Camera position indication system and method

Abstract

Disclosed herein are camera position indication systems and methods for communicating a camera position to a user during a surgical procedure and / or adjusting a camera view display to match a user's viewpoint. In one embodiment, an exemplary method can include receiving an output view from a camera positioned in a channel of an access device to view a surgical site within a patient, receiving a camera position input from a user, and displaying on a display the output view from the camera and an indication of the camera position based on the camera position input.

Description

Technical Field

[0001] This specification discloses, for example, a camera position indication system and method for communicating the camera position to a user during a surgical procedure and / or adjusting the camera view display to match the user's perspective.

Background Art

[0002] Many surgical procedures involve accessing the surgical site through a channel of an access device. For example, minimally invasive surgical procedures often utilize one or more small incisions and an access device extending through the incisions to provide a working channel from outside the patient's body to the surgical site within the patient's body. In addition to passing surgical instruments, implants, and other components through such access devices, imaging devices such as cameras are also passed through to provide the user with a view of the surgical site.

[0003] If a camera or other imaging device is connected to an access device and cannot rotate about its longitudinal axis within the access device, for example, because it is embedded in a channel extending axially along a tube or other access device, or is disposed within the access device or fixed to the access device, the camera position relative to the longitudinal axis of the access device may not be known, and / or the orientation of the image displayed on the screen from the camera may not be the same as the orientation seen when a surgeon or other user looks directly down the access tube. The mismatch between the surgeon or other user's perspective and the view of the camera within the access device can cause confusion, increase the complexity of the surgical procedure, and in some cases increase the risk of surgical errors.

Summary of the Invention

Problems to be Solved by the Invention

[0004] Therefore, there is a need for improved systems and methods to communicate the camera position to the user during surgical procedures and / or to adjust the camera view display to match the user's viewpoint. [Means for solving the problem]

[0005] This specification discloses a camera position indication system and method for communicating the camera position to a user during a surgical procedure and / or adjusting the camera view display to match the user's viewpoint. The systems and methods disclosed herein can ensure that the displayed camera view appropriately reflects the user's viewpoint or provide the user with feedback that helps associate the user's viewpoint with the camera position. The systems and methods provided herein also create a syntax or common language that helps the user identify the difference between the user's viewpoint and the camera position and express the desired adjustments that can be used to align the two viewpoints. This may be useful in an operating room environment where work is divided among multiple people. For example, a surgeon can quickly identify the camera position from an indicator displayed on a display along with the camera output view. If the camera position and / or the displayed output view does not match the surgeon's or another user's viewpoint, the user can change the access device and camera position to better align with the desired viewpoint, and the indicator can be updated to show the new position, for example, by the user instructing an assistant or another user to update the desired camera position setting. In other embodiments, the displayed output view can be adjusted using a transformation (e.g., rotation) of the output view on the display without moving the camera itself. This can be achieved by using the same syntax for camera position (e.g., to simulate camera position movement) or by directly specifying a desired transition (e.g., a 180-degree rotation). The displayed output view from the camera may always include position indications to remind the viewing user of the camera position and / or any transformations to the displayed camera output view. Control of camera position indications and any desired transformations of the displayed view may be provided, for example, by an assistant communicating with a surgeon or other user directly interacting with the patient using syntax or a common language. In other embodiments, the surgeon or other user may directly control these functions using, for example, a remote control unit or other interface.In yet another embodiment, the access device and / or camera may include one or more sensors for detecting these positions, and this information may be used to automatically control these functions.

[0006] In one embodiment, the surgical method according to the present disclosure may include receiving an output view from a camera positioned in a channel of an access device to view a surgical site within a patient, receiving input of the camera position from a user, and displaying on a display an indication of the camera position based on the output view from the camera and the camera position input.

[0007] The systems, apparatus, and methods described herein may have many additional features and / or variations, all of which are within the scope of this disclosure. In some embodiments, for example, input may be received on a second display. This second display may be positioned away from users who directly interact with the patient, such as a surgical technician assisting a surgeon and operating a controller or other equipment away from the patient. In some embodiments, the second display may display camera viewpoint indications. In some embodiments, the second display may also display a camera output view. The second display may be identical to the main display, or in some embodiments, it may be a smaller display, such as a display for a controller that operates the system. In some embodiments, the second display may continuously display camera viewpoint indications, or the display may temporarily display camera viewpoint indications in connection with oriented the camera output view on the display.

[0008] In some embodiments, the output view from the camera and / or the camera position indication can be displayed using an augmented reality display, such as a "head-up" display, which positions the output view and / or camera position indication within the user's line of sight when the user is directly viewing the patient or a surgical site within the patient. Such a display may be used in place of, or in addition to, more conventional displays such as liquid crystal display monitors.

[0009] In some embodiments, the input may be received using a control unit coupled to the camera. The control unit may be integrated into the camera, for example, by being connected inline between the camera and the display as part of the camera housing. In some embodiments, the remote control unit may be located separately from the camera and the display. In some embodiments, the remote control unit can transmit the received input wirelessly, and in other embodiments, the remote control unit can transmit the received input via a wire. For example, in some embodiments, the remote control unit may be connected inline to a wire or cable connecting the system controller to the camera.

[0010] In some embodiments, the camera viewpoint indicator may be displayed temporarily in connection with oriented the camera's output view on the display. In other embodiments, the camera viewpoint indicator may be displayed continuously. In some embodiments, a small indicator of the camera viewpoint may be displayed continuously, while a large indicator of the camera viewpoint may be displayed temporarily in connection with oriented the camera's output view on the display.

[0011] Camera viewpoint indications can utilize any of several formats to create a simple syntax for the user to recognize and identify different camera orientations. In some embodiments, camera viewpoint indications may be any of the following: clock readings, compass readings, basic body orientations, circle degree readings, quadrants, spatial orientations, colors, readings from alphabetical sequences, readings from numerical sequences, or readings from shape sequences.

[0012] In some embodiments, the method may further include receiving a second input of the camera position from a user based on the camera's repositioning, and displaying an output view from the camera and an updated indication of the camera position based on the second input of the camera position on a display.

[0013] In some embodiments, the method may further include receiving a desired transformation of an output view displayed on a display based on the user's viewpoint of the surgical site, and displaying on the display the transformed output view from the camera based on the desired transformation, along with an updated indication of the camera position reflecting the desired transformation.

[0014] In another embodiment, the surgical system according to the present disclosure may include an access device configured to provide at least one channel to a surgical site within a patient, a camera configured to be positioned within at least one channel of the access device for viewing the surgical site, a display, and a controller. The controller may be configured to receive an output view from the camera, receive camera position input from a user, and display on the display an indication of the camera position based on the output view from the camera and the camera position input.

[0015] As described above, the systems, apparatus and methods described herein may have many additional features and / or variations, all of which are within the scope of this disclosure. In some embodiments, for example, the output view from the camera and / or the camera position indication may be displayed using an augmented reality display, such as a "head-up" display, which positions the output view and / or camera position indication within the user's line of sight when the user is directly viewing the patient or a surgical site within the patient. Such a display may be used in place of, or in addition to, more conventional displays such as liquid crystal display monitors.

[0016] In some embodiments, the system may further include a second display. In some embodiments, the second display may be configured to receive input. In some embodiments, the controller may be further configured to display camera viewpoint indications on the second display. In some embodiments, the controller may be further configured to permanently display camera viewpoint indications on the second display and to temporarily display camera viewpoint indications on the display in connection with oriented the output view from the camera on the display.

[0017] In some embodiments, the system may further include a control unit coupled to the camera. The control unit may be integrated into the camera, for example, by being inline connected between the camera and the display as part of the camera housing. In some embodiments, the remote control unit may be located away from the camera and the display. In some embodiments, the remote control unit may transmit received inputs wirelessly to the controller, while in other embodiments, the remote control unit may transmit received inputs to the controller via a wire. In some embodiments, the controller may further be configured to temporarily display camera viewpoint indications in connection with oriented the camera's output view on the display. In other embodiments, the controller may further be configured to continuously display camera viewpoint indications on the display.

[0018] In some embodiments, the controller may be further configured to display camera viewpoint indications as any of the following: clock readings, compass readings, basic body orientation, circle degree readings, quadrants, spatial orientations, colors, readings from alphabetical sequences, readings from numerical sequences, or readings from shape sequences.

[0019] In some embodiments, the controller may be further configured to receive a second input of the camera position from the user based on the camera repositioning, and to display the output view from the camera and an updated indication of the camera position based on the second input of the camera position on the display.

[0020] In some embodiments, the controller may be further configured to receive a desired transformation of the output view displayed on the display based on the user's viewpoint of the surgical site, and to display on the display the transformed output view from the camera based on the desired transformation, along with an updated indication of the camera position reflecting the desired transformation.

[0021] Any of the features or modifications described above can be applied in several different combinations to any particular aspect or embodiment of this disclosure. No specific combination is explicitly stated, simply to avoid redundancy in this abstract. [Brief explanation of the drawing]

[0022] [Figure 1] This is a perspective view of one embodiment of an access device that provides at least one channel to a surgical site within a patient. [Figure 2] This is a perspective view of one embodiment of the system described herein. [Figure 3] This is a perspective view of one embodiment of a camera placed within a channel of an access device. [Figure 4] This is a side cross-sectional view of the camera in Figure 3. [Figure 5]It is a schematic diagram of a first configuration where the camera's perspective is not aligned with the user's perspective. [Figure 6] It is a schematic diagram of a second configuration where the camera's perspective is aligned with the user's perspective. [Figure 7] It is a top view of a configuration where the camera is arranged in a side view orientation. [Figure 8] It is a top view of a configuration where the camera is arranged in a top view orientation. [Figure 9A] It is a rear perspective view of an access device positioned with respect to the surgical site. [Figure 9B] It is a side perspective view of the access device of FIG. 9A with the camera arranged therein. [Figure 10] It is a front view of a controller according to the present disclosure and a display including an instruction for the camera perspective. [Figure 11] It is a view of a display including an instruction for the camera perspective according to the present disclosure. [Figure 12] It is a view of a controller user interface according to the present disclosure. [Figure 13] It is a view of a display including an instruction for the camera perspective according to the present disclosure. [Figure 14] It is a view of an embodiment of a method according to the present disclosure. [Figure 15] It is an embodiment of a syntax for expressing an instruction for the camera perspective. [[ID=​​​​​​​​​​​​​​​​ [Figure 22] This is one embodiment of syntax for indicating camera viewpoint. [Figure 23] This is one embodiment of syntax for indicating camera viewpoint. [Modes for carrying out the invention]

[0023] To provide a comprehensive understanding of the structure, function, manufacture, and use principles of the apparatuses, systems, and methods disclosed herein, certain exemplary embodiments are described below. One or more examples of these embodiments are illustrated in the accompanying drawings. The apparatuses, systems, and methods described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments. Features illustrated or described in relation to one embodiment may be combined with features of other embodiments. Such modifications and variations are intended to be included within the scope of this disclosure. In addition, similarly numbered components of various embodiments may generally have similar features. Furthermore, the size and shape of assemblies and / or their components may depend at least on the anatomical form of the subject in which the assembly or component will be used, the size and shape of the object to be used with the assembly or component, and the method and procedure in which the assembly or component will be used.

[0024] This specification discloses camera position or orientation indication systems and methods for communicating camera position or orientation to a user during a surgical procedure and / or adjusting the camera view display to match the user's viewpoint. The systems and methods disclosed herein can provide feedback to the user that helps to ensure that the displayed camera view appropriately reflects the user's viewpoint or to associate the user's viewpoint with the camera position. The systems and methods provided herein also create a syntax or common language that helps the user identify the difference between the user's viewpoint and the camera position and express the desired adjustment to align the two viewpoints. This can be useful in an operating room environment where work is divided among multiple people. For example, a surgeon can quickly identify the position of the camera and / or access device based on their own operation when positioning the access device and camera for use, and can easily instruct an assistant or other user on the desired camera position setting. The displayed view from the camera may include position indications to remind the user of the camera position. Furthermore, in some embodiments, one or more desired transformations (e.g., rotation, inversion, etc.) can be performed on the displayed camera view to align the displayed view with the user's viewpoint. The camera position can be directed and control over any desired transformation of the displayed view can be provided, for example, by a surgeon directly interacting with the patient or by an assistant communicating via syntax with another user.

[0025] Figure 1 shows one embodiment of a surgical system 100 in which the apparatus and methods described herein can be used, but it will be understood that such apparatus and methods may be used in a variety of other applications, either alternatively or additionally. Further details relating to the system in Figure 1 can be found in U.S. Patent Application Publication No. 2017 / 0156814, entitled "Multi-Shield Spinal Access System", U.S. Patent Application Publication No. 2019 / 0209154, entitled "Multi-Shield Spinal Access System", and U.S. Patent Application Publication No. 2019 / 0216454, entitled "Surgical Instrument Connectors and Related Methods". All content of each of these publications is incorporated herein by reference. System 100 can be used in a variety of surgical procedures, including spinal surgeries such as microsurgery, spinal decompression, and spinal fusion. Generally, system 100 may include any one or more of the following: an access device 102, a tissue retractor (not shown), a pedicle support or other anchoring part 106, a connector 104, and a camera (see Figure 2). An exemplary access device 102 is disclosed in U.S. Patent No. 10,758,220, entitled "Devices and Methods for Providing Surgical Access." An exemplary tissue retractor is disclosed in U.S. Patent No. 10,779,810, entitled "Devices and Methods for Surgical Retraction." An exemplary connector 104 is disclosed in U.S. Patent Application Publication No. 2019 / 0216454, entitled "Surgical Access Port Stabilization." An exemplary anchoring part 106 is disclosed in U.S. Patent Application Publication No. 20180098788, entitled "Surgical Access Port Stabilization." An exemplary camera is disclosed in U.S. Patent Application Publication No. 2018 / 0008138, entitled “Surgical Visualization Systems and Related Methods.” All content of each of these publications is incorporated herein by reference.

[0026] An exemplary method using the system 100 in Figure 1 involves the following steps, performed in any of a variety of sequences: a) making an incision in the patient's skin; b) percutaneously inserting a substantially tubular access device 102 (such as a tube or a retractor having multiple slots) through the incision, wherein the access device allows the patient's spine to access sensitive and non-sensitive tissues (e.g., superior articular process) through the incision. The process may include one or more of the following steps: a) a process having a length adapted to extend to the boundary with the process, SAP) or arch; c) stabilizing the access device against the anchoring portion 106 (e.g., the pedicle anchoring portion) using a connector 104; d) inserting an optical visualization device (see Figure 2) integrated with the access device; e) resecting a portion of the superior articular process and / or performing decompressive surgery by microsurgery; f) inserting or deploying a tissue retractor via or from the access device such that the distal end portion of the tissue retractor extends to the intervertebral disc, wherein the retractor has an outer surface; g) shielding the nerve root by bringing the outer surface of the retractor into contact with the nerve root; h) decompressing all tissues thought to be causing the neuropathy by microsurgery; i) excising intervertebral disc material, including the removal of cartilaginous material from the vertebral endplate; j) inserting an interbody device; and k) deploying a stabilization mechanism to stabilize the intervertebral portion.

[0027] Figure 2 shows one embodiment of a camera system 200 that can be used in connection with the surgical system 100 described above. The system 200 may include a camera or other visualization device 202 that can be configured to pass through the access device to reach the surgical site and visualize the surgical site. For example, the camera 202 can pass through the visualization channel 204 of the access device 102 and be positioned within the channel at any of several positions along the length of the access device. From such a position, the camera 202 can view the surgical site distal to the working channel 206 of the access device 102 and / or the distal end of the access device. The camera 202 may be coupled to the access device 102 using, for example, an interlocking fit, and such a camera can be positioned anywhere along the axis of the visualization channel 204, providing multiple field of view options. Furthermore, the access device 102 can be configured to rotate about its longitudinal axis, thereby allowing the camera to be moved to any position around the longitudinal axis of the access device.

[0028] In some embodiments, the camera 202 may be coupled to the controller 208 via one or more cables 210, or in other embodiments, it may communicate with the controller or other processor via wireless communication. The controller 208 may include a digital data processor, one or more memory, one or more inputs and outputs, and other components of a conventional electronic controller or computing device. The controller 208 may include one or more user interfaces for controlling the camera 202, as will be described in more detail below, or it may be coupled to one or more input devices, such as a control unit or remote control unit 212, which can be used to control the camera 202 and / or the controller 208. The control unit 212 may be coupled to the camera 202 and / or the controller 208 by a wired connection 214 or wireless communication 216. In some embodiments, the control unit 212 may be incorporated into the camera, for example, as part of the camera housing and connected inline between the camera and the display, or it may be an intermediate control unit located between the camera and the display.

[0029] The controller 208 and / or camera 202 may also be coupled to one or more displays 218 which can be configured to present to the user various data, including views of the work channel and / or surgical site provided by the camera 202. The various components of the system 200 may be incorporated into the mobile cart 220 as shown in the figure, or they may be arranged separately around the surgical environment. Furthermore, in some embodiments, the components of the system 200 may be configured to interact with multiple users. For example, in some embodiments, the surgeon or other user may be located near the patient and surgical site where the surgeon or other user may directly operate the access device 102 and camera 202. The displays 218 may be configured to be visible to the surgeon, and the controller 208 may be positioned adjacent to an assistant or other user who may be located further away from the patient within the surgical environment. In other embodiments, the remote control unit 212 may be positioned for use by the surgeon or any other user, for example, as a foot control, a hand control, etc. Furthermore, in some embodiments, the system 200 may further include a sensor 222 configured to detect the orientation of the access device, which can be coupled to or incorporated into the access device 102 and used to determine the viewpoint of the camera 202, as will be described in more detail below. In yet other embodiments, such a sensor may be incorporated into the camera 202 rather than the access device 102.

[0030] Furthermore, in some embodiments, the display 218 may include an augmented reality display, such as a "head-up" display, which places output views from camera 202 and / or other information, such as camera position indications as described below, within the user's line of sight when the user is directly viewing the patient or a surgical site within the patient. Such a display may be used in place of, or in addition to, more conventional displays such as liquid crystal display monitors, as shown in Figure 2.

[0031] Figure 3 shows further details of the access device 102, in which a working channel adjacent to the distal end of the access device and / or a camera 202 for viewing the surgical site are located inside. The access device 102 may include an elongated body having a proximal end and a distal end. The access device 102 may define a working channel 206 extending between the proximal and distal ends and having a longitudinal central axis A1. The working channel 206 may be cylindrical. The working channel 206 may have a circular cross-section. The working channel 206 may have diameters in the range of about 3 mm to about 30 mm, about 10 mm to about 20 mm, and / or about 12 mm to about 15 mm. In some embodiments, the working channel 206 may have a diameter of about 15 mm. Although a single working channel 206 is shown, the access device 102 may include any number of working channels. During use, instruments and / or implants can be placed in, passed through, and / or inserted into the working channel 206 to perform surgical procedures. In some embodiments, the access device 102 may be used to access the intervertebral disc space. A cutting instrument may be inserted through the working channel 206 to cut tissue such as bone or intervertebral disc tissue. A suction instrument may be inserted through the working channel 206 to aspirate material, including the excised bone or intervertebral disc tissue, from the intervertebral disc space. In some embodiments, the cutting instrument and the suction instrument may be a single tool. Implants such as fusion cages, fusion cages expandable in height and / or width, and intervertebral disc prostheses can be inserted into the intervertebral disc space through the working channel 206.

[0032] The access device 102 can define a visualization channel 204. The visualization channel 204 can extend between the proximal and distal ends of the access device 102, or along less than the entire length of the access device. The visualization channel 204 may include a longitudinal central axis A2. The central axis A2 of the visualization channel 204 may be positioned radially outward from the central axis A1 of the work channel 206. The work channel 206 may have a larger cross-sectional area than the visualization channel 204. The visualization channel 204 may open to or intersect with the work channel 206 along its length. In some embodiments, the visualization channel 204 may be isolated or separated from the work channel 206.

[0033] The visualization channel 204 may have an inner cross-section that coincides with, or substantially coincides with, the outer cross-section of the camera 202. When positioned within the visualization channel 204, the outer surface of the camera 202 can define at least a portion of the inner wall of the work channel 206. The work channel 206 may be cylindrical with a central axis A1, and the surface of the camera 202 facing the work channel can form a cylindrical cross-section with axis A1. The inner wall of the work channel 206 and the outer surface of the camera 202 can define a substantially smooth and continuous surface.

[0034] The access device 102 may include, for example, a mounting mechanism 302 for attaching the access device to a support or other object, allowing the access port to rotate about its longitudinal axis. The mounting mechanism 302 may be formed at the proximal end of the access device 102. For example, the access device 102 may include an annular circumferential groove 302 formed on its outer surface. Various other mounting mechanisms 302 are also possible, such as a ball and / or socket mechanism for connecting to a complementary mechanism on a connector or other component.

[0035] The access device 102 may have a circular external cross-section, an elliptical or oval external cross-section, or any of various other external cross-sectional shapes. The access device 102 may have an external diameter or dimensions in the range of approximately 5 mm to approximately 30 mm, approximately 10 mm to approximately 25 mm, and / or approximately 15 mm to approximately 22 mm. The access device 110 may have an external diameter or dimensions of approximately 17 mm. The external surface of the access device 102 may be roughened, ribbed, milled, or coated or formed with a material having a high coefficient of friction that can advantageously improve grip and stability with surrounding tissue when the access device is inserted into the patient.

[0036] Figure 4 is a side cross-sectional view of the camera 202. The camera 202 may include an image capture sensor 402, such as a charge-coupled device (CCD) or a complementary metal-oxide-semiconductor (CMOS) sensor, and an associated illumination device 404, such as an optical fiber for delivering light from an external light source, or one or more light-emitting diodes (LEDs) or other light-generating devices which may be incorporated into the camera 202. The camera 202 may also include a lens assembly 406 which may include one or more lenses to assist in focusing the view of the sensor 402 in a desired manner. The camera 202 may have a field-of-view (FOV), a direction of view (DOV), and a depth of field (DOF). In some embodiments, the FOV may be in the range of about 60 to about 70 degrees. In some embodiments, the DOV may be in the range of about 15 to 30 degrees. In some embodiments, the DOV may be in the range of about 20 to 25 degrees. In some embodiments, the DOV may be about 22.5 degrees. In some embodiments, the depth of field (DOF) can be in the range of approximately 7 mm to approximately 40 mm. Further details of exemplary cameras can be found in U.S. Patent Application Publication No. 2018 / 0214016, entitled "Surgical Visualization Systems and Related Methods," which is incorporated herein by reference in its entirety.

[0037] Figure 5 illustrates one embodiment of a potential difficulty that may arise with a camera positioned within an access device to view a surgical site inside a patient's body. User 502 is standing facing the bottom of the page in the view of the figure, and the user's viewpoint is facing the top of the page in the view of the figure. When the user looks directly down at the access device 102, view 504 is visible, and they can, for example, manipulate an instrument 506 inserted through the access device. However, the camera 202 may be oriented differently from the user 502. For example, as shown in Figure 5, the camera 202 may be positioned within a visualization channel of the access device, positioning the camera on the opposite side of the user (i.e., facing the top of the page in the view of the figure). As a result, the camera position, viewpoint, or orientation may be opposite to the user 502's position, viewpoint, or orientation, and therefore the image on the display 508 may appear upside down to the user 502 viewing the display. This can lead to confusion in the surgical environment and increase the complexity, time, and potential for errors when performing surgical procedures.

[0038] In contrast to the configuration in Figure 5, the configuration in Figure 6 shows a camera 202 positioned within the access device 102 to align with the user 502's viewpoint. As a result, the image of the surgical site from the camera 202 displayed on the display 508 is aligned with the user 502's viewpoint, making it easier to obtain a much more intuitive experience when performing surgical procedures.

[0039] A mismatch between the camera position and the user position can cause unexpected output view displays that may confuse the user, and the systems and methods described herein provide a syntax or common language for representing the camera position as a position around a circle and indicator on the display 508 in order to inform the user of the camera position. This allows the user to identify the viewpoint of the displayed camera view and relate it in conscious terms to their own viewpoint. Furthermore, in some embodiments, the syntax and camera position indications can facilitate the user manually adjusting the position of the access device by rotating the access device around its longitudinal axis between configurations shown in Figures 5 and 6, for example, in order to align the viewpoint of the camera 202 with their own direct viewpoint. Furthermore, the systems and methods described herein can facilitate any of the various transformations of the displayed output view of the camera to better align it with the user's viewpoint. For example, in some embodiments, as will be described in more detail below, certain operations of the access device and / or camera may not always be possible or desirable. Therefore, rather than physically reorienting the access device and / or camera to match the user's viewpoint, it may be desirable to provide a mechanism to switch the displayed viewpoint or orientation of the output view shown on the display to align it with the user's viewpoint. In Figure 5, for example, the output view of camera 202 can be rotated 180 degrees without moving the camera, as shown in Figure 6, to achieve a similar effect.

[0040] Accordingly, this disclosure provides a system, apparatus, and method for achieving viewpoint matching by providing a user with a representation syntax or common language for representing camera position or orientation, a displayed indication of camera position or orientation that can be used to easily represent the current and / or desired position, orientation, or viewpoint of the camera, and / or a displayed output view of the camera, which can be displayed on a display. This allows a user to easily adjust the orientation of the camera position or the displayed output view of the camera to match their own direct viewpoint in embodiments in which another user controls the operation of the camera and the placement of the camera and / or access port, and / or allows a user to easily communicate with one or more other users in the surgical team to efficiently achieve such viewpoint matching.

[0041] Figures 7 and 8 illustrate how differences in viewpoint may occur during the use of a camera introduced into the surgical site through an access device, and another example of how the physical reorientation or repositioning of the camera may not always be ideal. Also shown is one embodiment of a representational syntax or common language that can be used to describe the camera position as a location around a circle and to command any desired changes to the camera position and / or the displayed output view.

[0042] Figure 7 shows a configuration in which the access port 102 is positioned laterally or posterolaterally relative to the patient's vertebra 702, and the visualization channel and the camera 202 positioned therein are oriented anteriorly and laterally to the access port. Such positioning may be desirable in some cases to provide a field of view 704 oriented as laterally as possible, i.e., a “lateral view” orientation or configuration. As shown at the bottom of the figure, such positioning may be expressed using the syntax of a clock face 708, for example, with the camera at the 6 o'clock position 706 when viewed from above.

[0043] If the camera position is misaligned with the user's viewpoint, who is standing close to the patient and viewing the camera's output display, it may be useful to provide the user with indication of the camera position using the syntax of the clock face 708. This allows the user to better visualize the camera position and relate any displayed output view of the camera to their own direct view of the patient and surgical site.

[0044] Furthermore, in some embodiments, the user may wish to change the camera position or orientation to better align the displayed camera output view with their own viewpoint, or to better view the patient's anatomical structure or to view it from a different perspective. In such cases, the user may directly manipulate the access device 102 and / or camera 202, for example by rotating the access tube 180 degrees to the configuration of Figure 8, where, for example, camera 202 is positioned behind and inside the access port. Following such a movement, the user may wish to indicate the new position of camera 202 to others in the surgical environment and / or update any displayed camera position indication to match the new camera position. This may be done using the expression syntax or common language of the clock face 708. For example, the user may declare that the new camera is at the 12 o'clock position 806, and an assistant or other user operating the controller 208 may input an update to the displayed camera position indicator. Alternatively, the user operating the access device 102 and / or camera 202 may provide input to the controller 208 themselves to update the camera position indicator. For example, the user may interface directly with the controller 208 to input a new camera position, or they may use the wired or wireless remote control unit 212. Furthermore, in some embodiments, one or more sensors incorporated into the access device 102 and / or camera 202 can detect changes in position and automatically adjust the displayed camera position indicator, as will be described in more detail below.

[0045] However, in some embodiments, it may be undesirable to move the access device 102 or the camera 202. For example, such movement may unnecessarily change the field of view of the camera 202. In the embodiments of Figures 7 and 8, for example, a change in camera position from the position shown in Figure 7 to the position shown in Figure 8 may change the field of view 704 to a field of view 804, which is a more rearward "top view" orientation that may be less desirable than a more lateral field of view 704. Of course, in some embodiments, the situation may be reversed, namely the rearward "top view" of Figure 8 is desired, and it may be undesirable to physically reorient the camera 202 away from this positioning.

[0046] In such embodiments, it may be desirable to perform one or more transformations on the displayed output view of the camera without physically moving the camera. For example, the camera's output view may be rotated 180 degrees on the display 218 (e.g., by a function of the controller 208) to provide a viewpoint that can be better aligned with a user who may prefer the camera positioning in Figure 8, while maintaining the field of view 704. Such transformations (e.g., rotation, flip, etc.) may be specified by the user using the same expressive syntax or common language as the camera position indication. For example, the user may express that the camera is positioned at 6 o'clock, but they prefer the display to simulate the 12 o'clock position. Alternatively, the transformation can be expressed as a direct change to the displayed output view, such as a 180 (or other number) degree rotation, a horizontal flip, or a vertical flip. Any transformation may be reflected in the same way as the actual change in camera position using the displayed camera position indicator, but may also be expressed by a separate indicator or in some other way distinct from the actual change in camera position.

[0047] Figures 9A and 9B show further possible camera positions and syntactic representations of their viewpoints that can be used to indicate the camera positions. Figure 9A is a rear view of an access device 102 positioned in an interlayer view orientation for accessing an intervertebral disc, for example, during spinal fusion surgery. Following the syntax of the clock face 708 described above in relation to Figures 7 and 8, it can be said that the visualization channel 204 of the access device 102 and any camera 202 (see Figure 9B, not shown in Figure 9A) positioned therein is at the 3 o'clock position 906. Such positioning of the access device 102 and camera 202 may be desirable for a particular field of view 904 provided to the camera 202 at this position, for example, as shown in the side view of Figure 9B.

[0048] However, as mentioned above, the displayed output view of camera 202 may not align with the user's viewpoint if the position of camera 202 and the user's position are not the same, or at least not aligned relative to each other. This discrepancy between the displayed output view and the user's viewpoint may cause confusion or delays during the procedure. One way to address this is to provide indication of the camera's position in relation to the displayed output view of the camera, so that the user can easily recognize the camera's position and any discrepancies that may occur between their own viewpoint and the viewpoint of the displayed output view. The indication of the camera's position may be, for example, the camera's position around the clock face 708 as described in relation to Figures 7-9, or any other syntax or language that describes the position around a circle (see further examples below).

[0049] The use of such camera position or orientation indications may also allow a user to quickly reposition the access device 102 and / or camera 202 using a similar syntax and input camera position updates to the controller 208. This update can be input by the user directly to the controller 208 using the remote control unit 212, or by transmitting the desired new position to a second user, such as an assistant, who can input it. In yet another embodiment, one or more sensors incorporated in the access device 102 and / or camera 202 may detect any change in position and automatically update the displayed camera position indication.

[0050] Furthermore, in some embodiments, it may be desirable to allow one or more transformations (e.g., rotation, inversion, etc.) of the camera's displayed output view to provide the user with a more intuitive experience without repositioning the camera. Any desired transformation may be transmitted by direct instruction or input to a user interface (e.g., 180-degree rotation) using similar syntax (e.g., rotation by an angle according to a new desired clock face position). Moreover, any transformations performed without moving the camera can be reflected in the camera position instruction, for example, by updating the instruction to simulate camera movement, including separate transformation instructions in addition to the instruction for the true camera position.

[0051] Figures 10 and 11 show one embodiment of a camera controller 208 and a display 218 that may be included in the system 200 described above. Figure 10 is a front view of the camera controller 208. The controller 208 may include one or more physical inputs 1002 and / or outputs 1004, such as buttons, knobs, switches, and ports (e.g., a universal serial bus port or USB port, a secure digital card port or an SD card port). The controller 208 may also include a display 1006 that may be touch-sensitive to enable control or reception of user input through the display. In other embodiments, as described above, the controller may be coupled to a remote input device such as a remote control unit 212, or may receive input from another computer or controller coupled to the controller 208 by a network via a wired or wireless communication protocol.

[0052] The display 1006 of the controller 208 may include a graphical representation 1008 of the camera position or orientation, for example, as a position around a circle represented as a reading on a clock face. As shown in Figure 10, for example, the current camera position 1010 may be highlighted and / or emphasized in some way, such as by selecting a different color, a larger font, or a bolder font. Furthermore, the user can input a new or updated camera position by pressing the display 1006 or using the input 1002 (e.g., a knob) to select a new position in relation to the camera movement by the user. In addition, several other functions of the camera 202, such as illumination brightness, lens cleaning, photo or video capture, and output view conversion, may be controlled using the display 1006 via the graphical user interface buttons 1012.

[0053] Figure 11 shows a display 218 corresponding to the controller display 1006 shown in Figure 10. The display 218 can show the output view 1102 of the camera 202, as well as one or more indicators of the camera position. For example, the display 218 may include a persistent camera position indicator 1108 that is always present on the screen. The indicator 1108 may be small in size relative to the displayed view 1102. In addition, the display 218 may include a temporary indicator 1104 that can be displayed, for example, using the input interface of the display 1006 on the controller 208 whenever a change in camera position is specified. The temporary indicator 1104 may be larger and more prominent than the persistent indicator 1108, and may, for example, be placed in the center of the display and occupy a large portion of the displayed view 1102. Indicators 1104 and 1108 may coincide with the indicator 1008 on the controller 208.

[0054] Figures 12 and 13 show graphical representations of controllers 208 and displays 218 in different configurations where the camera position has been changed from the camera position shown in Figures 10 and 11. For example, the displays in Figures 10 and 11 show cameras at the 6 o'clock position 1010 and 1106 in a clock face syntax such as that shown in Figures 6 and 7, while the displays in Figures 12 and 13 show camera positions changed to the 12 o'clock position 1202 and 1302, as shown in Figures 5 and 8.

[0055] An exemplary method of surgical procedure according to this disclosure 1400 is shown in Figure 14 and will be described with reference to Figures 10-13. In the initial configuration, for example, the camera may be at the 6 o'clock position 1010, 1106 as shown in Figures 10 and 11. The controller 208 receives an output view from the camera (step 1402) and can display the output view 1102 on the display 218 along with camera position indicators 1106, 1108. The user can look at the display 218 and recognize that their viewpoint is not aligned with the camera position by either a temporary camera position indicator 1104 or (if, for example, the temporary camera position indicator is not displayed) a persistent camera position indicator 1108. This can help the user deal with any confusion regarding the displayed view 1102 of the surgical site.

[0056] To better align the camera's displayed output view with the user's viewpoint, the user may directly move the access device 102 and / or camera 202 to a new position. For example, the user may rotate the access device 102 and / or camera 202 180 degrees from the 6 o'clock position to the 12 o'clock position as shown in Figures 12 and 13. In connection with moving the access device 102 and / or camera 202, the user can directly input a new camera position by using an interface, such as the display 1006 on the controller 208, and pressing the new camera position on the representation 1008 of the display 1006. Alternatively, if the controller 208 is located further away from the user, and a second user, such as an assistant, is present, the user can indicate a new camera position using the clock face syntax or common language, and the second user can input this new position using the controller interface. As described above, other input interfaces (e.g., remote control unit) can also be used. In this way, the controller 208 can receive camera position input (step 1404).

[0057] Upon receiving input or instruction for camera position, the controller 208 can display the camera output view and camera position instruction on the display based on the received camera position input (step 1406). The camera position instruction may be an updated version of the persistent camera position indicator 1108 to display the new position, as shown in Figure 13. In addition, the camera position indicator 1008 on the controller display 1006 can also be updated. Finally, to emphasize that a change in camera position has been input, a more prominent temporary camera position indicator 1104 may be updated and displayed on the screen (see Figure 13) to highlight to the user viewing the display that the change has been registered. The temporary camera position indicator 1104 may be displayed for a finite time (compared to, for example, the continuously displayed persistent camera position indicator 1108) to avoid deviation from the displayed camera output view. The finite time may be, for example, about 1 second to about 1 minute. In some embodiments, the finite time may be about 1 second to about 10 seconds. In addition to the feedback described above, other feedback such as sound, haptic feedback, and other visual feedback may be given to the user.

[0058] In some embodiments, the camera can be repositioned multiple times during a procedure as the user moves around the patient and adjusts the camera position accordingly. In such cases, the above procedure may be repeated with each movement to update the camera position indicator displayed along with the camera output view. For example, the controller can receive a second input of the camera position from the user (step 1408) and display the camera output view and the updated camera position indicator on the display (step 1410).

[0059] Furthermore, in some embodiments, the user may wish to perform transformations (e.g., rotation, inversion, etc.) of the displayed output view 1102 of the camera without physically moving the access device 102 and / or the camera 202. Such transformations can be performed by the controller 208 using software and can be controlled using the display 1006 on the controller or other interface. For example, the controller 208 can receive a desired transformation of the output view displayed on the display based on the user's viewpoint of the surgical site (step 1412). The controller 208 can display the transformed output view from the camera based on the desired transformation, along with an updated indication of the camera position reflecting the desired transformation (step 1414). This may include, for example, updating the camera position indicator to simulate the new camera position, adding a transformation label or graphic representing the transformation, or displaying a second indicator separate from the camera position indicator.

[0060] While the embodiments described above utilize a representational syntax based on a clock face, various other syntaxes are also possible, including any of the various syntaxes that match positions around a circle with a common language that can be used to visually represent those positions and transmit adjustments thereto. Figures 15–23 show various exemplary syntaxes that can be used similarly. These include the number sequence of a clock face in Figure 15, or any other number sequence. For example, Figure 17 shows a number sequence of degrees around a circle similar to a compass. Compass directions such as north, south, west, and east can also be used, for example, as shown in Figure 16. In some embodiments, anatomical terms relating to positions such as head, tail, medial, and lateral can be used, for example, as shown in Figure 18. Other positional terms such as up, down, left, and right can also be used, for example, as shown in Figure 19. In some embodiments, directions can be indicated based on quadrants, sextants, octants, etc., as shown by the quadrant division in Figure 20.

[0061] Further syntax is also possible. For example, Figure 21 shows a syntax based on a color wheel, where different directions can be represented by different colors or color names. In some embodiments, alphabetic sequences or alphanumeric sequences can be used as well as numerical sequences. For example, Figure 22 shows an exemplary alphabetic sequence for representing directions or orientations of views. Figure 23 shows a further representation syntax based on shape matching, such as triangles, squares or rectangles, circles, and rhombuses, where each can represent a different direction or orientation of view.

[0062] The embodiments described above help the user identify the camera position from the instructions according to the syntax and provide a representation syntax for the user to use the syntax to transmit a new or desired camera position to another user and / or controller or other system component. However, in some embodiments, the systems and methods disclosed herein may also include one or more sensors that detect the position of the access tube 102 and / or camera 202 and automatically transmit the detected position using the controller 208, for example, to update the camera position indicators 1008, 1104, 1108 displayed on the interface display 218 of the controller 208 or the camera position indicators 1008, 1104, 1108 displayed on the display 218.

[0063] As described above and shown in Figure 2, the access device 102 and / or camera 202 may include one or more sensors 222 capable of detecting its position. The sensors 222 may be, for example, magnetic sensors, optical sensors, laser sensors, electronic sensors, or any other type of sensor, which can be configured to detect the position of the access port 102 and / or camera 202 relative to the axis of the access device 102.

[0064] In some embodiments, the user can position the access port to a desired initial configuration and specify the camera position, for example, by specifying the camera at a specific position around a circle according to a reading on a clock face, in the manner described above. Furthermore, the initial specification may be aligned with the user's direct viewpoint in the operating environment. After receiving the initial camera position instruction, one or more sensors 222 may be used to track any subsequent movements of the access port 102 and / or camera 202 and transmit such movements to the controller 208. The controller 208 can automatically adjust the camera position indicator based on the information received from one or more sensors 222 without requiring a separate new camera position input, for example, via the display 1006, as described above. Furthermore, in some embodiments, various transformations (e.g., rotation) may be performed based on the movement of the access device 102 and / or camera 202 to keep the displayed output view aligned with the initial camera position instruction provided by the user, corresponding to the user's direct viewpoint in the operating room. The camera position indicator can be updated to reflect such transformations, for example, by providing instructions for a separate transformation or by incorporating the transformation into the camera position instruction. For example, in one embodiment, the camera position indicator may show that the camera is at the 6 o'clock position, but the displayed output view has been rotated 180 degrees to simulate a view from the 12 o'clock position.

[0065] In other embodiments, the user may directly specify their viewpoint using any of the syntax disclosed herein (e.g., clock face readings, base compass readings, etc.). The controller 208 can track any movement of the access device 102 and / or camera 202 relative to this viewpoint and update the camera position indicator to reflect any changes. Alternatively or additionally, the controller 208 can perform any of the various transformations of the displayed output view to keep the displayed output view consistent with the user viewpoint.

[0066] In yet another embodiment, the access device 102 may include a viewpoint indicator 304, which can be coupled to the proximal end of the access device and configured to move around its outer circumference, as shown in Figure 3. The viewpoint indicator 304 may be positioned by the user to indicate the physical location of the access port after the access port has been positioned. The viewpoint indicator 304 may include or be coupled to a sensor that can detect the position of the viewpoint indicator around the access device 102 and transmit it to the controller 208. The controller 208 can use the position of the viewpoint indicator 304 to update the displayed camera position indicator and / or output view, track any future movement of the access device, camera, and / or viewpoint indicator, and update the displayed camera position indicator and / or displayed camera output view accordingly.

[0067] The instruments disclosed herein may be composed of any of a variety of known materials. Such materials include metals such as stainless steel, titanium, nickel, cobalt-chromium, or alloys and combinations thereof, polymers such as PEEK, and carbon fibers, all of which are suitable for use in surgical applications. The various components of the instruments disclosed herein may have varying degrees of rigidity or flexibility appropriate for their use. The size of the instrument may also vary considerably depending on the intended use and the biomimetic structure of the surgical site. Furthermore, certain components may be formed from different materials than other components. One or more components or parts of the instrument may be formed from radiopaque materials to facilitate visualization under fluoroscopy and other imaging techniques, or from radiopaque materials such as carbon fibers and / or high-strength polymers so as not to interfere with the visualization of other structures.

[0068] The devices, systems, and methods disclosed herein can be used in minimally invasive surgery and / or incisional surgery. Although the devices, systems, and methods disclosed herein are generally described in the context of surgery in human patients, it will be understood that the devices, systems, and methods disclosed herein can be used in any human or animal subject in any variety of surgical or non-surgical procedures.

[0069] The apparatus, systems, and methods disclosed herein may be designed to be discarded after a single use or to be designed for multiple uses. However, in either case, certain components may be readjusted for reuse after at least one use. Readjustment may include any combination of disassembly, cleaning or replacement of specific components, and subsequent reassembly. In particular, components may be disassembled, and any number of specific parts or sections of a component may be selectively replaced or removed in any combination. After cleaning and / or replacing specific parts, the components may be reassembled for subsequent use in a readjustment facility or by a surgical team immediately before a surgical procedure. Readjustment of apparatus may utilize a variety of techniques for disassembly, cleaning / replacement, and reassembly. All use of such techniques and the resulting readjusted components are included in the scope of this disclosure.

[0070] While specific embodiments are described above, modifications may be made within the spirit and scope of the concepts described. For example, while certain components disclosed herein are generally described as being operable by hand, in some embodiments these components may be operated by, for example, a robot. Therefore, this disclosure is not limited to the embodiments described and is intended to have the entire scope as defined by the language of the claims. All publications and references cited herein are expressly incorporated in their entirety by reference.

[0071] [Implementation Method] (1) Surgical methods, To view the surgical site within the patient, the system receives an output view from a camera placed within the access device's channel, Receiving camera position input from the user, The output view from the camera and the camera position indication based on the input of the camera position are displayed on the display. Surgical methods, including [specific method]. (2) The method according to Embodiment 1, wherein the display includes an augmented reality display. (3) The method according to Embodiment 1, wherein the input is received by a second display. (4) The method according to Embodiment 2, wherein the second display shows an indication of the camera position. (5) The method according to Embodiment 4, wherein the second display continuously displays an indication of the camera position, and the display temporarily displays an indication of the camera position in connection with receiving an input of the camera position.

[0072] (6) The method according to Embodiment 1, wherein the input is received using a control unit coupled to the camera. (7) The method according to embodiment 6, wherein the control unit is spaced apart from the camera and the display. (8) The method according to Embodiment 1, wherein the camera position indication is temporarily displayed in connection with receiving the input of the camera position. (9) The method according to Embodiment 1, wherein the camera position indication is continuously displayed. (10) The method according to Embodiment 1, wherein the camera position indication is any of the following: clock reading, compass reading, basic body orientation, circle degree reading, quadrant, spatial direction, color, reading from alphabetical sequence, reading from numerical sequence, or reading from shape sequence.

[0073] (11) Based on the repositioning of the camera, a second input of the camera position is received from the user, The output view from the camera and the updated camera position based on the second input of the camera position are displayed on the display. The method according to Embodiment 1, further comprising: (12) Receiving a desired transformation of the output view displayed on the display based on the user's viewpoint of the surgical site, Displaying on the display the converted output view from the camera based on the desired conversion, and the updated camera position indication reflecting the desired conversion. The method according to Embodiment 1, further comprising: (13) A surgical system, An access device configured to provide at least one channel to the surgical site within the patient, A camera configured to be positioned within at least one channel of the access device for viewing the surgical site, The display and It is a controller, The output view is received from the aforementioned camera. The camera position is input from the user. The output view from the camera and the camera position indication based on the input of the camera position are displayed on the display. A controller configured as follows, A surgical system equipped with [a specific feature / feature]. (14) The system according to embodiment 13, wherein the display includes an augmented reality display. (15) The system according to embodiment 13, further comprising a second display configured to receive the input.

[0074] (16) The system according to embodiment 15, wherein the controller is further configured to display the camera position indication on the second display. (17) The system according to embodiment 16, wherein the controller is further configured to continuously display the camera position indication on the second display and to temporarily display the camera position indication on the display in connection with receiving the camera position input. (18) The system according to embodiment 13, further comprising a control unit coupled to the camera. (19) The system according to embodiment 18, wherein the control unit is spaced apart from the camera and the display. (20) The system according to embodiment 13, wherein the controller is further configured to temporarily display an indication of the camera position in connection with receiving an input of the camera position.

[0075] (21) The system according to embodiment 13, wherein the controller is further configured to continuously display the camera position indication on the display. (22) The system according to Embodiment 13, wherein the controller is further configured to display the camera position indication as one of the following: clock reading, compass reading, basic body orientation, circle degree reading, quadrant, spatial orientation, color, reading from alphabetical sequence, reading from numerical sequence, or reading from shape sequence. (23) The controller Based on the repositioning of the camera, a second input of the camera position is received from the user. The output view from the camera and the updated camera position based on the second input of the camera position are displayed on the display. The system according to embodiment 13, further configured as follows. (24) The controller Based on the user's perspective of the surgical site, the desired transformation of the output view displayed on the display is received. The display shows the converted output view from the camera based on the desired conversion, and the updated camera position indicator reflecting the desired conversion. The system according to embodiment 13, further configured as follows.

Claims

1. A surgical system, An access device configured to provide a working channel to the surgical site within the patient, To view the surgical site, the access device includes a camera configured to be positioned on the circumference around the central axis of the work channel, The display and It is a controller, The output view is received from the aforementioned camera. The system receives input from the user regarding the camera position on the circumference, The output view from the camera and a graphical representation of the camera position on the circumference based on the input of the camera position are displayed on the display. A controller configured as follows, A surgical system equipped with [a specific feature / feature].

2. The surgical system according to claim 1, wherein the access device defines a visualization channel, the visualization channel having an inner cross-section that coincides with or substantially coincides with the outer cross-section of the camera, and the outer surface of the camera, when positioned within the visualization channel, defines at least a portion of the inner wall of the work channel.

3. The surgical system according to claim 2, wherein the inner wall of the working channel and the outer surface of the camera are configured to define a substantially smooth and continuous surface.

4. The surgical system according to any one of claims 1 to 3, wherein the display includes an augmented reality display.

5. The surgical system according to any one of claims 1 to 3, further comprising a second display configured to receive the aforementioned input.

6. The surgical system according to claim 5, wherein the controller is further configured to display the graphical representation of the camera position on the second display.

7. The surgical system according to claim 6, wherein the controller is further configured to continuously display the graphical representation of the camera position on the second display and to temporarily display the graphical representation of the camera position on the display in connection with receiving the input of the camera position.

8. The surgical system according to any one of claims 1 to 3, further comprising a control unit coupled to the camera.

9. The surgical system according to claim 8, wherein the control unit is spaced apart from the camera and the display.

10. The surgical system according to any one of claims 1 to 3, wherein the controller is further configured to temporarily display a graphical representation of the camera position in connection with receiving the input of the camera position.

11. The surgical system according to any one of claims 1 to 3, wherein the controller is further configured to continuously display the graphical representation of the camera position on the display.

12. The surgical system according to any one of claims 1 to 3, wherein the controller is further configured to display the graphical representation of the camera position as any of the following: clock readings, compass readings, basic body orientation, circle degree readings, quadrants, spatial orientations, colors, readings from alphabetical sequences, readings from numerical sequences, or readings from shape sequences.

13. The aforementioned controller, Based on the repositioning of the camera, a second input of the camera position is received from the user. The output view from the camera and the updated graphical representation of the camera position based on the second input of the camera position are displayed on the display. A surgical system according to any one of claims 1 to 3, further configured as follows.

14. A method for operating a surgical system, To view a part within the patient, the surgical system receives an output view from a camera located in an access device, the access device having a working channel, and the camera being positioned on a circle around the central axis of the working channel. The surgical system receives input from the user regarding the camera position on the circumference, The surgical system displays on a display the output view from the camera and a graphical representation of the camera position on the circumference based on the input of the camera position. A method of operating a surgical system, including [specific details omitted].

15. The method for operating the surgical system according to claim 14, wherein the display includes an augmented reality display.

16. The method of operating the surgical system according to claim 14, wherein the surgical system causes the input to be received on a second display.

17. The method of operating the surgical system according to claim 16, wherein the surgical system causes the graphical representation of the camera position to be displayed on the second display.

18. The method of operating the surgical system according to claim 17, wherein the surgical system causes the graphical representation of the camera position to be displayed on the second display at all times, and causes the graphical representation of the camera position to be displayed on the display in connection with receiving the input of the camera position.

19. The method of operating the surgical system according to claim 14, wherein the surgical system causes the input to be received using a control unit coupled to the camera.

20. The method for operating a surgical system according to claim 19, wherein the control unit is spaced apart from the camera and the display.

21. The method of operating the surgical system according to claim 14, wherein the surgical system temporarily displays the graphical representation of the camera position in connection with receiving the input of the camera position.

22. The method for operating the surgical system according to claim 14, wherein the surgical system continuously displays the graphical representation of the camera position.

23. The method for operating a surgical system according to claim 14, wherein the graphical representation of the camera position is any of the following: clock readings, compass readings, basic body orientation, circle degree readings, quadrants, spatial directions, colors, readings from alphabetical sequences, readings from numerical sequences, or readings from shape sequences.

24. The surgical system receives a second input of the camera position from the user based on the repositioning of the camera, The surgical system displays the output view from the camera and an updated graphical representation of the camera position based on the second input of the camera position on the display. A method for operating a surgical system according to claim 14, further comprising:

Images