as gears and motors, designed to use a vertically aligned leadscrew to mechanically translate carriage 17 in response to control signals generated in response to user input, such as input from console 16.

[0043] The robotic arm 12 may generally include a robotic arm base 21 and an end effector 22 separated by a series of links 23 connected by a series of joints 24, each joint including an independent actuator, each actuator including an independently controllable motor. Each independently controllable joint represents an independent degree of freedom available to the robotic arm 12. Each of the robotic arms 12 may have seven joints, thus providing seven degrees of freedom. A large number of joints results in a large number of degrees of freedom, allowing for "redundant" degrees of freedom. Having redundant degrees of freedom allows the robotic arms 12 to position their respective end effectors 22 at specific positions, orientations, and trajectories in space using different link positions and joint angles. This allows the system to position and orient the medical instrument from a desired point in space, while allowing the physician to move the arm joints to a clinically advantageous position away from the patient to create better access while avoiding arm collisions.

[0044] The cart base 15 balances the weight of the column 14, carriage 17, and robotic arm 12 on the floor. Thus, the cart base 15 houses the heavier parts such as electronics, motors, power supplies, and components that allow the cart 11 to be either mobile and / or immobilized. For example, the cart base 15 includes casters 25 in the form of rollable wheels that allow the cart 11 to be easily moved around the room before a procedure. After reaching the appropriate position, the casters 25 may be immobilized using wheel locks to hold the cart 11 in place during a procedure.

[0045] The console 16 positioned at the vertical end of the column 14 allows for both a user interface and a display screen (or dual-purpose device, e.g., touch screen 26) to receive user input to provide both pre-operative and intra-operative data to the physician user. Potential pre-operative data on the touch screen 26 may include pre-operative planning, navigation and mapping data derived from a pre-operative computerized tomography (CT) scan, and / or notes from a pre-operative patient interview. Intra-operative data on the display may include optical information provided by tools, sensor and coordinate information from sensors, and vital patient statistics such as respiration, heart rate, and / or pulse. The console 16 may be positioned and angled to allow a physician to access the console 16 from the side of the column 14 opposite the carriage 17. From this position, the physician can view the console 16, the robotic arm 12, and the patient while operating the console 16 from behind the cart 11. As shown, the console 16 also includes a handle 27 to aid in maneuvering and stabilizing the cart 11.

[0046] FIG. 3 illustrates an embodiment of the robotic-enabled system 10 positioned for ureteroscopy. In a ureteroscopy procedure, the cart 11 may be positioned to deliver a ureteroscope 32, a procedure-specific endoscope designed to traverse the patient's urethra and ureters, to the patient's lower abdominal region. In a ureteroscopy, it may be desirable for the ureteroscope 32 to be directly aligned with the patient's urethra to reduce friction and forces on sensitive anatomical structures in the region. As shown, the cart 11 may be aligned to the table leg to allow the robotic arm 12 to position the ureteroscope 32 for direct linear access to the patient's urethra. From the table leg, the robotic arm 12 may insert the ureteroscope 32 along a virtual rail 33 directly through the urethra and into the patient's lower abdomen.

[0047] After insertion into the urethra using control techniques similar to those in bronchoscopy, the ureteroscope 32 may be navigated to the bladder, ureters, and / or kidneys for diagnostic and / or therapeutic applications. For example, the ureteroscope 32 may be directed to the ureters and kidneys to fragment kidney stone buildup using a laser or ultrasonic lithotripsy device deployed down the working channel of the ureteroscope 32. After the lithotripsy is completed, the resulting stone fragments may be removed using a basket deployed down the ureteroscope 32.

[0048] FIG. 4 shows an embodiment of the robotic usable system 10 similarly positioned for a vascular procedure. In a vascular procedure, the system 10 may be configured such that the cart 11 can deliver a medical instrument 34, such as a steerable catheter, to an access point in the femoral artery in the patient's leg. The femoral artery presents both a larger diameter for navigation and a less circuitous and tortuous path to the patient's heart, which simplifies navigation. As in a ureteroscopy procedure, the cart 11 may be positioned toward the patient's leg and lower abdomen, allowing the robotic arm 12 to provide a virtual rail 35 with direct linear access to the femoral artery access point in the patient's thigh / hip region. After insertion into the artery, the medical instrument 34 may be oriented and inserted by translating the instrument driver 28. Alternatively, the cart may be positioned around the patient's upper abdomen to reach alternative vascular access points, such as the carotid and brachial arteries near the shoulder and wrist.

[0049] B. Robot System - Table An embodiment of a robot-enabled medical system may also incorporate a patient table. The incorporation of a table reduces the amount of capital equipment in the operating room by eliminating carts and allows greater access to the patient. FIG. 5 shows an embodiment of such a robot-enabled system deployed for a bronchoscopy procedure. The system 36 includes a support structure or column 37 for supporting a platform 38 (shown as a "table" or "bed") above the floor. As with cart-based systems, the end effector of the robotic arm 39 of the system 36 includes an instrument driver 42 designed to manipulate an elongated medical instrument, such as the bronchoscope 40 of FIG. 5, through or along a virtual rail 41 formed from the linear alignment of the instrument driver 42. In practice, a C-arm for providing fluoroscopic imaging may be positioned above the upper abdominal region of the patient by placing emitters and detectors around the table 38.

[0050] FIG. 6 provides an alternative view of the system 36 without the patient and medical instruments for illustrative purposes. As shown, the column 37 may include one or more carriages 43, illustrated as a ring shape in the system 36, which may be the base for one or more robotic arms 39. The carriages 43 may translate along a vertical column interface 44 that spans the length of the column 37 to provide different vantage points where the robotic arms 39 may be positioned to reach the patient. The carriages 43 may rotate around the column 37 using mechanical motors positioned within the column 37 to allow the robotic arms 39 to have access to multiple sides of the table 38, such as both sides of the patient. In embodiments with multiple carriages, the carriages may be individually positioned on the column and may translate and / or rotate independently of the other carriages. The carriages 43 do not have to surround the column 37 or even be circular, but the ring shape as illustrated facilitates the rotation of the carriages 43 around the column 37 while maintaining structural balance. Rotation and translation of carriage 43 allows system 36 to align medical instruments such as endoscopes and laparoscopes to different access points on the patient. In other embodiments (not shown), system 36 can include a patient table or bed with adjustable arm supports in the form of parallel extending bars or rails. One or more robotic arms 39 can be mounted on adjustable arm supports that can be adjusted vertically (e.g., via a shoulder with an elbow joint). By providing vertical adjustment, robotic arm 39 can advantageously be stored compactly under a patient table or bed and then raised during a procedure.

[0051] The robotic arm 39 may be attached to the carriage 43 via a set of arm mounts 45 that include a series of joints that may be individually rotated and / or telescopically extended to provide additional configurability to the robotic arm 39. Additionally, the arm mounts 45 may be positioned on the carriage 43 such that, when the carriage 43 is appropriately rotated, the arm mounts 45 may be positioned either on the same side of the table 38 (as shown in FIG. 6), on opposite sides of the table 38 (as shown in FIG. 9), or on adjacent sides of the table 38 (not shown).

[0052] The column 37 structurally provides support for the table 38 and a path for the vertical translation of the carriage 43. Internally, the column 37 may include a lead screw for guiding the vertical translation of the carriage, and a motor for mechanizing the translation of the carriage 43 based on the lead screw. The column 37 may also transmit power and control signals to the carriage 43 and to a robotic arm 39 mounted thereon.

[0053] The table base 46 serves a similar function as the cart base 15 of the cart 11 shown in FIG. 2, housing the heavier components to counterbalance the table / bed 38, column 37, carriage 43, and robotic arm 39. The table base 46 may also incorporate rigid casters to provide stability during a procedure. The casters, which deploy from the bottom of the table base 46, extend in opposite directions on either side of the base 46 and may be retracted when the system 36 needs to be moved.

[0054] With continued reference to FIG. 6, the system 36 may also include a tower (not shown) that divides the functionality of the system 36 between the table and the tower to reduce the form factor and bulk of the table. As with the previously disclosed embodiments, the tower may provide various support functions to the table, such as processing, computing, and control capabilities, power, fluidics, and / or optical and sensor processing. The tower may also be movable so that it can be positioned away from the patient to improve physician access and keep the operating room neat and tidy. Additionally, locating components in the tower allows for more storage space in the table base 46 for potential accommodation of the robotic arm 39. The tower may also include a master controller or console that provides both a user interface for user input, such as a keyboard and / or pendant, and a display screen (or touch screen) for pre-operative and intra-operative information, such as real-time imaging, navigation, and tracking information. In some embodiments, the tower may also include a holder for a gas tank used for insufflation.

[0055] In some embodiments, the table base may house and store the robot arm when not in use. FIG. 7 shows a system 47 for housing the robot arm in an embodiment of a table-based system. In the system 47, the carriage 48 may be translated vertically into the base 49 to house the robot arm 50, arm mount 51, and carriage 48 therein. The base cover 52 may be translated and retracted to open to deploy the carriage 48, arm mount 51, and robot arm 50 about the column 53, and closed to house and protect them when not in use. The base cover 52 may be sealed with a membrane 54 along the edge of its opening to prevent dirt and fluid ingress when closed.

[0056] FIG. 8 shows an embodiment of a robot-enabled table base system configured for a ureteroscopy procedure. For ureteroscopy, the table 38 may include a swivel portion 55 to position the patient off-angle from the column 37 and table base 46. The swivel portion 55 may rotate or pivot about a pivot point (e.g., positioned below the patient's head) to position the bottom of the swivel portion 55 away from the column 37. For example, pivoting the swivel portion 55 allows a C-arm (not shown) to be positioned above the patient's lower abdomen without competing for space with the column (not shown) below the table 38. By rotating a carriage (not shown) about the column 37, the robot arm 39 may insert a ureteroscope 56 directly into the patient's groin area along a virtual rail 57 to reach the urethra. In ureteroscopy, stirrups 58 may be secured to a swivel portion 55 of table 38 to support the position of the patient's legs during the procedure and allow clear access to the patient's groin area.

[0057] In a laparoscopic procedure, minimally invasive instruments may be inserted into a patient's anatomy through small incisions in the patient's abdominal wall. In some embodiments, the minimally invasive instruments include an elongated rigid member, such as a shaft, that is used to access anatomy within the patient. After distension of the patient's abdominal cavity, the instruments may be oriented to perform a surgical or medical task, such as grasping, cutting, ablation, suturing, etc. In some embodiments, the instruments may include a scope, such as a laparoscope. FIG. 9 illustrates an embodiment of a robotic table-based system configured for laparoscopic procedures. As shown in FIG. 9, the carriage 43 of the system 36 may be rotated and vertically adjusted to position a pair of robotic arms 39 on either side of the table 38 such that instruments 59 may be positioned using arm mounts 45 to pass through minimal incisions on either side of the patient to reach the patient's abdominal cavity.

[0058] To accommodate laparoscopic procedures, the robotic table system may also tilt the platform to a desired angle. FIG. 10 shows an embodiment of a robotic medical system with pitch or tilt adjustment. As shown in FIG. 10, the system 36 can accommodate the tilt of the table 38 to position one portion of the table at a greater distance from the floor than the other portion. Additionally, the arm mount 45 may rotate to match the tilt so that the robotic arm 39 maintains the same planar relationship with the table 38. To accommodate steeper angles, the column 37 may also include a nesting portion 60 that allows the column 37 to extend vertically to prevent the table 38 from contacting the floor or colliding with the table base 46.

[0059] FIG. 11 provides a detailed view of the interface between the table 38 and the column 37. The pitch rotation mechanism 61 may be configured to change the pitch angle of the table 38 relative to the column 37 in multiple degrees of freedom. The pitch rotation mechanism 61 may be enabled by the positioning of orthogonal axes 1, 2 at the column-table interface, each actuated by a separate motor 3, 4 in response to an electrical pitch angle command. Rotation along one screw 5 allows tilt adjustment in one axis 1, and rotation along the other screw 6 allows tilt adjustment along the other axis 2. In some embodiments, a ball joint may be used to change the pitch angle of the table 38 relative to the column 37 in multiple degrees of freedom.

[0060] For example, pitch adjustment is particularly useful when attempting to position the table in the Trendelenburg position, i.e., positioning the patient's lower abdomen higher off the floor than the patient's upper abdomen for lower abdominal surgery. The Trendelenburg position allows gravity to slide the patient's internal organs toward the patient's upper abdomen, emptying the abdominal cavity for entry of minimally invasive tools to perform lower abdominal surgical or medical procedures, such as laparoscopic prostatectomy.

[0061] 12 and 13 show isometric and end views of another embodiment of a table-based surgical robotic system 100. The surgical robotic system 100 includes one or more adjustable arm supports 105 (see, e.g., FIG. 14 ) that can be configured to support one or more robotic arms relative to the table 101. In the illustrated embodiment, a single adjustable arm support 105 is shown, but additional arm supports 105 can be provided on the opposite side of the table 101. The adjustable arm support 105 can be configured to move relative to the table 101 to adjust and / or change the position of the adjustable arm support 105 and / or any robotic arm attached thereto relative to the table 101. For example, the adjustable arm support 105 can be adjusted in one or more degrees of freedom relative to the table 101. The adjustable arm support 105 provides great versatility to the system 100, including the ability to easily accommodate one or more adjustable arm supports 105 and any robotic arms attached thereto under the table 101. The adjustable arm support 105 can be raised from a stowed position to a position below the top surface of the table 101. In other embodiments, the adjustable arm support 105 can be raised from a stowed position to a position above the top surface of the table 101.

[0062] The adjustable arm support 105 can provide several degrees of freedom, including lift, lateral translation, tilt, etc. In the illustrated embodiment of Figs. 12 and 13, the arm support 105 is configured with four degrees of freedom, indicated by arrows in Fig. 12. The first degree of freedom allows for adjustment of the adjustable arm support 105 in the z-direction ("Z-lift"). For example, the adjustable arm support 105 can include a carriage 109 configured to move up and down along or relative to the column 102 that supports the table 101. The second degree of freedom allows the adjustable arm support 105 to tilt. For example, the adjustable arm support 105 can include a rotational joint, which can allow the adjustable arm support 105 to align with the bed in a Trendelenburg position. The third degree of freedom can allow the adjustable arm support 105 to "pivot up", which can be used to adjust the distance between the side of the table 101 and the adjustable arm support 105. A fourth degree of freedom allows translation of the adjustable arm support 105 along the longitudinal length of the table.

[0063] The surgical robotic system 100 of Figures 12 and 13 can include a table supported by a column 102 mounted to a base 103. The base 103 and column 102 support the table 101 against a support surface. A floor axis 131 and a support axis 133 are shown in Figure 13.

[0064] The adjustable arm support 105 can be mounted to the column 102. In other embodiments, the arm support 105 can be mounted to the table 101 or the base 103. The adjustable arm support 105 can include a carriage 109, a bar or rail connector 111, and a bar or rail 107. In some embodiments, one or more robot arms mounted to the rail 107 can translate and move relative to each other.

[0065] The carriage 109 may be attached to the column 102 by a first joint 113, which allows the carriage 109 to move relative to the column 102 (e.g., up and down a first or vertical axis 123). The first joint 113 may provide a first degree of freedom ("Z lift") to the adjustable arm support 105. The adjustable arm support 105 may include a second joint 115 that provides a second degree of freedom (tilt) to the adjustable arm support 105. The adjustable arm support 105 may include a third joint 117 that may provide a third degree of freedom ("pivot up") to the adjustable arm support 105. An additional joint 119 (shown in FIG. 13) may be provided that mechanically constrains the third joint 117 to maintain the orientation of the rail 107 when the rail connector 111 is rotated about a third axis 127. The adjustable arm support 105 can include a fourth joint 121 that can provide a fourth degree of freedom (translation) to the adjustable arm support 105 along a fourth axis 129 .

[0066] 14 shows an end view of a surgical robotic system 140A having two adjustable arm supports 105A, 105B mounted on either side of a table 101. A first robotic arm 142A is attached to a bar or rail 107A of the first adjustable arm support 105B. The first robotic arm 142A includes a base 144A attached to the rail 107A. The distal end of the first robotic arm 142A includes an instrument drive mechanism 146A that can be attached to one or more robotic medical instruments or tools. Similarly, a second robotic arm 142B includes a base 144B attached to the rail 107B. The distal end of the second robotic arm 142B includes an instrument drive mechanism 146B. The instrument drive mechanism 146B can be configured to attach to one or more robotic medical instruments or tools.

[0067] In some embodiments, one or more of the robotic arms 142A, 142B include arms with seven or more degrees of freedom. In some embodiments, one or more of the robotic arms 142A, 142B can include eight degrees of freedom, including an insertion axis (one degree of freedom including insertion), wrist (three degrees of freedom including wrist pitch, yaw, and rotation), elbow (one degree of freedom including elbow pitch), shoulder (two degrees of freedom including shoulder pitch and yaw), and base 144A, 144B (one degree of freedom including translation). In some embodiments, the insertion degree of freedom can be provided by the robotic arms 142A, 142B, while in other embodiments, the instrument itself provides the insertion via an instrument-based insertion architecture.

[0068] C. Instrument Drivers and Interfaces The end effector of the robotic arm of the system may include (i) an instrument driver (alternatively called an "instrument drive mechanism" or "instrument device manipulator") that incorporates electromechanical means for actuating the medical instrument, and (ii) a removable or detachable medical instrument that may lack any electromechanical components such as a motor. This dichotomy may be based on the need to sterilize medical instruments used in medical procedures, their complex mechanical assemblies and delicate electronics making it impossible to adequately sterilize expensive capital equipment. Thus, medical instruments can be designed to be detached, removed, and replaced from the instrument driver (and thus the system) for individual sterilization or disposal by the physician or physician's staff. In contrast, instrument drivers do not need to be replaced or sterilized and can be draped for protection.

[0069] FIG. 15 illustrates an exemplary instrument driver. The instrument driver 62, positioned at the distal end of the robotic arm, includes one or more drive units 63 arranged with parallel axes to provide a controlled torque to the medical instrument via a drive shaft 64. Each drive unit 63 includes an individual drive shaft 64 for interacting with the instrument, a gear head 65 for converting the rotation of the motor shaft to a desired torque, a motor 66 for generating the drive torque, an encoder 67 for measuring the speed of the motor shaft and providing feedback to the control circuit, and a control circuit 68 for receiving control signals to operate the drive unit. Each drive unit 63 is independently controlled and motorized, and the instrument driver 62 can provide multiple (e.g., four as shown in FIG. 15) independent drive outputs to the medical instrument. In operation, the control circuit 68 receives the control signals, sends motor signals to the motors 66, compares the resulting motor speed measured by the encoders 67 to a desired speed, and modulates the motor signals to generate the desired torque.

[0070] For procedures that require a sterile environment, the robotic system may incorporate a drive interface, such as a sterile adapter connected to a sterile drape, located between the instrument driver and the medical instrument. The primary purpose of the sterile adapter is to transmit angular motion from the drive shaft of the instrument driver to the drive input of the instrument while maintaining physical separation, and therefore sterility, between the drive shaft and the drive input. Thus, an exemplary sterile adapter may include a set of rotational inputs and outputs intended to mate with the drive shaft of the instrument driver and a drive input to the instrument. The sterile drape connected to the sterile adapter is composed of a thin flexible material, such as a transparent or translucent plastic, and is designed to cover the instrument driver, the robotic arm, and capital equipment, such as a cart (in a cart-based system) or a table (in a table-based system). The use of the drape allows the capital equipment to be positioned in close proximity to the patient while still being located in an area that does not require sterility (i.e., the non-sterile field). On the other side of the sterile drape, the medical instrument may interface with the patient in an area that requires sterility (i.e., the sterile field).

[0071] D. Medical equipment FIG. 16 illustrates an exemplary medical instrument with a paired instrument driver. Similar to other instruments designed for use with a robotic system, the medical instrument 70 includes an elongated shaft 71 (or elongated body) and an instrument base 72. The instrument base 72, also referred to as an "instrument handle" due to its design intended for manual interaction by a physician, may generally include a rotatable drive input 73, e.g., a receptacle, pulley, or spool, designed to mate with a drive output 74 that extends through a drive interface on an instrument driver 75 at the distal end of a robotic arm 76. When physically connected, latched, and / or coupled, the mated drive input 73 of the instrument base 72 may share a rotational axis with the drive output 74 on the instrument driver 75 to enable the transfer of torque from the drive output 74 to the drive input 73. In some embodiments, the drive output 74 may include a spline designed to mate with a receptacle on the drive input 73.

[0072] The elongated shaft 71 is designed to be delivered through either an anatomical opening or lumen, such as in an endoscope, or a minimally invasive incision, such as in a laparoscopy. The elongated shaft 71 may be either flexible (e.g., with properties similar to an endoscope) or rigid (e.g., with properties similar to a laparoscope), or may include a customized combination of both flexible and rigid portions. When designed for laparoscopy, the distal end of the rigid elongated shaft may be connected to an end effector extending from a jointed wrist formed from a clevis having at least one degree of freedom, and a surgical tool or medical instrument, such as a grasper or scissors, that may be actuated based on forces from a tendon when the drive input rotates in response to torque received from the drive output 74 of the instrument driver 75. When designed for endoscopy, the distal end of the flexible elongated shaft may include a steerable or controllable bend that may articulate and bend based on torque received from the drive output 74 of the instrument driver 75.

[0073] Torque from the instrument driver 75 is transferred downstream of the elongated shaft 71 using tendons along the elongated shaft 71. These individual tendons, such as pull wires, may be individually secured to individual drive inputs 73 in the instrument handle 72. From the instrument handle 72, the tendons are directed down one or more pull lumens along the elongated shaft 71 and secured to a distal portion of the elongated shaft 71, or to a wrist portion of the distal portion of the elongated shaft. During a surgical procedure, such as a laparoscopic, endoscopic, or hybrid procedure, these tendons may be coupled to a distally attached end effector, such as a wrist, grasper, or scissors. Under such a configuration, torque exerted on the drive input 73 transfers tension to the tendons, thereby actuating the end effector in some way. In some embodiments, during a surgical procedure, the tendons can rotate the joint about an axis, thereby moving the end effector in one direction or another. Alternatively, the tendon may be connected to one or more jaws of a grasper at the distal end of elongate shaft 71, with tension from the tendon causing the grasper to close.

[0074] In endoscopy, the tendons may be coupled to a flex or articulating section located along the elongate shaft 71 (e.g., at the distal end) via adhesive, control rings, or other mechanical fixation. If fixedly attached to the distal end of the flex, torque exerted on the drive input 73 is transferred downstream of the tendons, bending or articulating the softer flex (sometimes referred to as the articulatable section or articulatable region). Along the non-flexing portions, it may be advantageous to spiral or convolute the individual pull lumens that point along (or inwardly) the wall of the endoscope shaft to counterbalance radial forces resulting from tension in the pull wires. The angle of the spirals and / or the spacing between them can be altered or designed for a particular purpose, with tighter spirals exhibiting less shaft compression under load forces, while lesser amounts of spirals result in greater shaft compression under load forces but limited bending. At the other end of the spectrum, the pull lumen may be oriented parallel to the longitudinal axis of the elongate shaft 71 to allow for controlled articulation at a desired bend or articulatable section.

[0075] In endoscopy, the elongated shaft 71 houses several components that aid in robotic procedures. The shaft 71 may include a working channel for deploying surgical tools (or medical instruments), irrigating, and / or aspirating the surgical field at the distal end of the shaft 71. The shaft 71 may also house wires and / or optical fibers for transmitting signals to an optical assembly at the distal tip, which may include an optical camera. The shaft 71 may also house optical fibers for carrying light from a proximally located light source, such as a light emitting diode, to the distal end of the shaft 71.

[0076] At the distal end of the instrument 70, the distal tip may include a working channel opening for delivering tools to the surgical site for diagnosis and / or treatment, irrigation, and aspiration. The distal tip may also include a port for a camera, such as a fiberscope or digital camera, to capture images of the internal anatomical space. Relatedly, the distal tip may also include a port for a light source to illuminate the anatomical space when a camera is used.

[0077] In the example of FIG. 16 , the drive shaft axis, i.e., the drive input axis, is perpendicular to the axis of the elongated shaft 71. However, this arrangement complicates the ability of the elongated shaft 71 to pivot. Pivoting the elongated shaft 71 along its axis while holding the drive input 73 stationary can result in undesirable entanglement of tendons as they extend from the drive input 73 and enter the pull lumen within the elongated shaft 71. Such resulting entanglement of tendons can confuse control algorithms intended to predict the movement of the flexible elongated shaft 71 during an endoscopic procedure.

[0078] FIG. 17 shows an alternative design of the instrument driver and instrument in which the axis of the drive unit is parallel to the axis of the elongated shaft of the instrument. As shown, a circular instrument driver 80 includes four drive units with parallel aligned drive outputs 81 at the end of a robotic arm 82. The drive units and their respective drive outputs 81 are housed in a rotating assembly 83 of the instrument driver 80 that is driven by one of the drive units in the assembly 83. In response to torque provided by the rotating drive units, the rotating assembly 83 rotates along a circular bearing that connects the rotating assembly 83 to a non-rotating portion 84 of the instrument driver 80. Power and control signals may be transferred from the non-rotating portion 84 of the instrument driver 80 to the rotating assembly 83 via electrical contacts that may be maintained throughout the rotation by a brushed slip ring connection (not shown). In other embodiments, the rotating assembly 83 may be responsive to a separate drive unit that is integrated into the non-rotatable portion 84 and thus not parallel to the other drive units. The rotation mechanism 83 enables the instrument driver 80 to rotate the drive units and their respective drive outputs 81 as a single unit about the instrument driver axis 85 .

[0079] Similar to the previously disclosed embodiments, the instrument 86 may include an elongated shaft portion 88 and an instrument base 87 (shown with a clear exterior skin for purposes of illustration) that includes a number of drive inputs 89 (such as receptacles, pulleys, and spools) configured to receive the drive outputs 81 in the instrument driver 80. Unlike the previously disclosed embodiments, the instrument shaft 88 extends from the center of the instrument base 87 with an axis that is substantially parallel to the axis of the drive inputs 89, rather than perpendicular as in the design of FIG.

[0080] When coupled to the rotation assembly 83 of the instrument driver 80, the medical instrument 86, including the instrument base 87 and the instrument shaft 88, rotates with the rotation assembly 83 about the instrument driver axis 85. Because the instrument shaft 88 is centrally located in the instrument base 87, the instrument shaft 88 is coaxial with the instrument driver axis 85 when attached. Thus, rotation of the rotation assembly 83 causes the instrument shaft 88 to rotate about its own longitudinal axis. Furthermore, as the instrument base 87 rotates with the instrument shaft 88, any tendons connected to the drive input 89 in the instrument base 87 do not become entangled during rotation. Thus, the parallelism of the axes of the drive output 81, drive input 89, and instrument shaft 88 allows for shaft rotation without entangling the control tendons.

[0081] FIG. 18 illustrates an instrument 150 having an instrument-based insertion architecture, according to some embodiments. The instrument 150 can be coupled to any of the instrument drivers described above. The instrument 150 includes an elongated shaft 152, an end effector 162 connected to the shaft 152, and a handle 170 coupled to the shaft 152. The elongated shaft 152 includes a tubular member having a proximal portion 154 and a distal portion 156. The elongated shaft 152 includes one or more channels or grooves 158 along its outer surface. The grooves 158 are configured to receive one or more wires or cables 180 therethrough. Thus, the one or more cables 180 extend along the outer surface of the elongated shaft 152. In other embodiments, the cables 180 can also extend through the elongated shaft 152. Manipulation of one or more of the cables 180 (e.g., via an instrument driver) results in actuation of the end effector 162.

[0082] The instrument handle 170, which may also be referred to as an instrument base, may generally include a mounting interface 172 having one or more mechanical inputs 174, such as receptacles, pulleys or spools, designed to reciprocally mate with one or more torque couplers on a mounting surface of the instrument driver.

[0083] In some embodiments, instrument 150 includes a series of pulleys or cables that allow elongate shaft 152 to translate relative to handle 170. In other words, instrument 150 itself includes an instrument-based insertion architecture that accommodates the insertion of the instrument, thereby minimizing reliance on a robotic arm to provide insertion of instrument 150. In other embodiments, the robotic arm can be significantly involved in the insertion of the instrument.

[0084] E. Controller Any of the robotic systems described herein can include an input device or controller for manipulating an instrument attached to the robotic arm. In some embodiments, the controller can be coupled (e.g., communicatively, electronically, electrically, wirelessly, and / or mechanically) to the instrument such that manipulation of the controller causes a corresponding manipulation of the instrument, e.g., via master-slave control.

[0085] 19 is a perspective view of an embodiment of controller 182. In this embodiment, controller 182 includes a hybrid controller that can have both impedance control and admittance control. In other embodiments, controller 182 can utilize only impedance or passive control. In other embodiments, controller 182 can utilize only admittance control. By being a hybrid controller, controller 182 can advantageously have a lower perceived inertia during use.

[0086] In the illustrated embodiment, the controller 182 is configured to enable operation of two medical instruments and includes two handles 184. Each of the handles 184 is connected to a gimbal 186. Each gimbal 186 is connected to a positioning platform 188.

[0087] 19, each positioning platform 188 includes a selective compliance assembly robot arm (SCARA) 198 coupled to a column 194 by a prismatic joint 196. The prismatic joint 196 is configured to translate along the column 194 (e.g., along a rail 197) to allow each of the handles 184 to be translated in the z-direction, providing a first degree of freedom. The SCARA 198 is configured to allow movement of the handles 184 in the xy-plane, providing two additional degrees of freedom.

[0088] In some embodiments, one or more load cells are positioned within the controller. For example, in some embodiments, a load cell (not shown) is positioned within the body of each of the gimbals 186. By providing load cells, a portion of the controller 182 can operate under admittance control, thereby advantageously reducing the perceived inertia of the controller during use. In some embodiments, the positioning platform 188 is configured for admittance control while the gimbal 186 is configured for impedance control. In other embodiments, the gimbal 186 is configured for admittance control and the positioning platform 188 is configured for impedance control. Thus, in some embodiments, the translational or positional degree of freedom of the positioning platform 188 can rely on admittance control while the rotational degree of freedom of the gimbal 186 relies on impedance control.

[0089] F. Navigation and Control Traditional endoscopy may involve the use of fluoroscopy (e.g., as may be delivered through a C-arm) and other forms of radiation-based imaging modalities to provide intraluminal guidance to the operator-physician. In contrast, the robotic system contemplated by the present disclosure may provide non-radiation-based navigation and localization means to reduce the physician's exposure to radiation and reduce the amount of equipment in the operating room. As used herein, the term "localization" may refer to determining and / or monitoring the position of an object in a reference coordinate system. Techniques such as pre-operative mapping, computer vision, real-time EM tracking, and robot command data may be used individually or in combination to achieve a radiation-free operating environment. In other cases where radiation-based imaging modalities are still used, pre-operative mapping, computer vision, real-time EM tracking, and robot command data may be used individually or in combination to improve the information obtained solely by radiation-based imaging modalities.

[0090] FIG. 20 is a block diagram illustrating a localization system 90 for estimating a location of one or more elements of a robotic system, such as a location of an instrument, according to an exemplary embodiment. The localization system 90 may be a set of one or more computing devices configured to execute one or more instructions. The computing devices may be embodied by a processor (or processors) and computer readable memory in one or more of the components discussed above. By way of example, and not by way of limitation, the computing devices may be in the tower 30 shown in FIG. 1, in the cart 11 shown in FIGS. 1-4, or in the bed shown in FIGS. 5-14.

[0091] 20, the localization system 90 may include a localization module 95 that processes the input data 91-94 to generate location data 96 of the distal tip of the medical instrument. The location data 96 may be data or logic that represents the location and / or orientation of the distal end of the instrument relative to a frame of reference. The frame of reference may be relative to a known object, such as the patient's anatomy or an EM field generator (see discussion of EM field generators below).

[0092] The various input data 91-94 will now be described in more detail. The localization module 95 may generate the model data 91 using pre-operative mapping. Pre-operative mapping may be accomplished using a series of low-dose CT scans. The pre-operative CT scans are reconstructed into three-dimensional images that are visualized, for example, as cross-sectional "slices" of the patient's internal anatomy. When analyzed as a whole, an image-based model may be generated for the anatomical cavities, spaces, and structures of the patient's anatomy, such as the patient's pulmonary network. Techniques such as center-line geometry may be determined and approximated from the CT images to create a three-dimensional volume of the patient's anatomy, referred to as model data 91 (also referred to as "pre-operative model data" when generated using only pre-operative CT scans). The use of center-line geometry is discussed in U.S. Patent Application Serial No. 14 / 523,760, the contents of which are incorporated herein in their entirety. Network topological models may also be derived from CT images and are particularly suited for bronchoscopy.

[0093] In some embodiments, the instrument may be equipped with a camera to provide visual data (or image data) 92 to the localization module 95. The localization module 95 may process the visual data 92 to enable one or more vision-based (or image-based) position tracking modules or functions. For example, the pre-operative model data 91 may be used in conjunction with the visual data 92 to enable computer vision-based tracking of a medical instrument (e.g., an endoscope or an instrument advancing through a working channel of the endoscope). For example, using the pre-operative model data 91, the robotic system may generate a library of predicted endoscopic images from the model based on the expected path of travel of the endoscope, with each image linked to a location in the model. During surgery, this library may be referenced by the robotic system to compare real-time images captured by a camera (e.g., a camera at the distal end of the endoscope) to those in the image library to assist with localization.

[0094] Other computer vision based tracking techniques use tracking functions to determine the motion of the camera and therefore the endoscope. Some features of the localization module 95 may identify circular geometric shapes in the pre-operative model data 91 that correspond to anatomical lumens and track changes in those geometries to determine which anatomical lumens have been selected as well as the relative rotational and / or translational motion of the camera. The use of a phase map may further enhance vision based algorithms or techniques.

[0095] Optical flow, another computer vision based technique, may analyze the displacement and translation of image pixels in a video sequence in the visual data 92 to infer camera movement. Examples of optical flow techniques may include motion detection, object segmentation calculations, luminance, motion compensated coding, stereo disparity measurements, etc. By comparing multiple frames over multiple iterations, the movement and position of the camera (and therefore the endoscope) can be determined.

[0096] The localization module 95 may use the real-time EM tracking and EM data 93 to generate a real-time position of the endoscope in a global coordinate system that may be registered to the patient's anatomy represented by the pre-operative model. In EM tracking, an EM sensor (or tracker) including one or more sensor coils embedded at one or more locations and orientations within a medical instrument (e.g., an endoscopic tool) measures variations in an EM field generated by one or more static EM field generators positioned at known locations. The position information detected by the EM sensor is stored as EM data 93. The EM field generator (or transmitter) may be placed in close proximity to the patient to generate a low-intensity magnetic field that the embedded sensor may detect. The magnetic field induces small currents in the sensor coils of the EM sensor, which may be analyzed to determine the distance and angle between the EM sensor and the EM field generator. These distances and orientations may be "registered" intraoperatively to the patient's anatomy (e.g., the pre-operative model) to determine a geometric transformation that aligns a single location in the coordinate system with a location in the pre-operative model of the patient's anatomy. Once registered, an EM tracker embedded at one or more locations on the medical instrument (e.g., the distal tip of an endoscope) can provide a real-time indication of the medical instrument's progression through the patient's anatomy.

[0097] The robotic commands and kinematic data 94 may also be used by a localization module 95 to provide location data 96 for the robotic system. The device pitch and yaw resulting from the articulation commands may be determined during pre-operative calibration. Intraoperatively, these calibration measurements may be used in combination with known insertion depth information to estimate the position of the instrument. Alternatively, these calculations may be analyzed in combination with EM, vision, and / or phase modeling to estimate the position of the medical instrument within the network.

[0098] As Fig. 20 illustrates, many other input data can be used by the localization module 95. For example, although not shown in Fig. 20, an instrument that utilizes shape sensing fibers can provide shape data that the localization module 95 can use to determine the location and shape of the instrument.

[0099] The localization module 95 may use a combination of the input data 91-94. In some cases, such a combination may use a probabilistic approach in which the localization module 95 assigns a confidence weight to the location determined from each of the input data 91-94. Thus, if the EM data is unreliable (such as when EM interference is present), causing the location determined by the EM data 93 to be less reliable, the localization module 95 may rely more heavily on the vision data 92 and / or the robot command and kinematic data 94.

[0100] As discussed above, the robotic systems discussed herein can be designed to incorporate a combination of one or more of the above-mentioned technologies. The computer-based control system of the tower, bed, and / or cart-based robotic system may store, for example in a non-transitory computer-readable storage medium, such as a persistent magnetic storage drive, solid-state drive, etc., computer program instructions that, when executed, cause the system to receive and analyze sensor data and user commands, generate system-wide control signals, and display navigation and localization data, such as instrument position within a global coordinate system, anatomical maps, etc.

[0101] 2. Axial motion drive for robotic medical systems This section relates to a driver configured to drive axial movement of a shaft of a medical instrument. The driver can be used, for example, to insert the shaft of the medical instrument into a patient during a medical procedure. The medical instrument can include, for example, a ureteroscope, a gastroscope, a bronchoscope, other endoscopes, laparoscopes, and the like. The shaft of the medical instrument can be configured to be inserted into the patient. The shaft can be, for example, an elongated shaft, a flexible shaft, and / or an articulatable shaft. The axial movement can include movement of the shaft of the medical instrument in a direction along a longitudinal axis of the shaft. For example, the axial movement can include inserting and / or retracting the shaft into and / or out of the patient and / or relative to the driver.

[0102] The drive may be used in a robotic medical system, including the robotic medical system described above with reference to FIGS. 1-20, the robotic medical system described below, and other robotic medical systems. In some embodiments, the drive may be used to perform various medical procedures, such as, for example, ureteroscopy, gastroscopy, bronchoscopy, etc. In some embodiments, the drive may be a reusable, reposable, or disposable tool configured to couple to a robotic arm, an instrument drive mechanism, and / or an adapter, as described above. In some embodiments, the drive may include a gearing or mechanism assembly to facilitate various functions associated with loading and driving the axial movement of the shaft of another medical instrument or tool.

[0103] As described in more detail below, the driver (also referred to as a drive assembly) can be configured to pull or push the shaft of the medical instrument through the driver. The driver can engage the shaft at a location along the length of the shaft. In some embodiments, the driver includes a set of opposing rollers (also referred to as "feed rollers") that engage the shaft and drive the axial motion (e.g., insertion and / or retraction) when rotated. In some embodiments, the driver can include a tread system, a rack and pinion system, or other mechanisms (e.g., linear mechanisms) for driving the axial motion of the shaft. In some embodiments, the driver can be configured to create and utilize one or more service loops during the insertion and retraction of the shaft. As used herein, a service loop can refer to the length of the shaft of the instrument between the instrument base (from which the shaft extends) and the driver, which is longer than the distance between the instrument base and the driver. The service loop can thus provide slack between the instrument base and the driver. An example of a service loop 226 is shown in FIG. 22, described in more detail below.

[0104] In general, the drives and associated robotic systems and methods described herein can provide one or more advantages over other devices and systems. In some cases, the drives described herein can allow for increased or higher speeds of insertion and / or retraction of the shaft of a medical instrument compared to other robotic systems. For example, in some robotic systems, the speed at which a robotically controlled ureteroscope can be inserted and / or retracted from a patient (e.g., from the urethral meatus to the renal pelvis) is limited by the linear speed of the robotic arm. In such systems, the speed of insertion and retraction is limited by how fast the robotic arm can move. The drives and associated robotic systems described in this section can, in some embodiments, allow for increased insertion and / or retraction speeds. In some embodiments, the drives can allow for insertion and / or retraction speeds that are greater than the linear speed of the robotic arm in the system. Increasing the insertion and / or retraction speeds can significantly reduce the overall time required to perform some medical procedures, which can improve, for example, patient outcomes. For example, during ureteroscopy, the ureteroscope may be inserted and retracted into the kidney multiple times to capture and remove all of the kidney stones and stone fragments. Thus, increasing the speed of insertion and / or retraction will cumulatively reduce the total time required for the procedure, reducing costs and improving patient outcomes.

[0105] Similarly, in some examples, the drives and associated robotic systems described herein can provide improved insertion depth (or stroke length) compared to some other robotic systems. In some robotic arm-based systems, the insertion depth (stroke length) can be limited to the stroke length of the robotic arm. This insertion depth may be insufficient for some procedures, such as gastroscopy, that may require a large insertion depth or range. Furthermore, moving the robotic arm through its full possible stroke length during a procedure can create kinematic challenges and risk colliding the arm with other objects, which can be undesirable and dangerous. As will be described later, the drives of the present application can, in some embodiments, increase the insertion depth beyond the stroke length of the robotic arm.

[0106] As another example, the drivers and associated robotic systems described herein can reduce or prevent buckling of the shaft during insertion. Because shafts are generally flexible, buckling can occur when driving insertion from the rear of the medical instrument (e.g., the instrument handle or instrument base). Such buckling can occur because the robotic arm applies force to the end of the shaft length, which is relatively long, flexible, and unsupported. The drivers, in some embodiments, can reduce or eliminate buckling because they drive the shaft insertion at a location proximate to the point where the shaft is inserted into the patient (also called the access point). The drivers can provide an insertion force that acts on the shaft of the medical instrument at a location close to the access point, rather than at the proximal end of the shaft, which may be relatively distant from the access point. By applying force by the drivers along the length of the shaft, proximal to the insertion point, the drivers described herein can reduce or eliminate buckling of the shaft.

[0107] Additionally, the driver can be configured to limit the amount of force that the shaft of the medical instrument can exert on the patient's tissue during insertion or retraction. This can be accomplished by configuring the driver such that the drive mechanism (e.g., rollers engaging the shaft) will slip relative to the shaft at a predetermined force, as described in more detail below. This can prevent or reduce the possibility of the shaft exerting a force on the patient that is greater than the predetermined force. The system can also adjust this drive force to ensure that a level of force that is considered acceptable or safe for the patient is maintained.

[0108] Features and advantages of the drive arrangement and associated robotic system will now be more fully described with reference to Figures 21-33. While these figures show several exemplary embodiments, these embodiments are for illustrative purposes and do not limit the scope of the present application.

[0109] A. Axial motion drive system with multiple robotic arms 21 shows a representation of a robotic medical system 200 including a driver 300 configured to drive axial motion of an elongated shaft 220 of a medical instrument 210. In the illustrated embodiment, the system 200 includes the medical instrument 210, the driver 300, a first robotic arm 202, and a second robotic arm 204. As shown, the system 200 further includes an access sheath 250 that is inserted into the patient and provides a conduit through which the shaft 220 of the medical instrument 210 can be inserted.

[0110] In the illustrated embodiment, the medical instrument 210 includes an instrument base 212 (also referred to as an instrument handle) and a shaft 220. The shaft 220 can extend from or through the base 212. The medical instrument 210 can be any of the medical instruments described above, such as, for example, instrument 13 of FIG. 1, instrument 32 of FIG. 3, instrument 34 of FIG. 4, instrument 40 of FIG. 5, instrument 56 of FIG. 8, instrument 59 of FIG. 9, instrument 70 of FIG. 16, instrument 86 of FIG. 17, and instrument 150 of FIG. 18. As described above, the medical instrument 210 can be an endoscope, a catheter, or a laparoscope. In the illustrated embodiment, the medical instrument 210 is a ureteroscope, although this example should not be construed as limiting. According to some embodiments, the first robotic arm 202 can support multiple medical instruments, and the drive 300 can be configured to drive the movement of any one or more of the multiple medical instruments. For example, the first robotic arm 202 can support a first medical instrument having a working channel, such as an endoscope or catheter, and a second medical instrument, which is a working channel instrument extending within the working channel, such as a biopsy tool, a basket tool, a laser fiber tool, an ablation tool, or other tool configured to manipulate or interact with a target within a patient's anatomy.

[0111] The instrument base 212 can be configured to be attached, mounted, or otherwise connected or coupled to the first robotic arm 202. The first robotic arm 202 can include an instrument drive mechanism, such as described above with reference to Figures 16 and 17, and the instrument base 212 can be attached to the instrument drive mechanism. The instrument drive mechanism can include a drive output configured to engage and actuate a corresponding drive input in the instrument base 212 to manipulate the medical instrument 210. The robotic arm 202 can also be configured to move to manipulate the position of the instrument base 212 in space.

[0112] The shaft 220 can be configured for insertion into a patient. In some embodiments, the shaft 220 comprises an elongate shaft, a flexible shaft, and / or an articulating shaft. The shaft 220 can be coupled at a proximal end to the instrument base 212 and can extend to a distal end configured for insertion into a patient. In some embodiments, the shaft 220 extends through the base 212, for example, as shown in FIG. 18 .

[0113] As shown in FIG. 21 , the shaft 220 can be engaged with the driver 300. In the illustrated embodiment, the driver 300 includes rollers 312 that can engage or contact the shaft 220. In some embodiments, the rollers 312 can include a deformable material that provides grip, friction, traction, or pressure between the rollers 312 and the shaft 220. In some embodiments, the deformable material includes silicone rubber. In the illustrated embodiment, as the rollers 312 rotate, the shaft 310 can be pulled, pushed, or otherwise driven axially through the driver 300. Rotating the rollers 312 in a first direction can cause insertion of the shaft 220 (e.g., in a distal direction toward the patient), and rotating the rollers 312 in an opposite second direction can cause retraction of the shaft 220 (e.g., in a proximal direction away from the patient). Here, the direction of the rollers 312 refers to the direction of the portion of the rollers 312 that is engaged with the shaft 220. For example, rotation in a first direction to insert shaft 220 means that the engaged portions of rollers 312 rotate in a distal direction, and rotation to retract means that the engaged portions of rollers 312 rotate in a proximal direction. In the illustration of rollers 312 as seen in FIG. 21, to rotate rollers 312 distally means that the left roller 312 rotates counterclockwise while the right roller 312 rotates clockwise, and vice versa to rotate rollers 312 proximally. As discussed above, other drive mechanisms or drive assemblies can be used in place of or in addition to rollers 312.

[0114] As shown in FIG. 21 , the shaft 220 can pass through a channel 310 of the driver 300. In the illustrated embodiment of FIG. 21 , the channel 310 comprises a closed channel. In other embodiments, such as the embodiment shown in FIG. 23 , the channel 310 can comprise an open channel 310. The use of an open channel 310 can facilitate loading of the shaft 220 of the medical instrument 210 into the driver 300, thereby simplifying use of the device and reducing operation time. For example, an open channel can facilitate loading and / or unloading of the medical instrument 210 during surgery or a medical procedure, such that a user, such as a medical professional, can manually adjust the medical instrument 210 without having to fully retract the medical instrument 210 from within the patient. In some embodiments, as described further below, the driver 300 can include a robotically actuated cover that can selectively open and close the channel 310 to facilitate loading and / or retaining the shaft in the driver as needed.

[0115] The driver 300 can be attached, mounted, or otherwise connected or coupled to the second robotic arm 204, for example, as shown in FIG. 21. The second robotic arm 204 can include an instrument drive mechanism to which the driver 300 can be attached. The instrument drive mechanism can include a drive output configured to engage and actuate a corresponding drive input (see, for example, drive inputs 334, 338 in FIG. 24C) in the driver 300 to activate or operate the driver 300. The robotic arm 204 can also be configured to move to manipulate the position of the driver 300 in space. In some embodiments, for example, as shown in FIG. 21, the driver 300 can be positioned proximate to the access sheath 250, for example, within 1 inch, within 1.5 inches, within 2 inches, within 3 inches, within 4 inches, within 5 inches, within 6 inches, or within 12 inches of the access sheath 250. Positioning the driver 300 proximate to where the shaft 220 is inserted can reduce buckling, as discussed above. As shown in FIG. 23, in some embodiments, the driver 300 can be configured to attach to the access sheath 250 (e.g., using clips 322), although this need not be the case in all embodiments. In some embodiments, attaching the driver 300 to the access sheath 250 can facilitate movement or repositioning of the access sheath 250 as needed via movement or repositioning of the driver 300 or robotic arm 204 coupled to the access sheath 250, as described further herein.

[0116] In the case of ureteroscopy, the access sheath 250 may comprise a ureteral access sheath. However, in some embodiments, the access sheath 250 may comprise a tube or other structure through which the shaft 220 may be inserted. In some embodiments, the access sheath 250 may comprise an elongated, flexible access sheath configured to be inserted into an anatomical lumen. In other procedures, other types of access sheaths may also be used. In some embodiments, the access sheath 250 is not used, and the elongated shaft 220 of the medical instrument 210 may be inserted directly into the patient (e.g., through a natural orifice in the patient or other surgical access port or incision).

[0117] FIG. 21 also shows that the driver can include a collector 222. In some embodiments, objects removed from a patient using the medical instrument 210 can be deposited in the collector 222. For example, in the case of ureteroscopy, the medical instrument 210 can include a basket device configured to capture and retrieve stones or stone fragments from within the patient. Once a stone is captured, the shaft 220 can be retracted until the distal end is positioned above the collector 222. The basket can then be opened to allow the stone to fall into the collector 222. In some embodiments, the collector 222 does not need to be positioned on the driver, for example as shown in FIG. 23.

[0118] In FIG. 21 , the shaft 220 of the medical instrument 210 extends straight between the instrument base 212 and the driver 300. In this configuration, when the driver 300 drives the axial movement of the elongated shaft, the first robotic arm 202 can move the instrument base 212 at a speed and in a direction corresponding to the speed of the axial movement provided by the driver 300. In this case, the insertion speed of the shaft 220 can be limited to the speed at which the first robotic arm 202 can move the instrument base 212. This may be preferable for slow speeds. A slow speed may be desirable, for example, when the distal tip of the shaft 220 is positioned outside the access sheath 250 and is therefore exposed to the patient's tissue (e.g., when inserting the distal tip of the sheath 250 into the patient).

[0119] FIG. 22 illustrates the robotic medical system 200 in another configuration, where the elongated shaft 220 of the medical instrument 210 is positioned to form a service loop 226 between the first robotic arm 202 and the second robotic arm 204 or between the instrument base 212 and the driver 300. The service loop 226 can include the length of the shaft 220 between the instrument base 212 and the driver 300. If the length of the shaft 220 exceeds the distance between the instrument base 212 and the driver 300, the shaft 220 can sag and the service loop 226 can be formed between the instrument base 212 and the driver 300. The service loop 226 can provide slack in the shaft 220 that can be used to allow for faster insertion and / or retraction. For example, during insertion, slack in the service loop 226 can be taken up (shortening or contracting the service loop 226). During retraction, the service loop 226 can be created (increasing or expanding the length). As used herein, expanding or contracting the service loop 226 may include increasing or decreasing the amount of excess length available in the service loop 226 to provide axial freedom to the flexible shaft.

[0120] As an example, the use of the service loop 226 allows the driver 300 to drive the insertion at a faster rate than the first robotic arm 202 can move the instrument base 212. In this case, the service loop 226 is taken up (e.g., reduced or shortened). In some embodiments, this can allow the shaft 220 to be inserted without the need to move the instrument base 212 by the first robotic arm 202. In some embodiments, this can allow the system 200 to be configured to insert at a rate of 100-300 mm per second, or more specifically, at a rate of 130-190 mm per second. Other speeds for fast insertion or retraction outside of these ranges are also possible. This type of fast insertion can be preferred, for example, when the distal tip of the shaft 220 is positioned within the access sheath 250, because the access sheath 250 can protect the patient's tissue. In some embodiments, when the distal tip of shaft 220 extends beyond access sheath 250 (exposed to patient tissue), the system can transition to a slower insertion speed, such as a speed of about 5-80 mm per second, more specifically 20-50 mm per second. Other speeds for slow insertion or retraction outside of these ranges are also possible, where the slow insertion speed is slower than the fast insertion speed. The slow insertion speed can operate, for example, as described above with reference to FIG. 21, where the insertion speed of drive 300 matches the movement speed of first robotic arm 202.

[0121] As another example, during retraction, when the distal tip of shaft 220 is positioned beyond the access sheath, driver 300 can drive retraction at a slower speed. At the slower speed, system 200 can operate as described above with reference to FIG. 21, with the retraction speed of driver 300 matching the movement speed of first robotic arm 202. When the tip of shaft 220 is positioned within access sheath 250, system 200 can retract at a faster speed, thereby creating (increasing or expanding the length of) service loop 226. While the coordinated operation of driver 300 and the slow movement of first robotic arm 202 can help mitigate shaft buckling that can lead to imprecise drive response if axial movement of the relatively thin and flexible shaft 220 is performed solely by robotic arm movement, in some embodiments, slow insertion or retraction of shaft 220 may be achieved using only arm 202 movement while driver 300 is disengaged from shaft 220.

[0122] B. Drive Architecture 23-29 illustrate an embodiment of a drive 300 and a mechanical architecture that can facilitate robotic control. The drive 300 includes a mechanism coupled to a drive input that is operable to control a function of the device, such as controlling rollers to advance or retract a shaft, opening and closing rollers to facilitate loading of the shaft, and / or controlling a robotically actuated cover to selectively open and close a channel that holds a shaft of a medical instrument on the device. FIG. 23 illustrates an isometric view of an embodiment of the drive 300. The drive 300 illustrated in FIG. 23 can be, for example, an embodiment of the drive 300 described above with reference to FIGS. 21 and 22. The drive 300 can be configured for use in a robotic medical system, such as the robotic medical system described above with reference to FIGS. 1-22, etc. As described in more detail below, the drive 300 can be configured to engage and drive axial movement (e.g., insertion and / or retraction) of a shaft (e.g., an elongated and / or flexible shaft) or a medical instrument (e.g., an endoscope). For example, the driver 300 can be used to drive the insertion and / or retraction of an elongate shaft of a medical instrument into and / or from a patient during a medical procedure. In a more specific, but non-limiting, example, the driver 300 can be configured to drive the insertion and / or retraction of a flexible, elongate shaft of a ureteroscope into and / or from a patient during a ureteroscopy. The driver 300 can also be used in a variety of other procedures, such as bronchoscopy, endoscopy, endoluminal surgery, or transcatheter procedures, among others.

[0123] The drive 300 can be configured to attach (e.g., connect, mount, engage, or otherwise couple) to a robotic arm of a robotic medical system. By way of example, the drive 300 can be configured to attach to any of the robotic arms 12 of the cart 11 shown in FIGS. 1-4, the robotic arm 39 of the platform 38 shown in FIGS. 6-10, or the robotic arms 142A, 142B of the system 140A shown in FIG. 14. In some embodiments, removal of the drive 300 allows the drive to be a reusable, reposable, or disposable tool having a different useful life than a robotic arm or instrument drive that may be part of capital equipment. In some embodiments, the drive 300 is configured to attach to a distal end of a robotic arm. The robotic arm can be moved or articulated to position the drive 300 in space. For example, in some embodiments, the robotic arm can be used to position the drive 300 in proximity to a patient to facilitate a robotic medical procedure. In some embodiments, the robotic arm can maintain the actuator 300 in a constant or stationary position during a procedure. In some embodiments, the robotic arm can move the actuator 300 during a procedure.

[0124] The driver 300 may be attached to an instrument drive mechanism (or instrument driver or drive unit) of a robotic arm. By way of example, the driver 300 may be configured to attach to the instrument drive mechanism 146A, 146B of FIG. 14, the drive unit 63 of FIG. 15, the instrument driver 74 of FIG. 16, or the instrument driver 80 of FIG. 17. The instrument drive mechanism may include a drive output configured to engage and actuate a corresponding drive input in the driver 300. Exemplary drive inputs 334, 338 of the driver 300 are shown, for example, in a bottom view in FIG. 24C, which is further described below.

[0125] As shown in FIG. 23, the driver 300 can include a housing 302. The housing 302 can be configured to surround or enclose (partially or completely) various internal components of the driver 300 that facilitate the functionality of the driver 300. The various internal components of the driver 300 are described in more detail below. As shown in FIG. 23, the housing 302 can include an upper portion 304 and a lower portion 306. The lower portion 306 can be configured to attach to a robotic arm and / or an instrument drive mechanism, as described above. In some embodiments, a sterile adapter can be positioned between the driver 300 and the robotic arm and / or an instrument drive mechanism to facilitate maintaining a sterile field during a medical procedure. In the illustrated embodiment, the upper portion 304 of the housing 302 includes an upper surface 308. The upper surface 308 can include a channel 310 formed therein.

[0126] The channel 310 can be configured to receive a portion of the shaft of a medical instrument. In some embodiments, including the channel 310 in the top surface 308 of the driver 300 can be advantageous because it can allow the shaft of the medical instrument to be loaded into the driver 300 from above or loaded laterally relative to the shaft 220. That is, because the channel 310 is open from above, the shaft of the medical instrument can be inserted into the channel from above or laterally in a simple manner. For example, in some embodiments including the channel 310 formed in the top surface 308, the shaft of the medical instrument may not need to be threaded through a closed guide in order for the shaft to engage the driver 300. Instead, the shaft can simply be inserted into the open channel 310 in the top surface 308 of the driver 300. This can simplify use of the driver 300 and advantageously reduce the time required to use the driver 300. Furthermore, reduced use time can advantageously reduce the overall time required to perform a medical procedure, improving patient outcomes and reducing medical costs.

[0127] When the shaft of the medical instrument is inserted or positioned in the channel 310, it can engage with rollers 312 positioned in the housing 302 of the driver. The rollers 312 are shown, for example, in FIGS. 24A and 24B, which show the driver 300 with the upper portion 304 of the housing 302 removed. As described in more detail below, the rollers 312 can be configured to contact (e.g., press against or otherwise engage) the shaft of the medical instrument in the channel 310. The rollers 312 can also be configured to rotate to drive axial movement of the shaft medical instrument (e.g., movement in a direction along the longitudinal axis of the shaft). In some embodiments, the rollers 312 can rotate in a first direction to drive insertion of the shaft of the medical instrument and in a second direction to drive retraction of the shaft of the medical instrument.

[0128] Within the channel 310, the driver 300 may also include one or more clips 314, 316 (also referred to as "snaps") configured to secure the shaft of the medical instrument within the channel 310. For example, in the illustrated embodiment, the driver 300 includes a proximal clip 314 positioned at a proximal end of the channel 310 and a distal clip 316 positioned at a distal end of the channel 310. Only a portion of the proximal clip 314 and the distal clip 316 are shown in FIG. 23. The proximal clip 314 and the distal clip 316 can be better seen in FIGS. 24A and 24B, for example, which show the driver 300 with the upper portion 304 of the housing 302 removed. As will be described in more detail below, the proximal clip 314 and the distal clip 316 can be configured to secure the shaft of the medical instrument within the channel 310 without restricting (or substantially restricting) axial movement of the shaft through the channel. For example, the proximal clip 314 and the distal clip 316 can be configured to prevent the shaft from lifting out of the channel, while still allowing the shaft to slide freely axially through the channel 310. Furthermore, in some embodiments, the proximal clip 314 and the distal clip 316 can be configured to secure the shaft within the channel 310 without restricting (or significantly restricting) the ability of the shaft to pivot about its longitudinal axis. For example, the proximal clip 314 and the distal clip 316 can be configured to prevent the shaft from lifting out of the channel, while still allowing the shaft to pivot freely about its longitudinal axis within the channel 310. For example, the inner diameter of the retaining portion of the proximal clip 314 and the distal clip 316 can be larger than the outer diameter of the shaft of the medical instrument. In some embodiments, in addition or alternatively, the driver 300 can include a cover 318, as shown, for example, in Figures 26A, 26B, 27A, and 27B (described below), which can also be configured to secure the shaft of the medical instrument within the channel 310.

[0129] In some embodiments, the proximal clip 314 and the distal clip 316 can be configured to provide tactile feedback to indicate to a user that the medical instrument shaft has been properly loaded into the channel 310. For example, in some embodiments, the proximal clip 314 and the distal clip 316 can be configured to allow the medical instrument shaft to snap through an entry portion of the clip (which serves to provide tactile feedback as well as retain the shaft in the channel). At the same time, after the shaft snaps through the entry portions of the clips 314, 316, the shaft can be retained within a retaining portion that has a diameter larger than the diameter of the instrument shaft so that the shaft can slide freely axially as described above (e.g., allowing axial movement and / or pivoting of the shaft).

[0130] In some embodiments, the channel 310 can have a length that facilitates the functionality of the driver 300. As described above, the driver 300 can be configured to drive axial movement (insertion and / or retraction) of the shaft of the medical instrument through contact with rollers 312 positioned within the driver 300. In the illustrated embodiment (e.g., shown in FIGS. 24A and 24B), the rollers 312 comprise a left roller 312 and a right roller 312 positioned on opposite sides of the channel 310. Contact between the rollers 312 and the shaft of the medical instrument can be limited to a small contact area between the opposing rollers 312. Because the contact area is relatively small (e.g., when compared to the overall length of the shaft), the shaft can tend to pivot or tilt about the point where it is in contact with the rollers 312. This can create difficulties in maintaining alignment of the shaft of the medical instrument. For example, the shaft can become misaligned with the access sheath or patient opening through which the shaft is inserted. The length of the channel 310 can be sufficient to limit or prevent this misalignment. Increasing the length of channel 310 can limit the tendency or ability of the medical instrument shaft to tilt or pivot about the point of contact with roller 312. Thus, distal driver 300 can be provided with a channel 310 having a sufficient length to limit or prevent displacement of the medical instrument shaft.

[0131] In some embodiments, the length of the channel 310 can be determined between the proximal and distal ends of the channel 310. In some embodiments, the length of the channel 310 can be determined between the proximal clip 314 and the distal clip 316. The channel 310 can have a length of at least 25 mm, at least 30 mm, at least 35 mm, at least 40 mm, at least 45 mm, at least 50 mm, at least 55 mm, at least 60 mm, at least 65 mm, at least 70 mm, at least 75 mm, at least 80 mm, at least 85 mm, at least 90 mm, at least 95 mm, at least 100 mm, or more. In one example tested, a driver 300 having a channel 310 length of about 68 mm was found to adequately maintain alignment of the shaft of a medical instrument to facilitate a ureteroscopy procedure. In some embodiments, the roller 312 is positioned to contact and engage the shaft at a point between the proximal and distal ends of the channel 310 or between the proximal clip 314 and the distal clip 316.

[0132] In the illustrated embodiment, the channel 310 includes a flared or tapered portion 320. The tapered portion 320 can be located at a proximal end of the channel 310. In some embodiments, the length of the channel 310 (as described above) includes the length of the tapered portion 320. In some embodiments, the length of the channel 310 (as described above) does not include the length of the tapered portion 320. As described above with reference to FIGS. 21 and 22, the shaft of the medical instrument may form a service loop between the driver 300 and a base of the medical instrument located proximal to the driver 300 (e.g., connected to an additional robotic arm). The tapered portion 320 can facilitate feeding the shaft into the driver 300 in the presence of angled conditions and / or service loops while avoiding sharp bends in the flexible shaft. For example, tapered portion 320 can provide room for a flexible shaft to feed into the proximal end of channel 310 at various angles, while the sidewalls of the tapered portion can provide a large bend radius or smooth entry for the shaft in the area where the shaft enters the driver. Tapered portion 320 can also accommodate some misalignment between driver 300 and the instrument base. Additionally, tapered portion 320 can facilitate feeding the shaft through driver 300 as driver 300 drives the axial movement of the shaft of a medical instrument.

[0133] As shown in FIG. 23, the driver 300 can further include a coupling member, engagement device, or holder, shown in FIG. 23 as a clip 322. The clip 322 can be positioned at a distal end of the driver 300. The clip 322 can be configured to engage an access sheath. The access sheath can be inserted, for example, into a patient to provide a conduit through which a shaft of a medical instrument can be inserted. In some embodiments, the clip 322 is configured to engage a proximal end of the access sheath. In some embodiments, the clip 322 is configured to support the access sheath. For example, the clip 322 can support a proximal end of the access sheath. In some embodiments, the access sheath is primarily supported by the patient (e.g., by insertion into the patient) or by other structure, and the clip 322 engages the access sheath to orient the driver 300 relative to the access sheath. Engaging the driver 300 to the access sheath by the clip 322 can facilitate alignment between the driver 300 and the access sheath. For example, clip 322 may be engaged with the access sheath to align channel 310 of driver 300 with the access sheath.

[0134] In some embodiments, the clip 322 can be a spring-loaded clip. For example, the clip 322 can include a spring, such as a torsion spring or other type of spring, that biases the clip 322 to a closed position. The force of the spring can be overcome to open the clip 322, and then the spring force can clamp the clip 322 onto the access sheath 250. In some embodiments, the clip 322 can be manually operated. In another embodiment, the clip 322 can be robotically controlled. In some embodiments, the clip 322 can be a self-centering clip. The self-centering feature can enhance ease of use by allowing opposing sides of the clip 322 to spread in opposite directions when opened (e.g., manually opened or activated by a user), and then when the spring is released, the clip 322 can close onto the access sheath while maintaining alignment between the center of the clip (and thus the entrance to the access sheath) and the exit of the channel 310.

[0135] In the illustrated embodiment of FIG. 23, the housing 302 of the driver 300 is configured to include a space or gap 324 between the clip 322 and a distal end or exit 326 of the channel 310. To achieve the gap 324, the clip 322 can be positioned on an arm 328 extending from the body of the driver 300. The arm 328 can be C-shaped, as shown, such that the gap 324 is formed between the clip 322 and the exit 326 of the channel 310 of the body of the driver 300. In some embodiments, the arm 328 is formed in or extends from the upper portion 304 of the housing 302. The gap 324 can be configured to allow access to the distal end of the shaft of a medical instrument when the distal end of the shaft is withdrawn from an access sheath engaged with the clip 322. For example, as described above, the driver 300 can be used to insert the shaft of a medical instrument through an access sheath and into a patient. The proximal end of the access sheath can engage clip 322. Driver 300 can then be used to withdraw the shaft of the medical instrument from the proximal end of the access sheath until the distal end of the shaft is positioned within gap 324, e.g., until the distal end of the shaft is positioned between clip 322 and exit 326 of channel 310. This can provide access to the distal end of the shaft.

[0136] In some embodiments, the gap 324 and access to the distal tip of the shaft of the medical instrument can facilitate basket procedures, biopsy procedures, or other procedures to remove objects, such as patient tissue, foreign bodies, or samples, from within the patient's anatomy. For example, in ureteroscopy, the medical instrument can include a ureteroscope, which can include a working channel through which a basket device can be inserted. The basket device and ureteroscope can be manipulated to remove a kidney stone from the patient. The kidney stone can be captured in the basket device. With the kidney stone captured, the ureteroscope can be retracted (using the driver 300) until the distal end of the ureteroscope is positioned within the gap 324. The basket device can then be opened and the kidney stone removed. The ureteroscope can then be reinserted (using the driver 300) through the access sheath into the patient, and the process can be repeated to capture additional stones. In some embodiments, when the distal tip of the shaft is positioned within the gap 324, the removed kidney stone can be dropped or otherwise deposited into a collector. The collector can be positioned over the driver 300 (e.g., as shown in FIG. 21 or FIG. 22) or can be positioned under the gap 324. A similar process can be used for any other object to be removed, or for any other working channel instrument having an end effector or tool at its distal end that can manipulate and / or expel an object from within a patient.

[0137] 24A and 24B are isometric and top views of the driver 300 of FIG. 23, shown with the upper portion 304 of the housing 302 removed. In these views, various internal components of the driver 300 are shown, including, for example, the rollers 312, the proximal clip 314, and the distal clip 316, as described above.

[0138] As shown in FIGS. 24A and 24B, the driver 300 can include rollers 312 configured to drive axial movement of the shaft of the medical instrument. As described above, the rollers 312 can be positioned on opposite sides of the channel 310 such that the rollers 312 are positioned on opposite sides of the shaft of the medical instrument when the shaft is loaded into the driver 300. The rollers 312 can thus be considered opposing rollers. As described in more detail below, the rollers 312 can be configured to move (e.g., translate) between a first position and a second position. In the first position, the rollers 312 can be configured to engage the shaft of the medical instrument. For example, in the first position, the rollers 312 can press or otherwise engage opposite or opposite sides of the shaft of the medical instrument. In some embodiments, when the rollers 312 are in the first position, the rollers 312 can be rotated in a first direction to drive the insertion of the shaft of the medical instrument. In some embodiments, when rotated in the second direction, the rollers 312 can drive the retraction of the shaft of the medical instrument. When the rollers 312 are moved to the second position, the rollers 312 can be spaced apart so that the rollers 312 are spaced apart from and do not engage the shaft of the medical instrument. The second position can thus be a loading position for the rollers 312. For example, the rollers 312 can be spaced apart to the second position to load the shaft of the medical instrument into the channel 310, and the rollers 312 can be moved to the first position to engage the shaft of the medical instrument.

[0139] In the illustrated embodiment of FIGS. 24A and 24B, the driver 300 includes a spring 330. The spring 330 can be configured to bias the roller 312 toward a first position (e.g., a closed position in which the roller 312 engages the elongated shaft). To move the roller 312 to a second position (e.g., an open or loaded position), the robot drives an output to overcome the spring force of the spring 330. In addition to biasing the roller 312 toward the first position, the spring 330 can also be configured to provide the pressure or friction required to engage the roller 312 with the shaft of the medical instrument. For example, the spring 330 determines the force with which the roller 312 presses against the shaft of the medical instrument. The force of the spring 330 can be selected to provide a desired pressure or friction against the shaft of the medical instrument. In some embodiments, the spring force of the spring 330 can be used to control or limit the pressure or force that may be exerted by the shaft of the medical instrument on the patient's anatomy during insertion and retraction. This can be accomplished by selecting or setting a spring force that corresponds to the friction drive force of the rollers 312 such that at a given load, the rollers 312 begin to slide on the shaft of the medical implement. By adjusting this drive force, the system can maintain a level of such force that is determined or defined as acceptable or safe for the patient.

[0140] In the illustrated embodiment, the spring 330 comprises a mechanical spring, such as a torsion spring. Other types of springs, such as a coil spring, may also be used. In the case of a mechanical spring, the force of the spring 330 may be adjusted (to provide the safety features discussed above) by adjusting the size of the spring 330 and / or the material from which the spring 330 is made. Additionally, various other parameters of the drive 300 may be considered as well. For example, the material of the contact area of ​​the roller 312 may be adjusted to provide different coefficients of friction between the shaft of the medical instrument and the roller 312. Similarly, the coefficient of friction of the shaft of the medical instrument may be adjusted. One or more of these parameters may be configured to reduce or prevent the roller 312 from slipping against the shaft of the elongated shaft to reduce or prevent the shaft from applying excessive force to the patient's anatomy. In some embodiments, the spring 330 may be omitted and the drive 300 may include a virtual spring that exerts a force against the shaft controlled via the operation of the drive shaft or drive input. For example, as described below, the drive 300 can include various drive inputs 334, 338 that can be configured to control the rotation of the roller 312 and move the roller 312 between first and second positions (e.g., opening and closing the roller 312). Alternatively, or in addition to including the spring 330, the system can operate these drive inputs 334, 338 to provide a function similar to a mechanical spring, thus providing a virtual spring that can grip against a shaft.

[0141] FIG. 24B also shows a roller drive shaft 332. The drive shaft 332 can provide a drive output on an instrument drive mechanism, adapter, or robotic arm that is coupled to a corresponding complementary drive input on the drive device 300, as described further below. In the illustrated embodiment, the roller drive shaft 332 can be configured to drive the rotation of the rollers 312. For example, the drive shaft 332 can be rotated to provide a corresponding rotation in the rollers 312. As shown, the drive device 300 can include two roller drive shafts 332, each associated with one of the rollers 312. Thus, in the illustrated example, each of the rollers 312 can be driven independently. In some embodiments, only a single roller drive shaft 332 is included, and the single roller drive shaft 332 can be configured to drive the rotation of both rollers 312. As described further below, the roller drive shaft 332 can be connected to a roller drive input 334 (as shown in FIG. 24C, described below). The roller drive shaft 332 can also be connected to the rollers 312. In the illustrated embodiment, the roller drive shaft 332 is connected to the rollers 312 via a gear assembly 335 (as shown in Figures 25B and 25C, described below). In alternative embodiments, the roller drive shaft 332 may be connected to the rollers 312 in other ways. By way of example, the roller drive shaft 332 may be directly connected to the rollers 312, or the roller drive shaft 332 may be connected to the rollers 312 by a belt drive system.

[0142] 24C is a bottom view of the drive 300. As shown in FIG. 24C, the drive 300 can include multiple drive inputs 334, 338 at a lower surface 336 of the housing 302. The lower surface 336 can be part of the lower portion 306 of the housing 302. In the illustrated embodiment, the drive 300 includes three drive inputs 334, 338, although other embodiments can include other numbers of drive inputs. The drive inputs can be located at fixed, spaced locations along the lower mating surface 336 of the drive 300, which facilitates coupling the drive inputs 334, 338 to corresponding drive inputs of a robotic system that can be located at fixed, spaced locations along a corresponding mating surface that is designed to be used modularly to attach a variety of other instruments. As will be further described below, the mechanical assembly within the drive 300 allows the drive inputs 334, 338 to be used to drive the rotation of the opposing rollers for axial movement of the shaft of the medical instrument and to allow the position of the opposing rollers 312 to be changed to allow for loading of the shaft or other uses. In the illustrated embodiment, the three drive inputs include two roller drive inputs 334 and an open / close drive input 338. Each of the drive inputs 334, 338 can be configured to engage with a corresponding drive output in a robotic arm or instrument drive mechanism, for example, as described above with reference to Figures 16 and 17. For example, each drive input can include a receptacle configured to mate with a drive output configured as a spline. The drive inputs and drive outputs can be configured to engage to transfer motion therebetween. Thus, the drive output can be rotated to cause a corresponding rotation of the drive inputs 334, 338 to control various functions of the drive 300. In the illustrated embodiment, the roller drive input 334 can be rotated to cause rotation of the roller 312. In the illustrated embodiment, the open / close drive input 338 can be rotated to move the roller 312 between the first and second positions (e.g., the closed and open positions) described above.In some embodiments, the open / close drive input 338 can also be operated to actuate the cover between open and closed positions to open or close the channel in coordination with engaging or disengaging the feed rollers.

[0143] 24D and 24E are front (distal) and back (proximal) views of the driver 300. In these figures, the shaft 220 of the medical instrument is shown to depict the engagement between the rollers 312 and the shaft 220. As shown, the rollers 312 are engaged on both sides or opposite sides of the shaft 220. The shaft 220 is positioned between the rollers 312. In the illustrated embodiment, the rollers 312 are shown in a first position in which they press against or otherwise engage the shaft 220. In the first position, the rollers 312 can rotate to drive axial motion, such as insertion or retraction (away from or towards the page relative to the orientation shown in FIGS. 24D and 24E).

[0144] 24D and 24E also show examples of the relationship of the proximal and distal clips 314, 316 to the shaft 220 when the shaft 220 is loaded into the driver 300. As shown, the proximal and distal clips 314, 316 can hold the shaft 220 inside the portion of the clips 314, 316 that has a diameter larger than the diameter of the shaft. This configuration allows the shaft 220 to move axially (across the page and to the side of the page relative to the orientation shown in FIGS. 24D and 24E) freely and to pivot about the longitudinal axis of the shaft 220 as described above. The proximal and distal clips 314, 316 can include detents on the portions of the clips 314, 316 that include the larger diameter, spaced a distance smaller than the diameter of the shaft 220. Pressing the shaft 220 through the detents can provide tactile feedback and hold the shaft 220 within the proximal and distal clips 314, 316 as described above.

[0145] 25A is an isometric view of one embodiment of a roller assembly 340 of the drive device 300. As will be described later, in the illustrated embodiment, the roller assembly 340 can be configured to drive the axial movement of the shaft of the medical instrument (by rotating the roller 312) and move the roller 312 between the first and second positions (e.g., closed and open positions) described above. In the illustrated embodiment, the roller assembly 340 includes a right assembly and a left assembly. Each of the right assembly and the left assembly can include a carrier plate 342. The term plate is used broadly to refer to a support structure, and the carrier plate 342 does not necessarily need to be considered flat or planar. Rather, the carrier plate 342 can have a complex shape or geometry configured to support various components of the roller assembly 340, as will be described later. The carrier plate 342 can also be referred to as a link or other support structure.

[0146] Generally, carrier plate 342 supports or is coupled to various other features or structures of roller assembly 340. For example, in the illustrated embodiment, each carrier plate 342 supports or is coupled to one of rollers 312 and one of roller drive shafts 332. As shown in FIG. 25A , roller 312 is configured to rotate about roller axis 344. Roller drive shaft 332 is configured to rotate about drive input axis 346. As shown, roller axis 344 and drive input axis 346 need not be coaxial. In some embodiments, roller axis 344 and drive input axis 346 are parallel (e.g., as shown). Further, the carrier plate 342 can support or be coupled to a gear assembly 335, as described below with reference to Figures 25B and 25C, which connects the roller drive shaft 332 to the rollers 312 such that rotation of the roller drive input 334 can cause rotation of the rollers 312.

[0147] In the illustrated embodiment, the carrier plate 342 can be configured to rotate about a drive input axis 346. Rotation of the carrier plate 342 about the drive input axis 346 can move the rollers 312 between first and second (closed and open) positions. As described above, the drive device 300 can include an open / close drive input 338 configured to move the rollers 312 between a first and second position. The open / close drive input 338 can be connected to an open / close drive shaft 348 shown in FIG. 25A. Rotation of the open / close drive input 338 can cause rotation of the open / close drive shaft 348. The open / close drive input 338 and the open / close drive shaft 348 can rotate about an open / close drive axis 350. The open / close drive shaft 348 can be further coupled to an off-axis projection 352. Thus, as the open / close drive shaft 348 rotates, the off-axis projection 352 also rotates about the open / close drive axis 350. However, the off-axis projection 352 is not symmetrical about the open / close axis 350. Thus, the off-axis projection 352 provides an eccentric member that is movable in an arc about the open / close axis 350.

[0148] As shown in FIG. 25A, each of the carrier plates 342 can include a pocket 354. In the illustrated embodiment, the off-axis projection 352 is at least partially positioned within the pocket 354 of one of the carrier plates 342. The off-axis projection 352 can contact the wall of the pocket 354 as it rotates about the open / close axis 350, thereby allowing the carrier plate 342 to rotate about the drive input axis 346. The off-axis projection 352 can be further rotated to a position where it does not contact the wall of the pocket 354. In this position, where the off-axis projection 352 is not contacting the pocket 354, the force applied by the roller 312 to the shaft of the medical instrument is determined entirely by the spring 330, which can be adjusted to provide the desired force as described above. In this position, the carrier plate 342 can be biased by the spring 330 to rotate to a position where the roller 312 is in the first or closed position. When the off-axis protrusions 352 are rotated to contact and press against the side walls of the pockets 354, the carrier plate 342 can rotate against the spring force of the springs 330. In some embodiments, the off-axis protrusions 352 comprise rollers configured to rotate about axes that are not coaxial with the open / close drive axis 350. Such rollers can reduce friction between the off-axis protrusions 352 and the pockets 354.

[0149] In the illustrated embodiment of FIG. 25A, the roller assembly 340 includes only one open / close drive shaft 348 and one off-axis projection 352. This is because the two carrier plates 342 are intermeshed together such that rotation of one carrier plate 342 causes a corresponding rotation of the other carrier plate 342 in the opposite direction, as best seen in FIGS. 25B-25D. In this manner, rotation of both carrier plates 342 can be driven by a single open / close drive input 338, as seen in FIG. 24C. This further facilitates symmetrical positioning of the rollers 312 with respect to the channel 310 of the drive 300. In the illustrated embodiment, although only one off-axis projection 352 is included, both carrier plates 342 include pockets 354, one of which is empty. The inclusion of the empty pocket can facilitate ease of manufacturing, as the same or similar molds can be used for each carrier plate 342. Additionally or alternatively, a second outer axis protrusion or other drive member can be used to rotate the other carrier plate independently, in which case there is no need to intermesh the two carrier plates together.

[0150] 25B and 25C are isometric and top views of the roller assembly 340 of FIG. 25A with portions of the roller 312 and carrier plate 342 removed for purposes of illustrating an embodiment of the gear assembly 335. As discussed above, the gear assembly 335 can transmit rotational motion between the roller drive input 334 (FIGS. 24C and 25C) and the roller 312 (FIGS. 24A, 24B, and 25A). As shown, the gear assembly 335 can include (at each carrier plate 342) a first gear 356 (e.g., a sun gear) and a second gear 358 (e.g., an orbital gear). In the illustrated embodiment, the first gear 356 is coupled to the roller drive input 332 such that rotation of the roller drive input 332 rotates the first gear 356. The first gear 356 is attached to the carrier plate 342 such that the first gear 356 can rotate relative to the carrier plate 342. The first gear 356 is rotatable about the drive input axis 346 (FIG. 25A).

[0151] In the illustrated embodiment, the first gear 356 is engaged with the second gear 358 such that rotation of the first gear 356 causes rotation of the second gear 358. The second gear 358 is attached to the carrier plate 342 such that the second gear 358 can rotate relative to the carrier plate 342. The second gear 358 can rotate about the roller axis 344 (FIG. 25A). Additionally, the second gear 358 is attached to (or otherwise engaged with) the roller 312 such that rotation of the second gear causes rotation of the roller 312. Thus, rotation of the roller drive input 332 can cause rotation of the roller 312 through transmission by the first gear 356 and the second gear 358.

[0152] As described above, the carrier plate 342 can rotate about the drive input axis 346 to move the rollers 312 between the first and second positions (closed and open positions). In the illustrated embodiment, the second gear 358 is attached to the carrier plate 342 at a location spaced from the drive input axis 346 such that the second / orbital gear 358 also rotates (with the carrier plate 342) about the drive input axis 346. As the second / orbital gear 358 rotates with the carrier plate 342 about the drive input axis 346, it also rotates about the first / sun gear 356.

[0153] This arrangement, with the second / orbital gear 358 rotating around the first / sun gear 356, can be seen in a top view in FIG. 25C. As shown in FIG. 25C, the off-axis projection 352 can be rotated into contact with the pocket 354 of the carrier plate 342 to drive the rotation of the carrier plate 342 in the direction indicated by the arrow in FIG. 25C. In particular, with respect to the orientation shown in the figure, the bottom of the carrier plate 342 can be rotated inwardly, toward the center of the page, and the top of the carrier plate 342 can be rotated outwardly, toward the outer edge of the page. The meshing portion 360 correspondingly rotates the other carrier plate 342 in the opposite direction. Each of the carrier plates 342 can rotate about a corresponding drive input axis 346. As the carrier plate 342 rotates, the second / orbital gear 358 is driven outwardly to rotate about the sun gear 356. This arrangement can be advantageous because it can drive rollers 312 (not shown in FIG. 25C, but coupled to second / orbital gear 358) regardless of the rotational position of carrier plate 342. This arrangement can accommodate, for example, instrument shafts having various diameters.

[0154] FIG. 25D is a bottom view of roller assembly 340 illustrating the relationship between roller drive input 334 and open / close drive input 338 of roller assembly 340 in accordance with one embodiment.

[0155] Figures 26A-27B illustrate various features of driver 300 in relation to cover 318, which is configured to retain or secure a shaft of a medical implement within channel 310 of driver 300. Figures 26A and 26B show top and side views of cover 318 in a closed position. Figures 26C and 26D show top and side views of cover 318 in an open position. Figures 27A and 27B show top and side views of driver 300 with an upper portion of housing 302 removed to further illustrate the features of cover 318.

[0156] 26A and 26B, the driver 300 can include a cover 318 that can be configured to close a portion of the channel 310 in a closed configuration as shown. When closed, the cover 318 can be configured to prevent the shaft of the medical instrument from lifting out of the channel 310. Similar to the proximal clip 314 and the distal clip 316 described above, the cover 318 can be configured to not restrict or not substantially restrict axial movement of the shaft of the instrument through the channel 310 when closed. For example, the cover 318 can be positioned above the shaft such that contact between the shaft and the cover 318 is limited. Similarly, the cover 318 can be configured to not restrict or not substantially restrict the ability of the shaft to pivot about its longitudinal axis within the channel 310.

[0157] Figure 26B includes arrows showing example directions that cover 318 can be moved to open it. Figures 26C and 26D show drive 300 with the cover in an open position. In the illustrated embodiment, cover 318 is a sliding or translating cover that facilitates a compact configuration of drive 300.

[0158] 27A and 27B illustrate an embodiment in which the cover 318 is mechanically coupled to one of the carrier plates 342 and one of the rollers 312 such that the cover 318 automatically opens and closes as the carrier plate 342 and roller 312 move between a first position and a second position. As shown, the cover 318 may comprise a plate positioned over one of the rollers 313. The cover 318 may include a slot 362 formed therein. The slot 362 may engage with a cam 364 extending from one of the rollers 312. In this example, as the roller 312 moves (e.g., as the carrier plate 342 rotates), the cam 364 engages the slot 362, causing a corresponding movement of the cover 318, opening and closing the cover 318 along with the movement of the roller 312.

[0159] In some embodiments, the cover 318 can be configured to move to an intermediate position between its open and closed positions. In the intermediate position, the cover 318 can still close the channel 310 so that the shaft of the medical instrument is retained. However, in the intermediate position, the rollers 312 are disengaged from the shaft of the medical instrument, allowing the shaft to slide or pivot freely within the channel 310. In some embodiments, this intermediate position of the cover 312 is used for various cases during a procedure where retention of the shaft is desired, but freer movement of the shaft relative to the driver is desired. In some embodiments where the position of the cover 318 is mechanically coupled to the position of the rollers 312 (e.g., as shown), the cover can be long enough to continue to close the channel 310 even when the rollers 312 are initially disengaged from the shaft. Then, as the rollers 312 continue to move away from the shaft, the cover 318 can continue to move and uncover the channel 310. In other embodiments, the position of the cover 318 can be controlled in a different manner. For example, the cover 318 may not be mechanically coupled to the rollers 312. In some embodiments, the cover 318 is independently controlled or not mechanically coupled to the rollers 312, in which case the fully open, fully closed, or any other intermediate position of the cover may be controlled by a separate drive input. Additionally, while the illustrated embodiment utilizes a cam mechanism to open and close the sliding or translating cover, other mechanisms may be used to form an operable connection between the drive input and the cover. Additionally or alternatively, the cover may be a pivoting cover or may be actuated to open and close by other motions.

[0160] FIG. 28 is a top view of the driver 300 with the top of the housing 302 removed to illustrate one embodiment of a sensor 366 that can be included to detect attachment of the device. In some embodiments, the sensor 366 can comprise a magnet. The magnet can be positioned so that it is detectable by a corresponding sensor (such as a Hall effect sensor) in the instrument drive mechanism to which the driver 300 is attached. The sensor 366 can be used to detect when the driver 300 is engaged with the instrument drive mechanism. In some embodiments, the sensor can be used to set the position of the cover 318 and / or rollers 312 when the driver 300 is attached to the instrument drive mechanism. For example, when the driver 300 is connected to the instrument drive mechanism, the sensor can provide a signal indicating that the device is attached. This can trigger the system to open the cover 318 and / or rollers 312 so that the shaft of the medical instrument can be loaded into the device. Although a magnet is described as the sensor 366, other types of sensors can be used, such as any proximity detection technology. Also, the number and location of the sensors 366 can be different than those shown in FIG. 28.

[0161] 29A-29C are top, bottom, and front views of the drive 300 with one embodiment of a locking mechanism or locking tab 368 installed. In some embodiments, the locking tab 368 can be configured for use during shipping and / or storage of the drive 300. The locking tab 368 can be configured to separate the rollers 312 so that they do not contact one another, which may cause the rollers 312 to deform over time. The locking tab 368 can be configured to hold the rollers 312 in the second (or open) position against the bias of the spring 330. In some embodiments, the locking tab interacts with the carrier plate 342 to hold the rollers 312 apart. As best seen in FIG. 29C, the locking tab 368 can be inserted into a locking tab slot 370 in the front of the device. The locking tab 368 is removed when the drive is in use.

[0162] C. Axial Drive and System Operation 30A-33 illustrate an exemplary control method and associated parameters and states of the drive that can be used to control the axial drive system.

[0163] Figures 30A and 30B illustrate a method 900 for controlling the actuator 300 in various operating states. Figure 30A is a flow chart illustrating the method 900, and Figure 30B illustrates a cross section of the actuator 300 in various states. The method 900 is described in the context of a system 200 (Figures 21-22) in which the medical instrument 210 is supported and controlled by a first robotic arm 202 and the actuator 300 is supported and controlled by a second robotic arm 204, although it will be appreciated that the actuator 300 may be robotically or electronically controlled using other architectures.

[0164] At block 905, the driver 300 is actuated to a fully closed state in which the cover 318 is closed and the rollers 312 are engaged with the instrument shaft 220. In this state, a robotic arm or instrument driver controlling the driver 300 can be configured to actuate the rollers 312 to drive axial movement of the shaft 220. The driver 300 can actuate the rollers 312 in either direction relative to the shaft 220 based on commands or control signals received from a processor to insert or retract the shaft 220. The cover 318 remains closed in this state and helps to retain the shaft 220 within the channel, for example, preventing the rollers from ejecting the shaft upwards and sideways out of the channel.

[0165] At block 910, the driver 300 is actuated to an intermediate or partially closed state in which the cover 318 is closed but the rollers 312 are disengaged from the instrument shaft 220. This state provides freedom of movement of the elongated shaft 220 independent of the rollers 312 while still allowing the shaft 220 to remain loaded into the driver 300.

[0166] A robotic arm or instrument driver controlling the drive 300 can be configured to actuate the drive 300 to an intermediate state based on commands or control signals received from the processor to pivot the instrument shaft 220. Such movement can also be facilitated by coordinated movement of the first and second robotic arms. For example, in response to a pivot command, the second robotic arm can actuate the drive 300 to an intermediate state and the first robotic arm can rotate the elongated shaft 220 about its longitudinal axis. The first robotic arm can rotate the elongated shaft 220 about its longitudinal axis using any suitable technique, such as movement of a pivot mechanism with a medical instrument, rotation of the first robotic arm, or rotation of an instrument driver at the end of the robotic arm.

[0167] Alternatively, or in combination, the robotic arm or instrument driver controlling the actuator 300 can be configured to actuate the actuator 300 to an intermediate state based on commands or control signals received from a processor to move the robotic arm holding the actuator 300. For example, the second robotic arm 204 can have an admittance mode or a manual arm operation mode in which the arm can be repositioned. If the robotic arm is coupled to an access sheath, this mode can be used to reposition the access sheath within the patient or to move the access sheath relative to the instrument shaft by disengaging the rollers 312 to allow the shaft 220 to slide freely independent of the rollers 312.

[0168] To actuate the drive 300 to an intermediate state, the robotic arm controlling the drive 300 can be configured to not move the carrier plate completely, but to partially rotate the open / close drive input to pivot the carrier plate and disengage the rollers 312 from the shaft 220 such that the cover 318 holds the channel closed. Alternatively, the cover 318 can be controlled independently as previously described.

[0169] In block 915, the driver 300 is actuated to a fully open state, in which the cover 318 is open and the rollers 312 are disengaged from the instrument shaft 220. This state may allow the instrument shaft 220 to be easily loaded or removed laterally from the channel. The robotic arm or instrument driver controlling the driver 300 may be configured to actuate the driver 300 to the fully open state based on a command or control signal received from the processor to load or unload the instrument shaft 220. This may be done, for example, based on a user inputting this command or a command based on detecting the attachment of the driver 300 (e.g., using a magnet in the driver).

[0170] Figure 31 is a schematic diagram of an axial drive system in various states of fast or slow drive, Figure 32 is a flow chart showing an exemplary process for transitioning between fast or slow drive speeds in an axial drive system, and Figure 33 is an illustration of several parameters that may be utilized by a robotic system to automatically determine whether to transition between fast or slow axial drive speeds in the insertion or retraction of an elongate shaft.

[0171] Referring to FIG. 31, an exemplary motion sequence of the drive unit 300 and medical instrument 210 is depicted that may include coordinated operation of the drive unit 300 and movement of the instrument base 212 using the first robotic arm 202 and the second robotic arm 204 (FIGS. 21-22).

[0172] From step (a) to step (b), the instrument shaft 220 is rotated for a period t 1 Distance or path length d between 1 The drive unit 300 is operated in coordination with the moving tool base 212 to retract the shaft at a slower speed by a shaft retraction distance d 1 Distance d is substantially the same as 2 The first robotic arm 202 (FIGS. 21-22) can be retracted proximally or away from the driver 300 to move the instrument base 212 by only 100 mm. During this time, therefore, no service loops are created or enlarged in the portion of the shaft 220 between the driver 300 and the instrument base 212, and the shaft 220 moves in a direction that is consistent with the change in distance of the distal tip of the shaft over time, d. 1 / t 1 During the slow motion period, the driver 300 can optionally be disengaged from the shaft 220 and axial motion of the shaft 220 can be accomplished by movement of the instrument base 212 or first robotic arm only, however, coordinating the movement of the instrument base 212 and first robotic arm 202 with the operation of the driver 300 can help mitigate shaft buckling by maintaining a generally taut portion of the instrument shaft 220 between the driver 300 and the instrument base 212.

[0173] From step (b) to step (c), the instrument shaft 220 is rotated for a period t 2 Distance or path length d between 3 The driver 300 is operated in coordination with the movement of the instrument base 212 to retract the shaft at a faster rate by d 3 Distance d is smaller than 4The first robotic arm 202 (FIGS. 21-22) can be retracted proximally or away from the driver 300 to move the instrument base 212 by 100 rpm, and thus the instrument shaft 220 is retracted at a rate that is faster than the rate of movement of the instrument base 210 or first robotic arm. By operating the driver 300 to retract the instrument shaft at this faster retraction rate, a service loop 226 is created or enlarged to provide a greater degree of freedom of axial movement that is not constrained by the movement or articulation capabilities of the first robotic arm, or other movable supports of the instrument base 212. Thus, during this period, a service loop is created or enlarged in the portion of the shaft 220 between the driver 300 and the instrument base 212, and the shaft 220 moves in a direction that is proportional to the change in distance of the distal tip of the shaft over time, d. 3 / t 2 The instrument base 212 is driven (retracted) at a fast axial motion rate that can be defined by: The instrument base 212 may optionally remain stationary during this fast rate of movement, but coordinating the movement of the instrument base 212 and first robotic arm 202 with the operation of the driver 300 may also help to mitigate sharp bends in the instrument shaft 220 that may be formed by rapidly creating or enlarging the service loop 226 without increasing the distance between the instrument base 212 and the driver 300.

[0174] The sequence (a)-(c) shown in FIG. 31 illustrates a transition from slow to fast axial motion during retraction of the shaft 220, where a service loop 226 is created or expanded and slack is introduced into the shaft 220. When inserting the shaft 220, the sequence can generally be reversed, transitioning from fast to slow insertion axial motion. For example, during insertion, the service loop 226 can be contracted or slack taken up by the driver 300 during fast insertion. The instrument base 212 or first robotic arm 202 can be moved distally or toward the driver in coordination with the motion of the driver. The system can then transition to a slow insertion speed where the service loop is eliminated or slack is taken up completely or the shaft 220 is inserted at or below the speed of movement of the instrument base 212 or first robotic arm 202.

[0175] It should be understood that the shaft 220 may follow a tortuous path within a patient's lumen or anatomy, and thus the distance in these examples is defined by the variations along the tortuous path or curved length of the shaft, and not necessarily the straight line distance connecting the distal tip between two locations. Thus, the distance may be defined by the length of the path traveled by the shaft. Similarly, the distance of the robotic arm or instrument base 212 may refer to the path length traveled by the robotic arm or instrument base.

[0176] 32 and 33 illustrate one embodiment of a method 1000 for controlling axial motion of a shaft using a robotic axial drive system, and related parameters associated with the method. Method 1000, and any other methods described herein, may be performed by a processor of a robotic system executing instructions stored on a computer readable medium that, when executed, controls components of the robotic system (such as an arm, an instrument driver, and / or a scope) to perform the method.

[0177] 32, the method 1000 includes detecting whether the distal tip of the shaft 220 is positioned within the access sheath 250 at block 1005. As described herein, the access sheath 250 can provide a conduit through which the shaft 220 can be inserted, and the access sheath 250 can protect patient tissue such that the shaft 220 can be safely inserted at a fast insertion speed. Thus, at block 1010, based on detecting that the distal tip is within the safety zone of the access sheath 250, the system drives the shaft axially (e.g., inserts or retracts the shaft) at a fast axial motion speed. At block 1015, based on detecting that the distal tip is outside the safety zone of the access sheath 250, e.g., beyond the distal end of the access sheath, the system drives the shaft axially (e.g., inserts or retracts the shaft) at a slower axial motion speed.

[0178] FIGURE 33 illustrates an example of information that the system can use to define a safety zone within the access sheath 250 and automatically detect whether the current position of the distal tip of the shaft is inside or outside the access sheath. As seen in FIGURE 33, various geometric information associated with components of the system can be used to detect the current position of the shaft 220 relative to the access sheath 250 and to determine the drive speed of the axial motion of the shaft 220. Such geometric information can include, for example, the length l of the shaft 220 of the instrument 210. shaft , length of access sheath 250 l sheath , and / or the robot's location information d arm Here, the location information d armincludes the distance between the distal ends of the first and second robotic arms 202 and 204, which corresponds to the distance between the distal drive 300 and the instrument base 210. Position information for the robotic arms 202, 204 can be determined based on kinematic information associated with each arm, such as, for example, encoder information captured at a series of joints in the arms. The lengths of the shaft 220 and sheath 250 can each be determined based on, for example, user-input information (e.g., a length or type of tool entered by the user), known or stored information defining the length of the tool, and / or automatic identification of the tool or tool length (which can be detected and associated with the tool when the tool is attached to the robotic system). Additionally or alternatively, robot driver information, such as encoder data for a drive output associated with the second robotic arm 204 that holds the drive 300, can be used to determine the position of the shaft.

[0179] In an example where shaft 220 is engaged with driver 300, instrument base 210 is attached to a first robotic arm 202, driver 300 is attached to a second robotic arm 204, and shaft 220 is held between the arms with no service loop present therebetween, the location of the distal tip of shaft 220 is determined by the length l of shaft 220. shaft Location information from arm The result is the length l of the access sheath 250. sheath If it is greater than 1, the system can detect that the distal tip is beyond the access sheath 250 and that the shaft 220 should be driven using a slow axial motion. sheath If it is less than (optionally with sufficient predefined tolerance), the system can detect that the distal tip is within the access sheath 250 and that the shaft 220 should or can be driven using fast axial motion.

[0180] It will be appreciated that this is an illustrative example and that other types of geometric or robotic information may be used to automatically detect the position of the shaft. For example, in some embodiments, image information captured by the medical instrument 210 (e.g., visual data from the tip of an endoscope) may be processed and analyzed to determine whether the captured image data corresponds to inside or outside the sheath. Such image information may be used alone or in combination with the geometric information described above. Additionally or alternatively, the system may use data captured from other types of sensors.

[0181] It should also be appreciated that detection of the position of the shaft relative to the access sheath may be used as a condition on which the drive speed is based. In some embodiments, the position of the shaft relative to the access sheath may not be the only condition for determining the drive speed, or may not be a sufficient condition for determining whether to transition to a faster or slower drive speed. For example, the system may employ other conditions to provide safety or to provide optimal availability or control of the axial drive speed.

[0182] It should also be understood that the fast or slow axial motion speeds described herein can encompass a range of speeds, and the speed of the axial motion may vary within the fast or slow axial motion range. Thus, fast axial motion does not necessarily refer to a single speed, but can encompass a range of different speeds, where the fast axial motion speed is faster than the slow axial motion speed, and the fast axial motion allows the drive system to expand or contract the service loop of the shaft. Similarly, slow axial motion does not necessarily refer to a single speed, but can encompass a range of different speeds, where the slow axial motion speed is slower than the fast axial motion speed.

[0183] 3. Mounting system and terminology Implementations disclosed herein provide systems, methods, and devices for driving axial movement of an elongated or flexible shaft of a medical instrument.

[0184] It should be noted that, as used herein, the terms "couple," "coupled," "coupled," or other variations of the word couple, may indicate either an indirect connection or a direct connection. For example, when a first component is "coupled" to a second component, the first component may be either indirectly connected to the second component through another component, or directly connected to the second component.

[0185] Phrases referring to certain computer-implemented processes and functions described herein may be stored as a processor-readable medium or one or more instructions on a computer-readable medium. The term "computer-readable medium" refers to any available medium that can be accessed by a computer or processor. By way of example, and not limitation, such media may include random access memory (RAM), read-only memory (ROM), electrically erasable programmable read-only memory (EEPROM), flash memory, compact disc read-only memory (CD-ROM), or other optical disk storage, magnetic disk storage, or other magnetic storage devices, or any other medium that can be used to store desired program code in the form of instructions or data structures and that can be accessed by a computer. It should be noted that computer-readable media may be tangible and non-transitory. As used herein, the term "code" may refer to software, instructions, code, or data that is executable by a computing device or processor.

[0186] The methods disclosed herein include one or more steps or acts for achieving the described method. Method steps and / or acts may be interchanged with one another without departing from the scope of the claims. In other words, unless a specific order of steps or acts is required for the proper operation of the described method, the order and / or use of specific steps and / or acts may be modified without departing from the scope of the claims.

[0187] As used herein, the term "plurality" refers to two or more. For example, a plurality of components refers to two or more components. The term "determining" encompasses a wide variety of acts, and thus "determining" can include calculating, computing, processing, calculating, investigating, looking up (e.g., looking in a table, database, or another data structure), ascertaining, and the like. "Determining" can also include receiving (e.g., receiving information), accessing (e.g., accessing data in a memory), and the like. "Determining" can also include resolving, selecting, choosing, establishing, and the like.

[0188] The phrase "based on" does not mean "based only on," unless expressly specified otherwise. In other words, the phrase "based on" describes both "based only on" and "based at least on."

[0189] The foregoing description of the disclosed implementations is provided to enable any person skilled in the art to make or use the present invention. Various modifications to these implementations will be readily apparent to those skilled in the art, and the general principles defined herein may be applied to other implementations without departing from the scope of the present invention. For example, those skilled in the art will recognize that many corresponding alternative and equivalent structural details may be employed, such as equivalent methods of fastening, mounting, coupling, or engaging tool components, equivalent mechanisms for producing specific actuation motions, and equivalent mechanisms for delivering electrical energy. Thus, the present invention is not intended to be limited to the implementations shown herein, but is to be accorded the widest scope consistent with the principles and novel features disclosed herein.

[0190] [Embodiment] (1) A robotic medical system, comprising: a medical instrument including an instrument base and an elongate shaft configured for insertion into a patient; a first robotic arm, the instrument base of the medical instrument attached to the first robotic arm, the first robotic arm being articulatable to move the instrument base; a second robotic arm; and a driver attached to the second robotic arm and distal to the instrument base, the driver configured to engage the elongate shaft of the medical instrument and drive axial movement of the elongate shaft; a processor, during a first period of axial movement, a processor configured to drive, by the driver, axial motion of the elongate shaft of the medical instrument at a first axial motion speed greater than a movement speed of the first robotic arm. (2) The system of embodiment 1, wherein during the first axial movement period, a portion of the elongate shaft of the medical instrument between the instrument base and the driver has a length greater than a distance between the instrument base and the driver, and the portion of the elongate shaft forms a service loop. (3) The system of embodiment 2, wherein during the first period of axial movement, a rate of change of the length of the service loop is greater than a rate of change of the distance between the instrument base and the drive device. (4) The system of embodiment 1, wherein the axial movement includes at least one of retraction or insertion of the elongate shaft. (5) The system of embodiment 1, wherein the processor is configured to drive axial motion of the elongate shaft at the first axial motion speed when a distal tip of the elongate shaft is positioned within an access sheath.

[0191] (6) The processor: The system of embodiment 1, wherein during a second axial movement period, the drive device is configured to drive the axial movement of the elongated shaft of the medical instrument at a second axial movement speed that is less than or equal to the movement speed of the first robotic arm. (7) The system of embodiment 6, wherein during the second axial movement period, a portion of the elongate shaft of the medical instrument between the instrument base and the driver has a length substantially equal to the distance between the instrument base and the driver, and the portion of the elongate shaft does not form a service loop. (8) The system of embodiment 6, wherein during the second period of axial motion, a portion of the elongate shaft of the medical instrument between the instrument base and the driver has a length greater than a distance between the instrument base and the driver, and the portion of the elongate shaft forms a service loop. (9) The system of embodiment 6, wherein during the second period of axial movement, the rate of change of the length is less than or equal to the rate of change of the distance between the instrument base and the driver. (10) The system of embodiment 6, wherein the processor is configured to drive axial motion of the elongate shaft at the second axial motion speed when a distal tip of the elongate shaft is positioned beyond an access sheath.

[0192] (11) The driver is configured to be attached to an access sheath configured to be inserted into the patient; 2. The system of claim 1, wherein the elongated shaft is configured to be inserted through the access sheath and into the patient. (12) The system of embodiment 11, wherein the driver includes a clip configured to be attached to the proximal end of the access sheath. (13) The drive device comprises: withdrawing the distal tip of the elongate shaft from the proximal end of the access sheath; 12. The system of claim 11, further comprising: a distal tip of the elongate shaft that is adapted to reinsert the distal tip into the proximal end of the access sheath. (14) The system of embodiment 1, further comprising an instrument driver having a plurality of drive outputs positioned at a distal end of the second robotic arm, the driver having a plurality of drive inputs configured to engage the plurality of drive outputs of the instrument driver. (15) The system of claim 14, further comprising a sterile adapter positioned between the instrument driver and the actuator.

[0193] (16) The system of claim 1, wherein the drive comprises a pair of opposed rollers configured to drive axial movement of the elongated shaft. (17) The drive device comprises: a body including a channel configured to receive the elongate shaft of the medical instrument; a roller configured to engage the elongate shaft, the second robotic arm configured to rotate the roller to drive axial movement of the elongate shaft received in the channel; The system of embodiment 1, comprising: a pivotable carrier supporting the roller, the second robot arm configured to pivot the carrier to selectively engage or disengage the roller from the elongated shaft. (18) upon receiving a pivot command to pivot the elongated shaft, the processor: causing the first robotic arm to rotate the elongate shaft about a longitudinal axis of the elongate shaft; 2. The system of claim 1, configured to cause the second robotic arm to disengage the drive unit from the elongated shaft. (19) A robotic medical system, comprising: a medical instrument including an instrument base and a flexible shaft configured for insertion into a patient; a first robotic arm attachable to the instrument base of the medical instrument; a driver configured to engage the flexible shaft; and a second robot arm attachable to the drive unit, the second robotic arm is configured to operate the drive to drive axial movement of the flexible shaft; A robotic medical system, wherein the first robotic arm is configured to move in coordination with the operation of the drive unit. (20) The robotic medical system of embodiment 19, wherein the second robot arm is configured to disengage the drive unit from the flexible shaft while retaining the flexible shaft within the drive unit with a robotically actuated cover.

[0194] (21) The robotic medical system of embodiment 19, wherein the second robot arm is configured to control the speed of the axial movement based on the position of the tip of the flexible shaft relative to an access sheath. (22) The robotic medical system of embodiment 19, wherein the second robotic arm is configured to expand or contract a service loop in a portion of the flexible shaft between the first robotic arm and the second robotic arm. (23) The robotic medical system of embodiment 19, wherein the medical instrument is an endoscope. (24) A robotic medical system, comprising: a first robotic arm configured to support an instrument base of a medical instrument, the medical instrument comprising an elongated shaft extending from the instrument base; a second robotic arm configured to operate one or more rollers engageable with the elongate shaft to drive axial movement of the elongate shaft. (25) The robotic medical system of embodiment 24, wherein the one or more rollers include a pair of opposing rollers of a drive mounted to the second robot arm and configured to drive axial motion of the flexible shaft.

[0195] (26) The robotic medical system of embodiment 25, wherein the second robot arm is configured to disengage the drive unit from the flexible shaft and retain the flexible shaft within the drive unit with a robotically actuated cover. (27) A method comprising the steps of: supporting an instrument base of a medical instrument by a first robotic arm; Driving axial movement of an elongate shaft of the medical instrument with a second robotic arm; and moving the first robotic arm in coordination with driving the axial motion. (28) The method of embodiment 27, wherein driving the axial motion includes moving a pair of opposing rollers by the second robotic arm. (29) The method of embodiment 27, wherein the first robotic arm moves at a slower speed than the axial motion of the elongated shaft. (30) The method of embodiment 27, wherein the second robotic arm is configured to disengage the drive from the elongated shaft while retaining the elongated shaft within the drive by a robotically actuated cover.

[0196] (31) A drive device configured to facilitate axial movement of an elongated shaft of a medical instrument, the drive device comprising: a housing including a lower surface configured for attachment to a robotic arm and an upper surface having a channel formed therein, the channel configured to receive the elongate shaft of the medical instrument; a first roller positioned within the housing on a first side relative to the channel; a second roller positioned within the housing on a second side relative to the channel; the first roller and the second roller are movable between a first position and a second position; In the first position, the first roller and the second roller are configured to engage the elongated shaft, and when rotated in a first direction, the first roller and the second roller drive the insertion of the elongated shaft, and when rotated in a second direction, the first roller and the second roller drive the retraction of the elongated shaft; In the second position, the first roller and the second roller are spaced apart from the elongated shaft. (32) a proximal clip positioned at a proximal end of the channel; a distal clip positioned at a distal end of the channel, 32. The device of embodiment 31, wherein the proximal clip and the distal clip are configured to retain the elongate shaft within the channel. (33) The apparatus of embodiment 31, further comprising a cover operable to close the channel when the first roller and the second roller are in the first position and to open the channel when the first roller and the second roller are in the second position. (34) The apparatus of embodiment 33, wherein movement of the cover is mechanically coupled to movement of one of the first roller and the second roller such that the cover opens and closes as the first roller and the second roller move between the second position and the first position. (35) The apparatus of embodiment 33, wherein at an intermediate position between the first position and the second position, the cover remains closed and the first roller and the second roller are disengaged from the elongated shaft.

[0197] (36) The device of embodiment 31, further comprising a collector distal to the channel for depositing matter retrieved from within the patient using the medical instrument. (37) The device of embodiment 31, further comprising a clip configured to support the proximal end of the access sheath. (38) The device of claim 37, further comprising a space between the clip and the channel for depositing matter retrieved from within the patient using the medical instrument. (39) A first spring positioned within the housing and configured to bias the first roller toward the first position; 32. The apparatus of claim 31, further comprising: a second spring positioned within the housing and configured to bias the second roller toward the first position. (40) The apparatus of embodiment 39, wherein the first spring and the second spring comprise torsion springs.

[0198] (41) A first carrier plate positioned within the housing and configured to rotate about a first axis, the first roller being attached to the first carrier plate, and rotation of the first carrier plate moving the first roller between the first position and the second position; and The apparatus of embodiment 31, further comprising: a second carrier plate positioned within the housing and configured to rotate about a second axis, the second roller being attached to the second carrier plate, and rotation of the second carrier plate moving the second roller between the first position and the second position. (42) A first roller drive input located on the lower surface of the housing; a first gear mounted to the first carrier plate and driven by the first roller drive input; a first orbital gear attached to the first carrier plate and driven by the first gear, the rotation of the first orbital gear driving the rotation of the first roller; a second roller drive input located on the lower surface of the housing; and a second gear mounted to the second carrier plate and driven by the second roller drive input; 42. The apparatus of claim 41, further comprising: a second orbital gear attached to the second carrier plate and driven by the second gear, wherein rotation of the second orbital gear drives rotation of the second roller. (43) The first axis about which the first carrier plate rotates is coaxial with the axis of the first roller input portion, 43. The apparatus of claim 42, wherein the second axis about which the second carrier plate rotates is coaxial with the axis of the second roller input portion. (44) The apparatus of embodiment 43, wherein the first carrier plate and the second carrier plate are intermeshed with each other such that rotation of one of the first carrier plate and the second carrier plate causes rotation of the other of the first carrier plate and the second carrier plate. (45) The apparatus of embodiment 44, further comprising a carrier plate rotational drive input configured to rotate one of the first carrier plate or the second carrier plate.

[0199] (46) The apparatus of claim 45, further comprising an off-axis protrusion coupled to the rotational drive input and configured to contact a pocket in the carrier plate to cause rotation of the first carrier plate. (47) A drive device configured to facilitate axial movement of an elongated shaft of a medical instrument, the drive device comprising: a body including a channel configured to receive the elongate shaft of the medical instrument; a roller configured to engage the elongate shaft, the roller, when rotated, driving axial movement of the elongate shaft received within the channel; a first drive input coupled to the body, the first drive input operable by a robotic system to rotate the roller; and a cover configured to selectively open or close the channel; a second drive input coupled to the body, the second drive input operable to actuate the cover. (48) The drive device of embodiment 47, wherein the second drive input is operable to actuate the cover between a first position in which the cover retains the elongated shaft within the channel and a second position in which the cover allows loading or unloading of the elongated shaft within the channel. (49) The drive device of embodiment 47, further comprising a carrier supporting the roller, the carrier being pivotable by a drive input coupled to the body to engage and disengage the elongated shaft received within the channel. (50) The drive device of embodiment 47, wherein the body is configured to be attached to the access sheath so as to align the channel with the access sheath.

[0200] (51) The drive device of embodiment 47, wherein the second drive input is operably connected to the cover via a cam. (52) The drive device of embodiment 47, further comprising one or more clips in the channel. (53) The drive device according to embodiment 47, wherein the roller is a first roller, and the drive device further comprises a second roller opposed to the first roller. (54) A robotic medical system, comprising: a drive device including a channel configured to receive an elongated shaft, one or more rollers configured to engage the elongated shaft received in the channel, and a cover configured to selectively close or open the channel; A driver, operating the drive device to a first condition in which the one or more rollers are disengaged from the elongated shaft and the cover is open; operating the drive to a second condition in which the one or more rollers are disengaged from the elongated shaft and the cover is closed; and and a driver configured to actuate the drive device to a third state in which the one or more rollers are engaged with the elongate shaft and the cover is closed. (55) The system of embodiment 54, wherein the driver is configured to actuate the actuator to the first state based on a command to load or unload the elongated shaft.

[0201] (56) The system of embodiment 54, wherein the driver is configured to actuate the actuator to the second state based on a command to pivot the elongated shaft. (57) The system of embodiment 54, wherein the driver is disposed at an end of a robot arm, and the driver is configured to actuate the drive unit to the second state based on a command to move the robot arm. (58) The system of embodiment 54, wherein the driver is configured to actuate the actuator to the third state to insert or retract the elongate shaft. (59) The system of embodiment 54, wherein the driver is configured to operate a first drive input of the drive device to rotate the roller relative to the elongated shaft and to operate a second drive input of the drive device to disengage the roller from the elongated shaft. (60) A method of robotic medical procedure, the method comprising: driving, with a driver, an insertion of a flexible shaft of a medical instrument at a first speed during a first insertion period during which a distal tip of the flexible shaft is positioned within an access sheath inserted into a patient; and transitioning, during a second insertion period during which the distal tip of the flexible shaft is positioned beyond the distal tip of the access sheath, to driving, by the driver, insertion of the flexible shaft of the medical instrument at a second speed slower than the first speed.

[0202] (61) The method of embodiment 60, wherein transitioning to driving the insertion of the flexible shaft of the medical instrument at the second speed by the driver includes automatically detecting when the distal tip of the flexible shaft is positioned beyond the distal tip of the access sheath. (62) driving the retraction of the flexible shaft of the medical instrument at a third speed with the driver during a first retraction period during which the distal tip of the flexible shaft is positioned beyond the distal tip of the access sheath; 61. The method of embodiment 60, further comprising automatically transitioning the driver to drive the retraction of the flexible shaft of the medical instrument at a fourth speed faster than the third speed during a second retraction period during which the distal tip of the flexible shaft is positioned within the access sheath. (63) The method of embodiment 62, wherein automatically transitioning to driving the retraction of the flexible shaft of the medical instrument at the fourth speed by the driver includes detecting when the distal tip of the flexible shaft is positioned within the access sheath. (64) attaching an instrument base of the medical instrument to a first robotic arm; Attaching the drive to a second robot arm; 61. The method of embodiment 60, further comprising engaging the flexible shaft of the medical instrument with the driver. 65. The method of claim 64, wherein engaging the flexible shaft of the medical instrument with the driver includes engaging opposing rollers of the driver with the flexible shaft.

[0203] (66) The method of embodiment 65, wherein engaging the flexible shaft of the medical instrument with the driver further comprises inserting the flexible shaft into a channel in a top surface of the driver. (67) moving the instrument base toward the driver by the first robotic arm during insertion; 65. The method of embodiment 64, further comprising: during retraction, moving the instrument base by the first robotic arm in a direction away from the driver. (68) A robotic medical system, comprising: a drive device including a pair of rollers configured to engage a shaft of the medical instrument; 1. A processor comprising: operating the rollers to drive insertion of the shaft at a first speed during a first insertion period during which a distal tip of the shaft is positioned within an access sheath inserted into a patient; and during a second insertion period during which the distal tip of the shaft is positioned beyond the distal tip of the access sheath, operating the rollers to drive insertion of the shaft at a second speed slower than the first speed. (69) The robotic medical system of embodiment 68, wherein the processor is configured to detect when the distal tip of the shaft is positioned beyond the distal tip of the access sheath based on geometric information associated with the access sheath and the shaft. (70) The robotic medical system of embodiment 68, wherein the processor is configured to detect when the distal tip of the shaft is positioned beyond the distal tip of the access sheath based on image information obtained by the medical instrument.

[0204] (71) The processor, operating the rollers to drive retraction of the shaft of the medical instrument at a third speed during a first retraction period during which the distal tip of the shaft is positioned beyond the distal tip of the access sheath; 69. The robotic medical system of embodiment 68, further configured to operate the rollers to drive retraction of the shaft of the medical instrument at a fourth speed faster than the third speed during a second retraction period during which the distal tip of the shaft is positioned within the access sheath. (72) A first robotic arm configured to support the medical instrument; The robotic medical system of embodiment 68, further comprising a second robotic arm configured to support the drive unit. (73) The first robotic arm is configured to move an instrument handle of the medical instrument toward the driver during insertion; A robotic medical system as described in embodiment 72, wherein the first robotic arm is configured to move the instrument handle away from the drive unit during retraction. (74) A robotic medical system, comprising: an elongated flexible access sheath; a medical instrument including an elongated flexible shaft; 1. A processor comprising: driving insertion of the shaft at a first speed during a first insertion period during which a distal tip of the shaft is positioned within the access sheath; and transitioning insertion of the shaft to be driven at a second speed slower than the first speed during a second insertion period based on a position of the distal tip of the shaft relative to the access sheath. (75) The robotic medical system of embodiment 74, wherein the processor is configured to detect when the distal tip of the shaft is positioned beyond the distal tip of the access sheath based on geometric information associated with the access sheath and the shaft.

[0205] (76) The robotic medical system of embodiment 74, wherein the processor is configured to detect when the distal tip of the shaft is positioned beyond the distal tip of the access sheath based on image information obtained by the medical instrument. (77) The processor, driving retraction of the shaft of the medical instrument at a third speed during a first retraction period during which the distal tip of the shaft is positioned beyond the distal tip of the access sheath; The robotic medical system of embodiment 74, further configured to transition to driving retraction of the shaft of the medical instrument at a fourth speed faster than the third speed during a second retraction period during which the distal tip of the shaft is positioned within the access sheath. (78) The processor, operating a drive to drive axial movement of the elongated flexible shaft; moving an instrument handle of the medical instrument toward the driver during insertion; 75. The robotic medical system of embodiment 74, configured to move the instrument handle away from the drive unit during retraction.

Claims

1. 1. A robotic medical system, comprising: a medical instrument including an instrument base, an elongate shaft having a proximal portion connected to the instrument base and a distal end, the elongate shaft configured for insertion into a patient; a first robotic arm, the instrument base of the medical instrument attached to a mounting portion of the first robotic arm, the mounting portion of the first robotic arm being movable in a retraction direction such that the mounting portion of the first robotic arm to which the instrument base of the medical instrument is attached moves the instrument base in the retraction direction away from a patient; a second robotic arm; and a driver attached to the second robotic arm and distal to the instrument base, the driver configured to engage the elongate shaft of the medical instrument and drive movement of the elongate shaft in the rearward direction; and a processor; 11. A robotic medical system comprising: a medical instrument including a first robot arm and a drive unit attached to the second robot arm; and a processor configured to control, with the instrument base of the medical instrument attached to the mount of the first robot arm and the drive unit attached to the second robot arm, the mount of the first robot arm to which the instrument base of the medical instrument is attached to move in the retraction direction during a first period of time; and the processor configured to drive, with the drive unit, the movement of the elongate shaft of the medical instrument in the retraction direction at a first movement speed that is greater than a movement speed of the mount of the first robot arm to which the instrument base of the medical instrument is attached in the retraction direction, whereby a portion of the elongate shaft of the medical instrument between the instrument base and the drive unit has a length that is greater than a distance between the instrument base and the drive unit, and the portion of the elongate shaft forms a service loop.

2. 1. A robotic medical system, comprising: a medical instrument including an instrument base, an elongate shaft having a proximal portion connected to the instrument base and a distal end, the elongate shaft configured for insertion into a patient; a first robotic arm, the instrument base of the medical instrument attached to a mounting portion of the first robotic arm, the mounting portion of the first robotic arm being movable in an insertion direction such that the mounting portion of the first robotic arm to which the instrument base of the medical instrument is attached moves the instrument base in the insertion direction into a patient; a second robotic arm; and a driver attached to the second robotic arm and distal to the instrument base, the driver configured to engage the elongate shaft of the medical instrument and drive movement of the elongate shaft in the insertion direction; and a processor; 11. A robotic medical system comprising: a medical instrument actuator configured to move a medical instrument in a direction parallel to the axis of the actuator; a first actuator configured to move the medical instrument in a direction parallel to the axis of the actuator; a drive unit configured to drive the drive unit to move the medical instrument in the direction parallel to the axis of the actuator; a second actuator configured to drive the drive unit to move the medical instrument in the direction parallel to the axis of the actuator; a drive unit configured to drive the drive unit to move the medical instrument in the direction parallel to the axis of the actuator;

3. 2. The robotic medical system of claim 1, wherein the processor is configured to drive the movement of the elongate shaft in the rearward direction at the first movement rate by the driver when the distal end of the elongate shaft is positioned within an access sheath.

4. 3. The robotic medical system of claim 2, wherein the processor is configured to drive, by the driver, movement of the elongate shaft in the insertion direction at the second movement speed when the distal end of the elongate shaft is positioned within an access sheath.

5. 2. The robotic medical system of claim 1, wherein during a third time period prior to the first time period, with the instrument base of the medical instrument attached to the mounting of the first robotic arm and the driver attached to the second robotic arm, the processor controls such that the mounting of the first robotic arm to which the instrument base of the medical instrument is attached moves in the retraction direction, and the processor is configured to drive, by the driver, the movement of the elongate shaft of the medical instrument in the retraction direction at a third movement speed that is the same as the movement speed of the mounting of the first robotic arm to which the instrument base of the medical instrument is attached in the retraction direction.

6. 3. The robotic medical system of claim 2, wherein during a fourth time period after the second time period, with the instrument base of the medical instrument attached to the mounting of the first robotic arm and the driver attached to the second robotic arm, the processor controls such that the mounting of the first robotic arm to which the instrument base of the medical instrument is attached moves in the insertion direction, and the processor is configured to drive, by the driver, the movement of the elongate shaft of the medical instrument in the insertion direction at a fourth movement speed that is the same as a movement speed of the mounting of the first robotic arm to which the instrument base of the medical instrument is attached in the insertion direction.

7. 6. The robotic medical system of claim 5, wherein the processor is configured to drive the rearward translation of the elongate shaft at the third translation rate by the driver when the distal end of the elongate shaft is positioned beyond an access sheath.

8. 7. The robotic medical system of claim 6, wherein the processor is configured to drive, by the driver, movement of the elongate shaft in the insertion direction at the fourth movement speed when the distal end of the elongate shaft is positioned beyond an access sheath.

9. The drive device is withdrawing the distal end of the elongate shaft from the proximal end of an access sheath; and reinserting the distal end of the elongate shaft into the proximal end of the access sheath.

10. and an instrument driver having a plurality of drive outputs positioned at a distal end of the second robotic arm, the driver having a plurality of drive inputs configured to engage the plurality of drive outputs of the instrument driver; 3. The robotic medical system of claim 1 or 2, further comprising a sterile adapter positioned between the instrument driver and the actuator.

11. The drive device is a body including a channel configured to receive the elongate shaft of the medical instrument; a roller configured to engage the elongate shaft, the second robotic arm configured to rotate the roller to drive the movement of the elongate shaft received in the channel in the rearward direction; 2. The robotic medical system of claim 1, comprising: a pivotable carrier supporting the roller, the second robotic arm configured to pivot the carrier to selectively engage and disengage the roller from the elongate shaft.

12. The drive device is a body including a channel configured to receive the elongate shaft of the medical instrument; a roller configured to engage the elongate shaft, the second robotic arm configured to rotate the roller to drive movement of the elongate shaft received in the channel in the insertion direction; 3. The robotic medical system of claim 2, comprising: a pivotable carrier supporting the roller, the second robotic arm configured to pivot the carrier to selectively engage and disengage the roller from the elongate shaft.

13. Based on receiving a pivot command to pivot the elongate shaft, the processor: causing the first robotic arm to pivot the elongate shaft; 3. The robotic medical system of claim 1 or 2, configured to cause the second robotic arm to disengage the drive from the elongate shaft.

14. 1. A robotic medical system, comprising: a medical instrument including an instrument base, a proximal portion coupled to the instrument base, and a flexible shaft having a distal end, the flexible shaft configured for insertion into a patient; a first robotic arm including a mount portion attachable to the instrument base of the medical instrument; a driver configured to engage the flexible shaft; and a second robot arm including a mounting portion attachable to the drive device, the second robotic arm is configured to operate the driver to drive movement of the flexible shaft in a rearward direction away from a patient; in a state in which the attachment portion of the first robot arm is attached to the instrument base of the medical instrument, the attachment portion of the first robot arm moves in the retreat direction, whereby the instrument base of the medical instrument moves in the retreat direction; the mounting portion of the first robot arm to which the instrument base of the medical instrument is attached is configured to move away from the mounting portion of the second robot arm during a retraction movement in which the drive device attached to the mounting portion of the second robot arm moves the flexible shaft in the retraction direction and the mounting portion of the first robot arm to which the instrument base of the medical instrument is attached moves in the retraction direction; 11. A robotic medical system comprising: a medical instrument having an instrument base attached to the mounting of the first robotic arm and a drive unit attached to the mounting of the second robotic arm; and, during the retraction motion, the drive unit drives the movement of the flexible shaft of the medical instrument in the retraction direction at a first movement speed that is greater than a movement speed of the mounting of the first robotic arm to which the instrument base of the medical instrument is attached in the retraction direction, whereby a portion of the flexible shaft of the medical instrument between the instrument base and the drive unit has a length that is greater than a distance between the instrument base and the drive unit, and the portion of the flexible shaft forms a service loop.

15. 1. A robotic medical system, comprising: a medical instrument including an instrument base, a proximal portion coupled to the instrument base, and a flexible shaft having a distal end, the flexible shaft configured for insertion into a patient; a first robotic arm including a mount portion attachable to the instrument base of the medical instrument; a driver configured to engage the flexible shaft; and a second robot arm including a mounting portion attachable to the drive device, the second robot arm is configured to operate the drive device to drive movement of the flexible shaft in an insertion direction; in a state in which the attachment portion of the first robot arm is attached to the instrument base of the medical instrument, the attachment portion of the first robot arm moves in the insertion direction, thereby causing the instrument base of the medical instrument to move in the insertion direction; the mounting portion of the first robot arm to which the instrument base of the medical instrument is attached is configured to approach the mounting portion of the second robot arm during an insertion movement in which the drive device attached to the mounting portion of the second robot arm moves the flexible shaft in the insertion direction and the mounting portion of the first robot arm to which the instrument base of the medical instrument is attached moves in the insertion direction; and wherein, when the instrument base of the medical instrument is attached to the mounting portion of the first robot arm and the driver is attached to the mounting portion of the second robot arm, and a portion of the flexible shaft of the medical instrument between the instrument base and the driver forms a service loop, during the insertion movement, the driver drives the movement of the flexible shaft of the medical instrument in the insertion direction at a second movement speed that is greater than the movement speed of the mounting portion of the first robot arm to which the instrument base of the medical instrument is attached, in the insertion direction, thereby contracting the service loop of the flexible shaft of the medical instrument between the instrument base and the driver.

16. the actuator includes one or more rollers configured to engage the flexible shaft, a body including a channel configured to receive the flexible shaft of the medical instrument, and a cover movable to a closed position that closes the channel, an open position that opens the channel, and an intermediate position between the closed position and the open position; 16. The robotic medical system of claim 14 or 15, wherein the second robotic arm is configured with the cover in the intermediate position to disengage the one or more rollers from the flexible shaft while retaining the flexible shaft in the channel of the drive.

17. 15. The robotic medical system of claim 14, wherein the second robotic arm is configured to control a rate of movement of the flexible shaft in the retraction direction based on a position of the distal end of the flexible shaft relative to an access sheath.

18. 1. A robotic medical system, comprising: a medical instrument including an instrument base, an elongate shaft having a proximal portion connected to the instrument base and a distal end, the elongate shaft configured for insertion into a patient; a first robotic arm, the instrument base of the medical instrument attached to a mounting portion of the first robotic arm, the mounting portion of the first robotic arm being movable in a retraction direction such that the mounting portion of the first robotic arm to which the instrument base of the medical instrument is attached moves the instrument base in the retraction direction away from a patient; a second robotic arm; and a driver including one or more rollers attached to the second robotic arm and distal to the instrument base, the one or more rollers configured to engage the elongate shaft of the medical instrument and drive movement of the elongate shaft in the rearward direction; 11. A robotic medical system comprising: a first robotic arm having a first mounting portion and a second robotic arm having a second mounting portion, the first mounting portion having a first mounting portion and the second mounting portion having a second mounting portion, the second mounting portion having a first mounting portion and the second mounting portion having a second mounting portion, the second mounting portion having a first mounting portion and the second mounting portion having a second mounting portion, the second mounting portion having a first mounting portion and the second mounting portion having a second mounting portion, the second mounting portion having a second mounting portion and the second mounting portion having a third mounting portion and the second mounting portion having a fourth ...

19. 1. A robotic medical system, comprising: a medical instrument including an instrument base, an elongate shaft having a proximal portion connected to the instrument base and a distal end, the elongate shaft configured for insertion into a patient; a first robotic arm, the instrument base of the medical instrument attached to a mounting portion of the first robotic arm, the mounting portion of the first robotic arm being movable in an insertion direction such that the mounting portion of the first robotic arm to which the instrument base of the medical instrument is attached moves the instrument base in the insertion direction into a patient; a second robotic arm; and a driver including one or more rollers attached to the second robotic arm and distal to the instrument base, the one or more rollers configured to engage the elongate shaft of the medical instrument and drive movement of the elongate shaft in the insertion direction; 11. A robotic medical system comprising: a medical instrument having an elongate shaft mounted to a first robotic arm and a second robotic arm, the medical instrument having an elongate shaft mounted to a first robotic arm; a first roller mounted to a second robotic arm; and a second roller driving the movement of the elongate shaft of the medical instrument in the insertion direction, the first roller driving the movement of the elongate shaft of the medical instrument in the insertion direction at a second speed of movement that is greater than a speed of movement of the first robotic arm mounting to the first robotic arm, the second roller driving the movement of the elongate shaft of the medical instrument in the insertion direction at a second speed of movement that is greater than a speed of movement of the first roller ... first roller driving the movement of the elongate shaft of the medical instrument in the insertion direction at a second speed of movement that is greater than a speed of movement of the first roller mounting to the first robotic arm, the second roller driving the movement of the elongate shaft of the medical instrument in the insertion direction at a second speed of movement that is greater than a speed of movement of the first roller mounting to the first robotic arm, the first roller driving the movement of the elongate

20. The robotic medical system of claim 18 or 19, wherein the one or more rollers are a pair of opposing rollers.

21. the actuator further includes a body including a channel configured to receive the elongate shaft of the medical instrument, and a cover movable to a closed position that closes the channel, an open position that opens the channel, and an intermediate position between the closed position and the open position; 21. The robotic medical system of claim 20, wherein the second robotic arm is configured to disengage the one or more rollers from the elongate shaft and retain the elongate shaft in the channel of the driver with the cover in the intermediate position.

Images