Patent Publication Number: US-2021186303-A1

Title: Endoscope control system

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     The present application is a divisional of U.S. patent application Ser. No. 14/909,976, filed on Feb. 3, 2016, which is a U.S. National Stage patent application of International Patent Application No. PCT/US2014/050217, filed on Aug. 7, 2014, which claims the benefit of U.S. Provisional Patent Application No. 61/865,996, filed on Aug. 14, 2013, the disclosures of each of which are incorporated herein by reference in their entirety. 
    
    
     TECHNICAL FIELD 
     Embodiments of the present invention are related to instrument control, and in particular to control of instruments used in minimally invasive robotic surgery. 
     DISCUSSION OF RELATED ART 
     Surgical procedures can be performed through a surgical robot in a minimally invasive manner. The benefits of a minimally invasive surgery are well known and include less patient trauma, less blood loss, and faster recovery times when compared to traditional, open incision surgery. In addition, the use of robot surgical systems (e.g., teleoperated robotic systems that provide telepresence), such as the da Vinci™ Surgical System manufacture by Intuitive Surgical, Inc. of Sunnyvale, Calif., is known. Such robotic surgical systems may allow a surgeon to operate with intuitive control and increased precision when compared to manual minimally invasive surgeries. 
     In a minimally invasive surgical system, surgery is performed by a surgeon controlling the robot. The robot includes one or more instruments that are coupled to robot arms. The instruments access the surgical area through small incisions through the skin of the patient. A cannula is inserted into the incision and a shaft of the instrument can be inserted through the cannula to access the surgical area. An endoscope can be used to view the surgical area. In many cases, the surgeon can control one instrument at a time. If the surgeon wants to change the view of the endoscope, control is shifted from the current surgical instrument to the endoscope, the surgeon manipulates the endoscope, and control is shifted back to the surgical instrument. 
     Therefore, there is a need to develop better surgical systems for robotic minimum invasive surgeries. 
     SUMMARY 
     In accordance with aspects of the present invention, movement of an image of the surgery can be controlled by motion of the surgeon&#39;s head or face at the surgeon&#39;s console. In some embodiments, for example, a surgeon&#39;s console includes an image display system that displays an image of a surgical area; and at least one sensor mounted in the surgeon&#39;s console to provide a signal related to a movement of the surgeon&#39;s face, the image being moved according to the signal. 
     In some embodiments, a headrest for a surgical console includes a forehead rest surface; a headrest mount that can attach to the surgical console; and one or more sensors in the headrest that detect inputs from a surgeon&#39;s head and provides signals to an endoscope control. 
     In some embodiments, an endoscope control system includes endoscope controls that receive signals that indicate movement of a surgeon&#39;s head and provide an indication of movement of an image received by an endoscope; endoscope manipulation configured to receive the indication of movement of an image and generate signals to affect movement of the endoscope to control the movement of the image; and actuators that can be coupled to the endoscope, the actuators receive the signals to affect movement and control the endoscope to provide the movement. 
     These and other embodiments are further discussed below with respect to the following figures. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIGS. 1A, 1B, and 1C  illustrate components of an example teleoperated robotic surgical system. 
         FIG. 2  illustrates cannulas as utilized by the system of  FIGS. 1A, 1B, and 1C . 
         FIG. 3  illustrates an endoscope that can be utilized with some embodiments of the present invention. 
         FIG. 4A  illustrates an imaging and control system according to some embodiments of the present invention. 
         FIG. 4B  illustrate a process that can be executed to control an endoscope according to the present invention. 
         FIGS. 5A, 5B, 5C, 5D, and 5E  illustrates a headrest. 
         FIGS. 6A, 6B, 6C, 6D, and 6E  illustrate an embodiment of the headrest according to the present invention. 
         FIG. 7  illustrates another embodiment of the headrest according to the present invention. 
         FIG. 8  illustrates another embodiment of the headrest according to the present invention. 
         FIG. 9  illustrates another embodiment of the headrest according to the present invention. 
         FIG. 10  illustrates another embodiment of the headrest according to the present invention. 
         FIG. 11  illustrates an embodiment of the invention. 
         FIG. 12  illustrates another embodiment of the invention. 
     
    
    
     DETAILED DESCRIPTION 
     In the following description, specific details are set forth describing some embodiments of the present invention. It will be apparent, however, to one skilled in the art that some embodiments may be practiced without some or all of these specific details. The specific embodiments disclosed herein are meant to be illustrative but not limiting. One skilled in the art may realize other elements that, although not specifically described here, are within the scope and the spirit of this disclosure. 
     This description and the accompanying drawings that illustrate inventive aspects and embodiments should not be taken as limiting—the claims define the protected invention. Various mechanical, compositional, structural, and operational changes may be made without departing from the spirit and scope of this description and the claims. In some instances, well-known structures and techniques have not been shown or described in detail in order not to obscure the invention. 
     Additionally, the drawings are not to scale. Relative sizes of components are for illustrative purposes only and do not reflect the actual sizes that may occur in any actual embodiment of the invention. Like numbers in two or more figures represent the same or similar elements. 
     Further, this description&#39;s terminology is not intended to limit the invention. For example, spatially relative terms—such as “beneath”, “below”, “lower”, “above”, “upper”, “proximal”, “distal”, and the like—may be used to describe one element&#39;s or feature&#39;s relationship to another element or feature as illustrated in the figures. These spatially relative terms are intended to encompass different positions (i.e., locations) and orientations (i.e., rotational placements) of a device in use or operation in addition to the position and orientation shown in the figures. For example, if a device in the figures is turned over, elements described as “below” or “beneath” other elements or features would then be “above” or “over” the other elements or features. Thus, the exemplary term “below” can encompass both positions and orientations of above and below. A device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly. Likewise, descriptions of movement along and around various axes includes various special device positions and orientations. In addition, the singular forms “a”, “an”, and “the” are intended to include the plural forms as well, unless the context indicates otherwise. And, the terms “comprises”, “comprising”, “includes”, and the like specify the presence of stated features, steps, operations, elements, and/or components but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups. Components described as coupled may be electrically or mechanically directly coupled, or they may be indirectly coupled via one or more intermediate components. 
     Elements and their associated aspects that are described in detail with reference to one embodiment may, whenever practical, be included in other embodiments in which they are not specifically shown or described. For example, if an element is described in detail with reference to one embodiment and is not described with reference to a second embodiment, the element may nevertheless be claimed as included in the second embodiment. 
     Aspects of embodiments of the invention are described within the context of a particular implementation of a robotic surgical system. Knowledgeable persons will understand, however, that inventive aspects disclosed herein may be embodied and implemented in various ways, including robotic and non-robotic embodiments and implementations. The implementations disclosed here are merely exemplary and are not to be considered as limiting the scope of the inventive aspects disclosed herein. 
       FIGS. 1A, 1B, and 1C  are front elevation views of three main components of a teleoperated robotic surgical system for minimally invasive surgery. These three components are interconnected so as to allow a surgeon, with the assistance of a surgical team, to perform diagnostic and corrective surgical procedures on a patient. 
       FIG. 1A  is a front elevation view of the patient side cart component  100  of, for example, the da Vinci™ Surgical System. The patient side cart includes a base  102  that rests on the floor, a support tower  104  that is mounted on the base  102 , and several arms that support surgical tools. As shown in  FIG. 1A , arms  106   a ,  106   b , and  106   c  are instrument arms that support and move the surgical instruments used to manipulate tissue. Arm  108 , for example, can be a camera arm that supports and moves an endoscope instrument  112 . Instrument arm  106   c  can be an optional third instrument arm that is supported on the back side of support tower  104  and that can be positioned to either the left or right side of the patient side cart as necessary to conduct a surgical procedure.  FIG. 1A  further shows interchangeable surgical instruments  110   a ,  110   b ,  110   c  mounted on the instrument arms  106   a , 106   b , 106   c , and it shows endoscope  112  mounted on the camera arm  108 . Knowledgeable persons will appreciate that the arms that support the instruments and the camera may also be supported by a base platform (fixed or moveable) mounted to a ceiling or wall, or in some instances to another piece of equipment in the operating room (e.g., the operating table). Likewise, they will appreciate that two or more separate bases may be used (e.g., one base supporting each arm). 
     As is further illustrated in  FIG. 1A , instruments  110   a ,  110   b ,  110   c , and endoscope  112  include an instrument interface  150   a ,  150   b ,  150   c , and  150   d , respectively, and an instrument shaft  152   a ,  152   b ,  152   c , and  152   d , respectively. In some embodiments, component  100  can include supports for cannulas that fix instruments  110   a ,  110   b ,  110   c , and endoscope  112  with respect to the cannulas. 
     Further, portions of each of the instrument arms  106   a ,  106   b ,  106   c , and  108  are adjustable by personnel in the operating room in order to position instruments  110   a ,  110   b ,  110   c , and endoscope  112  with respect to a patient. Other portions of arms  106   a ,  106   b ,  106   c , and  108  are actuated and controlled by the surgeon at a surgeon&#39;s console  120 . Surgical instruments  110   a ,  110   b ,  110   c , and endoscope  112 , can also be controlled by the surgeon at surgeon&#39;s console  120 . 
       FIG. 1B  is a front elevation view of a surgeon&#39;s console  120  component of an example surgical system. The surgeon&#39;s console  120  is equipped with left and right multiple degree-of-freedom (DOF) master tool manipulators (MTM&#39;s)  122   a ,  122   b , which are kinematic chains that are used to control the surgical tools. The surgeon grasps a pincher assembly  124   a ,  124   b  on each MTM  122 , typically with the thumb and forefinger, and can move the pincher assembly to various positions and orientations. When a tool control mode is selected, each MTM  122  is coupled to control a corresponding instrument and instrument arm  106  for the patient side cart  100 . For example, left MTM  122   a  may be coupled to control instrument arm  106   b  and instrument  110   a , and right MTM  122   b  may be coupled to control instrument arm  106   b  and instrument  110   b . If the third instrument arm  106   c  is used during a surgical procedure and is positioned on the left side, then left MTM  122   a  can be switched between controlling arm  106   a  and instrument  110   a  to controlling arm  106   c  and instrument  110   c . Likewise, if the third instrument arm  106   c  is used during a surgical procedure and is positioned on the right side, then right MTM  122   a  can be switched between controlling arm  106   b  and instrument  110   b  to controlling arm  106   c  and instrument  110   c . In some instances, control assignments between MTM&#39;s  122   a ,  122   b  and arm  106   a /instrument  110   a  combination and arm  106   b /instrument  110   b  combination may also be exchanged. This may be done, for example, if the endoscope is rolled 180 degrees, so that the instrument moving in the endoscope&#39;s field of view appears to be on the same side as the MTM the surgeon is moving. The pincher assembly is typically used to operate a jawed surgical end effector (e.g., scissors, grasping retractor, needle driver, and the like) at the distal end of an instrument  110 . 
     Additional controls are provided with foot pedals  128 . Each of foot pedals  128  can activate certain functionality on the selected one of instruments  110 . For example, foot pedals  128  can activate a drill or a cautery tool or may operate irrigation, suction, or other functions. Multiple instruments can be activated by depressing multiple ones of pedals  128 . Certain functionality of instruments  110  may be activated by other controls. 
     Surgeon&#39;s console  120  also includes a stereoscopic image display  126 . Left side and right side images captured by the stereoscopic endoscope  112  are output on corresponding left and right displays, which the surgeon perceives as a three-dimensional image on display system  126 . In an advantageous configuration, the MTMs  122  are positioned below display system  126  so that the images of the surgical tools shown in the display appear to be co-located with the surgeon&#39;s hands below the display. This feature allows the surgeon to intuitively control the various surgical tools in the three-dimensional display as if watching the hands directly. Accordingly, the MTM servo control of the associated instrument arm and instrument is based on the endoscopic image reference frame. 
     The endoscopic image reference frame is also used if the MTM&#39;s  122  are switched to a camera control mode. In some cases, if the camera control mode is selected, the surgeon may move the distal end of the endoscope  112  by moving one or both of the MTM&#39;s  122  together (portions of the two MTM&#39;s  122  may be servomechanically coupled so that the two MTM portions appear to move together as a unit). The surgeon may then intuitively move (e.g., pan, tilt, zoom) the displayed stereoscopic image by moving the MTM&#39;s  122  as if holding the image in the hands. 
     As is further shown in  FIG. 1B , a headrest  130  is positioned above display system  126 . As the surgeon is looking through display system  126 , the surgeon&#39;s forehead is positioned against headrest  130 . In some embodiments of the present invention, manipulation of endoscope  112  or other instruments can be achieved through manipulation of headrest  130  instead of utilization of MTM&#39;s  122 . In some embodiments, headrest  130  can, for example, include pressure sensors, a rocker plate, optically monitored slip plate, or other sensors that can detect movement of the surgeon&#39;s head. As such, headrest  130  includes a device that monitors and tracks motion of the surgeon&#39;s head. In each of these cases, the data indicating the motion of the surgeon&#39;s head can be used to manipulate endoscope  112  in order to change the image displayed on display system  126 . 
     The surgeon&#39;s console  120  is typically located in the same operating room as the patient side cart  100 , although it is positioned so that the surgeon operating the console is outside the sterile field. One or more assistants typically assist the surgeon by working within the sterile surgical field (e.g., to change tools on patient side cart  100 , to perform manual retraction, etc.). Accordingly, the surgeon operates remote from the sterile field, and so the console may be located in a separate room or building from the operating room. In some implementations, two consoles  120  (either co-located or remote from one another) may be networked together so that two surgeons can simultaneously view and control tools at the surgical site. 
       FIG. 1C  is a front elevation view of a vision cart component  140  of a surgical system. The vision cart  140  can, for example, house the surgical system&#39;s central electronic data processing unit  142  and vision equipment  144 . The central electronic data processing unit includes much of the data processing used to operate the surgical system. In various other implementations, however, the electronic data processing may be distributed in the surgeon console  120  and patient side cart  100 . The vision equipment includes camera control units for the left and right image capture functions of the stereoscopic endoscope  112 . The vision equipment also includes illumination equipment (e.g., Xenon lamp) that provides illumination for imaging the surgical site. As shown in  FIG. 1C , the vision cart includes an optional touch screen monitor  146  (for example a 24-inch monitor), which may be mounted elsewhere, such as on the patient side cart  100 . The vision cart  140  further includes space  148  for optional auxiliary surgical equipment, such as electrosurgical units, insufflators, suction irrigation instruments, or third-party cautery equipment. The patient side cart  100  and the surgeon&#39;s console  120  are coupled, for example via optical fiber communications links, to the vision cart  140  so that the three components together act as a single teleoperated minimally invasive surgical system that provides an intuitive telepresence for the surgeon. And, as mentioned above, a second surgeon&#39;s console may be included so that a second surgeon can, e.g., proctor the first surgeon&#39;s work. 
     During a typical surgical procedure with the robotic surgical system described with reference to  FIGS. 1A-1C , at least two incisions are made into the patient&#39;s body (usually with the use of a trocar to place the associated cannula). One incision is for the endoscope camera instrument, and the other incisions are for the surgical instruments. In some surgical procedures, several instrument and/or camera ports are utilized to provide access and imaging for a surgical site. Although the incisions are relatively small in comparison to larger incisions used for traditional open surgery, a minimum number of incisions is desired to further reduce patient trauma and for improved cosmesis. 
       FIG. 2  illustrates utilization of the surgical instruments illustrated in  FIGS. 1A, 1B , and  1 C. As shown in  FIG. 2 , shafts  152   a ,  152   b , and  152   d  pass through cannulas  202   a ,  202   b , and  202   d , respectively. Cannulas  202   a ,  202   b , and  202   d  extend through instrument incisions  204   a ,  204   b , and  204   d , respectively. As is shown in  FIG. 2 , shafts  152   a ,  152   b , and  152   d  extend through cannulas  202   a ,  202   b , and  202   d , respectively. End effectors  206   a ,  206   b , and  206   d  are attached to shafts  152   a ,  152   b , and  152   d , respectively. As discussed above, end effectors  206   a , and  206   b  can be jawed surgical end effectors (e.g., scissors, grasping retractor, needle driver, and the like). Further, end effector  206   c  is illustrated as an endoscope tip. As shown in  FIG. 2 , cannulas  202   a ,  202   b , and  202   d  and shafts  152   a ,  152   b , and  152   d  are positioned so that end effectors  206   a ,  206   b , and  206   d  operate in a surgical area  210 . 
     As shown in  FIG. 2  cannulas  202   a ,  202   b , and  202   d  include mounting fittings  208   a ,  208   b , and  208   d , respectively, that can be engaged by arms  106   a ,  106   b , and endoscope arm  108 , respectively, to allow for very little movement of the instrument end effectors  206   a ,  206   b , and  206   d , respectively, as possible. Cannulas  202   a ,  202   b , and  202   d  further include cannula seal mounts  212   a ,  212   b , and  212   d , respectively. 
     During surgery, particularly if the surgery is abdominal surgery, pressurized CO 2  can be utilized to expand the abdomen, allowing for better access to surgical area  210 . Cannula seals attached to cannula seal mounts  212   a ,  212   b , and  212   d  prevent leakage of fluids or other materials from the patient. 
     During the operation, the surgeon sitting at surgeon&#39;s console  120  can manipulate end effectors  206   a ,  206   b , and  206   d  as well as move shafts  152   a ,  152   b , and  152   d  along their lengths. In the particular arrangement illustrated in  FIG. 2 , instrument  206   d  is illustrated as an endoscope, instrument  206   a  can be, for example, a cautery tool, and instrument  206   b  can be, for example, a suction irrigator tool. While the surgeon needs to control instruments  206   a  and  206   d  with the MTMs  122 , it is difficult to further control the endoscopic camera of instrument  112 . Therefore, some embodiments of the present invention provide another control mechanism in order to allow the surgeon to use sensors on a headrest to control endoscopic camera instrument  112  while continuing to manipulate MTMs  122  to control surgical instruments  206   a  and  206   b.    
     According to some embodiments of the invention, a sensing method allows for the surgeon to manipulate the headrest in order to control, for example, the endoscopic camera while separately using MTMs  122  to control the surgical instruments. Some embodiments of the present invention can eliminate the need to switch modes from instrument control to camera control, and then back again, when it is necessary to reposition the camera. In some embodiments, positioning the camera or control of the camera zoom level can be accomplished while the surgical instruments are actively being controlled by the surgeon. 
     As shown in  FIG. 2 , endoscope  112  includes shaft  152   d  that passes through cannula  202   d . End effector  206   d  at the distal end of shaft  152   d  can include optics and mechanics to illuminate surgical area  210  and capture an image, in some cases a stereo image, of surgical area  210 . Although  FIGS. 1A, 1B, 1C and 2  illustrate, for example, a multi-port robotic surgical system, embodiments of the present invention can also be used in a single-port robotic surgical system. In general, embodiments of the present invention can be used with any robotic surgical system where the surgeon is controlling instruments from a remote panel. 
       FIG. 3  illustrates endoscope  112  in further detail. As shown in  FIG. 3 , endoscope  112  includes end effector  206   d  at the distal end, which includes optics for lighting surgical area  210  and for capturing an image, for example a stereo image, from surgical area  210 . End effector  206   d  can be coupled to a wrist  312  that is connected to shaft  310 . Wrist  312  allows for movement of end effector  206   d  in two degrees of freedom and may be controlled with cables or rods  310  that pass through shaft  310 . In some embodiments, some axial movement of end effector  206   d  can also be controlled by cables or rods  310 . Optical fiber (not shown) may also pass through shaft  152   d  and be coupled to the optics in end effector  206   d  to both provide light and to transmit the image. 
     Shaft  152   d  is connected to instrument interface  150   d . Instrument interface  150   d , as shown in  FIG. 1A , can be coupled to arm  108  of patient side cart  100 . In some embodiments, interface  150   d  couples actuation motors in arm  108  with cables and rods  310  in shaft  152   d . Instrument interface  150   d  includes, then, mechanisms that can be driven by an actuation motor that affect wrist  312  and end effector  206   d . Arm  108  can be actuated to provide movement of endoscope  112  along the axis of shaft  152   d.    
     In practice, the optics in end effector  206   d  can include an ability to zoom the image into or out of surgical area  210 . Further, instrument interface  150   d  or instrument arm  106   d  has the ability to move endoscope  112  laterally along the axis of shaft  152   d , thereby providing a zoom function. Whether a zoom feature in end effector  206   d  or movement of shaft  152   d  is used to zoom on an image can be controlled by software operating in the surgical system. End effector  206   d  can also be moved within a spherical surface by manipulating wrist  312 . Movement of end effector  206   d  with wrist  312  can be used to provide different images of surgical area  210 . 
       FIG. 4A  illustrates the control system for an embodiment of endoscope  112  such as that shown in  FIG. 3 . As shown in  FIG. 4A , endoscope controls  402  provide control signals to endoscope manipulation calculation  404 . Endoscope controls  402  can be controls according to some embodiments of the present invention, as described below, or may be input signals from MTMs  122  as described above. 
     Endoscope controls  402  may include processing capability to receive signals from one or more sensors and determine from those signals what the surgeon intends for the change in the image. For example, endoscope controls  402  can determine whether the surgeon requests a zoom function or whether the surgeon requests that the image be panned and in which direction the image should be panned. As such, endoscope controls  402  may include one or more processors coupled with memory (volatile, nonvolatile, or a combination) to hold data and programming instructions. The programming instructions may include instructions to translate signals received from the one or more sensors into signals that represent the requested action of the image produced by endoscope  112 . 
     Endoscope manipulation calculation  404  provides signals to actuators  406 . Actuators  406  are mechanically coupled to instrument interface  150   d  on endoscope  112 . Therefore, endoscope manipulation calculation  404  translates the signals received from endoscope controls  402  into actions performed by actuators  406  that result in the corresponding motion of end effector  206   d  of endoscope  112 . As discussed above, the motion of end effector  206   d  can be axial in end effector  206   d  (zooming end effector  206   d  using internal optics or by movement of end effector  206   d  along its axis), can be lateral by movement of wrist  312  which results in movement of the tip of end effector  206   d  along a substantially spherical surface, or can result in axial motion of endoscope  112  along the axis of shaft  152   d . Zoom and image adjustments can be performed by combinations of various motions that are communicated through instrument interface  150   d.    
     Endoscope manipulation calculation  404  can include a processor executing instructions that calculate the motions that actuators  406  perform in order to result in the motion according to the surgeon input at endoscope controls  402 . As discussed above with respect to endoscope controls  402 , endoscope manipulation calculation  404  can include one or more processors coupled to memories (volatile, nonvolatile, or a combination) that hold data and programming. In some embodiments, endoscope controls  402  and endoscope manipulation calculation  404  can be performed by the same processors executing the appropriate program instructions. 
     In some cases, endoscope controls  402  can include MTMs  122 . In accordance with some embodiments of the present invention, endoscope controls  402  can include sensors in headrest  130  and can be controlled by the surgeon&#39;s motion of his head on headrest  130 . Endoscope controls  402  included in headrest  130  are discussed in further detail below. In some embodiments, endoscope controls  402  can include sensors positioned on surgeon&#39;s console  120  that track the motion of the surgeon&#39;s head. 
     Endoscope manipulation calculation  404  provides signals to operate actuators  406 . Actuators  406  are generally rotary motors housed in patient side cart  100  arm  108 , on which endoscope  112  is attached, and drive interface  150   d  and arm  108 . As discussed above, instrument interface  150   d  translates the mechanical inputs of actuators  406  into movement of wrist  312  and end effector  206   d.    
     Endoscope controls  402  can also control the light output of illumination  410 . Illumination  410  provides light through optical fiber in endoscope  112  in order to illuminate surgical area  210  ( FIG. 2 ). An image of surgical area  210  is captured by end effector  206   d  and transported by optical fiber to image capture and processing  408 . Image capture and processing  408  digitizes the image captured by end effector  206   d  and provides that image to display  126  on surgeon&#39;s console  120  (Figure B). 
     As illustrated in  FIG. 4A , the surgeon controls the positioning of end effector  206   d  through endoscope controls  402 . Endoscope controls  402  can include MTMs  122  in an endoscope manipulation mode. In accordance with some embodiments of the present invention, endoscope controls  402  can include input from sensors embedded in headrest  130  or other sensors positioned on surgical console  120 . 
       FIG. 4B  illustrates a procedure  450  according to some embodiments that can be performed between endoscope controls  402  and endoscope manipulation  404 . As shown in  FIG. 4B , in step  452  endoscope controls  402  receives signals from one or more sensors mounted on surgeon&#39;s console  120 . In some embodiments, the sensors are integrated with headrest  130 . In some embodiments, the sensors are integrated with surgeon&#39;s console  120 . The sensors detect a surgeon&#39;s input respecting control of endoscope  112 . For example, the sensors can provide signals related to the surgeon&#39;s head movement or eye movement. 
     In step  454 , the action requested by the surgeon is determined by endoscope controls  402  based on the signals from the one or more sensors. Such actions can include panning the image generated by endoscope  112  or zooming in or out of the image generated by endoscope  112 . For example, a detected rotation of the surgeon&#39;s face to the right may be interpreted as a request to pan the image to the right while a movement of the surgeon&#39;s face into console  120  may be interpreted as a request to zoom into the image. 
     In step  456 , the action requested by the surgeon determined in step  454  is translated to input actuation signals for actuators  406  that drive endoscope  112  and robot arm  108  to perform the requested action. For example, a zoom request may result in signals that drive robot arm  108  or to zoom with the optics in end effector  206   d . A pan request results in activation of wrist  312  in the appropriate direction through interface  150   d . In step  458 , the actuation signals are applied to actuators  406  to perform the requested action. 
       FIGS. 5A through 5E  illustrate an example of a headrest  130  that can be attached to the surgeon console  120 . The example of headrest  130  shown in  FIGS. 5A through 5E  are presented for illustration only and are not meant to be limiting. One skilled in the art will recognize that a headrest can take a variety of shapes, any of which can be used according to some embodiments of the present invention. 
     In some cases, headrest  130  can be molded out of foam and covered with, for example a vinyl covering, for both decoration and functionality.  FIG. 5A  illustrates a generally frontal view of headrest  130 . As shown in  FIG. 5A , a forehead rest  502  is formed against which a surgeon&#39;s forehead can rest while viewing an image of surgical area  210  through display  126 . In some cases, speaker grills  506  can be formed in an upper portion  504  above forehead rest  502  to allow sound from speakers mounted behind speaker grills  506  to reach the surgeon. A curved front  510  can be formed below forehead rest  502 . A mounting portion  508  can be formed integral with upper portion  504  and forehead rest  502 .  FIG. 5B  illustrate a view of headrest  130  that further shows speaker grills  506  and forehead rest  502 . 
       FIG. 5C  illustrates a side view of an example headrest  130 . As shown in  FIG. 5C , mounting portion  508  can be shaped to facilitate mounting on surgeon&#39;s console  120 . In the example illustrated in  FIG. 5C , mounting portion  508  includes side surface  516 , back surface  518 , upper back surface  528 , and bottom surfaces  514  and  512  that serve to position and support headrest  130  against surgeon&#39;s console  120 . 
       FIGS. 5D and 5E  provide further views of headrest  130 .  FIG. 5D  shows generally a frontal view with a showing of rounded surface  512  and bottom surface  514 . As shown in  FIG. 5D , two angled surfaces  520  can be formed adjacent to bottom surface  514 .  FIG. 5E  illustrates a more detailed bottom view of headrest  130 , where surface  512  is adjacent angle surfaces  522 . 
     The shape of mounting portion  508  is dependent on the mounting of headrest  130  onto surgeon&#39;s console  120 . As such, the shape of mounting portion  508  can be as varied as the number of mounting configurations that can be used for attaching headrest  130  onto surgeon&#39;s console  120 . 
     In accordance with some embodiments of the present invention, sensors are embedded within or on headrest  130  to allow the surgeon to provide input signals for endoscope controls  420  by motion of the surgeon&#39;s head. In some embodiments, for example, a pressure sensor array can be embedded in headrest  130 . The pressure sensor array can sense pressure that the surgeon applies to areas of the front surface of forehead rest  502 . The pressure data from the pressure sensor array can then be converted into endoscope control data. In some embodiments, a rocker plate can be inserted into headrest  130 . The rocker plate can operate, for example, similarly to a joystick so that endoscope control data can be obtained by the motion of the surgeon&#39;s head against the front surface of forehead rest  502 . In some embodiments, an optical arrangement can be provided to read the movement of a slip plate mounted on headrest  130 . The motion of the slip plate is controlled by the surgeon&#39;s head motion and can be converted to control data. 
     In some further embodiments, a face tracker system can be mounted on headrest  130  or directly on surgeon&#39;s console  120 . The face tracker can be used to track the motion of the surgeon&#39;s face and convert that motion to endoscope control data. In some embodiments, an iris tracker system can be included in display  126  that can be used to track the motion of the surgeon&#39;s eyes. Depending on the type of viewer in display  126 , the iris tracker sensors can be included in the optics or, if the viewer is a video screen, can be mounted on headrest  130  or on surgeon&#39;s console  120  so as to track the motion of the surgeon&#39;s eyes and convert that motion to endoscope control data. 
     Some embodiments of the current invention include endoscope controls  402  attached to or within headrest  130 . Endoscope controls  402  include sensing techniques that can control some or all of the position and zoom level (optically or digitally) of an endoscope  112  in a surgical robotic system. In some embodiments, the sensing techniques can capture a sensor signature in two-dimensions to determine the direction of camera movement, and in a third dimension to control the zoom (in/out motion) of the endoscope camera. As such, embodiments of the present invention provide an alternative mode for the surgeon to enter where the endoscope camera is actively controlled simultaneously with the surgical instruments. Many of these systems are further discussed below. In some, a sensor input device is mounted into or onto headrest  130  in order to track the surgeons head motions. The head motion signals are then converted to endoscope control signals in endoscope controls  402  as shown in  FIG. 4 . 
       FIGS. 6A, 6B, and 6C  illustrate placement of a pressure sensor array  602  in headrest  130 . As shown in  FIG. 6B , pressure sensor array  602  can be inserted into headrest  130  in close proximity to forehead rest  502  such that the surgeon can provide pressure inputs to areas of the surface of forehead rest  502  by moving the surgeon&#39;s forehead.  FIG. 6C , for example, illustrates an example of sensor array  602 . As shown in  FIG. 6C , sensor array  602  can include a two dimensional array of sensors mounted on a planar circuit board or backplane  620 .  FIG. 6C  shows an example with pressure sensors  612 ,  614 ,  616 , and  618 , although pressure sensor array  602  can include any number of pressure sensors mounted on planar backplane  620 . 
     As illustrated in  FIG. 6B , pressure sensor array  602  can be positioned substantially parallel with the surface of forehead rest  502 . In some embodiments, pressure sensor array  602  can be contoured to follow the shape of forehead rest  502 . Further, pressure sensor array  602  can be provided with a support (not shown) that prevents motion relative to surgeon&#39;s console  120 . Such support can, for example, be studs that extend from pressure sensor array to attach to or contact with sturgeon&#39;s console  120 . 
     As shown in  FIG. 6A  the surface of forehead rest  502  is petitioned into areas according to the placement of individual pressure sensors in pressure sensor array  602  located beneath the surface of forehead rest  502 . In the particular example of pressure sensor array  602  with four pressure sensors illustrated in  FIG. 6C , the surface of forehead rest  502  is partitioned into four areas where one pressure sensor is placed beneath each of the areas. As illustrated, for example, area  604  corresponds to pressure sensor  612 , area  606  corresponds to pressure sensor  614 , area  608  corresponds to pressure sensor  616 , and area  610  corresponds to pressure sensor  618 . In other words, pressures sensor  612  senses the pressure applied to area  604 , pressure sensor  614  senses the pressure applied to area  606 , pressure sensor  616  senses the pressure applied to area  608 , and pressures sensor  618  senses the pressure applied to area  610 . Pressure applied to areas  604  through  610  and sensed by pressure sensors  612  through  618 , respectively, can be used to provide signals for endoscope controls  402 . 
     Pressure sensing array  602  is integrated into headrest  130 , which is mounted on surgeon&#39;s console  120 , within the foam under forehead rest  502 , where the surgeon rests his/her forehead. Surgeon&#39;s console can then be electrically coupled to pressure sensing array  602  to record the pressure signature of the surgeon&#39;s forehead against forehead rest  502 . As shown in  FIG. 6A , this signature can be divided into multiple regions (areas  604  through  610  are illustrated in  FIG. 6A ) to determine the direction of camera motion indicated by the surgeon&#39;s motion. 
     For example, to move end effector  206   d  of end effector  112  such that the image viewed at display  126  is moved to the right, the surgeon can, for example, roll their head slightly to the left to create a pressure profile with larger magnitudes in the left hand side of the array. The pressure profile for this example is illustrated in  FIG. 6D . As shown in  FIG. 6D , pressure sensors  612  and  614  measure increased pressure in areas  604  and  606 . In response to the data shown in  FIG. 6D , end effector  112  can be manipulated to move the image to the right. Alternatively, a surgeon&#39;s head roll to the left in some embodiments may result in movement of the image to the left. 
     In some embodiments, the velocity of the image movement can be a constant, which may be set by a surgeon input elsewhere on surgeon&#39;s console  120 . In some embodiments, the velocity of the image movement can vary based on the magnitude of the forces within the signature as shown in  FIG. 6D . In some embodiments, the speed of motion of the image can be audibly indicated to the surgeon. For example, the speed of motion of the image can be indicated with audible clicks whose frequency indicates the speed of motion. In some embodiments, for example, the speed of motion can be indicated by volume or frequency of a tone. 
     In addition to audible feedback, visual feedback and haptic feedback, or other feedback mechanisms can be used to communicate information to the surgeon. Visual feedback, for example, can be provided to the surgeon through display system  126  and may, for example, be a flashing light with frequency indicating the speed of motion or may be color coded so that different colors indicate different speeds. Additionally, haptic feedback may be included in headrest  130 . For example, through haptic feedback in headrest  130  a vibration, the frequency of which indicates the speed, is transmitted to the surgeon. 
     In some embodiments, a pressure profile indicating force perpendicular to the surgeon&#39;s forehead can indicate a request in/out motion of the endoscope  112  (motion along the endoscope shaft  152   d ), or to control the level of zoom. For example, as illustrated in  FIG. 6E  a linear relationship between the magnitude of the force perpendicular to the forehead rest  502  and the zoom level can be established. In that example, when the surgeon is operating in this control mode the surgeon can affect a zoom by pressing their forehead a little harder against the forehead rest  502  to zoom in and let up on the pressure to zoom out. The slope of this relationship, controlling the rate of zoom adjustment, can be a parameter that the user sets via the surgeon console touchpad or vision cart touch panel interface. 
     In some embodiments, surgeon headrest  130  can include detectors, for example proximity detectors, that determine the location of the surgeon&#39;s head from a fixed point. The fixed point can, for example, represent the tip of the endoscope camera (i.e. the tip of end effector  206   d ). Movement in the surgeon&#39;s head can then control endoscope motion, including image location and zoom.  FIG. 7  illustrates an embodiment of headrest  130  that includes one or more sensors  702  embedded under the surface of forehead rest  502  that collectively can determine the position and orientation of the surgeon&#39;s forehead relative to the fixed point. 
     As discussed above, sensors  702  can be coupled to provide signals for analysis in endoscope controls  402 . Endoscope controls  402  then can determine the location and/or the orientation of the surgeon&#39;s forehead. There may be any number of sensors  702 . Sensors  702  can, for example, be proximity sensors that measure the distance to the surgeon&#39;s forehead. For example, a single centered proximity sensor can be used as a zoom control, moving the camera in and out as the surgeon&#39;s forehead moves closer and further from forehead rest  502 . Other sensors can be used to determine side-to-side or up-and-down motions of the surgeon&#39;s forehead. Therefore, as the surgeon&#39;s head moves, the distance from the fixed point defined by the collection of sensors  702  is measured, and used as an input to control the camera. The perpendicular distance from the fixed point could be used to create a relationship between the zoom level and the distance from the fixed point to actively control the zoom. For example, as the surgeon&#39;s head rolls to the left, sensors  702  on the left of forehead rest  502  may measure closer distances and sensors  702  on the right of forehead rest  502  may measure farther distances. This data can be used in endoscope controls  402  to indicate that the surgeon has rolled his head to the left and endoscope  112  can be controlled accordingly. 
       FIG. 8  illustrates an embodiment where headrest  130  is mounted to a controller  800  that can be similar to a joystick. In the example of joystick controller  800  shown in  FIG. 8 , controller  800  can include a first plate  802  that is fixed to headrest  103 , for example opposite forehead rest  502 . First plate  802  can include a ball  806  fixed to first plate  802 . A sensor plate  804  can include a recess to receive ball  806  and sensors that determine the rotational orientation of ball  806  within the recess of sensor plate  804 . In some embodiments, ball  806  can be replaced with a rod that is coupled to a receiver in sensor plate  804 . As is further shown, springs  806  can be inserted between first plate  802  and sensor plate  804  to provide tension that biases headrest  103  toward a neutral position. In some embodiments, sensor plate  804  can detect additional pressure along a normal direction to sensor plate  804 . Two-dimensional motion of the camera can therefore be controlled by rolling first plate  802  in a particular direction to cause endoscope  112  to move the image in a corresponding direction. Pressure along the normal direction can be used to activate motion of the camera through headrest  130  or can be used to control zoom of the camera of endoscope  112 . 
       FIG. 9  illustrates another embodiment of headrest  130 . As shown in  FIG. 9 , headrest  130  can be connected to a slip plate  901 , which is allowed to slide in two dimensions with respect to surgeon&#39;s console  120 . A detector plate  902  can be fixed on surgeon&#39;s console  120  so that slip plate  901  moves with respect to detector plate  902 . Detector plate  902  can include, for example, an optical detector similar to an optical mouse that monitors movement of slip plate  901 . Movement of the surgeon&#39;s head then causes slip plate  901  to move relative to detector plate  902 , resulting in a signal that can be used in endoscope controls  402  to control endoscope  112 . For example, optical tracker  904 , which may include an optical source  906  and optical detector  908  pair, provides a signal that indicates the motion of slip plate  901  relative to detector plate  902 . Motion of slip plate  901  indicating left or right motion of the surgeon&#39;s head can provide signals in endoscope controls  402  to move the image from endoscope  112  left or right and motion of the surgeon&#39;s head up or down can provide signals to endoscope controls  402  to move the image from endoscope  112  up or down. 
     In some embodiments, face tracking can be used to track the surgeon&#39;s facial orientation and determine when and how the surgeon&#39;s face moves.  FIG. 10  illustrates a headrest  130  according to some embodiments of the present invention that includes a camera  1002  that can be used in face tracking software. Camera  1002  can provide images to endoscope controls  402 , which can analyze the images to perform face tracking. Therefore, endoscope controls  402  perform face tracking to determine the orientation of the surgeon&#39;s face relative to the surgeon&#39;s console  120 . Movement of the face can then be used to control movement of endoscope  112 . Zoom, for example, can be controlled by the movement of the surgeon&#39;s face perpendicular to camera  1002  (or in a direction away from headrest  130 ) while rotation of the surgeon&#39;s face in the plane headrest  130  can be used to control the planar motion of endoscope  112 . 
       FIG. 11  illustrates another embodiment that uses face tracking to track the surgeon&#39;s facial orientation and determine when and how the surgeon&#39;s face moves. As shown in  FIG. 12 , at least one camera  1102  is mounted on surgeon&#39;s console below headrest  130  and in proximity to image display  126 . Camera  1102  can then provide an image of the surgeon&#39;s face that can be analyzed in endoscope controls  402  as described above. 
     In some embodiments, an iris tracking system can be utilized.  FIG. 12  illustrates iris tracking in surgeon&#39;s console  120 . As shown in  FIG. 12 , iris tracking  1202  provides an optical tracking beam, which may be an IR beam, that is optically combined in combiner  1214  with image  1212 . The combined image is then incident on the surgeon&#39;s eye through the right eyepiece  1206 . A similar optical arrangement can combine optical tracking beam from iris tracker  1204  with image  1210  which is incident on the surgeon&#39;s eye through the left eyepiece  1308 . Iris trackers  1202  and  1204  can receive the reflected tracking beam. Signals from iris trackers  1204  and  1202 , which are related to movement of the surgeon&#39;s eyes, can then be provided to endoscope controls  402 . The surgeon can then request an image pan by moving the surgeon&#39;s eyes to the area to be centered in the image. 
     To address the safety concern of accidently moving the camera such that the instruments are outside the field of view the implementation could constrain the camera motion to a predefined region. The control strategy could also integrate tool tracking techniques to allow arbitrary camera motion as long as the instrument tips stay with the field of view. Tool tracking could also be used to ensure that the camera does not collide with the surgical instruments during motion. 
     In some embodiments, a clutching mechanism may also be included. For example, embodiments of the present invention may be activated with a foot pedal or by a particular motion of the head. Further, to avoid unintended movement, in some embodiments only particularly large motions may result in active control of endoscope  112 . 
     The above detailed description is provided to illustrate specific embodiments of the present invention and is not intended to be limiting. Numerous variations and modifications within the scope of the present invention are possible. The present invention is set forth in the following claims.