Laparoscope positioning apparatus

Abstract

A positioning apparatus (100) for a laparoscope having an arm arrangement having an arcuate arm segment (120) and a radial arm segment (130) and a support (110) having a connector (114) configured to rotate in relation to the support (110) and configured to connect the arcuate arm segment (120) in a slidable manner to the support (110). The radial arm segment (130) has a carrier (140) configured to attach a laparoscope and configured to move the laparoscope in a translational manner in a radial direction of the radial arm (130). The apparatus is configured to position the arm arrangement to support the laparoscope such that the laparoscope is positioned with a point of entry (22) into a body directly below an axis of rotation of the connector (114) and with the point of entry (22) at a centre of an arc defined by the arcuate arm segment (120).

Description

[0001] LAPAROSCOPE POSITIONING APPARATUS

[0002] CROSS-REFERENCE TO RELATED APPLICATIONS

[0003] This application claims priority from United Kingdom patent application number 2412815.9 filed on 2 September 2024, which is incorporated by reference herein.

[0004] FIELD

[0005] This disclosure relates to apparatus and systems for positioning and / or guiding a laparoscope inside a body and, in particular, to a laparoscope positioning apparatus and method of use of the apparatus.

[0006] BACKGROUND

[0007] Laparoscopy is a surgical procedure used to examine the organs in the abdomen. It typically involves a thin lighted tube called a laparoscope, which includes a camera at its distal end. Operating teams for laparoscopic procedures consist of the surgeon, an assistant, and a scrub nurse. During a laparoscopy, a patient is positioned supine, the surgeon stands at the patient’s side, the assistant stands next to the surgeon, and the scrub nurse and trolleys with equipment are positioned on the opposite side of the patient. Typically, a screen displaying a captured camera image is positioned in front of the surgeon when the surgeon stands upright.

[0008] Typically, three ports are inserted into the patient’s abdomen to perform a laparoscopic surgery, such as appendectomy. The ports allow for two instruments to be placed into the abdomen, which are controlled by the surgeon, and for one laparoscope to be inserted into the abdomen, which is generally controlled by the assistant. During the procedure, the assistant holds and positions the laparoscope such that the camera views the instruments while the surgeon uses them to perform the surgery. Therefore, the primary, and usually only, task of the assistant in a laparoscopic procedure is positioning the laparoscope.

[0009] There have been attempts to minimise the assistant’s involvement in the procedure and to give the surgeon control over it. Such attempts typically involve a linkage system to control the orientation of the camera or the distance the camera is from an area of interest. These devices are used to manipulate the camera such that it moves in up to four degrees of freedom, namely pitch, yaw, roll, and translation. The surgeon would typically have control over the translation of the camera to move it closer to or further away from the area of interest to effectively zoom in or out. In that scenario, the assistant would control the pitch, yaw, and roll.

[0010] A linkage system may provide the surgeon with more control but is bulky and has variable stability in that the further the camera is from the support or base of the laparoscope, the greater the moment about the support. However, providing the surgeon some control still does not eliminate the requirement for an assistant as the surgeon’s hands are occupied by the instruments. The assistant must manually adjust the laparoscope in at least one of the degrees of freedom such that an image displayed on a screen shows the instruments and the area of interest from the perspective of the surgeon.

[0011] The preceding discussion of the background is intended only to facilitate an understanding of the present disclosure. It should be appreciated that the discussion is not an acknowledgment or admission that any of the material referred to was part of the common general knowledge in the art as at the priority date of the application.

[0012] SUMMARY

[0013] According to a first aspect of the invention there is provided a positioning apparatus for a laparoscope, the apparatus comprising: an arm arrangement having an arcuate arm segment and a radial arm segment; a support having a connector configured to rotate in relation to the support and configured to connect the arcuate arm segment in a slidable manner in relation to the support; and the radial arm segment having a carrier configured to attach a laparoscope, the carrier configured to move the laparoscope in a translational manner in a radial direction of the radial arm.

[0014] The carrier may include an axis rotation mechanism configured to rotate an attached laparoscope around the longitudinal axis of the laparoscope. The support may be configured to position the arm arrangement to support the laparoscope such that the laparoscope is positioned with a point of entry into a body with the point of entry directly below an axis of rotation of the connector and with the point of entry at a centre of an arc defined by the arcuate arm segment, thereby allowing multiple degrees of movement of the laparoscope whilst keeping the point of entry constant. The apparatus may include a point of entry locating means configured to provide a reference point for positioning a body. The support may include adjustable height and reach components for adjusting the apparatus in relation to a body. The connector may include an arc adjustment mechanism configured to connect the arcuate arm segment to the connector in a slidable manner such that it is slidable between a free end of the arcuate arm segment and the radial arm segment that extends from a second end of the arcuate arm segment.

[0015] The apparatus may be configured to control multiple degrees of movement independently by operation of adjustable controls of the connector and the carrier, wherein the adjustable controls of the connector include an arc adjustment control and an arm rotation control, and the adjustable controls of the carrier include a laparoscope translation control and a laparoscope axis rotation control.

[0016] The apparatus may include a control system for control of the adjustable controls of the connector and the carrier, wherein the control system is configured to receive video data from the laparoscope, to identify at least one surgical instrument visible within a field of view of the laparoscope, and to change the position of the laparoscope based on the relative position of the at least one surgical instrument in the field of view.

[0017] The control system may be configured to identify two surgical instruments visible within the field of view of the laparoscope. The control system may be configured to change the position of the laparoscope so that a focal area is centred between the two surgical instruments. The control system may change the position of the laparoscope by moving it closer to or further away from the two surgical instruments so that both surgical instruments may remain within the field of view. The control system may change the position of the laparoscope so that each surgical instrument may remain within a band or zone offset from a centre of the field of view.

[0018] The control system may be configured to adjust the image of the received video data including rotation of the image. Image rotation may be accomplished by means of the control system controlling a display orientation of the video data and causing such orientation to progressively change so as to rotate the display orientation thereby rotating the field of view of the laparoscope. The control system may include a hand controller having controls for selecting the direction of each of the adjustable controls. The control system may include a foot controller having controls for activating the adjustable controls.

[0019] According to a second aspect of the invention there is provided a method of controlling a position of a laparoscope by means of a control system, comprising: receiving video data from a laparoscope held by a laparoscope positioning apparatus according to the first aspect; analysing the video data to identify at least one surgical instrument visible within a field of view of the laparoscope; and controlling movement of the laparoscope positing apparatus to change the position of the laparoscope based on the relative position of the at least one surgical instrument in the field of view.

[0020] The method may include identifying a marker on the at least one surgical instrument. The method may include controlling the movement of the arm segments based on the relative position of the marker in the field of view.

[0021] The video data may be analysed to identify two surgical instruments visible within the field of view of the laparoscope. The method may include controlling the movement of the arm segments to position the laparoscope so that a focal area may be centred between the two surgical instruments. The method may include changing the position of the laparoscope by moving it closer to or further away from the two surgical instruments so that both surgical instruments may remain within the field of view. The position of the laparoscope may be changed so that each surgical instrument may remain within a band or zone offset from a centre of the field of view.

[0022] The method may include moving one of the arm segments to change the position of the laparoscope within a degree of freedom associated with that arm segment. The method may include independently: changing a yaw of the laparoscope by means of rotational movement of the connector; changing a pitch of the laparoscope by translating the arcuate arm segment relative to the connector; changing a translation of the laparoscope by moving the carrier forwards-backwards on the radial arm segment: and changing a roll of the laparoscope about its own axis by rotation of the carrier.

[0023] The method may include manually controlling the rotation of the laparoscope about its own axis by means of a first foot controller. In addition, image rotation may be accomplished by means of the control system controlling a display orientation of the video data and causing such orientation to progressively change so as to rotate the display orientation thereby rotating the field of view of the laparoscope, for example so as to compensate for the rotation of the laparoscope and reorient the display to a correct point of view.

[0024] The method may include automatically controlling any one or more of the degrees of freedom when the control system may be in an active state. The method may include switching the control system between the active state and an inactive state by means of a second foot controller.

[0025] In accordance with an aspect of the disclosure there is provided a laparoscope positioning apparatus comprising: an arm arrangement having a first end with a mounting structure for attaching the arm arrangement to a support, and an opposite second end having a carrier for holding a laparoscope; wherein the arm arrangement includes a number of movable arm segments connected together by which a position of the laparoscope can be changed; and wherein movement of the arm segments is controlled by a control system which receives video data from the laparoscope, identifies at least one surgical instrument visible within a field of view of the laparoscope, and changes the position of the laparoscope based on the relative position of the at least one surgical instrument in the field of view. The at least one surgical instrument may include a marker by which the control system may identify the surgical instrument.

[0026] The apparatus may include a support which may extend from a mounting structure to a swivel joint, a arcuate arm segment which may be movable in translation relative to the swivel joint, and a radial arm segment which may be connected to the second arm segment and may have the laparoscope carrier movable in translation relative to the radial arm segment.

[0027] The carrier may rotate the laparoscope about its own axis. The position of the laparoscope may be movable in four degrees of freedom. The four degrees of freedom may be pitch, yaw, roll and forwards-backwards. Pitch may be movable by means of the translation of the second arm segment relative to the swivel joint. Yaw may be movable by means of the movement of the swivel joint. Roll may be movable by means of the rotation of the laparoscope about its own axis. Forward-backwards may be movable by means of the translation of the laparoscope carrier. Roll may be controlled manually by means of a first foot controller. Any of the degrees of freedom may be controlled automatically by the control system when the control system is in an active state. The control system may be switched between the active state and an inactive state by means of a second foot controller.

[0028] In accordance with a further aspect of the disclosure there is provided a method of controlling a position of a laparoscope during laparoscopic surgery, comprising, by means of a control system: receiving video data from a laparoscope held by a laparoscope positioning apparatus, the laparoscope positioning apparatus including a number of movable arm segments connected together by which a position of the laparoscope can be changed; analysing the video data to identify at least one surgical instrument visible within a field of view of the laparoscope; and controlling movement of the arm segments so as to change the position of the laparoscope based on the relative position of the at least one surgical instrument in the field of view.

[0029] Embodiments of the technology will now be described, by way of example only, with reference to the accompanying drawings. BRIEF DESCRIPTION OF THE DRAWINGS

[0030] In the drawings:

[0031] Figure 1 is a side view of an exemplary embodiment of a laparoscope positioning apparatus, according to aspects of the invention, holding a laparoscope and connected to a base;

[0032] Figure 2 is a three-dimensional view of the laparoscope positioning apparatus in use with a test abdomen;

[0033] Figure 3 is a perspective view demonstrating the degrees of freedom of the laparoscope positioning apparatus;

[0034] Figure 4 is a side view of the laparoscope positioning apparatus in use by a surgeon holding surgical instruments;

[0035] Figure 5 is a side view of an embodiment of the laparoscope positioning apparatus with support adjustments;

[0036] Figure 6 is a side view of an embodiment of the laparoscope positioning apparatus with a body positioning arrangement;

[0037] Figure 7 is a three-dimensional view of part of the laparoscope positioning apparatus of Figure 1 holding a laparoscope;

[0038] Figure 8 is a three-dimensional view of an arcuate arm segment of the laparoscope positioning apparatus of Figure 1;

[0039] Figure 9 is a side view of the arcuate curved arm segment of Figure 8;

[0040] Figure 10 is a side view of the part of the apparatus of Figure 7 with the laparoscope positioned substantially horizontally at one extreme translation of the arcuate arm segment;

[0041] Figure 11 is an exemplary side view of the part of the apparatus of Figure 7 positioned with the laparoscope at another extreme translation of the arcuate arm segment;

[0042] Figure 12 is a three-dimensional view of a radial arm segment of the laparoscope positioning apparatus;

[0043] Figure 13 is a side view of the laparoscope positioning apparatus connected to a hand controller and a foot controller, a control system and a video system;

[0044] Figures 14 to 20 are exemplary fields of view of a laparoscope in use with the laparoscope positioning apparatus; and

[0045] Figure 21 is a block diagram showing steps of a method of controlling a laparoscope positioning apparatus according to aspects of the invention. DETAILED DESCRIPTION WITH REFERENCE TO THE DRAWINGS

[0046] A laparoscope position apparatus is described that is configured to receive and move a laparoscope. The apparatus may move the laparoscope such that a camera of the laparoscope may record surgical tools used by a surgeon during laparoscopy. A video system may provide the surgeon with a live video feed of the surgical tools. The apparatus may be manually controlled or controlled by a control system which receives video data from the laparoscope, identifies at least one surgical instrument or tool visible within the field of view of the camera, and changes the position of the laparoscope based on the relative position of the at least one surgical instrument in the field of view.

[0047] Referring to Figure 1 , an example embodiment of a laparoscope positioning apparatus (100) is shown. The apparatus (100) has an arm arrangement having an arcuate arm segment (120) and a radial arm segment (130). The apparatus (100) has a support (110) including a base (112) for positioning the arm arrangement above an operating area in which a body will be placed.

[0048] The apparatus (100) has a connector (114) between the support (110) and the arm arrangement with the connector (114) configured to rotate in relation to the support (110) to rotate the arm arrangement. The connector (114) may be above the operating area and rotation of the connector may be about a vertical axis. The connector (114) connects the arm arrangement to the support (110) in a slidable manner such that the arcuate arm segment (120) slides in relation to the support (110) to allow a controlled movement of the arcuate arm segment (120) to move through the connector (114) in an arc. The connector (114) includes an arc adjustment mechanism configured to connect the arcuate arm segment (120) to the connector (114) in a slidable manner such that it is slidable between a free end (121) of the arcuate arm segment (120) and the radial arm segment (130) that extends from a second end (122) of the arcuate arm segment (120). The arcuate arm segment (120) may curve through approximately 90 degrees between the first free end (121) and the second end (122) from which the radial arm segment (130) extends inwardly.

[0049] The radial arm segment (130) has a carrier (140) configured to attach a laparoscope (102) in it when in use. The carrier (140) is configured to move the laparoscope (120) in a translational manner in a radial direction of the radial arm segment (130). The carrier (140) may also include an axis rotation mechanism configured to rotate an attached laparoscope (102) around the longitudinal axis of the laparoscope (102). The laparoscope (102) may have an angled camera at its distal end such that rotation around the longitudinal axis of the laparoscope changes the view of the angled camera. For example, the camera may be angled at 30 degrees. The laparoscope positioning apparatus (100) includes the arm arrangement having a first end with a mounting structure for attaching to the support (110) and a second end including the carrier (140) configured to hold the laparoscope. The support (110) may be any support acting as a stable structure providing stability to the apparatus. The support may attach to an operating table or be securely fastened to the floor. It should be appreciated that the support may only provide stability to the arm arrangement for smooth and stable movement of the laparoscope during operation.

[0050] The arm arrangement includes arm segments connected together by which the position of the laparoscope can be changed or manipulated. The arm arrangement may include a connector (114) provided on the support (110) and connecting the arcuate arm segment (120) to the support (110). The arcuate arm segment (120) may be curved and may be movable relative to the connector (114) that may be referred to as a swivel joint. More specifically, the arcuate arm segment (120) may be slidable relative to the swivel joint. The movement of the arcuate arm segment (120) relative to the swivel joint, or the support, may manipulate the pitch of the laparoscope. The curvature of the arcuate arm segment (120) may define a pitch path the laparoscope may follow when moved by the apparatus.

[0051] The arm arrangement includes the radial arm segment (130) having the laparoscope carrier (140). The radial arm segment may be in a fixed relationship to the arcuate arm segment (120). The radial arm segment (130) may be responsible for adjusting the translation of the laparoscope such that it moves linearly along its axis. The radial arm segment (130) may include a translation mechanism moving the carrier (140) along a laparoscope axis and relative to a portion of the radial arm segment (120). The linear translation of the laparoscope via the radial arm segment may be responsible for a zoom function of the laparoscope’s video feed. For example, translating the laparoscope along its axis towards a focus point may cause the area around the focus point to enlarge on the camera view, resulting in a zoomed-in camera view. Similarly, translating the laparoscope away from the focus point may cause the area around the focus point to shrink on the camera view, resulting in a zoomed-out camera view. The radial arm segment may also be responsible for the roll movement of the laparoscope about its axis. More specifically, the carrier may be responsible for the roll movement of the laparoscope.

[0052] Figure 2 shows a three-dimensional view of the laparoscope positioning apparatus (100) in use with a test abdomen (20). The test abdomen (20) simulates a body lying on an operation table during laparoscopy. The test abdomen (20) includes multiple access points (22 and 24) simulating insertions made to access the insides of the abdomen during laparoscopy. One of the access points is a laparoscope access point (22) and the others are instrument access points (24). Figure 2 shows the distal end of the laparoscope (102) inserted into the test abdomen (20) via the laparoscope access point (22). The proximal end is held by the carrier (140) and the laparoscope positioning apparatus (100) is connected to a base (112) which may be the operation table.

[0053] The support (110) is configured to position the arm arrangement (120, 130) to support the laparoscope (102) such that the laparoscope is positioned with a point of entry (22) into a body with the point of entry (22) directly below an axis of rotation (201) of the connector (114). The point of entry (22) may also be at a centre of an arc defined by the arcuate arm segment (120), thereby allowing multiple degrees of movement of the laparoscope whilst keeping the point of entry (22) constant.

[0054] The entry port (22) into the body being along the same axis as that of the top connector rotation and also being at a centre point of a circle defined by the arc of the arcuate arm segment together with the rotation of the laparoscope about its own axis and the translation of the laparoscope, means that each of these four movements can be independently carried out while keeping the point of the laparoscope where it enters the body in the same position so that it does not tear or widen the entry port (22).

[0055] For the purposes of reference, there is provided an exemplary cartesian coordinate system in Figures 1 and 2 where a Z-axis denominates the vertical and a Y-axis and an X-axis denominates a horizontal plane. Typically, when the apparatus (100) is used during laparoscopy, the Z-axis may be the surgeon’s vertical, the X-axis may be horizontal and parallel relative to the surgeon, and the Y-axis may be horizontal and perpendicular relative to the surgeon.

[0056] Referring to Figure 1 , the support (110) may extend from the mounting structure or base (112) to the connector (114) which may include a joint connection (114B), gears (114A), and a mount connection (118). The gears (114A) may be configured to rotate the joint connection (114B) about the Z-axis. The gears (114A) may include a yaw gear arrangement whereby the joint connection (114B) may be rotated about the Z-axis relative to the mount connection (118). The mount connection (118) may connect the gears (114A) to the mounting structure (112). Rotating the joint connection (114B) about the Z-axis may move the laparoscope (102) about the Z-axis when held by the carrier (140). The yaw degree of freedom of the laparoscope (102) may be the rotational movement of the laparoscope (102) about the Z-axis.

[0057] Figure 3 is a simplified schematic view of the arm arrangement of the laparoscope position apparatus (100) showing the different degrees of freedom the apparatus (100) provides. For the purposes of explaining the movement of the laparoscope (102) by the apparatus (100), the laparoscope may be received by the carrier (140) with the laparoscope axis (L-L) aligned with the Y-axis, the Z-axis being vertical and perpendicular to the Y-axis, and the X-axis being perpendicular to both the Y-axis and Z-axis. The laparoscope (102) may be movable in four degrees of freedom. The degrees of freedom may be pitch (P), yaw (Y), forwards-backwards (FB), and roll (R). The yaw (Y) movement may be by means of the rotational movement of the connector (114). More specifically, the yaw (Y) movement may be achieved by the rotation of the joint connection (114B) about the Z-axis as driven by the gears (114A). Rotating the joint connection (114B) may, in turn, rotate the arcuate curved arm segment (120) and the radial arm segment (130). This will cause the carrier (140) and the laparoscope (102), as held by the carrier (140), to rotate about the Z-axis, causing the yaw (Y) movement of the laparoscope.

[0058] The pitch (P) movement may be by means of the translation of the arcuate arm segment (120) relative to the connector (114). More specifically, the pitch (P) movement may be achieved by the pitch driver (124) rotating and engaging with the mating surface (122) to translate the curved body (126) to slide within the groove (116), causing the arcuate curved arm segment (120) to move relative to the support (110). The curvature of the curved body (126) may cause it and the radial arm segment (130) with the carrier (140) and laparoscope (102) to rotate about the X-axis. Rotation of the laparoscope (102) about the X-axis by the arm arrangement in the current orientation may cause the pitch (P) movement.

[0059] The roll (R) movement may be by means of the rotation of the laparoscope (102) about its own axis (L-L). This may be by means of the roll mechanism being configured to engage with the laparoscope (102) while the carrier (140) holds it in the housing (141). The roll mechanism may be configured to drive the rotation of the laparoscope (102) about its own axis (L-L). To compensate for the rotation of the image caused by the rotation of the laparoscope, the system may digitally rotate the display image so as to reorient the image to the correct view point of the surgeon.

[0060] The forwards-backwards (FB) movement may be by means of the translation of the laparoscope carrier (140) relative to the radial arm segment (130). More specifically, the translation mechanism of the radial arm segment (130) may engage with the carrier (140) and may translate the carrier (140) along the laparoscope axis (L-L) and relative to the radial arm segment (130). As the carrier (140) holds the laparoscope (102) it may move together with the carrier (140). Thereby, the laparoscope (102) may be translated in line with the Y-axis and, therefore, moved forwards- backwards. The apparatus (100) is configured to control multiple degrees of movement independently by operation of adjustable controls of the connector (114) and the carrier (140). The adjustable controls of the connector (114) include an arc adjustment control and an arm rotation control, and the adjustable controls of the carrier (140) include a laparoscope translation control and a laparoscope axis rotation control.

[0061] The arm rotation control at the connector (114) controls rotation at the connector of the arm arrangement providing the yaw (Y) movement. The arc adjustment control at the connector (114) controls the arc sliding of arcuate arm section (120) providing the pitch (P) movement. The laparoscope translation control at the carrier (140) controls translation along the radial arm section (130) providing the forwards-backwards (FB) movement. The laparoscope axis rotation control at the carrier (140) controls rotation of the laparoscope (102) about its own axis providing the roll (R) control.

[0062] Figure 4 shows the laparoscope positioning apparatus (100) as used with surgical instruments or tools (30 and 40). During laparoscopy, a surgeon typically uses two surgical instruments, i.e. a left instrument (30) and a right instrument (40). The apparatus (100) is shown as including a point of entry (22) into the body directly below the connector (140) and at the centre of the arc of the arcuate arm segment (120). The point of entry (22) is configured to remain constant during movement of the arm arrangement (120, 130). The laparoscope (102) may move to rotate about the point of entry (22) in the pitch (P) and yaw (Y) movements. The laparoscope (102) may move in a movement forwards and backwards (FB) movement through the point of entry (22). The laparoscope (102) may rotate or roll (R) about its axis through the point of entry (22).

[0063] Figure 4 shows how the apparatus (100) may control the movement of the laparoscope (102) during laparoscopy. A surgeon may hold the instruments (30 and 40) such that distal ends thereof may be in the field of view of the laparoscope (102) and that the distal ends may be recorded. The laparoscope is connected to a control system, which may include a processor and memory that is integral with the apparatus (100) or may be provided by a computing system used in conjunction with the apparatus (100). The control system is configured to receive video data from the laparoscope and to identify at least one surgical instrument (30, 40) visible within the field of view of the laparoscope (102). Typically, two surgical instruments are used in laparoscopy in conjunction with the laparoscope, a surgical tool such as a trocar or grasper, and a suction tube.

[0064] The at least one of the surgical instruments (30, 40) may include a marker (32, 42) by which the control system may identify the surgical instrument (30, 40). The marker (32, 42) may be a pattern, a colour marker, a distinguishable shape, a scratch, an indent, a protrusion, or anything that is distinguishable from the surroundings during laparoscopy. In a preferred embodiment, the marker may be a colour marker. The instrument (30, 40) is identifiable by the control system. It may be that only the left instrument (30) includes a marker (32) or that only the right instrument (40) includes a marker (42). It may also be that both instruments (40, 30) have markers (42, 32). It may also be that the markers (32, 42) are distinct such that the control system can distinguish between the left instrument (30) and the right instrument (40).

[0065] The control system may be able to identify the at least one surgical tool in the field of view of the laparoscope and may control each of the arm segments to adjust a specific degree of freedom of the laparoscope. For instance, when the at least one surgical tool is moved towards a surgeon along a horizontal plane, the control system may instruct and adjust the arcuate arm segment to adjust the pitch or the yaw of the laparoscope such that the surgical tool remains in the field of view. Similarly, moving the tool towards or away from the laparoscope may cause the control system to translate the laparoscope along its axis. It should be appreciated that the control system may control the movement of each arm segment individually and may control them all simultaneously. Moving only one arm segment may move the laparoscope within a single degree of freedom. The simultaneous movement of multiple arm segments may move the laparoscope in multiple degrees of freedom simultaneously.

[0066] The control system may further be configured to receive and process instructions from a user to control the movement of the arm arrangement and the laparoscope. Laparoscopes may have a lens with an optical axis that is offset from the longitudinal axis of the laparoscope itself. Physical rotation of the laparoscope is used to change the object of interest being viewed, but results in objects in the video feed rotating. To compensate for that, the control system may enable digital rotation to reorient the on-screen image to a correct point of view of the clinician. This digital rotation may therefore be considered an additional (virtual) degree of freedom. It should be appreciated that the digital adjustment of the orientation of the video may be manually controlled, for example by a foot controller.

[0067] The control system may further be toggled or switched between an active and inactive state by a user. In the active state, the control system may automatically adjust the movement, i.e. pitch, yaw, roll, and translation, of the apparatus, and thus the laparoscope, upon moving the surgical instrument. In the inactive state, the control system may not adjust the movement of the laparoscope in at least one degree of freedom upon movement of the surgical instrument. More specifically, in the inactive state, the control system may keep the laparoscope still and stationary upon movement of the surgical instrument. For the constraint of the entry port (22) being at a centre port of the circle defined by the arcuate arm segment to work, the height of the apparatus (100) may need to be adjustable to accommodate different sized patients. A guide may be provided for the operator to correctly adjust the height and / or reach of the apparatus.

[0068] Referring to Figure 5, a side view of the apparatus (100) shows the support (110) having an adjustable height support (110A) and an adjustable reach support (110B) for adjusting the apparatus in relation to a body. In this example, the adjustments are made by means of telescopic adjustment mechanisms (210A, 210B).

[0069] Referring to Figure 6, a side view of the apparatus (100) shows a guide in the form of a point of entry locating means (220) configured to provide a reference point for positioning a body. In Figure 6, the point of entry locating means (220) is provided by a pair of laser sources (221 , 222) that have lasers (223, 224) directed to intersect on a body (not shown) at the required point of entry (22). In another example, The point of entry locating means may be in the form of a measuring stick extension extending vertically below the point of rotation of the connector (114).

[0070] Figure 7 is a three-dimensional view of the arcuate arm segment (120) connected to the joint connection (114B) at one end and the radial arm segment (130) at an opposite end. Figures 8 and 9 are enlarged views of the arcuate arm segment (120). The arm arrangement may include a pitch mechanism whereby the arcuate arm segment (120) may be moved relative to the support (110). More specifically, the pitch mechanism may be configured to move the arcuate arm segment (120) relative to the joint connection (114B). The pitch mechanism may include a pitch driver (124) and the arcuate arm segment (120) may include a mating surface (122) configured to mate with the pitch driver (124). The pitch driver (124) may actuate or move the arcuate arm segment (120) due to the mating arrangement with the arcuate arm segment (120) when driven. In the embodiment shown, the pitch driver (124) may be a pinon (124), and the mating surface (122) on a curved body (126) of the arcuate arm segment (120) may form a rack. The rack and pinion (124), when assembled, may form a rack and pinion arrangement.

[0071] The joint connection (114B) may be configured to rotatably house the pinion (124) such that it is able to rotate within the housing. The joint connection (114B) may further include a groove (116) configured to receive the rack of the arcuate arm segment (120). The rack and pinion (124) may mate when the pinion (124) is housed by the joint connection (114B) and the rack is positioned within the groove (116). Rotation of the pinion (124) may cause the rack to slide within the groove (116), causing the arcuate arm segment (120) to move relative to the support (110). The curved body (126) may be configured to slide within the groove (116). Referring to Figure 9, when the pinion (124) is driven to rotate clockwise, the curved body (126) may slide within the groove (116) substantially from left to right in this view. When the pinion (124) is driven to rotate anti-clockwise, the curved body (126) may slide within the groove (116) substantially from right to left. Substantially from left to right should be understood to mean from a general left area to a general right area, and substantially from right to left should be understood to mean from a general right area to a general left area. It should be understood that the left-to- right or right-to-left movement does not need to be linear. The curvature of the arcuate arm segment (120) may cause the arcuate arm segment (120) to rotate about a virtual pivot point (PP) with a Z-Y plane. The rotation, or movement, of the arcuate arm segment (120) may manipulate the pitch of the laparoscope (102) within the same plane. Therefore, the curvature of the arcuate arm segment (120) may define a pitch path the laparoscope (102) may follow when moved by the apparatus (100). The curved body (126) may terminate with a stop (128) configured to prevent the body (126) from sliding out of the groove (116).

[0072] Figures 10 and 11 illustrate a pitch range of the arcuate arm segment (120). When the stop (128) abuts with the joint connection (114B), the arcuate arm segment (120) may be at a first end of the pitch range and the laparoscope (102) may be substantially horizontal, as shown in Figure 10. When the opposite end of the curved body (126) is positioned within the groove (116), the arcuate arm segment (120) may be at a second end of the pitch range and the laparoscope (102) may be pointing generally downwards, as shown in Figure 11. Substantially horizontal must not be understood to be exactly horizontal. Instead, it should be understood to be within 10 degrees from the horizontal. Similarly, pointing generally downwards must not be understood that the laparoscope is generally vertical, but that the laparoscope may be angled less than 20 degrees from the vertical, as determined by the requirements of the application.

[0073] Figure 12 shows an enlarged view of the radial arm segment (130) without the carrier (140). The radial arm segment (130) may be connected to the arcuate arm segment (120). The connection may include a portion of the arcuate arm segment (120) and be integral to the radial arm segment (130), as shown in Figure 12. In this embodiment, the connection may be detachable from the arcuate arm segment (120). However, it may very well be that the radial arm segment (130) is detachable from the connection, which is integral to the arcuate arm segment (120). It may also be that the connection is a separate segment of the arm arrangement which does not form an integral part of the second (120) or third (130) arm segments.

[0074] The radial arm segment (130) may include a carrier (140) which is more clearly shown in Figure 12. The radial arm segment (130) may include a translation mechanism (132) configured to move the carrier (140). The translation mechanism (132) may include a belt (132B) and translation pulley (132A) which may be driven by a translation motor (134). The belt (132B) may engage with the carrier (140) such that the carrier (140) may move together with the belt (132B). The belt (132B) may include teeth (132C) which may engage with a cooperating carrier engagement (138) such that the carrier (140) may move with the belt (132B). The cooperating carrier engagement (138) may accept a portion of the belt (132B) and an internal engagement mechanism of the cooperating carrier engagement (138) may engage with the teeth (132C) to secure the carrier (140) to the belt (132B). It should be appreciated that there may be various different mechanisms and engagements to connect the carrier (140) to the translation mechanism (132), such as a rack and pinion, a chain and chain connection, a slot and key arrangement, and the like. The translation mechanism (132) may engage with the carrier (140) and may translate the carrier (140) along a laparoscope axis (L). The belt (132) and cooperating carrier engagement (138) should be understood to be exemplary and may be used in a preferred embodiment.

[0075] Figure 13 shows an exemplary view of the laparoscope positioning apparatus (100) connected to the floor, controls (160, 170) for manually controlling the motors of the arm arrangement, and an enlarged view of the carrier (140). The carrier (140) may include a laparoscope housing (141) configured to accept and hold the laparoscope (102). The carrier (140) may further include a roll mechanism configured to rotate the laparoscope (102) about the laparoscope axis (L-L). Rotating the laparoscope (102) about the laparoscope axis (L-L) may designate the roll movement of the laparoscope. The roll mechanism may include a roll motor (148) configured to power and drive first (142) and second (144) roll pulleys connected by a roll belt (146). The second roll pulley (144) may be configured to engage with the laparoscope (102), or an end thereof, such that they may rotate together. It should be appreciated that similar to the translation mechanism, there may be other roll mechanisms which do not include a belt and pulley arrangement. These roll mechanisms may include a gear arrangement, a motor and follower arrangement, or the like. However, the illustrated roll mechanism may be used in a preferred embodiment.

[0076] The physical rotation of the laparoscope (102) is used to change the object of interest in the case that the optical axis of the lens is offset from the long axis of the laparoscope, for example, by a 30° offset. A digital rotation may be used to simply reorientate the on-screen image. Physically rotating the laparoscope will also result in rotation of the image, hence both mechanisms may need to be used simultaneously. In the case of a non-offset camera of a laparoscope, such physical rotation may not be required. Overall, the apparatus may account for four degrees of freedom physically (pitch, yaw, roll of the laparoscope, and translation), and another virtual degree of freedom of the rotation of the image. The apparatus (100) provides the center of rotation of each motorized arm lying at the point where the port through which the laparoscope is inserted into a body, meaning that for each movement (pitch, yaw, translation or roll), only one motor needed to be activated, resulting in fewer required computational steps (compared to conventional Selective Compliance Assembly Robot Arm (SCARA) systems), to achieve movement of the laparoscope.

[0077] Figures 14 to 20 are exemplary illustrations of a field of view (50) of the laparoscope (102) as displayed on a screen to a surgeon during laparoscopy. The field of view (50) may be the field of view of the laparoscope (102) as held and controlled by the laparoscope position apparatus (100) of Figure 13. The control system may be configured to identify two surgical instruments (30, 40) visible within the field of view (50). The field of view (50) may include a centre point (51) and a focal area (52). The centre point (51) may be the centre of the two surgical instruments (30, 40) and it may be that the surgeon desires the centre point (51) to be in the focal area (52). More specifically, the centre point may be the centre between the two markers (32, 42). The focal area (52) may be a virtual area (52) which may be displayed on the screen and may be designated by digital boundaries. The focal area (52) may be the centre of the field of view (50).

[0078] The field of view (50) may also include one or more virtual bands or zones (53, 54) for aligning the laparoscope (102) such that a portion thereof or the markers (32, 42) remain within the bands or zones (53, 54). These bands may or may not be visible in the display. The field of view (50) may have a band (53, 54) for each instrument (30, 40) the control system identifies. In the case where the control system identifies one instrument (30, 40), the field of view may only have one band or zone (53, 54). However, in the preferred embodiment, the control system may be configured to identify two instruments (30, 40) and the field of view (50) may therefore include two bands or zones (53, 54). The control system may control the laparoscope positioning apparatus (100) to position the laparoscope (102) such that the left instrument (30) remains within a left band (53) and the right instrument (40) remains within a right band (54). More specifically, the control system may control the laparoscope positioning apparatus (100) to position the laparoscope (102) such that the left instrument marker (32) remains within the left band (53) and the right instrument marker (42) remains within the right band (54). It should be appreciated that even though bands (53, 54) are used in the exemplary field of view (50), the zones may not be bands. For example, the zones may be blocks, circles, trapezoids, diamonds, or any other shaped zones. It is important that there may be zones and that the zones may be used to manoeuvre the apparatus (100) such that the instruments (30, 40), or a portion thereof, remain within the zones.

[0079] The control system may be configured to control the apparatus (100) such that each marker (32, 42) may be within its designated band (53, 54) in the field of view (50) and that the markers (32, 42) substantially align with the centre of the focal area (52), as illustrated in Figure 14. Therefore, the control system may control the apparatus such that the centre point (51) is positioned within the centre of the focal area (52). For example, when the centre point (51) is above or below the focal area (52), as illustrated in Figures 15 and 16, the apparatus (100) may be controlled to adjust the position of the laparoscope (102) such that centre point (51) is substantially in the centre of the focal area (52), thereby moving the field of view (50) up or down. Similarly, when the centre point (51) is left or right of the focal area (52) or the centre of the focal area (52), as illustrated in Figures 17 or 18, the apparatus (100) may be controlled to adjust the position of the laparoscope (102) such that centre point (51) is substantially in the centre of the focal area (52), thereby moving the field of view (50) left or right.

[0080] When the markers (32, 42) are outside of the bands (53, 54), as illustrated in Figure 19, the laparoscope (102) may be moved further away from the markers (32, 42) or an area of interest until the markers (32, 42) are aligned with the bands (53, 54). Similarly, when the markers (32, 42) are between the bands (53, 54), as illustrated in Figure 20, the laparoscope (102) may be moved closer to the markers (32, 42) or an area of interest until the markers (32, 42) are aligned with the bands (53, 54). Moving the laparoscope (102) further away from or closer to the markers (32, 42) may be a zoom-in and a zoom-out action.

[0081] The control system may be switched or toggled between an active state and an inactive state. In the active state, the pitch, yaw, roll, and translation may automatically be controlled by the control system based on the movement and position of the one or more instruments (30, 40) relative to the laparoscope (102). Therefore, in the active state, the surgeon may be able to control the position of the laparoscope (102) simply by moving the surgical instruments (30, 40). On the other hand, in the inactive state, the control system may be configured to keep the laparoscope (102) still and stable regardless of any instrument (30, 40) movements.

[0082] Referring to Figure 13, the laparoscope positioning apparatus (100) and control system (300) may be connected to a controller such as a remote controller. In a preferred embodiment, the controller may be a foot controller (170). The foot controller (170) may include user inputs such as push buttons, toggle switches, joysticks, or the like. The foot controller (170) may be for controlling the roll (R) of the laparoscope (102) when held by the carrier (140). The foot controller (170) may further be configured to receive a user input for adjusting the orientation of the field of view (50). The foot controller may also be used to switch the control system between the active state and the inactive state. During laparoscopy, the surgeon may move the instruments (30, 40) such that one can be higher or lower than the other within the field of view (50). When the control system is in the active state, it may control the apparatus (100) via its motors to move the laparoscope (102) to follow the instruments (30, 40) such that the surgeon may keep viewing them.

[0083] During movement of the instruments (30, 40), the control system may cause the image in the video feed of a video system (310) to rotate such that the instruments (30, 40) or the markers (32, 42) remain within the bands (53, 54) and the centre point (51) remains substantially at the centre of the focal area (52). In some instances (e.g. where the laparoscope is physically rotated), the perspective of the camera relative to the surgeon’s hands will change. The surgeon viewing the screen may be disorientated as the display may show the instruments in a different orientation than that in which the surgeon is holding them. To compensate for this, the surgeon may therefore toggle an orientation input, button or switch on the foot controller (170) to instruct the control system to adjust the orientation of the field of view (50) as displayed on the screen by rolling / rotating clockwise or anticlockwise, as desired.

[0084] In one example, there may only be a foot controller (170). Using the apparatus (100) with only a foot controller (170) for laparoscopy may enable the surgeon to conduct the procedure on his or her own. Therefore, an assistant may not be required for the procedure.

[0085] In an alternative embodiment, the controller may be a hand controller (160) which may include user inputs such as push buttons, toggle switches, joysticks, or the like. Each user input may be associated with activating a motor for manipulating degree of movement of the arm arrangement as described above. For example, a first user input may instruct the control system to control the movement of the support (110) to control the yaw (Y) of the arm arrangement and the laparoscope (102). Similarly, a second user input may instruct the control system to control the movement of the arcuate arm segment (120) to control the pitch (P) of the arm arrangement and laparoscope (102). A third user input may instruct the control system to control the movement of the radial arm segment (130) to control the forward-backward (FB) movement of the laparoscope (102). A fourth user input may instruct the control system to control the roll (R) of the laparoscope (102) while held in the carrier (140). There may be two user inputs for each of the pitch (P), yaw (Y), forwards- backwards (FB) and roll (R) movements of the laparoscope (102) The first of the two user inputs may be for movement in a first direction and a second of the two user inputs may be for a movement in an opposite direction. The control system may be configured to receive instructions from the hand controller (160) during the inactive state and manipulate the arm arrangement based on the instructions.

[0086] The hand controller (170) may, in the further embodiment, be used in conjunction with the foot controller (160). It may give an assistant control over the laparoscope positioning apparatus (100). The hand controller (170) may be useful as a failsafe, for example, where the control system malfunctions or is not accurate enough when attempting to move the laparoscope (102). Alternatively, it may be useful to give a teacher control over the laparoscope during training sessions when training a trainee surgeon, for example. However, as mentioned earlier, in one embodiment (which may be the preferred embodiment), only a foot controller may be present.

[0087] Figure 21 is a block diagram showing steps of a method (200) for controlling a position of a laparoscope during laparoscopy, the method (200) being performed by a control system. The method (200) includes receiving (202) video data from a laparoscope held by a laparoscope positioning apparatus, the laparoscope positioning apparatus including a number of movable arm segments connected together by which a position of the laparoscope can be changed. The method (200) further includes analysing (202) the video data to identify at least one surgical instrument visible within a field of view of the laparoscope. The control system may identify a marker on the at least one surgical instrument. More specifically, the video data may be analysed to identify two surgical instruments visible within the field of view of the laparoscope.

[0088] The method includes controlling (206) movement of the arm segments so as to change the position of the laparoscope based on the relative position of the at least one surgical instrument in the field of view. More specifically, controlling the movement of the arm segments may be based on the relative position of the marker in the field of view. The movement of the arm segments may be controlled to position the laparoscope so that a focal area may be centred between the two surgical instruments. The focal area may be an area of interest a surgeon is focusing on, such as an appendix during an appendectomy.

[0089] The method (200) may further include changing the position of the laparoscope by moving it closer to or further away from the two surgical instruments so that both surgical instruments may remain within the field of view. The position of the laparoscope may be changed so that each surgical instrument remains within a band or zone offset from a centre of the field of view.

[0090] The method may further include moving one of the arm segments to change the position of the laparoscope within a degree of freedom associated with that arm segment. Moving the arm arrangement may include changing a yaw of the laparoscope by means of movement of a swivel joint and a support. The support may be extending from a mounting structure to the swivel joint. Moving the arm arrangement may include changing a pitch of the laparoscope by translating a second arm segment relative to the swivel joint. The second arm segment may be connected to the swivel joint. Moving the arm arrangement may further include moving the laparoscope forwards-backwards by translating a carrier on a radial arm segment connected to the second arm segment. The carrier may be holding the laparoscope. Lastly, moving the arm arrangement may include rotating the laparoscope by the carrier about its own axis, while rotation may also be achieved virtually by rotation of the displayed video data rather to reorient the display to the correct point of view.

[0091] The method may include automatically controlling any one or more of the degrees of freedom when the control system is in an active state. More specifically, the method may include switching the control system between the active state and an inactive state by means of a second foot controller.

[0092] The method (200) may be implemented by a control system controlling a laparoscope positioning apparatus (100) holding a laparoscope (102) as explained earlier.

[0093] An advantage of the control system, method (200), and laparoscope positioning apparatus (100) is that the surgeon can attend to a laparoscopy without the use of an assistant controlling a laparoscope and without having to release one of the instruments. The laparoscope positioning apparatus (100) is able to identify at least one surgical instrument and manipulate and change the position of the laparoscope such that the at least one surgical instrument remains within the field of view of the laparoscope. Furthermore, if the surgeon requires manual control over the movement of the laparoscope, or for certain movements like, there may be provided a foot controller whereby the surgeon can adjust the laparoscope position. The control system may be toggled between an active and inactive state. The surgeon can be assured that the field of view may remain constant while performing fine surgical movements while the control system is in the inactive state, thereby keeping the laparoscope still while performing the fine movements. When the surgeon wishes to change the field of view, all that is required is to activate a foot controller to change the control system into the active state and then move the surgical tools to guide the field of view of the laparoscope.

[0094] Another advantage of the laparoscope positioning apparatus is the compact structure of the arm arrangement. The arm arrangement may be positioned between the surgeon and a body during a laparoscopy. As the arm arrangement is compact, the centre of gravity may remain substantially below a connection of the apparatus to support. Having the centre of gravity at a substantially constant point reduces the variable loads gravity imparts on the apparatus when moving the different arm segments. This increases the stability of the apparatus.

[0095] The foregoing description has been presented for the purpose of illustration; it is not intended to be exhaustive or to limit the technology to the precise forms disclosed. Persons skilled in the relevant art can appreciate that many modifications and variations are possible in light of the above disclosure.

[0096] The language used in the specification has been principally selected for readability and instructional purposes, and it may not have been selected to delineate or circumscribe the inventive subject matter. It is therefore intended that the scope of the present disclosure be limited not by this detailed description, but rather by any claims that issue on an application based hereon. Accordingly, the present disclosure is intended to be illustrative, but not limiting, of the scope of any accompanying claims. Finally, throughout the specification and any accompanying claims, unless the context requires otherwise, the word ‘comprise’ or variations such as ‘comprises’ or ‘comprising’ will be understood to imply the inclusion of a stated integer or group of integers but not the exclusion of any other integer or group of integers.

Claims

CLAIMS:1 . A positioning apparatus (100) for a laparoscope, the apparatus comprising: an arm arrangement having an arcuate arm segment (120) and a radial arm segment (130); a support (110) having a connector (114) configured to rotate in relation to the support (110) and configured to connect the arcuate arm segment (120) in a slidable manner in relation to the support (110); and the radial arm segment (130) having a carrier (140) configured to attach a laparoscope, the carrier configured to move the laparoscope in a translational manner in a radial direction of the radial arm (130).

2. The apparatus of claim 1 , wherein the carrier (140) includes an axis rotation mechanism configured to rotate an attached laparoscope around the longitudinal axis of the laparoscope.

3. The apparatus of claim 1 or claim 2, wherein the support (110) is configured to position the arm arrangement to support the laparoscope such that the laparoscope is positioned with a point of entry (22) into a body with the point of entry directly below an axis of rotation of the connector (114) and with the point of entry (22) at a centre of an arc defined by the arcuate arm segment (120), thereby allowing multiple degrees of movement of the laparoscope whilst keeping the point of entry constant.

4. The apparatus of any of claims 1 to 3, including a point of entry locating means (220) configured to provide a reference point for positioning a body.

5. The apparatus of any of the preceding claims, wherein the support (110) includes adjustable height and reach components (223, 224) for adjusting the apparatus in relation to a body.

6. The apparatus of any of the preceding claims, wherein the connector (114) includes an arc adjustment mechanism configured to connect the arcuate arm segment (120) to the connector (114) in a slidable manner such that it is slidable between a free end of the arcuate arm segment (120) and the radial arm segment (130) that extends from a second end of the arcuate arm segment (120).

7. The apparatus of any of the preceding claims, wherein the apparatus is configured to control multiple degrees of movement independently by operation of adjustable controls of theconnector (114) and the carrier (140), wherein the adjustable controls of the connector (114) include an arc adjustment control and an arm rotation control, and the adjustable controls of the carrier include a laparoscope translation control and a laparoscope axis rotation control.

8. The apparatus of claim 7, including a control system for control of the adjustable controls of the connector (114) and the carrier (140), wherein the control system is configured to receive video data from the laparoscope, to identify at least one surgical instrument visible within a field of view of the laparoscope, and to change the position of the laparoscope based on the relative position of the at least one surgical instrument in the field of view.

9. The apparatus of claim 7 or claim 8, wherein the control system is configured to identify two surgical instruments visible within the field of view of the laparoscope and is configured to change the position of the laparoscope so that a focal area is generally centred between the location of the two surgical instruments.

10. The apparatus of any of claims 7 to 9, wherein the control system is configured to adjust the image of the received video data including rotation of the image.

11. The apparatus of any of claims 7 to 10, wherein the control system includes a hand controller having controls for selecting the direction of each of the adjustable controls.

12. The apparatus of any of claims 7 to 11 , wherein the control system includes a foot controller having controls for activating the adjustable controls.

13. A method of controlling a position of a laparoscope (102) by means of a control system, comprising: receiving video data from a laparoscope (102) held by a laparoscope positioning apparatus (100) according to any of claims 1 to 12; analysing the video data to identify at least one surgical instrument (30, 40) visible within a field of view of the laparoscope (102); and controlling movement of the laparoscope positing apparatus (100) to change the position of the laparoscope based on the relative position of the at least one surgical instrument in the field of view.

14. The method of claim 13, including identifying a marker (32, 42) on the at least one surgical instrument (30, 40) and controlling the movement of the arm segments based on the relative position of the marker in the field of view.

15. The method of claim 13 or claim 14, including analysing the video data to identify two surgical instruments (30, 40) visible within the field of view of the laparoscope (102) and controlling the movement of the apparatus (100) to position the laparoscope (102) so that a focal area is generally centred between the two surgical instruments (30, 40).

16. The method of any of claims 13 to 15, including independently: changing a yaw of the laparoscope (102) by means of rotational movement of the connector (114); changing a pitch of the laparoscope (102) by translating the arcuate arm segment (120) relative to the connector (114); changing a translation of the laparoscope (102) by moving the carrier (140) forwards- backwards on the radial arm segment (130); and changing a roll of the laparoscope (102) about its own axis by rotation of the carrier (140).

17. The method of claim 16, including manually controlling the rotation of the laparoscope (102) about its own axis by means of a first foot controller (170), and causing a display orientation of the video data to rotate so as to reorient an on-screen image to compensate for the rotation of the laparoscope (102).

18. The method of claim 16 or claim 17, including automatically controlling the pitch, yaw, and translation when the control system is in an active state and switching the control system between the active state and an inactive state.

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