Device for controlling a remote surgical instrument

Abstract

The invention relates to a device (1) for controlling a remote surgical instrument, the device (1) comprising - a body intended to be handled by an operator; - at least one electrode (4a, 4b); - a plurality of sensors, comprising: -- a capacitive sensor configured to measure the capacitance of the at least one electrode; -- an inertial sensor configured to measure the angular velocity of the body and to measure the acceleration of the body; - a microcontroller configured to -- determine a movement of the body, based on the angular velocity and the acceleration; -- detect contact between the external surface of the body and the operator, based on the measured capacitance and the movement of the body, so as to check whether the device (1) is being held by the operator; and -- authorise a movement command for the surgical instrument when contact is detected, the remote surgical instrument being actuated so as to move in accordance with the movement command.

Description

[0001] DESCRIPTION

[0002] TITLE: Remote surgical instrument control device TECHNICAL FIELD

[0003] This disclosure relates to the general field of remote control devices for surgical instruments, and in particular to the telemanipulation of vitreoretinal surgical instruments in the context of robot-assisted ophthalmic microsurgery. STATE OF THE ART

[0004] Ophthalmic microsurgery, particularly vitreoretinal procedures, requires extreme precision and exceptional dexterity. Indeed, during these procedures, an operator, typically a surgeon, works on structures of the eye such as the retina, the epiretinal membrane, or capillaries, some of which are only a few tens of micrometers thick.

[0005] Recent technological advances have enabled the integration of robotic systems to assist surgeons in these delicate procedures. During robot-assisted teleoperated surgeries, the surgeon remotely controls surgical instruments to perform various operations on a patient. The surgeon's hands interact with a human-machine interface (HMI) to execute these actions. For example, document FR 3109717 A1 proposes a control interface for a robotic system that replicates the context of a vitreoretinal procedure by introducing mechanical constraints on a rod to control the movements of the robotic arm performing the microsurgical intervention.

[0006] However, remote control of vitreoretinal surgical instruments (VSI) remains a major challenge due to the precision and responsiveness requirements necessary for a successful procedure. Remote control presents additional difficulties for the surgeon. Firstly, the loss of tactile feedback from the remote control means that the surgeon cannot experience the same sensations as during conventional surgery. Furthermore, the surgeon cannot perform the procedure and simultaneously manage auxiliary equipment, such as the parameters of a vitrectomy station, a laser unit, a microscope, or the surgical robotic system. Therefore, the surgeon must receive external assistance or interrupt their surgical actions to manipulate the auxiliary equipment before resuming the operation.This can increase the risk of complications during the procedure, decrease its effectiveness and lengthen the operating time.

[0007] US patents 2023 / 126506 A1 and WO 2019 / 240824 A1 describe surgical instrument control devices configured to detect whether the remote control is being held by the operator. However, the solutions provided are insufficient to guarantee safe operation of the surgical instrument used for vitreoretinal surgery.

[0008] DESCRIPTION OF THE INVENTION

[0009] One aim of this disclosure is to propose a reliable and efficient device for the telemanipulation of surgical instruments, enabling improvement of the surgeon's autonomy, the fluidity and precision of his operative gestures and thus to improve the safety of surgical interventions, in particular robot-assisted vitreoretinal interventions.

[0010] This goal is achieved by a device for remotely controlling a surgical instrument, comprising

[0011] a body intended to be manipulated by an operator like a stylus, and comprising

[0012] an external surface,

[0013] o a gripping portion, intended to be grasped by the fingers of an operator,

[0014] o a support portion, intended to rest on a dorsal face of the operator's hand, when the body is manipulated by the operator like a stylus;

[0015] an array of electrodes arranged on the external surface of the body, comprising o a primary electrode arranged on the support portion; and o an electrode array formed by a plurality of secondary electrodes arranged on the grasping portion,

[0016] a plurality of sensors, including:

[0017] o a capacitive sensor, configured to measure:

[0018] ■ a capacitance of the main electrode;

[0019] ■ a capacitance of a secondary electrode in the electrode array; o an inertial sensor, configured to measure the angular velocity of the body and to measure the acceleration of the body; a microcontroller, configured to

[0020] to determine, from the angular velocity and acceleration, a displacement of the body;

[0021] to detect, from the measured capacitance of the primary electrode, the measured capacitance of the secondary electrode, and the body's displacement, contact between the external surface of the body and the operator, so as to verify whether the device is being held by the operator like a stylus, with contact between the support portion and the operator's hand being detected from the measured capacitance of the primary electrode; and contact between the gripping portion and the operator's fingers being detected from the measured capacitance of the secondary electrode; and

[0022] o to allow a remote movement command for the surgical instrument, when contact between the external surface of the body and the operator is detected, the device being held by the operator like a stylus;

[0023] the remote surgical instrument being actuated so as to move in accordance with the movement command.

[0024] The proposed control device comprises a portable body equipped with a full suite of sensors to detect contact with the operator's fingers, body accelerations, and changes in angular velocity as the operator manipulates it. The body can have a shape and dimensions that allow for ergonomic use, similar to that of a conventional portable surgical instrument, with the device being manipulated like a stylus.

[0025] The control device can be easily integrated into a surgical station implementing state-of-the-art robotics and remote control technologies. Using the control device allows surgeons to manipulate the surgical instrument remotely with micrometric precision, while minimizing the risk of complications.

[0026] The control device is particularly well-suited to ophthalmic microsurgery, offering a reliable and efficient solution for the remote manipulation of vitreoretinal surgical instruments, thus contributing to optimal surgical outcomes. The invention is advantageously complemented by the following features, taken individually or in any technically feasible combination thereof:

[0027] - The microcontroller is further configured to determine a movement of an operator's finger in contact with the gripping portion, from capacitances of the plurality of secondary electrodes measured by the capacitive sensor.

[0028] - The plurality of secondary electrodes is arranged on the gripping portion, so as to cover at least 90% of the external surface of the gripping portion.

[0029] - The body includes an outer envelope forming the external surface, the outer envelope being elastically deformable, and the electrode assembly further includes a reference electrode arranged inside the body, opposite at least one electrode, so that the outer envelope is disposed between at least one electrode and the reference electrode, the microcontroller being further configured to determine a pressure exerted on the external surface by the operator, from the measured capacitance and a capacitance of the reference electrode measured by the capacitive sensor.

[0030] - The microcontroller is also configured to:

[0031] to determine the operator's tremor frequency, based on the angular velocity and / or acceleration measured by the inertial sensor, when contact is detected; and

[0032] The angular velocity and acceleration measured by the inertial sensor are filtered, and the displacement command is authorized based on the filtered angular velocity and acceleration, so as to eliminate from the displacement command any displacements associated with a frequency within a specified frequency range, the specified frequency range including the determined tremor frequency. The control device further includes a haptic actuator designed to generate body vibration, and the microcontroller is further configured to activate the haptic actuator upon receiving an external signal.

[0033] - The haptic actuator is designed to generate vibration within a predetermined frequency range, and the microcontroller is further configured to filter the angular velocity and acceleration measured by the inertial sensor, with displacement control permitted from the filtered angular velocity and filtered acceleration, so as to eliminate from the displacement control displacements associated with a frequency within the predetermined frequency range.

[0034] - The body extends between a first end and a second end, the first end and / or the second end comprising a connection portion configured to receive a connector linked to a surgical station, so as to allow

[0035] a transmission of signals generated by the microcontroller to the surgical station; and / or

[0036] transmission of an event signal generated by the surgical station to the microcontroller.

[0037] According to another aspect, a surgical system is proposed comprising:

[0038] a control system as described above;

[0039] a remotely controlled surgical instrument;

[0040] a surgical station, comprising a robotic arm configured to move the surgical instrument in accordance with the movement command, when the piloting device is held by an operator.

[0041] DESCRIPTION OF THE FIGURES

[0042] Other features, purposes and advantages of the invention will become apparent from the following description, which is purely illustrative and not limiting, and which should be read in conjunction with the accompanying drawings on which:

[0043] Figure 1 is a perspective view of a control interface comprising two control devices according to the invention.

[0044] Figure 2 is a schematic representation of a control device according to the invention. Figure 3 is a cross-sectional view of the control device of Figure 2.

[0045] Figure 4 is a schematic representation of the control device with a connector for the interface of Figure 1.

[0046] Figure 5 is a schematic representation of another model of a control device according to the invention.

[0047] Figure 6 is a cross-sectional view of the control device of Figure 5.

[0048] Across all figures, similar elements bear identical references.

[0049] DETAILED DESCRIPTION OF THE INVENTION Control Interface

[0050] The proposed surgical instrument control device can be used with a control interface used to operate a surgical robot. As presented in the introduction, the control interface, for example, that proposed in document FR3109717A1, can be advantageously used in the field of robot-assisted, remotely operated ophthalmic microsurgery, or vitreoretinal surgery.

[0051] With reference to Figure 1, the control interface 100 of a robotic platform includes a guidance device 110, 110' comprising two rods, each rod being connected to a control device 1, 1' according to the invention. The control device 1, 1' is intended to be manipulated by an operator during a surgical operation. It is removably mounted on the guidance device 110, 110'.

[0052] The control interface 100 comprises two articulated chains 200. The control interface 1 enables highly precise positioning measurements in space. In other words, the purpose of the control interface 100 is to measure the positions of the control device 1,1' with very high accuracy. From these measured positions, the control command for the robotic arms can be generated.

[0053] The articulated chain 200 comprises at least two articulated arms 202 connected to each other by joints 201 designed to allow the articulated chain 200 to move. Preferably, each joint 201 is equipped with its own motor, enabling it to generate forces, and includes an angular position sensor to precisely measure its orientation.

[0054] One end of the articulated chain 200 is connected to a support 400. Each articulated chain 200 has a free end 300, opposite the end fixed to the support 400. The free end 300 is fixed to the guide device 110.

[0055] The guide device 110 comprises a fixed surface 111 relative to the support 400, a rod, and a guide means through which the surface and the rod cooperate. The fixed surface 111 provides support for the guide means, i.e., it provides its mechanical support. The guide means is mounted on the fixed surface 111 by a ball joint, and the rod is mounted on the guide means by a sliding joint, thus forming a sliding ball joint.

[0056] Incidentally, the rod of the 110,110' guide device can be manipulated by changing its orientation around the ball joint, by rotating it around its axis, and by translating it along its axis. In this context, from the surgeon's perspective, the rod is comparable to the shaft of a surgical instrument used in vitreoretinal surgery. The rotation of the rod around its axis, that is, the rotation of the rod 30 on itself, corresponds to a rotation of the instrument on itself. The change in the rod's orientation corresponds to a change in the orientation of the instrument and the axis of a trocar inserted into the patient's eye, the trocar necessarily following the changes in orientation of the surgical instrument.Finally, the translational movement of the rod along its axis corresponds to an insertion / retraction of the instrument into / from the trocar, the insertion or retraction depending on the direction in which the translational movement is operated.

[0057] Using the interface to control a surgical instrument

[0058] Thus, the control device 1 can be used in a surgical system comprising a remotely controllable surgical instrument, and a surgical station, including a robotic arm.

[0059] The control interface 100 communicates with the robotic arm, to which one or more surgical instruments are attached. The robotic arm is configured so that the movements of the surgical instruments are identical to the movements performed by the control device 1,1' attached to the control interface 100 when the control device 1,1' is manipulated by the surgeon. In other words, the robotic arm is configured to move the surgical instrument according to a movement command generated from the operator's manipulation of the control device 1,1'. Thus, a patient can be operated on remotely. The movement command can be generated by a processor in the control interface 100 or in the surgical station.

[0060] The 100 control interface coupled with the 1.1' control device allows intuitive manipulation of many surgical instruments, in particular vitreoretinal surgical instruments.

[0061] The operator thus benefits from greater flexibility, as the control device is compatible with different types of vitreoretinal surgical instruments.

[0062] Conventional surgical instruments that can be used in ophthalmic microsurgery and that can be manipulated by the robotic arm as part of a surgical procedure using the 100 pilot interface include, for example, an endo-illumination probe, an endodiathermy probe, a vitrectomy probe, a cannula with a retractable needle tip, a counter-current rinsing device, a laser probe with a foldable tip, and vitreoretinal forceps or scissors.

[0063] All these instruments are designed to be used by hand, allowing the surgeon to manipulate them manually to achieve three-dimensional positioning.

[0064] Some surgical instruments have specific functions that are also operated manually. For example, a cannula with a retractable needle tip may include a sliding mechanism on a handle, which extends the retractable needle to perform injections into the patient's posterior chamber. Flushing devices, laser probes, and vitreoretinal scissors require the surgeon to apply pressure with their fingers to specific elements of the handle, such as squeezing a tube to activate an eye rinse or pinching tabs on the laser probe to operate it effectively.

[0065] As will be detailed later, the 1.1' control device allows the specific functions of surgical instruments to be used remotely, without requiring direct manipulation of the surgical instruments or the involvement of an external operator.

[0066] Presentation of the control system 1

[0067] With reference to Figure 2, the piloting device 1 comprises a body extending substantially along a longitudinal axis X. The body includes an external surface and is intended to be manipulated by an operator, typically the surgeon.

[0068] The design of the control device 1 closely resembles that of traditional surgical instruments, while incorporating several advanced features that enhance remote operation with the robotic arm. The user experience is comparable to that of a conventional handheld surgical instrument.

[0069] The body includes a support portion 3. The support portion 3 extends along the longitudinal axis X from a first end of the body to a junction zone. The support portion 3 has a substantially cylindrical or conical shape. When the control device 1 is assembled on the control interface of Figure 1, the support portion 3 extends in line with the rod of the guide device 110 connected to the end 300 of the articulated arm 202; that is, the X axis coincides with the axis along which the articulated arm 202 extends. The support portion 3 is designed to rest on the operator's hand when the body is held by the operator, like a stylus. The body includes a gripping portion 2 extending along the longitudinal axis X in line with the support portion 3.The cross-section of the gripping portion 2 in a plane orthogonal to the longitudinal axis X increases progressively from the junction zone with the support portion 3, then decreases to a second end of the body.

[0070] The gripping portion 2 is designed to be grasped by the operator's fingers, like a stylus. Thus, the operator's fingers, typically the fingertips of the thumb and index finger, are in contact with the outer surface of the gripping portion 2 when using the control device 1. The support portion 3 can rest on the back of the operator's hand grasping the gripping portion 2. Typically, the outer surface of the support portion 3 can be in contact with the anatomical snuffbox formed between the operator's thumb and index finger. In this way, the control device 1 can be held firmly and ergonomically by the operator during a surgical procedure when the operator manipulates the control device 1 coupled to the control interface 100.

[0071] With reference to the pilot device model 1 illustrated in Figures 2 to 4, the gripping portion 2 may include a low-curvature zone and a maximum-curvature zone. The maximum-curvature zone corresponds to a portion of the external surface of the gripping portion 2 where the cross-section of the gripping portion 2 is maximized. The maximum-curvature zone may be designed to be gripped by the operator when the pilot device is being manipulated. This allows for ergonomic handling.

[0072] The low-curvature zone is typically a portion of the external surface extending between the maximum curvature zone and the junction with the support portion 3. The intersection between the low-curvature zone and a sagittal plane of the control device 1 passing through the longitudinal axis X forms, for example, a straight line. When the gripping portion 2 is grasped by the operator, the operator can slide one of their fingers, for example, the middle or index finger, along the low-curvature zone, for example, in the direction of the longitudinal axis. This enables the activation of specific functions of the remotely operated surgical instrument, as detailed below.

[0073] Referring to the pilot device model 1 illustrated in Figures 5 and 6, the gripping portion 2 can have a substantially cylindrical shape. The gripping portion 2 extends along the X-axis as a continuation of the support portion 3. The gripping portion 2 has a larger cross-section than the support portion 3. A junction zone connects the two cylindrical portions, preferably forming a curved transition. This improves the ergonomics of the pilot device 1. The lateral surface of the gripping portion 2 creates a surface on which an operator's finger can slide along a straight line parallel to the X-axis, or along a curved line, for example, a circle centered at a point on the X-axis. Such a design is particularly suitable for manipulating the surgical instrument remotely.

[0074] The control device 1 comprises an electrode array including at least one electrode arranged on the external surface of the body.

[0075] With reference to Figure 3, the control device 1 comprises a set of sensors. The sensor set includes a capacitive sensor 54, configured to measure the capacitance of at least one electrode.

[0076] The sensor assembly also includes an inertial sensor 52, configured to measure the angular velocity of the body and to measure the acceleration of the body. Preferably, the inertial sensor 52 is configured to measure the angular accelerations and velocities of the control device 1 along three orthogonal axes.

[0077] The control device 1 further includes a microcontroller 51. The microcontroller 51 is configured to

[0078] - determine, from the angular velocity and acceleration, a displacement of the body;

[0079] - to detect, based on the measured capacity and body movement, contact between the external surface of the body and the operator, in order to verify whether the device is being held by the operator; and

[0080] - to allow a remote movement command for the surgical instrument, when contact is detected, the device being held by the operator.

[0081] Thus, the robotic arm to which the control interface 100 is connected can remotely actuate the surgical instrument so that it moves according to the displacement command. The use of acceleration measurement allows for more reliable detection of body movement. The capacitive measurement redundantly ensures that the control device 1 is properly held by the operator.

[0082] Preferred embodiment described in detail: In the illustrated embodiment, the electrode assembly includes a main electrode 4a. The main electrode 4a is arranged on the support portion 3. The main electrode 4a can almost completely cover the outer surface at the support portion 3, so that the operator's hand is in contact with the main electrode 4a when the control device 1 is manipulated. Alternatively, the main electrode 4a can be arranged on the outer surface at a point of contact with the operator's hand during the intended manipulation.

[0083] The electrode assembly comprises an electrode array. The electrode array is formed by a plurality of secondary electrodes 4b arranged on the gripping portion 2, that is, distributed across the outer surface of the gripping portion 2. Each secondary electrode 4b has a surface area smaller than that of the primary electrode 4a. The secondary electrodes 4b of the electrode array may be identical or different in shape. Typically, the secondary electrodes 4b are triangular, rectangular, or, in the model shown in Figure 5, all have an identical hexagonal shape. The secondary electrodes 4b are arranged on the outer surface of the gripping portion 2 to form a grid.

[0084] The gripping portion 2 covered by the secondary electrode array 4b is intended to be mainly manipulated by the thumb, index and middle fingers of the operator, in the same way that an operator would hold a traditional surgical instrument or more generally a stylet.

[0085] The control unit comprises an electronic board 5 with a printed circuit board (PCB). The microcontroller 51 (or MCU) is connected to the electronic board 5. The microcontroller 51 is configured to perform calculations and fulfill several essential functions of the control unit 1, as will be detailed later. It is connected to the sensor array and, in particular, configured to receive signals emitted by the capacitive sensor 54 and the inertial sensor 52. Thus, it collects operating data from the control unit 1 and can process the signals received from sensors 52 and 54.

[0086] The sensor array can be powered via the electronic board 5. The inertial sensor 52, for example, includes a microelectromechanical system (MEMS) integrated circuit incorporating both an accelerometer and a gyroscope. The integrated circuit includes a digital communication interface with the microcontroller 51. Thus, the inertial sensor 52 can transmit acceleration and / or angular velocity measurements to the microcontroller 51.

[0087] The capacitive sensor 54 is, for example, a capacitive touch sensor or a proximity sensor. The capacitive sensor 54 includes a digital communication interface with the microcontroller 51. Thus, the capacitive sensor 54 can transmit contact information between one of the electrodes 4a, 4b and an operator's finger to the microcontroller 51. The capacitive sensor 54 is configured to match a number N of input channels to the number N of electrodes in the electrode array of the control device 1. In the illustrated embodiment, the capacitive sensor 54 includes a main input channel connected to the main electrode 4a, a secondary input channel for each secondary electrode 4b of the secondary electrode array, and a reference input channel for the reference electrode 4r.

[0088] The electrode array comprises a plurality of small conductors, which can be in the form of cables, pads, or tubes. Nearby elements, such as the operator's hand or finger, act as impedances that interfere with the electric field generated by the secondary electrodes 4b. By estimating the variations in the electric field from capacitance measurements of the capacitive sensor 54, the microcontroller 51 can detect contact, finger movement, and pressure intensity, as will be detailed later.

[0089] Thus, the microcontroller 51 is configured to detect contact between the support portion 3 and the operator's hand based on the capacitance of the main electrode 4a measured by the capacitive sensor 54. Alternatively, the microcontroller 51 is configured to detect contact between the gripping portion 2 and the operator's fingers based on the capacitance of a secondary electrode 4b measured by the capacitive sensor 54. Therefore, the microcontroller 51 detects, in particular, contact with the operator's fingertip when the control device 1 is grasped by the operator. This functionality will be described in detail later.

[0090] The body comprises an outer casing 11 forming the external surface. The outer casing 11 is made of an elastic material, i.e., elastically deformable. The material used has a defined relative permittivity and is, for example, a dielectric material. The electrode assembly further comprises a reference electrode 4r arranged inside the body, opposite at least one electrode, such that the outer casing 11 is positioned between at least one electrode and the reference electrode 4r. For example, the reference electrode 4r is fixed to a rigid surface inside the body of the control device 1, in the gripping portion 2. The reference electrode 4r may further extend into the support portion 3, where it has a tubular shape. The reference electrode 4r is separated from the electrode array by the outer envelope 11. The outer envelope 11 also separates the main electrode 4a from the reference electrode 4r.

[0091] The microcontroller 51 is further configured to determine a pressure exerted on the external surface by the operator, from the capacitance measured for at least one electrode, and a capacitance of the reference electrode, also measured by the capacitive sensor 54. This functionality will be detailed later.

[0092] Preferably, the microcontroller 51 includes communication capabilities. This facilitates communication between the operator and the surgical station controlling the robotic arm. The microcontroller 51 uses a suitable digital communication protocol, for example, serial, I2C, SPI, USB, or 1-Wire.

[0093] The control device 1 includes a connection portion 27, 37. The connection portion 27, 37 is intended to allow a physical interface between the microcontroller 51 and the surgical station, via a connector 7.

[0094] The connector 7 includes a rod 72 with a slip ring 71. The slip ring 71 includes electrical connectors configured to transmit power and data signals between the microcontroller 51 and the surgical station, via cables arranged inside the rod 72. The rod 72 is preferably rigid, in order to prevent twisting of the cables and to avoid hindering the operator during the procedure.

[0095] According to another example, in the model illustrated in figures 5 and 6, the connector 7 is integrated inside the gripping portion 3, and directly connected to the electronic board 5. It includes two electrical connectors extending outside the gripping portion from the connection portion 27.

[0096] With reference to Figure 4, connector 7 can be used to assemble the control device 1 onto the control interface, and more specifically to connect the control device 1 to the guidance device 110 mounted on the support 4. This allows the control interface 100 described previously to be used with the control device 1. More specifically, the connection portion 27, 37 allows the transmission of commands or more generally of signals generated by the microcontroller 51 to the surgical station, and / or the transmission of a signal generated by the surgical station to the microcontroller 51, such as a trigger signal for haptic feedback informing of an event on the operating scene (acceptance of a command, change of parameter or configuration...).As will be described later, the commands generated by the microcontroller 51 are not, in this case, commands to remotely move the surgical instrument, but rather, for example, navigation commands within an interface or changes to the robot's configuration, based on movements of an operator's finger on or near the external surface, or on pressure exerted on the external surface. Preferably, the connector 7 can be removably connected to either end of the control device 1. Typically, the first end of the control device 1, on the support portion 3, includes a first connection portion 31, and the second end of the control device 1, on the gripping portion 2, includes a second connection portion 27. This allows for greater flexibility in the use of the control device 1 and improved ergonomics.

[0097] Conformation of the electrode array

[0098] The electrode array enables precise, multi-point detection, improving gesture recognition and the functionality of the controllable device 1 for interactive commands. Recognized gestures include, for example, tapping (or "finger tapping") or specific gestures on the external surface, such as sliding in a predetermined direction ("finger sliding"). Interactive commands can include, as mentioned above, and by way of example, navigating a directory, adjusting a parameter value, or changing functions or tools.

[0099] To improve the sensitivity and resolution of the electrode array for gesture detection, various factors can be chosen, such as the size of each secondary electrode 4b, the spacing between two adjacent secondary electrodes 4b, the shape of each secondary electrode 4b, or the total surface area covered by the electrode array. Preferably, the secondary electrodes 4b of the secondary electrode array 4b have a curvature that conforms to the outer surface of the gripping portion 2. Designing secondary electrodes 4b to match the natural curvature of the operator's fingers improves contact and the reliability of gesture detection by the microcontroller 51, particularly in the area of ​​high curvature of the outer surface of the gripping portion 2.

[0100] Preferably, the main electrode 4a also conforms to the external surface of the pilot device 1 at the support portion 3. This increases user comfort by adapting the curvature of the main electrode 4a to the natural curvature of the operator's wrist.

[0101] The geometry of the electrode array can also be considered. As explained previously, the secondary electrodes 4b of the secondary electrode array can be square, rectangular, or hexagonal. A hexagonal shape provides more uniform coverage of the external surface of the gripping portion 2, thus improving the sensitivity of the capacitive sensor and the detection of gestures from multiple angles.

[0102] Preferably, the plurality of secondary electrodes 4b is arranged on the gripping portion 2 so as to cover at least 90% of the external surface of the gripping portion 2. This allows contact and movement to be detected over the entire external surface at the level of the gripping portion 2.

[0103] Preferably, the secondary electrodes 4b include complementary shapes that may differ between the different areas of the grasping portion, so as to cover the external surface of the grasping portion 2 completely and homogeneously. The balance between the various factors mentioned above makes it possible to considerably improve the performance of the secondary electrode network 4b for precise gesture recognition in the context of vitreoretinal surgery in particular.

[0104] Haptic feedback during use

[0105] Preferably, the control device 1 includes a haptic actuator 6. The haptic actuator 6 is capable of generating vibrations within a predetermined frequency range, for example, between 30 Hz and 500 Hz, or even within a more restricted frequency range, for example, between 200 Hz and 210 Hz. In another example, the predetermined frequency range is between 150 Hz and 250 Hz. The haptic actuator 6 is arranged within the body of the control device 1. Preferably, the haptic actuator 6 is located inside, under the outer casing 11, near the junction between the gripping portion 2 and the support portion 3. In this way, the operator feels the vibrations generated by the haptic actuator 6 and receives information through them.

[0106] The haptic actuator 6 can be a linear resonant actuator (LRA). Such an actuator is configured to vibrate in a preferred direction, for example, orthogonal to the longitudinal X-axis, like a loudspeaker diaphragm. It oscillates a weight along a linear axis to produce vibrations with high precision.

[0107] Alternatively, the haptic actuator 6 can be an eccentric rotating mass motor (ERM), for example, a brushed or brushless direct current (BLDC) ERM. It uses an eccentric mass to create mechanical vibrations as the motor rotates. This type of haptic actuator 6 allows for a higher vibration amplitude and the generation of vibrations in two orthogonal directions.

[0108] Alternatively, the haptic actuator 6 can be a piezoelectric actuator. Such an actuator uses piezoelectric materials that deform under electrical stress, generating rapid and precise vibrations. It enables a fast response and high-frequency vibrations.

[0109] Alternatively, the haptic actuator 6 can be a force feedback actuator. Such an actuator generates physical resistance (or force) against movement, simulating complex physical interactions (e.g., the resistance of a button or trigger). It allows the operator to easily identify the type of event signaled by the surgical station.

[0110] The haptic actuator 6 can be placed inside a specific partition or attached to a rigid surface with an adhesive strip. It can be connected directly to the electronic board 5.

[0111] The haptic actuator is controlled via the microcontroller 51. Preferably, it is associated with a power stage controlled by the microcontroller 51. The vibration amplitude and frequency can thus be modulated by the microcontroller 51, according to the information to be transmitted to the operator. The microcontroller 51 controls the integrated circuit of the power stage to produce vibrations within a defined frequency range.

[0112] Preferably, the microcontroller 51 is further configured to filter the angular velocity and acceleration measured by the inertial sensor 52. Thus, the displacement command is enabled based on the filtered angular velocity and acceleration, thereby eliminating from the displacement command any displacements associated with a frequency within the predetermined frequency range. The processor generating the displacement command can take the filtered angular velocity and acceleration into account when establishing the displacement command.

[0113] Thus, the control device 1 can provide haptic feedback by activating the haptic actuator 6, without the movement control being disturbed by the vibration of the control device 1, and therefore of the rod of the guide device 110, when the control device 1 is used with the interface 100.

[0114] This enables the transmission of information from the surgical station. The control device 1 communicates with the connected surgical station, providing feedback on demand. The surgical station can request haptic feedback based on movement instructions transmitted by the microcontroller 51 or on remote information.

[0115] For example, the surgical station can send a signal to the microcontroller 51 via connector 7 to signal an event. Events that can be signaled include, for example, confirmation of a parameter selection by the operator, and other remote warnings, such as when the surgical instrument is close to a sensitive point in the surgical area, or when the user needs to perform a validation of the control station. This advantageously compensates for the loss of feedback known in remotely operated systems.

[0116] Preferably, the microcontroller 51 determines, from the signal received from the surgical station, the parameters of the haptic response, such as the intensity and duration of the vibration to be produced. The microcontroller 51 triggers the activation of the haptic actuator 6 upon receiving the signal. For example, the control device can activate the vibration when measurements are taken at the remote operating site or when the status of the robotic arm is updated.

[0117] This feature represents a significant advancement over existing advanced robotic systems for ophthalmic microsurgery and addresses the common problem of information loss in teleoperated systems. The ability to provide haptic feedback, via vibration, to the operator ensures that the precision essential for surgical tasks is maintained without compromise.

[0118] As the haptic actuator 6 vibrates within the predetermined frequency range, the corresponding frequencies can be filtered by the microcontroller 51. Thus, the event is signaled to the operator by haptic feedback, without impacting the accuracy of the movement of the remote surgical instrument.

[0119] Preferably, the microcontroller 51 digitally implements a band-stop filter, the cutoff frequency range of which corresponds to the specified prohibited frequency range. This minimizes potential interference with the precision of surgical movements when the operator receives feedback from the haptic actuator. Alternatively, the electronic board 5 can implement an analog band-stop filter.

[0120] Control device functionalities 1

[0121] The control device 1 allows the operator to control all the specific functionalities of the surgical instrument. In the context of a vitreoretinal procedure, the functionalities may include the actuation of a countercurrent rinse, the use of a retractable cannula, the adjustment of a foldable laser, the use of auxiliary surgical tools such as forceps or scissors, as will be described.

[0122] Contact release detection

[0123] As explained previously, the microcontroller 51 can detect contact between the operator and the external surface, and therefore a release of the control device 1. This feature allows the surgical robot to mimic the behavior observed when a surgeon interrupts a procedure and relinquishes control of a conventional surgical instrument. For example, when hand contact is lost, the remote surgical instrument ceases to respond to movement commands issued by the control device 1 or the surgical station. Thus, the safety of the control device is enhanced, as any movement of the robotic arm is automatically stopped in the event of incapacity, inattention, or absence of the operator remotely controlling the surgical instrument.

[0124] Contact between the operator's hand and the control device 1 creates an impedance that disturbs the electric field continuously controlled by the secondary electrodes 4b and the primary electrode 4a arranged on the external surface of the control device 1 and connected to the capacitive sensor 54. When the operator releases the control device 1, a capacitive change, specifically a decrease in the measured capacitance, is detected simultaneously across all electrodes. This can lead to the absence of signals received by the capacitive sensor 54, indicating that the operator's hand is no longer in contact with the control device 1.

[0125] In an embodiment where the capacitive sensor 54 is a capacitive touch sensor, the capacitance increases when the operator touches an electrode of the electrode set 4a, 4b, because the operator's body acts as a conductor, adding capacitance between the electrode and ground. The capacitive sensor 54 identifies this increase and interprets it as a touch input. Conversely, when contact is lost, the capacitance decreases. Therefore, a detected decrease in capacitance between the electrodes of the electrode set 4a, 4b suggests that contact between the hand and the control device 1 has been lost.

[0126] Thus, the microcontroller 51 can detect, in particular, the absence of contact between the operator's hand and the external surface of the support portion 3, from the signal received by the input channel connected to the main electrode 4a. The microcontroller 51 can also detect the absence of contact between the operator's hand and the external surface of the gripping portion 2, from the signals received by the input channels connected to the secondary electrodes 4b.

[0127] The microcontroller 51 can also use the signals from the inertial sensor 52 to identify the absence of movement of the control device 1, or a fall of the control device 1. The presence of the inertial sensor 52 improves the reliability of the detection of loss of contact.

[0128] Almost simultaneously with the capacitive measurements indicating loss of contact, the inertial sensor 52 can measure the absence of hand movement (i.e. there is no change in acceleration or angular velocity due to hand movement and / or there is no physiological tremor of the operator's hand), which confirms that the operator has released the control device 1.

[0129] This avoids forcing the operator to use an additional "dead man's" system, for example, to continuously press a switch or pedal during the operation, as is classically the case.

[0130] Finger gesture recognition

[0131] The microcontroller 51 can recognize the operator's finger gestures, in other words, identify a particular movement of an operator's finger on the external surface of the gripping portion 2. The resolution of the determined movement depends on the shape, spacing, and size of each secondary electrode 4b, as explained previously.

[0132] The variations in capacitance between the secondary electrodes 4b allow the identification of finger movements made by the operator's hand.

[0133] A first example of a gesture that can be detected by the microcontroller 51 is a finger touch, that is, a single contact of the operator's finger on the external surface. When the operator touches the electrode array 4b in the gripping portion 2, the sequence of capacitive changes, that is, the succession of contacts and releases according to a timing determined by the microcontroller 51, makes it possible to determine whether the operator is touching the external surface.

[0134] This enables the activation of functions of the surgical instrument, and in particular input for the surgical station to which the control device 5 is connected via connector 7. For example, the microcontroller 51 can be configured to detect a single or double contact, for example a tap, and to actuate the surgical instrument according to the type of contact detected.

[0135] Preferably, the microcontroller 51 takes into account the signals from the inertial sensor 52 to determine the type of contact. Indeed, almost simultaneously with the capacitive detection of the finger touch, the inertial sensor 52 measures accelerations that correspond to the moment the finger touches the external surface at the gripping portion 2. This increases the robustness of the contact type detection thanks to the redundancy of the measurements. A first example of a gesture that can be detected by the microcontroller 51 is a finger slide, that is, a movement of the finger on the external surface. When the operator slides the tip of one or more fingers along the secondary electrode array 4b, changes in capacitance are detected along the secondary electrode array 4b in the gripping portion 2.The microcontroller 51 determines, from these changes, that the operator slides one (or more) finger(s) in a specific direction, to positions defined by the input channel of the received signal, associated with a secondary electrode 4b of the network.

[0136] The microcontroller 51 can determine a movement speed from predetermined position sequences. This information can be used by the surgical station to remotely control the actuation of the surgical instrument or to navigate a menu and adjust parameter values.

[0137] For example, to manipulate forceps or scissors, the operator can open or close the forceps by sliding one fingertip in opposite directions along the gripping portion 2, or by spreading or bringing two fingers together on the outer surface. The degree of opening and closing of the surgical instrument's forceps can thus be precisely adjusted.

[0138] According to another example, to operate a laser whose degree of flex is adjustable, the operator can, by sliding one end of a finger in one direction in two opposite directions on the gripping portion 2, increase or decrease the degree of flex of the laser.

[0139] Preferably, a surgical instrument physically actuated by a sliding mechanism can be activated remotely by tapping the gripping portion 2 a predetermined number of times. For example, to operate a cannula-type surgical instrument with a retractable needle, the operator can tap to reveal the cannula tip. Alternatively, the operator can increase or decrease the degree of retraction of the retractable cannula needle by sliding a fingertip in opposite directions along the gripping portion.

[0140] The robotic arm holding the surgical instrument receives the appropriate command, depending on the settings of the control device 1. According to another example, to operate a surgical instrument for backflushing, the operator can tap the gripping portion 2 to activate or stop the suction.

[0141] Thus, the control means of the pilot device 1 can be adapted to allow the functionality to be implemented in a manner similar to that intended for the surgical instrument manipulated by the robot. However, the pilot device 1 can also be configured to allow the functionality to be implemented in a manner different from that intended for the surgical instrument used.

[0142] This allows the operator to perform a movement more precisely and with greater control. For example, to control and maintain the degree of closure of forceps, the operator would, in conventional surgery, have to squeeze the forceps with their index finger and thumb. This can lead to muscle fatigue with prolonged pressure, and therefore risks of tremors or reduced precision of movement. With the proposed control device 1, the operator can control the degree of closure of the forceps by progressively sliding their index finger along the outer surface; the degree of closure is maintained when contact with the index finger is broken. The degree of closure is thus defined more precisely and stably.

[0143] The external surface allows for various interactions with the surgical instrument, depending on the actual physical actuation mechanism of the surgical instrument in use. The operator can thus implement all the functionalities enabled by the surgical instrument while using the control interface 100.

[0144] Finger pressure estimation

[0145] The microcontroller 51 can estimate the pinch pressure of the gripping portion 2 of the control device 1, particularly in the area of ​​high curvature. Typically, the microcontroller 51 can evaluate the pinch pressure from signals received by two secondary electrodes 4b arranged on either side of the external surface of the gripping portion 2.

[0146] More generally, when the operator applies pressure to one or more secondary electrodes of the secondary electrode array 4b in the gripping portion 2, the elastic material of the outer sheath 11 between the secondary electrodes 4b and the fixed reference electrode 4r deforms, causing the secondary electrodes 4b on which the operator is pressing to move closer to the reference electrode 4r. As the distance between two electrode surfaces separated by a material with a defined relative permittivity decreases, the capacitance increases. This increase is due to the fact that the capacitance is directly proportional to the electrode surface area and the relative permittivity of the material, while it is inversely proportional to the distance separating the electrodes from the material.

[0147] When the distance decreases due to the elastic deformation of the outer casing 11, the electric field between the secondary electrode 4b and the reference electrode intensifies, resulting in an increase in capacitance. From the measurement of the capacitance of the secondary electrodes 4b relative to the reference electrode 4r, the microcontroller 51 estimates a value proportional to the finger pressure on the secondary electrode 4b. This information can be used by the surgical station to remotely control the action of the surgical instrument (e.g., closing the forceps, flexing the laser, retracting the cannula) or as user interface input for the surgical station (e.g., confirmation by pressure).

[0148] For example, to operate forceps or scissors, the opening and closing of which is controlled by the robotic arm, the operator can pinch the gripping portion 2 at the point of maximum curvature. Depending on the pressure applied and determined by the microcontroller 51, the robotic arm operates the forceps or scissors accordingly. Preferably, to operate a surgical instrument physically actuated by a sliding mechanism, the operator can activate the functionality remotely by pinching the gripping portion 2. For example, to operate a cannula-type surgical instrument with a retractable needle, the operator can pinch to reveal a cannula tip, each pinch revealing a distance predetermined by calibration.According to another example, to operate a surgical instrument for backflushing, the operator can pinch the gripping portion 2 once to trigger activation, then pinch it a second time to stop the suction.

[0149] Detection of atypical movements

[0150] The microcontroller 51 can evaluate the movement of the control device 1 from the signals from the inertial sensor 52, in order to detect atypical movement of the control device 1. "Atypical movement" is defined as any movement other than that performed during a precision surgical procedure, for example, a jerk or a movement with excessive acceleration, which should not occur during precise vitreoretinal microsurgery. These atypical movements thus differ from the precise, low-amplitude movements measured by the control interface 100 for establishing the control command for the robotic arms moving the surgical instruments.

[0151] Typically, the microcontroller 51 detects, from the signals received by the inertial sensor 52, abrupt changes in linear acceleration and angular velocity. Preferably, the microcontroller 51 receives information from the control interface 100 about the precise movements detected and the control commands transmitted to the robotic arms. For example, the microcontroller 51 calculates, from a first signal emitted by the inertial sensor 52, a first linear acceleration in one direction at a first instant. The microcontroller 51 calculates, from a second signal emitted by the inertial sensor 52, a second linear acceleration in the same direction at a second instant, subsequent to the first instant.

[0152] From the first and second linear accelerations, the microcontroller 51 calculates a change in linear acceleration. The microcontroller 51 then compares the calculated change in linear acceleration to a maximum threshold. If the change in linear acceleration exceeds the maximum threshold, the microcontroller 51 detects an atypical movement.

[0153] A similar method of detecting abnormal movement can be implemented by the microcontroller 51 from signals from the inertial sensor 52 allowing the calculation of angular velocities.

[0154] This information can serve as input for the surgical station to take appropriate action, such as alerting the operator or preventing the movement of the surgical instrument remotely, particularly if such movement leads to contact between two surgical tools, such as when multiple tools are inserted into the patient's eye. Preferably, the microcontroller 51 commands the emission of an alarm to inform the operator, for example, via a visual or audible signal generated by the surgical station, or by activating a vibration of the haptic actuator 6.

[0155] Tremor detection

[0156] Preferably, the microcontroller 51 is further configured to: determine an operator shaking frequency from the angular velocity and / or acceleration measured by the inertial sensor 52 when contact is detected; and

[0157] The angular velocity and acceleration measured by the inertial sensor 52 are filtered, and the displacement command is then generated based on the filtered angular velocity and acceleration. This eliminates displacements associated with frequencies within a specific frequency range, which includes the determined tremor frequency. The processor generating the displacement command can then use the filtered angular velocity and acceleration from the microcontroller to establish a more precise movement command for the surgical instrument and better control the robotic arm.

[0158] In other words, the linear acceleration and angular velocity values ​​calculated by the microcontroller 51 are used to estimate the operator's hand tremor. Hand tremor is typically characterized by two parameters: amplitude and frequency. The amplitude and frequency of the tremor are directly related to the linear acceleration and angular velocity measurements of the control device 1 taken by the inertial sensor 52.

[0159] Human physiological tremor, common to all human beings, is generally in a frequency range of 8 Hz to 12 Hz, its amplitude depending on factors such as the physical capabilities and level of fatigue of the operator.

[0160] Preferably, the microcontroller 51 estimates characteristics of the operator's hand tremor from the inertial measurement signals from the inertial sensor 52. For example, the microcontroller 51 determines the amplitude and frequency of the tremor by implementing a fast Fourier transform (or FFT).

[0161] Preferably, the microcontroller 51 can identify different types of hand trembling of the operator, by comparing the determined frequency value with threshold frequency values.

[0162] The microcontroller 51 can determine, for example, an essential tremor related to a neurological condition, if the calculated frequency is between 4 Hz and 12 Hz. According to another example, the microcontroller 51 can determine a parkinsonian tremor related to a neurological disease, if the calculated frequency is between 3 Hz and 6 Hz.

[0163] Other specific frequency ranges can be used, depending on the type of tremor that the control device 1 can identify. This information can be used to characterize the tremor and filter out hand tremor at the surgical station.

[0164] Preferably, the control interface processor filters the calculated displacement command, from the shaking characteristics determined by the microcontroller 51, so as to transmit filtered displacement commands from the remote surgical instrument to the surgical station.

[0165] During filtering, the microcontroller 51 or the processor implements a band-stop digital filter to eliminate frequencies in the movement command that fall within a specific frequency range. The digital filter used can be, for example, a finite impulse response (Fl R) filter or an infinite impulse response (HR) filter. This allows the surgical instrument to be moved with greater precision, as the commanded movement is not affected by involuntary tremors of the operator.

[0166] Preferably, the implemented filter is an adaptive filter. In other words, the cutoff frequencies of the implemented band-stop filter are dynamically adapted based on the motion conditions detected by the microcontroller 51. This allows for a better response to changing situations, such as rapid voluntary acceleration or varying tremor frequencies. For example, the microcontroller 51 implements an adaptive Kalman filter.

[0167] Preferably, the microcontroller 51 takes into account the signals from the capacitive sensor 54 for identifying the operator's hand tremor. Indeed, the estimation of the tremor characteristics can be carried out reliably and in real time only when it is established that the operator is holding the control device 1, that is, when the microcontroller 51 detects the presence of contact with the hand.

[0168] Preferably, the microcontroller 51 can generate an alert for the operator if tremors exceeding a threshold amplitude are detected. For example, by triggering a visual or audible alert from the surgical station. According to unTl

[0169] As another example, the microcontroller 51 controls the power stage integrated circuit to provide feedback on the tremor detected via the haptic actuator 6. The microcontroller 51 can also block actuation of the surgical instrument remotely. This helps prevent errors during the surgical procedure and potential complications for the patient.

[0170] Station parameter modification

[0171] The control device 1 allows interaction with the auxiliary equipment without the need to interrupt the operation or require external assistance.

[0172] The 51 microcontroller implements algorithms to interpret signals received from sensors and to recognize movements such as slides, rotations, and complex multitouch gestures. Gesture processing algorithms allow the 51 microcontroller to recognize and interpret specific movements, such as scrolling, swiping, pinching to zoom, and other custom gestures. These gestures are translated into specific commands for the user interface and the robotic arm.

[0173] For example, the operator can signal a setting change by tapping the surface of grip portion 2 a defined number of times (single tap, double tap, etc.). They can then navigate through a menu of options by sliding their fingertips across the surface of the grip portion and confirm their selection by tapping (tap confirmation) or pressing the grip portion (press confirmation) once the desired option is highlighted.

[0174] The operator thus benefits from greater autonomy compared to conventional manual vitreoretinal microsurgery or current surgical arm control devices. Specifically, the operator can perform the procedure without external assistance and without interruption for adjustments.

Claims

28 DEMANDS 1. A device for remotely controlling (1) a surgical instrument, comprising a body intended to be manipulated by an operator like a stylus, and comprising an external surface, o a gripping portion (2), intended to be grasped by the fingers of an operator, o a support portion (3), intended to rest on a dorsal face of one of the operator's hands, when the body is manipulated by the operator like a stylus; an array of electrodes arranged on the external surface of the body, comprising o a main electrode (4a) arranged on the support portion (3); and o an electrode array formed by a plurality of secondary electrodes (4b) arranged on the grasping portion (2), a plurality of sensors, including: o a capacitive sensor (54), configured to measure: ■ a capacitance of the main electrode (4a); ■ a capacitance of a secondary electrode (4b) of the electrode array; an inertial sensor (52), configured to measure an angular velocity of the body and to measure an acceleration of the body; a microcontroller (51), configured for to determine, from the angular velocity and acceleration, a displacement of the body; to detect, from the measured capacitance of the main electrode (4a), the measured capacitance of the secondary electrode (4b) and the displacement of the body, contact between the external surface of the body and the operator, so as to verify whether the device (1) is being held by the operator like a stylus, contact between the support portion (3) and the operator's hand is detected from the measured capacitance of the primary electrode (4a); and contact between the gripping portion (2) and the operator's fingers is detected from the measured capacitance of the secondary electrode (4b); and o to allow a remote movement command for the surgical instrument, when contact between the external surface of the body and the operator is detected, the device (1) being held by the operator like a stylus; the remote surgical instrument being actuated so as to move in accordance with the movement command.

2. Control device (1) of a remote surgical instrument according to claim 1, wherein the microcontroller (51) is further configured to determine a movement of a finger of the operator in contact with the gripping portion (2), from capacitances of the plurality of secondary electrodes (4b) measured by the capacitive sensor (54).

3. A device for remotely controlling a surgical instrument according to one of claims 1 and 2, wherein the plurality of secondary electrodes (4b) is arranged on the gripping portion (2) so as to cover at least 90% of the external surface of the gripping portion (2).

4. A remote control device (1) for a surgical instrument according to any one of claims 1 to 3, wherein the body comprises an outer casing (11) forming the external surface, the outer casing (11) being elastically deformable, and wherein the electrode assembly further comprises a reference electrode (4r) arranged inside the body, opposite at least one electrode (4a, 4b), such that the outer casing (11) is disposed between at least one electrode (4a, 4b) and the reference electrode (4r), the microcontroller (51) further being configured to determine a pressure exerted on the external surface by the operator, from the measured capacitance and a capacitance of the reference electrode (4r) measured by the capacitive sensor (54). 5.Control device (1) of a remote surgical instrument according to any one of claims 1 to 4, wherein the microcontroller (51) is further configured to - determine an operator tremor frequency, from the angular velocity and / or acceleration measured by the inertial sensor (52), when contact is detected; and. - filter the angular velocity and acceleration measured by the inertial sensor (52), the displacement command being allowed from the filtered angular velocity and filtered acceleration, so as to eliminate from the displacement command displacements associated with a frequency within a range of frequencies to be eliminated, the range of frequencies to be eliminated including the determined shaking frequency.

6. A control device (1) for a remote surgical instrument according to any one of claims 1 to 5, further comprising a haptic actuator (6) for generating a vibration of the body, and wherein the microcontroller (51) is further configured to activate the haptic actuator (6) upon receiving an external signal.

7. A remote control device (1) for a surgical instrument according to claim 6, wherein the haptic actuator (6) is suitable for generating vibration in a predetermined frequency range, and wherein the microcontroller (51) is further configured to filter the angular velocity and acceleration measured by the inertial sensor (52), the displacement command being allowed from the filtered angular velocity and filtered acceleration, so as to eliminate from the displacement command displacements associated with a frequency within the predetermined frequency range.

8. A control device (1) for a remote surgical instrument according to any one of claims 1 to 7, wherein the body extends between a first end and a second end, the first end and / or the second end comprising a connection portion (27, 37) configured to receive a connector linked to a surgical station, so as to allow - a transmission of signals generated by the microcontroller (51) to the surgical station; and / or - a transmission of a signal generated by the surgical station to the microcontroller (51).

9. Surgical system comprising: - a control device according to any one of claims 1 to 8, - a remotely controlled surgical instrument; - a surgical station, comprising a robotic arm configured to move the surgical instrument in accordance with the movement command, when the piloting device is held by an operator.

Images