Modular posable patient cart for robotic surgical system

Abstract

A modular patient cart for a robotic surgical system includes first second and third modules. The first module includes a cart portion and a tower portion, wherein the cart portion is adapted and configured to translate over a horizontal surface and the tower portion extends upwardly from the cart portion to define a vertical elevation axis. The second module includes a central drive unit and a translation stage assembly defining a central drive axis. The third module includes a roll stage mechanism and a pitch stage mechanism, wherein the third module is adapted and configured to operatively connect the second module to the first module.

Description

MODULAR POSABLE PATIENT CART FOR ROBOTIC SURGICAL SYSTEMCROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority to and the benefit of U.S. Provisional Patent Application Numbers 63 / 677,557, 63 / 677,576, 63 / 677,614, and 63 / 677,648, each filed July 31, 2024. This application also claims priority to and the benefit of International Patent Applications PCT / US2025 / 027397 and PCT / US2025 / 027399, each filed May 1, 2025. The entire contents of each of the foregoing are incorporated herein by reference in their entirety.COPYRIGHT NOTICE

[0002] A portion of the disclosure of this patent document contains material which is subject to copyright protection. The copyright owner has no objection to the facsimile reproduction by any one of the patent disclosures, as it appears in the patent files or records of this Office, but otherwise reserves all copyright rights whatsoever.TECHNICAL FIELD

[0003] This disclosure is directed to surgical robotic systems and to related methods utilizing a flexible steerable overtube or access port, which are particularly suited for use in single-site and endoluminal surgical procedures. More particularly, this disclosure is directed to robotically assisted transoral, transesophageal, transumbilical, intragastric, transanal and transvaginal endoscopic surgical procedures, techniques, and treatments, sometimes referred to as Natural Orifice Transluminal Endoscopic Surgery (NOTES), as well as in Single Incision Laparoscopic Surgery (SILS), Single Port Access (SPA) surgery, Natural Orifice Trans-Umbilical Surgery (NOTUS), Laparo-Endoscopic Singlesite Surgery (LESS), One Port Umbilical Surgery (OPUS), Single Port Incisionless Conventional Equipment-utilizing Surgery (SPICES), Single Access Site Surgical Endoscope (SASSE) procedures. However, the subject systems, devices and methods are not limited to only these procedures.

[0004] The subject systems, devices and methods can also advantageously be applied to or utilized in various nonmedical fields, including manual or robotically-controlledboroscopy. Applications of the devices, systems and methods of the present disclosure may include but are not limited to industrial robots, remotely operated vehicles (such as in outer space or deep-sea, including oil and gas exploration). The devices, systems and methods of the present disclosure are particularly advantageous in fields where precise depth-perception and control for performing complex tasks in confined and / or difficult- to-reach structures is needed, such as within long conduits, or where access requires navigation around or through existing structures, including curved structures.BACKGROUND OF THE INVENTION

[0005] Surgical procedures such as endoluminal surgery and single-site laparoscopic surgery are known in the art and provide many benefits over traditional open or multiport laparoscopic surgical procedures. Endoluminal surgical procedures are performed endoscopically within hollow organs using typical surgical techniques, such as dissection, suturing, cutting, and stapling. These procedures may be performed trans-orally within the upper gastrointestinal (GI) tract, transanally within the lower GI tract, or transvaginally within the abdominal or pelvic cavity. Endoluminal surgery is beneficial in that no skin incision is required to gain access to the surgical site within a patient’s natural lumen. This can dramatically reduce patient recovery time and can improve procedural safety. Single-site or single-incision surgical procedures are typically performed within a patient’s abdominal cavity or thoracic cavity through a single incision. This too can reduce patient recovery time and trauma since multiple incisions are not required to access the patient’s abdominal or thoracic cavity and incisional location is more flexible. Single-incision abdominal surgical procedures are often performed through a patient's umbilicus or navel, also beneficially minimizing the visual appearance of any subsequent scarring.

[0006] Robotic surgical systems are also known in the art and have been used to perform both endoluminal and single-site surgical procedures. An example of such a system is disclosed, for example, in commonly assigned U.S. Patent 12,138,001, which is incorporated herein by reference in its entirety. This flexible robotic system includes a patient cart with a multi-axis positioning system and employs a steerable overtubeassembly having a plurality of working channels for introducing surgical devices to a surgical site. The overtube assembly is also described in detail in commonly assigned U.S. Patent 11,963,730, which is also incorporated herein by reference in its entirety. Exemplary surgical devices and end effectors or tools that can be introduced to a surgical site through a working channel of the steerable overtube assemblies are disclosed in commonly assigned U.S. Patent 12,186,007, the disclosure of which is incorporated herein by reference in its entirety.

[0007] Systems, devices and methods in accordance with the invention can incorporate or utilize aspects of devices, systems and methods disclosed in the following, each of which is incorporated herein by reference in its entirety: U.S. Patent Numbers: 12,064,196, 12,144,571, 11,504,144, 10,881,422, and 12,193,770; U.S. Patent Application Publication Numbers: 2024 / 0374325, 2025 / 0041011, 2023 / 0363842, 2023 / 0210621, 2023 / 0248450, 2025 / 0082393, 2023 / 0285099, 2025 / 0090255, 2024 / 0268907, 2023 / 0248457, 2023 / 0363847, 2025 / 0057610, 2023 / 0355221, 2025 / 0228637, 2025 / 0186757, and 2020 / 0107898; and Unpublished U.S. Patent Application Numbers: 18 / 596,171 filed March 5, 2024, 18 / 790,627 filed July 31, 2024, 63 / 751,912, 63 / 751,927, and 63 / 751,953 filed January 31, 2025, 63 / 798,435 filed May 1, 2025, and 63 / 804,414, filed May 12, 2025.

[0008] Applicant recognizes a need in the art to provide systems, devices and methods to provide improved surgical outcomes in robotically assisted endoluminal surgical procedures including, but not limited to, endoluminal submucosal dissection (ESD) procedures, endoluminal sleeve gastroplasty (ESG) procedures, bariatric endoluminal antral myotomy (BEAM) procedures, endoluminal sleeve gastroplasty with endoscopic myotomy (GEM) procedures, peroral endoluminal myotomy (POEM) procedures, trans- vaginal hysterectomy and oophorectomy procedures, and trans-oral endoluminal fundoplication procedures. The present disclosure provides systems, devices and methods that address these needs.SUMMARY OF THE INVENTION

[0009] The purposes and advantages of the below-described illustrated embodiments will be set forth in and apparent from the description that follows. Additional advantages of the illustrated embodiments will be realized and attained by the devices, systems and methods particularly pointed out in the written description and claims hereof, as well as from the appended drawings.

[0010] In accordance with the present invention, systems, devices, methods and computer program products, or computer software are provided for use in robotically- assisted surgical procedures.

[0011] In one aspect, the subject disclosure is directed to a new and useful patient cart for a robotic surgical system. The modular patient cart for a robotic surgical system comprises first, second and third modules. The first module includes a cart portion and a tower portion, wherein the cart portion is adapted and configured to translate over a horizontal surface and the tower portion extends upwardly from the cart portion to define a vertical elevation axis. The second module includes a central drive unit and a translation stage assembly defining a central drive axis. The third module includes a roll stage mechanism and a pitch stage mechanism, wherein the third module is adapted and configured to operatively connect the second module to the first module.

[0012] The second module can be mounted for movement along the vertical elevation axis of the tower portion. The central drive unit can be mounted for longitudinal translation relative to the translation stage assembly along the central drive axis. The roll stage mechanism can be adapted and configured to rotate the central drive unit about the central drive axis and the pitch stage mechanism is adapted and configured to rotate the central drive unit about a pitch axis that extends perpendicular to the central drive axis and the vertical elevation axis.

[0013] The central drive unit can have a pose for stowage and transport in which the central drive unit is rotated about a pitch axis and elevated on the elevation axis so it is recessed into the cart in a stowed position. The central drive unit can have a pose for performing trans-anal or trans-vaginal surgical procedures in which the central drive unit is elevated on the elevation axis to a minimum operating height above the horizontalsupport surface and rotated about a pitch axis so that the central drive axis extends parallel to the horizontal support surface. The central drive unit can have a pose for performing trans-oral or trans-umbilical surgical procedures in which the central drive unit is elevated on the elevation axis to a maximum operating height above the horizontal support surface and rotated about a pitch axis so that the central drive axis extends at an angle of 30 degrees relative to the horizontal support surface.

[0014] The modular patient cart can further comprise a wrap-around handle for gross positioning of the cart with side portions having vertical front sections to provide for differing handling heights and a rear portion that is slightly higher than the sides portions. The modular patient cart can further comprise an illuminated indicator for displaying a position of the central drive unit with respect to the elevation axis, the central drive axis or a pitch axis. The illuminated indicator can be adapted and configured for visibility through a transparent drape.

[0015] In accordance with another aspect, a posable patient cart for a robotic surgical system comprises a cart, tower and central drive unit. The cart is configured for transport over a horizontal support surface. The tower extends upwardly from the cart and defining a vertical elevation axis. The central drive unit defines a central drive axis, wherein the central drive unit is operatively connected to the tower and mounted for movement about a pitch axis extending perpendicular to the vertical elevation axis of the tower.

[0016] The central drive unit can have a first pose for stowage and transport in which the central drive unit is rotated about the pitch axis and elevated on the elevation axis so it is recessed into the cart in a stowed position. The central drive unit can have a second pose for performing trans-anal or trans-vaginal surgical procedures in which the central drive unit is elevated on the elevation axis to a minimum operating height above the horizontal support surface and rotated about the pitch axis so that the central drive axis extends parallel to the horizontal support surface. The central drive unit can have a third pose for performing trans-oral or trans-umbilical surgical procedures in which the central drive unit is elevated on the elevation axis to a maximum operating height above the horizontal support surface and rotated about the pitch axis so that the central drive axis extends at an angle of 30 degrees relative to the horizontal support surface.

[0017] In accordance with a further aspect, a robotic surgical system adapted and configured to perform a robotically assisted surgical procedure comprises a physician console, a patient cart and a system controller. The physician console comprises i) a plurality of hand control input devices adapted to receive 3-dimensional hand gesture inputs from an operator; and ii) a plurality of foot pedals configurable to perform system functions adapted to receive a foot pedal input from the operator. The patient cart is adapted and configured for bidirectional data communication with the physician console, having a spatially configurable supporting frame having a plurality of degrees of freedom and configured to support a central drive unit, the patient cart comprising: i) an axial translation actuator for actuating axial translation of the central drive unit along a central drive axis thereof; and ii) a roll actuator for actuating roll movement of the central drive unit about the central drive axis of thereof, the central drive unit comprising: i) a steerable overtube controller adapted and configured to operatively engage and actuate bidirectional steering of a steerable overtube in two degrees of freedom; ii) a plurality of instrument controllers adapted and configured to operatively engage and actuate each of a plurality of elongate flexible surgical instruments deployable through first and second working channels of the steerable overtube; and iii) a videoscope controller adapted and configured to operatively engage and actuate a videoscope deployable through a third working channel of the steerable overtube. The system controller is adapted and configured to receive a plurality of control inputs from each of the plurality of hand control input devices, to process the plurality of control inputs and to transmit a plurality of control outputs to each of the axial translation actuator, the roll actuator, the steerable overtube controller, the plurality of instrument controllers and the videoscope controller, the control outputs causing the system to position a steerable overtube assembly at a surgical site, wherein the steerable overtube assembly is configured for introducing and deploying from a distal end thereof one or more robotically controlled surgical instruments.

[0018] The patient cart can further comprise a pitch actuator for actuating pitch rotation of the central drive unit about a pitch axis. The patient cart can further comprise an elevate actuator for actuating elevation of the central drive unit along an elevation axis.The patient cart can comprise: a) a first module including a cart portion and a tower portion, wherein the cart portion is adapted and configured to translate over a horizontal surface and the tower portion extends upwardly from the cart portion to define a vertical elevation axis; b) a second module including the central drive unit and a translation stage assembly defining the central drive axis of the central drive unit; and c) a third module including a roll stage mechanism and a pitch stage mechanism, wherein the third module is adapted and configured to operatively connect the second module to the first module. The third module can be mounted for movement along the vertical elevation axis of the tower portion of the first module. The second module can be mounted to the third module. The central drive unit can be mounted for longitudinal translation relative to the translation stage assembly along the central drive axis. The roll stage mechanism can be adapted and configured to rotate the central drive unit about the central drive axis and the pitch stage mechanism is adapted and configured to rotate the central drive unit about a pitch axis that extends perpendicularly to the central drive axis and the vertical elevation axis.

[0019] In accordance with yet another aspect, a method of positioning a steerable overtube to provide surgical access for a robotic surgical instrument to a surgical site comprises: a) instructing a first actuator to change a position of a central drive unit with respect to a vertical elevation axis; b) instructing a second actuator to change a position of the central drive unit along a central drive axis; c) instructing a third actuator to change a position of the central drive unit about the central drive axis; and d) instructing a fourth actuator to change a position of the central drive unit about a pitch axis. The pitch axis can be perpendicular to both the elevation axis and the central drive axis.

[0020] In accordance with a further aspect, a computer program product adapted and configured to enable a robotically assisted surgical procedure comprises computer- readable program code capable of being executed by one or more processors when retrieved from a non-transitory computer-readable medium, the program code comprising instructions configurable to effect actuation of: a) a first actuator to position of a central drive unit with respect to a vertical elevation axis; b) a second actuator to position of the central drive unit along a central drive axis; c) a third actuator to position of the centraldrive unit about the central drive axis; and d) a fourth actuator to position of the central drive unit about a pitch axis, the central drive unit supporting a steerable overtube assembly at a surgical site, wherein the steerable overtube assembly is configured for introducing and deploying from a distal end thereof one or more robotically controlled surgical instruments.

[0021] All optional features described above and below can be additionally included with the subject systems, devices, methods, and program code, and elements described in connection with one embodiment can advantageously be incorporated into other embodiments.

[0022] These and other features of the modular patient cart of the subject disclosure will become more readily apparent to those having ordinary skill in the art to which the subject invention appertains from the detailed description of the preferred embodiments taken in conjunction with the following brief description of the drawings.BRIEF DESCRIPTION OF DRAWINGS

[0023] So that those skilled in the art to which the subject disclosure appertains will readily understand how to make and use the devices, systems and methods of the subject disclosure without undue experimentation, embodiments thereof will be described in detail herein below with reference to certain figures, wherein:

[0024] Fig. 1 is a schematic plan view of an example embodiment of a robotic surgical system in accordance with the invention;

[0025] Fig. 2A is an isometric view of an example embodiment of a physician console of robotic surgical systems in accordance with the invention;

[0026] Figs. 2B & 2C are detail views of a hand control device for use in controlling surgical instruments, overtube and videoscope of the subject invention;

[0027] Fig. 3 is an isometric view of an example embodiment of a posable patient cart of robotic surgical systems in accordance with the invention;

[0028] Fig. 4A illustrates an example embodiment of a central drive unit in accordance with the invention, including instrument controllers, a videoscope controller and an overtube controller, illustrated with a protective casing;

[0029] Fig. 4B is an isometric view of an example embodiment of an instrument controller in accordance with the present invention illustrated with a drape adapter attached thereto;

[0030] Fig. 4C is an isometric view of an example embodiment of a robotic overtube controller for a steerable overtube, in accordance with the present invention;

[0031] Fig. 5 A is an isometric view of an example embodiment of a steerable overtube of robotic surgical systems in accordance with the invention in a straight or neutral conformation;

[0032] Fig. 5B is an isometric view illustrating the steerable overtube of Fig. 5 A showing a bent steerable distal end;

[0033] Fig. 5C is a cross-sectional view of a shaft of the steerable overtube of Fig. 5A illustrating working channels and other construction features;

[0034] Fig. 5D is a bottom view of a hub portion of the steerable overtube of Fig. 5 A;

[0035] Fig. 6A is an isometric view of the instrument controller of Fig. 4B, illustrated aligned with flexible robotically-controlled surgical instrument in accordance with the invention (instrument shown in partial cutaway view exposing an internal force-reversal mechanism);

[0036] Fig. 6B is a cutaway side view of a robotically-controlled surgical instrument of Fig. 6A, illustrating force reversal mechanisms in a neutral state;

[0037] Fig. 6C is a cutaway side view of the robotically-controlled surgical instrument of Fig. 6A illustrating force reversal mechanisms in flexed state of second (wrist) joint;

[0038] Fig. 6D is a detailed cutaway side view of the robotically-controlled surgical instrument of Fig. 6A illustrating a force reversal mechanism in a force-applied state;

[0039] Fig. 6E is a side view illustrating a variety of end effectors for robotically controlled surgical instruments in accordance with the invention;

[0040] Fig. 7 is a distal isometric view of a distal end portion of a steerable overtube in accordance with the invention, including a plurality of instruments extending through the distal end of working channels thereof, as well as a videoscope deployed therefrom;

[0041] Fig. 8 is a block diagram illustrating example control flow between a surgeon console and an instrument in accordance with the systems of the present invention;

[0042] Fig. 9 is a perspective view of the posable patient cart of Fig. 3, with the three modules thereof separated from one another for ease of illustration, including the cart and tower module, the central drive unit module, and the roll and pitch module;

[0043] Fig. 10 is an illustration of the modular patient cart shown in Figs. 3, illustrating the axes of motion associated with each of the three modules thereof;

[0044] Fig. 11 is a rear perspective view of the posable patient cart of Fig. 3;

[0045] Fig. 12A is a side elevational view illustrating various poses of which the posable patient cart is capable, in order to provide surgical access to a patient's anatomy;

[0046] Fig. 12B is an annotated illustration showing an example range of motion of the posable patient cart and the central drive unit thereof;

[0047] Fig. 13 is a perspective view of the posable patient cart of the subject disclosure, with the central drive unit disposed in a recessed position for stowage and transport;

[0048] Fig. 14 is a side elevational view of the posable patient cart as shown in Fig. 13;

[0049] Fig. 15 is a side elevational view of the posable patient cart with the central drive unit disposed in a position for performing trans-anal or trans- vaginal surgical procedures;

[0050] Fig. 16 is a perspective view of the posable patient cart as shown in Fig. 15;

[0051] Fig. 17 is a side elevational view of the posable patient cart with the central drive unit disposed in a position for performing trans-oral or trans-umbilical surgical procedures;

[0052] Fig. 18 is a perspective view of the posable patient cart as shown in Fig. 17;

[0053] Fig. 19 is a perspective view of the cart and tower module of the patient cart shown in Figs. 3 and 9, with the exterior cladding removed for ease of illustration;

[0054] Fig. 20 is an exploded perspective view of the cart and tower module shown inFig. 19, with parts separated for ease of illustration;

[0055] Fig. 21 is a perspective view of the cart portion of the cart and tower module, illustrating the castors and the brake assembly;

[0056] Fig. 21A illustrates three different operational modes of the castor and brake assembly;

[0057] Fig. 21B is a diagram illustrating multiple modes of the castors and brake assembly;

[0058] Fig. 22 is a partial perspective view of the tower portion of the cart and tower module, illustrating portions of the elevation mechanism;

[0059] Fig. 23 is a perspective view of the tower portion showing features of the elevation mechanism;

[0060] Fig. 24A is a perspective view of components of the elevation mechanism shown in Fig. 22;

[0061] Fig. 24B is a perspective view of the bottom of the tower portion showing the lift motor housing;

[0062] Fig. 25 is a perspective view of the bottom of the patient cart showing an access hatch for servicing the elevation mechanism;

[0063] Fig. 26 is a perspective view of the roll and pitch module of the patient cart of Fig. 3;

[0064] Fig. 27 is a perspective view of the roll and pitch module shown in Fig. 3, with the outer cladding removed for ease of illustration;

[0065] Fig. 28 is a front perspective view of the pitch stage mechanism of the roll and pitch module of the subject disclosure;

[0066] Fig. 29 is a rear perspective view of the pitch stage mechanism of the roll and pitch module of the subject disclosure;

[0067] Fig. 30 is a front perspective view of the roll stage mechanism of the roll and pitch module of the subject disclosure;

[0068] Fig. 31 is a rear perspective view of the roll stage mechanism of the roll and pitch module of the subject disclosure;

[0069] Fig. 32 is a rear elevational view of the roll stage mechanism of the roll and pitch module of the subject disclosure;

[0070] Fig. 33 is a detail perspective view of a distal portion of the central drive unit of Fig. 4A, including an overtube support arm of the patient cart shown in Fig. 1 ;

[0071] Fig. 34 is a detail view of the user interface panel on the overtube support arm of the central drive unit shown in Figs. 4A & 33;

[0072] Fig. 35 is a perspective view of the central drive unit and translation module of the subject disclosure with the outer cladding removed for ease of illustration, as viewed from the distal end thereof;

[0073] Fig. 36 is a perspective view of the central drive unit and translation module of the subject disclosure with the outer cladding removed for ease of illustration, as viewed from the proximal end thereof;

[0074] Fig. 37 is a side elevational view of the central drive unit and translation module of the subject disclosure, with the drive beam in a fully extended position;

[0075] Fig. 38 is a perspective view of the chassis of the central drive unit, with the three instrument controllers removed for ease of illustration;

[0076] Fig. 39 is a perspective view of the elongated drive beam of the central drive unit and translation module of the subject disclosure, separated from the chassis of the central drive unit;

[0077] Fig. 40 is a cross-sectional view of the drive beam shown in Fig. 39 illustrating the internal components of the translation mechanism;

[0078] Fig. 41 is a cross-sectional view of the distal end portion of the drive beam shown with the top plate of the translation mechanism, which connects to the chassis and translates relative to the carriage by way of the motor driven linear drive screw;

[0079] Fig. 42 is a perspective view of the distal end portion of the drive beam shown in Fig. 41 with the top plate of the translation mechanism advanced to its distal-most position;

[0080] Fig. 43 is a side elevational view of the distal end portion of the drive beam, corresponding to Figs. 41 and 42;

[0081] Fig. 44 is a rear end elevational view of the translation mechanism, viewed in a distal direction;

[0082] Fig. 45 is a localized side cross-sectional view of the distal end portion of the central drive unit and translation module of the subject disclosure illustrating the connection between the chassis of the central drive unit and the top plate of the translation mechanism;

[0083] Figs. 46 and 47 illustrate cable management features of the main drive beam;

[0084] Fig. 48 is a user interface screen for facilitating joint control in positioning the patient cart of Fig. 3;

[0085] Fig. 49 is a user interface screen for controlling stowage and deployment of the patient cart of Fig. 3; and

[0086] Fig. 50 is a user interface screen for facilitating configuration control of the patient cart of Fig. 3.DETAILED DESCRIPTION OF THE INVENTION

[0087] Reference will now be made to the drawings wherein like reference numerals identify similar structural features or aspects of the subject disclosure.

[0088] Robotic Surgical Systems

[0089] For purposes of explanation and illustration, and not limitation, a schematic diagram of an exemplary embodiment of a robotic surgical system 100 in accordance with the invention is illustrated in Figure 1, along with certain ancillary devices, as will be described below. The system 100 includes a patient cart 110 with a steerable overtube 140 attached thereto, and a physician console 120. The physician console 120 includes two hand control devices 121a, 121b, one or more foot controls 123, 124 such as foot pedals and a display screen 125. A patient bed 180 and one or more optional ancillary equipment carts, such as vision tower 190 are also illustrated.

[0090] In accordance with the illustrated embodiment, a system cable 1 is provided to connect and facilitate data transfer between the physician console 120 and patient cart 110, while electrical power is provided separately by respective power cables 10 and 6. The system cable 1 enables bidirectional communication by transferring control signals to and from the patient cart 110 and video data to the physician console, as well as other feedback signals, including position feedback signals of system components, and status and error messages. One or more video cable(s) 2 can be provided for one or more accessory display(s), if desired. Image data is transferred from a videoscope (726, Fig. 7) by videoscope cable 7 to the patient cart 110 for encoding and transmission to thephysician console 120. A camera control unit can also be provided if needed to support operation of the videoscope and signal transmission therefrom.

[0091] Ancillary surgical equipment can be provided, including a vision tower 190, which may include components such as a surgical insufflator 3 and an electrosurgical unit 4. The surgical insufflator 3 may interface with one or more ports on the steerable overtube 140 via insufflation tubing 8. The electrosurgical unit 4 connects to robotic electrosurgical instruments through appropriate cabling, respectively and can be controlled via an energy activation cable 5 to the patient cart 110 for pass-through control from the physician console 120. The electrosurgical unit 4 also connects to a robotic electrosurgical instrument via an instrument cable 9. Additional items, including anesthesia equipment 11 and one or more sterile tables 12 can be provided. The sterile table(s) 12 can hold accessories, components or instruments for the subject system 100 needed during a procedure, as well as other supplies.

[0092] Additionally illustrated are a physician or operator 21 (which terms are used interchangeably herein) seated at the physician console 120, an assistant 22 (e.g., a sterile assistant tasked primarily with monitoring the patient cart 110, handling accessories, and removing or installing instruments, as needed), and a circulating assistant 23. Further medical professionals, such as an anesthesiologist, can also be present and interact with the system 100.

[0093] Physician Console and Patient Cart

[0094] With reference now to Figure 2A, an isometric view of an example embodiment of a physician console 120 is shown, including the hand control devices 121a, 121b, a display screen 125, and foot controls 123, 124, and 126. The foot controls 123, 124 and 126 (e.g., foot pedals) are provided for control of system functions, including selecting system components to be controlled by the respective hand control devices 121a, 121b, and / or for control of ancillary equipment, such as the electrosurgical unit 4.

[0095] Figures 2B and 2C illustrate detailed views of the hand control devices 121a, 121b for the physician console 120. An operator or physician e.g., surgeon) uses the hand control devices 121a, 121b of the physician console 120 to control various aspectsof the system, including a manipulate videoscope, surgical instruments, and a steerable overtube 140. The steerable overtube 140 is a flexible access port through which robotic surgical instruments and the videoscope of the subject systems pass to reach a surgical site, and which will be described in more detail below. A physician 21 or operator grips handle portions 226 of each of the left and right hand control devices 121a, 121b. The handle portions 226 include finger grip controls 229 which pivot with respect to a body of the handle portion 226. Under normal operation, the finger grip controls 229 control operation of end effectors of corresponding surgical instruments. A finger clutch button 227 is also provided, which allows a user to temporarily disengage the functionality of the respective hand control device to allow repositioning of the hand control devices 121a, 121b, without causing movement of a corresponding instrument itself. The handle portions 226 are rotatable about their own axes, which movement during normal operation causes rotation of a corresponding surgical instrument about its own axis. The handle portions 226 are translatable and in 3 dimensions — vertically (up, down), laterally (left, right), forward (distally), backward (proximally), or combinations thereof. The handle portions 226 are also bendable vertically (e.g., about the y-axis) and laterally (e.g., about the z-axis), and rotatable about their own axis 228. These movements are interpreted by the subject systems as corresponding movements of surgical instruments or other system components, such as the steerable overtube or videoscope, depending on the mode selected, and as will be described in further detail below. In some embodiments, the subject system can include a mode selection mechanism that allows the physician to toggle between different control targets, such as surgical instruments, the steerable overtube 140, and the videoscope 726. Mode switching can be accomplished via dedicated buttons or foot controls, enabling intuitive hands-free operation. Upon mode selection, the system can reconfigure input interpretation from the hand control devices 121a, 121b to control the selected subsystem. For example, in "videoscope mode," hand controller movements are interpreted as camera orientation commands, whereas in "instrument mode," the same motions control the associated instruments and end effectors. Visual or auditory feedback may be provided to confirm mode transitions.

[0096] Figure 3 is an isometric view of an example embodiment of a patient cart 110 of robotic surgical systems in accordance with the invention. Among various features, the patient cart 110 can house one or more controllers, such as a system controller 150 for coordinating all the functions of the system, including receipt of instructions, signal processing and commanding actuators to operate. System controller functions can be distributed across multiple controllers housed respectively in different components, including in the physician console 120. The patient cart 110 is positionable and adjustable in three-dimensions to enable orientation suitable for the particular access route for the surgery being performed. For example, a transesophageal approach requires a position slightly above the patient, and angled downwardly, while other surgical approaches require different positioning of the patient cart 110. Such positions will be described in further detail below in connection with Figures 1 A-18.

[0097] With reference to Figure 3, a steerable overtube axis 396 is defined by the steerable overtube 140, and thus also with respect to the central drive unit 313. The steerable overtube 140 is connectable to a robotic overtube controller 170, and thus is translatable along the steerable overtube axis 396 through motorized adjustment of a translation stage 385. The steerable overtube 140 is also rotatable about the same axis 396 through adjustment of a motorized roll joint or mechanism 386. A vertical axis 398 is defined through the patient cart 110. Vertical translation along the vertical axis 398 is effected through adjustment of a motorized elevation stage 382, while rotation about the vertical axis 398 is effected through adjustment of the cart base 380 by casters 381, or alternatively with a motorized yaw joint (not included in the illustrated embodiment). Pitch adjustment about pitch axis 393 is effected through adjustment of a motorized pitch joint mechanism 384. Further horizontal adjustments can also be made by movement of the cart base 380 and therefore the entire patient cart 110. Such movements can include motorized assistance or be purely manual.

[0098] The patient cart 110 can include various user interfaces to provide information to and / or to receive input from a user or operator. Certain interfaces are graphical, and displayed on a screen, as will be described in further detail below, while others include other visual, tactile and / or auditory interfaces for a user.

[0099] Central Drive Unit

[0100] Figure 4 A illustrates an example embodiment of a central drive unit 313 in accordance with the invention. The central drive unit 313 includes instrument controllers 420, which can receive sanitary drape adapters (e.g., 424, Fig. 4B) prior to attachment of an instrument. Also illustrated is a videoscope controller 430, which can also receive a sanitary drape adapter prior to attachment of a videoscope. Such drape adapters (e.g., 424) are detachable from their respective controllers to facilitate sterilization and the placement of draping materials over the central drive unit 313. An overtube arm 480 extends distally from the central drive unit 313 and provides a point to attach the steerable overtube 140, thereby enabling control of its robotic steering functions. The robotic steering functions are accomplished through actuators of an overtube controller 170 housed in the overtube arm 480. In certain embodiments, the overtube arm 480 is static relative to the central drive unit 313. Rotation, translation and other spatial positioning thereof can therefore be accomplished by movement of the entire central drive unit 313.

[0101] The overtube arm 480, along with its corresponding robotic controller 170, serves as the attachment interface and driver of bending or flexural motion of the overtube 140. The flexural motion is controlled by the physician or operator at the physician console 120 with two degrees of freedom (left / right and up / down) via the system controller 150 and robotic overtube controller 170. Docking of the overtube 140 to the overtube controller is achieved by aligning and engaging the overtube hub 510 (the proximal control end and connection interface, Fig. 5A) with the overtube controller 170. When the overtube 140 engages with the overtube controller 170, the user may observe feedback, such as a change in visual indicator 375 on the overtube arm 480 to a green color for confirmation of complete connection, in certain embodiments. A sterile drape adapter can be interposed between the overtube controller 170 and the hub 510, in certain embodiments.

[0102] The central drive unit 313 can include various additional user interfaces to provide information to and / or to receive input from a user or operator, which are described in further detail below.

[0103] Instrument Controllers and Videoscope Controller

[0104] Figure 4B is an isometric view of one example of an instrument controller 420 in accordance with the present invention. The instrument controller includes a plurality of linear actuators 454, each corresponding to a respective pushing coupling 474. However, for simplicity, only one linear actuator 454 is illustrated. A drape adapter 424 is also illustrated on the distal end of the instrument controller 420, interfacing between the instrument controller 420 and an instrument, allowing for mechanical passthrough of linear driving force of each of the linear actuators while maintaining a sterile barrier by being removable and sterilizable, and adapted and configured to secure a sterile drape to the central drive unit 313.

[0105] Each of the plurality of linear actuators 454 (by way of the pushing couplings 474 of the drape adapter 424, if so embodied) actuates respective pushing actuators 601 of a reverse motion mechanism 609 of a transmission system 600 of a respective surgical instrument 690 (e.g., Fig. 6D). Such linear actuators 454 can include lead screw mechanisms or other linear motion devices.

[0106] In accordance with one example, individual linear actuators 454 are arranged in connection with a supportive structure and / or housing 456 to actuate respective reverse motion mechanisms 609 and corresponding control wires 603 coupled to instrument bending joints 673, 675 or an end effector 671 (e.g., Figs. 6B-6D). In one example embodiment, each linear actuator 454 includes a lead screw housing, a motor, a threaded shaft, and a connecting bracket. The lead screw housing is physically connected to the supportive structure or housing 456, grounding it against rotation and axial movement. The connecting bracket has a first connector portion and may include other ancillary components. The first connector portion can also have internal threads into which the threaded shaft extends. An extension member can be provided and can extend distally therefrom in a direction away from a corresponding motor. Thus, linear pushing force isoutput from each linear actuator 454 through pushing couplings 474 to respective pushing actuators 601 of a reverse motion mechanism 609 of an instrument 690. As illustrated, ten linear push couplings 474 are provided on the drape adapter 424, corresponding respectively to ten linear actuators 454. Each actuator 454 is adapted to impart pushing force on a respective pushing actuator 601 of a corresponding reverse motion mechanism 600 (e.g., Fig. 6D), and is controlled to do so in response to system commands generated by the system controller 150.

[0107] Additionally, the instrument controller 420 imparts axial translation 410 and rotation 402, 404 about a central axis 444 on instruments (e.g., 690) by way of additional, respective actuators. Such actuators move the linear actuators 454, the drape adapter 424 and instruments (e.g., 690) in unison when controlled to do so in response to system commands generated by the system controller 150.

[0108] Similarly to the instrument controller 420, the videoscope controller 430 includes a plurality of individual linear actuators (e.g., 454) dedicated respectively to actuate individual reverse motion mechanisms (e.g., 609) and corresponding control wires (e.g., 603), coupled to videoscope bending joints. With reference to Figure 7, the videoscope 726 can be embodied to include two degrees of freedom in bending, as well as freedom in axial translation, imparted by the videoscope controller 430. The bending allows the videoscope 726 to deploy from its respective channel and extend radially outward, and away from a central axis to illuminate and provide a wider viewing angle of the operative site with improved perspective. In the illustrated embodiment, each of the two bending sections of the videoscope 726 utilizes two control wires, two respective reverse motion mechanisms and two linear actuators 454, requiring a total of four linear actuators and other corresponding components. In an alternate embodiment, additional degrees of freedom in bending can be provided to the videoscope (as with the instruments), requiring additional linear actuators 454, reverse motion mechanisms 609 and control wires 603. The subject systems can be embodied to provide a videoscope controller 430 mechanically identical to the instrument controllers but configured to actuate only the required linear actuators 454, allowing adaptation to interface with a third surgicalinstrument (e.g., 690), in place of a videoscope, providing visualization by alternative means, as through a separate endoscope.

[0109] As with the instrument controller 420, the videoscope controller 430 imparts axial translation on the videoscope (e.g., 726) via respective actuators. Such actuators move the linear actuators 454, any drape adapter and the videoscope in unison, when controlled to do so in response to system commands generated by the system controller 150.

[0110] In one embodiment, movements of the videoscope 726 are controlled by a physician or operator through one or both hand control devices 121a, 121b. In accordance with one embodiment, the movements of the videoscope 726 are controlled by the right hand control device 121b following activation of a mode control switch. For example, the right hand control device 121b can control the movements of the videoscope 726 following activation of a mode control switch. In one embodiment, this switch can be provided among the foot pedals 123 of the physician console 120, or elsewhere on the physician console 120, and can be included in a GUI thereof.

[0111] Steerable Overtube Controller

[0112] Figure 4C is a detailed view illustrating the overtube arm 480 including the robotic overtube controller 170, which is embodied as a component of the central drive unit 313, in accordance with an exemplary aspect of the present invention. The robotic overtube controller 170 is adapted and configured to engage and robotically steer the steerable overtube 140 in response to system commands generated by the system controller 150. A sterile drape adapter (not shown), along with a drape material affixed thereto can be provided to ensure a sterile operating environment. The robotic overtube controller 170 includes a plurality of couplers or “drive dogs” 484a, 484b for securely engaging an interfacing portion of the steerable overtube 140. The drive dogs 484a, 484b are operably connected to and driven by respective mechanical actuators housed within the overtube controller 170. The actuators, in turn, receive instructions from the physician console 120 via one or more controllers, such as system controller 150. In one embodiment, the actuators for the drive dogs 484a, 484b can be servomotors or alternative actuators that allow for precise control. The drive dogs 484a, 484b interfacewith first and second robotic actuator interfaces 584a, 584b provided on the hub 510 (Fig.5D). In this manner, actuators within the robotic overtube controller 170 become operably connected to mechanical steering portions of the steerable overtube 140.

[0113] Steerable Overtube

[0114] With reference to Figure 5 A, an isometric view of the steerable overtube 140 of the subject robotic surgical systems is illustrated. The steerable overtube 140 includes a hub 510 for interfacing the steerable overtube 140 with a patient cart 110 of a robotic surgical system 100. The hub 510 also provides access to working channels (e.g., for inserting instruments and other accessories). The steerable overtube 140 includes manual control handles 511 for operating the bending of the steerable portion 541 thereof when not engaged with the patient cart 110. As illustrated in this exemplary embodiment, a flexible portion 543 is provided between the hub 510 at the proximal end portion of the steerable overtube 140 and the distal end of the steerable portion 541 thereof.

[0115] In accordance with the illustrated embodiment, the hub 510 includes multiple ports for introducing or connecting surgical instruments and other functional surgical devices, such as insufflation, irrigation, suction, smoke removal equipment, introduction and / or removal of suture material and needles, specimen retrieval tools, and the like. On its lower surface, various functional features are included for engaging with a robotic overtube controller 170 (which will be described in more detail below in connection with subsequent figures). Among these features are first and second robotic actuator interfaces 584a, 584b for engaging corresponding drive dogs 484a, 484b of the robotic overtube controller 170.

[0116] As illustrated, the steerable overtube 140 is steerable in two planes (e.g., pitch (up / down plane) and yaw (left / right plane), and combination of motion in these planes). A manual actuator 511 is provided in the illustrated embodiment and includes coaxial dual knob manual control. The first and second robotic actuator interfaces 584a, 584b are configured to mate with drive dogs 484a, 484b of the overtube controller 170 of the patient cart 110, thereby enabling both manual and robotic steering control. The hub 510 includes access channels connected to each working channel 591a, 591b, 592, 593a,593b, 595 (Fig. 5C) for inserting instruments, materials or supplies. Figure 5B illustrates a distal end portion of the steerable overtube 140 in a flexed state, bent toward the left (in x-y plane) by angle (p (phi). Although illustrated as approximately a 90-degree bend, it is to be understood that the distal steerable portion 541 of the steerable overtube 140 can bend up, down, left, right or combinations of such bends to a degree up to and beyond 180-degrees.

[0117] With reference to Figure 5C, a cross-sectional view of a flexible shaft 543 of the steerable overtube of Fig. 5 A illustrates various working channels, including primary instrument channels 591a, 591b. All working channels can advantageously be used for more than one function. For example, the primary instrument channels 591a, 591b accommodate robotically controlled surgical instruments (e.g., 690, Fig. 6A) or manual instruments, and can be repurposed for specimen retrieval. A videoscope channel 592, located in an upper middle portion of the steerable overtube 140, supports a videoscope (e.g., videoscope 726, Fig. 7), which similarly can be repurposed for manual instruments, additional robotic instruments, or for other purposes. Additionally, insufflation channels 593a, 593b are provided to permit fluid communication between the insufflator 3 (Fig. 1) and the operative space. One or more channels support irrigation, suction and / or smoke removal, if desired. An accessory channel 595 is also provided, which can permit introduction of additional surgical instruments or materials (e.g., needle, suture material) while the primary instrument channels 591a, 591b are utilized, typically each by robotic surgical instruments 690.

[0118] With reference to Figure 5C, a cross-sectional view illustrates control wires 594a, 594b, 594c, 594d operably connected between the distal steerable portion 541 and the steering mechanism in the hub 510. The steering mechanism applies tension to the control wires 594a-d to manipulate the steerable portion 541. In accordance with a preferred embodiment, the steering mechanism is operable both manually through handles 511 and through the robotic actuator interfaces 584a, 584b, best seen in the bottom view of Figure 5D. In that manner, robotic control of overtube bending can be initiated at the physician console 120, with commands processed by the controller 150 and sent to the overtube controller 170.

[0119] Robotic Assisted Control

[0120] Gross Positioning

[0121] Gross positioning of the steerable overtube 140 is accomplished by moving the patient cart 110 itself, as well as through adjustments of its integrated components that support and position the central drive unit 313. In contrast, fine bending adjustments of the distal end portion of the steerable overtube 140 are accomplished through actuation of the overtube controller 170, which interfaces with the steering mechanism of the steerable overtube 140. In one embodiment, the steerable overtube 140 is first manually advanced to a surgical site, under visual guidance (using manual knobs 511), and docked with the overtube controller 170 when at or near the surgical site. Compatible surgical instruments, as will be described in more detail below, are adapted and configured to extend through working channels of the steerable overtube 140. Therefore, gross positioning (including translation, rotation and bending) of the distal end portions of the surgical instruments can be achieved by positioning the distal end of the steerable overtube 140. Fine control of instruments (such as axial and radial translation, rotation, actuation of bending joints, and actuation of end effector) is controlled by the respective instrument controller 420, or in the case of a videoscope 726, by the videoscope controller 430.

[0122] Scaling

[0123] In all cases of gross and fine movement control of system components, the system controller 150 processes control signals to determine the scaling of control input to actuator output. This scaling can be preprogrammed, and / or input or adjusted by the physician. For example, a 1 : 1 scaling ratio provides a direct correlation between operator input and instrument movement. In this mode, the full mechanical range of the hand control devices 121a, 121b maps to the complete operational range of each degree of freedom, such as joint bending, translation, rotation, and end effector movement. To reduce operator fatigue, the ratio can be increased (e.g., 1:2), so that one unit ofmovement from the hand controller 121a, 121b is amplified into more (e.g., 2) units of movement at the instrument. Conversely, for finer control, the ratio can be decreased (e.g., 2:1), meaning two units of movement from the hand controller 121a, 121b are scaled down to fewer (e.g., 1) units of movement at the instrument. Scaling ratios can be globally selected or independently selected for each degree of freedom. For example, rotational scaling can be increased to reduce stress on an operator's wrist, while maintaining or reducing scaling for other functions, such as lateral movement to enhance precision when required or desired.

[0124] Patient Cart Positioning

[0125] With reference to Fig. 3, the patient cart 110 is spatially positioned and adjusted so that the central drive unit 313 is in a location to facilitate engagement of the hub 510 of the steerable overtube 140 with the robotic overtube controller 170. This occurs after initial placement of the steerable overtube 140 under manual control. The illustrated embodiment of a patient cart 110 includes multiple degrees of freedom to permit flexibility in positioning. Horizontal positioning, yaw, elevation, pitch, axial translation, and roll can all be adjusted through positioning of the patient cart 110, by movement of the patient cart base 380 and by adjustment of positioning actuators thereof.

[0126] In accordance with certain embodiments, during a procedure, rotation about and axial translation along the overtube axis 396 can be controlled from the physician console 120. Accordingly, a translation stage (e.g., 385) actuator and roll joint (e.g., 386) actuator will be operable from the physician console 120 and effect corresponding movements of the entire steerable overtube 140, videoscope, any surgical instruments inserted therethrough, and the corresponding instrument controllers 420 and videoscope controller 430. Optionally, movements of other joints of the patient cart 110, 310 can be entirely blocked by the controller 150, such as when attachment of a steerable overtube 140 to the overtube controller 170 is detected.

[0127] Insertion of Overtube and Docking

[0128] In accordance with one aspect of the invention, during use, the steerable overtube 140 is manually navigated to an operative site (or a "working site" in non-medical applications) using manual control handles 511 to operate the steerable portion 541 of the steerable overtube 140. The steerable overtube 140 is advanced under visualization with the videoscope 726 or separate endoscope, for example. Once the distal portion of the steerable overtube 140 is positioned at the operative site, the hub 510 is connected to the robotic overtube controller 170, allowing the surgical procedure to continue under robotic control. One or more surgical instruments are inserted through the steerable overtube 140 and can be removed or exchanged during a procedure.

[0129] In accordance with one aspect of the invention, the first and second robotic actuator interface portions 584a, 584b of the hub 510 of the steerable overtube 140 are directly connected to the manual control handles 511 of the hub 510. They are also connected through the internal mechanism thereof to the steering elements of the steerable overtube 140, such as control wires (e.g., 594a-594d).

[0130] Overtube Positioning

[0131] Following the above-described engagement, the steerable overtube 140 can be used under robotic control of the system 100 by way of the robotic overtube controller 170. More specifically, flexural motions e.g., up, down, left, right) of the steerable portion 541 are controlled by the robotic overtube controller 170. Translational movements (along overtube axis 396) and roll movements (about overtube axis 396) are facilitated by corresponding actuated joints of the patient cart 110, as described above. In certain embodiments, the robotic overtube controller 170, to which the steerable overtube 140 is securely engaged, is translated, or rotated in its entirety to effect translation or roll movements of the steerable overtube 140. In certain embodiments, all instrument controllers 420 and videoscope controller 430 rotate or translate in unison, as enabled by the patient cart 110.

[0132] In accordance with one embodiment, movements of the steerable overtube 140 are controlled by a physician or operator through one or both hand control devices 121a,121b. In one embodiment, the left hand control device 1 1a controls the movements of the steerable overtube 140 following activation of a mode control switch. This overtube control switch mode can be a foot control (such as foot pedals) provided among the other foot controls 123 and 124 of the physician console 120.

[0133] In accordance with the illustrated embodiment, the foot control 126 for overtube control mode switch is depressed, and movements of a hand control device 121a, 121b {e.g., left hand control device 121a) are received by the system controller 150, processed and then output to respective actuators of the system 100 to effect the commanded movements. In one embodiment, forward (distal) or backward (proximal) movements of the hand control device 121a, 121b are interpreted by the controller 150 as axial translation commands. In one embodiment, rotation movements of the hand control device 121a, 121b are interpreted by the controller 150 as roll commands. In one embodiment, lateral (sideways - left / right) translation motions of the hand control device 121a, 121b are interpreted by the controller 150 as left / right flexural commands. Alternatively, in one embodiment, lateral (sideways- left / right) bending motions of the hand control device 121a, 121b e.g., by flexion / extension of a user's wrist) are interpreted by the controller 150 as lateral (left / right) flexural commands. In one embodiment, vertical translation motions (up / down) of the hand control device 121a, 121b are interpreted by the controller 150 as up / down flexural commands. Alternatively, in one embodiment, vertical bending motions (up / down) of the hand control device 121a, 121b are interpreted by the controller 150 as up / down flexural commands.

[0134] Upon receipt of a flexural command from the hand control device 121a, 121b, the controller 150 determines the corresponding actuator action. The controller 150 then commands the actuator operably connected to the drive dogs 484a, 484b to rotate either clockwise or counterclockwise. This in turn rotates the corresponding engagement portion 584a, 584b of the hub 510 of the steerable overtube 140. Each engagement portion operates a mechanism corresponding to one of lateral (left / right) or vertical (up / down) flexural motion. Such mechanisms are configured to apply tension to control wires corresponding to their respective movements, such as by g asymmetric tension to a bending joint. A first engagement portion e.g., 584a) and corresponding drive dog {e.g.,484a) therefore operate one of lateral (left / right) bending and vertical (up / down) bending, while a second engagement portion (e.g., 584b) and corresponding drive dog (e.g., 484b) operate bending in the remaining direction or plane. Accordingly, if all elements of the system 100, including the steerable overtube 140, its hub 510, and programming of the controller 150, are configured consistently, either drive dog 484a, 484b can be configured to operate bending in either plane.

[0135] In certain embodiments, bending inputs at the hand control devices 121a, 121b can be processed by the controller 150 prior to generating an output control signal. A scaling process correlates input motion magnitude to output motion magnitude. This scaling can be set to a default amount or adjusted by the user to control movements of the steerable portion 541 of the steerable overtube 140 more precisely.

[0136] Examples of System Control

[0137] The following nonlimiting examples illustrate control of the steerable overtube 140 bending through interaction with the robotic overtube controller 170 and other elements of the system 100. For example, to bend the steerable portion 541 of the steerable overtube 140 left, an operator translates the left hand control device 121a to the left, which outputs a control signal to the controller 150, being processed to determine a direction and degree of rotation for the corresponding drive dog. The controller 150 signals the corresponding actuator to advance in the prescribed direction. Similarly, right translation of the hand control device 121a causes opposite rotation of the drive dog and the actuator, effecting right bending of the steerable portion 541. Upward and downward bending is similarly achieved using the other drive dog and its corresponding actuator, responding to upward and downward translation of the hand control device 121a.

[0138] Instrument Fine Positioning

[0139] Instrument Fine Rotation

[0140] With reference to Figure 6 A, in accordance with one embodiment, the instrument controller 420 and thus the surgical instrument 690 connected thereto are moveable in theaxial direction 610 by movement of the housing 456 in the axial direction 610. This movement is by actuation of a designated actuator held in a further housing of the central drive unit 313, for example. The instrument controller 420 is also rotatable about its central axis 444 by a designated actuator, such as one rotating a ring gear connected thereto. This allows controllable rotation of the surgical instrument 690, in either of opposed rotational directions 402, 404. The central drive unit 313 is also controllably translated along or rotated about the overtube axis 396, such that housing 456 held therein will move about axis 396, along with any attached instrument 690.

[0141] With reference to Figs. 6B & 6C, cutaway views of a robotic instrument 690, incorporating a force transmission system 600 are illustrated and demonstrate movement of the reverse linkage 625 and control wires 603 in relation to articulation in one plane of a second bending joint 675 at the distal end of an elongate shaft 670 thereof. Also illustrated are a first bending joint 673 and an end effector 671. Bending in one plane is illustrated using one pair of antagonistic actuators, their respective reverse motion mechanisms and control wires. It is to be understood that bending at each joint, in each plane, and actuation of an end effector 671 (e.g., graspers, needle driver, scissors) also utilize respective pairs of antagonistic actuators, their respective reverse motion mechanisms and control wires. For example, the second bending joint 675 can be bent downward as illustrated, as well as upward or in other directions (e.g., left or right (into or out of the page, not illustrated here) or a combination of those motions) by actuating the opposed control wire, using four independent control wires and corresponding reverse motion mechanisms 609 (including reverse linkages 625 and pushing actuators 601) of the force transmission system 600. The first bending joint 673 is preferably bendable in each of two orthogonal planes, or a combination thereof (i.e., in 3-dimensions), using an additional four independent control wires and reverse motion mechanisms 609 of the force transmission system 600. Likewise, opening and closing actuation of an end effector 671 utilizes two additional, respective independent control wires and reverse motion mechanisms 609 operating antagonistically for precise positioning.

[0142] With reference to Figure 6D, a force transmission system 600 for a robotic instrument 690 includes a pushing actuator 601 configured to be pushed by a linearactuator (e.g., 454) of a robotic instrument controller (e.g., 420 described in further detail herein in connection with Figs. 4B and 6 A) and a control wire 603. The control wire 603 has a first end 603a attached to a location 605a that moves with movement of the pushing actuator 601. The control wire 603 has a second end 603b attached to a distal location 607 of the robotic instrument 690 (e.g., anchored within a steerable assembly to cause bending of a joint of the robotic instrument, or actuation of an end effector thereof).

[0143] The force transmission system 600 can include a reverse motion mechanism 609 interfaced with the control wire 603 between the first end 603a and the second end 603b. The reverse motion mechanism 609 can be configured to cause a proximal pulling action on the second end 603b of the control wire 603 in response to distal pushing by the pushing actuator 601 on the first end 627 of the reverse linkage 625. The reverse motion device 609 can be configured to maintain a point of contact 611 with the control wire 603 in the same spatial location (e.g., a fixed point relative to the base 613 of the instrument adapter 680 of the robotic instrument) to prevent lateral (radial) wire motion due to actuation.

[0144] The reverse motion mechanism 609 can be a reverse linkage 625 attached to the pushing actuator 601 on a first end 627 (e.g., at a first pin 629) and interfaced with a control wire 603 on the second end 631. The reverse linkage 625 can be rotatably mounted and axially fixed to a base 613 (e.g., at a pivot 634, such as by second pin 634, via frame 633). The second end 631 of the reverse linkage 625 can be or can include a curved contact surface 631a to maintain the point of contact 611 with the control wire 603 in the same spatial location (i.e., radial position, with respect to a central axis 444 of the robotic instrument 690) to prevent control wire motion due to actuation. Other configurations of a reverse actuation mechanism may also advantageously be utilized, in accordance with the invention.

[0145] In the illustrated embodiment, when urged by movement of a respective linear actuator 454, the pushing actuator 601 moves linearly (e.g., parallel to the central axis 444 of the instrument 690), while the portion of the reverse linkage 625 between the pivot 634 and the pin 629 rotates. Accordingly, devices of the present invention can beequipped with a sliding joint 660 to compensate for a changing radius between the pivot 634 and the pin 629 at the pushing actuator 601.

[0146] With reference to Fig 6E, various end effectors 671 are illustrated for use with the subject surgical instruments 690. These include pinching forceps 671a, monopolar cautery knife 671b, needle driver 671c, monopolar curved scissors 671d, rat tooth forceps 67 le, or Cadiere forceps 67 If. Optionally, bipolar scissors, surgical staplers and suturing devices can also advantageously be provided in accordance with the systems of the present invention. Fine positioning of spatial orientation of the end effectors 67 la-67 If is accomplished by bending of the first joint 673 and second joint 675, while actuation of end effectors is also accomplished by a pair of designated reverse linkages 625 and control wires 603. Optionally, manual endoscopic surgical instruments can be utilized in connection with the present invention, alone or in combination with robotically controlled surgical instruments if required or desired.

[0147] Instrument Fine Axial Rotation

[0148] With reference to the flow diagram of Figure 8, in one embodiment, fine instrument rotation is achieved by a physician or operator rotating either of the hand control devices 121a or 121b corresponding to the instrument 690 either clockwise or counter-clockwise. The hand control device 121a or 121b generates a control input signal 810 input to the controller 150. The controller 150 processes the control input signal 810 and outputs a control output signal 820 directed to one or more rotation actuators of the instrument controller 420 (e.g., a drive motor). In this manner, rotation of the instrument controller 420 (clockwise / counter-clockwise) results in corresponding rotation of the instrument 690, relative to steerable overtube 140.

[0149] Instrument fine axial translation

[0150] In accordance with one embodiment, fine instrument translation of each instrument 690 is achieved by a physician or operator moving a corresponding hand control device 121a or 121b forward (distally from the operator) or backward (proximally toward the operator). The hand control device 121a or 121b generates a control inputsignal 810, which is input to the controller 150. The controller 150 processes the signal 810 and outputs a control output signal 820 directed to one or more axial translation actuators of the instrument controller 420. In one embodiment, the axial translation actuator includes a motor effecting translation of the instrument controller 420, as described above. In this manner, translation of instrument controller 420 moves the attached instrument 690 correspondingly relative to the steerable overtube 140.

[0151] Instrument fine bending

[0152] In accordance with one embodiment, fine instrument bending of one or more joints 673, 675 is achieved by a physician or operator rotating a corresponding hand control device 121a or 121b laterally, vertically or a combination thereof (left and up, right and up, right and down, left and down), such as by the operator flexing their wrist. The hand control device 121a or 121b generates a control input signal 810, input to the controller 150. The controller 150 processes the signal 810 and outputs a control output signal 820 directed to the one or more linear actuators (e.g., a lead screw mechanism) of the instrument controller 420. For a bend of one joint in one plane, one corresponding actuator is driven distally to provide pushing force to a corresponding reverse motion mechanism 609 and its control wire 603, corresponding to the desired directional bend of the desired joint. Optionally, an antagonistic control wire 603 can be additionally similarly tensioned to a predetermined complementary degree to stabilize the joint position. Similarly, for a bend of one joint in two planes, two corresponding actuators are driven distally, corresponding to the desired directional bend of the desired joint. Optionally, antagonistic control wires 603 can be additionally similarly tensioned to a predetermined complementary degree to stabilize the joint position in two planes.

[0153] In accordance with some embodiments, the controller 150 programmatically interprets the above-described rotational input to effect corresponding bending at the instrument second (distal) joint 675. Alternatively, in some embodiments, this rotational input effects corresponding bending at the instrument first (proximal) joint 673. Alternatively still, in some embodiments, this rotational input effects corresponding bending at the instrument first (proximal) joint 673 and second (distal) joint 675.Optionally, such extreme bending can be undertaken when a large degree of bending input is sensed by the hand control device 121a, 121b, or triggered by the operator through operator input (such as offered through a user interface (including not but limited to, a mechanical button or a graphical user interface and / or in a settings menu).

[0154] Example of Instrument Bending

[0155] To bend the end effector 671 to the left, a first (proximal) joint 673 is controlled to bend left. If so embodied, a second (distal) joint 675 can alternatively or additionally be controlled to bend left. Accordingly, either one control wire 603 corresponding to a single joint action, or two control wires 603 corresponding respectively to two joint actions, are placed under tension, as described above. Optionally, antagonistic control wires 603 can be tensioned for stabilization, as described above.

[0156] Instrument fine radial translation

[0157] As illustrated in Figure 7, the surgical instruments 690a, 690b are deployable from the steerable overtube 140. At that point, they can be controlled to translate laterally for easier work in the operative space. To provide a useful working arrangement of the end effectors 671 of the subject instruments 690, the first joint 673 and second joint 675 can be actuated in unison to displace the end effector 671 radially outwardly. Such configuration allows multiple instruments 690 to work jointly on a task (e.g., grasping by one instrument and cutting by the other instrument), all while viewed through a videoscope 726.

[0158] In accordance with one embodiment, radial translation is achieved by translation by an operator of the hand control devices 121a or 121b corresponding to the instrument 690 e.g., left, right, up, down). Optionally, a combination bend (e.g., left and up, right and up, right and down, left and down) can also be accommodated by the subject devices. Alternatively, lateral deployment can be implemented by the subject systems automatically as the instruments are advanced axially.

[0159] With reference to Figure 8, as illustrated in the block diagram 800 of an example control system in accordance with the invention, the hand control devices 121a and 121bgenerate control input signals 810 input to the controller 150. The controller 150 processes the control input signal 810 and outputs a control output signal 820 directed to the corresponding linear actuators, causing the linear actuators to drive distally. Linear pushing force is transferred to the respective reverse motion mechanism 609, which converts pushing force into tensile force in the corresponding control wire 603. In turn, this force effects the prescribed bends for the desired translation: either two control wires 603 are actuated, corresponding to bending of each of the first joint 673 and second joint 675 in one plane, or four wires 603 are actuated, corresponding to bending of each of the first joint 673 and second joint 675 in two planes. As described above, antagonistic wires 603 for each degree of freedom can additionally be tensioned to stabilize that joint. In this latter case, this means that eight wires 603, reverse motion mechanisms 609 and actuators 454 are employed for the complex movement. Additionally, bending of each joint in one plane can be coupled with axial rotation and translation (i.e., about axis 444, described above).

[0160] With continued reference to Fig. 7, a distal isometric view of a distal end portion of a steerable overtube 140 in accordance with the invention is illustrated. An outer sheath 722 encloses two instruments 690a, 690b and a videoscope 726, each of which is extendable from a cap 724 having openings defined therein through which the instruments 690a, 690b and videoscope 726 are selectively extendable. As illustrated, the distal ends of the instruments 690a, 690b extend outwardly of the cap 724, positioning the first joint 673 and second joint 675 of each instrument 690a, 690b outwardly of the outer sheath 722. The end of the videoscope 726 is likewise extended outwardly of the cap 724 and the sheath 722.

[0161] If the instrument controller 420 is rotated in the directions 402, 404 (Fig. 4B) about its centerline 444, the distal ends of the instruments 690a, 690b likewise rotate at the cap 724 in directions 702, 704. If the first joint 673 and second joint 675 are straight (not bent), the end effector 671 is therefore colinear with the whole instrument 690a, 690b. In this state, it will likewise rotate about its own centerline of the axial direction 644 (Fig. 7) in directions 702, 704. However, as the first joint 673 and second joint 675 are bendable by selective pulling of control wires 603. This allows the centerline 728 ofthe end effector 671 and the centerline of the distal end of the instruments 690a, 690b to be controllably offset from the instrument's centerline. In one embodiment, a single bend in one joint 673 or 675 creates a single angle of offset, while bending both joints 673 and 675 creates a compound double angle.

[0162] Instrument Control in General

[0163] As discussed above, the overtube 140 and the instruments 690a, 690b and the videoscope 726 therein can be advanced or retracted along, and rotated about axis 396 (Fig. 3), rotating in directions 730, 732. Additionally, each instrument 690a, 690b and the end effector 671 attached thereto, is independently moveable in the axial direction 644 by independent movement of the instrument controller 420 to which it is coupled, in translation directions 410. Accordingly, a physician can position the distal end (i.e., the cap 724 end) of the steerable overtube 140 in a desired working area or operative space (e.g., a location in a body lumen). The physician can then view the operative space including the end effectors 671 with the videoscope 726. Because each of the first joint 673 and second joint 675 are independently bendable in two orthogonal planes, and the overtube 140 is rotatable about axis 396, the end effector 671 can be positioned in a multitude of orientations in the operative space.

[0164] The instruments 690a, 690b have many degrees of freedom, including translation (along the axis of the axial direction 644), rotation (about the axis of the axial direction 644 in opposing directions 702, 704) and 4-way-bending at each of two joints 673 and 675. In combination with gross positioning afforded by the steerable overtube 140, this allows the physician or operator to reach difficult locations and to complete delicate and complex tasks. The large degree of freedom afforded to the end effectors 671 by the first joint 673 and second joint 675 allows triangulation of the end effectors 671 for natural task performance. Meanwhile, progress is monitored through the videoscope 726 with the image transmitted through the system 100 (e.g., by system cable 1) to the display 125.

[0165] Each of the four bending directions at each of the joints 673, 675, along with each of an open and close motion of the end effectors 671 is designated a control wire 603. The control wires 603 is actuated through applied tension via the above-described reversemotion mechanisms 609 as part of a force transmission system 600. In turn, each reverse motion mechanism 609 is actuated by a designated linear actuator 454 of an instrument controller 420. Optionally, one or more adapters, such as drape adapters 424 or other interface can be applied between the instrument controller 420 and the instrument 690.

[0166] The linear actuators 454 are selectively controlled by the control output signals 820 from a controller 150 to effect the desired motion of the instrument 690. The controller 150 generates the control output signals 820 in response to control input signals 810 from the physician console 120. The control input signals 810 are processed by the controller 150 to interpret command inputs, including position change of a corresponding hand control device 121a, 121b of the console 120. Processing of the control input signal 810 can include a scaling function, which can be adjustable by the physician. Processing can also include filtering or smoothing of a control input signal 810 to remove unintentional or undesired motion, such as small involuntary movements (e.g., shaking), or sudden and / or large movements, which may indicate an error (e.g., accidental bumping of a controller).

[0167] The controller 150 may be embodied as hardware and / or software, but regardless is referred to herein as a controller, control module and / or system controller. A single physical or software controller can be provided to control all aspects or the system, or alternatively multiple physical or software controllers, such as master controllers and slave controllers can be provided, for example. Accordingly, computer executable code performing the functions of the block diagram 800 of Figure 8, and / or other system functions is also encompassed by the present disclosure.

[0168] As discussed above, gross positioning of the steerable overtube 140 is accomplished by movements of the patient cart 110 itself and adjustable elements thereof supporting the central drive unit 313, particularly axial translation and axial rotation (roll). Smaller bending adjustments of the distal end portion of the steerable overtube 140 are accomplished through actuation of the overtube controller 170, which interfaces with the bending mechanism of the steerable overtube 140. The subject instruments 690a, 690b are adapted and configured to extend through working channels of the steerableovertube 140. Gross positioning of the distal end portions of the surgical instruments 690a, 690b is achieved by positioning the distal end of the steerable overtube 140.

[0169] In all cases, processing of control signals by the controller 150 can include scaling of control input to actuator output. This scaling can be preprogrammed, and / or input or adjusted by an operator.

[0170] In all cases of the described antagonistic control mechanisms, even though one actuator may be activated to perform a bending or actuation function, an opposed actuator can be driven to a position in order to maintain force applied to the opposing reverse motion mechanism 609 and control wire 603, stabilizing a desired degree of bending of a joint or actuation of an end effector.

[0171] Examples of Radial Translation

[0172] To translate left, a first (proximal) joint 673 is controlled to bend left, while the second (distal) joint 675 is controlled to bend right, compensating for the bending of the first joint while allowing the end effector 671 to shift left. Accordingly, at least two control wires 603, one corresponding to each joint action are placed under tension, as described above. Opposing antagonistic control wires 603 can also be placed under a degree of tension to stabilize the joint.

[0173] To translate to the upper right, a first (proximal) joint 673 is controlled to bend up and to the right, while the second (distal) joint 675 is controlled to bend down and to the left, thereby counteracting the directional change of the end effector 671 by the bending of the first joint 673. This results only in a translation of the end effector 671. In a compound movement like up and right or down and left, at least four control wires 603, one for each joint action, are placed under tension. Two control wires 603 are used for bending in each plane. Opposing antagonistic control wires 603 can also be placed under a degree of tension to stabilize the joint.

[0174] Instrument End Effector Actuation

[0175] Not every instrument 690 is necessarily embodied with an active (i.e., operable) end effector 671, such as a forceps, grasper, needle driver or scissors. It may insteadinclude an end effector including a hook or static blade, for example. In accordance with one embodiment, if the end effector 671 is operable (e.g., grasper jaws), actuation is accomplished by actuation of a handpiece gripper 226 with a physician's or operator's fingers, as best seen in Figure 2C. A finger or grip control 229 of the hand control device 121a, 121b is moved to a position corresponding to an open or closed position of end effectors 671, or a point therebetween. The hand control device 121a or 121b generates a control input signal 810, which is input to the controller 150. The controller 150 processes the input signal 810 and outputs a control output signal 820 directed to the corresponding linear actuator 454 either corresponding to an opening direction or a closing direction of the end effector 671.

[0176] Thereafter, the respective linear actuator 454 of the instrument controller 420 drives distally. Linear pushing force is transferred to the respective reverse motion mechanism 609 of the connected instrument 690, converting pushing force into tensile force in the corresponding control wire 603. In turn, this force is transferred to the end effector 671 where the end effector mechanism is operably engaged with the control wire 603.

[0177] If the end effector 671 is static, the control wires 603 originally used to operate the end effector can effect movement of an additional degree of freedom, such as an extra bending joint to impart additional flexibility and versatility. In accordance with certain embodiments, the controller 150 is adapted and configured to recognize the presence of an instrument's specific functionality, and programmatically map control for those functions to respective linear actuators 454. Control inputs from a physician or operator are prompted through a mechanical / tactile interface by a mode switching input, such as a button, pedal, or GUI, or provided via alternate inputs like voice recognition.

[0178] Superposition of Commands and Movements

[0179] Control inputs can be interpreted by the subject systems and superimposed to effect complex movements simultaneously. For example, as described above, a radially outward translation command actuates bending of multiple joints from a neutral home position to a laterally displaced home position, at which position further bendingcommands can be instructed. To achieve this, new bending commands are superimposed on the existing actuator positions that maintain the outward translation. In other words, the controller adds the new positioning commands to the current ones. That is, although joints 673, 675 are bent due to outward translation of the end effector 671, further reorientation of the end effector 671 may require additional bending. Similarly, an initial orientation (e.g., pointed distally) of the end effector 671 can be maintained when translating the end effector 671 to a radially outward location.

[0180] Instrument Identification & Control Mapping

[0181] When connecting an instrument 690 to the robotic instrument controller 420, an instrument identification process can be initiated by the controller 150 upon connection of the instrument 690 with the instrument controller 420. Alternatively, instrument identification can be performed manually by a physician or other user.

[0182] Such information can include an identifier, instrument type, calibration data, prior use data or the like. Alternatively or additionally, the information can be simply a unique identifier for which the controller 150 searches a local or remote database to retrieve relevant data. Subsequently, the controller 150 maps each individual linear actuator (454) to its corresponding reverse motion mechanism (609) and control wire (603). This mapping links the actuator to a specific instrument function. Such functions can include bending a joint (673, 675) in a particular direction (e.g., up, down, left, or right) or actuating the end effector (671) (e.g., open / close). The controller 150, also mapping the input control signals from a hand control device 121a, 121b to a function (e.g., bend up, close end effector) therefore can map the input command to the appropriate linear actuator 454 to achieve the desired function.

[0183] Modular Posable Patient Cart Overview

[0184] The following sections further elaborate on details of the patient cart 110 described above in connection with Figure 3.

[0185] With reference to Fig. 9 the posable patient cart 110 of Fig. 3 is again illustrated, but here in partially exploded view in order to better reference the functional modulesthereof. A first module 912 includes a cart portion 914 and a tower portion 916. A second module 922 includes the central drive unit 313 and linear (axial) translation mechanism therefor, while a third module 932 includes a roll mechanism 934 and a pitch mechanism 936. All modules work in cooperation to position the central drive unit 313, steerable overtube 140 and instruments 690 in a favorable position to provide access for a surgical procedure.

[0186] The cart portion 914 is adapted and configured to translate over a horizontal surface and the tower portion 916 extends upwardly from the cart to define a vertical elevation axis (398 of Fig. 3). The patient cart 110 is dimensioned and configured to be readily transported throughout a hospital or surgical facility, easily passing through doorways and other openings. The cart 914 includes a set of four independent and fully rotatable and spinnable castors 381 and a brake mechanism 920 having multiple operating positions.

[0187] More particularly, the brake mechanism 920 includes a three stage foot pedal lock that toggles between holonomic, straight ahead and braked positions. The cart 914 further includes an ergonomic wrap-around handle 374 that offers multiple ways to grossly position the patient cart 110. Users can stand at the rear of the system or on either side of it to maneuver the patient cart 110. The handle 374 has vertical front sections 915a, 915b to provide for differing handling heights to maneuver the patient cart 110, and the rear portion 915c of the handle 374 is slightly higher than the sides portions. The handle 374 also serves as protection for the patient cart 110 during stowage and transport. The cart portion art 914 is also provided with clear user touchpoints that are highlighted or accented with color.

[0188] By way of example, the patient cart 110 can have a width of about 690 mm (2 ft 3 in), a depth of about 920 mm (3 ft) and a minimum stowage height of about 1056 mm (4 ft 11 in) and a maximum operating height of about 1935 mm (6 ft 4 in). The patient cart 110 can have an overall base footprint of 1200 x 800 mm and a wheelbase of 750 x 500 mm. These dimensions are for illustrative purposes only and should not be viewed as limiting in any way.

[0189] The posable patient cart 110 includes a second module 922 having a central drive unit 313 that is mounted for linear movement relative to an elongated support beam 926 along a central drive axis 396, as shown and referenced in Figs. 3 and 10. The central drive unit 313 includes a distal control arm or overtube arm 480. As discussed above, the overtube arm 480 is configured to support a steerable overtube assembly 140, which is best seen in Figs. 5A-5D. The central drive unit 313 is adapted and configured for linear translation relative to the elongated support beam 926 along the central drive axis 396 between a minimum linear position (i.e., the proximal-most position) and a maximum linear position (i.e., the distal-most position).

[0190] The posable patient cart 110 includes a third module 932 having a roll mechanism 934 and a pitch mechanism 936 connecting the second module 922 to the first module 912. The roll mechanism 934 is adapted and configured to rotate the central drive unit 313 about the central drive axis 396. The pitch mechanism 936 is adapted and configured to rotate the central drive unit 313 about a pitch axis 393 that extends perpendicular to the central drive axis 396, as best seen and referenced in Fig. 10.

[0191] Fig. 11 is a rear perspective view of the patient cart 100, which includes various functional features including user interfaces, some of which will be described in more detail in connection with other figures. Also illustrated is a service hatch 1195 for gaining access to the interior components of the cart module 912 for performing maintenance and service. A connection point 1192 is provided at the rear end of cart module 912 to facilitate communication with a physician console 120 and / or an external monitor, or the like. Spaced apart cable spooling hooks 1194 are provided at the rear end of module 912 for managing external cables. A main On / Off switch 1196 is also located the rear end the patient cart 110. A user interface panel 1152 is also provided for displaying graphical user interfaces, which will be discussed in further detail below in connection with Figs. 48-50. For risk mitigation, an emergency stop button 1154 is located below the user interface panel 1152 for easy access when controlling the system from the rear. This will directly cut power to all motors and brake release windings. It is envisioned that a secondary or alternative stop button can be mounted on a tether to be located where needed, such as adjacent a distal end of the patient cart 110. Additional emergency stopinterfaces can be provided elsewhere on the patient cart 110 or physician console 120, and can be physical buttons, or alternatively can be integrated into a graphical user interface.

[0192] Poses

[0193] Figs. 12A illustrates various positions or poses 1210, 1220, 1230 of the patient cart 110. These positions include positions suitable for transoral, single incision laparoscopic, transanal or transvaginal procedures, for example, as well as a compact and stable conformation ideally suited for storage and transportation, and will be described in further detail below.

[0194] With reference to Fig. 12B, there is illustrated a depiction of the overall ICU positioning range of the central drive unit 313 with reference to a nominal bed height of about 700 mm (2 ft 4 in). More particularly, the overall ICU range of motion for the central drive unit 313 extends from about 30 degrees above the nominal bed height to about 10 degrees below the nominal bed height, in one embodiment.

[0195] Referring to Figs. 13 and 14, the central drive unit 313 has a first pose 1210 for stowage and transport. In this first pose 1210, the central drive unit 313 is rotated about the pitch axis 393 of the pitch mechanism 936 of the third module 932 and elevated on the elevation axis of the tower 916 of the first module 912 in such a manner that the overtube arm 480 is recessed into a protective bay area 925 or cutout that is formed in the front end portion of the cart 914 of the first module 912. In this stowage position, the central drive unit 313 is recessed, in one embodiment, about 60 mm (2.4 in) behind the leading edge of the cart 914 and protected from damage in stowage and during transport. The small height and volume of the stowed configuration enables good line-of-sight and safe maneuverability of the robot.

[0196] Referring to Figs. 15 and 16, the central drive unit 313 of the second module 922 has a second pose 1220 for performing trans-anal or trans- vaginal surgical procedures. Examples of trans-anal surgical procedures that may be performed include endoscopic submucosal dissection procedures (ESD), full thickness resection procedures, and procedures involving a total resection of the rectum, for example. Examples of transvaginal surgical procedures include hysterectomy procedures, oophorectomy procedures, salpingectomy procedures and ovarian cyst removal procedures, for example.

[0197] In this second pose 1220, the central drive unit 313 of the second module 922 is elevated on the elevation axis of the tower 916 of the first module 912 to a minimum operating height above the horizontal support surface and it is rotated about the pitch axis of the pitch mechanism 936 of the third module 932 so that the central drive axis 396 of the central drive unit 313 extends parallel to the horizontal support surface, such as an operating room floor (i.e., 0° pitch).

[0198] In this operating position, the central drive unit 313 is elevated to an operating height of about 850 mm above the horizontal support surface, whereby the operative portion of the steerable overtube assembly 140 supported on the overtube arm 480 is located about 100 mm above the operating table 1540, in one embodiment. This is an optimal position for interacting with a patient situated on the operating table 1540 in a supine position with their legs separated, flexed, and supported in stirrups.

[0199] Referring now to Figs. 17 and 18, the central drive unit 313 of the second module 922 has a third pose 1230 for performing trans-oral or trans-umbilical surgical procedures. Examples of trans-oral procedures include endoluminal submucosal dissection (ESD) procedures, endoluminal sleeve gastroplasty (SG) procedures, fundoplication or endoluminal GERD procedures, bariatric endoluminal antral myotomy (BEAM) procedures and endoluminal antral myotomy (POEM). Examples of trans- umbilical surgical procedures include cholecystectomy procedures, appendectomy procedures, prostatectomy procedures and nephrectomy procedures.

[0200] In this third pose 1230, the central drive unit 313 is elevated on the elevation axis of the tower 916 of the first module to a maximum operating height above the horizontal support surface and it is rotated about the pitch axis 393 of the pitch mechanism 936 of the third module 932 so that the central drive axis 396 of the central drive unit 313 extends at an angle of 30° relative to the horizontal support surface.

[0201] In this operating position, the central drive unit 313 is elevated to an operating height of about 1935 mm (6 ft 4 in) above the horizontal support surface, whereby the operative portion of the steerable overtube assembly 140 supported on the overtube arm480 is located about 300 mm above the operating table 1540. This is an optimal position for interacting with a patient situated on the operating table 1540 in a supine position with their head tilted to the left or right, or alternatively in a so-called "sword-swallower position."

[0202] The central drive unit 313 is translated to the minimum linear position on the central drive axis 396 when it is in the first pose shown in Figs. 13 and 14. It is translated to a location on the central drive axis 396 between the minimum linear position and the maximum linear position when it is in the second pose shown in Figs. 15 and 16, and it is translated to the maximum linear position on the central drive axis 396 when it is in the third pose shown in Figs. 17 and 18.

[0203] Cart and Tower Modules

[0204] Figs. 19 and 20 respectively illustrate the cart and tower module 912 of patient cart 110 shown with its outer covers or cladding 1930 removed for ease of illustration, and an exploded view of components. The outer cladding 1930 of the first module 912 includes an ergonomic wrap-around handle assembly 374 that substantially surrounds patient cart 110 and offers multiple ways to grossly position the patient cart 110. Users can stand at the rear or on either side to maneuver patient cart 110. The cart portion 914 of the first module 912 includes a bottom tub 1934 that is adapted and configured to support a castor assembly 381, a brake mechanism or brake assembly 920, and a set of modules 1935 for the patient cart 110, such as control, and power conversion and distribution functions. The bottom tub 1934 can be formed by molding, casting, machining or by other technique out of a metal (e.g., aluminum), a polymeric material, or other material, for example.

[0205] Referring to Fig. 21A, the castor assembly 381 includes four independent castors 381a-381d. Exemplary castors are available from Tente Casters, Inc. of Hebron KY, including for example, the 150 mm Linea castors rated at 200 kg each. Each castor 38 la- 38 Id is mounted to roll about a horizontal axis and swivel about a vertical axis, as referenced in Fig. 10. The castor assembly 381 has three locking states. These include a forward (without swivel) state for transport, a swivel and roll state for positioning, and anall braked state for securing the position of the patient cart 110. More particularly, as illustrated in Fig. 21B, in the transport mode the front castors 381a and 381c can swivel and roll, while the rear castors 381b and 381d are only able to roll. In the strafe mode, all four castors 381a-381d can swivel and roll. In the braked mode, all four castors 381a- 381d are unable to swivel or roll.

[0206] Each castor 381a-381d in castor assembly 1936 is controlled by shared left and right centrally located angled foot pedals 1940a, 1940b. The foot pedals 1940a, 1940b are configured to improve action and comfort and are sized to minimize foot force. The foot pedals 1940a- 1940b are connected by a length-adjustable rocker rod assembly 1942. The rocker rod assembly 1942 includes right front and rear rocker arms 1942a, 1942b, left front and rear rocker arms 1942c, 1942d, and a central connective rod 1942e. The rocker rods can be individually adjusted in length to accommodate component variations. Each castor 381a-381d in castor assembly 1936 is also electronically sensed for a latch position by a respective state sensor 1937a-1937d in one embodiment. Magnetic proximity sensors or the like are suitable for this purpose.

[0207] Referring back to Figs. 19 and 20, the set of electrical modules 1935 supported in the tub 1934 of the cart portion 914 include a power module 1944 containing all mains to DC voltage conversion and safety components, an uninterrupted power supply module 1946 containing batteries and a power controller, and a communication control module 1948 containing a communication system for communicating with a surgeon console. Cooling fans can be provided for cooling the aforementioned modules, including one or more fans for cooling each of the power module 1944, the power supply module 1946 and the communication control module 1948.

[0208] The cart and tower module 912 employs insulated and shielded cables and connectors between the modules and sub-assemblies for EMC protection. The lift motor 1962 is preferably EMC shielded without a separate motor housing. In accordance with a preferred embodiment, all cable bundles are double-insulated and cable shielded.

[0209] A lift module 1950 is also provided, containing a lift motor and a lift motor controller for operating an elevation mechanism of the tower portion 916, which will be described in greater detail below. The electrical modules 1935 are each designed for easyremoval and replacement. Preferably, each module is self-contained within a sheet metal faraday cage having connector panels for EMI shielding and electrical connections are provided by grounded and shielded cable bundles. Fans are also provided for cooling the electrical modules.

[0210] With continuing reference to Figs. 19 and 20, the tower portion 916 of the first module 912 of patient cart 110 also includes a user interface panel 1152 which in the illustrated embodiment takes the form of a touch screen (e.g., of about 10 inches diagonally) that is readily accessible to a user. The user interface panel 1152 provides an individual with the ability to control system movements and positions. Exemplary user interface screens are shown in Figs. 48 through 50 and will be discussed below. In particular, Fig. 48 illustrates the touchscreen interface 4800 that provides a user with the ability to facilitate joint control including the ability to control elevation, pitch, roll and translation. Fig. 49 illustrates the touchscreen interface 4900 that provides a user with the ability to move the system between a deployed position and a stowed or transport position. Fig. 50 illustrates the touchscreen interface 5000 that provides a user with the ability to manually control elevation of the tower module 912, pitch and roll for module 932, and translation of the central drive unit 313 of module 922.

[0211] Referring now to Figs. 22, 23 and 24A, the tower portion 916 of the first module 912 includes an elevation mechanism 1960 operating along the vertical elevation axis 398, which axis is referenced in Figs. 3 and 10. The elevation mechanism 1960 includes a lift motor 1962 (e.g., Maxon EC90260 W, max speed 1200 rpm), a drive pulley 1964 operatively connected to the lift motor 1962 by a drive shaft 1966, and an elongated lead screw 1968 e.g., Abssac R1605 OAL 1215 mm). The lift motor 1962 is preferably EMC shielded within a separate motor housing 1965, as best seen in Fig. 24B. A driven pulley 1970 is operatively connected to a lower end of the lead screw 1968 and a pre-tensioned drive belt 1972 (e.g., ELA-flex SD AT5-10 mm) operatively connects the driving pulley 1964 to the driven pulley 1970.

[0212] The elevation mechanism 1960 further includes a pair of linear rails 1974a, 1974b (e.g., 2 x LRXD20 rails) extending parallel to the lead screw 1968, and a set of carriages 1976 supported on the rails 1974a, 1974b (e.g., 4 x IKO MXD20 carriages). As best seenin Fig. 25, a maintenance service hatch 1990 is provided on the underside of the tub portion 1934 of the cart 914 of module 912 to facilitate belt replacement and tensioning. A lifter 1975 is bolted to the set of carriages 1976 and is operatively connected to a drive nut 1978 driven by the lead screw 1968. Fixed bearings are provided on each end of the lead screw 1968 to support the axial rotation thereof.

[0213] The elevation mechanism 1960 further includes a magnetic brake 1978 associated with the lead screw 1968 (e.g., Sepac PMB-197). The elevation mechanism 1960 includes a vertical E-chain 1980 having one end connected to the carriage 1976 for cable and wire management, as best seen in Fig. 22. The elevation mechanism 1960 also includes a linear encoder for monitoring the position of the carriage 1976 relative to the lead screw 1968. The elevation mechanism 1960 is adapted and configured to translate the carriage 1976 along the vertical elevation axis through a linear distance of about 1213 mm at a maximum speed of 100 m / s with a maximum acceleration to maximum speed in 0.5 s, in accordance with one embodiment.

[0214] Roll and Pitch Module

[0215] The third module 932 of the modular patient cart 110 includes a roll stage mechanism 386 and a pitch stage mechanism 384. The third module 932 (i.e., the roll and pitch module) is adapted and configured to operatively connect the second module 922 (containing the central drive unit 313), ) to the first module 912 (i.e., the cart and tower module). The roll stage mechanism 386 is adapted and configured to rotate the central drive unit 313 about the central drive axis 396. The pitch stage mechanism 384 is adapted and configured to rotate the central drive unit 313 about a pitch axis 393, which extends perpendicular to the central drive axis 396 and the vertical elevation axis 398, as illustrated in Figs. 3 and 10.

[0216] The third module 932 includes a pitch stage mounting frame 2630 having a rear plate 2632 for securement to a tower mounting structure 2634 and opposed right and left side plates 2636 and 2638 that extend forwardly from the rear plate 2632. The side plates 2636 and 2638 can be integrally formed with the rear plate 2632. The pitch stage mechanism 384 includes a motor 2640 (e.g., Maxon EC45 120W) and a reductiongearbox 2642 (e.g., 53:1 reduction) that are supported on an interior surface of the right side plate 2636 of the pitch stage mounting frame 2630. A motor controller 2644 (e.g., Maxon 50 / 15) is supported on an exterior surface of the left side plate 2638 of the pitch stage mounting frame 2630.

[0217] The pitch stage mechanism 384 further includes a drive pulley 2646 that is mounted for rotation on an exterior surface of the right side plate 2636 of the pitch stage mounting frame 2630. The drive pulley 2646 is driven by the motor 2640. A pitch joint 2648 is mounted for rotation on the exterior surface of the right side plate 2636 of the pitch stage mounting frame 2630 spaced from the drive pulley 2646. A driven pulley 2650 is mounted coaxially with the pitch joint 2648, and a drive belt 2652 operatively connects the drive pulley 2646 to the driven pulley 2650 (e.g., Cross & Morse with 1:1 ratio). The motor 2640 and drive pulley 2646 have support bearings to resist belt tension and torque, while a belt cover is provided to prevent particulates from damaging any associated electronics.

[0218] The pitch stage mechanism 384 further includes an adjustable tensioner idler pulley 2654 that is operatively associated with the drive belt 2652. The pitch stage mechanism 384 further includes a brake 55 (e.g., SEP AC TSEB 382 with PWM controller) that is operatively associated with the motor 2640 and a pitch harmonic drive 2657 (e.g., HD SHG-40-160-2UH) that is operatively associated with the pitch joint 2648. Preferably, the pitch joint 2648 and the harmonic drive 2657 are mounted to the same component to reduce the tolerance loop. The pitch stage mechanism 384 further includes an output encoder 2656 (e.g., RLS AksIM-2 MB064) that is operatively associated with the pitch joint 2648 and an LED controller 2658 that is also operatively associated with the pitch joint 2648.

[0219] An outer casing 2660 is provided for enclosing or otherwise covering the pitch stage mounting frame 2630 and the pitch stage mechanism 384 (see Fig. 26). The LED controller 2658 operates one or more arcuate LED indicator strips 371 located on the outer casing 2660 to provide a visual indication of a degree of pitch for the pitch stage mechanism 384. A similar indicator can optionally be provided for a degree of roll. A vertical LED status indicator bar can also be provided on the outer casing 2660, orelsewhere on the patient cart 110, to indicate the height of the roll and pitch module 932 relative to the cart and tower module 912. The LED status indicators would be clearly visible to beside assistants through draping.

[0220] The third module 932 further includes a roll stage mounting frame 2670 having a front plate 2672 and opposed right and left side plates 2674 and 2676 that extend rearwardly from the front plate 2672. The front plate 2672 and right and left side plates 2674 and 2676 can be integrally formed. The right side plate 2674 of the roll stage mounting frame 2670 is adapted and configured to cooperate with the pitch joint 2648 of the pitch stage mechanism 384. The roll stage mechanism 386 includes a motor 2678 (e.g., Maxon EC60 100W), a reduction gearbox 2680 (e.g., 3.5:1) and a motor controller 2682 (e.g., Maxon 50 / 15) that are supported on a top surface of the roll stage mounting frame 2670.

[0221] The roll stage mechanism 386 further includes a drive pulley 2684 that is driven by the motor 2678. A roll joint 2686 is mounted for rotation on an exterior surface of the front plate 2672 of the roll stage mounting frame 2670 spaced apart from the drive pulley 2684. A central drive unit mounting plate 2685 is fastened to the roll joint 2686. The mounting plate 2685 is the primary connection between the support beam 926 of the translation stage assembly 3522 of the second module 922 (i.e., the central drive unit and translation stage module) and this third module 932 (i.e., the roll and pitch module). A driven pulley 2688 is mounted adjacent an interior surface of the front plate 2672 of the roll stage mounting frame 2670 coaxially with the roll joint 2686. A drive belt 2690 operatively connects the drive pulley 2684 to the driven pulley 2688 (e.g., Cross & Morse with 1:1 ratio).

[0222] The roll stage mechanism 386 further includes an adjustable tensioner idler pulley 2692 that is operatively associated with the drive belt 2690. The roll stage mechanism 386 further includes a brake 2694 (e.g., SEP AC UTSEB 221 with PWM controller) that is operatively associated with the motor 2678. Preferably, the motor, brake and pulley subassembly have support bearings to resist belt tension and torque. The roll stage mechanism 386 further includes a roll harmonic drive 2696 (e.g., HD SHG-32-160-2UH) and an output encoder 2698 (e.g., RLS ARTOS) that are operatively associated with theroll joint 2686. A belt cover is provided to prevent particulates from damaging any associated electronics. An outer casing or cover 2600 is provided for enclosing the roll stage mounting frame 2670 and the roll stage mechanism 386 (see Fig. 26), and slidably adjusts for varying degrees of pitch imparted by the pitch stage mechanism 384.

[0223] Preferably, each of the electronic assemblies of the third module 932 is individually shielded for EMC purposes. For example, the roll motor 2678 and the roll motor driver 2682 of the roll stage mechanism 386 are individually shieled; the rotary encoder 2698, user interface PCB, pitch motor 2640 and pitch motor driver 2644 of the pitch stage mechanism 384 are individually shielded, as are the distribution PCB and mounted connectors of the tower mounting structure 2634. The distribution PCB is the junction for power STO lines and the CANbus and it is designed to eliminate the need for spliced cables, which are difficult to shield. Preferably, the motor controllers are located near their respective motors, to minimize wire length and there is adequate space provide around the PCBs to allow for EMC shielding and cable terminations. Preferably, all cable bundles of the third module 932 are double insulated and shielded.

[0224] Roll Pitch and Elevate Visual Indicators

[0225] Referring now to Figs 3 and 11, in addition to the visual indicator 377 on the instrument controller assembly 313 and visual indicator 375 on the overtube arm 480, visual indicators 371, 379 can be placed elsewhere on the patient cart 100, such as on an upper portion of the casework thereof. Such indicators 371, 379 can display system status (e.g., normal as blue, green or cyan, warning as yellow, error as a blinking red), and / or can display position of a respective joint along a scale— such as by a segmented illumination configuration. In accordance with one embodiment, the visual indicator 371 can be configured to display the status and / or position of the pitch mechanism 384. Further, in accordance with one embodiment, a visual indicator 373 can be configured to display the status and / or position of the roll mechanism 386.

[0226] Similarly, a visual user interface 379 can be provided in connection with the patient cart 110 and the elevation stage 382. The visual user interface 379 can be configured as the foregoing. As illustrated, and particularly with reference to Fig. 3,illumination of the visual indicator 379 along a linear scale is shown, and is representative of the vertical position of the elevation stage 382. Under normal operation, the color of the user interface 379 can be a first color (e.g., green, cyan, blue), for normal operation. Conditions that can trigger a change in status color include positioning of the corresponding actuator at or near its mechanical limit, a failure of the corresponding mechanism, or a general system fault, for example. In accordance with one embodiment, the visual user interface 379 displays a green, cyan or blue indicator when the actuator thereof is active but in a locked state. In accordance with one embodiment, the visual user interface 379 displays a yellow indicator and / or a blinking indicator during movement thereof. In accordance with one embodiment, the visual user interface 379 displays a white indicator during system startup. In accordance with one embodiment, the visual user interface 379 displays a red indicator during a system fault. Other color meanings and illumination patterns as described herein in connection with other visual indicators can be applied to the visual user interface 379.

[0227] With reference to Fig. 26, as mentioned above, in one embodiment, the outer casing 2660 of the third module 932 has an arcuate LED indicator strip or band 371 to provide a visual indication of positioning, but also can be used to indicate system status. This indicator band 371 can be incorporated into one side or both sides of the casing 2660. The indicator band 371 is designed to be clearly visible and highlight important safety information to a bedside assistant. In one embodiment, the indicator band 371 will be yellow colored during mechanical movements, colored white during startup, green when the system is powered off and red to indicate a system fault has occurred. Additional colors can be utilized to indicate other system status events.

[0228] Central Drive Unit User Interfaces

[0229] Figs. 33 and 34 illustrate detail views of a distal portion of the central drive unit 313 illustrated in Fig. 4A, including the overtube arm 480 and pushbutton interface 376. The central drive unit 313 of the second module 922 is encased or covered within an outer cladding 435 (Fig. 4A). A user interface button panel 376 is operatively associated with the overtube arm 480 that extends distally from the central drive unit 313 forenabling a user to make bedside adjustments to the position of the central drive unit 313 (e.g., increase feed, decrease feed, pitch control, roll control, increase mast height, lower mast height), as best seen in Figs. 33 and 34. An LED light strip 377 is provided on each side of the outer cladding 435 of central drive unit 313 to indicate the extent or amount of longitudinal feed or translation. A similar LED feed indicator strip 375 is provided on the upper surface of overtube arm 480, as shown in Figs. 4A and 34. In addition, six (6) illuminated clutch buttons 378 are provided on the front face of the central drive unit 313, which relate to the instrument controllers 420 and videoscope controller 430.

[0230] With reference to Fig. 34, the illustrated user interface 376 is a button pad and can be a membrane button pad or of another type. The user interface 376 can include an illumination source such as those described above, including LED, OLED, electroluminescent, and the like. As illustrated, a control lock button 3410 can be provided to enable and disable the user interface 376 to inhibit unintentional activation of the controls thereof. Locking or unlocking of the user interface 376 by control lock button 3410 can be accomplished by a long press and hold, for example. Further in accordance with the invention, the controls of the user interface 376, and / or those of a GUI can be automatically locked when under control from a physician console 120. Controls for forward (distal) translation 3421, rearward (proximal) translation 3422, pitch 3424, roll 3426 and elevation 3430 can be provided. Predetermined functions can be disabled while others are enabled, depending on the implementation.

[0231] The interface panel 376, in one embodiment, is a flat membrane control panel with illuminated buttons that will readily appear through drape material and have a low accidental activation due to their position on the overtube arm 480, away from a clear touch point. The distal-most portion 437 of the overtube arm 480 is configured to function as a primary grip point for a user and a second grip point 439 is provided near the pushbutton interface panel 376 to allow a user to pull the central drive unit 313 towards the patient. The user interface 376 is provided for easy adjustment of the joints of the patient cart 110. The user interface 376 can be provided on one or on both sides of the overtube arm 480 to allow flexibility in positioning of operators and technicians. Suchfunctions are alternatively or additionally available on the user input device 1152 and on a physician console 120.

[0232] User interface features in connection with the overtube arm 480, include an elongate visual indicator 375, which in accordance with a preferred aspect is illuminated. The visual indicator 375, as with others described herein, can include any controllable display technology, including LED, OLED, electroluminescent materials, backlit LCD, and the like. In accordance with certain embodiments, the visual indicator 375 is composed of a linear array of LED modules. In accordance with certain embodiments, the LED modules can illuminate in a variety of colors, such as with RGB or RGBW modules.

[0233] In connection with visual indicators described herein, color changes or illumination patterns (e.g., solid, blinking, sequential illumination, partial illumination) can be selected so as to guide a user through setup steps, indicate component position, indicate active motion of a corresponding component, or to indicate a fault relating to a corresponding component or other system error.

[0234] During guided system setup, a blinking pattern can draw a user's attention to the next prescribed setup step, as determined by the system. For example, upon initial preparation of a surgical robotic system, draping is needed to maintain a sterile field in the operating suite. Accordingly, the subject systems can be provided with programming and sensors to both guide setup steps and detect when those steps have been completed. For example, guiding draping of a portion of the patient cart 110 to be draped next can be accomplished through blinking of an associated status indicator. Once that step is detected as having been completed by sensor (or alternatively manually indicated to the system by an operator or technician, such as through a menu), that step having been satisfied, the status indicator color and / or illumination pattern can change, such as from blinking to solid illumination, or from blue to green, for example. A visual indicator representing a subsequent setup step can then be illuminated, and so on.

[0235] Overtube Visual Interface

[0236] The visual indicator 375 and other visual indicated disclosed herein (e.g., 371 of Fig. 26), can be configured to illuminate so as to draw the attention of a user during a setup process, and / or indicate that a component, such as a linear translation stage supporting the instrument controller assembly 1313 and / or the overtube itself are actively moving. The visual indicators, such as visual indicator 375 can be configured to display a system status indicator, and / or to display the extent of travel of a component, such as the linear translation stage and / or the overtube, such as by partially illuminating along its length (e.g., as a scale or bar graph, for example). Various segments can be illuminated independently, which can be in any number suitable to perform the prescribed function indication.

[0237] The overtube arm 480, and its corresponding robotic controller 170 is the attachment interface and driver of flexural motion of the overtube 140 at the surgical target, as controlled by the user at the physician console 120. Once the overtube 140 is docked to the overtube controller 170, LEDs of the visual indicator 375 can be configured to illuminate to confirm the connection status. This is achieved by aligning and pressing the overtube hub 510 (the proximal control end and connection interface) into connection with the overtube controller 170, as well as any sterile drape adapter, if provided. When the overtube 140 engages with the controller 170 of the overtube arm 480, the user will observe the visual indicator 375 on the overtube arm 480 change to a green color for confirmation of complete connection, for example.

[0238] In accordance with further aspects of the invention, the subject systems can be configured to illuminate the visual indicator 375 in various colors and patterns to convey various status messages visually to an operator or user. The following example embodiments are provided for illustration: In one embodiment, the visual indicator 375 in a solid white state indicates a docking state and / or a ready state for draping. In one embodiment, the visual indicator 375 in a solid blue state indicates that the sanitary drape adapter has been attached but the overtube has not yet been attached. In one embodiment, the visual indicator 375 in a solid yellow state indicates the sanitary drape adapter and the overtube have been attached. In one embodiment, the visual indicator 375 in a blinkingwhite state indicates that a self-test is in progress and / or that the robotic controller is performing an engagement or alignment process with the overtube. In one embodiment, the visual indicator 375 in a solid green state indicates that the overtube is fully engaged with its controller and ready to operate. In one embodiment, the visual indicator 375 in a blinking green state indicates that the overtube is under active control by the physician console 120. In one embodiment, the visual indicator 375 in an off state indicates the patient cart 110 is off, or alternatively that there is an error, or still alternatively that an emergency state has been detected or initiated by an operator.

[0239] Instrument and Videoscope Controller Visual Interfaces

[0240] The central drive unit 1313 can also include one or more visual indicators 377 provided on the side or sides of the central drive unit 1313, which indicators can indicate status of the instrument controllers 420 (420a, 420b) or other system messages. Likewise, one or more visual indicators can also be provided corresponding to the videoscope controller 430. These visual indicators 377 are, in some embodiments elongate in form and can be configured to represent the status or position of a corresponding instrument controller 420, the videoscope controller 430 and / or status of the system 100 as a whole.

[0241] As with the visual indicator 375 on the overtube arm 480, the visual indicator 377 on the central drive unit 1313 can be configured to illuminate to draw the attention of a user during a setup process, and / or indicate that a component, such as the corresponding instrument controller and instrument is actively moving, and / or display a system status information, and / or to display the extent of travel of a component, such as linear translation of a corresponding instrument controller, such as by partially illuminating along its length. Suitable illumination technologies can include those described above in connection with the visual indicator 375.

[0242] In accordance with further aspects of the invention, the subject systems can be configured to illuminate the visual indicator 377 in various colors and patterns to convey various status messages visually to an operator or user. The following example embodiments are provided: In one embodiment, the visual indicator 377 in a blinking blue state indicates that the patient cart is initiating operation (i.e., starting up). In oneembodiment, the visual indicator 377 in a blinking white state indicates that a self-test is in progress and / or that the robotic controller is performing an engagement or alignment process with the overtube 140. In one embodiment, the visual indicator 377 in a solid green state indicates that the overtube 140 is fully engaged with its controller 170 and ready to operate. In one embodiment, the visual indicator 377 in a blinking green state indicates the overtube 140, an instrument and / or other system component is under active control by the physician console 120. In one embodiment, the visual indicator 377 in a solid blue state indicates a cleaning state. In one embodiment, the visual indicator 377 in a solid yellow state indicates that a recoverable fault has been detected, or that a manual emergency stop button has been activated and that the operator can recover system control through system functions, such as a recovery button on the physician console. In one embodiment, the visual indicator 377 in a solid red state indicates a nonrecoverable fault of the instrument controller or other system component has been detected. In such an instance, restart of the patient console can be indicated.

[0243] Central Drive Unit Clutch Interfaces

[0244] Additionally, user interface features provided in connection with central drive unit 1313 include one or more clutch buttons 378. The clutch buttons 378 are adapted and configured to disengage at least one motion control device of a corresponding robotic instrument controller 420 or videoscope controller 430 to allow a user to manually manipulate a position of the controller 420, 430. In accordance with certain embodiments, more than one (e.g., two) clutch buttons 378 can be provided in connection with each instrument controller 420, and the videoscope controller 430, to facilitate ease of use by an operator, technician, nurse, physician, or the like. In certain embodiments, each clutch button 378 is adapted and configured to disengage a drive assembly for axial translation (and optionally also for rotation and / or bending) of a respective controller to allow a distal portion thereof to me moved manually to connect and disconnect instruments and / or the videoscope.

[0245] The clutch buttons 378 can be provided one or more visual indicators, such as illuminated indicators, which can include the above-described illumination types. Inaccordance with one alternative embodiment, the visual indicators relating to the clutch buttons 378 of the instrument controllers 420, and / or videoscope controller 430 can include one or more digital displays to display detailed information or symbols. Any of the aforementioned visual indicators can be integrated into the clutch button 378 interface itself, such as by an illuminated button, or a clear button or touch-sensitive surface over a digital display, for example, or placed in proximity thereto. In the illustrated embodiment, the functions are integrated into an illuminated button which can display various colors (e.g., produced by an RGBW LED module), depending on a status of a corresponding device and / or a system status.

[0246] In accordance with further aspects of the invention, the subject systems can be configured to illuminate the visual indicators associated with instrument controllers 420 and videoscope controller 430 and / or the clutch buttons 378 in various colors and patterns to convey various status messages visually to an operator or user. The following example embodiments are provided: In one embodiment, a blinking white state indicates a self-test is in progress. In one embodiment, a solid white state indicates a loading / unloading position. In one embodiment, a blinking blue state indicates a drape not yet attached. In one embodiment, a solid blue state indicates a drape is attached, but an instrument or videoscope is not yet attached. In one embodiment, a solid yellow state during a setup procedure indicates that an instrument or videoscope needs to be retracted to a loading position before initiating or completing a self test. In one embodiment, a solid yellow state during regular operation indicates that an instrument or videoscope is attached but not in a ready position, and that manual advancement is required. In one embodiment, a solid green state indicates that an instrument or videoscope is in a ready position. In one embodiment, no indicator light during a setup process indicates that draping is in process but not all drape components are yet attached. In one embodiment, no indicator light during normal operation indicates an error or emergency state, or that a recoverable fault has been detected.

[0247] In accordance with a further embodiment, a blinking red state indicates a warning, such as an instrument error. In one embodiment, a solid white state indicates an instruction to an operator or technician to detach a corresponding instrument orvideoscope. In one embodiment, a blinking white state indicates an instruction to an operator or technician to attach a corresponding instrument or videoscope. In one embodiment, a solid yellow state indicates to take caution, such as that an instrument is not ready to operate. In one embodiment, a blinking yellow state indicates that a homing function is being performed. In one embodiment, a solid cyan state indicates that an instrument or videoscope should be unlocked by an operator or technician. In one embodiment, a blinking cyan state indicates that an instrument or videoscope has been successfully detected. In one embodiment, a solid green state indicates that an instrument or videoscope is ready to operate. In one embodiment, a blinking green state indicates that an instrument or videoscope is actively operating. In one embodiment, a solid blue state indicates that an instrument or videoscope can be moved manually.

[0248] In accordance with still further embodiments, when a digital display is used as a status indicator for each instrument controller 420 and / or the videoscope controller 430, more detailed status indications are possible, including text prompts indicating a message or instructions to an operator or technician. In such embodiments, a house icon can indicate that a homing function is being performed. The house icon can be any color, including green to indicate normal operation or yellow to indicate a delay in operation because of the process, for example. Icons of any color or shape can be provided, such as red to indicate an error or stopping of a function. Further graphical animations can be used, such as a moving circular animation to indicate an ongoing process such as instrument identification. A single or double-headed arrow can be displayed to indicate that an instrument or videoscope controller can be operated manually. Such an arrow can be animated or static and can be any color such as blue, or alternatively green to indicate that the process may proceed. In accordance with one embodiment, icons in gray can instruct an operator to attach or detach an instrument or videoscope. In one embodiment a solid icon can indicate instructions to detach an instrument. In one embodiment, a blinking icon can indicate to attach an instrument. In one embodiment, a solid cyan icon indicates to unlock an instrument. In one embodiment, a blinking cyan icon indicates that instrument detection is completing. In one embodiment, a solid yellow icon indicates that an instrument is ready to operate. In one embodiment, a blinking yellow icon indicatesthat an instrument or videoscope is not ready to operate. In one embodiment, an animated yellow icon indicates that a valid instrument has been detected. In one embodiment, an animated red icon indicates that an invalid instrument has been detected. Such icon can be in the shape of an X for example. In one embodiment, a solid green icon indicates an instrument or videoscope actively moving. These foregoing status conditions can be duplicated in other user interfaces, including position indicators, system GUIs, and the like.

[0249] Example 1 - Use of Clutch Button and Visual Indicator During Draping: An example use of a clutch button 378 and visual user interface feedback is demonstrated in the following example process of installing the videoscope drape adapter or instrument drape adapter, as performed by an operator or other technician: 1) Extend the videoscope controller 430 or instrument controller 420 by pressing and holding a corresponding clutch button 378 and advancing the controller 420, 430 until the visual indicator (e.g. clutch button 378 LED) stops blinking blue. 2) Install sterile drape and drape adapter, if any. 3) Retract the videoscope controller 430 by pressing and holding a clutch button 378 corresponding to the videoscope controller 430 until the LED changes to a solid blue color, manually retracting the videoscope controller 430 back to the loading position, and then releasing the corresponding videoscope controller clutch button 378.

[0250] Example 2 - Advancing Videoscope Controller to Ready Position: To advance the videoscope controller 430 to a ready position, the following steps are taken: 1) Press and hold videoscope controller 430 clutch button 378 and manually advance videoscope controller 430 (towards the patient) until reaching flush position (e.g., even with a distal end of the overtube). 2) Release the videoscope controller 430 clutch button 378 when the flush position is reached. The physician may advance the videoscope controller 430 to the ready position at the physician console 120. 3) If desired, press and hold videoscope controller 430 clutch button 378 and manually advance videoscope controller 430 to a ready position, in communication with the physician. Observe the visual indicator (such as LED) on the respective videoscope controller 430 change to a green color for confirmation of ready status.

[0251] Example 3 - Detaching and removing an instrument: The instruments are removed from the instrument controllers 420 one at a time. To remove an instrument for exchange, inspection, and / or cleaning the end effector with sterile gauze, or final removal after the procedure is completed, in accordance with one embodiment the following steps are taken for each instrument, as needed: 1) On the respective instrument controller 420 (left 420b / right 420a), press and hold a corresponding clutch button 378 and manually retract the instrument controller 420 (away from the patient) to the loading position, indicated by the visual indicator (e.g., an LED changing to a solid white color). 2) Release the instrument controller 420 clutch button 378 to maintain the instrument controller 420 in the loading position. 3) This example can further include the following step: Wait for the instrument to auto align to its removal position (the instrument controller 420 will automatically rotate until the red latch on the instrument drape adapter is at “12 o-clock”.

[0252] Central Drive Unit Structure

[0253] Referring to Figs. 35 through 38, the second module 922 (i.e., the central drive unit module) includes a chassis 3530 defining a framework having a distal end portion 3532 and a proximal end portion 3534, which is best seen in Fig. 38. A drive controller overtube arm 480 extends from the distal end portion 3532 of the chassis 3530. The overtube arm 480 is preferably constructed as a generally U-shaped channel to provide stiffness in torsion and bending. Cables can be readily routed from the chassis 3530 through the interior of the channel of the overtube arm 480, and a removable bottom preferably encloses the channel.

[0254] The overtube arm 480 is adapted and configured to cooperate with a steerable overtube assembly 140 (Figs. 5A-5D) of the type disclosed in commonly assigned U.S. Patent Application Publication No. 2023 / 0210618. More particularly, as best seen in Figs. 35 and 36, the overtube arm 480 includes an interface plate on its top surface for operative engagement with the steerable overtube assembly. A power transmission assembly of the overtube controller 170 is operatively associated with the lower portion of the overtube arm 480 for driving the steerable overtube assembly 140. The powertransmission assembly of the steerable overtube controller 170 includes a pair of drive motors 3577a, 3577b, which drive respective gear sets 3585a, 3585b that transfer torque to respective rotatable drive couplings 484a, 484b the steerable overtube assembly (also see Fig. 4C).

[0255] Referring to Figs. 35 through 38, the chassis 3530 is configured to house a central instrument or videoscope controller 430, a right-side instrument controller 420a, and a left-side instrument controller 420b. More particularly, chassis 3530 includes a central support frame section 3550 for supporting the videoscope controller 430, a right-side support frame section 3552 for supporting right instrument controller 420a, and a leftside support frame section 3554 for the supporting left instrument controller 420b.

[0256] The chassis 3530 further supports PCBs 3555 associated with each controller 420a, 420b, 430. The PCBs 3555 are thermally managed by fans and the electronics are protected for electro-magnetic compatibility. Each controller (420a, 420b, 430) has a respective E-chain 3565 for cable maintenance during translation. The framework of chassis 3530 further defines an interior cage 3556 for receiving a distal end portion of the drive beam 926 of the translation stage assembly 3522. The interior cage 3556 of chassis 3530 is open at its proximal end and it includes a distal end wall 3562, a ceiling section 3564 and a floor section 3566.

[0257] Referring now to Figs. 39 through 45, the elongated drive beam 926 of the translation stage assembly 922 includes a main body portion 3570, a distal end section 3572 and a proximal end section 3574. An engagement flange 3576 is provided at the proximal end section 3574 of drive beam 926 for connecting with the roll mechanism 386 of the third module 932, best seen in Fig. 39.

[0258] As best seen in Figs. 40 and 41, the translation stage assembly 3522 further includes a translation mechanism 3580 for translating the chassis 3530 relative to the drive beam 926 along the central drive axis 396 (Figs. 3 & 10) from a retracted or starting position to a fully extended position. The translation mechanism 3580 is partially housed within the interior of drive beam 926 and it includes a drive motor 3582 (e.g., Maxon EC 45 flat, 70W, 24V), a linear drive screw 3584 (e.g., Eichenberger KGT-12x2-FBR-RH-l- SAG) driven by the drive motor 3582, and a drive nut 3586 operatively associated with6the linear drive screw 3584 and adapted to translate along the length thereof (see Fig. 41). A slotted coupling 3583 (e.g., ASK-020 BB 4H7) operatively connects the proximal end of the drive screw 3584 to the drive motor 3582.

[0259] The translation mechanism 3580 further includes left and right parallel carriages 3590a, 3590b mounted on a top surface of a distal end section 3572 of drive beam 926. The carriages 3590a, 3590b define a pair of spaced apart parallel tracks 3592a, 3592b, best seen in Fig. 44. The translation mechanism 3580 also includes an elongated top plate 3594 that is adapted and configured to be mounted to the chassis 3530 within the interior cage 3556, as illustrated in Fig. 45. A pair of spaced apart parallel rails 3596a, 3596b extend downwardly from a bottom surface of the top plate 3594 for cooperative engagement with and translation within the parallel tracks 3592a, 3592b of the carriages 3590a, 3590b, as best seen in Figs. 43 and 44.

[0260] As illustrated in Figs. 41 and 45, a nut bridge 3598 connects the translating drive nut 3586 on drive screw 3584 to the top plate 3594 by way of threaded fasteners 35100. The nut bridge 3598 is dimensioned to pass through an elongated slot 35102 formed in the top surface of the main body portion 3570 of drive beam 926, as the drive nut 3586 translates relative to the drive beam 926, driven by the axial rotation of linear drive screw 3584. The elongated slot 35102 in drive beam 926 is best seen in Fig. 42.

[0261] Referring to Fig. 40, a linear encoder 35104 (e.g., RLS LA11 with AS10 scale) is operatively associated with the drive screw 3584 for monitoring the axial position of the drive nut 3586 and hence the carriage 3590 relative to the drive beam 926. A distal end portion of drive screw 3584 is supported by a radial bearing 35106 and the proximal end portion of drive screw 3584 is supported by a matched pair of angular bearings 35108 (e.g., NSK 7000A). A spring-engaged brake mechanism 35110 e.g., Sepac UTSEB-189, 24V) is operatively associated with the drive motor 3582.

[0262] Referring now to Figs. 46 and 47, the main drive beam 926 of the translation stage assembly 922 contains casework to shield cables and PCBs from EMC. Moreover, plastic components are used to protect cables from moving components, and while cables (e.g., cable 35120) are restrained as they enter the drive beam 926, and they are preferably constrained along the interior side walls of the drive beam, slack is provided inthe cables to accommodate for the moving components with which they are associated. Spacing is provided around PCBs to allow for EMC shielding and cable termination points, and all cable bundles are double insulated and shielded in one embodiment. Preferably, a motor controller from drive motor 3582 is located at the distal end of the main drive beam 926, spaced away from the drive motor 3582. In addition, as best seen in Fig. 47, cables (e.g., cable 35122) are routed to PCBs through the e-chain mount 35125.

[0263] Patient Cart GUI

[0264] Referring now to Figures 48-50, there are illustrated example embodiments of graphical user interface (GUI) 4800, 4900 and 5000 for display and user input on the user input device 1152 of the subject patient cart 110.

[0265] The GUI 4800 of Figure 48 provides joint control for positioning components of the patient cart 110, including elevation in panel 4851, pitch in panel 4853, roll in panel 4855 and translation in panel 4857. An image can be displayed in the central panel 4810, which can be a static image, animation, or a rendering representing positioning of the joints of the patient cart 110. Additionally, a system status message can be displayed in panel 4830. As illustrated, the status indicates that the patient cart 110 is under surgeon control, for example. Moreover, other information can be displayed in panel 4840, such as date and time and / or manufacturer or institution indicia. Further, a navigation panel 4820 can be provided on a bottom portion thereof to allow easy switching between control modes or settings, for example.

[0266] Fig. 49 illustrates a stow / deploy GUI 4900 providing controls for pre-set conformations of the patient cart 110. As illustrated in the main control pane 4910, functions of stow and deploy are provided to a user to enable easy storage or set-up of the patient cart 110. Stowing the patient cart 110 allows for its most compact and stable conformation to allow for easy storage or transport thereof, while deploying quickly extends the position of each joint (axis of freedom) to a convenient starting point for a procedure. At that point, an operator or technician can make fine adjustments to individual joints, if needed. As such, an operator does not need to individually controleach joint simply to unfold the patient cart 110 from the stow position. As embodied, the GUI 4900 can be configured to prompt an operator to press and hold a function in order to accomplish the function. If the operator discontinues pressing the function, the movement will stop. Further the GUI 4900 can be configured to confirm that a command has been received and the corresponding function is in progress, as illustrated. The GUI 4900 can also include an image displayed in the panel 4950, which can be a static image, animation, or a rendering representing positioning of the joints of the patient cart 110. As with the GUI 4800 of Fig. 48, other information can be displayed in panel 4840, such as date and time and / or manufacturer or institution indicia. A navigation panel 4820 can be provided on a bottom portion thereof to allow easy switching between control modes or settings.

[0267] A further GUI 5000 can be accessed by a user or programmed to display by default in use, and illustrates position of manipulable joints of the patient cart 110 across their respective ranges of motion in the main panel 5010. This window can also permit a user to adjust the position of those joints, if so embodied. The GUI 5000 can also include an image displayed in the panel 5050, which can be a static image, animation, or a rendering representing positioning of the joints of the patient cart 110. Other information can be displayed in panel 4840, such as date and time and / or manufacturer or institution indicia. A navigation panel 4820 can be provided on a bottom portion thereof. A further GUI can incorporate an emergency stop trigger.

[0268] While the devices, systems and related methods of the subject disclosure have been shown and described with reference to preferred embodiments, those skilled in the art will readily appreciate that changes and / or modifications may be made thereto without departing from the spirit or scope of the subject disclosure.

[0269] In light of the various illustrated embodiments of the subject systems, devices and methods described above, it is to be appreciated that such various non-limiting embodiments, or elements thereof, may be used separately, combined, or selectively combined for specific applications. Further, any of the various features of the above nonlimiting embodiments can be used without the corresponding use of other described features. The foregoing description should therefore be considered as merely illustrativeof the principles, teachings, and exemplary embodiments of this invention, and not in limitation thereof.

[0270] Any module(s) disclosed herein can include any suitable hardware and / or software module(s) configured to perform any suitable function(s) (e.g., as disclosed herein, e.g., as described above). As will be appreciated by those skilled in the art, aspects of the present disclosure may be embodied as a system, method or computer program product. Accordingly, aspects of this disclosure may take the form of an entirely hardware embodiment, an entirely software embodiment (including firmware, resident software, micro-code, etc.), or an embodiment combining software and hardware aspects, all possibilities of which can be referred to herein as a “circuit,” “module,” or “controller.” A “circuit,” “module,” or “controller” can include one or more portions of one or more separate physical hardware and / or software components that can together perform the disclosed function of the “circuit,” “module,” or “controller”, or a “circuit,” “module,” or “controller” can be a single self-contained unit (e.g., of hardware and / or software). Furthermore, aspects of this disclosure may take the form of a computer program product embodied in one or more computer readable medium(s) having computer readable program code embodied thereon.

[0271] Any combination of one or more computer readable medium(s) may be utilized. The computer readable medium may be a computer readable signal medium or a computer readable storage medium. A computer readable storage medium may be, for example, but not limited to, an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system, apparatus, or device, or any suitable combination of the foregoing. More specific examples (a non-exhaustive list) of the computer readable storage medium would include the following: an electrical connection having one or more wires, a portable computer diskette, a hard disk, a random access memory (RAM), a read-only memory (ROM), an erasable programmable read-only memory (EPROM or Flash memory), an optical fiber, a portable compact disc read-only memory (CD-ROM), an optical storage device, a magnetic storage device, or any suitable combination of the foregoing. In the context of this document, a computer readable storage medium may beany tangible medium that can contain or store a program for use by or in connection with an instruction execution system, apparatus, or device.

[0272] A computer readable signal medium may include a propagated data signal with computer readable program code embodied therein, for example, in baseband or as part of a carrier wave. Such a propagated signal may take any of a variety of forms, including, but not limited to, electro-magnetic, optical, or any suitable combination thereof. A computer readable signal medium may be any computer readable medium that is not a computer readable storage medium and that can communicate, propagate, or transport a program for use by or in connection with an instruction execution system, apparatus, or device.

[0273] Program code embodied on a computer readable medium may be transmitted using any appropriate medium, including but not limited to wireless, wireline, optical fiber cable, RF, etc., or any suitable combination of the foregoing.

[0274] Computer program code for carrying out operations for aspects of this disclosure may be written in any combination of one or more programming languages, including an object-oriented programming language such as Java, Smalltalk, C++ or the like and conventional procedural programming languages, such as the "C" programming language or similar programming languages. The program code may execute entirely on the user's computer, partly on the user's computer, as a stand-alone software package, partly on the user's computer and partly on a remote computer or entirely on the remote computer or server. In the latter scenario, the remote computer may be connected to the user's computer through any type of network, including a local area network (LAN) or a wide area network (WAN), or the connection may be made to an external computer (for example, through the Internet using an Internet Service Provider).

[0275] Aspects of this disclosure may be described above with reference to flowchart illustrations and / or block diagrams of methods, apparatus (systems) and computer program products according to embodiments of this disclosure. It will be understood that each block of any flowchart illustrations and / or block diagrams, and combinations of blocks in any flowchart illustrations and / or block diagrams, can be implemented by computer program instructions. These computer program instructions may be provided toa processor of a general purpose computer, special purpose computer, or other programmable data processing apparatus to produce a machine, such that the instructions, which execute via the processor of the computer or other programmable data processing apparatus, create means for implementing the functions / acts specified in any flowchart and / or block diagram block or blocks.

[0276] These computer program instructions may also be stored in a computer readable medium that can direct a computer, other programmable data processing apparatus, or other devices to function in a particular manner, such that the instructions stored in the computer readable medium produce an article of manufacture including instructions which implement the function / act specified in the above-described flowchart and / or block diagram block or blocks.

[0277] The computer program instructions may also be loaded onto a computer, controller other programmable data processing apparatus, or other devices to cause a series of operational steps to be performed on the computer, other programmable apparatus or other devices to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide processes for implementing the functions / acts specified herein.

[0278] Those having ordinary skill in the art understand that any numerical values disclosed herein can be exact values or can be values within a range. Further, any terms of approximation (e.g., “about,” “approximately,” “around”) used in this disclosure can mean the stated value within a range. For example, in certain embodiments, the range can be within (plus or minus) 20%, or within 10%, or within 5%, or within 2%, or within 1% or within any other suitable percentage or number as appreciated by those having ordinary skill in the art (e.g., for known tolerance limits or error ranges).

[0279] The use of the term “substantially” in the Specification and Claims means largely but not wholly that which is specified. The term “substantially” can also mean “consisting essentially of.”

[0280] With regard to degree, the term “substantially” in one aspect means greater than 50%, up to and including 100%. The term “substantially” in another aspect means 90% to 100%, inclusive. The term “substantially” in another aspect means 95% to 100%,inclusive. The term “substantially” in another aspect means 97% to 100%, inclusive. The term “substantially” in another aspect means 98% to 100%, inclusive. The term “substantially” in another aspect means 99% to 100%, inclusive. The term “substantially” in another aspect means 99.5% to 100%, inclusive. The term “substantially” in another aspect means 99.6% to 100%, inclusive. The term “substantially” in another aspect means 99.7% to 100%, inclusive. The term “substantially” in another aspect means 99.8% to 100%, inclusive. The term “substantially” in another aspect means 99.9% to 100%, inclusive.

[0281] With regard to function and corresponding functional language, the term “substantially” in the Specification and the Claims means sufficiently to such a degree of being precise such that performance of the prescribed action or task, from the perspective of one with ordinary skill in the art, is the same as though the object, element or step were exactly precise.

[0282] The term “predetermined” as used herein, including in the Specification and Claims, means an element, quantity or value, for example, which is selected in advance, where precise details, quantities or values can vary, but which nevertheless is relevant to the claimed invention.

[0283] The articles “a,” “an,” and “the” as used herein and in the appended claims are used herein to refer to one or to more than one (i.e., to at least one) of the grammatical object of the article unless the context clearly indicates otherwise. By way of example, “an element” means one element or more than one element.

[0284] The phrase “and / or,” as used herein in the specification and in the claims, should be understood to mean “either or both” of the elements so conjoined, i.e., elements that are conjunctively present in some cases and disjunctively present in other cases. Multiple elements listed with “and / or” should be construed in the same fashion, i.e., “one or more” of the elements so conjoined. Other elements may optionally be present other than the elements specifically identified by the “and / or” clause, whether related or unrelated to those elements specifically identified. Thus, as a non-limiting example, a reference to “A and / or B”, when used in conjunction with open-ended language such as “comprising” can refer, in one embodiment, to A only (optionally including elements other than B); inanother embodiment, to B only (optionally including elements other than A); in yet another embodiment, to both A and B (optionally including other elements); etc.

[0285] As used herein in the specification and in the claims, “or” should be understood to have the same meaning as “and / or” as defined above. For example, when separating items in a list, ”or” or “and / or” shall be interpreted as being inclusive, i.e., the inclusion of at least one, but also including more than one, of a number or list of elements, and, optionally, additional unlisted items. Only terms clearly indicated to the contrary, such as “only one of’ or “exactly one of,” or, when used in the claims, “consisting of,” will refer to the inclusion of exactly one element of a number or list of elements. In general, the term “or” as used herein shall only be interpreted as indicating exclusive alternatives (i.e., “one or the other but not both”) when preceded by terms of exclusivity, such as “either,” “one of,” “only one of,” or “exactly one of.”

[0286] With regard to positioning in space and relative positional terms, as used herein, have conventional meaning and are to be interpreted as such, unless explicitly indicated otherwise. For example, the terms distal and proximal mean farther / farthest or nearer / nearest from a reference point. Where represented there may be illustrated axes shown in phantom line or otherwise, and / or a reference legend oriented with respect to one or more figures to visually guide understanding of use of such relative positional terms. As such translation along or rotation about such axes and / or movement within planes defined thereby can be easily understood.

[0287] The embodiments of the present disclosure, as described above and shown in the drawings, provide for improvement in the art to which they pertain. While the systems, devices / apparatus and methods of the subject disclosure have been shown and described, those skilled in the art will readily appreciate that changes and / or modifications may be made thereto without departing from the scope of the subject disclosure. For example, those skilled in the art will readily appreciate that the various aspects of the invention described and illustrated throughout the specification, and components thereof, can be readily interchanged with one another and utilized alone or in any combination, without limitation, which is explicitly contemplated herein.

[0288] It is to be appreciated that the concepts, systems, circuits and techniques sought to be protected herein are not limited to use in the example applications described herein (e.g., medical, surgical or industrial applications), but rather may be useful in substantially any application where the subject devices, systems and methods find advantageous applications. While particular embodiments and applications of the present disclosure have been illustrated and described, it is to be understood that embodiments of the disclosure are not limited to the precise construction and compositions disclosed herein and that various modifications, changes, and variations can be apparent from the foregoing descriptions without departing from the spirit and scope of the disclosure as defined in the appended claims. Accordingly, it is submitted that that scope of the patent should not be limited to the described embodiments but rather should be limited only by the spirit and scope of the following claims.

Claims

CLAIMS1. A modular patient cart for a robotic surgical system comprising: a) a first module including a cart portion and a tower portion, wherein the cart portion is adapted and configured to translate over a horizontal surface and the tower portion extends upwardly from the cart portion to define a vertical elevation axis; b) a second module including a central drive unit and a translation stage assembly defining a central drive axis; and c) a third module including a roll stage mechanism and a pitch stage mechanism, wherein the third module is adapted and configured to operatively connect the second module to the first module.

2. The modular patient cart as recited in claim 1, wherein the second module is mounted for movement along the vertical elevation axis of the tower portion.

3. The modular patient cart as recited in claim 1, wherein the central drive unit is mounted for longitudinal translation relative to the translation stage assembly along the central drive axis.

4. The modular patient cart as recited in claim 1, wherein the roll stage mechanism is adapted and configured to rotate the central drive unit about the central drive axis and the pitch stage mechanism is adapted and configured to rotate the central drive unit about a pitch axis that extends perpendicular to the central drive axis and the vertical elevation axis.

5. The modular patient cart as recited in claim 1, wherein the central drive unit has a pose for stowage and transport in which the central drive unit is rotated about a pitch axis and elevated on the elevation axis, so it is recessed into the cart in a stowed position.

6. The modular patient cart as recited in claim 1, wherein the central drive unit has a pose for performing trans-anal or trans-vaginal surgical procedures in which the central drive unit is elevated on the elevation axis to a minimum operating height above the horizontal supportsurface and rotated about a pitch axis so that the central drive axis extends parallel to the horizontal support surface.

7. The modular patient cart as recited in claim 1, wherein the central drive unit has a pose for performing trans-oral or trans-umbilical surgical procedures in which the central drive unit is elevated on the elevation axis to a maximum operating height above the horizontal support surface and rotated about a pitch axis so that the central drive axis extends at an angle of 30 degrees relative to the horizontal support surface.

8. The modular patient cart as recited in claim 1, further comprising a wrap-around handle for gross positioning of the cart with side portions having vertical front sections to provide for differing handling heights and a rear portion that is slightly higher than the sides portions.

9. The modular patient cart as recited in claim 1, further comprising an illuminated indicator for displaying a position of the central drive unit with respect to the elevation axis, the central drive axis or a pitch axis.

10. The modular patient cart as recited in claim 9, the illuminated indicator being adapted and configured for visibility through a transparent drape.

11. A posable patient cart for a robotic surgical system comprising: a) a cart configured for transport over a horizontal support surface; b) a tower extending upwardly from the cart and defining a vertical elevation axis; and c) a central drive unit defining a central drive axis, wherein the central drive unit is operatively connected to the tower and mounted for movement about a pitch axis extending perpendicular to the vertical elevation axis of the tower.

12. The posable patient cart as recited in claim 11 , wherein the central drive unit has a first pose for stowage and transport in which the central drive unit is rotated about the pitch axis and elevated on the elevation axis, so it is recessed into the cart in a stowed position.

13. The posable patient cart as recited in claim 11, wherein the central drive unit has a second pose for performing trans-anal or trans-vaginal surgical procedures in which the central drive unit is elevated on the elevation axis to a minimum operating height above the horizontal support surface and rotated about the pitch axis so that the central drive axis extends parallel to the horizontal support surface.

14. The posable patient cart as recited in claim 11, wherein the central drive unit has a third pose for performing trans-oral or trans-umbilical surgical procedures in which the central drive unit is elevated on the elevation axis to a maximum operating height above the horizontal support surface and rotated about the pitch axis so that the central drive axis extends at an angle of 30 degrees relative to the horizontal support surface.

15. A robotic surgical system adapted and configured to perform a robotically assisted surgical procedure, the system comprising: a) a physician console comprising: i) a plurality of hand control input devices adapted to receive 3-dimensional hand gesture inputs from an operator; and ii) a plurality of foot pedals configurable to perform system functions adapted to receive a foot pedal input from the operator; b) a patient cart adapted and configured for bidirectional data communication with the physician console, having a spatially configurable supporting frame having a plurality of degrees of freedom and configured to support a central drive unit, the patient cart comprising: i) an axial translation actuator for actuating axial translation of the central drive unit along a central drive axis thereof; and ii) a roll actuator for actuating roll movement of the central drive unit about the central drive axis thereof,the central drive unit comprising: i) a steerable overtube controller adapted and configured to operatively engage and actuate bidirectional steering of a steerable overtube in two degrees of freedom; ii) a plurality of instrument controllers adapted and configured to operatively engage and actuate each of a plurality of elongate flexible surgical instruments deployable through first and second working channels of the steerable overtube; and iii) a videoscope controller adapted and configured to operatively engage and actuate a videoscope deployable through a third working channel of the steerable overtube; and c) a system controller adapted and configured to receive a plurality of control inputs from each of the plurality of hand control input devices, to process the plurality of control inputs and to transmit a plurality of control outputs to each of the axial translation actuator, the roll actuator, the steerable overtube controller, the plurality of instrument controllers and the videoscope controller, the control outputs causing the system to position a steerable overtube assembly at a surgical site, wherein the steerable overtube assembly is configured for introducing and deploying from a distal end thereof one or more robotically controlled surgical instruments.

16. The robotic surgical system as recited in claim 15, the patient cart further comprising a pitch actuator for actuating pitch rotation of the central drive unit about a pitch axis.

17. The robotic surgical system as recited in claim 15, the patient cart further comprising an elevate actuator for actuating elevation of the central drive unit along an elevation axis.

18. The robotic surgical system of claim 15, wherein the patient cart comprises: a) a first module including a cart portion and a tower portion, wherein the cart portion is adapted and configured to translate over a horizontal surface and the tower portion extends upwardly from the cart portion to define a vertical elevation axis; b) a second module including the central drive unit and a translation stage assembly defining the central drive axis of the central drive unit; andc) a third module including a roll stage mechanism and a pitch stage mechanism, wherein the third module is adapted and configured to operatively connect the second module to the first module.

19. The robotic surgical system as recited in claim 18, wherein the third module is mounted for movement along the vertical elevation axis of the tower portion of the first module.

20. The robotic surgical system as recited in claim 18, wherein the second module is mounted to the third module.

21. The robotic surgical system as recited in claim 18, wherein the central drive unit is mounted for longitudinal translation relative to the translation stage assembly, along the central drive axis.

22. The robotic surgical system as recited in claim 18, wherein the roll stage mechanism is adapted and configured to rotate the central drive unit about the central drive axis and the pitch stage mechanism is adapted and configured to rotate the central drive unit about a pitch axis that extends perpendicularly to the central drive axis and the vertical elevation axis.

23. A method of positioning a steerable overtube to provide surgical access for a robotic surgical instrument to a surgical site, the method comprising: a) instructing a first actuator to change a position of a central drive unit with respect to a vertical elevation axis; b) instructing a second actuator to change a position of the central drive unit along a central drive axis; c) instructing a third actuator to change a position of the central drive unit about the central drive axis; and d) instructing a fourth actuator to change a position of the central drive unit about a pitch axis.

24. The method of positioning a steerable overtube as recited in claim 23, wherein the pitch axis is perpendicular to both the elevation axis and the central drive axis.

25. A computer program product adapted and configured to enable a robotically assisted surgical procedure, the computer program product comprising computer-readable program code capable of being executed by one or more processors when retrieved from a non-transitory computer-readable medium, the program code comprising instructions configurable to effect actuation of: a) a first actuator to position of a central drive unit with respect to a vertical elevation axis; b) a second actuator to position of the central drive unit along a central drive axis; c) a third actuator to position of the central drive unit about the central drive axis; and d) a fourth actuator to position of the central drive unit about a pitch axis, the central drive unit supporting a steerable overtube assembly at a surgical site, wherein the steerable overtube assembly is configured for introducing and deploying from a distal end thereof one or more robotically controlled surgical instruments.

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