Tubing guide system

Abstract

Disclosed herein are methods and apparatuses for an external tubing guide system to manage and route tubing lines for use with a scope, such as a colonoscope during diagnostic or therapeutic procedures. These methods and apparatuses may provide coordinated management of fluid, pressure, light, and optics delivered through tubing lines as well as minimizing stress and strain as well as catching and pinching of tubing lines during use. These methods and apparatuses may be partially or fully automated, and tubing lines may be pre-bundled and removably installed onto the external tubing guide system.

Description

TUBING GUIDE SYSTEMPRIORITY CLAIM

[0001] This patent application claims priority to U.S. provisional patent application no. 63 / 636,712, titled “TUBING GUIDE SYSTEM,” filed on April 19, 2024, and herein incorporated by reference in its entirety.INCORPORATION BY REFERENCE

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

[0003] During medical procedures using an endoscope, both manual and robotic, various cables or tubing lines may be utilized to provide light, suction, fluids, insufflation or other features for navigation and visualization of the human body. Problematically, tubing may become tangled or hard to manage and may not move in proper coordination with the endoscope by, for example, not maintaining a constant length as machinery coupled to an endoscope moves. Such issues may lead to slack, stretching, dragging, lifting, catching, pinching, and tangling of tubing lines that make delivery of fluids or pressure via tubing difficult and may disrupt optics, lighting, and endoscopic navigation coupled to such tubing lines.

[0004] Accordingly, there is a need for apparatuses that may provide safe and accurate tubing management and guiding for usage with endoscopic or other medical procedures.SUMMARY OF THE DISCLOSURE

[0005] Described herein are methods and apparatuses for controlling tubing (including cabling) during operation of a telescoping link assembly (e.g., telescoping robotic link assembly). In some cases, these apparatuses may be configured to maintain a constant path length (+ / - about 10%, about 7%, about 5%, about 2.5% etc.) of the tubing as the telescoping link assembly move in / out to treat these apparatuses.

[0006] For example, described herein are apparatuses comprising: a base; a telescoping link assembly coupled to the base and comprising: a plurality of links that are adjacent to each other, wherein adjacent links of the plurality of links are slidably coupled together viaone or more shuttles; and an external tubing guide comprising a plurality of redirectors, wherein each redirector comprising one or more surfaces configured to support one or more tubes, further wherein each redirector extends from either a link or a shuttle of the link assembly so that a continuous path extending between each redirector of the plurality of redirectors maintains a constant length as the links of the link assembly move relative to each other.

[0007] Any of these apparatuses may include a first redirector that is coupled to a first shuttle, a third redirector that is coupled to a second shuttle, and a second redirector that is coupled to a link between the first and second shuttle.

[0008] The first and third redirectors are configured to rotate, and the second redirector is fixed. Any of these apparatuses may include at least one linear driver coupled to one or more of the plurality of links and shuttles to control extension and retraction of the telescoping link assembly. The link assembly comprises a bidirectional link assembly configured to extend both distally and proximally from a neutral position. The plurality of links may be vertically adjacent to each other.

[0009] In general, the shuttle of the one or more shuttles moves approximately half of the relative distance moved between adjacent links on either side of the shuttle of the one or more shuttles as the links of the telescoping link assembly change position. For example, the external tubing guide may further comprise one or more panels coupled to one or more of the links configured to limit movement of the tubing. The apparatuses described herein may include one or more clips configured to secure the one or more tubes to one or more links of the link assembly. The one or more tubes may be coupled to the external tubing guide.

[0010] The one or more tubes may comprise a ribbon comprising a plurality of tubes, or a compound tube having multiple separate lumen, etc. In general, the one or more tubes may comprise a circular, tubular, or circular with relieved geometry arrangement of a plurality of lumens or tubes; these may include individual tubes coupled together (including axially slidably coupled together) or they may be a compound tube having a single body with multiple lumens. The one or more tubes may comprise one or more of: a suction line, an insufflation line, an optics line, a guide light line, and a fluid line. Other elements could also be incorporated, for example, electronics to support endoscopic ultrasound or other imaging modalities. Other elements could also be incorporated, for example, electronics to support energy delivery modalities. The apparatus may include lines of the tubing that are stacked in a vertical fashion, wherein the suction line is placed superior in the tubing. Other stacking or combination methods are also depicted and configured. The tubing may be removablyinstallable onto the external tubing guide. One or more of the redirectors may be mounted off-axis. In some cases, one or more of the redirectors are configured as a pulley or a spool.

[0011] Tubing sets may be a plastic, an elastomer, or a plastomer. Plastics could include polyethylenes and nylons. Elastomers could include urethanes, silicones, vinyls (PVC) and TPEs.

[0012] For example, an apparatus may include: a base; a bidirectional telescoping link assembly coupled to the base and comprising: a plurality of links that are adjacent to each other (including but not limited to, vertically adjacent), wherein adjacent links of the plurality of links are slidably coupled together via one or more shuttles; and an external tubing guide comprising a plurality of redirectors, wherein each redirector comprising one or more surfaces configured to support one or more tubes, further wherein each redirector extends from either a link or a shuttle of the link assembly so that a continuous path extending between each redirector of the plurality of redirectors maintains a constant length as the links of the link assembly move relative to each other.

[0013] Also described herein are methods comprising: installing a tubing onto a telescoping link assembly comprising a plurality of adjacent links; extending the telescoping link distally and / or proximally by moving an outermost link of the telescoping link assembly relative to a base to which an innermost link of the telescoping link assembly is coupled, wherein the adjacent links of the plurality of links are slidably coupled together via one or more shuttles; and guiding the tubing between and around each of a plurality of redirectors, wherein each redirector extends from either a link of the plurality of adjacent links or a shuttle of the link assembly so that the tubing extends in a continuous path between each redirector of the plurality of redirectors in a constant length as the links of the link assembly move relative to each other while the telescoping link assembly extends proximally and / or distally.

[0014] Installing the tubing may comprise coupling the tubing to a first clip coupled to an outermost link of the telescoping link assembly and coupling the tubing to a second clip holding a second end region of the tubing onto an innermost link of the telescoping link assembly. In some examples installing the tubing comprises coupling a first clip holding a first end region of the tubing to an outermost link of the telescoping link assembly and a second clip holding a second end region of the tubing onto an innermost link of the telescoping link assembly. The tubing may comprise a plurality of lines of tubing. Installing the tubing may comprise installing tubing comprises one or more of: a suction line, an insufflation line, an optics line, a guide light line, and a fluid line. Installing the tubing may comprise installing the plurality of lines of the tubing so that the plurality of lines of tubingare stacked in a vertical fashion. The step of installing the tubing may comprise removably installing the tubing onto the external tubing guide. Portions of the tubing may be single use, portions may be used for multiple cases, and portions may be reusable indefinitely.

[0015] Any of these methods may include coupling a first end of the tube to a scope mounted to the telescoping link assembly and coupling a second end of the tube to one or more of: a source of positive and / or negative pressure, an optical source, an electronics source, and / or a fluid source.

[0016] Also described herein are sub-systems of tubing, e.g., a preassembled tubing set for a telescoping link assembly, the tubing set comprising: a plurality of tubing lines; a first clip coupled to a proximal region of the plurality of tubing lines; and a second clip coupled to a distal region of the plurality of tubing lines; wherein the first clip and the second clip are each configured to mount to a link of a telescoping link assembly. The tubing lines of the plurality of tubing lines may be arranged adjacent to each other. The tubing lines of the plurality of tubing lines may, in some examples, form a ribbon. The tubing lines may, in some examples, comprise a circular, tubular, or circular with relieved geometry arrangement of a plurality of lumens or tubes. The plurality of tubing lines may comprise one or more of: a suction line, an insufflation line, an optics line, an electronics source, a guide light line, and a fluid line. The plurality of tubing lines may pass through a central channel through the first clip and a central channel through the second clip. In some cases, the central channel through the first clip is open to allow the tubing lines to be inserted and withdrawn into the central channel.

[0017] The central channel through the first clip may be closed around the plurality of tubing lines. The first clip further comprises an upper channel configured to separately and releasably hold a pressure line.

[0018] In some cases an external tubing guide system may include: an external tubing guide apparatus, comprising: a base; a telescoping link assembly coupled to the base and comprising: a plurality of links that are adjacent to each other, wherein adjacent links of the plurality of links are slidably coupled together via one or more shuttles; and an external tubing guide comprising a plurality of redirectors, wherein each redirector comprising one or more surfaces configured to support a preassembled tubing set, further wherein each redirector extends from either a link or a shuttle of the link assembly so that a continuous path of a plurality of tubing lines of the preassembled tubing set extending between each redirector of the plurality of redirectors maintains a constant length as the links of the link assembly move relative to each other; and the preassembled tubing set for the telescoping link assembly, comprising: the plurality of tubing lines; a first clip coupled to a proximalregion of the plurality of tubing lines; and a second clip coupled to a distal region of the plurality of tubing lines; wherein the first clip and the second clip are each configured to mount to a link of a telescoping link assembly.

[0019] All of the methods and apparatuses described herein, in any combination, are herein contemplated and can be used to achieve the benefits as described herein.BRIEF DESCRIPTION OF THE DRAWINGS

[0020] The novel features of the invention are set forth with particularity in the claims that follow. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings of which:

[0021] FIG. 1 A shows an example of an external tubing guide apparatus coupled to a telescoping robot that includes a plurality of links and shuttles. The external tubing guide apparatus includes a plurality of redirectors coupled to the links and shuttles, and a tubing assembly is coupled to the apparatus via clips.

[0022] FIG. IB schematically illustrates a close-up version of the back of the handle (also referred to as base) of the inner rigidizing elongate member forming part of the apparatus, illustrating connection of tubing.

[0023] FIG. 1C schematically illustrates an example of a robotic endoscope apparatus including an external tubing guide apparatus as shown in FIG. IB.

[0024] FIG. 2A is a schematic illustration of an exemplary external tubing guide apparatus coupled to a telescoping robot shown extended distally.

[0025] FIG. 2B is a schematic illustration of the exemplary external tubing guide apparatus coupled to a telescoping robot shown in FIG. 2A extended proximally.

[0026] FIG. 2C shows one example of a panel (e.g., manifold) interface for tubing that may be included as part of the apparatus.

[0027] FIG. 2D shows an enlarged view of the back of the handle of the inner rigidizing elongate member, showing connections.

[0028] FIG. 3 is a schematic illustration of an exemplary superior view of an external tubing guide apparatus coupled to a telescoping robot without tubing.

[0029] FIG. 4A is a schematic illustration of an exemplary external tubing guide apparatus coupled to a top portion of a telescoping robot showing a plurality of links, redirectors, and tubing.

[0030] FIGS. 4B-4C show front extended and retracted views, respectively, or a telescoping robot assembly including the tubing guide, similar to the variation shown in FIG. 4A.

[0031] FIGS. 4D-4E show back retracted and extended views, respectively, or a telescoping robot assembly including the tubing guide, similar to the variation shown in FIG. 4 A. In FIGS. 4D-4E, for simplicity, only the optical (e.g., liquid light and camera) lines are shown.

[0032] FIG. 5A is a schematic illustration of an exemplary external tubing guide apparatus coupled to a portion of a telescoping robot extended proximally the external tubing guide apparatus includes redirectors coupled to the plurality of links and shuttles of the telescoping robot.

[0033] FIG. 5B is a schematic illustration of the tubing guide apparatus of FIG. 5 A, extended distally.

[0034] FIG. 5C is a schematic illustration of the tubing guide apparatus of FIG. 5 A, illustrating a continuous path of tubing in this first, proximally extended, configuration.

[0035] FIG. 5D is a schematic illustration of the tubing guide apparatus of FIG. 5 A, illustrating a continuous path of tubing in this second, distally extended, configuration.

[0036] FIG. 5E shows a schematic illustration of an example of a tubing guide apparatus coupled to a portion of a telescoping robot shown in a neutral configuration.

[0037] FIG. 5F shows a schematic illustration of the tubing guide apparatus coupled to the telescoping robot of FIG. 5E, shown in an extended configuration.

[0038] FIG. 6A is an exemplary side view of a redirector coupled to a shuttle via a redirector arm.

[0039] FIG. 6B is another perspective view of an example of the redirector of FIG. 6A, including the redirector, shown coupled to the shuttle.

[0040] FIG. 6C is an exemplary perspective view of a redirector attached between links of the robotic assembly (e.g., telescoping robot).

[0041] FIG. 7A is an exemplary front view of a clip attachment configured to secure to a plurality of tubing lines (e.g., shown in this example as a ribbon of tubing and / or cables).

[0042] FIG. 7B is an exemplary side view of the clip attachment similar to that shown in FIG. 7A.

[0043] FIG. 7C is an exemplary schematic side view of a clip attachment for tubing having a back clip portion.

[0044] FIG. 7D is the exemplary schematic side view of a clip attachment for tubing shown in FIG. 7C with cross-sectional circles representing traversal of tubing lines.

[0045] FIGS. 8A-8H illustrate examples of sections through tubing assemblies that may be used with any of the apparatuses described herein.

[0046] FIG. 9 schematically illustrates an example of a method for installing tubing onto a tubing guide system.DETAILED DESCRIPTION

[0047] Aspects of the present disclosure may be integrated into a robotically and / or telerobotically enabled medical apparatus capable of performing a variety of medical procedures, including both minimally invasive procedures, such as laparoscopy, and less- invasive procedures, such as endoscopy. Among endoscopy procedures, the system may be capable of performing colonoscopy, enteroscopy, bronchoscopy, ureteroscopy, gastroscopy, etc. In general, an endoscope as described herein may be refer to any appropriate type of scope. Thus, the apparatuses described herein may be used with any appropriate endoscope. Examples of endoscopes may include, but are not limited to colonoscopes, arthroscopes, bronchoscopes, cystoscopes, hysteroscope, enteroscopes, esophagogastroduodenoscopes, hysteroscopes, neuroendoscopes, sinuscopes, laparoscopes, laryngoscopes, mediastinoscopes, sigmoidoscopes, nasopharyngoscopes, thoracoscopes, ureteroscopes, etc. Endoscopes are typically long compared to their diameter, are typically either rigid or flexible, and are configured for inserting into a body.

[0048] In addition to performing the breadth of procedures, the system may provide additional benefits, such as enhanced imaging and guidance to assist the physician. Additionally, the system may provide the physician with the ability to perform the procedure from an ergonomic position without the need for awkward arm motions and positions. Still further, the system may provide the physician with the ability to perform the procedure with improved ease of use such that one or more of the instruments of the system can be controlled by a single user. An apparatus (e.g., a system, devices, etc.) for operating and / or dispensing a robotic scope (e.g., endoscope) may be configured extend (distally) and / or retract (proximally) to control operation of the flexible tubular member.

[0049] In general, these apparatuses may be used to deliver a flexible tubular member, including in particular, a nested endoscope that include both an outer “overtube” an inner endoscope that may be moved proximally / distally relative to each other and may be rigidized to guide and / or steer the device through the patient’s body, while simultaneously managing and controlling the plurality of different tubing / cabling lines that are used to operate the robotic system. The nested endoscope assembly may be configured so that either or both the outer member, e.g., overtube, and / or the inner member, e.g., endoscope assembly, may berigidized, e.g., by applying positive and / or negative pressure. In any of these apparatuses the inner member may be a rigidizing endoscope; in some examples the inner member may be an endoscope that is coupled with a rigidizing shield.

[0050] These apparatuses may include a telescoping set of links, and in particular vertically arranged links. The tubing management portion of the apparatus may be coupled to the links and / or the shuttles between the links. For example, the apparatuses (device, systems, etc.) described herein may be configured as a portion of a robotic system for delivery of a pair of a nested endoscope device, including an inner endoscope and an outer overtube, that are each capable of relatively high and low levels of compliance.

[0051] The apparatuses described herein may have a generally linear form factor and may therefore provide a linear kinematic system for delivery of devices while controlling the path taken by a plurality of tubing members. The primary linear axis that may position the apparatus (e.g., the overtube of the endoscope) into the patient includes a telescoping mechanism formed of a link assembly. The bidirectional telescoping action of this link assembly may allow the relatively long linear axis to be relatively short when its full extension is not needed, all while controlling the path taken by the plurality of tubes / cables required, which may address room size limitations in some facilities, while preventing binding up or disruption of the apparatus. In examples including flexible tubular member systems with both inner and outer members, the position of the inner endoscope relative to the outer overtube may be controlled by an independent linear axis. Although these apparatuses may be used with virtually any flexible tubular member, they may be particularly helpful when using a nested, and in particular rigidizing, endoscope, such as a dual rigidizing endoscope.

[0052] In general, described herein are methods and apparatuses (e.g., devices, systems, etc.) for management and guiding of tubing and / or cabling during endoscopic or other procedures, particularly robotic procedures using a telescoping robot. For example, the apparatus and methods described herein may include a base; a telescoping link assembly coupled to the base and including: a plurality of links that are adjacent to each other, wherein adjacent links of the plurality of links are slidably coupled together via one or more shuttles; and an external tubing guide having a plurality of redirectors, in which each redirector has one or more surfaces configured to support one or more tubes, further in which each redirector extends from either a link or a shuttle of the link assembly so that a continuous path extending between each redirector of the plurality of redirectors maintains a constant length as the links of the link assembly move relative to each other.

[0053] As used herein the term “tubing” may refer equivalently to tubing and / or cabling. Tubing may refer to and / or include an elongate length of flexible, typically polymeric, material in the form of a tube. Tubing may be hollow or solid, and may include cables (e.g., power cables, including metallic wires, fiber optic cables, typically comprised of a glass core with a cladding or jacket, etc.). Tubing may include fluid lines (e.g., carrying air, water, etc.), pressure lines (e.g., positive pressure lines, e.g., carrying a pressurized fluid, such as air, water, etc. and / or negative pressure lines, e.g., suction and / or vacuum lines). The tubing may be individual tubing or coupled tubing, in which the individual tubing lines are joined together. The coupled tube may be one cohesive structure and may be constructed to enable maximum flexibility between its constituent elements, so as to minimize bending stiffness.

[0054] In some examples, the apparatus described herein may include: a base; a bidirectional telescoping link assembly coupled to the base and including: a plurality of links that are vertically adjacent to each other, in which adjacent links of the plurality of links are slidably coupled together via one or more shuttles; and an external tubing guide sub-system (referred to herein as simply a tubing guide, for convenience) that may include a plurality of redirectors, in which each redirector includes one or more surfaces configured to support one or more tubes, further in which each redirector extends from either a link or a shuttle of the link assembly so that a continuous path extending between each redirector of the plurality of redirectors maintains a constant length as the links of the link assembly move relative to each other.

[0055] In general, a redirector may be coupled to a shuttle and / or a link or a telescoping robotic apparatus. For example, a first redirector may be coupled to a first shuttle, a third redirector may be coupled to a second shuttle, and a second redirector may be coupled to a link between the first and second shuttle. The redirector may be a spool, capstan, spindle ramp, etc. The redirection may be static or may move (e.g., rotate) as the tubing moves relative to the redirector. In some cases, some of the redirectors may be static (non-moving relative to the tubing, while some of the redirector may move (e.g., rotate) relative to the tubing. In some examples, a first redirector and a third redirector may be configured to rotate, and the second redirector is fixed. Rotating elements could rotate passively or actively (i.e., being driven by a motor).

[0056] The apparatus may further have at least one linear driver coupled to one or more of the plurality of links and shuttles to control extension and retraction of the telescoping link assembly.

[0057] The external tubing guide sub-systems described herein may include one or more clips (e.g., fasteners, clamps, etc.) to secure the tubing, e.g., all or some of the tubing, to aportion of the telescoping robotic assembly. The clip may rigidly secure all or some of the tubing to a clip body that may then be secured to the telescoping apparatus. For example, the apparatus may further include one or more clips configured to secure the one or more tubes to one or more links of the link assembly.

[0058] In such an example, the link assembly may have a bidirectional link assembly configured to extend both distally and proximally from a neutral position.

[0059] In some cases, the plurality of links may be vertically adjacent to each other. In this case, the tubing redirectors may extend vertically from a lateral edge of at least some of the links.

[0060] In general, although the apparatus is configured so that the links move in and out, e.g., telescoping both distally and proximally from a compact neutral position, in general, the apparatus may be configured, so that the pathway taken by the tubing remains at a constant length, even as the links and shuttles move during operation. For example, each shuttle of the one or more shuttles may move approximately half of the relative distance moved between adjacent links on either side of the shuttle of the one or more shuttles as the links of the telescoping link assembly change position.

[0061] In some examples the external tubing guide may include one or more panels coupled to one or more of the links configured to limit movement of the tubing.

[0062] Any of these apparatuses may include the one or more tubes coupled to the external tubing guide. In some cases, the one or more tubes may include a ribbon having a plurality of tubes. In some examples, the one or more tubes may include one or more of: a suction line, an insufflation line, an optics line, a guide light line, and a fluid line. In some examples the one or more tubes may include one or more cables, e.g., power line, optical line, etc.

[0063] In such an example, lines of the tubing may be stacked in a vertical fashion, in which the suction line is placed superior in the tubing. In some cases, the tubing may not be stacked (see, e.g., FIGS. 8A-8H).

[0064] In general, the tubing may be removably installable onto the external tubing guide. In some cases, one or more of the redirectors may be mounted off-axis, e.g., off-axis with the particular link or shuttle to which it is initially mounted. Thus, the redirector may project laterally off the proximal-to-distal midline of the link.

[0065] As mentioned above, the redirectors may be configured as a pulley or a spool. In some examples, there is a preassembled tubing set for a telescoping link assembly, the tubing set including: a plurality of tubing lines; a first clip coupled to a proximal region of the plurality of tubing lines; and a second clip coupled to a distal region of the plurality of tubinglines; in which the first clip and the second clip are each configured to mount to a link of a telescoping link assembly.

[0066] The tubing lines of the plurality of tubing lines may be arranged adjacent to each other. For example, the tubing lines of the plurality of tubing lines may form a ribbon. In some cases, the plurality of tubing lines may include one or more of a suction line, an insufflation line, an optics line, a guide light line, a fluid line, and / or one or more cables. The plurality of tubing lines may pass through a central channel through the first clip and a central channel through the second clip. The central channel through the first clip may be open to allow the tubing lines to be inserted and withdrawn into the central channel. The central channel through the first clip may be closed around the plurality of tubing lines. The first clip may further include an upper channel configured to separately and releasably hold a pressure line.

[0067] In yet another example, there is an external tubing guide system, having: an external tubing guide apparatus, having: a base; a telescoping link assembly coupled to the base and having: a plurality of links that are adjacent to each other, in which adjacent links of the plurality of links are slidably coupled together via one or more shuttles; and an external tubing guide having a plurality of redirectors, in which each redirector has one or more surfaces configured to support a preassembled tubing set, further in which each redirector extends from either a link or a shuttle of the link assembly so that a continuous path of a plurality of tubing lines of the preassembled tubing set extending between each redirector of the plurality of redirectors maintains a constant length as the links of the link assembly move relative to each other; and the preassembled tubing set for the telescoping link assembly, having: the plurality of tubing lines; a first clip coupled to a proximal region of the plurality of tubing lines; and a second clip coupled to a distal region of the plurality of tubing lines; in which the first clip and the second clip are each configured to mount to a link of a telescoping link assembly.

[0068] All of the methods and apparatuses described herein, in any combination, are herein contemplated and can be used to achieve the benefits as described herein.

[0069] FIG. 1 A shows an example of a perspective view of an external tubing guide system 100. As shown, there is a including a plurality of links as part of a telescoping link assembly 102 which may include a first link 103, second link 104, and third link 105. Telescoping link assembly 102 may rest on a base 101. Coupled to the links is an external tubing guide assembly 106 which may include a first redirector 107, second redirector 108, and third redirector 109. Redirectors 107 / 108 / 109 may be pulleys or spools. In certainexamples, one or more redirectors 107, 108, 109 are coupled to the links via shuttles 112, as will be further described in FIGS. 6A-6B.

[0070] Base 101 of external tubing guide system is also shown, and according to certain examples, may store sources of fluids, pressure, electronics, or other components coupled to tubing lines 110 that extend though the external tubing guide assembly 106 between and around redirectors 107, 108. 109 and towards an endoscope or other apparatus for a diagnostic or surgical procedure on a patient. Thus, tubing lines 110 may include one or more lines of tubing that are fluid lines, vacuum lines, insufflation lines, optics / camera lines, electric guide light lines, etc. According to certain examples, tubing lines 110 route above telescoping link assembly system 102 and extend between and around redirectors 107, 108, 109, for example in a continuous path as further described in FIGS. 5C-5D. Redirectors 107, 108, 109 may be large diameter pulleys configured to provide a light fiber bend radius of, for example, 40 mm to minimize strain and stress on tubing lines 110 when they wrap around redirectors 107, 108, 109. According to certain examples, tubing lines 110 may be removable and / or installed onto external tubing guide system 110 by a user or by automated means. In some examples, tubing line 110 may be a pre-assembled or bundled set of various tubing lines, bundled in a stacked ribbon or circular arrangement (as will be further described in FIGS. 7A-7D). As mentioned, in some cases the tubing may be configured for single use, for multiple use, or for continuous (e.g., indefinite) use. In some cases, the tubing may be configured to be replaced every few cases or, for example, at the end of each day.

[0071] One or more clips 113 may be placed at various points of external tubing guide system 100 to secure tubing lines 110 to each other or to panels such as panel 127. For example, installing tubing lines 110 may involve coupling the tubing 110 to a first clip coupled to an outermost link (such as link 103) of the telescoping link assembly 102 and coupling the tubing 110 to a second clip holding a second end region of the tubing onto an innermost link (such as link 105) of the telescoping link assembly 102. In certain examples, one or more clips 113 may be preassembled to the pre-assembled or bundled set of various tubing lines. In yet other examples, installing tubing 110 involves coupling a first clip holding a first end region of the tubing to an outermost link of the telescoping link assembly 102 and a second clip holding a second region of the tubing 110 onto an innermost link of the telescoping link assembly 102.

[0072] Panel 127 coupled to link assembly 102 between links 103 / 104 / 105 may also be present to serve as barriers or attachment points for tubing lines 110 to limit movement of tubing lines, to prevent tubing lines 110 from moving away from above the link they may becoupled to, and / or to prevent tubing lines 110 from coming into contact with other components of the external tubing guide system 100.

[0073] The external tubing guide system 100 may prevent tubing lines 110 from dragging onto links 103, 104, 105 and the floor upon which base 101 rests. External tubing guide system 100 also aims to reduce friction on telescoping link assembly 102 for force safety which links 103, 104, 105 are moving, as well as to prevent caught and pinches lines of tubing 110, tangling and / or maintaining proper coordination with the endoscope by, for example, not maintaining a constant length as machinery coupled to an endoscope moves.

[0074] FIG. 1C shows an example of a perspective view of the external tubing guide system of a robotic apparatus 160. A plurality of links form part of the telescoping link assembly 102 which may include a first link 103, second link 104, and third link 105. Telescoping link assembly 102 may rest on a base. An external tubing guide assembly 106 is coupled to the links and may include a first redirector 107 and a second redirector 108.Redirectors 107, 108 may be pulleys or spools.

[0075] The base 101 of external tubing guide system may store sources of fluids, pressure, electronics, or other components coupled to tubing lines 110, for example, through an interface 150 between the tubing set that is coupled to the robotic telescoping member and the sources to which the tubing 110 is to be connected. In FIG. 1C the base is shown without an external cover, but an external cover may be included. The tubing may extend though the external tubing guide assembly 106 between and around redirectors 107, 108 and couple to an endoscope assembly (e.g., including an outer overtube 182 and an inner endoscope assembly 184) or other apparatus for a diagnostic or surgical procedure on a patient. As mentioned, tubing lines 110 may include one or more flexible lines that are fluid lines, vacuum lines, insufflation lines, optics / camera lines, shape sensing lines, electric guide light lines, etc.

[0076] As shown in FIG. IB, the fluid lines (including electrical / optical lines, pressure lines, wash, e.g., saline, lines, etc.) may be coupled to the mount(s) for the endoscope assembly. In FIG. 1C the robotic apparatus 160 includes a first mount (e.g., overtube mount) 126 and a second mount (endoscope mount) 128. All or some of these flexible lines may couple directly to the handle(s) of the endoscope assembly or indirectly to the mount 126, 128 and through the mount to the overtube and / or endoscope.

[0077] FIG. 2A is a schematic illustration of an exemplary left extended external tubing guide system. As shown here, there are first, second, and third links 203, 204, 205, with redirectors 207 and 208 coupled to links 203, 204, 205 and tubing 210 extending between and around redirectors 207 and 208. According to certain examples, a third or further redirector(s)may be present. Also shown are mounts 226 and 228 which may be used to attach panels such as panel 127 (from FIG. 1 A) to the external tubing guide system, for example on mount 226. Mounts 226 and 228 may also serve as connection points or hangers. Also shown is a pressure or hydraulic source cannister 220, 220’ for the external tubing guide system which according to various examples may power the telescoping mechanism of link assembly 203, 204, 205, or in other examples this cannister and / or other storage sources or equipment may serve as a source of positive pressure, negative pressure, for rigidizing the scope coupled to the telescoping apparatus. Other lines may include fluid, optics, and guide lights making up one or more lines of tubing 210 and may be coupled at a first end of tubing 210, with a second end of tubing 210 connected to a scope mounted to the telescoping link assembly 203, 204, 205.

[0078] In certain examples, linear drivers may be coupled to one or more of the plurality of links 203, 204, 205 and shuttles (such as shuttle 112 from FIG. 1 A), in order to control extension and retraction of telescoping link assembly 203, 204, 205. The handles 260 (e.g., bases) of the apparatuses may be mounted to one of the links, as shown and in some cases may be actuated to move the inner and outer rigidizing members (which may be nested together) relative to each other. FIG. IB shows an example of portion of the handle of an inner rigidizing member that is coupled to the outer link of the telescoping assembly and to which tubing (pressure line, optical line(s), power line(s), control line(s), etc.) are coupled.

[0079] Various features of the base of the external tubing guide system are also illustrated. For example, there is a link base 221 which first link 203 may rest upon, and first link 203 may have a stop (which may be separate from or part of a motor cover end cap 229). Also shown is a base column 222 link base 221 (in some cases referred to as a supporting link base), a horizontal partition 224 which may be at a middle point along the height of base 201, a control panel 223 to operate the external tubing guide system, and wheels 225 which may be lockable. 223 points towards an electronics panel, but really not the fluidics panel. The tubing system may include a manifold and / or a panel with valves and elements (e.g., pinch valves) which may be applied and / or removed. See, e.g., FIG. 2C, showing a panel that may act as an interface between the tubing set that is coupled to the robotic telescoping member and the sources to which the tubing is to be connected. In FIG. 2C, the pane 250 includes tubing and valves 252, as well as connectors 254, 254’ that may couple to the tubing of the tubing set and the panel or between the sources and the panel. The various tubing lines may be labeled 256, as shown (in this example, irrigation, lubrication, tip wash, insufflation, suction, etc.).

[0080] In any of these examples, the other end of the tubing of the tubing set may couple to the base of the endoscope (e.g., a telescoping, robotic endoscope). For example, FIG. 2B shows the base 281 portion, with the rigidizing scope removed, for simplicity. FIGS. 4B-4E illustrate the telescoping assembly with the nested, rigidizing scope included. One example of an interface of the base to connect to the tubing is shown in FIG. 2D. FIG. 2D shows a back view of the base 260, with multiple inlet ports 262 shown. In FIG. 2D, the base may receive power and control lines (e.g., driving steering of the inner elongate member of the nested system), pressure inlet (e.g., driving rigidizing / derigidizing of the inner elongate member), and inlet for a working channel, optical output and / or input (e.g., light source), etc.

[0081] FIG. 2B is a schematic illustration of an exemplary right extended external tubing guide system. This illustration is a mirror image of FIG. 2A showing the previously described components in another configuration.

[0082] FIG. 3 is a schematic illustration of an exemplary superior view of a collapsed tubing guide system without tubing. As shown here, link assembly with links 303, 304, 305 are in a collapsed or rest configuration aligned parallel and stacked adjacent to each other. Tubing is not shown for illustrative purposes. First, second, and third redirectors 307, 308, 309 are attached to shuttles 312 via redirector arms 330. Also shown is cover 329. A stop may also be included. Link assembly with links 303, 304, 305 may be configured to extend both distally and proximally from a neutral position. In certain examples, links 303, 304, 305 may be vertically adjacent to each other.

[0083] FIG. 4A is a schematic illustration of an exemplary left extended top portion of a tubing guide system showing a plurality of links, redirectors, and tubing. As shown here, there are first, second, and third links 403, 404, 405, first, second, and third redirectors 407, 408, 409, and tubing 410 extending between redirectors 407, 408, 409. The apparatus may also include a lock (not shown) for locking the links 404, 406, 406 and link assembly in a desired position. In FIG. 4A, the apparatus also includes a plurality of deployable guide supports 430, 460’. These supports may extend out of the apparatus as the system is deployed. These supports may be spring-loaded and may extend and or be retracted or displaced mechanically so as not to interfere with the telescoping movement of the assembly.

[0084] FIGS. 4B-4C show the robotic apparatus in an extended configuration (FIG. 4B) and a retracted configuration (FIG. 4C). in FIGS. 4B-4C the nested outer and inner rigidizing members are shown coupled to the outer link 405, on a pair of platforms 406, 406’ that may be moved independently of each other to insert / retract the nested inner rigidizing member 261 relative to the outer rigidizing member 265. The tubing may connect to the bases 260,263 (e.g., handles) of the inner member and outer rigi dizing members. The rigi dizing members are truncated but may extend distally over an extended length for insertion into the body.

[0085] FIGS. 4D-4E show perspective views of the back of the distally extended telescoping assembly similar to that shown in FIG. 4B. FIG. 4D shows a view with a limited number of tubes shown, for simplicity, while FIG. 4E shows the same view with a full set of tubing shown. In FIG. 4D a middle redirector 408 is visible and may be sued to route a subset of the tubing, e.g., the optics tubing. In some cases, the other tubing may be held in a fixed relation to the shuttle to which the middle redirector is attached. In some cases, the middle redirector may be replaced with just a clip. In FIGS. 4D and 4E inner and outer rigidizing members are not shown, for simplicity, but the base (handle) of the inner rigidizing member 260 is shown.

[0086] FIG. 5A is a schematic illustration of an exemplary right extended plurality of links with redirectors and shuttles. Shown here are first, second, and third links 503, 504, 505 and first, second, and third redirectors 507, 508, and 509. As shown here, third link 505 is extended the most rightwards followed by second link 504 and first link 503 may remain in a stationary position. Redirectors 507, 508, 509 may be coupled to shuttles 512 via redirector arms 530. One or more links 503, 504, 505 may also have a cover 529 at one or more ends; the apparatus may also include a stop to aid in movement and stoppage of links 503, 504, 505.

[0087] FIG. 5B is a schematic illustration of an exemplary left extended plurality of links with redirectors and shuttles. Shown here are first, second, and third links 503, 504, 505 and first, second, and third redirectors 507', 508', and 509'. As shown here, third link 505' is extended the most leftwards followed by second link 504' and first link 503' may remain in a stationary position. Redirectors 507', 508', 509' may be coupled to shuttles 512' via redirector arms 530'. One or more links 503', 504', 505' may also have a stop at one or more ends to aid in movement and stoppage of links 503', 504', 505'.

[0088] FIG. 5C is a schematic illustration of an exemplary right extended plurality of links with redirectors and shuttles showing a first configuration of a continuous path of tubing.

[0089] In certain examples, first redirector 507 and third redirector 509 may be rotatable, whereas second redirector 508 may be fixed (non-rotatable). This may ensure a first configuration of a continuous path of tubing 590 having parallel segments of tubing, for example between two or more of: the tubing segment from first redirector 507 to second redirector 508, the tubing segment from second redirector 508 to third redirector 509, and thetubing segment form third redirector 509 onwards across third link 506. Such a parallel continuous path 590 allows for a constant length of tubing that does not have slack or entangling as the plurality of links 502, 504, 506 move, for example in coordination with an endoscope.

[0090] FIG. 5D is a schematic illustration of an exemplary left extended plurality of links with redirectors and shuttles showing a second configuration of a continuous path of tubing.

[0091] In certain examples, first redirector 507' and third redirector 509' may be rotatable, whereas second redirector 508' may be fixed (non-rotatable). This may ensure a second configuration of a continuous path of tubing 590' having parallel segments of tubing, for example between two or more of: the tubing segment across first link 503' to first redirector 507', the tubing segment from first redirector 507' to second redirector 508', the tubing segment from second redirector 508' to third redirector 509', and the tubing segment form third redirector 509' onwards across third link 505'. Such a parallel continuous path 590' allows for a constant length of tubing that does not have slack or entangling as the plurality of links 502', 504', 506' move.

[0092] FIGS. 5E and 5F show another example of an apparatus including tubing / cable management. In FIG. 5E, the apparatus includes a base (not shown) to which a plurality of telescoping links 503, 504, 505 (forming a telescoping link) are coupled. The telescoping links each include a plurality of links that are adjacent to each other, wherein adjacent links of the plurality of links are slidably coupled together via one or more shuttles 512, 512’. In FIGS. 5E and 5F the spacing between the links (including the shuttles) is shown enlarged; in practice, the dimensions shown may be adjusted, including making the spacing smaller and the shuttles thinner. The apparatus also includes an external tubing guide comprising a plurality of redirectors 522, 522’, 522”, shown configured as panels, walls or plates, wherein each redirector comprising one or more surfaces configured to support one or more tubes 532, 532’, further wherein each redirector extends from a link of the link assembly so that a continuous path extending between each redirector of the plurality of redirectors maintains a constant length as the links of the link assembly move relative to each other. In this example, the external tubing may be attached (e.g., rigidly attached) in multiple locations 534, 534’ on the links of the link assembly. These attachments may include removable attachments such as clips, snaps, etc.

[0093] In FIGS. 5E and 5F the external tubing has a sufficient stiffness / rigidity to support itself as the links are moved relative to each other. The redirectors (e.g., shown as panels in FIGS. 5E and 5F) may extend from the links at the same height as, or slightly taller than, the width of the tubing (e.g., ribbon tubing). In this example, the redirectors prevent the tubing,which may otherwise be free-floating above the link, other than the attachment regions 534, 534’ on each link, to prevent the tubing from interfering with the movement of the telescoping links and the base.

[0094] FIG. 5E is a schematic illustration of an exemplary un-extended plurality of links, shown in a neutral middle configuration, with redirectors and shuttles. In FIG. 5E there are first, second, and third links 503, 504, 505, respectively, and first, second, and third redirectors 522, 522’, 522”. In this example, the first link 503 includes a redirector extending proud along the length of the link; the redirector may be a wall, series of posts, etc. Each of the links also includes a redirector (e.g., wall) extending along the length of the link. In FIG. 5E the middle line 504 has a centered redirector; in some examples the redirector may be off axis, as shown for the outermost 503 link and the innermost links 505. The FIG. 5F shows the telescoping link assembly and tubing guide assembly (e.g., redirectors) shown in FIG. 5E in an extended configuration with the first link 503 followed by a second link 504, and a third link 505. One or more links 503, 504, 505 of the apparatus shown in FIG. 5F may also be may also have a stop at one or more ends to aid in movement and stoppage of the movements of links 503, 504, 505.

[0095] FIG. 6A is an exemplary side view of a redirector coupled to a shuttle via a redirector arm. Shown here is redirector 607 coupled to shuttle 612 via a redirector arm 630, which according to certain examples may be made of plastic, metal, or other material. In certain examples, redirector arm 630 may have different shapes and geometries. In certain examples, one or more redirector(s) 607 may be mounted to the link assembly system via shuttle 612 in an off-axis configuration (off-axis relative to the link assembly system).

[0096] FIG. 6B is an exemplary perspective view of the redirector coupled to a shuttle via a redirector arm of FIG. 6 A.

[0097] FIG. 6C is an exemplary perspective view of a redirector between links.

[0098] Shown here is a redirector 607 between links 603 and 604. According to certain examples, redirector 607 may be a second redirector coupled to a shuttle (not shown) between links 603 and 604. In certain examples, shuttle 612 (see FIG. 6A) may move approximately half of the relative distance moved between adjacent links on either side of the shuttle such as links 603 and 604.

[0099] FIG. 7A is an exemplary front view of a ribbon of tubing secured to a clip attachment.

[0100] As shown here, there is a plurality of tubing lines 710 and a clip 713. According to certain examples, the plurality of tubing lines 710 may include one or multiple tubing linesbundled or arranged together in various configurations such as a ribbon of vertically or horizontally stacked tubing lines or tubing lines arranged in a circle with a hollow center. In one example with the tubing lines stacked vertically, a suction line may be placed superior in the tubing. According to certain examples, the plurality of tubing lines 710 may be preattached to clip 713, clip 713 may separately attach to the plurality of tubing lines 710 through a paper clip-like mechanism with the front portion of clip 713 being configured to lift or move to encompass the plurality of tubing lines 710, or alternatively the plurality of tubing lines 713 may feed between the front and back portions of clip 713. According to certain examples, the bottom portion of clip 713 may be a mount attachment portion 714 configured to secure clip 713 and, or plurality of tubing lines 710 onto the external tubing guide system, for example to the plurality of links via counterpart receiving structures such as mounts or apertures on the plurality of links.

[0101] The plurality of tubing lines 710 mat be a preassembled tubing set configured to mount to a link of telescoping link assembly (such as links 103, 104, 105 of link assembly 102 from FIG. 1A).

[0102] FIG. 7B is an exemplary side view of a clip attachment for tubing.

[0103] As shown here, there may be an attachment for pressure tubing 716 which may be a reusable pressure tubing, a central channel 715 which may secure, for example, fluid lines that may be disposable. There is also a mount attachment portion 714 which may also secure optics or electronic lights tubing lines, which may be reusable, and / or to a mount coupled to the link assembly or other components of the external tubing guide system. In one example, tubing lines 710 may pass through central channel 715 of two or more clip attachments mounted to links of telescoping link assembly (such as links 103, 104, 105 of link assembly 102 from FIG. 1 A). In such an example, central channel 715 may either be open through a first clip to allow tubing lines 710 to be inserted and withdrawn into the central channel, or central channel 715 may be closed around tubing lines 710.

[0104] FIG. 7C is an exemplary schematic side view of a clip attachment for tubing having a back clip portion.

[0105] As shown here, there may be an upper attachment channel 716 on the clip attachment, and upper attachment channel 716 may be configured to hold a pressure line tubing, which may be a reusable pressure tubing. There is also a central channel 715 which may secure, for example, fluid lines that may be disposable. There is also a mount attachment portion 714 which may also secure optics or electronic lights tubing lines, which may be reusable, and / or to a mount coupled to the link assembly or other components of the externaltubing guide system. According to certain examples, there may also be a back clip attachment portion 718 with space configured to receive an additional tubing line 717.

[0106] FIG. 7D is the exemplary schematic side view of a clip attachment for tubing shown in FIG. 7C with circles representing cross-sectional slices depicting traversal points of tubing lines 719, for example, according to the exemplary placement of tubing lines described in FIG. 7C.

[0107] As mentioned above, any type of tubing set may be used, including a tubing set that has a plurality of tubing and / or power lines arranged in a stacked order, e.g., as a ribbon such as the ribbon shown in FIG. 5A. In some cases, the tubing set may include tubing and / or cables having different radial sizes (e.g., diameters), different wall thicknesses, made of different materials, etc. In some cases, the walls of one or more of the tubes may be reinforced, including to withstand either positive and or negative pressure. Negative pressure extends to full vacuum (1 ATM). Positive pressure values can be about 4 ATM, about 6 ATM, about 8 ATM, about 10 ATM, about 20 ATM, even about 30 or about 40 ATM. Any number of tubes may be included and may be arranged as a group or cluster. For example, FIG. 8A shows a set of three tubes 851. In any of these examples the tubes may be coupled together by attaching them, e.g., using an adhesive between the tubes 854, or may be surrounding them with a tie, band, cover, etc. 853, as shown in FIG. 5D. The tubes may be created as an integrated set, for example, as a unitary extrusion. The tubes of the tubing set may be axially movable relative to each other or may be fixed relative to each other. FIG. 8B shows an example of a set of four tubes that are coupled together. FIG. 8C shows an example of a set of seven tubes 851, 851’ of different sizes that are adhesively secured together. FIG. 8D shows another example of seven tubes that are held together by an outer band (e.g., elastic / elastomeric band, etc.) or housing 853 over all or a length of the tubing set. The tubing may have geometries and construction such that they are held together as a unitary set but may be configured to bend with minimized bending force. FIGS. 8E-8H illustrate examples of compound tubing sets that include a plurality of individual lumen 851 each formed through a single flexible member 853. In FIG. 8E the tubing is a multi-lumen extrusion. In FIGS. 8F and 8G the tubing also includes a plurality of internal lumen.

[0108] FIG. 9 is a flow chart illustrating a method for installing tubing onto an external tubing guide system 900.

[0109] Method 900 begins at step 905 with installing a tubing onto a telescoping link assembly comprising a plurality of adjacent links.

[0110] Method 900 continues at step 910 with extending the telescoping link distally and / or proximally by moving an outermost link of the telescoping link assembly relative to abase to which an innermost link of the telescoping link assembly is coupled, in which the adjacent links of the plurality of links are slidably coupled together via one or more shuttles. [OHl] The method 900 shown in FIG. 9 also includes guiding the tubing between and around each of the plurality of redirectors 915, in which each redirector extends from either a link of the plurality of adjacent links or a shuttle of the link assembly so that the tubing extends in a continuous path between each redirector of the plurality of redirectors in a constant length as the links of the link assembly move relative to each other while the telescoping link assembly extends proximally and / or distally. Finally, all or some of the tubing (or all or some of the tubing in the tubing set) may be removed 920.

[0112] According to an example of method 900, installing the tubing includes coupled the tubing to a first clip coupled to an outermost link of the telescoping link assembly and coupling the tubing to a second clip holding a second end region of the tubing onto an innermost link of the telescoping link assembly.

[0113] According to an example of method 900, installing the tubing includes coupling a first clip holding a first end region of the tubing to an outermost link of the telescoping link assembly and a second clip holding a second end region of the tubing onto an innermost link of the telescoping link assembly.

[0114] According to an example of method 900, the tubing comprises a plurality of lines of tubing.

[0115] According to an example of method 900, installing the tubing includes one or more of: a suction line, an insufflation line, an optics line, a guide light line, and a fluid line.

[0116] According to an example of method 900, installing the tubing includes installing the plurality of lines of the tubing so that the plurality of lines of tubing is stacked in a vertical fashion.

[0117] According to an example of method 900, installing the tubing includes removably installing the tubing onto the external tubing guide.

[0118] According to an example of method 900, further including coupling a first end of the tube to a scope mounted to the telescoping link assembly and coupling a second end of the tube to one or more of: a source of positive and / or negative pressure, an optical source, and / or a fluid source.

[0119] All publications and patent applications mentioned in this specification are herein incorporated by reference in their entirety to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference. Furthermore, it should be appreciated that all combinations of the foregoing concepts and additional concepts discussed in greater detail below (provided such conceptsare not mutually inconsistent) are contemplated as being part of the inventive subject matter disclosed herein and may be used to achieve the benefits described herein.

[0120] Any of the methods (including user interfaces) described herein may be implemented as software, hardware or firmware, and may be described as a non-transitory computer-readable storage medium storing a set of instructions capable of being executed by a processor (e.g., computer, tablet, smartphone, etc.), that when executed by the processor causes the processor to control perform any of the steps, including but not limited to: displaying, communicating with the user, analyzing, modifying parameters (including timing, frequency, intensity, etc.), determining, alerting, or the like. For example, any of the methods described herein may be performed, at least in part, by an apparatus including one or more processors having a memory storing a non-transitory computer-readable storage medium storing a set of instructions for the processes(s) of the method.

[0121] While various embodiments have been described and / or illustrated herein in the context of fully functional computing systems, one or more of these example embodiments may be distributed as a program product in a variety of forms, regardless of the particular type of computer-readable media used to actually carry out the distribution. The embodiments disclosed herein may also be implemented using software modules that perform certain tasks. These software modules may include script, batch, or other executable files that may be stored on a computer-readable storage medium or in a computing system. In some embodiments, these software modules may configure a computing system to perform one or more of the example embodiments disclosed herein.

[0122] As described herein, the computing devices and systems described and / or illustrated herein broadly represent any type or form of computing device or system capable of executing computer-readable instructions, such as those contained within the modules described herein. In their most basic configuration, these computing device(s) may each comprise at least one memory device and at least one physical processor.

[0123] The term “memory” or “memory device,” as used herein, generally represents any type or form of volatile or non-volatile storage device or medium capable of storing data and / or computer-readable instructions. In one example, a memory device may store, load, and / or maintain one or more of the modules described herein. Examples of memory devices comprise, without limitation, Random Access Memory (RAM), Read Only Memory (ROM), flash memory, Hard Disk Drives (HDDs), Solid-State Drives (SSDs), optical disk drives, caches, variations or combinations of one or more of the same, or any other suitable storage memory.

[0124] In addition, the term “processor” or “physical processor,” as used herein, generally refers to any type or form of hardware-implemented processing unit capable of interpreting and / or executing computer-readable instructions. In one example, a physical processor may access and / or modify one or more modules stored in the above-described memory device. Examples of physical processors comprise, without limitation, microprocessors, microcontrollers, Central Processing Units (CPUs), Field-Programmable Gate Arrays (FPGAs) that implement softcore processors, Application-Specific Integrated Circuits (ASICs), portions of one or more of the same, variations or combinations of one or more of the same, or any other suitable physical processor.

[0125] Although illustrated as separate elements, the method steps described and / or illustrated herein may represent portions of a single application. In addition, in some embodiments one or more of these steps may represent or correspond to one or more software applications or programs that, when executed by a computing device, may cause the computing device to perform one or more tasks, such as the method step.

[0126] In addition, one or more of the devices described herein may transform data, physical devices, and / or representations of physical devices from one form to another. Additionally or alternatively, one or more of the modules recited herein may transform a processor, volatile memory, non-volatile memory, and / or any other portion of a physical computing device from one form of computing device to another form of computing device by executing on the computing device, storing data on the computing device, and / or otherwise interacting with the computing device.

[0127] The term “computer-readable medium,” as used herein, generally refers to any form of device, carrier, or medium capable of storing or carrying computer-readable instructions. Examples of computer-readable media comprise, without limitation, transmission-type media, such as carrier waves, and non-transitory-type media, such as magnetic-storage media (e.g., hard disk drives, tape drives, and floppy disks), optical-storage media (e.g., Compact Disks (CDs), Digital Video Disks (DVDs), and BLU-RAY disks), electronic-storage media (e.g., solid-state drives and flash media), and other distribution systems.

[0128] A person of ordinary skill in the art will recognize that any process or method disclosed herein can be modified in many ways. The process parameters and sequence of the steps described and / or illustrated herein are given by way of example only and can be varied as desired. For example, while the steps illustrated and / or described herein may be shown or discussed in a particular order, these steps do not necessarily need to be performed in the order illustrated or discussed.

[0129] The various exemplary methods described and / or illustrated herein may also omit one or more of the steps described or illustrated herein or comprise additional steps in addition to those disclosed. Further, a step of any method as disclosed herein can be combined with any one or more steps of any other method as disclosed herein.

[0130] The processor as described herein can be configured to perform one or more steps of any method disclosed herein. Alternatively or in combination, the processor can be configured to combine one or more steps of one or more methods as disclosed herein.

[0131] When a feature or element is herein referred to as being "on" another feature or element, it can be directly on the other feature or element, or intervening features and / or elements may also be present. In contrast, when a feature or element is referred to as being "directly on" another feature or element, there are no intervening features or elements present. It will also be understood that, when a feature or element is referred to as being "connected", "attached" or "coupled" to another feature or element, it can be directly connected, attached or coupled to the other feature or element or intervening features or elements may be present. In contrast, when a feature or element is referred to as being "directly connected", "directly attached" or "directly coupled" to another feature or element, there are no intervening features or elements present. Although described or shown with respect to one embodiment, the features and elements so described or shown can apply to other embodiments. It will also be appreciated by those of skill in the art that references to a structure or feature that is disposed "adjacent" another feature may have portions that overlap or underlie the adjacent feature.

[0132] Terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. For example, as used herein, the singular forms "a", "an" and "the" are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms "comprises" and / or "comprising," when used in this specification, specify the presence of stated features, steps, operations, elements, and / or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and / or groups thereof. As used herein, the term "and / or" includes any and all combinations of one or more of the associated listed items and may be abbreviated as " / ".

[0133] Spatially relative terms, such as "under", "below", "lower", "over", "upper" and the like, may be used herein for ease of description to describe one element or feature's relationship to another element(s) or feature(s) as illustrated in the figures. It will be understood that the spatially relative terms are intended to encompass different orientations of the device in use or operation in addition to the orientation depicted in the figures. For example, if a device in the figures is inverted, elements described as "under”, or "beneath"other elements or features would then be oriented "over" the other elements or features. Thus, the exemplary term "under" can encompass both an orientation of over and under. The device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly. Similarly, the terms "upwardly", "downwardly", "vertical", "horizontal" and the like are used herein for the purpose of explanation only unless specifically indicated otherwise.

[0134] Although the terms “first” and “second” may be used herein to describe various features / elements (including steps), these features / elements should not be limited by these terms, unless the context indicates otherwise. These terms may be used to distinguish one feature / element from another feature / element. Thus, a first feature / element discussed below could be termed a second feature / element, and similarly, a second feature / element discussed below could be termed a first feature / element without departing from the teachings of the present invention.

[0135] In general, any of the apparatuses and methods described herein should be understood to be inclusive, but all or a sub-set of the components and / or steps may alternatively be exclusive and may be expressed as “consisting of’ or alternatively “consisting essentially of’ the various components, steps, sub-components or sub-steps.

[0136] As used herein in the specification and claims, including as used in the examples and unless otherwise expressly specified, all numbers may be read as if prefaced by the word "about" or “approximately,” even if the term does not expressly appear. The phrase “about” or “approximately” may be used when describing magnitude and / or position to indicate that the value and / or position described is within a reasonable expected range of values and / or positions. For example, a numeric value may have a value that is + / - 0.1% of the stated value (or range of values), + / - 1% of the stated value (or range of values), + / - 2% of the stated value (or range of values), + / - 5% of the stated value (or range of values), + / - 10% of the stated value (or range of values), etc. Any numerical values given herein should also be understood to include about or approximately that value, unless the context indicates otherwise. For example, if the value " 10" is disclosed, then "about 10" is also disclosed. Any numerical range recited herein is intended to include all sub-ranges subsumed therein. It is also understood that when a value is disclosed that "less than or equal to" the value, "greater than or equal to the value" and possible ranges between values are also disclosed, as appropriately understood by the skilled artisan. For example, if the value "X" is disclosed the "less than or equal to X" as well as "greater than or equal to X" (e.g., where X is a numerical value) is also disclosed. It is also understood that the throughout the application, data is provided in a number of different formats, and that this data, represents endpoints and starting points, andranges for any combination of the data points. For example, if a particular data point “10” and a particular data point “15” are disclosed, it is understood that greater than, greater than or equal to, less than, less than or equal to, and equal to 10 and 15 are considered disclosed as well as between 10 and 15. It is also understood that each unit between two particular units are also disclosed. For example, if 10 and 15 are disclosed, then 11, 12, 13, and 14 are also disclosed.

[0137] Although various illustrative embodiments are described above, any of a number of changes may be made to various embodiments without departing from the scope of the invention as described by the claims. Optional features of various device and system embodiments may be included in some embodiments and not in others. Therefore, the foregoing description is provided primarily for exemplary purposes and should not be interpreted to limit the scope of the invention as it is set forth in the claims.

[0138] The examples and illustrations included herein show, by way of illustration and not of limitation, specific embodiments in which the subject matter may be practiced. As mentioned, other embodiments may be utilized and derived there from, such that structural and logical substitutions and changes may be made without departing from the scope of this disclosure. Such embodiments of the inventive subject matter may be referred to herein individually or collectively by the term “invention” merely for convenience and without intending to voluntarily limit the scope of this application to any single invention or inventive concept, if more than one is, in fact, disclosed. Thus, although specific embodiments have been illustrated and described herein, any arrangement calculated to achieve the same purpose may be substituted for the specific embodiments shown. This disclosure is intended to cover any and all adaptations or variations of various embodiments. Combinations of the above embodiments, and other embodiments not specifically described herein, will be apparent to those of skill in the art upon reviewing the above description.

Claims

CLAIMSWhat is claimed is:

1. An apparatus, the apparatus comprising: a base; a telescoping link assembly coupled to the base and comprising: a plurality of links that are adjacent to each other, wherein adjacent links of the plurality of links are slidably coupled together via one or more shuttles; and an external tubing guide comprising a plurality of redirectors, wherein each redirector comprising one or more surfaces configured to support one or more tubes, further wherein each redirector extends from either a link or a shuttle of the link assembly so that a continuous path extending between each redirector of the plurality of redirectors maintains a constant length as the links of the link assembly move relative to each other.

2. The apparatus of claim 1, wherein a first redirector is coupled to a first shuttle, a third redirector is coupled to a second shuttle, and a second redirector is coupled to a link between the first and second shuttle.

3. The apparatus of claim 2, wherein the first and third redirectors are configured to rotate.

4. The apparatus of any of claims 1-3, further comprising at least one linear driver coupled to one or more of the plurality of links and shuttles to control extension and retraction of the telescoping link assembly.

5. The apparatus of any of claims 1-4, wherein the link assembly comprises a bidirectional link assembly configured to extend both distally and proximally from a neutral position.

6. The apparatus of any of claims 1-5, wherein the plurality of links are vertically adjacent to each other.

7. The apparatus of any of claims 1-6, wherein each shuttle of the one or more shuttles moves approximately half of the relative distance moved between adjacent links on either side of the shuttle of the one or more shuttles as the links of the telescoping link assembly change position.

8. The apparatus of any of claims 1-7, wherein the external tubing guide further comprises one or more panels coupled to one or more of the links configured to limit movement of the tubing.

9. The apparatus of any of claims 1-8, further comprising one or more clips configured to secure the one or more tubes to one or more links of the link assembly.

10. The apparatus of any of claims 1-9, further comprising the one or more tubes coupled to the external tubing guide.

11. The apparatus of claim 10, wherein the one or more tubes comprises a ribbon comprising a plurality of tubes.

12. The apparatus of claim 10, wherein the one or more tubes are a multi-lumen tube about a central axis.

13. The apparatus of claim 10, wherein the one or more tubes comprises one or more of: a suction line, an insufflation line, an optics line, a guide light line, and a fluid line.

14. The apparatus of claim 10, wherein lines of the tubing are stacked in a vertical fashion, wherein the suction line is placed superior in the tubing.

15. The apparatus of claim 10, wherein the tubing is removably installable onto the external tubing guide.

16. The apparatus of any of claims 1-15, wherein one or more of the redirectors are mounted off-axis.

17. The apparatus of any of claims 1-16, wherein one or more of the redirectors are configured as a pulley or a spool.

18. An apparatus, the apparatus comprising: a base; a bidirectional telescoping vertically adjacent link assembly, wherein adjacent links are slidably coupled together via one or more shuttles; and an external tubing guide comprising a plurality of redirectors, wherein each redirector comprises one or more surfaces configured to support one or more tubes, further wherein each redirector extends from either a link or a shuttle of the link assembly so that a continuous path extending between each redirectorof the plurality of redirectors maintains a constant length as the links of the link assembly move relative to each other.

19. A method, the method comprising: installing a tubing onto a telescoping link assembly comprising a plurality of adjacent links; extending the telescoping link relative to a base, wherein the adjacent links of the plurality of links are slidably coupled together via one or more shuttles; and guiding the tubing relative to a plurality of redirectors, wherein each redirector extends from either a link of the plurality of adjacent links or a shuttle of the link assembly so that the tubing extends between each redirector of the plurality of redirectors in a constant length as the links of the link assembly moves relative to each other while the telescoping link assembly extends.

20. The method of claim 19, wherein installing the tubing comprises coupling the tubing to a first clip coupled to an outermost link of the telescoping link assembly and coupling the tubing to a second clip holding a second end region of the tubing onto an innermost link of the telescoping link assembly.

21. The method of claim 19, wherein installing the tubing comprises coupling a first clip holding a first end region of the tubing to an outermost link of the telescoping link assembly and a second clip holding a second end region of the tubing onto an innermost link of the telescoping link assembly.

22. The method of claim 19, wherein the tubing comprises a plurality of lines of tubing.

23. The method of claim 19, wherein installing the tubing comprises installing tubing comprises one or more of: a suction line, an insufflation line, an optics line, a guide light line, and a fluid line.

24. The method of claim 23, wherein installing the tubing comprises installing the plurality of lines of the tubing so that the plurality of lines of tubing are stacked in a vertical fashion.

25. The apparatus of claim 19, wherein the one or more tubes are a multi-lumen tube about a central axis.

26. The method of claim 19, wherein installing the tubing comprises removably installing the tubing onto the external tubing guide.

27. The method of claim 19, further comprising coupling a first end of the tube to a scope mounted to the telescoping link assembly, and coupling a second end of the tube to one or more of: a source of positive and / or negative pressure, an optical source, and / or a fluid source.

28. A preassembled tubing set for a telescoping link assembly, the tubing set comprising: a plurality of tubing lines; a first clip coupled to a proximal region of the plurality of tubing lines; and a second clip coupled to a distal region of the plurality of tubing lines; wherein the first clip and the second clip are each configured to mount to a link of a telescoping link assembly.

29. The tubing set of claim 28, wherein the tubing lines of the plurality of tubing lines are arranged adjacent to each other.

30. The tubing set of any of claims 28-29, wherein the tubing lines of the plurality of tubing lines form a ribbon.

31. The apparatus of any of claims 28-30, wherein the one or more tubes are a multilumen tube about a central axis.

32. The tubing assembly of any of claims 28-31, wherein the plurality of tubing lines comprise one or more of: a suction line, an insufflation line, an optics line, a guide light line, and a fluid line.

33. The tubing assembly of any of claims 28-32, wherein the plurality of tubing lines pass through a central channel through the first clip and a central channel through the second clip.

34. The tubing assembly of claim 33, wherein the central channel through the first clip is open to allow the tubing lines to be inserted and withdrawn into the central channel.

35. The tubing assembly of claim 33, wherein the central channel through the first clip is closed around the plurality of tubing lines.

36. The tubing assembly of any of claims 28-35, wherein the first clip further comprises an upper channel configured to separately and releasably hold a pressure line.

37. An external tubing guide system, comprising: an external tubing guide apparatus, comprising: a base; a telescoping link assembly coupled to the base and comprising: a plurality of links that are adjacent to each other, wherein adjacent links of the plurality of links are slidably coupled together via one or more shuttles; and an external tubing guide comprising a plurality of redirectors, wherein each redirector comprising one or more surfaces configured to support a preassembled tubing set, further wherein each redirector extends from either a link or a shuttle of the link assembly so that a continuous path of a plurality of tubing lines of the preassembled tubing set extending between each redirector of the plurality of redirectors maintains a constant length as the links of the link assembly move relative to each other; and the preassembled tubing set for the telescoping link assembly, comprising: the plurality of tubing lines; a first clip coupled to a proximal region of the plurality of tubing lines; and a second clip coupled to a distal region of the plurality of tubing lines; wherein the first clip and the second clip are each configured to mount to a link of a telescoping link assembly.

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