Medical system with robotically controlled support

Abstract

Among other things, a robotic medical system is disclosed. The robotic medical system includes a support configured to couple to an access instrument, where the access instrument has a channel. A robotic manipulator is configured to couple to the support and to an elongate instrument. A control system having a processor and a memory is configured to: advance the elongate instrument through the channel by moving the robotic manipulator; and control a position of the access instrument by actuating the support with the robotic manipulator as the elongate instrument is advanced through the channel.

Description

MEDICAL SYSTEM WITH ROBOTICALLY CONTROLLED SUPPORTPRIORITY

[0001] This application claims the benefit of U.S. Patent Application No. 63 / 715,448, entitled "MEDICAL SYSTEM WITH ROBOTICALLY CONTROLLED SUPPORT," filed November 1, 2024, the disclosure of which is incorporated by reference herein.BACKGROUND

[0002] Minimally invasive medical procedures, such as endoscopy or robotically- assisted surgery, are increasingly used for the diagnosis or treatment of a variety of patient conditions. These techniques are attractive for their potential to minimize trauma to the patient, reduce recovery times, enhance surgeon precision, or facilitate new surgical approaches that may not be possible with traditional technologies. Minimally invasive procedures often involve insertion of elongate instruments into a patient’s body through small anatomical openings, such as natural orifices or small incisions. These elongate instruments are then advanced to an anatomical site and used to observe, manipulate, or interact with tissue or objects within the patient. To provide safe passage of these elongate instruments as they are inserted into the patient, access instruments can be placed at the openings where the elongate instruments are introduced into the patient.BRIEF DESCRIPTION OF DRAWINGS

[0003] While the specification concludes with claims which particularly point out and distinctly claim this technology, it is believed this technology will be better understood from the following description of certain examples taken in conjunction with the accompanying drawings, in which like reference numerals identify the same elements and in which:

[0004] FIG. 1 depicts an example of a medical system.

[0005] FIG. 2 depicts an example of a medical system having an articulated arm.

[0006] FIG. 3 depicts an example of a medical system having a robotically controlled support.

[0007] FIG. 4 depicts an example of a medical system having a robotically controlled support and a pair of elongate instruments.

[0008] FIG. 5 depicts an example of a device having a robotically controlled support.

[0009] FIG. 6 depicts an example of an adapter for a robotically controlled support.

[0010] FIG. 7 depicts an example of an instrument driver.

[0011] FIG. 8 depicts an example of an elongate instrument.

[0012] FIG. 9 depicts an example of a medical system having an elongate instrument and a robotically controlled support for a percutaneous sheath.

[0013] FIG. 10A depicts an example of a collapsible robotically controlled support having a linkage, with the robotically controlled support in an expanded configuration.

[0014] FIG. 10B depicts an example of a collapsible robotically controlled support having a linkage, with the robotically controlled support in a collapsed configuration.

[0015] FIG. 11A depicts an example of a collapsible robotically controlled support having a spool, with the spool in an expanded configuration.

[0016] FIG. 11B depicts an example of a collapsible robotically controlled support having a spool, with the spool in a collapsed configuration.

[0017] FIG. 11C depicts an example of a collapsible robotically controlled support having a spool, with the spool in a configuration where the spool is wound or unwound at an instrument driver.

[0018] FIG. 12A is a perspective view depicting an example of an offset robotically controlled support.

[0019] FIG. 12B is a cross section view depicting an example of an offset robotically controlled support.

[0020] FIG. 13 depicts an example of a method of operating a robotically controlled support.

[0021] The drawings are not intended to be limiting in any way, and it is contemplated that various embodiments of the technology may be carried out in a variety of other ways, including those not necessarily depicted in the drawings. The accompanying drawings incorporated in and forming a part of the specification illustrate several aspects of the present technology, and together with the description serve to explain the principles of the technology; it being understood, however, that this technology is not limited to the precise arrangements shown.DETAILED DESCRIPTION

[0022] The following description and appended drawings contain certain examples and configurations of this technology and are not intended to be an exhaustive disclosure ofthe only configurations in which the technology may be practiced. Other examples, features, aspects, embodiments, and advantages of the technology will be apparent to those skill in the art from this disclosure. As will be realized, the technology described herein is capable of other different and obvious aspects, all without departing from the inventive concepts disclosed herein. Accordingly, the drawings and descriptions should be regarded as illustrative in nature and not restrictive. In some instances, well-known structures and components are not described in detail or are shown in block diagram form to avoid obscuring concepts of this technology.

[0023] Minimally invasive procedures can involve insertion of elongate instruments through small anatomical openings, such as natural orifices or small incisions. To provide safe passage for introducing these elongate instruments to a target anatomical site, access instruments may be placed at the opening and stabilized so that the elongate instrument can be inserted through a channel of the access instrument. To facilitate these procedures, medical staff typically performs several set-up steps, such as preparing the patient for the procedure or preparing instrumentation for use. In the case of robotically assisted procedures, for example, medical staff may deploy a robot from stowage, dock instruments to the robot, or position access instruments with respect to the patient.

[0024] Among other things, the following description relates to technologies that can facilitate set up, stabilization, or control of robotic instrumentation in medical procedures. In illustrated examples, a robotically controlled support is depicted that can be mounted to a robot and coupled to an access instrument for support as medical instruments are advanced or retracted therethrough. The robotically controlled support may be actuatable by the robot while the robot advances or retracts elongate instruments through the access instrument to stabilize the access instrument or control the position of the access instrument in space.

[0025] These and other features of this technology are further described below with respect to examples of FIGS. 1-13. However, there are multiple inventive concepts disclosed herein which may be practiced independently, in combination, or in other contexts beyond these particular examples. Accordingly, these examples are explanatory in nature but should not be construed as limiting.

[0026] FIG. 1 depicts an example of a medical system, in accordance with some embodiments. In the illustrated configuration, the medical system 199 is deployed for robotically-assisted bronchoscopy, a robotically-assisted endoscopic procedure wherea flexible instrument is introduced into a patient’s airways and used to view or access a target within the patient. Such a procedure may be useful for diagnosis or treatment of patient conditions, such as lung cancer, inflammation, or foreign objects within the body.

[0027] As shown in FIG. 1, medical system 199 includes a robot 103, a physician console 106, and multiple medical instruments. These components are set up in a procedure area 109, such as an operating room or an endoscopy suite, to perform a procedure on a patient 112. Patient 112 can be positioned on a patient platform 115, such as the top of an operating table. As illustrated, robot 103 is configured as a mobile cart that can be positioned beside to the patient platform 115 to access the patient 112 with elongate instruments 118. Physician console 106 is configured to provide inputs or receive outputs from the robot 103 or the elongate instruments 118 via cabling or wireless communication. A user 121, such as a physician, bedside assistant, or other member of medical staff, can operate, observe, or interact with components of the medical system 199 to facilitate the procedure.

[0028] As illustrated, robot 103 includes a pair of robotic manipulators 135, which are mounted to robot base 161 and configured to manipulate a pair of elongate instruments 118. These elongate instruments 118 can be introduced into a mouth of a patient 112 through an access instrument 124, which is stabilized near the patient’s mouth to provide a safe passage for insertion of the elongate instruments 118. Once inserted, elongate instruments 118 can be controlled by the robot 103 to reach a target destination or perform desired surgical tasks. For example, robot 103 may be configured to advance, retract, or actuate the elongate instruments 118 to reach a target destination within the patient 112. Once the desired target is reached, these elongate instruments 118 may be used to capture endoscopic images, take a sample for biopsy, or provide localized treatment, for example. In some configurations, and as further described below, a robotically controlled support can be used to control a position of the access instrument 124 as elongate instruments 118 are advanced or retracted through the access instrument.

[0029] Physician console 106 includes or is coupled to an input device 130, which user 121 can operate to provide commands for teleoperation of robot 103. As illustrated, input device 130 is configured as a handheld controller (e.g., a pendant) having one or more joysticks and one or more buttons to control various aspects of the medical system 199. As seen in FIG. 1, physician console 106 can also include a display 133, whichcan be configured to present images for observation by the user 121. For example, display 133 can be configured to display endoscopic images captured with the elongate instruments 118, so that user 121 can provide commands to the robot 103 via the input device 130 while viewing a real-time camera feed captured within the patient’s anatomy. Alternatively, or in combination, display 133 can be configured to display, for example, pre-operative images, intra-operative images, navigation information, or interactive menus. In the illustrated example, physician console 106 is configured as a tower that may provide additional supporting functionality to the medical system 199, such as vision processing, navigation support, fluidics delivery, or energy delivery.

[0030] Control system 127 includes processing circuitry and memory communicatively coupled to the robot 103 and / or physician console 106. Control system 127 can be configured to implement functions of the medical system 199, such as controlling or actuating the robot 103, controlling or operating the elongate instruments 118, or processing inputs or outputs to or from physician console 106. For example, processing circuitry of the control system 127 can be configured via hardware or software programming to implement any functions described further herein in connection with operation of the medical system 199. Examples of processing circuitry include one or more central processing units (CPUs), graphics processing units (GPUs), field programmable gate arrays (FPGAs), application specific integrated circuits (ASICs), or other processors configured to process inputs or outputs for the medical system 199. As used herein, the term “processor” can encompass a single processing chip or integrated circuit, or multiple processing chips or integrated circuits that may be co-located or distributed in different locations and configured to execute functions described herein. Memory can store instructions that, when executed by the processor, cause execution of methods described herein. As used herein, the term “memory” can encompass any suitable non-transitory computer readable medium embodied in one or several memory devices, such as hard drives, flash memory, solid state memory, storage discs, or tapes. Components of the control system 127 may be physically disposed in or connected to components of the medical system 199, such as the robot 103 or the physician console 106, or components of the control system 127 may be otherwise communicatively coupled to components of the medical system 199 via various wired or wireless interconnections .

[0031] Although an example configuration of the medical system 199 is shown and described, the medical system 199 may be configured in various ways, where suchvariations are not all separately illustrated or explicitly enumerated for the sake of clarity and conciseness of this description.

[0032] For example, in some configurations, the medical system 199 can include one or multiple robots 103 or robotic carts, where multiple robots or robotic carts may be configured to operate in cooperation with each other. In some configurations, a robot 103 may include one or multiple robotic manipulators 135 to manipulate one or multiple instruments. For example, robot 103 can include one, two, three, four, five, six, or more robotic manipulators 135, and each manipulator can manipulate one or multiple elongate instruments or access instruments. In the illustrated example, each robotic manipulator 135 includes a robotic arm having a series of links connected via a series of joints, where joints of the arm can be actuated to manipulate the instruments. In some configurations, robotic manipulators can include arm-based manipulators, carriagebased manipulators (e.g., where a motorized carriage moves along a track), or a manipulator employing a combination of a carriage and an arm. While the examples shown depict robot 103 as a robotic cart, in some configurations, robot 103 can be configured as a table-integrated robot, where one or more robotic manipulators are coupled to or integrated with an operating table that supports the patient. Additionally, or alternatively, robot 103 can be configured as a boom -based robot, where robotic manipulators descend from an overhead boom that can be suspended above the patient.

[0033] In the illustrated example, physician console 106 is configured as a tower with an open design, where a user or physician may stand in proximity to the tower to observe images from display 133 or provide control inputs to input device 130. In some configurations, physician console 106 may have an immersive design, where the user places their head into an immersive display for viewing images. Additionally, or alternatively, physician console 106 may be configured for the user to be seated at the console when viewing the display or operating the input device 130. Display 133 can be, for example, a flat panel display, touch screen display, two-dimensional display, three-dimensional display, stereoscopic display, head-mounted display, or any suitable electronic display device. Additionally, or alternatively, the physician console 106 or the medical system 199 can include one or multiple displays to display various information. As illustrated, input device 130 is configured as a pendant or handheld controller, with finger inputs (e.g., joysticks and buttons) that the user can operate to provide input to the robot 103 or components of the medical system 199, but various types of input devices may be employed instead of or in addition to the pendant.Examples of input devices include gimbal-based controllers, graspers, touch pads, trackballs, joysticks, buttons, or foot pedals. In the illustrated configurations, physician console 106 is configured as integrated with a support tower that can provide additional support functionality for the robot or the instruments, such as vision processing, navigation processing, fluidics, or energy. In some configurations, physician console may be configured as a separate cart or separate device from such a support tower. Additionally, or alternatively, physician console 106 or the support tower may be integrated with the robot 103, for example, by providing a display or an input device connection directly on the robot 103 that manipulates the instruments.

[0034] The illustrated configuration includes a pair of elongate instruments 118, which can be independently controlled by the pair of robotic manipulators. The pair of elongate instruments 118 can be inserted together through the access instrument 124 in a co-axial or telescoping configuration. For example, the elongate instruments 118 can include an outer steerable sheath and an inner steerable endoscope that can be cooperatively controlled by the robot 103 to reach a target destination within the patient. Though a pair of elongate instruments is shown, in various configurations, the medical system 199 can involve one or multiple elongate instruments which can be inserted through one or more multiple access instruments, each having one or multiple channels, and where the type and number of instruments involved can vary depending on the procedural tasks or access points involved in various procedural configurations. Some examples of elongate instruments include flexible endoscopes, catheters, or rigid surgical instruments (e.g., laparoscopic surgical instruments). Some examples of access instruments include introducers, sheaths, cannulas, or tubes having channels or lumens through which elongate instruments can be inserted. Access instruments can be used, for example, to access natural orifices, percutaneous openings, or incisions in the body.

[0035] Various technical concepts are described herein with reference to example configurations involving robotically-assisted bronchoscopy. It will be appreciated that certain principles of the technology described herein can be applied in a variety of medical procedures or contexts. Some examples of procedures include ureteroscopy, laparoscopy, colonoscopy, gastrointestinal procedures, cardiovascular procedures, general surgery, or endoluminal surgery. Accordingly, while example configurations for robotic bronchoscopy are described and illustrated herein, it will be appreciated that aspects of present technology can be employed in a variety of configurations or procedures, such as robotic or non-robotic endoscopic or surgical procedures.

[0036] To facilitate a procedure, medical staff may perform several set up steps to prepare the medical system 199 and the patient 112 for the medical procedure. For example, the patient may be positioned on patient platform 115 and anesthetized as appropriate. The robot 103 or the physician console 106 may be connected via cabling to various components or positioned within the procedure area 109 in optimal positions. Surgical drapes may be applied over the robot 103 or other components. Instruments may be set up for use and attached to the robot or mounting components as appropriate.

[0037] FIG. 2 depicts an example of a medical system, as set up for a medical procedure. In the illustrated configuration of medical system 199, patient 112 is supported on a patient platform 115, which is provided at a top surface of an operating table. Access instrument 124 is stabilized over the patient 112 by an articulated arm 250, which is removably mounted to a rail of the operating table. Articulated arm 250 includes a series of articulated joints 207 and a manual knob 202, which can be loosened and tightened to varying degrees to loosen or tighten the articulated joints 207. The positioning of the access instrument 124 can be freely adjusted by loosening the manual knob 202, manually articulating the various joints of the arm to a desired pose, then tightening the manual knob 202 with sufficient force to lock the articulated joints 207 in place. Robotic manipulator 135 is positioned on an opposite side of the table from the articulated arm 250 to avoid collisions. Robotic manipulator 135 is configured to advance or retract elongate instrument 118 through the access instrument 124 and into the patient 112 while the articulated arm 250 stabilizes the access instrument 124.

[0038] The configuration shown in FIG. 2 suffers from several drawbacks. For example, the various degrees of freedom (DOF) allow the articulated arm to be inadvertently placed into undesirable poses that can interfere with or hinder surgical processes. There is quantitative ambiguity in how strongly the user should tighten the manual adjustment knob, making it cumbersome to use. If the articulated arm 250 is set up improperly, the access instrument 124 or the articulated arm could fall or lose position.

[0039] FIG. 3 depicts an example of a medical system having a robotically controlled support, in accordance with some embodiments.

[0040] As illustrated, medical system 199 includes robotically controlled support 340 coupled to access instrument 124 and configured to hold or stabilize the access instrument 124 at the patient opening. As used herein, an access instrument positioned “at” an opening, entry point, or access site can include instances where the accessinstrument is inserted directly into the opening, entry point, or access site, as well as instances where the access instrument is positioned proximate the opening, entry point, or access site without being physically or directly coupled to that opening, entry point, or access site. For example, an access instrument can be positioned at an opening when it is physically hovering over the opening. As another example, an access instrument can be positioned at an opening when it is inserted directly through the opening. Robotically controlled support 340 is mounted to robotic manipulator 135, which can actuate the support 340 to control a position of the access instrument 124. Robotic manipulator 135 also controls or manipulates elongate instrument 118, which is inserted through a channel of the access instrument 124 and introduced into the patient’s body.

[0041] In the illustrated configuration, both the elongate instrument 118 and the support340 are mounted to the robotic manipulator 135. Accordingly, the robotic manipulator 135 can control both the support 340 and the elongate instrument 118 concurrently. For example, robotic manipulator 135 can be configured to advance the elongate instrument 118 by moving the elongate instrument 118 and robotic manipulator 135, in direction of arrow 380, while concurrently actuating the support 340, to advance the elongate instrument through the access instrument 124 and further into patient 112. As the elongate instrument 118 is advanced, the robotic manipulator 135 can actuate the support 340 to retract the support 340 in the opposite direction relative to the robotic manipulator 135, in direction of arrow 390, to control the position of the access instrument 124. Alternatively, or in combination, the medical system 199 can be configured to reverse these directions, so that the elongate instrument 118 is retracted through the access instrument 124 as the robotically controlled support is advanced relative to the manipulator. Accordingly, by actuating the support 340 in a direction opposite the direction of movement of the robotic manipulator 135 or elongate instrument 118, and at the same velocity, a position of the access instrument 124 can be maintained in space or maintained relative to the patient 112. In some configurations, as further described below, the robotic manipulator 135 can be configured to articulate, steer, or otherwise actuate a tip of the elongate instrument 118 while that instrument is extended through the channel of the access instrument 124.

[0042] As seen in FIG. 3, robotic manipulator 135 includes a robotic arm coupled to robot base 161. The robotic arm includes a series of links 365 connected by a series of joints 363, which form a kinematic chain that can be actuated to control a pose of the robotic arm, and accordingly move or manipulate the elongate instrument 118. Aninstrument driver 375 can be arranged at the distal end of the robotic arm to provide an instrument mount for mounting the elongate instrument 118 and robotically controlled support 340. A series of actuators or motors can be housed within the robotic arm and operatively coupled to the series of joints 363 to actuate the pose of the robotic arm. In some configurations, the robot is configured to advance or retract the elongate instrument 118 linearly along a virtual rail 379, by actuating a pose of the robotic arm to move the instrument driver 375 at the distal end of the robotic arm, and accordingly the elongate instrument mounted thereto, along the virtual rail. A proximal end of the robotic arm can be coupled to robot base 161 so that the arm may be actuated or moved relative to the base.

[0043] In this example, the robotically controlled support is actuated to maintain the position or location of the access instrument 124 in space. This may advantageously allow the robot to hold or stabilize the access instrument as elongate instruments are manipulated through the access channel. In some variations, the robotically controlled support 340 can be actuated to control the position of the access instrument in other ways, for example, by moving or positioning the access instrument 124 independently or concurrently with movement of the elongate instrument 118 to change a position of the access instrument in space. In some instances, the robotically controlled support 340 can provide a degree of freedom in the robotic system that can generally be used to control a position of the access instrument in space independently from the elongate instrument 118.

[0044] In the illustrated example, access instrument 124 is shown as a patient introducer, which is held in space over a mouth of the patient 112 to provide passage for an elongate instrument 118 inserted into the patient’s mouth. In various configurations, the access instrument 124 can be positioned at the patient opening in various ways, depending on the procedure or type of access provided. For example, in some instances, the access instrument is positioned at the opening without being inserted into the opening, like in the example of FIG. 2 where the introducer is suspended over the patient. Alternatively, or in combination, the robotically controlled support can be configured to hold the access instrument at the opening with the instrument inserted directly into the access site, like in the percutaneous sheath example described later in this description.

[0045] FIG. 3 and various examples disclosed herein describe usage of the medical system 199 and support 340 to perform a procedure on a patient 112, where accessinstrument 124 is positioned at an opening on a body of the patient 112. In various configurations, the medical system 199 and / or robotically controlled support 340 may be used, for instance, in educational or lab settings, where, for example, access instrument 124 is positioned at an opening on a body of a model, cadaver, animal, or inanimate object, and elongate instrument 118 is inserted into the body. Such methods may be useful for surgeon training, product testing, development applications, or the like. Accordingly, it will be understood that methods described herein are not limited to medical procedures performed on a human body but can be implemented on bodies that are not part of a live patient.

[0046] FIG. 4 depicts an example of a medical system having a robotically controlled support and multiple elongate medical instruments, in accordance with some embodiments. FIG. 4 depicts the support and elongate instruments in an un-mounted configuration with respect to the robot.

[0047] As illustrated, the medical system 199 includes multiple robotic manipulators mounted to robot base 161. These manipulators include a first manipulator 135-1 and a second manipulator 135-2, which are configured to manipulate a first elongate instrument 118-1 and second elongate instrument 118-2, respectively. Each of these manipulators may be configured similarly, like the manipulator as described with reference to FIG. 3. For example, first robotic manipulator 135-1 can be configured to advance or retract first elongate instrument 118-1 through the access instrument 124. Alternatively, or in combination, second robotic manipulator 135-2 can be configured to advance or retract second elongate instrument 118-2 through the access instrument 124. Alternatively, or in combination, each robotic manipulator 135 can be configured to articulate, steer, or otherwise actuate the corresponding elongate instrument 118 while that instrument is inserted through the access instrument.

[0048] Each elongate instrument 118 can include an elongate instrument shaft coupled to an instrument base or handle. In the example shown, first elongate instrument 118-1 includes instrument base 381-1 coupled to first instrument shaft 383-1, and second elongate instrument 118-2 includes instrument base 381-2 coupled to second instrument shaft 383-2. Each of these shafts can be, for example, an elongate and flexible member that can be introduced into the patient 112 through a channel of the access instrument 124. The first and second instrument are arranged in a telescoping configuration, where second instrument shaft 383-2 is inserted through both the second elongate instrument 118-2 and the access instrument 124, and where the robotic manipulators can move thispair of elongate instruments independently or in concert. In some configurations, the second instrument 118-2 is a steerable endoscope positioned on a proximal robotic arm, and the first instrument 118-1 is a steerable sheath positioned on a distal robotic arm.

[0049] As seen in FIG. 4, each instrument base can provide a handle that the robot holds or manipulates to move or actuate the elongate instrument accordingly. As illustrated, a first instrument driver 375-1 is arranged at the distal end of first robotic manipulator 135-1 and configured to couple to first instrument base 381-1. A second instrument driver 375-2 is arranged at the distal end of second robotic manipulator 135- 2 and configured to couple to second instrument base 381-2. Each instrument driver can have one or more actuators (e.g., motors) that are configured to actuate mechanisms of the corresponding instrument. For example, each of the instrument bases 381 can include a housing that may house spools, capstans, or gears that can be actuated to control an instrument via, for example, pull wires, actuation cables, or push rods that extend through the instrument shaft.

[0050] The elongate support 340 can be coupled to or extend through adapters that can provide an interface between the robotic manipulator and the elongate instruments. As illustrated, elongate support 340 extends through a first adapter 398-1 and a second adapter 398-2, where the first adapter 398-1 provides an interface between the first manipulator 135-1 and the first elongate instrument 118-1, and the second adapter 398- 2 provides an interface between the second manipulator 135-2 and the second elongate instrument 118-2. As seen in FIG. 4, the first adapter 398-1 can be mounted to the first instrument driver 375-1, and the first instrument base 381-1 can be mounted to the first adapter 398-1. The second adapter 398-2 can be mounted to the second instrument driver 375-2, and the second instrument base 381-2 can be mounted to the second adapter 398-2. In various configurations, as further described below, one or more of these adapters may house mechanisms for actuating movement of the support 340 relative to the adapter or the robotic manipulator. Alternatively, or in combination, one or more of these adapters may house mechanisms for transferring torque or force from the robotic manipulators to mechanisms of the elongate instruments.

[0051] FIG. 5 depicts an example of a device having a robotically controlled support, in accordance with some embodiments.

[0052] As illustrated, accessory holding device 550 may be mountable to and removable from the robot (e.g., as described above with respect to FIG. 4) to provide a support for holding or controlling a position of access instrument 124. As illustrated,support 340 is configured as a rail that extends through first adapter 398-1 and second adapter 398-2. A distal end 516 of the support is configured to engage with access instrument 124 and can be configured to hold the access instrument in a fixed position with respect to the rail when the access instrument is coupled thereto. In the illustrated example, the engagement interface at the distal end 516 includes a slot that engages with an attachment portion of the access instrument 124, where the attachment portion that can be slid into the slot for mating the access instrument with the support 340. In some variations, the engagement interface at the distal end of the support and the access instrument 124 includes one or more clips, latches, clamps, receptacles, magnets, or other features for retaining the access instrument 124 on the support 340. In the illustrated example, access instrument 124 is configured as an introducer that provides a curved channel to redirect a trajectory of the elongate instruments passing through it. In some configurations, the access instrument or the introducer can provide a straight channel for passage of the instruments.

[0053] As seen in FIG. 5, each of the adapters includes a set of one or more drive couplers 567 that can transfer torque or driver forces to mechanisms of the elongate support or instruments mounted to the adapters, as appropriate. In some configurations, the first adapter 398-1 is configured as a distal adapter that is configured to operatively couple to and drive motion of the support relative to the adapter 398-1, while the second adapter is not operatively coupled to the support but instead provides a pass through for the rail to extend therethrough. In some variations, any one or more of the adapters may be operatively coupled to the support to drive motion of the support relative to the adapters. Each drive coupler 567 can be configured, for example, as a rotatable disc that is retained in the adapter housing and rotatable with respect to the adapter housing to transfer torque output from the robotic manipulator, as further described below. Each drive coupler can include suitable engagement features, such as teeth, for mating with corresponding couplers of the instrument or robot, as appropriate.

[0054] FIGS. 6-8 depict examples of drive interfaces, in accordance with some embodiments. FIG. 6 depicts an example of an adapter for a robotically controlled support, with a top housing removed to show inner components. FIG. 7 depicts an example of an instrument driver for coupling to the adapter of FIG. 6. FIG. 8 depicts an example of an elongate instrument for coupling to the adapter of FIG. 6.

[0055] As seen in FIG. 6, adapter 398 can include a set of drive couplers, including a first drive coupler 567-1 for actuating motion of the support 340, and a set of one ormore second drive couplers 567-2 for actuating an instrument mounted to the adapter. The first drive coupler 567-1 can be operatively coupled to the support 340 such that actuation of the drive coupler causes motion of the support 340 relative to the adapter housing 688. For example, as illustrated, the first drive coupler 567-1 can be operatively coupled to the support 340 via a rack and pinion gearing, where the first drive coupler 567-1 is coupled to pinion gear 633 and operable to rotate pinion gear 633, which is meshed with rack gear 637 that can be fixed to, and extend along, a rail portion of the support 340. Rotation of the first drive coupler 567-1 in a first direction can rotate the pinion gear 633 in a first direction (e.g., clockwise) to drive linear movement of the support in a first direction (e.g., proximally), while rotation of the first drive coupler 567-1 in a second direction can rotate the pinion gear 633 in a second direction (e.g., counterclockwise) to drive linear movement of the support in a second direction (e.g., distally).

[0056] With reference to FIGS. 6-8, the drive couplers of the adapter 398 can be configured to operatively couple to or engage with corresponding couplers of the instrument driver 375 (FIG. 7) and elongate instrument 118 (FIG. 8). For example, the first drive coupler 567-1 can be configured to engage with first drive output 767-1 of the instrument driver 375, so that actuation of the first drive output 767-1 in a first or second direction can actuate the support 340 in a first or second direction. The second drive couplers 567-2 of the adapter 398 (FIG. 6) can be configured to engage with the second drive outputs 767-2 of the instrument driver (FIG. 7) and the drive inputs 867- 2 of the elongate instrument 118 (FIG. 8), so that the second drive outputs 767-2 can be actuated to actuate the drive inputs 867-2 in the instrument base 381 or housing, via transfer of torque from the intermediate second drive couplers 567-2 in the adapter. Actuation of the drive inputs 867-2 can actuate the instrument tip 844 in one or more degrees of freedom relative to the instrument base 381. For example, the instrument can be actuatable to articulate or bend the instrument tip in one or more direction, or to actuate an end effector function of the tip. In the illustrated example, four drive inputs are shown in the instrument, which can be configured, in some configurations, to respectively actuate the tip 844 in four directions (e.g., up, down, left, or right) depending on which drive input is driven. Each of the drive outputs or drive couplers of the instrument driver can be actuated by a corresponding motor or actuator housed within the instrument driver housing, based on signals received from the control system 127 (FIG. 1). Although a particular number of drive couplers is shown, in somevariations, any suitable number of one or more drive couplers may be used in the adapter, instrument driver, or elongate instrument to transfer torque or actuation forces, as appropriate. Furthermore, in some variations, any suitable number of one or more drive couplers may be used to actuate the support 340 and any suitable number of one or more drive couplers may be used to actuate the elongate instrument 118.

[0057] FIG. 9 depicts an example of a medical system having a robotically controlled support for a percutaneous sheath, in accordance with some embodiments.

[0058] As illustrated, the medical system 199 includes three robotic manipulators mounted to robot base 161, where a first robotic manipulator 135-1 is coupled to the robotically controlled support 340 and the elongate instrument 118, while a pair of other robotic manipulators 135-3 are freed up for use with other instruments (other instruments not pictured). In some configurations, this medical system 199 may be used for a urology procedure, such as percutaneous nephrolithotomy, where access instrument 124 is configured as a percutaneous sheath that is inserted through a percutaneous opening in the patient’s body to access a kidney, and elongate instrument 118 is a suction catheter that can be manipulated by the robotic manipulator 135-1 to suction kidney stone fragments or fluids from the kidney through the sheath. Here, distal end 516 of the support includes a clamp configured to grasp a proximal portion of the sheath. In some configurations, the adapter 398 for the robotically controlled support is configured as a sterile adapter coupled to a drape 965, which can extend over the robotic manipulator 135-1 and provide a barrier to maintain sterility or avoid contamination during the procedure. As noted above, in use, robotic manipulator 135- 1 can advance or retract the catheter through the sheath, and can actuate the support 340 to control the position of the sheath as the catheter is advanced or retracted through the sheath.

[0059] FIGS. 10A-10B depict an example of a medical system having a collapsible support, in accordance with some embodiments. FIG. 10A depicts the support in an expanded (or extended) configuration, and FIG. 10B depicts the support in a collapsed (or compacted) configuration.

[0060] As illustrated, the support 340 includes an elongate linkage, having a series of links, which are coupled to adapter 398 at a proximal end of the linkage and the access instrument 124 at the distal end of the linkage. The support 340 may be actuated by rail portion 1012, which can be advanced or retracted by a drive input in the adapter 398 to advance or retract the position of the access instrument 124 relative to the adapter.Alternatively, or in combination, actuation of the rail portion 1012 can expand or collapse the support 340 based on movement of the series of links in the linkage structure. Alternatively, or in combination, the support 340 can be configured to provide anti -buckling support to the instrument shaft 383 to avoid buckling of a portion of the shaft when the support is in the expanded configuration.

[0061] FIGS. 11A-11C depict an example of a medical system having a collapsible support, in accordance with some embodiments. FIG. 11A depicts the support in an expanded (or extended) configuration, and FIG. 1 IB depicts the support in a collapsed (or compacted) configuration. FIG. 11C depicts the support in a configuration where the support may be wound or unwound at the instrument driver.

[0062] As illustrated, the support 340 includes a beam that can be spooled or unspooled to collapse or expand the support and thereby advance or retract the access instrument relative to the robotic manipulator. The unspooled portion of the beam may have, for example, a lenticular cross section that provides stiff structure, but allows the beam to be coiled to collapse the support. The lenticular shape of the cross section forms a shape of double convex lens, thus providing rigidity for support when unspooled while also permitting the beam to spooled. The beam is coiled (stowed / collapsed) onto or uncoiled (deployed / expanded) from a spool that may be passively rotated (by the action of compressive or tensile force applied to the deployed portion of the beam, actively rotated (motorized), spring energized, or a combination of these means of spool rotation. Alternatively, or in combination, support 340 can be configured to provide anti -buckling support to the instrument shaft 383 to avoid buckling of a portion of the shaft when the support is in the expanded configuration.

[0063] FIGS. 12A-12B depicts an example of a device having an offset robotically controlled support, in accordance with some embodiments. FIG. 12A depicts an overall view of the device, and FIG. 12B depicts a cross section of the adapter of the device.

[0064] As illustrated, the support 340 can be coupled to adapter 398 in a configuration where the support 340 is a rail that is offset to a side of the adapter. Compared to a configuration where the rail extends through a center of the adapter housing, the offset configuration allows a thickness (or height) of the adapter housing to be reduced, which may be useful to bring the mounted elongate instrument closer to the instrument driver in configurations where the instrument needs to be sensed by the instrument driver or signals need to be exchanged with the instrument (e.g., RFID identification). As seen in FIG. 12A, to provide the offset configuration, the distal end 516 may be angled (e.g.,L-shaped) to support the access instrument while maintaining alignment with the elongate instrument that is inserted therethrough. As illustrated, in FIG. 12B, one or more intermediate gears 1283 may be used to transfer torque from the first drive coupler 567-1 to the support 340. Alternatively, or in combination, one or more belts or other power transmission structures may be used to transfer torque from the first drive input to the support 340.

[0065] FIG. 13 depicts an example of a method, in accordance with some embodiments.

[0066] At stage 1310, the method 1300 includes actuating a robotic manipulator and thereby advancing an elongate instrument through a channel of an access instrument supported by a robotically controlled support.

[0067] At stage 1320, the method 1300 includes actuating a robotic manipulator and thereby advancing an elongate instrument through a channel of an access instrument supported by a robotically controlled support.

[0068] The following examples relate to various non-exhaustive ways in which the teachings herein may be combined or applied. It should be understood that the following examples are not intended to restrict the coverage of any claims that may be presented at any time in this application or in subsequent filings of this application. No disclaimer is intended. The following examples are being provided for nothing more than merely illustrative purposes. It is contemplated that the various teachings herein may be arranged and applied in numerous other ways. It is also contemplated that some variations may omit certain features referred to in the below examples. Therefore, none of the aspects or features referred to below should be deemed critical unless otherwise explicitly indicated as such at a later date by the inventors or by a successor in interest to the inventors. If any claims are presented in this application or in subsequent filings related to this application that include additional features beyond those referred to below, those additional features shall not be presumed to have been added for any reason relating to patentability.

[0069] Example 1: A robotic medical system may include: a support configured to couple to an access instrument, the access instrument having a channel; a robotic manipulator configured to couple to the support and to an elongate instrument; and a control system may include a processor and a memory, the control system being configured to: advance the elongate instrument through the channel by moving the robotic manipulator; and control a position of the access instrument by actuating thesupport with the robotic manipulator as the elongate instrument is advanced through the channel.

[0070] Example 2: The robotic medical system as example 1 describes, where controlling the position of the access instrument may include: maintaining the position of the access instrument in space by actuating the support to move with respect to the robotic manipulator in an opposite direction to a direction of movement of the robotic manipulator as the elongate instrument is advanced through the channel.

[0071] Example 3: The robotic medical system as either of examples 1 or 2 describe, further may include: a second manipulator configured to couple to a second instrument, where the control system is configured to: advance the second instrument through the channel as the elongate instrument is advanced through the channel and as the position of the access instrument is controlled.

[0072] Example 4: The robotic medical system as any of examples 1-3 describe, where the control system is further configured to: retract the elongate instrument through the channel by moving the robotic manipulator in reverse direction relative to a direction of movement of the robotic manipulator that advances the elongate instrument through the channel; and control the position of the access instrument by actuating the support with the robotic manipulator as the elongate instrument is retracted through the channel, where the support is actuated in a first direction as the elongate instrument is advanced through the channel, and the support is actuated in a second direction opposite the first direction as the elongate instrument is retracted through the channel.

[0073] Example 5: The robotic medical system as any of examples 1-4 describe, where the robotic manipulator may include a robotic arm and an instrument driver arranged at an end of the robotic arm, the instrument driver having a drive output configured to engage with a drive input operatively coupled to the support, and where the control system is configured to: advance the elongate instrument by actuating the robotic arm to move the instrument driver along a virtual rail in space; and control the position of the access instrument by actuating the drive output.

[0074] Example 6: The robotic medical system as any of examples 1-5 describe, where the robotic manipulator is operatively coupled to the support via a rack gear and pinion gear so that rotation of the pinion gear in a first direction causes the support to retract relative to the robotic manipulator, and rotation of the pinion gear in a second direction opposite the first direction causes the support to advance relative to the robotic manipulator.

[0075] Example 7: The robotic medical system as any of examples 1-6 describe, where the support is collapsible as the elongate instrument is advanced through the channel.

[0076] Example 8: The robotic medical system as any of examples 1-7 describe, where the support may include a collapsible linkage or a collapsible lenticular spool.

[0077] Example 9: A device may include: a support configured to couple to an access instrument; and an adapter coupled to the support and configured to mount to a robotic manipulator, the adapter may include a plurality of drive couplers configured to engage a plurality of drive outputs of the robotic manipulator, where a first drive coupler of the plurality of drive couplers is operable to move the support relative to the adapter, and where a second drive coupler of the plurality of drive couplers is operable to actuate a medical instrument mounted to the adapter.

[0078] Example 10: The device as example 9 describes, where the adapter may include an adapter housing and each of the drive couplers may include a disc rotatably retained in the adapter housing.

[0079] Example 11: The device as either of examples 9 or 10 describe, where the support may include a rail having a rack gear operatively coupled to the first drive coupler via a pinion gear so that rotation of the pinion gear by the first drive coupler causes translation of the support relative to the adapter.

[0080] Example 12: The device as any of examples 9-11 describe, where the support is collapsible.

[0081] Example 13: The device as any of examples 9-12 describe, where the support may include a linkage having a series of links movable between an expanded configuration and a collapsed configuration.

[0082] Example 14: The device as any of examples 9-13 describe, where the support may include a lenticular spool windable between an expanded configuration and a collapsed configuration.

[0083] Example 15: The device as any of examples 9-14 describe, where a distal end of the support is configured to engage the access instrument.

[0084] Example 16: The device as any of examples 9-15 describe, where the distal end may include a slot configured to engage an introducer.

[0085] Example 17: The device as any of examples 9-16 describe, where the distal end may include a clamp configured to engage a percutaneous sheath.

[0086] Example 18: A robotic medical system may include: the device as any of paragraphs 9-17 describe; and a robot may include the robotic manipulator, where therobot is configured to: advance the medical instrument through the access instrument by moving the robotic manipulator; and control a position of the access instrument by actuating the support with the robotic manipulator as the medical instrument is advanced through the access instrument.

[0087] Example 19: A method may include: actuating a robotic manipulator and thereby advancing an elongate instrument through a channel of an access instrument supported by a robotically controlled support; and actuating the robotically controlled support and thereby controlling a position of the access instrument as the elongate instrument is advanced through the channel of the access instrument.

[0088] Example 20: The method as example 19 describes, where: actuating the robotically controlled support may include moving the robotic manipulator in a first direction; and actuating the robotically controlled support may include moving the robotically controlled support in a reverse direction relative to movement of the robotic manipulator to thereby maintain a position of the access instrument in space.

[0089] Use of “or” is intended in the inclusive rather than exclusive sense, unless explicitly stated otherwise or the context clearly dictates otherwise. Thus, for example, reference to “A” or “B” can encompass “A” only, “B” only, or both “A” and “B.” As another example, reference to “A, B, or C” can encompass “A” only, “B” only, “C” only, or any combination of two or more of “A” or “B” or “C.” Accordingly, the term “or” should be generally understood as equivalent to “and / or” unless stated otherwise or the context clearly dictates to the contrary. In some instances, where an exclusive usage is intended, the phrase “either” is used in connection with the use of “or.” Thus, for example, the phrase “either A or B” can be used encompass “A” only or “B” only while precluding the combination of both “A and B.”

[0090] It should be appreciated that any specific order of steps shown or described herein is illustrative in nature and should not be construed as required unless explicitly stated or the context clearly dictates otherwise. Thus, for example, with respect to any processes or methods herein, any two or more steps or stages in a method or process may performed serially or in parallel, in any combination, and may be performed in any order, unless explicitly stated or the context clearly dictates otherwise.

[0091] In some instances, relative positions or orientations are used, such as top, bottom, upper, lower, forward, backward, front, rear, left, right, up down, horizontal, vertical, longitudinal, lateral, or the like. These terms may be used to refer to an arbitrary frame of reference or a frame of reference shown in the drawings, for purposesof explanation or to demonstrate the relative spatial configurations associated with various elements. These terms should not be understood to require any particular gravitational or other frame of reference unless explicitly stated or the context clearly dictates otherwise.

[0092] To the extent any headings are used through this description, these headings are used for convenience only and should not be construed as limit the scope of disclosure or the description under a heading to only the topic associated with the heading in anyway.

[0093] It should be appreciated that any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated material does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.

[0094] Having shown and described various examples, configurations, or embodiments of the present technology, further adaptations of the systems or methods described herein may be accomplished by appropriate modifications by one of ordinary skill in the art without departing from the scope of the technology described herein. Several of such potential modifications have been mentioned, and others will be apparent to those skilled in the art. For instance, the examples, embodiments, geometries, materials, dimensions, ratios, steps, and the like discussed above are illustrative and are not required. Accordingly, the scope of the claimed subject matter should be considered in terms of the following claims and is understood not to be limited to the details of structure and operation shown and described in the specification and drawings.

Claims

CLAIMSWhat is claimed is:

1. A robotic medical system comprising: a support configured to couple to an access instrument, the access instrument having a channel; a robotic manipulator configured to couple to the support and to an elongate instrument; and a control system comprising a processor and a memory, the control system being configured to: advance the elongate instrument through the channel by moving the robotic manipulator; and control a position of the access instrument by actuating the support with the robotic manipulator as the elongate instrument is advanced through the channel.

2. The robotic medical system of claim 1, wherein controlling the position of the access instrument comprises: maintaining the position of the access instrument in space by actuating the support to move with respect to the robotic manipulator in an opposite direction to a direction of movement of the robotic manipulator as the elongate instrument is advanced through the channel.

3. The robotic medical system of claim 1, further comprising: a second manipulator configured to couple to a second instrument, wherein the control system is configured to: advance the second instrument through the channel as the elongate instrument is advanced through the channel and as the position of the access instrument is controlled.

4. The robotic medical system of claim 1, wherein the control system is further configured to: retract the elongate instrument through the channel by moving the robotic manipulator in reverse direction relative to a direction of movement ofthe robotic manipulator that advances the elongate instrument through the channel; and control the position of the access instrument by actuating the support with the robotic manipulator as the elongate instrument is retracted through the channel, wherein the support is actuated in a first direction as the elongate instrument is advanced through the channel, and the support is actuated in a second direction opposite the first direction as the elongate instrument is retracted through the channel.

5. The robotic medical system of claim 1, wherein the robotic manipulator comprises a robotic arm and an instrument driver arranged at an end of the robotic arm, the instrument driver having a drive output configured to engage with a drive input operatively coupled to the support, and wherein the control system is configured to: advance the elongate instrument by actuating the robotic arm to move the instrument driver along a virtual rail in space; and control the position of the access instrument by actuating the drive output.

6. The robotic medical system of claim 1, wherein the robotic manipulator is operatively coupled to the support via a rack gear and pinion gear so that rotation of the pinion gear in a first direction causes the support to retract relative to the robotic manipulator, and rotation of the pinion gear in a second direction opposite the first direction causes the support to advance relative to the robotic manipulator.

7. The robotic medical system of claim 1, wherein the support is collapsible as the elongate instrument is advanced through the channel.

8. The robotic medical system of claim 1, wherein the support comprises a collapsible linkage or a collapsible lenticular spool.

9. A device comprising: a support configured to couple to an access instrument; andan adapter coupled to the support and configured to mount to a robotic manipulator, the adapter comprising a plurality of drive couplers configured to engage a plurality of drive outputs of the robotic manipulator, wherein a first drive coupler of the plurality of drive couplers is operable to move the support relative to the adapter, and wherein a second drive coupler of the plurality of drive couplers is operable to actuate a medical instrument mounted to the adapter.

10. The device of claim 9, wherein the adapter comprises an adapter housing and each of the drive couplers comprises a disc rotatably retained in the adapter housing.

11. The device of claim 9, wherein the support comprises a rail having a rack gear operatively coupled to the first drive coupler via a pinion gear so that rotation of the pinion gear by the first drive coupler causes translation of the support relative to the adapter.

12. The device of claim 9, wherein the support is collapsible.

13. The device of claim 12, wherein the support comprises a linkage having a series of links movable between an expanded configuration and a collapsed configuration.

14. The device of claim 12, wherein the support comprises a lenticular spool windable between an expanded configuration and a collapsed configuration.

15. The device of claim 9, wherein a distal end of the support is configured to engage the access instrument.

16. The device of claim 15, wherein the distal end comprises a slot configured to engage an introducer.

17. The device of claim 15, wherein the distal end comprises a clamp configured to engage a percutaneous sheath.

18. A robotic medical system comprising: the device of claim 9; and a robot comprising the robotic manipulator, wherein the robot is configured to:advance the medical instrument through the access instrument by moving the robotic manipulator; and control a position of the access instrument by actuating the support with the robotic manipulator as the medical instrument is advanced through the access instrument.

19. A method comprising: actuating a robotic manipulator and thereby advancing an elongate instrument through a channel of an access instrument supported by a robotically controlled support; and actuating the robotically controlled support and thereby controlling a position of the access instrument as the elongate instrument is advanced through the channel of the access instrument.

20. The method of claim 19, wherein: actuating the robotically controlled support comprises moving the robotic manipulator in a first direction; and actuating the robotically controlled support comprises moving the robotically controlled support in a reverse direction relative to movement of the robotic manipulator to thereby maintain a position of the access instrument in space.

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