Surgical table base with high stiffness and adjustable support members with force feedback

Apparatus and methods for providing a surgical table base with sufficient stiffness and adjustable support members with force feedback are described herein. In some embodiments, a base for a surgical table includes a base body to which other components of a surgical table can be coupled. A surgical table, and optionally a patient supportable by the surgical table, and any equipment to be carried by the surgical table, collectively representing a table load to be carried by the base body to support the surgical table on a surface. The base further includes a support assembly coupled to the base body to support the base body on the surface. The support assembly includes at least four support members. Each support member has a surface-engaging end and can transmit a portion of a total load represented by the weight of the base and the table load through the surface-engaging end to the surface. The surface-engaging ends of any three of the four support members define a plane. One of the support members is adjustable to move the one support member relative to a plane defined by the three of the other support members and thereby to change the portion of the total load carried by one of the support members. The base further includes a load sensor operably coupled to the support assembly and disposed to detect the portion of the total load carried by one of the support members.

BACKGROUND

Some embodiments described herein relate to apparatus and methods for a base for a surgical table having four or more support members to support the base stably on a surface. Further embodiments described herein relate to surgical tables with robotic surgical arms, and apparatus and methods for reducing unwanted vibration at the working ends of the robotic arms. Yet further embodiments described herein relate to adapters for surgical tables with robotic surgical arms, and apparatus and methods for reducing unwanted vibration at the working ends of the robotic arms.

Stability of surgical tables during surgery is important to their safe and effective clinical use. Certain design characteristics improve the stability of surgical tables, such as a rigid support structure. In addition, it is also desirable for surgical tables to allow adjustment of patient position in one or more axes of motion, and to allow for wheeled transport around the hospital. The most common design of surgical tables is to have a large base sufficiently sized to prevent tipping, containing wheels, and having a means of locking to the floor to enhance stability.

One conflicting requirement with stability is dealing with floor irregularities. The problem is that to achieve stability, both in rigidity, as well as tipping, the base must be as large as possible. However, the base is also limited to a size that enables clinical access, which means that it must have a footprint no larger than the footprint of the table top. Thus, bases typically have a generally rectangular shape, and have four points of contact with the floor instead of the three needed for kinematic constraint.

Some surgical tables are mobile, can be wheeled around, and are frequently swapped in and out of an operating room based on the type of surgical procedure being performed. Such movement of the surgical tables within the operating room requires dealing with irregularities in the floor surface (e.g., variations in elevation of the floor surface). Given irregularities, such as drains, craftsmanship defects, bubbling, delamination of flooring, even dirt and grime, a rigid base with four points of contact may result in only three points in contact, and one in the air. This creates a situation where the table can rock back and forth, as is commonly observed in restaurant tables. Instability during surgery could cause irritation to surgeons and assistants at the very least or even a dangerous surgical situation. Thus, a solution is needed where the table is not only structurally rigid, but also mobile, and able to tolerate irregularities in the floor.

Further, robotic surgical systems can include robotic surgical arms that are coupled, directly or indirectly (e.g., via an adapter), to a surgical table on which a patient can be supported during a surgical procedure. The robotic surgical arms may support at their distal, working ends various devices, including surgical instruments, cannulae for providing access to the patient's body cavity(ies) and organ(s) for application of surgical instruments, imaging devices, lights, etc. In such systems, it is desirable to establish and maintain high positional accuracy for the devices mounted on the distal ends of the robotic arms.

Positional accuracy can be reduced or degraded by vibration of the distal ends of the robotic arms. Such vibration may be in the form of vibrational cross-talk, which is unwanted vibration occurring in one part of the system that originates in another part of the system. For example, vibration may be induced within a robotic arm, such as by operation of a motor driving movement of some portion of the arm relative to another portion of the arm and/or to the surgical table or other supporting structure, and the energy introduced into the arm by operation of the motor may propagate through the arm to the distal end, inducing vibration in the distal end. This arm may be referred to as the “active” arm. Alternatively, or additionally, energy introduced into the active arm, such as by operation of a motor within the active arm, may propagate through the active arm, through the table or other supporting structure, and through another robotic arm (which may be referred to as the “passive” arm) to the passive arm's distal end.

It is desirable to reduce vibrational cross-talk to enhance positional accuracy of the distal ends of robotic arms and the devices attached thereto.

SUMMARY

Apparatus and methods for providing a surgical table base with sufficient stiffness and adjustable support members with force feedback are described herein. In some embodiments, a base for a surgical table includes a base body having a lower side and an upper side to which other components of a surgical table can be coupled. A surgical table, and optionally a patient supportable by the surgical table, and any equipment to be carried by the surgical table, collectively represent a table load to be carried by the base body to support the surgical table on a surface. The base further optionally includes wheels, and includes a support assembly coupled to the base body to support the base body on the surface. A mechanism in a base having wheels allows switching the table from a mobile configuration to a fixed configuration by transferring load from the wheels to the support assembly. The support assembly includes at least four support members spaced about the base body. Each support member has a surface-engaging end and can transmit a portion of a total load represented by the weight of the base and the table load through the surface-engaged end to the surface. The surface-engaging ends of any three of the four support members define a plane. One of the support members is adjustable to move the surface-engaging end of the one support member relative to a plane defined by the surface-engaging ends of three of the other support members and thereby to change the portion of the total load carried by one of the support members. The base further includes a load sensor operably coupled to the support assembly and disposed to detect the portion of the total load carried by one of the support members.

Apparatus and methods for providing a pivotable surgical table with robotic surgical arms, having sufficient stiffness to limit unwanted vibration at the working ends of the robotic arms, are described herein. In some embodiments, a surgical table includes a base, a support column extending upwardly from the base and having an upper end, a table top, and a pivot assembly coupling the table top to the upper end of the support column. The pivot assembly includes a support flange attached to the upper end of the support column and has portions distributed about the support column. The pivot assembly further includes a primary load support, a first actuator and a second actuator. The primary load support has a lower end coupled to the support flange and an upper end having a pivotable coupling to the table top. The first actuator has a lower end coupled to the support flange at a first portion of the flange disposed on a first side of the support column and an upper end having a pivotable coupling to the table top. The first actuator is variable in length to pivot the table top about the pivotable coupling of the primary load support about a first pivot axis. The second actuator has a lower end coupled to the support flange at a second portion of the flange disposed on a second side of the support column opposite to the first side and an upper end having a pivotable coupling to the table top. The second actuator is variable in length to pivot the table top about the pivotable coupling of the primary load support about a second pivot axis different from the first pivot axis.

Apparatus and methods for providing an adapter coupleable to, and supportable by, a surgical table below a tabletop of the surgical table. The surgical table has a support coupled to the tabletop and a base coupled to the support. The adapter has a first section configured to be coupled to a proximal end portion of a first robotic arm and a second section configured to be coupled to a proximal end portion of a second robotic arm. The first section has a first stiffness and the second section has a second stiffness that is greater than the first stiffness. A distal end portion of the first robotic arm is coupleable to a first surgical tool and a distal end portion of the second robotic arm is coupleable to a second surgical tool.

DETAILED DESCRIPTION

Apparatus and methods for providing a surgical table base with sufficient stiffness and adjustable support members with force feedback are described herein with respect toFIGS.1A-8. In some embodiments, a base for a surgical table includes a base body having a lower side and an upper side to which other components of a surgical table can be coupled. A surgical table, and optionally a patient supportable by the surgical table, and any equipment to be carried by the surgical table, collectively represent a table load to be carried by the base body to support the surgical table on a surface. The base further includes a support assembly coupled to the base body to support the base body on the surface. The support assembly includes at least four support members spaced about the base body. Each support member has a surface-engaging end and can transmit a portion of a total load represented by the weight of the base and the table load through the surface-engaged end to the surface. The surface-engaging ends of any three of the four support members define a plane. One of the support members is adjustable to move the surface-engaging end of the one support member relative to a plane defined by the surface-engaging ends of three of the other support members and thereby to change the portion of the total load carried by one of the support members. The base further includes a load sensor operably coupled to the support assembly and disposed to detect the portion of the total load carried by one of the support members.

In some embodiments, a method includes stabilizing a surgical table on a surface. The surgical table has a base. The surgical table and optionally a patient supportable by the surgical table, and any equipment carried by the surgical table collectively representing a total load supported on the surface. The base includes a support assembly. The support assembly includes at least four support members spaced about the base. Each support member has a surface-engaging end and can transmit a portion of the total load through the surface-engaging end to the surface. One of the support members is adjustable to move the surface-engaging end of the one support member. The base further includes a load sensor disposed to detect the portion of the total load carried by one of the support members. The method includes receiving a signal from the load sensor indicative of the portion of the total load carried by the one of the support members, and determining whether the portion of the total load is not within an acceptable range. The method further includes, if the portion of the total load is not within the acceptable range, causing the surface-engaging end of the adjustable support member to move relative to a plane defined by the surface-engaging ends of three of the other support members and thereby to change the portion of the total load carried by one of the support members. In some embodiments, stabilization may occur when at least a portion of the load is being transferred from the wheels to the support members to transition the table from a mobile to a fixed configuration. In other embodiments, stabilization may occur any time the support members are carrying at least a portion of the load of the table.

As used herein, a “set” can refer to multiple features or a singular feature with multiple parts. For example, when referring to a set of ribs, the set of ribs can be considered as one rib with distinct portions, or the set of ribs can be considered as multiple ribs.

As shown schematically inFIGS.1A-1B, a surgical table100includes a table top120, a table support122and a table base150. The table top120has an upper surface on which a patient P can be disposed during a surgical procedure, as shown schematically inFIG.1A. The table top120is disposed on the support122, which can be, for example, a pedestal, at a suitable height above the floor. The support122(also referred to herein as a pedestal) may provide for movement of the table top120in a desired number of degrees of freedom, such as translation in the Z axis (height above the floor), Y axis (along the longitudinal axis of the table), and/or X axis (along the lateral axis of the table), and/or rotation about the Z, Y, and/or X axis. The table top120may also include multiple sections that are movable relative to each other along/about any suitable axes, e.g., separate sections for each of the torso, one or both legs, and/or one or both arms, and a head support section. Movement of the table top120and/or its constituent sections may be performed manually, driven by motors, controlled remotely, or through any other suitable means. The support122for the table top120may be mounted to the base150. In some embodiments, the height of the support122can be adjusted, which together with, for example, the motion (e.g., axial (longitudinal) or lateral motion) of the table top120, can allow for the table top120to be positioned at a desired surgical site at a certain height above the floor (e.g., to allow surgeon or other medical professional access) and a certain distance from the support122.

FIGS.2A-8illustrate various embodiments describing apparatus and methods for stabilizing a surgical table on a surface (e.g., a floor of an operating room). As described above and in accordance with various embodiments disclosed in more detail below, a surgical table can include a base configured to support other components of the surgical table (e.g., table top, pedestal, robotic arms and associated equipment, and/or the like) and a patient disposed on the surgical table, while simultaneously remedying undesirable consequences associated with irregularities in a floor or other surface on which the table is disposed, and/or other undesirable load imbalances (e.g., due to location and/or movement of equipment coupled to the surgical table and/or movement of a patient lying on the surgical table) during a surgical procedure.

For example, as shown schematically inFIGS.2A(bottom view) and2B (side view), a base250for a surgical table includes a base body255and a support assembly260coupled to the base body255. The base250is configured to support a surgical table load, and to monitor and/or adjust distribution of a total load (the table load together with the weight of the base) to a surface (e.g., a floor within a surgical room). The table load is a collective load including loads from various components of a surgical table, such as, for example, a table top, a pedestal, surgical tools and associated components, robotic arms, and the like, and a patient. The surgical table can be the same or similar in structure and function to the surgical table100described above. For example, the surgical table can include a table support and a table top having an upper surface on which a patient P can be disposed during a surgical procedure.

As shown inFIG.2Band described in further detail herein, the support assembly260has a first end coupled to the base body255, and a second end (also referred to herein as surface-engaging end) opposite and extending from the first end arranged to transmit the total load from the base body255to the surface. In some instances, the support assembly260and the base body255are monolithically constructed, while in other instances, the support assembly260is formed separately from and then coupled to the base body255.

The support assembly260includes at least four support members262. Each support member262is configured to transmit a portion of the table load to the surface. With four support members262spaced about the base body255, any three support members262from the support assembly260define a plane. Specifically, the surface-engaging ends of any three support members262from the support assembly260define a plane. The three support members262can thus support the table on a surface, including an uneven surface, without wobbling or excessive vibration. However, it is desirable to support the table on the floor or other surface at four or more points to provide a more stable support, e.g. to be more resistant to tipping . . . . As shown inFIG.2C, a base with three points of support on the floor or other surface has a triangular region of stability RS defined by the three points of support. If the center of gravity GC of the table (i.e. the total load) is disposed within the triangular RS, the table remains upright. However, if the CG is displaced outside of RS, the table can tip. The CG may shift for numerous reasons, including being on a non-level floor, movement of the table top sections, attachment of surgical accessories to the table, and/or movement of robotic arms attached to the table. As is apparent fromFIG.2C, relatively small movements of the CG can move it outside of TS. In contrast, as shown inFIG.2D, a base with four points of support on the floor has a rectangular (or other four sided geometric shape) region of stability RS. The CG must be shifted a larger distance before it moves outside of RS. Thus, a base with four points of contact with the floor or other supporting surface is more stable, i.e. better able to accommodate movement of the CG without tipping

A problem with having four support members, however, is that it can introduce another source of instability, e.g., wobbling or excessive vibration, or insufficient resistance to propagation of vibration. For example, if the floor surface is not flat and/or if any of the support members are uneven in length (e.g., due to manufacturing tolerances, defects, and/or wear and tear), one of the four support members may be out of contact with the floor, or may carry an insufficient portion of the total load to be in sufficiently firm contact with the floor. This problem is more pronounced for a more stiff structure in the base, because the base is less able to flex to accommodate variations in the floor, i.e. is less compliant.

To limit, reduce, or otherwise prevent such instability, at least one of the support members262is adjustable relative to the remaining support members262and/or the base body255. For ease of explanation, in this embodiment, the adjustable support member is identified as262′. Specifically, the adjustable support member262′ is adjustable to move its surface-engaging end relative to a plane defined by the surface-engaging ends of the three other support members262. In this manner, in use, adjusting the adjustable support member262′ changes the portion of the total load carried by one or more of the support members262and/or the adjustable support member262′ itself.

As also shown inFIG.5, the adjustable support member262′ includes a fixed section264and a movable section266configured to move relative to the fixed section264and/or relative to the base body255. The movable section266can be coupled to the fixed section264in any suitable manner. In some embodiments, for example, the movable section266and the fixed section264can be monolithically constructed, while in other embodiments the movable section266and the fixed section264can be formed separately and then joined together. Further, the movable section266can be movable relative to the fixed section264in any suitable manner. For example, in some embodiments, the movable section266can be at least partially slidably disposed within or with respect to the fixed portion264. In this manner, for example, to shorten the height of the adjustable support member262′, the movable section266can be slid into or along a portion of the fixed portion264. In other embodiments, the movable section266can be at least partially disposed about the fixed portion264such that the height of the adjustable support member262′ can be adjusted by sliding at least a portion of the fixed portion264into the movable portion266. The relative movement of the movable section266and the fixed portion264can be produced by any suitable actuator268. For example, the actuator268can include a motor and any suitable mechanism (e.g. rack and pinion, nut and leadscrew, hydraulic or pneumatic pump) to enable the motor to generate the desired motion. The motor may be electric, coupled to a suitable power source, and its activation and deactivation may be initiated by a control signal, manual user input (such as by a switch), or other suitable means. The actuator may be a hydraulic or pneumatic system, with the pressure and flow rate of the liquid or gas driven by any suitable mechanism such as a pump (driven by an electric motor, manually, etc.) and converted to linear motion via piston and cylinder.

To illustrate the adjustability of the adjustable support member262′,FIG.3Aillustrates schematically in side view the base ofFIGS.2A and2B, showing the surface-engaging ends of three of the support members262defining a plane PL and the surface-engaging end of the adjustable support member262′ movable relative to the plane PL. The range of motion along the Z axis of the surface-engaging end of the adjustable support member262′ is shown in dotted line format. As illustrated inFIG.3A, for example, the range of motion of the surface-engaging end of adjustable support member262′ is shown such that the surface-engaging end can extend above and below the plane PL defined by the remaining support members262.

To illustrate the adjustability of the support member262′ to accommodate a non-flat surface while optimizing base250stability,FIG.3Billustrates schematically in side view the base body255and support assembly260ofFIG.3, showing the surface-engaging ends of three of the support members262contacting a flat portion of a support surface S that has an irregularity, and the surface-engaging end of the adjustable support member262′ is arranged such that it is in contact with the irregularity of the otherwise flat support surface S. In this manner, the adjustable support member262′ can be selectively placed in contact with the surface S such that the adjustable support member262′ and the remaining support members262transmit a desirable portion of the table load to the surface S, thereby optimizing load balancing and stability of the base250.

FIGS.4A and4Bshow the base250. The forces imposed on it by the table load, and the resultant total load (the table load together with the weight of the base250) acting through the center of gravity CG of the entire table (including the base), and the reactive force that is carried by each of the four support members262, i.e. forces F1, F2, F3, and F4. As shown in the bottom view of the base inFIG.4B, the forces F1-F4are directed toward the base, in the +Z direction, indicated by an X. The total load acts in the −Z direction, indicated by a dot. Although the CG of the table is shown approximately centered between the four support members262, the CG may be anywhere within the rectangle bounded by the support members262. In addition, during a surgical procedure, the table load is dynamic. For example, various movements of components (e.g., movement of the table top or equipment such as robotic arms or surgical tools), movement of a surgeon or other medical professionals, and movement of the patient. This can result in changes to the magnitude of the table load and to the location of the center of gravity. Thus, the portion of the total load carried by each of the support members need not be equal, and can vary during a procedure. As noted above, irregularities in the floor or other support surface can affect the distribution of the total load across the four support members, and that distribution can be changed by movement of an adjustable support member.

To enable the detection and/or determination of the amount of force carried by one or more of the support members, and thus to enable an evaluation of whether the force for one or more of the support members should be changed by adjustment of one or more of the support members, the base250may include one or more load sensors270disposed and configured to detect a portion of the total table load carried by one of the support members262. In this embodiment, a load sensor270is shown inFIG.5as being coupled to the adjustable support member262′, however, in other embodiments, the load sensor270can be coupled to any suitable portion of the base250such that the load sensor270can sensor the portion of the total load carried by at least one of the support members262.

The load sensor270can be any suitable device configured to sense a load, such as a pressure sensor (to sense hydraulic and/or pneumatic pressure in embodiments in which the some or all of the total load is carried on a hydraulic and/or pneumatic element), a strain gauge sensor, a vibrating wire sensor, a capacitive sensor, and the like. For example, in some embodiments, the load sensor270can include a piezoelectric transducer, and the transducer can be coupled to a support member262(e.g., surface-engaging end of the support member262and/or the actuator268) such that the transducer is strained by load carried by the support member. In some embodiments in which the adjustable support member262is hydraulically actuated, for example, the load sensor270can be disposed to detect a pressure of the hydraulic fluid.

The load sensor270may be operably coupled to a controller202that can, for example, control adjustment of the adjustable support member262′ via the actuator268based on measurements acquired by the load sensor270. As shown schematically inFIG.6, the controller202can include a memory206, a processor204, and various components or modules that are part of, or separate from, the processor204for interacting with other devices. For example in the illustrated embodiment, the processor204includes an input/output module210(or interface) that receives data signals from the load sensor270and may convey them to a load feedback module212. Optionally (as indicated by dashed lines), the input/output module210may send output signals to a user display to provide a visual indication of information about the load carried by the support members, the location of the CG, and/or other information. The load feedback module212may receive the load signal from the load sensor270, via the input/output module210. The load feedback module212includes circuitry, components, and/or code to produce a control signal to send to the actuator268to control movement of the movable portion266of the adjustable support member262′. In some embodiments, the controller202includes a position feedback module214that receives a position, velocity, and/or acceleration information associated with movement of the movable portion266of the adjustable support member262′. The controller202can be coupled to a computer (not shown) or other input/output device via the input/output module210.

The processor204can be any processor configured to, for example, write data into and read data from the memory206of the controller202, and execute the instructions and/or methods stored within the memory206. Furthermore, the processor can be configured to control operation of the modules within the controller (e.g., the load feedback module212and the position feedback module214). Specifically, the processor can receive a signal including user input, load data, pressure data, distance measurements or the like and determine an amount of movement for the adjustable support member262′, and/or an amount of force to be applied by the actuator268. In other embodiments, the processor204can be, for example, an application-specific integrated circuit (ASIC) or a combination of ASICs, which are designed to perform one or more specific functions. In yet other embodiments, the processor can be an analog or digital circuit, or a combination of multiple circuits.

The memory206can be any suitable device such as, for example, a read only memory (ROM) component, a random access memory (RAM) component, electronically programmable read only memory (EPROM), erasable electronically programmable read only memory (EEPROM), registers, cache memory, and/or flash memory. Any of the modules can be implemented by the processor204and/or stored within the memory206.

In some embodiments, in use, if a portion of the total load supported by a particular support member262as measured by the load sensor270falls below a predetermined threshold, the controller270can adjust the adjustable support member262′ such that the portion of the table load supported by that particular support member262returns to an acceptable level (e.g., a minimum threshold load or proportion of the load). Further, in some embodiments, the adjustable support member262′ can be operably coupled to a position sensor (not shown) that can sense a position of the adjustable support member262′, e.g., to determine the range of motion available to the adjustable support member. For example, the position sensor can detect a distance that the movable portion266of the adjustable support member262′ is extended from the fixed portion264to determine if and by how much the adjustable support member can be adjusted in either direction, e.g., raised or lowered relative to the floor surface. In other embodiments, any suitable position indication or measurement can be used (e.g., a percentage of the maximum extension height).

In some embodiments, the base250can include any suitable number of load sensors270. For example, in some embodiments, each support member260can be operably coupled to a load sensor270such that a portion of the total load supported by each support member270can be determined. In this manner, in use, in response to detecting that a portion of the table load carried by any one or more of the support members260is not within an acceptable range, the adjustable support member270can be adjusted to change the portion of the table load carried by one or more of the support members260. Maintaining suitable distribution of the table load in this way can encourage stability and limit, reduce or prevent wobbling or vibration of the surgical table200.

In some embodiments, the support assembly260can include multiple adjustable support members262′ (e.g., two, three, four, five or more). In such embodiments, each adjustable support member262′ may be operably coupled to a load sensor270, and each load sensor70can detect a portion of the total load carried by the adjustable support member262′ to which it is coupled. In such embodiments, each adjustable support member262′ can be independently controlled and adjusted (e.g., raised and/or lowered) to achieve a desired amount of total load distribution across the adjustable support members262′.

Determining when to adjust an adjustable support member260can be based on any suitable table load balancing plan. For example, in some embodiments, a total load balancing plan can include defining an acceptable range of load to be carried by one or more of the support members260or adjustable support members262′. This acceptable range, in some instances, can be based on the total load. In some instances, an acceptable range can be a percentage of the total load. For example, a total load balancing plan can include an acceptable range of about 1 percent to about 40 percent of the total load. In such cases, if the portion of the total load supported by any of the support members262falls outside of the acceptable range, one or more of the adjustable support members262′ will be adjusted to redistribute the total load until one or more, or all, of the support members262are supported a portion of the total load within the acceptable range.

In some embodiments, the total load balancing plan can include determining and/or tracking the location of the center of gravity CG of the surgical table200. The center of gravity CG can be determined and/or calculated based on load information sensed by the load sensors270. For example, as described in connection withFIG.2D, the center of gravity CG may be centered within a region of stability RS bounded by the support members262. In practice, however, as described above, due to irregularities in the support surface, dynamic forces results from surgical procedures, and/or movement of components of the table load during a surgical procedure, the location of the CG may shift to a location unacceptable close to the boundary of the RS. To detect such instances, in some embodiments, the location of the center of gravity CG can be determined and tracked in real-time (e.g., during a surgical procedure). If, for example, the center of gravity CG reaches a threshold distance from the boundary, the controller202can detect such an event and respond in any suitable manner, such as, for example, sending a signal to alert the surgeon or other medical staff, and/or a signal to adjust one or more of the adjustable support members262′ and/or additional stabilizing support members to provide desired stable support.

In some embodiments, adjustment of an adjustable support member may be initiated automatically in response to a determination that the total load needs to be redistributed. In another embodiment, adjustment of an adjustable support member may occur only when the base is being configured to a fixed arrangement with the floor. In other embodiments, the adjustable support member can be actuated manually by a user. In such embodiments, the base can be operably coupled to and/or can include a user display, such as user display290illustrated schematically inFIG.6, and when the controller, for example, determines that the portion of the table load is not within an acceptable range, the controller can send a signal to the user display to generate on the user display an instruction to a user to actuate the actuator to move the surface-engaging end of the adjustable support member to change the portion of the table load carried by at least one of the support members. Further, in some instances, for example, when the controller determines that the portion of the table load is not outside of the acceptable range, the controller can send a signal to the user display to generate on the user display an indication that the user can cease activation of the actuator. In some embodiments, any type of visual, audio, and/or tactile feedback or alert can be generated to alert a user of a condition, such as an unacceptable load distribution.

Surgical tables, in addition to be structurally rigid and adjustable to accommodate for irregularities, can be mobile to allow for wheeled transport around the hospital. For example, as shown schematically inFIGS.7A(bottom view) and7B (side view), a base350for a surgical table includes a base body355and a support assembly360coupled to the base body355. The base350can be the same or similar in structure and function to the base350described above, except the base350includes a wheel380to support the base350for movement on the surface (e.g., such that the surgical table can be wheeled around the operating room and/or around other areas of a hospital).

The base350can include any suitable number of wheels380to support the base350for movement on the surface, and can be coupled to the base350in any suitable location and any suitable manner. For example, in some embodiments, the base350can include two, three, four, or more wheels or casters to support the base350for movement on the surface. Further, in some embodiments, the wheel380is physically separate from the support members360(including the adjustable support member362′), while in other embodiments, the wheel is included, coupled to, and/or integrated with a support member360(optionally including the adjustable support member362′). For example, in some embodiments, one or more wheels380can be coupled to one or more of the support members362and can define at least in part the surface-engaging end of support member362to which it is coupled.

In some embodiments, one or more wheels380of the base350is movable upwardly (e.g., along the Z axis) relative to the surface-engaging ends of the support members to change the base350from a movable arrangement, in which the base350is supported only one the wheels380and movable relative to the surface on the wheels380, to a fixed arrangement in which the base350is supported at least in part by at least two of the support members362and fixed relative to the surface. In this manner, the base350can be transitioned from a movable arrangement to a fixed arrangement, and vice versa, such that the surgical table can be moved around the hospital to a desired location, and then fixed to the surface in preparation for the surgical procedure. In some embodiments, in the fixed arrangement, the base350is supported only by the support members362(e.g., and not a wheel380).

In some embodiments, the surface-engaging ends of at least two support members362are movably downwardly relative to the wheels380. In this manner, the base350can be changed from a movable arrangement in which the base350is supported only on the wheels380and movable relative to the surface on the wheels380, to a fixed configuration in which the base350is supported at least in party by the at least two support members362and fixed relative to the surface. In some embodiments, the surface engaging ends of at least four of the support members362are movable downwardly relative to the wheels380, and in the fixed arrangement, the base350is supported only by the support members362. Each of the support members326may be an adjustable support member, and downward movement of the surface engaging portion of each of the support members362may therefore include movement of an adjustable portion of the support member by an actuator in the same manner as the adjustable support member262′ described above.

FIG.8is a flow chart that illustrates a method400of stabilizing a surgical table on a surface with a base such as the base250or350described above. In some embodiments, the method includes receiving at402a signal from the load sensor indicative of the portion of the total load carried by the one of the support members. The method optionally further includes receiving at404a signal from an adjustable support member indicative of an adjustment position (e.g., a position of the movable portion of the adjustable support member relative to the base body and/or fixed portion). The method further includes comparing at406the portion of the total load to an acceptable range. If, at408, the portion of the total load is determined not to be within the acceptable range, then the method optionally further includes, at410, determining the adjustability of the adjustment member based at least in part on the adjustment position and determining if the adjustability is sufficient to achieve optimal stability. If the adjustability is sufficient to achieve optimal stability, then the method further includes, at412, causing the surface-engaging end of the adjustable support member to move relative to a plane defined by the surface-engaging ends of three of the other support members and thereby to change the portion of the total load carried by one of the support members. If the adjustability is determined to be insufficient to achieve optimal stability, then the method optionally further includes, at414, sending a signal indicative of an alert that the surgical table may not be optimally stable. If, at406, the portion of the total load is determined to be within the acceptable range, then the method may return to receiving at a later time another signal from the load sensor, and repeating the method from402. The method may further include after causing the movement of the surface-engaging end of the support member to move and/or after sending the signal indicative of the alert, returning to402to receive an updated signal from the load sensor and repeating the method until the portion of the total load is within the acceptable range.

Although in various embodiments described herein, the support assembly as illustrated and explained included a particular number of support members, and particular number of which are adjustable, in other embodiments, a support assembly can include any suitable number of support members and any suitable number of adjustable support members. For example, in some embodiments, a support assembly can include four support members, and all four support members can be adjustable. In yet other embodiments, a support assembly can include more than four support members, such as, for example, five or more support members. For example, in some embodiments, a support assembly can include five support members, and four of the five support members can be non-adjustable relative to the base body and/or the other support member (e.g., the adjustable support member. Similarly, a base can include any suitable number of wheels and any suitable number of load sensors, and those wheels and load sensor can be coupled to any suitable portions of the base.

As described above, it is desirable to reduce unwanted vibration at the working ends of the robotic arms of a robotic surgical system. Robotic surgical systems can include robotic surgical arms that are coupled, directly or indirectly, to a surgical table on which a patient can be supported during a surgical procedure. The robotic surgical arms may support at their distal, working ends various devices, including surgical instruments, cannulae for providing access to the patient's body cavity(ies) and organ(s) for application of surgical instruments, imaging devices, lights, etc. In such systems, it is desirable to establish and maintain high positional accuracy for the devices mounted on the distal ends of the robotic arms.

Positional accuracy can be reduced or degraded by vibration of the distal ends of the robotic arms. Such vibration may be in the form of vibrational cross-talk, which is unwanted vibration occurring in one part of the system that originates in another part of the system. For example, vibration may be induced within a robotic arm, such as by operation of a motor driving movement of some portion of the arm relative to another portion of the arm and/or to the surgical table or other supporting structure, and the energy introduced into the arm by operation of the motor may propagate through the arm to the distal end, inducing vibration in the distal end. This arm may be referred to as the “active” arm. Alternatively, or additionally, energy introduced into the active arm, such as by operation of a motor within the active arm, may propagate through the active arm, through the table or other supporting structure, and through another robotic arm (which may be referred to as the “passive” arm) to the passive arm's distal end. It is desirable to reduce vibrational cross-talk to enhance positional accuracy of the distal ends of robotic arms and the devices attached thereto.

To address vibrational cross-talk and positional accuracy of the distal ends of robotic arms and the devices attached thereto, apparatus and methods for providing a robotic surgical system including a surgical table having a table top on which a patient can be disposed are described in various embodiments herein with respect toFIGS.9A-23B. In some embodiments, an apparatus includes a surgical table and robotic arms coupled, or coupleable to, the surgical table, with each robotic arm supporting a medical instrument, such as a surgical tool, tool driver, cannula, light, and/or imaging device. The surgical table includes a base, a pedestal or column, and a table top coupled to the column. Each of the robotic arms may be coupled to at least one of the table top, the column or the base. Each robotic arm provides two or more links between the proximal end of the arm (at which the arm is coupled to the table) and the distal end of the arm (at which the arm is coupled to the medical instrument). The links are coupled to each other, and may be coupled to the table and to the medical instrument, by a joint that provides one or more degrees of freedom of relative movement between the links coupled by the joint, and correspondingly one or more degrees of freedom of relative movement between the distal end of the robotic arm and the surgical table. The links and corresponding degrees of freedom allow for movement of the distal end of the robotic arm about and/or along the X, Y, and/or Z axes, to a desired location relative to the table top and/or a patient disposed thereon and/or a desired target portion of the anatomy of a patient disposed thereon. Relative movement of the links about the joints can be initiated and continued by operation of devices such as motors, and/or resisted or stopped by active devices such as motors and/or passive devices such as brakes. As noted above, such devices can introduce energy into the robotic surgical system, which can produce unwanted vibrations at the distal ends of the robotic arms.

In some embodiments, an apparatus includes a surgical table having a patient table top, an adapter coupled to the surgical table, and one or more robotic arms coupled to the adapter. In some embodiments, an apparatus can include a surgical table having a patient table top and an adapter/robotic arm assembly coupled to the surgical table. For example, the adapter and robotic arm can be an integral mechanism or component. Each of the adapter and the robotic arms, or an adapter/robotic arm assembly, can include one or more links to allow for movement of the adapter and/or arms about and/or along the X, Y, and/or Z axes, to a desired location relative to the table top and/or a patient disposed thereon and/or a desired target portion of the anatomy of a patient disposed thereon.

In some embodiments, the robotic arm can be releasably coupled to the surgical table. In some embodiments, the robotic arm can include a releasable coupling between its proximal end and its distal end, such that the proximal portion of the robotic arm can be coupled to the surgical table and the distal portion of the robotic arm can be removed from the proximal portion. In some embodiments, the proximal portion of the robotic arm can be implemented as an adapter, which may be fixedly coupled to the surgical table. The adapter can include a table interface structure or mechanism, a first link member pivotally coupled to the interface structure at a first joint, and a second link member coupled to the first link member at a second joint. In some embodiments, the second link member can be pivotally coupled to the first link member at the second joint. The second link member is also configured to be coupled to a robotic arm at a coupling that includes a coupling portion of the second link member and a coupling portion at a proximal or mounting end portion of the robotic arm. The robotic arm also includes a target joint at the mounting end portion of the robotic arm. In some embodiments, the target joint is included with the coupling portion at the mounting end portion of the robotic arm.

The robotic arm can be used to perform a surgical procedure on a patient disposed on the surgical table. The first joint can provide for rotational motion of the first link member about a vertical Z-axis relative to a table top of the surgical table and movement of the first link member and the second link member in lateral and longitudinal directions (also referred to herein as X-direction and Y-direction) relative to the table top of the surgical table. The second joint can provide a lift mechanism to allow for vertical movement (e.g. movement closer to, above, and/or further above, the table top of the surgical table) of the second link member and the mounting end portion of a robotic arm coupled thereto. The collective movement of the first link member and the second link member allows for the adapter and a robotic arm when coupled thereto to move between a variety of different positions relative to the surgical table. For example, the adapter and robotic arm can be moved to a stowed position, and various operating positions where the target joint of the robotic arm can be placed at a target location to perform a particular surgical procedure on a patient disposed on the table top of the surgical table. The motion of the first link member and the second link member also provides for movement of the adapter and robotic arm to various parked or clearance positions in which the adapter and robotic arm are disposed such that access to the patient is not obstructed. For example, it may be desirable to move the adapter and robotic arm during a surgical procedure to provide clearance for equipment such as an imaging device and/or to provide clearance for additional medical personnel in, for example, an emergency during the procedure. In some cases, an operating position can also be a parked position.

As shown schematically inFIGS.9A-9B, a surgical table500includes a table top520, a table support or column522and a table base524. The table top520has an upper surface on which a patient can be disposed during a surgical procedure, as shown schematically inFIG.9A. The table top520is disposed on the column522, which can be, for example, a pedestal, at a suitable height above the floor. The column522may provide for movement of the table top520in a desired number of degrees of freedom. For example, as illustrated schematically inFIG.9A, the column522may have two sections that telescope relative to each other to provide translation in the Z axis (height above the floor). Additionally, or alternatively, the table top520may be movable relative to the base550along the Y axis (along the longitudinal axis of the table), and/or the X axis (along the lateral axis of the table), and/or about the Z, Y, and/or X axis. The table top520may also include multiple sections that are movable relative to each other along/about any suitable axes, e.g., separate sections for each of the torso, one or both legs, and/or one or both arms, and a head support section. Movement of the table top520and/or its constituent sections may be performed manually, driven by motors, controlled remotely, etc. The column522for the table top may be mounted to the base524, which can be fixed to the floor of the operating room, or can be movable relative to the floor, e.g., by use of wheels on the base. As shown schematically inFIG.9A, in some embodiments, the height of the column522can be adjusted, which together with, for example, the motion (e.g., axial (longitudinal) or lateral motion) of the table top520, can allow for the table top520to be positioned at a desired surgical site at a certain height above the floor (e.g., to allow surgeon access) and a certain distance from the column520. This also can allow robotic arms530coupled to the table500to reach a desired treatment target on a patient disposed on the table top520.

In a robotically assisted surgical procedure, one or more robotic arms530can be disposed in a desired operative position relative to a patient disposed on the table top520of the surgical table500(also referred to herein as “table”), as shown schematically inFIGS.9Cand9D. The robotic arm(s) can be used to perform a surgical procedure on a patient disposed on the surgical table500. In particular, the distal end of each robotic arm can be disposed in a desired operative position so that a medical instrument coupled to the distal end of the robotic arm can perform a desired function.

In accordance with various embodiments, each robotic arm530may be permanently, semi-permanently, or releasably coupled to the table top520via a coupling518, as shown inFIGS.9C and9D. The coupling518can include a variety of different coupling mechanisms, including a coupling portion (not shown) on the table top520that can be matingly coupled to a coupling portion (not shown) on the robotic arm. Each robotic arm530can be coupled at a fixed location on the table500or can be coupled such that the robotic arm530can be movable to multiple locations relative to the table top520and/or a patient disposed on the table top520as described in more detail herein. For example, the robotic arm530can be moved relative to the table top520and/or a specific target treatment location on the patient. In some embodiments, the axial motion (e.g., in the Y-axis direction) of the table top520can assist in allowing the arms530(and therefore, the medical instrument or tool coupled to the distal end of the arm) to reach the desired anatomy on the patient or provide clearance for access to the patient as needed. In some embodiments, the combination of vertical movement of the column522, axial movement of the table top520and movement of, for example, links in the robotic arm530allow the robotic arm to be placed in a position where it can reach the anatomy of the patient at the required height over the floor.

As shown schematically inFIGS.10A and10B, each robotic arm530can include a distal end portion537and a proximal end portion536. The distal end portion537(also referred to herein as “operating end”) can include or have coupled thereto a medical instrument or tool515. The proximal end portion536(also referred to herein as the “mounting end portion” or “mounting end”) can include the coupling portion to allow the robotic arm530to be coupled to the table top520of the table500. The robotic arm530can include two or more link members or segments510coupled together at joints that can provide for translation along and/or rotation about one or more of the X, Y and/or Z axes. The coupling portion of the robotic arm530to couple the robotic arm530to the table top522at the coupling518can be disposed at the distal or mounting end536of the arm530and may be coupled to a segment510or incorporated within a segment510. The robotic arm530also includes a target joint J1disposed at or near the mounting end536of the robotic arm530that can be included within the coupling portion of the coupling518or disposed on a link or segment510of the robotic arm530coupled to the coupling portion. The target joint J1can provide a pivot joint to allow a distal segment of the robotic arm530to pivot relative to the table top520. The robotic arm530can be moved between various extended configurations for use during a surgical procedure, as shown inFIG.10A, and various folded or collapsed configurations for storage when not in use, as shown inFIG.10B.

In some embodiments the connection between the surgical table and the distal end of the robotic arm (and thus the position and orientation of the medical instrument at the distal end of the robotic arm relative to the patient), is implemented with an adapter528and robotic arm(s)530coupled to the adapter528, as shown inFIGS.11A and11B. The adapter528can be separate from, but engageable with, or coupleable to, the surgical table500, or can be fixedly attached to the surgical table500. The adapter528can be coupled to, for example, the column522, the table base524and/or the table top520of the table500. However, the distinction between an adapter and robotic arm can be disregarded, and the connection between the surgical table and the distal end of the robotic arm can be conceptualized and implemented as a series of links and joints that provide the desired degrees of freedom for movement of the medical instrument, i.e. at the distal end of the connection. The connection may include a releasable coupling at any one or more link(s) or joint(s) or any location along the series of links and joints.

As described herein, in some embodiments, the various sections of the table top520can move relative to each other (e.g., can be tilted or angled relative to each other) and/or the table top520can be moved (e.g., tilted, angled) relative to the column522and/or the base524of the surgical table500. In some embodiments, it is contemplated that the adapter528and robotic arms530coupled thereto can move with the torso section of the table top520such that the frame of reference to the X, Y and Z axes for various embodiments remains relative to the top surface of the table top520. In some embodiments, the adapter528and robotic arms530can be coupled to the support pedestal522of the table500and when the table top520is moved relative to the support522, the positioning of the adapter528and arms530can be coordinated with the movement of the table top520.

As shown schematically inFIGS.12A and12B, the adapter528can include a table interface structure or mechanism540, and one or more link members. In this example embodiment, the adapter528includes a first link member532coupled to the interface structure540at a first joint533, and a second link member534coupled to the first link member532at a second joint535. In some embodiments, the first link member532can be pivotally coupled to the table interface structure540at the first joint533. In some embodiments, the first link member532can be coupled to the table interface structure540with a joint that provides for linear motion. In some embodiments, the second link member534can be pivotally coupled to the first link member at the second joint. Other types of coupling joints for the first joint533and the second joint535can alternatively be used. Thus, various different types of coupling joints (e.g., linear, rotational) can be used between the link members of the adapter to achieve a desired movement and reach of the adapter. The second link member534is also coupleable to a robotic arm530at a coupling518(also referred to herein as “coupling joint”). The adapter528can be moved between various extended configurations for use during a surgical procedure as shown inFIG.12A, and various folded or collapsed configurations for storage when not in use, as shown inFIG.12B.

In some embodiments, the adapter528can include more than two link members. For example, an adapter can include a third link member (not shown) coupled to the second link member534between the second link member534and the coupling518to the robotic arm530. In other embodiments, more than three link members can be included. The number and size of link members can vary such that the adapter528can provide a longer or shorter reach to extend the robotic arm530(e.g., the target joint J1discussed below), for example, further above the patient, for larger patients. It can also be used to extend the position of the robotic arm530further under the table top520when the arm530is moved to a position on an opposite side of the table500as described in more detail below (e.g., the arm is moved to the opposite side to have three arms on one side of the table). The first joint533and the second joint535of the adapter528can provide for movement of the robotic arm530along and/or about the X, Y, and/or Z axes.

In accordance with various embodiments, each robotic arm530may be permanently, semi-permanently, or releasably coupled to the adapter528via the coupling518. The coupling518can include a variety of different coupling mechanisms, including a coupling portion (not shown) on the adapter528that can be matingly coupled to a coupling portion (not shown) on the robotic arm. Each robotic arm530can be coupled at a fixed location on the table500or can be coupled such that the robotic arm530can be movable to multiple locations relative to the table top520and/or a patient disposed on the table top520as described in more detail herein. For example, the robotic arm530can be moved relative to the table top520and/or a specific target treatment location on the patient. In some embodiments, the axial motion (e.g., in the Y-axis direction) of the table top520can assist in allowing the arms530(and therefore, the medical instrument or tool coupled to the distal end of the arm) to reach the desired anatomy on the patient or provide clearance for access to the patient as needed. In some embodiments, the combination of vertical movement of the support pedestal522, axial movement of the table top520and movement of, for example, the first link member532and the second link member534, allows for placement of the robotic arms530in a position where it can reach the anatomy of the patient at the required height over the floor.

Some structural requirements for the adapter528can include providing a rigid support of the robotic arm530while maintaining adjustability for pre-operative and intra-operative position changes of the robotic arm530. In some embodiments, the table adapter528can include a means of holding or locking the adapter528at a fixed position to withstand, for example, the effects of gravity, inertial effects due to robotic arm motion, and/or to withstand accidental bumps from a user or another part of the robotic system (including other robotic arms or table motion). The table adapter528can also include one or more sensors for measuring the spatial position of the adapter528and/or angles and displacements of various joints and coupling points of the adapter528.

The collective motion of the first link member532and the second link member534of the adapter528can provide for movement of the coupling518, and therefore, movement of a robotic arm530coupled thereto along and/or about the X, Y, and/or Z axes. For example, the target joint J1of the robotic arm530can be moved to various target treatment locations relative to the table500to perform a variety of different surgical procedures on a patient disposed thereon. The collective motion of the first link member532and the second link member534also allows the adapter528and robotic arm530to move between a variety of different positions relative to the surgical table500including stowed positions, operating positions and parked or clearance positions.

FIG.13is a top view of a portion of support522, adapter528and a robotic arm530illustrating example degrees of freedom associated with the joints of the adapter528and/or robotic arm530. As shown inFIG.13, and as described above, the first link member532can be coupled to the interface mechanism540at a joint533and the second link member534can be coupled to the first link member532at a joint535. The robotic arm530can be coupled to the second link member534at a coupling joint518and each of the links510of the robotic arm530can be coupled to each other at a joint. As shown in this example, the J1joint of the robotic arm530coincides with the coupling joint518. In some embodiments, the adapter528, and more particularly, the interface mechanism540can be movably coupled to the surgical table (e.g., to the support522) at a coupling joint513such that a first degree of freedom DOF1is provided at the coupling joint513. In the example ofFIG.13, the coupling joint513provides for linear movement between the interface mechanism540and the surgical table, i.e. translation parallel to the X axis. In other embodiments, the coupling joint can provide pivotal or rotational movement of the interface mechanism540relative to the surgical table. In other embodiments, the interface mechanism540is fixedly coupled to the surgical table, and thus, does not move relative to the surgical table.

As also shown inFIG.13, a second degree of freedom DOF2is provided at the joint533between the first link member532and the interface mechanism, and a third degree of freedom DOF3is provided at the joint535between the first link member532and the second link member534. A fourth degree of freedom DOF4is provided at the joint518, J1between the second link member534and a link510of the robotic arm530. In this example, each of DOF2, DOF3, and DOF4are shown as rotation about the Z axis.

The robotic arm530or a portion thereof can be releasably coupled to the adapter528and/or portions (e.g., links) of the robotic arm530can be incorporated into the adapter528. Thus, the connection between the surgical table and the distal end of the robotic arm530can be conceptualized and implemented as a series of links and joints that provide the desired degrees of freedom for movement of the medical instrument515at the distal end of the connection. The connection may include a releasable coupling at any one or more link(s) or joint(s) or any location along the series of links and joints.

The various degrees of freedom of the links of the adapter528and/or robotic arm530provide for movement of the robotic arm530and therefore, a medical instrument515disposed at a distal end thereof to be moved to a variety of different positions and orientations relative to the table top520to perform various different procedures on a patient disposed thereon. The adapters528described herein can also provide for variations on the number of robotic arms530that are coupled to the table to use for a particular procedure, and to position robotic arms530on one or both sides of the table top520. For example, in some procedures, it may be desirable to position two robotic arms530on one side of the table top520and two robotic arms530on an opposite side of the table top520. In other procedures, it may be desirable to position three robotic arms530on one side of the table top520and one robotic arm530on an opposite side of the table top520. Although many of the embodiments described herein describe the use of four robotic arms530, it should be understood that the number of robotic arms530to be used for a particular surgery can vary and more or less than four robotic arms530can be used. Various specific example embodiments are described herein demonstrating the movement and location of the robotic arms relative to the table top520within a treatment area or treatment “cloud” for various different procedures.

To secure the table adapter528at various locations used during pre-operative setup and/or during surgery, the various joints and/or coupling locations may utilize braking or locking mechanisms. For example, braking mechanisms may provide the ability to hold position at any point in the range of motion of the joint. Braking mechanisms may include, for example, disc-caliper-style, drum-roller-style, or other friction-based mechanisms. Locking mechanisms may provide the ability to hold position at any number of discrete positions, but may not allow for continuous adjustment. Locking mechanisms can include, for example, disengaging-toothed, disengaging-pinned, or ball-detent, or other discrete position style locking mechanisms. In some embodiments, braking or locking mechanisms can prevent motion in an unpowered state and be biased towards a stopped or locked position via a spring or other mechanism. In some embodiments, in a powered state, braking or locking mechanisms may optionally release or engage depending on the desired state of the system.

As shown schematically inFIG.14, an energy source ES, such as motor at a joint between two links in active arm530, in use, can induce unwanted vibration V1in tool515of active arm530, and/or vibration V2in tool515′ of passive arm530′ via interface structure(s)540and column522. For example, energy introduced by the energy source ES in the active arm530may propagate through the active arm530, through the interface structure(s)540and column522, and through the passive arm530′ to the tool515′ of the passive arm530′, inducing vibration V2in tool515′. It is desirable to reduce such vibrational cross-talk from energy source ES of active arm530to tool515of active arm530and to tool515of passive arm530′ to enhance positional accuracy of the tool515of active arm530and tool515′ of passive arm. In some instances, various components along/about each of three axes of the system may be subject to varying vibrations. In such instances, it is desirable to reduce amplitude of at least the most critical components, if not all of the components, to enhance positional accuracy of the distal ends of the robotic arms and the devices attached thereto.

FIGS.15A-23Billustrate various embodiments of apparatus and methods for reducing vibrational cross-talk by separating the modal frequencies of vibration of the robotic arm and the table structure(s) to which the arms are coupled.

Decoupling the modal vibration frequencies of the arms (or their constituent components) from the table reduces the efficiency of transmission of the energy introduced into the active arm by, for example the motor and/or brake. For example, if an active robotic arm has a mode of 4 Hertz (Hz), energy introduced into the active robotic arm is best transferred to a passive robotic arm when the intervening structure to which the two arms are mounted has a mode equal to the mode of the active robotic arm; in this case, a mode of 4 Hz. Transmission of the energy introduced into the active robotic arm can be lessened and/or interrupted by arranging the intervening structure to have a mode different than the mode of the active robotic arm; in this case, for example, the intervening structure can be arranged to have a mode of about 6 Hz, thereby creating modal separation between the active arm and the intervening structure, and thus reducing the efficiency of energy transmission to the passive arm. Less energy transmitted between arms results in less vibration produced, i.e. lower amplitude in/about one or more axes.

Conventional surgical tables have a lowest modal frequency of about 6-8 Hz. Robotic surgical arms may have lowest modal frequencies on the order of about 4-6 Hz. To produce desired magnitude of decoupling, it is desirable to separate table frequency from arm frequency by at least about 2 Hz. In some instances, it is preferable to have a table frequency that is about two times or more than arm frequency. In disclosed embodiments, it is preferable for table frequency to be 10 Hz or more, or in some instances more preferably 12 Hz or more.

Several approaches to increasing the lowest modal frequency of the table are disclosed. As described briefly above, the table can include several components or subassemblies, including a base, adjustable column, and table top with one or more relatively moveable components. The lowest modal frequency for the overall system is typically defined by relative movement between the components or subassemblies of the surgical table, along or about different axes produced by bending, compression, or torsion of the structural components coupling the subassemblies.

Another source of undesirable lower modal frequencies is backlash, slop or play in the system, between the subassemblies or components, or between the system and the environment. For example, as discussed in Appendix A, if the base of the table is relatively stiff, resistant to bending and/or compression, it is less able to accommodate irregularities in the floor or other surface on which the base is supported. This can produce rocking or other movement of the table, which can lower one or more of the modal frequencies of movement of the system.

The lowest frequencies for the system may be defined by bending of the support column and/or base, and corresponding sway of the table top relative to the base. This bending and resulting sway may be in the Y-Z plane (i.e. about the X axis), as shown inFIG.15A. It may result from the center of gravity (CG) of the load carried by the column522(i.e. the table top, the robotic arms, the patient, and any other equipment mounted to the table top or support column) being displaced longitudinally (along the Y axis) from the center line CL of the column, as shown inFIG.15A. The bending/sway may also be in the X-Z plane (i.e. about the Y axis), as shown inFIG.15B. This may result from the CG of the load being displaced longitudinally (along the X axis) from the center of the column, as shown inFIG.15B. The CG may be displaced from the CL by positioning of the robotic arms and/or the patient for the surgical procedure.

As discussed above, the table top may also be pivotable relative to the column to position the table top and patient in a desired orientation for a given surgical procedure. As shown inFIG.16A, this pivotal movement may be about the X axis, i.e. about a pivot521. As shown inFIG.16B, this pivotal movement may be about the Y axis, i.e. about a pivot523. Either pivotal movement may also produce a displacement of the CG relative to the CL of the column. The mechanism that enables and produces either or both pivotal movements may also be a source of backlash, which, as noted above, can lower the modal frequency of one or more of the degrees of movement of the table. Described below are several embodiments of mechanisms that can enable and/or produce pivotal movement of the table top but have relatively high structural rigidity, minimize tendency to bend the column, otherwise resist sway of the table top relative to the base, and/or reduce sources of backlash in the system.

To allow the table top to pivot relative to the column (e.g., along and/or about the Z, Y, and/or Z axis) to position the table top and patient in a desired orientation (e.g., a Trendelenburg orientation) for a given surgical procedure, a surgical table can include a pivot assembly coupled to its telescopic column and having actuators operably coupled to various portions of the table top and arranged to move the table top into the desired orientation. For example, as shown schematically inFIGS.17A-17C, such a surgical table600includes a table top620, a table support or column622, a table base650, and a pivot assembly660. The table top620is disposed on the column622, which can be, for example, a pedestal, at a suitable height above the floor. The column622includes two sections that telescope relative to each other to provide translation in the Z axis (height above the floor), as illustrated schematically inFIGS.17A and17C. The surgical table600can be the same as or similar in structure and function to the surgical table500described herein. Thus, some details regarding the surgical table600are not described below. It should be understood that for features and functions not specifically discussed, those features and functions can be the same as or similar to any of the surgical tables described herein.

As discussed in further detail herein, in this embodiment, the pivot assembly660is coupled to the column622. In this manner, the column622and the pivot assembly660can translate simultaneously in the Z axis (height above the floor). The pivot assembly660includes a primary load support662, a first actuator663A, a second actuator663B, a third actuator663C, and a support flange661arranged to support the pivot assembly660and to couple the pivot assembly660with the column622, as illustrated schematically inFIGS.17A-17C.

The primary load support662includes a pivot664operably coupled to the table top620. Similarly as described with respect to pivot121and pivot123, the pivot664allows for pivotal movement of the table top620relative to the column622about the X axis and about the Y axis to position the table top622and patient (not shown) in a desired orientation for a given surgical procedure. Pivot664may be implemented with a gimbal joint arrangement to enable the two-axis pivoting motion.

As illustrated inFIGS.17A-17C, the pivot assembly660is coupled to the column622in a cantilevered fashion. In this embodiment, the column622is located off the origin of the X and Y axis of the base650, with the primary load support662disposed near the centerline of the table top620. In this arrangement, the cantilevered pivot assembly660and the table load can collectively cause an undesirable bending moment M (see e.g.,FIG.17C) and shear force on the column622. The bending moment M and shear force on the column622can cause wear due to undesirable contact or rubbing between the two sections of the column622(e.g., between telescoping joints) during their relative movement. Over time, the wear can result in lowered structural rigidity, increased sway of the table top620, and/or increased backlash in the system. Further, the cantilevered position of the pivot assembly660relative to the column622may lead to the center of gravity being displaced beyond an acceptable boundary defined by the base650(e.g., beyond an acceptable distance from the center line of the column622), for example if the patient is disposed more to the opposite side of the table top620, and/or robotic arms are extended on the opposite side of the table top620.

To enable and/or produce pivotal movement of a table top but remedy the deficiencies illustrated and described with respect to the embodiment shown inFIGS.17A-17C, rather than coupling the pivot assembly with the column in a cantilevered fashion, the pivot assembly can be arranged about the column, and the column can be relocated towards the center of the base (rather than off-center as shown an described with respect to the embodiment shown inFIGS.17A-17C). In this manner, the location of the center of gravity is improved by moving it towards the central vertical axis of the column).FIGS.18A-18Cillustrate a surgical table700according to such an embodiment. As shown, in this embodiment, the surgical table700includes a table top720, a table base750, a table support or column722located at or near the center of the table base750, and a pivot assembly760distributed about the column722. The table top720is disposed on the column722, which can be, for example, a pedestal, at a suitable height above the floor. The column722includes two sections that telescope relative to each other to provide translation in the Z axis (height above the floor), as illustrated schematically inFIGS.18A and18C. The surgical table700can be the same as or similar in structure and function to any of the surgical tables (e.g., surgical table500,600, etc.) described herein. Thus, some details regarding the surgical table700are not described below. It should be understood that for features and functions not specifically discussed, those features and functions can be the same as or similar to any of the surgical tables described herein.

The pivot assembly760includes a primary load support762, a first actuator763A, a second actuator763B, a third actuator763C, and a support flange761arranged to support the pivot assembly760and to couple the pivot assembly260with the column722, as illustrated schematically inFIGS.18A-18C. The actuators763A,763B,763C and the primary load support762are spaced about various sides or portions of the column722, as best illustrated schematically in top view inFIG.18B(section A-A ofFIG.18A). More specifically, the primary load support762is connected at its lower end to the support flange761at a first portion of the support flange761on one side of the column722. The primary load support762includes a pivot764(e.g. a gimbal joint) operably coupled to the lower side of the table top720. In turn, the second actuator763B is connected at its lower end to another portion of the support flange, on the side of the column722opposite to the portion of the support flange761to which the lower end of the primary load support762is connected. Further, the first actuator763A is connected at its lower end to the support flange761at a third portion of the support flange on the side of the column722between the first and second portions of the support flange761, i.e. between the primary load support762and the second actuator763B, and the third actuator763C is connected at its lower end to the support flange761at a fourth portion of the support flange on the opposite side of the column722from the first actuator763A, and between the first and second portions of the support flange761, i.e. between the primary load support762and the second actuator763B. Each of the actuators763A,763B, and763C is coupled at its upper end (e.g. with a gimbal joint) to the lower side of the table top320,

Distributing the pivot assembly760about the column722in this manner allows the center of gravity (CG) of the load carried by the column722(i.e. the table top, the robotic arms, the patient, and any other equipment mounted to the table top or support column) to be placed at or near the center of the column722, thereby limiting or reducing uneven loading at the telescoping column722, improving stiffness and stability of the system, and increasing modal frequency of the table top720and the column722. In this embodiment, the center of gravity, and the center of the column722is also be placed at or near the origin of the base's750X axis and Y axis.

An alternative configuration of pivot assembly760is shown inFIG.18D. In this configuration, the portions of the support flange761to which the lower ends of the primary load support762and the actuators763A,763B, and763C are attached are configured as discrete lateral projections from the body of the support flange761.FIG.18Dalso illustrates a possible arrangement of drive motors765A,765B and765C for the respective actuators763A,763B and763C.

In another embodiment, a surgical table can be the same as or similar in structure and function to the surgical table500, the surgical table600, and/or the surgical table700described herein, except the primary load support can be relocated to the top end of the column, with the actuators distributed about the primary load support.FIGS.19A-19Dillustrate a surgical table800according to such an embodiment. As shown, in this embodiment, the surgical table800includes a table top820, a table base850, a table support or column822located at or near the center of the table base850, and a pivot assembly860disposed on top of the column822. The table top820is disposed on the pivot assembly860. The column822can be, for example, a pedestal. The column822includes two sections that telescope relative to each other to provide translation in the Z axis (height above the floor), as illustrated schematically inFIGS.19A and19C.

As shown, the pivot assembly860is disposed on top of and coupled to the top of the column822and the bottom of the table top820. In this manner, the column822and the pivot assembly860can translate simultaneously in the Z axis (height above the floor), and the table top820can be disposed at a suitable height above the floor. The pivot assembly860includes a primary load support862, a first actuator863A, a second actuator863B, a third actuator863C, and a support flange861arranged to support the pivot assembly860and to couple the pivot assembly860with the column822, as illustrated schematically inFIGS.19A-19C.

In this embodiment, the primary load support862is disposed on top of the column822. More specifically, the lower end of the primary load support862is disposed within the periphery of the support column822in a plane transverse to the vertical axis (Z axis) of the column822, i.e. in the X-Y plane. The upper end of primary load support862includes a pivot864(e.g. a gimbal joint) operably coupled to the lower side of the table top820. Disposing the primary load support862on top of the column822in this manner allows the center of gravity (CG) of the load carried by the column322(i.e. the table top, the robotic arms, the patient, and any other equipment mounted to the table top or support column) to be placed at or near the center of the column822, thereby limiting or reducing uneven loading at the telescoping column822, improving stiffness and stability of the system, and increasing modal frequency of the table top820and the column822. In this embodiment, the center of gravity, and the center of the column822is also placed at or near the origin of the base's850X axis and Y axis. Further, disposing the primary load support863on top of the column822and distributing the actuators863A,863B,863C about the primary load support863reduces and/or eliminates the undesirable bending moment and shear force described above with respect toFIGS.17A-17C, thereby limiting or reducing uneven loading at the telescoping column822, improving stiffness and stability of the system, and increasing modal frequency of the table top820and the column822.

Disposing the entire pivot assembly860on top of column822, i.e. with all components including the actuators863A,863B, and863C above the top of the column, increases the height of the table top820, which can aggravate the bending forces on the column822and lower modal frequency(ies) associated with the column bending. An alternative arrangement is shown inFIG.19D. In this arrangement support flange861includes an upper portion861A coupled to the top of support column822, a lower peripheral portion861B, and a side portion861C connecting the lower peripheral portion861B to the upper portion861A. The lower end of primary load support862is coupled to the upper portion861A of support flange861, and the lower ends of the actuators863A,863B, and863C are coupled to the lower peripheral portion861B.

An alternative configuration of pivot assembly860is shown inFIG.19D. In this configuration, the portions of the lower peripheral portion861B of support flange861to which the lower ends of the primary load support862and the actuators863A,863B, and863C are attached are configured as discrete lateral projections from the side portion861C of the support flange861.FIG.18Dalso illustrates a possible arrangement of drive motors865A,865B and865C for the respective actuators863A,863B and863C.

As described above with respect toFIGS.9C and9D, one or more robotic arms can be coupled to the table to reach a desired treatment target on a patient disposed on the table top. In a robotically assisted surgical procedure, the robotic arm(s) can be disposed in a desired operative position relative to a patient disposed on the table top of the surgical table. In some embodiments, a table top can be coupled to the column via a table top adapter coupling.FIGS.20A and20Billustrate such an embodiment. In this embodiment, the surgical table900can be the same as or similar in structure and function to any of the surgical tables described herein. Thus, some details regarding the surgical table900are not described below. It should be understood that for features and functions not specifically discussed, those features and functions can be the same as or similar to any of the surgical tables described herein.

In this embodiment, the surgical table900includes a table top920, a table support or column922, a table base950, a pivot assembly960, a table top adapter coupling975(also referred to herein as “table top adapter”) disposed between and arranged to couple the column922and the table top920, and two robotic arms930coupled to the table top adapter coupling975. The pivot assembly960is operably coupled to the table top adapter975and can enable pivoting (as discussed with respect to previous embodiments) of the table top adapter975and in turn the table top920to place the table top920in a desirable position and orientation for a given procedure.

In this embodiment, the robotic arms930are coupled to and extend from the table top adapter975. Coupling the robotic arms930to the table top adapter975in this manner, however, may have some drawbacks. For example, in such an embodiment, tilt of the table top920and/or its constituent sections will cause movement or tilt of the robotic arms930because the robotic arms930are coupled to the table top920via the table top adapter975, as illustrated schematically inFIG.20B. As such, positioning of the robotic arms930(and any instruments attached thereto) needs to incorporate table top920positioning, thereby complicating the operation of the system. As another example of a potential drawback, coupling both the table top920and the robotic arms930to the table top adapter975may result in the table top920and the robotic arms930having too similar of modal frequencies, thereby potentially increasing unwanted vibration at the working ends, as described in more detail herein.

Such drawbacks can be addressed, for example, by coupling the robotic arms to a more rigid structure of the surgical table and to a structure independent from tilting motions of the table top and/or its constituent sections. Such an embodiment is illustrated schematically inFIGS.21A-21E. In this embodiment, the surgical table1000can be the same as or similar in structure and function to any of the surgical tables described herein. Thus, some details regarding the surgical table1000are not described below. It should be understood that for features and functions not specifically discussed, those features and functions can be the same as or similar to any of the surgical tables described herein.

In this embodiment, the surgical table1000includes a table top1020, a table base1050, a table support or column1022located at or near the center of the table base1050, a pivot assembly1060disposed on top of the column1022, two robotic arms1031,1032, and a table top adapter coupling1075(also referred to herein as “table top adapter”) disposed between and arranged to couple the column1022and the table top1020. The table top adapter1075is operably coupled to the pivot assembly1060and the table top1050. The column1022includes two sections that telescope relative to each other to provide translation in the Z axis (eight above the floor).

As shown, the pivot assembly1060is disposed on top of and coupled to the top of the column1022, and is further coupled to the bottom of the table top adapter1075. In this manner, the column1022and the pivot assembly1060can translate simultaneously in the Z axis (height above the floor), and the table top1020can be disposed at a suitable height above the floor. The pivot assembly1060includes a primary load support1062, a first actuator1063A, a second actuator1063B, a third actuator1063C, and a support flange1061arranged to support the pivot assembly1060and to couple the pivot assembly1060with the column1022, as illustrated schematically inFIGS.21A-21C.

In this embodiment, the primary load support1062is disposed on top of the column1022. More specifically, the lower end of the primary load support1062is disposed within the periphery of the support column1022in a plane transverse to the vertical axis (Z axis) of the column1022, i.e., in the X-Y plane. The upper end of the primary load support1062includes a pivot1064(e.g., a gimbal joint) operably coupled to the lower side of the table top adapter1075. Disposing the primary load support1062on top of the column1022in this manner allows the center of gravity (CG) of the load carried by the column1022(i.e., the table top, the robotic arms, the patient, and any other equipment mounted to the table top or support column) to be placed at or near the center of the column1022, thereby limiting or reducing uneven loading at the telescoping column1022, improving stiffness and stability of the system, and increasing modal frequency of the table top1020and the column1022. In this embodiment, the center of gravity (CG) and the center of the column1022is also placed at or near the origin of the base's1050X axis and Y axis. Further, disposing the primary load support1063on top of the column1022and distributing the actuators1063A,1063B,1063C about the primary load support1063reduces and/or eliminates the undesirable bending moment and shear force described above with respect toFIGS.17A-17C, thereby limiting or reducing uneven loading at the telescoping column1022, improving stiffness and stability of the system, and increasing modal frequency of the table top1020and the column1022.

Similarly as described with respect to the embodiment ofFIG.19D, in this embodiment, the support flange1061includes an upper portion1061A coupled to the top of the support column1022, a lower peripheral portion1061B, and a side portion1061C connecting the lower peripheral portion1061B to the upper portion1061A. The lower end of the primary load support1062is coupled to the upper portion1061A of the support flange1061, and the lower ends of the actuators1063A,1063B, and1063C are coupled to the lower peripheral portion1061B.

In this embodiment, with the primary load support1062connected at its lower end to the support flange1061, and the pivot1064(e.g., a gimbal joint) of the primary load support1062is operably coupled to the lower side of the table top adapter1075, as described above, the actuators are distributed about the periphery of the column1022and the primary load support1062(similar to the embodiment ofFIG.19B). More specifically, the first actuator1063is connected at its lower end to the lower peripheral portion1061B, on one side of the column1022. The third actuator1063C is connected at its lower end to another portion of the lower peripheral portion1061B of the support flange1061, on a side of the column1022opposite to the portion of the support flange1061to which the lower end of the first actuator1063A is connected. Further, the second actuator1063B is connected at its lower end to the lower peripheral portion1061B of the support flange1061at a third portion of the lower peripheral portion1061B on a side of the column1022between the first and second portions of the support flange1061along the Y axis, and such that the primary load support862is disposed between the first/second portions and the third portion of the support flange1061along the X axis. Each of the actuators1063A,1063B, and1063C is coupled at its upper end (e.g., with a gimbal joint) to the lower side of the table top adapter1075.

Further, as shown, in this embodiment, the robotic arms1031,1032are coupled to the support flange1061of the pivot assembly1060(rather than being coupled to the table top adapter or the table top). In this manner, in use, the robotic arms1031,1032can translate simultaneously with the column1022, the table top1020, and the table top adapter1075in the Z axis (height above the floor), but are independent from any pivoting or tilting of the table top1020and table top adapter1075. This feature is illustrated schematically in FIG.21C in which the pivot assembly1050is adjusted such that the table top1020and the table top adapter1075are tilted, while the robotic arms1031,1032remain in a vertical position (i.e., the same vertical position the robotic arms1031,1032were in prior to the pivot assembly being adjusted, as illustrated schematically inFIG.21A).

An alternative configuration of surgical table1000is shown inFIGS.21D and21E. In this configuration, four robotic arms1031,1032,1033, and1034are shown coupled to the table top adapter1075.FIG.21Ealso illustrates a possible arrangement of drive motors1065A,1065B and1065C for the respective actuators1063A,1063B and1063C.

Coupling the robotic arms to the support flange1061in this manner increases desirable modal frequency separation and reduces crosstalk vibration between the robotic arms and between the robotic arms and the table structure(s) to which the robotic arms are coupled. Even more, as the support flange1061and the column1022to which the support flange1061is coupled are stiffer and more stable than the table top1020and the table top adapter1075(i.e., the support flange1061and the column1022have a higher modal frequency), coupling the robotic arms to the support flange1061improves stiffness and stability of the system, and can reduce undesirable vibrations at the distal ends of the robotic arms.

To further stiffen the surgical table and increase its modal frequency and thus reduce undesirable vibrations at the distal ends of robotic arms attached thereto, any of the embodiments described herein can include telescoping and lockable support struts.FIGS.22A and22Billustrate such an embodiment. In this embodiment, for ease of description, as illustrated, the surgical table1100is shown with only a table top1120, a table base1150, a table support or column1122, and three support struts1178. The surgical table1100, however, can be the same as or similar in structure and function to any of the surgical tables described herein. Thus, some details regarding the surgical table1100are not described below. It should be understood that for features and functions not specifically discussed, those features and functions can be the same as or similar to any of the surgical tables described herein.

The support struts1178are disposed between and coupled to the table top1120and the table base1150, and include an upper section1178A and a lower section1178B that telescope relative to each other to provide translation in the Z axis (height above the floor). In this manner, the support struts1178can translate simultaneously with the column1122and the table top1120along the Z axis to place the table top1120at a suitable height above the floor. Each support strut1178includes a pivot joint (which may be, for example, a gimbal join) at each of its upper and lower ends to allow pivotal or rotational movement of the table top1120relative to the support struts1178and the column1122. Each support strut1178is lockable, i.e. the telescoping sections can be selectively fixed to each other so that they cannot telescope. In this manner, in use, once the table top1122is placed in a desired position above the floor and in a desired orientation (e.g., a desired tilt), the support struts1178can be locked. Locking the support struts1178provides greater structural resistance to movement of the table top relative to the base and thus can increase the modal frequency of table structures (e.g., the table top1122) to which the robotic arms (not shown) are coupled. In particularly, the support struts1178can limit and/or reduce potential sway of the table top1178, e.g., as discussed with respect toFIGS.15A and15B.

In an alternative embodiment, rather than coupling one or more support struts between the table top and directly to the table base, one or more support struts can have an upper end coupled to the table top and a lower end coupled to the column (e.g., an upper end of the column).

The support struts1178can be lockable in any suitable manner. In this embodiment, the support struts1178include a brake1179, as illustrated schematically in cross-section inFIGS.23A and23B. As shown, the brake1179is disposed between the telescoping sections of the support struts1178can be extended from a first position (FIG.23A), in which the sections of the support struts1178are “free following” or otherwise allowed to telescope relative to one another along the Z axis, to a second, engaged position (FIG.23B) in which the telescoping sections are locked and thus prevented from telescoping relative to one another along the Z axis.

In other embodiments, in addition to or instead of brakes, support struts can include lockable bearings to lock the support struts such that the sections of the support struts cannot telescope relative to one another.

Although in this embodiment the support struts1178are shown and described as being located outside of the column1122, in other embodiments, one or more support struts can be disposed inside of the column.

Further, although in this embodiment the surgical table1100includes three support struts, in other embodiments, a surgical table can include any suitable number of support struts (e.g., one support strut, two support struts, four support struts, or more).

In other embodiments, any or all of the support struts1178can include more than two sections that telescope relative to each other. In such embodiments, a locking mechanism is provided to selectively lock each section relative to the adjacent section.

As described above, it is desirable to reduce unwanted vibration at the working ends of the robotic arms of a robotic surgical system. Robotic surgical systems can include robotic surgical arms that are coupled to a surgical table via an adapter on which a patient can be supported during a surgical procedure. The robotic surgical arms may support at their distal, working ends various devices, including surgical instruments, cannulae for providing access to the patient's body cavity(ies) and organ(s) for application of surgical instruments, imaging devices, lights, etc. In such systems, it is desirable to establish and maintain high positional accuracy for the devices mounted on the distal ends of the robotic arms.

Positional accuracy can be reduced or degraded by vibration of the distal ends of the robotic arms. Such vibration may be in the form of vibrational cross-talk, which is unwanted vibration occurring in one part of the system that originates in another part of the system. For example, vibration may be induced within a robotic arm, such as by operation of a motor driving movement of some portion of the arm relative to another portion of the arm and/or to the surgical table or other supporting structure, and the energy introduced into the arm by operation of the motor may propagate through the arm to the distal end, inducing vibration in the distal end. This arm may be referred to as the “active” arm. Alternatively, or additionally, energy introduced into the active arm, such as by operation of a motor within the active arm, may propagate through the active arm, through the table or other supporting structure, and through another robotic arm (which may be referred to as the “passive” arm) to the passive arm's distal end. It is desirable to reduce vibrational cross-talk to enhance positional accuracy of the distal ends of robotic arms and the devices attached thereto.

To address vibrational cross-talk and positional accuracy of the distal ends of robotic arms and the devices attached thereto, apparatus and methods for providing a robotic surgical system including robotic surgical arms that are coupled to a surgical table via an adapter on which a patient can be supported during a surgical procedure are various embodiments described herein with respect toFIGS.24A-30B.

Apparatus and methods for providing a robotic surgical system including a surgical table having a tabletop on which a patient can be disposed are described herein. In some embodiments, an apparatus includes a surgical table and robotic arms coupled, or coupleable to, the surgical table, with each robotic arm supporting a medical instrument, such as a surgical tool, tool driver, cannula, light, and/or imaging device. The surgical table includes a base, a pedestal or column, and a tabletop coupled to the column. Each of the robotic arms may be coupled to at least one of the tabletop, the column or the base. Each robotic arm provides two or more links between the proximal end of the arm (at which the arm is coupled to the table) and the distal end of the arm (at which the arm is coupled to the medical instrument). The links are coupled to each other, and may be coupled to the table and to the medical instrument, by a joint that provides one or more degrees of freedom of relative movement between the links coupled by the joint, and correspondingly one or more degrees of freedom of relative movement between the distal end of the robotic arm and the surgical table. The links and corresponding degrees of freedom allow for movement of the distal end of the robotic arm about and/or along the X, Y, and/or Z axes, to a desired location relative to the tabletop and/or a patient disposed thereon and/or a desired target portion of the anatomy of a patient disposed thereon. Relative movement of the links about the joints can be initiated and continued by operation of devices such as motors, and/or resisted or stopped by active devices such as motors and/or passive devices such as brakes. As noted above, such devices can introduce energy into the robotic surgical system, which can produce unwanted vibrations at the distal ends of the robotic arms.

In some embodiments, an apparatus includes a surgical table having a patient tabletop, an adapter coupled to the surgical table, and one or more robotic arms coupled to the adapter. In some embodiments, an apparatus can include a surgical table having a patient tabletop and an adapter/robotic arm assembly coupled to the surgical table. For example, the adapter and robotic arm can be an integral mechanism or component. Each of the adapter and the robotic arms, or an adapter/robotic arm assembly, can include one or more links to allow for movement of the adapter and/or arms about and/or along the X, Y, and/or Z axes, to a desired location relative to the tabletop and/or a patient disposed thereon and/or a desired target portion of the anatomy of a patient disposed thereon.

In some embodiments, an apparatus includes an adapter coupleable to, and supportable by, a surgical table below a tabletop of the surgical table. The surgical table has a support coupled to the tabletop and a base coupled to the support. As discussed in more detail herein the adapter is designed to reduce vibrational cross-talk to enhance positional accuracy of the distal ends of the robotic arms and devices attached thereto. To this end, the adapter has at least two sections, including a first section configured to be coupled to a proximal end portion of a first robotic arm and a second section configured to be coupled to a proximal end portion of a second robotic arm. The first section has a first stiffness and the second section has a second stiffness that is greater than the first stiffness. In this manner, the first section with the first stiffness will have a first resonant or modal frequency, and the second section with the second stiffness will have a second resonant or modal frequency different from the first resonant frequency. Varying the resonant frequencies across the adapter can reduce vibrational cross-talk to/from the robotic arms attached to the adapter.

In some embodiments, an adapter, in addition to or instead of having multiple sections with varying stiffness, can define a gap between the first section and the second section. In such embodiments, the apparatus may further include a damper disposed within the gap of the adapter to absorb crosstalk vibration between the robotic arms attached to the adapter. In alternative embodiments, instead of a damper disposed within the gap, an apparatus can include a spring-damper assembly disposed within the gap of the adapter to absorb crosstalk vibration between the robotic arms attached to the adapter.

As shown schematically inFIGS.24A-24B, a surgical table1200includes a tabletop1220, a table support or column1222and a table base1224. The tabletop1220has an upper surface on which a patient can be disposed during a surgical procedure, as shown schematically inFIG.24A. The tabletop1220is disposed on the column1222, which can be, for example, a pedestal, at a suitable height above the floor. The column1222may provide for movement of the tabletop1220in a desired number of degrees of freedom. For example, as illustrated schematically inFIG.24A, the column1222may have two sections that telescope relative to each other to provide translation in the Z axis (height above the floor). Additionally, or alternatively, the tabletop1220may be movable relative to the base1250along the Y axis (along the longitudinal axis of the table), and/or the X axis (along the lateral axis of the table), and/or about the Z, Y, and/or X axis. The tabletop1220may also include multiple sections that are movable relative to each other along/about any suitable axes, e.g., separate sections for each of the torso, one or both legs, and/or one or both arms, and a head support section. Movement of the tabletop1220and/or its constituent sections may be performed manually, driven by motors, controlled remotely, etc. The column1222for the tabletop may be mounted to the base1224, which can be fixed to the floor of the operating room, or can be movable relative to the floor, e.g., by use of wheels on the base. As shown schematically inFIG.24A, in some embodiments, the height of the column1222can be adjusted, which together with, for example, the motion (e.g., axial (longitudinal) or lateral motion) of the tabletop1220, can allow for the tabletop1220to be positioned at a desired surgical site at a certain height above the floor (e.g., to allow surgeon access) and a certain distance from the column1220. This also can allow robotic arms1230coupled to the table1200to reach a desired treatment target on a patient disposed on the tabletop1220.

In a robotically assisted surgical procedure, one or more robotic arms1230can be disposed in a desired operative position relative to a patient disposed on the tabletop1220of the surgical table1200(also referred to herein as “table”), as shown schematically inFIGS.24C and24D. The robotic arm(s) can be used to perform a surgical procedure on a patient disposed on the surgical table1200. In particular, the distal end of each robotic arm can be disposed in a desired operative position so that a medical instrument coupled to the distal end of the robotic arm can perform a desired function.

In accordance with various embodiments, the connection between the surgical table and the proximal end of each robotic arm (and thus the position and orientation of the medical instrument at the distal end of the robotic arm relative to the patient), is implemented with an adapter1228and robotic arm(s)1230coupled to the adapter1228. The adapter1228can be separate from, but engaged with, or coupleable to, the surgical table1200, or can be fixedly attached to the surgical table1200. The adapter1228can be coupled to, for example, the support1222, the table base1224, and/or the tabletop1220of the table1200. As shown schematically inFIGS.24C and24D, the adapter1228is disposed below the tabletop1220of the surgical table1200.

In use, the robotic arms1230can be moved relative to the tabletop1220and/or a specific target treatment location on the patient. In some embodiments, the axial motion (e.g., in the Y-axis direction) of the tabletop1220can assist in allowing the arms1230(and therefore, the medical instrument or tool coupled to the distal end of the arm) to reach the desired anatomy on the patient or provide clearance for access to the patient as needed. In some embodiments, the combination of vertical movement of the column1222, axial movement of the tabletop1220and movement of, for example, links in the robotic arm1230allow the robotic arm to be placed in a position where it can reach the anatomy of the patient at the required height over the floor.

As shown schematically inFIGS.25A and25B, each robotic arm1230can include a distal end portion1237and a proximal end portion1236. The distal end portion1237(also referred to herein as “operating end”) can include or have coupled thereto a medical instrument or tool1215. The proximal end portion1236(also referred to herein as the “mounting end portion” or “mounting end”) can include the coupling portion to allow the robotic arm1230to be coupled to the tabletop1220of the table1200. The robotic arm1230can include two or more link members or segments1210coupled together at joints that can provide for translation along and/or rotation about one or more of the X, Y and/or Z axes. The coupling portion of the robotic arm1230to couple the robotic arm1230to the tabletop1222at the coupling1218can be disposed at the distal or mounting end1236of the arm1230and may be coupled to a segment1210or incorporated within a segment1210. The robotic arm1230also includes a target joint J1disposed at or near the mounting end1236of the robotic arm1230that can be included within the coupling portion of the coupling1218or disposed on a link or segment1210of the robotic arm1230coupled to the coupling portion. The target joint J1can provide a pivot joint to allow a distal segment of the robotic arm1230to pivot relative to the tabletop1220. The robotic arm1230can be moved between various extended configurations for use during a surgical procedure, as shown inFIG.25A, and various folded or collapsed configurations for storage when not in use, as shown inFIG.25B.

As described with respect toFIGS.24C and24D, the adapter1228can be coupled to, for example, the column1222, the table base1224and/or the tabletop1220of the table1200. However, the distinction between an adapter and robotic arm can be disregarded, and the connection between the surgical table and the distal end of the robotic arm can be conceptualized and implemented as a series of links and joints that provide the desired degrees of freedom for movement of the medical instrument, i.e. at the distal end of the connection. The connection may include a releasable coupling at any one or more link(s) or joint(s) or any location along the series of links and joints.

As described herein, in some embodiments, the various sections of the tabletop1220can move relative to each other (e.g., can be tilted or angled relative to each other) and/or the tabletop1220can be moved (e.g., tilted, angled) relative to the column1222and/or the base1224of the surgical table1200. In some embodiments, it is contemplated that the adapter1228and robotic arms1230coupled thereto can move with the torso section of the tabletop1220such that the frame of reference to the X, Y and Z axes for various embodiments remains relative to the top surface of the tabletop1220. In some embodiments, the adapter1228and robotic arms1230can be coupled to the support pedestal1222of the table1200and when the tabletop1220is moved relative to the support1222, the positioning of the adapter1228and arms1230can be coordinated with the movement of the tabletop1220.

In accordance with various embodiments, each robotic arm1230may be permanently, semi-permanently, or releasably coupled to the adapter1228via the coupling1218. The coupling1218can include a variety of different coupling mechanisms, including a coupling portion (not shown) on the adapter1228that can be matingly coupled to a coupling portion (not shown) on the robotic arm. Each robotic arm1230can be coupled at a fixed location on the table1200or can be coupled such that the robotic arm1230can be movable to multiple locations relative to the tabletop1220and/or a patient disposed on the tabletop1220as described in more detail herein. For example, the robotic arm1230can be moved relative to the tabletop1220and/or a specific target treatment location on the patient. In some embodiments, the axial motion (e.g., in the Y-axis direction) of the tabletop1220can assist in allowing the arms1230(and therefore, the medical instrument or tool coupled to the distal end of the arm) to reach the desired anatomy on the patient or provide clearance for access to the patient as needed. In some embodiments, the combination of vertical movement of the support pedestal1222, axial movement of the tabletop1220and movement of, for example, one or more link members, allows for placement of the robotic arms1230in a position where it can reach the anatomy of the patient at the required height over the floor.

Some structural requirements for the adapter1228can include providing a rigid support of the robotic arm1230while maintaining adjustability for pre-operative and intra-operative position changes of the robotic arm1230. In some embodiments, the table adapter1228can include a means of holding or locking the adapter1228at a fixed position to withstand, for example, the effects of gravity, inertial effects due to robotic arm motion, and/or to withstand accidental bumps from a user or another part of the robotic system (including other robotic arms or table motion). The table adapter1228can also include one or more sensors for measuring the spatial position of the adapter1228and/or angles and displacements of various joints and coupling points of the adapter1228.

The various degrees of freedom of the links of the adapter1228and/or robotic arm1230provide for movement of the robotic arm1230and therefore, a medical instrument1215disposed at a distal end thereof to be moved to a variety of different positions and orientations relative to the tabletop1220to perform various different procedures on a patient disposed thereon. The adapters1228described herein can also provide for variations on the number of robotic arms1230that are coupled to the table to use for a particular procedure, and to position robotic arms1230on one or both sides of the tabletop1220. For example, in some procedures, it may be desirable to position two robotic arms1230on one side of the tabletop1220and two robotic arms1230on an opposite side of the tabletop1220. In other procedures, it may be desirable to position three robotic arms1230on one side of the tabletop1220and one robotic arm1230on an opposite side of the tabletop1220. It should be understood that the number of robotic arms1230to be used for a particular surgery can vary.

As shown schematically inFIG.26, an energy source ES, such as motor at a joint between two links in active arm1230, in use, can induce unwanted vibration V1in tool1215of active arm1230, and/or vibration V2in tool1215′ of passive arm1230′ via interface structure(s)1240and column1222. For example, energy introduced by the energy source ES in the active arm1230may propagate through the active arm1230, through the interface structure(s)1240and column1222, and through the passive arm1230′ to the tool1215′ of the passive arm1230′, inducing vibration V2in tool1215′. It is desirable to reduce such vibrational cross-talk from energy source ES of active arm1230to tool1215of active arm1230and to tool1215of passive arm1230′ to enhance positional accuracy of the tool1215of active arm1230and tool1215′ of passive arm. In some instances, various components along/about each of three axes of the system may be subject to varying vibrations. In such instances, it is desirable to reduce amplitude of at least the most critical components, if not all of the components, to enhance positional accuracy of the distal ends of the robotic arms and the devices attached thereto.

FIGS.27A-28Billustrate various embodiments of apparatus and methods for reducing vibrational cross-talk by separation the modal frequencies of vibration across various sections of the table structure(s) (e.g., a table adapter) to which the robotic arms are coupled, and/or by isolating at least in part the connection points of the table structure(s) to which the robotic arms are coupled.

To limit vibrational cross-talk across an adapter to which robotic arms are coupled, in some embodiments, an adapter can have multiple sections in which one section has a modal frequency of vibration different from a modal frequency of vibration of one or more of the remaining sections. Decoupling the modal frequencies of the sections of the adapter reduces the efficiency of transmission of the energy introduced into the active arm. For example, if an active robotic arm has a mode of 4 Hertz (Hz), energy introduced into the active robotic arm is best transferred across the adapter to another robotic arm (e.g., a passive robotic arm) when the adapter has a mode equal to the mode of the active robotic arm; in this case, a mode of 4 Hz. Transmission of the energy across the adapter can be lessened and/or interrupted by arranging the adapter to have varying modal frequencies of vibration, thereby creating modal separation between one connection point of the adapter to another connection point of the adapter. Less energy transmitted between the connection points (and thereby the robotic arms coupled to the connection points) results in less vibration produced, e.g., at the passive arm.

To vary the modal frequency of an adapter to interrupt energy transfer across the adapter, in some embodiments, an adapter can have multiple sections each having a characteristic different from a characteristic of at least one other section of the adapter, the different characteristic(s) resulting in a different modal frequency for each section. A characteristic, for example, can include dimensions (e.g., width, height, and/or length) and/or geometry, such as the presence of absences of ribs, flanges, or other configurations that affect the moment of inertia about the axis or axes of interest for response to vibration. Thus, the table adapter can be monolithically or integrally formed of a single material but each section can be formed with different dimensions and/or geometries. Alternatively, or in addition, the multiple sections can be formed of one or more different materials, or combinations of materials, that have different physical properties, such as modulus of elasticity, density, and the like.

As an example,FIGS.27A and27Billustrate an adapter1328having a first section1328A with a first thickness t1and a second section1328B with a second thickness t2less than the first thickness, according to an embodiment. In this manner, the first section1328A has a mode different from a mode of the second section1328B, thereby lessening energy transfer from one robotic arm130, across both the first section1328A and second section1328B, to another robotic arm130. In this example, adapter1328may be monolithically or integrally formed from a single material. Alternatively, adapter1328may be assembled from multiple pieces, e.g. first section1328A and second section1328B may be integrally formed of a material of thickness t2, and a separate piece of the same material may be fixed to first section1328A to increase the thickness to t1, as illustrated inFIG.27C. Alternatively, one or more of the sections1328A and1388B may be formed of a composite or laminate of different materials with different physical properties

In alternative configurations, instead of or in addition to the first section and the second sections having different thicknesses, the first section can have any characteristic(s) affecting its mode different from one or more characteristics of the second section affecting the mode of the second section. For example, in some embodiments, the first section of the adapter can be shaped or configured to have a first moment of inertia or stiffness, and the second section of the adapter can be shaped or configured to have a second moment of inertia or stiffness different from the first stiffness. In this manner, the first section of the adapter can be configured to have a higher mode than the mode of the second section, thereby reducing efficiency of energy transmission between the first and second sections. Such an example is illustrated inFIGS.27D and27Ein which the first section1328A of the adapter1328includes a set of ribs1327. In this manner, first section1328A with the ribs1327has a moment of inertia different from a moment of inertia of the second section1328B. The ribs1327can be monolithically formed or integral to the first section1328, or the ribs1327can be formed separately and then coupled to the first section1328, or a combination of the two. Further, although this embodiment includes three ribs, in alternative embodiments, any suitable number of ribs (e.g., 1, 2, 4 or more) can be used, and the ribs can be of the same or varying sizes and shapes. Moreover, although the adapters described herein having two sections, in alternative embodiments, an adapter can have any suitable number of sections (e.g., 3, 4, 5, 6 or more), each to support a different robotic arm, with any variation of modal frequencies such that undesirable vibrational cross-talk is reduced or otherwise limited.

An additional or alternative approach to reducing vibrational cross-talk can include decoupling in part (e.g., limit direct coupling) the connection points of the adapter to which the robotic arms are coupled. Isolating the connection points to which the robotic arms are coupled or otherwise interrupting energy transfer pathways (e.g., via separation, dampening, varying materials and dimensions, and the like) between those connection points reduces the efficiency of transmission of the energy introduced into the active arm by, for example a motor and/or brake. For example, energy introduced into the active robotic arm is best transferred to a passive robotic arm when the intervening structure (e.g., a table adapter) to which the two arms are mounted presents minimal obstacles to energy transfer (e.g., via a direct coupling). Transmission of the energy introduced into the active robotic arm across the intervening structure can be lessened and/or interrupted by various means discussed below, thereby complicating the pathway energy would need to transfer to reach the connection points, thereby reducing the efficiency of energy transmission to the passive arm. Less energy transmitted between arms results in less vibration produced, i.e. lower amplitude in/about one or more axes.

FIGS.28A and28Billustrate such an embodiment whereby the connections points of an adapter1428are isolated in part from each other. As shown, the adapter1428includes a first section1428A, a second section1428B, a third section1428C, a fourth section1428D (also referred to herein collectively as the “sections of the adapter”), with robotic arms coupleable to a connection portion of the first section1428A, the second section1428B, and the third section1428C. Further, as illustrated, the adapter defines a set of gaps1429between the sections of the adapter1428. In this manner, the gaps1429provide partial separation/decoupling of the sections of the adapter1428to each other, resulting in less efficient transmission of energy across the adapter, e.g., from a connection point to which an active robotic arm is coupled to a connection points to which a passive robotic arm is coupled. In other words, the vibrational energy must travel through the central portion of adapter1428, which may be coupled to the tabletop and/or the table column (not shown) and thus has a relatively higher stiffness and modal frequency than that of either of the adapter sections.

In some embodiments, one or more (e.g., including all) of the gaps between sections of an adapter can include a damping component configured to absorb or otherwise dissipate energy introduced into the adapter at its connection points to which the robotic arms are coupled, thereby reducing or otherwise limiting vibrational cross-talk in the system. One such embodiment is shown inFIGS.29A-29C. As shown, the adapter1528includes a first section1528A, a second section1528B, a third section1528C, and a fourth section1528, with gaps1529defined therebetween. Further, disposed within each gap1529is a damping component1531. Each of the damping components1531, for example, can include at least one viscoelastic material (e.g., a viscoelastic polymer) or otherwise any material that exhibits both viscous and elastic characteristics when undergoing deformation, and is suitable for isolating vibration, dampening noise, and/or absorbing shock. Some non-limiting examples of viscoelastic materials include urethane polymers such as Sorbothane® (Sorbothane, Inc.), vulcanized cross-linked rubber material such as Akton® (Action Products, Inc.), hydrophobic melamine foams such as Polydamp® (Polymer Technologies, Inc.), and viscous damping gels such as NyeMed® (Nye Lubricants, Inc.). The damping between any two adjacent sections, i.e. across one of the gaps1529, can be varied by varying the material and/or the dimensions of the material, i.e. the width of the gap and/or the portion of the length and or vertical extent of the gap filled by the material.

In another embodiment, one or more of the gaps in the adapter can have disposed therein a damper assembly. As shown schematically inFIGS.30A and30B, damper assembly1632can be coupled to adjacent sections1628A,1628B of adapter1628, across gap1629(and similarly to adjacent sections1628A,1628C, adjacent sections1628C,1628D, and adjacent sections1628B,1628D). Damper assembly1632can include a damper, shown schematically inFIGS.30A and30Bas dashpot, which provides a resistance to relative movement of sections1628A,1628B that is proportional to the velocity of the relative movement. This may be implemented as a hydraulic or pneumatic damper, in which a fluid is forced through an orifice by relative movement of sections1628A,1628B. As shown schematically inFIGS.30A and30B, damper assembly1632may also include a structure that functions as a spring, i.e. produces a force that is proportion to the relative displacement between sections1628A,1628B. The damping and spring coefficients for damper assembly1632may be selected to provide the desired response function to reduce the transfer of energy across gap1629.

Any suitable combination of damping components can be used to dampen energy otherwise being transferred across sections of the adapter, thereby limiting and/or reducing undesirable vibrational cross-talk in the system. Further, although adapters1428and1528are shown and described as having four sections and four gaps, in alternative embodiments, an adapter can have any suitable number of sections and gaps, and the sections and gaps can be similar or different in shape and size to each other.

Although various embodiments have been described as having particular features and/or combination of components, other embodiments are possible having a combination of any features and/or components from any of the embodiments described herein. For example, any of the bases (e.g., table base150,250,350,550,650,750, etc.) described herein can be used in combination with any of the supports (e.g., table support122, support member262, table support1122, etc.), and/or adapters (e.g., adapter528, adapter coupling975, adapter coupling1075, etc.) described herein. Similarly stated, for ease of explanation some embodiments described herein focus on discrete features to address particular shortcomings of existing systems. It should be understood, however, that the discrete features described across various embodiments can be combined into a single embodiment in any suitable combination. For example, in some embodiments, a surgical system may include a base (e.g., similar to base250) configured to remedy undesirable consequences associated with irregularities in a floor or other surface on which a surgical table is disposed and/or other undesirable load imbalances (e.g., due to movement if equipment coupled to table and/or movement of patient lying on table) during a surgical procedure; an adapter (e.g., adapter528) configured to facilitate desired degrees of freedom for movement of a robotic arm coupled thereto and/or having varying sections of modal frequency or other features to inhibit vibrational cross-talk; and a pivot assembly (e.g. pivot assembly660).

As used herein the term “module” refers to any assembly and/or set of operatively-coupled electrical components that can include, for example, a memory, a processor, electrical traces, optical connectors, software (executing in hardware), and/or the like. For example, a module executed in the processor can be any combination of hardware-based module (e.g., a field-programmable gate array (FPGA), an application specific integrated circuit (ASIC), a digital signal processor (DSP)) and/or software-based module (e.g., a module of computer code stored in memory and/or executed at the processor) capable of performing one or more specific functions associated with that module.

Where schematics and/or embodiments described above indicate certain components arranged in certain orientations or positions, the arrangement of components may be modified. Similarly, where methods and/or events described above indicate certain events and/or procedures occurring in certain order, the ordering of certain events and/or procedures may be modified. While the embodiments have been particularly shown and described, it will be understood that various changes in form and details may be made. Any portion of the apparatus and/or methods described herein may be combined in any combination, except mutually exclusive combinations. The embodiments described herein can include various combinations and/or sub-combinations of the functions, components and/or features of the different embodiments described.