Surgical robot and methods of operating the same

Abstract

The present disclosure generally relates to surgical robotic systems and methods of using the surgical robotic system. The operation of the system can include receiving medical image data, that represents a volume of an imaged subject including a target, instructing a robotic arm or an end effector to re-align a medical tool from a position along a first trajectory to a position along a second trajectory to reach the target, and instructing the robotic arm or the end effector to insert the medical tool into the target along the second trajectory.

Description

Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025SURGICAL ROBOT AND METHODS OF OPERATING THE SAMERELATED APPLICATIONS

[0001] This application claims the benefit of and priority’ to European Application No. 24221830.3 filed December 19, 2024, European Application No. 24221852.7 filed December 19, 2024, and U.S. Provisional Application No. 63 / 808,248 filed May 19, 2025, the contents of which are incorporated herein by reference in their entirety7.TECHNICAL FIELD

[0002] The present disclosure generally relates to image-guided surgical robotic systems, and methods of image-guided intervention, more particularly to image-guided surgical robotic systems and methods that robotically insert a medical tool along a trajectory7reaching a target of interest.BACKGROUND

[0003] In recent years, robotics has significantly advanced medical imaging and interventional procedures, particularly in image-guided percutaneous needle placement. This technique is critical for diagnostic and therapeutic interventions such as biopsies, drug delivery, tumor ablation, and drainage. Tumor ablation can be performed using one or several needles delivering energy such as radio frequency, microwave, cryogeny, or the like. Percutaneous needle placement involves inserting a needle through the skin to reach a target in an organ or lesion, w ith imaging used to ensure precision. The introduction of surgical robotic systems into these procedures has transformed planning and execution, enhancing accuracy and reducing the risk of human error.

[0004] However, sometimes the target may shift during the insertion, for example, due to the patient’s movement or breathing. Accordingly, there is still aneed for systems and methods that reduce the insertion time, while ensuring the accuracy of the needle placement.SUMMARY

[0005] In some embodiments, the present disclosure relates to a system for inserting a medical tool into a patient to reach a target location. In some embodiments, the systems and methods of the present disclosure are designed to increase the speed and accuracy of insertions compared to conventional systems and methods.

[0006] In some aspects, the techniques described herein relate to a surgical robotic system(100), including: an end effector (102) configured to hold and insert a medical tool (108); andPage 1 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 a computing device (5000) communicatively coupled to the end effector (102), wherein the computing device (5000) includes a computer readable medium storing computer program instructions which, when executed by one or more processors (130), cause the one or more processors (130) to perform a method including: (a) receiving first medical image data from an imaging device (103), wherein the first medical image data represents a first volume of an imaged subject (106), including a target (109) within the subject (106), an entry point (110), and a reference marker (107) attached to or integrated in the end effector (102) that are located and identified within the first medical image data; (b) instructing the end effector ( 102) to align the medical tool (108) held by the end effector (102) and being located at or above the entry point (110) along a trajectory (111) reaching the target (109), wherein the trajectory (111) is determined between the target (109) and the entry point (110) based on the first medical image data; (c) receiving second medical image data from the imaging device (103), wherein the second medical image data represents a second volume of the imaged subject (106), including the target (109), the second medical image data being registered to the first medical image data; (d) instructing the end effector (102) to re-align the medical tool (108) at or above the entry point (110) along anew trajectory (1 1 1 (1)) reaching the target ( 109), wherein the new trajectory (111(1)) is determined betw een the target (109) and the entry point (110) based on the second medical image data by comparing the position data of the end effector (102) or the medical tool (108) to the reference marker (107) in the second image data relative to the first image data; and (e) instructing the end effector (102) to insert the medical tool (108) located at or above the entry point (110) along the new trajectory (111(1)) reaching the target (109) upon receiving an insertion instruction.

[0007] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the second volume of the imaged subject (106) is smaller than the first volume of the imaged subject (106).

[0008] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein a reference marker coordinate system is registered with a coordinate system (A) of the end effector (102) and wherein the coordinate system (A) of the end effector (102) is registered with an image coordinate system (Rx), and wherein the coordinate system (Rx) ofPage 2 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 the first medical image data is registered with the coordinate system (A) of the reference marker (107) using fiducials of the reference marker (107).

[0009] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the reference marker (107) includes a) an emitter or receiver trackable by a tracking system, and b) an object that is visible in both the first and second medical images.

[0010] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the method including: tracking, via a tracking sy stem, the reference marker (107) and the end effector (102) with respect to each other, wherein the end effector (102) has a receiver or emitter trackable by the tracking system.

[0011] In some aspects, the techniques described herein relate to a surgical robotic system (100) 1-5, wherein the first and the second medical image data are three-dimensional medical image data.

[0012] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the medical tool (108) is a needle.

[0013] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the end effector (102) has three or less degrees of freedom.

[0014] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the surgical robotic system (100) further includes a robotic arm (101) connected to the end effector (102).

[0015] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the system (100) further includes a display configured to display the first medical image data and the second medical image data, the trajectory (111, and the new trajectory (111(1)); and a user interface configured to receive user inputs.

[0016] In some aspects, the techniques described herein relate to a non-transitory computer readable medium storing computer program instructions which, when executed by one or more processors (130), cause the one or more processors (130) to perform a method including: receiving first medical image data from an imaging device (103), wherein the first medical image data represents a first volume of an imaged subject (106), and locating and identifying a target (109) within the subj ect ( 106), an entry point (110). and a reference marker (107) attached to or integrated in an end effector (102) within the first medical image data; registering aPage 3 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 reference marker coordinate system with a coordinate system (A) of the end effector (102) and registering the coordinate system (A) of the end effector (102) with an image coordinate system (Rx); generating instructions for the end effector (102) to align the medical tool (108) held by the end effector (102) and being located at or above the entry point (110) along a trajectory (111) reaching the target (109), wherein the trajectory (111) is determined between the target (109) and the entry point (110) based on the first medical image data; receiving second medical image data from the imaging device (103), wherein the second medical image data represents a second volume of the imaged subject (106), including the target (109) and the reference marker (107); registering the second medical image data to the first medical image data; generating instructions for the end effector (102) to align the medical tool (108) at or above the entry point (110) along a new trajectory (111(1)) reaching the target (109), wherein the new trajectory is determined between the target (109) and the entry point (110) based on the second medical image data by comparing the position data of the end effector (102) or the medical tool (108) to the reference marker (107) in the second image data relative to the first image data; and generating instructions for the end effector (102) to insert the medical tool (108) located at or above the entry point (1 10) along the new trajectory (11 1 (1) reaching the target (109) upon receiving an insertion instruction.

[0017] In some aspects, the techniques described herein relate to a non-transitory computer readable medium storing computer program instructions which, when executed by one or more processors (130), cause the one or more processors (130) to perform a method including: (a) receiving first medical image data from an imaging device (103), wherein the first medical image data represents a first volume of an imaged subject (106) and includes a target (109) within the subject (106), an entry point (110, 1503), and a reference marker (107) attached to or integrated in an end effector (102) that are located and identified within the first medical image data, wherein a reference marker coordinate system is registered with a coordinate system (A) of the end effector (102) and wherein the coordinate system (A) of the end effector (102) is registered with an image coordinate system (Rx); (b) instructing the end effector (102) to maintain alignment of a medical tool (108, 1505) held by the end effector (102) along a trajectory (111) extending from the entry point (110, 1503) on the subject's surface (1704) to the target (109), the trajectory' (111) being determined between the target (109) and the entry'Page 4 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 point (110, 1503) based on the first medical image data, wherein the alignment is maintained by instructing the end effector (102) to apply a force exerted on the subject's surface (1704) while the medical tool (108, 1505) is positioned at the entry point (110, 1503) aligned with the trajectory (111); (c) receiving second medical image data distinct from the first medical image data from the imaging device (103) while the medical tool (108, 1505) maintained its position at the entry point (110, 1503) aligned with the trajectory (111), wherein the second medical image data represents a second volume of the imaged subject (106) and includes the target (109), the entry point (110, 1503), and the reference marker (107), the second medical image data being registered to the first medical image data; and (d) instructing the end effector (102) to pivot the medical tool (108, 1705) at the entry point (110, 1503) to align with anew traj ectory (111(1)) and to insert the medical tool (108, 1505) located at the entry point (110) along the new trajectory' (111(1)) extending from the entry point (110, 1503) on the subject's surface (1504) to the target (109) upon receiving an insertion instruction, wherein the new trajectory' (111(1)) is determined based on the second medical image data by comparing the positron data of the end effector (102) or the medical tool (108, 1505) to the reference marker (107) in the second image data relative to the first image data.

[0018] In some aspects, the techniques described herein relate to a non-transitory computer readable medium, wherein the second volume of the imaged subject (106) is smaller than the first volume of the imaged subject (106).

[0019] In some aspects, the techniques described herein relate to a non-transitory' computer readable medium, the method includes: maintaining alignment of the medical tool (108. 1505) along the new trajectory (111(1)) by an applied force exerted by the end effector (102) while the medical tool (108. 1505) is positioned at the entry’ point (110, 1503).

[0020] In some aspects, the techniques described herein relate to a non-transitory' computer readable medium 12-14, the method further including: instructing the end effector (102) to maintain an applied force while pivoting the medical tool (108, 1505) at the entry point (110, 1503) to align with the new trajectory (111(1)).

[0021] In some aspects, the techniques described herein relate to a non-transitory' computer readable medium, the method further including: receiving identification data for the target ( 109) based on the first medical image data; determining a trajectory’ (111) extending from the targetPage 5 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025(109) to an external point on the subject, wherein the external point is identified as the entry point (110).

[0022] In some aspects, the techniques described herein relate to a non-transi tory computer readable, the method further including: receiving identification data for the target ( 109) and the entry point (110, 1503) based on the first medical image data; and determining the trajectory7(111) between the identified target (109) and the entry point (1 10, 1503).

[0023] In some aspects, the techniques described herein relate to a non-transitory computer readable medium, wherein the reference marker (107) includes an emitter or receiver trackable by a tracking system and an object that is visible in both the first and second medical image data.

[0024] In some aspects, the techniques described herein relate to a non-transitory computer readable medium, the method further including: instructing a tracking system to track the reference marker (107) and the end effector (102) with respect to each other, wherein the end effector (102) has a receiver or emitter trackable by the tracking system.

[0025] In some aspects, the techniques described herein relate to a non-transitory computer readable, wherein the medical tool (108, 1505) is a needle.

[0026] In some aspects, the techniques described herein relate to a surgical robotic system (100) including: an end effector (102) configured to hold and actuate at least one medical tool (108, 1505); and a computing device (5000) communicatively coupled to the end effector (102), wherein the computing device (5000) includes a non-transitory computer readable medium storing computer program instructions which, when executed by one or more processors (130), cause the one or more processors (130) to perform a method.

[0027] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the end effector (102) has three or less degrees of freedom.

[0028] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the end effector (102) includes a support arm (130) in contact with a surface (1504) of a subject (106) and a pivoting mechanism (1502) to pivot the medical tool (108, 1505) at the entry7point (110).

[0029] In some aspects, the techniques described herein relate to a surgical robotic system (100), including: a robotic arm having an end effector configured to hold a medical tool (108);Page 6 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 at least one processor; and at least one storage medium having encoded thereon executable instructions that, when executed by the at least one processor, cause the at least one processor to: (a) receive a medical image data, wherein the medical image data represents a volume of an imaged subject including a target (109); (b) instruct at least one of the robotic arm or the end effector to re-align the medical tool (108) from a position along a first trajectory to a position along a second trajectory to reach the target (109), wherein the second trajectory is determined based on the medical image data; and (c) instruct at least one of the robotic arm or the end effector to insert the medical tool (108) into the target (109) along the second trajectory.

[0030] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the end effector includes an insertion member configured to insert the medical tool into the target, the end effector being configured to move the insertion member in two degrees of freedom.

[0031] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the end effector includes an insertion member configured to insert the medical tool into the target and one or more actuators configured to move the insertion member about a first axis and a second axis.

[0032] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the insertion member includes a actuator to advance the medical tool along the second trajectory into the target.

[0033] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the executable instructions, when executed by the one or more processors, further cause the one or more processors to re-align the medical tool by rotating the insertion member.

[0034] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the end effector includes a support arm and a pad at a distal end of the support arm, wherein the pad includes an opening, and wherein the executable instructions, when executed by the one or more processors, further cause the one or more processors to position the pad around an entry point on the subject and insert the medical tool into the entry point through the opening.Page 7 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0035] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the support arm is configured to support at least some of the weight of the robotic arm such that the pad applies a force to the subject around the entry7point wherein the force is configured to limit the movement of the target.

[0036] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the robotic arm can move with at least three degrees of freedom, wherein the executable instructions, when executed by the one or more processors, prior to analyzing the medical image data, further cause the one or more processors to position the medical tool near a subject along the first trajectory, and wherein the positioning includes moving the robotic arm with at least three degrees of freedom.

[0037] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the executable instructions, when executed by the one or more processors, further cause the one or more processors to re-align the medical tool by repositioning the end effector while restricting the movement of the robotic arm.

[0038] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the medical image data is a second medical image data, and wherein the executable instructions, when executed by the one or more processors, further cause the one or more processors to compare the second medical image data with a first medical image data, wherein the first medical image data is captured before the second medical image data.

[0039] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the executable instructions, when executed by the one or more processors, further cause the one or more processors to register the first medical image data with the second medical image data.

[0040] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the registering includes registering one or more of the target, an undesirable area, the first trajectory, the medical tool, and an entry7point from the first medical image data with the second medical image data.

[0041] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the size of the image data of the second medical image is smaller than the size of the image data of the first medical image.Page 8 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0042] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein the medical image data includes at least two CBCT projections.

[0043] In some aspects, the techniques described herein relate to a surgical robotic system (100), wherein a first projection of the at least two CBCT projections is positioned at an angle relative to a second projection of the at least two CBCT projections.

[0044] In some aspects, the techniques described herein relate to a method including: (a) situating a medical tool relative to a subject to enable insertion of the medical tool into a target of a subject along a first trajectory, wherein the medical tool is situated without substantially penetrating the skin of the subject; (b) adjusting the position of the medical tool based on one or more medical images of the target along a second trajectory: and (c) advancing the medical tool along the second trajectory to the target of the subject.

[0045] In some aspects, the techniques described herein relate to a method, wherein the first trajectory is determined based on a first medical image, wherein the second trajectory is determined based on a second medical image, and wherein the size of the image data of the second medical image not greater than the size of the image data of the first medical image.

[0046] In some aspects, the techniques described herein relate to a method, wherein the adjusting step (c) includes adjusting the position of the medical tool based on a registration of the first medical image with the second medical image, and wherein the size of the image data of the second medical image not greater than smaller than the size of the image data of the first medical image.

[0047] In some aspects, the techniques described herein relate to a method, wherein the one or more medical images capture a portion of the target, and wherein the portion of the target is selected based on prior information.

[0048] In some aspects, the techniques described herein relate to a method, wherein the prior information includes a first medical image of the target and wherein the first medical image of the target captures a greater area than the one or more medical images.

[0049] In some aspects, the techniques described herein relate to a method, the method further including releasing the medical tool into the target of the subject.

[0050] In some aspects, the techniques described herein relate to a method, wherein the target is a location within or on a surface of a tumor.Page 9 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0051] In some aspects, the techniques described herein relate to a method including: (a) situating a medical tool relative to a subject to enable insertion of the medical tool into a target of a subject along a first trajectory7, wherein the medical tool is situated without substantially penetrating the skin of the subject; (b) determining an operational interval based on a respiration cycle of the subject; (c) adjusting the position of the medical tool based on one or more medical images of the target of the subject along a second trajectory; and (d) advancing the medical tool along the second trajectory to the target of the subject; wherein the adjusting step (c) and the advancing step (d) occur during the operational interval.

[0052] In some aspects, the techniques described herein relate to a method, wherein the first trajectory is determined based on a first medical image, wherein the second trajectory is determined based on a second medical image, and wherein the size of the image data of the second medical image is not greater than the size of the image data of the first medical image.

[0053] In some aspects, the techniques described herein relate to a method, wherein the adjusting step (c) includes adjusting the position of the medical tool based on a registration of the first medical image with the second medical, and wherein the size of the image data of the second medical image is smaller than the size of the image data of the first medical image.

[0054] In some aspects, the techniques described herein relate to a method, wherein the determining the operational interval includes detecting the duration the target is within a positional threshold.

[0055] In some aspects, the techniques described herein relate to a method, wherein the determining the operational interval includes estimating the operational interval based on at least one previous respiration cycle of the subject.

[0056] In some aspects, the techniques described herein relate to a method, wherein the operational interval begins an estimated time after a predetermined point in the respiration cycle.

[0057] In some aspects, the techniques described herein relate to a method, wherein the predetermined point is an end of an inhale or an end of an exhale.

[0058] In some aspects, the techniques described herein relate to a method, wherein the respiration of the subject is uninterrupted during the inserting step (d).Page 10 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0059] In some aspects, the techniques described herein relate to a method, wherein the operational interval is the duration the target is within a positional threshold.

[0060] In some aspects, the techniques described herein relate to a method, wherein the positional threshold includes a range of allowable positions for the target during the advancing step (d).

[0061] In some aspects, the techniques described herein relate to a method, wherein the adjusting step (c) is performed within a time duration Tadjusting, and wherein Tadjusting is between 50 milliseconds and 1 second.

[0062] In some aspects, the techniques described herein relate to a method, wherein the advancing step (d) is performed within a time duration Tadvancing, and wherein Tadvancing is between 50 milliseconds and 1 second.

[0063] In some aspects, the techniques described herein relate to a method, wherein the one or more medical images capture a portion of the target, and wherein the portion of the target is selected based on prior information.

[0064] In some aspects, the techniques described herein relate to a method, wherein the prior information includes a first medical image of the target and wherein the first medical image of the target captures a greater area than the one or more medical images.

[0065] In some aspects, the techniques described herein relate to a method, the method further including releasing the medical tool into the target of subject.

[0066] In some aspects, the techniques described herein relate to a method, the method further including, releasing the medical tool into the target of the subject.

[0067] In some aspects, the techniques described herein relate to a method, wherein the target is a location within or on a surface of a tumor.

[0068] The above-described aspects, features, advantages, and further aspects of the present disclosure will become more apparent from the following disclosure and drawings.BRIEF DESCRIPTION OF DRAWINGS

[0069] The features and advantages of the present disclosure will be more apparent considering the embodiments below, w hich are provided by way of illustration and in no w ay are limiting:

[0070] FIG. 1 is an exemplary flowchart illustrating a process according to the present disclosure.Page 11 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0071] FIG. 2 is an exemplary box diagram of a system of the present disclosure.

[0072] FIG. 3 is an example diagram of a surgical robotic system.

[0073] FIG. 4 is a perspective view of an exemplary end effector.

[0074] FIGS. 5A-5F are perspective views of exemplary support pads.

[0075] FIGS. 5G-5I are perspective views of support pads with variable members disposed between.

[0076] FIG. 6 is a perspective view of an exemplary end effector.

[0077] FIG. 7A is another exemplary7box diagram of a system of the present disclosure.

[0078] FIG. 7B shows a perspective view of an exemplary surgical robotic system.

[0079] FIG. 8 is an exemplary flowchart illustrating various aspects of positioning a medical tool near a subject.

[0080] FIG. 9A shows a perspective view of an exemplary7surgical robotic system with an end effector inside the gantry of an imaging device.

[0081] FIG. 9B shows another perspective view of an exemplary surgical robotic system with an end effector outside of a gantry.

[0082] FIG. 9C shows another perspective view of an exemplary^ surgical robotic system showing an exemplary7traj ectory from an entry point to a target.

[0083] FIG. 9D shows another perspective view of an exemplary surgical robotic system showing the medical tool positioned along a trajectory from an entry point to a target.

[0084] FIG. 10 is an exemplary flowchart illustrating various aspects of determining a respiration cycle of a subject.

[0085] FIG. 11A is a diagram showing a portion of a subject for imaging.

[0086] FIGS. 1 IB and 11C are perspective views of exemplary medical images.

[0087] FIG. 12A shows another perspective view of an exemplary surgical robotic system showing the imaging bed together with the end effector inside the gantry7.

[0088] FIG. 12B shows another perspective view of an exemplary surgical robotic sy stem showing the medical tool pivoting at the entry point to align with a new trajectory.

[0089] FIG. 13 A shows another perspective view of an exemplary surgical robotic system using a tracking system. As illustrated, the first medical image (CT1) is obtained. CT1 includes target and a reference marker comprising an emitter or receiver detectable by a tracking and an object detectable on the CT1.

[0090] FIG. 13B shows another perspective view of an exemplary surgical robotic system using a tracking system showing a patient partially outside of the gantry.Page 12 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0091] FIG. 13C shows another perspective view of an exemplary surgical robotic system using a tracking system showing a trajectory from an entry point to a target.

[0092] FIG. 13D shows another perspective view of an exemplary surgical robotic system utilizing a tracking system showing a medical tool positioned along the trajectory' from an entry' point to the target.

[0093] FIG. 13E shows another perspective view of an exemplary surgical robotic system using a tracking system showing the imaging bed together with the end effector inside the gantry', while maintaining the position of medical tool at the entry' point along the trajectory' reaching the target. As illustrated, the target, the entry point, and the reference marker are inside CT2.

[0094] FIG. 13F shows another perspective view' of an exemplary surgical robotic system using a tracking system showing the imaging bed inside the gantry'. The end effector remains outside of the gantry' while maintaining the position of medical tool at the entry' point along the trajectory reaching the target. As illustrated, the target and the reference marker are inside CT2. The entry point is outside CT2.

[0095] FIG. 13G shows another perspective view' of an exemplary' surgical robotic system using a tracking system showing the imaging bed inside the gantry7. The end effector remains outside of the gantry' while maintaining the position of medical tool at the entry point along the trajectory reaching the target. As illustrated, the target, the intermediate referential, and the reference marker are inside CT2. The entry point is outside CT2.

[0096] FIG. 14 is an exemplary' flowchart illustrating a process according to the present disclosure using a CBCT image.

[0097] FIG. 15 is an exemplary flowchart illustrating a process of image-guided intervention.

[0098] FIG. 16 is another exemplary flow'chart illustrating a process of image-guided intervention.

[0099] FIG. 17 is an exemplary7flowchart illustrating a process for determining an operational interval according to the present disclosure.

[0100] FIG. 18A is a perspective view showing a change in position of a subject.

[0101] FIG. 18B is an exemplary7graph showing a change in position of a target over time.

[0102] FIG. 19 shows an exemplary schematic diagram illustrating a computing device suitable for implementing the surgical robotic system and methods of present disclosure.DETAILED DESCRIPTION OF EMBODIMENTSPage 13 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0103] The embodiments disclosed herein are illustrative of the principles of the present disclosure and are not intended to limit the scope thereof. Those skilled in the art will appreciate that the features, configurations, and functions described with respect to particular embodiments may be applied to other embodiments, and in various combinations, without departing from the scope of the present disclosure. Unless expressly stated otherwise, each feature disclosed in connection with one embodiment is applicable to other embodiments as well, in any suitable combination, to achieve desired results. Modifications, alterations, and adaptations to the embodiments described herein may be made, as will be apparent to those skilled in the art, without departing from the spirit or scope of the present disclosure.

[0104] In the following description, reference is made to the accompanying drawings which illustrate several embodiments of the present disclosure. It is understood that other embodiments and features disclosed herein may be utilized.

[0105] The present disclosure provides a system for inserting a medical tool into a patient to reach a target location. In some embodiments, the systems and methods of the present disclosure are designed to increase the speed and accuracy of insertions compared to conventional systems and methods. For example, in some embodiments, the systems of the present disclosure can include an end effector that can be lightweight and move in 3 or less degrees of freedom, enabling the system to quickly adjust the position of the medical tool (e.g., pivot) and quickly insert the medical tool into a target of interest, among other things. Additionally, the systems of the present disclosure can effectively operate with less image data than traditionally necessary in similar methods, thereby decreasing the time required to capture the images, analyze the images, and provide instructions to the surgical robotic devices, for example, to adjust the trajectory of insertion. In some embodiments, such systems are able to position a surgical robotic device near a subject, and then quickly capture an image of a target, analyze the image, make the necessary adjustments to the position of the medical tool, and insert the medical tool into the patient to reach a target of interest. In some embodiments, in part due to the speed and accuracy of the systems and methods of the present disclosure, such methods can be performed while a target is moving (e.g., due to the respiration of the subject).

[0106] FIG. 1 depicts an exemplary method of operating a system to insert a needle into a target of interest, or simply a target, in accordance with the present disclosure. In somePage 14 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 embodiments, methods disclosed herein can include positioning a medical tool near a subject in step 1000 at a position in which, upon insertion, the medical tool would be expected to reach the target of interest (for example, located on the skin of a subject and oriented along a first trajectory), receiving additional information about a subject (e.g., current position of the target) in step 2000, adjusting the position of the medical tool based on the additional information in step 3000, and inserting the medical tool in step 4000 into the target. In some embodiments, the surgical robotic system can include a medical tool.

[0107] In some embodiments, the target or target of interest can include an anatomical feature of a subject. Reference herein can be made to interventions performed on a subject. In some embodiments, a subject can be a patient (e.g., a human patient). In some embodiments, the subject can be a portion of a patient (e g., an arm of the patient). Further, in some embodiments, the subject can be an animal. In some embodiments, the subject can also include one or more parts of a living or non-living subject, such as one or more body parts of a human or an animal.

[0108] In some embodiments, a medical tool can be positioned (e.g., situated) near or in a target, for example, for diagnostic or therapeutic purposes. In some embodiments, the target can be a blood vessel or cardiovascular structures (e.g., coronary arteries, peripheral arteries, cardiac valves, and arteriovenous malformations), tumors or cancerous lesions (e g., liver tumors, kidney tumors, lung nodules and tumors, brain tumors, breast tumors, and spinal tumors), joints or spine (e.g., spinal nerves, joints, vertebrae, and herniated discs), gastrointestinal and hepatobiliary system (e.g., liver, spleen, pancreas, colon, and gallbladder), central nervous system (e.g., spinal cord and brain), kidney and urinary system (e.g., kidney stones, ureter, and bladder), lung and respiratory system (e.g., lung nodules or masses, pleural space, lung tumors, trachea, and bronchi), musculoskeletal system (e.g., bones and soft tissues), lymphatic system (e.g.. lymph nodes), or reproductive system (e.g. ovarian cysts or tumors, uterus, and ovaries). In some embodiments, the target or the target of interest can be a smaller, identifiable portion of any of the above anatomical features. For example, the target can be a specific location within any of the above anatomical features (e.g., a center of the tumor, or within 1 mm of the center of the tumor). In some embodiments, the target or the target of interest can be at a predetermined depth within any of the above anatomical features. For example, thePage 15 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 target can be at the surface of a tumor, inside the tumor, halfway through the thickness of the tumor, or 1 mm within the outer surface of the tumor, among other suitable depths. In some embodiments, if it is desired to, for example, insert more than one medical tool into the subject, the target for each medical tool may be different. For example, the target for a first medical tool can be spaced apart from a second medical tool to ensure that the first medical tool and the second medical tool are inserted at locations or depths that are more effective for treating or diagnosing the target, for example, a tumor. In some embodiments, the multiple medical tools can be evenly spaced throughout the target.

[0109] In some embodiments, the target of interest can be identified in a medical image or based on other information. In some embodiments, the position and shape of the target can change, for example, when the organs and tissues move. After an image is acquired, but before a medical tool, such as a needle, is inserted into the body for diagnostic or therapeutic purposes, the location of the target, or the location of the target within an acceptable variation, can be determined. If the medical tool is inserted when the target is at a position outside a suitable distance from a known location, such as during a different point in the cardiac or respiratory' cycle, the medical tool may miss the target or reach it inaccurately, leading to procedural complications or less effective outcomes, among other defects.

[0110] In some embodiments, a medical tool can include an instrument, a device, or the like used to reach the target of interest. For example, a medical tool can be any tool, instrument, or device used for diagnostic or therapeutic purposes. In some embodiments, medical tools include needles, cannulas, drills, guidewires, stents, balloon catheters, ablation probes (e.g., radiofrequency or microwave), trocars, biopsy forceps, biopsy needles, embolization coils, snare devices, vascular filters, endoscopic instruments, coagulation probes (laser, plasma, and the like), aspiration devices, and other devices suitable for performing surgery or intervention.

[0111] In some embodiments, a trajectory can be a path desired or intended for the medical tool to follow from an entry point to reach its target. In some embodiments, the trajectory can avoid undesirable areas. In some embodiments, undesirable areas can include critical structures, sensitive areas, bones, other medical tools (e.g., in multi-medical tool insertions), or obstacles, among other areas. In some embodiments, a trajectory can be modeled based on a medical image, prior knowledge of a clinician, or other information. In some embodiments, graphicsPage 16 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 representing the trajectory can be displayed on a display screen. In some embodiments, a trajectory can be a linear trajectory (e.g., wherein all points along the trajectory fall onto a linear line) or a non-linear trajectory'. In some embodiments, the trajectory can be an expected path of travel for a medical tool to reach the target. In some embodiments, the robotic system can advance the medical tool along the trajectory'. In some embodiments, the trajectory' can be modified based on additional information, for example, position of the target, pnor to the insertion of the medical tool into the patient. In some embodiments, a first trajectory' can be based on data collected at a first time, and a second trajectory can be determined after the first trajectory' based on data collected at a second time. The imaging data can be used to model the trajectory. In some embodiments, the second trajectory can be the same trajectory as the first trajectory. In some embodiments, the second trajectory can be a different trajectory than the first trajectory, such that the position of the medical tool can be adjusted so it can be inserted along the second trajectory. In some embodiments, the trajectory of the medical tool can be determined to reach a desired portion of a target (e g., a specific location of a tumor), reach a desired depth of the target (e.g., inserts into a tumor a desired distance), or avoid undesirable areas, among other aspects.

[0112] In some embodiments, an entry' point can be a point on the surface of a subject (such as a patient’s skin) where a medical tool is initially contacted to gain access to internal anatomical structures of the subject and a target. The entry’ point can serve as the initial point of contact between the medical tool and the subject. The entry’ point can be a predefined point or a dynamically determined point on the surface of a subject. In some embodiments, a dynamically' determined point includes a point determined by a process that is adjusted or calculated based on changing conditions or information gathered during a procedure (e.g., an intervention). For example, when the condition or information indicates changes in the position of the target or surrounding anatomy, the system may adjust the entry point to maintain precision and safety7.

[0113] In some embodiments, a position (e.g., a position of a medical tool) or a pose can include one or both of a location (e.g., a location of the medical tool relative to another object) and an orientation (e.g., an orientation associated with a trajectory of the medical tool). To change the position of a medical tool, the medical tool’s location, the medical tool’s orientation,Page 17 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 or both can be changed. For example, in some embodiments, to align a medical tool along an updated trajectory, the orientation of the end effector can be changed. In some embodiments, changing the orientation of the end effector can include rotating or pivoting the end effector.

[0114] In some embodiments, the location can refer to the location of an object (e.g., medical tool, target, or entry point) or a portion of an object in a three-dimensional space (e.g., three degrees of translational freedom along Cartesian X, Y, Z coordinates). In some embodiments, positioning can include locating an object (e.g., medical tool or end effector) or a portion of an object in a location in a three-dimensional space (e.g., three degrees of translational freedom along Cartesian X, Y, Z coordinates).

[0115] In some embodiments, the orientation of an object (e.g., medical tool or end effector) can include the rotational alignment of an object or a portion of an object to place it in a desired orientation in a three-dimensional space (e.g., roll, pitch, and yaw). In some embodiments, the orientation of an object can be determined relative to the position of another object. For example, in some embodiments, the orientation of an end effector can be changed by rotating (e.g., pivoting) the end effector, which can also change the orientation of the medical tool.

[0116] In some embodiments, a function (e g., inserting a medical tool from an entry point along a trajectory reaching a target of interest) capable of being performed robotically can include a function capable of being performed autonomously, without human intervention. For example, a surgical robotic system of present disclosure can perform an insertion of a needle to a target autonomously by receiving instructions from a computing device having one or more processors. In some embodiments, a robotically performed function can include a function that is controlled by a human (e.g., with levers, controls, etc.) that is performed by a robot. In some embodiments, a robotically performed function can assist a clinician (e.g., a human operator or a human surgeon).

[0117] Furthermore, during medical tool insertion, whether performed manually or robotically, the target can shift due to factors such as tissue elasticity, increasing the risk of misplacement.

[0118] In some embodiments, the present disclosure provides methods and systems that ensure accurate insertion of a medical tool. For example, the methods and systems providedPage 18 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 herein can determine an operational interval and enable insertion of a medical tool during the operational interval.

[0119] In some embodiments, systems according to the present disclosure can achieve insertion speeds of between approximately 10 mm / s and 40 mm / s. At faster insertion speeds, the position of the target can vary less, leading to increased accuracy and efficiency. In some embodiments, systems according to the present disclosure can operate in a shorter duration, which can reduce the time from imaging to insertion. In some embodiments, decreasing the duration from imaging to insertion, among other steps, can lead to improved interventions (e.g., reaching the target with greater accuracy and consistency).

[0120] In some embodiments, the systems disclosed herein can be controlled automatically to perform the methods of the present disclosure with little to no clinician intervention. For example, one or more processors can be used to perform various steps described in greater detail below. In some embodiments, the systems may include user in the loop features to provide added control for a clinician. In some embodiments, the interventions described herein can be performed while the patient is breathing during a normal breathing cycle. In some embodiments, the intervention can be performed without requiring the patient to be under general anesthesia.

[0121] In some embodiments, because of the benefits disclosed herein, interventions performed according to the present disclosure are performed accurately, reducing the amount of interventions required. For example, the number of ineffective treatments can be reduced, thereby decreasing the number of corrective (e.g., second or subsequent) procedures required.

[0122] Additionally, the methods and systems disclosed herein enable reaching a target, including moving targets, without the need for continuous monitoring, optimizing, or steering of a medical tool inside the patient. For example, according to the methods and surgical robotic systems of present disclosure, a needle is inserted once along a trajectory, and it reaches the target of interest accurately without a need for verification of the needle's path at various checkpoints along the trajectory. This approach results in reduced radiation exposure for both the patient and clinicians and reduces the procedural time reaching the target as described above. In some embodiments, using methods and systems described herein, there is not a need to verify the depth of the medical tool into the subject (e.g.. there is not a need for imaging after the medical tool has been inserted into the subject). For example, before inserting the medicalPage 19 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 tool, a trajectory' can be determined such that the medical tool will reach a desired depth into the subject at a desired angle. During the intervention, by following the trajectory and monitoring that the trajectory has been followed, it can be determined whether the medical tool has reached the subject without the need for additional imaging.

[0123] In some embodiments, the system described herein includes a surgical robot (e.g., a robotic arm with an end effector) and one or more processors. In some embodiments, because of the limited aspects required to operate the systems according to the present disclosure, the system can be implemented in many different locations (e.g., in hospital rooms with limited space) and can require only a small amount of space. In some embodiments, the systems described herein can be implemented in or on already existing medical systems. In some embodiments, these benefits allow for the system to operate in difficult to reach locations.

[0124] FIG. 2 shows a schematic diagram illustrating the surgical robotic system 100 according to an embodiment of the present disclosure. In this exemplary' embodiment, a surgical robotic system of the present disclosure includes a surgical robot 112 and one or more processors 130. Additional features and components can also be included in the surgical robotic system 100. Non-limiting examples of the additional features and components are shown in various other figures.

[0125] In some embodiments, a surgical robotic system 100 of the present disclosure can be a system configured to perform or assist in a performance of a diagnostic or therapeutic intervention (also referred to as, a procedure, an operation or a surgery'). For example, a surgical robotic system 100 can be configured for use in an intervention performed on a subject for diagnostic or therapeutic purposes. In some embodiments, an intervention can be done by any manipulation of a target of interest, for example, for diagnostic or therapeutic purposes. Exemplary diagnostic or therapeutic purposes include biopsies, fluid aspiration and drainage, catheterization, tumor removal, tumor ablation, stent placement and angioplasty, endovascular embolization, percutaneous drainage of abscesses, fracture repairs, orthopedic fixation, pain management (e.g., radiofrequency or cryoablation), and drug delivery, among other purposes. In some embodiments, a surgical robotic system 100 can also be used in other surgical and non- surgical applications, as will be appreciated by a person skilled in the art.Page 20 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0126] In some embodiments, the one or more processors 130 can include any suitable processors. In some embodiments, the one or more processors 130 are configured to be a portion of a computing device (e.g., a processor 5014 of computing device 5000 of FIG. 19).

[0127] An example of a surgical robot 112 having a robotic arm 101 and end effector 102 is shown in FIG. 3. As shown in FIG. 3, the robotic arm 101 can be coupled to a base 180. In some embodiments, the base 180 can be stationary. In some embodiments, the base 180 can be moveable. In some embodiments, the base 180 can be a table, a gantry, or any other suitable apparatus for connecting to the robotic arm 101 to position an end effector 102 at a desired position. In some embodiments, the robotic arm 101 can have multiple segments 182 coupled to multiple joints 184. In some embodiments, the position of the multiple segments 182 relative to other segments (e.g., other segments of the multiple segments 182) can be adjusted by rotating a segment about a joint 184. In some embodiments, the joints 184 and the multiple segments 182 are configured such that a first segment can rotate, move laterally, or otherwise reposition relative to a second segment. While the robotic arm 101 shown in FIG. 3 includes four segments and three rotational elements, any number of segments and rotational elements may be used in a robotic arm 101. Additionally, any robotic arm known in the art (e.g., a conventional robotic arm generally available) may be used with the present disclosure.

[0128] In some embodiments, the robotic arm of the present disclosure can have one or more joints providing a plurality of degrees of freedom (DoF) in operating and controlling the movement of the end effector. In some embodiments, the robotic arm can have up to six DoF. In some embodiments, a robotic arm can have at least 2. 3, 4, 5. 6, 7, or 8 DoF. For example, the robotic arm can have 6 DoF. Having 6 DoF allows the robotic arm to position itself with freedom in the workspace and around the patient, mimicking the range of motion a human arm in three-dimensional space might have. 6 DoF includes three translational (linear) movements and three rotational (angular) movements. The translational movements are movements along the three Cartesian axes including X-axis (forward / backward), Y-axis (left / right), and Z-axis (up / down). The rotational movements describe rotations around each of the three Cartesian axes such as roll (rotation about X-axis), pitch (rotation about Y -axis), and yaw (rotation about Z- axis).Page 21 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0129] Optionally, the surgical robot can operate based on commands from the computing device (or control unit) having one or more processors. In some embodiments, the surgical robot and the computing device can be communicatively coupled. For example, one element (e.g., object) can direct or control another. In some embodiments, one or more processors direct or control the movements and actions of the imaging device, robotic arm, or end effector. In some embodiments, communicatively coupled can include two or more elements that can be in contact with one another by any means of communication, including through a wire or other interconnect connection, through a wireless communication or link, or the like. In some embodiments, communicatively coupled includes, but is not limited to, one element being configured to share data with a second element. In some embodiments, two objects that are communicatively coupled can communicate control signals.

[0130] In some embodiments, the surgical robotic system 100 of present disclosure incorporates a tracking system, such as an electromagnetic (EM) tracking system to provide precise alignment and tracking of the end effector during an intervention (e.g., an image-guided intervention). For example, a tracking system can provide the precise position of the surgical robot 112 of FIG. 3.

[0131] In some embodiments, as shown in FIG. 3, an end effector 102 according to the present disclosure can be positioned at a distal end of a surgical robot 112 (e.g., a distal end of a robotic arm 101). In some embodiments, the function of the surgical robot, in particular the robotic arm 101, can be to position the end effector in an appropriate position (e.g., appropriate location and orientation). In some embodiments, the robotic arm 101 can position the end effector when the subject is positioned inside of a gantry, as described in greater detail below. In some embodiments, an end effector can perform a function such as holding a medical tool, inserting a medical tool, assisting in inserting a medical tool, or supporting the surgical robot, among other functions. In some embodiments, the end effector of present disclosure comprises a medical tool holding mechanism to hold and to release a medical tool. For example, the end effector includes a clamp or collet mechanism to firmly hold the medical tool and allow its release when instructed by one or more processors or manually by a clinician (e.g., an operator). In some embodiments, the end effector is configured to perform multiple functions.Page 22 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0132] In some embodiments, the end effector of the present disclosure can be designed to robotically actuate (e.g., position, insert) a medical tool along a trajectory from an entry point to a target. Optionally, the functions of the end effector such as actuating (e.g., positioning and inserting) a medical tool, can be controlled by one or more processors. In some embodiments, actuating a tool (e.g., a medical tool) can include inserting, moving, positioning, exerting a force on, withdrawing, ejecting, releasing, and other similar actions alone or in combination thereof. For example, one or more processors can instruct an end effector to actuate a medical tool. In some embodiments, the actuation of the medical tool can include, but is not limited to, robotically inserting a medical tool (e.g., a needle) along a trajectory that reaches a target. In some embodiments, the insertion is performed without manual insertion by a clinician like a surgeon or a radiologist. In some embodiments, the actuation mechanism can be configured to subsequently return the medical tool from the insertion position to its initial position. In some embodiments, the actuation mechanism can also be configured to release the medical tool (e.g., release the medical tool into the target) after insertion or after a return instruction.

[0133] FIG. 4 shows one example of an end effector 102 according to the present disclosure. As shown in FIG. 4, an end effector 102 can include a housing 158 having one or more actuators (e.g., actuator 160, actuator 162) that can be coupled to an insertion member 172, which may include an actuator to insert the medical tool 174 into the target. In some embodiments, the one or more actuators can comprise one or more motors. In some embodiments, the one or more actuators can cause the system to perform one or more linear actuations (e.g., inserting a medical tool), or one or more non-linear actuations (e.g., positioning an insertion member). In some embodiments, the one or more actuators can impart rotational movement to the insertion member 172. In some embodiments, a first actuator can enable a first rotation and a second actuator can enable a second rotation. For example, actuator 160 can rotate the insertion member 172 about a first axis (e.g., axis 164) and actuator 162 can rotate the insertion member 172 about a second axis (e.g., axis 166). In some embodiments, the insertion member 172 can be rotated by the one or more actuators, without changing the location of the insertion member 172. For example, the end of the insertion member 172 or the medical tool 174 can be located at the same point (e.g., the entry point) before and after rotating (e.g., pivoting) the insertion member 172. In some embodiments, the actuators (e.g., actuator 160, actuator 162) are coupledPage 23 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 to joints (e.g., joint 168, joint 170). In some embodiments, the joint can include an element capable of being rotated and a bracket, among other elements. In some embodiments, the actuators facilitate the rotation of the insertion member 172 by adjusting the position of (e.g., rotating) the joints (e.g., joint 168, joint 170). In some embodiments, the two actuators (e.g., actuator 160, actuator 162) can facilitate motion in two degrees of freedom DoF. For example, actuator 160 can rotate a first joint (e.g., joint 168) about afirst axis (e.g., axis 164), and actuator 162 can rotate a second joint (e.g., joint 170) about a second axis (e.g., axis 166). In some embodiments, a single actuator can be used to facilitate rotational movement of the insertion member 172. In some embodiments, the actuators (e.g., actuator 160, actuator 162) can position the insertion member 172 along a desired trajectory to insert a medical tool (e.g., medical tool 174) into the subj ect. In some embodiments, the insertion member may include a linear actuator such that the medical tool 174 is actuated (e.g., inserted) along axis 176. In some embodiments, the end effector 102 shown in FIG. 4 can operate in three degrees of freedom (e.g., the rotation about axis 164, the rotation about axis 166, the insertion of the medical tool 174 along axis 176).

[0134] As noted above, methods according to the present disclosure can include adjusting the position of the medical tool or updating the trajectory of the medical tool, among other steps. In some embodiments, the end effector 102 shown in FIG. 4 can adjust the position of the medical tool or update the trajectory of the medical tool. In some embodiments, the end effector 102 shown in FIG. 4 can adjust the position of the medical tool or update the trajectory of the medical tool within the operational interval. In some embodiments, the end effector 102 shown in FIG. 4 can adjust the position of the medical tool or update the trajectory of the medical tool to accommodate for any change in position of the target. For example, once the end effector 102 of FIG. 4 is positioned near the target, any necessary changes to the positioning or the trajectory of the medical tool can be made by the end effector 102, without any movement of the robotic arm. In some embodiments, the necessary changes are performed using actuator 160 and actuator 162 to rotate the insertion member 172 into an appropriate position. For example, as noted above, in some embodiments, actuator 160 can facilitate rotation of the insertion member 172 about axis 164 and actuator 162 can facilitate rotation of the insertion member 172 about axis 166. In some embodiments, the total area that the medical tool can reach using the end effector 102, is greater than the possible change in position of the targetPage 24 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025(e.g., due to breathing, small movements, etc.). For example, in some embodiments, because of the ability of the end effector to position the medical tool in many different positions, the target can remain within the range of the medical tool regardless of the position of the target within, for example, the breathing cycle. In such embodiments, it may be unnecessary to synchronize the medical images with the breathing cycle because the medical tool can reach the target regardless of the time in the breathing cycle. In some embodiments, at least in part due to the ability of the end effector 102 to rotate the insertion member 172, it may be unnecessary to move the robotic arm (e.g., the robotic arm 101 of FIG. 3) when updating the trajectory7of the medical tool.

[0135] In some embodiments, the end effector of present disclosure can have a plurality of DoF in operating and controlling the movement of one or more medical tools. For example, the end effector can have up to six DoF. For example, the end effector can have at least 2, 3, 4, 5, or 6 DoF. For example, as shown above relative to FIG. 4, the end effector can have 3 DoF. In some embodiments, as noted above, the robotic arm can have up to six DoF. In some embodiments, both the robotic arm and the end effector can separately have up to six DOF, increasing the options for positioning the robotic arm and the end effector. In some embodiments, for example during the positioning step 1000 of FIG. 1, positioning the medical tool near the subject can utilize the movement and the corresponding degrees of freedom of both the robotic arm and the end effector. In some embodiments, the end effector with 3 DoF reduces the complexity of the system and can speed up the medical tool actuation (e.g., during the adjusting step 3000 and the inserting step 4000, as described in greater detail below). For example, in certain interventions, like needle insertion for biopsies, injections, or minimally invasive surgeries, the task may require high precision in one or two linear movements (e.g., inserting along a straight line). The end effector with 3 DoF results in a faster and more direct insertion. Each additional degree of freedom can require extra control and planning. An end effector with 3 DoF can have less processing load on the processor. In some embodiments, the movement of the robotic arm is not used in certain steps (e.g., the adjusting step 3000 and inserting step 4000 of FIG. 1) to increase the speed of the insertion. This combination (e.g., a robotic arm with up to six DoF and an end effector with up to three DoF) allows flexible movement within the workspace and around the patient in addition to precise pivoting, angling,Page 25 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 or positioning of a medical tool at an entry point. Furthermore, this combination allows for safer and faster processing time by a processor to send an instruction to the end effector to insert a medical tool (e.g., a needle) along the trajectory'.

[0136] In addition, by limiting the range of movements of the end effector (e.g., to 2 or 3 DoF), the surgical robotic system of present disclosure can reduce the risk of unintended or unsafe actions that might occur during the procedure. This can stabilize the medical tool when the medical tool is actuated or when the medical tool is inside the subject. For example, using 2 or 3 DoF can ensure that the medical tool, such as a needle, does not inadvertently shift or translate in any direction, which could potentially cause trauma to the surrounding tissue or lead to an inaccurate insertion.

[0137] In some embodiments, an end effector that rotates (e.g., pivots) a medical tool at a fixed entry point can have 2 or 3 rotational DoF. For example, an end effector configured to pivot around a single fixed point can have 2 rotational DoF. For example, the tool can pivot around two axes (e.g., perpendicular axes) that intersect at the fixed point, allowing full rotational control relative to that point. In another example, an end effector configured to pivot around a single fixed point can have 3 rotational DoF and can be configured to additionally allow for axial rotation (twisting around the medical tool's own axis). In some embodiments, a medical tool can be twisted around the medical tool’s axis to assist in the insertion or to orient the medical tool in a desired location (e.g., to face the medical tool in a specific direction). In addition to the rotational DoFs, the end effectors of the present disclosure can be configured to move in one linear degree of freedom to facilitate linear movement of the medical tool along a trajectory (e.g., during the insertion of the medical tool).

[0138] In some embodiments, the end effector of the present disclosure can be configured to pivot the medical tool (e.g., a needle) at an entry point (e.g., a point on the skin of a patient). This allows for angular adjustments around a fixed contact point, enabling the tool to move along various trajectories to reach the target without repositioning the entry' point. For example, the end effector can comprise a gimbal-like joint or a spherical bearing that allows multidirectional pivoting. A gimbal mount or similar structure can allow the end effector to hold the medical tool (e.g.. a needle) at an adjustable angle while maintaining contact at the same entry point, allowing for manipulation in various directions.Page 26 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0139] In some embodiments, an end effector of the present disclosure can include a spring- loaded mechanism near the tip of a medical tool in contact with the entry point (e.g., near a needle tip). In this manner, the end effector can enable the end effector to press against the surface of the entry point (e.g., skin) without substantially penetrating the surface of the entry point.

[0140] As noted above, in some embodiments, the surgical robotic systems of the present disclosure can include a support arm. In some embodiments, the support arm can be configured to support or guide a medical device during the insertion procedure. In some embodiments, the support arm can be coupled to another portion of the end effector of the same surgical robotic system (e.g., the end effector 102 of FIG. 3). In some embodiments, a support arm can assist in preventing a medical tool from entering a patient before desired. In some embodiments, a pad can create a suitable surface on the surface of the subject (e.g., the skin of a patient). In some embodiments, the pad can prevent the medical tool from entering the subject before it is desired, and create a uniform surface for insertion, among other functions. Additionally, in some embodiments, the pad can be applied to the subject prior to positioning the medical tool for insertion.

[0141] In some embodiments, the support arm can be positioned adjacent to the entry' point on the surface of the subject. In some embodiments, the support arm can provide stability7, control pressure and enables precise alignment of the medical tool at the entry point with the target. In some embodiments, the support arm comprises a pivot mechanism, allowing for rotational adjustments to align the medical tool precisely with the trajectory7extending from the entry' point to the target. The support arm can be configured in any shape and size to provide the best contact with the surface of the subject.

[0142] In some embodiments, the support arm can include a pressure sensor, continuously monitoring the applied force to prevent premature puncture. In some embodiments, the pressure sensor can provide feedback to a control processor, which can dynamically adjust the applied force to ensure that the medical tool remains stable at the entry point without penetrating the surface of the subject (e.g., skin) until insertion is instructed.

[0143] In some embodiments, the end effector comprises a support arm having a semi- spherical base surrounding the entry' point and is in contact with surface of the subject (e.g., thePage 27 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 skin of a patient). In some embodiments, the medical tool (e.g., a needle), through a hole at the center of the base, can be in contact with the entry point. In some embodiments, the semi- spherical support structure that surrounds the entry point creates a uniform distribution of pressure around the entry point. Optionally, pressure sensors are distributed around the circumference of the semi-spherical support, which can help monitor the total applied force. This configuration can keep the medical tool stable at the entry point and prevent unwanted punctures.

[0144] In some embodiments, the systems of the present disclosure can include a pad configured to be placed on the subject to apply pressure around an area of the subject. In some embodiments, the pad can distribute force evenly across a contact area (e.g., an area around an entry point), preventing localized pressure spikes that could unintentionally penetrate the surface (e.g., skin). In some embodiments, at least some of the weight of the robotic arm can be supported by the pad, such that the weight of the robotic arm that is supported by the pad can cause the pad to apply the pressure onto the subject. In some embodiments, the pad can restrain the movement of the subject near the pad (e.g., by applying pressure onto the subject). In some embodiments, the pad can restrain the movement of areas on the surface (e.g., skin) of the subject and below the surface of the skin of the subject (e.g., internal organs). For example, in some embodiments, the pad can be positioned on a subject around the entry point. In some embodiments, before, concomitantly, or after to placing the pad on the subject, the medical tool can be positioned to insert into the subject along a first trajectory through the entry point. In some embodiments, at least in part because the pad applies pressure on the subject around the pad, the movement of the target or the entry point, among other areas, can be restricted. For example, once the pad is placed, the area around the pad can remain in substantially the same place until the pad is removed. In some embodiments, for example, one or more steps described in FIG. 1, such as the receiving or analyzing the medical image step 2000, the adjusting the position of the medical tool step 3000, or inserting the medical tool step 4000 can occur while the pad is placed on the subject and restricts the movement of the target. In some embodiments, if the movement of the target is reduced, the extent or amount of adjustments necessary' to update the trajectory can also be reduced. In some embodiments, reducing the extent or amountPage 28 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 of adjustments to the trajectory can increase the speed of the intervention or increase the chance the medical tool reaches the target, among other benefits.

[0145]

[0146] In some embodiments, as shown in FIGS. 5A-5F, the end effector can combine a support arm and a pad. For example, FIGS. 5A-5F illustrate embodiments of a support arm 140 having a connection arm 142 and a pad 144 according to the present disclosure. In some embodiments, the connection arm 142 can couple the pad 144 to a portion of a robotic arm (e g., a robotic arm 101 of FIG. 7B). In some embodiments, the connection arm 142 can couple the pad 144 and an end effector (e.g., end effector 102 of FIG. 7B).

[0147] In some embodiments, the cross section of the pad 144 can be circular, horse-shoe shaped, ovular, or irregular, among other shapes. In some embodiments, the cross section of the pad can be from 20 to 150 mm in diameter. In some embodiments, the pad 144 can have a thickness. In some embodiments, the thickness of the pad 144 can be from 0.5 mm to 10 mm. In some embodiments, as shown, for example in FIG. 5E, the cross section of the pad 144 can be uniform, or approximately uniform throughout the thickness of the pad 144. In some embodiments, as shown, for example in FIG. 5D, the cross section of the pad 144 can be non- uniform.

[0148] In some embodiments, based on the cross section of the pad, the amount of pressure, and the pressure distribution on the patient can be varied. For example, the pressure distribution on a patient when using the pad 144 shown in FIG. 5D will be dispersed over a smaller area than the pressure distribution when using the pad 144 shown in FIG. 5E because more material will be contacting the patient w hen using the pad 144 of FIG. 5E.

[0149] As shown in FIGS. 5A-5F, the center of the pad 144 can include an opening 146 to enable insertion of a medical tool into the patient. In some embodiments, the opening 146 can enable the insertion of the medical tool into the patient. For example, in some embodiments, the pad 144 can be placed on the surface of the skin where it is desirable for the medical tool to enter. In some embodiments, the end effector can insert the medical tool into the patient in the opening 146 of the pad 144.

[0150] In some embodiments, the opening 146 can be circular, or ovular, among other geometric shapes. In some embodiments, the opening 146 can be a non-geometric shape. AsPage 29 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 shown by comparing, for example, FIGS. 5B and 5C, the size of the opening 146 relative to the pad 144 can vary.

[0151] In some embodiments, as shown in FIGS. 5A-5F, the pad 144 can have a gap 148. In some embodiments, the gap is a space between opposite sides of the pad 144. In some embodiments, the gap can be from 2 to 20 mm wide. In some embodiments, the gap is sized such that a medical tool (e.g., a needle) can pass through the gap after being inserted into a patient. In some embodiments, during an intervention, a medical tool is aligned such that it will enter the patient through the opening 146 of the pad 144, and will pass through the gap 148 of the pad 144 to reach the opening 146. For example, in some embodiments, it can be preferred to insert the medial tool at an angle (e.g., as opposed to orthogonal to the skin of the patient). In some embodiments, to move the pad 144 while the medical tool remains inserted in the patient, the medical tool can move from the opening 146 of the pad 144 through the gap 148 to outside of the pad 144 allowing the pad 144 to move without removing the medical tool.

[0152] In some embodiments, a pad 144 can directly contact the patient. For example, the pads shown in FIGS. 5 A-5E can contact the skin of the patient. However, in some embodiments, as shown in FIG. 5F, an additional layer 150 can be disposed between the pad 144 and a subject. In some embodiments, the additional layer 150 can include an adhesive. In some embodiments, the additional layer 150 can ensure the pad 144 does not move before, during, or after an intervention (e.g., an insertion).

[0153] In some embodiments, and with reference to FIG. 5G, the connection arm 142 can be a single piece of material. In some embodiments, the connection arm 142 can be a rigid material. In some embodiments, as shown in FIGS. 5H-5I, the connection arm 142 can have multiple segments (e.g.. segment 151, segment 152, segment 154). In some embodiments, as shown in FIG. 5H, one or more segments can be separated by a joint (e.g., segment 151 and segment 152 can be separated by joint 156). In some embodiments, ajoint (e.g., joint 156, joint 157) can enable a first segment to be positioned in different configuration than a second segment. For example, a first segment (e.g., segment 151 of FIG. 5H) can be at a different angle to the patient than a second segment (e.g., segment 152 of FIG. 5H). In some embodiments, a joint can enable one or more segments to be positioned in a different directionPage 30 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 relative to another segment. In some embodiments, ajoint (e.g., joint 157 of FIG. 51) can adjust the position of a pad (e.g.. pad 144 of FIG. 51).

[0154] In some embodiments, a support system can provide additional support to the surgical robot (e.g., the robotic arm 101 of FIG. 3). For example, in some embodiments, a support system (e.g., a support arm) can be coupled to the surgical robot and contact another object (e.g., a patient, a bed, a gantry, etc.). In some embodiments, at least some of the mass of the end effector can be distributed to other object. In some embodiments, offsetting at least some of the weight (e.g., distributing at least some of the mass to the object) can enable the surgical robot to operate faster. For example, less force can be required to move the robotic arm from a first position to a second position. In some embodiments, at least in part because some of the weight of the surgical robot can be distributed to the object, the surgical robot can utilize equipment (e.g., actuators, among other elements) that is graded for less weight. In some embodiments, the equipment that is graded for less weight can operate faster than the equipment that is graded for more weight.

[0155] In some embodiments, to monitor and control the force exerted by the end effector on the subject, the method and the robotic system of present disclosure include force-monitoring based on the electrical current consumed by a robotic system’s actuators (e.g., motors). The current drawn by the actuator can be directly correlated with the torque output of the actuator, which in turn can be linked to the force applied by the end effector on the subject's surface.

[0156] In some embodiments, the end effector of present disclosure provides a pivot point on the entry (e.g., on the skin of a patient) with controlled force to stabilize the medical tool at the point of entry and to avoid puncturing surface of the entry point (e.g., puncturing the skin) while pivoting. For example, the end effector can include a force sensor that can adjust pressure as the angle of the medical tool changes, ensuring a balanced distribution of force around the pivot point. For example, multi-axis force / torque sensors can measure the applied forces and moments (torque) around the pivot point. These sensors can enable control over both the force applied to the entry point (e.g.. a point on the skin) and the pivoting force, allowing the end effector to adjust its angle without exceeding the pressure threshold that can puncture the entry point.Page 31 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0157] In some embodiments, the medical tool such as a needle is positioned (e.g., located or oriented) at the entry point on the patient’s skin. In some embodiments, force sensors communicatively coupled with the end effector at the pivot point can ensure that a consistent pressure is maintained on the skin without puncture. As a processor receives input about anew trajectory7reaching the target from an entry7point, the end effector can adjust the angle of the medical tool by activating actuators in the gimbal or pivot mechanism. Throughout this process, force feedback can be continuously monitored adjusting any excess force on the skin. The control algorithms, via one or more processors, can ensure that the pivot angle aligns with the new trajectory7, adjusting based on position and force data. Thus, end effector can pivot accurately around a fixed skin contact point, applying controlled pressure while adjusting the needle’s angle to align with the new trajectories.

[0158] In some embodiments, the end effector of present disclosure can include a force sensor, a torque sensor, or another sensor to continuously monitor the force applied to the surface of the entry point (e.g., the skin). Feedback from a sensor (e g., a force sensor) can allow the system to adjust if the applied force nears a threshold that can lead to puncturing. For example, placing a force or torque sensor near a tip of a needle or within the end effector can allow monitoring of the force exerted on the skin. Feedback from the force or torque sensor can be processed by7control algorithms (such as PID controllers) that can adjust the applied force based on the sensor's readings, ensuring it remains below the puncture threshold.

[0159] In some embodiments, the end effector of present disclosure can comprise adaptive control algorithms such as adaptive impedance control to adjust the end effector’s force based on the ty pe of the entry7point (e.g., ty pe of tissue or skin the medical tool is interacting with). For example, the system detects resistance from the skin and dynamically models the force.

[0160] In some embodiments, as shown for example in FIG. 6, an end effector 102 according to the present disclosure can include elements configured to perform multiple functions. For example, the end effector 102 can be configured to position and insert a medical tool (e.g., using an insertion member 172, among other elements), and support at least some of the weight of the robotic arm (e.g., using a support arm 140, among other elements), among other functions. To that end, in some embodiments, the end effector 102 shown in FIG. 6 can include the support arm 140 and the insertion member 172. In some embodiments, the supportPage 32 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 arm 140 can be placed on the patient to support the weight of a robotic arm. The pad 144 of the support arm 140 can be placed around the entry point, such that the medical tool 174 can be positioned at the entry' point through the opening 146 of the pad 144 in a first orientation. For example, the robotic arm can position pad 144 of the support arm 140 around the entry point. Next, if necessary', the end effector may pivot or rotate the insertion member 172, as described above, to orient the medical tool 174 along a desired trajectory. Finally, a linear actuator of the insertion member 172 can insert the medical tool 174 into the subject and advance the medical tool 174 toward the target along the desired trajectory.

[0161] In some embodiments, and with reference to FIG. 7A, a surgical robotic system 100 can include a surgical robot 112, one or more processors 130, and one or more imaging devices 103. In some embodiments, the one or more processors of the surgical robotic system 100 of present disclosure can be communicatively coupled to an imaging device 103, a robotic arm 101, an end effector 102, or a combination thereof.

[0162] In some embodiments, the imaging device (e.g., the imaging device 103 of FIG. 7A) can assist the surgical robotic system in an image-guided intervention or an image guided operation. An image guided intervention or operation can include a procedure in which an imaging device is employed, either directly or indirectly, to assist or guide in an intervention or operation. In some embodiments, the robotic surgical system of present disclosure comprises high-resolution cameras with image processing algorithms that can track the indentation or deformation of the entry point (e.g., a point on the skin of a patient). By' estimating deformation, the system can indirectly measure the force being applied and adjust the medical tools or needle’s pressure to stay within limits.

[0163] In some embodiments, an imaging device can be a device that captures an image or set of data indicative of an image of a subject or of a part thereof. The image can be onedimensional, two dimensional, or three dimensional. In some embodiments, the imaging device can be a camera, CT, CTF, CBCT, MRI, C-Arm Fluoroscopy, Positron Emission Tomography (PET), Intraoperative CT (iCT). Intraoperative MRI (iMRI), 3D endoscopic camera, or Optical Coherence Tomography (OCT), among other suitable imaging devices. In some embodiments, the imaging device can integrate with other systems to support the functions of the methods and surgical robotic systems of present disclosure. For instance, the imaging device can integratePage 33 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 with a tracking systems (e.g., the tracking system described in FIGS. 13A-13G), such as optical tracking, or electromagnetic tracking systems, among other tracking systems. Additionally, the imaging device can capture more than one set of data (e.g., more than one image) and integrate the more than one set of data into a single compilation of data (e.g., capture a first image at a first angle and a second image at a second angle and combine the two images together into a single image). In some embodiments, the set of data can include two or three spatial dimensions and one or more additional dimensions including spectral, temperature, pressure, or time, among other aspects. In some embodiments, the image can include small-scale structures perceivable in an image based on spatial arrangement of colors or intensities, for instance. In some embodiments, the imaging device can capture spectral or hyperspectral images. In some embodiments, the imaging device can generate a set of data based on the captured data. In some embodiments, the imaging device can send or transmit data (e.g., to one or more processors).

[0164] In some embodiments, a reference marker can be an object that can be identifiable or visible. In some embodiments, the reference marker can be identifiable or visible in a medical image. In some embodiments, reference markers can be an emitter, a receiver, or a sensor detectable by a tracking system. For example, objects visible in a medical image include radiopaque materials. Examples of radiopaque materials include platinum, titanium, tantalum, stainless steel, gold, barium sulfate, radiopaque ceramics, and iodine-based materials. In some embodiments, a sensor can include receivers or emitters detectable by a tracking system such as an optical, electromagnetic (EM), RFID based technology or an ultrasonic tracking system. In some embodiments, a sensor can be a device or component that detects or emits a signal (e.g., infrared light, electromagnetic waves, ultrasound) to track its position. For example, a sensor can be an active sensor (e.g., an LED that emits infrared light) or a passive sensor (e.g., a reflective sphere). For example, the sensor can include elements that emit or detect ultrasound signals. In EM Tracking Systems sensors detect EM fields and provide positional data, while emitters generate the EM field for tracking purposes.

[0165] In some embodiments, reference markers disclosed herein can comprise an emitter or receiver detectable by a tracking system and an object visible in a medical image by an imaging device such as radiopaque material. An example of such reference marker is describedPage 34 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 in U.S. Pat. No. 8,611,985, the disclosure of which is herein incorporated by reference in its entirety. In some embodiments, the reference marker comprises a magnetic emitter or receiver having at least two coils arranged in a manner to define at least two vectors in a coordinate system of the magnetic tracking system and a geometric element comprising hollow plastic tubes visible on image data of the imaging device and having a unique geometry detectable by the imaging device. In some embodiments, reference markers can be in any shape and size such as spherical balls, tubes, or rods.

[0166] As noted above, in some embodiments, the imaging device can be a CBCT (i.e., a conebeam CT) imaging device. In some embodiments, capturing a CBCT image includes rotating a cone-shaped X-ray beam about an area of interest. In some embodiments, images are captured as the beam is rotated about the patient. In some embodiments, one or more images are combined together to create a single image. In some embodiments, the width of the imaged area can increase as more images are acquired. In some embodiments, a single rotation of an imaging device about a patient can produce a CBCT image that shows an area that is about 4 cm wide. In some embodiments, a CBCT scan is designed to acquire 2D images. In some embodiments, a CBCT imaging device is not designed to rotate fast. In some embodiments, a shape of a ray of a CBCT image is a cone. In some embodiments, a CBCT image can be acquired when the patient is under general anesthesia. In some embodiments, acquiring a CBCT image can require a longer time than a CT image.

[0167] FIG. 7B shows a schematic diagram of a surgical robotic system 100 according to some embodiments of the present disclosure. In some embodiments, the surgical robotic system of present disclosure includes one or more processors (e.g., a processor 5014 of computing device 5000 of FIG. 19) and a surgical robot 112 (e.g., a robotic arm 101 and end effector 102) configured to hold a medical tool. In the description that follows, surgical robotic system 100 is configured to perform the methods of present disclosure. As shown in FIG. 7B. the imaging device 103, for example, includes a gantry 104 that contains an imaging sensors, and a bed 105, which can be moved into the gantry 104 while the imaging sensors rotate around a subject (e.g., a patient) on the bed 105.

[0168] In some embodiments, a medical tool, or a portion of a medical tool can be pivoted. In some embodiments, pivoting, or the like, can include the movement of an object (e.g., aPage 35 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 medical tool) around a fixed point, or substantially fixed point of contact. For example, when a medical tool, such as a needle, pivots at an entry point (e.g.. a point on the patient’s skin), the point of contact on the patient's skin serves as the pivot. During this movement, the angle or orientation of the medical tool changes relative to this fixed point, while the point of contact itself remains stationary'.

[0169] Referring back to FIG. 1, the systems described above may be used to insert a needle into a target of interest. In particular, the systems of the present disclosure may assist in positioning a medical tool near a subject in step 1000 according to an expected trajectory of the medical device from an entry point to the target of interest, acquiring and analyzing a medical image in step 2000, adjusting the position based along an updated trajectory based on the additional information in step 3000, and inserting the medical tool in step 4000 into the target of interest.

[0170] FIG. 8 provides an exemplary method according to the present disclosure that can include positioning a medical tool (e.g., a surgical robotic system) near a subject. The method can also include acquiring and analyzing a medical image (step 1100), using prior information and knowledge step (1200), determining an insertion or entry point (step 1300), determining a traj ectory to a target of interest (step 1400), and moving the medical tool to position the medical tool near the entry point along the trajectory (step 1450).

[0171] In some embodiments, the using prior information and knowledge step 1200 can include a clinician (e.g., a physician, an operator) using prior information and knowledge to perform one or more steps of the methods described herein (e.g., the methods shown in FIGS. 1 and 8). For example, if a physician is aware the medical tool needs to be inserted into the lungs, the clinician can select an entry point based on the prior experience or knowledge of anatomy. In some embodiments, the clinician can also estimate a trajectory' for the medical tool to reach the target of interest.

[0172] In some embodiments, at least some of the steps of the process of positioning the medical tool near the subject can include acquiring and analyzing a medical image step 1100. In some embodiments, the acquiring a medical image can occur while the patient is under general anesthesia. In some embodiments, the patient can be taken out of general anesthesia after the image is acquired.Page 36 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0173] FIG. 9A illustrates an embodiment of the surgical robotic system 100 of present disclosure, including a system that can acquire and analyze a medical image. In some embodiments, the imaging device 103 obtains a first medical image (e.g. 3D medical image) data representing a first volume of the imaged subject 106. In some embodiments, the first volume of the imaged subject 106 can be of a subject 200. In some embodiments, a processor can receive the first medical image data. In some embodiments, the first medical image (e.g., 3D medical image) data representing the first volume of the imaged subject 106 includes a target 109 and a reference marker 107. Optionally, the first medical image (e.g., 3D medical image) data representing the first volume of the imaged subject includes a target 109, an entry point, and a reference marker 107. As shown in FIG. 9 A, reference marker 107 in the first volume is integrated as part of the end effector material or is attached to the end effector. However, the reference marker in the first image volume can be placed on the subject (e.g., the patient). In some embodiments, the first medical image can include a plurality of first medical images. For example, one or more medical images taken at different angles or perspectives relative to the target can be used.

[0174] FIG. 9B shows the end effector 102 positioned outside the imaging gantry alongside the patient, who is on an bed 105 (e g., an imaging bed). Reference markers (e.g., reference marker 107) are attached to the end effector, creating a reference marker coordinate system that is registered to the end effector's own coordinate system (Coordinate System A). When the imaging device acquires the first medical image, it captures a (e.g., 3D) volume that includes the target as well as the reference marker, representing this information within the imaging device’s coordinate system (Coordinate System Rx). Optionally, the medical image data is stored in DICOM (Digital Imaging and Communications in Medicine) format, which includes spatial, and metadata used for coordinating the position of the image volume relative to the imaging device.

[0175] In some embodiments, the reference markers can be used to assist in registering an image with another image. For example, multiple individual images can be combined to create a single medical image, and corresponding single medical image data. In some embodiments, a registration (e.g., of a plurality of medical images) can include the spatial transformation relating to two or more coordinate systems (e.g., end effector coordinate system, trackingPage 37 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 system coordinate system, image coordinate system). The registration can be a pose between two coordinate systems, and may be expressed, and represented in computer memory, according to any convenient convention (e.g. vectors, rotation matrices, transformation matrix, Euler angles, quaternions, etc.). In some embodiments, a registration can be performed via an intermediate referential.

[0176] In some embodiments, an intermediate referential can be a coordinate system or a reference frame that acts as a bridge between two or more coordinate systems. For example, the intermedial referential can enable alignment and translation of positional data from one coordinate system to another, ensuring that two or more devices (e.g., devices from different systems) can accurately track with respect to each other.

[0177] In some embodiments, the end effector’s coordinate system A is registered with image coordinate system Rx. For example, the registration process involves aligning the end effector's coordinate system A with the imaging coordinate system Rx to ensure accurate spatial correspondence between the medical tool and the target. The positions of the reference markers within the image are identified, allowing their coordinates to be established within the imaging coordinate system. Using, for example, the DICOM metadata, which provides information such as voxel size, slice spacing, and position within the image volume, the system can map the reference markers’ positions. Since the reference markers have a known spatial relationship to the end effector, this information is used to calculate a transformation matrix, which maps points from the end effector’s coordinate system to the imaging coordinate system. By applying this transformation, any position or movement of the medical tool in the end effector's coordinate system A can be accurately expressed within the imaging coordinate system Rx, allowing for precise medical tool positioning.

[0178] In some embodiments, analyzing a medical image can include using a registration to analyze a medical image. In some embodiments, the one or more processors of the surgical robotic system of present disclosure can apply known image registration methods and algorithms such as transformation algorithms (e.g., rigid transformations such as translation and rotation, or non-rigid transformations depending on tissue deformation) to perform the registration. For example, the surgical robotic system uses a rigid transformations algorithm. Optionally, the processor stores this registration information in a memory' for further use suchPage 38 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 as in trajectory calculation. For example, the processor executes the registration algorithm, applying linear algebraic transformations to compute a mapping between the first medical image data and where the robotic arm, the end effector, or the medical tool operates.

[0179] In some embodiments, the first medical image data can be registered onto the second medical image data or the second medical image data can be registered onto the first medical image data. In some embodiments, determining which image data (e.g., the first image data or the second image data) to register onto the other image data can be determined based on the required number of computational steps. In some embodiments, a smaller number of computational steps can be performed faster.

[0180] In some embodiments, the target, reference marker, and optionally the entry point in the first medical image can be identified by one or more processors of present disclosure (e g., by analyzing the medical images). For example, one or more processors can be configured to receive a medical image (e.g., a first medical image data) and locate the target, the reference marker, the entry point, or undesirable areas.

[0181] In some embodiments, upon receiving the first medical image data, the processor decodes and processes the data (e.g., 3D data) to locate and identify one or more features such as the target, entry point, the reference markers, and undesirable areas. The processor uses, for example, known image processing algorithms to recognize the features in the image data. Techniques such as edge detection or pattern recognition, or machine learning-based subject detection may be used to automatically identify the reference marker, entry point, and the target. For example, the control unit's processor runs a detection algorithm, which analyzes, for example, the pixel / voxel intensify of the medical image to identify the features.

[0182] In some embodiments, the processor can receive information about the identity (e.g., identification data) of the target or entry point from a display via a display interface or from a memory device. In some embodiments, the entry point can be determined in step 1300. For example, a clinician viewing the first medical image on the display can identify the target or the entry’ point on the screen of the display. The processors can receive the identification data of the target or the entry’ point via a display interface. In another example, the processors can receive the identification data from a memory device. In some embodiments, one or more processors of the surgical robotic system of the present disclosure can receive information aboutPage 39 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 the position of the entry point from, for example, a display. For example, a clinician can identify the position of the entry point on the subject from a medical image displayed on a monitor and the one or more processors can receive the positional data of the entry7point. In another example, one or more processors can determine the entry point, which is aligned with a calculated trajectory7to the target.

[0183] In some embodiments, as shown in FIG. 9B, following the acquisition of the first medical image, the bed 105 (e.g., an imaging bed) carrying the patient, the robotic arm 101, and the end effector 102, can slide out of the imaging gantry7. This movement brings both the end effector 102 and the target 109 outside the gantry7, positioning them in a more accessible area for further procedure. Moving the bed outside the gantry can provide the medical team with greater physical access to the patient, end effector, and entry7point to perform preparatory7steps. Additionally, moving the bed outside the gantry7may enhance patient safety, as they are not positioned within the enclosed imaging space for extended periods.

[0184] As noted above, the methods described herein can include a determining an entry point step 1300. In some embodiments, with reference to FIG. 8, after an entry point is determined (step 1300), a trajectory can be determined (step 1400). FIG. 9C illustrates a trajectory from an entry point 110 on the subject’s surface (e.g., patient's skin) to a target 109 within the subject. While FIG. 9C depicts this trajectory with the patient positioned outside of the imaging gantry7, the trajectory can alternatively be determined while the patient is inside the gantry7. For example, one or more processes of the system of present disclosure can directly identify the target, (optionally) entry7point, and the reference markers in the first medical image and capture the spatial relationship between them and plan the trajectory. Once the trajectory7is determined, it can be used outside the gantry, for example, providing access to the entry point.

[0185] In some embodiments, one or more processors can calculate and determine a trajectory for a medical tool between the identified entry point and the target in the first medical image data based on known methods. In some embodiments, the trajectory7can avoid undesirable areas. In some embodiments, the trajectory can include an angle of insertion, and a desired insertion depth. Methods like inverse kinematics, spline interpolation, or ray tracing may be used to define the trajectory. For example, the processor can calculate the trajectory by solving a series of geometric equations that map from the entry7point to the target. The trajectory7Page 40 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 can then be used by one or more processors to instruct the robotic arm and the end effector how to position themselves to bring the medical tool (e.g., a needle) in precise alignment with the trajectory and thus with the target. In some embodiments, the trajectory' can be determined before identifying a suitable entry point.

[0186] In some embodiments, the target can be identified within the first medical image. The target identification may be performed by a clinician, and the target identification data is received by the processor. Optionally, the target can be identified by a processor of the system disclosed herein, as described above. Based on this target location, a trajectory can be calculated and determined before identifying the entry point on the subject (e.g., on the patient’s skin). For example, the identity of the target within the first medical image is obtained. The first imaging volume captures the target’s position in the Rx coordinate frame. Once the target’s coordinates are established, the system can calculate a potential trajectory' extending from the target toward the surface of the subject (e.g., skin of the patient), considering anatomical structures, angles, any spatial constraints, and safety’. In some embodiments, the trajectory can be determined by analyzing possible paths that ensure the medical tool can reach the target while avoiding undesirable areas. In some embodiments, the system can give buffer regions to avoid undesirable areas. For example, when determining the trajectory', it may be desirable to avoid an undesirable area by at least a certain distance. In some embodiments, the distance required to safely avoid an undesirable area using the systems and methods described herein can be less than the distances traditionally required because of the speed of the interventions of the present disclosure. For example, in a conventional insertion process, a medical tool may be partially inserted, imaged, inserted further, imaged again, etc., until the medical tool reaches the target location. However, using methods according to the present disclosure, a smaller buffer region can be afforded to the undesirable areas because the undesirable areas will not move, or will move minimally, during the insertion process. Accordingly, because undesirably regions can be afforded less of a buffer zone, additional trajectories (e.g., in addition to trajectories available using conventional methods) that safely avoid the buffer region can be implemented.

[0187] After establishing this trajectory’, the system can then identify a suitable entry' point on a subject (e.g., the patient’s skin) where the end effector can position a medical tool forPage 41 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 further intervention. This approach may provide greater flexibility, as the entry point can be selected to optimize medical tool access and minimize procedural complexity.

[0188] In some embodiments, one or more processors can optimize the trajectory by considering factors like avoiding undesirable areas, minimizing tissue damage, and maximizing accuracy. The optimization process may involve calculating known algorithms to ensure that the medical tool follows the most efficient and safest route. In cases where multiple medical tools (e.g., needles) need to be inserted, the processor can also determine the optimal order in which the medical tools should be inserted. Optimization can be based on several factors like minimizing collision between medical tools, ensuring stability7of the tissue, or reducing overall procedure time.

[0189] In some embodiments, the processor receives the trajectory information from the entry point to the target or the information about the order in which the medical tools should be aligned along each trajectory from a display via a user interface or from a memory device.

[0190] With reference back to FIG. 8, after the trajectory is determined 1400, the medical tool can be positioned (e.g., in step 1450) into a position (e.g., location and orientation) at an entry point along a trajectory, enabling the medical tool to reach the target from the entry point.

[0191] In reference to FIG. 9D, the robotic arm can position (e.g., move and orient) the medical tool 108 (e.g., the needle) at the identified entry point 1 10 (a point on the patient’s skin), aligning it with a trajectory 111 that extends from the entry7point 110 to a target 109.

[0192] In some embodiments, as previously described, the end effector can apply a controlled amount of force on the surface of the subject (e.g., the skin of the patient), for example via a support arm, ensuring the medical tool can be stably positioned at the entry point without substantially penetrating the skin. For example, to prevent unwanted penetration at the entry point, the surgical robotic system of present disclosure can include force-controlled feedback, where a force sensor monitors the pressure applied by the end effector to the needle tip. The force feedback is processed by one or more processors that can adjust the force to ensure it remains below the puncture threshold. Should the applied force approach this threshold, the control system via one or more processors can reduce the pressure to maintain safe contact with the entry point surface (e.g., skin). In another example, the surgical robotic system of present disclosure includes an impedance control, in which the end effector’s force dynamicallyPage 42 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 adjusts based on the encountered resistance. For example, setting a low impedance, by one or more processors, allows the end effector to apply a pressure when meeting resistance from the entry point (e.g., entry point on the skin), thus enabling the needle to rest stably at the entry point without puncturing. In another example, the surgical robotic system of present disclosure includes ultrasound or optical monitoring systems to detect deformation at the entry' point, providing feedback to adjust force as needed, thereby maintaining stable contact without puncturing the surface at the entry' point. As another example, pre-defined force thresholds cab be stored in a memory based on, for example, the skin’s resistance properties ensuring the applied force remains within a range that allows stabilization of the medical tool at the entry' point without risking penetration. By employing one or a combination of these exemplary methods, the medical tool can be positioned (e.g., located or oriented) stably at the entry' point in precise alignment with the trajectory, while avoiding or substantially puncture.

[0193] In some embodiments, the end effector of present disclosure can be configured to position a medical tool (e.g., a needle) at an entry' point, with controlled force such that the medical tool can achieve an insubstantial penetration. Insubstantial penetration refers to positioning a medical tool at an entry point on the skin without advancing beyond the skin tissue layers, epidermis, dermis, or hypodermis. In some embodiments, the medical tool does not advance beyond the epidermis. The epidermis is the outermost layer of the skin and is avascular and relatively resilient, making it suitable for minor penetration without significant tissue impact. Penetrating with a depth limited to the skin tissue layers such as epidermis or dermis provides a stable anchor point for the needle without deeper tissue engagement. In some embodiments, a tip of a medical tool can extend less than about 3 millimeters into the surface of the subject without substantially penetrating the skin of the subject. In some embodiments, a medical tool can apply a small force to the surface of the subject without substantially penetrating the surface of the subject. For example, the surface of the subject can deform (e.g., the skin can indent) without the medical tool penetrating the skin of the subject. In some embodiments, a portion of the medical tool can penetrate the skin of the subject without substantially penetrating the surface of the subject. For example, a tip of a medical tool can extend through some, but not all the layers of skin of the subject without substantiallyPage 43 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 penetrating the surface of the subj ect. In some embodiments, the medical tool can be positioned near the subject without directly touching the subject.

[0194] In some embodiments, the medical tool can move towards the entry' point along a trajectory toward a target without penetrating or without substantially penetrating the surface of the subject (e.g., the skin of the subject).

[0195] By applying a controlled force that the medical tool (e.g., needle) is positioned in the epidermal layers (e.g., epidermis or dermis), the end effector can ensure that the medical tool is stabilized at the entry point, achieving sufficient anchoring to align or to maintain alignment along the trajectory7, for example, when pivoting at the entry7point, while reducing the potential injury to the surrounding tissues.

[0196] In some embodiments, an applied force by the end effector is controlled until one or more processors instruct the end effector to actuate (e.g. insert) a medical tool. For example, an applied force can be controlled to maintain the position of the medical tool (e.g., needle) at the entry' point on the skin along the trajectory until the end effector is instructed by one or more processors to insert the needle along a new trajectory. For example, once the medical tool is positioned (e g., oriented and located) at the entry point, an applied force maintains the medical tool's (e.g., needle’s) point of contact with the entry point at the fixed position.

[0197] In some embodiments, and with reference to FIG. 10, receiving and analyzing a medical image (e.g., as per step 2000 of FIG. 1) can include receiving a medical image in step 2100, analyzing a medical image in step 2200, and determining a second traj ectory in step 2300.

[0198] In some embodiments, receiving the medical image step 2100 can include receiving medical image data.

[0199] In some embodiments, the medical image data received in step 2100 can be second medical image data. For example, if medical image data was used in a prior step of the method (e.g., step 1100 of FIG. 8), the medical image data used in step 2100 can be second medical image data. In some embodiments, the medical image data is the first medical image data, if for example, the positioning the medical tool step (e.g., step 1000 of FIG. 1) is performed without the use of medical image data (e.g., using prior information and knowledge as per step 1200 of FIG. 8). In some embodiments, the medical image data can be from an imaging device. In some embodiments, the image data can be received by one or more processors. In somePage 44 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 embodiments, the medical image data can represent a volume of the imaged subject comprising the target and the reference marker. The volume of the medical image data can include one or more medical images. Optionally, the reference marker is registered to the end effector. In some embodiments, the imaging device used to acquire the first medical image data (e.g., the medical image data used for step 1000 of FIG. 1) and the second medical image (e.g., as per some embodiments of step 2100) can be the same or different imaging devices, or they can be the same imaging devices but not used in the same procedure. Optionally, the same imaging device within the same procedure can be used to acquire the first and the second medical images.

[0200] In some embodiments, the second volume of the image data is distinct from the first volume of the image data (e.g., the volume of the first medical image data is a different size than the volume of the second medical image data). In some embodiments, the second volume of the image data can be determined by a clinician (e.g., an operator of an imaging device, an electro radiology' technician). For example, a clinician can determine an appropriate volume of medical image data required to ensure the intervention can be adequately performed.

[0201] In some embodiments, the volume of the second medical image data is smaller than the volume of the first medical image data. In some embodiments, the volume of the second medical image data is not greater than the volume of the first medical image data. In some embodiments, and with reference to FIGS. 11 A-l 1C, the volume of the second medical image data can be smaller because a smaller portion of the patient is imaged (e.g., by selecting a smaller portion of a subject to image). For example, an area 240 of the subject 200 can be selected for imaging (e.g., with an imaging device 103). In some embodiments, a clinician (e.g., an operator) of the imaging device can select the area 240 to be imaged. In some embodiments, the clinician can select the area 240 to be imaged using a controller 250. For example, the controller 250 can be a screen depicting an outline of the patient and the clinician can select the portion of the patient (e.g., area 240) to be imaged. In some embodiments, the clinician can see a screen showing the first medical image 260 and can select an area 240 to be imaged in a second image (e.g., second medical image 270). In some embodiments, the controller 250 (e.g., with the use of one or more processors to locate a target) can automatically select the area 240 to be imaged. In some embodiments, the imaging device 103 and the controller 250 can be communicatively coupled. In some embodiments, the area 240 to be imaged can be increasedPage 45 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 or decreased. For example, the position of the target 109 can be determined based on a first medical image 260. Then, in some embodiments, the area 240 can be selected to be narrowly positioned about the target 109 (e.g., be centered about the target identified from the first medical image 260 with a variance on either side of the target 109). In some embodiments, in part because the imaging device used for the second medical image 270 is positioned based on the first medical image 260, the second medical image 270 can capture an area 240 that covers a smaller portion of the subject. In some embodiments, the second medical image 270 can capture a smaller area 240 of the subject while still capturing the target 109. In some embodiments, the area 240 captured in the first or second medical image can vary depending on the intervention or the target, among other variables.

[0202] In some embodiments, in part to minimize radiation exposure and procedural time, the second imaged volume is reduced relative to the first imaged volume. Optionally, the first image data can be a higher-resolution, larger volume dataset that encompasses a substantial portion of the region of interest. In some embodiments, the first image data can be 3D image data and the second image data can be 2D image data. For instance, the first medical image data can include 160 or more image slices with varying thicknesses, such as 2.5 mm or less. These slices include the region of interest and its surrounding tissues or organs (e.g., lung, kidney, or liver) to allow for accurate planning. In some embodiments, the first image data can be acquired while the subject is under general anesthesia. The second medical image data can, for example, contain 128 or less image slices with varying thicknesses, such as 2.5 mm or less. The second medical image data can have, for example, 128, 64, 32, or 16 slices.

[0203] In some embodiments, after the medical image is received in step 2100 of FIG. 10, the method can include analyzing the medical image in step 2200. In some embodiments, the second medical image data (e.g., one or more 2D or 3D medical images) representing a second volume of the imaged subject includes the target and the reference marker, wherein the reference marker is registered to the end effector. Optionally, the second medical image (e.g. one or more 2D or 3D medical images) data representing a second volume of the imaged subject includes the target and the refence marker, wherein the reference marker is registered to the medical tool. Optionally, the second volume further includes the entry point. Optionally, the second medical image (e.g., one or more 2D or 3D medical images) data representing a secondPage 46 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 volume of the imaged subject includes a target, an entry point, and a reference marker, wherein the reference marker is registered to an end effector or medical tool. Optionally, the reference marker in the second medical image data is the same reference marker detectable in the first medical image data. Optionally, only part of the reference marker detectable in the first medical image data is detectable in the second medical image data. However, the reference marker in the second medical image data can be used for guiding the end effector to align the medical tool along a trajectory7to reach the target from an entry7point.

[0204] In some embodiments, with reference to FIG. 10, analyzing the medical image in step 2200 can include determining the position of the target. In some embodiments, after receiving the medical image in step 2100, the position of the target within the image data can be determined, for example, via one or more processors. Common methods include image segmentation, pattern recognition, or machine learning algorithms trained to distinguish the target from surrounding anatomy. Optionally, one or more processors receive the position of the target, for example, from a user interface such as a display or a memory device.

[0205] In some embodiments, analyzing the medical image step 2200 can include registering one or more medical images. Registration includes, but is not limited to, aligning, or mapping a first image data with a second image data, accounting for differences in orientation, scale, and deformation between the two volumes. In some embodiments, a second medical image (e.g., medical image data received in step 2100 of FIG. 10) can be registered with first medical image data (e.g., medical image data used relative to step 1100 of FIG. 8). This registration can align the second medical image data’s coordinate system with that of the first, using, for example, the end effector’s reference markers, which can remain detectable in both sets of image data. In some embodiments, multiple features can be registered in the second medical image. For example, in some embodiments, one or more of the target(s), the undesirable area(s), the trajectory (e.g.. a trajectory determined in step 1400 of FIG. 8), entry point, and the reference marker(s), among other things, can be registered in the second medical image data. For example, a target and a rib (e.g.. an undesirable area) can be registered in the second image, and the trajectory' can be updated to reach the target that avoids the rib. In some embodiments, the surgical robotic system via one or more processors can perform registering the second medical image data with the first medical image data. The processor can applyPage 47 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 known algorithms such as transformation algorithms (e.g., rigid transformations such as translation and rotation, or non-rigid transformations depending on tissue deformation) to register the second medical image data with the first medical image data. For example, a processor can compute a rigid registration between the first and second 3D images by utilizing the data contained w ithin the DICOM associated with each image. These DICOM tags include geometric and spatial information such as the position, orientation, and scaling factors of the images.

[0206] In some embodiments, a processor can compute registration of the second medical image (e.g., 3D medical image) data with the first medical image date via image-to-image registration method. These methods include rigid registration, affine registration, and deformable registration. Exemplary known algorithms for image-to-image registration are mutual information-based registration, normalized cross-correlation, and Demons algorithm (deformable registration).

[0207] In some embodiments, a processor can compute registration of the second medical image data with the first medical image data using known Demons algorithm. The Demons algorithm is a known non-rigid image registration technique that aligns two images by iteratively estimating the local displacement (or deformation) field between them. The algorithm is used, for example, for registering images that have been deformed due to, for example, patient or medical equipment movement during the procedure. Optionally, before applying the Demons algorithm, the second medical image data volume is aligned to the first medical image data volume. This can be done using a rigid or affine transformation to correct differences in translation, rotation, and scaling between the two volumes. Optionally, the initial displacement field is defined, for example, the initial displacement field (deformation map) is set to zero, indicating that, initially, there is no deformation between the images.

[0208] The known Demons algorithm is used, for example, by iteratively estimating a displacement field that maps the second image onto the first image by matching image intensities. According to the present disclosure, the Demons algorithm, optionally, stops after a set number of iterations, for example 1-5 iterations, optionally 2 iterations. The registration information can be saved in a memory for further use according to the present disclosure such as determining the new trajectory'.Page 48 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0209] In some embodiments, according to the present disclosure, both the first and second medical image data contain a reference marker that its coordinate system is registered to coordinate system of the end effector or medical tool. For example, the coordinate system or a reference frame of the reference marker is aligned with that of the end effector or the medical tool directly or via an intermediate referential. For example, the reference marker can be directly attached to the end effector or a medical tool or can be part of the material of the end effector or medical tool. In another example, the reference marker is placed on the subject like patient’s skin and its coordinate system is registered to coordinate system of the end effector or the medical tool (e.g., the needle), optionally, via an intermediate referential. This allows the processor to maintain an accurate measurement of the spatial relationship between the end effector or medical tool and the target throughout the procedure. For example, during the period between the acquisition of the first medical image and receiving instruction to actuate the medical tool along the trajectory, the end effector, patient, or medical tool may undergo movements due to, for example, mechanical drift, vibrations, or adjustments made by the clinician or robotic system. The processor compares the position data of the end effector or medical tool to the reference markers in the second image dataset relative to the first image data. Any detected deviation relative to the target is corrected by one or more processors. Having the reference marker in both the first and second medical image data, any movements are quickly detected and corrected. This means that medical tool actuation such as needle insertion along the trajectory can be performed with high accuracy.

[0210] With continued reference to FIG. 10, in some embodiments, after a medical image (e.g., a second medical image) is received in step 2100 or analyzed in step 2200, a second trajectory can be determined in step 2300. In some embodiments, determining a second trajectory can include receiving or calculating a trajectory.

[0211] In some embodiments, based on the target’s determined position (e.g.. the position determined when analyzing a medical image in step 2200), a second trajectory (e.g., a new trajectory) can be calculated from the entry point, for example, where the medical tool (e.g., a needle) is positioned on the skin. In some embodiments, the position of undesirable areas within the medical image data can be determined in addition to the position of the target. In some embodiments, the position of the undesirable areas can be determined using the same methodsPage 49 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 as determining the position of the target in the medical image. In some embodiments, the new trajectory can be calculated accounting for (e.g., avoiding) the undesirable areas.

[0212] In some embodiments, as shown in FIG. 12A, the end effector 102 can be configured to maintain the medical tool’s position at entry point 110 (e.g., patient’s skin), aligning with the trajectory7111 to the target 109 for the second medical imaging. This controlled positioning of the end effector allows the medical tool (e.g., needle) to remain stable and aligned with the trajectory7while securing the entry' point for further steps of the procedure.

[0213] In some embodiments, and with reference to FIG. 1, the method can include an adjusting the position of the medical tool step 3000. In some embodiments, adjusting the position of the medical tool step 3000 can include realigning the medical tool. In some embodiments, realigning the medical tool can include realigning the medical tool to be inserted along the second trajectory (e.g., the second trajectory determined in step 2300). In some embodiments, adjusting the position of the medical tool step 3000 can be performed to ensure the target is reached. For example, by performing the adjusting the position of the medical tool step 3000 the target can be reached even if the target has moved.

[0214] FIG. 12B illustrates an example of adjusting the trajectory of the medical tool from a first trajectory 111, to a second trajectory 111(1). In some embodiments, the medical tool 108 (e.g., a needle) already positioned at the entry' point and aligned along trajectory 111, pivots the medical tool at the entry point to align with the newly calculated trajectory reaching the target. In some embodiments, the end effector can pivot the medical tool. In some embodiments, pivoting can include realigning the medical tool . This pivoting process can ensure that the medical tool remains securely' positioned at the entry point while adjusting its angle to precisely align with the new trajectory’, considering any changes in the target’s position determined in the second medical image. As disclosed above, for example, a gimbal-like joint or spherical bearing integrated within the end effector allows pivoting and multi-directional adjustments. This can ensure that the medical tool can pivot to match the angle required by the new' trajectory' w'ithout disrupting its stable placement on the skin. For example, force sensors within the end effector can control the pivoting force, ensuring the medical tool (e.g., a needle) can maintain a stable connection with the entry point while aligning precisely with the new trajectory.Page 50 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0215] In some embodiments, the pivoting can ensure that the end effector can dynamically adjust to positional changes of the target, enabling timely medical tool alignment and insertion where the target may shift due to, for example, patient movement, respiration, or factors disclosed herein.

[0216] The pivoting of the medical tool at the entry point, as described above, represents just one example of aligning the medical tool with the new trajectory to the target. Alternative methods for adjusting the medical tool’s position (e.g., location or orientation) may also be used to achieve alignment, each with distinct degrees of freedom (DoF) as disclosed above, preferably 3 DoF or less. For instance, the end effector comprises a linear actuator with 2 or 3 DoF to provide reliable medical tool positioning with minimal mechanical complexity, supporting fast and accurate trajectory alignment and insertion. As noted above, the surgical robot and end effector combined can operate in more DoF (e.g., 6 DoF) when initially positioning the end effector near the subject, however, in some embodiments, to assist with the speed or accuracy of the insertion, the end effector can operate with 2 or 3 DoF during the pivoting or the adjusting steps. In some embodiments, the moving the medical tool along the updated trajectory (e.g., the pivoting of the medical tool) can occur within a duration of from 50 milliseconds to 500 milliseconds.

[0217] As a way of a non-limiting example, the pivoting of the end effector 102 shown in FIG. 4 can be performed using one or more actuators. For example, the pivoting can include rotation in a first direction (e.g., about axis 164) using actuator 160 and rotation in a second direction (e.g., about axis 166) using actuator 162. The rotation about the two axis (e.g., axis 164, axis 166) corresponds to pivoting with two distinct DoF.

[0218] In some embodiments as illustrated in FIGS. 13A-13G. the surgical robotic system of present disclosure incorporates a tracking system, such as an electromagnetic (EM) tracking system to provide precise alignment and tracking of the end effector during image-guided intervention.

[0219] In some embodiments, a tracking system or localization unit can refer to all tracking systems known for tracking objects in a coordinate space. For example, the tracking system can be used to track the position of a medical tool, end effector, or robotic arm during the surgical or interventional procedure. Suitable tracking systems can include ElectromagneticPage 51 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025(EM) tracking systems, Optical tracking systems, Ultrasound tracking systems, Inertia Measurement Units (IMUs), Camera-Based or Vision-Based systems, Radiofrequency (RF) tracking systems, or hybrid tracking systems where two or more tracking systems are used.

[0220] In some embodiments, the end effector 102 comprises a rigidly linked EM Sensor A, establishing a local coordinate system designated as coordinate system A. Optionally, the EM Sensor A can be linked to the end effector non-rigidly. In some embodiments, rigidly linked can refer to a sensor being physically attached to another object (such as the end effector or the patient’s body) in a way that prevents any relative movement between the objects. In some embodiments, rigidly linking objects ensures that the spatial relationship between the objects remains constant throughout the procedure. For example, when EM sensor A is rigidly linked to the end effector, any movement of the end effector will translate directly to a change in the sensor’s position, without any independent motion of the sensor itself.

[0221] In some embodiments, sensor A can be configured as an EM emitter or receiver, and can provide continuous positional data corresponding to the end effector’s position (e.g., location and orientation). Additionally, a reference EM sensor (reference marker), designated Sensor B, can be rigidly linked to the patient, establishing coordinate system B, which is associated with the patient's position. Optionally, the reference EM sensor B is non-rigidly linked to the patient. Sensor B can be configured as either an EM emitter or receiver and, optionally, is equipped with radiopaque fiducials. making it visible within the imaging volume. The imaging system itself operates within a fixed coordinate system Rx, representing the radiographic reference frame, which defines the spatial orientation of the imaging volume.

[0222] As shown in FIG. 13A, the patient, with Sensor B rigidly attached, can be positioned within the imaging gantry, and a first medical image is acquired. This first image captures a volume (e.g., 3D volume) containing both the target 109 and Sensor B. The processor uses the radiopaque fiducials of Sensor B to establish its position within Coordinate System Rx. The EM tracking system monitors the positional relationship between Sensor A (associated with the end effector's Coordinate System A) and Sensor B (associated with the patient’s Coordinate System B). By detecting the positions of these sensors within their respective coordinate systems, the EM tracking system computes the relative transformation between Coordinate System A and Coordinate System B. This data is processed by the surgical robotic system’s onePage 52 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 or more processors, which aligns and maintains alignment between the end effector and the subject.

[0223] To establish the position of Sensor A within the imaging coordinate frame Rx, the processor combines, for example, two coordinate transformations. First, it identifies Sensor B’s position within Coordinate System Rx using, for example, its radiopaque fiducials, captured during the first medical imaging. Second, it utilizes the EM tracking data to determine the relative spatial relationship between Sensor A and Sensor B. By combining these transformations, the processor accurately locates Sensor A and thus the end effector within the imaging coordinate frame Rx, aligning the medical tool precisely with the target. This dualtracking configuration, using both EM tracking and radiopaque fiducials, maintains precise alignment of the medical tool with the trajectory in the intervention. For instance, if movements occur (e.g., patient or end effector), the processor recalculates the positions in Coordinate Systems A, B, and Rx, dynamically updating the alignment to maintain along the trajectory.

[0224] Alternative embodiments may employ different localization units, such as optical tracking systems, optionally, in combination with radiopaque fiducials, while maintaining the same principles of coordinate-based alignment and tracking.

[0225] In some embodiments, as shown in exemplary' FIG. 13B, following the acquisition of the first medical image, the imaging bed with the sensor B rigidly or non-rigidly linked to the patient slides out of the imaging gantry, like the process previously described in relation to FIG. 9B.

[0226] In some embodiments, as shoyvn in FIG. 13C a trajectory 111 from the entry point 110 on the subject (e.g., patient's skin) to the target within the patient can be determined, for example via one or more processors. Exemplary methods of determining the trajectory and alternatively identifying an entry point via the determined trajectory are described, for example, in relation to any of FIGS. 8, 9C, and 10.

[0227] For example, as previously disclosed, the first medical image can capture a 3D volume containing both the target and the reference EM sensor B, which is rigidly or non- rigidly linked to the patient, and it is visible in the imaging data through its radiopaque fiducials. This image can be represented within the imaging system's coordinate system, designated as Rx. The position of the target can be defined within this coordinate system and registered inPage 53 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 relation to reference sensor B. The EM tracking system continuously tracks both Sensor A, which is rigidly or non-rigidly linked to the end effector, and Sensor B, attached to the patient. Using the known position of Sensor B within the Rx coordinate system and the EM data providing the relative positions between Sensor A and Sensor B, the processor calculates the position of the end effector and entry7point relative to the target.

[0228] In some embodiments, as described, for example, in connection to FIG. 9C, the target can be identified within a first medical image, and based on this target location, a trajectory7is determined before determining the entry point on the subject (e.g., the patient s skin). In some embodiments, the EM tracking system can monitor the movements (e g. patient and end effector) and ensure the medical tool is aligned and remains aligned with the target once the entry point is identified.

[0229] In some embodiments, as shown in FIG. 13D, the end effector 102, or a clinician, positions a medical tool 108 at an identified entry point 110 on the patient’s skin, aligning it with a traj ectory 1 11 that extends from the entry7point to a target as described in relation to FIG. 9B. In some embodiments, the EM tracking system continuously tracks both Sensor A and Sensor B.

[0230] FIG. 13E shows another configuration of a surgical robotic system according to the present disclosure. As shown, the end effector 102 is configured to maintain medical tool’s position at the entry point 110 (e g., on patient’s skin), aligning with the trajectory 111 to the target 109. The imaging bed moves the patient into the imaging gantry for the second medical imaging. This controlled positioning of the end effector allows the medical tool (e.g., needle) to remain stable and aligned with the trajectory7while securing the entry point for further steps of the procedure. In some embodiments, the second medical image can then be acquired. As shown in exemplary FIG. 13E, the second medical image represents a volume (optionally, smaller than the first medical image volume) and it captures the specific region containing the reference sensor B (the reference marker) and the target. In another example, the second medical image contains sensor B. entry point, and the target as shown in FIG. 13E.

[0231] In some embodiments, following the acquisition of the second medical image, the position of the target within the second image volume is determined, for example, via the system or one or more processors. Based on the target’s determined position, a new trajectoryPage 54 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 is calculated from the entry point, for example, where the medical tool (e.g., a needle) is positioned to the target. As described in FIG. 12B, after target’s position is determined based on the second medical image, one or more processors instruct the end effector to realign and insert the medical tool along the new trajectory from the entry point to the target. For example, as described above, the medical tool pivots at the entry point to align with the new trajectory7and then is inserted by instructions received from one or more processors to reach the target.

[0232] In some embodiments, as show n in FIG. 13E, the surgical robotic system utilizes an EM tracking system in combination with radiopaque fiducials to precisely align and track the end effector during the procedure, for example, image-guided intervention. In this example, reference sensor B having radiopaque fiducials is visible in the second medical image data. The EM tracking system tracks the relative position between Sensor A and Sensor B, providing position data of the end effector relative to the patient. For example, the processors receive two transformations: Sensor B’s position in Rx (via radiopaque fiducials) and the relative position of Sensor A to Sensor B (via EM tracking). By combining these transformations, the processor calculates the exact position of Sensor A within the imaging reference frame Rx, ensuring that the end effector remains precisely aligned with the trajectory.

[0233] FIG. 13F illustrates another embodiment related to FIG. 13E, however in this embodiment the entry point 110 remains positioned outside of the gantry and, consequently, outside the field of the second medical image while the target 109 and the reference marker sensor B are in the second medical image volume. As shown, the end effector 102 maintains its contact yvith the entry point outside of the gantry.

[0234] In FIG. 13G, a patient is positioned yvithin the gantry, and a second medical image, optionally smaller in volume than the first medical image, is acquired by the imaging device. The second medical image comprises the target, reference sensor B (reference marker), and an intermediate referential designated as referential sensor C. In this example, the end effector, which holds a medical tool at an entry7point located outside of the gantry7, is equipped with Sensor A. Each sensor A, B, and C has an independent coordinate system, allowing for specific positional references. The imaging system itself operates yvithin the Rx coordinate system, which defines the spatial orientation of the imaging volume.Page 55 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0235] As show n in FIG. 13G, the second medical image data includes referential sensor C and Sensor B. establishing a reference within the Rx coordinate system. Referential sensor C functions as a link that enables the EM tracking system to effectively connect the position of Sensor A, rigidly linked to the end effector, with Sensor B rigidly linked to the patient. Optionally, Sensor A and Sensor B are non-rigidly linked to the patient. This bridging mechanism allows the system to determine the precise position of the end effector relative to the target, despite the end effector and the entry' point being outside the gantry.

[0236] In some embodiments, the EM tracking system continuously tracks the relative positions of Sensors A, B, and intermediate referential C. By determining the spatial relationship between Sensor A (end effector) and referential C, and then linking referential C with Sensor B (patient), the system is able to align the end effector's Coordinate System A with the imaging coordinate frame Rx via the intermediate referential C. This intermediate referential provides a positional relationship within the second medical image that compensates for any movement of the patient or end effector during the procedure.

[0237] Using referential sensor C, the processor calculates the new trajectory from the entry' point to the target. For example, this trajectory is based on the relative positioning data of Coordinate Systems A, B, C, and Rx, allowing the medical tool to be positioned along the trajectory from the entry point (outside the gantry) to the target. By integrating referential sensor C as an intermediary’ between the Sensor A and Sensor B, the system maintains the accuracy of trajectory calculations, even when the entry' point is outside the gantry' and not directly visible in the second medical image data.

[0238] As noted above and with reference to FIG. 1, methods described herein can include inserting a medical tool (e.g., step 4000). In some embodiments, the insertion of the medical tool can be fast, ultra-fast, or standard. Depending on the intervention, the duration of inserting the medical tool can be varied to meet the time requirements. In some embodiments, when ultra-fast insertion is required (e.g.. when the subject is breathing normally), the insertion can occur within a duration of from 0.2 seconds to 2 seconds. In some embodiments, when fast insertion is required (e.g., when the subject is holding their breathe), the insertion can occur within a duration of from 1 second to 10 seconds. In some embodiments, when standard insertion is required (e.g., when the subject’s breathing is paused), the insertion can occur within a duration of from 1 second to 30 seconds.Page 56 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0239] In some embodiments, the speed of inserting can be determined based on the speed of actuating the surgical robot. In some embodiments, as noted above, the end effector of the surgical robot can be limited to 2 degrees of freedom. In some embodiments, because the end effector contains fewer (e.g., 2) degrees of freedom, the end effector can actuate faster than other end effectors.

[0240] Additionally, in some embodiments, additional actions occur after inserting the medical tool. For example, after the inserting step 4000, a treatment can be administered (e.g., a fluid can be inserted at the target location), and the medical tool can be withdrawn from the target. Further, in some embodiments, after the medical tool reaches the target, the medical tool can be ejected or released by the surgical robot (e.g., the end effector of the surgical robot). In some embodiments, the medical tool can remain in the subject at the target after the medical tool is ejected or released. In some embodiments, the end effector can maintain control of the medical tool after the medical tool reaches the target. In some embodiments, after inserting a medical tool, the surgical robot (e.g., the robotic arm or end effector) can hold the inserted medical tool and can optionally move with the subject as the subject moves (e.g., to maintain control of the medical tool after inserting the medical tool without causing the medical tool to move within the subject after reaching the target). For example, in some embodiments, the end effector can hold the medical tool in place and adjust the position of the medical tool as the patient moves (e.g., breathes) to ensure the medical tool remains inserted in the target.

[0241] In some embodiments, multiple medical tools can be inserted in a single intervention. In such embodiments, one or more of the steps described above can be repeated for each medical tool. For example, one or more of the steps described in FIG. 10 can be repeated. In some embodiments, for example, after a first medical tool is inserted, a new second medical image can be captured, the second medical image can be registered with the first medical image, a new second trajectory can be determined, the position of the second medical tool can be adjusted, and the second medical tool can be inserted, among other steps. In some embodiments, a first medical tool can be inserted in a parallel direction as a second medical tool.

[0242] FIG. 14 shows an example flow chart of a workflow 600 (e.g., an insertion) using CBCT imaging. As shown in FIG. 14, a first step of a work How can include an injecting a target with a contrast agent step 602. In some embodiments, the contrast agent increases thePage 57 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 contrast of certain features of a patient in a CBCT image, among other images. In some embodiments, the contrast agent is inserted into the patient near the target location.

[0243] In some embodiments, after injecting the target with the contrast agent step 602, the method can include a capturing a CBCT image step 604. In some embodiments, the CBCT image can be a 3D CBCT image. In some embodiments, capturing a CBCT image can include capturing a CBCT image of a large portion of the patient. In some embodiments, the capturing step 604 can occur while the patient is under general anesthesia.

[0244] In some embodiments, after the capturing step 604, the method can include a planning the insertion step 606. In some embodiments, as described above, the planning the insertion step 606 can include identifying the target, identifying any undesirable areas, determining a suitable entry point, determining a suitable trajectory, planning the movement of the surgical robot, and combinations thereof, among other steps. In some embodiments, the patient can be awake (e.g., not under general anesthesia) during the planning step 606.

[0245] In some embodiments, after the planning step 606, the method can include a positioning the medical tool step 608. In some embodiments, as described above, the positioning the medical tool step 608 can include moving the medical tool along a trajectory to the entry' point and positioning the medical tool to insert into the patient along the desired trajectory, and combinations thereof, among other steps.

[0246] In some embodiments, after the positioning the medical tool step 608, the method can include capturing a test image step 610. In some embodiments, the test image can be a single 2D CBCT image can. In some embodiments, the test image can be analyzed to determine if the target is present in the test image. If the target is not present in the test image, the CBCT imaging device can be repositioned, as necessary.

[0247] In some embodiments, after the positioning the medical tool step 608 and optionally a capturing a test image step 610. the method can include an injecting a contrast agent into the subject step 612. In some embodiments, the contrast agent can be the same contrast agent used in step 602.

[0248] In some embodiments, after the injecting the contrast agent step 612, the method can include an acquiring at least two projections step 614. In some embodiments, the at least two projections (e.g., 2D images) can be positioned at different angles. In some embodiments, aPage 58 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 first projection can be at an angle of from 5 to 45 degrees different than a second projection. In some embodiments, the at least two projections can be captured with a single CBCT imaging device.

[0249] In some embodiments, after the acquiring the at least two projections step 614, the method can include a registering the at least two projections with the CBCT image (e.g., the CBCT image from step 604) step 616. In some embodiments, the registering can include identifying one or more of the target, undesirable areas, the trajectory for the medical tool, and combinations thereof, among other aspects of the image.

[0250] In some embodiments, the method can also include a registering the surgical robot (e.g., the robotic arm) on the at least two projections step 618. In some embodiments, registering the surgical robot on the at least two projections can include identifying the position of the surgical robot relative to the target, undesirable areas, entry point, desired pathway for the medical tool, and combinations thereof, among other aspects.

[0251] In some embodiments, after registering the surgical robot on the at least two projections, the method can include a calculating a new trajectory step 620. In some embodiments, and as described above, calculating a new trajectory can include updating a previous trajectory' based on changes in, for example, the position of the target, the position of the medical tool, and combinations thereof, among other steps.

[0252] In some embodiments, after the calculating a new trajectory step 620, the method can include a pivoting the medical tool step 622. In some embodiments, and as described above, pivoting the medical tool can include changing the position of the surgical robot without removing the surgical robot from the skin of the subject. In some embodiments, pivoting the surgical medical tool step 622 can include pivoting the surgical robot such that the medical tool can be positioned along the new trajectory'. In some embodiments, the pivoting the medical tool step 622 can be performed quickly using the systems described herein, as described above.

[0253] In some embodiments, after the pivoting the medical tool step 622, the method can include an inserting the medical tool step 624.

[0254] In some embodiments, one or more of the steps shown in FIG. 14 can be completed for each medical tool of a plurality’ of medical tools. For example, if a plurality of medical toolsPage 59 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 are inserted into a patient in succession, steps 608-624 can be repeated, as necessary, for each insertion of the medical tool.

[0255] Additionally, in some embodiments, one of more of the steps shown in FIG. 14 can be completed during an operational interval, as described in greater detail below. For example, one or more of steps 614-622 can occur during an operational interval.

[0256] FIG. 15 and FIG. 16 are flowcharts of exemplary methods of present disclosure. In some implementations, one or more process blocks of FIG. 15 and FIG. 16 may be performed by one or more processors of the system. Although FIG. 15 and FIG. 16 show example blocks of the methods, in some implementations, the methods may include additional blocks, few er blocks, different blocks, differently arranged blocks, additional features, or fewer features in each block than those depicted in FIG. 15 and FIG. 16. For example, while not depicted in FIG. 15 or FIG. 16, the methods may include determining a respiration cycle of a subject and an operational interval, among other steps.

[0257] FIG. 15 shows a flow chart illustrating an exemplary method according to some embodiments of the present disclosure. The surgical robotic system comprises at least one processor communicatively coupled to the robotic arm and the end effector. At least one processor performs at least one operation of the show n methods. At step 1501, the robotic arm brings the end effector near the target. For example, the robotic arm brings the end effector within the volume of the first medical image that includes the target. At step 1502, the processor receives the first medical image data (e.g., 3D image acquired by an imaging device). The first medical image includes a target and a reference marker. Optionally, the reference marker is attached to the end effector and calibrated with the end effector. Steps 1503(1) and 1503(2) can be performed simultaneously, before, or after each other or only one of the steps is performed. At step 1503(1), the processor receives identity of the target, (optionally, entry point as w ell), and the reference marker in the first medical image data from, for example, a display via a display interface; or the processor identifies the target, (optionally, entry point), and the reference marker in the first medical image data. At step 1503 (2), the coordinate system of the first 3D medical image data is registered with the coordinate system of the reference marker using fiducials of the reference marker. At step 1504. the processor receives or determines a trajectory from the identified target and the identified entry' point based on the first medicalPage 60 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 image data. Optionally, the processor determines a trajectory' based on the identified target and determines an entry point.

[0258] At step 1505, the processor determines the position of the medical tool in the end effector coordinate system. At step 1506, the processor calculates, optimizes, and determines the medical tool’s path to be aligned with the trajectory'. Optionally, when multiple trajectories are calculated, for each trajectory the order of medical tools to be inserted along each trajectory is calculated and optimized. At step 1507, a second medical image data is received from an imaging device by the processor (optionally the same imaging device that acquired the first medical image). Optionally, the volume of the second image data is smaller than the volume of the first imaging device. The second image data includes the target, and the reference marker. At step 1508, the processor receives position information of the target or determines the position of the target in the second medical image from, for example, a display via a display interface. Optionally , the position of the target in the second medical image data is determined by one or more processors. At step 1509, the processor determines a new trajectory' from the target in the second medical image data to the previously identified entry point. At step 1510, the processor instructs the end effector to align (e.g., via pivoting) the medical tool in contact with surface of the subject at the entry point to align with the new trajectory. At step 1511, the processor instructs the end effector to actuate (e.g., to insert) the medical tool along the new trajectory.

[0259] FIG. 16 shows a flow chart illustrating an exemplary method according to some embodiments of the present disclosure. The disclosed method utilizes a tracking system such as EM tracking system. At least one processor performs one or more operations of the methods.

[0260] At step 1601, a processor receives the first medical image data, which includes a target and a reference sensor B (a reference marker). The reference sensor B is rigidly linked to the subject (e.g. a patient’s skin). Optionally, reference sensor B is non-rigidly linked to the subject. The reference sensor B is an emitter / receiver that is tracked by a tracking system such as EM tracking system. Optionally, reference sensor B further comprises an object such as radiopaque material or having recognizable shape that is visible in the medical images.

[0261] Steps 1602(1) and 1602(2) can be performed simultaneously, before, or after each other or only one of the steps is performed. At step 1602(1). the processor receives identity of the target, (optionally, entry' point), and the reference marker in the first medical image dataPage 61 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 from, for example, a display via a display interface; or the processor identifies the target, (optionally, entry point), and the reference marker in the first medical image data. At step 1602(2), the coordinate system of the first medical image data is registered with the coordinate system of the reference sensor B using fiducials of the reference sensor B visible in the first medical image data. At step 1603, the processor receives or calculates a trajectory' from the identified target and the identified entry point based on the first medical image data. Optionally, the processor calculates a trajectory based on the identified target and determines an entry point.

[0262] At step 1604, for each trajectory, the processor determines the position of the medical tool in coordinate system of Sensor A (receiver or emitter) that is rigidly or non-rigidly linked to the end effector. In step 1605, for each trajectory, the processor calculates, optimizes, and determines the medical tool’s path using measurements between the reference sensor B and a sensor A to align with the trajectory. Optionally, when multiple trajectories are calculated, for each trajectory' the order of medical tools to be inserted is calculated and optimized by the processor. The measurements include the positional data gathered by the tracking system to calculate the spatial relationship between reference sensor B and sensor A. For example, measurements include one or more of the following: distance (Linear Measurement), which is the straight-line distance between the reference sensor B and sensor A; orientation (Angular Measurement), which is the relative orientation or angle between the two sensors; positional coordinates, which are coordinates (e.g.. X, Y, Z) of each sensor's position in space, which allow for calculating relative positions and directions.

[0263] At step 1606, a second medical image data is received from the imaging device by one or more processors. Optionally, the volume of the second image data is smaller than the volume of the first imaging device. The second image data includes the target, and reference marker sensor B. At step 1607, the position of the target in the second medical image data is determined by one or more processors or the positional information of the target is received by one or more processors from, for example, a display or a user interface or from a memory' device. At step 1608, the processor calculates a new trajectory from the target in the second medical image data to the previously identified entry' point. At step 1609, the processor instructs the end effector to pivot the medical tool at the entry point to align with the new trajectory. At stepPage 62 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 20251610, the processor instructs the end effector to actuate (e.g., to insert) the medical tool along the new trajectory to reach the target.

[0264] In some embodiments, additional steps can be performed to help, for example, increase the accuracy or consistency of the insertion (e.g., increase the percent of successful interventions). In some embodiments, additional information about a subject can be acquired and analyzed to assist in increasing the accuracy or consistency of the insertion. In some embodiments, the additional information can include the respiration pattern of the subject. In some embodiments, the target can move during normal respiration of the subject, and, for example, the position of the target during the respiration cycle can be determined and analyzed. Based on the position of the target during the respiration cycle, an operational interval can be determined that corresponds to the time the target is within an acceptable area (e.g., positional threshold). If the target is outside an acceptable area, it may increase the chances the medical tool may not reach the target and result in an unsuccessful intervention. In some embodiments, by performing one or more steps within the operational interval, the accuracy or consistency of the insertion can be increased.

[0265] In some embodiments, one or more of the steps described above can be completed within an operational interval. In some embodiments, as shown in FIG. 17, to assist in determining an operational interval, additional information about the subject can be received in step 7000 to further improve accuracy of the insertion method of the present disclosure. In some embodiments, receiving additional information about the subject can include analyzing the breathing of the subject step 7100, monitoring the position of the target during the respiration cycle step 7200, predicting the position of the target based on the respiration cycle step 7300. and determining an operational interval step 7400.

[0266] In some embodiments, regular, predictable cycles (e.g., respiration cycles, cardiac cycles), non-periodic and unpredictable movements of the patient or medical equipment (e.g., robotic arm, end effector, needle) can contribute to procedural inaccuracies. For example, vibration or a reflex action (e.g., a sneeze) can cause abrupt and unanticipated displacement of tissues and devices. In some embodiments, the systems and methods described above can be used to decrease procedural inaccuracies. In some embodiments, performing an interventionPage 63 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 according to the present disclosure within an operational interval can further decrease procedural inaccuracies.

[0267] FIG. 18A illustrates an exemplary system for monitoring and analyzing the breathing of a subject (e.g., as per step 7100 of FIG. 17). For example, as illustrated in FIG. 18A, a subject 200, can have a first sensor 210 attached to the skin 203 of the subject 200. The first sensor 210 can be in communication with a second sensor 215 via a communication device 220 (e.g., electromagnetic communication, optical communication, a cable, etc.). In some embodiments, a plurality of first sensors (e.g., first sensor 210) or a plurality of second sensors (e.g., second sensor 215) can be used. In some embodiments, the second sensor 215 can be in communication with a medical tool (e.g., a surgical arm). In some embodiments, while the subject 200 is breathing, the outer surface of the skin 203 can move from a first position 205 A to a second position 205B. In some embodiments, because of the movement of the skin 203 of the patient, the first sensor can move from a first position to a second position, such that a change in position 230 can be measured. In some embodiments, the first sensor 210 can detect the change in position 230. In some embodiments, the second sensor 215 can detect the change in position 230 of the first sensor 210. Other suitable methods of monitoring or analyzing the breathing of the subject can be used (e.g., using a belt configured around the patient, monitoring one or more markers on the skin of the patient, fixing a sensor to the skin of the patient, etc.).

[0268] FIG. 18B shows an exemplary graph showing the position of a target (e.g., a target 109 of FIG. 9A), a sensor (e.g., first sensor 210 of FIG. 18A), or another reference point during the respiration cycle of a subject. In FIG. 18B. the x-axis is time, and the y-axis is position of the relative position of reference point (e.g., the distance between the reference point and a medical tool). While the position of the reference point can vary in multiple directions, for purposes of illustration reference is made to a single change in position (i.e., increasing or decreasing in the y direction in the graph of FIG. 18B). The maximums in the y-direction (i.e., maximum 301, 303, and 305), can correspond to the position of the reference point when the position is a maximum (e.g., the instant before subject begins to exhale and the lungs are full or approximately full). The time between two maximums (i.e., time 350 between maximum 301 and maximum 303) can be used to measure one respiration cycle of a subject (e.g.. the time from when a subject to begins an inhale to the time the subject finishes the next exhale). ThePage 64 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 minimums in the y-direction (i.e., minimum 302, 304, and 306) can correspond to the position of the reference point when the position is a minimum (e.g.. the instant before the subject begins to inhale and the lungs are empty or approximately empty). The change in position 360 from a maximum (e.g., maximum 301) and a minimum (e.g., minimum 302) can be the total distance the reference point moves during a respiration cycle.

[0269] In some embodiments, one or more steps of the methods according to the present disclosure can be optionally completed during an operational interval (e.g., one or more of the steps described in FIG. 1). For example, in some embodiments, performing one or more steps during the operational interval can increase the chance of reaching the target. However, in some embodiments, as described above, all the steps of the methods described herein can be completed without regard to the operational interval. In some embodiments, to effectively reach a target, the target may need to be in a specific position or within an allowable range of a specific position (i.e., a positional threshold). In some embodiments, there is variance in the positional threshold. For example, if a target is within a positional threshold, the medical tool can still reach the target. FIG. 18B illustrates exemplary operational intervals 320, 321 and corresponding positional thresholds 310, 311. The positional threshold can be determined based on the maximum change in position from a reference point that the medical tool can still reach the target. In some embodiments, the operational interval can be determined (e.g., determining the operational interval step 7400 of FIG. 17) based on the duration the reference point (e.g., a target) is within the positional threshold. For example, the operational interval 320 can start at the time corresponding to point 330 when the reference point reaches a first end of the positional threshold 310 and can terminate at the time the reference point reaches point 340 when the reference point leaves a second end of the positional threshold 310.

[0270] In some embodiments, the operational interval can be maximized by positioning the operational interval about a chosen moment of a respiration cycle. For example, as shown in FIG. 18B, the operational interval is based around a minimum 302. However, if the position threshold was positioned at a different location, the reference point would pass through the position threshold in a shorter duration, thus decreasing the operational interval. While FIG. 18B depicts the position threshold and operational interval about a minimum (e.g.. minimumPage 65 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025302 and minimum 304) the position threshold and operational interval can be based around any point in the respiration cycle, including being based about a maximum (e.g.. maximum 303).

[0271] In some embodiments, a sensor (e.g., a first sensor 210 of FIG. 18A) can detect when the reference point first enters the positional threshold (e.g., can detect when a reference point reaches point 330). In some embodiments, a specific operational interval can be determined and can start once a reference point reaches a certain position (e.g., when a reference point reaches point 330). For example, an operational interval of 3 seconds can begin the moment the reference point reaches a predetermined point (e.g., point 330). In some embodiments, an operational interval can begin when the reference point reaches the point 330 and can end when the reference point leaves the positional threshold (e.g., when the reference point is beyond point 340). For example, a sensor can detect when the reference point reaches point 330, thereby beginning an operational interval, and a sensor can detect when the reference point reaches point 340, thereby ending the operational interval. However, the duration between the time the reference point reaches point 330 and point 340 can be undefined.

[0272] In some embodiments, the respiration cycle of the patient is cyclical. For example, the time 350 can be the same as the time between other maximums (e g., the time between maximum 303 and maximum 305). In some embodiments, an operational interval can be determined by analyzing a first respiration cycle (e.g., the cycle between maximum 301 and maximum 303) and determining a suitable operational for a subsequent respiration cycle. For example, the time from a maximum (e.g., maximum 301) to the beginning of a suitable operational interval (e.g., point 330) and the end of a suitable operational interval (e.g., point 340) can be determined from a first cycle. An operation can then occur during a second respiration cycle, by, for example, beginning and ending the operational interval based on the time when the respiration begins or ends (e.g., step 7300 of FIG. 17, predicting the position of a target based on the respiration cycle ). In some embodiments, an average operational interval can be determined from several respiration cycles (e.g., a first and second respiration cycle) and subsequently used to predict a suitable operational interval for a subsequent operational interval. Similarly, the duration of an operational interval can be determined based on a previous operational interval or a plurality of previous operational intervals.Page 66 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0273] In some embodiments, the time between operational intervals can also be measured. For example, the time between the end of a first operational interval (e.g., point 340) and the beginning of a second operational interval (e.g., point 331) can also be determined. In some embodiments, for example, the time between the end of a first operational interval (e.g., at point 340) and the end of a second operational interval (e.g., point 341) can be determined.

[0274] In some embodiments, the timing of beginning or ending an operational interval can be determined based on a maximum (e.g., maximum 301), a minimum (e.g., minimum 302), or some other reference point during the respiration cycle. In some embodiments, an operational interval can be determined for a first respiration cycle or a first plurality of respiration cycles. In some embodiments, after the operational interval is determined for a first or first plurality of respiration cycles, the timing (e.g., average time) between a reference point (e.g., a maximum 301) and the beginning of the operational interval can be determined. Additionally, the average duration of the operational interval can be determined. In some embodiments, subsequent operational intervals can begin a predetermined time after the respiration cycle reaches the reference point (e.g., maximum) in the respiration cycle. Additionally, in some embodiments, subsequent operational intervals can terminate a predetermined after the operational interval begins.

[0275] In some embodiments, the operational interval can increase by increasing the duration the reference point is within the positional threshold. For example, a patient can hold their breath, thereby increasing the time the reference point is at a specific position (e.g., a minimum or a maximum). Additionally, in some embodiments, the patient can be under general anesthesia or for some other reason not moving, thereby creating an operational interval with no defined ending (e.g., an operational interval that can be manually stopped by an anesthesiologist terminating the anesthesia). In some embodiments, the operational interval can increase under any form of general anesthesia. For example, under jet ventilation anesthesia, the subject may receive high speed and low pressure ventilation, resulting in relatively lower movement of the organs. Under low tidal volume ventilation anesthesia, the subject may receive low volume ventilation that reduces the movement of the organs. In some embodiments, regardless of the type of anesthesia the subject is under, due to the ability of the end effector toPage 67 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 pivot positions in multiple directions (e.g., because of actuator 160 and actuator 162 of FIG. 4), the medical tool can reach the target regardless of the position in the breathing cycle.

[0276] FIG. 18B depicts the lower end of the positional threshold (e.g., positional threshold 310) at the positional minimum (e.g., minimum 302). However, in some embodiments, the positional threshold may have a minimum that is below the positional minimum. For example, variance in operating equipment can cause uncertainty in the exact position the medical tool can be inserted. Accordingly , to accommodate for such uncertainty', the positional threshold can be positioned lower which can increase the likelihood the medical tool reaches the target.

[0277] Additionally, while reference is made to changes in position based on the respiration cycle, the position of a reference point (e.g., a target) can vary for other reasons. For example, if a patient coughs, sneezes, or moves for any other reason, the position of the reference point can move outside of the positional threshold. In some embodiments, systems described herein are configured to terminate the procedure if the reference point leaves the positional threshold, regardless of the reason the reference point leaves the positional threshold.

[0278] In some embodiments, the duration of the operational interval can vary depending on the breathing status of the patient. For example, in some embodiments, when the respiration of the patient is not adjusting position of the target (e.g., when the lungs are not inflating or deflating because the patient is under general anesthesia), the operational interval can have an undefined ending. In some embodiments, when the respiration of the patient is paused (e.g., when the patient is holding their breath), the operational interval can be longer than when the patient is regularly breathing. For example, when the patient holds their breath, the duration the position of the target is within an allowable area is increased, and the operational interval can increase. Exemplary operational intervals when the patient is holding their breath can include 10 to 20 seconds. In some embodiments, when the respiration cycle of the patient is normal (e.g., the patient is breathing normally, the respiration of the subject is uninterrupted) the target is constantly moving or is almost constantly moving. In some embodiments, the operational interval can be centered around the beginning or end of an inhale or an exhale (e.g., when the lungs are at a minimum or maximum volume). Exemplary- operational intervals when the patient is normally breathing can include 1 to 3 seconds. In some embodiments, the operational interval can be from 0.5 to 3 seconds. In some embodiments, the operationalPage 68 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 interval can be from 3 to 5 seconds. In some embodiments, the operational interval can be from 5 to 10 seconds. In some embodiments, the operational interval can be from 10 to 20 seconds.

[0279] In some embodiments, various steps (e.g., acquiring a medical image, analyzing a medical image, determining a trajectory, adjusting the position of the medical tool, inserting the medical tool, etc.) can be performed during the operational interval. In some embodiments, the operational interval can be longer than the time required to perform the various steps. For example, an operational interval can be 3 seconds and the time it takes to perform the various steps can be 1 second. In some embodiments, the time required to perform the various steps can be from 1 to 20 % of the operational interval. In some embodiments, the time required to perform the various steps can be from 20 to 50 % of the operational interval. In some embodiments, the time required to perform the various steps can be greater than 50% of the operational interval.

[0280] In some embodiments, the beginning of the operational interval can be estimated (e.g., by predicting a time after a reference point in the respiration cycle (e.g., a maximum 301), by predicting a time after the position is detected in a predetermined area). In some embodiments, the system is configured to operate after the operational interv al has begun (e.g., after point 330 of FIG. 18B). In some embodiments, the system is configured to begin at any time during the operational interval.

[0281] In some embodiments, the system is configured to reset when the operational interval ends (e.g., at point 340), regardless of when the system began operating. In some embodiments, the resetting operations can include withdrawing the medical tool (if necessary), preventing the insertion of the medical tool, pausing movement of the surgical robot (e.g., stop adjusting the position), among other operations designed to stop the current intervention and prepare the system for a subsequent intervention. In some embodiments, a system can be in progress (e.g., in progress of the adjusting step 3000 or the inserting step 4000 of FIG. 1) when the operational interval ends. In some embodiments, if the system determines (e.g., via one or more processors) to perform a reset (e.g.. because an operational interval ends, a reference point is outside of a positional threshold, etc.), the system can reset (e.g., withdraw the medical tool (if necessary), prevent the medical tool from inserting) and continue or restart the operation during a subsequent operational interval (e.g., the next operational interval).Page 69 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0282] As noted above, in some embodiments, adjusting the position of the medical tool can occur within the operational interval. For example, acquiring and analyzing a medical image (e.g., a second medical image) can occur during the operational interval. In some embodiments, the step of capturing one or more medical images (e.g., one or more second medical images) can occur within a duration of from 100 milliseconds to 1 second. In some embodiments, the duration of capturing one or more medical images can be decreased by decreasing the area (e.g., area 240) selected to be imaged. In some embodiments, the step of acquiring and analyzing a medical image (e.g., creating a registration based on a first medical image and a second medical image) can occur within a duration of from 50 milliseconds and 800 milliseconds. In some embodiments, the duration of acquiring (e.g., transferring the related data) and analyzing a medical image can be decreased by decreasing the area (e.g., area 240) selected to be imaged. In some embodiments, a smaller area that is imaged can result in less data that needs to be acquired and analyzed.

[0283] Any suitable computing systems can be used to implement the computing devices and methods / functionality described herein and be converted to a specific system for performing the operations and features described herein through modification of hardware, software, and firmw are, in a manner significantly more than mere execution of softw are on a generic computing device, as w ould be appreciated by those of skill in the art. One illustrative example of such a computing device 5000 is depicted in FIG. 19. The computing device 5000 is merely an illustrative example of a suitable computing environment and in no way limits the scope of the present disclosure. A "computing device," as represented by FIG. 19, can include a "workstation," a "server," a "laptop," a "desktop," a "hand-held device," a "mobile device," a "tablet computer," or other computing devices, as would be understood by those of skill in the art. Given that the computing device 5000 is depicted for illustrative purposes, embodiments of the present disclosure may utilize any number of computing devices 5000 in any number of different ways to implement a single embodiment of the present disclosure. Accordingly, embodiments of the present disclosure are not limited to a single computing device 5000. as would be appreciated by one with skill in the art, nor are they limited to a single type of implementation or configuration of the example computing device 5000.Page 70 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0284] The computing device 5000 can include a bus 5010 that can be coupled to one or more of the following illustrative components, directly or indirectly: a memory 5012, one or more processors 5014, one or more presentation components 5016, input / output ports (I / O ports) 5018, input / output components (I / O components) 5020, and a power supply 5024. One of skill in the art will appreciate that the bus 5010 can include one or more busses, such as an address bus, a data bus, or any combination thereof. One of skill in the art additionally will appreciate that, depending on the intended applications and uses of a particular embodiment, multiple of these components can be implemented by a single device. Similarly, in some instances, a single component can be implemented by multiple devices. As such, FIG. 19 is merely illustrative of an exemplary computing device that can be used to implement one or more embodiments of the present disclosure, and in no way limits the disclosure.

[0285] The computing device 5000 can include or interact with a variety of computer- readable media. For example, computer-readable media can include Random Access Memory' (RAM); Read Only Memory (ROM); Electronically Erasable Programmable Read Only Memory (EEPROM); flash memory' or other memory' technologies; CDROM. digital versatile disks (DVD) or other optical or holographic media; magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices that can be used to encode information and can be accessed by the computing device 5000.

[0286] The memory 5012 can include computer-storage media in the form of volatile or nonvolatile memory'. The memory' 5012 may be removable, non-removable, or any combination thereof. Exemplary hardyvare devices are devices such as hard drives, solid-state memory, optical-disc drives, and the like. The computing device 5000 can include one or more processors that read data from components such as the memory 5012, the various I / O components 5020, etc. Presentation component(s) 5016 present data indications to a user or other device. Exemplary’ presentation components include a display device, speaker, printing component, vibrating component, etc.

[0287] The I / O ports 5018 can enable the computing device 5000 to be logically coupled to other devices, such as I / O components 5020. Some of the I / O components 5020 can be built into the computing device 5000. Examples of such I / O components 5020 include a microphone,Page 71 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 joystick, recording device, game pad, satellite dish, scanner, printer, wireless device, networking device, and the like.

[0288] It should be appreciated that the methods discussed above need not be completed in the order of steps discussed above. Multiple steps of the methods can be performed substantially simultaneously or in a different order than presented above. Similarly, multiple steps of the methods can be omitted, or additional steps could be added.

[0289] As utilized herein, the terms "comprise" and "comprising" are intended to be construed as being inclusive, not exclusive. As utilized herein, the terms "exemplary", "example", and "illustrative", are intended to mean "serving as an example, instance, or illustration" and should not be construed as indicating, or not indicating, a preferred or advantageous configuration relative to other configurations. As utilized herein, the terms "about", "generally", and "approximately" are intended to cover variations that may existing in the upper and lower limits of the ranges of subjective or objective values, such as variations in properties, parameters, sizes, and dimensions. In one non-limiting example, the terms "about", "generally", and "approximately" mean at, or plus 10 percent or less, or minus 10 percent or less. In one nonlimiting example, the terms "about", "generally", and "approximately" mean sufficiently close to be deemed by one of skill in the art in the relevant field to be included. As utilized herein, the term "substantially" refers to the complete or nearly complete extent or degree of an action, characteristic, property, state, structure, item, or result, as would be appreciated by one of skill in the art. For example, an object that is "substantially" circular would mean that the object is either completely a circle to mathematically determinable limits, or nearly a circle as would be recognized or understood by one of skill in the art. The exact allowable degree of deviation from absolute completeness may in some instances depend on the specific context. However, in general, the nearness of completion will be so as to have the same overall result as if absolute and total completion were achieved or obtained. The use of "substantially" is equally applicable when utilized in a negative connotation to refer to the complete or near complete lack of an action, characteristic, property, state, structure, item, or result, as would be appreciated by one of skill in the art. The use of the terminology' X "or" Y should be interpreted as meaning either "X" or "Y" individually, or both "X and Y" together.Page 72 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0290] All patents and publications mentioned in this specification are herein incorporated by reference to the same extent as if each independent patent and publication was specifically and individually indicated to be incorporated by reference.

[0291] Numerous modifications and alternative embodiments of the present disclosure will be apparent to those skilled in the art in view of the foregoing description. Accordingly, this descnption is to be construed as illustrative only and is for the purpose of teaching those skilled in the art the best mode for carry ing out the present disclosure. Details of the structure may vary' substantially without departing from the spirit of the present disclosure, and exclusive use of all modifications that come within the scope of any appended claims is reserved. Within this specification, embodiments have been described in a way which enables a clear and concise specification to be written, but it is intended and will be appreciated that embodiments may be variously combined or separated without parting from the scope of the present disclosure. It is intended that the present disclosure be limited only to the extent required by any appended claims and the applicable rules of law.

[0292] Non-limiting embodiments of the present disclosure are set out in the following clauses:

[0293] Clause 1. A surgical robotic sy stem, comprising: an end effector configured to hold and insert a medical tool; a computing device communicatively coupled to the end effector, wherein the computing device comprises a computer readable medium storing computer program instructions which, when executed by one or more processors, cause the one or more processors to perform a method comprising: (a) receiving first medical image data from an imaging device, wherein the first medical image data represents a first volume of an imaged subject, comprising a target within the subject, an entry’ point, and a reference marker attached to or integrated in the end effector that are located and identified within the first medical image data; (b) instructing the end effector to align the medical tool held by the end effector and being located at or above the entry point along a trajectory reaching the target, wherein the trajectory is determined between the target and the entry point based on the first medical image data; (c) receiving second medical image data from the imaging device, wherein the second medical image data represents a second volume of the imaged subject, comprising the target, the second medical image data being registered to the first medical image data; (d) instructing the endPage 73 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 effector to re-align the medical tool at or above the entry7point along anew trajectory reaching the target, wherein the new trajectory is determined between the target and the entry point based on the second medical image data by comparing the position data of the end effector or the medical tool to the reference marker in the second image data relative to the first image data; and instructing the end effector to insert the medical tool located at or above the entry7point along the new trajectory reaching the target upon receiving an insertion instruction.

[0294] Clause 2. The surgical robotic system according to clause 1, wherein the second volume of the imaged subject is smaller than the first volume of the imaged subject.

[0295] Clause 3. The surgical robotic system according to any one of clauses 1-2, wherein a reference marker coordinate system is registered with a coordinate system (A) of the end effector and wherein the coordinate system (A) of the end effector is registered with an image coordinate system (Rx), and wherein the coordinate system (Rx) of the first medical image data is registered with the coordinate system (A) of the reference marker using fiducials of the reference marker.

[0296] Clause 4. The surgical robotic system according to any one of clauses 1-3, wherein the reference marker comprises a) an emitter or receiver trackable by a tracking system, and b) an object that is visible in both the first and second medical images.

[0297] Clause 5. The surgical robotic system according to any one of clauses 3-4, wherein the method comprises : tracking, via a tracking system, the reference marker and the end effector with respect to each other, wherein the end effector has a receiver or emitter trackable by the tracking system.

[0298] Clause 6. The surgical robotic system according to any one of clauses 1-5, wherein the first and the second medical image data are three-dimensional medical image data.

[0299] Clause 7. The surgical robotic system according to any one of clauses 1-6, wherein the medical tool is a needle.

[0300] Clause 8. The surgical robotic system according to any one of clauses 1-7, wherein the end effector has three or less degrees of freedom.

[0301] Clause 9. The surgical robotic system according to any one of clauses 1-8, wherein the surgical robotic system further comprises a robotic arm connected to the end effector.Page 74 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0302] Clause 10. The surgical robotic system according to any one of clauses 1-9, wherein the system further comprises a display configured to display the first medical image data and the second medical image data, the trajectory', and the new trajectory'; and a user interface configured to receive user inputs.

[0303] Clause 11. A non-transitory computer readable medium storing computer program instructions which, when executed by one or more processors, cause the one or more processors to perform a method comprising: receiving first medical image data from an imaging device, wherein the first medical image data represents a first volume of an imaged subject, and locating and identifying a target within the subject, an entry' point, and a reference marker attached to or integrated in an end effector within the first medical image data; registering a reference marker coordinate system with a coordinate system (A) of the end effector and registering the coordinate system (A) of the end effector with an image coordinate system (Rx); generating instructions for the end effector to align the medical tool held by the end effector and being located at or above the entry' point along a trajectory reaching the target, wherein the trajectory is determined between the target and the entry' point based on the first medical image data; receiving second medical image data from the imaging device, wherein the second medical image data represents a second volume of the imaged subject, comprising the target and the reference marker; registering the second medical image data to the first medical image data; generating instructions for the end effector to align the medical tool at or above the entry point along a new trajectory reaching the target, wherein the new trajectory' is determined between the target and the entry’ point based on the second medical image data by comparing the position data of the end effector or the medical tool to the reference marker in the second image data relative to the first image data: and generating instructions for the end effector to insert the medical tool located at or above the entry point along the new trajectory' reaching the target upon receiving an insertion instruction.

[0304] Clause 12. A non-transitory' computer readable medium storing computer program instructions which, when executed by one or more processors, cause the one or more processors to perform a method comprising: (a) receiving first medical image data from an imaging device , wherein the first medical image data represents a first volume of an imaged subject and comprises a target within the subject, an entry' point, and a reference marker attached to orPage 75 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 integrated in an end effector that are located and identified within the first medical image data, wherein a reference marker coordinate system is registered with a coordinate system (A) of the end effector and wherein the coordinate system (A) of the end effector is registered with an image coordinate system (Rx); (b) instructing the end effector to maintain alignment of a medical tool held by the end effector along a trajectory extending from the entry7point on the subject’s surface to the target, the trajectory7being determined between the target and the entry point based on the first medical image data, wherein the alignment is maintained by instructing the end effector to apply a force exerted on the subject’s surface while the medical tool is positioned at the entry7point aligned with the trajectory; (c) receiving second medical image data distinct from the first medical image data from the imaging device while the medical tool maintained its position at the entry point aligned w ith the trajectory, wherein the second medical image data represents a second volume of the imaged subject and comprises the target, the entry point, and the reference marker, the second medical image data being registered to the first medical image data; (d) instructing the end effector to pivot the medical tool at the entry point to align with anew- trajectory and to insert the medical tool located at the entry7point along the new trajectory extending from the entry point on the subject’s surface to the target upon receiving an insertion instruction, wherein the new trajectory is determined based on the second medical image data by comparing the position data of the end effector or the medical tool to the reference marker in the second image data relative to the first image data.

[0305] Clause 13. The non-transitory computer readable medium of any one of clauses 11- 12, wherein the second volume of the imaged subject is smaller than the first volume of the imaged subject.

[0306] Clause 14. The non-transitory computer readable medium according to any one of clauses 11-13, the method further comprising: maintaining alignment of the medical tool along the new trajectory7by an applied force exerted by the end effector while the medical tool is positioned at the entry7point.

[0307] Clause 15. The non-transitory computer readable medium according to any one of clauses 11-14, the method further comprising: instructing the end effector to maintain an applied force while pivoting the medical tool at the entry point to align with the new trajectory.Page 76 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0308] Clause 16. The non-transitory computer readable medium according to any one of clauses 11-15. the method further comprising: receiving identification data for the target based on the first medical image data; determining a trajectory' extending from the target to an external point on the subject, wherein the external point is identified as the entry point.

[0309] Clause 17. The non-transitory' computer readable according to any one of clauses 11- 16, the method further comprising: receiving identification data for the target and the entry point based on the first medical image data; determining the trajectory' between the identified target and the entry point.

[0310] Clause 18. The non-transitory computer readable medium according to any one of clauses 11-17, wherein the reference marker comprises an emitter or receiver trackable by a tracking system and an object that is visible in both the first and second medical image data.

[0311] Clause 19. The non-transitory computer readable medium according to any one of clauses 11-18, the method further comprising: instructing a tracking system to track the reference marker and the end effector with respect to each other, wherein the end effector has a receiver or emitter trackable by the tracking system.

[0312] Clause 20. The non-transitory computer readable according to any one of claims 11- 19, wherein the medical tool is a needle.

[0313] Clause 21. A surgical robotic system, comprising: an end effector configured to hold and actuate at least one medical tool; a computing device communicatively coupled to the end effector, wherein the computing device comprises a non-transitory computer readable medium storing computer program instructions which, when executed by one or more processors, cause the one or more processors to perform a method of any' one of clauses 11-20.

[0314] Clause 22. The surgical robotic system according to clause 21, wherein the end effector has three or less degrees of freedom.

[0315] Clause 23. The surgical robotic system according to any one of clauses 21-22, wherein the end effector includes a support arm in contact with a surface of a subject and a pivoting mechanism to pivot the medical tool at the entry’ point.

[0316] Clause 24. A surgical robotic system, comprising: a robotic arm having an end effector configured to hold a medical tool; at least one processor: and at least one storage medium having encoded thereon executable instructions that, when executed by the at least onePage 77 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 processor, cause the at least one processor to: (a) receive a medical image data, wherein the medical image data represents a volume of an imaged subject comprising a target; (b) instruct at least one of the robotic arm or the end effector to re-align the medical tool from a position along a first trajectory to a position along a second trajectory to reach the target, wherein the second trajectory is determined based on the medical image data; and (c) instruct at least one of the robotic arm or the end effector to insert the medical tool into the target along the second trajectory7.

[0317] Clause 25. The surgical robotic system clause 24, wherein the end effector comprises an insertion member configured to insert the medical tool into the target, the end effector being configured to move the insertion member in two degrees of freedom.

[0318] Clause 26. The surgical robotic system of any of clauses 24-25, wherein the end effector comprises an insertion member configured to insert the medical tool into the target and one or more actuators configured to move the insertion member about a first axis and a second axis.

[0319] Clause 27. The surgical robotic system of any one of clauses 24-26, wherein the insertion member comprises an actuator to advance the medical tool along the second traj ectory into the target.

[0320] Clause 28. The surgical robotic system of any one of clauses 24-27, wherein the executable instructions, when executed by the one or more processors, further cause the one or more processors to re-align the medical tool by rotating the insertion member.

[0321] Clause 29. The surgical robotic system of any one of clauses 24-28, wherein the end effector comprises a support arm and a pad at a distal end of the support arm, wherein the pad comprises an opening, and wherein the executable instructions, when executed by the one or more processors, further cause the one or more processors to position the pad around an entry point on the subject and insert the medical tool into the entry point through the opening.

[0322] Clause 30. The surgical robotic system of any one of clauses 24-29, wherein the support arm is configured to support at least some of the weight of the robotic arm such that the pad applies a force to the subject around the entry7point wherein the force is configured to limit the movement of the target.Page 78 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0323] Clause 31. The surgical robotic system of any one of clauses 24-30, wherein the robotic arm can move with at least three degrees of freedom, wherein the executable instructions, when executed by the one or more processors, prior to analyzing the medical image data, further cause the one or more processors to position the medical tool near a subject along the first trajectory. and wherein the positioning comprises moving the robotic arm with at least three degrees of freedom.

[0324] Clause 32. The surgical robotic system of any one of clauses 24-31, wherein the executable instructions, when executed by the one or more processors, further cause the one or more processors to re-align the medical tool by repositioning the end effector while restricting the movement of the robotic arm.

[0325] Clause 33. The surgical robotic system of any one of clauses 24-32, wherein the medical image data is a second medical image data, and wherein the executable instructions, when executed by the one or more processors, further cause the one or more processors to compare the second medical image data with a first medical image data, wherein the first medical image data is captured before the second medical image data.

[0326] Clause 34. The surgical robotic system of any one of clauses 24-33, wherein the executable instructions, when executed by the one or more processors, further cause the one or more processors to register the first medical image data with the second medical image data.

[0327] Clause 35. The surgical robotic system of clause 34, wherein the registering comprises registering one or more of the target, an undesirable area, the first trajectory, the medical tool, and an entry point from the first medical image data with the second medical image data.

[0328] Clause 36. The surgical robotic system of any one of clauses 33-35, wherein the size of the image data of the second medical image is smaller than the size of the image data of the first medical image.

[0329] Clause 37. The surgical robotic system of any one of clauses 24-36, wherein the medical image data comprises at least two CBCT projections.

[0330] Clause 38. The surgical robotic system of clause 37, wherein a first projection of the at least two CBCT projections is positioned at an angle relative to a second projection of the at least two CBCT projections.Page 79 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025

[0331] Clause 39. A method comprising: (a) situating a medical tool relative to a subject to enable insertion of the medical tool into a target of a subject along a first trajectory, wherein the medical tool is situated without substantially penetrating the skin of the subject; (b) adjusting the position of the medical tool based on one or more medical images of the target along a second trajectory: and (c) advancing the medical tool along the second trajectory' to the target of the subject.

[0332] Clause 40. The method of clause 39, wherein the first traj ectory is determined based on a first medical image, wherein the second trajectory is determined based on a second medical image, and wherein the size of the image data of the second medical image not greater than the size of the image data of the first medical image.

[0333] Clause 41. The method of any one of clauses 39-40, wherein the adjusting step (c) comprises adjusting the position of the medical tool based on a registration of the first medical image with the second medical image, and wherein the size of the image data of the second medical image not greater than smaller than the size of the image data of the first medical image.

[0334] Clause 42. The method of any one of clauses 39-41, wherein the one or more medical images capture a portion of the target, and w herein the portion of the target is selected based on prior information.

[0335] Clause 43. The method of clause 42, wherein the prior information comprises a first medical image of the target and wherein the first medical image of the target captures a greater area than the one or more medical images.

[0336] Clause 44. The method of any one of clauses 39-43, the method further comprising releasing the medical tool into the target of the subj ect.

[0337] Clause 45. The method of any one of clauses 39-44, wherein the target is a location within or on a surface of a tumor.

[0338] Clause 46. A method comprising: (a) situating a medical tool relative to a subject to enable insertion of the medical tool into a target of a subject along a first trajectory, wherein the medical tool is situated without substantially penetrating the skin of the subject; (b) determining an operational interval based on a respiration cycle of the subject; (c) adjusting the position of the medical tool based on one or more medical images of the target of the subject along a second trajectory; and (d) advancing the medical tool along the second trajectory' to thePage 80 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 target of the subject; wherein the adjusting step (c) and the advancing step (d) occur during the operational interval.

[0339] Clause 47. The method of clause 46, wherein the first traj ectory is determined based on a first medical image, wherein the second trajectory is determined based on a second medical image, and wherein the size of the image data of the second medical image is not greater than the size of the image data of the first medical image.

[0340] Clause 48. The method of any one of clauses 46-47, wherein the adjusting step (c) comprises adjusting the position of the medical tool based on a registration of the first medical image with the second medical, and wherein the size of the image data of the second medical image is smaller than the size of the image data of the first medical image.

[0341] Clause 49. The method of any one of clauses 46-48, wherein the determining the operational interval comprises detecting the duration the target is within a positional threshold.

[0342] Clause 50. The method of any one of clauses 46-49, wherein the determining the operational interval comprises estimating the operational interval based on at least one previous respiration cycle of the subject.

[0343] Clause 51. The method of any one of clauses 46-50, wherein the operational interval begins an estimated time after a predetermined point in the respiration cycle.

[0344] Clause 52. The method of clause 51, wherein the predetermined point is an end of an inhale or an end of an exhale.

[0345] Clause 53. The method of any one of clauses 46-52, wherein the respiration of the subject is uninterrupted during the inserting step (d).

[0346] Clause 54. The method of any one of clauses 46-53, wherein the operational interval is the duration the target is within a positional threshold.

[0347] Clause 55. The method of clause 54, wherein the positional threshold comprises a range of allowable positions for the target during the advancing step (d).

[0348] Clause 56. The method of any one of clauses 46-55, wherein the adjusting step (c) is performed within a time duration Tadjusting, and wherein Tadjusting is between 50 milliseconds and 1 second.Page 81 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCT Electronically Filed: December 18. 2025

[0349] Clause 57. The method of any one of clauses 46-56, wherein the advancing step (d) is performed within a time duration Tadvancing, and wherein Tadvancing is between 50 milliseconds and 1 second.

[0350] Clause 58. The method of any one of clauses 46-57, wherein the one or more medical images capture a portion of the target, and wherein the portion of the target is selected based on prior information.

[0351] Clause 59. The method of clause 58, wherein the prior information comprises a first medical image of the target and wherein the first medical image of the target captures a greater area than the one or more medical images.

[0352] Clause 60. The method of any one of clauses 46-59, the method further comprising releasing the medical tool into the target of subject.

[0353] Clause 61. The method of any one of clauses 46-60, wherein the target is a location within or on a surface of a tumor.Page 82 of 94ACTIVE 717494056v1

Claims

Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025CLAIMSWhat is claimed is:

1. A surgical robotic system (100), comprising: an end effector (102) configured to hold and insert a medical tool (108); and a computing device (5000) communicatively coupled to the end effector (102), wherein the computing device (5000) comprises a computer readable medium storing computer program instructions which, when executed by one or more processors (130), cause the one or more processors (130) to perform a method comprising:(a) receiving first medical image data from an imaging device (103), wherein the first medical image data represents a first volume of an imaged subject (106), comprising a target (109) within the subject (106), an entry point (1 10), and a reference marker (107) attached to or integrated in the end effector (102) that are located and identified within the first medical image data;(b) instructing the end effector (102) to align the medical tool (108) held by the end effector (102) and being located at or above the entry point (110) along a trajectory (1 11) reaching the target (109), wherein the trajectory (111) is determined between the target (109) and the entry' point (110) based on the first medical image data;(c) receiving second medical image data from the imaging device (103), wherein the second medical image data represents a second volume of the imaged subject (106), comprising the target (109), the second medical image data being registered to the first medical image data;(d) instructing the end effector (102) to re- align the medical tool (108) at or above the entry point (110) along a new trajectory (111(1)) reaching the target (109), wherein the new traj ectory ( 111 (1 )) is determined between the target (109) and the entry point (110) based on the second medical image data by comparing the position data of the end effector (102) or the medical tool (108) to the reference marker (107) in the second image data relative to the first image data; and(e) instructing the end effector (102) to insert the medical tool (108) located at or above the entry point (110) along the new trajectory (111(1)) reaching the target (109) upon receiving an insertion instruction.

2. The surgical robotic system (100) according to claim 1, wherein the second volume of the imaged subject (106) is smaller than the first volume of the imaged subject (106).Page 83 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 20253. The surgical robotic system (100) according to claim I . wherein a reference marker coordinate system is registered with a coordinate system (A) of the end effector ( 102) and wherein the coordinate system (A) of the end effector (102) is registered with an image coordinate system (Rx), and wherein the coordinate system (Rx) of the first medical image data is registered with the coordinate system (A) of the reference marker (107) using fiducials of the reference marker (107).

4. The surgical robotic system (100) according to claim 3, wherein the reference marker (107) comprises a) an emitter or receiver trackable by a tracking system, and b) an object that is visible in both the first and second medical images.

5. The surgical robotic system (100) according to claim 4, wherein the method comprising: tracking, via a tracking system, the reference marker (107) and the end effector (102) with respect to each other, wherein the end effector (102) has a receiver or emitter trackable by the tracking system.

6. The surgical robotic system (100) according to any one of claims 1-5, wherein the first and the second medical image data are three-dimensional medical image data.

7. The surgical robotic system (100) according to claim 6, wherein the medical tool (108) is a needle.

8. The surgical robotic system (100) according to claim 1, wherein the end effector (102) has three or less degrees of freedom.

9. The surgical robotic system (100) according to claim 8, wherein the surgical robotic system (100) further comprises a robotic arm (101) connected to the end effector (102).

10. The surgical robotic system (100) according to claim 1, wherein the system (100) further comprises a display configured to display the first medical image data and the second medical image data, the trajectory (111, and the new trajectory (111(1)); and a user interface configured to receive user inputs.Page 84 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 202511. A non-transitory computer readable medium storing computer program instructions which, when executed by one or more processors (130), cause the one or more processors (130) to perform a method comprising: receiving first medical image data from an imaging device (103), wherein the first medical image data represents a first volume of an imaged subject (106), and locating and identifying a target (109) within the subject (106), an entry point (1 10), and a reference marker (107) attached to or integrated in an end effector (102) within the first medical image data; registering a reference marker coordinate system with a coordinate system (A) of the end effector (102) and registering the coordinate system (A) of the end effector (102) with an image coordinate system (Rx); generating instructions for the end effector (102) to align the medical tool (108) held by the end effector (102) and being located at or above the entry point (110) along a trajectory' (111) reaching the target (109), wherein the trajectory (111) is determined between the target (109) and the entry point (110) based on the first medical image data; receiving second medical image data from the imaging device (103), wherein the second medical image data represents a second volume of the imaged subject (106), comprising the target (109) and the reference marker (107); registering the second medical image data to the first medical image data; generating instructions for the end effector (102) to align the medical tool (108) at or above the entry point (110) along anew trajectory (111(1)) reaching the target (109), wherein the new trajectory' is determined between the target (109) and the entry' point (110) based on the second medical image data by comparing the position data of the end effector (102) or the medical tool(108) to the reference marker (107) in the second image data relative to the first image data; and generating instructions for the end effector (102) to insert the medical tool (108) located at or above the entry point (110) along the new trajectory (111(1) reaching the target (109) upon receiving an insertion instruction.

12. A non-transitory' computer readable medium storing computer program instructions which, when executed by one or more processors (130), cause the one or more processors (130) to perform a method comprising:(a) receiving first medical image data from an imaging device (103), wherein the first medical image data represents a first volume of an imaged subject (106) and comprises a target(109) within the subject (106), an entry' point (110, 1503), and a reference marker (107) attached to or integrated in an end effector (102) that are located and identified within the first medicalPage 85 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 image data, wherein a reference marker coordinate system is registered with a coordinate system (A) of the end effector (102) and wherein the coordinate system (A) of the end effector (102) is registered with an image coordinate system (Rx);(b) instructing the end effector (102) to maintain alignment of a medical tool (108, 1505) held by the end effector (102) along a trajectory (111) extending from the entry point (110. 1503) on the subject’s surface (1704) to the target (109), the trajectory (111) being determined between the target (109) and the entry point (110, 1503) based on the first medical image data, wherein the alignment is maintained by instructing the end effector (102) to apply a force exerted on the subject’s surface (1704) while the medical tool (108, 1505) is positioned at the entry point (110, 1503) aligned with the trajectory (111);(c) receiving second medical image data distinct from the first medical image data from the imaging device (103) while the medical tool (108, 1505) maintained its position at the entry point (110, 1503) aligned with the traj ectory (111), wherein the second medical image data represents a second volume of the imaged subject (106) and comprises the target (109), the entry point (110, 1503), and the reference marker (107), the second medical image data being registered to the first medical image data; and(d) instructing the end effector (102) to pivot the medical tool (108, 1705) at the entry point (110, 1503) to align with anew trajectory (111(1)) and to insert the medical tool (108, 1505) located at the entry point (110) along the new trajectory (111(1)) extending from the entry point (HO, 1503) on the subject’s surface (1504) to the target (109) upon receiving an insertion instruction, wherein the new7trajectory7(111(1)) is determined based on the second medical image data by comparing the position data of the end effector (102) or the medical tool (108, 1505) to the reference marker (107) in the second image data relative to the first image data.

13. The non-transitory computer readable medium of claim 12, wherein the second volume of the imaged subject (106) is smaller than the first volume of the imaged subject (106).

14. The non-transitory computer readable medium according to claim 12, the method comprises: maintaining alignment of the medical tool (108, 1505) along the new trajectory(111(1)) by an applied force exerted by the end effector (102) while the medical tool (108, 1505) is positioned at the entry point (110, 1503).

15. The non-transitory7computer readable medium according to any one of claims 12-14, the method further comprising:Page 86 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 instructing the end effector ( 102) to maintain an applied force while pivoting the medical tool (108, 1505) at the entry point (110, 1503) to align with the new trajectory (111(1)).

16. The non- transitory computer readable medium according to claim 12, the method further comprising: receiving identification data for the target (109) based on the first medical image data; determining a trajectory (111) extending from the target (109) to an external point on the subject, wherein the external point is identified as the entry point (110).

17. The non-transitory computer readable according to claim 12. the method further comprising: receiving identification data for the target (109) and the entry point (1 10, 1503) based on the first medical image data; and determining the trajectory' (111) between the identified target (109) and the entry point (110, 1503).

18. The non-transitory computer readable medium according to claim 12, wherein the reference marker (107) comprises an emitter or receiver trackable by a tracking system and an object that is visible in both the first and second medical image data.

19. The non-transitory computer readable medium according to claim 18, the method further comprising: instructing a tracking system to track the reference marker (107) and the end effector (102) with respect to each other, wherein the end effector (102) has a receiver or emitter trackable by the tracking system.

20. The non-transitory computer readable according to claim 12, wherein the medical tool (108, 1505) is a needle.

21. A surgical robotic system (100) comprising: an end effector (102) configured to hold and actuate at least one medical tool (108, 1505); and a computing device (5000) communicatively coupled to the end effector (102), wherein the computing device (5000) comprises a non-transitory computer readable medium storingPage 87 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 computer program instructions which, when executed by one or more processors (130), cause the one or more processors (130) to perform a method of any one of claims 16-20.

22. The surgical robotic system (100) according to claim 21, wherein the end effector (102) has three or less degrees of freedom.

23. The surgical robotic system (100) according to claim 21, wherein the end effector (102) includes a support arm (130) in contact with a surface (1504) of a subject (106) and a pivoting mechanism (1502) to pivot the medical tool (108, 1505) at the entry point (110).

24. A surgical robotic system (100), comprising: a robotic arm having an end effector configured to hold a medical tool (108); at least one processor; and at least one storage medium having encoded thereon executable instructions that, when executed by the at least one processor, cause the at least one processor to:(a) receive a medical image data, wherein the medical image data represents a volume of an imaged subject comprising a target (109);(b) instruct at least one of the robotic arm or the end effector to re-align the medical tool (108) from a position along a first trajectory to a position along a second trajectory to reach the target (109), wherein the second trajectory is determined based on the medical image data; and(c) instruct at least one of the robotic arm or the end effector to insert the medical tool (108) into the target (109) along the second trajectory.

25. The surgical robotic system (100) of claim 24, wherein the end effector comprises an insertion member configured to insert the medical tool into the target, the end effector being configured to move the insertion member in two degrees of freedom.

26. The surgical robotic system (100) of claim 24, wherein the end effector comprises an insertion member configured to insert the medical tool into the target and one or more actuators configured to move the insertion member about a first axis and a second axis.

27. The surgical robotic system (100) of claim 26, wherein the insertion member comprises a actuator to advance the medical tool along the second trajectory' into the target.Page 88 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 202528. The surgical robotic system (100) of claim 25, wherein the executable instructions, when executed by the at least one processor, further cause the at least one processor to re-align the medical tool by rotating the insertion member.

29. The surgical robotic system (100) of claim 24, wherein the end effector comprises a support arm and a pad at a distal end of the support arm, wherein the pad comprises an opening, and wherein the executable instructions, when executed by the one or more processors, further cause the one or more processors to position the pad around an entry point on the subject and insert the medical tool into the entry point through the opening.

30. The surgical robotic system (100) of claim 29, wherein the support arm is configured to support at least some of the weight of the robotic arm such that the pad applies a force to the subject around the entry point wherein the force is configured to limit the movement of the target.

31. The surgical robotic system (100) of claim 24, wherein the robotic arm can move with at least three degrees of freedom, wherein the executable instructions, when executed by the at least one processor, prior to analyzing the medical image data, further cause the one or more processors to position the medical tool near a subject along the first trajectory’, and wherein the positioning comprises moving the robotic arm with at least three degrees of freedom.

32. The surgical robotic system (100) of claim 24, wherein the executable instructions, when executed by the at least one processor, further cause the one or more processors to re-align the medical tool by repositioning the end effector while restricting the movement of the robotic arm.

33. The surgical robotic system (100) of claim 24, wherein the medical image data is a second medical image data, and wherein the executable instructions, when executed by the at least one processor, further cause the one or more processors to compare the second medical image data with a first medical image data, wherein the first medical image data is captured before the second medical image data.Page 89 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 202534. The surgical robotic system (100) of claim 33, wherein the executable instructions, when executed by the one or more processors, further cause the one or more processors to register the first medical image data with the second medical image data.

35. The surgical robotic system (100) of claim 34, wherein the registering comprises registering one or more of the target, an undesirable area, the first trajectory, the medical tool, and an entry point from the first medical image data with the second medical image data.

36. The surgical robotic system (100) of claim 35, wherein the size of the image data of the second medical image is smaller than the size of the image data of the first medical image.

37. The surgical robotic system (100) of claim 24, wherein the medical image data comprises at least two CBCT projections.

38. The surgical robotic system (100) of claim 37, wherein a first projection of the at least two CBCT projections is positioned at an angle relative to a second projection of the at least two CBCT projections.

39. A method comprising:(a) situating a medical tool relative to a subject to enable insertion of the medical tool into a target of a subject along a first trajectory. wherein the medical tool is situated without substantially penetrating the skin of the subject;(b) adjusting the position of the medical tool based on one or more medical images of the target along a second trajectory; and(c) advancing the medical tool along the second trajectory to the target of the subject.

40. The method of claim 39, wherein the first trajectory is determined based on a first medical image, wherein the second trajectory is determined based on a second medical image, and wherein the size of the image data of the second medical image not greater than the size of the image data of the first medical image.41 . The method of claim 39, wherein the adjusting step (c) comprises adjusting the position of the medical tool based on a registration of the first medical image with the second medicalPage 90 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 image, and wherein the size of the image data of the second medical image not greater than smaller than the size of the image data of the first medical image.

42. The method of claim 39, wherein the one or more medical images capture a portion of the target, and wherein the portion of the target is selected based on prior information.

43. The method of claim 42, wherein the prior information comprises a first medical image of the target and wherein the first medical image of the target captures a greater area than the one or more medical images.

44. The method of claim 39, the method further comprising releasing the medical tool into the target of the subject.

45. The method of claim 39, wherein the target is a location within or on a surface of a tumor.

46. A method comprising:(a) situating a medical tool relative to a subject to enable insertion of the medical tool into a target of a subject along a first trajectory, wherein the medical tool is situated without substantially penetrating the skin of the subject;(b) determining an operational interval based on a respiration cycle of the subject;(c) adjusting the position of the medical tool based on one or more medical images of the target of the subject along a second trajectory; and(d) advancing the medical tool along the second trajectory to the target of the subject; wherein the adjusting step (c) and the advancing step (d) occur during the operational interval.

47. The method of claim 46, wherein the first trajectory is determined based on a first medical image, wherein the second trajectory is determined based on a second medical image, and wherein the size of the image data of the second medical image is not greater than the size of the image data of the first medical image.

48. The method of claim 46, wherein the adjusting step (c) comprises adjusting the position of the medical tool based on a registration of the first medical image with the second medical, andPage 91 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCTElectronically Filed: December 18. 2025 wherein the size of the image data of the second medical image is smaller than the size of the image data of the first medical image.

49. The method of claim 46, wherein the determining the operational interval comprises detecting the duration the target is within a positional threshold.

50. The method of claim 49, wherein the determining the operational interval comprises estimating the operational interval based on at least one previous respiration cycle of the subject.

51. The method of claim 50, wherein the operational interval begins an estimated time after a predetermined point in the respiration cycle.

52. The method of claim 51, wherein the predetermined point is an end of an inhale or an end of an exhale.

53. The method of claim 46, wherein the respiration of the subject is uninterrupted during the inserting step (d).

54. The method of claim 46, wherein the operational interval is the duration the target is within a positional threshold.

55. The method of claim 54, wherein the positional threshold comprises a range of allowable positions for the target during the advancing step (d).

56. The method of claim 46, wherein the adjusting step (c) is performed within a time duration Tadjusting, and wherein Tadjusting is between 50 milliseconds and 1 second.

57. The method of claim 46, wherein the advancing step (d) is performed within a time duration Tadvancing, and wherein Tadvancing is between 50 milliseconds and 1 second.

58. The method of claim 46, wherein the one or more medical images capture a portion of the target, and wherein the portion of the target is selected based on prior information.Page 92 of 94ACTIVE 717494056v1Atorney Docket No. 234839-010203 / PCT Electronically Filed: December 18. 202559. The method of claim 58, wherein the prior information comprises a first medical image of the target and wherein the first medical image of the target captures a greater area than the one or more medical images.

60. The method of claim 46, the method further comprising releasing the medical tool into the target of subject.

61. The method of claim 46, wherein the target is a location within or on a surface of a tumor.Page 93 of 94ACTIVE 717494056v1

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