Abstract:
A robotic medical system comprises a user interface configured for receiving at least one command, a first drive mechanism configured for receiving the outer medical implement, a second drive mechanism configured for receiving the inner medical implement, a linear drive arrangement (e.g., one of a drive screw drive arrangement, a rack and pinion drive arrangement, and a belt/pulley drive arrangement) mechanically coupled to the first and second drive mechanisms, and a motor array. The robotic medical system further comprises an electric controller configured for directing the motor array to cause the first drive mechanism to axially rotate the outer medical implement, to cause the second drive mechanism to axially rotate the inner medical implement, and to cause the linear drive mechanism to linearly translate the first and second drive mechanisms relative to each other in response to the at least one command.

Description:
RELATED APPLICATIONS 
   This application is a continuation of U.S. application Ser. No. 11/467,886, filed Aug. 28, 2006, which is a continuation of U.S. application Ser. No. 10/270,740, filed Oct. 11, 2002 (now abandoned), which claims the benefit of U.S. application Ser. No. 60/332,287, filed Nov. 21, 2001, and is a continuation-in-part of U.S. application Ser. No. 10/216,069, filed Aug. 8, 2002 (now abandoned), which claims the benefit of U.S. application Ser. No. 60/313,495, filed Aug. 21, 2001, and is a continuation-in-part of U.S. application Ser. Nos. 10/023,024 (now abandoned), 10/011,371 (now U.S. Pat. No. 7,090,683), 10/011,449 (now abandoned), 10/010,150 (now U.S. Pat. No. 7,214,230), 10/022,038 (now abandoned), and 10/012,586 (now U.S. Pat. No. 7,371,210), all filed Nov. 16, 2001, and all of which claim the benefit of U.S. application Ser. Nos. 60/269,200, filed Feb. 15, 2001, 60/276,217, filed Mar. 15, 2001, 60/276,086, filed Mar. 15, 2001, 60/276,152, filed Mar. 15, 2001, and 60/293,346, filed May 24, 2001. 
   This application is also related to U.S. application Ser. Nos. 11/762,749 and 11/762,751, all of which are filed on Jun. 13, 2007. The entire disclosures of the above applications are expressly incorporated herein by reference. 

   BACKGROUND OF THE INVENTION 
   Catheters are used extensively in the medical field in various types of medical procedures, as well as other invasive procedures. In general, minimally invasive medical procedures involve operating through a natural body opening or orifice of a body lumen, or through small incisions, typically 5 mm to 10 mm in length, through which instruments are inserted. In general, minimally invasive surgery is less traumatic than conventional surgery, due, in part, because no incision is required in certain minimally invasive procedures, or the significant reduction in the incision size in other procedures. Furthermore, hospitalization is reduced and recovery periods are shortened as compared with conventional surgical techniques. 
   Catheters maybe provided in a variety of different shapes and sizes depending upon the particular application. It is typical for a clinician to manipulate the proximal end of the catheter to guide the distal end of the catheter inside the body, for example, through a vein or artery. Because of the small size of the incision or opening and the remote location of the distal end of the catheter, much of the procedure is not directly visible to the clinician. Although clinicians can have visual feedback from the procedure site through the use of a video camera or endoscope inserted into the patient, or through radiological imaging or ultrasonic imaging, the ability to control even relatively simple instruments remains difficult. 
   In view of the above, some have proposed using robotic tele-surgery to perform minimally invasive procedures. Typically, these robotic systems use arms that reach over the surgical table and manipulate the surgical instruments inserted into the patient, while the surgeon sits at a master station located a distance from the table and issues commands to the arms. 
   SUMMARY OF THE INVENTION 
   In accordance with a first aspect of the present inventions, a robotic medical system for use with a coaxial arrangement of an outer medical implement and an inner medical implement is provided. One or both of the outer and inner medical implements may be a flexible intravascular catheter. The robotic medical system comprises a user interface (e.g., one that includes a dial, joystick, wheel, or mouse) configured for receiving at least one command, a first drive mechanism configured for receiving the outer medical implement, a second drive mechanism configured for receiving the inner medical implement, a linear drive arrangement (e.g., one of a drive screw drive arrangement, a rack and pinion drive arrangement, and a belt/pulley drive arrangement) mechanically coupled to the first and second drive mechanisms, and a motor array. The robotic medical system further comprises an electric controller configured for directing the motor array to cause the first drive mechanism to axially rotate the outer medical implement, to cause the second drive mechanism to axially rotate the inner medical implement, and to cause the linear drive mechanism to linearly translate the first and second drive mechanisms relative to each other in response to the at least one command. 
   In one embodiment, the user interface is located remotely from the motor array, and the electrical controller is coupled to the motor array via external cabling. In another embodiment, the robotic medical system further comprises a single housing containing the motor array and linear drive arrangement. The first and second drive mechanisms are mounted to (e.g., to a side of) the single housing. In still another embodiment, the first drive mechanism has a first gripping mechanism in which the outer medical implement is secured, and the second drive mechanism has a second gripping mechanism in which the inner medical implement is secured. In this case, the motor array may have a first pulley and a second pulley, and the robotic medical system may further comprise a first belt wrapped around the first gripping mechanism and the first pulley, and a second belt wrapped around the second gripping mechanism and the second pulley. 
   In accordance with a second aspect of the present inventions, another robotic medical system for use with a coaxial arrangement of an outer medical implement and an inner medical implement is provided. The robotic medical system comprises a user interface configured for receiving at least one command, a single integrated drive unit configured for receiving the outer and inner medical implements, and an electric controller configured for directing the base unit to axially rotate and linearly translate the outer and inner medical implements relative to each other in response to the at least one command. The details of the inner and outer medical implements, user interface, drive unit, and electric controller can be the same as those described above. 

   
     BRIEF DESCRIPTION OF THE DRAWINGS 
     The foregoing and other objects, features and advantages of the invention will be apparent from the following more particular description of preferred embodiments of the invention, as illustrated in the accompanying drawings in which like reference characters refer to the same parts throughout the different views. The drawings are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention. 
       FIG. 1  is a schematic perspective view of a coaxial catheter in accordance with the present invention; 
       FIG. 2A  is a side view of the coaxial catheter system of  FIG. 1 ; 
       FIG. 2B  is a cross-sectional view of the catheter system illustrated in  FIG. 2A ; 
       FIG. 3  is a schematic and block diagram of the coaxial catheter system in accordance with the present invention; 
       FIG. 4  is a block diagram of another embodiment of the present invention employing controllable balloons for controlled movement of the coaxial catheter system; 
       FIG. 5  is a timing diagram associated with the block diagram of  FIG. 4 ; 
       FIG. 6  is a schematic diagram illustrating the coaxial catheter arrangement and associated proximal and distal balloons, associated with the block diagram of  FIG. 4 ; 
       FIG. 7  is a schematic diagram illustrating another aspect of the present invention employing a detector; 
       FIG. 8  is a schematic and block diagram of still another embodiment of the present invention; 
       FIG. 9  illustrates another principle of the present invention in a coaxial catheter system illustrated being used in a vein or artery; 
       FIG. 9A  illustrates a multi-lobed balloon of the system of  FIG. 9 ; 
       FIG. 10  illustrates another embodiment of the invention for distal drive of one of the catheters; 
       FIG. 11A  a block and schematic view a catheter drive system with a fluid delivery system in accordance with the invention; 
       FIG. 11B  is a close-up view of a manifold of the fluid delivery system of  FIG. 11A ; 
       FIG. 12  illustrates a catheter coupled to a catheter drive mechanism in accordance with the invention; 
       FIG. 12A  is a cross-sectional view of the drive mechanism of  FIG. 12 ; 
       FIG. 13  illustrates the catheter of  FIG. 12  and a guide wire coupled to respective drive mechanisms in accordance with the invention; 
       FIG. 14  illustrates the linear movement of the drive mechanisms of  FIG. 13 ; 
       FIGS. 15A-15C  illustrate various devices used to move the drive mechanisms of  FIG. 13  in a linear manner; 
       FIG. 16  is a perspective view of the catheter and guide wire of  FIG. 13  shown coupled to respective drive mechanisms of a base unit; 
       FIG. 16A  is a top view of one of the drive mechanisms shown in  FIG. 16 ; 
       FIG. 16B  is a view of the drive mechanism of  FIG. 16A  taken along the line  16 B- 16 B; 
       FIGS. 17A-17C  illustrate a connector used to couple the catheter and guide wire to their respective drive mechanisms; 
       FIGS. 18 and 18A  illustrate an alternative embodiment of the connector; and 
       FIGS. 19 ,  19 A and  19 B illustrate yet another embodiment of the connector. 
       FIGS. 20A and 20B  illustrate yet another embodiment of the connector. 
   

   DETAILED DESCRIPTION OF THE INVENTION 
   A description of preferred embodiments of the invention follows. Referring to  FIG. 1  there is shown a catheter system  5  including three separate catheter shafts  10 ,  20 , and  30 , with an end effector  12  supported at the distal end of the catheter shaft  10 . The end effector  12  may be, for example, an articulated tool such a grasper with a pair of jaws  12   a  and  12   b  that pivot about a joint  15  to grasp an item between the two jaw members. Other articulated tools that may be used as the end effector  12  include scissors, needle holders, micro dissectors, staple appliers, tackers, suction irrigation tools, and clip appliers. The end effector  12  can also be a non-articulated tool, such as a cutting blade, probe, irrigator, catheter or suction orifice, and dilation balloon. Further details of catheter systems, particularly those relating to mechanisms for multiple degrees-of-freedom of motion of catheter shafts can be found in U.S. application Ser. Nos. 10/023,024, 10/011,449, 10/022,038, 10/012,586, by Brock, Lee, Weitzner and Rogers, Ser. No. 10/011,371, by Brock, Lee, Weitzner, Rogers, and Ailenger, and Ser. No. 10/010,150, by Brock, Lee, Weitzner, Rogers, and Cunningham, all of which were filed Nov. 16, 2001 and are incorporated herein by reference in their entirety. 
   Each of the catheter shafts  10 ,  20 , and  30  has a different diameter that is able to move with multiple degrees-of-freedom. The catheter shafts shown in  FIG. 1  are arranged in a coaxial manner with the small diameter catheter  10  positioned inside the medium diameter catheter  20  which in turn is positioned inside the large catheter  30 . The arrangement in  FIG. 1  is a coaxial arrangement with the small diameter catheter  10  adapted for sliding inside of the medium diameter catheter  20 . 
   As illustrated in  FIG. 1 , as well as  FIG. 2A , the catheter  30  is able to move with a linear translation in the direction  31 , while the medium diameter catheter  20  is able to slide inside the catheter  30  with a linear translation motion in the direction  21 , and the small catheter  10  is able to slide inside the medium catheter with a linear translation motion in the direction  11 . 
   In addition to the translation motions, each of the catheter shafts  10 ,  20 , and  30  is able to rotate and bend. Hence, the shafts  10 ,  20 , and  30  have three degrees-of-freedom of movement. The rotational motion of the catheters  10 ,  20 , and  30  is indicated by the double arrows S 3R , S 2R  and S 1R , respectively, and the orthogonal bending motions of the catheters  10 , 20 , and  30  are indicated by the double arrows S 3B1  and S 3B2 , S 2B1  and S 2B2  and S 1B1  and S 1B2    
   Referring also to  FIG. 2B , there is shown the coaxial arrangement of the catheters  10 ,  20 , and  30 , as well as the rotational motions of the catheters identified by the double arrows  13 ,  23 , and  33 , respectively. Indicated in  FIG. 2A  are the operative segments  01 ,  02 , and  03  of the respective catheters  10 ,  20 , and  30  where the bending may occur in each of the catheters. As shown, this bending generally occurs near the distal end of the respective catheters. However, the operative segments may also be located at different places along each of the catheters or may not be required at all. 
   Turning now to  FIG. 3 , the multiple coaxial catheters  10 ,  20 , and  30  are shown coupled to a drive system  35 . Also shown in  FIG. 3  are the operative sections  01 , 02 , and  03  of the catheters  10 ,  20 , and  30 , respectively, as well as the linear translational degree-of-freedom  11 ,  21 , and  31 . At some position along the catheters, there is a patient interface, not specifically illustrated in  FIG. 3  but considered to be the location where the catheter enters the anatomic body. The entry of the catheter may, for example, be percutaneously, via an incision, or even through a natural body orifice. Procedures to be described below are particularly adapted for transitioning a multi-shaft catheter constriction through an anatomic body vessel such as through the intestines. Of course, the concepts of the illustrated embodiments may be used in association with the control and transition of the catheters through other body vessels or body cavities as well. 
   Each catheter  10 ,  20 , and  30  is arranged and supported in a manner to enable multiple degrees-of-freedom of the catheter including movement of the catheter to an anatomic body target site, as well as rotation of the catheter. In particular, there are respective support blocks  40 ,  50 , and  60  associated with the catheters  10 ,  20 , and  30 . In the embodiment illustrated in  FIG. 3 , these support blocks  40 ,  50 , and  60  are coupled to the respective proximal ends of the catheters identified as  10 A,  20 A, and  30 A. Each of the support blocks controls linear translational movements of the catheters with the use of wheels  42 ,  52 , and  62 . In support block  40 , there is also illustrated control of the rotational motion  46  of the catheter  10 . Similarly, support blocks  50  and  60  provide rotational control  56  and  66  to the respective catheters  50  and  60 . 
   The drive system  35  also includes an electromechanical drive member  70  coupled to the support blocks  40 ,  50 , and  60  with mechanical cablings  80 ,  81 , and  82 , respectively. The drive member  70  is a under the direction of a controller  72  that is also coupled to an input device  76  which interfaces the drive system  35 , and hence the catheter system  5 , with a user who is typically a surgeon. 
   In the illustrated embodiment, the electromechanical drive member  70  is a motor array with a plurality of drive motors. The mechanical cablings  80 ,  81 , and  82  provide control of the respective blocks and controls the linear and rotational movement of the respective catheters. Thus, in the motor array  70 , there can be at least one motor for controlling linear translation, and a separate motor for controlling rotational translation relative to each of the support blocks. 
   Thus, when the system  35  is in use, the surgeon provides instructions to the 
   controller  72  through the input device  72 . In turn, the controller  72  directs the operation of the motor array  70  and hence the support blocks  40 ,  50 , and  60  which drive the respective catheters with multiple degrees-of-freedom of movement. 
   The motor array  70  also includes separate motors for driving the bending movements S 3B1  and S 3B2 , S 2B1  and S 2B2  and S 1B1 , and S 1B2  of the catheters as previously indicated in  FIG. 1 . In  FIG. 3 , in addition to the operative segments  01 ,  02 , and  03  where the bending of the individual catheter occurs, there are also shown in cut-out cross-section in each of the catheters respective cablings Cl, C 2 , and C 3 . These cablings extend along the length of the respective catheters and can be used for controlling the bending of the operative segments. Also, cabling that extends through catheters  10 ,  20 , and  30  can be used to operate the end effector  12  as well. The cabling Cl, C 2 , and C 3  can extend through the catheters and through the corresponding support blocks, coupling through the various mechanical cablings  80 ,  81 , and  82 . Accordingly, there may be control motors in the motor array  70  that control the bending movements of the catheters, as well as operation of the end effector  12 . Further details of mechanical cabling used for the operation of catheters including bending and flexing thereof can be found in the U.S. application Ser. Nos. 10/023,024, 10/011,371, 10/011,449, 10/010,150, 10/022,038, and 10/012,586 mentioned earlier. 
   In some embodiments, the controller  72  is a microprocessor that receives input commands from the input device  76 . The input device  76  can be one of various types of controls such as a dial, joystick, wheel, or mouse. A touch-screen can also be employed as the input device  76  to allow the surgeon to input information about the desired location of a particular portion of the catheter by touching the screen. In this regard, reference may also be made to the U.S. Application entitled “Catheter Tracking System,” by Weitzner and Lee, U.S. application Ser. No. 10/216,669 filed herewith, the entire contents of which are incorporated herein by reference, which describes a catheter tracking system that enables an operator at the input device to select a particular anatomic body site and direct the catheter automatically to that site. 
   Referring to  FIGS. 4 ,  5  and  6 , there is shown another implementation of the catheter control. Here, the system employs multiple catheters with multiple balloons in combination with a control mechanism by which the balloons are inflated and deflated to move the catheters in increments through a body vessel. In  FIG. 6 , a set of catheters  110 ,  120 , and  130  are located within a body vessel  100 . Associated with catheter  120  is a distal balloon D, and similarly, associated with the distal end of catheter  130  is a proximal balloon P. In  FIG. 6  there are also shown ports D 1  and P 1  through which air or other fluid is introduced into each of the balloons to inflate the balloons or removed to deflate the balloons. In  FIG. 6  the proximal balloon P is shown inflated and the distal balloon D is shown deflated. Note that although only two balloons are shown, one or more additional balloons can be associated with a third or even a fourth catheter. 
   In the block diagram of  FIG. 4  there is identified an inner catheter  86  and an outer catheter  87 , which may correspond respectively to catheters  120  and  130  in  FIG. 6 . Also illustrated in  FIG. 4  is an inner catheter control  84  and an outer catheter control  85 . These controls may be similar to the controls illustrated in  FIG. 3  for at least controlling the advancement in a linear manner of the corresponding catheter. Thus, the catheter control  84  can be considered as controlling the linear movement of the inner catheter  86  while the catheter control  85  can be considered as controlling the linear translation of the outer catheter  87 . 
   The outputs of a motor array  90  are coupled to the inner catheter control  84  and the outer catheter control  85 , while a controller  92  is coupled to and controls the motor any  90 . An input device  96  connected to the controller  92  provides an interface for a user such as surgeon to operate the inner and outer catheters  86  and  87 . 
   Also illustrated in  FIG. 4  is a balloon controller  94  associated with the controller  92  and that has two separate outputs coupled to the proximal, P, and distal, D, balloons. Under the direction of the controller  92  the balloon controller controls the inflation and deflation of the proximal balloon P and the distal balloon D. Details about the timing of the inflation and deflation sequence are illustrated in  FIG. 5 . 
   The proximal, P, and distal, D, balloons are inflated and deflated in a sequence in association with advancement of the different catheter segments  86  and  87 . This is carried out so that the catheters can progress in increments under automatic control. Hence, the surgeon or other operator need not direct the catheter continuously by hand, but instead the controller  92  initiates a sequence by which the catheter creeps or advances in increments through a vessel  100  ( FIG. 6 ). 
   An example of the timing sequence for the advancement of the inner and other catheters  86  and  87  of  FIG. 4  or  120  or  130  of  FIG. 6  is illustrated in  FIG. 5 . Once the advancement sequence is initiated, for example, through the input device  96 , no further control via the input device is necessary. Instead the controller  92  simply repeats a predetermined sequence to cause incremental movement of the catheter system through the body. 
     FIG. 5  depicts certain timing actions relating primarily to the inflation and deflation of the balloons, P and D, as well as the forward advancement of the catheters  86  and  87 , or  120  and  130 . 
   In step (a), there is an inflation of the proximal balloon P. This causes the catheter  130  to lock against the side wall of the vessel  100  to create an anchor point for the distal end of the catheter  130 . 
   Next, in step (b) the inner catheter  120  is advanced by a certain amount in the vessel  100 . Note that, as illustrated in  FIG. 6 , the distal balloon D is deflated, and thus is not locked in position but is readily moveable in a forward direction with the catheters  110  and  120 . 
   In step (c), the process inflates the distal balloon D, which locks the distal end of catheter  120  to the inner wall of the vessel  100 . Subsequently, the proximal balloon P is deflated so that it is no longer locked against the inner wall of the vessel  100 . The outer catheter  130  is then free to move. 
   In step (e) the outer catheter  130  in  FIG. 6  is moved forward carrying the proximal balloon P, which has previously been deflated allowing it to move readily through the vessel  100 . 
   After the catheter  130  and its associated proximal balloon P has moved a certain distance, then, as illustrated in step (f) the process again inflates the proximal balloon P, and in step (g) deflates the distal balloon D. Once this occurs, the catheter system is then in the position illustrated in  FIG. 6 , having advanced by an incremental amount related to the length of movement of the inner and outer catheters  120  and  130 . 
   Note that the particular control illustrated in  FIGS. 4-6  does not necessarily require the use of an input device. Alternatively, if an input device is used, it can be of the type that simply initiates a sequence that is stored in the algorithm of controller  92 . Hence again, in this way, once the sequence is initiated, then subsequent moves are controlled by the controller  92  and not by any specific manipulations at the input device  96 . 
   Moreover, there may also be provided a force feedback, usually associated with a distal catheter  110 . If the distal end of this catheter, or an end effector supported at the distal end, detects an obstruction or some blockage that provides a force feedback signal to the controller, then the controller may interrupt the sequence of steps depicted in the timing diagram of  FIG. 5 . This enables the surgeon to observe the position of the catheters, for example, through the use of known display techniques including Fluoroscopy, Ultrasound, MRI, CT, or PET. 
   Referring now to  FIG. 7 , there is shown another embodiment of a catheter system having separate catheters  210 ,  220  and  230 , and a detector  240 . For illustrative purposes, the catheter  220  may be considered a proximal catheter, while the catheter  210  may be considered a distal catheter. A drive system such as that shown in  FIG. 3  is used for the linear translation of the catheters. A particular feature of the catheter system shown in  FIG. 7  is a feedback signal provided to the detector  240  to indicate movement of the catheters, as well as relative movement between catheters. To accomplish this, each of the catheters  210 ,  220 , and  230  is provided with indicia  211 ,  221 , and  231 , respectively, that may be of the optical type. The detector  240  may be or include a counter that counts passing indicia. 
   As an example, if the catheter  220  is stationary and the catheter  210  is being moved forward linearly, then the detector  240  such as an optical system can simply read the indicia  211  as the catheter  210  moves coaxially out of the catheter  220 . Each of the indicia is separated by a predetermined length and the optical system simply reads each indicia as it moves relative to an adjacent fixed catheter to determine the overall distance of movement of the catheter system. 
   The detection system  240  illustrated in  FIG. 7  may be used with the incremental advancement system depicted in  FIGS. 4-6 . In connection with the balloons illustrated in  FIGS. 4 and 6 , mention has been made of the incremental forward movement of the inner and outer catheters  86  and  87 , or  120  and  130 . The optical detection scheme illustrated in  FIG. 7  can be used to measure the distance of movement of either or both of the catheters. 
   A further embodiment is illustrated in the schematic and block diagram of  FIG. 8 . Unlike the drive arrangement shown in  FIG. 3  where coaxial catheters are driven from their proximal ends, the catheters  210 ,  220 , and  230  shown in  FIG. 8  are driven from their distal ends. The catheter system also implements the indicia and detector  240  described with reference to  FIG. 7 . 
   Here, the catheter  220  is considered the proximal catheter and the catheter  210  is considered the distal catheter. The operation of the catheters  210 ,  220 , and  230  are controlled from the drive member  160 . The drive member  160  may be placed at the master station of  FIG. 3 , or controlled from a remote location such as at the master station, usually with surgeon input control. 
   Each catheter is driven relative to an adjacent coaxial catheter member, such as catheter  220  relative to catheter  230 , with drive mechanisms  150  and  140  mounted to frame pieces  225  and  235  extending from more proximal catheters. 
   In  FIG. 8  there are illustrated two drive blocks  140  and  150  which control the respective catheters  210  and  220 . Note that the catheter system of  FIG. 8  may also include the proximal drive arrangement of  FIG. 3  for one or more of the catheters. If both proximal and distal drive is used for any one particular catheter, then the proximal drive may be considered as a “coarse” drive while the more distal drive may be considered as a “fine” drive. 
   The drive block  140  includes wheels  142  for controlling linear translation of the catheter  210 , as illustrated by arrow  144 . In the drive block  140  there is also illustrated rotational translation of the catheter  210 , as illustrated by the arrow  146 . In a similar manner, the linear translation relating to drive block  150  is represented by wheels  152  indicated by the arrow  154 . Also, with regard to drive block  150 , and catheter  220 , the arrow  156  illustrates rotational movement of the catheter  220  produced by the drive block  150 . 
     FIG. 8  also illustrates the feedback signal to the detector  240  to sense incremental of movement of the respective catheters. For this purpose, on each of the catheters there is provided indicia that may be of the optical type described earlier. In  FIG. 8  these are indicated as indicia  211  on catheter  210 , indicia  221  on catheter  220 , and indicia  231  on catheter  230 . The detector  240  may include a counter that counts passing indicia to indicate the liner distance of relative movement between catheters. 
   Although the drive blocks  140  and  150  are shown in a schematic fashion about each of their respective catheters, it is understood that the drive mechanisms can also be employed within the catheter construction, such as shown in  FIG. 10 , or other drives may be employed between adjacent catheters. Also, the block  160  illustrated in  FIG. 8  as a drive block may in practice be cabling that connects back through the catheters to the motor array, such as the motor array  70  depicted in  FIG. 3 . In this way, at an input device, such as the input device  76  in  FIG. 3 , the surgeon can control the movement of the catheters in both a proximal manner and in a distal manner, or either manner. 
   The feedback at detector  240  may be incorporated with the drive  160  so that the drive provides for “fine” movement of catheters in an incremental manner. The movement is fed back by way of detector  240  to provide for fine adjustment of the catheters, particularly the smaller diameter distal catheter  210 . 
   Mention has been made that control of the movement of the catheters can be provided at both the proximal and distal ends of the coaxial catheter system. For certain procedures, it may be advantageous to control the proximal end of the catheters, as well as directly control the movement at the distal end of the catheters. For example,  FIG. 9  depicts a coaxial catheter system extending through the aorta  300  of the heart  304  and used in a vascular artery  302  that may be considered as including a main artery and several branches of the artery that are to be negotiated by the catheter system. 
   In the particular embodiment illustrated in  FIG. 9  the coaxial catheter system includes a large outer catheter  330 , a middle catheter  320 , and a small distal or inner catheter  310 . The distal end of the catheter  310  supports or carries an end effector  312  which may be in the form of a jaw member. For the particular system depicted in  FIG. 9 , the outer catheter  330  and the middle catheter  320  are driven from their respective proximal ends in a manner as illustrated in  FIG. 3  with the use of the input device  76 , controller  72 , and motor array  70 . 
   To position each of the separate catheters, there is illustrated in  FIG. 9  a fixing or securing means such as balloon  332  located at the distal end of large outer catheter  330  and balloon  322  located at the distal end of the middle catheter  320 . Each of these balloons may be inflated to hold its corresponding catheter in a relatively fixed position in the body vessel. Alternatively, rather than the use of balloons, other securing devices may be employed such as sonic type of expandable mechanical member. Regardless of the type of securing member employed, it is capable of being operated by the surgeon from a remote location at the master station, and at the appropriate time selected by the surgeon. The balloons  322  and  332  can be a single lobed balloon that totally obstructs the vessel when inflated. Alternatively, the balloons may have a multi-lobed configuration as illustrated in  FIG. 9A . The balloon  322  or  332  shown in  FIG. 9A  has three lobes  305  that when inflated in a vessel  306  allows fluid to flow in the space  307  between the lobes. The balloon  322  or  332  can have fewer or more than three lobes in other arrangements. In certain implementations, the individual lobes can be inflated independently of each other. 
   Initially, both the middle catheter  320  and the small inner catheter  310  may be in a withdrawn position, coaxially positioned within the outer catheter  330 . When the outer catheter  330  is controlled by the surgeon to be positioned in the manner illustrated in  FIG. 9 , the surgeon can then instruct the balloon  332  to inflate to secure the outer catheter  330  in the position illustrated in  FIG. 9 . The balloon  332  expands against the walls of the vessel and essentially locks the outer catheter in position, particularly at its distal end. 
   Next, under the control of the surgeon through the use of an input device, the middle catheter  320  is moved forward linearly through the vessel of the anatomy. The control of the forward movement of the catheter  320  relative to the catheter  330  may be carried out in a manner illustrated in  FIG. 3  from the proximal end of the catheter  320 . 
   Previously, mention was made that the balloon  332  is inflated to secure the outer catheter  330 . After the middle catheter  320  is moved forward some distance, then the balloon  322  may also be inflated. This procedure is under the surgeon&#39;s control at the master station through the input device to now secure the distal end of the middle catheter  320  at an appropriate position within a body vessel. 
   For “fine” control of the small inner catheter  310 , it is intended, in the embodiment of  FIG. 9 , that the control of the inner catheter  310  is implemented in the manner illustrated in  FIG. 8  in which the support and drive block  140  can provide direct drive of the inner catheter&#39;s  310  forward linear movement out of the middle catheter  320 . Although the drive is located at the distal end of the catheter, the drive is remotely controlled by the surgeon at the master station. Again, this control can be by way of an input device such as an input interface or a joystick moved in a direction to cause a consequent movement of the various catheters depicted in  FIG. 9 . 
   Because of the significant length of the catheters that may be employed in a surgical procedure, it may be desirable to provide direct drive of the inner catheter  310  at its distal end, rather than drive it at its proximal end. For example, this may be particularly desirable when the length of the entire catheter system is so long that it may have some tendency to deflect or bend even when secured by, for example, the balloons  322  and  332 . 
   After the balloons  322  and  332  are inflated, the surgeon at the master station can continue to control the forward movement of the distal end of inner catheter  310 . As indicated previously, the drive for the inner catheter  310  is typically of the type illustrated in  FIG. 8 , or in  FIG. 10  discussed below. 
   In  FIG. 10 , the small diameter inner catheter  310  is driven relative to the middle diameter catheter  320 . The linear movement of the catheter  310  is illustrated by the arrow  352  when driven by the wheels  350 . The rotation of the catheter  310  relative to the catheter  320  is driven the block  354 , as indicated by the rotational arrow  356 . 
     FIG. 10  also illustrates a detector or reader  360 . This again may be an optical device that detects the passage of the indicia  311  on the inner catheter  310 . Appropriate electrical signal lines coupled from the detector  360  back to the master station transmit information related to the movement of the inner catheter  310  relative to the middle catheter  320 . 
   The detector  360  may also be used for detecting rotation of the catheter  310  relative to the catheter  320 . For this purpose, in addition to the linear set of indicia  311  on the catheter  310 , the catheter  310  is also provided with additional indicia  315  that extend about the circumference of the catheter. The reader  360  is able to read not only linear passage of indicia  311 , but also read rotation of the indicia  315  from one linear set of indicia  311  to the next. 
   Although a single detector  360  is shown in  FIG. 10 , other detectors may also be employed. For example, one detector could be used for detecting linear translation of the catheter  310 , and a second detector could be used for detecting rotation of the catheter  310  with the use of indicia  315 . 
   The catheter drive system described above can be implemented in other configurations as well. For example, there is shown in  FIG. 11A  a catheter drive system associated with a fluid or drug delivery system. Note in  FIG. 11A , emphasis is placed on the proximal end of a catheter  1070  and guide wire  1072 . The more distal portion of the catheter is identified by the dotted lines. Details of the distal portions of the catheter  1070  and guide wire  1072  can be found in the U.S. Application entitled “Catheter Drive System,” by Weitzner, U.S. application Ser. No. 10/216,067 filed herewith, the entire contents of which are incorporated herein by reference. 
   At some position along the catheter  1070 , there is a patient interface illustrated at  1074  where the catheter may be considered as entering into the patient&#39;s body. The entry of the catheter may, for example, be percutaneously, via an incision, or even through a natural body orifice. 
   A support block  1076  supports the catheter  1070  in a manner to enable at least two degrees-of-freedom of the catheter including axial movement of the catheter to an anatomic body target sit; as well as rotation of the catheter. The support block  1076  controls both the linear translation of the catheter  1070  by the wheels  1078 , as indicated by the arrow  1079 , and the rotational translation of the catheter, as illustrated by the arrow  1080 . Again, further details of such a catheter support system illustrating multiple degrees-of-freedom can be found in the U.S. patent application Ser. Nos. 10/023,024, 10/011,371, 10/011,449, 10/010,150, 10/022,038, and 10/012,586 mentioned earlier. 
   In  FIG. 11A , there is also a block  1082  which controls the movement of the guide wire  1072 . In particular, the wheels  1084  move the guide wire  1072  in a linear manner in the direction  1085 . The block  1082  is also able to rotate the guide wire  1072  in the direction  1086 . Note that the blocks  1076  and  1082  can be supported on a common support structure  1120 . Although the support  1120  provides a physical connection between the blocks  1076  arid  1082 , the blocks are operated independently so that the guide wire  1072  and the catheter  1070  can be driven independently of each other. 
   The drive or support blocks  1076  and  1082  arc coupled to an electromechanical drive member or motor array  1090  that controls the movements of both the catheter  1070  and the guide wire  1072  with at least two degrees-of-freedom. In particular, mechanical cablings  1087  and  1088  couples the motor array  1090  to the support blocks  1076  and  1082 , respectively. The motor array  1090  is also coupled to a controller  1092  that directs a plurality of motors in the motor array. An input device  1096  provides an interface to the system for use by a surgeon. 
   The mechanical cablings  1087  and  1088  transmit the mechanical movements of the various motors in the motor array  1090  to the respective support blocks  1076  and  1082  to provide the linear and rotational movements of the catheter  1070  and guide wire  1072 . Thus, in the motor array  1090 , there may be at least one motor for the linear translation and a separate motor for the rotational translation for the block  1076 . Similarly, there can be motors in the motor array  1090  for both the linear and rotational translations of the support block  1082 . 
   The controller  1092 , maybe a microprocessor that receives input commands from the input device  1096 . The input device  1096  may include various types of controls such as a dial, joystick, wheel or mouse. A touch screen may also be employed as the input device  1096  to input information about the desired location of a particular portion of the catheter. Details of such a tracking system can be found in the U.S. Application entitled “Catheter Tracking System,” U.S. application Ser. No. 10/216,669, mentioned earlier. Such a tracking system enables an operator, such as a surgeon, through the input device to select a particular anatomic body site and direct the catheter directly and automatically to that site. 
   Although a manifold  1100  is shown with a single port, the manifold may include multiple ports. The manifold  1100  provides a delivery conduit to the catheter  1080  for the delivery of fluids to a site in the patient&#39;s body. For example, one of the fluids  1105  employed may be a contrast fluid for purposes of visualization, which is coupled to a feed line  1107  by a valve A. There may also be a drug delivery system indicated generally at  1108  coupled to the feed line  1107  by way of a line  1109  to a valve B. Alternatively, the manifold  1100  can be provided with two separate ports with a respective valve A and B in each of these ports. 
   As shown in  FIG. 11B , the manifold  1100  includes an end piece  1200  sealed to the back end of the manifold  1100  and provided with an opening  1202  through which the guide wire  1072  enters into the manifold  1100 , and hence the catheter  1070 . Positioned within the manifold  1110  and adjacent to the end piece  1200  is a gasket  1204 . The guide wire  1072  pierces the gasket  1204  such that the gasket forms a seal about the guide wire. Thus, as fluid enters from the feedline  1107  into the manifold  1100 , the gasket  1204  prevents the fluid from leaking out the back end of the manifold  1100 . 
   As indicated previously, the input device  1096  may take on a variety of different forms. If a wheel, dial, or pivoting switch is employed as the input device  1096 , then one of these may be used for controlling the two degrees-of-freedom of movement of the catheter  1070 , while another such device is used to control the two degrees-of-freedom of movement of the guide wire  1072 . Thus, the operator has independent control of the drive or support blocks  1076  and  1082  byway of the input device  1096 . This permits the operator to selectively move the guide wire  1072  and the catheter  1070  independently of each other. Typically, the operator advances the guide wire  1072  a certain distance, and then the catheter  1070 , such that the guide wire  1072  can be used to access certain twists or turns in a body lumen such as an artery or vein. 
   The input device  1096  may also operate means such as buttons, switches, etc. that provide signals through lines  1111  and  1112  to the respective valves A and B for controlling the dispensing of liquids from the fluid sources  1105  and  1108 . Although shown coupled to the controller  1092 , the lines  1111  and  1112  can be coupled directly to the input device  1096  in other implementations. 
   When the system is in operation, the surgeon advances the catheter  1070  and guide wire  1072  through the patient&#39;s body with the drive system. To provide visualization of the end of the catheter, the surgeon can instruct, with the input device  1096 , the valve A to open. That is, the surgeon interfaces with the system through the input device  1096  to generate a signal on line  1111  that opens the valve A to dispense a contrast fluid through the manifold  1000  and the catheter  1070  to the target site of interest. Similarly, the surgeon may deliver drugs to the target site by instructing the valve B to open which would allow drugs from the source  1108  to flow through the catheter  1070  into the body. 
   In the following discussion, greater detail will be provided about the drive mechanisms ( FIGS. 12-16 ) and various devices ( FIGS. 17-19 ) used to couple the medical instruments to the drive mechanisms. Although the drive mechanisms and connectors are described in reference to the catheter  1070  and guide wire  1072  discussed above, they can be used in any number of combinations with any of the other medical instruments described earlier. 
   The catheter  1070  referred to in these figures is of the type commonly used in angioplasty. The catheter  1070  includes a first leg  1300  joined with a second leg  1302  at a coupler  1304 , and a single extended leg  1306  that extends from the coupler  1304 . Typically, a part or much of the extended leg  1306  is the portion of the catheter  1070  that is inserted into the patient. The leg  1302  is connected to an end piece  1305  through which the guide wire  1072  is inserted such that the guide wire  1072  typically extends from outside the end piece  1305  through the legs  1302  and  1306 . As are the legs  1302  and  1306 , the leg  1300  is hollow to allow the transmission of a liquid or gas through the leg  1306  to the surgical site. Hence, the leg  1300  would function in much the same way as the feedline  1107  shown in  FIG. 11 . The leg  1300  is also provided with a valve  1307  that controls the delivery rate of the liquid or gas, and prevents the liquid or gas from escaping once the liquid or gas source is disconnected from the leg  1300 . Note that a gasket is typically located in the coupler  1304  or the end piece  1305  that forms a seal with the guide wire  1072  to prevent the liquid or gas from escaping out the opening of the end piece  1305 . 
   Referring now to  FIGS. 12 and 12A , the drive or support block described earlier is identified as drive mechanism  1308   a  associated with the catheter  1070 . As can be seen in  FIG. 12A , which is a view of the drive mechanism along the length of the leg  1306 , the drive mechanism  1308  includes a gripping device  1310  in which the catheter  1070  is secured, and a motor  1312 . A belt  1314  is wrapped around pulleys  1315   a  and  1315   b  of the motor  1312  and gripping device  1310 , respectively. Hence, as the motor  1312  rotates, this rotary motion is transmitted to the gripping device  1310  through the belt  1314  as indicated by the double arrow  1316 , such that the catheter  1070  rotates accordingly as indicated by the double arrow  1318   a  ( FIG. 12 ). 
   As shown in  FIG. 13 , a similar type of drive mechanism  1308   b  can be coupled to guide wire  1072  to provide it with a rotary motion as indicated by the double arrow  1318   b . In addition, the drive mechanisms  1308   a  and  1308   b  shown in  FIG. 13  also provide the catheter  1070  and guide wire  1072  with linear motion as indicated by the double arrows  1319   a  and  1319   b  (referred to generally as direction  1319 ), respectively. In certain embodiments, as shown in  FIG. 14 , the drive mechanisms  1308   a  and  1308   b  are supported on and slide back and forth along respective rails  1350  and  1352 . 
   To move the drive mechanisms  1308   a  and  1308   b  (referred to generally as drive mechanism  1308 ) linearly in the direction  1319 , various configurations can be used as illustrated in  FIGS. 15A ,  15 B, and  15 C. Referring in particular to  FIG. 15A , there is shown a lead screw drive arrangement  1360  with a threaded connector  1362  attached to the drive mechanism  1308 . A lead screw  1364  is threaded through the connector  1362  and coupled to a stationary motor  1366 . Accordingly, rotary motion of the lead screw  1364  induced by the motor  1366  in the direction  1368  results in a linear motion of the connector  1362 . Since the connector  1362  is attached to the drive mechanism  1308 , linear motion of the connector  1362  produces a consequent linear motion of the drive mechanism  1308  in the direction  1319 . 
   Referring now to  FIG. 15B , there is shown a rack and pinion drive arrangement  1370  for moving the drive mechanism  1308  in a linear manner. The rack and pinion drive  1370  includes a rack  1372  attached to the drive mechanism  1308 , and a pinion  1374  coupled to a stationary motor  1376 . The teeth of the pinion  1374  engage with those of the rack  1372  such that as the motor  1376  rotates the pinion  1374  in the direction  1378 , the rack  1372  and hence the drive mechanism  1308  moves linearly back and forth in the direction  1379 . 
   Turning now to  FIG. 15C , there is illustrated yet another configuration for moving the drive mechanism  1308  linearly. In particular there is shown a belt/pulley drive  1380  that includes a belt, chain or cable  1382  wrapped around a pulley  1386  and a motor pulley  1384  coupled to a stationary motor. The belt, chain, or cable  1382  is attached in turn to the drive mechanism  1308  with a connector  1388 . Hence, rotary motion of the motor pulley  1384  produced by the motor is transformed into a linear motion of the connector  1388 . Thus, as the motor rotates the motor pulley  1384 , the drive mechanism  1308  moves back and forth in the direction  1319 . 
   Greater detail of the catheter  1070  and guide wire  1072  arrangement of  FIG. 13  is illustrated in  FIG. 16 , and that of the drive mechanism  1308  is shown in  FIGS. 16A and 16B . In particular, the catheter  1070  and guide wire  1072  are shown as a typical “off-the-shelf” apparatus coupled to a base unit  1400 . That is, the base unit  1400  is meant to be easily coupled to and decoupled from any number of medical instruments, such as the catheter  1070  and guide wire  1072  combination. In other implementations, such as some of those described earlier, the medical instrument and base unit is considered as a single instrument not to be decoupled from each other. 
   Referring now in particular to  FIGS. 16A and 16B , in addition to the features illustrated in  FIG. 12A , the drive mechanism  1308  includes a housing  1401  which encloses much of the moving parts of the drive mechanism  1308 . As described before, rotary motion of the motor  1312  is transferred by the belt  1314  to the guide wire  1072  or the leg  1306  of the catheter  1070  via the pulley  1315   b  coupled to the gripping device  1310  ( FIG. 12A ). The pulley  1315   b  itself is supported in the housing  1401  with a pair of bearings  1402 . 
   Turning now to the discussion of the connector  1310 , to facilitate coupling the catheter  1070  and the guide wire  1072  to their respective drive mechanisms  1308 , many types of connectors can be used. In some implementations, a Toohy Borst type of fitting may be optimal. Another type of connector  1310  is shown in  FIG. 17A , in which the leg  1306  or guide wire  1072  would be placed in an enlarged portion  1500  of a slot  1502 . A clamping force  1504  would then be provided to secure the leg  1306  or guide wire  1072  to the drive mechanism. For example, as shown in  FIG. 17B , the clamping force could be provided with a thumb screw  1506  threaded into a block  1508  in which the connector  1310  is mounted. In another type of arrangement shown in  FIG. 17C , a sliding ring  1510  is fitted over the connector  1310  in the direction  1512 . The clamping force can also be provided by a vise like device that functions similar to a collet/pin vise. 
   In another embodiment, as shown in  FIG. 18A , the connector  1310  and the pulley  1315   b  are one and the same device. Here, the leg  1306  or guide wire  1072  snaps into an enlarged portion  1520  of a slot provided in an extended segment  1522  of the connector device  1310 . Since, the enlarged portion  1520  is slightly smaller than the diameter of the leg  1306  or the guide wire  1072 , the legs  1524  of the segment  1522  provide a sufficient clamping force to the leg  1307  or guide wire  1072 . In this arrangement, the belt  1314  is wrapped around the pulley  1315   a  of the motor  1312  and attaches to the two curved segments  1526  of the connector  1310 . Thus, rotary motion of the pulley  1315   a  produces a rotary motion of the connector  1310 , and hence the leg  1306  or guide wire  1072 , indicated by the double arrow  1318 . 
   Referring now to  FIGS. 19 ,  19 A and  19 B, there is shown another embodiment of the connector  1310 . In this embodiment, the connector  1310  includes an inner  1550  and an outer  1552  C-shaped rings. To grasp the leg  1306  or guide wire  1072 , the outer ring  1552  is slid over the inner ring  1550  in the direction  1554 . The guide wire  1072  or the leg  1306  of the catheter  1070  is placed in the inner ring  1550 , and the outer ring  1552  is then rotated or twisted in the direction  1556  around the inner ring  1550 , thereby capturing the leg  1306  or guide wire  1072 . Alternatively, the leg  1306  or guide wire  1072  can first be placed in the inner  1550  and outer  1554  rings, and then the outer ring  1554  can be rotated about the leg or catheter and subsequently slid over the inner ring  1550 . 
   Yet another embodiment of the connector  1310  is shown in  FIGS. 20A and 20B . In this embodiment, the connector  1310  includes a pin vise  1600  provided with slot  1602  cut along its length, and a sleeve  1604  that is threaded onto the pin vise  1600 . The pin vise is operated by turning the sleeve  1604  so that as it threads onto the vise  1600  in the direction  1606  which causes the slot  1602  to narrow. Thus to secure the leg  1306  or guide wire  1072  to the drive mechanism  1308 , the leg or guide wire is first placed into the slot  1602  as shown in  FIG. 20B . The operator then rotates the sleeve  1604  to thread it over the pin vise  1600 , and hence to close the slot  1602  about the leg or guide wire until the pin vise is sufficiently tightened about the leg  1306  or guide wire  1072 . 
   This invention can be implemented and combined with other applications, systems, and apparatuses, for example, those discussed in greater detail in U.S. Provisional Application No. 60/332,287, filed Nov. 21, 2001, the entire contents of which are incorporated herein by reference, as well as those discussed in greater detail in each of the following documents, all of which are incorporated herein by reference in theft entirety: 
   U.S. application Ser. No. 09/783,637 filed Feb. 14, 2001, which is a continuation of PCT application Ser. No. PCT/US00/12553 filed May 9, 2000, which claims the benefit of U.S. Provisional Application Ser. No. 60/133,407 filed May 10, 1999; U.S. Application entitled “Articulated Apparatus for Telemanipulator System,” by Brock and Lee, U.S. application Ser. No. 10/208,807, filed Jul. 29, 2002, which is a continuation of U.S. application No. 09/827,503 filed Apr. 6, 2001, now U.S. Pat. No. 6,432,112 issued Aug. 13, 2002, which is a continuation of U.S. application Ser. No. 09/746,853 filed Dec. 21, 2000, now U.S. Pat. No. 6,692,485 issued Feb. 17, 2004, which is a divisional of U.S. application Ser. No. 09/375,666 filed Aug. 17, 1999, now U.S. Pat. No. 6,197,017 issued on Mar. 6, 2001, which is a continuation of U.S. application Ser. No. 09/028,550 filed Feb. 24, 1998, now abandoned; PCT application Ser. No. PCT/US01/11376 filed Apr. 6, 2001, which claims priority to U.S. application Ser. No. 09/746,853 filed Dec. 21, 2000, and U.S. application Ser. No. 09/827,503 filed Apr. 6, 2001; U.S. application Ser. Nos. 10/014,143, 10/012,845, 10/008,964, 10/013,046, 10/011,450, 10/008,457, and 10/008,871, all filed Nov. 16, 2001 and all of which claim benefit to U.S. Provisional Application No. 60/279,087 filed Mar. 27, 2001; U.S. application Ser. No. 10/077,233 filed Feb. 15, 2002, which claims the benefit of U.S. Provisional Application No. 60/269,203 filed Feb. 15, 2001; U.S. application Ser. No. 10/097,923 filed Mar. 15, 2002, which claims the benefit of U.S. Provisional Application No. 60/276,151 filed Mar. 15, 2001; U.S. application Ser. No. 10/034,871 filed Dec. 21, 2001, which claims the benefit of U.S. Provisional Application No. 60/257,816 filed Dec. 21, 2000; U.S. application Ser. No. 09/827,643 filed Apr. 6, 2001, which claims the benefit of U.S. Provisional Application No. 60/257,869 filed Dec. 21, 2000, and U.S. Provisional Application No. 60/195,264 filed Apr. 7, 2000. 
   While this invention has been particularly shown and described with references to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the invention encompassed by the appended claims. 
   For example, although a detector for sensing relative movement between adjacent catheters has been described, a detector for sensing movement of any one or more of the catheters relative to a base position that may or may not be a location on a particular one of the catheters can be employed. Also described herein is the use of cabling through the catheters for controlling the movement of the catheters. In certain embodiments a piezo-electric arrangement may be employed in which electrical signal wires would extend through the catheter system for actuation of a mechanical (piezoelectric) member to provide motion of the distal end of the catheter.