Abstract:
Robotic and/or surgical devices, systems, and methods include kinematic linkage structures and associated control systems configured to facilitate preparation of the system for use. One or more kinematic linkage sub-systems may include joints that are actively driven, passive, or a mix of both. A set-up mode employs an intuitive user interface in which one or more joints are initially held static by a brake or joint drive system. The user may articulate the joint(s) by manually pushing against the linkage with a force, torque, or the like that exceeds a manual articulation threshold. Articulation of the moving joints is facilitated by modifying the signals transmitted to the brake or drive system. The system may sense completion of the reconfiguration from a velocity of the joint(s) falling below a threshold, optionally for a desired dwell time. The system may provide a detent-like manual articulation that is not limited to mechanically pre-defined detent joint configurations. Embodiments of the invention provide, and can be particularly well-suited for manual movement of a platform supporting a plurality of surgical manipulators in a robotic surgical system or the like without having to add additional input devices.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims priority to U.S. Provisional Patent Application No. 61/954,298 filed Mar. 17, 2014, the entirety of which is incorporated by reference. 
     
    
     BACKGROUND 
       [0002]    Minimally invasive medical techniques are intended to reduce the amount of extraneous tissue that is damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and deleterious side effects. One effect of minimally invasive surgery, for example, is reduced post-operative hospital recovery times. Because the average hospital stay for a standard surgery is typically significantly longer than the average stay for an analogous minimally invasive surgery, increased use of minimally invasive techniques could save millions of dollars in hospital costs each year. While many of the surgeries performed each year in the United States could potentially be performed in a minimally invasive manner, only a portion of the current surgeries use these advantageous techniques due to limitations in minimally invasive surgical instruments and the additional surgical training involved in mastering them. 
         [0003]    Minimally invasive robotic surgical or telesurgical systems have been developed to increase a surgeon&#39;s dexterity and avoid some of the limitations on traditional minimally invasive techniques. (Teleoperated medical devices, such as surgical systems, are sometimes called robotic surgical systems because they incorporate robot technology). In telesurgery, the surgeon uses some form of remote control (e.g., a servomechanism or the like) to manipulate surgical instrument movements, rather than directly holding and moving the instruments by hand. In telesurgery systems, the surgeon can be provided with an image of the surgical site at a surgical workstation. While viewing a two or three dimensional image of the surgical site on a display, the surgeon performs the surgical procedures on the patient by manipulating master control devices, which in turn control motion of the servo-mechanically operated instruments. 
         [0004]    The servomechanism used for telesurgery will often accept input from two master controllers (one for each of the surgeon&#39;s hands) and may include two or more robotic arms on each of which a surgical instrument is mounted. Operative communication between master controllers and associated robotic arm and instrument assemblies is typically achieved through a control system. The control system typically includes at least one processor that relays input commands from the master controllers to the associated robotic arm and instrument assemblies and back from the instrument and arm assemblies to the associated master controllers in the case of, for example, force feedback or the like. One example of a robotic surgical system is the DA VINCI® system commercialized by Intuitive Surgical, Inc. of Sunnyvale, Calif. 
         [0005]    A variety of structural arrangements can be used to support the surgical instrument at the surgical site during robotic surgery. The driven linkage or “slave” is often called a robotic surgical manipulator, and exemplary linkage arrangements for use as a robotic surgical manipulator during minimally invasive robotic surgery are described in U.S. Pat. Nos. 7,594,912; 6,758,843; 6,246,200; and 5,800,423; the full disclosures of which are incorporated herein by reference. These linkages often make use of a parallelogram arrangement to hold an instrument having a shaft. Such a manipulator structure can constrain movement of the instrument so that the instrument pivots about a remote center of manipulation positioned in space along the length of the rigid shaft. By aligning the remote center of manipulation with the incision point to the internal surgical site (for example, with a trocar or cannula at an abdominal wall during laparoscopic surgery), an end effector of the surgical instrument can be positioned safely by moving the proximal end of the shaft using the manipulator linkage without imposing potentially dangerous forces against the abdominal wall. Alternative manipulator structures are described, for example, in U.S. Pat. Nos. 7,763,015; 6,702,805; 6,676,669; 5,855,583; 5,808,665; 5,445,166; and 5,184,601; the full disclosures of which are incorporated herein by reference. 
         [0006]    A variety of structural arrangements can also be used to support and position the robotic surgical manipulator and the surgical instrument at the surgical site during robotic surgery. Supporting linkage mechanisms (e.g., serial kinematic chains of two or more individual links, connected by movable joints, and the like), sometimes referred to as set-up joints, or set-up joint arms, are often used to position and align each manipulator with the respective incision point in a patient&#39;s body. A single linkage may include two or more individual component mechanical joints (or an infinite number, in the case of a continuously flexible structure), but as a whole be considered a single joint with two or more degrees of freedom corresponding to the individual component joints. The supporting linkage mechanism facilitates the alignment of a surgical manipulator with a desired surgical incision point and targeted anatomy. Exemplary supporting linkage mechanisms are described in U.S. Pat. No. 6,246,200; U.S. Pat. No. 6,788,018; U.S. Pat. No. 7,763,015; and U.S. Pat. No. 7,837,674 the full disclosures of which are incorporated herein by reference. 
         [0007]    While the new telesurgical systems and devices have proven highly effective and advantageous, still further improvements are desirable. In general, improved minimally invasive robotic surgery systems are desirable. It would be particularly beneficial if these improved technologies enhanced the efficiency and ease of use of robotic surgical systems. For example, it would be particularly beneficial to increase maneuverability, improve space utilization in an operating room, provide a faster and easier set-up, inhibit collisions between robotic devices during use, and/or reduce the mechanical complexity and size of these new surgical systems. 
       BRIEF SUMMARY 
       [0008]    The following presents a simplified summary of some embodiments of the invention in order to provide a basic understanding of the invention. This summary is not an extensive overview of the invention. It is not intended to identify key/critical elements of the invention or to delineate the scope of the invention. Its sole purpose is to present some embodiments of the invention in a simplified form as a prelude to the more detailed description that is presented later. 
         [0009]    The present invention generally provides improved robotic and/or surgical devices, systems, and methods. Kinematic linkage structures and associated control systems described herein are particularly beneficial in helping system users to arrange the robotic structure in preparation for use, including in preparation for a surgical procedure on a particular patient. Exemplary robotic surgical systems described herein may have one or more kinematic linkage sub-systems that are configured to help align a manipulator structure with the surgical work site. The joints of these set-up systems may be actively driven, passive (so that they are manually articulated and then locked into the desired configuration while the manipulator is used therapeutically), or a mix of both. Embodiments of the robotic systems described herein may employ a set-up mode in which one or more joints are initially held static by a brake or joint drive system. Inadvertent articulation is limited by the brake or drive system, but the user can manually actuate one of a plurality of inputs (e.g., depressible buttons) each positioned on one of the set-up joints supporting the plurality of manipulators to modify the signals transmitted to the brake or joint drive system to allow for manual movement of the one or more joints. When the user arrives at the desired configuration, the user may stop actuation of the input to reactuate the brake or drive system to limit inadvertent manual movement of the one or more joints thereafter. Embodiments of the invention provide a user interface that is intuitive, and can be particularly well-suited for manual movement of a platform supporting a plurality of surgical manipulators in a robotic surgical system or the like without having to add additional joint position or torque sensors or the like. 
         [0010]    In some embodiments, a teleoperated surgical system is provided. The teleoperated surgical system may include a support structure supporting a mounting platform. The support structure may include a support linkage including a base and a drive or brake system operatively coupled to the support linkage so as to limit inadvertent manual rotation of the mounting platform relative to the support structure base. The teleoperated surgical system may further include a first manipulator and a second manipulator extending from and supported by the mounting platform. The first manipulator and the second manipulator may be coupled to the mounting platform via a first set-up linkage and a second set-up linkage, respectively. The teleoperated surgical system may further include a first actuatable input and a second actuatable input—each configured for user actuation of the drive or brake system to allow for manual rotation of the mounting platform by a user. The first actuatable input and the second actuatable input may be positioned on the first set-up linkage and second set-up linkage, respectively. 
         [0011]    Optionally, the first and second actuatable inputs may each comprise switches. The switches may each comprise depressible buttons. In some embodiments, each of the first and second set-up linkages comprise a base link that extends horizontally from the mounting platform. The first and second actuatable inputs for user actuation of the drive or brake system may be positioned distally from the base link of each of the first and second set-up linkages, respectively. In some embodiments, the first and second set-up linkages may comprise a vertical link coupled with the base link that extends downwardly from an end of the base link. The first and second actuatable inputs may be positioned on or distally from the vertical link of each of the first and second set-up linkages, respectively. 
         [0012]    In some embodiments a teleoperated surgical system may be provided that includes a support structure supporting a mounting platform. The support structure may include a support linkage including a base and a drive or brake system operatively coupled to the support linkage so as to limit inadvertent manual rotation of the mounting platform relative to the support structure base. The teleoperated surgical system may further include a plurality of manipulators extending from and supported by the mounting platform. The plurality of manipulators may each couple to the mounting platform via a set-up linkage. The teleoperated surgical system may further include a plurality of actuatable inputs. The plurality of inputs may be positioned between an associated one of the plurality of manipulators and the mounting platform. A processor may be provided that couples with the plurality of actuatable inputs and the drive or brake system. The processor may be configured to actuate the drive or brake system to allow for manual rotation of the mounting platform by a user when the user actuates any one of the plurality of actuatable inputs. 
         [0013]    Optionally, the plurality of actuatable inputs may be switches. In some embodiments, the switches may be depressible buttons. In some embodiments, each of the set-up linkages may include a base link that extends horizontally from the mounting platform. The plurality of actuatable inputs for user actuation of the drive or brake system may be positioned distally from the base link of each of the set-up linkages, respectively. In some embodiments each of the set-up linkages may include a vertical link coupled with the base link that extends downwardly from an end of the base link. The plurality of actuatable inputs may be positioned on or distally from the vertical link of each of the set-up linkages, respectively. 
         [0014]    In some embodiments, a method of positioning one or more manipulators of a teleoperated surgical system is provided. The method may include providing a teleoperated surgical system including a support structure supporting a mounting platform. The support structure may include a support linkage including a base and a drive or brake system operatively coupled to the support linkage. The teleoperated surgical system may further include a plurality of manipulators extending from and supported by the mounting platform. The plurality of manipulators may each couple to the mounting platform via a set-up linkage. The teleoperated surgical system may further include a plurality of actuatable inputs. The plurality of inputs may each be positioned between an associated one of the plurality of manipulators and the mounting platform. The method may further include actuating the drive or brake system so as to limit inadvertent manual rotation of the mounting platform relative to the support structure base. The method may further include receiving a signal from any one of the plurality of actuatable inputs indicating user actuation of one of the actuatable inputs. Thereafter, the method may include actuating the drive or brake system so as to allow for manual rotation of the mounting platform by a user so long as the signal is being received from any one of the plurality of actuatable inputs. The method may further include reactuating the drive or brake system so as to limit inadvertent manual rotation of the mounting platform once the signal from any one of the plurality of actuatable inputs is no longer received. 
         [0015]    In some embodiments, the plurality of actuatable inputs comprise switches. Optionally, the switches comprise depressible buttons. 
         [0016]    For a fuller understanding of the nature and advantages of the present invention, reference should be made to the ensuing detailed description and accompanying drawings. Other aspects, objects and advantages of the invention will be apparent from the drawings and detailed description that follows. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0017]      FIG. 1  is a plan view of a minimally invasive robotic surgery system being used to perform a surgery, in accordance with many embodiments. 
           [0018]      FIG. 2  is a perspective view of a surgeon&#39;s control console for a robotic surgery system, in accordance with many embodiments. 
           [0019]      FIG. 3  is a perspective view of a robotic surgery system electronics cart, in accordance with many embodiments. 
           [0020]      FIG. 4  diagrammatically illustrates a robotic surgery system, in accordance with many embodiments. 
           [0021]      FIG. 5A  is a partial view of a patient side cart (surgical robot) of a robotic surgery system, in accordance with many embodiments. 
           [0022]      FIG. 5B  is a front view of a robotic surgery tool, in accordance with many embodiments. 
           [0023]      FIG. 6  is a perspective schematic representation of a robotic surgery system, in accordance with many embodiments. 
           [0024]      FIG. 7  is a perspective schematic representation of another robotic surgery system, in accordance with many embodiments. 
           [0025]      FIG. 8  shows a robotic surgery system, in accordance with many embodiments, in conformance with the schematic representation of  FIG. 7 . 
           [0026]      FIG. 9  illustrates rotational orientation limits of set-up linkages relative to an orienting platform of the robotic surgery system of  FIG. 8 . 
           [0027]      FIG. 10  shows a center of gravity diagram associated with a rotational limit of the boom assembly for a robotic surgery system, in accordance with many embodiments. 
           [0028]      FIG. 11  shows an exemplary system and the positioning of mounting platform rotation buttons according to some embodiments of the invention. 
       
    
    
     DETAILED DESCRIPTION 
       [0029]    In the following description, various embodiments of the present invention will be described. For purposes of explanation, specific configurations and details are set forth in order to provide a thorough understanding of the embodiments. However, it will also be apparent to one skilled in the art that the present invention may be practiced without the specific details. Furthermore, well-known features may be omitted or simplified in order not to obscure the embodiment being described. 
         [0030]    The kinematic linkage structures and control systems described herein are particularly beneficial in helping system users to arrange the robotic structure of a procedure on a particular patient. Along with actively driven manipulators used to interact with tissues and the like during treatment, robotic surgical systems may have one or more kinematic linkage systems that are configured to support and help align the manipulator structure with the surgical work site. These set-up systems may be actively driven or may be passive, so that they are manually articulated and then locked into the desired configuration while the manipulator is used therapeutically. The passive set-up kinematic systems may have advantages in size, weight, complexity, and cost. Unfortunately, a plurality of manipulators may be used to treat tissues of each patient, the manipulators may each independently benefit from accurate positioning so as to allow the instrument supported by that instrument to have the desired motion throughout the workspace, and minor changes in the relative locations of adjacent manipulators may have significant impact on the interactions between manipulators (with poorly positioned manipulators potentially colliding or having their range and/or ease of motion significantly reduced). Hence, the challenges of quickly arranging the robotic system in preparation for surgery can be significant. 
         [0031]    One option is to mount multiple manipulators to a single platform, with the manipulator-supporting platform sometimes being referred to as an orienting platform. The orienting platform can be supported by an actively driven support linkage (sometimes referred to herein as a set-up structure, and typically having a set-up structure linkage, etc.) The system may also provide and control motorized axes of the robotic set-up structure supporting the orienting platform with some kind of joystick or set of buttons that would allow the user to actively drive those axes as desired in an independent fashion. This approach, while useful in some situations, may suffer from some disadvantages. In particular, it may be difficult to locate a drive button for all the elements of a complex system so that each is accessible to users approaching the system in all its potential configurations. Furthermore, both sterile and non-sterile members of a surgical team may want to articulate some joints or linkages (such as by grabbing differing locations inside or outside the sterile field). Hence a more intuitive and flexible user interface would be desirable. This is particularly true of an orienting platform for use in multi-quadrant surgery, or for a structure that supports a plurality of surgical manipulators and may pivot about an axis extending at least roughly vertically so as to orient the manipulators relative to a patient on a surgical table or other support. 
         [0032]    Minimally Invasive Robotic Surgery 
         [0033]    Referring now to the drawings, in which like reference numerals represent like parts throughout the several views,  FIG. 1  is a plan view illustration of a Minimally Invasive Robotic Surgical (MIRS) system  10 , typically used for performing a minimally invasive diagnostic or surgical procedure on a Patient  12  who is lying down on an Operating table  14 . The system can include a Surgeon&#39;s Console  16  for use by a Surgeon  18  during the procedure. One or more Assistants  20  may also participate in the procedure. The MIRS system  10  can further include a Patient Side Cart  22  (surgical robot) and an Electronics Cart  24 . The Patient Side Cart  22  can manipulate at least one removably coupled tool assembly  26  (hereinafter simply referred to as a “tool”) through a minimally invasive incision in the body of the Patient  12  while the Surgeon  18  views the surgical site through the Console  16 . An image of the surgical site can be obtained by an endoscope  28 , such as a stereoscopic endoscope, which can be manipulated by the Patient Side Cart  22  to orient the endoscope  28 . The Electronics Cart  24  can be used to process the images of the surgical site for subsequent display to the Surgeon  18  through the Surgeon&#39;s Console  16 . The number of surgical tools  26  used at one time will generally depend on the diagnostic or surgical procedure and the space constraints within the operating room among other factors. If it is necessary to change one or more of the tools  26  being used during a procedure, an Assistant  20  may remove the tool  26  from the Patient Side Cart  22 , and replace it with another tool  26  from a tray  30  in the operating room. 
         [0034]      FIG. 2  is a perspective view of the Surgeon&#39;s Console  16 . The Surgeon&#39;s Console  16  includes a left eye display  32  and a right eye display  34  for presenting the Surgeon  18  with a coordinated stereo view of the surgical site that enables depth perception. The Console  16  further includes one or more input control devices  36 , which in turn cause the Patient Side Cart  22  (shown in  FIG. 1 ) to manipulate one or more tools. The input control devices  36  can provide the same degrees of freedom as their associated tools  26  (shown in  FIG. 1 ) to provide the Surgeon with telepresence, or the perception that the input control devices  36  are integral with the tools  26  so that the Surgeon has a strong sense of directly controlling the tools  26 . To this end, position, force, and tactile feedback sensors (not shown) may be employed to transmit position, force, and tactile sensations from the tools  26  back to the Surgeon&#39;s hands through the input control devices  36 . 
         [0035]    The Surgeon&#39;s Console  16  is usually located in the same room as the patient so that the Surgeon may directly monitor the procedure, be physically present if necessary, and speak to an Assistant directly rather than over the telephone or other communication medium. However, the Surgeon can be located in a different room, a completely different building, or other remote location from the Patient allowing for remote surgical procedures. 
         [0036]      FIG. 3  is a perspective view of the Electronics Cart  24 . The Electronics Cart  24  can be coupled with the endoscope  28  and can include a processor to process captured images for subsequent display, such as to a Surgeon on the Surgeon&#39;s Console, or on another suitable display located locally and/or remotely. For example, where a stereoscopic endoscope is used, the Electronics Cart  24  can process the captured images to present the Surgeon with coordinated stereo images of the surgical site. Such coordination can include alignment between the opposing images and can include adjusting the stereo working distance of the stereoscopic endoscope. As another example, image processing can include the use of previously determined camera calibration parameters to compensate for imaging errors of the image capture device, such as optical aberrations. 
         [0037]      FIG. 4  diagrammatically illustrates a robotic surgery system  50  (such as MIRS system  10  of  FIG. 1 ). As discussed above, a Surgeon&#39;s Console  52  (such as Surgeon&#39;s Console  16  in  FIG. 1 ) can be used by a Surgeon to control a Patient Side Cart (Surgical Robot)  54  (such as Patent Side Cart  22  in  FIG. 1 ) during a minimally invasive procedure. The Patient Side Cart  54  can use an imaging device, such as a stereoscopic endoscope, to capture images of the procedure site and output the captured images to an Electronics Cart  56  (such as the Electronics Cart  24  in  FIG. 1 ). As discussed above, the Electronics Cart  56  can process the captured images in a variety of ways prior to any subsequent display. For example, the Electronics Cart  56  can overlay the captured images with a virtual control interface prior to displaying the combined images to the Surgeon via the Surgeon&#39;s Console  52 . The Patient Side Cart  54  can output the captured images for processing outside the Electronics Cart  56 . For example, the Patient Side Cart  54  can output the captured images to a processor  58 , which can be used to process the captured images. The images can also be processed by a combination the Electronics Cart  56  and the processor  58 , which can be coupled together to process the captured images jointly, sequentially, and/or combinations thereof. One or more separate displays  60  can also be coupled with the processor  58  and/or the Electronics Cart  56  for local and/or remote display of images, such as images of the procedure site, or other related images. 
         [0038]    Processor  58  will typically include a combination of hardware and software, with the software comprising tangible media embodying computer readable code instructions for performing the method steps of the control functionally described herein. The hardware typically includes one or more data processing boards, which may be co-located but will often have components distributed among the robotic structures described herein. The software will often comprise a non-volatile media, and could also comprise a monolithic code but will more typically comprise a number of subroutines, optionally running in any of a wide variety of distributed data processing architectures. 
         [0039]      FIGS. 5A and 5B  show a Patient Side Cart  22  and a surgical tool  62 , respectively. The surgical tool  62  is an example of the surgical tools  26 . The Patient Side Cart  22  shown provides for the manipulation of three surgical tools  26  and an imaging device  28 , such as a stereoscopic endoscope used for the capture of images of the site of the procedure. Manipulation is provided by robotic mechanisms having a number of robotic joints. The imaging device  28  and the surgical tools  26  can be positioned and manipulated through incisions in the patient so that a kinematic remote center is maintained at the incision to minimize the size of the incision. Images of the surgical site can include images of the distal ends of the surgical tools  26  when they are positioned within the field-of-view of the imaging device  28 . 
         [0040]    Surgical tools  26  are inserted into the patient by inserting a tubular cannula  64  through a minimally invasive access aperture such as an incision, natural orifice, percutaneous penetration, or the like. Cannula  64  is mounted to the robotic manipulator arm and the shaft of surgical tool  26  passes through the lumen of the cannula. The manipulator arm may transmit signals indicating that the cannula has been mounted thereon. 
         [0041]    Robotic Surgery Systems and Modular Manipulator Supports 
         [0042]      FIG. 6  is a perspective schematic representation of a robotic surgery system  70 , in accordance with many embodiments. The surgery system  70  includes a mounting base  72 , a support linkage  74 , an orienting platform  76 , a plurality of outer set-up linkages  78  (two shown), a plurality of inner set-up linkages  80  (two shown), and a plurality of surgical instrument manipulators  82 . Each of the manipulators  82  is operable to selectively articulate a surgical instrument mounted to the manipulator  82  and insertable into a patient along an insertion axis. Each of the manipulators  82  is attached to and supported by one of the set-up linkages  78 ,  80 . Each of the outer set-up linkages  78  is rotationally coupled to and supported by the orienting platform  76  by a first set-up linkage joint  84 . Each of the inner set-up linkages  80  is fixedly attached to and supported by the orienting platform  76 . The orienting platform  76  is rotationally coupled to and supported by the support linkage  74 . And the support linkage  74  is fixedly attached to and supported by the mounting base  72 . 
         [0043]    In many embodiments, the mounting base  72  is a movable and floor supported, thereby enabling selective repositioning of the overall surgery system  70 , for example, within an operating room. The mounting base  72  can include a steerable wheel assembly and/or any other suitable support features that provide for both selective repositioning as well as selectively preventing movement of the mounting base  72  from a selected position. The mounting base  72  can also have other suitable configurations, for example, a ceiling mount, fixed floor/pedestal mount, a wall mount, or an interface configured for being supported by any other suitable mounting surface. 
         [0044]    The support linkage  74  is operable to selectively position and/or orient the orienting platform  76  relative to the mounting base  72 . The support linkage  74  includes a column base  86 , a translatable column member  88 , a shoulder joint  90 , a boom base member  92 , a boom first stage member  94 , a boom second stage member  96 , and a wrist joint  98 . The column base  86  is fixedly attached to the mounting base  72 . The translatable column member  88  is slideably coupled to the column base  86  for translation relative to column base  86 . In many embodiments, the translatable column member  88  translates relative to the column base  86  along a vertically oriented axis. The boom base member  92  is rotationally coupled to the translatable column member  88  by the shoulder joint  90 . The shoulder joint  90  is operable to selectively orient the boom base member  92  in a horizontal plane relative to the translatable column member  88 , which has a fixed angular orientation relative to the column base  86  and the mounting base  72 . The boom first stage member  94  is selectively translatable relative to the boom base member  92  in a horizontal direction, which in many embodiments is aligned with both the boom base member  92  and the boom first stage member  94 . The boom second stage member  96  is likewise selectively translatable relative to the boom first stage member  94  in a horizontal direction, which in many embodiments is aligned with the boom first stage member  94  and the boom second stage member  96 . Accordingly, the support linkage  74  is operable to selectively set the distance between the shoulder joint  90  and the distal end of the boom second stage member  96 . The wrist joint  98  rotationally couples the distal end of the boom second stage member  96  to the orienting platform  76 . The wrist joint  98  is operable to selectively set the angular orientation of the orienting platform  76  relative to the mounting base  72 . 
         [0045]    Each of the set-up linkages  78 ,  80  is operable to selectively position and/or orient the associated manipulator  82  relative to the orienting platform  76 . Each of the set-up linkages  78 ,  80  includes a set-up linkage base link  100 , a set-up linkage extension link  102 , a set-up linkage parallelogram linkage portion  104 , a set-up linkage vertical link  106 , a second set-up linkage joint  108 , and a manipulator support link  110 . In each of the set-up linkage base links  100  of the outer set-up linkages  78  can be selectively oriented relative to the orienting platform  76  via the operation of the a first set-up linkage joint  84 . In the embodiment shown, each of the set-up linkage base links  100  of the inner set-up linkages  80  is fixedly attached to the orienting platform  76 . Each of the inner set-up linkages  80  can also be rotationally attached to the orienting platform  76  similar to the outer set-up linkages via an additional first set-up linkage joints  84 . Each of the set-up linkage extension links  102  is translatable relative to the associated set-up linkage base link  100  in a horizontal direction, which in many embodiments is aligned with the associated set-up linkage base link and the set-up linkage extension link  102 . Each of the set-up linkage parallelogram linkage portions  104  configured and operable to selectively translate the set-up linkage vertical link  106  in a vertical direction while keeping the set-up linkage vertical link  106  vertically oriented. In example embodiments, each of the set-up linkage parallelogram linkage portions  104  includes a first parallelogram joint  112 , a coupling link  114 , and a second parallelogram  116 . The first parallelogram joint  112  rotationally couples the coupling link  114  to the set-up linkage extension link  102 . The second parallelogram joint  116  rotationally couples the set-up linkage vertical link  106  to the coupling link  114 . The first parallelogram joint  112  is rotationally tied to the second parallelogram joint  116  such that rotation of the coupling link  114  relative to the set-up linkage extension link  102  is matched by a counteracting rotation of the set-up linkage vertical link  106  relative to the coupling link  114  so as to maintain the set-up linkage vertical link  106  vertically oriented while the set-up linkage vertical link  106  is selectively translated vertically. The second set-up linkage joint  108  is operable to selectively orient the manipulator support link  110  relative to the set-up linkage vertical link  106 , thereby selectively orienting the associated attached manipulator  82  relative to the set-up linkage vertical link  106 . 
         [0046]      FIG. 7  is a perspective schematic representation of a robotic surgery system  120 , in accordance with many embodiments. Because the surgery system  120  includes components similar to components of the surgery system  70  of  FIG. 6 , the same reference numbers are used for similar components and the corresponding description of the similar components set forth above is applicable to the surgery system  120  and is omitted here to avoid repetition. The surgery system  120  includes the mounting base  72 , a support linkage  122 , an orienting platform  124 , a plurality of set-up linkages  126  (four shown), and a plurality of the surgical instrument manipulators  82 . Each of the manipulators  82  is operable to selectively articulate a surgical instrument mounted to the manipulator  82  and insertable into a patient along an insertion axis. Each of the manipulators  82  is attached to and supported by one of the set-up linkages  126 . Each of the set-up linkages  126  is rotationally coupled to and supported by the orienting platform  124  by the first set-up linkage joint  84 . The orienting platform  124  is rotationally coupled to and supported by the support linkage  122 . And the support linkage  122  is fixedly attached to and supported by the mounting base  72 . 
         [0047]    The support linkage  122  is operable to selectively position and/or orient the orienting platform  124  relative to the mounting base  72 . The support linkage  122  includes the column base  86 , the translatable column member  88 , the shoulder joint  90 , the boom base member  92 , the boom first stage member  94 , and the wrist joint  98 . The support linkage  122  is operable to selectively set the distance between the shoulder joint  90  and the distal end of the boom first stage member  94 . The wrist joint  98  rotationally couples the distal end of the boom first stage member  94  to the orienting platform  124 . The wrist joint  98  is operable to selectively set the angular orientation of the orienting platform  124  relative to the mounting base  72 . 
         [0048]    Each of the set-up linkages  126  is operable to selectively position and/or orient the associated manipulator  82  relative to the orienting platform  124 . Each of the set-up linkages  126  includes the set-up linkage base link  100 , the set-up linkage extension link  102 , the set-up linkage vertical link  106 , the second set-up linkage joint  108 , a tornado mechanism support link  128 , and a tornado mechanism  130 . Each of the set-up linkage base links  100  of the set-up linkages  126  can be selectively oriented relative to the orienting platform  124  via the operation of the associated first set-up linkage joint  84 . Each of the set-up linkage vertical links  106  is selectively translatable in a vertical direction relative to the associated set-up linkage extension link  102 . The second set-up linkage joint  108  is operable to selectively orient the tornado mechanism support link  128  relative to the set-up linkage vertical link  106   
         [0049]    Each of the tornado mechanisms  130  includes a tornado joint  132 , a coupling link  134 , and a manipulator support  136 . The coupling link  134  fixedly couples the manipulator support  136  to the tornado joint  132 . The tornado joint  130  is operable to rotate the manipulator support  136  relative to the tornado mechanism support link  128  around a tornado axis  136 . The tornado mechanism  128  is configured to position and orient the manipulator support  134  such that the remote center of manipulation (RC) of the manipulator  82  is intersected by the tornado axis  136 . Accordingly, operation of the tornado joint  132  can be used to reorient the associated manipulator  82  relative to the patient without moving the associated remote center of manipulation (RC) relative to the patient. 
         [0050]      FIG. 8  is a simplified representation of a robotic surgery system  140 , in accordance with many embodiments, in conformance with the schematic representation of the robotic surgery system  120  of  FIG. 7 . Because the surgery system  140  conforms to the robotic surgery system  120  of  FIG. 7 , the same reference numbers are used for analogous components and the corresponding description of the analogous components set forth above is applicable to the surgery system  140  and is omitted here to avoid repetition. 
         [0051]    The support linkage  122  is configured to selectively position and orient the orienting platform  124  relative to the mounting base  72  via relative movement between links of the support linkage  122  along multiple set-up structure axes. The translatable column member  88  is selectively repositionable relative to the column base  86  along a first set-up structure (SUS) axis  142 , which is vertically oriented in many embodiments. The shoulder joint  90  is operable to selectively orient the boom base member  92  relative to the translatable column member  88  around a second SUS axis  144 , which is vertically oriented in many embodiments. The boom first stage member  94  is selectively repositionable relative to the boom base member  92  along a third SUS axis  146 , which is horizontally oriented in many embodiments. The wrist joint  98  is operable to selectively orient the orienting platform  124  relative to the boom first stage member  94  around a fourth SUS axis  148 , which is vertically oriented in many embodiments. 
         [0052]    Each of the set-up linkages  126  is configured to selectively position and orient the associated manipulator  82  relative to the orienting platform  124  via relative movement between links of the set-up linkage  126  along multiple set-up joint (SUJ) axes. Each of the first set-up linkage joint  84  is operable to selectively orient the associated set-up linkage base link  100  relative to the orienting platform  124  around a first SUJ axis  150 , which in many embodiments is vertically oriented. Each of the set-up linkage extension links  102  can be selectively repositioned relative to the associated set-up linkage base link  10  along a second SUJ axis  152 , which is horizontally oriented in many embodiments. Each of the set-up linkage vertical links  106  can be selectively repositioned relative to the associated set-up linkage extension link  102  along a third SUJ axis  154 , which is vertically oriented in many embodiments. Each of the second set-up linkage joints  108  is operable to selectively orient the tornado mechanism support link  128  relative to the set-up linkage vertical link  106  around the third SUJ axis  154 . Each of the tornado joints  132  is operable to rotate the associated manipulator  82  around the associated tornado axis  138 . 
         [0053]      FIG. 9  illustrates rotational orientation limits of the set-up linkages  126  relative to the orienting platform  124 , in accordance with many embodiments. Each of the set-up linkages  126  is shown in a clockwise limit orientation relative to the orienting platform  124 . A corresponding counter-clockwise limit orientation is represented by a mirror image of  FIG. 9  relative to a vertically-oriented mirror plane. As illustrated, each of the two inner set-up linkages  126  can be oriented from 5 degrees from a vertical reference  156  in one direction to 75 degrees from the vertical reference  156  in the opposite direction. And as illustrated, each of the two outer set-up linkages can be oriented from 15 degrees to 95 degrees from the vertical reference  156  in a corresponding direction. 
         [0054]    In use, it will often be desirable for a surgical assistant, surgeon, technical support, or other user to configure some or all of the linkages of robotic surgical system  140  ( FIG. 8 ) for surgery, including the set-up structure linkage, the set-up joints, and/or each of the manipulators. Included among the task in configuring these linkages will be positioning the orienting platform  124  relative to first stage member  94  about vertical fourth SUS axis  148  of wrist joint  98 . A joint drive motor and/or brake system is coupled to wrist joint  98 , with one exemplary embodiment including both a drive and brake. Additionally, a joint sensor system will typically sense an angular configuration or position of wrist joint  98 . 
         [0055]    An exemplary user interface, system, and method for manually configuring the system for use will be described herein with reference to manual articulation of orienting platform  124  by articulation of wrist joint  98  about fourth SUS axis  148 . It should be understood that alternative embodiments may be employed to articulate one or more alternative joints of the overall kinematic system, including one or more alternative joints of the set-up structure, one or more of the set-up joints, or one or more of the joints of the manipulators linkages. Use of the exemplary embodiment for articulating the motorized wrist joint embodiments may allow a user to efficiently position manipulators  82 . The manual articulation of wrist joint  98  as described herein can improve speed and ease of use while manually docking manipulators  82  to their associated cannulas  64 , as shown in  FIG. 5B . 
         [0056]      FIG. 10  shows a center of gravity diagram associated with a rotational limit of a support linkage for a robotic surgery system  160 , in accordance with many embodiments. With components of the robotic surgery system  160  positioned and oriented to shift the center-of-gravity  162  of the robotic surgery system  160  to a maximum extent to one side relative to a support linkage  164  of the surgery system  160 , a shoulder joint of the support linkage  164  can be configured to limit rotation of the support structure  164  around a set-up structure (SUS) shoulder-joint axis  166  to prevent exceeding a predetermined stability limit of the mounting base. 
         [0057]    The robotic system may include a configuration mode which allows a user to manually configure the orienting platform in a desired orientation about fourth SUS axis  148 . In some embodiments, the robotic system may enter the configuration mode when the user actuates one of a plurality of inputs positioned on associated set-up joint linkages. For example,  FIG. 11  shows an exemplary teleoperated surgical system  200  which includes a plurality of inputs  202  for entering the configuration mode. The teleoperated surgical system  200  includes a set-up structure  204 . The set-up structure  204  includes a base  205 , a column  206 , and a horizontal boom  207 , and supports an mounting/orienting platform  208 . A plurality of manipulators  210  are supported from the mounting platform  208  via set-up joint linkages  212 . The set-up joint linkages  212  extend from and are supported by the orienting platform  208 . The plurality of inputs  202  may be positioned on each of the set-up joint linkages  212  so that a user may enter the configuration mode by actuating any one of the plurality inputs  202  on each of the set-up joint linkages  212 . In some embodiments, the inputs  202  may be switches. In some embodiments, the switches may be depressible buttons, or the like. In some embodiments, a safety measure may be provided where, when a cannula is mounted to any of the manipulators supported by platform  124 , the system may apply the brake to the wrist joint  98  and exit the configuration mode or prevent entry into the configuration mode so as to inhibit manual movement of the wrist joint. 
         [0058]    While the system is not in the configuration mode, the system processor will typically transmit signals to the joint motor or break associated with wrist joint  98  so as to keep the platform in its initial position so as to reduce inadvertent manual rotation of the platform. Hence, when the system is bumped, pushed, or pulled lightly the wrist motor may prevent movement or urge the platform back toward the initial position by applying a joint torque per an error E that varies with the difference between the sensed joint position (θ) and the initial joint position (θ I ): 
         [0000]    
       
      
       E=θ−θ 
       I  
      
     
         [0000]    The servo control may also be achieved by using a torque that is proportional to the difference between sensed position and initial position. This driving of the joint toward the initial pose may be overcome by user actuation of any one of the plurality of inputs  202  that enter the system  200  into the configuration mode. For example, the system may enter the configuration mode when the user presses and holds one of the inputs  202 . When in the configuration mode, the processor may halt servoing of the wrist joint to counteract articulation of the joint so as to allow a user to manually rotate the platform from its initial position toward a desired position. In some embodiments, it may be advantageous to provide an input on each of the set-up joint linkages between the manipulator and the platform so as to provide a number inputs that are convenient for user actuation. Further, positioning a plurality of inputs on the set-up joint linkages may provide an effective moment arm for rotating the orienting platform to a desired position. 
         [0059]    Although servoing so as to counteract the user movement of the platform is halted when the system is in a configuration mode, drive signals may still be sent to the wrist motor. For example, friction compensation, gravity compensation, momentum compensation, and/or the like may be provided by applying appropriate drive signals during manual movement of the platform. Exemplary compensation drive systems are more fully described in US Patent Publication 2009/0326557 in the name of Neimeyer and entitled “Friction Compensation in a Minimally Invasive Surgical Apparatus,” in US Patent Publication 2011/0009880 in the name of Prisco et al. and entitled “Control System for Reducing Internally Generated Frictional and Inertial Resistance to Manual Positioning of a Surgical Manipulator,” and the like. In some embodiments, the system may employ joint range of motion limits alone or in addition to the drive signals when servoing is halted. Such range of motion limits may respond similar to servoing when a user pushes beyond a range motion limit except they are one sided. 
         [0060]    Once the user has manually articulated the wrist at the desired orientation, the user may halt movement of the platform and release the input  202  to exit the configuration mode. When the system exits the configuration mode, signals may then be resent to the brake or drive system to maintain the orienting platform in the desired orientation and to reduce inadvertent manual rotation of the orienting platform. 
         [0061]    Other variations are within the spirit of the present invention. Thus, while the invention is susceptible to various modifications and alternative constructions, certain illustrated embodiments thereof are shown in the drawings and have been described above in detail. It should be understood, however, that there is no intention to limit the invention to the specific form or forms disclosed, but on the contrary, the intention is to cover all modifications, alternative constructions, and equivalents falling within the spirit and scope of the invention, as defined in the appended claims. 
         [0062]    The use of the terms “a” and “an” and “the” and similar referents in the context of describing the invention (especially in the context of the following claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. The terms “comprising,” “having,” “including,” and “containing” are to be construed as open-ended terms (i.e., meaning “including, but not limited to,”) unless otherwise noted. The term “connected” is to be construed as partly or wholly contained within, attached to, or joined together, even if there is something intervening. Recitation of ranges of values herein are merely intended to serve as a shorthand method of referring individually to each separate value falling within the range, unless otherwise indicated herein, and each separate value is incorporated into the specification as if it were individually recited herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., “such as”) provided herein, is intended merely to better illuminate embodiments of the invention and does not pose a limitation on the scope of the invention unless otherwise claimed. No language in the specification should be construed as indicating any non-claimed element as essential to the practice of the invention. 
         [0063]    Preferred embodiments of this invention are described herein, including the best mode known to the inventors for carrying out the invention. Variations of those preferred embodiments may become apparent to those of ordinary skill in the art upon reading the foregoing description. The inventors expect skilled artisans to employ such variations as appropriate, and the inventors intend for the invention to be practiced otherwise than as specifically described herein. Accordingly, this invention includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above-described elements in all possible variations thereof is encompassed by the invention unless otherwise indicated herein or otherwise clearly contradicted by context. 
         [0064]    All references, including publications, patent applications, and patents, cited herein are hereby incorporated by reference to the same extent as if each reference were individually and specifically indicated to be incorporated by reference and were set forth in its entirety herein.