Cable guides for robotic microsurgical instruments

Abstract

An articulatable flexible instrument is provided. The flexible instrument comprises: (a) an elongated member extending between a distal end and a proximal end, where the elongated member comprises a flexible body; and (b) one or more radial openings located at different locations along the flexibly body and each is configured to each receive a modular cable guide. Each of the one or more openings are configured to couple with the modular cable guide for routing one or more cables through one or more internal features of the modular cable guide.

Description

Attorney docket No. 55441-735601CABLE GUIDES FOR ROBOTIC MICROSURGICAL INSTRUMENTSCROSS-REFERENCE

[0001] This application claims priority to U.S. Provisional Patent Application No. 63 / 697,959, filed on September 23, 2024, which is entirely incorporated herein by reference.BACKGROUND

[0002] Endoscopy procedures use an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inserted into the organ directly. Flexible endoscopes that can deliver instinctive steering and control are useful in diagnosing and treating diseases that are accessible through any natural orifice in the body. Depending on the clinical indication, the endoscope may be designated as bronchoscope, ureteroscope, colonoscope, gastroscope, ENT scope, and various others. For example, flexible bronchoscopes may be used for lung cancer diagnosis and / or surgical treatment. However, one challenge in bronchoscopy is reaching the upper lobe of the lung while navigating through the airways. In another example, flexible endoscopy has been used to inspect and treat disorders of the gastrointestinal (GI) tract without the need for creating an opening on the patient's body. The endoscope is introduced via the mouth or anus into the upper or lower GI tracts respectively. A miniature camera at the distal end captures images of the GI wall that help the clinician in their diagnosis of the GI diseases. Simple surgical procedures (like polypectomy and biopsy) can be performed by introducing a flexible tool via a working channel to reach the site of interest at the distal end.

[0003] Some of the flexible tools are actuated by tendons or pull wires. In the tendon actuated steerable surgical instruments, endoscopes, and catheters, cable routing is critical. For example, poor boundary conditions of the cable may have negative implications on motion fluidity, directional accuracy, unintended motion, responsiveness, motion coupling with the end effector, hysteresis following de-articulation, or other effects that can cause worsened joint space tracking.SUMMARY

[0004] There exists a need for improved methods and apparatus for routing tendon cables in flexible instruments that provide high dimensional stability throughout the instrument’s range of motion while minimizing cost and simplifying assembly. The present disclosure addresses the above needs by providing methods and apparatus to guide and route a plurality of tendon cables with high-dimensional stability (e.g., both in location and the diameter of the routing lumens).Docket No.: 55441-735.601High dimensional stability may generally refer to maintaining both (i) the lateral position of each tendon relative to a reference datum and (ii) the effective diameter of the routing lumen, even as the elongated member undergoes articulation.

[0005] In some embodiments, the present disclosure provides cable guiding elements and methods to arrange the position of cables or route cables through robotically steered end effectors, wrists and / or continuums (e.g., bending section). The cable guiding elements may have unique structures allowing for flexibility to accommodate various cable configurations. Additionally, the cable guiding elements can be conveniently assembled to an elongated member at various selected locations along the length. The elongated member may comprise a flexible shaft (passive portion) following an articulable bending section (active portion) for steering rigid distal end of the elongated member.

[0006] In some embodiments, the elongated member may have a simplified design comprising a single-sheath without hinged vertebra-type configuration thereby allowing for a single-use, disposable endoscope. Existing approaches to tendon routing include vertebra-type shafts with stacked control rings having internal holes for cable passage, braided sheaths with embedded lumens, and continuous liners (e.g., Bowden tubes). These approaches suffer from several drawbacks. Vertebra-type assemblies involve complex, high-cost manufacturing and alignment tolerances. Braided sheaths allow cable migration, producing variable lumen geometry and hysteresis. Continuous liners can be difficult to align precisely along complex curves and are not readily adaptable to varied cable pitch or layout. Unlike the vertebra-type shaft where the control rings are assembled with internal holes and structures to pass through cable guiding elements, a continuous single-piece sheath of the endoscopic instrument herein may be a substantially tubular sheath without such control rings throughout the length of the shaft. Unlike vertebra-type shafts, which require complex alignment of stacked rings, the disclosed guiding elements can be independently placed, indexed, or keyed into position relative to the sheath in both the length direction and along the circumference. This reduces tolerance stack-up and improves repeatability of tendon routing. The modular cable guiding elements herein beneficially provides further flexibility to vary the location of the cable guiding elements.

[0007] In some embodiments, the cable guiding elements may have a substantially planar form factor that provides significant advantages in both cost and manufacturability. The planar nature allows the elements to be produced using scalable two-dimensional fabrication processes — such as photo-etching, laser cutting, stamping, lithography, water-jet cutting, or combinations thereof — which are inherently low-cost and capable of producing features with sub- 100 micron tolerances in high volume. Unlike conventional vertebra-type components that require complex three-dimensional machining or molding of thick parts, the substantially planar guiding elementsDocket No.: 55441-735.601 may be fabricated from thin sheets of metal, polymer, or composite materials (e.g., stainless steel, Nitinol, PEEK, PPS, or laminated polymer-metal composites). This permits rapid, parallelized production of hundreds or thousands of guides per sheet, reducing per-unit cost and simplifying quality control.

[0008] The cable guiding elements may further comprise three-dimensional (3D) features (e.g., slots, counterbores, chamfers, fillets, etc.) to provide additional functionality (e.g., for assembly guidance, integration with flexure of bending section, etc.). The cable guiding elements may incorporate various localized three-dimensional (3D) features to enhance functionality. Examples of such features include precision slots to receive tendon jackets, counterbores or recessed pockets to capture cable liners or inserts, chamfers to reduce insertion friction, and fillets to mitigate stress concentrations. These 3D features can be fabricated using low-cost secondary operations such as injection molding, overmolding, thermoforming, stamping with forming dies, embossing, or precision milling. In some embodiments, polymer overmolding onto the planar blank may provide integrated low-friction routing channels (e.g., PTFE-lined lumens), while in other embodiments, micro-machined slots or counterbores ensure axial positioning and prevent cable migration. In other embodiments, additive manufacturing (e.g., microstereolithography) may be applied locally to build up 3D features only where needed, maintaining overall planar manufacturability. The planar form factor further facilitates precise registration and assembly of the guiding elements onto the elongated member. Because each element is thin and lightweight, it can be stacked, clipped, or bonded onto the sheath at defined axial intervals with minimal effect on shaft bending stiffness. The substantially two-dimensional profile also allows integration into roll-to-roll or pick-and-place assembly workflows, thereby enabling high-volume production of disposable instruments.

[0009] In some embodiments, the cable guiding elements may comprise integral features to guide / route other cables or components that may not be tendons or pull wires. For instance, cables or components such as microfluidic lines, springs, electrical harnesses, optical fibers, or others may be passed through or guided by the cable guiding elements. In some embodiments, the cable guiding elements may comprise integral passages, apertures, or retention features configured to guide or route auxiliary components beyond tendon cables. For example, the guiding element may include channels sized for microfluidic lines used for irrigation, suction, or drug delivery; grooves or pockets for coil springs or stiffening rods that provide passive restoring force; conduits for electrical harnesses used to transmit power or signals to distal actuators or sensors; and apertures for optical fibers or fiber bundles used in illumination, imaging, or sensing applications. These auxiliary routing features may be co-located with the tendon lumens in aDocket No.: 55441-735.601 common planar guide, thereby reducing part count and simplifying instrument cross-section management.

[0010] The described tendon cables may be active or passive. Active tendons are connected to actuators (e.g., motors, pulleys, or linear actuators) located at the proximal end such that axial displacement of the tendon produces local articulation or motion at the distal end effector, wrist, or bending section. Passive tendons may function as stiffening members or spring-back elements that reside within the instrument cross-section to provide desired mechanical properties (e.g., increased column stiffness, torsional rigidity, or controlled return force after deflection). By accommodating both active and passive tendons, the cable guiding elements allow for hybrid designs in which select cables transmit actuation forces while others provide structural reinforcement or compliant biasing.

[0011] In an aspect, an articulatable flexible instrument comprising is provided. The flexible instrument comprises: (a) an elongated member extending between a distal end and a proximal end, wherein the elongated member comprises a flexible body and wherein the distal end is steerable by one or more cables; (b) one or more openings formed at different locations along the flexibly body and each of the one or more openings is configured to receive a modular cable guide. In some cases, the modular cable guide is configured for routing the one or more cables through one or more internal features of the modular cable guide.

[0012] In some embodiments, the modular cable guide comprises a peripheral feature mating with a shape and size of at least one of the one or more openings. In some cases, the peripheral feature allows for a single configuration for placing the modular cable guide.

[0013] In some embodiments, the one or more internal features comprise through holes of a circular shape, a non-circular shape or a combination of both. In some embodiments, the modular cable guide is received in a radial direction. In some embodiments, the modular cable guide is received in an axial direction. For instance, the modular cable guide is stacked between two adjacent tubular segments.

[0014] In some embodiments, the modular cable guide is configured to be coupled to an opening selected from the one or more openings at a selected location. In some embodiments, the modular cable guide is configured to be loaded in an axially fashion at a wrist section of the articulatable flexible instrument. In some embodiments, the modular cable guide is configured to be loaded at a bending section or a passive shaft portion of the articulatable flexible instrument. In some cases, the one or more cables comprise one or more pull wires actuated by one or more actuators to steer the distal end of the elongated member.Docket No.: 55441-735.601

[0015] In some embodiments, the one or more openings are cutout formed in the flexible body and the flexible body is formed of a single-piece sheath. In some embodiments, the one or more openings are formed by linking two or more tubular segments.

[0016] In some embodiments, the modular cable guide is coupled to the one or more openings without additional fastening means. In some embodiments, the modular cable guide, once is coupled to the flexible body, does not have axial or radial movement relative to the flexible body.

[0017] In some embodiments, the one or more cables are routed through one or more of the modular cable guides to have a non-linear configuration. In some embodiments, the one or more cables are routed through one or more of the modular cable guides to have a linear or straight configuration.

[0018] In some embodiments, the articulatable flexible instrument is robotically controlled via an instrument driving mechanical releasably coupled to the proximal end. In some embodiments, the modular cable guide has a substantially planar form factor.

[0019] In some embodiments, the modular cable guide is further configured to route one or more of electrical wire cables, signaling cables, monitoring cables, fiber optic cables, ultrasonic cables, microfluidic line cables, springs, electrical harnesses, sensor cables, or any combination thereof.

[0020] The articulatable flexible instrument may be a robotic endoscopic device or a flexible instrument (e.g., needle, grasper, etc.) that is passed through a robotic endoscopic device. The modular cable guide comprises peripheral features mating with a shape and size of at least one of the one or more radial openings. The one or more internal features comprise through holes of circular or non-circular shapes.

[0021] It should be noted that the provided flexible instrument, flexible device, end effector, endoscope components and various components of the device can be used in various minimally invasive surgical procedures, therapeutic or diagnostic procedures that involve various types of tissue including heart, bladder and lung tissue, and in other anatomical regions of a patient’s body such as a digestive system, including but not limited to the esophagus, liver, stomach, colon, urinary tract, or a respiratory system, including but not limited to the bronchus, the lung, and various others. The devices and systems can be used in any subject that may or may not involve human body, animal, or tissue.

[0022] Additional aspects and advantages of the present disclosure will become readily apparent to those skilled in this art from the following detailed description, wherein only illustrative embodiments of the present disclosure are shown and described. As will be realized, the present disclosure is capable of other and different embodiments, and its several details are capable of modifications in various obvious respects, all without departing from the disclosure.Docket No.: 55441-735.601Accordingly, the drawings and description are to be regarded as illustrative in nature, and not as restrictive.INCORPORATION BY REFERENCE

[0023] All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference.BRIEF DESCRIPTION OF THE DRAWINGS

[0024] The novel features of the disclosure are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present disclosure will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the disclosure are utilized, and the accompanying drawings of which:

[0025] FIGs. 1A and IB illustrate a non-limiting example of a cable guide.

[0026] FIG. 2A and FIG. 2B show an example of assembling or loading one or more cable guides to a bending section of a flexible instrument.

[0027] FIGs. 3A and 3B show examples of cable guides mated with radial opening features of a flexure component, in accordance with some embodiments.

[0028] FIGs. 4A and 4B show examples of a cable guide configured to receive one or more cables via internal holes at various locations.

[0029] FIGs. 5A-5C and FIGs. 6A, 6B show an example of axially loading a cable guide to be stacked between two tubular components.

[0030] FIG. 7A depicts a non-limiting example of a cable guide that is configured with one or more teeth with a different tooth angle.

[0031] FIG. 7B illustrates a non-limiting example of a cable guide that is configured with one or more teeth that can correspond to the receiving areas of a tubular component pre-configured to receive the cable guide.

[0032] FIG. 8A illustrates a non-limiting example of a cable guide positioned at a radial angle to be held in place by only the cables.

[0033] FIG. 8B shows a non-limiting example of a cable guide positioned at a radial angle and held in place by a tubular component.

[0034] FIGs. 9A and 9B illustrate a non-limiting embodiment of exemplary material removal of a tube of a flexible cable guide to create cable guide receiving cavity slots.Docket No.: 55441-735.601

[0035] FIG. 10 illustrates a non-limiting example of a cable guide with multiple orthogonal holes for cables to prevent cable twisting with orthogonality mapped across the cable guide between holes.

[0036] FIG. 11A depicts a non-limiting example of a cable guide contacting a plurality of cables so that surface area between the cable guide and each cable of the plurality of cables is minimized.

[0037] FIG. 11B depicts a non-limiting example of a cable guide contacting a plurality of cables so that surface area between the cable guide and the cable of a plurality of cables is maximized.

[0038] FIG. 12A shows a non-limiting example of a cable guide that can be contained within a wrist section of a flexible endoscope body that can be attached to an end effector.

[0039] FIG. 12B depicts a non-limiting example of an assembled wrist section of a flexible endoscope body comprising the cable guide and attached to an end effector.

[0040] FIG. 13 depicts a non-limiting example of a combination of a plurality of cable guides laterally located from each other within an assembled wrist section of a flexible endoscope body.

[0041] FIG. 14 illustrates a non-limiting example of cable routing in a nonlinear pattern, for example a helical pattern, within the endoscope body.

[0042] FIG. 15 illustrates a non-limiting example of a flexible endoscope, in accordance with some embodiments of the present disclosure.

[0043] FIG. 16 shows a non-limiting example of a robotic endoscope comprising a handle portion and a flexible elongate member.

[0044] FIG. 17 shows a non-limiting example of an instrument driving mechanism providing a mechanical interface to the handle portion of the robotic endoscope.

[0045] FIG. 18 shows a non-limiting example of a distal tip of an endoscope.

[0046] FIG. 19 shows a non-limiting exemplary distal portion of the catheter with integrated imaging device and an illumination device.

[0047] FIG. 20 shows a non-limiting example of an endoscope tip portion with a reduced diameter.

[0048] FIG. 21 illustrates a non-limiting example of a compact configuration of a plurality of electronic elements disposed at a distal portion of a catheter, in accordance with some embodiments disclosed herein.DETAILED DESCRIPTION

[0049] While various embodiments of the invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions may occur to those skilled in the artDocket No.: 55441-735.601 without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein may be employed.

[0050] The embodiments disclosed herein can be combined in one or more of many ways to provide improved diagnosis and therapy to a patient. The disclosed embodiments can be combined with existing methods and apparatus to provide improved treatment, such as combination with known methods of pulmonary diagnosis, surgery and surgery of other tissues and organs, for example. It is to be understood that any one or more of the structures and steps as described herein can be combined with any one or more additional structures and steps of the methods and apparatus as described herein, the drawings and supporting text provide descriptions in accordance with embodiments.

[0051] While exemplary embodiments will be primarily directed at a device or system for bronchoscopy, one of skill in the art will appreciate that this is not intended to be limiting, and the devices described herein may be used for other therapeutic or diagnostic procedures and in various anatomical regions of a patient’s body. The provided device or system can be utilized in urology, gynecology, rhinology, otology, laryngoscopy, gastroenterology with the endoscopes, combined devices including endoscope and instruments, endoscopes with localization functions, one of skill in the art will appreciate that this is not intended to be limiting, and the devices described herein may be used for other therapeutic or diagnostic procedures and in other anatomical regions of a patient’s body, such as such as brain, heart, lungs, intestines, eyes, skin, kidney, liver, pancreas, stomach, uterus, ovaries, testicles, bladder, ear, nose, mouth, soft tissues such as bone marrow, adipose tissue, muscle, glandular and mucosal tissue, spinal and nerve tissue, cartilage, hard biological tissues such as teeth, bone and the like, as well as body lumens and passages such as the sinuses, ureter, colon, esophagus, lung passages, blood vessels and throat, and various others, in the forms of: NeuroendoScope, EncephaloScope, Ophthalmoscope, OtoScope, RhinoScope, LaryngoScope, GastroScope, EsophagoScope, BronchoScope, ThoracoScope, PleuroScope, AngioScope, MediastinoScope, NephroScope, GastroScope, DuodenoScope, CholeodoScope, CholangioScope, LaparoScope, AmioScope, UreteroScope, HysteroScope, CystoScope, ProctoScope, ColonoScope, ArthroScope, SialendoScope, Orthopedic Endoscopes, and others, in combination with various tools or instruments.

[0052] The systems and apparatuses herein can be combined in one or more of many ways to provide improved diagnosis and therapy to a patient. Systems and apparatuses provided herein can be combined with existing methods and apparatus to provide improved treatment, such as combination with known methods of pulmonary diagnosis, surgery and surgery of other tissues and organs, for example. It is to be understood that any one or more of the structures and steps as described herein can be combined with any one or more additional structures and steps of theDocket No.: 55441-735.601 methods and apparatus as described herein, the drawings and supporting text provide descriptions in accordance with embodiments.

[0053] Whenever the term “at least,” “greater than,” or “greater than or equal to” precedes the first numerical value in a series of two or more numerical values, the term “at least,” “greater than” or “greater than or equal to” applies to each of the numerical values in that series of numerical values. For example, greater than or equal to 1, 2, or 3 is equivalent to greater than or equal to 1, greater than or equal to 2, or greater than or equal to 3.

[0054] Whenever the term “no more than,” “less than,” or “less than or equal to” precedes the first numerical value in a series of two or more numerical values, the term “no more than,” “less than,” or “less than or equal to” applies to each of the numerical values in that series of numerical values. For example, less than or equal to 3, 2, or 1 is equivalent to less than or equal to 3, less than or equal to 2, or less than or equal to 1.

[0055] As used herein, the terms distal and proximal may generally refer to locations referenced from the apparatus, and can be opposite of anatomical references. For example, a distal location of a primary shaft or catheter may correspond to a proximal location of an elongate member of the patient, and a proximal location of the primary sheath or catheter may correspond to a distal location of the elongate member of the patient.

[0056] As described above, one challenge in endoscopy is being flexible enough to navigate through tortuous pathways while being able to reach hard-to-reach body cavities and conduits (e.g., the upper lobe of the lung while navigating through the airway) without tangling of internal cables.

[0057] In an aspect of the present disclosure, a flexible endoscope with improved performance at reduced cost is provided. In some embodiments, a flexible elongate member of the endoscope herein may comprise a bending section with one or more cable guiding elements of the present disclosure. FIG. 15 illustrates an example of a flexible endoscope 1500, in accordance with some embodiments of the present disclosure. As shown in FIG. 15, the flexible endoscope may comprise a handle / proximal portion 1509 and a flexible elongate member to be inserted inside of a subject (e.g., patient or non-human part). In some embodiments, the flexible elongate member may comprise a proximal shaft (e.g., insertion shaft 1501), steerable tip (e.g., tip 1505), and a steerable section (bending section 1503). The bending section 1503 is located between the distal tip 1505 and insertion shaft 1501. The bending section may comprise configurations as described later herein. For example, the bending section may comprise a plurality of modular cable guiding elements to improve the stability of one or more pull wires / tendon cables while minimizing the cost. Alternatively or additionally, the cable guiding elements may be located outside of the bending section such as in at least a portion of the tip 1505 or end effector, or at least a portion ofDocket No.: 55441-735.601 the insertion shaft 1501. The endoscope 1500 may also be referred to as steerable catheter assembly as described elsewhere herein. In some cases, the endoscope 1500 may be a single-use robotic endoscope. In some cases, the entire catheter assembly may be disposable. In some cases, at least a portion of the catheter assembly may be disposable. In some cases, the entire endoscope may be released from an instrument driving mechanism and can be disposed of. In some embodiment, the endoscope may contain varying levels of stiffness along the shaft, as to improve functional operation.

[0058] The endoscope or steerable catheter assembly 1500 may comprise a handle portion 1509 that may include one or more components configured to process image data, provide power, or establish communication with other external devices. For instance, the handle portion may include a circuitry and communication elements that enables electrical communication between the steerable catheter assembly 1500 and an instrument driving mechanism (not shown), and any other external system or devices. In another example, the handle portion 1509 may comprise circuitry elements such as power sources for powering the electronics (e.g., camera, electromagnetic sensor and LED lights) of the endoscope.

[0059] The one or more components located at the handle may be optimized such that expensive and complicated components may be allocated to the robotic support system, a hand-held controller or an instrument driving mechanism thereby reducing the cost and simplifying the design the disposable endoscope. The handle portion or proximal portion may provide an electrical and mechanical interface to allow for electrical communication and mechanical communication with the instrument driving mechanism. The instrument driving mechanism may comprise a set of motors that are actuated to rotationally drive a set of cables such as tendon cables of the catheter. The handle portion of the catheter assembly may be mounted onto the instrument drive mechanism so that its pulley / capstans assemblies are driven by the set of motors. The number of pulleys may vary based on the cable, such as a tendon cable / pull wires, configurations. In some cases, one, two, three, four, or more cables such as tendon cables may be utilized for articulating the flexible endoscope or catheter. In some embodiments, cables may comprise tendon cables, electrical wire cables, signaling cables, stabilizing cables, monitoring cables, fiber optic cables, ultrasonic cables, microfluidic line cables, springs, electrical harnesses, sensor cables, or other types of cables. As described later herein, the variety of cables may be guided by the cable guiding elements herein thereby improving stability of the tendon cables with flexibility of accommodate various scopes, use applications or desired performances.

[0060] The handle portion may be designed allowing the robotic endoscope (e.g., bronchoscope) to be disposable at reduced cost. For instance, classic manual and robotic endoscope may have a cable in the proximal end of the endoscope (e.g., bronchoscope, colonoscope, etc.) handle. TheDocket No.: 55441-735.601 cable often includes illumination fibers, camera video cable, and other sensors fibers or cables such as electromagnetic (EM) sensors, or shape sensing fibers. Such complex cable can be expensive adding to the cost of the endoscope (e.g., bronchoscope, colonoscope, etc.). The provided robotic endoscope may have an optimized design such that simplified structures and components can be employed while preserving the mechanical and electrical functionalities. In some cases, the handle portion of the robotic endoscope may employ a cable-free design while providing a mechanical / electrical interface to the catheter.

[0061] The electrical interface (e.g., printed circuit board) may allow image / video data and / or sensor data to be received by the communication module of the instrument driving mechanism and may be transmitted to other external devices / systems. In some cases, the electrical interface may establish electrical communication without cables or wires. For example, the interface may comprise pins soldered onto an electronics board such as a printed circuit board (PCB). For instance, receptacle connector (e.g., the female connector) is provided on the instrument driving mechanism as the mating interface. This may beneficially allow the endoscope to be quickly plugged into the instrument driving mechanism or robotic support without utilizing extra cables. Such type of electrical interface may also serve as a mechanical interface such that when the handle portion is plugged into the instrument driving mechanism, both mechanical and electrical coupling is established. Alternatively or in addition to, the instrument driving mechanism may provide a mechanical interface only. The handle portion may be in electrical communication with a modular wireless communication device or any other user device (e.g., portable / hand-held device or controller) for transmitting sensor data and / or receiving control signals.

[0062] In some cases, the handle portion 1509 may comprise one or more mechanical control modules such as lure 1511 for interfacing the irrigation system / aspiration system. Depending on the type of robotic endoscope, the handle portion may comprise fluidics channels for insufflation (e.g., CO2), camera rinse, forward irrigation and / or smoke evacuation. For example, Carbon dioxide (CO2) insufflation may be provided using of CO2 gas to inflate a space, such as the abdomen or digestive tract, for a variety of medical procedures. In some cases, the handle portion may include lever / knob for articulation control. Alternatively, the articulation control may be located at a separate controller attached to the handle portion via the instrument driving mechanism.

[0063] The endoscope may be attached to a robotic support system or a hand-held controller via the instrument driving mechanism (IDM). The instrument driving mechanism may be provided by any suitable controller device (e.g., hand-held controller) that may or may not include a robotic system. The instrument driving mechanism may provide mechanical and electrical interface to the steerable catheter assembly 1500. The mechanical interface may allow theDocket No.: 55441-735.601 steerable catheter assembly 1500 to be releasably coupled to the instrument driving mechanism. For instance, the handle portion of the steerable catheter assembly can be attached to the instrument driving mechanism via quick install / release means, such as magnets, spring-loaded levels and the like. In some cases, the steerable catheter assembly may be coupled to or released from the instrument driving mechanism manually without using a tool.

[0064] In the illustrated example, the distal tip of the catheter or endoscope shaft is configured to be articulated / bent in two or more degrees of freedom to provide a desired camera view or control the direction of the endoscope. As illustrated in the example, imaging device (e.g., camera), illumination elements (e.g., LED light source) or other optional position sensors (e.g., electromagnetic sensor) 1507 is located at the tip of the catheter or endoscope shaft 1505. For example, line of sight of the camera may be controlled by controlling the articulation of the bending section 1503. In some instances, the angle of the camera may be adjustable such that the line of sight can be adjusted without or in addition to articulating the distal tip of the catheter or endoscope shaft. For example, the camera may be oriented at an angle (e.g., tilt) with respect to the axial direction of the tip of the endoscope with aid of an optimal component.

[0065] The distal tip 1505 may be a rigid component that allow for various components such as positioning sensors (e.g., electromagnetic (EM) sensors), imaging devices (e.g., camera) and other electronic components (e.g., LED light source) being embedded at the distal tip.

[0066] In the embodiments where the endoscope includes an EM sensor or employ real-time EM tracking, the EM sensor comprising of one or more sensor coils embedded in one or more locations and orientations in the medical instrument (e.g., tip of the endoscopic tool) measures the variation in the EM field created by one or more static EM field generators positioned at a location close to a patient. The location information detected by the EM sensors is stored as EM data. The EM field generator (or transmitter), may be placed close to the patient to create a low intensity magnetic field that the embedded sensor may detect. The magnetic field induces small currents in the sensor coils of the EM sensor, which may be analyzed to determine the distance and angle between the EM sensor and the EM field generator. For example, the EM field generator may be positioned close to the patient torso during procedure to locate the EM sensor position in 3D space or may locate the EM sensor position and orientation in 5DOF (degrees of freedom) or 6DOF (degrees of freedom). This may provide a visual guide to an operator when driving the endoscope towards the target site.

[0067] The endoscope may have a unique design in the elongate member. In some embodiments, the bending section 1503 may comprise cable guides as described elsewhere herein with improved mechanical properties. Details about the cable guides are described later herein. In some cases, the proximal shaft of the endoscope may consist of a single tube that incorporates aDocket No.: 55441-735.601 series of cuts (e.g., reliefs, slits, etc.) along its length to allow for improved flexibility, and a desirable stiffness.

[0068] As described above, the bending section 1503 may be designed to allow for bending in two or more degrees of freedom (e.g., articulation). For example, the bending section may be steered or articulated in up, down, pitch, yaw direction, or any direction in-between. A greater bending degree such as 180 and 270 degrees (or other articulation parameters for clinical indications) can be achieved by the unique structure of the bending section while kinking or prolapse may be prevented. In some cases, the bending section may be fabricated separately as a modular component and assembled to the proximal shaft.

[0069] The articulation of the endoscope may be controlled by applying force to the distal end of the endoscope via one or multiple cables, such as tendon cables. The one or more cables, such as tendon cables, may be attached to the distal end of the endoscope. In the case of multiple cables such as tendon cables, pulling one wire at a time may change the orientation of the distal tip to pitch up, down, left, right or any direction needed. In some cases, the cables such as tendon cables may be anchored at the distal tip of the endoscope, running through the bending section, and entering the handle where they are coupled to a driving component (e.g., pulley). This handle pulley may interact with an output shaft from the robotic system.

[0070] In some embodiments, the proximal end or portion of one or more cables such as tendon cables may be operatively coupled to various mechanisms (e.g., gears, pulleys, capstans, etc.) in the handle portion of the catheter assembly. The cable, such as a tendon cable, may be a metallic wire, cable or thread, or it may be a polymeric wire, cable or thread. The cable, such as a tendon cable, can also be made of natural or organic materials or fibers. The cable, such as a tendon cable, can be any type of suitable wire, cable or thread capable of supporting various kinds of loads without deformation, significant deformation, or breakage. The distal end / portion of one or more cables such as tendon cables may be anchored or integrated to the distal portion of the catheter, such that operation of the cables such as tendon cables by the control unit may apply force or tension to the distal portion which may steer or articulate (e.g., up, down, pitch, yaw, or any direction in-between) at least the distal portion (e.g., flexible section) of the catheter.

[0071] The cables may be made of any suitable material such as stainless steel (e.g., SS316), metals, alloys, polymers, optical fibers, nylons or biocompatible material. Cables, such as a tendon cables, may comprise a wire, cable or a thread. In some embodiments, different cables such as tendon cables may be made of different materials for varying the load bearing capabilities of the cables such as tendon cables. In some embodiments, different sections of the cables such as tendon cables may be made of different material to vary the stiffness and / or loadDocket No.: 55441-735.601 bearing along the pull. In some embodiments, cables such as electrical wires may be utilized for the transfer of electrical signals.

[0072] The proximal design may improve the reliability of the device without introducing extra cost allowing for a low-cost single-use endoscope. In some cases, the device may be a single-use robotic endoscope. The robotic endoscope (e.g., bronchoscope, colonoscope, etc.) and can be the same as the steerable catheter assembly as described elsewhere herein. Traditional endoscopes can be complex in design and are usually designed to be re-used after procedures, which require thorough cleaning, dis-infection, or sterilization after each procedure. The existing endoscopes are often designed with complex structures to ensure the endoscopes can endure the cleaning, dis-infection, and sterilization processes. The provided robotic endoscope (e.g., bronchoscope, colonoscope, etc.) can be a single-use endoscope that may beneficially reduce crosscontamination between patients and infections. In some cases, the robotic endoscope may be delivered to the medical practitioner in a pre-sterilized package and are intended to be disposed of after a single-use.Cable Guides in an Articulatable Flexible Endoscope

[0073] Disclosed herein in some embodiments is an articulatable flexible endoscope with improved cable routing features. In some embodiments, the articulatable flexible endoscope may comprise an elongated member. FIG. 15 illustrates an example of an elongated member 1501. In some embodiments, the elongated member 1501 may extend between a distal end and a proximal end of the articulatable flexible endoscope. In some embodiments, the elongated member 1501 may comprise a flexible body. The elongated member 1501 may comprise a flexible body that provides sufficient axial stiffness for insertion yet permits bending in multiple directions for navigation inside a patient’s anatomy.

[0074] In some embodiments, the articulatable flexible endoscope can further comprise one or more radial openings. In some embodiments, the insertion shaft 1501 may be a substantially tubular sheath formed as a single continuous piece, without hinged control rings or vertebra-type configurations. For example, the insertion shaft may be formed with one or more radial openings to receive one or more cable guiding elements thereby facilitating routing of tendon cables or other components, while maintaining a simplified, low-cost construction suitable for single-use or partially disposable endoscopes. In some cases, each of the plurality of radial openings may be formed as radial cuts extending completely through the wall thickness of the tubular sheath along its circumference, with each radial opening oriented substantially perpendicular to the longitudinal axis of the shaft, such that when a cable guiding element is captured within a respective radial opening, the cable guiding element extends radially outward from the shaft and is substantially perpendicular to the longitudinal axis of the shaft.Docket No.: 55441-735.601

[0075] In some embodiments, the bending section 1503 may be formed as a flexure, with strategically placed openings, slots, or cut patterns along its length. These openings may be configured to receive one or more cable guiding elements of the present disclosure. Unlike traditional vertebra-based bending sections that rely on complex stacked rings with integrated cable paths, the disclosed bending section may be formed as a single-piece structure (e.g., a continuous polymeric or metallic flexure body) that allows the integration of modular cable guiding elements at selected positions. This configuration improves dimensional stability of tendon routing while maintaining high flexibility and enabling scalable manufacturing processes.

[0076] As used herein, the terms “cable guides” or “cable guiding elements” are used interchangeably to refer to modular structures designed to guide, route, and stabilize tendon cables, pull wires, or other elongated components within the shaft or bending section of the endoscope. In some embodiments, the cable guiding elements may have a substantially planar form factor that enables high-precision, low-cost fabrication and easy assembly. The planar form factor may also allow these elements to be integrated into or onto the flexure of the bending section with improved positional accuracy and reduced assembly complexity compared to traditional vertebra designs.

[0077] The unique structures of the cable guiding elements allowing them to be assembled with high precision, low cost, and convenience. In some embodiments, the cable guiding elements may comprise unique internal hole patterns, slots, or channels that define pathways for passing through tendon cables and / or auxiliary components. FIGs. 1A and IB show an example of a cable guide. As shown in the example, a cable guide 100 may have a substantially planar shape with integral internal holes or openings for passing through tendons or other cables.

[0078] The planar configuration of the cable guide may beneficially allow the cable guides to be fabricated using scalable two-dimensional (2D) planar manufacturing processes including, without limitation, photo etching, laser cutting, stamping, or lithography. To further enhance performance and assembly convenience, the planar guiding elements may incorporate three- dimensional (3D) features such as slots, counterbores, chamfers, fillets, or raised bosses. Such features may serve to align the cable guiding element with the flexure, provide anchoring or mating interfaces, and reduce cable friction or wear during bending. These 3D features may be fabricated using low-cost processes such as injection molding, micro-milling, or additive manufacturing.

[0079] In some embodiments, the cable guiding elements may comprise integral features for routing other components beyond tendon cables or pull wires. For example, the cable guiding elements may guide microfluidic tubing for irrigation or suction, electrical harnesses for sensors or imaging devices, optical fibers for illumination or laser delivery, or springs for reinforcement.Docket No.: 55441-735.601In some embodiments, the mechanical cables (tendons) routed through the guides may be active (e.g., actuated by the instrument driving mechanism to effect bending or distal articulation), or passive (e.g., spring-back or stiffening members that provide desired structural characteristics to the cross section). By combining active and passive members in the same routing architecture, the disclosed design enables improved mechanical performance, high dimensional stability, and reduced cost relative to vertebra-based prior art systems.

[0080] FIG. 2A and FIG. 2B show an example 200 of assembling or loading one or more cable guides to a bending section of a flexible instrument. The cable guides 210 may be configured with a generally planar form factor, which beneficially allows the guides to be loaded or assembled radially into a flexure 220 of the bending section. In some embodiments, the flexure 220 may be formed with openings, recesses, or cutouts disposed along the length of the bending section to receive the cable guides 210. The one or more radial openings 211 can be arranged at regular or irregular patterned distances throughout the length of the articulatable flexible instrument, or at least along a portion of a bending section thereof. Such arrangement allows a modular and repeatable manner of attaching cable guides while minimizing assembly complexity. Each of the plurality of radial openings may be formed along a circumference of the tubular sheath so the cable guiding element once is captured by the respective radial opening, the cable guiding element is substantially perpendicular to the longitudinal axis of the shaft.

[0081] In some embodiments, the flexure 220 may comprise a substantially tubular structure with repeated cuts or openings. The openings may be defined by a repeated pattern with a predetermined pitch. The term “predetermined pitch” may refer to the longitudinal spacing between adjacent features of the repeated opening pattern. As an example, the flexure 220 may be a monolithic laser-cut stainless steel or nitinol hypotube with cuts formed by laser machining or mechanical machining to provide spring-like or link-type structures. In some cases, the flexure 220 may be a single continuous piece with cut patterns that impart desired bending and torsional characteristics. The cut patterns may be formed of repeated features at a constant or varying pitch.

[0082] In some embodiments, the flexure 220 may comprise a stack of discrete links arranged sequentially to form a chain-like structure. In either case, the flexure 220 with the loaded cable guides may provide improved hoop strength, torque transmission, cable stability, and bend radius control compared to conventional bending sections without such cable guides.

[0083] It should be noted that the cut pattern or opening pattern 211 in the flexure may have various different sizes, shapes, pitches or location sections to achieve different mechanical properties (e.g., tortional stiffness, bending stiffness, bending radius, etc.). In some cases, the cut pattern may vary in pitch, size, shape (e.g., gap size or shape), location / distribution along theDocket No.: 55441-735.601 length of the bending section to achieve variable mechanical properties (e.g., tortional stiffness, bending stiffness, bending radius, etc.) along the length of the bending section. For instance, the cut pattern may be varied along the length of the bending section to locally adjust torsional stiffness, bending stiffness, bending radius, compression resistance, or axial flexibility. As a nonlimiting example, openings closer to the distal end may be larger and more densely spaced to increase flexibility, whereas openings closer to the proximal end may be smaller and spaced farther apart to provide increased rigidity and support.

[0084] In the illustrated example 200, the flexure 220 may comprise a stack of linked components 221. In some cases, a plurality of modular components 221 or linked components with interlocking features 223. In some cases, a modular component 221 may include interlocking features 223 such as tabs, ears, slots, or dovetails. The plurality of modular components 221 can be linked or coupled to each other via the interlocking features 223 without additional fastening means. In some cases, the plurality of modular components may be coupled or decoupled without additional tools. For example, a contact surface of the interlocking feature may be radially slanted such that once the modular components are interlocked, they may not move radially relative to one another due to the slanted contact surface while locked axially due to the interlocking feature (e.g., ear or tab). For example, each interlocking feature 223 may include a radially slanted or tapered contact surface such that, once interlocked, the modular components resist radial displacement while maintaining axial locking. Alternatively, additional coupling means such as adhesive or welding may be used to connect the modular components.

[0085] The interlocking features may beneficially provide axial and rotational alignment. The modular and interlocking features may allow for flexibility to vary the structures of the modular components thereby varying the mechanical properties of the bending section. For example, the plurality of modular components with different structures or mechanical properties (e.g., material, bending stiffness, wall thickness, etc.) may be selected to form a chain such that by placing a given modular component at a selected location along the length of the elongated member, the mechanical property of the bending section can be modified. In some cases, the connecting point or the location of the interlocking features 223 along the circumference may be selected or varied for connecting two modular components such that a chain of linked modular components may form a substantially coil spring structure. The interlocking features 223 may provide beneficial axial and rotational alignment, thereby reducing assembly error.Advantageously, the modularity allows flexibility to vary the geometry, thickness, material composition, or stiffness of the modular components 221 along the bending section, thereby customizing the overall performance profile. For example, a first modular component formed of stainless steel may be interlocked with a second modular component formed of nitinol to achieveDocket No.: 55441-735.601 a mixed stiffness profile. Furthermore, the circumferential location of interlocking features 223 may be selectively varied to form a helical or coil-like structure, which can provide spring-back- to-center properties.

[0086] In some embodiments, a modular component may comprise at least an interlocking feature and an opening for receiving a cable guide. The gap size or shape of the opening 211 may match a dimension and shape of the cable guide for receiving the cable guide. In some embodiments as illustrated in FIG. 2A and FIG. 2B, for example, the one or more radial openings 211 can be configured to each receive a cable guide 210. In some embodiments, selected one or more radial openings 211 can be configured to couple with the cable guide 211 at preferred locations. The opening 211 may be shaped and dimensioned to mate with the geometry of a corresponding cable guide 210. For example, the opening may be substantially circular, elliptical, rectangular, or polygonal. In some embodiments, selected openings may remain unused, thereby permitting selective routing of cables through only designated cable guides. This selective loading enables customizable steering performance and reduces unnecessary friction.

[0087] In some embodiments, one or more cables inside of the elongated member 1501 can be routed or guided by the cable guides. In some embodiments, the one or more cables may comprise mechanical or active cables. In other embodiments, the one or more cables may comprise non-mechanical or passive cables. In some embodiments, the mechanical cables may comprise tendon cables. In some embodiments, the tendon cables can be connected to an actuator. In some embodiments, the actuator can be a remote actuator. In some embodiments, the tendon cables may comprise steering cables. In some embodiments, the tendon cables can be configured to cause a movement of the flexible body.

[0088] In some embodiments, passive tendon cables can include stiffening cables, spring back members, or both. In some embodiments, the one or more cables comprise one or more of electrical wire cables, signaling cables, monitoring cables, fiber optic cables, ultrasonic cables, microfluidic line cables, springs, electrical harnesses, sensor cables, or any combination thereof. In some embodiments, the one or more cables can be configured to transfer energy signals between the distal and the proximal end of the elongated member. In some embodiments, the energy signals may comprise electricity. In some embodiments, the energy signals may comprise one or more of an analog signal, a digital signal, a periodic signal, a random signal, a continuous signal, a discrete signal, a time-variant signal, a composite signal, a radio signal, an ultrasonic signal, an audio signal, a video signal, an electromagnetic signal, a pulse signal, an EEG signal, a network signal, or any combination thereof.Docket No.: 55441-735.601

[0089] In some embodiments, the one or more radial openings 211 may have a dimension and a shape as illustrated in FIGs. 2A and 2B to mate with a thickness and radial dimension and shape of a cable guide. As illustrated in the non-limiting example of FIGs. 2A and 2B, in some embodiments, the one or more radial openings 211 can be at least partially circular. The radial openings 211 of the flexure 220 may be dimensioned and shaped to mate with corresponding features of the cable guide 210. In some embodiments, the openings 211 may be substantially circular, arcuate, polygonal, or irregular to ensure secure seating of the cable guide 210. The thickness and radial profile of the cable guide 210 may be selected to ensure minimal protrusion into the lumen of the flexure while maintaining stability.

[0090] In some embodiments, the cable guide may have one or more internal features (e.g., holes, openings, grooves, or channels, etc.) integrally formed to receive one or more cables. The one or more holes may be formed at various locations and / or may have various shapes (e.g., circular, ellipse, etc.) for accommodating various tendon cable configurations. The internal features of a plurality of cable guides may or may not be the same. Details about the internal features of the plurality of cable guides are described later herein. The holes may be of varying number, spacing, or cross-sectional shape (e.g., circular, oval, square) to accommodate different tendon cable arrangements. The internal features may differ across a plurality of cable guides, allowing certain cable guides to handle higher loads or different cable routing angles.Additionally, peripheral features such as teeth, grooves, or protrusions may be integrally formed on the outer surface of the cable guide to engage with complementary features of the flexure 220, thereby providing angular alignment and positional stability. The peripheral features may be formed to assist in coupling the cable guide to a respective opening of a flexure with a selected orientation (e.g., angular orientation with respect to the longitudinal axis of the bending section). Details about the peripheral features are described later herein.

[0091] The planar form factor of the cable guide 210 beneficially allows the cable guides to be manufactured by planar manufacturing techniques, such as stamping, laser cutting, etching, or micromachining. The cable guides may initially be produced in a flat configuration and subsequently oriented or assembled into a three-dimensional flexure assembly. This manufacturing approach reduces cost, simplifies mass production, and enables high precision in forming intricate features. Furthermore, the planar form factor permits use of a variety of materials, including metals (e.g., stainless steel, nitinol, titanium), polymers (e.g., PEEK, polyimide), or composites, depending on desired performance.

[0092] FIGs. 3A and 3B show examples 300 of cable guides mated with radial opening features of a flexure component 311, in accordance with some embodiments. As illustrated in FIGs. 3A and 3B, the flexure component 311 may comprise a substantially tubular shape. In someDocket No.: 55441-735.601 embodiments, the flexure component 311 may be formed with opening features 314 having a shape and dimension (e.g., gap size substantially matching a thickness or profile of the cable guide) configured to couple with the cable guide 310. Such opening features may be uniformly distributed around the circumference of the flexure component or arranged in asymmetrical patterns depending on the desired routing path of the cables.

[0093] The cable guide 310 may be formed with peripheral features 315 to mate with the corresponding opening features 314 of the flexure component. For example, in some embodiments, the surface of a tooth 315 of the cable guide may be brought into contact with the surface of a protrusion 312 of the flexure upon assembly to provide stable interlocking. The peripheral features 316 may further comprise arcs, grooves, notches, or similar geometrical features configured to mate with protrusions 312 or recesses 313 of the flexure component 311. Such mating features can beneficially restrict radial translational movement and axial rotational movement of the cable guide relative to the flexure. In some embodiments, as illustrated in FIG. 3B, one or more edge protrusions or edge recesses of the cable guide 310 can be specifically shaped to engage with complementary features of the flexure 311 to enhance positional stability during repeated articulation cycles.

[0094] The cable guide may be formed with internal features for receiving one or more cables. FIGs. 4A and 4B show examples of the cable guide configured to receive the one or more cables via internal holes at various locations. In some embodiments, the one or more cables 410 can be routed through the one or more holes of the cable guide 411. These internal holes may be distributed in radial, concentric, or asymmetric patterns to facilitate flexible routing configurations depending on the mechanical design requirements of the bending section or overall elongate member.

[0095] Referring back to FIG. 3 A and FIG. 3B, the plurality of holes 321, 323, 325 within a cable guide may or may not have the same size. For example, a center hole 321 may have a greater diameter compared to the hole 323, 325. The size of the hole may be selected depending on the cable diameter to be routed through. In some cases, the plurality of holes may or may not have the same shape. For example, the hole may have circular shape or non-circular shape (e.g., hole 323).

[0096] In some embodiments, the holes may have circular shapes to better constrain cable motion, thereby reducing unintended lateral displacement. Alternatively, one or more of the holes may be formed with non-circular geometries. For example, a non-circular shape (e.g., rectangular, oval, polygonal, or irregular) may beneficially reduce the contact surface area between the inner surface of the hole and the routed cable, thereby lowering friction, reducing wear, and enhancing durability of both the cable and guide element. In some embodiments, atDocket No.: 55441-735.601 least one of the holes has an oval shape 323. In some embodiments, at least one of the holes has an irregular shape 1112 as illustrated in, for example FIG. 11 A. In some embodiments, the cable guide may comprise one or more edge protrusions or edge recesses as illustrated in, for example, FIGs. 11A and 11B

[0097] The non-circular shape of the hole can further maximize the wall thickness between adjacent holes, thereby preserving the structural integrity of the cable guide. In some cases, it can be preferred to maximize the surface area between the tendon guide and the routed tube / cable. In some embodiments as illustrated in FIGs. 11A and 11B, an inner surface 1112 of the one or more holes of the cable guide 1110 can be configured to contact a surface of the one or more cables 1111. In some embodiments, as illustrated in FIG. 11B, an inner protrusion 1112 of the cable guide 1110 can be configured to contact the surface of the one or more cables 1111. In some embodiments, by varying the shape of hole formed in the cable guide 1110, the apparatus can decrease or increase surface area contact between the cable guide 1110 and the routed cable 1111. In some embodiments, the cable guide 1110 can be configured to minimize surface area contact with the routed cable 1111 to reduce the risk of ovalization, kink, or wear between components or achieve different mechanical properties of the bending section. Such selective contact can allow tuning of the bending stiffness, fatigue resistance, or responsiveness of the bending section in which the cable guide resides.

[0098] Referring back to FIGs. 4A and 4B, for example, the one or more cable guides 410 may comprise a center hole. In some embodiments, for example, the one or more cable guides 410 may comprise one or more holes or slots positioned in one or more pattern circles. In some embodiments, for example, the one or more cable guides 410 may comprise one or more holes or slots positioned asymmetrically relative to the cross section of the cable guide 410.

[0099] The internal features of the cable guide thus provide substantial flexibility in routing cables in linear, radial, circumferential, or non-linear configurations. For example, a set of cables routed through multiple cable guides at the same radial angle may be maintained in a straight path throughout the elongate member. Conversely, cables may be routed through offset holes at different radial or angular positions to achieve controlled pre-bending, stiffness tuning, or specific motion profiles of the bending section. In this manner, the modular cable guide design facilitates both uniform cable alignment and customized routing configurations to improve performance of a flexible endoscope or steerable catheter assembly.

[0100] In some embodiments, the one or more cables can be routed through a plurality of the cable guides arranged along a longitudinal axis of an elongated member. The routing of the cables may be achieved by sequentially passing each cable through corresponding holes of successive cable guides, thereby defining a predetermined cable pathway throughout the lengthDocket No.: 55441-735.601 of the bending or continuum section. In some embodiments, the one or more cables can be routed through a differently positioned hole on a first cable guide of the plurality of cable guides as compared to a second cable guide of the plurality of cable guides. Such staggered or offset routing configurations can allow for non-linear cable paths, selective cable length adjustments, and optimization of load distribution across the bending section. In some embodiments, the elongated member can further comprise a central continuum (e.g., a backbone, rod, tube, or other structural element) around which the cable guides are positioned and relative to which the cables are routed.

[0101] In some embodiments, one or more cables can be routed in a non-linear configuration. For example, by passing a cable through holes located at different radial locations across selected cable guides, the cables can be routed in various non-linear or non-straight configurations. In some cases, the modular cable guide is swappable. For instance, different modular cable guides may be fit into the same openings such that a modular cable guide can be swapped out with another modular cable guide. In some cases, a same modular cable guide can be placed at selected openings. FIG. 14 shows various examples of cable configurations guided by the cable guides. As illustrated in FIG. 14, the one or more cables 1410 can be routed in a non-linear or non-straight configuration around the central continuum 1411. In some cases, some of the cables 1413 may be routed straight while some of the cables 1410 may be routed non-straight, thereby providing a hybrid routing scheme within the same bending section. A non-linear cable configuration for routing tendon cables may beneficially prevent undesired changes in cable length during continuum bending, which can occur due to geometric path length variations, as well as provide additional axial load bearing capacity and stiffness to the tendon. In some embodiments, routing cables in a non-linear configuration can further contribute to improved durability, reduced frictional wear, and increased reliability of motion transmission in highly articulated regions of the continuum instrument.

[0102] In some embodiments, the cable guides may be axially loaded to a bending section. For instance, instead of being radially assembled to a radial opening in the flexure component, the cable guides may be stacked between two modular interlockable components of a bending section by axial loading along the longitudinal axis of the elongated member. FIGs. 5A-5C and FIGs. 6A-6B show examples of axially loading a cable guide to be stacked between two tubular components. This approach may beneficially simplify assembly by allowing the guides to be integrated during the axial stacking of modular subcomponents, and may further allow for compact and uniform integration without protruding elements.

[0103] As illustrated in FIGs. 5A-5C, the cable guide can be configured to fit precisely between two adjacent modular components or tubes. As shown in FIGs. 5 A and 5B, in someDocket No.: 55441-735.601 embodiments the cable guide can be shaped to conform to the inner or outer geometries of the adjacent tubes such that the mating shapes and dimensions create a secure fit. Once assembled, the external surface of the adjacent tubes and the cable guide may form a substantially continuous and smooth outer surface, which can minimize frictional interference with surrounding tissue or structures in minimally invasive surgical applications. In some embodiments, as shown in FIG. 5C, the cable guide 510 can be rendered kinematically stationary between the two adjacent tubes 511, thereby ensuring that the guide maintains its position relative to the bending section and does not rotate or translate during actuation.

[0104] In some embodiments, as illustrated in FIGs. 6A and 6B, the cable guide 610 can be axially loaded to the tube 612. In some embodiments, the tube 612 can be the modular component that can be coupled to another tube to form a bending section, a wrist section or any other part of a flexible instrument. The tube may or may not be coupled to one another via interlocking features. In some embodiments, as illustrated in FIG. 6A, the cable guide 610 can be contained within a wrist component 611 or a portion of an end effector In some embodiments, as illustrated in FIG. B, the wrist component 611 can be coupled with the tube 612 using tongue and groove features. In some embodiments, the wrist component 611 can be coupled with the tube 612 using welding. In some embodiments, the wrist component 611 can be coupled with the tube 612 using shape memory, pressing, screwing, riveting, adhesive bonding, soldering, brazing, snap fitting, magnetic assembling, ultrasonic welding, pin connecting, interlocking, or crimping, or any combination thereof.

[0105] In some embodiments, the cable guide may be formed of one or more materials, including, without limitation, metal, polymer, ceramic, laminate, or any combination thereof. The material selection may be tailored to provide desired physical, chemical, or functional characteristics to the cable guide. For example, in some embodiments, materials may be selected based on one or more of thermal conductivity, electrical conductivity, lubricity, coefficient of friction, compressive modulus, compressive strength, wear resistance, weldability, optical transmissivity, biocompatibility, or other material properties suitable for the intended application of the flexible endoscope. In some embodiments, the cable guide may comprise composite or layered materials to achieve a combination of desired properties, such as a polymer-metal laminate that provides both flexibility and mechanical strength.

[0106] The unique structure of the cable guide may facilitate low-cost, scalable, and precise assembly processes. In some embodiments, the cable guide may be coupled to an elongate member (e.g., bending section, wrist, distal end effector) in a manner that prevents unintended movement. Various methods of kinematic constraint or permanent attachment may be employed. For example, the cable guide may be laser welded to a mating feature or directly to the body ofDocket No.: 55441-735.601 the flexible endoscope. In other embodiments, the cable guide may be pressed, snapped, or otherwise friction-fitted to a modular component or the body of the endoscope. In some embodiments, the cable guide may be constrained using shape memory elements that bias it into the desired position. In alternative embodiments, the cable guide may be constrained using any combination of mechanical or material joining methods including screwing, riveting, adhesive bonding, soldering, brazing, snap fitting, magnetic attachment, ultrasonic welding, pin connections, interlocking geometries, crimping, or combinations thereof. The assembly method may be selected based on manufacturing, cost, or performance requirements.

[0107] In some embodiments, the cable guides of the present disclosure may allow for both radially loading and axially loading as described above. Radial loading refers to inserting the cable guide through a radial opening in the flexure, whereas axial loading refers to sliding or stacking the cable guide along the longitudinal axis between modular components. In some embodiments, the cable guides may allow for additional flexibility of loading the cable guides with preferrable orientations by symmetrical peripheral features. For example, the symmetrical peripheral features / teeth formed on the cable guide (e.g., cable guide 610) may allow the cable guide to be axially loaded to a tube at different orientations. When the holes are formed asymmetrically, the beneficially provides additional flexibility to vary the cable configurations. The cable guides may further comprise symmetrical peripheral features, such as teeth or tabs, that enable loading in multiple preferred orientations. For example, when the internal holes of the cable guide are asymmetrically positioned, symmetrical peripheral features allow the cable guide to be oriented in different rotational configurations during assembly, thereby providing additional flexibility for tailoring cable routing paths or mechanical properties of the bending section.

[0108] Alternatively, the cable guide may have peripheral features to allow for a single loading configuration which provides precision and guided assembly process. As illustrated, for example in FIGs. 7A and 7B, the cable guide can be configured such that only one assembly configuration is kinematically possible. In some embodiments, this configuration can prevent assembly error. In some embodiments, this configuration can be performed by modifying the engagement features of the two-dimensional cable guide. In some embodiments, this configuration can be performed by modifying the engagement features of the tube. In some embodiments, this configuration can be performed by modifying the engagement features of the two-dimensional cable guide and the tube. For example, as illustrated in FIG. 7A, one exterior edge of the cable guide may comprise a tooth angle, for example alpha 710. In some embodiments, for example as illustrated in FIG. 7A, the remaining one or more exterior edges of the cable guide may comprise a different tooth angle, for example beta 711. In someDocket No.: 55441-735.601 embodiments, any number of exterior edges of the cable guide may comprise a different tooth angle from any other exterior edges of the cable guide. In some embodiments, as illustrated in FIG. 7B, the different tooth angles, for example a tooth angle alpha 710 and beta 711, can fit in different recesses amongst protrusions 712 of a tube (e.g., at a wrist) or a modular component at a bending section.

[0109] In some embodiments, as illustrated in FIGs. 8A and 8B, the cable guide 810 can be loaded with cables in one possible kinematic orientation. As illustrated in FIG. 8A, in some embodiments an angular offset 811 of the cable guide position 810 from a central axis can allow for only a single assembly configuration. In such embodiments, the angular offset may be formed by asymmetrical features, including but not limited to non-uniform tooth spacing, asymmetric openings, offset alignment pins, or non-circular outer geometries. This design provides precision in cable placement and may be particularly advantageous where cable routing must maintain strict positional tolerances to ensure predictable mechanical response of the bending section, wrist, or end effector. In some embodiments, as illustrated in FIG. 8B, the cable guide 810 may not require additional fixturing features to secure its position within a tube 812. Instead, the tension of the cables routed through the cable guide may themselves bias or draw the guide into a seated position during assembly. In such embodiments, the elastic properties or pre-tensioning of the cables may provide sufficient constraint to hold the guide in place without permanent fixtures, thereby reducing assembly complexity and cost. In other embodiments, temporary fixturing may be employed to facilitate cable guide placement. For example, during assembly, the cable guides may be held in position using temporary guide pins, mandrels, or support tabs that align the guide relative to the tube prior to final cable insertion or permanent fixation. These temporary fixtures may be removed, dissolved, broken away, or otherwise released after the cables and guide are fully assembled, thereby allowing the cable guide to remain kinematically constrained by the cables or the surrounding tubular structure.

[0110] In some embodiments, placement of the cable guides can be performed manually. In other embodiments, placement of the cable guides may be performed using mechanical fixtures designed to simplify alignment. For example, the fixtures may comprise slots, rails, or jigs that guide the cable guide into its correct orientation and position relative to the bending section or tube. In some embodiments, specialized fixtures such as cartridges may be employed, where multiple cable guides are preloaded into a cartridge system and sequentially inserted into the endoscope body to streamline assembly. In other embodiments, a tab break jig may be used, wherein cable guides are manufactured in a sheet or strip with small tabs, and the jig allows for sequential breaking off and positioning of the guides into the elongate member. In some embodiments, cable guide placement may be performed using machines or automated systems.Docket No.: 55441-735.601Automated placement may employ a variety of techniques, including but not limited to robotic manipulators, pick-and-place systems, or precision feeders. In some embodiments, magnetism or electromagnetism may be employed to orient and move cable guides into position, particularly if the cable guide comprises a magnetic or magnetically responsive material. In other embodiments, vibration-based feeding or parts-feeding systems may be used to align and deliver cable guides in a repeatable manner. In some embodiments, assembly may be further facilitated by kitting or binning systems, flow racks, or tray -based storage that organizes cable guides for efficient retrieval. Identification and tracking systems such as barcoding, RFID tagging, or machine-readable labels may be employed to ensure proper sequencing of cable guides during automated assembly. In some embodiments, vision systems may be employed to verify orientation, detect defects, or confirm placement accuracy during or after insertion. In other embodiments, lean manufacturing techniques, such as continuous flow assembly or just-in-time feeding of cable guides, may be implemented to reduce waste, improve throughput, and ensure consistency in manufacturing. In some embodiments, any combination of the above methods may be employed to optimize assembly efficiency, precision, and scalability depending on production volume, cost requirements, or desired reliability of the flexible endoscope system, [oni] In some embodiments, as illustrated in FIGs. 9A and 9B, the tube 911 may be formed with the one or more radial openings 910 using subtractive manufacturing. In some embodiments, one or more radial openings 910 may be formed in a tubular structure 911 using subtractive manufacturing techniques. The subtractive manufacturing may begin with a two- dimensional design of the tube profile incorporating the desired placement, spacing, and orientation of the one or more radial openings 910. The design may then be translated into a cutting path or toolpath suitable for execution by computer numerical control (CNC) equipment or other automated subtractive manufacturing platforms. In some embodiments, subtractive manufacturing may comprise laser cutting, etching, electrical discharge machining (EDM), milling, boring, abrasive jet machining, ultrasonic machining, waterjet cutting, electrochemical machining, wire electrical discharge machining (wire EDM), or any combination thereof. In some embodiments, laser cutting may provide micron-level tolerances suitable for delicate cable routing, while waterjet or abrasive jet machining may provide efficient processing for thicker- walled tubes. In some embodiments, ultrasonic machining or electrochemical machining may be selected to reduce thermal effects or residual stresses on the tube material, thereby preserving fatigue resistance of the tube when flexed in operation. In some embodiments, subtractive manufacturing techniques may be selected based on material composition of the tube 911, including stainless steel, Nitinol, titanium, polymeric materials, or composite materials. In some embodiments, subtractive manufacturing may be supplemented or followed by surface finishingDocket No.: 55441-735.601 processes, including polishing, passivation, deburring, chemical etching, or electropolishing, to ensure smooth edges around the radial openings 910. This beneficially reduces stress concentrations, minimizes friction with cables routed through the openings, and prolongs operational lifespan of the flexible instrument. In some embodiments, coatings such as low- friction polymer films or hydrophilic coatings may be applied after subtractive manufacturing to further reduce cable wear.

[0112] In some embodiments, as illustrated in FIG. 10, a cable guide 1010 may be configured to minimize twist or angulation of a cable routed through the guide. In some embodiments, the angular position and relative spacing of holes 1011 may be predetermined through mapping or computational modeling. Such mapping may account for the predicted twist or angular deviation of cables as they pass through multiple guides distributed along the flexible instrument. In some embodiments, the modeling may comprise determining predicted angles 1012 between holes of successive cable guides through which the cables are threaded, thereby enabling prediction and compensation of cumulative twist. In some embodiments, the holes 1011 may be non-circular, such as oval, polygonal, or custom-shaped apertures, to accommodate flattened cables, ribbon cables, or cables requiring anti-rotation constraints.[0H3] ] In some embodiments, one or more cable guides may be assembled into any suitable section or component of a flexible instrument in addition to a bending section. For example, in some embodiments, one or more cable guides may be assembled into a wrist section, as illustrated in FIGs. 12A, 12B, and 13. As shown in FIGs. 12A and 12B, a wrist section 1210 may comprise a highly flexible coupling 1211 that provides multiple degrees of freedom for distal articulation. In some embodiments, the wrist section 1210 may be coupled to an end effector 1212. In some embodiments, the end effector may comprise a surgical tool, such as biopsy forceps, snares, needle holders, electrocautery or electrosurgery tools, laser fibers, graspers, dilators, retrieval baskets or nets, injection needles, suturing and stapling devices, ultrasonic scalpels, hemostasis clips, cannulas, argon plasma coagulation probes, cryotherapy probes, stents, scissors, drills or burrs, decloggers, trocars, balloon catheters, or any combination thereof. In some embodiments, as illustrated, a cable guide 1210 may be stacked between two adjacent tubes 1211, 1212, wherein the adjacent tubes may optionally comprise interlocking or non-interlocking features to assist in alignment or prevent relative rotation.

[0114] In some embodiments, as illustrated in FIG. 13, multiple cable guides 1310 may be arranged in combination to trap or secure elements of a tendon assembly, such as crimped ends or anchor features, within a cross-sectional region between a wrist section 1311 and an end effector 1312. This beneficially enables force transmission from cable motion to the end effectorDocket No.: 55441-735.6011312, thereby producing controlled articulation, actuation, or other functional movement of the surgical tool.

[0115] In some embodiments, a distance between two adjacent tendon guides may be selected by varying the longitudinal placement of the tendon guides along the length of the flexible instrument. Unlike conventional design with fixed routing configuration, the methods and systems herein beneficially allow for flexibility in adjusting routing configuration by simply placing the modular cable guides in different selection of slots. This beneficially provides design flexibility in cable routing, enabling optimization of bending stiffness, mechanical efficiency, and fatigue resistance. In some embodiments, the total number of radial openings configured to receive cable guides may be varied to modulate the mechanical performance of the flexible body. For example, increasing the number of radial openings and cable guides may distribute tendon forces more evenly, improving bending smoothness, whereas decreasing the number may reduce friction and simplify assembly.

[0116] In some embodiments, the number of cable guides inserted into the radial openings may be selectively adjusted to tailor instrument flexibility for different procedures or patient anatomies. In some embodiments, the shapes of each cable guide may be configured to control the bending mechanics of the instrument, such as employing elliptical, trapezoidal, or asymmetric geometries to bias bending in a particular direction. In some embodiments, the position, shape, or both of each of the holes of one or more cable guides may be selected to modulate torque transmission, minimize backlash, or optimize repeatability of distal articulation. Flexible Endoscope

[0117] In some embodiments, the bending section herein may be utilized for improving flexibility and stability of a flexible endoscope without introducing extra cost. The provided bending section may be utilized by any devices or apparatuses. In an aspect of the invention, a flexible endoscope with improved performance (e.g., improved reliability) at reduced cost is provided. FIG. 15 illustrates an example of a flexible endoscope 1500, in accordance with some embodiments of the present disclosure. As shown in FIG. 10, the flexible endoscope 1500 may comprise a handle / proximal portion 1509 and a flexible elongate member to be inserted inside of a subject. The flexible elongate member can be the same as the one described above. In some embodiments, the flexible elongate member may comprise a proximal shaft (e.g., insertion shaft 1501), steerable tip (e.g., tip 1505), and a steerable section (bending section 1503). The bending section may have improved performance that may be adjustable by coupling one or more cable guides at various locations.

[0118] As shown in FIG. 16, a robotic endoscope (e.g., bronchoscope) 1620 may comprise a handle portion 1613 and a flexible elongate member 1611. In some embodiments, the flexibleDocket No.: 55441-735.601 elongate member 1611 may comprise a shaft, steerable tip, a steerable bending section and an anti-prolapse passive section. The robotic endoscope 1620 can be the same as the steerable catheter assembly as described in FIG. 10. The robotic endoscope may be a single-use robotic endoscope. In some cases, only the catheter may be disposable. In some cases, at least a portion of the catheter may be disposable. In some cases, the entire robotic endoscope may be released from the instrument driving mechanism and can be disposed of. In some cases, the endoscope may contain varying levels of stiffness along its shaft, as to improve functional operation. In some cases, a minimum bend radius along the shaft may vary so that the kink resistance capability may be configurable along the length.

[0119] The robotic endoscope can be releasably coupled to an instrument driving mechanism 1615. The instrument driving mechanism 1615 may be mounted to the arm of the robotic support system or to any actuated support system as described elsewhere herein. The instrument driving mechanism may provide mechanical and electrical interface to the robotic endoscope 1610. The mechanical interface may allow the robotic endoscope 1610 to be releasably coupled to the instrument driving mechanism. For instance, the handle portion of the robotic endoscope can be attached to the instrument driving mechanism via quick install / release means, such as magnets and spring-loaded levels. In some cases, the robotic endoscope may be coupled or released from the instrument driving mechanism manually without using a tool.

[0120] FIG. 17 shows an example of an instrument driving mechanism 1715 providing mechanical interface to the handle portion 1713 of the robotic endoscope. As shown in the example, the instrument driving mechanism 1715 may comprise a set of motors that are actuated to rotationally drive a set of pull wires of the flexible endoscope or catheter. The handle portion 1718 of the catheter assembly may be mounted onto the instrument drive mechanism so that its pulley assemblies or capstans are driven by the set of motors. The number of pulleys may vary based on the pull wire configurations. In some cases, one, two, three, four, or more pull wires may be utilized for articulating the flexible endoscope or catheter.

[0121] The handle portion may be designed allowing the robotic endoscope to be disposable at reduced cost. For instance, classic manual and robotic bronchoscopes may have a cable in the proximal end of the bronchoscope handle. The cable often includes illumination fibers, camera video cable, and other sensors fibers or cables such as electromagnetic (EM) sensors, or shape sensing fibers. Such complex cable can be expensive, adding to the cost of the endoscope. The provided robotic endoscope may have an optimized design such that simplified structures and components can be employed while preserving the mechanical and electrical functionalities. In some cases, the handle portion of the robotic bronchoscope may employ a cable-free design while providing a mechanical / electrical interface to the catheter.Docket No.: 55441-735.601

[0122] FIG. 18 shows an example of a distal tip 1800 of an endoscope. In some cases, the distal portion or tip of the catheter 1800 may be substantially flexible such that it can be steered into one or more directions (e.g., pitch, yaw). The catheter may comprise a tip portion, bending section, and insertion shaft as described above. In some embodiments, the catheter may have variable bending stiffness along the longitudinal axis direction. For instance, the catheter may comprise multiple sections having different bending stiffness (e.g., flexible, semi-rigid, and rigid). The bending stiffness may be varied by selecting materials with different stiffness / rigidity, varying structures in different segments (e.g., cuts, patterns), adding additional supporting components or any combination of the above. In some embodiments, the catheter may have variable minimum bend radius along the longitudinal axis direction. The selection of different minimum bend radius at different location long the catheter may beneficially provide anti-prolapse capability while still allow the catheter to reach hard-to-reach regions. In some cases, a proximal end of the catheter needs not be bent to a high degree thus the proximal portion of the catheter may be reinforced with additional mechanical structure (e.g., additional layers of materials) to achieve a greater bending stiffness. Such design may provide support and stability to the catheter. In some cases, the variable bending stiffness may be achieved by using different materials during extrusion of the catheter. This may advantageously allow for different stiffness levels along the shaft of the catheter in an extrusion manufacturing process without additional fastening or assembling of different materials.

[0123] The distal portion of the catheter may be steered by one or more pull wires 1805. The distal portion of the catheter may be made of any suitable material such as co-polymers, polymers, metals or alloys such that it can be bent by the pull wires. In some embodiments, the proximal end or terminal end of one or more pull wires 1805 may be coupled to a driving mechanism (e.g., gears, pulleys, capstan etc.) via the anchoring mechanism as described above.

[0124] The pull wire 1805 may be a metallic wire, cable or thread, or it may be a polymeric wire, cable or thread. The pull wire 1805 can also be made of natural or organic materials or fibers. The pull wire 1805 can be any type of suitable wire, cable or thread capable of supporting various kinds of loads without deformation, significant deformation, or breakage. The distal end or portion of one or more pull wires 1805 may be anchored or integrated to the distal portion of the catheter, such that operation of the pull wires by the control unit may apply force or tension to the distal portion which may steer or articulate (e.g., up, down, pitch, yaw, or any direction inbetween) at least the distal portion (e.g., flexible section) of the catheter.

[0125] The catheter may have a dimension so that one or more electronic components can be integrated to the catheter. For example, the outer diameter of the distal tip may and the diameter of the working channel 1803 may be selected such that one or more electronic components canDocket No.: 55441-735.601 be embedded into the wall of the catheter. However, it should be noted that based on different applications, the outer diameter and the diameter of the working channel can be in any suitable range according to the tool dimensional or specific application.

[0126] The one or more electronic components may comprise an imaging device, illumination device or sensors. In some embodiments, the imaging device may be a video camera 1818. The imaging device may comprise optical elements and image sensor for capturing image data. The image sensors may be configured to generate image data in response to wavelengths of light. A variety of image sensors may be employed for capturing image data such as complementary metal oxide semiconductor (CMOS) or charge-coupled device (CCD). The imaging device may be a low-cost camera. In some cases, the image sensor may be provided on a circuit board. The circuit board may be an imaging printed circuit board (PCB). The PCB may comprise a plurality of electronic elements for processing the image signal. For instance, the circuit for a CCD sensor may comprise A / D converters and amplifiers to amplify and convert the analog signal provided by the CCD sensor. Optionally, the image sensor may be integrated with amplifiers and converters to convert analog signal to digital signal such that a circuit board may not be required. In some cases, the output of the image sensor or the circuit board may be image data (digital signals) can be further processed by a camera circuit or processors of the camera. In some cases, the image sensor may comprise an array of optical sensors.

[0127] The illumination device may comprise one or more light sources 1811 positioned at the distal tip. The light source may be a light-emitting diode (LED), an organic LED (OLED), a quantum dot, or any other suitable light source. In some cases, the light source may be miniaturized LED for a compact design or Dual Tone Flash LED Lighting.

[0128] Distal Portion or Tip of the catheter

[0129] The imaging device and the illumination device may be integrated to the catheter. For example, the distal portion of the catheter may comprise suitable structures matching at least a dimension of the imaging device and the illumination device. The imaging device and the illumination device may be embedded into the catheter. FIG. 19 shows an example distal portion of the catheter with integrated imaging device and the illumination device. A camera may be located at the distal portion. The distal tip may have a structure to receive the camera, illumination device and / or the location sensor. For example, the camera may be embedded into a cavity 1910 at the distal tip of the catheter. The cavity 1910 may be integrally formed with the distal portion of the cavity and may have a dimension matching a length / width of the camera such that the camera may not move relative to the catheter. The camera may be adjacent to the working channel 1915 of the catheter to provide near field view of the tissue or the organs. InDocket No.: 55441-735.601 some cases, the attitude or orientation of the imaging device may be controlled by controlling a rotational movement (e.g., roll) of the catheter.

[0130] The power to the camera may be provided by a wired cable. In some cases, the cable wire may be in a wire bundle providing power to the camera as well as illumination elements or other circuitry at the distal tip of the catheter. The cables such as electric wires may be captured by the internal structures of the bending section as described above. The camera and / or light source may be supplied with power from a power source located at the handle portion via wires, copper wires, or via any other suitable means running through the length of the catheter. In some cases, real-time images or video of the tissue or organ may be transmitted to an external user interface or display wirelessly. The wireless communication may be WiFi, Bluetooth, RF communication or other forms of communication. In some cases, images or videos captured by the camera may be broadcasted to a plurality of devices or systems. In some cases, image and / or video data from the camera may be transmitted down the length of the catheter to the processors situated in the handle portion via wires, copper wires, or via any other suitable means. The image or video data may be transmitted via the wireless communication component in the handle portion to an external device / system. In some cases, the system may be designed such that no wires are visible or exposed to operators.

[0131] In conventional endoscopy, illumination light may be provided by fiber cables that transfer the light of a light source located at the proximal end of the endoscope, to the distal end of the robotic endoscope. In some embodiments of the disclosure, one or more miniaturized LED lights may be employed and embedded into the distal portion of the catheter to reduce the design complexity. In some cases, the distal portion may comprise a structure 1930 having a dimension matching a dimension of a miniaturized LED light source. The distal portion may be embedded with one or more LED light sources. As shown in the illustrated example, two cavities 1930 may be integrally formed with the catheter to receive two LED light sources. For instance, the outer diameter of the distal tip may be around 4 to 4.4 millimeters (mm) and diameter of the working channel of the catheter may be around 2 mm such that two LED light sources may be embedded at the distal end. The outer diameter can be in any range smaller than 4 mm or greater than 4.4 mm, and the diameter of the working channel can be in any range according to the tool's dimensional or specific application. Any number of light sources may be included. The internal structure of the distal portion may be designed to fit any number of light sources.

[0132] In some cases, each of the one or more LEDs may be connected to power wires which may run to the proximal handle. In some embodiment, the one or more LEDs may be soldered to separated power wires that later bundle together to form a single strand. In some embodiments, the LEDs may be soldered to pull wires that supply power. In other embodiments, the one orDocket No.: 55441-735.601 more LEDs may be crimped or connected directly to a single pair of power wires. In some cases, a protection layer such as a thin layer of biocompatible glue may be applied to the front surface of the one or more LEDs to provide protection while allowing light emitted out. In some cases, an additional cover 1931 may be placed at the forwarding end face of the distal tip providing precise positioning of the one or more LEDs as well as sufficient room for the glue. The cover 1931 may be composed of transparent material matching the refractive index of the glue so that the illumination light may not be obstructed.

[0133] The working channel (e.g., working channel 1803, 1915) may be designed to provide protection for the internal components such as flexible instruments (e.g., needle, forceps, etc.). When flexible instruments pass through a conventional working channel, they may be abstracted by the working channel due to kinking, ovalizing and / or high friction force. The working channel herein may advantageously address the above drawbacks by providing a high hoop strength and a capability of achieving low bend radius. The working channel may also be designed to provide low friction in the inner surface.

[0134] In some embodiments, the distal portion or the tip may have a flat front surface without chamfered surfaces. In alternative embodiments, the distal portion or the tip may have a reduced dimension to fit into an airway. FIG. 20 shows an example of a tip with a smaller diameter. As illustrated in FIG. 20, the distal portion 2000 may have an angled or chamfered tip so that the leading distal end of the tip has a smaller diameter. The angled or chamfered tip beneficially allows the endoscope to fit into smaller airways.

[0135] The angled tip may have one or more chamfered surfaces 2011, 2013. The chamfered surface may comprise a main chamfer 2013 located at the frontend surface of the distal tip. As further illustrated in FIG. 20, the angled tip may have a frontend surface formed of a main chamfer surface 2001. The main chamfer surface may have any suitable angle (e.g., about 45° angle, about 25° angle, about 30° angle, about 35° angle, about 40° angle, about 50° angle, about 55° angle, about 60° angle, about 65° angle, about 70° angle, etc.) to reduce the distal diameter of the tip. In some embodiments, the one or more chamfered surfaces may comprise one or more chamfers on the side (e.g., left or right side or both sides) which helps to further reduce the distal diameter of the tip 2011. The chamfers on the sides may have angles and dimensions suitable to reduce the diameter of the tip while allowing for sufficient internal structure to hold the one or more components embedded at the distal tip (e.g., camera, lighting device, etc.).

[0136] The angled tip may have one or more chamfered surfaces. In some cases, the chamfered portion of the tip may be substantially at the working channel 2001. As shown in FIG. 17, an exit port of the working channel 2001 may be at least partially chamfered. In some cases, at least 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90% of an exit port of the working channel has aDocket No.: 55441-735.601 chamfered end surface. In some cases, the compartment for holding the imaging device / camera 2003 and the lighting / illumination device 2005 may be located substantially at the non-angled or non-chamfered surface such that the chambers may not impact the function of the camera or the lighting element.

[0137] While preferred embodiments of the present disclosure have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the disclosure. It should be understood that various alternatives to the embodiments of the present disclosure may be employed in practicing the present disclosure. It is intended that the following claims define the scope of the present disclosure and that methods and structures within the scope of these claims and their equivalents be covered thereby.

Claims

Docket No.: 55441-735.601CLAIMSWhat is claimed is:

1. An articulatable flexible instrument comprising:(a) an elongated member extending between a distal end and a proximal end, wherein the elongated member comprises a flexible body and wherein the distal end is steerable by one or more cables; and(b) one or more openings formed at different locations along the flexibly body and each of the one or more openings is configured to receive a modular cable guide, wherein the modular cable guide is configured for routing the one or more cables through one or more internal features of the modular cable guide.

2. The articulatable flexible instrument of claim 1, wherein the modular cable guide comprises a peripheral feature mating with a shape and size of at least one of the one or more openings.

3. The articulatable flexible instrument of claim 2, wherein the peripheral feature allows for a single configuration for placing the modular cable guide.

4. The articulatable flexible instrument of claim 1, wherein the one or more internal features comprise through holes of a circular shape, a non-circular shape or a combination of both.

5. The articulatable flexible instrument of claim 1, wherein the modular cable guide is received in a radial direction.

6. The articulatable flexible instrument of claim 1, wherein the modular cable guide is received in an axial direction.

7. The articulatable flexible instrument of claim 6, wherein the modular cable guide is stacked between two adjacent tubular segments.

8. The articulatable flexible instrument of claim 1, wherein the modular cable guide is configured to be coupled to an opening selected from the one or more openings at a selected location.

9. The articulatable flexible instrument of claim 1, wherein the modular cable guide is configured to be loaded in an axially fashion at a wrist section of the articulatable flexible instrument.

10. The articulatable flexible instrument of claim 1, wherein the modular cable guide is configured to be loaded at a bending section or a passive shaft portion of the articulatable flexible instrument.Docket No.: 55441-735.60111 . The articulatable flexible instrument of claim 1, wherein the one or more cables comprise one or more pull wires actuated by one or more actuators to steer the distal end of the elongated member.

12. The articulatable flexible instrument of claim 1, wherein the modular cable guide is further configured to route one or more of electrical wire cables, signaling cables, monitoring cables, fiber optic cables, ultrasonic cables, microfluidic line cables, springs, electrical harnesses, sensor cables, or any combination thereof.

13. The articulatable flexible instrument of claim 1, wherein the one or more openings are cutout formed in the flexible body and the flexible body is formed of a single-piece sheath.

14. The articulatable flexible instrument of claim 1, wherein the one or more openings are formed by linking two or more tubular segments.

15. The articulatable flexible instrument of claim 1, wherein the modular cable guide is coupled to the one or more openings without additional fastening means.

16. The articulatable flexible instrument of claim 1, wherein the modular cable guide, once is coupled to the flexible body, does not have axial or radial movement relative to the flexible body.

17. The articulatable flexible instrument of claim 1, wherein the one or more cables are routed through one or more of the modular cable guides to have a non-linear configuration.

18. The articulatable flexible instrument of claim 1, wherein the one or more cables are routed through one or more of the modular cable guides to have a linear or straight configuration.

19. The articulatable flexible instrument of claim 1, wherein the articulatable flexible instrument is robotically controlled via an instrument driving mechanical releasably coupled to the proximal end.

20. The articulatable flexible instrument of claim 1, wherein the modular cable guide has a substantially planar form factor.

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