Robotic surgical manipulator system

Abstract

Surgical systems can include a repositionable structure, an instrument holder, and a probe holder. A control system can be configured to insert an instrument and move a sensing probe to keep the instrument within a field of view as the instrument moves, where movement of the repositionable structure moves both the instrument holder and probe holder. A control system can be configured to impose a set of constraints on degrees of freedom of motion of the system when controlling movement about a remote center and not imposing the set of constraints during an initial scan with a sensing probe. Surgical systems can include an instrument driver, a needle coupled to the instrument driver, a high frequency vibration mechanism coupled to the needle, and a low frequency vibration mechanism coupled to the needle.

Description

ROBOTIC SURGICAL MANIPULATOR SYSTEMCROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority to and the benefit of the filing date of U.S. Provisional Patent Application No. 63 / 580,860 entitled “WORKFLOW FOR AN ULTRASOUND GUIDED PERCUTANEOUS NEEDLE ROBOT,” filed on September 6, 2023 and U.S. Provisional Application No. 63 / 580,868 entitled “ROBOTIC SURGICAL MANIPULATOR SYSTEM,” filed on September 6, 2023, the entireties of which are hereby expressly incorporated by reference herein.FIELD

[0002] Disclosed embodiments relate to robotic surgical manipulator systems.BACKGROUND

[0003] Minimally invasive medical techniques are intended to reduce the amount of tissue that is damaged during medical procedures, thereby reducing patient recovery time, discomfort, and harmful side effects. Such minimally invasive techniques may be performed through natural orifices in a patient anatomy or through one or more surgical incisions. Through these natural orifices or incisions, physicians may insert minimally invasive medical instruments (including surgical, diagnostic, therapeutic, and / or biopsy instruments) to reach a target tissue location.SUMMARY

[0004] The following presents a simplified summary of various examples described herein and is not intended to identify key or critical elements or to delineate the scope of the claims.

[0005] In accordance with a first example, a computer-assisted system is described that includes a repositionable structure including a plurality of links and a plurality of joints, an instrument holder coupled to a distal link of the plurality of links, a probe holder coupled to the distal link, and a control system operably coupled to the repositionable structure, the instrument holder, and the probe holder. The instrument holder can have at least three degrees of freedom of motion and be configured to receive an instrument. The probe holder can have at least three degrees of freedom of motion and be configured to receive a sensing probe having a field of view. The control system can be configured to control operation of the instrument holder and movement of the repositionable structure, the instrument holder, and the probe holder to: move the instrument along an insertion path, and move the sensing probe to keep the instrument within the field of viewas the instrument moves along the insertion path. Movement of the repositionable structure moves both the instrument holder and probe holder.

[0006] In a further example, a method for operating the above system is described that includes the control system controlling operation of the instrument holder to move the instrument along an insertion path, and controlling movement of the repositionable structure, the instrument holder, and the probe holder to move the sensing probe to keep the instrument within the field of view as the instrument moves along the insertion path, where movement of the repositionable structure moves both the instrument holder and probe holder.

[0007] In a further example, a non-transitory computer readable medium is described herein that has instructions stored thereon that when executed by a computing device, cause the computing device to control operation of the instrument holder to move the instrument along an insertion path, and control movement of the repositionable structure, the instrument holder, and the probe holder to move the sensing probe to keep the instrument within the field of view as the instrument moves along the insertion path, where movement of the repositionable structure moves both the instrument holder and probe holder.

[0008] In accordance with a second example, a surgical system is described that includes an instrument driver, a needle coupled to the instrument driver to be driven thereby along an insertion axis, a high frequency vibration mechanism coupled to the needle, and a low frequency vibration mechanism coupled to the needle.

[0009] In a further example, a method for operating the above system is described that includes driving the needle along the insertion axis, vibrating the needle with a high frequency vibration mechanism, and vibrating the needle with a low frequency vibration mechanism.

[0010] In a further example, a non-transitory computer readable medium is described herein that has instructions stored thereon that when executed by a computing device, cause the computing device to drive the needle along the insertion axis, vibrate the needle with a high frequency vibration mechanism, and vibrate the needle with a low frequency vibration mechanism.

[0011] In accordance with a third example, a surgical system is described that includes a repositionable structure including a plurality of links and a plurality of joints, an instrument holder coupled to a distal link of the plurality of links, a probe holder coupled to the distal link, and a control system operably coupled to the repositionable structure, the instrument holder, and the probe holder. The instrument holder can include an instrument driver configured to receive aninstrument. The probe holder can be configured to receive a sensing probe having a field of view. The control system can be configured to: control movement of the rcpositionablc structure and probe holder without imposing a set of constraints on a set of degrees of freedom of motion of the repositionable structure or of the instrument holder to perform an initial scan of a target region within a patient with the sensing probe, and control movement of the repositionable structure and instrument holder about a remote center corresponding to an instrument insertion point into the patient, movement about the remote center imposing the set of constraints on at least one of: one or more of the degrees of freedom of motion of the repositionable structure or one or more degrees of freedom of motion of the instrument holder.

[0012] In a further example, a method for operating the above system is described that includes the control system controlling movement of the repositionable structure and probe holder without imposing the set of constraints on the set of degrees of freedom of motion of the repositionable structure or of the instrument holder to perform the initial scan of the target region within a patient with the sensing probe; and controlling movement of the repositionable structure and instrument holder about the remote center corresponding to the instrument insertion point into the patient, movement about the remote center imposing the set of constraints on at least one of: one or more of the degrees of freedom of motion of the repositionable structure or one or more degrees of freedom of motion of the instrument holder

[0013] In a further example, a non-transitory computer readable medium is described herein that has instructions stored thereon that when executed by a computing device, cause the computing device to control movement of the repositionable structure and probe holder without imposing the set of constraints on the set of degrees of freedom of motion of the repositionable structure or of the instrument holder to perform the initial scan of the target region within a patient with the sensing probe; and control movement of the repositionable structure and instrument holder about the remote center corresponding to the instrument insertion point into the patient, movement about the remote center imposing the set of constraints on at least one of: one or more of the degrees of freedom of motion of the repositionable structure or one or more degrees of freedom of motion of the instrument holder.

[0014] It is to be understood that both the foregoing general description and the following detailed description are illustrative and explanatory in nature and are intended to provide an understanding of the present disclosure without limiting the scope of the present disclosure. In thatregard, additional aspects, features, and advantages of the present disclosure will be apparent to one skilled in the art from the following detailed description.BRIEF DESCRIPTIONS OF THE DRAWINGS

[0015] FIG. 1 is a schematic diagram for a robotically-assisted manipulator system according to some examples.

[0016] FIG. 2A is a perspective view of a manipulator system according to some examples.

[0017] FIG. 2B is an alternative perspective view of the manipulator system of FIG. 2A according to some examples.

[0018] FIG. 2C is an alternative perspective view of the manipulator system of FIG. 2A according to some examples.

[0019] FIG. 3 is a perspective view of an instrument holder for a manipulator system according to some examples.

[0020] FIG. 4 is a diagrammatic view of high and low frequency vibration mechanisms for an instrument driver of an instrument holder according to some examples.

[0021] FIG. 5 is a schematic view of a manipulator system according to some examples.

[0022] FIG. 6 is a perspective view of a first portion of a repositionable structure for a manipulator system according to some examples.

[0023] FIG. 7 is a perspective view of a second portion of a repositionable structure for a manipulator system according to some examples.

[0024] FIG. 8 is a simplified diagram of a manipulator system showing a sensing probe tracking an instrument inserted along an insertion path according to some examples.

[0025] Embodiments of the present disclosure and their advantages are best understood by referring to the detailed description that follows. It should be appreciated that like reference numerals are used to identify like elements illustrated in one or more of the figures, wherein showings therein are for purposes of illustrating embodiments of the present disclosure and not for purposes of limiting the same.DETAILED DESCRIPTION

[0026] In the following description, specific details are set forth describing some embodiments consistent with the present disclosure. Numerous specific details are set forth in order to providea thorough understanding of the emhodiments. It will he apparent, however, to one skilled in the art that some embodiments may be practiced without some or all of these specific details. The specific embodiments disclosed herein are meant to be illustrative but not limiting. One skilled in the art may realize other elements that, although not specifically described here, are within the scope and the spirit of this disclosure. In addition, to avoid unnecessary repetition, one or more features shown and described in association with one embodiment may be incorporated into other embodiments unless specifically described otherwise or if the one or more features would make an embodiment non-functional. In some instances, well known methods, procedures, components, and circuits have not been described in detail so as not to unnecessarily obscure aspects of the embodiments.

[0027] This disclosure describes various instruments and portions of instruments in terms of their state in three-dimensional space. As used herein, the term “position” refers to the location of an object or a portion of an object in a three-dimensional space (e.g., three degrees of translational freedom along Cartesian x-, y-, and z-coordinates). As used herein, the term “orientation” refers to the rotational placement of an object or a portion of an object (e.g., one or more degrees of rotational freedom such as, roll, pitch, and yaw). As used herein, the term “pose” refers to the position of an object or a portion of an object in at least one degree of translational freedom and to the orientation of that object or portion of the object in at least one degree of rotational freedom (e.g., up to six total degrees of freedom). As used herein, the term “shape” refers to a set of poses, positions, and / or orientations measured along an object. As used herein, the term “distal” refers to a position that is closer to a procedural site and the term “proximal” refers to a position that is further from the procedural site. Accordingly, the distal portion or distal end of an instrument is closer to a procedural site than a proximal portion or proximal end of the instrument when the instrument is being used as designed to perform a procedure.

[0028] Systems and methods are provided utilizing a manipulator arm and device holders movable about several degrees of freedom of motion, allowing complex positioning and control. In some examples, the systems and methods control needle insertion and track movement of the needle along an insertion path, such as with an ultrasound probe. In these examples, the manipulator arm may have at least four degrees of freedom (e.g., three pivots about vertical axes and a distal pivot about a horizontal axis) and can include an additional degree of freedom to adjust a height of the manipulator arm. Holders for the needle and ultrasound probe may each have atleast three degrees of freedom (e.g., x-axis, z-axis, pitch, and / or yaw). In additional or alternative examples, the degrees of freedom of the holder for the ultrasound probe combined with the degrees of freedom of the manipulator arm allow the system to move the ultrasound probe parallelly across a patient and relative to a target region, sequentially line-by-line for an initial scan of the target region. This initial scan enables complete coverage of the target region for creating a high fidelity 3-dimensional model of the target region. The 3-dimensional model can be utilized to determine an insertion path and / or identify areas of interest.

[0029] In further or additional examples, the systems and methods control movement of the manipulator and an instrument holder according to a remote center around a needle insertion point. In these examples, a control system determines an insertion point and direction vector for needle insertion and controls movement of the manipulator arm and instrument holder to position an instrument driver to align an insertion axis thereof with the insertion point along the direction vector. The control system can then operate the instrument driver to drive the needle along the insertion axis to the insertion point and control movement of the manipulator arm and instrument holder about the insertion point as a remote center in response to the needle reaching the insertion point.

[0030] An instrument driver for the needle can be configured to impart two degrees of freedom of movement on the needle, including insertion along an insertion axis and rotation about the insertion axis. The systems and methods can further include a stylus that is coupled to and driven by the instrument driver through a lumen of the needle. The instrument driver may also impart two degrees of freedom of movement on the stylus, including insertion along the insertion axis and rotation about the insertion axis.

[0031] In the above or alternative examples, a needle driver for a needle includes both high and low frequency vibration mechanisms coupled to the needle. The high frequency vibration mechanism can be utilized to aid needle insertion through tissue and aid visualization of the needle on ultrasound. In one example, the high frequency vibration mechanism includes a stack of piezoelectric members received within a housing coupled to the needle. The low frequency vibration mechanism can be utilized to decrease pain during needle insertion. In one example, the low frequency vibration mechanism can be an eccentric motor or linear actuator coupled to the needle. The needle driver can be utilized within the overall system as a component of the instrument holder. The system can also include the manipulator arm and probe holder.

[0032] Aspects of this disclosure herein can be part of a computer-assisted teleoperational manipulator system, sometimes referred to as a robotically-assisted manipulator system or a robotic system. The manipulator system can include one or more manipulators that can be operated with the assistance of an electronic controller (e.g., computer) to move and control functions of one or more instruments when coupled to the manipulators.

[0033] FIG. 1 illustrates an embodiment of a robotically-assisted manipulator system for use with the tools described herein. The manipulator system can be used, for example, in surgical, diagnostic, therapeutic, biopsy, or non-medical procedures, and is generally indicated by the reference numeral 100. As shown in FIG. 1, a robotically-assisted manipulator system 100 can include one or more manipulator assemblies 102 for operating one or more medical instrument systems 104 in performing various procedures on a patient P positioned on a table T in a medical environment 101. For example, the manipulator assembly 102 can drive catheter or end effector motion, can apply treatment to target tissue, and / or can manipulate control members. The manipulator assembly 102 can be teleoperated, non-teleoperated, or a hybrid teleoperated and nonteleoperated assembly with select degrees of freedom of motion that can be motorized and / or teleoperated and select degrees of freedom of motion that can be non-motorized and / or non- teleoperated. An operator input system 106, which can be inside or outside of the medical environment 101, generally includes one or more control devices for controlling manipulator assembly 102. Manipulator assembly 102 supports medical instrument system 104 and can optionally include a plurality of actuators or motors that drive inputs on medical instrument system 104 in response to commands from a control system 112. The actuators can optionally include drive systems that when coupled to medical instrument system 104 can advance medical instrument system 104 into a naturally or surgically created anatomic orifice. Other drive systems can move the distal end of medical instrument in multiple degrees of freedom, which can include three degrees of linear motion (e.g., linear motion along the X, Y, Z Cartesian axes) and in three degrees of rotational motion (e.g., rotation about the X, Y, Z Cartesian axes). The manipulator assembly 102 can support various other systems for irrigation, treatment, or other purposes. Such systems can include fluid systems (including, for example, reservoirs, heating / cooling elements, pumps, and valves), generators, lasers, interrogators, and ablation components.

[0034] Robotically-assisted manipulator system 100 also includes a display system 110 for displaying an image or representation of the surgical site and medical instrument system 104generated by an imaging system 109 which can include an imaging system, such as an endoscopic imaging system. Display system 110 and operator input system 106 can be oriented so an operator O can control medical instrument system 104 and operator input system 106 with the perception of telepresence. A graphical user interface can be displayable on the display system 110 and / or a display system of an independent planning workstation.

[0035] In some examples, the endoscopic imaging system components of the imaging system 109 can be integrally or removably coupled to medical instrument system 104. However, in some examples, a separate imaging device, such as an endoscope, attached to a separate manipulator assembly can be used with medical instrument system 104 to image the surgical site. The endoscopic imaging system 109 can be implemented as hardware, firmware, software, or a combination thereof which interact with or are otherwise executed by one or more computer processors, which can include the processors of the control system 112.

[0036] Robotically-assisted manipulator system 100 can also include a sensor system 108. The sensor system 108 can include a position / location sensor system (e.g., an actuator encoder or an electromagnetic (EM) sensor system) and / or a shape sensor system (e.g., an optical fiber shape sensor) for determining the position, orientation, speed, velocity, pose, and / or shape of the medical instrument system 104. The sensor system 108 can also include temperature, pressure, force, or contact sensors or the like.

[0037] Robotically-assisted manipulator system 100 can also include a control system 112. Control system 112 includes at least one memory 116 and at least one computer processor 114 for effecting control between medical instrument system 104, operator input system 106, sensor system 108, and display system 110. Control system 112 also includes programmed instructions (e.g., a non-transitory machine-readable medium storing the instructions) to implement a procedure using the robotically-assisted manipulator system including for navigation, steering, imaging, engagement feature deployment or retraction, applying treatment to target tissue (e.g., via the application of energy), or the like.

[0038] Control system 112 can optionally further include a virtual visualization system to provide navigation assistance to operator O when controlling medical instrument system 104 during an image-guided surgical procedure. Virtual navigation using the virtual visualization system can be based upon reference to an acquired pre-operative or intra-operative dataset of anatomic passageways. The virtual visualization system processes images of the surgical siteimaged using imaging technology such as computerized tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermography, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, nanotube X-ray imaging, and / or the like. The control system 112 can use a pre-operative image to locate the target tissue (using vision imaging techniques and / or by receiving user input) and create a pre-operative plan, including an optimal first location for performing treatment. The pre-operative plan can include, for example, a planned size to expand an expandable device, a treatment duration, a treatment temperature, and / or multiple deployment locations. Other configurations of teleoperated manipulator systems are also contemplated, such as systems configured for multi-port or single-port procedures. For example, the embodiments described herein can be used with a da Vinci® Surgical System, such as the da Vinci X®, Xi®, or SP® Surgical Systems, all commercialized by Intuitive Surgical, Inc., of Sunnyvale, California.

[0039] FIGS. 2A-2C illustrate an example embodiment of a manipulator system 200 that can be used as part of the manipulator system 100. The manipulator system 200 includes a repositionable structure 202 that includes a plurality of links 204 and a plurality of joints 206. The system 200 further includes an instrument holder 208 configured to receive an instrument 210 (FIG. 3) and a probe holder 212 configured to receive a sensing probe 214 (e.g., an ultrasound probe) having a field of view. The instrument 210 can be any suitable instrument, such as a needle, cannula, and so forth. Further, the sensing probe 214 can be part of the system 200 or can be a separate component added to the system 200.

[0040] The instrument holder 208 and the probe holder 212 are coupled to one or more of the links 204. With this configuration, the repositionable structure 202 has a number of mechanical degrees of freedom of motion through which the instrument holder 208 and the probe holder 212 can be positioned and controlled to scan a patient with the sensing probe 214 and insert the instrument 210 into the patient. In some examples, the instrument holder 208 has at least three degrees of freedom of motion and the probe holder 212 has at least three degrees of freedom of motion. In some examples, the repositionable structure 202 has at least four mechanical degrees of freedom of motion.

[0041] The manipulator system 200 includes a control system 216 described in more detail below with reference to FIG. 5 that is operably coupled to the repositionable structure 202, the instrument holder 208, and the probe holder 212 to control operation of the instrument holder 208and movement of the repositionable structure 202, the instrument holder 208, and the probe holder 212. In some examples, the control system 216 can correspond to the control system 112 described above.

[0042] The system 200 is configured to move the instrument 210 along an insertion path and move the sensing probe 214 to keep the instrument 210 within the field of view of the sensing probe 214 as the instrument 210 moves along the insertion path. The repositionable structure 202 is configured such that movement of the repositionable structure 202 moves both the instrument holder 208 and the probe holder 212. As shown, both the instrument holder 208 and the probe holder 212 are coupled to a distal link 204a of the repositionable structure 202, such that when any of the links 204 and joints 206 move, the repositionable structure 202 moves both the instrument 210 and the sensing probe 214 through the instrument holder 208 and the probe holder 212.

[0043] In other words, the control system 216 is configured to operate the instrument holder 208 to move the instrument 210 along the insertion path at least by moving the repositionable structure 202 according to a first set of movements and moving the instrument holder 208 according to a second set of movements. The control system 216 is also configured to move the sensing probe 214 to keep the instrument 210 within the field of view of the sensing probe 214 as the instrument 210 moves along the insertion path at least by moving the repositionable structure 202 according to the first set of movements and moving the probe holder 212 according to a third set of movements. Accordingly, the instrument holder 208 and the probe holder 212 have a shared set of movements, as well as independent movements.

[0044] In some examples, the repositionable structure 202 includes a support assembly 218 including a base 220 and a support column 222. An arm 224 is connected to the support column 222. The arm 224 and, in some examples, the support column 222, can be used as the manipulator assembly 102. The arm 224 includes the links 204 and joints 206. As shown, the arm 224 can include shoulder 206a, elbow 206b, and wrist 206c joints that are pivotable about vertical axes. The arm 224 can further includes a distal joint 206d that is pivotable about a horizontal axis. As such, the arm 224 has four mechanical degrees of freedom of motion, but additional or fewer links 204 and joints 206 can be utilized to provide a desired number of mechanical degrees of freedom of motion.

[0045] As shown, a drive 226 can be disposed between the support column 222 and the arm 224. The drive 226 can be operated to move the arm 224 along a Z axis (e.g., height) of the supportcolumn 222 for an additional degree of freedom of motion for the repositionable structure 202. Any of the drives described herein can be any suitable drive mechanism. For example, the drives can be servomotors or other motors configured to generate linear or circular’ motion. In some examples, one or more of the drives may also be backdriveable.

[0046] The probe holder 212 includes a drive 228 operable to move the sensing probe 214 along an X axis, a drive 230 to move the sensing probe 214 along a Z axis (e.g., toward and away from a patient), and a joint 232 to pivot the sensing probe 214 about a pitch axis. This configuration gives the probe holder 212 three degrees of freedom of motion. In some examples, a pressure sensor 234 (FIG. 5) can be operably coupled to the probe holder 212 so that the control system 216 can, via the various degrees of freedom of motion offered by its joints, maintain a desired pressure on the patient with the sensing probe 214 using data from the pressure sensor 234. The pressure sensor 234 can be part of the sensing probe 214, part of the probe holder 212, or a separate sensor coupled to the probe holder 212, etc.

[0047] The instrument holder 208 includes a drive 236 operable to move the instrument holder 208 along an X axis, a joint 238 to pivot the instrument holder 208 about a yaw axis, and a joint 240 to pivot the instrument holder 208 about a pitch axis. Furthermore, as shown in FIG. 3, the instrument holder 208 can include an instrument driver 242 that includes an insertion drive 244 to move the instrument 210 along an insertion axis I and, in some examples, a rotation drive 246 to rotate the instrument 210 about the insertion axis I. This configuration gives the instrument holder 208 four or five degrees of freedom of motion. In some examples, a pressure sensor 248 (FIG. 5) can be operably coupled to the instrument driver 242 or instrument 210 so that the control system 216 can monitor a pressure at the tip of the instrument 210 (e.g., during piercing of the patient’s skin and / or during insertion) to adjust for tissue pressure and collect insertion data. This can be helpful for when the instrument 210 transitions from soft tissue to hard tissue (e.g., a tumor nodule) and from hard tissue to soft tissue. The pressure sensor 248 can be a load cell, for example.

[0048] With the above configuration, the instrument holder 208 can move the instrument 210 along the insertion path. Moving the instrument 210 along the insertion path can include both aligning the insertion axis I to drive in and out along the insertion axis I using the insertion drive 244 for straight segments of the insertion path and rotating the instrument 210 using the rotation drive 246 (e.g., when using an instrument with a beveled tip) to subsequently or concurrently cause curving along the insertion path when moving the instrument 210 using the insertion drive 244 forwhen the insertion path includes non-linear segments. Further, for tissue collection within the instrument 210, rotating the instrument 210 with the rotation drive 246 may allow the instrument 210 to obtain a larger tissue specimen as compared to tissue collection without rotation. Due to this, the instrument 210 can have a smaller diameter / gauge to obtain a desired amount of tissue as compared to a non-rotating instrument.

[0049] As shown, both the instrument holder 208 and the probe holder 212 can be coupled to the distal link 204a of the repositionable structure 202. Furthermore, both of the X axis drives 228, 236 can interact with the distal link 204a to move the probe holder 212 and instrument holder 208, respectively along the distal link 204a. For example, the X axis drives 228, 236 can be rack and pinion drives that utilize a common rack extending along the distal link 204a.

[0050] As shown in FIG. 4, one or more vibration mechanisms can be included to aid in instrument insertion. In one example, a high frequency vibration mechanism 250 can be coupled to the instrument 210. Vibrating the instrument 210 at a high frequency can help visualizing the instrument 210 with the sensing probe 214 (e.g., under ultrasound). High frequency vibration can also reduce an insertion force needed for instrument insertion and drag induced tissue distortion. Additionally or alternatively, a low frequency vibration mechanism 252 can be coupled to the instrument 210. Vibrating the instrument 210 at a low frequency can reduce patient pain during instrument insertion by numbing the local area around the insertion path. Additionally, vibration of the instrument 210 combined with rotation of the instrument 210 via the rotation drive 246 can help the instrument 210 penetrate a free floating / moving object (e.g., a lymph node or similar structure not fixed inside tissue) rather than undesirably pushing the object away as can happen with conventional systems.

[0051] In some examples, the frequency range for the high frequency vibration mechanism 250 can be about 27 kHz to about 44 kHz, which can be advantageous for visibility under ultrasound vision, between about 20 kHz to about 50 kHz, which can be advantageous to reduce insertion forces, or about 34 kHz; and the frequency range for the low frequency vibration mechanism 252 can be about 75 Hz to about 250 Hz, which can be advantageous for pain reduction, or about 166 Hz. The vibration mechanisms 250, 252 can be part of the instrument holder 208, coupled to the instrument holder 208, or be a separate component directly coupled to the instrument 210 separate from the instrument holder 208.

[0052] In one example, the high frequency vibration mechanism 250 can include a plurality of piezoelectric members 254 received within a housing 256 coupled to the instrument 210. If desired, the housing 256 can be coupled to a proximal mount 258 of the instrument 210 with a radial coupling such that the piezoelectric members 254 are offset relative to insertion axis I and instrument 210. The stack of members 254 and housing 256 can be spring-loaded against one another to manage movement of the housing 256 relative to movement of the members 254. Alternatively, the members 254 and housing 256 could be coaxial with and extend around the instrument, such as with a circular or C-shaped cross-section.

[0053] In one example, the instrument holder 208 can include a distal instrument guide 260 that supports the instrument 210 adjacent to an insertion location. The instrument guide 260 can have any suitable form. For example, the instrument guide 260 can be side or top loaded and define a path for the instrument 210 to be inserted therethrough. The low frequency vibration mechanism 252 can be coupled to the instrument guide 260 to vibrate the instrument 210 through the instrument guide 260. In some examples, the low frequency vibration mechanism 252 can be an eccentric motor or linear actuator.

[0054] Example degrees of freedom of motion for the repositionable structure 202 are shown in FIGS. 6 and 7. It will be understood that the system 200 can include more or fewer degrees of freedom than those shown. Five degrees of freedom are shown in FIG. 6. The degrees of freedom include height provided by the drive 226 movable along the support column 222 of the support assembly 218. The degrees of freedom also include movement of the arm 224, including rotation about vertical axes of the wrist joint 206a, the elbow joint 206b, and the shoulder joint 206c, and rotation about a horizontal axis to provide a desired X axis pitch of the distal joint 206d.

[0055] Six degrees of freedom are shown in FIG. 7. The degrees of freedom for the probe holder 212 include in / out movement along the Z-axis provided by the drive 230, movement along the X- axis by the drive 228, and pitch rotation about the joint 232. The degrees of freedom for the instrument holder 208 include movement along the X-axis by the drive 236, yaw rotation about the joint 238, and pitch rotation about the joint 240. Within the yaw degree of freedom for the instrument holder 208, secondary degrees of freedom can include in / out movement along the insertion axis I for the instrument 210 with the insertion drive 244, rotation about the insertion axis I of the instrument 210 with the rotation drive 246, in / out movement along the insertion axis I forthe second instrument 262 with the insertion drive 264, and rotation about the insertion axis I of the second instrument 262 with the rotation drive 266.

[0056] In some examples, the system 200 can be configured to insert multiple instruments 210 into a patient by decoupling an inserted instrument from the instrument holder 208 / instrument driver 242 and loading a subsequent instrument 210. For example, the system 200 can be used to insert multiple instruments 210 (e.g., needles) into a patient as described herein, which can subsequently be utilized as electrodes. Pursuant to this, as shown in FIG. 4, the instrument driver 242 can include one or more slots 272 allowing the instrument 210 to be off loaded from the instrument driver 242. Alternatively, the instrument driver 242 can include a releasable collet allowing the instrument to be decoupled therefrom. Additionally, in examples having the high frequency vibration mechanism, the housing 256 can also include a slot 274 or releasable connector for the radial coupling.

[0057] The instrument 210 can be used for any suitable task. For example, the instrument 210 can be utilized as an electrode, for fluid delivery / aspiration, for biopsy, for ablation, and so forth. The instrument 210 can define a lumen that extends longitudinally through a length of the instrument 210 from a proximal opening to a distal opening. Additionally or alternatively, the system 200 can include a second instrument 262 (e.g., a stylus) that is inserted through proximal opening into the lumen of the instrument 210. The second instrument 262 can be utilized for any desired reason. In some examples, the second instrument 262 can have a solid cross-section and complementary bevel to provide a solid overall tip between the first and second instruments 210, 262 during insertion, can be a biopsy stylus or needle, can be an anchor stylus, can be a shape sensor (e.g., fiber), can be an ablation needle, can include a surgical end effector, and so forth. A plurality of second instruments 262 can be utilized during a procedure to perform multiple tasks, which can be different tasks.

[0058] Pursuant to the above, the instrument driver 242 can further include an insertion drive 264 to move the second instrument 262 along the insertion axis I within the lumen of the first instrument 210 and, in some examples, a rotation drive 266 to rotate the second instrument 262 about the insertion axis I. This configuration gives the instrument holder 208 an additional one or two degrees of freedom of motion. In one example, the insertion drives 244, 264 can be rack and pinion drives that utilize a common rack. In another example, the insertion drives 244, 264 can utilize a common ball screw, which can provide precise motion control.

[0059] If desired, as shown in FIG. 3, a high frequency vibration mechanism 268 can be coupled to the second instrument 210 to provide similar benefits as described above. For example, the high frequency vibration mechanism 268 can be coupled to a proximal mount 270 of the second instrument 262. The high frequency vibration mechanism 268 can be any suitable mechanism, including a plurality of piezoelectric members as described above, an ultrasonic transducer, and so forth.

[0060] As shown in FIG. 5, the control system 216 can be configured to control the movement and operation of the components of the system 100. These include the support assembly drive 226, the joints 206 of the arm 224, the drives and joints 228, 230, 232 of the prob holder 212, the drives and joints 236, 238, 240, 244, 246, 264, 266, and the vibration mechanisms 250, 252, 268, if included.

[0061] In some examples, the control system 216 can be configured to control the movement (e.g., actuation of one or more degrees of freedom and, in some examples, restriction of one or more degrees of freedom) of the repositionable structure 202 (e.g., drive 226 and joints 206) and the instrument holder 208 (e.g., drives 236 and joints 238, 240) to selectively move and operate about a remote center during a procedure. For example, the remote center can correspond to an insertion point of the instrument 210 into a patient along the insertion path. This configuration allows the system 100 to move as needed during a procedure to insert the instrument 210 along the insertion path while minimizing or avoiding damage at the insertion point. In one example, the control system 216 can be configured to control movement of the repositionable structure 202 and instrument holder 208 about the remote center to deflect the insertion path, such as by rotating the instrument 210 with the rotation drive 246.

[0062] In further examples, the control system 216 can be configured to control the movement (e.g., actuation of one or more degrees of freedom and, in some examples, restriction of one or more degrees of freedom) of the repositionable structure 202 (e.g., drive 226 and joints 206) and the instrument holder 208 (e.g., drives 236 and joints 238, 240) to move in a reverse operation to remove the instrument 210 along a retraction path (e.g., a reverse of the insertion path). Movement while retracting the instrument 210 along the retraction path can be a reverse of the actuation / restriction of the degrees of freedom associated with insertion of the instrument 210 along the insertion path.

[0063] Pursuant to the above, the control system 216 can be configured to control movement of the rcpositionablc structure 202 and the instrument holder 208 about the remote center corresponding to the instrument insertion point into the patient. Movement about the remote center imposes a set of constraints on at least one of: one or more of the degrees of freedom of motion of the repositionable structure 202 or one or more degrees of freedom of motion of the instrument holder 208.

[0064] Furthermore, the control system 216 can be configured to control movement of the repositionable structure 202 and the probe holder 212 to perform an initial scan of a target region within the patient with the sensing probe 214. Some example target regions can include the pancreas, breast, liver, and so forth. It will be understood, however, that the target region is not limited to any particular region. The initial scan can be utilized to determine the insertion path. For example, the control system 216 can utilize the initial scan to determine the instrument insertion point and a direction vector for instrument insertion.

[0065] To allow the system 100 to complete a full scan, the initial scan can be performed without imposing the set of constraints on the set of degrees of freedom of motion of the repositionable structure 202 or of the instrument holder 208 that are imposed while movement is performed around the remote center. Accordingly, the system 100 can operate without moving about a remote center for the initial scan.

[0066] Thereafter, the remote center functionality can be activated in response to the instrument 210 reaching the insertion point, after which the control system 216 controls movement of the repositionable structure 202 and instrument holder 208 about the remote center. Reaching the insertion point can be determined based data from the pressure sensor 234, a length of the instrument 210 that has been driven forward by the insertion drive 244, and so forth. Further, control of movement about the remote center can be maintained until the instrument 210 is withdrawn from the patient.

[0067] In some examples, the control system 216 can control operation of the instrument holder 208 and the probe holder 212 to both move the instrument 210 along the insertion path and move the sensing probe 214 to keep the instrument 210 within the field of view as the instrument 210 moves along the insertion path. This functionality can include the control system 216 controlling movement of the repositionable structure 202 about the remote center and controlling movementof the probe holder 212 to keep the instrument 210 within the field of view as the instrument 210 moves along the insertion path.

[0068] In the example of the sensing probe 214 being an ultrasound probe having a 2D field of view, the control system 216 can be configured to move the sensing probe 214 to maintain a tip of the instrument 210 within the ultrasound 2D slice at all times during insertion. An example of such a configuration is shown in the simplified diagram of FIG. 8. While the instrument holder 208 is operated to drive the instrument 210 along an insertion path, movement of the repositionable structure 202 and the probe holder 212 is controlled, for example by the control system 216, to keep a plane of the ultrasound 2D slice represented by the dashed line in FIG. 8 generally perpendicular to the insertion path and aligned with the tip of the instrument 210. The control system 216 can also be configured to perform a status check by scanning a length of the instrument 210 with the sensing probe 214 while inserted and returning to the tip of the instrument 210. The sensing probe 214 can also be using to monitor the tip of the second instrument 262. As set forth above, the control system 216 can be configured to control the movement (e.g., actuation of one or more degrees of freedom and, in some examples, restriction of one or more degrees of freedom) of the repositionable structure 202 (e.g., drive 226 and joints 206) and the instrument holder 208 (e.g., drives 236 and joints 238, 240) to selectively move and operate about a remote center during instrument insertion and retraction. The control system 216 can further be configured to coordinate movement of the probe holder 212 to maintain the sensing probe 214 in the above orientation relative to the inserting instrument 210, while controlling the movement of the repositionable structure 202 and the instrument holder 208 about the remote center. This can include, as set forth above, the instrument holder 208 and the probe holder 212 being coupled to the same distal link 204 of the arm 224, such that movement of the repositionable structure 202 moves both the instrument holder 208 and the probe holder 212 simultaneously.

[0069] If desired, the instrument 210 can be identified by the system 200 prior to use to provide information about the instrument 210. Identification can be by user input, near field communication, infrared or radio frequency identification, etc. The information can include any relevant information, such as instrument length, instrument tip shape, etc.

[0070] Methods of operating and / or controlling operation / movement of any of the components of the systems (e.g., system 100, system 200) set forth herein are also disclosed. The methods caninclude any of the functions described herein, including methods directed to the functions corresponding to the configurations set forth in the claims.

[0071] One or more components of the embodiments discussed in this disclosure, such as control system 112, 216 may be implemented in software for execution on one or more processors of a computer system. The software may include code that when executed by the one or more processors, configures the one or more processors to perform various functionalities as discussed herein. The code may be stored in a non-transitory computer readable storage medium (e.g., a memory, magnetic storage, optical storage, solid-state storage, etc.). The non-transitory computer readable storage medium may have instructions stored thereon that, when executed by a computing device, cause the computing device to perform any of the operations (e.g., controlling movement or operation of one or more components of the system 100, 200) described herein and set forth in the claims. The computer readable storage medium may be part of a computer readable storage device, such as an electronic circuit, a semiconductor device, a semiconductor memory device, a read only memory (ROM), a flash memory, an erasable programmable read only memory (EPROM); a floppy diskette, a CD-ROM, an optical disk, a hard disk, or other storage device. The code may be downloaded via computer networks such as the Internet, Intranet, etc. for storage on the computer readable storage medium. The code may be executed by any of a wide variety of centralized or distributed data processing architectures. The programmed instructions of the code may be implemented as a number of separate programs or subroutines, or they may be integrated into a number of other aspects of the systems described herein. The components of the computing systems discussed herein may be connected using wired and / or wireless connections. In some examples, the wireless connections may use wireless communication protocols such as Bluetooth, near-field communication (NFC), Infrared Data Association (IrDA), home radio frequency (HomeRF), IEEE 802.11, Digital Enhanced Cordless Telecommunications (DECT), and wireless medical telemetry service (WMTS).

[0072] Various general-purpose computer systems may be used to perform one or more processes, methods, or functionalities described herein. Additionally or alternatively, various specialized computer systems may be used to perform one or more processes, methods, or functionalities described herein. In addition, a variety of programming languages may be used to implement one or more of the processes, methods, or functionalities described herein.

[0073] While certain embodiments and examples have been described above and shown in the accompanying drawings, it is to be understood that such embodiments and examples arc merely illustrative and are not limited to the specific constructions and arrangements shown and described, since various other alternatives, modifications, and equivalents will be appreciated by those with ordinary skill in the art.

Claims

What is claimed is:

1. A computer-assisted system comprising: a repositionable structure including a plurality of links and a plurality of joints; an instrument holder coupled to a distal link of the plurality of links, the instrument holder having at least three degrees of freedom of motion and configured to receive an instrument; a probe holder coupled to the distal link, the probe holder having at least three degrees of freedom of motion and configured to receive a sensing probe having a field of view; and a control system operably coupled to the repositionable structure, the instrument holder, and the probe holder, the control system configured to control operation of the instrument holder and movement of the repositionable structure, the instrument holder, and the probe holder to: move the instrument along an insertion path, and move the sensing probe to keep the instrument within the field of view as the instrument moves along the insertion path, wherein movement of the repositionable structure moves both the instrument holder and probe holder.

2. The computer-assisted system of claim 1, wherein movement of the repositionable structure simultaneously moves both the instrument holder and the probe holder.

3. The computer-assisted system of claim 1, wherein the repositionable structure has at least four degrees of freedom of motion.

4. The computer-assisted system of claim 1, wherein the repositionable structure includes a support assembly and manipulator arm.

5. The computer-assisted system of claim 4, wherein the support assembly includes a drive to move the manipulator arm along a Z-axis.

6. The computer-assisted system of claim 4, wherein the manipulator arm includes shoulder, elbow, and wrist joints pivotable about vertical axes, and a distal joint pivotable about a horizontal axis.

7. The computer-assisted system of any one of claims 1 to 6, wherein the probe holder includes a drive operable to move the sensing probe along an X axis, a drive to move the sensing probe along a Z axis, and a joint to pivot the sensing probe about a pitch axis.

8. The computer-assisted system of any one of claims 1 to 6, further comprising the sensing probe, the sensing probe being coupled to the probe holder.

9. The computer-assisted system of any one of claims 1 to 6, further comprising a pressure sensor operably coupled to the probe holder for maintaining desired pressure on a patient with the sensing probe.

10. The computer-assisted system of any one of claims 1 to 6, wherein the distal link comprises an X axis drive for both the probe holder and instrument holder.

11. The computer-assisted system of any one of claims 1 to 6, wherein the control system configured to move the instrument along the insertion path comprises the control system configured to: align an instrument insertion axis for the instrument to drive the instrument in and out along the insertion axis for straight segments; and rotate the instrument for when the insertion path includes non-linear segments.

12. The computer-assisted system of any one of claims 1 to 6, wherein the control system is further configured to control movement so that an insertion point of the instrument along the insertion path is a remote center.

13. The computer-assisted system of claim 12, wherein the control system is configured to control movement of the sensing probe to perform an initial scan of a target region.

14. The computer-assisted system of claim 13, wherein the control system configured to control movement of the sensing probe to perform the initial scan of the target region includes controlling movement of the repositionable structure and the probe holder via combinations of degrees of freedom of motion thereof to move the sensing probe parallelly across the target region, sequentially line-by-line for the initial scan of the target region.

15. The computer-assisted system of claim 13, wherein the control system is configured to allow movement of the sensing probe without a remote center for the initial scan.

16. The computer-assisted system of any one of claims 1 to 6, wherein the control system being configured to move the sensing probe to keep the instrument within the field of view as the instrument moves along the insertion path comprises the control system being configured to maintain a tip of the instrument within an ultrasound 2D slice.

17. The computer-assisted system of any one of claims 1 to 6, wherein the instrument holder includes an instrument driver configured to receive and control the one or more instruments.

18. The computer-assisted system of claim 17, wherein the instrument holder includes a drive operable to move the instrument driver along an X axis, and joints to pivot the instrument driver about pitch and yaw axes.

19. The computer-assisted system of claim 17, wherein the instrument driver includes a rotation drive to rotate the instrument about an insertion axis.

20. The computer-assisted system of claim 17, further comprising an instrument coupled to the instrument driver to be driven thereby along an insertion axis.

21. The computer-assisted system of claim 20, wherein the instrument comprises: a needle defining a lumen extending longitudinally therethrough; and a stylus coupled to the instrument driver to be driven thereby along an insertion axis, the stylus insertable into the lumen of the needle.

22. The computer-assisted system of claim 21 , wherein the stylus has solid cross-section and a distal end bevel complementary to a bevel of the needle.

23. The computer-assisted system of any one of claims 1 to 6, further comprising a pressure sensor operably coupled to the instrument, the control system configured to monitor insertion of the instrument by analyzing data from the pressure sensor.

24. The computer- as sis ted system of any one of claims 1 to 6, further comprising a high frequency vibration mechanism operably coupled to the instrument.

25. The computer-assisted system of claim 24, wherein the high frequency vibration mechanism comprises: a housing coupled to the instrument; and a plurality of piezoelectric members received within the housing.

26. The computer-assisted system of claim 25, wherein the housing positions the plurality of piezoelectric offset from an insertion axis.

27. The computer-assisted system of claim 25, wherein the housing defines an opening configured to allow the instrument to be decoupled from the instrument driver.

28. The computer-assisted system of any one of claims 1 to 6, further comprising a low frequency vibration mechanism.

29. A surgical system comprising: an instrument driver; a needle coupled to the instrument driver to be driven thereby along an insertion axis; a high frequency vibration mechanism coupled to the needle; and a low frequency vibration mechanism coupled to the needle.

30. The surgical system of claim 29, wherein the high frequency vibration mechanism comprises: a housing coupled to the needle; and a plurality of piezoelectric members received within the housing.

31. The surgical system of claim 30, wherein the housing positions the plurality of piezoelectric offset from the insertion axis.

32. The surgical system of claim 30, wherein the housing defines an opening configured to allow the needle to be decoupled from the instrument driver.

33. The surgical system of any one of claims 29 to 32, wherein the needle includes a proximal coupling, and the high frequency vibration mechanism is coupled to the proximal coupling.

34. The surgical system of any one of claims 29 to 32, wherein the instrument driver includes a needle guide, and the low frequency vibration mechanism is coupled to the needle guide.

35. The surgical system of any one of claims 29 to 32, wherein the high frequency vibration mechanism is configured to vibrate at a frequency range of about 20 kHz to about 50 kHz.

36. The surgical system of any one of claims 29 to 32, wherein the low frequency vibration mechanism is configured to vibrate at a frequency range of about 75 Hz to about 250 Hz.

37. The surgical system of any one of claims 29 to 32, further comprising a pressure sensor operably coupled to the needle, the control system configured to monitor insertion of the needle by analyzing data from the pressure sensor.

38. The surgical system of any one of claims 29 to 32, further comprising a stylus coupled to the instrument driver to be driven thereby along the insertion axis, and wherein the needle defines a lumen extending longitudinally therethrough to receive the stylus.

39. The surgical system of any one of claims 29 to 32, wherein the instrument driver includes one or more rotation drives to rotate the needle about the insertion axis.

40. A surgical system comprising: a repositionable structure including a plurality of links and a plurality of joints; an instrument holder coupled to a distal link of the plurality of links, the instrument holder including an instrument driver configured to receive an instrument; a probe holder coupled to the distal link and configured to receive a sensing probe having a field of view; and a control system operably coupled to the repositionable structure, the instrument holder, and the probe holder, the control system configured to: control movement of the repositionable structure and probe holder without imposing a set of constraints on a set of degrees of freedom of motion of the repositionable structure or of the instrument holder to perform an initial scan of a target region within a patient with the sensing probe; and control movement of the repositionable structure and instrument holder about a remote center corresponding to an instrument insertion point into the patient, movement about the remote center imposing the set of constraints on at least one of: one or more of the degrees of freedom of motion of the repositionable structure or one or more degrees of freedom of motion of the instrument holder.

41. The surgical system of claim 40, wherein the control system is further configured to control movement of the repositionable structure and instrument holder about the remote center to deflect an insertion path.

42. The surgical system of claim 40, wherein the instrument driver includes a rotation drive to rotate the instrument about an insertion axis.

43. The surgical system of any one of claims 40 to 42, wherein the control system is further configured to move the instrument along an insertion path and move the sensing probe to keep the instrument within the field of view as the instrument moves along the insertion path.

44. The surgical system of any one of claims 40 to 42, wherein the control system is configured to control movement of the rcpositionablc structure about the remote center initiated in response to the instrument reaching the instrument insertion point.

45. The surgical system of any one of claims 40 to 42, wherein the control system is configured to control movement of the repositionable structure about the remote center until the instrument is withdrawn from the patient.

46. The surgical system of any one of claims 40 to 42, wherein the control system is configured to utilize the initial scan to determine the instrument insertion point and a direction vector for instrument insertion.

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