Surgical robotic system for controlling endoluminal instruments

Abstract

A surgical robotic system for controlling an endoluminal robotic (ELR) instrument includes a robotic arm equipped with an ELR instrument having a videoscope and a surgeon console with a display for the video feed. The console features two hand controllers and a foot pedal for 3D movement input. The system can switch between dual and single controller modes, allowing simultaneous or individual control of the ELR instrument. The system processes user input to generate movement commands and provides haptic feedback through the controllers. The ELR instrument is flexible, steerable, and can articulate in multiple directions, enhancing precision in minimally invasive procedures.

Description

SURGICAL ROBOTIC SYSTEM FOR CONTROLLING ENDOLUMINAL INSTRUMENTSCROSS REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit of and priority to U.S. Provisional Application No. 63 / 669,722, filed July 11, 2024; U.S. Provisional Application No. 63 / 669,882, filed July 11, 2024; and U.S. Provisional Application No. 63 / 673,314, filed July 19, 2024. The entire disclosures of the foregoing applications are incorporated by reference herein.BACKGROUND

[0002] Surgical robotic systems are currently being used in a variety of surgical procedures, including laparoscopic and endoluminal minimally invasive procedures. Laparoscopic surgical robotic systems include a surgeon console for controlling a surgical robotic arm and a surgical instrument having an end effector (e.g., forceps or grasping instrument coupled to and actuated by the robotic arm). In operation, the robotic arm is moved to a position over a patient and then guides the surgical instrument into a small incision via a surgical port to position the end effector at a work site within the patient’s body. The robotic arm and the instrument are actuated using motors, which may be controlled using various parameters. Such instruments generally have rigid shafts with optionally articulating end effectors. As a result of mechanical constraints, positioning the instruments within the patient may be accomplished by moving one or more links of the arm.

[0003] Endoluminal robotic (ELR) surgical systems insert instruments through a natural orifice of a patient. Instruments used with ELR systems are flexible and may include catheters or singlechannel or multi-channel robotic endoscopic instruments. However, due to different types of instruments using different types of mechanical movement (e.g., articulating an end effector vs. advancing a sheathed instrument), laparoscopic multiport systems and ELR systems use different types of input controls and interfaces. Thus, there is a need for a surgical robotic system that uses endoluminal robotic instruments with laparoscopic single or multi-port surgical robotic arms. As endoluminal robotics procedures continue to evolve and take larger portions of procedures, the need for precise, instinctive control of the catheter motion outside and inside the body will be increasingly significant for the procedure outcomes and user desire to use the system.SUMMARY

[0004] The present disclosure provides different methods for controlling an ELR instrument such as a single channel catheter using a surgeon console as well as other various types of inputs devices. The surgeon console includes a pair of hand controllers that provide for 3D movement input. The surgeon console provides for either single or dual hand controller input to control the movement of a flexible ELR instrument.

[0005] According to one embodiment of the present disclosure, a surgical robotic system for controlling an endoluminal robotic (ELR) instrument is disclosed. The surgical robotic system includes a robotic arm having an ELR instrument with a videoscope. The system also includes a surgeon console having: a display configured to display a video feed from the videoscope and a first hand controller and a second hand controller configured to provide 3D movement input to control the ELR instrument, and a foot pedal. The system further includes a controller configured to receive user input from the surgeon console and process the input to generate movement commands for the robotic arm and the ELR instrument. The surgeon console is configured to switch between a dual controller mode and a single controller mode, where in the dual controller mode the first and second hand controllers are used simultaneously to provide 3D movement input to control the ELR instrument and in the single controller mode one of the first hand controller or the second hand controller is used to provide 3D movement input to control the ELR instrument.

[0006] Implementations of the above embodiment may include one or more of the following features. According to one aspect of the above embodiment, the foot pedal may be configured to act as a clutch to disengage the first and second hand controllers from controlling the robotic arm and the ELR instrument, allowing the user to reposition the first and second hand controllers without moving the robotic arm and the ELR instrument. The ELR instrument may be a flexible, steerable instrument. Each of the first and second hand controllers may include a gimbal assembly allowing for movement and rotation of the first and second hand controllers in a coordinate system. The ELR instrument may be configured to articulate and is movable longitudinally in a forward direction or a backward direction. In the dual controller mode the first and second hand controllers may be moved in tandem in the same direction to articulate the ELR instrument. In the single controller mode one of the first hand controller or the second hand controller may be articulated in a desired direction to articulate the ELR instrument. The controller may be further configured to process the movement commands and provide haptic feedback through the first and second handcontrollers. The haptic feedback provided may be different at least in type or intensity based on type of the movement command. The controller may provide position-to-position and position-to- velocity mapping for movement commands of the ELR instrument.BRIEF DESCRIPTION OF THE DRAWINGS

[0007] Various embodiments of the present disclosure are described herein with reference to the drawings wherein:

[0008] FIG. 1 is a perspective view of a surgical robotic system including a control tower, a console, and one or more surgical robotic arms each disposed on a movable cart according to an embodiment of the present disclosure;

[0009] FIG. 2 is a perspective view of a surgical robotic arm of the surgical robotic system of FIG.1 according to an embodiment of the present disclosure;

[0010] FIG. 3 is a perspective view of a movable cart having a setup arm with the surgical robotic arm of the surgical robotic system of FIG. 1 according to an embodiment of the present disclosure;

[0011] FIG. 4 is a schematic diagram of a computer architecture of the surgical robotic system of FIG. 1 according to an embodiment of the present disclosure;

[0012] FIG. 5 is a plan schematic view of movable carts of FIG. 1 positioned about a surgical table according to an aspect of the present disclosure;

[0013] FIG. 6 is a schematic diagram of a system for determining phases of a surgical procedure according to an embodiment of the present disclosure;

[0014] FIG. 7 is a perspective view of the surgical robotic system with an ELR arm including an ELR instrument according to an embodiment of the present disclosure; and

[0015] FIG. 8 is a perspective view of an input hand controller according to one embodiment of the present disclosure.DETAILED DESCRIPTION

[0016] Embodiments of the presently disclosed surgical robotic system are described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views.

[0017] As will be described in detail below, the present disclosure is directed to a surgical robotic system with an endoluminal robotics (ELR) platform, which includes a surgeon console, and anendoluminal robotic (ELR) arm including a flexible, steerable ELR surgical instrument. The surgeon console receives user input through one or more interface devices. The input is processed by the control tower as movement commands for moving the robotic arms and an instrument and / or camera coupled thereto. Thus, the surgeon console enables teleoperation of the robotic arms and attached instrum ents / cam era. The robotic arms each include a controller, which is configured to process the movement commands and to move the robotic arms in response to the movement commands.

[0018] With reference to FIG. 1, a surgical robotic system 10 includes a control tower 20, which is connected to all of the components of the surgical robotic system 10 including a surgeon console 30 and one or more movable carts 60. Each of the movable carts 60 includes a robotic arm 40 having a surgical instrument 50 coupled thereto (e.g., a laparoscopic robotic arms having a laparoscopic instrument or an ELR robotic arm having an ELR instrument). The robotic arms 40 also couple to the movable carts 60. The robotic system 10 may include any number of movable carts 60 and / or robotic arms 40.

[0019] The surgical instrument 50 is configured for use during minimally invasive surgical procedures. In embodiments, the surgical instrument 50 may be configured for open surgical procedures. In further embodiments, the surgical instrument 50 may be an electrosurgical forceps configured to seal tissue by compressing tissue between jaw members and applying electrosurgical current thereto. In yet further embodiments, the surgical instrument 50 may be a surgical stapler including a pair of jaws configured to grasp and clamp tissue while deploying a plurality of tissue fasteners, e.g., staples, and cutting stapled tissue. In yet further embodiments, the surgical instrument 50 may be a surgical clip applier including a pair of jaws configured to apply a surgical clip onto tissue. However, it will be understood that various types of surgical instruments for use during minimally invasive surgical procedures are contemplated and within the scope of this disclosure.

[0020] One of the robotic arms 40 may include an endoscopic camera 51 configured to capture video of the surgical site. The endoscopic camera 51 may be a stereoscopic endoscope configured to capture two side-by-side (i.e., left and right) images of the surgical site to produce a video stream of the surgical scene. The endoscopic camera 51 is coupled to a video processing device 56, which may be disposed within the control tower 20. The video processing device 56 may be anycomputing device as described below configured to receive the video feed from the endoscopic camera 51 and output the processed video stream.

[0021] The surgeon console 30 includes a first display 32, which displays a video feed of the surgical site provided by camera 51 disposed on the robotic arm 40, and a second display 34, which displays a user interface for controlling the surgical robotic system 10. The first display 32 and second display 34 may be touchscreens allowing for displaying various graphical user inputs.

[0022] The surgeon console 30 also includes a plurality of user interface devices, such as foot pedals 36 and a pair of hand controllers 38a and 38b which are used by a user to remotely control robotic arms 40. The surgeon console further includes an armrest 33 used to support clinician’s arms while operating the hand controllers 38a and 38b.

[0023] The control tower 20 includes a display 23, which may be a touchscreen that may display the graphical user interfaces (GUIs). The control tower 20 also acts as an interface between the surgeon console 30 and one or more robotic arms 40. In particular, the control tower 20 is configured to control the robotic arms 40, such as to move the robotic arms 40 and the corresponding surgical instrument 50, based on a set of programmable instructions and / or input commands from the surgeon console 30, in such a way that robotic arms 40 and the surgical instrument 50 execute a desired movement sequence in response to input from the foot pedals 36 and the hand controllers 38a and 38b. The foot pedals 36 may be used to enable and lock the hand controllers 38a and 38b, repositioning camera movement and electrosurgical activation / deactivation. In particular, the foot pedals 36 may be used to perform a clutching action on the hand controllers 38a and 38b. Clutching is initiated by pressing one of the foot pedals 36, which disconnects (i.e., prevents movement inputs) the hand controllers 38a and / or 38b from the robotic arm 40 and corresponding instrument 50 or camera 51 attached thereto. This allows the user to reposition the hand controllers 38a and 38b without moving the robotic arm(s) 40 and the instrument 50 and / or camera 51. This is useful when reaching control boundaries of the surgical space.

[0024] Each of the control tower 20, the surgeon console 30, and the robotic arm 40 includes a respective computer 21, 31, 41. The computers 21, 31, 41 are interconnected to each other using any suitable communication network based on wired or wireless communication protocols. The term “network,” whether plural or singular, as used herein, denotes a data network, including, but not limited to, the Internet, Intranet, a wide area network, or a local area network, and withoutlimitation as to the full scope of the definition of communication networks as encompassed by the present disclosure. Suitable protocols include, but are not limited to, transmission control protocol / internet protocol (TCP / IP), datagram protocol / internet protocol (UDP / IP), and / or datagram congestion control protocol (DCCP). Wireless communication may be achieved via one or more wireless configurations, e.g., radio frequency, optical, Wi-Fi, Bluetooth (an open wireless protocol for exchanging data over short distances, using short length radio waves, from fixed and mobile devices, creating personal area networks (PANs), ZigBee® (a specification for a suite of high level communication protocols using small, low-power digital radios based on the IEEE 122.15.4-1203 standard for wireless personal area networks (WPANs)).

[0025] The computers 21, 31, 41 may include any suitable processor (not shown) operably connected to a memory (not shown), which may include one or more of volatile, non-volatile, magnetic, optical, or electrical media, such as read-only memory (ROM), random access memory (RAM), electrically erasable programmable ROM (EEPROM), non-volatile RAM (NVRAM), or flash memory. The processor may be any suitable processor (e.g., control circuit) adapted to perform the operations, calculations, and / or set of instructions described in the present disclosure including, but not limited to, a hardware processor, a field programmable gate array (FPGA), a digital signal processor (DSP), a central processing unit (CPU), a microprocessor, and combinations thereof. Those skilled in the art will appreciate that the processor may be substituted by using any logic processor (e.g., control circuit) adapted to execute algorithms, calculations, and / or set of instructions described herein.

[0026] With reference to FIG. 2, each of the robotic arms 40 may include a plurality of links 42a, 42b, 42c, which are interconnected at joints 44a, 44b, 44c, respectively. Other configurations of links and joints may be utilized as known by those skilled in the art. The joint 44a is configured to secure the robotic arm 40 to the movable cart 60 and defines a first longitudinal axis. With reference to FIG. 3, the movable cart 60 includes a lift 67 and a setup arm 61, which provides a base for mounting of the robotic arm 40. The lift 67 allows for vertical movement of the setup arm 61. The movable cart 60 also includes a display 69 for displaying information pertaining to the robotic arm 40. In embodiments, the robotic arm 40 may include any type and / or number of joints.

[0027] The setup arm 61 includes a first link 62a, a second link 62b, and a third link 62c, which provide for lateral maneuverability of the robotic arm 40. The links 62a, 62b, 62c areinterconnected at joints 63a and 63b, each of which may include a motor (not shown) for rotating the links 62b and 62b relative to each other and the link 62c. In particular, the links 62a, 62b, 62c are movable in their corresponding lateral planes that are parallel to each other, thereby allowing for extension of the robotic arm 40 relative to the patient (e.g., surgical table). In embodiments, the robotic arm 40 may be coupled to the surgical table (not shown). The setup arm 61 includes controls 65 for adjusting movement of the links 62a, 62b, 62c as well as the lift 67. In embodiments, the setup arm 61 may include any type and / or number of joints.

[0028] The third link 62c may include a rotatable base 64 having two degrees of freedom. In particular, the rotatable base 64 includes a first motor 64a and a second motor 64b. The first motor 64a is rotatable about a first stationary arm axis which is perpendicular to a plane defined by the third link 62c and the second motor 64b is rotatable about a second stationary arm axis which is transverse to the first stationary arm axis. The first and second motors 64a and 64b allow for full three-dimensional orientation of the robotic arm 40.

[0029] The motor 48b of the joint 44b is coupled to the joint 44c via the belt 45a, and the joint 44c is in turn coupled to the joint 46b via the belt 45b. loint 44c may include a transfer case coupling the belts 45a and 45b, such that the motor 48b is configured to rotate each of the links 42b, 42c and a holder 46 relative to each other. More specifically, links 42b, 42c, and the holder 46 are passively coupled to the motor 48b which enforces rotation about a pivot point “P” which lies at an intersection of the first axis defined by the link 42a and the second axis defined by the holder 46. In other words, the pivot point “P” is a remote center of motion (RCM) for the robotic arm 40. Thus, the motor 48b controls the angle 0 between the first and second axes allowing for orientation of the surgical instrument 50. Due to the interlinking of the links 42a, 42b, 42c, and the holder 46 via the belts 45a and 45b, the angles between the links 42a, 42b, 42c, and the holder 46 are also adjusted in order to achieve the desired angle 9. In embodiments, some or all of the joints 44a, 44b, 44c may include a motor to obviate the need for mechanical linkages.

[0030] The joints 44a and 44b include a motor 48a and 48b configured to drive the joints 44a, 44b, 44c relative to each other through a series of belts 45a and 45b or other mechanical linkages such as a drive rod, a cable, or a lever and the like. In particular, the motor 48a is configured to rotate the robotic arm 40 about a longitudinal axis defined by the link 42a.

[0031] With reference to FIG. 2, the holder 46 defines a second longitudinal axis and configured to receive an instrument drive unit (IDU) 52 (FIG. 1). The IDU 52 is configured to couple to anactuation mechanism of the surgical instrument 50 and the camera 51 and is configured to move (e g., rotate) and actuate the instrument 50 and / or the camera 51. IDU 52 transfers actuation forces from its motors to the surgical instrument 50 to actuate components of an end effector 49 of the surgical instrument 50. The holder 46 includes a sliding mechanism 46a, which is configured to move the IDU 52 along the second longitudinal axis defined by the holder 46. The holder 46 also includes a joint 46b, which rotates the holder 46 relative to the link 42c. During endoscopic procedures, the instrument 50 may be inserted through an endoscopic access port 55 (FIG. 3) held by the holder 46. The holder 46 also includes a port latch 46c for securing the access port 55 to the holder 46 (FIG. 2).

[0032] The IDU 52 is attached to the holder 46, followed by a sterile interface module (SIM) 43 being attached to a distal portion of the IDU 52. The SIM 43 is configured to secure a sterile drape (not shown) to the IDU 52. The instrument 50 is then attached to the SIM 43. The instrument 50 is then inserted through the access port 55 by moving the IDU 52 along the holder 46. The SIM 43 includes a plurality of drive shafts configured to transmit rotation of individual motors of the IDU 52 to the instrument 50 thereby actuating the instrument 50. In addition, the SIM 43 provides a sterile barrier between the instrument 50 and the other components of robotic arm 40, including the IDU 52.

[0033] The robotic arm 40 also includes a plurality of manual override buttons 53 (FIG. 1) disposed on the IDU 52 and the setup arm 61, which may be used in a manual mode. The user may press one or more of the buttons 53 to move the component associated with the one or more buttons 53.

[0034] With reference to FIG. 4, each of the computers 21, 31, 41 of the surgical robotic system 10 may include a plurality of controllers, which may be embodied in hardware and / or software. The computer 21 of the control tower 20 includes a controller 21a and safety observer 21b. The controller 21a receives data from the computer 31 of the surgeon console 30 about the current position and / or orientation of the hand controllers 38a and 38b and the state of the foot pedals 36 and other buttons. The controller 21a processes these input positions to determine desired drive commands for each joint of the robotic arm 40 and / or the IDU 52 and communicates these to the computer 41 of the robotic arm 40. The controller 21a also receives the actual joint angles measured by encoders of the motors 48a and 48b and uses this information to determine force feedback commands that are transmitted back to the computer 31 of the surgeon console 30 toprovide force feedback, such as haptic feedback, through the hand controllers 38a and 38b. The safety observer 21b performs validity checks on the data going into and out of the controller 21a and notifies a system fault handler if errors in the data transmission are detected to place the computer 21 and / or the surgical robotic system 10 into a safe state.

[0035] The computer 41 includes a plurality of controllers, namely, a main cart controller 41a, a setup arm controller 41b, a robotic arm controller 41c, and an instrument drive unit (IDU) controller 4 Id. The main cart controller 41a receives and processes joint commands from the controller 21a of the computer 21 and communicates them to the setup arm controller 41b, the robotic arm controller 41c, and the IDU controller 4 Id. The main cart controller 41a also manages instrument exchanges and the overall state of the movable cart 60, the robotic arm 40, and the IDU 52. The main cart controller 41a also communicates actual joint angles back to the controller 21a.

[0036] Each of joints 63 a and 63b and the rotatable base 64 of the setup arm 61 are passive joints (i.e., no motors are present therein) allowing for manual adjustment thereof by a user. The joints 63a and 63b and the rotatable base 64 include brakes that are disengaged by the user to configure the setup arm 61. The setup arm controller 41b monitors slippage of each of joints 63a and 63b and the rotatable base 64 of the setup arm 61, when brakes are engaged or can be freely moved by the operator when brakes are disengaged, but do not impact controls of other joints. The robotic arm controller 41c controls each joint 44a and 44b of the robotic arm 40 and calculates desired motor torques required for gravity compensation, friction compensation, and closed loop position control of the robotic arm 40. The robotic arm controller 41c calculates a movement command based on the calculated torque. The calculated motor commands are then communicated to one or more of the motors 48a and 48b in the robotic arm 40. The actual joint positions are then transmitted by the motors 48a and 48b back to the robotic arm controller 41c.

[0037] The IDU controller 41d receives desired joint angles for the surgical instrument 50, such as wrist and jaw angles, and computes desired currents for the motors in the IDU 52. The IDU controller 41 d calculates actual angles based on the motor positions and transmits the actual angles back to the main cart controller 41a.

[0038] The robotic arm 40 is controlled in response to a pose of the hand controller controlling the robotic arm 40, e.g., the hand controller 38a, which is transformed into a desired pose of the robotic arm 40 through a hand eye transform function executed by the controller 21a. The hand eye function, as well as other functions described herein, is / are embodied in software executable bythe controller 21a or any other suitable controller described herein. The pose of one of the hand controllers 38a may be embodied as a coordinate position and roll-pitch-yaw (RPY) orientation relative to a coordinate reference frame, which is fixed to the surgeon console 30. The desired pose of the instrument 50 is relative to a fixed frame on the robotic arm 40. The pose of the hand controller 38a is then scaled by a scaling function executed by the controller 21a. In embodiments, the coordinate position may be scaled down and the orientation may be scaled up by the scaling function. In addition, the controller 21a may also execute a clutching function, which disengages the hand controller 38a from the robotic arm 40. In particular, the controller 21a stops transmitting movement commands from the hand controller 38a to the robotic arm 40 if certain movement limits or other thresholds are exceeded and in essence acts like a virtual clutch mechanism, e.g., limits mechanical input from effecting mechanical output.

[0039] The desired pose of the robotic arm 40 is based on the pose of the hand controller 38a and is then passed by an inverse kinematics function executed by the controller 21a. The inverse kinematics function calculates angles for the joints 44a, 44b, 44c of the robotic arm 40 that achieve the scaled and adjusted pose input by the hand controller 38a. The desired angles are then passed to the robotic arm controller 41c, which includes a joint axis controller having a proportional- derivative (PD) controller, the friction estimator module, the gravity compensator module, and a two-sided saturation block, which is configured to limit the commanded torque of the motors of the joints 44a, 44b, 44c. In aspects, hand controller 38a may be substituted for and / or employed in conjunction with hand controller 38b. While reference is made above to hand controller 38a, hand controller 38b may also be used in a similar manner.

[0040] With reference to FIG. 5, the surgical robotic system 10 is set up around a surgical table 90. The system 10 includes movable carts 60a-d, which may be numbered “1” through “4.” During setup, each of the carts 60a-d are positioned around the surgical table 90. The robotic arm 60a is an ELR arm 40a and includes an ELR instrument 50a, which may be inserted through any natural orifice of a patient and as shown in FIG. 5, is inserted through the mouth. FIGS. 7-9 below shows the ELR arm 40a and the ELR instrument 50a in more detail.

[0041] Position and orientation of the carts 60a-d depends on a plurality of factors, such as placement of a plurality of access ports 55b-d, which in turn, depends on the surgery being performed. Once the port placements are determined, the access ports 55b-d are inserted into the patient, and carts 60b-d are positioned to insert instruments 50 and the endoscopic camera 51 intocorresponding ports 55b-d. The robotic arm 60a is positioned in proximity of the natural orifice through which the ELR instrument 50a is going to be inserted.

[0042] During use, each of the robotic arms 40b-d is attached to one of the access ports 55b-d that is inserted into the patient by attaching the latch 46c (FIG. 2) to the access port 55 (FIG. 3). The IDU 52 is attached to the holder 46, followed by the SIM 43 being attached to a distal portion of the IDU 52. Thereafter, the instrument 50 is attached to the SIM 43. The instrument 50 is then inserted through the access port 55 by moving the IDU 52 along the holder 46.

[0043] With reference to FIG. 6, the surgical robotic system 10 may include an AI / ML processing system 310 that processes the surgical data using one or more ML models to identify one or more features, such as surgical phase, instrument, anatomical structure, etc., in the surgical data. The ML processing system 310 includes a ML training system 325, which may be a separate device (e g., server) that stores its output as one or more trained ML models 330. The ML models 330 are accessible by a ML execution system 340. The ML execution system 340 may be separate from the ML training system 325, namely, devices that “train” the models are separate from devices that “infer,” i.e., perform real-time processing of surgical data using the trained ML models 330.

[0044] System 10 includes a data reception system 305 that collects surgical data, including the video data and surgical instrumentation data. The data reception system 305 can include one or more devices (e.g., one or more user devices and / or servers) located within and / or associated with a surgical operating room and / or control center. The data reception system 305 can receive surgical data in real-time, i.e., as the surgical procedure is being performed.

[0045] The ML processing system 310, in some examples, may further include a data generator 315 to generate simulated surgical data, such as a set of virtual or masked images, or record the video data from the image processing device 56, to train the ML models 330 as well as other sources of data, e.g., user input, arm movement, etc. Data generator 315 can access (read / write) a data store 320 to record data, including multiple images and / or multiple videos.

[0046] The ML processing system 310 also includes a phase detector 350 that uses the ML models to identify a phase within the surgical procedure. Phase detector 350 uses a particular procedural tracking data structure 355 from a list of procedural tracking data structures. Phase detector 350 selects the procedural tracking data structure 355 based on the type of surgical procedure that is being performed. In one or more examples, the type of surgical procedure is predetermined orinput by user. The procedural tracking data structure 355 identifies a set of potential phases that may correspond to a part of the specific type of surgical procedure.

[0047] In some examples, the procedural tracking data structure 355 may be a graph that includes a set of nodes and a set of edges, with each node corresponding to a potential phase. The edges may provide directional connections between nodes that indicate (via the direction) an expected order during which the phases will be encountered throughout an iteration of the surgical procedure. The procedural tracking data structure 355 may include one or more branching nodes that feed to multiple next nodes and / or may include one or more points of divergence and / or convergence between the nodes. In some instances, a phase indicates a procedural action (e.g., surgical action) that is being performed or has been performed and / or indicates a combination of actions that have been performed. In some instances, a phase relates to a biological state of a patient undergoing a surgical procedure. For example, the biological state may indicate a complication (e.g., blood clots, clogged arteries / veins, etc.), pre-condition (e.g., lesions, polyps, etc.). In some examples, the ML models 330 are trained to detect an “abnormal condition,” such as hemorrhaging, arrhythmias, blood vessel abnormality, etc.

[0048] The phase detector 350 outputs the phase prediction associated with a portion of the video data that is analyzed by the ML processing system 310. The phase prediction is associated with the portion of the video data by identifying a start time and an end time of the portion of the video that is analyzed by the ML execution system 340. The phase prediction that is output may include an identity of a surgical phase as detected by the phase detector 350 based on the output of the ML execution system 340. Further, the phase prediction, in one or more examples, may include identities of the structures (e.g., instrument, anatomy, etc.) that are identified by the ML execution system 340 in the portion of the video that is analyzed. The phase prediction may also include a confidence score of the prediction. Other examples may include various other types of information in the phase prediction that is output. The predicted phase may be used by the controller 21a to determine when to enable interfaces for controlling combined laparoscopic and ELR instruments as described below.

[0049] With reference to FIG. 7, robotic system 10 includes the surgeon console 30 and other robotic arms 40b-d described above. The ELR arm 40a is coupled to a movable cart 60 via the setup arm 61. The ELR arm 40a may be substantially similar to the robotic arm 40. The ELR arm40a includes an ELR IDU 152 configured to drive the ELR instrument 50a, which may be any flexible endoscopic instrument.

[0050] The ELR instrument 50a is a flexible, steerable instrument such as a catheter or an endoscope. The ELR instrument 50a may be a single-channel having one end effector or a multichannel with multiple end effectors. The ELR instrument 50a may include a plurality of end effectors and a videoscope 157, which may include a camera for capturing images of the surgical site and one or more lights for illuminating the same.

[0051] The ELR instrument 50a includes an instrument housing 154 and a flexible elongated shaft 156 extending therefrom and a videoscope 157 disposed at a distal end portion of the flexible shaft 156. The video feed from the videoscope 157 may be output on the main display screen 32 of the surgeon console 30.

[0052] A sterile interface module (SIM) 158 may be disposed between the instrument housing 154 and the shaft 156 The SIM 158 may include mechanical couplers for transferring motor output from the ELR IDU 152 to the shaft 156. In addition, the SIM 158 may be used to secure a sterile drape to the ELR arm 40a. The instrument housing 154 may be integrally connected to the shaft 156 and disposed after use. Alternatively, the instrument housing 154 may be re-usable while the shaft 156 is disconnected and is disposed after use.

[0053] The ELR instrument 50a may be driven longitudinally, e.g., inserted into or extended from the body lumen, by moving the holder 46 along the sliding mechanism 46a (FIGS. 2 and 7). The ELR instrument 50a may also be bent in any suitable direction. This may be accomplished by a plurality of cables (not shown) inside the ELR instrument 50a.

[0054] The surgeon console 30 may be used to control all of the robotic arms 40a-d. In particular, the hand controllers 38a and 38b, the foot pedals 36, and touch screen of the second display 34 may be remapped to control a steerable flexible manipulator of the ELR instrument 50a. In particular, the surgeon console 30 is configured to use the same interface (i.e., hand controllers 38a and 38b, foot pedals 36, etc.) that may be switched between different operating modes of the system 10, multi-port, single-port, and ELR mode. The system 10 may be operated in a multi-port configuration, where each robotic arm 40 inserts the instrument 50 or the camera 51 through a corresponding access port 55. In a single port mode, the system 10 may use a multi-channel instrument that is inserted through the access port 55. Endoluminal modes include single channeland multi-channel modes during which the system 10 operates the corresponding ELR instrument 50a.

[0055] Interface options for controlling the ELR instrument 50a include velocity command or position (e.g., backward or forward) command, or combinations thereof, such as where a position command is used until reaching a set position and then switching to a velocity command. The position and velocity commands may be mapped to buttons or other inputs (e.g., capacitive pads) on the hand controllers 38a and 38b, the foot pedals 36, as well as buttons on the second display 34 and / or the instrument housing 154. In additional embodiments, the surgeon console 30 may include a gaze tracking device 37 (FIG. 7) or alternatively, a head set with gaze tracking may be used to a certain pattern in eye blink for, for example, an emergency stop, or it can detect a certain gaze pattern for motion command. Head tracking or eye tracking may be used to generate a motion command for the instruments 50 or 50a to move in a direction. To register the input command, the user may hold the gaze or head position as an input to enable this mode. The phase detector 350 may also be used to automatically change the insertion command method based on current phase of the procedure.

[0056] Either one or both of the hand controllers 38a and 38b may be used to control the ELR instrument 50a. FIG. 8 shows the left-hand controller 38b, which is a mirror copy of the right-hand controller 38a. The hand controllers 38a and 38b may be used to control, i.e., move, activate, etc., a tool coupled to the IDU 52 of the robotic arms 40, such as the instrument 50, the laparoscopic camera 51. Each of the hand controllers 38a and 38b includes an input 70 and a paddle 72 that is pivotally coupled to the input 70 at one end (e.g., proximal) of the paddle 72. The paddle 72 is configured to actuate a function of the instrument 50. The paddle 72 may include a finger sensor (not shown) configured to detect presence or movement of a finger, such as touch sensors, capacitive sensors, optical sensors, and the like. In embodiments, the finger sensor may be disposed on any portion of the hand controllers 38a and 38b. Each of the hand controllers 38a and 38b may also include a trigger 74a and one or more buttons 74b for activating various functions of the instrument 50. In addition, each of the hand controllers 38a and 38b may include a gimbal assembly 76 allowing for movement and rotation of the hand controllers 38a and 38b in a coordinate system of the hand controller 38a. The coordinate system is represented by a 3D axis symbol including the X-axis, Y-axis, Z-axis. The gimbal assembly includes a plurality of frames 78a, 78b, 78c interconnected by rotatable joints 77 between each of the frames 78a, 78b, 78c, theinput 70, and a support frame 79. The joints include encoders or other sensors suitable for measuring rotation, which are then used as input to control movement (e.g., pitch, roll, yaw, etc.) of the instrument 50. In embodiments, the hand controllers 38a and 38b may be any other directional input device, such as an analog joy stick, a directional pad, a touchpad, trackball, mouse, and the like.

[0057] In two-handed movement control both hand controllers 38a and 38b are used for advancement and steering the ELR instrument 50a. A method for controlling the ELR instrument 50a may be embodied as software instructions stored in memory and executable by a processor (e.g., controller 21a.) Initially, the catheter navigation may be enabled by pressing and holding a designated catheter movement control pedal, i.e., one of the foot pedals 36. Once enabled, both hand controllers 38a and 38b are used together to control the motion of the ELR instrument 50a. In addition, the GUI on the display screen 32 and / or 34 may be updated to indicate that motion control of the ELR instrument 50a is now active. To move the ELR instrument 50a, both hand controllers 38a and 38b are moved together. Movement input may be stopped by stopping moving the hand controllers 38a and 38b and releasing the corresponding foot pedal 36.

[0058] Movement of the ELR instrument 50a as reflected in the video feed may correspond to dragging the workspace (i.e., the anatomy and the instruments displayed on the video feed from the videoscope of the ELR instrument 50a). Panning in any direction of the workspace is achieved by articulating the ELR instrument 50a. Thus, to look to the right both surgeon hand controllers 38a and 38b are moved to the left (drag the workspace to the left). The workspace will move left on screen as the view shifts to the right. To look to the left both surgeon hand controllers 38a and 38b are moved to the right. The workspace will move right on screen 32 as the view shifts to the left. To look upward, hand controllers 38a and 38b are moved downward to drag the workspace downward. To look downward, hand controllers 38a and 38b are moved upward to drag the workspace upward.

[0059] Longitudinal movement of the ELR instrument 50a may also be accomplished by moving both hand controllers 38a and 38b. To move the ELR instrument 50a toward the anatomy, e.g., advance the ELR instrument 50a, both surgeon hand controllers 38a and 38b are pulled toward the user and away from the display screen 32, which will drag the workspace closer on the video feed. To move the ELR instrument 50a away from the anatomy, e.g., withdraw the ELR instrument 50a, both surgeon hand controllers 38a and 38b are pushed away from the user and toward thedisplay screen 32 (i.e., push the workspace further away). Rolling of the ELR instrument 50a in a clockwise direction may be achieved by lowering the right hand controller 38b while simultaneously lifting the left hand controller 38a. Rolling of the ELR instrument 50a in a counterclockwise direction may be achieved by lowering the left hand controller 38b and simultaneously lifting the right hand controller 38a.

[0060] In a single-handed movement control, only one of the hand controllers 38a and 38b is used for advancement and steering the ELR instrument 50a. Similar to two-handed input scheme, control of the the ELR instrument 50a may be enabled using one of the foot pedals 36. Once established, articulation of the ELR instrument 50a may be achieved by articulating the hand controller 38a in the desired direction. In embodiments, articulation may be commanded by panning the hand controller 38a in the same manner as described above with respect to moving both hand controllers 38a and 38b. Advancing or withdrawing of the ELR instrument 50a may be done by pushing or pulling a single hand controller 38a or 38b toward or away from the display screen 32 as described above. In embodiments, such movement may be achieved by pressing one of the buttons 74b or foot pedals 36 to move the ELR instrument 50a in a first direction, e.g., advance, and another of the buttons 74b or foot pedals 36 to move the ELR instrument 50a in a second, reverse direction, e.g., withdraw. In some embodiments, the ELR instrument 50a may be inserted and / or retracted by pressing and holding one or more of the buttons 74b or foot pedals 36. Other buttons and / or pedals described herein may be used to control insertion and / or retraction of the ELR instrument 50a.

[0061] For both dual or single hand controller control schemes, the system 10 may provide control settings to switch (i.e., reverse) some or all of these movements, e.g., upward panning is achieved by moving the hand controllers 38a and 38b upwards rather than downwards as described above. The movement inputs may also use either position-to-position mapping or position-to-velocity mapping for different movement commands. Additionally, the surgeon console 30 may be switched between operating in dual controller mode or a single controller mode.

[0062] In position-to-position mapping, the input control directly corresponds to the target position of the robotic instrument. The user's input specifies the exact position where the robotic instrument should move. Thus, when the user moves the hand controlled s), the ELR instrument 50a is commanded to move by a certain amount. If the user moves the hand controller(s) further, the ELR instrument 50a is commanded to move further.

[0063] In position-to-velocity mapping, the input control corresponds to the velocity at which the robotic instrument should move. The user's input specifies the speed and direction of movement rather than the exact target position. Thus, when the user moves the hand controller! s), the ELR instrument 50a is commanded to continuously move at a velocity that is related to the hand displacement amount. If the user moves the hand controlled s) further, the commanded velocity is increased accordingly. In some embodiments using position-to-velocity mapping, roll motion may be ignored.

[0064] In addition, force feedback, such as haptic feedback, may be provided to the hand controllers 38a and 38b during movement of the ELR instrument 50a during execution of the movement commands for either position-to-position or position-to-velocity mapping schemes. The force (e.g., haptic) feedback may also vary (e.g., in intensity, type, etc.) for each of the movement inputs as well (e.g., panning vs. withdrawing or advancing). In some embodiments using position-to-position mapping, there may be no force feedback (e.g., haptic or other types of force feedback).

[0065] The system 10 also supports clutching, which may allow the user to reorient and reposition the hand controller(s) 38a / 38b to a more ergonomically comfortable position. Clutching input controls are used to temporarily disengage the control input from the robotic instrument, allowing the user to reposition the input device without affecting the instrument's position. This is particularly useful for making large movements with high precision or for resetting the position of the input device. The system 10 can behave in different ways after the hand controller 38a / 38b is repositioned and the user resumes control of the system. In embodiments, a so-called “reward- and-punish” realignment algorithm may be implemented where the user’ s motions gradually bring the hand controller 38a / 38b and the ELR instrument 50a orientation into alignment with each other. Alternatively, the ELR instrument 50a may be automatically articulated to match the orientation and direction of the hand controller 38a / 38b. Additionally, the system 10 may be configured to stack up orientation offsets, where additional articulation commands are calculated based on the global coordinate frame of the surgeon console 30 or based on the local coordinate frame of the bending section of the flexible shaft 156.

[0066] As described above, foot pedals 36 or buttons 74b and other inputs on the hand controllers 38a / 38b, touchscreen of the display screen 34 may be used to command movement of the ELR instrument 50a. These inputs may be used to command insertion and retraction. In embodiments,these inputs may also be used to include multiple compound movements such as articulation to specific angles, shapes, and orientation. In some embodiments, these inputs may be used to simultaneously articulate and insert the ELR instrument 50a.

[0067] Further aspects and embodiments of the present disclosure are set out in the below numbered clauses:1. A surgical robotic system for controlling an endoluminal robotic (ELR) instrument, comprising: a robotic arm including an ELR instrument having a videoscope; a surgeon console including: a display configured to display a video feed from the videoscope; and a first hand controller and a second hand controller configured to provide 3D movement input to control the ELR instrument, and a foot pedal; and a controller configured to receive user input from the surgeon console and process the input to generate movement commands for the robotic arm and the ELR instrument, wherein the surgeon console is configured to switch between a dual controller mode and a single controller mode, wherein in the dual controller mode the first and second hand controllers are used simultaneously to provide 3D movement input to control the ELR instrument and in the single controller mode one of the first hand controller or the second hand controller is used to provide 3D movement input to control the ELR instrument.2. The surgical robotic system of clause 1, wherein the foot pedal is configured to act as a clutch to disengage the first and second hand controllers from controlling the robotic arm and the ELR instrument, allowing the user to reposition the first and second hand controllers without moving the robotic arm and the ELR instrument.3. The surgical robotic system of any one of clauses 1 or 2, wherein the ELR instrument is a flexible, steerable instrument.4. The surgical robotic system of clause 3, wherein each of the first and second hand controllers includes a gimbal assembly allowing for movement and rotation of the first and second hand controllers in a coordinate system.5. The surgical robotic system of clause 4, wherein the ELR instrument is configured to articulate and is movable longitudinally in a forward direction or a backward direction.6. The surgical robotic system of clause 5, wherein in the dual controller mode the first and second hand controllers are moved in tandem in the same direction to articulate the ELR instrument.7. The surgical robotic system of clause 5, wherein in the single controller mode one of the first hand controller or the second hand controller is articulated in a desired direction to articulate the ELR instrument.8. The surgical robotic system of clause 5, wherein the controller is further configured to process the movement commands and provide haptic feedback through the first and second hand controllers.9. The surgical robotic system of clause 8, wherein the haptic feedback provided is different at least in type or intensity based on type of the movement command.10. The surgical robotic system of any one of clauses 1-9, wherein the controller supports position-to-position and position-to-velocity mapping for movement commands of the ELR instrument.11. A method for controlling an endoluminal robotic (ELR) instrument using a surgical robotic system, the method comprising: displaying, on a display of a surgeon console, a video feed from a videoscope of the ELR instrument, the ELR instrument coupled to and controllable by a robotic arm; receiving 3D movement input from a first hand controller and a second hand controller of the surgeon console; receiving a foot pedal input from the surgeon console; processing, by a controller, the received 3D movement input to generate movement commands for the robotic arm and the ELR instrument; and switching, via the surgeon console, between a dual controller mode and a single controller mode, wherein in the dual controller mode the first and second hand controllers are used simultaneously to provide 3D movement input to controlthe ELR instrument, and wherein in the single controller mode one of the first hand controller or the second hand controller is used to provide 3D movement input to control the ELR instrument.12. The method of clause 11, further comprising disengaging, via the foot pedal, the first and second hand controllers from controlling the robotic arm and the ELR instrument to allow repositioning of the first and second hand controllers without moving the robotic arm and the ELR instrument.13. The method of any one of clauses 11 or 12, wherein the ELR instrument is a flexible, steerable instrument.14. The method of clause 13, wherein receiving 3D movement input from each of the first and second hand controllers comprises detecting movement and rotation via a gimbal assembly associated with each controller in a coordinate system.15. The method of clause 14, further comprising articulating the ELR instrument and moving the ELR instrument longitudinally in a forward direction or a backward direction in response to the movement input.16. The method of clause 15, wherein in the dual controller mode, the first and second hand controllers are moved in tandem in the same direction to articulate the ELR instrument.17. The method of clause 15, wherein in the single controller mode, one of the first hand controller or the second hand controller is articulated in a desired direction to articulate the ELR instrument.18. The method of clause 15, further comprising providing, by the controller, haptic feedback through the first and second hand controllers based on the processed movement commands.19. The method of clause 18, wherein the haptic feedback provided is different at least in type or intensity based on the type of the movement command.20. The method of any one of clauses 11-19, further comprising applying position-to-position mapping or position-to-velocity mapping to the movement commands for controlling the ELR instrument.

[0068] It will be understood that various modifications may be made to the embodiments disclosed herein. Therefore, the above description should not be construed as limiting, but merely as exemplifications of various embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended thereto.

Claims

WHAT IS CLAIMED IS:

1. A surgical robotic system for controlling an endoluminal robotic (ELR) instrument, comprising: a robotic arm including an ELR instrument having a videoscope; a surgeon console including: a display configured to display a video feed from the videoscope; and a first hand controller and a second hand controller configured to provide 3D movement input to control the ELR instrument, and a foot pedal; and a controller configured to receive user input from the surgeon console and process the input to generate movement commands for the robotic arm and the ELR instrument, wherein the surgeon console is configured to switch between a dual controller mode and a single controller mode, wherein in the dual controller mode the first and second hand controllers are used simultaneously to provide 3D movement input to control the ELR instrument and in the single controller mode one of the first hand controller or the second hand controller is used to provide 3D movement input to control the ELR instrument.

2. The surgical robotic system of claim 1, wherein the foot pedal is configured to act as a clutch to disengage the first and second hand controllers from controlling the robotic arm and the ELR instrument, allowing the user to reposition the first and second hand controllers without moving the robotic arm and the ELR instrument.

3. The surgical robotic system of claim 1, wherein the ELR instrument is a flexible, steerable instrument.

4. The surgical robotic system of claim 3, wherein each of the first and second hand controllers includes a gimbal assembly allowing for movement and rotation of the first and second hand controllers in a coordinate system.

5. The surgical robotic system of claim 4, wherein the ELR instrument is configured to articulate and is movable longitudinally in a forward direction or a backward direction.

6. The surgical robotic system of claim 5, wherein in the dual controller mode the first and second hand controllers are moved in tandem in the same direction to articulate the ELR instrument.

7. The surgical robotic system of claim 5, wherein in the single controller mode one of the first hand controller or the second hand controller is articulated in a desired direction to articulate the ELR instrument.

8. The surgical robotic system of claim 5, wherein the controller is further configured to process the movement commands and provide haptic feedback through the first and second hand controllers.

9. The surgical robotic system of claim 8, wherein the haptic feedback provided is different at least in type or intensity based on type of the movement command.

10. The surgical robotic system of claim 1, wherein the controller supports position-to- position and position-to-velocity mapping for movement commands of the ELR instrument.

11. A method for controlling an endoluminal robotic (ELR) instrument using a surgical robotic system, the method comprising: displaying, on a display of a surgeon console, a video feed from a videoscope of the ELR instrument, the ELR instrument coupled to and controllable by a robotic arm; receiving 3D movement input from a first hand controller and a second hand controller of the surgeon console; receiving a foot pedal input from the surgeon console; processing, by a controller, the received 3D movement input to generate movement commands for the robotic arm and the ELR instrument; and switching, via the surgeon console, between a dual controller mode and a single controller mode,wherein in the dual controller mode the first and second hand controllers are used simultaneously to provide 3D movement input to control the ELR instrument, and wherein in the single controller mode one of the first hand controller or the second hand controller is used to provide 3D movement input to control the ELR instrument.

12. The method of claim 11, further comprising disengaging, via the foot pedal, the first and second hand controllers from controlling the robotic arm and the ELR instrument to allow repositioning of the first and second hand controllers without moving the robotic arm and the ELR instrument.

13. The method of claim 11, wherein the ELR instrument is a flexible, steerable instrument.

14. The method of claim 13, wherein receiving 3D movement input from each of the first and second hand controllers comprises detecting movement and rotation via a gimbal assembly associated with each controller in a coordinate system.

15. The method of claim 14, further comprising articulating the ELR instrument and moving the ELR instrument longitudinally in a forward direction or a backward direction in response to the movement input.

16. The method of claim 15, wherein in the dual controller mode, the first and second hand controllers are moved in tandem in the same direction to articulate the ELR instrument.

17. The method of claim 15, wherein in the single controller mode, one of the first hand controller or the second hand controller is articulated in a desired direction to articulate the ELR instrument.

18. The method of claim 15, further comprising providing, by the controller, haptic feedback through the first and second hand controllers based on the processed movement commands.

19. The method of claim 18, wherein the haptic feedback provided is different at least in type or intensity based on the type of the movement command.

20. The method of claim 11, further comprising applying position-to-position mapping or position-to-velocity mapping to the movement commands for controlling the ELR instrument.

Images