Robotic system showing the boundaries of the robot arm

Abstract

To provide a robotic system for performing a medical procedure.SOLUTION: Certain aspects relate to systems and techniques for surgical robotic arm setup. In one aspect, there is provided a system including a first robotic arm configured to manipulate a medical instrument, a processor, and a memory. The processor is configured to: determine a minimum stroke length of the first robotic arm that allows advancing of the medical instrument by the first robotic arm to reach a target region from an access point via a path; determine a boundary for an initial pose of the first robotic arm based on the minimum stroke length and a mapping stored in the memory; and, during an arm setup phase prior to performing a procedure, provide an indication of the boundary during movement of the first robotic arm.SELECTED DRAWING: Figure 16

Description

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit of U.S. Provisional Patent Application No. 62 / 568,733, filed October 5, 2017, and U.S. Patent Application No. 16 / 141,755, filed September 25, 2018, the disclosures of which are incorporated by reference in their entireties. [Technical Field]

[0002] The disclosed systems and methods relate to configuring a robotic arm, and more particularly to providing indications of boundaries for an initial pose of a robotic arm in a robotic system. [Background technology]

[0003] Medical procedures, such as endoscopy (e.g., bronchoscopy), involve inserting medical tools into a patient's luminal network (e.g., airways) for diagnostic or therapeutic purposes. Surgical robotic systems can be used to control the insertion and / or manipulation of medical tools during medical procedures. Surgical robotic systems can include at least one robotic arm having a manipulation assembly that can be used to control the positioning of the medical tool before and during the medical procedure. Summary of the Invention

[0004] The systems, methods, and devices of the present disclosure each have several innovative aspects, none of which is solely responsible for the desired characteristics disclosed herein.

[0005] In one aspect, a system is provided that includes a first robotic arm for manipulating a medical instrument, a processor, and a memory storing a mapping of a patient's anatomy, the mapping including data regarding (i) a target area within the anatomy and (ii) a path from an access point on the patient to the target area. The memory further stores computer-executable instructions that, when executed, cause the processor to: determine a minimum stroke length of the first robotic arm that will allow the first robotic arm to advance the medical instrument from the access point to the target area via the path; determine a boundary for an initial pose of the first robotic arm based on the minimum stroke length and the mapping; and provide an indication of the boundary during movement of the first robotic arm during an arm setup phase prior to performance of the procedure.

[0006] In another aspect, provided is a non-transitory computer-readable storage medium having instructions stored thereon that, when executed, cause at least one computing device to: determine a minimum stroke length for a first robotic arm to advance a medical instrument to a target area based on mapping of a patient's anatomy, the mapping having data regarding (i) a target area within the anatomy and (ii) a path from an access point on the patient to the target area, wherein the medical instrument is advanced from the access point to the target area via the path; determine a boundary for an initial pose of the first robotic arm based on the minimum stroke length and the mapping; and provide an indication of the boundary during movement of the first robotic arm during an arm setup phase prior to performance of a procedure.

[0007] In yet another aspect, there is provided a method of positioning a first robotic arm, the method including: determining a minimum stroke length of the first robotic arm that allows the first robotic arm to advance a medical instrument to reach a target area based on mapping of a patient's anatomy, the mapping having data regarding (i) a target area within the anatomy and (ii) a path from an access point on the patient to the target area, the medical instrument being advanced from the access point to the target area via the path; determining boundaries for an initial pose of the first robotic arm based on the minimum stroke length and the mapping; and providing an indication of the boundaries during movement of the first robotic arm during an arm setup phase prior to performance of a procedure. [Brief explanation of the drawings]

[0008] Aspects of the present disclosure are described below in conjunction with the accompanying figures and tables, which illustrate but do not limit aspects of the disclosure, and in which like elements are designated with like labels.

[0009] [Figure 1] FIG. 1 illustrates one embodiment of a cart-based robotic system configured for diagnostic and / or therapeutic bronchoscopy procedures. [Figure 2] FIG. 2 is a diagram showing another side of the robot system of FIG. 1. [Figure 3] FIG. 2 illustrates an embodiment of the robotic system of FIG. 1 configured for ureteroscopy. [Figure 4] FIG. 2 illustrates an embodiment of the robotic system of FIG. 1 configured for a vascular procedure. [Figure 5] FIG. 1 illustrates one embodiment of a table-based robotic system configured for a bronchoscopy procedure. [Figure 6] FIG. 6 is an alternative view of the robotic system of FIG. 5. [Figure 7] FIG. 1 illustrates an example of a system configured to accommodate a robotic arm. [Figure 8]FIG. 1 illustrates one embodiment of a table-based robotic system configured for ureteroscopy. [Figure 9] FIG. 1 illustrates one embodiment of a table-based robotic system configured for laparoscopy. [Figure 10] FIG. 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 view of the interface between the table and column of the table-based robotic system of FIGS. 5-10. [Figure 12] FIG. 1 illustrates an exemplary tool driver. [Figure 13] 1A-1C illustrate an exemplary medical instrument having paired instrument drivers. [Figure 14] 13A-13C show an alternative design of the instrument drive and instrument, where the axis of the drive unit is parallel to the axis of the elongate shaft of the instrument. [Figure 15] FIG. 15 is a block diagram illustrating a positioning system for estimating the position of one or more elements of the robotic system of FIGS. 1-10, such as the position of the instrument of FIGS. 13 and 14, in an example embodiment. [Figure 16] FIG. 1 illustrates one embodiment of a surgical robotic system configured for diagnostic and / or therapeutic bronchoscopy procedures in accordance with aspects of the present disclosure. [Figure 17A] 1 is a flowchart illustrating an example configuration procedure for a medical procedure according to aspects of the present disclosure. [Figure 17B] 10 is a flowchart illustrating another example feature of a setup sequence for a medical procedure according to aspects of the present disclosure. [Figure 18] FIG. 1 illustrates one embodiment of a bronchoscope that can be used in aspects of the present disclosure. [Figure 19] 10 is a flowchart illustrating another example of a setup procedure for a bronchoscopy procedure according to an aspect of the present disclosure. [Figure 20] 1 is a flowchart illustrating an example of a method for simulating a medical procedure according to an aspect of the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0010] (1. Introduction) Aspects of the present disclosure can be incorporated into robotic-enabled medical systems capable of performing a variety of medical procedures, including minimally invasive procedures such as laparoscopy and non-invasive procedures such as endoscopy. In endoscopic procedures, the system can perform bronchoscopy, ureteroscopy, gastroenterological examinations, etc.

[0011] In addition to being able to perform a variety of procedures, the system can provide additional benefits, such as enhanced image acquisition and guidance to assist the surgeon. The system can also provide the surgeon with the ability to perform procedures from an ergonomic position without having to accommodate awkward arm movements or positions. Furthermore, the system can provide the surgeon with the ability to perform procedures with improved ease of use, with one user controlling one or more instruments of the system.

[0012] Various embodiments are described below with reference to the drawings for illustrative purposes. Many other implementations of the disclosed concepts are possible, and various advantages are obtained with the implementations of the disclosure. Also, headings are included herein for reference and to identify the location of various sections. These headings do not limit the scope of the concepts described by the headings. Each concept may be applied throughout the entire specification.

[0013] (A. Robot System - Cart) Robot-enabled medical systems can be configured in various ways depending on the specific procedure. FIG. 1 illustrates one embodiment of a cart-based robot-enabled system 10 configured for a diagnostic and / or therapeutic bronchoscopy procedure. During a bronchoscopy, the system 10 includes a cart 11 with one or more robotic arms 12 for carrying medical instruments, such as a bronchoscope specialized for the bronchoscopy procedure, and a maneuverable endoscope 13 to access a natural orifice access point (such as the mouth of a patient positioned on a table) for diagnostic and / or therapeutic tools. As shown, the cart 11 is positioned near the patient's upper body to access the access point. Similarly, the robotic arms 12 are operable to position the bronchoscope relative to the access point. The configuration illustrated in FIG. 1 can also be used when performing a gastrointestinal (GI) procedure using a gastroscope, a specialized endoscope for such procedures. FIG. 2 illustrates an exemplary cart embodiment in more detail.

[0014] Continuing with 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 can include at least two telescoping sections, such as an inner leader section and an outer sheath section, each coupled to a separate instrument driver from a set of instrument drivers 28, with each instrument driver coupled to the distal end of a respective robotic arm. This linear arrangement of the instrument drivers 28, which facilitates coaxial alignment of the leader section with the sheath section, 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 illustrated using dashed lines and, therefore, do not represent any physical structure of the system. Movement of the instrument driver 28 along the virtual rail 29 telescops the inner leader section relative to the outer sheath section or advances or retracts the endoscope 13 from the patient. The angle of the virtual rail 29 may be adjusted, moved, 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 between providing the physician access to the endoscope 13 while minimizing friction caused by bending the endoscope 13 into the patient's mouth.

[0015] After insertion, the endoscope 13 can be directed through the patient's trachea and lungs using precise commands from the robotic system until the target location or surgical site is reached. To enhance navigation through the patient's pulmonary network and / or reach the desired target, the endoscope 13 can be manipulated to telescope the inner leader portion 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 each other.

[0016] For example, the endoscope 13 may be instructed to deliver a biopsy needle to a target, such as a lesion or nodule in a patient's lung. The needle may be deployed along a working channel spanning the length of the endoscope to obtain a tissue sample to be analyzed by a pathologist. Depending on the pathology results, additional tools may be placed down the working channel of the endoscope for additional biopsies. After identifying a malignant nodule, the endoscope 13 may endoscopically deliver a tool to remove the potentially cancerous tissue. In some instances, diagnostic and therapeutic procedures may need to be delivered 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 instances, diagnostic and therapeutic procedures may be delivered during the same procedure.

[0017] The system 10 may also include a mobile tower 30, which may be connected to the cart 11 via a support cable to provide support for control, electronics, fluidics, optics, sensors, and / or power for the cart 11. Locating such functionality within the tower 30 allows for a smaller form factor cart 11, which may be more easily adjusted and / or repositioned by the operating surgeon and his or her staff. Additionally, the division of functionality between the cart / table and the support tower 30 facilitates reducing clutter in the operating room and improving clinical workflow. While the cart 11 may be positioned near the patient, the tower 30 may be housed in a remote location to stay out of the way during the procedure.

[0018] In support of the robotic system described above, the tower 30 may include computer-based control system components that store computer program instructions in non-transitory computer-readable storage media, such as, for example, a persistent magnetic storage drive, a solid-state drive, or the like. Execution of these instructions, whether execution occurs within the tower 30 or the cart 11, can control the entire system or its subsystems. For example, when executed by a processor in a computer system, the instructions can 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 control signals, motors in the joints of a robotic arm can position the arm in a particular pose.

[0019] Tower 30 may also include pumps, flow meters, valve controls, and / or fluid access to provide controlled irrigation and aspiration capabilities to a system that may be deployed through endoscope 13. These components may also be controlled using a computer system on tower 30. In some embodiments, irrigation and aspiration capabilities may be delivered directly to endoscope 13 via separate cables.

[0020] The tower 30 may include voltage and surge protectors designed to provide filtered and protected power to the cart 11, thereby avoiding the placement of power transformers and other auxiliary power components within the cart 11, resulting in a smaller, more mobile cart 11.

[0021] The tower 30 may also include support for sensors deployed throughout the robotic system 10. For example, the tower 30 may include optoelectronics for detecting, receiving, and processing data received from optical sensors or cameras throughout the robotic system 10. In combination with a control system, such optoelectronics may be used to generate real-time images for display on any number of consoles located throughout the system, including the tower 30. Similarly, the tower 30 may also include electronic subsystems for receiving and processing signals received from located electromagnetic (EM) sensors. The tower 30 may also be used to house and position electromagnetic field generators for detection by electromagnetic sensors in or on a medical instrument.

[0022] The tower 30 may also include a console 31 in addition to other consoles available to the rest of the system, such as a console mounted on top of a cart. The console 31 may include a user interface and a display screen, such as a touchscreen, for the physician operator. The consoles in the system 10 are generally designed to provide both robotic control and pre-operative and real-time information, such as navigation and positioning information for the endoscope 13. If the console 31 is not the only console available to the physician, it may be used by a second operator, such as a nurse, to monitor the patient's health and activity status and system operation, and to provide procedure-specific data, such as navigation and positioning information. In other embodiments, the console 31 is housed in a separate enclosure from the tower 30.

[0023] The tower 30 can be coupled to the cart 11 and endoscope 13 via one or more cables or connections (not shown). In some embodiments, support functions from the tower 30 can be provided to the cart 11 via a single cable, simplifying the operating room and eliminating clutter. In other embodiments, certain functions can be combined with separate cabling and connections. For example, power can be provided to the cart via a single power cable, while support for control, optics, fluids, and / or navigation can be provided via separate cables.

[0024] FIG. 2 provides a detailed view of an embodiment of a cart from the cart-based robot-enabled system 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 end of the column 14. The column 14 can include one or more carriages, such as a carriage 17 (or "arm support") for supporting the deployment of one or more robotic arms 12 (three are shown in FIG. 2). The carriage 17 can include individually configurable arm mounts that rotate along a vertical axis to adjust the base of the robotic arms 12 for better positioning relative to the patient. The carriage 17 also includes a carriage interface 19 that allows the carriage 17 to move vertically along the column 14.

[0025] Carriage interface 19 connects to column 14 via slots, such as slots 20, located on either side of column 14 to guide the vertical movement of carriage 17. Slots 20 comprise vertical movement interfaces for positioning and holding the carriage at various vertical heights relative to cart base 15. Vertical movement of carriage 17 allows cart 11 to adjust the reach of robotic arm 12 to accommodate various table heights, patient sizes, and physician preferences. Similarly, individually configurable arm mounts on carriage 17 allow robotic arm base 21 of robotic arm 12 to be angled in various configurations.

[0026] In some embodiments, the slot 20 may be supplemented with a slot cover that is flush with and parallel to the slot surface to prevent dirt and fluid ingress into the column 14 interior chamber and vertical movement interface as the carriage 17 moves vertically. The slot cover may be deployed through a pair of spring spools located near the top and bottom vertical ends of the slot 20. The covers are coiled within the spools until they are deployed and extend from their coiled state as the carriage 17 translates vertically up and down. The spring load of the spools provides a force to retract the covers into the spools as the carriage 17 moves toward the spools, while maintaining a tight fit as the carriage 17 moves away from the spools. The covers may be connected to the carriage 17, for example, using brackets within the carriage interface 19 to ensure proper extension and retraction of the covers as the carriage 17 moves.

[0027] The column 14 may include therein mechanisms such as gears and motors designed to use a vertically aligned lead screw to move the carriage 17 in a mechanical manner in response to control signals generated in response to user input, e.g., input from the console 16.

[0028] The robotic arm 12 may generally include a robotic arm base 21 and an end effector 22 separated by a series of linkages 23 connected by a series of joints 24, each with an independent actuator, and each actuator with an independently controllable motor. Each independently controllable joint represents an independent degree of freedom available to the robotic arm. Each of the arms 12 has 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. The redundant degrees of freedom allow the robotic arm 12 to position each end effector 22 at a specific location, orientation, and trajectory in space using different joint positions and joint angles. This allows the system to position and orient medical instruments from a desired location in space, while allowing the physician to move the arm joints to a clinically advantageous position away from the patient, avoiding arm collisions and achieving a wider range of access.

[0029] The cart base 15 balances the weight of the column 14, carriage 17, and arm 12 on the floor. Thus, the cart base 15 houses heavier components, such as electronics, motors, and power supplies, as well as components that allow the cart to be either moved and / or stabilized. For example, the cart base 15 includes casters 25 in the form of rotatable wheels that allow the cart to be easily moved around the room prior to a procedure. Once in the proper position, the casters 25 may be secured using wheel locks to hold the cart 11 in place during the procedure.

[0030] The console 16 is positioned at the vertical end of the column 14, allowing it to function both as a user interface for receiving user input and as a display screen (or dual-purpose device, such as a touchscreen 26) for providing both pre- and intra-operative data to the physician user. Potential pre-operative data on the touchscreen 26 can include pre-operative planning, navigation and mapping data derived from a pre-operative computed tomography (CT) scan, and / or notes from a pre-operative patient interview. Intra-operative data on the display can include optical information provided by instruments, coordinate information from sensors, and patient activity statistics such as respiration, heart rate, and / or pulse. The console 16 may be positioned and tilted to allow the physician to access the console 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 assist in steering and stabilizing the cart 11.

[0031] FIG. 3 illustrates an embodiment of the robot-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. During a ureteroscopy, it may be desirable to align the ureteroscope 32 directly with the patient's urethra to reduce friction and force on the delicate anatomical structures in the region. As shown in the figure, the cart 11 may be aligned with a 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 can insert the ureteroscope 32 along a virtual rail 33 directly through the urethra and into the patient's lower abdomen.

[0032] After insertion into the urethra, using control techniques similar to those used in bronchoscopy, the ureteroscope 32 can be navigated into the bladder, ureters, and / or kidneys for diagnostic and / or therapeutic applications. For example, the ureteroscope 32 can be directed toward the ureters and kidneys to destroy kidney stone accumulations using a laser or ultrasonic lithotripsy device positioned down the working channel of the ureteroscope 32. After the lithotripsy procedure is complete, the resulting stone fragments can be removed using a basket positioned beneath the ureteroscope 32.

[0033] FIG. 4 illustrates an embodiment of a robot-enabled system similarly positioned for a vascular procedure. In a vascular procedure, the system 10 can be configured so that the cart 11 can deliver a medical instrument 34, such as a steerable catheter, to an access point in the femoral artery of a patient's leg. The femoral artery is characterized by both a larger diameter for navigation and a relatively circuitous and tortuous path to the patient's heart, simplifying navigation. As in a ureteroscopy procedure, the cart 11 can be positioned toward the patient's leg and lower abdomen to allow 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 can be oriented and inserted by moving the instrument driver 28. Alternatively, the cart can 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.

[0034] (B. Robot System - Table) Embodiments of robot-enabled medical systems may also incorporate a patient table. Incorporating a table reduces the amount of capital equipment in the operating room by removing the cart, allowing for greater access to the patient. Figure 5 shows an embodiment of such a robot-enabled system deployed for a bronchoscopy procedure. The system 36 includes a support structure or support column 37 for supporting a platform 38 (shown as a "table" or "bed") above the floor. Similar to 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 Figure 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 images can be positioned over the patient's upper abdominal region by positioning emitters and detectors around the table 38.

[0035] FIG. 6 shows an alternative view of the system 36, excluding the patient and medical instruments for illustrative purposes. As shown, the column 37 can include one or more carriages 43, shown as a ring-shaped structure within the system 36, from which one or more robotic arms 39 can be configured. The carriages 43 can move along a vertical column interface 44 extending along the length of the column 37 to provide different vantage points from which the robotic arms 39 can be positioned to reach the patient. The carriages 43 can rotate around the column 37 using mechanical motors located within the column 37 to allow the robotic arms 39 to access multiple sides of the table 38, e.g., both sides of the patient. In embodiments with multiple carriages, the carriages can be individually positioned on the column and can move and / or rotate independently of the other carriages. While the carriages 43 need not surround the column 37 or be circular, the ring-shaped structure shown facilitates rotation of the carriages 43 around the column 37 while maintaining structural balance. Rotation and translation of carriage 43 allows the system to align medical instruments, such as endoscopes and laparoscopes, with different access points on the patient. In another embodiment (not shown), system 36 may include a patient table or bed with adjustable arm supports, which may be in the form of bars or rails extending along the table or bed. One or more robotic arms 39 (such as via shoulders with elbow joints) may be attached to the adjustable arm supports with vertical adjustment. Vertical adjustment allows robotic arms 39 to be compactly stored under the patient table or separately and later raised for the procedure.

[0036] Arm 39 may be attached to the carriage via a set of arm mounts 45 that comprise a series of joints that can be independently rotated and / or telescopically extended to provide additional components to robotic arm 39. Additionally, arm mounts 45 may be positioned on carriage 43 such that when carriage 43 is appropriately rotated, arm mounts 45 are positioned either on the same side of table 38 (as shown in FIG. 6 ), on opposite sides of table 38 (as shown in FIG. 9 ), or on adjacent sides of table 38 (not shown).

[0037] Structurally, column 37 supports table 38 and provides a path for vertical carriage movement. Internally, column 37 may include a lead screw for guiding the carriage's vertical movement and a motor for mechanizing the carriage's movement based on the lead screw. Column 37 may also transmit power and control signals to carriage 43 and a robotic arm 39 mounted thereon.

[0038] The table base 46 functions similarly to the cart base 15 of the cart 11 shown in FIG. 2, housing the heavier components for balancing 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 the procedure. The casters deploy from the bottom end of the table base 46, extend in opposite directions on either side of the base 46, and can be retracted when the system 36 needs to be moved.

[0039] Continuing with 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. Similar to the above embodiment, the tower may provide various support functions to the table, such as processing, computing, and control capabilities, power, fluidics, and / or optics and sensor processing. The tower may also be movable so that it is positioned away from the patient to improve physician access and reduce clutter in the operating room. Additionally, locating components within the tower allows for more storage space within the table base for potential storage of a robotic arm. The tower may also include a console that provides both a user interface for user input, such as a keyboard and / or pendant, and a display screen (or touchscreen) for pre- and intra-operative information, such as real-time images, navigation, and tracking information.

[0040] In some embodiments, the table base can accommodate and store the robotic arm when not in use. FIG. 7 shows a system 47 for housing the robotic arm in one embodiment of a table-based system. In the system 47, a carriage 48 can be moved vertically into a base 49 to accommodate the robotic arm 50, arm mount 51, and carriage 48 within the base 49. A base cover 52 can be moved and opened / closed to deploy the carriage 48, arm mount 51, and arm 50 near a row 53 and can be closed to protect them when not in use. The base cover 52 can be sealed with a membrane 54 along the edge of its opening to prevent the ingress of dirt and fluids when closed.

[0041] FIG. 8 illustrates an embodiment of a robotic-enabled table-based system configured for a ureteroscopy procedure. For ureteroscopy, the table 38 may include a pivoting section 55 for positioning the patient at an angle away from the column 37 and table base 46. The pivoting section 55 may rotate or pivot about a pivot point (e.g., located below the patient's head) to position the lower end of the pivoting section 55 away from the support column 37. For example, pivoting the pivoting section 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 the carriage 35 (not shown) about the support column 37, the robotic arm 39 can insert the ureteroscope 56 along the virtual rail 57 directly into the patient's groin to reach the urethra. For ureteroscopy, stirrups 58 may also be secured to the pivoting section 55 of the table 38 to support the patient's leg position during the procedure and allow clear access to the patient's groin.

[0042] In laparoscopic procedures, minimally invasive instruments (elongated to accommodate the size of one or more incisions) may be inserted into the patient's anatomy through small incisions in the patient's abdominal wall. After distending the patient's abdominal cavity, the instruments, often referred to as laparoscopes, may be directed to perform surgical tasks such as grasping, cutting, resecting, and suturing. FIG. 9 illustrates an embodiment of a robotically enabled table-based system configured for laparoscopic procedures. As shown in FIG. 9, the carriage 43 of the system 36 is rotated and vertically adjusted to position a pair of robotic arms 39 on either side of the table 38, so that the laparoscope 59 can be positioned using the arm mounts 45 to pass through minimally invasive incisions on either side of the patient to access the patient's abdominal cavity.

[0043] To accommodate laparoscopic procedures, the robot-enabled table system can also tilt the platform to a desired angle. FIG. 10 illustrates an embodiment of a robot-enabled 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 another portion. Additionally, the arm mount 45 can rotate to accommodate the tilt so that the arm 39 maintains the same planar relationship with the table 38. To accommodate steeper angles, the column 37 can also include a telescoping section 60 that vertically extends the column 37 to keep the table 38 clear of the floor or collision with the base 46.

[0044] FIG. 11 shows details of the interface between the table 38 and the column 37. A 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 positioning orthogonal axes 1 and 2 at the column-table interface, with each axis actuated by a separate motor 3 and 4 in response to an electrical pitch 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, ball joints may be used to change the pitch angle of the table 38 relative to the column 37 in multiple degrees of freedom.

[0045] For example, pitch adjustment is particularly useful when attempting to position the table in the Trendelenburg position for lower abdominal surgery, i.e., positioning the patient's lower abdomen higher off the floor than the patient's lower abdomen. The Trendelenburg position allows gravity to slide the patient's internal organs toward the patient's upper abdomen, freeing up space in the abdominal cavity for minimally invasive tools to initiate and perform lower abdominal surgical procedures, such as laparoscopic prostatectomy.

[0046] C. Fixture Drivers and Interfaces The end effector of the system's robotic arm comprises (1) an instrument driver (alternatively called an "instrument drive mechanism" or "instrument device manipulator (IDM)") that incorporates electromechanical means for actuating the medical instrument, and (2) a removable or detachable medical instrument, allowing for the removal of any electromechanical components, such as motors. This dichotomy can arise from the need to sterilize medical instruments used in medical procedures and the inability to adequately sterilize expensive capital equipment due to their complex mechanical assemblies and delicate electronics. Thus, medical instruments may be designed to be detached, removed, and replaced from the instrument driver (and thus the system) for individual sterilization or disposal by a physician or physician's staff. In contrast, instrument drivers do not need to be replaced or sterilized and may be draped for protection.

[0047] FIG. 12 shows an exemplary instrument driver. An instrument driver 62 located at the distal end of the robotic arm includes one or more drive units 63 arranged on parallel axes to provide controlled torque to a medical instrument via a drive shaft 64. Each drive unit 63 includes an individual drive shaft 64 for interacting with the instrument, a gearhead 65 for converting motor shaft rotation into a desired torque, a motor 66 for generating the drive torque, an encoder 67 for measuring the motor shaft speed and providing feedback to the control circuitry, and a control circuit 68 for receiving control signals and operating the drive unit. Each drive unit 63 is independently controlled and motorized, allowing the instrument driver 62 to provide multiple (four as shown in FIG. 12) independent drive outputs to the medical instrument. In operation, the control circuitry 68 receives control signals, sends motor signals to the motors 66, compares the resulting motor speed measured by the encoders 67 to the desired speed, and modulates the motor signals to generate the desired torque.

[0048] For procedures requiring a sterile environment, the robotic system can incorporate a drive interface, such as a sterile adapter connected to a sterile drape, positioned between the instrument driver and the medical instrument. The primary purpose of the sterile adapter is to transfer angular motion from the instrument driver's drive shaft to the instrument's drive input while maintaining physical separation, and therefore sterility, between the drive shaft and the drive input. Thus, an exemplary sterile adapter may include a series of rotational inputs and outputs intended to mate with the instrument driver's drive shaft and the drive input on the instrument. The sterile drape connected to the sterile adapter is made of a thin, flexible material, such as transparent or translucent plastic, and is designed to cover the instrument driver, robotic arm, and capital equipment, such as a cart (in cart-based systems) or table (in table-based systems). The use of the drape allows the capital equipment to be placed near the patient while still being placed in an area not requiring sterility (i.e., a non-sterile area). The other side of the sterile drape allows the medical instrument to come into contact with the patient in an area requiring sterility (i.e., a sterile field).

[0049] (D. Medical Devices) FIG. 13 shows an exemplary medical instrument with a paired instrument driver. Similar to other instruments designed for use with a robotic system, the medical instrument 70 comprises an elongated shaft 71 (or elongated body) and an instrument base 72. The instrument base 72, also referred to as an “instrument handle” as it is designed for manual manipulation by a physician, may generally comprise a rotatable drive input 73, e.g., a receptacle, pulley, or spool, designed to mate with a drive output 74 extending 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 shares an axis of rotation with the drive output 74 in the instrument driver 75, allowing for the transfer of torque from the drive output 74 to the drive input 73. In some embodiments, the drive output 74 may comprise a spline designed to mate with a receptacle on the drive input 73.

[0050] The elongate shaft 71 is designed to be delivered either through an anatomical opening or lumen, as in endoscopy, or through a minimally invasive incision, as in laparoscopy. The elongate shaft 66 can be either flexible (e.g., having properties similar to an endoscope) or rigid (e.g., having properties similar to a laparoscope), or can include a customized combination of both flexible and rigid sections. When designed for laparoscopy, the distal end of the rigid elongate shaft can be connected to an end effector comprising an articulated wrist formed from a clevis having an axis of rotation and one or more surgical tools, such as graspers, that can be actuated based on force 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 elongate shaft can include a steerable or controllable bend that can articulate and bend based on torque received from the drive output 74 of the instrument driver 75.

[0051] Torque from the instrument driver 75 is transmitted to the elongated shaft 71 using tendons within the shaft 71. These individual tendons, such as pull wires, can be individually secured to individual drive inputs 73 within the instrument handle 72. From the handle 72, the tendons are directed into one or more pull lumens within the elongated shaft 71 and secured to a distal portion of the elongated shaft 71. In laparoscopy, these tendons may be coupled to a distally attached end effector, such as a wrist, grasper, or scissors. In this configuration, torque exerted on the drive input 73 transmits surface tension to the tendons, thereby actuating the end effector in some manner. In laparoscopy, the tendons can rotate a joint about an axis, thereby moving the end effector in one direction or another. Alternatively, the tendons can be connected to one or more jaws of a grasper at the distal end of the elongated shaft 71, where tension from the tendons causes the grasper to close.

[0052] In endoscopy, tendons may be coupled via adhesives, control rings, or other mechanical fixation to bending or articulating sections located along the elongate shaft 71 (e.g., at the distal end). When fixedly attached to the distal end of a bending section, torque exerted on the drive input 73 is transmitted to the tendon, causing the more flexible bending section (sometimes called the articulating section or articulating region) to bend or articulate. Along non-bending sections, it can be effective to spiral or helical the individual pull lumens that direct the individual tendons along (or inward from) the wall of the endoscope shaft to counterbalance radial forces resulting from surface tension in the pull wire. The angle of the spirals and / or their spacing may be modified or designed for specific purposes; a tighter spiral results in less shaft compression under load, while a looser spiral results in more shaft compression under load but at critical bending. At the other end of the spectrum, pull lumens may be oriented parallel to the longitudinal axis of the elongate shaft 71, allowing for controlled articulation at the desired bending or articulating section.

[0053] In endoscopy, the elongated shaft 71 houses several components to assist the robotic system procedure. The shaft may include a working channel for deploying surgical tools, irrigation, and / or suction to the surgical area at the distal end of the shaft 71. The shaft 71 may also house wires and / or optical fibers to transmit signals to / from an optical assembly at the distal tip, which may include an optical camera. The shaft 71 may also house optical fibers to carry light from a proximally located light source, such as a light emitting diode, to the distal end of the shaft.

[0054] At the distal end of instrument 70, the distal tip may also 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 obtain images of the internal anatomical space. Relatedly, the distal tip may also include a port for a light source for illuminating the anatomical space when using a camera.

[0055] 13, the drive shaft axis, and therefore the drive input axis, is perpendicular to the axis of the elongate shaft. However, this arrangement complicates the roll function of the elongate shaft 71. Rotating the elongate shaft 71 along its axis while holding the drive input 73 stationary will result in undesirable entanglement of the tendons as they extend from the drive input 73 and enter the pull lumen within the elongate shaft 71. Such tendon-induced entanglement can be an obstacle to any control algorithm aimed at predicting the movement of a flexible elongate shaft during an endoscopic procedure.

[0056] FIG. 14 shows an alternative design for the instrument driver and instrument, in which the axes of the drive units are parallel to the axis of the instrument's elongated shaft. As shown, a circular instrument driver 80 includes four drive units with parallel-aligned drive outputs 81 at the ends of a robotic arm 82. The drive units and their respective drive outputs 81 are housed within a rotating assembly 83 of the instrument driver 80, which is driven by one of the drive units in the assembly 83. In response to torque provided by the rotary drive units, the rotating assembly 83 rotates along a circular bearing connecting the rotating assembly 83 to a non-rotating portion 84 of the instrument driver. Power and control signals can be transmitted from the non-rotating portion 84 of the instrument driver 80 to the rotating assembly 83 via electrical contacts, which can be maintained in rotation by a brushed slip-ring connection (not shown). In other embodiments, the rotating assembly 83 can be integrated into the non-rotating portion 84 and therefore responsive to a separate drive unit that is not parallel to the other drive units. The rotation mechanism 83 enables the instrument driver 80 to rotate the drive units and respective drive outputs 81 as a single unit about the instrument driver axis 85 .

[0057] Similar to the previously disclosed embodiments, the instrument 86 can include an elongated shaft portion 88 and an instrument base 87 (shown with a transparent skin for purposes of illustration) that includes a plurality 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 orthogonal as in the design of FIG.

[0058] When coupled to the rotation assembly 83 of the instrument driver 80, the medical instrument 86, comprising an instrument base 87 and an instrument shaft 88, rotates in combination 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 rotates the instrument shaft 88 about its own anterior-posterior axis. Furthermore, as the instrument base 87 rotates with the instrument shaft 88, the tendons connected to the drive input 89 of the instrument base 87 do not entangle during rotation. Thus, the parallelism of the axes of the drive output 81, drive input 89, and instrument shaft 88 allows the shaft to rotate without causing entanglement of any control tendons.

[0059] (E. Navigation and Control) Traditional endoscopy involves the use of X-ray fluoroscopy (e.g., as may be delivered via a C-arm) and other forms of radiation-based imaging modalities to provide intraluminal guidance to the operating physician. In contrast, the robotic systems realized by the present disclosure provide non-radiation-based navigation and positioning means to reduce physician exposure to radiation and reduce the amount of equipment in the operating room. As used herein, the term "positioning" can refer to identifying and / or monitoring the position of an object in a reference coordinate system. Technologies such as preoperative mapping, computer vision, real-time electromagnetic 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, preoperative mapping, computer vision, real-time electromagnetic tracking, and robot command data may be used individually or in combination to improve information obtained solely by radiation-based imaging modalities.

[0060] FIG. 15 is a block diagram illustrating a positioning system 90 for estimating the position of one or more elements of a robotic system, such as the position of an instrument, according to an exemplary embodiment. The positioning system 90 can be a set of one or more computing devices configured to execute one or more instructions. The computing devices can be embodied by a processor (or processors) and computer-readable memory in one or more of the components described above. By way of example and not limitation, the computing devices can be located in the tower 30 shown in FIG. 1, in the cart shown in FIGS. 1-4, in the bed shown in FIGS. 5-10, etc.

[0061] 15, the positioning system 90 may include a positioning module 95 that processes the input data 91-94 to generate position data 96 for the distal tip of the medical instrument. The position data 96 may be data or logic that represents the position and / or orientation of the distal tip 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 electromagnetic field generator (see below for a description of electromagnetic field generators).

[0062] The various input data 91-94 will now be described in more detail. Preoperative mapping can be achieved through the use of a collection of low-dose CT scans. Preoperative CT scans produce two-dimensional images, each representing a cutaway "slice" of the patient's internal anatomy. When analyzed collectively, an image-based model can be generated for the anatomical cavities, spaces, and structures of the patient's anatomy, such as the patient's pulmonary network. Techniques such as centerline geometry can be determined and approximated from the CT images to develop a three-dimensional volume of the patient's anatomy, referred to as preoperative model data 91. The use of centerline geometry is described in U.S. Patent No. 14 / 523,760, the entire contents of which are incorporated herein by reference. Network topology models may also be derived from CT images, particularly suited to bronchoscopy.

[0063] In some embodiments, the instrument can be equipped with a camera to provide visual data 92. The positioning module 95 can process the visual data to enable one or more vision-based positional tracking. For example, the pre-operative model data may be used in conjunction with the vision data 92 to enable computer vision-based tracking of a medical instrument (e.g., an endoscope or the advancement of an instrument through the working channel of an endoscope). For example, using the pre-operative model data 91, the robotic system can 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) with images in the image library to assist with positioning.

[0064] Other computer vision-based tracking techniques use feature tracking to determine camera and, therefore, endoscope movement. Some features in the positioning module 95 can 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 are selected and the relative rotational and / or translational movement of the camera. Vision-based algorithms or methods can be further enhanced by the use of topology maps.

[0065] Optical flow, another computer vision-based technique, can analyze the displacement and movement of image pixels within a video sequence of vision data 92 to infer camera motion. By comparing multiple frames over multiple iterations, the movement and position of the camera (and therefore the endoscope) can be determined.

[0066] The positioning module 95 can use real-time electromagnetic tracking to generate a real-time position of the endoscope in a global coordinate system that can be registered to the patient's anatomy represented by the pre-operative model. In electromagnetic tracking, an electromagnetic sensor (tracker) comprising one or more sensor coils embedded in one or more positions and orientations of a medical instrument (e.g., an endoscopic tool) measures variations in an electromagnetic field generated by one or more static electromagnetic field generators placed at known locations. The position information detected by the electromagnetic sensor is stored as electromagnetic data. An electromagnetic field generator (or transmitter) can be placed near the patient to generate a low-intensity magnetic field that can be detected by the embedded sensor. The magnetic field induces a small current in the electromagnetic sensor coil, which can be analyzed to determine the distance and angle between the electromagnetic sensor and the electromagnetic field generator. These distances and orientations can be "registered" intraoperatively to the patient's anatomy (e.g., the pre-operative model) to determine a geometric transformation that aligns a single position in the coordinate system with a position in the pre-operative model of the patient's anatomy. Once aligned, an electromagnetic tracking device implanted 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 progress through the patient's anatomy.

[0067] The robot commands and kinematic data 94 may also be used by a positioning module 95 to provide positioning data 96 for the robotic system. The device pitch and yaw resulting from the joint movement commands may be determined during pre-operative calibration. During surgery, these calibration metrics 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 electromagnetic, visual, and / or topology modeling to estimate the position of the medical instrument within a network.

[0068] As shown in Figure 15, numerous other input data can be used by the positioning module 95. For example, although not shown in Figure 15, an instrument that uses shape-sensing fibers can provide shape data that the positioning module 95 uses to determine the position and shape of the instrument.

[0069] The positioning 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 positioning module 95 assigns a reliability weight to the position determined from each of the input data 91-94. Thus, if the electromagnetic data is unreliable (such as in the presence of electromagnetic interference), the reliability of the position determined by the electromagnetic data may be reduced, and the positioning module 95 may rely more on the vision data 92 and / or the robot command and kinematic data 94.

[0070] As noted above, the robotic systems described herein can be designed to incorporate one or a combination of the above techniques. The computer-based control system of a tower-, bed-, and / or cart-based robotic system can store computer program instructions in a non-transitory computer-readable storage medium, such as a persistent magnetic storage drive, a solid-state drive, etc., that, when executed, causes the system to receive and analyze sensor data and user commands, generate system-wide control signals, and display navigation and positioning data, such as instrument positions within a global coordinate system, anatomical maps, etc.

[0071] (2. Setting up the robotic arm before the procedure)

[0003] Embodiments of the present disclosure relate to systems and techniques for positioning one or more robotic arms prior to a medical procedure. Depending on the type of medical procedure, there may be limitations on the extent to which the robotic arms can be positioned or moved during setup of the surgical system. For example, certain physical or mechanical considerations, such as the shape and dimensions (e.g., length) of the medical instrument, the shape and physiological characteristics of the patient's luminal network, the location of the target objective for the procedure, and the working area of ​​the robotic arms, may limit the area or volume in which the robotic arms can be positioned during setup.

[0072] Setup procedures for surgical robotic systems help ensure and / or ensure that a given procedure can be accomplished. For example, a target location or surgical site may be located a certain distance from an access point within a patient's body. Furthermore, the length of a medical instrument and the stroke length of a robotic arm may be substantially fixed for a given surgical robotic system (e.g., a robotic arm stroke length and a medical instrument length may be defined). As used herein, the stroke length of a robotic arm generally refers to the capability or range over which a robotic arm can insert an instrument toward a target, e.g., from a start position / position of a reference point of the robotic arm to an end position / position of the reference point. In one embodiment, the reference point may be the IDM of the robotic arm, and the stroke length may refer to the distance from the position of the IDM in an initial position of the robotic arm for starting a medical procedure (e.g., an initial position and position of the robotic arm that facilitates loading / attaching an instrument to the robotic arm, referred to herein as the loaded instrument position) to the position of the IDM at maximum insertion of a medical instrument. For example, the stroke length of a robotic arm can determine whether the robotic arm can reach a target site / region from a given access point within a patient's body. Depending on the context, the "stroke length of the robotic arm" can be rephrased as the "stroke length of the medical instrument" since the movement of the robotic arm can be directly correlated to the insertion / retraction of the medical instrument.

[0073] Given the length of the medical instrument, the distance from the access point to the target location, and the maximum achievable stroke length of the robotic arm, there are limitations to the positions that can be used as the initial posture of the robotic arm before surgery. That is, a certain initial posture of the robotic arm may enable the medical instrument to reach the target location, while other initial postures may not be able to reach the target location. The placement of the cart relative to the patient's access point, and therefore the location of the area / volume in which the robotic arm can be freely positioned, may affect the achievable stroke length of the robotic arm. If the achievable stroke length is reduced to a length shorter than the distance from the access point to the target location for a given medical procedure, it may not be possible to perform the medical procedure based on the robotic system setup.

[0074] Aspects of the present disclosure relate to systems and methods that assist a user (e.g., a technician or surgeon) in determining whether a desired procedure can be completed based on a given initial pose of a robotic arm. This technique can solve the problem of being unable to reach a target position during a procedure.

[0075] (A. Example of a bronchoscopy system) One aspect of the present disclosure will be described generally using bronchoscopy as an exemplary medical procedure, although the present disclosure is also applicable to other types of medical procedures performed by surgical robotic systems, such as, for example, ureteroscopy and gastroenterology.

[0076] FIG. 16 illustrates an embodiment of a robotic system configured for a diagnostic and / or therapeutic bronchoscopy procedure according to one aspect of the present disclosure. As shown in FIG. 16, the system 100 includes a cart 111, one or more robotic arms 112, a medical instrument such as a steerable endoscope 13, and a patient introduction device 115. The cart 111 may include a processor (not shown), a memory (not shown), and a display 120 configured to display information related to the positioning of the robotic arm 112. However, depending on the embodiment, one or more of the processor, memory, and display may be located on or within another device, such as the movable tower 30 shown in FIG. 1 . Furthermore, in other embodiments, feedback devices other than the display 120 may be used instead of or in addition to the display 120. Other feedback devices that may be used include a haptic device, a speaker, force feedback actuated via one or more of the robotic arms 112, one or more light-emitting diodes, etc.

[0077] The robotic arms 112 may be configured to manipulate a medical instrument (e.g., a steerable endoscope 113) before and / or during the procedure. During the arm setup phase (e.g., the arm pushing or pulling phase), the position of the robotic arms 112 may be adjustable by the user. In particular, it may be important that at least one of the robotic arms is aligned with the patient. This alignment may allow the system to track the entry / access point of the medical instrument into the patient. Depending on the embodiment, the system may be configured to allow the user to directly move the arms 112 by applying a force directly to a portion of the robotic arms 112. For example, the system may be configured to detect when the user grasps one of the robotic arms 112 and physically moves the arm 112 to a desired position by applying a force to move the arm 112 (e.g., pushing or pulling the arm). In certain embodiments, the system may accept user input to switch on or off an admittance mode in which the arm accepts force as an input for arm movement. In other embodiments, the system may be configured with an input device to allow a user to control the robotic arm 112 by adjusting one or more positions of the robotic arm via the input device.

[0078] As described in more detail below, the memory can be configured to store instructions that, when executed, cause the processor to perform one or more methods according to aspects of the present disclosure. The memory may be further configured to store data related to pre-procedure robotic arm setup. For example, the memory can store a mapping of a patient's anatomy. The mapping can include data related to (i) a target area within the anatomy and (ii) a path from a patient access point to the target area. The mapping can include or be based on procedure data related to the medical procedure being performed. The procedure data can include data related to the type of procedure being performed, the type of instrument used in the procedure (which may be related to the type of procedure), instrument attributes (e.g., instrument length, number of IDMs required to operate the instrument, etc.), patient anatomy related to the procedure (e.g., target location within the anatomy, path from the patient access point to the target area, patient anatomical features or dimensions, etc.), arm setup (which may also be related to the type of procedure, instrument type, and instrument attributes), etc. For example, the mapping can include the location of the target region within the anatomy and a path from the patient access point to the target region, which can be determined based on the procedure data.

[0079] (B. Robot arm setup) Positioning one or more robotic arms 112 may be part of a setup procedure to prepare the robotic arm system for a medical procedure. The particular setup procedure used may depend on the medical procedure being performed, the configuration of the robotic system (e.g., whether the arms are mounted on a cart (see FIG. 16) or on a platform support (see FIG. 6), etc.).

[0080] 17A is a flowchart illustrating features of an exemplary setup procedure for a medical procedure (e.g., a bronchoscopy) according to an embodiment of the present disclosure. The method 1700 illustrated in FIG. 17A is merely an example implementation, and method 1700 may be modified by adding, deleting, and / or changing one or more of the blocks associated with method 1700.

[0081] Method 1700 begins at block 1701. In block 1705, method 1700 includes moving a cart to an initial position. For example, a user can move the cart to position it proximate (e.g., within a predetermined distance) to a patient access point. Once the cart is moved into position, a user can secure the cart, for example, by locking the cart's casters. It should be understood that not all robotic systems utilize carts, and this block is optional for systems that do utilize carts.

[0082] Block 1710 may include an arm setup phase in which a user can place one or more robotic arms in an initial position that aligns the robotic arms with the patient prior to the procedure. Accordingly, the arm setup phase may include an alignment step for aligning one or more robotic arms 112 with a patient access point. Because the access point used may depend on the type of medical procedure being performed, the specific alignment procedure may depend on the type of medical procedure. In the example of a bronchoscopy, a patient introducer (a device that guides the bronchoscope into the patient's mouth) may be positioned within the patient's mouth. In one embodiment of the bronchoscopy setup procedure, a user may align a first of the robotic arms with the patient introducer. The remaining robotic arms may, for example, be automatically aligned with the first robotic arm's position selected by the user. As described above, a user may directly move the robotic arms by pressing an admittance button, which allows the user to direct the robotic arm movement by applying a force. In other embodiments, the first robotic arm may track the patient introducer via one or more position tracking devices, allowing the system to automatically align the first robotic arm with the patient introducer.

[0083] The system may provide the user with an indication of a boundary for the initial pose of the first robotic arm. In certain embodiments, the system may provide an indication of the boundary for the movement of the first robotic arm during the arm setup phase before the medical procedure. The boundary may be set by the system to ensure that the pose of the first robotic arm does not interfere with the medical procedure. In one embodiment, the boundary may be set as an area or volume within which the first robotic arm can be freely positioned without reducing the stroke length of the robotic arm by more than a threshold amount. In the example of bronchoscopy, the boundary may define an area within which the robotic arm can be aligned with a patient introducer such that the distance between the initial pose of the robotic arm (e.g., the pose of the robotic arm aligned with the patient introducer) and the loaded instrument pose is equal to or greater than a threshold stroke length. In certain embodiments, the threshold stroke length may be selected such that a target area associated with the medical procedure can be reached when the stroke length achievable by the robotic arm is greater than the threshold stroke length.

[0084] After the first robotic arm is aligned with the patient introducer, at block 1715, the method includes retracting the robotic arm to the load-instrument orientation. In some embodiments, the system may retract the robotic arm to the load-instrument orientation in response to receiving, for example, a load-instrument orientation input or command from a user. This input may indicate that the alignment step is complete and that an instrument (e.g., a bronchoscope sheath and reader) should be loaded onto the robotic arm. At block 1720, the method includes loading a medical instrument onto the corresponding robotic arm. Method 1700 ends at block 1725.

[0085] FIG. 17B is a flowchart illustrating features of another exemplary setup procedure for a medical procedure according to aspects of the present disclosure. The flowchart in FIG. 17B illustrates an exemplary method, executable by a surgical robotic system or components thereof, for positioning one or more robotic arms prior to a medical procedure according to aspects of the present disclosure. For example, the steps of method 1750 illustrated in FIG. 17B may be performed by a processor of the surgical robotic system. For convenience, method 1750 will be described as being performed by the system's processor.

[0086] Method 1750 can be performed as part of a setup procedure for a medical procedure, such as medical procedure 1700 shown in Figure 17A. In certain embodiments, method 1750 can be performed during execution of block 1710 to provide boundary indication during movement of the robotic arm.

[0087] Method 1750 begins at block 1751. In block 1755, the processor determines a minimum stroke length of the robotic arm that allows advancement of the medical instrument by the robotic arm to reach the target area. The processor can determine the minimum stroke length based on a mapping of the patient's anatomy. The mapping includes data regarding (i) the target area within the anatomy and (ii) a pattern from an access point on the patient to the target area. The medical instrument can be advanced by the robotic arm to reach the target area from the access point via that path.

[0088] At block 1760, the processor determines bounds for the initial pose of the robotic arm based on the minimum stroke length and the mapping. At block 1765, the processor provides indications of bounds for when the robotic arm will move during the pre-procedure arm setup phase. Method 1750 ends at block 1770.

[0089] Because the structure of the medical instrument and robotic arm is known prior to the medical procedure, the boundaries can be determined offline (e.g., before the arm setup phase). However, depending on the complexity of the medical procedure and medical instrument, determining the boundaries can require significant computational resources. In some cases, the calculations can take as long as several hours to complete. An example of considerations for defining the boundaries of the initial pose is described with reference to FIG. 18.

[0090] FIG. 18 illustrates an embodiment of a bronchoscope that can be used in accordance with aspects of the present disclosure. As shown in FIG. 18, bronchoscope 200 can include two nested portions: a sheath 210 and a reader 220. For example, reader 220 can be a portion that defines a working channel through which a camera / video device, an EM sensor, and other instruments can be inserted. Sheath 210 can include a base 211 configured to couple to an IDM of a first robotic arm and an elongated shaft 213 attached to base 211. Similarly, reader 220 can include a base 221 configured to couple to an IDM of a second robotic arm and an elongated shaft 223 attached to base 221. The first and second robotic arms can be configured to advance sheath 210 and leader 220, respectively. The elongated shaft 213 of sheath 210 has a working channel configured to receive the elongated shaft 223 of leader 220. The distal end of each of the elongate shafts 213, 223 may include an articulation configured to bend under tension applied to a tendon disposed along (or within) the wall of the corresponding elongate shaft.

[0091] In the example shown in FIG. 18 , the elongate shaft 213 of the sheath 210 has a length of approximately 683 mm. Therefore, the maximum stroke length of the elongate shaft 213 is approximately 683 mm minus the working length of the patient introducer. If the working length of the patient introducer is approximately 150 mm, then, by way of example and not limitation, the maximum stroke length of the elongate shaft 213 of the sheath 210 may be approximately 533 mm. Furthermore, the elongate shaft 223 of the leader 220 may be approximately 930 mm in this example. Here, the leader 220 may extend approximately 130 mm beyond the distal end of the sheath 210, allowing the distal end of the leader 220 to access a target site (e.g., to perform a medical procedure). Therefore, the maximum stroke length of the leader 220 may be approximately 663 mm in one example.

[0092] However, the maximum stroke length of each of the sheath 210 and the reader 220 can be reduced based on the positioning of the cart and robotic arm setup. For example, if a first robotic arm (e.g., the arm attached to the sheath 210) reaches its maximum extension before contacting the patient introducer, the first robotic arm cannot further insert the sheath 210, reducing the achievable stroke length. In another example, after aligning the first robotic arm with the patient introducer in a first position (e.g., a partially extended position), the first robotic arm is retracted to the load-instrument position. However, the distance between the load-instrument position and the initial position may not be sufficient to achieve full insertion of the sheath 210. Similar considerations affect the achievable stroke length of the reader 220.

[0093] Another factor that may limit the achievable stroke length of sheath 210 and / or reader 220 includes potential collisions between one or more robotic arms and other objects present in the operational environment. For example, if the IDM of a second robotic arm (attached to the leader) is prevented from moving into contact with the IDM of a first robotic arm, reader 220 will lose a portion of its stroke length beyond the distal end of sheath 210.

[0094] FIG. 19 is a flowchart illustrating another example of a setup procedure for a bronchoscopy procedure according to aspects of the present disclosure. Method 1900 can begin after a user positions a cart adjacent to a patient to align one or more robotic arms of the cart with the patient. Method 1900 begins at block 1901. At block 1905, the system receives an admittance mode input from a user. One of the robotic arms may include an admittance button (e.g., on or near the IDM) that allows the user to transition to admittance mode. As described above, in admittance mode, a user can apply a force directly to a portion of the robotic arm as an input to move the arm. In certain embodiments, each of the robotic arms can maintain a substantially constant separation and relative orientation when a user moves a first robotic arm (of one or more robotic arms) in admittance mode.

[0095] In block 1910, the system provides a representation of the boundary to the user. The boundary may be an area within which the user is permitted to move the first robotic arm in admittance mode. The boundary may be determined by the system such that when the first robotic arm is aligned with an access point within the boundary, the stroke lengths of the sheath and reader exceed a predetermined threshold (also referred to herein as a "stroke length threshold"). In one example, the access point may include a patient introduction device that can be attached to a user's mouth, for example, when performing a bronchoscopy procedure. However, in other medical procedures, the access point may include a separate device designed to guide a medical instrument through the access point into the user. The access point may also be a natural orifice (e.g., the patient's mouth) without an attached device. In other embodiments, the access point may be a small incision that allows an instrument to access the patient's anatomy in a minimally invasive manner.

[0096] Depending on the embodiment, the system may provide an indication of the boundary via at least one of a tactile, visual, and audio indication. For example, the system may provide a visual indication of the first robotic arm's position within the boundary to the user via a display. In another embodiment, a speaker may be used to indicate the distance to the nearest portion of the boundary, or an indication may be provided that the user has moved the first robotic arm within a threshold distance of the boundary to warn that the first robotic arm is approaching the boundary.

[0097] In another embodiment, the system can provide a tactile indication of the boundary to the user. For example, motors in the first robotic arm can allow the user to freely move the first robotic arm within the boundary but impede movement of the first robotic arm outside the boundary. In certain implementations, the IDM of the first robotic arm can give the user the feeling that it is against an invisible wall. Alternatively, as the first robotic arm approaches the boundary, it can increase the pseudo-resistance to movement, preventing further movement once the IDM reaches the boundary. Thus, the system can restrict movement of the first robotic arm within a bounded region during the arm setup phase. In other embodiments, such as when the boundary is represented by a volume, the system can restrict movement of the first robotic arm within a bounded volume during the arm setup phase.

[0098] In certain embodiments, the boundary is a two-dimensional region that restricts movement only within the plane of the boundary. For example, in bronchoscopy embodiments, the vertical axis (Z-axis) of the IDM is aligned with a corresponding feature on the patient introduction device. This height is typically fixed during the procedure, and insertion of the bronchoscope into the patient does not require substantial movement in the Z-axis. Therefore, variations in the Z-axis of the first robotic arm during the arm setup phase do not significantly affect the achievable stroke length. Therefore, in these embodiments, the boundary can be defined only in the XY plane, allowing free movement in the Z-axis.

[0099] However, other medical procedures and / or robotic system configurations may involve movement of one or more robotic arms in the Z-axis during a medical procedure. In these embodiments, boundaries may be defined in three dimensions, including within the Z-axis.

[0100] Returning to method 1900, at block 1915, the system receives or detects input from the user that overrides the boundaries previously provided to the user. For example, the cart may not have been placed in an ideal position before starting the arm setup phase, and an access point (e.g., a patient introduction device) may not be within the boundaries. If the access point is not reachable by the IDM of the first robotic arm, the user may wish to override the boundaries to determine whether the first robotic arm can align with an access point outside the boundaries. The user can then override the boundaries by inputting an override command to the system, for example, via an override input or another input / output device (e.g., a touchscreen display) coupled to the system.

[0101] In block 1920, in response to detecting an input that does not invalidate the boundary, the system aligns the first robotic arm with the access point based on the input received from the user. For example, the user can apply a force to the first robotic arm in admittance mode, and the system can use the force as an input to reposition the first robotic arm. This alignment may involve matching markings or other alignment devices on the IDM of the first robotic arm with corresponding markings or alignment devices (e.g., a patient introduction device) on the access point, including corresponding physical components on the IDM, a matable patient introduction device, an electronic communication device such as an RFID tag / reader, a position tracking system (which may be based on optical and / or acoustic technology), etc. After the first robotic arm is aligned with the access point, in block 1925, the system receives onboard instrument pose input from the user. This input indicates that the user has completed the alignment steps and is ready to load the instruments (e.g., bronchoscope sheath and reader) onto the robotic arm(s).

[0102] In block 1945, the system moves the first robotic arm to the load instrument position so that the user can load the medical device onto the first robotic arm.

[0103] In block 1930, in response to detecting input from a user and invalidating the boundaries, the system aligns the robotic arm with the access point based on the input received from the user. For example, the user can apply a force to the first robotic arm in admittance mode, and the system can use the force as an input to reposition the first robotic arm. In this case, the user can move the first robotic arm outside the boundaries previously provided to the user in block 1910. In block 1935, the system calculates the achievable stroke length and provides a display of the calculation result to the user. In one implementation, the system can perform the calculation in “real time” and provide a display of the calculation result to the user. For example, the system can detect movement of the first robotic arm at a sampling frequency. Then, the system can determine a position of the first robotic arm based on the detected movement of the first robotic arm. Then, based on the position of the first robotic arm, the system can simulate an achievable stroke length of the first robotic arm that facilitates advancing the medical instrument into the patient. One approach for simulating the achievable stroke length is described in more detail below with reference to FIG. 20 .

[0104] There are various techniques that can be used to provide the user with an indication of the achievable stroke length. In one embodiment, the system can provide the user with a numerical value representing the simulated achievable stroke length. In another implementation, the system can store (e.g., in memory) the stroke length required to perform a particular medical procedure on a patient. In some embodiments, the required stroke length may be the minimum stroke length of the robotic arm that allows advancement of the medical instrument by the robotic arm from the access point on the patient via a predetermined path to reach the target area.

[0105] For example, prior to the arm setup phase, an image of the patient's luminal network may have been acquired. For a particular medical procedure, pre-operative mapping of the patient's luminal network may have been performed through the use of low-dose CT scan acquisition. Based on the mapping, the system can determine a path from the selected access point to the target location and calculate the stroke length required to reach the target location via the determined path. The system can then compare the required stroke length with the achievable stroke length and provide a user with an indication of whether the target location can be reached based on the pose of the first robotic arm. For example, the system can determine whether the achievable stroke length is greater than or equal to a minimum stroke length and provide an indication of whether the achievable stroke length is greater than or equal to the minimum stroke length. Depending on the system's computational bandwidth, the system can continuously update a simulation of the procedure and provide an indication of whether the desired target location can be reached when the user moves the first robotic arm in admittance mode.

[0106] In certain embodiments, the system may determine whether the achievable stroke length is greater than or equal to the minimum stroke length in response to the user releasing the admittance mode button. For example, during admittance mode, the user may still be moving the robot arm to align it, and the initial robot arm pose may not be set while the admittance button is pressed. After the user releases the admittance button, the system may consider the first robot arm pose to be aligned with the access point and compare the achievable stroke length with the subsequent minimum stroke length. Thus, in certain embodiments, the system may provide or update an indication of whether the target position can be reached only in response to the user releasing the admittance mode button.

[0107] At block 1940, the system receives input from the user accepting the stroke length provided by the user. For example, the system may be configured to use an input indicating whether the provided achievable stroke length is acceptable to the user. If the user accepts the provided achievable stroke length, the system receives input (e.g., user input) including instructions to move to the onboard instrument orientation at block 1925. If the input received by the system indicates that the user does not accept the achievable stroke length, the method ends at block 1950, and the system may display instructions to the user to reposition the cart to further extend the achievable stroke length. However, in other embodiments, the system may determine a direction of movement of the first robotic arm to adjust the achievable stroke length so that the medical procedure can be performed. In this embodiment, the system may determine that the achievable stroke length is less than the minimum stroke length, calculate a direction from the current position to the boundary, and provide an indication of the direction from the current position to the boundary.

[0108] (C. Simulation of achievable stroke length) In certain embodiments, to determine achievable stroke lengths for one or more initial robotic arm positions, the system can perform a simulation of a medical procedure. For example, a given medical procedure may include a series of movements of the associated robotic arms, depending on the particular procedure. Also, for some medical procedures, the movement sequence may vary depending on patient characteristics.

[0109] 20 is a flowchart illustrating an exemplary method for simulating a medical procedure according to aspects of the present disclosure. In particular, the embodiment of FIG. 20 relates to a bronchoscopy procedure. The details of the simulation will depend on the medical procedure being performed and the corresponding configuration of the surgical system, including the number of robotic arms involved in the procedure, alignment processes, and any additional devices attached or installed to the patient.

[0110] Method 2000 begins at block 2001. In block 2005, the system simulates full insertion of the reader into the sheath. Block 2005 corresponds to full insertion of both the sheath and the reader into the patient, since the position of the sheath robotic arm is presumed to be aligned with the access point (e.g., a patient introducer) for purposes of the simulation. In block 2010, the system determines the achievable stroke length of the reader based on the results of the simulated insertion in block 2005. That is, if the simulation results in some kind of collision or other impediment to the reader fully inserting into the sheath, the achievable stroke length of the simulated reader may be shorter than the maximum achievable stroke length of the reader under ideal conditions.

[0111] In block 2015, the system simulates retraction of the reader from the working channel of the sheath. This may include simulating retracting the reader to return the reader's robotic arm to its initial position before the simulation in block 2005. In block 2020, the system simulates full retraction of both the sheath and the reader from the patient. Here, full retraction may mean fully retracting the sheath and reader from the patient but leaving the sheath and reader at the access point. In block 2025, the system determines the achievable stroke length of the sheath based on the simulated results of block 2020. For example, if the system determines that a collision or other obstacle prevents the sheath from being fully retracted from the patient, the simulated achievable stroke length of the sheath may be shorter than the maximum achievable stroke length of the leader under ideal conditions.

[0112] At block 2030, the system compares the simulated achievable stroke length of the leader and sheath to the required stroke length for the procedure. As described above, the system can calculate the required stroke length for the procedure based on pre-operative mapping of the patient's luminal network. Method 200 ends at block 2035.

[0113] The method 2000 described with reference to Figure 20 includes a simulation of a bronchoscopy procedure. However, the order of movements during a particular medical procedure may be varied from that described with reference to Figure 20 depending on the requirements for performing the procedure. Similarly, the order of movements may be simulated other than that shown in Figure 20, so long as the achievable stroke length of the leader and sheath can be simulated.

[0114] In another example, the system can simulate movements of the first and second robotic arms in the same order as they are performed during a procedure. For example, the system can determine at least one first movement of the first robotic arm that facilitates advancing a sheath from an access point through a path to a target area. The system can also determine at least one second movement of the second robotic arm that facilitates advancing a reader through the sheath to the target area. The system can then simulate the at least one first movement and the at least one second movement at positions of the first and second robotic arms and calculate an achievable stroke length of at least one of the first and second robotic arms based on the simulation.

[0115] While method 2000 has been described with reference to the example of bronchoscopy, embodiments of the present disclosure may also simulate the achievable stroke length of one or more robotic arms for other types of medical or surgical procedures. In certain implementations, a robotic system may be configurable to perform one of a plurality of surgical procedures. In these embodiments, the system may be configured to receive input indicating a surgical procedure on a patient. Based on the received surgical procedure input, the system may determine at least one desired movement of a first robotic arm that facilitates advancing a medical instrument from an access point to a target area via a predetermined path and performing the surgical procedure at the target area. This may be based on the surgical or medical instrument used to perform the procedure, as well as the number of robotic arms required to manipulate the instrument. The system may also simulate at least one desired movement at a position of the first robotic arm and calculate the achievable stroke length of the first robotic arm based on the simulated movement.

[0116] The system can identify whether the simulated movement could cause the first robotic arm to collide with an object. The object could be another robotic arm, another part of the surgical robotic system, such as a cart, or another object in the operating environment. To simulate a collision with another object, the system's memory can be programmed with the location and shape of the object in the operating environment. For example, a C-arm may be used in various medical procedures and be positioned within the robotic arm's working envelope. Therefore, the system can simulate whether a given procedure will result in a collision with the C-arm based on a selected initial pose. The calculation of the achievable stroke length can also be based on determining whether the simulated movement would cause the first robotic arm to collide with an object or whether the simulated movement would fully extend the first robotic arm.

[0117] Additionally, full extension of one or more robot arms may limit the stroke length of the corresponding arm. Thus, during simulation, the system may also determine whether the simulated movement will result in one of the robot arms being fully extended. The system may also calculate an achievable stroke length based on a determination that the simulated movement will result in one of the robot arms being fully extended.

[0118] In an alternative embodiment, instead of calculating or simulating the achievable stroke length in real time, the system may store in memory a stroke length validation module that defines the achievable stroke length of the first robotic arm for each of a plurality of initial poses of the first robotic arm. The stroke length validation module has a database or procedure stored in memory that associates values ​​of the initial poses of the first robotic arm with corresponding achievable stroke lengths. In certain embodiments, the stroke length validation module may have a lookup table or other data structure that stores the achievable stroke length for each of a plurality of initial poses of the first robotic arm. In other embodiments, the stroke length validation module may comprise techniques for calculating the achievable stroke length for a given initial pose of the robotic arm.

[0119] This is useful for performing a medical procedure that is suitably configured and does not involve additional factors (e.g., object collisions) that limit the stroke length beyond the initial posture of the first robotic arm. These implementations may include detecting, during the arm setup phase, movement of the first robotic arm to an initial posture and obtaining an achievable stroke length from a stroke-length validation module based on the initial posture. The system may also determine whether the achievable stroke length is greater than or equal to a minimum stroke length and provide an indication of whether the achievable stroke length is greater than or equal to the minimum stroke length. The system may also obtain the achievable stroke length from the stroke-length validation module in response to detecting a user-initiated event, such as a user input that instructs the system to use the stroke-length validation module in determining the achievable stroke length.

[0120] (3. System Implementation and Terminology) Embodiments disclosed herein provide systems, methods, and devices for compensating for compression in an elongate shaft of a medical instrument, which compression can optionally be determined using compression compensation parameters determined during calibration of the medical instrument, and can be compensated for by moving the medical instrument using an instrument positioning device coupled to the medical instrument.

[0121] It should be noted that as used herein, the terms "couple," "coupled," "coupled," or other variations of word pairs can indicate either an indirect connection or a direct connection; for example, if a first component is "coupled" to a second component, the first component can be indirectly connected to the second component through another component, or directly connected to the second component.

[0122] The feature similarity calculation, position estimation, and robot motion actuation functions described herein can be stored as one or more instructions on a processor-readable medium or 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 can comprise RAM (random access memory), ROM (read-only memory), EEPROM (electrically erasable programmable read-only memory), flash memory, CD-ROM (compact disc read-only) 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. Note that computer-readable media can be tangible and non-transitory. As used herein, the term “code” can refer to software, instructions, code, or data that is executable by a computing device or processor.

[0123] The methods disclosed herein comprise one or more steps or actions for achieving the described method. The steps and / or actions of the methods may be interchanged with one another without departing from the scope of the alternatives. In other words, unless the specific order of the steps or actions is required for the proper operation of the described method, the order and / or use of specific steps and / or actions may be modified without departing from the scope of the alternatives.

[0124] As used herein, the term "plurality" means two or more. For example, a plurality of components refers to two or more components. The term "identifying" encompasses a wide variety of actions, and thus "identifying" can include calculating, computing, processing, deriving, examining, referencing (e.g., referencing a table, database, or another data structure), ascertaining, etc., and "identifying" can include receiving (e.g., receiving information), accessing (e.g., accessing data in a memory), etc. Also, "identifying" can include resolving, selecting, choosing, establishing, etc.

[0125] The phrase "based on" does not mean "based only on," unless specifically stated otherwise. In other words, the phrase "based on" describes both "based only on" and "based at least on." The above description of the disclosed embodiments is provided to enable any person skilled in the art to make or use the present disclosure. 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 disclosure. For example, those skilled in the art will recognize that several corresponding alternative and equivalent structural details may be employed, such as equivalent methods of securing, mounting, coupling, or engaging tool components, equivalent mechanisms for generating specific actuation motions, and equivalent mechanisms for delivering electrical energy. Thus, the present disclosure 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.

[0126] [Embodiment] (1) A robotic system for performing a medical procedure, comprising: a first robotic arm for manipulating a medical instrument; a processor; a memory storing a mapping of a patient's anatomy, the memory having data relating to (i) a target area within the anatomy and (ii) a route from an access point on the patient to the target area, and further storing computer-executable instructions that, when executed, cause the processor to: determining a minimum stroke length of the first robotic arm that allows the first robotic arm to advance the medical instrument from the access point through the path to the target area; determining a boundary for an initial pose of the first robot arm based on the minimum stroke length and the mapping; providing an indication of the boundary during movement of the first robotic arm during an arm setup phase prior to performance of the procedure; and a memory for executing the A robot system comprising: (2) the memory further stores computer-executable instructions that, when executed, cause the processor to: providing the indication of the boundary via at least one of a tactile indication, a visual indication, and an audio indication; The system of embodiment 1 is characterized by executing the following. (3) the boundary has a boundary area; The memory further stores computer-executable instructions that, when executed, cause the processor to restrict the movement of the first robot arm within the bounded area during the arm setup phase. The system of embodiment 1, characterized in that (4) The memory further stores computer-executable instructions that, when executed, cause the processor to: restricting movement of the first robot arm within the boundary during the arm setup phase. The system of embodiment 1, characterized in that (5) The memory further stores computer-executable instructions that, when executed, cause the processor to: detecting an input that overrides the restriction; Detecting movement of the first robotic arm; determining a position of the first robotic arm based on the detected movement of the first robotic arm; simulating an achievable stroke length of the first robotic arm to assist in advancing the medical instrument into the patient based on the position of the first robotic arm; Run The system of embodiment 4, characterized in that (6) The memory further stores computer-executable instructions that, when executed, cause the processor to: receiving an input indicative of a surgical procedure for the patient; determining, based on the surgical procedure, at least one desired movement of the first robotic arm to assist in advancement of the medical instrument from the access point via the path to the target area and in performing the surgical procedure at the target area; simulating movement of the at least one object at the position of the first robotic arm; and calculating an achievable stroke length of the first robotic arm based on the simulated movement; The system of embodiment 1 is characterized by executing the following. (7) The memory further stores computer-executable instructions that, when executed, cause the processor to: determining that the simulated movement causes the first robotic arm to collide with an object; Execute the calculation of the achievable stroke length is further based on the determination that the simulated movement will cause the first robot arm to collide with the object and the determination that the simulated movement will cause the first robot arm to fully extend. The system of embodiment 6, characterized in that (8) The memory further stores computer-executable instructions that, when executed, cause the processor to: determining that the simulated movement results in full extension of the first robotic arm; Execute the calculation of the achievable stroke length is further based on the determination that the simulated movement results in full extension of the first robotic arm. The system of embodiment 1, characterized in that (9) The memory further stores computer-executable instructions that, when executed, cause the processor to: determining that the achievable stroke length is less than the minimum stroke length; calculating a direction from a current position to the boundary; providing an indication of the direction from the current location to the boundary; Run The system of embodiment 5, characterized in that (10) The medical device has a sheath; the system further comprising a second robotic arm that advances a reader through the sheath; The memory further stores computer-executable instructions that, when executed, cause the processor to: determining at least a first movement of the first robotic arm to assist in advancing the sheath from the access point through the pathway to the target area; determining at least a second movement of the second robotic arm to assist advancement of the reader through the sheath to the target area; simulating the at least first movement and the at least second movement in positions of the first and second robotic arms; calculating an achievable stroke length of at least one of the first and second robot arms based on the simulation; and Run The system of embodiment 1, characterized in that (11) A non-transitory computer-readable storage medium having stored thereon instructions that, when executed, cause at least one computing device to: determining a minimum stroke length of a first robotic arm that allows a medical instrument to be advanced to reach a target area based on mapping of a patient's anatomy, the mapping having data regarding (i) a target area within the anatomy and (ii) a path from an access point on the patient to the target area, the medical instrument being advanced from the access point to reach the target area via the path; determining a boundary for an initial pose of the first robot arm based on the minimum stroke length and the mapping; providing an indication of the boundary during movement of the first robotic arm during an arm setup phase prior to execution of a procedure; Run A non-transitory computer-readable storage medium comprising: (12) The non-transitory computer-readable storage medium stores further instructions that, when executed, cause at least one computing device to: providing the indication of the boundary via at least one of a tactile indication, a visual indication, and an audio indication; Run A non-transitory computer-readable storage medium according to embodiment 11. (13) The boundary has a boundary area, and the non-transitory computer-readable storage medium stores further instructions, which, when executed, cause at least one computing device to: limiting the movement of the first robot arm within the bounded area during the arm setup phase; Run A non-transitory computer-readable storage medium according to embodiment 11. (14) The non-transitory computer-readable storage medium stores further instructions that, when executed, cause at least one computing device to: restricting movement of the first robot arm within the boundary during the arm setup phase. A non-transitory computer-readable storage medium according to embodiment 11. (15) The non-transitory computer-readable storage medium stores further instructions that, when executed, cause at least one computing device to: detecting an input that overrides the restriction; Detecting movement of the first robotic arm; determining a position of the first robotic arm based on the detected movement of the first robotic arm; simulating an achievable stroke length of the first robotic arm to assist in advancing the medical instrument into the patient based on the position of the first robotic arm; Run 15. A non-transitory computer-readable storage medium according to claim 14. (16) The non-transitory computer-readable storage medium stores further instructions that, when executed, cause at least one computing device to: receiving an input indicative of a surgical procedure for the patient; determining, based on the surgical procedure, at least one desired movement of the first robotic arm to assist in advancement of the medical instrument from the access point via the path to the target area and in performing the surgical procedure at the target area; simulating movement of the at least one object at the position of the first robotic arm; and calculating an achievable stroke length of the first robotic arm based on the simulated movement; 12. A non-transitory computer-readable storage medium according to claim 11, which causes the computer to execute the following: (17) The non-transitory computer-readable storage medium stores further instructions that, when executed, cause at least one computing device to: determining that the simulated movement causes the first robotic arm to collide with an object; Execute the calculation of the achievable stroke length is further based on the determination that the simulated movement will cause the first robot arm to collide with the object and the determination that the simulated movement will cause the first robot arm to fully extend. 17. A non-transitory computer-readable storage medium according to claim 16, (18) The non-transitory computer-readable storage medium stores further instructions that, when executed, cause at least one computing device to: determining that the simulated movement results in full extension of the first robotic arm; Execute the calculation of the achievable stroke length is further based on the determination that the simulated movement results in full extension of the first robotic arm. The system of embodiment 17, characterized in that (19) The non-transitory computer-readable storage medium stores further instructions that, when executed, cause at least one computing device to: determining that the achievable stroke length is less than the minimum stroke length; calculating a direction from a current position to the boundary; providing an indication of the direction from the current location to the boundary; Run 16. A non-transitory computer-readable storage medium according to claim 15, characterized in that: (20) The medical device has a sheath; the system further comprising a second robotic arm that advances a reader through the sheath; The non-transitory computer-readable storage medium stores further instructions that, when executed, cause at least one computing device to: determining at least a first movement of the first robotic arm to assist in advancing the sheath from the access point through the pathway to the target area; determining at least a second movement of the second robotic arm to assist advancement of the reader through the sheath to the target area; simulating the at least first movement and the at least second movement in positions of the first and second robotic arms; calculating an achievable stroke length of at least one of the first and second robot arms based on the simulation; and Run A non-transitory computer-readable storage medium according to embodiment 11. (21) A method of positioning a first robotic arm, comprising: determining a minimum stroke length of a first robotic arm that allows a medical instrument to be advanced to reach a target area based on mapping of a patient's anatomy, the mapping having data regarding (i) a target area within the anatomy and (ii) a path from an access point on the patient to the target area, the medical instrument being advanced from the access point to reach the target area via the path; determining a boundary for an initial pose of the first robot arm based on the minimum stroke length and the mapping; providing an indication of the boundary during movement of the first robotic arm during an arm setup phase prior to execution of a procedure; A method comprising: (22) providing the indication of the boundary via at least one of a tactile indication, a visual indication, and an audio indication; 22. The method of claim 21, further comprising: (23) limiting the movement of the first robot arm within the boundary area during the arm setup phase; 22. The method of claim 21, further comprising: (24) limiting movement of the first robot arm within the boundary during the arm setup phase; 22. The method of claim 21, further comprising: (25) detecting an input that overrides the restriction; Detecting movement of the first robotic arm; determining a position of the first robotic arm based on the detected movement of the first robotic arm; simulating an achievable stroke length of the first robotic arm to assist in advancing the medical instrument into the patient based on the position of the first robotic arm; 25. The method of claim 24, further comprising: (26) receiving an input indicating a surgical procedure for the patient; determining, based on the surgical procedure, at least one desired movement of the first robotic arm to assist in advancement of the medical instrument from the access point via the path to the target area and in performing the surgical procedure at the target area; simulating movement of the at least one object at the position of the first robotic arm; and calculating an achievable stroke length of the first robotic arm based on the simulated movement; 22. The method of claim 21, further comprising: (27) determining that the simulated movement causes the first robot arm to collide with an object; further comprising the calculation of the achievable stroke length is further based on the determination that the simulated movement will cause the first robot arm to collide with the object and the determination that the simulated movement will cause the first robot arm to fully extend. 27. The method of embodiment 26, (28) determining that the simulated movement results in full extension of the first robotic arm; further comprising the calculation of the achievable stroke length is further based on the determination that the simulated movement results in full extension of the first robotic arm. 28. The method of embodiment 27, (29) determining that the achievable stroke length is less than the minimum stroke length; calculating a direction from a current position to the boundary; providing an indication of the direction from the current location to the boundary; 26. The method of claim 25, further comprising: (30) The medical device has a sheath; the system further comprising a second robotic arm that advances a reader through the sheath; The method comprises: determining at least a first movement of the first robotic arm to assist in advancing the sheath from the access point through the pathway to the target area; determining at least a second movement of the second robotic arm to assist advancement of the reader through the sheath to the target area; simulating the at least first movement and the at least second movement in positions of the first and second robotic arms; calculating an achievable stroke length of at least one of the first and second robot arms based on the simulation; and 22. The method of claim 21, further comprising:

Claims

1. 1. A robotic system for performing a minimally invasive or non-invasive medical procedure, comprising: a first robotic arm configured to manipulate a medical instrument, the medical instrument configured to be manipulated through a luminal network of a patient's body; a processor; a memory storing a mapping of the patient's anatomy, the mapping comprising data regarding (i) a target area within the anatomy and (ii) a path through the luminal network from an access point of a natural orifice of the patient to the target area, the memory further storing computer-executable instructions that, when executed, cause the processor to: determining a minimum stroke length of the first robotic arm that allows the first robotic arm to advance the medical instrument from the access point through the path to the target area; determining a boundary for an initial pose of the first robot arm based on the minimum stroke length and an achievable stroke length of the first robot arm at one or more given initial poses of the first robot arm; providing an indication of the boundaries of the initial pose of the first robotic arm during a movement of the first robotic arm during an arm setup phase prior to performance of the medical procedure; and a memory for executing the wherein the boundary comprises a bounded area or volume.

2. The memory has further computer-executable instructions that, when executed, cause the processor to: providing the indication of the boundary to a user via at least one of a tactile indication, a visual indication, and an audio indication; The robot system according to claim 1 ,

3. 2. The robotic system of claim 1, wherein the memory further comprises computer-executable instructions that cause the processor to restrict the movement of the first robot arm within the bounded area during the arm setup phase.

4. The memory has further computer-executable instructions that, when executed, cause the processor to: The robotic system of claim 1 , further comprising: limiting movement of the first robotic arm within the boundary during the arm setup phase.

5. The memory has further computer-executable instructions that, when executed, cause the processor to: detecting an input that overrides the restriction; Detecting movement of the first robotic arm; determining a position of the first robotic arm based on the detected movement of the first robotic arm; simulating an achievable stroke length of the first robotic arm to assist in advancing the medical instrument into the patient based on the position of the first robotic arm; The robot system according to claim 4 , wherein the robot system executes the following:

6. The memory has further computer-executable instructions that, when executed, cause the processor to: receiving an input indicative of a surgical procedure for the patient; determining, based on the surgical procedure, at least one desired movement of the first robotic arm to assist in advancing the medical instrument from the access point via the path to the target area and performing the surgical procedure at the target area; simulating movement of the at least one object at a position of the first robotic arm; Calculating an achievable stroke length of the first robotic arm based on the simulated movement; The robot system according to claim 1 ,

7. The memory has further computer-executable instructions that, when executed, cause the processor to: determining that the simulated movement causes the first robot arm to collide with an object; Execute 7. The robotic system of claim 6, wherein the calculation of the achievable stroke length is further based on the determination that the simulated movement will cause the first robotic arm to collide with the object and the determination that the simulated movement will cause the first robotic arm to fully extend.

8. The memory has further computer-executable instructions that, when executed, cause the processor to: determining that the simulated movement results in full extension of the first robotic arm; Execute The robotic system of claim 7 , wherein the calculation of the achievable stroke length is further based on the determination that the simulated movement results in full extension of the first robotic arm.

9. The memory has further computer-executable instructions that, when executed, cause the processor to: determining that the achievable stroke length is less than the minimum stroke length; calculating a direction from a current position to the boundary; providing an indication of the direction from the current location to the boundary; The robot system according to claim 5 , wherein the robot system executes the following:

10. the medical device has a sheath; the robotic system further comprising a second robotic arm configured to advance a reader through the sheath; The memory has further computer-executable instructions that, when executed, cause the processor to: determining at least one first movement of the first robotic arm to assist in advancing the sheath from the access point through the path to the target area; determining at least one second movement of the second robotic arm to assist advancement of the reader through the sheath to the target area; simulating the at least one first movement and the at least one second movement in positions of the first and second robot arms; calculating an achievable stroke length of at least one of the first and second robot arms based on the simulation; and The robot system according to claim 1 ,

11. A program comprising: determining a minimum stroke length of a first robotic arm that allows a medical instrument to be advanced to reach a target area based on mapping of a patient's anatomy, the mapping having data regarding (i) the target area within the anatomy and (ii) a path from an access point of a natural orifice of the patient to the target area, the medical instrument being advanced from the access point to reach the target area via the path; determining a boundary for an initial pose of the first robot arm based on the minimum stroke length and the mapping; providing an indication of the boundaries during movement of the first robotic arm during an arm setup phase prior to performance of a minimally invasive or non-invasive medical procedure; wherein the boundary comprises a bounded area or volume.

12. the at least one computing device; providing the indication of the boundary to a user via at least one of a tactile indication, a visual indication, and an audio indication; The program according to claim 11 , further comprising:

13. The program causes the at least one computing device to: limiting the movement of the first robot arm within the bounded area during the arm setup phase; The program according to claim 11 , further comprising:

14. the at least one computing device; The program of claim 11 , further comprising: constraining movement of the first robot arm within the boundary during the arm setup phase.

15. the at least one computing device; detecting an input that overrides the restriction; Detecting movement of the first robotic arm; determining a position of the first robotic arm based on the detected movement of the first robotic arm; simulating an achievable stroke length of the first robotic arm to assist in advancing the medical instrument into the patient based on the position of the first robotic arm; The program according to claim 14, further comprising:

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